The opinion
UNITED STATES DISTRICT COURT
DISTRICT OF MASSACHUSETTS
PATRICIA H.,1 )
)
Plaintiff, )
)
v. ) Case No. 3:25-cv-30053-CLM
)
FRANK J. BISIGNANO, )
Commissioner of Social )
Security Administration,2 )
)
Defendant. )
MEMORANDUM AND ORDER REGARDING PLAINTIFF’S MOTION
FOR JUDGMENT ON THE PLEADINGS AND DEFENDANT’S
MOTION TO AFFIRM THE COMMISSIONER’S DECISION
(Docket Nos. 8 & 10)
MORGAN, U.S.M.J.
Patricia H. (“Plaintiff”) brings this action pursuant to 42 U.S.C. § 405(g) and
28 U.S.C. §1361 seeking review of a final decision of the Commissioner of the Social
Security Administration denying her application under Sections 216(i) and 223(d) of
the Social Security Act for disability insurance benefits for the period from October
16, 2020, through December 31, 2021 (Dkt. No. 1). Plaintiff contends that the
Administrative Law Judge’s (“ALJ”) decision was not supported by substantial
1 In the interest of privacy, this Report and Recommendation uses only the
first name and first initial of the last name of the non-governmental party in this
case. See S.R. v. Soc. Sec. Admin., Civil No. 24-12335-LTS, 2025 WL 815122, at *2
(D. Mass. Mar. 6, 2025) (“Use of [the] initial[ ] protects the claimant’s privacy while
still ensuring public access to the [c]ourt’s reasoning and decision.”).
2 Pursuant to Fed. R. Civ. P. 25(d), Frank J. Bisignano, Commissioner of the
Social Security Administration, is automatically substituted for Leland Dudek, the
former Acting Commissioner.
evidence and relied on an incorrect legal standard, and, as a result, seeks reversal
and remand. Before the court are Plaintiff’s motion for judgment on the pleadings
(Dkt. No. 8) and the Commissioner’s motion for an order affirming the decision
(Dkt. No. 10). The parties have consented to this court’s jurisdiction (Dkt. No. 14).
See 28 U.S.C. § 636(c); Fed. R. Civ. P. 73. For the reasons set forth below, the court
GRANTS the Commissioner’s motion and DENIES Plaintiff’s motion. The Clerk’s
Office is directed to close this case on the court’s docket.
I. RELEVANT FACTUAL BACKGROUND
On or about April 12, 2017, Plaintiff filed an application seeking Social
Security disability insurance benefits (“disability benefits”) based on a claim that
her disability made her unable to work beginning April 28, 2016 (A.R. 81).3 During
the pendency of her application, Plaintiff was diagnosed with lupus by
rheumatologist Susan Y. Ritter, M.D., Ph.D., which then served as part of the basis
of her disability application (A.R. 87-88, 250).4 On April 29, 2020, an ALJ found
Plaintiff disabled for a closed period from April 28, 2016, through June 10, 2019—
the full period for which Plaintiff sought benefits— based in part on findings that
chronic pain and fatigue would cause Plaintiff to be off task approximately twenty
five percent of the workday (A.R. 81-93). The ALJ found that Plaintiff’s conditions
3 All citations to “A.R.” refer to the administrative record, which appears at
docket number seven of this case. The page numbers were assigned by the Social
Security Administration and appear in the lower righthand corner of each page.
4 Plaintiff also claimed that she suffered severe impairments from episodic
pericarditis, anemia, Raynaud’s Syndrome, and a hiatal hernia. Because Plaintiff
only challenges the ALJ’s evaluation of her lupus symptoms in this case, the court
limits its discussion of the evidence accordingly.
had medically improved to the point that she could sustain full-time work by June
11, 2019, when she returned to working approximately 37 hours per week as a
victim-witness advocate for the Berkshire County District Attorney’s Office (A.R.
87).
Plaintiff switched from in-person work to remote work in March 2020 because
of the COVID-19 pandemic (A.R. 361). Plaintiff was required to return to the office
around August 2020 (id.). Plaintiff reported that, after returning to the office, she
had trouble keeping up with her job responsibilities due to her condition, and her
employment was ultimately terminated for falling asleep on the job (A.R. 23, 45-46,
48, 245, 257, 361; Dkt. No. 8-1, at 8).
Plaintiff protectively filed the instant application for disability benefits with
the Social Security Administration on February 7, 2022, alleging disability
beginning on October 16, 2020 (A.R. 66-67, 198-99). Because Plaintiff was only
insured for disability benefits through December 31, 2021, the period under
consideration by the ALJ was limited to October 16, 2020, through December 31,
2021 (A.R. 17-18).
A. Medical Records
Prior to and throughout the period under consideration, Plaintiff primarily
received care from her primary care physician, Amy Campion, D.O. In August 2020,
when required to return to work in-person and two months before the alleged onset
date, Plaintiff expressed concern regarding workplace exposure to COVID-19
because of her lupus diagnosis (A.R. 361). At the time, Dr. Campion noted that
Plaintiff’s lupus was “not currently active” and that she was not taking a disease-
modifying agent (id.). Nevertheless, the doctor provided documentation supporting
either remote work or a leave of absence due to the “increased risk for poor
outcome” of a COVID-19 infection, based on Plaintiff’s lupus diagnosis and age (id.).
In September 2020, Plaintiff sought treatment for epigastric pain and
gastrointestinal complaints (A.R. 490-93). During a follow-up in October, Plaintiff
reported fatigue and requested laboratory testing (A.R. 495-96). In December 2020,
Plaintiff reported fatigue and pain in her arms and legs and questioned whether
those symptoms were related to lupus (A.R. 500). Dr. Campion, who did “not have
records for review,” described Plaintiff’s symptoms as “a complex constellation . . .
which may or may not be related to lupus” and noted that Plaintiff had never used
an immunosuppressive agent for lupus, instead managing her symptoms with over-
the-counter pain management medications (id.). Plaintiff expressed interest in re-
establishing rheumatology care, so Dr. Campion provided a rheumatology referral
and strongly encouraged Plaintiff to obtain the medical records from her prior
rheumatologist (A.R. 504). There is no evidence in the record of Plaintiff obtaining
these records or receiving care from a rheumatologist during the insured period
(A.R. 23, 26).
Following the end of the insured period, in October 2022, Plaintiff returned to
Dr. Campion, complaining of chronic pain and fatigue, among other issues (A.R.
528-29). Dr. Campion and Plaintiff discussed another rheumatology referral but
decided to hold off (A.R. 528).
During an office visit on February 1, 2023, Dr. Campion documented chronic
complaints including abdominal pain, shortness of breath, weakness, and fatigue,
and opined that “it is possible that all of her symptoms perhaps can be explained by
an autoimmune condition such as lupus” (A.R. 532). Dr. Campion noted that
Plaintiff was unable to work and recorded in her notes that she would “provide a
note for disability stating that [Plaintiff] is currently 100% disabled” (id.). A few
days later, Dr. Campion wrote the note, opining that Plaintiff remained disabled
and unable to work “due to an ongoing medical issue” that had significantly
worsened over the prior two to three years (A.R. 249).
In October 2023, Plaintiff again reported debilitating fatigue and difficulty
predicting her daily functional capacity, but the medical records note that she had
“not had any ongoing rheumatologic care” (A.R. 540). Dr. Campion again urged
Plaintiff to seek rheumatologic care (id.). Dr. Campion subsequently wrote a letter
stating that Plaintiff suffered from “crippling fatigue and weakness of limbs” and
requesting that she be excused from jury duty (A.R. 436).
B. State Agency Consultants
On initial review of Plaintiff’s application for disability benefits, Elaine Hom,
M.D., reviewed Plaintiff’s medical records and completed a residual functional
capacity assessment on August 5, 2022 (A.R. 60-65). Dr. Hom acknowledged
Plaintiff’s reports of fatigue, weakness, shortness of breath, and chronic pain (A.R.
60). In assessing Plaintiff’s residual functional capacity, Dr. Hom opined that
Plaintiff has some exertional and postural limitations: she could occasionally lift
and carry twenty pounds and frequently lift and carry ten pounds; stand and walk
six hours in an eight-hour day; sit six hours in an eight-hour day; and climb,
balance, stoop, kneel, crouch, and crawl occasionally (A.R. 62-63). Dr. Hom found
that Plaintiff did not have any manipulative, visual, or communicative limitations,
but should avoid concentrated exposure to extreme cold, extreme heat, wetness,
humidity, vibration, hazards, or fumes, odors, dusts, or gases (A.R. 63).
On reevaluation, Alice Truong, M.D., reviewed Plaintiff’s medical records and
provided her opinion as to Plaintiff’s residual functional capacity on February 8,
2023. She similarly concluded that Plaintiff could perform a range of light work
with the same exertional and environmental limitations noted by Dr. Hom (A.R. 68-
74).
C. Administrative Hearing
1. Plaintiff’s Testimony
At the January 17, 2024, hearing, Plaintiff testified regarding fatigue and
other limitations she attributed to lupus (A.R. 44-53). Plaintiff testified that she
went back to work in June 2019, at the end of her previous closed period of receiving
disability benefits, because it was an entry-level, non-physical job, and she “thought
it would be a lot easier than other jobs [she had] had” (A.R. 44). She testified she
worked there from June 2019 to around August 2020, at which point she felt unable
to keep up with the job (A.R. 45). She struggled with her fatigue, fell asleep at work
(id.), and was eventually fired (A.R. 46). Plaintiff testified that she sought work in
the months following her termination (id.).
Plaintiff attributed her fatigue to lupus (A.R. 48). Plaintiff testified that her
fatigue had worsened over time, was sometimes crippling, and particularly
impacted her legs (id.). She testified that she needed to rest frequently throughout
the day due to her fatigue, making it difficult to complete daily chores (A.R. 52).
When asked if she thought she could work as of the date of the hearing, she testified
that she would be too drowsy to work from a chair for six hours in an eight-hour day
(A.R. 53).
Plaintiff further testified as to the lack of recent treatment records. She
explained that her rheumatologist offered her immunosuppressant drugs, which she
rejected because “they don’t always help,” and instead relied on “over the counter
and other medications” (A.R. 50). She stated that she was also hesitant to take
immunosuppressant drugs because she already had a compromised immune system
and had a friend with lupus who was on immunosuppressants and died from
COVID-19 (A.R. 51). Plaintiff mostly tried to stay inside during the pandemic, even
missing her mother’s funeral, due to fears of infection (id.). According to Plaintiff,
she still spent most of her time at home due to her compromised immune system
(A.R. 52).
At the conclusion of Plaintiff’s testimony, the ALJ directed Plaintiff to
provide any other records pertaining to her lupus since the alleged onset date of
October 16, 2020 (A.R. 53-54).
2. Vocational Expert’s Testimony
The ALJ first asked Warren Maxim, the vocational expert, to consider a
hypothetical individual of Plaintiff’s age, education, and work experience, who could
lift and carry ten pounds occasionally and less than ten pounds frequently, stand
and walk for two hours in an eight-hour day, sit for a total of six hours, engage in
only occasional postural activities (including climbing, balancing, stooping,
kneeling, crouching, and crawling), and must avoid concentrated exposure to
extreme cold, extreme heat, wetness, humidity, vibration, hazards or fumes, odors,
dust, or gases (A.R. 54). The vocational expert testified that these limitations would
not eliminate Plaintiff’s past work as generally described in the Dictionary of
Occupational Titles, but they would eliminate her job as she actually performed it
(A.R. 55). The ALJ then asked the vocational expert to consider the same
hypothetical individual, but with the ability to sit reduced to four hours total per
workday (id.). The vocational expert indicated that such a limitation would
eliminate all past work, as well as all other work in the national economy, and that
there would not be any transferable skills for the hypothetical individual (id.).
Finally, the vocational expert testified that all work would be eliminated if the
hypothetical individual was off task fifteen percent of the time or missed work on
average two days per month (id.).
At the conclusion of the vocational expert’s testimony, the ALJ again
reminded Plaintiff to provide any other records pertaining to her lupus (A.R. 56).
II. THE ALJ’S DECISION
On April 23, 2024, the ALJ issued a decision denying Plaintiff’s claim (A.R.
18-28). The ALJ conducted the requisite five-step sequential analysis set forth in
the regulations promulgated by the Social Security Administration (“SSA”). See 20
C.F.R. § 404.1520(a)(i)-(v); 20 C.F.R. § 416.920(a)(4)(i)-(v). At the first step, the ALJ
found that Plaintiff had not engaged in substantial gainful activity between October
16, 2020, and December 31, 2021, the date on which she was last insured (A.R. 19).
At the second step, he found that Plaintiff’s severe impairments included lupus,
venous insufficiency, metatarsalgia of left forefoot, neuroma of left third
intermetatarsal space, small hiatal hernia, and minimal subsegmental atelectasis
(A.R. 20). At step three, the ALJ determined that Plaintiff did not have an
impairment or combination of impairments that met or medically equaled the
severity of a listed impairment (A.R. 21). Before considering step four, the ALJ
found that, for the entire period at issue, Plaintiff had the residual functional
capacity to:
perform sedentary work as defined in 20 CFR 404.1567(a)
except she can stand and walk 2 hours in an 8 hour day;
she can sit 6 hours in an 8 hour day; she can climb, balance,
stoop, kneel, crouch, and crawl occasionally; she can have
no concentrated exposure to extreme cold, extreme heat,
wetness, humidity, vibration, hazards, or fumes, odors,
dusts, or gases.
(A.R. 22). At step four, the ALJ determined that Plaintiff was capable of performing
past relevant work as a community relations representative and sales and
promotions agent, neither of which required the performance of work-related
activities precluded by the claimant’s residual functional capacity (A.R. 27).
Because the ALJ determined that Plaintiff had the residual functional capacity to
do her past relevant work, the ALJ found she was not disabled, and the analysis did
not proceed to the fifth and final step (A.R. 27).
III. STANDARD OF REVIEW
The district court may enter a judgment affirming, modifying, or reversing
the final decision of the Commissioner, with or without remanding for rehearing.
See 42 U.S.C. § 405(g). Judicial review is limited to determining “‘whether the
[ALJ’s] final decision is supported by substantial evidence and whether the correct
legal standard was used.’” Coskery v. Berryhill, 892 F.3d 1, 3 (1st Cir. 2018) (quoting
Seavey v. Barnhart, 276 F.3d 1, 9 (1st Cir. 2001)). The court reviews questions of
law de novo, id., but “the ALJ’s findings [of fact] shall be conclusive if they are
supported by substantial evidence, and must be upheld ‘if a reasonable mind,
reviewing the evidence in the record as a whole, could accept it as adequate to
support his conclusion,’ even if the record could also justify a different conclusion.”
Applebee v. Berryhill, 744 F. App’x 6, 6 (1st Cir. 2018) (per curiam) (quoting
Rodriguez v. Sec’y of Health & Human Servs., 647 F.2d 218, 222-23 (1st Cir. 1981)).
“Substantial-evidence review is more deferential than it might sound to the lay ear:
though certainly ‘more than a scintilla’ of evidence is required to meet the
benchmark, a preponderance of evidence is not.” Purdy v. Berryhill, 887 F.3d 7, 13
(1st Cir. 2018) (quoting Bath Iron Works Corp. v. U.S. Dep’t of Labor, 336 F.3d 51,
56 (1st Cir. 2003) (internal quotation marks omitted)). In applying the substantial
evidence standard, the court must be mindful that it is the province of the ALJ, and
not the courts, to determine issues of credibility, resolve conflicts in the evidence,
and draw conclusions from such evidence. See Applebee, 744 F. App’x at 6. That
said, the ALJ may not ignore evidence, misapply the law, or judge matters
entrusted to experts. See Nguyen v. Chater, 172 F.3d 31, 35 (1st Cir. 1999) (per
curiam).
IV. ANALYSIS
Here, Plaintiff presents four separate claims of error. First, she contends that
the ALJ failed to properly evaluate the opinion evidence. Second, she argues that
the ALJ failed to consider certain objective medical evidence and thus the ALJ's
decision is not supported by substantial evidence. Third, she contends that the ALJ
mischaracterized the evidence. Finally, Plaintiff alleges that the ALJ imposed the
incorrect evidentiary standard of proof. The court addresses each of Plaintiff’s
theories in turn.
A. The ALJ Properly Evaluated the Opinion Evidence
In her memorandum, Plaintiff contends that the ALJ failed to adequately
address Plaintiff’s lupus symptoms by failing to “reasonably cite [the] consistency or
supportability factors [of 20 C.F.R. § 404.1520c] in his decision regarding
[Plaintiff’s] primary symptom: fatigue,” leaving the court “with mere speculation as
to the ALJ’s bases for rejecting the opinion of the treating internist [Dr. Campion]
and . . . the adequacy of the non-examining DDS internists’ [Dr. Hom’s and Dr.
Truong’s] opinions . . . ” (Dkt. No. 8-1, at 14). For his part, the Commissioner argues
that the ALJ adequately explained his reasons for not adopting Dr. Campion’s
opinions, as well as his reasoning for accepting, in part, the opinions of Drs. Hom
and Truong (Dkt. No. 11, at 9-13).5
“Although it is well-established that an ALJ need not articulate precisely his
reasoning for rejecting a treating source statement on a claimant’s residual
functional capacity, it is similarly well-established that an ALJ must articulate his
reasoning sufficient for a reviewing court to achieve meaningful appellate review”
(Dkt. No. 8-1, at 13) (citing Harrison v. Saul, Civil No. 20-10295-LTS, 2021 WL
1153028, at *5 (D. Mass Mar. 16, 2021)). In determining a claimant’s residual
functional capacity (RFC), an ALJ “must always consider and address medical
source opinions. If the RFC assessment conflicts with an opinion from a medical
source, the adjudicator must explain why the opinion was not adopted.” Harrison,
2021 WL 1153028, at *5 (quoting SSR 96-8p, 1996 WL 374184, at *7 (S.S.A. July 2,
1996)). In making this determination, “the ALJ must consider the following factors:
supportability, consistency, relationship, specialization, and other factors,” the most
important of which are supportability and consistency. Id. (citing 20 C.F.R. §§
404.1520c(c)(1)-(5), 416.920c(c)(1)-(5); Nicole C. v. Saul, C.A. No. 19-127JJM, 2020
WL 57727, at *4 (D.R.I. Jan. 6, 2020)). “Supportability is the degree to which a
5 In his Memorandum, the Commissioner raises the question of whether Dr.
Campion’s letter excusing Plaintiff from jury duty constitutes a “medical opinion” or
should be considered “other medical evidence,” but states that the ALJ “reasonably
erred on the side of caution and treated” the letter as a medical opinion (Dkt. No.
11, at 8-9). (id.). Because the Commissioner does not ask the court to find that the
ALJ erred in treating the letter as a medical opinion, the court does not consider the
question.
provider supports their opinion with relevant, objective medical evidence and
explanation, and consistency is the degree to which a provider's opinion is
consistent with the evidence of other medical and non-medical sources in the
record.” Oakes v. Kijakazi, 70 F.4th 207, 212 (4th Cir. 2023) (citing 20 C.F.R. §
404.1520c(c)(1)-(2)).
1. Dr. Campion’s Opinion
Although Plaintiff complains of an “absence of §[ ]404.1520c factors” (Dkt. No.
8-1, at 14), the ALJ did in fact properly consider Dr. Campion’s opinion (A.R. 25). As
the ALJ stated:
[Dr. Campion’s] letter states [Plaintiff] had crippling
fatigue and weakness of limbs. However, the evidence on
record does not support these limitations. The claimant has
no rheumatologic treatment during the period at issue.
Treatment records from her primary care source reflect[]
the claimant declined multiple referrals to a
rheumatologist. The claimant’s lack of treatment does not
support the statement that she has “crippling” symptoms.
There is also no evaluation of her legs indicating objective
support of weakness . . . . Therefore, the opinion of Dr.
Campion is not supported by or consistent with the record
and is not persuasive (A.R. 25).
The court is not, as Plaintiff purports, “left with mere speculation as to the
ALJ’s bases for rejecting” Dr. Campion’s opinion (Dkt. No. 8-1, at 14). The ALJ
explicitly found that Dr. Campion’s opinion was unsupported by and inconsistent
with evidence that Plaintiff was not actively treating her lupus, declined referrals to
a rheumatologist, and found relief from over-the-counter medications (A.R. 25). The
record shows that Dr. Campion did not actively treat Plaintiff’s lupus, even noting
that she did “not have records for review,” and that Plaintiff’s symptoms “may or
may not be related to lupus” (A.R. 500). A rational factfinder could find Dr.
Campion’s statement that Plaintiff’s lupus “causes crippling fatigue and weakness
of limbs” (A.R. 436) was inconsistent with her prior notes, conclusory, and otherwise
devoid of objective medical evidence, and therefore unsupported by and inconsistent
with the record. See Darling v. Kijakazi, No. 22-35594, 2023 WL 4103935, at *1 (9th
Cir. June 21, 2023) (affirming ALJ’s supportability and consistency findings where
the “opinion was internally inconsistent, as well as inconsistent with [the plaintiff’s]
work history and reports to other medical sources”).
Moreover, the record reflects that the ALJ conducted a detailed review of the
medical evidence and Plaintiff’s own testimony (A.R. 22-27). See Marshall v.
Bisignano, 1:24-cv-11431-JEK, 2025 WL 2207245, at *5-7 (D. Mass. Aug. 4, 2025)
(finding ALJ’s in-depth discussion of pertinent evidence supportive of his finding of
medical opinion as unsupported and inconsistent). The lack of objective medical
support for Dr. Campion’s opinion was a factor the ALJ could not ignore. The court
thus concludes that the ALJ fulfilled his obligation to explain his consideration of
both the consistency and supportability factors when explaining why he was not
persuaded by Dr. Campion’s opinion.
2. Dr. Hom’s and Dr. Truong’s Opinions
Plaintiff further argues that the ALJ failed to explain why he found the
opinions of Drs. Hom and Truong partially persuasive and posits that these
opinions are inadequate because they are “not well justified” (Dkt. No. 8-1, at 14-
16). The court finds that the ALJ appropriately considered the opinions of DDS
examiners Drs. Hom and Truong. The ALJ noted “[t]he overall evidence of record,
including . . . reported fatigue and pain from [l]upus . . . warrant a restriction to
sedentary work” with postural, environmental, and pulmonary limitations, as
opined by Drs. Hom and Truong (id.). Both doctors reviewed Plaintiff’s medical
records and considered Plaintiff’s symptoms in making their opinions (see A.R. 61,
63-64, 72). The ALJ noted that the doctors’ opinions were “consistent with the
record,” and that the Plaintiff’s conditions, including fatigue from lupus, “support
these limitations” (A.R. 26). The court thus finds that the ALJ adequately explained
his application of the consistency and supportability factors in assessing the
opinions of Drs. Hom and Truong and concluding that he was partially persuaded
by them.
Plaintiff takes specific issue with both doctors’ use of the phrase “some
fatigue” (A.R. 63, 72) and implies that this shows that “[t]he DDS reviewing
internist[s’] opinions were not well justified by any objective measure” (Dkt. No. 8-1,
at 16) (citing Alcantara v. Astrue, 257 F. App’x 333, 335 (1st Cir. 2007)). The court
disagrees. Dr. Hom’s and Dr. Truong’s opinions are supported by the objective
evidence in the record, including medical records of Plaintiff’s symptoms and
treatment. Dr. Hom received medical records through June 2022, and cited specific
treatment notes for lupus and other conditions from August 2020 through May 2022
(A.R. 61, 63-64). She noted that Plaintiff:
“[e]xperiences fatigue and [shortness of breath], falls
asleep all the time, weakness in arms and legs. can not [sic]
stand for a long time. Does not have difficulties with
personal care but sometimes lacks the energy. Goes outside
for short walks. [C]an drive short distance. [L]ikes to read.
[D]ifficulties lifting, squatting, bending, standing[ ]. [U]ses
reading glasses, can handle money” (id.).
Dr. Truong, for her part, cited Plaintiff’s history of disability from April 2016
through June 2019, her subsequent period of full-time work from June 2019 to
October 2020, and the new alleged onset date of disability in October 2020, from
which Plaintiff “had to stop [working] again due to increasing symptoms,” and “the
reduced ability to sustain sedentary work” (A.R. 69). She noted that “[e]vidence is
needed for the time she stopped working in 10/2020 to 12/2021,” as “[t]here is plenty
of evidence in the prior allowance to support her conditions ongoing” (id.). Dr.
Truong also cited to records from September 2017 to May 2022 (A.R. 69-70).
Plaintiff does not point to any specific evidence in the record which Drs. Hom
or Truong missed. Rather, she seems to contend that Drs. Hom and Truong
impermissibly ignored her “uncontradicted reports of marked limitations” at work
and in daily life (Dkt. No. 8-1, at 16). But Drs. Hom and Truong both credited
Plaintiff’s reports in finding that she had some limitations due to her conditions
(A.R. 63, 71-72). Further, the fact that Dr. Hom’s and Dr. Truong’s opinions are
consistent with each other does not suggest that they are not well-justified, as
Plaintiff suggests (Dkt. No. 8-1, at 17).
B. The ALJ Properly Considered All Available Evidence
Even if the ALJ did not explicitly address every detail in the record, there is
no indication that he impermissibly “ignore[d] evidence” here. See Nguyen, 172 F.3d
at 35. In his decision, he summarized Plaintiff’s history of lupus, including her
diagnosis, symptoms (“pain in her arms and legs, and also fatigue”), treatment
(“never been on an immunosuppressive agent . . . Ibuprofen and Tylenol were used
periodically”), and referrals to see a rheumatologist (A.R. 23, 25). He found that,
despite the minimal notation of lupus in the record for the period at issue, Plaintiff’s
“impairment supports a sedentary work capacity given the subjective complaint by
the claimant of fatigue and weakness caused by [l]upus” (id., at 24). The ALJ also
considered Dr. Campion’s treatment notes and her October 23, 2023, letter
mentioning Plaintiff’s “crippling fatigue and weakness of limbs” (id., at 25). In
reviewing the record as a whole, a reasonable mind “could accept it as adequate to
support [the ALJ’s] conclusion.” Applebee, 744 F. App’x at 6 (quoting Rodriguez, 647
F.2d at 222-23). This court may not reject these findings, as Plaintiff seeks, to reach
a different conclusion by relying more heavily on Plaintiff’s self-reported symptoms.
Plaintiff further contends that the ALJ relied upon incorrect legal standards
in reaching his decision. First, she argues that the ALJ “conflat[ed] the requirement
of ‘objective’ evidence required of a diagnosis with formulating a residual function
capacity employing” the § 404.1520c factors when the ALJ noted that “[n]o objective
evaluation was performed” at the December 22, 2020, video appointment (Dkt. No.
8-1, at 17). Second, Plaintiff maintains that the ALJ “misapplied the failure to
follow prescribed treatment standard” (id., at 18).
As for the first contention, the ALJ remarking that an objective evaluation
was not performed does not mean he required such an evaluation. In evaluating
Plaintiff’s symptoms, the ALJ was required to “consider all of the available
evidence, including [her] medical history, the medical signs and laboratory
findings,” in addition to Plaintiff’s statements about her symptoms. 20 C.F.R. §
404.1529(a). Consideration of objective evaluations, or a lack thereof, falls within
the scope of “all of the available evidence.” While “[a]n ALJ cannot reject a
claimant’s statements about the intensity and persistence of pain or about the effect
those symptoms have on her ability to do work solely because the objective medical
evidence does not substantiate her statements[,] . . . [t]he absence of objective
medical evidence supporting a claimant’s statements of pain is . . . one factor that
the ALJ must consider, and he must consider the statements in the context of all
evidence.” Obijo vs. Astrue, Civil Action No. 11-10472-JLT, 2012 WL 2126879, at *5
(D. Mass. May 7, 2012) (citing 20 C.F.R. § 404.1529(c)(2); SSR 96–7p). And “[i]n
determining a claimant’s RFC, an ALJ is not required to take a claimant’s
subjective allegations of pain and functional limitations at face value and may reject
them where they are unsupported by the medical evidence, treatment history, and
activities of daily living.” Id. (citing, inter alia, Avery v. Sec'y of Health & Human
Servs., 797 F.2d 19, 22-23 (1st Cir. 1986)) (“In making [an RFC] determination, an
ALJ must consider the so-called ‘Avery factors,’ which are the claimant’s daily
activities, functional restrictions, non-medical treatment, medications and side-
effects, precipitating and aggravating factors, and the nature, location, onset,
duration, frequency, radiation, and intensity of the pain.”).
Here, the ALJ found that, although Plaintiff’s “medically determinable
impairments could reasonably be expected to cause the alleged symptoms . . . , [her]
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 . . . ” (A.R. 23). Plaintiff’s symptoms, which she purported to be
debilitating, were manageable with over-the-counter medication (id.). Although she
reported her symptoms were “crippling,” she did not seek treatment with a
rheumatologist (A.R. 25). In fact, there were no treatment records for Plaintiff’s
lupus symptoms from December 2020 through the date last insured (A.R. 23). And
as the ALJ noted, although Plaintiff did have physical limitations (“chronic fatigue,”
“long time to shower and bathe,” “difficulty with lifting, squatting, bending,
standing, reaching, walking, kneeling, talking, stair climbing, and using hands”),
she could still complete many daily living activities, including “mak[ing] simple or
prepared meals,” driving, shopping, and occasionally visiting with a friend (A.R. 23).
The court therefore finds that the ALJ properly considered Plaintiff’s subjective
reports of symptoms in the context of all the available evidence, including the lack
of objective medical evidence.
Secondly, Plaintiff contends that the ALJ should not have used Plaintiff’s
“failure to follow prescribed treatment” as “a negative consistency factor” because
she was not prescribed treatment for her lupus, there was no finding that
“treatment would restore [Plaintiff’s] ability to work,” and the ALJ did not
determine whether Plaintiff had “good cause for not following the prescribed
treatment” (Dkt. No. 8-1, at 18). She argues that, because an assessment of a
claimant’s failure to follow prescribed treatment follows a finding of disability, the
ALJ implicitly found her disabled (id.). Plaintiff further takes issue that “the
decision did not address [her] decision to avoid immunosuppressant medications for
fear that a reduced immune system put her at great risk for [COVID-19] . . . ” (id.,
at 19).
The court does not agree that the ALJ considered Plaintiff’s “failure to follow
prescribed treatment,” because, as Plaintiff notes, she was not prescribed
immunosuppressant agents, and the ALJ did not represent that she was. However,
courts have found that, aside from an individual’s failure to follow prescribed
treatment, an ALJ may also consider “failure to ‘seek or pursue regular medical
treatment’ . . . .” Dooley v. Comm’r of Soc. Sec., 656 Fed. App’x. 113, 119 (6th Cir.
2016). See Irlanda Ortiz v. Sec’y of Health & Human Servs., 955 F.2d 765, 769 (1st
Cir. 1991) (finding that gaps in treatment are evidence that an impairment is not as
severe as alleged); Baez Velez v. Sec'y of Health & Human Servs., No. 92-2438, 1993
WL 177139, at *6 (1st Cir. May 27, 1993) (per curiam) (deferring to ALJ’s credibility
assessment based, in part, upon finding that plaintiff’s allegations “were
unsupported by [a plaintiff’s] ‘conservative treatment’”); Perez Torres v. Sec'y of
Health & Human Servs., 890 F.2d 1251, 1255 (1st Cir. 1989) (where a plaintiff
“sought no regular treatment for his . . . allegedly painful conditions . . . the ALJ
was entitled to discount the severity of the pain complaints”). “However, before
drawing a negative inference from [such a failure], the ALJ must consider ‘any
explanations that the individual may provide, or other information in the case
record, that may explain infrequent or irregular medical visits or failure to seek
medical treatment.’” Dooley, 656 Fed. App’x at 119 (citing Social Security Ruling
(“SSR”) 96-7p (now rescinded)). See SSR 16-3p, 2017 WL 5180304, at *9 (“We will
not find an individual’s symptoms inconsistent with the evidence in the record on
this basis without considering possible reasons he or she may not comply with
treatment or seek treatment consistent with the degree of his or her complaints.”).
During the January 17, 2024, hearing, the ALJ asked about Plaintiff’s lack of
treatment (A.R. 50). Plaintiff explained that she had rejected her rheumatologist’s
offer of immunosuppressant drugs because “they don’t always help,” she already
had a compromised immune system, and she had a friend with lupus who was on
immunosuppressants who died from COVID-19 (A.R. 50-51). She further testified
that she rarely left the house due to her compromised immune system during the
pandemic and at the time of the hearing (A.R. 51-52). See A.R. 248 (Plaintiff
“avoided going to doctors [in 2020 and 2021] because of the pandemic and [her]
compromised immune system with lupus”).
Plaintiff argues that “the ALJ should have recontacted the treating internist
or sought the opinion of an acceptable medical source” to determine whether an
immunosuppressant medication would have allowed Plaintiff to return to work and
whether it would have put her at a greater risk of contracting COVID-19 (Dkt. No.
8-1, at 19) (citing, inter alia, Heggarty v. Sullivan, 947 F.2d 990, 997 (1st Cir. 1991)
(“Because Social Security proceedings are not adversarial in nature, the Secretary
had a duty to develop an adequate record from which a reasonable conclusion can be
drawn.”)). However, as Plaintiff herself notes, an ALJ is “under no obligation to seek
additional information where there are no obvious gaps in the record, and where
there is a complete medical history.” Veiga v. Colvin, 5 F. Supp. 3d 169, 176 (D.
Mass 2014) (citations omitted). The ALJ here noted that Plaintiff “had never been
on an immunosuppressive agent despite being diagnosed many years ago” and had
expressed interest in re-establishing rheumatology care repeatedly, but never
followed through (A.R. 23, 25). The ALJ did request any additional records that
existed pertaining to Plaintiff’s lupus for the insured period, but none were
produced (A.R. 53-54, 56).
A claimant’s failure to seek care may be attenuated by “the extraordinary
circumstance of the COVID-19 pandemic.” Blanca T. v. O'Malley, Case No. 5:23-cv-
00159-SP, 2024 WL 6847881, at *4 (C.D. Cal. Mar. 27, 2024). Plaintiff testified that
her failure to seek treatment from a rheumatologist during the insured period was
due, in part, to COVID-19. “If this was the only gap in treatment, the pandemic
would be adequate explanation for failing to seek treatment. . . . But the other gaps
in treatment have no such explanation.” Lydia G. v. Comm’r of Soc. Sec., Civ. No.
3:22-cv-00810-CL, 2023 WL 5928627, at *4 n.3 (D. Ore. Sept. 12, 2023) (internal
citation omitted). Plaintiff had never taken a disease-modifying agent from her
diagnosis in 2017, through the pandemic, until the end of the insured period in
2021. Instead, she managed her symptoms with over-the-counter medications.
Courts have found that “remand based on lack of inquiry into the reasons for
a claimant’s failure to seek treatment is required only when the ALJ’s
determination of non-disability relies ‘primarily if not exclusively’ on a claimant’s
failure to seek treatment.” Crenshaw v. Kijakazi, Civil Action No. 21-00549-B, 2023
WL 2664756, at *15 (S.D. Ala. Mar. 28, 2023) (citations omitted). Here, although the
ALJ did consider Plaintiff’s failure to seek treatment in denying her disability based
on lupus, he did not rely primarily on this failure in his decision. Rather, as
discussed, he found that, while Plaintiff’s “medically determinable impairments
could reasonably be expected to cause the alleged symptoms . . . the intensity,
persistence and limiting effects of these symptoms are not entirely consistent with
the medical evidence” (A.R. 23). Plaintiff’s purportedly “crippling” symptoms were
manageable with over-the-counter medication, she did not seek treatment with a
rheumatologist, there were no treatment records for Plaintiff’s lupus symptoms
from December 2020 through the date last insured, and, although Plaintiff did have
several physical limitations, she could still complete many daily living activities
(id., A.R. 25). The failure to seek treatment was merely one aspect of the ALJ’s
analysis. The court therefore finds that remand based on lack of inquiry is not
warranted, and the ALJ properly considered all available evidence.
C. The ALJ Reasonably Characterized the Record
Plaintiff next contends that the ALJ mischaracterized the evidence in
denying her claim (Dkt. No. 8-1, at 20). In particular, Plaintiff claims that the ALJ’s
characterizations of the “frequency of lupus treatment, the break in lupus treatment
with her internist, the subsequent absence of treatment for lupus, and in classifying
treatment as ‘minimal’” (id., at 21), were inconsistent with the evidence presented
or ignored other evidence in the record. The record reflects, however, that the ALJ
properly weighed the record evidence, and it is not the place of this court to re-
weigh the evidence considered by the ALJ. Applebee, 744 F. App’x at 6.
First, Plaintiff claims that the ALJ mischaracterized the frequency of her
lupus treatment because her “lupus was described as an ‘active’ problem at five
appointments . . . from September, [sic] 2020 through May, [sic] 2021, and
thereafter” (Dkt. No. 8-1, at 21). But this standardized “active problem” list,
duplicated throughout Plaintiff’s treatment notes, includes several other “active
problem” items that appear to be neither ongoing nor problems, such as “routine
gynecological examination” and “abnormal finding on imaging” (A.R. 491, 496-97,
501, 505, 508, etc.). Moreover, Dr. Campion’s records reflect that Plaintiff’s “[l]upus
[was] not currently active” in August 2020, within the same treatment note that
lists lupus as an “active problem” (A.R. 361-62). “It is the responsibility of the ALJ
to weigh competing medical evidence and resolve any conflicts.” San Antonio v.
Saul, 433 F. Supp. 3d 29, 34 (D. Mass. 2020) (citing Rodriguez, 647 F.2d at 222).
The ALJ did so here (A.R. 22-27). While Plaintiff may not agree with the ALJ’s
conclusion in weighing the evidence, it does not mean that the ALJ
“mischaracterized” the evidence.
Second, Plaintiff asserts that the ALJ mischaracterized her course of
treatment, arguing that her medical history does not reflect that her lupus resolved
or that she had a break in treatment for her lupus, and that she continued to
receive treatment for lupus after her date last insured (Dkt. No. 8-1, at 21). As a
basis for these arguments of “mischaracterization,” Plaintiff again cites to the fact
that her medical records list her lupus under “active” conditions as evidence that
she was receiving “treatment” (id.). Again, as the ALJ noted, Plaintiff was not
actively treating her lupus with a disease modifying agent, declined referrals to a
rheumatologist, and found relief from over-the-counter medications (A.R. 25). Dr.
Campion noted that Plaintiff’s lupus was “not currently active” as of August 2020,
within a treatment note that also listed lupus as an “active problem” (A.R. 361-62).
Moreover, although Dr. Campion referred to an “ongoing medical issue” in 2023, she
did not directly link the “issue” to lupus (A.R. 249), and in fact, did not even have
access to the medical records from Plaintiff’s prior rheumatologist (A.R. 504). In
addition, although Plaintiff contends that Dr. Campion noted that her “[c]omplex of
symptoms may be . . . related [to lupus]” (Dkt. No. 8-1, at 21), the language omitted
by Plaintiff reflects that her internist thought her “symptoms . . . may or may not be
related to lupus” (A.R. 365), consistent with the ALJ’s finding a lack of objective
medical evidence supporting Plaintiff’s reported symptoms. Thus, the ALJ’s
assessment of Plaintiff’s treatment does not mischaracterize the evidence.
Third, Plaintiff complains that the court is left to “merely guess what factors
the ALJ relied upon, if any” in reaching his decision (Dkt. No. 8-1, at 23). According
to Plaintiff, the ALJ failed to address “uncontradicted” evidence regarding her
symptoms, including the variability of her symptoms, factors that would trigger or
relieve her symptoms, and the effect her symptoms had on her daily living. But the
ALJ is required to “consider all of the available evidence, including [her] medical
history, the medical signs and laboratory findings,” in addition to Plaintiff’s
statements about her symptoms. 20 C.F.R. § 404.1529(a). As the record reflects,
that is precisely what the ALJ did here. He considered all the evidence presented,
including Plaintiff’s self-reported symptoms, in reaching his conclusion (see A.R. 22-
27). Despite Plaintiff’s characterization of her symptoms as “uncontested,” the ALJ’s
decision reflects that he considered her symptoms to determine whether they were
supported by the medical evidence and concluded that he did not “find the
claimant’s statements regarding her limitations entirely consistent with the medial
evidence and other substantial evidence” (A.R. 27). See Suliman v. Saul, No. 1:20-
CV-11985-RWZ, 2022 WL 3108850, at *3 (D. Mass. Aug. 3, 2022) (finding that ALJ’s
RFC supported by substantial evidence where self-reported symptoms were
inconsistent with the medical evidence).
Plaintiff also briefly asserts that her prior attorney erred in stipulating to the
classification of Plaintiff’s past work as “generally sedentary but actually performed
light,” which she alleges “weakens” her claim (Dkt. No. 8-1, at 25-26). In turn, she
contends her counsel failed to argue, and the ALJ did not consider, that she
performed work under special conditions for six to twelve months, which reflected
subsidized employment not rising to the level of gainful activity (id.). The court
finds this argument unavailing. “When a claimant is represented, the ALJ[] ‘should
ordinarily be entitled to rely on claimant’s counsel to structure and present the
claimant’s case in a way that claimant’s claims are adequately explored.’” Faria v.
Comm’r of Soc. Sec., No. 97-2421, 1998 WL 1085810, at *1 (1st Cir. Oct. 2, 1998)
(quoting Hawkins v. Chater, 113 F.3d 1162, 1167 (10th Cir. 1997)). It was
ultimately her “burden to prove at Step 4 that she was unable to perform her past
relevant work and an obligation to develop the record regarding the requirements of
that work at the hearing.” Julianne P. v. Kijakazi, No. 2:22-cv-00064-JDL, 2022 WL
17494867, at *2 (D. Me. Dec. 8, 2022), report and recommendation adopted, No.
2:22-CV-00064-JDL, 2023 WL 1785542 (D. Me. Feb. 6, 2023). Thus, the court’s
inquiry on this point ends here.
Finally, Plaintiff argues the ALJ erred in not adopting, in full, the medical
opinions in this case in determining her RFC, suggesting that the ALJ simply “split
the difference between the competing opinions” (Dkt. No. 8-1, at 23). While some
courts have “rejected the idea that an ALJ is qualified to split the difference
between expert opinions,” the instant case is distinguishable. Chantal E. v. Kijikazi,
No. 2:22-cv-00126-NT, 2023 WL 2806497, at *3 (D. Me. Apr. 6, 2023) (citing Kaylor
v. Astrue, No. 2:10-cv-33-GZS, 2010 WL 5776375, at * 4-5 (D. Me. Dec. 30, 2010),
aff’d, 2011 WL 487844 (D. Me. Feb. 7, 2011)). This is so because, as recognized by
the Chantal court, it is permissible for the ALJ to “split the difference” between
medical opinions, so to speak, where “it is reasonably clear that the ALJ did not do
so based on his own interpretation of the medical evidence,” but rather based on “a
permissible crediting of Plaintiff’s subjective complaints.” Id. at *4 (citations
omitted). Here, the ALJ explained his reasons for finding Dr. Campion’s opinion
that Plaintiff remained disabled and unable to work “due to an ongoing medical
issue” unpersuasive, and the opinions of Drs. Hom and Truong limiting Plaintiff to
light work to be “partially persuasive” (A.R. 25-26). He explicitly found that “[w]hile
treatment and notation of [l]upus is minimal from the alleged onset date through
the date last insured, . . . this impairment supports a sedentary work capacity given
[the Plaintiff’s] subjective complaints . . . of fatigue and weakness caused by [l]upus”
(A.R. 23-24). Accordingly, the court finds that the ALJ permissibly relied on
Plaintiff’s subjective complaints of fatigue and pain rather than impermissibly
interpreted raw medical data.
Moreover, even if the ALJ had committed error in settling on an RFC falling
between Dr. Campion’s and the state agency examiner’s opinions, any such error
would be harmless because the RFC he adopted was more restrictive than that
identified by the state agency examiners. Smith v. Berryhill, 370 F. Supp. 3d, 282,
289 (1st Cir. 2019) (finding any error harmless where the plaintiff’s treating
provider assessed the plaintiff as “disabled for the foreseeable future,” while two
non-examining State agency doctors opined that the plaintiff was capable of light
work because “[t]he ALJ adopted essentially all of the limitations identified by the
State agency doctors . . . [and] also set some restrictions that went beyond those
identified by the State agency physicians, . . . limitations that offered [the p]laintiff
a more restrictive RFC . . . [including] sedentary instead of light work”). See also
Betancourt-Guadalupe v. Bisignano, No. 25-1645, 2026 WL 1643240, at *1 (1st. Cir.
June 3, 2026) (citing Smith favorably in connection with its finding that the
appellant before it had failed to show prejudice). Under these circumstances,
remand would be no more than an empty gesture and is unwarranted.
D. Plaintiff’s Argument That the ALJ Imposed the Incorrect Evidentiary
Standard Is Without Merit
Lastly, Plaintiff contends that the ALJ incorrectly imposed upon her a
“higher evidentiary standard of proof, presumably clear and convincing rather than
the preponderance of evidence” (Dkt No. 8-1, at 27). Plaintiff’s argument does not
cite to any portion of the ALJ’s decision where he allegedly applied the incorrect
evidentiary standard. Instead, Plaintiff’s argument is based entirely on her
interpretation of two sections of the Social Security Administration regulations—20
C.F.R. §§ 404.708 & 404.709—which she misreads to argue that the ALJ applied the
incorrect standards. The error in Plaintiff’s analysis is that both sections on which
she relies are contained within Subpart H, which relates “to evidentiary
requirements for establishing an initial and continuing right to monthly benefits
and for establishing a right to lump-sum death payment.” 20 C.F.R. § 404.1(h). The
determination of disability, however, is governed by Subpart P of the Social Security
Administration’s regulations, 20 C.F.R. §§ 404.1501-404.1599, and the regulations
explicitly provide “[e]videntiary requirements relating to disability are contained in
subpart P.” See 20 C.F.R. § 404.1(p) (“Subpart P relates to the determination of
disability or blindness.”). Thus, because the regulations on which Plaintiff relies
explicitly do not apply to her disability benefits claim, her argument is without
merit and requires no further consideration here.
IV. CONCLUSION
For the foregoing reasons, the court GRANTS the Commissioner’s motion to
affirm (Dkt. No. 10) and DENIES Plaintiff’s motion for judgment on the pleadings
(Dkt. No. 8). The Clerk’s Office may close the case.
It is so ordered.
Date: September 10, 2026 /s/ Christopher L. Morgan
CHRISTOPHER L. MORGAN
U.S. MAGISTRATE JUDGE