Straub

IN THE UNITED STATES DISTRICT COURT

FOR THE MIDDLE DISTRICT OF PENNSYLVANIA

ANNETTE STRAUB, : CIVIL NO.: 1:25-cv-00078

:

Plaintiff, : (Magistrate Judge Schwab)

:

v. :

:

:

FRANK BISIGNANO,1 :

Commissioner of Social Security, :

:

Defendant. :

MEMORANDUM OPINION

I. Introduction.

In this social security action, Plaintiff Annette Straub seeks judicial review

of the final decision of the Commissioner of Social Security (“Commissioner”)

denying her claims for disability insurance benefits and supplemental security

income under Titles II and XVI of the Social Security Act. We have jurisdiction

under 42 U.S.C. §§ 405(g) and 1383(c)(3). For the reasons set forth below, we

1 Frank Bisignano is now the Commissioner of Social Security, and he is

automatically substituted as the defendant in this action. See Fed. R. Civ. P.

25(d) (providing that when a public officer sued in his or her official capacity

ceases to hold office while the action is pending, “[t]he officer’s successor is

automatically substituted as a party”); 42 U.S.C. § 405(g) (“Any action instituted

in accordance with this subsection shall survive notwithstanding any change in the

person occupying the office of Commissioner of Social Security or any vacancy in

such office.”).

will vacate the Commissioner’s decision and remand the case to the Commissioner

for further proceedings.

II. Background and Procedural History.

We refer to the transcript provided by the Commissioner. See docs. 9-1 to 9-

8.2 On July 29, 2021, Straub filed an application for disability insurance benefits

and an application for supplemental security income, alleging that she has been

disabled since April 1, 2013. See Admin. Tr. at 194–210. After the Commissioner

administratively denied her claims, id. at 115–35, Straub requested an

administrative hearing, id. at 136–38. On November 15, 2023, Straub—appearing

without counsel—as well as a vocational expert testified at a hearing before

Administrative Law Judge Howard Kauffman (the “ALJ”). Id. at 42–65.

On February 13, 2024, the ALJ denied Straub’s claims for benefits. Id. at

20-40. Straub appealed the ALJ’s decision to the Appeals Council, which denied

her request for review. Id. at 1–6. This makes the ALJ’s decision the final decision

of the Commissioner subject to judicial review by this Court.

In January 2025, Straub, now represented by counsel, began this action by

filing a complaint seeking review of the Commissioner’s decision denying her

2 Because the facts of this case are well known to the parties, we do not

repeat them here in detail. Instead, we recite only those facts that bear on Straub’s

claims.

claims. See Doc. 1. She requests that the court reverse the Commissioner’s

decision and award her benefits or, in the alternative, remand the case for further

proceedings. Id. ¶ 14 (Wherefore Clause). She also seeks “such relief” as the court

deems justified, including attorney’s fees. Id.

The parties consented to proceed before a magistrate judge pursuant to 28

U.S.C. § 636(c), and the case was referred to the undersigned. Doc. 7. The

Commissioner then filed an answer and a certified transcript of the administrative

proceedings. Docs. 8, 9. The parties filed briefs, see docs. 14, 15, 18, and this

matter is ripe for decision.

III. Legal Standards.

A. Substantial Evidence Review—the Role of This Court.

When reviewing the Commissioner’s final decision denying a claimant’s

application for benefits, “the court has plenary review of all legal issues decided by

the Commissioner.” Ficca v. Astrue, 901 F. Supp. 2d 533, 536 (M.D. Pa. 2012).

But the court’s review of the Commissioner’s factual findings is limited to whether

substantial evidence supports those findings. See 42 U.S.C. § 405(g); Biestek v.

Berryhill, 587 U.S. 97, 99 (2019). “[T]he threshold for such evidentiary

sufficiency is not high.” Biestek, 587 U.S. at 103. Substantial evidence “means—

and means only—‘such relevant evidence as a reasonable mind might accept as

adequate to support a conclusion.’” Id. (quoting Consol. Edison Co. of New York v.

N.L.R.B., 305 U.S. 197, 229 (1938)).

Substantial evidence “is less than a preponderance of the evidence but more

than a mere scintilla.” Jesurum v. Sec’y of U.S. Dep’t of Health & Human Servs.,

48 F.3d 114, 117 (3d Cir. 1995). A single piece of evidence is not substantial

evidence if the ALJ ignores countervailing evidence or fails to resolve a conflict

created by the evidence. Mason v. Shalala, 994 F.2d 1058, 1064 (3d Cir. 1993).

But in an adequately developed factual record, substantial evidence may be

“something less than the weight of the evidence, and the possibility of drawing two

inconsistent conclusions from the evidence does not prevent [the ALJ’s] finding

from being supported by substantial evidence.” Consolo v. Fed. Maritime Comm’n,

383 U.S. 607, 620 (1966). “In determining if the Commissioner’s decision is

supported by substantial evidence the court must scrutinize the record as a whole.”

Leslie v. Barnhart, 304 F.Supp.2d 623, 627 (M.D. Pa. 2003).

The question before this court, therefore, is not whether Straub is disabled,

but whether substantial evidence supports the Commissioner’s finding that she is

not disabled and whether the Commissioner correctly applied the relevant law.

B. Initial Burdens of Proof, Persuasion, and Articulation.

To receive benefits under Title II or Title XVI of the Social Security Act, a

claimant generally must demonstrate an “inability to engage in any substantial

gainful activity by reason of any medically determinable physical or mental

impairment which can be expected to result in death or which has lasted or can be

expected to last for a continuous period of not less than 12 months.” 42 U.S.C.

§ 423(d)(1)(A); see also 42 U.S.C. §1382c(a)(3)(A); 20 C.F.R. §§ 404.1505(a),

416.905(a). To satisfy this requirement, a claimant must have a severe physical or

mental impairment that makes it impossible to do his or her previous work or any

other substantial gainful work that exists in the national economy. 42 U.S.C.

§§ 423(d)(2)(A), 1382c(a)(3)(B); 20 C.F.R. §§ 404.1505(a), 416.905(a).

Further, to receive disability insurance benefits under Title II of the Social

Security Act, a claimant must show that he or she contributed to the insurance

program, is under retirement age, and became disabled prior to the date on which

he or she was last insured. 42 U.S.C. § 423(a); 20 C.F.R. § 404.131(a).3 Unlike

with disability insurance benefits under Title II of the Social Security Act,

3 “Disability insurance benefits are paid to an individual if that individual is

disabled and ‘insured,’ that is, the individual has worked long enough and paid

social security taxes.” Jury v. Colvin, No. 3:12-CV-2002, 2014 WL 1028439, at *1

n.5 (M.D. Pa. Mar. 14, 2014) (citing 42 U.S.C. §§ 415(a), 416(i)(1)). “The last

date that an individual meets the requirements of being insured is commonly

referred to as the ‘date last insured.’” Id. (citing 42 U.S.C. § 416(i)(2)). Here, the

ALJ determined that Straub met the insured-status requirements through

September 30, 2016. Admin. Tr. at 24, 26.

“[i]nsured status is irrelevant in determining a claimant’s eligibility for

supplemental security income benefits” under Title XVI of the Social Security Act.

Snyder v. Colvin, No. 3:16-CV-01689, 2017 WL 1078330, at *1 (M.D. Pa. Mar.

22, 2017). Supplemental Security Income “is a federal income supplement

program funded by general tax revenues (not social security taxes)” “designed to

help aged, blind or other disabled individuals who have little or no income.” Id.

The ALJ follows a five-step sequential-evaluation process to determine

whether a claimant is disabled. 20 C.F.R. §§ 404.1520(a), 416.920(a). Under this

process, the ALJ must sequentially determine: (1) whether the claimant is engaged

in substantial gainful activity; (2) whether the claimant has a severe impairment;

(3) whether the claimant’s impairment meets or equals a listed impairment;

(4) whether the claimant is able to do his or her past relevant work; and

(5) whether the claimant is able to do any other work, considering his or her age,

education, work experience, and residual functional capacity (“RFC”). 20 C.F.R.

§§ 404.1520(a)(4)(i)–(v), 416.920(a)(4)(i)–(v).

The ALJ must also assess a claimant’s RFC at step four. Hess v. Comm’r of

Soc. Sec., 931 F.3d 198, 198 n.2 (3d Cir. 2019). The RFC is ‘“that which an

individual is still able to do despite the limitations caused by his or her

impairment(s).’” Burnett v Comm’r of Soc. Sec., 220 F.3d 112, 121 (3d Cir. 2000)

(quoting Hartranft v. Apfel, 181 F.3d 358, 359 n.1 (3d Cir. 1999)); see also 20

C.F.R. §§ 404.1545(a)(1), 416.945(a)(1). In making this assessment, the ALJ

considers all the claimant’s medically determinable impairments, including any

non-severe impairment identified by the ALJ at step two of his or her analysis. 20

C.F.R. §§ 404.1545(a)(2), 416.945(a)(2).

“The claimant bears the burden of proof at steps one through four” of the

sequential-evaluation process. Smith v. Comm’r of Soc. Sec., 631 F.3d 632, 634 (3d

Cir. 2010). But at step five, “the burden of production shifts to the Commissioner,

who must . . . show there are other jobs existing in significant numbers in the

national economy which the claimant can perform, consistent with her medical

impairments, age, education, past work experience, and residual functional

capacity.” Fargnoli v. Massanari, 247 F.3d 34, 39 (3d Cir. 2001).

The ALJ’s disability determination must also meet certain basic substantive

requisites. Most significantly, the ALJ must provide “a clear and satisfactory

explication of the basis on which” his or her decision rests. Cotter v. Harris, 642

F.2d 700, 704 (3d Cir. 1981). “The ALJ must indicate in his decision which

evidence he has rejected and which he is relying on as the basis for his finding.”

Schaudeck v. Comm’r of Soc. Sec. Admin., 181 F. 3d 429, 433 (3d Cir. 1999). The

“ALJ may not reject pertinent or probative evidence without explanation.” Johnson

v. Comm’r of Soc. Sec., 529 F.3d 198, 204 (3d Cir. 2008). Otherwise, ‘“the

reviewing court cannot tell if significant probative evidence was not credited or

simply ignored.’” Burnett, 220 F.3d at 121 (quoting Cotter, 642 F.2d at 705).

IV. The ALJ’s Decision.

On February 13, 2024, the ALJ denied Straub’s claims for benefits. Admin.

Tr. at 20–40. He proceeded through the five-step sequential-evaluation process.

A. Step One.

At step one of the sequential-evaluation process, the ALJ found that Straub

had not engaged in substantial gainful activity since her alleged onset date of April

1, 2013. Id. at 26.

B. Step Two.

At step two of the sequential-evaluation process, the ALJ found that Straub

had the following severe impairments: degenerative disc disease and migraine

headaches. Id. He also found that Straub’s obesity and diabetes mellitus, were

non-severe medically determinable impairments. Id.

The ALJ further determined that Straub’s depression and anxiety were non-

severe medically determinable impairments, and with regard to these mental

impairments, he considered the four broad areas of mental functioning set forth in

the disability regulations for evaluating mental disorders4 and in the listings,

known as the paragraph B criteria.5 He concluded that Straub had no limitation in

understanding, remembering, or applying information; no limitation in interacting

with others; mild limitation in concentrating, persisting, or maintaining pace; and

mild limitation in the adapting or managing oneself. Id. at 27.

In making those findings, the ALJ considered Straub’s medical records

regarding her mental impairments. Id. He acknowledged that Straub’s “medical

record shows [she] received psychotropic medications for depression and anxiety

4 When “mental impairments are at issue, additional inquiries are layered on

top of the basic five-step disability analysis.” Hess v. Comm’r Soc. Sec., 931 F.3d

198, 202 (3d Cir. 2019). The regulations set forth a “special technique” used for

evaluating mental impairments. See 20 C.F. R. § 404.1520a. As part of that

“special technique,” a claimant’s degree of functional limitation is rated in four

broad functional areas: understanding, remembering, or applying information;

interacting with others; concentrating, persisting, or maintaining pace; and

adapting or managing oneself. Id. at § 404.1520a(c)(3). A claimant’s degree of

limitation in these functional areas is rated using “the following five-point scale:

None, mild, moderate, marked, and extreme.” Id. at § 404.1520a(c)(4). The ratings

in these four broad functional areas are used at Step 2 to determine if the claimant

has a severe mental impairment, and if the claimant has a severe mental

impairment, the ratings are also used at Step 3 to determine if the claimant’s severe

mental impairment meets or equals a listed mental disorder. Id. at § 404.1520a(d).

5 The listings for mental disorders contain either two paragraphs (A and B)

or three paragraphs (A, B, and C). See 20 C.F.R. § Pt. 404, Subpt. P, App. 1,

12.00.A.2. Except as to Listing 12.05 (intellectual disorder), paragraph B of each

of the listings for the mental disorders sets forth the same four functional criteria as

set forth in 20 C.F. R. § 404.1520a, and the listings use the same five-point rating

scale as those regulations. See 20 C.F.R. Pt. 404, Subpt. P, App. 1, 12.00.A.2.b,

12.00.E, 12.00.F. This is what the ALJ is referring to when he refers to the

paragraph B criteria.

from her primary care physician prior to November 2022.” Id. “At that time,

[Straub] began treating with outpatient psychiatry for psychiatric medication

management.” Id. But, the ALJ concluded, Straub’s “treatment records

demonstrate that despite her impairments, [she] continued to present with

unremarkable findings on psychiatric mental status examinations[,]” and “her

treatment records note that her conditions remain well-controlled and stable.” Id.

The ALJ also considered Straub’s statements concerning her limitations and

her activities of daily living, concluding that her activities support his finding of no

or mild limitations in the paragraph B categories of functioning:

Despite [Straub]’s allegations regarding her mental health

impairments causing her difficulty with remembering

information, completing tasks, and concentrating, [Straub]

admitted in the record that she has no difficulty remembering to

take care of her own personal needs and grooming. Both

[Straub] and her husband further admitted she retains the ability

to prepare daily meals, clean her home, launder clothes, vacuum

floors, drive a car, travel independently, shop in stores, manage

personal and household finances, and engage in daily social

activities. That [Straub] is capable of preparing meals suggests

[she] is capable of following simple instructions consistent with

a recipe or package directions. That [Straub] can shop in stores

for groceries suggests [she] is capable of identifying purchase

needs, making a list, selecting food items, managing money,

and interacting appropriately with checkout personnel. That

[Straub] is capable of performing routine household activities

such as laundering clothes, cleaning, and vacuuming floors

suggests [she] is capable of sustaining the attention and

concentration necessary to perform and complete the[se] simple

activities and remains able to utilize simple machinery safely.

Additionally, [Straub]’s participation in social activities

suggests [she] has a good capacity for maintaining relationships

and acting appropriately in public. That [Straub] is able to

travel independently and drive a car suggests [she] is capable of

making a travel plan, executing the plan, and adapting to

changes and variables in the situation including other drivers on

the road, road closures, or changed travel schedules. These

activities suggest [Straub] retains a greater capacity for

cognitive, social, executive, and adaptive skills than alleged in

connection with their disability application and appeal and do

not suggest a degree of impairment consistent with any

limitation in understanding, remembering information, applying

information, or maintaining social functioning and no more

than a mild limitation in concentration, persistence, pace,

adaptation, or self-management.

Id.

In making these findings, the ALJ also considered opinion evidence. Id. at

28. He considered and found persuasive the opinions of the state agency

psychological consultants, who determined that Straub’s “mental health

impairments do not result in more than mild limitations in any area of work-related

cognitive, social, executive, or adaptive functioning.” Id. The ALJ explained that

these “assessments are consistent with [Straub]’s treatment records, containing

little evidence to suggest moderate limitations i[n] daily activity functioning, social

skills, executive capacities, or adaptability.” Id. He also determined that “[t]he

assessments are also well-supported [by] [Straub]’s clinical record, prognostic

expectations, and functioning, particularly [her] repeated treating psychiatric

mental status examinations, showing little evidence of any significant functional

abnormality.” Id.

The ALJ further considered the opinion of Dr. Kathleen Ledermann, a

consultative psychological examiner who performed a mental status evaluation6 on

Straub on May 16, 2022. Id. The ALJ noted that Dr. Ledermann opined that

Straub has “moderate-to-marked difficulties performing complex work tasks and

making judgments on complex work-related decisions due to memory problems

observed on mental status examination.” Id. The ALJ stated that “[w]hile Dr.

Ledermann’s assessment may have been consistent with her findings on

examination that one day, [Straub]’s treatment record shows little evidence of any

continuing deficits in [her] attention, concentration, memory, insight, judgment, or

cognition.” Id. The ALJ also stated that “Dr. Ledermann noted the assessed

limitations were likely the result of [Straub’s] physical pain, secondary to

degenerative disc disease and spinal stenosis[.]” Id. Thus, according to the ALJ,

they “do not constitute limitations on the basis of any psychopathology.” Id.

“Moreover,” the ALJ determined that “the assessment is poorly supported by

[Straub]’s own admissions in the record regarding her retained capacity for

sustained daily activities.” Id.

“Because [Straub]’s medically determinable mental impairments cause no

more than ‘mild’ limitation in any of the functional areas and the evidence does not

otherwise indicate that there is more than a minimal limitation in [Straub]’s ability

6 See Admin. Tr. at 1260–71.

to do basic work activities,” the ALJ concluded Straub’s mental impairments are

non-severe impairments. Id. at 27. The ALJ recognized that the paragraph B

criteria are not an RFC; rather, they “are used to rate the severity of mental

impairments at steps 2 and 3 of the sequential evaluation process[,]” and the RFC

“assessment used at steps 4 and 5 of the sequential evaluation process requires a

more detailed assessment.” Id. at 28. And he asserted that the RFC that follows

“reflects the degree of limitation” he “has found in the ‘paragraph B’ mental

function analysis.” Id.

C. Step Three.

At step three of the sequential-evaluation process, the ALJ found that Straub

did not have an impairment or combination of impairments that met or medically

equaled an impairment listed in 20 C.F.R. Part 404, Subpart P, Appendix 1. Id. at

28–29. Specifically, with regard to Straub’s degenerative disc disease, the ALJ

considered Listing 1.15. Id. at 28.

The ALJ also stated that “[t]here is no Listing for migraine headaches,” but

“pursuant to Social Security Ruling 19-4p, [he] considered [Straub]’s headaches

under equivalence to Listing 11.02.” Id. And he determined:

The record does not provide sufficient information regarding

the frequency or presentation of [Straub]’s headaches to

demonstrate symptoms equivalent to the requirements of

Listing 11.02. Additionally, no medical source opined

[Straub]’s headaches were equivalent in severity to Listing

11.02; [Straub] does not allege equivalence to the Listing; and

there is insufficient evidence to suggest an opinion on

equivalence to Listing 11.02 need be developed.

Id. at 28–29.

D. The RFC.

The ALJ then determined that Straub had the RFC to do sedentary work7

with some limitations. Id. at 29. He concluded that Straub “can only occasionally

climb ramps/stairs, balance, stoop, kneel, crouch, and crawl”; she “can never climb

ladders/ropes/scaffolds”; she “can tolerate no concentrated exposure to extreme

cold, extreme heat, wetness, humidity, vibration, fumes, dusts, gases, odors, poor

ventilation, unprotected heights, and moving machinery parts”; and she “can

tolerate Selected Characteristics of Occupations (SCO) noise levels of no greater

than 3.” Id.

In making this RFC assessment, the ALJ considered Straub’s testimony and

assertions regarding her limitations as well as the statement by her husband. Id. at

29–30. The ALJ concluded that although Straub’s “medically determinable

impairments could reasonably be expected to cause the alleged symptoms[,]” her

7 See 20 C.F.R. §§ 404.1567(a), 416.967(a) (“Sedentary work involves

lifting no more than 10 pounds at a time and occasionally lifting or carrying

articles like docket files, ledgers, and small tools. Although a sedentary job is

defined as one which involves sitting, a certain amount of walking and standing is

often necessary in carrying out job duties. Jobs are sedentary if walking and

standing are required occasionally and other sedentary criteria are met.”).

“statements concerning the intensity, persistence and limiting effects of these

symptoms are not entirely consistent with the medical evidence and other evidence

in the record for the reasons explained in this decision.” Id. at 30.

The ALJ also considered Straub’s medical records. Id. at 30–32. In addition

to the medical records relevant to her degenerative disc disease, the ALJ

considered the records relating to her migraines:

The record also demonstrates [Straub] is diagnosed with

migraine headaches. In June 2018, [Straub] presented to the

emergency department with complaints of headache attenuated

[sic] by pain, nausea, vomiting, and facial numbness. CT

imaging of [Straub]’s head was normal. [Straub] was

administered an intramuscular injection of Toradol, Reglan, and

Benadryl and was discharged to home with improvement in her

pain shortly thereafter.

In March 2019, [Straub] also presented for an acute care visit

reporting symptoms of headache for one week. She noted her

pain was intermittent and that she had been taking ibuprofen for

her pain. However, records show [Straub] was provided

treatment and medication only for her associated cough.

By November 2019, [Straub] was sent for an MRI of her brain

due to continued complaints of headaches; however, the

imaging showed no evidence of intracranial abnormality.

[Straub] was prescribed abortive and preventative medications

for migraine symptoms and records show that while she

continued to have regular headache days, [she] reported having

no further migraine symptoms until January 2021, when she

experienced a change in her presentation following sinus

surgery.[8] Follow-up records show some continued changes in

[Straub]’s abortive and preventative medications, and by

8 The medical record cited by the ALJ for this assertion provides:

Ms. Straub is a 32 y/o female with PMH DM, HLD, headaches,

depression, anxiety, IBS, following up with Neurology through

VIDEO VISIT for chronic migraine, migraine with aura,

intractable, wo status migrainosus. Her headaches have overall

significantly improved and are now episodic migraines,

migraines with aura, not intractable, without status migrainosus.

I think her symptoms which occurred on Nov 29, 2019 were

likely migraines with aura since she states that she has had right

face, arm numbness/weakness prior to the onset of headache,

though difficulty getting words out was new this time. No

further episode since Nov. 29, 2019.

Admin. Tr. at 1094. Two pages of the medical record later, an explanation of what

occurred on November 29, 2019 is provided:

Briefly, on Nov 29, 2019, she went . . . grocery shopping[.]

[W]hen she got home, she went to get a drink, [and] her eyes

got blurry, [the] right side of [her] face and arm started going

numb with weakness, followed by difficulty getting words

out[.] [S]he had trouble putting words together, her words

weren’t making sense[.] [S]he states that she couldn’t even

hold a pen in her right hand[.] [S]he starting getting a headache

within 5-10 mins of onset of her symptoms on her left side[.]

[S]he went to lay down, [and] her symptoms of right side face

and arm numbness/tingling and speech improved within 2

hours[.] [Her] HA continued[.] [S]he did not go to the ER[.]

[S]he went to go see her PCP that following Monday, [and] she

was told that she had a “mini stroke” by her PCP and was

started on Aspirin 81 mg.

November 2021, [Straub] reported her headache frequency had

decreased to only 3 events per month.

In 2022, [Straub] noted some uncontrolled symptoms and her

medications were adjusted. However, the record shows little

evidence of any further complaints of symptoms or

neurological treatments dated after December 2022, despite

those records having been updated in December 2023,

suggesting [Straub] had good benefit from her change in

medications.

Id. at 31–32.

The ALJ further considered the medical opinions in the record. Id. at 32–33.

He did not find persuasive the March 2023 opinion of the state agency consultant

that Straub was capable of light work. Id. at 33. Rather, he concluded that Straub

was limited to sedentary work. Id.

The ALJ found persuasive the June 2022 opinion of the state agency medical

consultant that Straub was capable of no more than a range of sedentary work with

She states that he has had the right face and arm

numbness/tingling/weakness before with her migraines but

never had word finding difficulties.

Id. at 1096. When read in context, the medical record that the ALJ cites for the

proposition that after November 2019, Straub reported having no further migraine

symptoms until January 2021, does not support that proposition. Rather, it

supports a much narrower proposition—that after November 2019, Straub reported

that she did not have an episode like she experienced on November 29, 2019. And

there are references in the record to Straub having headaches between November

29, 2019, and January 2021, see, e.g., Admin. Tr. 1095, 1104–06, which her

neurologist characterized as migraines, see Admin. Tr. at 1104 (noting that her

headaches have improved and “are now heading towards becoming episodic

migraine, migraine with aura, not intractable wo status migrainosus.”); 1094 (“Her

headaches . . . are now episodic migraines, migraines with aura, not intractable,

without status migrainosus.”).

some limitations. Id. at 32. That ALJ concluded that “[t]hese findings are

consistent with the objective imaging showing evidence of degenerative processes

in [Straub]’s cervical and lumbar spine and the environmental restrictions remain

consistent with [Straub]’s need to avoid environmental triggers consistent with her

diagnosis of migraine headache.” Id. He also concluded that “[t]he assessment is

well supported by [Straub]’s presentation on intermittent examinations using a

walker or cane for ambulatory assistance and impaired balance.” Id.

The ALJ also considered the opinions of Dr. Kneifati, who completed two

“Internal Medicine Examination[s]” and two “Medical Source Statement[s] of

Ability to Do Work-Related Activities (Physical),”9 one on May 16, 2022, and the

other on March 2, 2023. Id. The ALJ found Dr. Kneifati’s opinions partially

persuasive, and he explained the basis for that finding. Id. Relevant to the claims

in the instant case, the ALJ noted that Dr. Kneifati opined that Straub “had a

limited tolerance for environmental conditions.” Id.10

9 See Admin. Tr. at 1237–57, 1426–40.

10 Dr. Kneifati’s opinion regarding Straub’s environmental limitations in his

May 16, 2022 medical source statement are not consistent with his opinion

regarding Straub’s environmental limitations in his March 2, 2023 medical source

statement. Compare Admin. Tr. at 1246 with Admin. Tr. at 1435. Of note, in his

May 16, 2022 medical source statement, Dr. Kneifati opined that Straub was

limited to “Quiet (Library)” level noise, see id. at 1246, but in his March 2, 2023

medical source statement, Dr. Kneifati opined that Straub could tolerate “Very

Loud (Jackhammer)” level noise, see id. at 1435.

In making the RFC assessment, the ALJ also incorporated by reference this

earlier discussion of Dr. Ledermann’s opinion. Id. at 33.

The ALJ then summarized the reasons for his RFC assessment:

The record demonstrates [Straub] suffers from cervical and

lumbar degenerative disc disease resulting in chronic pain,

intermittent sensory loss, and difficulty with maintenance of

gait, range of motion, and balance. To accommodate these

symptoms, the undersigned limited [Straub] to sedentary work

activity involving a limited capacity for postural activities and

the need to avoid exposure to temperature extremes, wetness,

humidity, vibration, and hazards. The record also demonstrates

[Straub] suffers from migraine headaches resulting in

intermittent pains and environmental sensitivities. While the

undersigned notes the record shows [Straub] has demonstrated

adequate control of her symptoms with sustained compliance to

treatment, the undersigned limited [Straub]’s environmental

tolerances in order to prevent exacerbations in the frequency

and intensity of her symptoms, particularly with regard to

olfactory triggers and noise.

Id.

E. Step Four.

At step four of the sequential-evaluation process, the ALJ found that Straub

had no past relevant work. Id.

F. Step Five.

At step five of the sequential-evaluation process, considering Straub’s age,

education, work experience, and RFC, as well as the testimony of a vocational

expert, the ALJ found that there were jobs—such as food and beverage order clerk,

telephone clerk, and stuffer/packaging machine tender—that exist in significant

numbers in the national economy that Straub could perform. Id. at 34.

In sum, the ALJ concluded that Straub was not disabled from April 1, 2013

(which is the alleged onset date), through the date of the ALJ’s decision on

February 13, 2024. Id. at 34. Thus, he denied Straub’s claims for benefits. Id. at

35.

V. Discussion.

Straub presents two main claims: (1) the ALJ erred in evaluating her mental

impairments; and (2) substantial evidence does not support the ALJ’s step-three

analysis regarding her migraine headaches. Doc. 14 at 1.

We begin by addressing Straub’s claim that the ALJ erred at step three of the

sequential-evaluation process. Straub contends that the ALJ failed to adequately

address Listing 11.02 with regard to her headaches. For the reasons discussed

below, we conclude that the ALJ erred at step three by failing to articulate whether

Straub’s headaches are equivalent to Listing 11.02. Before we address Straub’s

specific contentions, we set forth the standards applicable to the step-three analysis

of headaches.

A. Step 3 and Headaches.

Appendix 1 of 20 C.F.R. Part 404, Subpart P (“Listing of Impairments”)

describes, for each major body system, impairments that the Commissioner

considers to be severe enough to prevent a claimant from doing any gainful activity

regardless of the claimant’s age, education, or work experience. 20 C.F.R.

§ 404.1525(a). “Each impairment is defined in terms of several specific medical

signs, symptoms, or laboratory test results.” Sullivan v. Zebley, 493 U.S. 521, 530

(1990). “[T]he medical criteria defining the listed impairments” is set “at a higher

level of severity than the statutory standard.” Id. at 532. “The listings define

impairments that would prevent an adult, regardless of his age, education, or work

experience, from performing any gainful activity, not just ‘substantial gainful

activity.’” Id. (italics in original). “The reason for this difference between the

listings’ level of severity and the statutory standard is that, for adults, the listings

were designed to operate as a presumption of disability that makes further inquiry

unnecessary.” Id. If a claimant’s impairment meets or is equivalent to a listed

impairment, then the claimant “is per se disabled and no further analysis is

necessary.” Burnett v. Comm’r of Soc. Sec. Admin., 220 F.3d 112, 119 (3d Cir.

2000). But “[i]f a claimant does not suffer from a listed impairment or its

equivalent, the analysis proceeds to steps four and five.” Plummer v. Apfel, 186

F.3d 422, 428 (3d Cir. 1999).

“In step three, the ALJ must determine whether [the claimant’s] impairment

matches, or is equivalent to, one of the listed impairments.” Burnett, 220 F.3d at

119. “For a claimant to show that his impairment matches a listing, it must meet

all of the specified medical criteria.” Zebley, 493 U.S. at 530 (italics in original);

see also 20 C.F.R. § 404.1525(c)(3) (“We will find that your impairment(s) meets

the requirements of a listing when it satisfies all of the criteria of that listing,

including any relevant criteria in the introduction, and meets the duration

requirement.”); 20 C.F.R. § 404.1525(d) (“To meet the requirements of a listing,

you must have a medically determinable impairment(s) that satisfies all of the

criteria in the listing.”). “An impairment that manifests only some of those criteria,

no matter how severely, does not qualify.” Zebley, 493 U.S. at 530 (footnote

omitted). “For a claimant to qualify for benefits by showing that his unlisted

impairment, or combination of impairments, is ‘equivalent’ to a listed impairment,

he must present medical findings equal in severity to all the criteria for [a] listed

impairment.” Id. at 531 (italics in original) (footnote omitted); see also 20 C.F.R.

§ 404.1526(a) (“Your impairment(s) is medically equivalent to a listed impairment

in appendix 1 if it is at least equal in severity and duration to the criteria of any

listed impairment.”); 20 C.F.R. § 416.926(a) (“Your impairment(s) is medically

equivalent to a listed impairment in appendix 1 of subpart P of part 404 of this

chapter if it is at least equal in severity and duration to the criteria of any listed

impairment.”).

The Third Circuit “requires the ALJ to set forth the reasons for his decision”

at step three. Burnett, 220 F.3d at 119. The purpose of this requirement “is to

ensure that there is sufficient development of the record and explanation of

findings to permit meaningful review.” Jones v. Barnhart, 364 F.3d 501, 505 (3d

Cir. 2004) (citing Burnett, 220 F.3d at 120). “Conclusory statements that a

condition does not constitute the medical equivalent of a listed impairment are

insufficient.” Diaz v. Comm’r of Soc. Sec., 577 F.3d 500, 504 (3d Cir. 2009). This

is because a bare conclusion that an impairment does not meet or equal a listing

‘“is beyond meaningful judicial review.’” Burnett, 220 F.3d at 119 (quoting Clifton

v. Chater, 79 F.3d 1007, 1009 (10th Cir. 1996)). But the ALJ is not required “to

use particular language or adhere to a particular format in conducting his analysis.”

Jones, 364 F.3d at 505. And the ALJ’s decision must be “read as a whole[.]” Id.

Consistent with the principle that the ALJ’s decision must be read as a

whole, “where an ALJ’s conclusion at step three is not adequately articulated,

courts may review the ALJ’s entire decision before determining whether remand is

required.” Izalia V. v. O’Malley, No. 4:22-CV-1819, 2024 WL 4505469, at *5

(M.D. Pa. Oct. 16, 2024). “In other words, ‘the Court must determine whether the

evidentiary discussion—regardless of its placement in the ALJ’s decision—

supports meaningful judicial review of the challenged Step Three finding(s)

pursuant to the applicable legal standards.” Fewell v. O’Malley, No. 1:23-CV-

00865, 2024 WL 4182115, at *4 (M.D. Pa. Aug. 19, 2024) (quoting Gonzalez v.

Saul, No. 1:17-CV-02524 (PAZ), 2019 WL 13401378, at *12 (D.N.J. Oct. 31,

2019)), report and recommendation adopted, 2024 WL 4173790 (M.D. Pa. Sept.

12, 2024). In this vein, the Social Security Administration issued a Social Security

Ruling which, among other things, sets forth articulation requirements for step 3

findings about medical equivalence. Soc. Sec. Ruling 17-2p, Titles II & XVI:

Evidence Needed by Adjudicators at the Hearings & Appeals Council Levels of the

Admin. Rev. Process to Make Findings About Med. Equivalence, 2017 WL

3928306 (S.S.A. Mar. 27, 2017) (“SSR 17-2p”). SSR 17-2p provides that if an

ALJ “believes that the evidence already received in the record does not reasonably

support a finding that the individual’s impairment(s) medically equals a listed

impairment, the [ALJ] is not required to articulate specific evidence supporting his

or her finding that the individual’s impairment(s) does not medically equal a listed

impairment.” Id. at *4. Rather, “[g]enerally, a statement that the individual’s

impairment(s) does not medically equal a listed impairment constitutes sufficient

articulation for this finding.” Id. And “[a]n ALJ’s articulation of the reason(s) why

the individual is or is not disabled at a later step in the sequential evaluation

process will provide rationale that is sufficient for a subsequent reviewer or court

to determine the basis for the finding about medical equivalence at step 3.” Id.

“Nonetheless, for an unarticulated medical equivalency finding to be upheld[,] an

ALJ’s decision as a whole ‘must still enable this court to follow the ALJ’s

reasoning in determining that Plaintiff’s impairment is not the medical equivalent

of the listing’ Plaintiff alleges on appeal” and “[i]f it does not, remand is required.”

Izalia V. 2024 WL 4505469, at *5.

There is no listing for migraine headaches. See Soc. Sec. Ruling 19-4p, Titles

II & XVI: Evaluating Cases Involving Primary Headache Disorders, 2019 WL

4169635 (S.S.A. Aug. 26, 2019) (“SSR 19-4p”) (“Primary headache disorder is not

a listed impairment in the Listing of Impairments (listings).”). But “SSR 19-4p

explains how primary headache disorders, like migraines, are evaluated at step

three.” Tyson v. Kijakazi, 1:21-CV-855, 2022 WL 3975002, at *10 (M.D. Pa. July

25, 2022), report and recommendation adopted, 2022 WL 3971041 (M.D. Pa.

Aug. 31, 2022)). SSR 19-4p provides that “a primary headache disorder, alone or

in combination with another impairment(s)” may “medically equal[] a listing.” SSR

19-4p, 2019 WL 4169635 at *7. And it identifies Listing 11.02, which addresses

epilepsy, as “the most closely analogous listed impairment” for a primary headache

disorder. Id. More specifically, SSR 19-p4 provides that “[w]hile uncommon, a

person with a primary headache disorder may exhibit equivalent signs and

limitations to those detailed in listing 11.02 (paragraph B or D for dyscognitive

seizures), and we may find that his or her MDI(s) [medically determinable

impairment(s)] medically equals the listing.” Id. “Thus, an ALJ should look to

Listings 11.02B and 11.02D in assessing whether a claimant’s migraine headache

impairment medically equals a listing.” Tyson, 2022 WL 3975002 at *10.

“Listing 11.02B describes dyscognitive seizures ‘occurring at least once a

week for at least 3 consecutive months . . . despite adherence to prescribed

treatment.’” Falardo-Weller v. Kijakazi, NO. 3:22- CV-01026, 2023 WL 6119101,

*6 (M.D. Pa. Sept. 18, 2023) (quoting 20 C.F.R. Part 404, Subpart P, App.1,

§ 11.02B). “To evaluate whether a primary headache disorder is equal in severity

and duration to the criteria in 11.02B,” the ALJ should consider the following

factors:

[(1)] A detailed description from an AMS [acceptable medical

source] of a typical headache event, including all associated

phenomena (for example, premonitory symptoms, aura,

duration, intensity, and accompanying symptoms); [(2)] the

frequency of headache events; [(3)] adherence to prescribed

treatment; [(4)] side effects of treatment (for example, many

medications used for treating a primary headache disorder can

produce drowsiness, confusion, or inattention); and [(5)]

limitations in functioning that may be associated with the

primary headache disorder or effects of its treatment, such as

interference with activity during the day (for example, the need

for a darkened and quiet room, having to lie down without

moving, a sleep disturbance that affects daytime activities, or

other related needs and limitations).

SSR 19-4P, 2019 WL 4169635 at *7.

Listing 11.02D, on the other hand, “requires dyscognitive seizures occurring

at least once every 2 weeks for at least 3 consecutive months despite adherence to

prescribed treatment, and marked limitation in one” of the following areas:

“[p]hysical functioning; understanding, remembering, or applying information;

interacting with others; concentrating, persisting, or maintaining pace; or adapting

or managing oneself.” Id. In evaluating 11.02D, the ALJ should consider the same

factors—set forth above—for considering 11.02B. Id.

B. The ALJ did not adequately articulate his reasoning in connection

with the analysis of Straub’s headaches.

Straub contends that the ALJ failed to adequately address Listing 11.02 in

accordance with SSR 19-4p. We agree.

The ALJ’s step three analysis regarding Straub’s migraine headaches is

brief. It reads in full:

There is no Listing for migraine headaches. However, pursuant

to Social Security Rule 19-4p, the undersigned considered

[Straub]’s headaches under equivalence to Listing 11.02. The

record does not provide sufficient information regarding the

frequency or presentation of [Straub]’s headaches to

demonstrate symptoms equivalent to the requirements of

Listing 11.02. Additionally, no medical source opined

[Straub]’s headaches were equivalent in severity to Listing

11.02; [Straub] does not allege equivalence to the Listing; and

there is insufficient evidence to suggest an opinion on

equivalence to Listing 11.02 need be developed.

Admin. Tr. at 28–29.

Straub contends that the ALJ failed to adequately consider whether her

migraines are medically equivalent to Listing 11.02 because he failed to address

the factors set forth in SSR 19-4p. And, according to Straub, the record

demonstrates that she suffers from debilitating headaches. Doc. 14 at 18. In this

regard, Straub cites a January 2021 neurological evaluation. Id. The report from

that evaluation notes that Straub reported that she currently was “having around 2

HA days/week, around 6-8 HA days/month, lasting about 2 hours with tx.” Admin.

Tr. at 1095. It further noted that she reported suffering from six to eight headache

days a month11 in October, November, and December 2020.12 Id. She was

prescribed Ubrelvy and told to continue Topamax. Id. at 1094–95. Straub further

asserts:

In July 2021, Ms. Straub reported daily headaches for the past

1.5 weeks. The pain started in her neck on the right and

radiated to the back of her head. Prior to that, she was having 2

headaches [] per week, lasting around 2 hours. In November

11 In her brief, Straub refers to six to eight headache days a week. Doc. 14 at

18. And the underlying record also refers to six to eight headache days a week for

October and November, and six to eight headache days per month for December.

Admin. Tr. at 1095. Because there are only seven days in a week, we assume that

what was meant was six to eight headache days a month.

12 In her brief, Straub refers to these months as October, November, and

December of 2019. But given that the medical record she cites is from January

2021, and after referencing October, November, and December, it states that

Straub reported “4 HA days so far” for January, see Admin. Tr. at 1095, it appears

that the references in the record to October, November, and December are

references to October, November, and December of 2020.

2021, Ms. Straub reported episodic migraines and cervicogenic

headaches. She detailed suffering from 3 headaches per month.

She was prescribed Relpax, Ubrelvy, and Topamax, and

Rizatriptan was discontinued. During the May 2022

consultative examination, Ms. Straub described suffering from

migraine headaches associated with nausea, light sensitivity,

and sound sensitivity. Dr. Kneifati diagnosed migraine

headache and opined that Ms. Straub was limited to quiet

(library) level of noise. At the hearing, Ms. Straub testified that

she suffered from migraine headaches 1-2 times a week, lasting

at least a couple of hours. For her migraine headaches, she was

prescribed Ubrelvy, Flexeril, and Aimovig injections.

Doc. 14 at 19 (citations to the record omitted).

The Commissioner contends that the ALJ’s discussion was sufficient

because he addressed Straub’s headaches in connection with his RFC assessment.

We agree with the Commissioner that we must look to the ALJ’s decision as a

whole, including his discussion in connection with the RFC assessment. But

reading the ALJ’s decision as a whole—including his discussion of Straub’s

headaches in connection the RFC assessment—we nevertheless conclude that the

ALJ’s step three analysis is beyond meaningful judicial review.

Here, in connection with his RFC assessment, the ALJ acknowledged that

Straub “reported that she suffers weekly headaches resulting in severe pain,

nausea, and vomiting[,]” and “her events last a couple of hours each and require

her to lay down in a quiet location.” Admin. Tr. at 29. But he concluded based on

Straub’s medical records—which as set forth by the ALJ included visits to the

emergency room and acute care facilities, the prescription and use of several

medications (both preventative and abortive) for her migraines, and periods of

fewer headaches and periods of “uncontrolled symptoms”—that she had “good

benefit from her change in medications” and “adequate control of her symptoms

with sustained compliance to treatment.” Admin. Tr. at 31–33. And the ALJ

asserted that he “limited [Straub]’s environmental tolerances in order to prevent

exacerbations in the frequency and intensity of her symptoms, particularly with

regard to olfactory triggers and noise.” Id. But the ALJ does not address the

requirements of Listing 11.02B or 11.02D or the factors set forth in SSR 19-4p.

For example, the ALJ does not discuss whether the frequency of Straub’s

migraines meet the frequency requirements of 11.02 and 19-4p, which are for

11.02B, “at least once a week for at least 3 consecutive months despite adherence

to prescribed treatment,” and for 11.02D, “at least once every 2 weeks for at least 3

consecutive months despite adherence to prescribed treatment.” SSR 19-4p, 2019

WL 4169635 at *7.13 In fact, although the ALJ found that Straub’s migraines were

13 In addition to the considerations of the factors relevant to both 11.02B and

11.02D, as the summary of SSR 19-4p set forth earlier shows, to be medically

equivalent to 11.02D, a marked limitation is required in one of the five following

areas: “[p]hysical functioning; understanding, remembering, or applying

information; interacting with others; concentrating, persisting, or maintaining pace;

or adapting or managing oneself.” SSR 19-4p, 2019 WL 4169635 at *7. When

discussing the paragraph B criteria in connection with his step two finding as to

Straub’s mental impairments, the ALJ found that Straub did not have a marked

limitation in the latter four of these areas. See Admin. Tr. at 27. But the ALJ did

not address whether Straub has a marked limitation in “physical functioning” when

a sever impairment, it is unclear how many migraines the ALJ thinks Straub

suffers even though she purportedly achieved “good benefit from her change in

medications” and “adequate control of her symptoms with sustained compliance to

treatment.” See Admin. Tr. at 32, 33.

Further, the ALJ does not address the severity and duration of Straub’s

migraines or whether she suffers side effects from her treatment. And although the

ALJ acknowledged that Straub asserted that her migraines “require her to lay down

in a quiet location,” Admin. Tr. at 29, he nevertheless did not discuss what

limitations in functioning she experiences during a migraine.

In sum, the ALJ’s step three analysis—even when coupled with his later

RFC assessment—fails to adequately address whether Straub’s migraine headaches

are equivalent to Listing 11.02 in accordance with SSR 19-4p, which “prevents the

Court from conducting a meaningful, albeit deferential, review.” Falardo-Weller,

2023 WL 6119101 at *8, *9 (finding the ALJ’s analysis regarding step 3 and

Listing 11.02 to be deficient, vacating the Commissioner’s decision, and

remanding the case for further proceedings); see also Amy B. v. Bisignano, No.

1:24-CV-02091, 2026 WL 567656, at *8 (M.D. Pa. Jan. 28, 2026) (recommending

that the Commissioner’s decision be vacated because the ALJ failed to evaluate on

the record the applicability of 11.02B and 11.02D, thus preventing the court from

he addressed the paragraph B criteria because that is not one of the paragraph B

criteria.

conducting a meaningful review), report and recommendation adopted, 2026 WL

565809, at *1 (M.D. Pa. Feb. 27, 2026); Fewell, 2024 WL 4182115, at *6 (same),

report and recommendation adopted, 2024 WL 4173790 (M.D. Pa. Sept. 12,

2024); Tyson, 2022 WL 3975002, at *15 (same), report and recommendation

adopted, 2022 WL 3971041 (M.D. Pa. Aug. 31, 2022).

The question then is whether the ALJ’s error was harmless. “Ordinary

harmless error review, in which the appellant bears the burden to demonstrate

harm, is applicable to administrative appeals.” Holloman v. Comm’r Soc. Sec., 639

F. App’x 810, 814 (3d Cir. 2016). Thus, a claimant must explain ‘“how the . . .

error to which he points could have made any difference.’” Id. (quoting Shinseki v.

Sanders, 556 U.S. 396, 413 (2009)). “An error is ‘harmless’ when, despite the

technical correctness of an appellant’s legal contention, there is also ‘no set of

facts’ upon which the appellant could recover.” Brown v. Astrue, 649 F.3d 193,

195 (3d Cir. 2011). Although an error may be harmless, we must be mindful that

“‘[t]he grounds upon which an administrative order must be judged are those upon

which the record discloses that its action was based.’” Fargnoli, 247 F.3d at 44 n.7

(quoting Sec. & Exch. Comm’n v. Chenery Corp., 318 U.S. 80, 87 (1943)).

As set forth above, Straub has cited to evidence that she contends shows that

her migraines are debilitating and that may support application of the listing. See

doc. 14 at 18–19. Given this, we cannot say that the ALJ’s error was harmless, and

we will vacate the ALJ’s decision.

C. Other Claims.

Given our conclusion that the Commissioner’s decision must be vacated

based on the ALJ’s error at step 3, we will not address Straub’s remaining claims

of error. “Plaintiff’s additional claims of error may be remedied through the case’s

treatment on remand.” Brown v. Saul, No. CV 3:18-1619, 2020 WL 6731732, at *7

(M.D. Pa. Oct. 23, 2020), report and recommendation adopted, 2020 WL

6729164, at *1 (M.D. Pa. Nov. 16, 2020). “A remand may produce different

results on these claims, making discussion of them moot.” Id.

D. Remand is the appropriate remedy.

Because the ALJ’s decision is not supported by substantial evidence, the

question then is whether the court should remand the case to the Commissioner for

further proceedings or award benefits to Straub. We conclude that remand is the

appropriate remedy.

Under sentence four of 42 U.S.C. § 405(g), the court has the “power to enter,

upon the pleadings and transcript of the record, a judgment affirming, modifying,

or reversing the decision of the Commissioner of Social Security, with or without

remanding the cause for a rehearing.” Thus, although a remand is often the

appropriate remedy, the court may also enter an order awarding the claimant

benefits. See Brownawell v. Comm’r of Soc. Sec., 554 F.3d 352, 358 (3d Cir. 2008)

(remanding the case to the district court with directions to enter an order awarding

the payment of benefits); Morales v. Apfel, 225 F.3d 310, 320 (3d Cir. 2000)

(same); Podedworny v. Harris, 745 F.2d 210, 223 (3d Cir. 1984) (same). But an

“award [of] benefits should be made only when the administrative record of the

case has been fully developed and when substantial evidence on the record as a

whole indicates that the claimant is disabled and entitled to benefits.” Podedworny,

745 F.2d at 221–22. Whether there has been excessive delay and/or prior remands

also bears on whether to award benefits or to remand for further proceedings. Diaz

v. Berryhill, 388 F. Supp. 3d 382, 391 (M.D. Pa. 2019). “Thus, in practice any

decision to award benefits in lieu of ordering a remand for further agency

consideration entails the weighing of two factors: First, whether there has been an

excessive delay in the litigation of the claim which is not attributable to the

claimant; and second, whether the administrative record of the case has been fully

developed and substantial evidence on the record as a whole indicates that the

claimant is disabled and entitled to benefits.” Id.

Here, although Straub’s claims have been pending since 2021, we cannot

say, at this point, that any delay in the litigation of Straub’s claims has been

excessive. Moreover, we cannot say that substantial evidence on the record as a

whole shows that she is disabled and entitled to benefits. Thus, we will remand the

case to the Commissioner for further proceedings.

VI. Conclusion.

For the foregoing reasons, we will vacate the decision of the Commissioner

and remand the case to the Commissioner for further proceedings pursuant to

sentence four of 42 U.S.C. § 405(g). An appropriate order follows.

S/Susan E. Schwab

Susan E. Schwab

United States Magistrate Judge