Case Name in Social Security Case - Unavailable

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IN THE UNITED STATES DISTRICT COURT
FOR THE MIDDLE DISTRICT OF PENNSYLVANIA
CHARLENE HOFFMAN, 	: 	Civil No. 4:24-CV-507
:
Plaintiff, 	:
:
v. 	: 	(Magistrate Judge Carlson)
:
FRANK BISIGNANO,1 :
Commissioner of Social Security, 	:
:
Defendant. 	:
MEMORANDUM OPINION
I. 	Introduction
The Social Security disability analysis frequently involves the evaluation of a
claimant’s symptoms of mental impairments such as anxiety and depression. This
evaluation requires the consideration of medical records which are often equivocal,
since mental health conditions are often cyclical in nature, producing periods of
severe debilitating symptoms mixed with periods of stability. Thus, in evaluating
such cases, it is incumbent upon Administrative Law Judges (ALJs) to give fair
1 Frank Bisignano became the Commissioner of Social Security on May 6, 2025.
Pursuant to Rule 25(d) of the Federal Rules of Civil Procedure, Frank Bisignano
should be substituted as the defendant in this suit. No further action need be taken to
continue this suit by reason of the last sentence of section 205(g) of the Social
Security Act, 42 U.S.C. § 405(g).
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consideration to the medical record as a whole. On this score, it is well-settled that
“[t]he ALJ need not make reference to every relevant note in the record, but the ALJ
may not ‘cherry-pick’ results that support his conclusion and ignore those that do
not.” Stoltzfus v. Berryhill, No. CV 16-6308, 2019 WL 1981888, at *5 (E.D. Pa.
May 1, 2019) (citing Rivera v. Astrue, 9 F. Supp. 3d 495, 504 (E.D. Pa. 2014)). And,
in recognizing the cyclical nature of mental health impairments, courts have found,
“it is error for an ALJ to pick out a few isolated instances of improvement over a
period of months or years and to treat them as a basis for concluding a claimant is
capable of working.” Garrison v. Colvin, 759 F.3d 995, 1017 (9th Cir. 2014).
We are reminded of these paradigms in the instant case, in which we are called
upon to review a decision by a Social Security Administrative Law Judge that denied
disability benefits to the plaintiff, Charlene Hoffman. Hoffman filed applications for
disability insurance and supplemental security income benefits alleging that she was
disabled as of January 31, 2018, due to an array of mental impairments, including
severe anxiety with panic attacks and depression. As to these mental impairments,
the record shows her symptoms waxed and waned, with some periods of stability
but that, at their worst, her impairments caused extreme anxiety, panic, and
agoraphobia and that Hoffman reported being unable to leave her home. The record
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also reflects that, at the beginning of the disability period in 2018, Hoffman was in
significant mental crisis and was psychiatrically hospitalized after attempting
suicide.
Against this medical backdrop, which showed unequivocally that Hoffman
had overdosed on her psychiatric medications during the time her disability
application was being evaluated, a fact which was undisputedly known and
discussed by the ALJ at the hearing when Hoffman testified she “took a handful of
pills,” the ALJ made no mention of Hoffman’s suicide attempt in the decision
denying her benefits, instead writing it off as “voluntary inpatient mental health
treatment in February 2018.” (Tr. 24). Then, the ALJ, selectively citing medical
records showing periods of stability and improvement in her symptoms and focusing
on her noncompliance with treatment activities of daily living, found Hoffman’s
statements regarding her subjective symptoms were not entirely consistent with the
record, 	wholly 	ignoring 	her 	history 	of 	suicidal 	behavior, 	downplaying 	her
psychiatric hospitalizations, and ignoring periods of severe, debilitating symptoms.
This error on the part of the ALJ in failing to consider the evidence of
Hoffman’s severe mental health symptomology, including her February 2018
suicide attempt, compels remand. Since the ALJ fashioned an RFC that clearly did
not give adequate consideration to this serious manifestation of Hoffman’s mental
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impairments, more is needed here before we can engage in an informed analysis of
this claim. Therefore, for the reasons set forth below, this case will be remanded to
the Commissioner for further proceedings.
II. 	Statement of Facts and of the Case
The administrative record of Hoffman’s disability application reveals the
following 	essential 	facts: 	On 	November 	12, 	2020, 	Charlene 	Hoffman 	filed
applications for disability insurance and supplemental security income benefits,
alleging disability beginning January 31, 2018. (Tr. 90). According to Hoffman, she
was totally disabled due to the combined effects of the following impairments:
severe anxiety, depression, panic disorder, PTSD, high cholesterol, and acid reflux.
(Id.) Thus, Hoffman’s reported impairments were both physical and psychological,
but her testimony revealed that she was unable to work primarily due to her mental
impairments. (Tr. 49). At the time of the alleged onset of her disability Hoffman,
who was born in 1970, was forty-seven years old, which is defined as a younger
individual under the Commissioner’s regulations. (Tr. 89). She turned fifty during
the 	course 	of 	her 	disability 	proceeding, 	making 	her 	an 	individual 	closely
approaching advanced age. (Id.) She has a GED and a CNA certificate and had
previously worked as a medical assistant, home health aide, and house cleaner. (Tr.
50-51, 79).
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A. Hoffman’s Clinical History and the Medical Opinion Evidence.
With 	respect 	to 	Hoffman’s 	emotional 	impairments, 	the 	clinical 	record
disclosed that her alleged onset date of disability at the end of January 2018
coincided with what appeared to be a period of severe, life threatening psychological
symptoms. On February 10, 2018, Hoffman presented to the emergency department
for what was identified as a suicide attempt after stating that she had taken twelve
Klonopin that morning.2 (Tr. 521). She was complaining of panic attacks daily for
the previous year, had severe depression and suicidal thoughts, and had been self-
medicating by “drinking sporadically” for the last six months. (Id.) On February 11,
2018, she underwent voluntary inpatient mental health treatment at Pennsylvania
Psychiatric Institute (PPI) for eight days secondary to overdose of Klonopin. (Tr.
525-546). She was discharged home on February 19, 2018, (tr. 539), and began
intensive outpatient substance abuse treatment at CPAC on February 20, 2018. (Tr.
2 Whether Hoffman actually intended to end her life by taking twelve Klonopin in
February 2018 is not entirely clear. Hoffman later stated that she did not intentionally
intend to harm herself and that she was “just having a significant flare of anxiety and
took more than her usual amount of Klonopin.” (Tr. 555). Nonetheless, the medical
records characterize the overdose as a suicide attempt, (tr. 521, 1172, 1186), and
Hoffman testified that she “took a handful of pills” at the hearing. (Tr. 62). In our
view, whether Hoffman later denied she intended to end her life is irrelevant since
the fact that she overdosed on Klonopin during a significant flare of anxiety is
unequivocally a significant manifestation of her mental impairments which the ALJ
should have addressed in a more fulsome and meaningful fashion.
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1165-1271). At her initial assessment, her psychological symptoms were described
as follows:
Client presents as ox3, with a broad affect and a severely anxious mood.
She reports past trauma but did not disclose in detail. Client reports hx
of alcohol abuse. She has increased her drinking over the years and is
now drinking until blackout. Client reports she drinks as a means to
deal with her panic attacks. Client also recently attempted suicide via
an attempted suicide. She was admitted to PPI psychiatric hospital for
8 days. Client has a positive family support. Client denies current SIMI,
delusion, confusion, or hallucinations. She is currently on psychotropic
medications 	and 	takes 	as 	prescribed. 	Client 	would 	benefit 	from
individual therapy. She would also benefit from Intensive outpatient
group therapy but will possibly need to transition into group therapy
gradually.
(Tr. 1186). During her outpatient treatment, Hoffman reported she found it difficult
to function and had been isolating because of her panic attacks. (Tr. 1193). A
significant abuse and trauma history was also noted, stating that she was sexually
abused by her father as a child and was living with him at the time of her treatment.
(Tr. 1193-95). She reported feeling extremely anxious and panicky. (Id.) By the end
of March 2018, she was discharged from the outpatient program, against the
facility’s advice, due to disengagement. (Tr. 1201). But, by way of explanation, her
primary care notes state that, following her discharge from inpatient treatment, PPI
had not provided her psychiatric follow-up or medication management. Therefore,
she ran out of medication, was experiencing significant anxiety and agoraphobia,
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and was afraid to leave her house to attend therapy appointments. (Tr. 658). Her
primary care provider noted “it was quite a struggle for her to come into the office
today even.” (Id.) She reported no significant suicidal ideation at the time but
reported significant anxiety, depression, and agoraphobia. (Id.)
She returned to treatment in April 2018 and on a symptom evaluation form
reported significant difficulty managing her day-to-day life and coping with her
problems and moderate difficulty concentrating. (Tr. 1247). She reported abstaining
from alcohol. (Tr. 1228). In June 2018 she reported suicidal ideations to her primary
care provider but stated “her kids are the reason that she would not do such a thing.”
(Tr. 650). It was also noted that she was agoraphobic and “anything out and about,
she is not able to do independently.” (Id.) In August 2018, Hoffman reported having
problems with depression and anxiety “alternating,” and stated that Prozac was no
longer working and that she had no energy to get out of bed until the afternoon
recently. (Tr. 669). Treating psychiatric provider CRNP Janet Marie Passley-Clarke
recommended a higher level of care in the form of a partial hospitalization program,
but Hoffman was hesitant to commit because she felt that she was unable to drive
and would have to depend on others to take her places. (Id.)
At a September 2018 psychiatric evaluation for admission to the partial
hospitalization program, Hoffman stated that her anxiety and panic had increased,
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and she had been drinking more to cope with her anxiety. (Tr. 673). She reported
symptoms of depression including having little interest or pleasure in doing things,
feeling hopeless, difficulty sleeping, feeling fatigued, having a low appetite, feeling
badly and guilty about herself, difficulty concentrating, and feeling that she is
moving so slowly that other people notice but she denied thoughts of suicide. (Id.)
Her anxiety symptoms were again rated as severe, and she reported confusion,
flashbacks, numbness, and occasional insomnia related to her childhood sexual
abuse. (Id.) A mental status examination showed anxious mood and guarded affect
with fair insight and judgment but intact attention and concentration and cooperative
behavior. (Tr. 675). She was diagnosed with major depressive disorder and
generalized anxiety disorder with her primary complaint being panic attacks. (Tr.
677). It was noted that her chronic alcohol use possibly contributed to her disorders.
(Id.)
Hoffman’s participation in the partial hospitalization program was marked by
absenteeism, and she frequently reported that she was unable to attend due to
difficulty sleeping and other medical problems. (Tr. 681-86). She was eventually
discharged from the partial hospitalization program against medical advice for
failure to attend but continued medication management with CRNP Passley-Clarke.
(Tr. 686). In November 2018 she noted she was driving and felt that the depression
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had lifted. (Tr. 687). In February and July 2019 she had normal mental status
examinations and stated she was doing much better. (Tr. 691-95). In October 2019
she reported to CRNP Passley-Clarke that her anxiety and depression were a little
worse but that she was managing. (Tr. 698). She asked for “something more” to
assist with depression going into the winter months. (Id.)
At a PCP appointment in October 2019 she noted being stable on her
medications but reported still consuming alcohol but being functional. (Tr. 613). She
also noted working part-time cleaning and wanting to get back to full-time work but
worrying about “random panic attacks,” reporting five over the prior three months.
(Id.) At a medication management appointment with CRNP Passley-Clarke in
January 2020 she reported using benzodiazepines on a more standing basis over the
holidays and was advised that the current use of high dose benzodiazepines was not
warranted given her diagnosis. (Tr. 702-03). In March 2020 she reported to her PCP
that her anxiety and depression were “under control,” but also reported feeling down
or depressed nearly every day. (Tr. 606). The following month at a medication
management appointment she reported taking Klonopin twice daily rather than on
an as needed basis but reported that depression “has not been an issue.” (Tr. 704). In
July 2020 she again reported being stable on her medications and declined therapy.
(Tr. 708). She stated she was back at work cleaning homes. (Id.) Hoffman reported
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feeling more depressed at an August 2020 medication management appointment and
contacted a therapy clinic. (Tr. 712). She reported depressed mood, loss of energy,
feelings of losing control, and worry and was not working. (Id.)
Then, in January 2021, Hoffman told her primary care provider that she had
been experiencing extreme anxiety with almost daily panic attacks over the prior
months, especially when she was cleaning homes and driving. (Tr. 593). She stated
even small triggers sent her into a full panic attack where she was unable to focus
and she had to take medication to calm down. (Id.) She also reported many
nightmares due to posttraumatic stress from her childhood abuse. (Id.) Depression
and anxiety screenings showed severe symptoms (GAD 7 score 21 out of 21 and her
PHQ 9 scored 19 out of 27 which the doctor noted was “high”). She reported fleeting
thoughts of suicide and overwhelming fatigue. (Id.) Her generalized anxiety disorder
was characterized as “severe and debilitating” and medication adjustments were
recommended. (Id.) She also reported feeling more anxious and depressed at a
medication management appointment with CRNP Passley-Clarke and reported
thoughts about death or suicide, thoughts of worthlessness or guilt, feelings of losing
control and worry. (Tr. 721). She did not want any medication changes, although she
agreed to a trial of Buspar. (Tr. 721).
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Hoffman began individual therapy with Katherine Hutcheson in January
2021. At her initial appointment, it was noted:
Charlene is currently struggling with her anxiety and depression
symptoms. She states she is not able to leave her home due to her
anxiety and feels that she has constant panic attacks when she leaves
the house to go to the store. Charlene has been able to manage her
anxiety in the past and was working with the same company for over
20 years. Charlene states her symptoms have gotten worse over the last
two years and is to the point she does not leave her house, except to go
to the grocery store.
(Tr. 737). Hoffman stated: “I turtle. I don’t do anything I will stay at home in my
safe place when my anxiety gets bad and can’t do anything social.” (Id.) Telehealth
visits were suggested to account for Hoffman’s difficulty leaving her home. (Id.) She
also reported significant depressive symptoms. (Tr. 738). But at a primary care
examination in May 2021, she reported her anxiety level being much improved and
that she was weaning off all her psychiatric medications and had not had a drink
since Thanksgiving 2020. (Tr. 808). In July 2021 she reported to CRNP Passley-
Clarke that she was doing better but had not returned to work because she was afraid
of becoming anxious. (Tr. 829).
Thus, the medical evidence demonstrates that Hoffman experienced cyclical
symptoms of her mental impairments, including periods of severe symptoms like
suicidality, 	agoraphobia, 	and 	daily 	panic 	attacks 	and 	periods 	of 	stability.
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Nonetheless, even during periods when she was experiencing severe symptoms, her
mental status examinations were frequently unremarkable in certain mental spheres,
showing:
[T]he claimant is fully oriented and cooperative with full range and
appropriate 	affect, 	normal 	perceptions, 	appropriate 	appearance,
appropriate 	dress, 	appropriate 	grooming, 	coherent 	speech, 	good
attention, intact concentration, logical and linear thought process, intact
associations, intact recent and remote memory, normal behavior, intact
fund of knowledge, intact language, good insight, and good judgment
(1F; 3F; 4F; 5F; 7F; 8F; 9F; 10F; 11F; 13F; 16F; 20F; 24F; 27F; 28F;
19F).
(Tr. 24).
Against this clinical backdrop, three medical professionals opined on the
limiting effects of Hoffman’s mental impairments. One treating source opined that
Hoffman’s symptoms, specifically absenteeism and off-task time, would render her
disabled while two non-treating, non-examining State agency experts concluded her
impairments were not severe and caused her, at most, mild limitations in functioning.
Hoffman’s treating psychiatric provider, CRNP Pressley-Clark, stated that
Hoffman continued to struggle with depression and anxiety and had not returned to
work due to concern for anxiety. (Tr. 921). She indicated her prognosis was fair.
(Id.) According to CRNP Pressley-Clark, Hoffman had marked limitations in
maintaining regular attendance and being punctual and dealing with normal work
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stress, moderate limitations in sustaining an ordinary routine, making simple work-
related decisions, completing a normal workday and workweek, performing at a
consistent pace, accepting instructions and responding appropriately to criticism
from supervisors, and getting along with coworkers or peers. (Tr. 925). Overall, she
opined Hoffman had no limitations in understanding, remembering, or applying
information, marked limitations in interacting with others, and moderate limitations
in concentrating, persisting, or maintaining pace and adapting or managing oneself
but concluded she would be less than 80% as efficient as other workers and would
be absent four or more days per month (Tr. 926).
The non-treating, non-examining sources painted a vastly different view of
Hoffman’s abilities. On initial review of her application in February 2021, State
agency psychological consultant Dr. Richard Williams concluded Hoffman had no
limitations in her ability to understand, remember, or apply information or adapt or
manage oneself and only mild limitations in her ability to interact with others and
concentrate, persist, or maintain pace. (Tr. 96). A second non-examining source, Dr.
John David Gavazzi, also opined that Hoffman had, at most, mild limitations in her
functioning, adopting the same limitations as Dr. Williams. (Tr. 125). Both experts
concluded Hoffman’s mental impairments were not severe. (Tr. 108, 125). Notably,
these experts also significantly downplayed Hoffman’s symptoms and did not
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mention her suicide attempt or inpatient psychiatric hospitalization at the beginning
of the relevant period. Indeed, at the time Dr. Williams issued his opinion that
Hoffman’s impairments were non-severe, she was reporting to her primary care
doctor that she was experiencing daily panic attacks and was unable to leave her
home due to her anxiety.3 Thus, the State agency medical opinions recommended,
at 	most, 	mild 	limitations 	in 	any 	area 	of 	mental 	functioning 	but 	made 	no
accommodations for her history of inpatient psychiatric hospitalization and suicidal
tendencies.
It was against this medical backdrop that the ALJ came to hear Hoffman’s
case.
B. The ALJ Hearing and Decision
A disability hearing and a supplemental hearing were conducted in this case
on February 2, 2022, and August 9, 2022, at which Hoffman and a vocational expert
testified. (Tr. 38-88). At the first hearing, Hoffman testified that she was unable to
drive due to panic attacks, had three to four panic attacks per week and was unable
to get out of bed two days per week due to depression. (Tr. 51-57). The ALJ
3 Dr. Williams also glibly characterized Hoffman’s history of childhood sexual abuse
by 	her 	father 	as 	“a 	dysfunctional 	upbringing.” 	(Tr. 	109). 	In 	fact, 	Hoffman
experienced PTSD symptoms due to this history of sexual abuse. (Tr. 820, 845,
1075, 1194, 1220, 1248).
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questioned Hoffman about her February 2018 inpatient treatment, which Hoffman
attributed to her panic disorder and depression and stated she “took a handful of
pills,” but that she was no longer suicidal. (Tr. 62). At the supplemental hearing, a
vocational expert (VE) testified that an individual that misses more than one day of
work per month on a continuous and ongoing basis would not be able to sustain full-
time competitive employment (Tr. 84). The VE also testified that an individual that
would be off-task greater than 15% of the workday would not be able to sustain full-
time competitive employment. (Id.)
Following the hearing, on February 15, 2023, the ALJ issued a decision
denying Hoffman’s application for benefits. (Tr. 15-36). In that decision, the ALJ
first concluded that Hoffman met the insured status requirements of the Act through
December 31, 2022, and had not engaged in substantial gainful activity since January
31, 2018, the alleged onset date. (Tr. 21). At Step 2 of the sequential analysis that
governs Social Security cases, the ALJ found that Hoffman had the following severe
impairments: moderate recurrent major depressive disorder, anxiety disorder with
panic attacks, social anxiety disorder, and post-traumatic stress disorder.4 (Id.) At
4 The plaintiff does not challenge the ALJ’s Step 2 determination that her alcohol
dependence was not severe. Nonetheless, the record tends to indicate that Hoffman
struggled more with this impairment during the relevant period than the ALJ
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Step 3, the ALJ determined that Hoffman did not have an impairment or combination
of impairments that met or medically equaled the severity of one of the disability
listing impairments. (Tr. 21-22). At this step, the ALJ seemingly adopted the mental
limitations of Hoffman’s treating psychiatric provider, concluding she had no
limitation 	in 	understanding, 	remembering, 	or 	applying 	information, 	marked
limitations in interacting with others, and moderate limitations in concentrating,
persisting or maintaining pace and adapting or managing oneself. (Tr. 22).
Between Steps 3 and 4, the ALJ then fashioned a residual functional capacity
(“RFC”) for the plaintiff which considered Hoffman’s impairments as reflected in
the medical record, and found that:
After careful consideration of the entire record, I find that the claimant
has the residual functional capacity to perform a full range of work at
all exertional levels but has the mental capacity for no more than
occasional work setting, process, and tool changes. She cannot tolerate
work in coordination with others such as tandem or teamwork but can
tolerate occasional incidental interaction with people, requires no more
explained. 	In 	finding 	her 	alcohol 	dependence 	nonsevere, 	the 	ALJ 	stated,
“[c]ounseling managed her alcohol dependence . . . and the claimant testified she no
longer drinks alcohol.” (Tr. 21). Indeed, the plaintiff testified that she last drank
alcohol in January 2018 before going into inpatient treatment, but her medical
records show she struggled with drinking alcohol to cope with her anxiety in
September 2018, when it was noted that her chronic alcohol use possibly contributed
to her disorders, she reported consuming alcohol, but being functional, to her
primary care physician in October 2019, (tr. 613), and in May 2021 she stated to her
primary care provider that she had not had a drink “since Thanksgiving.” (Tr. 808).
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than occasional supervision and cannot tolerate fast-paced production
rate work or work requiring hourly quotas.
(Tr. 23).
In formulating the RFC, the ALJ did not mention or consider Hoffman’s
February 2018 overdose which caregivers described as a suicide attempt and
occurred during the relevant period, instead focusing first on longitudinal treatment
notes showing normal mental examination findings and then stating only, “The
claimant underwent voluntary inpatient mental health treatment in February 2018
(3F), at which time, the claimant reports using [alcohol] twice per week, consisting
of 	10 	cans 	of 	beer.” 	(Tr. 	24) 	(internal 	quotations 	omitted). 	Thus, 	the 	ALJ
acknowledged her inpatient psychiatric hospitalization but inexplicably failed to
explain that her hospitalization resulted from the most severe manifestation of
psychiatric symptoms imaginable: an act of self-harm.
The ALJ then went on to characterize the period following her hospitalization
which, as summarized above, the record revealed was marked by severe symptoms
in the following terms:
In February 2018, the claimant’s counselor stated the claimant “drank
alcohol daily. Her intake increased on the weekends where she reports
drinking until blackout” (29F/3). In March 2018, the claimant was
discharged from counseling as she “disengaged, [u]nable to contact”
(29F/37). In April 2018, the claimant’s primary care provider noted the
claimant 	“is 	feeling 	significant 	anxiety, 	depression, 	agoraphobia
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because she has been off her medications” (4F/22; 7F/77). In September
2018, the claimant was referred to a partial hospitalization program
after she “was unwilling to make any medication changes” (8F/9), and
during this program, the claimant’s psychiatrist indicated the claimant
“tends to be noncompliant with her medication regimen” (8F/18). The
claimant was discharged against medical advice from the partial
hospitalization program “due to lack of attendance and compliance”
(8F/22). In October 2018, the claimant responded “[t]rue” to the
statement “mental health symptoms are under control” (28F/32). In
November 2018, the claimant’s psychiatric provider observed the
claimant “went to 1 meeting with therapist but has not returns. Spoke
about h[istory] of missed app[ointmen]t[s] and not following through
with mental health care” (8F/23). While the claimant alleges she does
not drive, at this time, the claimant’s psychiatric provider reported the
claimant “is now driving and feels that the depression has lifted”
(8F/24).
(Tr. 24). This characterization of this dark period of Hoffman’s mental health is
remarkable for at least two interrelated reasons. First, it makes clear that the times
when Hoffman experienced the worst exacerbation of her mental health symptoms
were marked by chronic absenteeism. Moreover, it selectively summarizes the
record to demonstrate that the exacerbation of her symptoms during this time was
somehow due to Hoffman’s noncompliance with treatment. However, what the ALJ
failed to mention in this summary was that it was actually the exacerbation of
Hoffman’s symptoms that prevented her from seeking care. For example, during her
outpatient treatment, Hoffman reported she found it difficult to function and had
been isolating because of her panic attacks. (Tr. 1193). After being discharged from
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the outpatient program due to disengagement in March 2018, she reported to her
primary care provider that she had not been connected with follow-up psychiatric
care after her inpatient hospitalization, had run out of medication, and was
experiencing significant anxiety and agoraphobia and was afraid to leave her house
to attend therapy appointments. (Tr. 658). Her primary care provider noted “it was
quite a struggle for her to come into the office today even.” (Id.) These notes which
were omitted by the ALJ show Hoffman’s mental health symptoms, including
extreme anxiety and agoraphobia, caused her absenteeism.
The balance of the ALJ’s RFC assessment similarly focuses only on treatment
notes indicating periods of stability, but selectively omits periods when she was
experiencing the most extreme symptoms of her mental impairments. For example,
the ALJ noted:
In July 2019, the claimant’s psychiatric provider stated the claimant
“advised that she is doing much better. She says that she is working and
she feels that this is better for her” (8F/32). While the claimant alleges
she has three to four panic attacks per week, in October 2019, the
claimant’s primary care provider noted the claimant’s “mood and affect
are much improved today,” “[d]epression is under good control,” and
“is working some part-time work with a cleaning company,” and “has
experienced probably 5 [random panic attacks] over the past 3 months”
(7F/32). In April 2020, the claimant’s psychiatric provider indicated the
claimant “advises that she has been doing ok,” “states that [klonopin]
has been effective,” and “depression has not been a[n] issue” (8F/41).
While the claimant alleges she has medication side effects, in July 2020,
the claimant’s psychiatric provider remarked the claimant is “taking
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medication without any issues. She states that she has had no [side
effects] and does not want any dosage changes,” “is now back to work
cleaning houses,” and “does not desire any therapy services at this
time” (8F/45). Although the claimant insists she does not care for
anyone, including her mother (Hearing Testimony), in October 2020,
the claimant’s psychiatric provider noted the claimant reported her
“mother falling and having a stroke which has left her with loss of leg
movements. Her mother refused a rehab care in facility so [the
claimant] now is assuming care at home” (8F/53). In May 2021, the
claimant’s primary care provider reported the claimant’s “overall is
doing much better” and “[h]er anxiety level is much improved and she
is weaning off all of her psychiatric medications” (12F/17). Although
the claimant maintains she does not drive and avoids leaving her home
(Hearing Testimony), in November 2021, the claimant’s psychiatric
provider stated the claimant “drove to this appointment w[ithout] the
assistance of her case worker” (16F/8; 24F/8; 26F/8). In May 2022, the
claimant’s psychiatric provider noted the claimant was “[s]table at this
time” (26F/15). In June 2022, the claimant’s psychiatric provider
indicated the claimant is “doing well on psychiatric medication”
(27F/9). There is no medical evidence of record the claimant received
inpatient mental health treatment or referral to crisis intervention after
February 2018.
(Tr. 25).
This summary was incomplete in that it failed to mention notes during the
same relevant period showing exacerbation of the plaintiff’s symptoms, including
statements to providers that she had been experiencing extreme anxiety with almost
daily 	panic 	attacks 	over 	the 	prior 	months, 	fleeting 	thoughts 	of 	suicide, 	the
characterization by her primary care provider that her generalized anxiety disorder
was “severe and debilitating,” her reported thoughts about death or suicide, (tr. 721),
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21
and therapy notes stating “she is not able to leave her home due to her anxiety and
feels that she has constant panic attacks when she leaves the house to go to the store.”
(Tr. 737). These notes came from the same records the ALJ cited and were
undisputedly before the ALJ.
The ALJ then considered the medical opinion evidence, finding each of the
opinions, which reached vastly different conclusions about Hoffman’s mental
abilities, partially persuasive. On this score, the ALJ found the opinion of Hoffman’s
treating provider persuasive to the extent she opined Hoffman had no limitations
understanding, 	remembering, 	or 	applying 	information, 	marked 	limitations
interacting 	with 	others, 	moderate 	limitations 	concentrating, 	persisting, 	or
maintaining pace, and moderate limitations adapting or managing herself. (Tr. 26).
The ALJ concluded these opinions were consistent with Hoffman’s inpatient
psychiatric treatment in February 2018, psychiatric care, and medication. (Id.) But
the ALJ found the parts of CRNP Passley-Clarke’s opinion that would have rendered
Hoffman disabled, i.e., her opinion that she would be absent and off-task in excess
of allowable standards, unpersuasive and unsupported by her notes showing normal
mental status examinations.
As to the much less restrictive opinions of the State agency consultants, the
ALJ also found these opinions partially persuasive only insofar as they opined
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22
Hoffman 	had 	no 	limitations 	in 	understanding, 	remembering, 	or 	applying
information, 	but 	the 	ALJ 	recognized 	that 	the 	remainder 	of 	these 	opinions,
understated the plaintiff’s marked limitations interacting with others and moderate
limitations concentrating, persisting, or maintaining pace and adapting or managing
herself and were inconsistent with her inpatient treatment, psychiatric care, and
medication.
Thus, the ALJ fashioned an RFC that was more restrictive than the opinions
of these State agency consultants, but rejected the opinion of the treating source that
Hoffman would be absent and off-task in excess of allowable standards without
mentioning Hoffman’s documented history of suicidality, periods of severe panic,
and agoraphobia.
Having made these determinations, the ALJ concluded that Hoffman could
not return to her past skilled work as a medical assistant but that, considering her
age, education, and RFC, there were jobs that existed in the significant numbers in
the national economy that Hoffman could perform and thus found she had not been
under a disability during the relevant period. (Tr. 27-29).
This appeal followed. (Doc. 1). On appeal, Hoffman argues that the ALJ’s
RFC findings were not supported by substantial evidence and that the ALJ failed to
properly evaluate her symptoms. In our view, in rejecting Hoffman’s subjective
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symptoms, the ALJ mischaracterized the record, including Hoffman’s suicide
attempt, and failed to account for the cyclical nature of mental illness. This was error.
Accordingly, 	we 	will 	remand 	this 	case 	for 	further 	consideration 	by 	the
Commissioner.
III. 	Discussion
A. 	Substantial Evidence Review – the Role of this Court
When reviewing the Commissioner’s final decision denying a claimant’s
application for benefits, this Court’s review is limited to the question of whether the
findings of the final decision-maker are supported by substantial evidence in the
record. See 42 U.S.C. §405(g); Johnson v. Comm’r of Soc. Sec., 529 F.3d 198, 200
(3d Cir. 2008); Ficca v. Astrue, 901 F. Supp.2d 533, 536 (M.D. Pa. 2012).
Substantial evidence “does not mean a large or considerable amount of evidence, but
rather such relevant evidence as a reasonable mind might accept as adequate to
support a conclusion.” Pierce v. Underwood, 487 U.S. 552, 565 (1988). Substantial
evidence is less than a preponderance of the evidence but more than a mere scintilla.
Richardson v. Perales, 402 U.S. 389, 401 (1971). A single piece of evidence is not
substantial evidence if the ALJ ignores countervailing evidence or fails to resolve a
conflict created by the evidence. Mason v. Shalala, 994 F.2d 1058, 1064 (3d Cir.
1993). But in an adequately developed factual record, substantial evidence may be
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24
“something less than the weight of the evidence, and the possibility of drawing two
inconsistent conclusions from the evidence does not prevent [the ALJ’s decision]
from being supported by substantial evidence.” Consolo v. Fed. Maritime Comm’n,
383 U.S. 607, 620 (1966). “In determining if the Commissioner’s decision is
supported by substantial evidence the court must scrutinize the record as a whole.”
Leslie v. Barnhart, 304 F. Supp.2d 623, 627 (M.D. Pa. 2003).
The Supreme Court has recently underscored for us the limited scope of our
review in this field, noting that:
The phrase “substantial evidence” is a “term of art” used throughout
administrative law to describe how courts are to review agency
factfinding. T-Mobile South, LLC v. Roswell, 574 U.S. ––––, ––––,
135 S.Ct. 808, 815, 190 L.Ed.2d 679 (2015). Under the substantial-
evidence standard, a court looks to an existing administrative record
and asks whether it contains “sufficien[t] evidence” to support the
agency's factual determinations. Consolidated Edison Co. v. NLRB,
305 U.S. 197, 229, 59 S.Ct. 206, 83 L.Ed. 126 (1938) (emphasis
deleted). And whatever the meaning of “substantial” in other contexts,
the threshold for such evidentiary sufficiency is not high. Substantial
evidence, this Court has said, is “more than a mere scintilla.” Ibid.; see,
e.g., Perales, 402 U.S. at 401, 91 S.Ct. 1420 (internal quotation marks
omitted). It means—and means only—“such relevant evidence as a
reasonable mind might accept as adequate to support a conclusion.”
Consolidated Edison, 305 U.S. at 229, 59 S.Ct. 206. See Dickinson v.
Zurko, 527 U.S. 150, 153, 119 S.Ct. 1816, 144 L.Ed.2d 143 (1999)
(comparing the substantial-evidence standard to the deferential clearly-
erroneous standard).
Biestek, 139 S. Ct. at 1154.
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The question before this Court, therefore, is not whether the claimant is
disabled, but rather whether the Commissioner’s finding that he is not disabled is
supported by substantial evidence and was reached based upon a correct application
of the relevant law. See Arnold v. Colvin, No. 3:12-CV-02417, 2014 WL 940205,
at *1 (M.D. Pa. Mar. 11, 2014) (“[I]t has been held that an ALJ’s errors of law denote
a lack of substantial evidence”) (alterations omitted); Burton v. Schweiker, 512 F.
Supp. 913, 914 (W.D. Pa. 1981) (“The Secretary’s determination as to the status of
a claim requires the correct application of the law to the facts.”); see also Wright v.
Sullivan, 900 F.2d 675, 678 (3d Cir. 1990) (noting that the scope of review on legal
matters is plenary); Ficca, 901 F. Supp.2d at 536 (“[T]he court has plenary review
of all legal issues . . . .”).
Several fundamental legal propositions which flow from this deferential
standard of review. First, when conducting this review “we are mindful that we must
not substitute our own judgment for that of the fact finder.” Zirnsak v. Colvin, 777
F.3d 607, 611 (3d Cir. 2014) (citing Rutherford v. Barnhart, 399 F.3d 546, 552 (3d
Cir. 2005)). Thus, we are enjoined to refrain from trying to re-weigh the evidence.
Rather our task is to simply determine whether substantial evidence supported the
ALJ’s findings. However, we must also ascertain whether the ALJ’s decision meets
the burden of articulation demanded by the courts to enable informed judicial
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review. Simply put, “this Court requires the ALJ to set forth the reasons for his
decision.” Burnett v. Comm'r of Soc. Sec. Admin., 220 F.3d 112, 119 (3d Cir. 2000).
As the Court of Appeals has noted on this score:
In Burnett, we held that an ALJ must clearly set forth the reasons for
his 	decision. 	220 	F.3d 	at 	119. 	Conclusory 	statements 	. 	. 	. 	are
insufficient. The ALJ must provide a “discussion of the evidence” and
an “explanation of reasoning” for his conclusion sufficient to enable
meaningful judicial review. Id. at 120; see Jones v. Barnhart, 364 F.3d
501, 505 & n. 3 (3d Cir.2004). The ALJ, of course, need not employ
particular “magic” words: “Burnett does not require the ALJ to use
particular language or adhere to a particular format in conducting his
analysis.” Jones, 364 F.3d at 505.
Diaz v. Comm'r of Soc. Sec., 577 F.3d 500, 504 (3d Cir. 2009). Further, it is clear
that this duty of articulation extends to analysis of a claimant’s mental and emotional
limitations. See generally Hess v. Comm’r Soc. Sec., 931 F.3d 198, 212 (3d Cir.
2019).
Thus, in practice ours is a twofold task. We must evaluate the substance of the
ALJ’s decision under a deferential standard of review, but we must also give that
decision careful scrutiny to ensure that the rationale for the ALJ’s actions is
sufficiently articulated to permit meaningful judicial review.
This principle applies with particular force to legal challenges, like the claim
made here, based upon alleged inadequacies in the articulation of a claimant’s
mental RFC. In Hess v. Comm’r Soc. Sec., 931 F.3d 198, 212 (3d Cir. 2019), the
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United States Court of Appeals recently addressed the standards of articulation that
apply in this setting. In Hess the court of appeals considered the question of whether
an RFC which limited a claimant to simple tasks adequately addressed moderate
limitations on concentration, persistence, and pace. In addressing the plaintiff’s
argument that the language used by the ALJ to describe the claimant’s mental
limitations was legally insufficient, the court of appeals rejected a per se rule which
would require the ALJ to adhere to a particular format in conducting this analysis.
Instead, framing this issue as a question of adequate articulation of the ALJ’s
rationale, the court held that: “as long as the ALJ offers a ‘valid explanation,’ a
‘simple tasks’ limitation is permitted after a finding that a claimant has ‘moderate’
difficulties in ‘concentration, persistence, or pace.’ ” Hess v. Comm’r Soc. Sec., 931
F.3d 198, 211 (3d Cir. 2019). On this score, the appellate court indicated that an ALJ
offers a valid explanation a mental RFC when the ALJ highlights factors such as
“mental status examinations and reports that revealed that [the claimant] could
function effectively; opinion evidence showing that [the claimant] could do simple
work; and [the claimant]’s activities of daily living, . . . . ” Hess v. Comm’r Soc.
Sec., 931 F.3d 198, 214 (3d Cir. 2019).
In our view, the teachings of the Hess decision are straightforward. In
formulating a mental RFC the ALJ does not need to rely upon any particular form
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of words. Further, the adequacy of the mental RFC is not gauged in the abstract.
Instead, the evaluation of a claimant’s ability to undertake the mental demands of
the workplace will be viewed in the factual context of the case, and a mental RFC is
sufficient if it is supported by a valid explanation grounded in the evidence.
B. 	Initial Burdens of Proof, Persuasion, and Articulation for the ALJ
To receive benefits under the Social Security Act by reason of disability, a
claimant must demonstrate an inability to “engage in any substantial gainful activity
by reason of any medically determinable physical or mental impairment which can
be expected to result in death or which has lasted or can be expected to last for a
continuous period of not less than 12 months.” 42 U.S.C. §423(d)(1)(A); see also 20
C.F.R. §404.1505(a). To satisfy this requirement, a claimant must have a severe
physical or mental impairment that makes it impossible to do his or her previous
work or any other substantial gainful activity that exists in the national economy. 42
U.S.C. §423(d)(2)(A); 20 C.F.R. §404.1505(a). To receive benefits under Title II of
the Social Security Act, a claimant must show that he or she contributed to the
insurance program, is under retirement age, and became disabled prior to the date on
which he or she was last insured. 42 U.S.C. §423(a); 20 C.F.R. §404.131(a).
In making this determination at the administrative level, the ALJ follows a
five-step sequential evaluation process. 20 C.F.R. §404.1520(a). Under this process,
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the ALJ must sequentially determine: (1) whether the claimant is engaged in
substantial gainful activity; (2) whether the claimant has a severe impairment; (3)
whether the claimant’s impairment meets or equals a listed impairment; (4) whether
the claimant is able to do his or her past relevant work; and (5) whether the claimant
is able to do any other work, considering his or her age, education, work experience
and residual functional capacity (“RFC”). 20 C.F.R. §404.1520(a)(4).
Between Steps 3 and 4, the ALJ must also assess a claimant’s residual
functional capacity (RFC). RFC is defined as “that which an individual is still able
to do despite the limitations caused by his or her impairment(s).” Burnett v. Comm’r
of Soc. Sec., 220 F.3d 112, 121 (3d Cir. 2000) (citations omitted); see also 20 C.F.R.
§§404.1520(e), 404.1545(a)(1). In making this assessment, the ALJ considers all of
the claimant’s medically determinable impairments, including any non-severe
impairments identified by the ALJ at step two of his or her analysis. 20 C.F.R.
§404.1545(a)(2).
There is an undeniable medical aspect to an RFC determination, since that
determination entails an assessment of what work the claimant can do given the
physical limitations that the claimant experiences. Yet, when considering the role
and necessity of medical opinion evidence in making this determination, courts have
followed several different paths. Some courts emphasize the importance of medical
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opinion support for an RFC determination and have suggested that “[r]arely can a
decision be made regarding a claimant's residual functional capacity without an
assessment from a physician regarding the functional abilities of the claimant.”
Biller v. Acting Comm'r of Soc. Sec., 962 F. Supp. 2d 761, 778–79 (W.D. Pa. 2013)
(quoting Gormont v. Astrue, Civ. No. 11–2145, 2013 WL 791455 at *7 (M.D. Pa.
Mar. 4, 2013)). In other instances, it has been held that: “There is no legal
requirement that a physician have made the particular findings that an ALJ adopts
in the course of determining an RFC.” Titterington v. Barnhart, 174 F. App’x 6, 11
(3d Cir. 2006). Further, courts have held in cases where there is no evidence of any
credible medical opinion supporting a claimant’s allegations of disability that “the
proposition that an ALJ must always base his RFC on a medical opinion from a
physician is misguided.” Cummings v. Colvin, 129 F. Supp. 3d 209, 214–15 (W.D.
Pa. 2015).
These 	seemingly 	discordant 	legal 	propositions 	can 	be 	reconciled 	by
evaluation of the factual context of these decisions. Those cases which emphasize
the importance of medical opinion support for an RFC assessment typically arise in
the factual setting where a well-supported medical source has identified limitations
that would support a disability claim, but an ALJ has rejected the medical opinion
which supported a disability determination based upon a lay assessment of other
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evidence. Biller, 962 F.Supp.2d at 778–79. In this setting, these cases simply restate
the commonplace idea that medical opinions are entitled to careful consideration
when making a disability determination, particularly when those opinions support a
finding of disability. In contrast, when an ALJ is relying upon other evidence, such
as contrasting clinical or opinion evidence or testimony regarding the claimant’s
activities of daily living, to fashion an RFC courts have adopted a more pragmatic
view and have sustained the ALJ’s exercise of independent judgment based upon all
of the facts and evidence. See Titterington v. Barnhart, 174 F. App'x 6, 11 (3d Cir.
2006); Cummings v. Colvin, 129 F. Supp. 3d 209, 214–15 (W.D. Pa. 2015). In either
event, once the ALJ has made this determination, our review of the ALJ's assessment
of the plaintiff's RFC is deferential, and that RFC assessment will not be set aside if
it is supported by substantial evidence. Burns v. Barnhart, 312 F.3d 113, 129 (3d
Cir. 2002); see also Metzger v. Berryhill, No. 3:16-CV-1929, 2017 WL 1483328, at
*5 (M.D. Pa. Mar. 29, 2017), report and recommendation adopted sub nom. Metzgar
v. Colvin, No. 3:16-CV-1929, 2017 WL 1479426 (M.D. Pa. Apr. 21, 2017); Rathbun
v. Berryhill, No. 3:17-CV-00301, 2018 WL 1514383, at *6 (M.D. Pa. Mar. 12,
2018), report and recommendation adopted, No. 3:17-CV-301, 2018 WL 1479366
(M.D. Pa. Mar. 27, 2018).
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At Steps 1 through 4, the claimant bears the initial burden of demonstrating
the existence of a medically determinable impairment that prevents him or her in
engaging in any of his or her past relevant work. Mason, 994 F.2d at 1064. Once this
burden has been met by the claimant, it shifts to the Commissioner at Step 5 to show
that jobs exist in significant number in the national economy that the claimant could
perform that are consistent with the claimant’s age, education, work experience and
RFC. 20 C.F.R. §404.1512(f); Mason, 994 F.2d at 1064.
The ALJ’s disability determination must also meet certain basic substantive
requisites. Most significant among these legal benchmarks is a requirement that the
ALJ adequately explain the legal and factual basis for this disability determination.
Thus, in order to facilitate review of the decision under the substantial evidence
standard, the ALJ's decision must be accompanied by “a clear and satisfactory
explication of the basis on which it rests.” Cotter v. Harris, 642 F.2d 700, 704 (3d
Cir. 1981). Conflicts in the evidence must be resolved and the ALJ must indicate
which evidence was accepted, which evidence was rejected, and the reasons for
rejecting certain evidence. Id. at 706-07. In addition, “[t]he ALJ must indicate in his
decision which evidence he has rejected and which he is relying on as the basis for
his finding.” Schaudeck v. Comm’r of Soc. Sec., 181 F.3d 429, 433 (3d Cir. 1999).
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C. 	This Case Will Be Remanded.
As we have noted, the RFC in this case is flawed in at least two ways. At the
outset, standing alone, the ALJ’s complete failure to acknowledge or consider
Hoffman’s history of suicidal ideation and February 2018 suicide attempt requires
remand. On this score, an ALJ’s decision must be accompanied by “a clear and
satisfactory explication of the basis on which it rests.” Cotter, 642 F.2d at 704.
Furthermore, it is well settled that “[t]he ALJ must consider all relevant evidence
when 	determining 	an 	individual’s 	residual 	functional 	capacity.” 	Fargnoli 	v.
Massanari, 247 F.3d 34, 41 (3d Cir. 2001). And, “when a conflict in the evidence
exists, the ALJ may choose whom to credit but ‘cannot reject evidence for no reason
or for the wrong reason.’ The ALJ must consider all the evidence and give some
reason for discounting the evidence she rejects.” Plummer v. Apfel, 186 F.3d 422,
429 (3d Cir. 1999) (quoting Mason v. Shalala, 994 F.2d 1058, 1066 (3d Cir. 1993)).
Thus, it is well-settled that, at a minimum, a remand is necessary when an ALJ’s
opinion ignores or fails to address material evidence supporting a disability claim.
See Morales v. Apfel, 225 F.3d 310, 312 (3d Cir. 2000). This principle applies with
particular force when an ALJ has “ignored competent medical evidence regarding
psychological disability in favor of his own contrary conclusion.” Wallace v. Sec’y
of Health & Human Servs., 722 F.2d 1150, 1154–55 (3d Cir. 1983).
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Applying these legal benchmarks, it is generally conceded that an unexplained
failure by an ALJ to fully acknowledge or address evidence of suicidal impulses by
a disability claimant compels a remand. See, e.g., Salazar v. Barnhart, 468 F.3d 615,
622 (10th Cir. 2006); Glaser v. Bisignano, No. 4:23-CV-1922, 2025 WL 3124700,
at *1 (M.D. Pa. Nov. 7, 2025); Roat v. Barnhart, 717 F. Supp. 2d 241, 267 (N.D.N.Y.
2010). As one court has aptly observed in this regard: “Due to the ALJ’s
simultaneous silence as to a suicide attempt and reliance on progress notes
containing a claimant’s denials of suicidal ideations close in time to the suicide
attempt, the Court is unable to conclude that the ALJ considered Plaintiff’s medical
condition as a whole or applied the appropriate legal standards.” Lewis v. Colvin,
No. 14-14495-CIV, 2016 WL 4810585, at *3 (S.D. Fla. Mar. 4, 2016).
So it is in the instant case.
In February 2018, Hoffman was psychiatrically hospitalized after overdosing
on Klonopin and was treated for attempted suicide. (Tr. 521). While she later stated
she did not intend to kill herself, the medical records, which were squarely before
the ALJ, repeatedly state her hospitalization was secondary to an overdose suicide
attempt. (Tr. 521, 1172, 1186). Moreover, her medical records reference severe
depression and suicidal thoughts at various points during the relevant period. (Tr.
650, 698, 593, 721). Finally, the plaintiff testified at the hearing that she was
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hospitalized after she “took a handful of pills” due to her depression. (Tr. 62). Thus,
undisputedly before the ALJ was ample evidence that Hoffman had attempted
suicide during the relevant period which required hospitalization. Despite this
evidence that the ALJ was required to consider in fashioning the RFC, the ALJ made
no mention of Hoffman’s suicide attempt, instead stating only that, “[t]he claimant
underwent voluntary inpatient mental health treatment in February 2018,” (Tr. 24).
This benign characterization of an attempted act of self-destruction was materially
misleading. Rather, the ALJ’s failure to acknowledge or address Hoffman’s suicide
attempt which were clearly before the ALJ was plainly in error, and we find this
error to be material and not subject to any form of harmless error analysis. See Pool
v. Colvin, No. 15-CV-02061-WHO, 2016 WL 4363405, at *2 (N.D. Cal. Aug. 16,
2016) (concluding that suicide attempt was material evidence for purposes of
remand of Social Security Appeal for consideration of new evidence).
While this failure to address the most severe manifestation of Hoffman’s
mental health symptoms, standing alone, warrants remand, we also find that the
ALJ’s overarching mischaracterization of the record led to a failure to adequately
address the plaintiff’s subjective symptoms. On this score, the ALJ concluded that
Hoffman’s statements regarding the intensity, persistence, and limiting effects of her
symptoms 	were 	inconsistent 	with 	the 	record 	showing 	normal 	mental 	status
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examinations, noncompliance with treatment, and functional activities of daily
living. But in so concluding, the ALJ erroneously focused on parts of the record
which supported the rejection of Hoffman’s symptoms and ignored parts of the
record which tended to support her subjective reports.
This too was error. At the outset, it is well-settled that “[t]he ALJ need not
make reference to every relevant note in the record, but the ALJ may not “cherry-
pick” results that support his conclusion and ignore those that do not.” Stoltzfus v.
Berryhill, No. CV 16-6308, 2019 WL 1981888, at *5 (E.D. Pa. May 1, 2019) (citing
Rivera v. Astrue, 9 F. Supp. 3d 495, 504 (E.D. Pa. 2014)). Indeed, other courts have
found substantial evidence does not support the conclusions of an ALJ where the
ALJ “selectively cited treatment notes that supported her opinion but ignored
contrary portions without explanation.” Maximiliano L. v. Kijakazi, No. 3:21-CV-
0083, 2022 WL 4550631, at *8 (D.N.J. Sept. 29, 2022) (collecting cases). The
selective citation of treatment notes is particularly problematic in the context of
mental impairments such as depression and anxiety, which are cyclical in nature. As
one court of appeals explained:
As we have emphasized while discussing mental health issues, it is
error to reject a claimant's testimony merely because symptoms wax
and wane in the course of treatment. Cycles of improvement and
debilitating 	symptoms 	are 	a 	common 	occurrence, 	and 	in 	such
circumstances it is error for an ALJ to pick out a few isolated instances
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37
of improvement over a period of months or years and to treat them as a
basis for concluding a claimant is capable of working.
Garrison v. Colvin, 759 F.3d 995, 1017 (9th Cir. 2014)
In this case, Hoffman’s medical records are a textbook example of the cyclical
nature of mental impairments. Indeed, Hoffman’s medical records begin with a
severe manifestation of her mental impairments in the form of an intentional
overdose and inpatient psychiatric treatment in February 2018, go on to show some
periods of improvement and stability in late 2019 and 2020, but then reveal a
regression in early 2021 when she reported 	daily panic attacks, inability to focus,
nightmares, fleeting thoughts of suicide, “severe and debilitating” anxiety, and an
inability to leave her home due to anxiety. (Tr. 593, 721, 737-38). In concluding the
plaintiff overstated the limitations caused by her mental health symptoms, the ALJ
selectively cited the treatment notes showing periods of stability and normal mental
status examination findings but ignored the portions of those same records showing
the severe manifestations of Hoffman’s mental health impairments. In doing so, the
ALJ ignored the cyclical nature of mental health impairments. This was error.
Finally, in rejecting the plaintiff’s statements regarding the severity of her
symptoms, the ALJ paradoxically references the plaintiff’s noncompliance with
mental health treatment during the period in 2018 when she was experiencing the
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38
most severe exacerbation of her mental health impairments. This characterization of
the record ignores the treatment notes during this time which stated Hoffman was,
in fact, agoraphobic, and that her anxiety and panic were so severe she was unable
to leave her home. For example, during her outpatient treatment, Hoffman reported
she found it difficult to function and had been isolating because of her panic attacks.
(Tr. 	1193). 	After 	being 	discharged 	from 	the 	outpatient 	program 	due 	to
disengagement in March 2018, she reported to her primary care provider that she
had 	not 	been 	connected 	with 	follow-up 	psychiatric 	care 	after 	her 	inpatient
hospitalization, had run out of medication, and was experiencing significant anxiety
and agoraphobia and was afraid to leave her house to attend therapy appointments.
(Tr. 658). Her primary care provider noted “it was quite a struggle for her to come
into the office today even.” (Id.) These notes, which were omitted by the ALJ, show
Hoffman’s mental health symptoms, including extreme anxiety and agoraphobia,
caused her absenteeism. As the plaintiff points out, courts have often adopted the
view that noncompliance with treatment is a result of mental impairments. For
example, this court has stated:
In assessing credibility, the ALJ may rely on Plaintiff's course of
treatment. 	SSR 	96–7p. 	However, 	the 	ALJ 	“must 	not 	draw 	any
inferences about an individual's symptoms and their functional effects
from a failure to seek or pursue regular medical treatment without first
considering any explanations that the individual may provide, or other
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information in the case record, that may explain infrequent or irregular
medical 	visits 	or 	failure 	to 	seek 	medical 	treatment.” 	Id.
Hennion v. Colvin, No. 3:13-CV-00268, 2015 WL 877784, at *24 (M.D. Pa. Mar.
2, 2015). Here, the plaintiff’s well-documented social anxiety, panic attacks, and
documented agoraphobia, which the ALJ failed to adequately acknowledge or
assess, explain her irregular medical visits. See Newell v. Comm'r of Soc. Sec., 347
F.3d 541, 547 (3d Cir. 2003) (quoting Nguyen v. Chater, 100 F.3d 1462, 1465 (9th
Cir.1996) (“Appellant may have failed to seek psychiatric treatment for his mental
condition, but it is a questionable practice to chastise one with a mental impairment
for the exercise of poor judgment in seeking rehabilitation.”); Hennion v. Colvin,
2015 	WL 	877784, 	at 	*24 	(“Plaintiff's 	reluctance 	to 	participate 	in 	a 	partial
hospitalization program may have been a symptom of his agoraphobia, not a sign
that his agoraphobia was less limiting”).
In sum, while the ALJ cites to the plaintiff’s noncompliance with treatment in
concluding her symptoms are not as severe as she avers, this noncompliance with
treatment in fact proves the opposite in showing that Hoffman’s symptoms, at times,
were so severe she was unable to leave her home, evidence of chronic absenteeism
that the ALJ failed to adequately address. This is a potentially prejudicial oversight
since the issue of Hoffman’s absenteeism was endorsed by her treating provider in
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her opinion which stated Hoffman would be absent more than four days per month.
Yet, the ALJ found this opinion unpersuasive based upon his selective summary of
the record, a summary which failed to acknowledge material clinical evidence.
Given the ALJ’s failure to address material evidence in the record—including
evidence of an apparent act of attempted self-destruction—more is needed here.
Thus, we conclude that the ALJ’s decision in this case is not supported by substantial
evidence. Accordingly, we will remand this case to the Commissioner for further
consideration of this evidence. Yet, while we reach this conclusion, we note that
nothing in this Memorandum Opinion should be deemed as expressing a judgment
on what the ultimate outcome of any reassessment of this evidence should be. Rather,
consistent with this opinion that task should remain the duty and province of the ALJ
on remand. Finally, because we have found a basis for remand on these grounds, we
need not address the plaintiff’s remaining arguments since “[a] remand may produce
different results on these claims, making discussion of them moot.” Burns v. Colvin,
156 F.Supp.3d 579, 598 (M.D. Pa. Jan. 13, 2016)..
IV. 	Conclusion
For the foregoing reasons the plaintiff’s request for a new administrative
hearing will be GRANTED, the final decision of the Commissioner denying these
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claims will be vacated, and this case will be REMANDED to the Commissioner to
conduct a new administrative hearing.
An appropriate order follows.
S/ Martin C. Carlson
Martin C. Carlson
United States Magistrate Judge
DATED: March 13, 2026
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