Case Name in Social Security Case - Unavailable

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THE UNITED STATES DISTRICT COURT
FOR THE WESTERN DISTRICT OF NORTH CAROLINA
STATESVILLE DIVISION
CIVIL CASE NO. 5:25-cv-00017-MR
TIMOTHY SHEPHERD, )
)
Plaintiff, )
)
vs. ) O R D E R
)
COMMISSIONER OF SOCIAL )
SECURITY, )
)
Defendant. )
________________________________ )
THIS MATTER is before the Court on the Plaintiff’s appeal of the
Commissioner’s decision denying his benefits. The parties have fully briefed
the issues. [Docs. 6, 9, 11].
I. BACKGROUND
On April 5, 2018, the Plaintiff, Timothy Shepherd, filed an application
for disability insurance benefits under Title II and Title XVI of the Social
Security Act (the “Act”), alleging an onset date of October 1, 2014, which was
subsequent amended to October 21, 2015. [Transcript (“T.”) at 249, 252,
254, 261]. The Plaintiff’s claim was denied initially on July 13, 2018, and
denied upon reconsideration on January 16, 2019. [Id. at 126-27, 171, 182,
194]. The Plaintiff requested a hearing and appeared with counsel at a
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hearing before an Administrative Law Judge (“ALJ”) on October 21, 2019.
[Id. at 31-71, 201]. Prior to the hearing, the Plaintiff moved to amend his
alleged onset date to August 28, 2017, and the ALJ amended the date
accordingly. [Id. at 33-34, 279]. On November 18, 2019, the ALJ issued a
written decision denying the Plaintiff benefits, finding that the Plaintiff was
not disabled within the meaning of the Act from the alleged onset date of
August 28, 2017 through the date of the ALJ’s decision. [Id. at 10-20]. On
July 1, 2020, the Appeals Council denied the Plaintiff’s request for review,
making the ALJ’s decision the final decision of the Commissioner. [Id. at 1].
The Plaintiff sought judicial review of the ALJ’s decision, the Defendant
requested remand, and the Plaintiff consented. [Id. at 633-38]. On October
28, 2021, the case was remanded for further administrative proceedings. [Id.
at 636].
On October 27 and December 7, 2020, before his pending case was
remanded, the Plaintiff filed new applications for disability insurance benefits
under Title II and Title XVI of the Act, alleging an onset date of November 19,
2019. [Id. at 806, 808]. After the Plaintiff’s original claim was remanded for
further administrative proceedings, the Appeals Council consolidated the
Plaintiff’s new applications with his original claim. [Id. at 645]. On remand,
the ALJ held a hearing on the consolidated claims on July 19, 2022 and
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issued a partially favorable written decision on September 1, 2022, finding
that the Plaintiff became disabled on July 19, 2022, but was not disabled at
any time through his last insured date of December 31, 2020. [Id. at 517-55,
649-63]. Accordingly, the ALJ denied the Plaintiff’s application for benefits
under Title II of the Act. [Id. at 663]. On April 5, 2023, the Appeals Council
remanded the case to the ALJ. [Id. at 674-77]. On remand from the Appeals
Council, the ALJ held a hearing on August 29, 2023 and again issued a
partially favorable written decision on September 20, 2023, finding that the
Plaintiff became disabled on August 27, 2022, but was not disabled at any
time through his last insured date of December 31, 2020. [Id. 489-507, 556-
606]. Accordingly, the ALJ again denied the Plaintiff’s application for benefits
under Title II of the Act. [Id. at 507]. On December 2, 2024, the Appeals
Council denied the Plaintiff’s request for review, making the ALJ’s decision
the final decision of the Commissioner. [Id. at 480-83]. The Plaintiff has
exhausted all available administrative remedies, and this case is now ripe for
review pursuant to 42 U.S.C. § 405(g).
II. STANDARD OF REVIEW
The Court’s review of a final decision of the Commissioner is limited to
(1) whether substantial evidence supports the Commissioner’s decision,
Richardson v. Perales, 402 U.S. 389, 401 (1971); and (2) whether the
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Commissioner applied the correct legal standards. Hays v. Sullivan, 907
F.2d 1453, 1456 (4th Cir. 1990). “When examining [a Social Security
Administration] disability determination, a reviewing court is required to
uphold the determination when an ALJ has applied correct legal standards
and the ALJ’s factual findings are supported by substantial evidence.” Bird
v. Comm’r, 699 F.3d 337, 340 (4th Cir. 2012). “Substantial evidence is such
relevant evidence as a reasonable mind might accept as adequate to support
a conclusion.” Johnson v. Barnhart, 434 F.3d 650, 653 (4th Cir. 2005)
(internal quotation marks omitted). “It consists of more than a mere scintilla
of evidence but may be less than a preponderance.” Hancock v. Astrue, 667
F.3d 470, 472 (4th Cir. 2012) (internal quotation marks omitted).
“In reviewing for substantial evidence, [the Court should] not undertake
to reweigh conflicting evidence, make credibility determinations, or substitute
[its] judgment for that of the ALJ.” Johnson, 434 F.3d at 653 (internal
quotation marks and alteration omitted). Rather, “[w]here conflicting
evidence allows reasonable minds to differ,” the Court defers to the ALJ’s
decision. Id. (internal quotation marks omitted). To enable judicial review for
substantial evidence, “[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
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F.3d 288, 295 (4th Cir. 2013). It is the duty of the ALJ to “build an accurate
and logical bridge from the evidence to his conclusion.” Monroe v. Colvin,
826 F.3d 176, 189 (4th Cir. 2016) (internal quotation marks omitted).
“Without this explanation, the reviewing court cannot properly evaluate
whether the ALJ applied the correct legal standard or whether substantial
evidence supports his decisions, and the only recourse is to remand the
matter for additional investigation and explanations.” Mills v. Berryhill, No.
1:16-cv-25-MR, 2017 WL 957542, at *4 (W.D.N.C. Mar. 10, 2017) (Reidinger,
J.) (citing Radford, 734 F.3d at 295).
III. THE SEQUENTIAL EVALUATION PROCESS
A “disability” entitling a claimant to benefits under the Social Security
Act, as relevant here, is “[the] 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). The Social Security Administration Regulations
set out a detailed five-step process for reviewing applications for disability.
20 C.F.R. §§ 404.1520, 416.920; Mascio v. Colvin, 780 F.3d 632, 634 (4th
Cir. 2015). “If an applicant’s claim fails at any step of the process, the ALJ
need not advance to the subsequent steps.” Pass v. Chater, 65 F.3d 1200,
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1203 (4th Cir. 1995) (citation omitted). The burden is on the claimant to make
the requisite showing at the first four steps. Id.
At step one, the ALJ determines whether the claimant is engaged in
substantial gainful activity. If so, the claimant’s application is denied
regardless of the medical condition, age, education, or work experience of
the claimant. Id. (citing 20 C.F.R. § 416.920). If not, the case progresses to
step two, where the claimant must show a severe impairment. If the claimant
does not show any physical or mental deficiencies, or a combination thereof,
which significantly limit the claimant’s ability to perform work activities, then
no severe impairment is established, and the claimant is not disabled. Id.
At step three, the ALJ must determine whether one or more of the
claimant’s impairments meets or equals one of the listed impairments
(“Listings”) found at 20 C.F.R. 404, Appendix 1 to Subpart P. If so, the
claimant is automatically deemed disabled regardless of age, education, or
work experience. Id. If not, before proceeding to step four, the ALJ must
assess the claimant’s residual functional capacity (“RFC”). The RFC is an
administrative assessment of “the most” a claimant can still do on a “regular
and continuing basis” notwithstanding the claimant’s medically determinable
impairments and the extent to which those impairments affect the claimant’s
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ability to perform work-related functions. Social Security Ruling 96-8p; 20
C.F.R. §§ 404.1546(c); 404.943(c); 416.945.
At step four, the claimant must show that his or her limitations prevent
the claimant from performing his or her past work. 20 C.F.R. §§ 404.1520,
416.920; Mascio, 780 F.3d at 634. If the claimant can still perform his or her
past work, then the claimant is not disabled. Id. Otherwise, the case
progresses to the fifth step where the burden shifts to the Commissioner. At
step five, the Commissioner must establish that, given the claimant’s age,
education, work experience, and RFC, the claimant can perform alternative
work which exists in substantial numbers in the national economy. Id.; Hines
v. Barnhart, 453 F.3d 559, 567 (4th Cir. 2006). “The Commissioner typically
offers this evidence through the testimony of a vocational expert responding
to a hypothetical that incorporates the claimant’s limitations.” 20 C.F.R. §§
404.1520, 416.920; Mascio, 780 F.3d at 635. If the Commissioner succeeds
in shouldering his burden at step five, the claimant is not disabled and the
application for benefits must be denied. Id. Otherwise, the claimant is
entitled to benefits.
IV. THE ALJ’S DECISION
At step one, the ALJ found that the Plaintiff has not engaged in any
substantial gainful activity since his alleged onset date, August 28, 2017. [T.
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at 495]. At step two, the ALJ found that during the relevant period the Plaintiff
had severe impairments including: “chronic obstructive pulmonary disorder
(COPD)/emphysema; degenerative joint disease; degenerative disc disease
of the lumbar spine; partial amputation of the left hand; hip fracture;
depression; and anxiety.” [Id.]. At step three, the ALJ determined that the
Plaintiff did not have an impairment or combination of impairments that met
or medically equaled the Listings. [Id.]. The ALJ then determined that the
Plaintiff, notwithstanding his impairments, had the RFC
to perform light work as defined in 20 CFR
404.1567(b) and 416.967(b) except the claimant
requires the option to alternate between sitting and
standing every half hour while remaining on task; and
is limited to occasional climbing of ramps and stairs;
no climbing of ladders, ropes, or scaffolds;
occasional balancing, stooping, kneeling, and
crouching; no crawling; frequent handling and
fingering; frequent reaching except occasional
reaching overhead with the right upper extremity;
occasional pushing and pulling foot controls with the
bilateral lower extremities; occasional exposure to
hazards; no more than frequent exposure to
environmental factors and temperature extremes;
simple instructions and routine repetitive tasks in
two-hour segments; work at a non-production pace
(non automated / conveyor pacing); infrequent
changes in the work setting; interaction with the
public incidental to work; frequent interaction with
supervisors and coworkers but no teamwork;
communication in brief task oriented exchanges;
rapid responses to emergency situations not
required; and no handling of money without cash
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register that calculates balance due and change
needed.
[Id. at 497].
At step four, the ALJ found that the Plaintiff was unable to perform any
past relevant work. [Id. at 505]. At step five, based upon the testimony of
the vocational expert, the ALJ concluded that, considering the Plaintiff’s age,
education, work experience, and RFC, the Plaintiff was capable of
performing jobs that exist in significant numbers in the national economy,
including marker, garment sorter, and assembler II, prior to August 27, 2022.
[Id. at 505-06]. However, the ALJ also concluded that beginning on August
27, 2022, the Plaintiff’s fiftieth birthday and the date the Plaintiff’s age
category changed, the Plaintiff was not capable of performing jobs that exist
in significant numbers in the national economy. [Id. at 506]. The ALJ
therefore concluded that the Plaintiff was not disabled prior to August 27,
2022, but became disabled on that date and has continued to be disabled
through the date of the ALJ’s decision. [Id.]. Accordingly, the ALJ further
concluded that the Plaintiff was not disabled within the meaning of the Act at
any time through his last insured date of December 31, 2020. [Id.].
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V. DISCUSSION1
In this appeal, the Plaintiff assigns four errors to the ALJ’s decision: (1)
the ALJ improperly held the Plaintiff’s inability to afford consistent medical
treatment against him by discounting the Plaintiff’s testimony regarding his
symptoms based on his lack of consistent treatment for those symptoms; (2)
the ALJ failed to perform a function-by-function assessment necessary to
support the RFC; (3) the ALJ relied on improper testimony from the
vocational expert; and (4) the ALJ did not properly weigh the consulting
psychologists’ opinions. [Doc. 6 at 6-25].
Regarding the Plaintiff’s first assignment of error, the ALJ found that
the Plaintiff received “little to no treatment” for his symptoms in 2017 and
2019, “did not consistently return” for treatment after initially establishing
care on several occasions, and had “not treated with any specialists on a
regular basis since the amended onset date.” [T. at 501]. As a result, the
ALJ concluded that “the lack of treatment suggests that his symptoms were
not as persistent or limiting as alleged.” [Id.]. The ALJ recognized that the
Plaintiff’s “financial situation is not optimal” and that his financial situation
“has been a factor in his inability to afford healthcare,” but the ALJ
1 Rather than set forth the relevant facts in a separate section, the Court has incorporated
the relevant facts into its legal analysis.
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nevertheless found that on the record available he was “unable to make a
finding that the claimant has exhausted all resources available to individuals
who cannot afford medical treatment or medication such as hospitals, clinics,
or community agencies.” [Id. at 501-02]. The ALJ accordingly concluded
that “the record as a whole does not support the claimant’s testimony with
respect to the intensity and persistence his pain and other symptoms.” [Id.
at 502].
The Plaintiff, however, contends that this conclusion improperly
prejudiced the Plaintiff based on his inability to afford medical care. [Doc. 6
at 6-10; Doc. 11 at 1-3]. The Plaintiff further contends that he attempted to
testify to his financial situation in his 2022 and 2023 hearings but the ALJ
interfered with his testimony by characterizing it as not providing functional
information, and, in a hearing before a different ALJ in 2019, the Plaintiff
testified that he was unaware of any free clinics in the area where he could
have received treatment. [Doc. 6 at 8-10]; see also [T. at 50-51, 531-32, 580-
81].
Under Social Security Ruling 16-3p, “if the frequency or extent of the
treatment sought by an individual is not comparable with the degree of the
individual’s subjective complaints . . . [an ALJ] may find the alleged intensity
and persistence of an individual’s symptoms are inconsistent with the overall
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evidence of record.” SSR 16-3p, 2016 WL 1119029, at *8 (S.S.A. Mar. 16,
2016). However, before finding that inconsistency, an ALJ must consider
“possible reasons [the plaintiff] may not comply with treatment or seek
treatment consistent with the degree of the [the plaintiff’s] complaints.” Id.
Such reasons include whether the plaintiff can “afford treatment” or whether
the plaintiff has “access to free or low-cost medical services.” Id. at *9. An
ALJ must “consider and address reasons for not pursuing treatment that are
pertinent to an individual’s case” and “explain how [the ALJ] considered the
individuals reasons in [the ALJ’s] evaluation of the individual’s symptoms.”
Id.
Here, the ALJ considered the effect of the Plaintiff’s financial situation
on his ability to afford healthcare, and the ALJ explained why he discounted
that effect—namely, because the record did not support a finding that the
Plaintiff had exhausted the resources available to him for treatment. That
exhaustion requirement, however, imposed an unduly high burden on the
Plaintiff. Moreover, the underdevelopment of the record regarding the
Plaintiff’s alleged inability to receive treatment may be partially attributable
to the ALJ’s suggestions, during the Plaintiff’s 2022 and 2023 hearings, that
information about the Plaintiff’s financial and insurance circumstances was
not “functional.” [T. at 532, 580]. As a result, the Court lacks an adequate
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record of the basis for the ALJ’s decision, and the ALJ has not satisfied his
duty to “build an accurate and logical bridge from the evidence to his
conclusion.” Monroe, 826 F.3d at 189 (citation omitted).
Accordingly, the Court must remand this case so that the ALJ can
properly determine whether the Plaintiff’s asserted reason for not pursuing
treatment excuses the apparent inconsistency between that lack of treatment
and the Plaintiff’s testimony about the intensity and persistence of his
symptoms. Because the proper crediting of the Plaintiff’s testimony may
have an effect on both the ALJ’s function-by-function assessment and the
ALJ’s evaluation of the psychologists’ opinions, the Plaintiff’s second and
fourth assignments of error need not be addressed at this time but may be
addressed by him on remand.2
VI. CONCLUSION
Because the Court lacks an adequate record of the basis for the ALJ’s
decision, it cannot conduct a meaningful review of the ALJ’s decision and
must remand. See Radford, 734 F.3d at 295.
2 Regarding the Plaintiff’s third assignment of error, however, the Plaintiff’s argument is
not well taken. The Plaintiff contends that the jobs identified by the vocational expert—
marker, garment sorter, and assembler II—were in apparent conflict with the hypothetical
posed to the vocational expert, which included occasional exposure to “open machinery.”
[Doc. 6 at 20-21]. For grounds, the Plaintiff contends that the jobs include exposure to
open machinery because they include exposure to a “ticket-printing machine,” an “iron,”
and a “drill press.” [Id. at 21]. Exposure to these tools, however, cannot reasonably be
construed as exposure to “open machinery.”
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ORDER
IT IS, THEREFORE, ORDERED that, pursuant to the power of this
Court to enter judgment affirming, modifying, or reversing the decision of the
Commissioner under Sentence Four of 42 U.S.C. § 405(g), the decision of
the Commissioner is REVERSED, and the case is hereby REMANDED for
further administrative proceedings consistent with this opinion.
IT IS SO ORDERED.
Signed: March 17, 2026
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