The opinion
IN THE UNITED STATES DISTRICT COURT
FOR THE EASTERN DISTRICT OF NORTH CAROLINA
WESTERN DIVISION
No. 5:25-CV-00647-RN
Cody Ernst,
Plaintiff,
v.
Memorandum & Order
Frank J. Bisignano, Commissioner of
Social Security,
Defendant.
Plaintiff Cody Ernst challenges an Administrative Law Judge’s decision to deny his
application for Social Security disability benefits. Ernst claims that the ALJ made two errors in
reaching that determination. First, he says the ALJ failed to properly evaluate the medical opinion
evidence. And second, Ernst claims she erred in determining his residual functional capacity (RFC)
by ignoring the effects of his migraine headaches. Both Ernst and Defendant Frank Bisignano,
Commissioner of Social Security, ask the court to issue a decision in their favor. D.E. 12, 16, 17.
After reviewing the parties’ arguments, the undersigned has determined that the ALJ erred
in her determination. The ALJ’s reasons to find unpersuasive an opinion from a provider at the
Department of Veterans Affairs (VA) do not withstand scrutiny. And the residual functional
capacity (RFC) determination fails to sufficiently account for Ernst’s migraines and the limitations
he claimed. The court thus grants Ernst relief, denies Bisignano relief, and remands the matter to
the Commissioner for further consideration.1
1 The parties have consented to jurisdiction by a United States Magistrate Judge. 28 U.S.C. § 636(c). D.E. 13.
I. Background2
A. Factual
Ernst served in the Air Force for over 10 years before his 2019 discharge. Prior to his
alleged disability onset date, Ernst experienced back pain after a 2013 motor vehicle accident. Tr.
at 1604.
In 2018, Claudia Campbell, DNP, FNP-BC, completed a headache questionnaire in
connection with a compensation and pension examination for the VA. Tr. at 1607–08, 1269–70.
Campbell observed that Ernst suffered from migraines that had increased in frequency and
severity. Tr. at 1269. His neck and back pain played a role in his migraines. Id.
Ernst’s migraines caused pulsating, throbbing pain on both sides of his head that worsened
with activity. Id. And symptoms like nausea, sensitivity to light and sound, and vision changes
accompanied his migraines. Id. They lasted less than a day. Tr. at 1270.
Campbell determined that Ernst suffered from “prostrating” migraines which produced
pain that caused “severe economic inadaptability.” Id. She concluded that the migraines resulted
in decreased focus and concentration. Tr. at 1271. And Campbell noted that these occurred more
than once a month. Id.
Imaging studies in 2019 revealed vertebral body height loss and disc space narrowing in
Ernst’s back. Tr. at 1604. Chiropractic care and medication improved his symptoms. Id. Later that
year, Ernst displayed a normal gait. Id. Providers remarked that his lower back condition was stable
with medication. Id.
A January 2020 MRI of Ernst’s thoracic spine showed a chronic compression fracture
without marrow edema, vertebral compression, or spinal stenosis. Id. Providers assessed thoracic
2 The parties’ memoranda focus on Ernst’s migraines and related symptoms, so the court concentrates the discussion
of the medical background on those conditions.
spondylosis. Id. He treated his back symptoms with chiropractic care, pain patches, and injections.
Id. Bilateral radiofrequency ablation performed at periodic intervals also provided him with relief
of his symptoms. Id.
Marcia Love, PA-C, performed a consultative physical examination of Ernst in May 2023.
He reported thoracic back pain that radiated into his neck. Id. And Ernst complained of migraine
headaches occurring a couple of times a month which lasted three or four hours until he fell asleep.
Id.
The exam revealed normal gait as well as the ability to tandem walk and walk on his heels
and toes. Tr. at 1605. Ernst had slightly diminished strength, significant spinal tenderness, and
limited range of motion in his thoracolumbar spine with forward flexion. Id.
The consultative examiner concluded that Ernst had mild limitations with prolonged sitting
but moderate limitations with prolonged standing, walking, and postural movements. Tr. at 1606–
07. And he was severely limited in his ability to lift and carry. Tr. at 1607.
Around this time, Ernst underwent a consultative psychological evaluation with Michelle
Rich, MA, LPA, and Elizabeth Shaw, Ph.D. Id. They found that Ernst could understand, retain,
and follow instructions, sustain attention, and relate to others. Id. But he could have trouble
performing work duties because of medication side effects and a reduced ability to handle stress.
Id.
In May 2024, an MRI of his thoracic spine revealed multilevel degenerative disc disease
without significant canal or neuroforaminal compromise. Tr. at 1604. Six months later, an MRI of
his cervical spine showed no significant degenerative changes. Id.
State agency consultants opined that Ernst could perform medium work with restrictions
on noise, vibrations, and some postural movements. Tr. at 1608.
Ernst’s mother provided a Third Party Function Report. Id. She noted that he had trouble
lifting, bending, standing, and walking. Id.
At the first hearing, Ernst testified that he had constant back pain which limited his
functioning and sleep. Tr. at 1603. He estimated he could sit for one hour and stand for 30 minutes,
but both activities increased his pain. Id. Ernst suffered from migraines about four times a month.
Id. He took no prescription medication, but sleep helped his symptoms. Id.
At the second hearing, Ernst stated that he had trouble driving more than an hour or two
because sitting aggravated his pain. Id. He occasionally had stabbing back pain that required him
to change positions. Id. And Ernst experienced migraines several times a month that could last all
day. Tr. at 1700.
B. Procedural
In January 2023, Ernst filed for disability benefits alleging a disability that began about
four years earlier. Tr. at 15. After the Social Security Administration denied his claim at the initial
level and upon reconsideration, Ernst appeared for a hearing before an ALJ to determine whether
he was entitled to benefits. The ALJ denied his application and the Appeals Council denied review.
Tr. at 5, 27. After filing an action in this forum, the court remanded the matter. See Order, D.E.
18, Ernst v. O’Malley, No. 5:24-CV-317-FL (E.D.N.C. Oct. 2, 2024).
Ernst appeared for a second hearing before the ALJ who again determined Ernst had no
right to benefits because he was not disabled. Tr. at 1596–1610.
The ALJ found that Ernst lived with several severe impairments. Tr. at 1598. These
included degenerative disc disease, asthma, chronic obstructive pulmonary disease (COPD),
migraines, depression, anxiety, and an adjustment disorder with mixed anxious and depressed
moods. Id. The ALJ also found that Ernst’s impairments, either alone or in combination, did not
meet or equal a Listing impairment. Tr. at 1599.
Next, the ALJ determined that Ernst had the residual functional capacity (RFC) to perform
medium work with limitations. Tr. at 1602. He can frequently climb ramps and stairs but cannot
climb ladders, ropes, or scaffolds. Id. Ernst can frequently stoop, crouch, and reach bilaterally. Id.
Ernst can have occasional exposure to dust, odors, fumes, and pulmonary irritants, but he
must avoid concentrated exposure to extreme heat and humidity. Id. And he can have no exposure
to unprotected heights and moving, mechanical parts. Id.
Ernst can understand, remember, and carry out simple instructions and maintain
concentration and attention for two-hour periods of time to do so. Id. And he can interact
occasionally with supervisors, coworkers, and the public. Id.
The ALJ then determined that Ernst had no past work experience. Tr. at 1609. But
considering his age, education, work experience, and RFC, the ALJ found that jobs existed in
significant numbers in the national economy that Ernst could perform. Id. These included store
laborer, counter supply worker, and hospital cleaner. Id. These findings led the ALJ to conclude
that Ernst was not disabled. Tr. at 1610.
After unsuccessfully seeking review by the Appeals Council, Ernst commenced this action
in October 2025. D.E. 1. Both parties seek a decision in their favor. D.E. 12, 16, 17.
II. Analysis
Ernst argues that the ALJ erred in evaluating the medical opinion evidence. The ALJ’s
consideration of a medical assessment that was part of his VA disability determination was flawed.
Her reasons for discounting the opinion are unsound. So this issue provides grounds for remand.
Ernst also contends that the ALJ erred in failing to account for the limitations he
experiences with migraine headaches. The ALJ made no findings about the frequency of his
headaches or their duration. There is evidence that shows he would be off-task or absent when he
was suffering from a migraine. But the RFC does not reflect related non-exertional restrictions or
explain why they are unnecessary. So further consideration of this issue is appropriate.
The court thus grants Ernst relief and remands this matter to the Commissioner.
A. Standard for Review of the Commissioner’s Final Decision
When a claimant appeals the Commissioner’s final decision, the district court considers
whether, based on the entire administrative record, there is substantial evidence to support the
Commissioner’s findings. 42 U.S.C. § 405(g); Richardson v. Perales, 402 U.S. 389, 401 (1971).
Substantial evidence is “evidence which a reasoning mind would accept as sufficient to support a
particular conclusion.” Shively v. Heckler, 739 F.2d 987, 989 (4th Cir. 1984) (quoting Laws v.
Celebrezze, 368 F.2d 640, 642 (4th Cir. 1966)). The court must affirm the Commissioner’s
decision if it is supported by substantial evidence. Smith v. Chater, 99 F.3d 635, 638 (4th Cir.
1996).
B. Standard for Evaluating Disability
Under the Social Security Act, a claimant is disabled if they are unable “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). ALJs use a five-step,
sequential process when considering disability claims. 20 C.F.R. § 404.1520.
First, at step one, the ALJ considers whether the claimant is engaged in substantial gainful
activity. Id. § 404.1520(a)(4)(i). If so, the claim is denied. Id.
Then, at step two, the ALJ looks at whether the claimant has a severe impairment or
combination of impairments that significantly limit his ability to perform basic work activities. Id.
§ 404.1520(a)(4)(ii). If not, the claim is denied. Id.
Next, at step three, the ALJ compares the claimant’s impairments to those in the Listing of
Impairments. Id. § 404.1520(a)(4)(iii). If the impairment appears in the Listing or if it is equal to
a listed impairment, the ALJ must find that the claimant is disabled. Id.
But if the ALJ concludes that a presumption of disability is unwarranted, the ALJ must
then assess the claimant’s residual functional capacity (“RFC”). A claimant’s RFC “is the most
work-related activity the claimant can do despite all of her medically determinable impairments
and the limitations they cause.” Arakas v. Comm’r, Soc. Sec. Admin., 983 F.3d 83, 90 (4th Cir.
2020). Determining the RFC requires the ALJ to “first identify the claimant’s ‘functional
limitations or restrictions’ and assess the claimant’s ‘ability to do sustained work-related’ activities
‘on a regular and continuing basis’—i.e., ‘8 hours a day, for 5 days a week, or an equivalent work
schedule.’” Id. (quoting SSR 96–8p, 1996 WL 374184, at *1 (July 2, 1996)). The ALJ will then
“express the claimant’s Residual Functional Capacity ‘in terms of the exertional levels of work[:]
sedentary, light, medium, heavy, and very heavy.’” Id. (alteration in original).
After assessing the claimant’s RFC, the ALJ, at step four, considers whether the claimant
can perform his past work despite his impairments. Id. § 404.1520(a)(4)(iv). If the claimant can,
the ALJ will deny the claim. Id. If the claimant cannot, the analysis moves on to step five.
This final step considers whether the claimant, based on his age, work experience, and
RFC, can perform other substantial gainful work. Id. § 404.1520(a)(4)(v). If so, the claimant is not
disabled; if not, the claimant is disabled. Id.
The burden of proof shifts between the Commissioner and the claimant during the
evaluation process. The claimant has the burden of proof on the first four steps, but the
Commissioner bears it on the last one. Pass v. Chater, 65 F.3d 1200, 1203 (4th Cir. 1995).
C. Medical Opinion Evidence
Ernst contends that the ALJ failed to properly consider Campbell’s medical assessment of
his migraines. The Commissioner maintains that the ALJ properly explained why the opinion was
unpersuasive. The court finds that the ALJ’s reasons to conclude this opinion lacked persuasive
value are faulty.
The Regulations direct the ALJ to consider each medical opinion in the record. 20 C.F.R.
§§ 404.1520c, 416.920c.
A medical opinion is a statement from a medical source about what you can still do
despite your impairment(s) and whether you have one or more impairment-related
limitations or restrictions in the [following] abilities . . .
(A) Your ability to perform physical demands of work activities, such as sitting,
standing, walking, lifting, carrying, pushing, pulling, or other physical
functions (including manipulative or postural functions, such as reaching,
handling, stooping, or crouching);
(B) Your ability to perform mental demands of work activities, such as
understanding; remembering; maintaining concentration, persistence, or pace;
carrying out instructions; or responding appropriately to supervision, co-
workers, or work pressures in a work setting;
(C) Your ability to perform other demands of work, such as seeing, hearing, or
using other senses; and
(D) Your ability to adapt to environmental conditions, such as temperature
extremes or fumes.
Id. §§ 404.1513(a)(2), 416.913(a)(2).
The Regulations provide that the ALJ “will not defer or give any specific evidentiary
weight, including controlling weight, to any medical opinion(s) or prior administrative medical
finding(s), including those from [claimant’s] medical sources.” Id. §§ 404.1520c(a), 416.920c(a).
Instead, the ALJ must evaluate each medical opinion and articulate the “persuasiveness” of all
medical opinions by considering five factors:
(1) supportability, meaning that “[t]he more relevant the objective medical
evidence and supporting explanations presented by a medical source are to support
his or her medical opinion(s) . . . the more persuasive the medical opinions or prior
administrative medical finding(s) will be”; (2) consistency, meaning that the more
consistent an opinion is with other evidence in the record, the more persuasive the
medical opinion will be; (3) the medical source’s relationship with the claimant,
which considers the length of the treating relationship, frequency of examinations,
purpose of the treating relationship, extent of the treatment relationship, and
whether the medical source examined the claimant; (4) specialization, meaning that
“a medical source who has received advanced education and training to become a
specialist may be more persuasive”; and (5) other factors that tend to support or
contradict a medical opinion.”
Id. §§ 404.1520c(c)(1)–(5), 416.920c(c)(1)–(5).
Supportability and consistency are the “most important” factors, and the ALJ must discuss
how they considered these factors in the written opinion. Id. §§ 404.1520c(b)(2), 416.920c(b)(2).
The ALJ may explain their consideration of the other factors but need only do so when contrary
medical opinions are equally persuasive in terms of both supportability and consistency. Id. §§
404.1520c(b)(3), 416.920c(b)(3). In that situation, the ALJ must then articulate the remaining
factors and their application to the persuasiveness of the medical opinion. Id.
The Regulations require the ALJ to “articulate in [her] determination or decision how
persuasive [she] find[s] all of the medical opinions and all of the prior administrative medical
findings in [the] case record.” Id. §§ 404.1520c(b), 416.920c(b). But when a medical source
provides multiple opinions, the ALJ may use a single analysis to evaluate all the opinions from a
single source, and the ALJ is “not required to articulate how [she] considered each medical opinion
or prior administrative medical finding from one medical source individually.” Id.
As noted above, in 2018 Campbell found that Ernst suffered from prostrating migraines
that occurred more than once a month and resulted in decreased focus and concentration. Tr. at
1271. The ALJ found the evaluation unpersuasive for several reasons. The ALJ remarked that
Campbell failed to define the restrictions in a vocationally relevant manner. Tr. at 1608. Campbell
pointed to no objective evidence to support her finding that he would have diminished focus or
concentration. Id. And aside from stating they lasted less than a day, there was no analysis of how
often his headaches occurred. Id. The ALJ also determined that limiting Ernst to simple
instructions adequately addressed any deficits in concentration stemming from his headaches. Id.
Ernst challenges the ALJ’s evaluation of Campbell’s opinion. First, Campbell’s assessment
states that Ernst experiences prostrating migraines more than once a month. Tr. at 1271. The
Commissioner argues, unpersuasively, that Campbell’s statement is “vague and unsupported.” Br.
at 10, D.E. 16. There is no ambiguity in the frequency. So the ALJ erred in discrediting the opinion
for failing to state the frequency of Ernst’s migraines.
Second, Ernst notes that migraine headaches are among the conditions which may produce
no objective evidence to corroborate symptoms. The Commissioner contends that objective
evidence is relevant to evaluating the condition and symptoms.3 It is unclear what objective proof
is necessary, or available, to corroborate this impairment. See Robinson v. Colvin, 31 F. Supp. 3d
789, 793 n.1 (E.D.N.C. 2014) (“[T]here will often be no ‘objective’ evidence of migraine
3 The Commissioner references SSR 19-4p which provides that an ALJ considers how a claimant’s symptoms are
consistent with the record. Br. at 11, D.E. 16. But the ALJ did not assess how Ernst’s symptoms tracked or departed
from the evidence. Instead, she cited a lack of objective evidence as a basis to conclude Campbell’s opinion was not
persuasive. Tr. at 1608. Yet the absence of objective evidence is a distinct consideration from consistency with the
record.
headaches.”); see also Patricia M. v. Bisignano, No. 1:24-CV-691, 2025 WL 2697242, at *10
(M.D.N.C. Sept. 22, 2025) (citing SSR 19–4p, 2019 WL 4169635, at *4 (Aug. 26, 2019)
(“[I]maging . . . is not required for a primary headache disorder diagnosis[.]”)); Celestaine v.
Kijakazi, No. 4:21-CV-03818-TER, 2023 WL 33639, at *5 n.6 (D.S.C. Jan. 4, 2023) (“Migraines
are not generally detectable through objective testing or physical exams and thus a lack of findings
would not necessarily reflect an absence of the conditions or a lesser degree of the severity.”).
In any event, the ALJ included migraines among Ernst’s severe impairments, thus
recognizing the condition affected his ability to perform basic work activities. A lack of objective
evidence for a condition which may show none is thus an unsound basis to reject Campbell’s
opinion.
And third, contrary to the ALJ’s conclusion, Ernst maintains that Campbell’s assessment
indicates how his migraines would interfere with his focus and concentration. She described his
attendant symptoms—pain, nausea, vision changes, and sensitivity to sound and light. Tr. at 1269.
But the Commissioner contends that listing symptoms does not explain Campbell’s findings.
Yet the SSA’s own Ruling states that “symptoms of a primary headache disorder, such as
photophobia, may cause a person to have difficulty sustaining attention and concentration.” SSR
19–4p, at *8. Campbell’s assessment points out that Ernst experiences light sensitivity when he
has a migraine. Tr. at 1269. This finding would appear to support Campbell’s conclusion that
Ernst’s migraines limited his ability to focus and concentrate under the Ruling. And Ernst contends
that Campbell’s characterization of his migraines as “prostrating” means they left him “lying flat.”4
So this suggests that he would need to lie down when he experienced a migraine, thus limiting his
4 See Prostrate, Merriam-Webster.com, https://www.merriam-webster.com/dictionary/prostrate (last visited Aug. 21,
2026).
functional abilities. The court agrees that Campbell’s evaluation signals how his migraines would
interfere with Ernst’s focus and concentration. The ALJ thus erred in disregarding the opinion for
lacking any rationale.
As with all medical opinions, an ALJ must “provide a sufficient explanation” as to why
she finds the evidence unpersuasive. See Bill Branch Coal Corp. v. Sparks, 213 F.3d 186, 190 (4th
Cir. 2000); John S. v. O’Malley, No. 1:23-CV-216, 2024 WL 4348972, at *6 (M.D.N.C. Sept. 30,
2024) (observing that although the current regulations did not require the ALJ to evaluate the VA
decision itself, the underlying medical evidence, “including medical opinion evidence, remains
relevant under 20 C.F.R. § 404.1504 and must be considered.”) (citing 20 C.F.R. § 404.1513(a)(1)-
(4)). Here, however, the ALJ’s proffered reasons to conclude Campbell’s assessment was not
persuasive do not withstand scrutiny. Lacking a sound basis to reject them, the ALJ could not
discredit Campbell’s conclusions.5
In sum, the ALJ erred by failing to properly consider Campbell’s opinion. The court thus
finds that Ernst has offered a meritorious argument on this issue. So it grants Ernst relief and
remands the matter for further consideration of this issue.
D. Migraine Headaches
Ernst next contends that the ALJ erred by failing to account for the limiting effects
stemming from his migraine headaches. He argues that the evidence shows that he would be off
task or absent from work when he experienced a migraine. Yet the RFC includes no corresponding
5 The parameters of Campbell’s limitation on concentration and focus are discernible from her assessment. Based on
her findings, more than once a month Ernst would have reduced ability to concentrate and focus for less than one day.
And as discussed below, the cited lack of vocationally relevant terminology as a reason similarly fails where the ALJ
identified no evidence that undermined Ernst’s allegations about his symptoms, including the frequency, duration, and
severity of his migraines. With no sound basis to discredit his subjective statements, the ALJ erred in failing to include
non-exertional limitations in the RFC determination that address his limitations, including absences, time off-task,
and reduced ability to concentrate.
limitations. The Commissioner maintains that the RFC reflects all well-supported restrictions. The
court is persuaded by Ernst’s argument.
1. Residual Functional Capacity
The RFC is a determination, based on all the relevant medical and non-medical evidence,
of what a claimant can still do despite his impairments; the assessment of a claimant’s RFC is the
responsibility of the ALJ. See 20 C.F.R. §§ 404.1520, 404.1545, 404.1546; SSR 96–8p, 1996 WL
374184, at *2. If more than one impairment is present, the ALJ must consider all medically
determinable impairments, including medically determinable impairments that are not “severe,”
when determining the claimant’s RFC. Id. §§ 404.1545(a), 416.945(a). The ALJ must also consider
the combined effect of all impairments without regard to whether any such impairment, if
considered separately, would be of sufficient severity. Id. § 404.1523; see Walker v. Bowen, 889
F.2d 47, 50 (4th Cir. 1989) (“[I]n evaluating the effect[] of various impairments upon a disability
benefit claimant, the [Commissioner] must consider the combined effect of a claimant’s
impairments and not fragmentize them.”).
The ALJ must provide “findings and determinations sufficiently articulated to permit
meaningful judicial review.” DeLoatche v. Heckler, 715 F.2d 148, 150 (4th Cir. 1983); see also
Wyatt v. Bowen, 887 F.2d 1082, 1989 WL 117940, at *4 (4th Cir. 1989) (per curiam). The ALJ’s
RFC determination “must include a narrative discussion describing how the evidence supports
each conclusion, citing specific medical facts (e.g., laboratory findings) and nonmedical evidence
(e.g., daily activities, observations).” Mascio v. Colvin, 780 F.3d 632, 636 (4th Cir. 2015) (quoting
SSR 96–8p). Furthermore, “[t]he record should include a discussion of which evidence the ALJ
found credible and why, and specific application of the pertinent legal requirements to the record
evidence.” Radford v. Colvin, 734 F.3d 288, 295 (4th Cir. 2013). Fourth Circuit precedent “makes
it clear that it is not [the court’s] role to speculate as to how the ALJ applied the law to [her]
findings or to hypothesize the ALJ’s justifications that would perhaps find support in the record.”
Fox v. Colvin, 632 F. App’x 750, 755 (4th Cir. 2015).
Social Security Ruling 96–8p explains how adjudicators should assess residual functional
capacity. The Ruling instructs that the residual functional capacity “assessment must first identify
the individual’s functional limitations or restrictions and assess his or her work-related abilities on
a function-by-function basis, including the functions” listed in the regulations. “Only after that
may [residual functional capacity] be expressed in terms of the exertional levels of work,
sedentary, light, medium, heavy, and very heavy.” SSR 96–8p. The Ruling further explains that
the residual functional capacity “assessment must include a narrative discussion describing how
the evidence supports each conclusion, citing specific medical facts (e.g., laboratory findings) and
nonmedical evidence (e.g., daily activities, observations).” Id.
There is no “per se rule requiring remand when the ALJ does not perform an explicit
function-by-function analysis[.]” Mascio, 780 F.3d at 636. But “[r]emand may be appropriate . . .
where an ALJ fails to assess a claimant’s capacity to perform relevant functions, despite
contradictory evidence in the record, or where other inadequacies in the ALJ’s analysis frustrate
meaningful review.” Id. (quoting Cichocki v. Astrue, 729 F.3d 172, 177 (2d Cir. 2013)). The
function-by-function requirement can be satisfied by reference to a properly conducted analysis
by a state agency consultant. See, e.g., Linares v. Colvin, No. 5:14-CV-00129, 2015 WL 4389533,
at *3 (W.D.N.C. July 17, 2015) (“Because the ALJ based his RFC finding, in part, on the function-
by-function analysis of the State agency consultant, the ALJ’s function-by-function analysis
complied with [Soc. Sec. Ruling] 96–8p.” (citing Lemken v. Astrue, No. 5:07-CV-33-RLV-DCK,
2010 WL 5057130, at *8 (W.D.N.C. July 26, 2010))).
Here, the ALJ found that Ernst could perform medium work with postural and
environmental limitations. Tr. at 1602. She also included some non-exertional restrictions for
simple instructions, working in two-hour segments, and limited interactions. Id. The RFC did not,
however, allow Ernst additional time off-task or absences.
2. Subjective Statements
Under the regulations implementing the Social Security Act, an ALJ follows a two-step
analysis when considering a claimant’s subjective statements about impairments and symptoms.
SSR 16–3p, 2016 WL 1119029 (Mar. 16, 2016); 20 C.F.R. § 404.1529. First, the ALJ looks for
objective medical evidence showing a condition that could reasonably produce the alleged
symptoms, such as pain. 2016 WL 1119029, at *3; § 404.1529(b).
If the claimant clears this threshold, at the second step the ALJ must evaluate the intensity,
persistence, and limiting effects of the claimant’s symptoms to determine how much they limit the
claimant’s ability to work. Id. In making that determination, the ALJ considers the “entire case
record, including the objective medical evidence; an individual’s statements about the intensity,
persistence, and limiting effects of symptoms; statements and other information provided by
medical sources and other persons; and any other relevant evidence in the individual’s case
record.” Id. at *4.
The ALJ has full discretion to weigh the subjective statements with the objective medical
evidence and other matters of record. Craig v. Chater, 76 F.3d 585, 595 (4th Cir. 1996) (holding
that claimant’s allegations of pain need not be accepted to extent that they conflict with the record).
In a district court’s review, the ALJ’s findings are entitled to great weight because of the ALJ’s
ability to observe and evaluate testimony firsthand. Shively, 739 F.2d at 989–90.
No objective evidence is required in assessing the alleged symptoms at the second step.
Oakes v. Kijakazi, 70 F.4th 207, 215 (4th Cir. 2023) (citing Arakas, 983 F.3d at 95). Instead, “a
claimant is entitled to ‘rely exclusively on subjective evidence to prove that [his] symptoms [are]
so continuous and/or severe that they prevented [him] from working[.]’” Id. (citing Arakas, 983
F.3d at 96); see also Shelley C. v. Comm’r of Soc. Sec. Admin., 61 F.4th 341, 360 (4th Cir. 2023)
(error to discount subjective statements based on objective medical evidence, or a lack of it, where
condition may not produce such evidence).
But the ALJ does not have to accept the claimant’s statements at face value. Hawley v.
Colvin, No. 5:12-CV-260-FL, 2013 WL 6184954, at *15 (E.D.N.C. Nov. 14, 2013). The ALJ must
balance the record evidence, while being mindful that “[a] report of minimal or negative findings
or inconsistencies in the objective medical evidence is one of the many factors” considered inr
evaluating an individual’s symptoms. SSR 16–3p, 2016 WL 1119029, at *5.
So although “contradictory evidence may discredit [claimant’s] subjective statements . . .
a mere absence of medical evidence should not.” Minchew v. Kijakazi, No. 5:22-CV-214-FL, 2023
WL 5919333, at *8 (E.D.N.C. Aug. 21, 2023), adopted by 2023 WL 5916528 (E.D.N.C. Sept. 11,
2023); see William J. v. Kijakazi, Civ. No. 22–2962-BAH, 2023 WL 6518118, at *5 (D. Md. Oct.
5, 2023) (“[W]hile a claimant cannot be required to prove the extent and severity of their subjective
complaints with objective evidence, such evidence—if it exists—may still be considered by the
ALJ to evaluate those complaints.”).
In 2018, Ernst reported worsening migraines and increased frequency. Tr. at 1269. Activity
aggravated his headache pain. Id. At that time, he experienced more than one migraine a month
that lasted less than a day. Id. His symptoms included nausea, vision changes, and sensitivity to
light and sound. Tr. at 52–53, 1269.
At the first hearing, Ernst stated that he had to lie down in a dark room when he experienced
a migraine. Tr. at 42, 52–53. The migraine would last four to six hours if he could sleep but
otherwise it would last all day. Id. They occurred two to four times a month when he worked and
one to two times a month when he was not working. Tr. at 42.
At the time of the second hearing, Ernst acknowledged problems with focus and
concentration. Tr. at 1630. He had no focus when a migraine occurred. Tr. at 1635.
Ernst experienced migraines about three times a month when he was not working. Tr. at
1633–34. He would lie down where there was no light since just a little light made his headaches
terrible. Tr. at 1634–35. They could last all day until he fell asleep. Id. And Ernst did not take
prescription medication because of the side effects. Id.6
The ALJ determined that Ernst’s impairments could cause some of the symptoms he
alleged. Tr. at 1603. But she concluded that there were inconsistencies between his statements of
symptoms and the record. Id.
3. Analysis
The ALJ offered infirm grounds to discount Ernst’s subjective statements. And the RFC
determination fails to sufficiently account for Ernst’s migraines and related symptoms.
The record reflects evidence about the frequency of Ernst’s migraines. In 2018, he
experienced more than one migraine a month. At the 2023 hearing, Ernst stated that he had two to
four migraines a month when working and one to two a month when he was not working. And at
the 2025 hearing, when he no longer worked, his migraines had increased to about three a month.
There is evidence about how long his migraine symptoms endured. In 2018, Ernst’s
migraines lasted less than one day. Five years later, he stated that they would last four to six hours
6 After the ALJ’s decision, Ernst told providers that he was up to eight migraines a month. Tr. at 1991.
if he were able to sleep. But if he could not sleep, the migraine persisted all day. At the second
hearing, Ernst again maintained that his headaches would last all day if he were not able to sleep.
And the severity of Ernst’s migraine symptoms is apparent from the record. Nausea, vision
changes, and sensitivity to light and sound accompanied his headaches. Ernst must lie down in a
dark room because even a small amount of light worsens his migraines. And sleep is the only
measure that abates his symptoms.
Campbell’s 2018 opinion, too, sets out the frequency, severity, and duration of Ernst’s
migraines. She noted that they happened more than once a month and lasted less than a day. Tr. at
1270–71. Campbell noted the attendant symptoms his headaches caused. Tr. at 1269. She pointed
out that the migraines caused throbbing pain on both sides of his head and worsened with activity.
Tr. at 1269. Campbell characterized the migraines as prostrating and determined that they limited
Ernst’s ability to focus and concentrate. Tr. at 1271. So Campbell’s evaluation supports Ernst’s
statements about his migraines and their effects. And, as noted above, the ALJ offered no
reasonable basis to discredit this assessment.
There is thus no merit to the Commissioner’s contention that Ernst’s argument fails because
he did not establish the frequency, severity, or duration of his migraines. But the ALJ made no
findings about the frequency, severity, and duration of Ernst’s migraines.7 This oversight warrants
remand. See Woody v. Kijakazi, No. 22–1437, 2023 WL 5745359, at *1 (4th Cir. Sept. 6, 2023)
(finding that ALJ’s failure to reach an express conclusion on the “potentially dispositive issue of
whether the frequency and severity” of claimant’s headaches required remand); Shawn R. v.
Bisignano, No. 1:25-CV-118, 2026 WL 607376, at *6 (M.D.N.C. Mar. 4, 2026) (remanding case
7 And there is no finding about how Ernst’s sensitivity to light impacts the RFC determination or why it has no effect.
where the ALJ failed to make findings about the frequency and severity of claimant’s headache-
related symptoms, noting they were “critical to the overall disability determination.”).
The Commissioner contends that Ernst’s daily activities undermine his statements about
his symptoms and their limiting effects. The court disagrees.
The daily activities Ernst described do not discredit his statements about his migraines and
related symptoms. The Commissioner points out that he cared for his children and dog, prepared
meals, shopped in stores, helped rebuild a car, worked on a home remodeling project, and went
hiking with his children. Tr. at 1605–06.
But the evidence discloses that these activities were not as demanding as the Commissioner
suggests. Ernst performed limited household chores in the morning, usually taking breaks, so he
could rest in the afternoons. Tr. at 1636. He watched television but sometimes lost focus. Tr. at 56.
His older children, who were 11 and 12 years old in November 2023, lived with him and
his younger daughter was with Ernst every other weekend. Tr. at 45, 46. He forced himself to
attend his children’s school events even when he was in pain. Tr. at 52. The activities involved
watching baseball games or seeing chorus performances. Tr. at 1639–40.
Ernst’s hikes with his children involved walking in parks. Tr. at 60–61. And he could walk
no more than a half mile. Tr. at 228–29.
On good days, Ernst would take his dog for a walk but no more than a half mile. Tr. at 230.
When he had bad days, his older children walked the dog, helped care for their younger sister, and
prepared meals. Id. At the time of the second hearing, Ernst testified that his older children had
taken over caring for his dog. Tr. at 1635.
He cooked most of the time, as long as he was not in pain. Tr. at 45–46. But Ernst made
only simple foods, like frozen dinners or premade meals, that took little time. Tr. at 231. And his
children sometimes did the cooking. Tr. at 45–46.
He drove to the grocery store and took his children to and from school. Tr. at 233. Ernst
shopped in the grocery store for 30 minutes once a month. Tr. at 232. And he visited the town
market once a week for 10 minutes. Id.
With laundry, Ernst operated the washer and dryer and folded clothes. Tr. at 231. His
children moved and lifted the laundry. Tr. at 45–46, 231. By the time of his second hearing, Ernst
testified that he relied on his children to do all the laundry as well as mopping. Tr. at 1640.
Records from a mental health visit in February 2023 reflect that Ernst said he may help his
father rebuild an old car. Tr. at 539, 1605. And he was working on an upstairs remodel. Id. But no
other information is offered about what these activities involved. They may have been arduous and
demanding. But it could also be that they were not difficult and involved limited tasks like handing
tools to his father or hanging pictures in his home. So the court declines to infer that these activities
conflict with Ernst’s statement about his symptoms.
What’s more, there is no evidence that Ernst performed these activities for eight hours, five
days a week consistent with employment. See Arakas, 983 F.3d at 101 (observing that “[a]
claimant’s inability to sustain full-time work due to pain and other symptoms is often consistent
with her ability to carry out daily activities.”); Brown v. Comm’r of Soc. Sec., 873 F.3d 251, 263
(4th Cir. 2017) (rejecting ALJ’s finding that preparing meals or walking a short distance showed
that the claimant could persist through an eight-hour workday); Williams v. Bisignano, No. 0:24–
7022-RMG, 2026 WL 363519, at *3 (D.S.C. Feb. 10, 2026). And there is no contention or support
for a claim that he undertook such actions while he was experiencing a migraine.
Evidence in the record corroborates Ernst’s allegations about how other conditions may
contribute to the limitations from his migraine symptoms. He has a history of spinal fractures at
the thoracic level. Ernst reported chronic pain that radiated into his neck. His temporomandibular
joint (TMJ) disorder with bruxism contributes to the head pain he experiences. Tr. at 58. He
underwent right thoracic radiofrequency ablation to address his pain. And Ernst was in a motor
vehicle accident in 2024 which worsened his back pain and migraines.
Ernst points out that the failure to properly consider his statements about his migraine
symptoms is material to the disability determination. The Vocational Expert (VE) testified that a
person who would be absent from work more than once a month or off task more than 15% of the
workday would not be employable. Tr. at 64, 1722.
The Commissioner contends that Ernst’s argument misses the mark because the VE
referenced a hypothetical individual when testifying about employers’ tolerance for absences and
time off-task. Br. at 17–18, D.E. 16. This argument is unpersuasive.
The VE twice testified that more than one absence from work each month would preclude
competitive employment. As the court has determined, errors in the ALJ’s disability analysis
warrant remand for further consideration. Regardless of whether the ALJ adopts this limitation,
the VE’s testimony is material to the disability determination without a reasonable explanation for
disregarding Ernst’s statements about the frequency, duration, and severity of his migraine
symptoms.
Nor can the court agree with the ALJ’s finding that a limitation to simple work sufficiently
accounts for Ernst’s symptoms. Ernst could not focus at all and needed to lie down in a dark room
when he suffered a migraine, which could last an entire day. So his statements about his migraines
would appear to foreclose even simple work.
The ALJ thus proffered no reasonable basis to discredit Ernst’s statements about his
migraines. Her consideration of his subjective statements of symptoms thus fails to explain the
omission of restrictions for tume off task or absences in the RFC. In other words, if endorsed,
Ernst’s allegations of how the migraines limit his functioning undermine the RFC determination.
So the RFC may not adequately address this condition because it includes no restrictions
addressing time off-task or work absences.
Finding merit to Erst’s argument, the court grants him relief on this claim and remands
the matter to the Commissioner for further consideration of this issue.
III. Conclusion
For these reasons, the court grants Emst’s request for relief (D.E. 12, 17), denies
Bisignano’s request for relief (D.E. 16), and remands this matter to the Commissioner for further
consideration.®
This action is dismissed. The Clerk shall close this case.
Dated: August 21, 2026
Robert T. Numbers, II
United States Magistrate Judge
8 The court instructs that a different ALJ further consider Ernst’s application given that the court has twice remanded
his claim.
22