Case Name in Social Security Case - Unavailable

IN THE UNITED STATES DISTRICT COURT FOR THE
WESTERN DISTRICT OF MISSOURI
SOUTHWESTERN DIVISION
JESSICA MAE JOHNSON,
Plaintiff,
v.
COMMISSIONER OF SSA;
Defendant.
)
)
)
)
)
)
)
)
)
Case No. 3:25-05002-CV-RK
ORDER
Before 	the 	Court 	is 	Plaintiff 	Jessica 	Mae 	Johnson’s 	appeal 	brought 	under
42 U.S.C. § 405(g) seeking review of the Commissioner of the Social Security Administration’s
denial of disability benefits as rendered in a decision by an Administrative Law Judge (“ALJ”).
After careful consideration and for the reasons explained below, the Court ORDERS that the ALJ’s
decision is REVERSED and REMANDED.
Background
Plaintiff filed a protective application under Title II of the Social Security Act for disability
and disability insurance benefits and a protective application under Title XVI of the Social Security
Act for supplemental security income. After Plaintiff’s applications were denied at both the initial
and reconsideration levels, Plaintiff requested a hearing before an ALJ. Following a hearing, the
ALJ issued an unfavorable decision, which was subsequently reversed and remanded by this Court.
See Johnson v. Kijakazi, No. 3:21-cr-05082-RK (W.D. Mo. Jan. 13, 2023) (doc. 15). On remand,
another hearing before an ALJ was held, and the ALJ again issued an unfavorable decision finding
Plaintiff not disabled for purposes of receiving social security benefits. The Appeals Council then
denied Plaintiff’s request for review, making the ALJ’s decision the final decision of the
Commissioner. 	Plaintiff accordingly seeks judicial review of the ALJ’s second unfavorable
decision denying her applications to receive social security benefits.
Discussion
The Court’s review of the ALJ’s social security decision denying Plaintiff’s application for
social security disability benefits is limited to determining if the decision “complies with the
relevant legal requirements and is supported by substantial evidence in the record as a whole.”
Halverson v. Astrue, 600 F.3d 922, 929 (8th Cir. 2010) (quoting Ford v. Astrue, 518 F.3d 979, 981
Case 3:25-cv-05002-RK Document 11 Filed 02/11/26 Page 1 of 9

2
(8th Cir. 2008)). Here, Plaintiff raises one issue on appeal: whether the ALJ erred as a matter of
law in assessing the medical opinions provided by Arlynna Hendrix, a certified physician assistant,
P.A.-C, regarding Plaintiff’s physical and mental limitations for her ability to function in a
workplace.
I. 	ALJ’s Decision
PA-C Hendrix, treated Plaintiff at Mercy Clinic Family Medicine 50th Street Clinic in
February and May 2023.1 (See Tr. 2094, 2100.) In September 2023, she provided both a “Medical
Source Statement—Physical” and a “Medical Source Statement—Mental” on behalf of Plaintiff.
(Tr. at 2228-30, 2233-34.) 	In the physical medical source statement, PA-C Hendrix noted that
Plaintiff suffered from chronic and daily pain and fatigue and decreased focus and concentration
(primarily decreased long-term memory and concentration) and diagnosed Plaintiff with chronic
migraine without aura, fibromyalgia, gastroesophageal reflux disease, history of traumatic brain
injury, and chronic bilateral low-back pain. (Tr. at 2228.) She opined that as a result of Plaintiff’s
conditions, Plaintiff:
(1) could never lift/carry 50 pounds, rarely lift/carry 10-20 pounds, and occasionally
lift/carry less than 10 pounds;
(2) could never crawl or climb; rarely stoop, balance, and crouch, but could occasionally
twist;
(3) could never reach, handle, finger, or feel;
(4) could sit or stand for 30 minutes before needing to change positions or walk around;
that she would need to shift positions at will from sitting, standing, or walking; and that she can
sit and stand for a total of less than 2 hours in an 8-hour workday;
(5) would need to take 10-15 minute breaks every 2-3 hours during an 8-hour workday,
and would miss work or need to leave early approximately 4 days per month;
(6) would likely be off task 20 percent of the time; and
(7) would be capable of low stress work.
(Tr. at 2229.)
1 Mercy Clinic Primary Care or Mercy Clinic Family Medicine was Plaintiff’s primary care
provider beginning in July 2020. While Plaintiff saw other providers, PA-C Hendrix saw Plaintiff for two
of her three-month follow-up appointments. (Tr. 2094, 2100.)
Case 3:25-cv-05002-RK Document 11 Filed 02/11/26 Page 2 of 9

3
PA-C Hendrix’s mental medical source statement similarly opined that Plaintiff would need
to miss work or leave work early approximately 4 days per month and was likely to be off task for
20 percent of the time. (Tr. at 2233.) She opined that Plaintiff had mild and moderate limitations
in (1) understanding and memory, (2) concentration and persistence (with marked limitations in
maintaining attention and concentration for extended periods and the ability to complete a normal
workday and workweek without interruption at a consistent pace without an unreasonable number
and length of rest periods), (3) social interaction, and (4) adaptation. (Tr. at 2233-34.)
As relevant here, the ALJ found that Plaintiff has the residual functional capacity (“RFC”)2
to perform sedentary work with the following limitations:
she can lift 10 pounds occasionally and 5 pounds frequently and can stand and/or
walk for a cumulative total of 2 hours during an 8-hour workday but for no more
than 30 minutes continuously and can sit for a cumulative total of 8 hours during
an 8-hour workday. While performing seated work she requires the opportunity to
make a positional change every 30 minutes; such positional change can be
performed at the workstation and without being off task and would consist of the
ability to stand, briefly, for a period not to exceed 3 minutes. In addition, she can
use her lower extremities to operate foot controls on a frequent basis. 	She can
occasionally climb ramps and stairs but can never climb ladders and scaffolds, and
can occasionally stoop, kneel, and crouch, but can never crawl. The claimant must
work in an environment that will not result in concentrated exposure to extreme
cold, to vibration, or to respiratory irritants such as fumes, odors, and dust. 	In
addition, she cannot work in an environment that would result in more than rare
exposure to flashing lights and would need to work in an environment with a noise
level 	no 	greater 	than 	moderate, 	or 	Level 	3 	as 	described 	in 	the 	Selected
Characteristics of Occupations. In addition, the claimant must work in an indoor
environment. 	The claimant can understand, remember, and carry out simple
instructions, and can maintain concentration, persistence, and pace sufficient to
perform work that consists of simple, routine tasks, requiring only simple
workplace judgments, in an environment that does not require performing fast-
paced production work. In addition, the claimant must work in an environment that
does not require interaction with the public, and requires only occasional interaction
with coworkers; however, she can tolerate frequent interaction with supervisors.
She can recognize and avoid hazards, adjust to changes, and accept direction and
respond appropriately to criticism while working in an environment that requires
performing only simple routine tasks in the socially limited environment described.
(Tr. at 856.)3
2 A social security claimant’s RFC “is the most [she] can do despite [her] [physical and mental]
limitations,” and is assessed by the ALJ “based on all the relevant evidence” in the administrative record.
20 C.F.R. § 404.1545(a)(1).
3 The ALJ’s ultimate RFC determination was thus both more and less restrictive than PA-C
Case 3:25-cv-05002-RK Document 11 Filed 02/11/26 Page 3 of 9

4
In analyzing the medical opinions and prior administrative medical findings, the ALJ
found generally unpersuasive the medical opinions of PA-C Hendrix and Dr. Michael O’Day (a
consulting physician at the state disability services reconsideration level). The ALJ first noted that
Dr. O’Day’s medical opinion “is not consistent with subsequent medical evidence that shows
similar findings on exams” as the evidence that Dr. O’Day had reviewed at the state disability
services review stage. This evidence included (1) that Plaintiff retained 5/5 motor strength, intact
sensation, and normal gait on exams, (2) susceptibility to light due to her migraines and chronic
post-traumatic headaches “but no symptoms analogous to seizures on neurological examinations,”
(3) “widespread tenderness with multiple focal tender points and trigger points secondary to
fibromyalgia but no evidence of muscle wasting,” (4) a “diagnosis of vasovagal syncope with
symptoms 	of 	dizziness 	and 	passing 	out 	but 	no 	associated 	cardiac 	or 	neurological
symptomatology,” as well as (5) “BMI values over 30 kg/m2, which could exacerbate her
musculoskeletal and neurological symptoms.” (Tr. at 860.) The ALJ then indicated that he found
PA-C Hendrix’s opinion “generally unpersuasive considering the foregoing reasons,” i.e., for the
same reasons he found Dr. O’Day’s opinion to be unpersuasive.
At the same time, the ALJ found the opinion of Dr. Lauren Christine Frey, who testified at
the hearing as a medical expert, to be persuasive “for the reasons stated above” (i.e., referring to
the discussion of Dr. O’Day and PA-C Hendrix’s opinions). (Tr. at 861.) The ALJ noted that Dr.
Frey opined at the hearing that due to Plaintiff’s migraine headaches, syncope, and lumbar
spondylosis, Plaintiff retained an RFC with greater abilities than what the ALJ ultimately imposed.
For instance, Dr. Frey opined, inter alia, that Plaintiff could frequently lift/carry 10 pounds and
could occasionally lift/carry 20 pounds; that she could sit for 6 hours and stand and/or walk for 4
hours in an 8-hour workday; and that she could frequently climb ramps and stairs. (Id.)
As to Plaintiff’s mental RFC, the ALJ found the opinion of Dr. Thomas Kuich (a treating
mental health specialist) to be unpersuasive and PA-C Hendrix to be generally unpersuasive,
reasoning that “[t]he objective medical evidence does not support limitations beyond a moderate
degree in any area of mental functioning.” 	(Id.) 	The ALJ noted specifically that the objective
medical evidence illustrated that Plaintiff “remained stable with treatment,” and “did not
experience any episode of decompensation” or psychiatric hospitalization. 	(Id.) 	Similar to the
Hendrix’s medical source statement opinions.
Case 3:25-cv-05002-RK Document 11 Filed 02/11/26 Page 4 of 9

5
physical medical opinion analysis, the ALJ first analyzed the mental health opinion of Dr. Kuich
and then found that “[s]imilarly, . . . the opinion from PA Hendrix . . . [is] generally unpersuasive
for the reasons stated above,” i.e., the ALJ’s analysis of Dr. Kuich’s opinion. The ALJ specifically
noted that “[t]he objective medical evidence shows that [Plaintiff] demonstrated . . . generally
normal attention and concentration upon mental status evaluations.” (Tr. at 854.)
In addition, the ALJ found the opinion of the consulting mental health services at the state
disability services reconsideration level, Dr. Marsha Toll, to be “generally persuasive,” finding in
part that although Plaintiff “demonstrated deficits in delayed recall and attention on the Montreal
Cognitive Assessment test,” she also displayed “generally normal memory, average intelligence,
and normal attention and concentration upon mental status evaluations.” (Tr. at 861.)
II. 	Evaluation of Medical Opinion Evidence—Supportability and Consistency
On appeal, Plaintiff argues that the ALJ did not properly evaluate or weigh PA-C Hendrix’s
medical opinions under 20 C.F.R. §§ 404.1520c and 416.920c. 	In evaluating medical opinion
evidence, the relevant SSA regulations require that the ALJ must consider the persuasiveness of
each medical opinion. In doing so, the ALJ is guided by five factors to consider: “supportability,
consistency, relationship with the claimant (including length of treatment relationship, frequency
of examination, purpose of treatment relationship, and examining relationship), specialization, and
other factors that tend to support or contradict a medical opinion.” 	Engum v. Kijakazi, No. 20-
06110-CV-SJ-WBG, 2022 WL 902740, at *2 (W.D. Mo. Mar. 28, 2022) (quotation modified). The
first two factors—supportability and consistency—“are the most important[.]” 	Id. (internal
quotation marks omitted).
In this context, supportability refers to the objective medical evidence and supporting
explanations presented by a medical source to support his or her medical opinions. 	20 C.F.R.
§§ 404.1520c(c)(1), 416.920c(c)(1). 	Put another way, supportability considers the evidence
offered in support of a proffered medical opinion regarding a plaintiff’s work-related limitations
as a result of their impairments. 	Spiers v. Colvin, No. 5:23-CV-06116-SJ-JAM-SSA, 2024 WL
5245089, at *4 (W.D. Mo. Dec. 30, 2024) (“Supportability refers to how a medical opinion is
supported by relevant objective medical evidence and the medical provider’s explanations . . . .”);
see §§ 404.1520c(c)(1) & 419.920c(c)(1) (“The more relevant the objective medical evidence and
supporting explanations presented by a medical source are to support his or her medical opinion(s)
. . . the more persuasive the medical opinions . . . will be.”). Consistency refers to how consistent
Case 3:25-cv-05002-RK Document 11 Filed 02/11/26 Page 5 of 9

6
the subject medical opinion is with “evidence from other medical sources and nonmedical sources
in the claim.” 20 C.F.R. §§ 404.1520c(c)(2), 416.920c(c)(2); see Spiers, 2024 WL 5245089, at *4
(“[C]onsistency measures how the opinion aligns with evidence from other medical and
nonmedical sources in the record.”)
Here, Plaintiff argues that the ALJ erred as a matter of law because “the ALJ’s assessment
of PA Hendrix’s opinions failed to comply with the regulatory articulation requirements.”
Specifically, she asserts that “[t]he ALJ provided no articulation of how the factors of
supportability and consistency were considered.” (Doc. 8 at 10, 12.) The regulations establishing
the persuasiveness-evaluation framework for medical opinions, however, require that the ALJ
“articulate how [he or she] considered the medical opinions,” including specifically (1) “how
persuasive [the ALJ] find[s] all of the medical opinions” and (2) how the ALJ “considered all of
the factors.” 	20 C.F.R. §§ 404.1520c(a), (b)(1), 416.920c(a), (b)(1). 	As the Commissioner
acknowledges, the relevant regulations also expressly require that the ALJ in particular “explain
how [he or she] considered the supportability and consistency factors.” 	§§ 404.1520c(b)(2),
416.920c(b)(2).
The Court is persuaded that the ALJ at a minimum failed to properly consider the
supportability of PA-C Hendrix’s medical opinion statements in evaluating their persuasiveness.
The ALJ’s somewhat conclusory discussion of PA-C Hendrix’s medical opinion statements might
be sufficient as to the consistency factor. As indicated above, a natural and common sense reading
of the ALJ’s decision incorporated the objective medical evidence in the administrative record that
undercut (or at least was inconsistent with) Dr. O’Day and Dr. Kuich’s opinions to the ALJ’s
discussion of the persuasiveness of PA-C Hendrix’s opinions in the immediately following
paragraph. Nothing in the ALJ’s discussion of the persuasiveness of Dr. O’Day and Dr. Kuich’s
opinions make or include any relevant findings as to the supportability of PA-C Hendrix’s medical
opinion statements, however. The ALJ acknowledges that PA-C Hendrix was one of Plaintiff’s
treating medical providers, (Tr. at 860), but does not make any finding or include any discussion
or consideration of the supportability of PA-C Hendrix’s opinion statements.
In Bonnett v. Kijakazi, 859 F. App’x 19 (8th Cir. 2021) (per curiam), the Eighth Circuit
found reversible legal error where an ALJ adequately evaluated the supportability of a medical
expert opinion but “did not address whether [the] opinion was consistent with the other evidence
of record, as required by the applicable regulation.” Id. at 20 (citing Lucus v. Saul, 960 F.3d 1066,
Case 3:25-cv-05002-RK Document 11 Filed 02/11/26 Page 6 of 9

7
1069-70 (8th Cir. 2020); other citation omitted).4 As reflected in the district court decision in
Bonnett (which the Eighth Circuit reversed), the ALJ in that case had found the medical opinion
statement by Dr. Thompson not persuasive, explaining that:
[a]lthough [Dr. Thompson] has a long, treating relationship with the claimant, Dr.
Thompson provides little support or explanation for his opinion . . . . In addition,
his opinion is not consistent with his own examinations of the claimant. 	For
example, his examinations show mostly normal strength and sensation with
variable limits in lumbar range of motion . . . . 	Furthermore, Dr. Thompson’s
treatment notes often report that the claimant’s functionality and activities of daily
living are improved with pain medication . . . . 	Likewise, Dr. Thompson
consistently reported the claimant appeared in no acute distress . . . . Therefore, the
undersigned finds Dr. Thompson’s opinion is not persuasive.
Bonnett v. Comm’r, Soc. Sec’y Admin., No. 1:20-cv-01032, 2021 WL 816945, at *3 (W.D. Ark.
Mar. 3, 2021).
Here, the Commissioner argues that the ALJ made clear that “her explanations for finding
[PA-C Hendrix’s] opinions unpersuasive consisted chiefly of pointing to the evidence discussed in
the remainder of the decision” and the Court should accordingly consider that the “decision is
otherwise quite thorough and . . . the record shows that substantial evidence support[s] the
administrative law judge’s conclusions.” 	(Doc. 9 at 8.) 	The Court is not persuaded by this
argument and finds that it is inconsistent with the Eighth Circuit’s opinion in Bonnett applying
Lucus, and the standard of review recognized by the Eighth Circuit in Cropper v. Dudek, 136 F.4th
809 (8th Cir. 2025).
First, the Court notes that the Eighth Circuit in Bonnett rejected essentially the same
argument made by the Commissioner here—that to the extent the subject medical opinion “was
not consistent with specific other evidence in the record,” there is no reversible error. 859 F. App’x
at 20. The Eighth Circuit disagreed, reasoning simply that “the ALJ made no such findings.” Id.
(citing SEC v. Chenery Corp., 318 U.S. 80, 87 (1943)). Second, the articulation requirement under
§§ 404.1520c(b)(2) and 416.920c(b)(2) for supportability and consistency is an important one.
4 In Lucus, the Eighth Circuit recognized that “[t]he failure to comply with SSA regulations is more
than a drafting issue, it is [reversible] legal error.” 	960 F.3d at 1070. As set out above, and which the
Commissioner acknowledges, the applicable regulations require that the ALJ must specifically explain her
consideration of the supportability and consistency factors, the two most important factors in weighing the
persuasiveness of a medical opinion statement. Lucus pre-dated the amendments to the opinion-evaluation
framework now codified in §§ 404.1520c and 416.920c. Thus, the decision by the Eighth Circuit panel in
Bonnett simply applied Lucus to the current regulatory framework which sets forth how an ALJ is required
to evaluate the persuasiveness of medical opinion statements in the disability-benefits analysis.
Case 3:25-cv-05002-RK Document 11 Filed 02/11/26 Page 7 of 9

8
Indeed, as the Eighth Circuit recently clarified in Cropper v. Dudek, judicial review of an ALJ’s
determination as to the persuasiveness of a medical opinion is focused only on “whether the ALJ
adequately analyzed persuasiveness, including the supportability and consistency factors.” 	136
F.4th at 814. 	Judicial review does not include “whether [the Court] agree[s] with the ALJ’s
evaluation of the record evidence on those issues.” Id.; see id. at 815 (recognizing that on judicial
review the Court does not consider whether the ALJ’s “explanation and findings [as to
supportability and consistency] were . . . [individually] supported by substantial evidence,” but
instead focuses on whether the ALJ’s “ultimate persuasiveness and residual functional capacity
findings are supported by substantial evidence”).
The Commissioner cites the district court’s opinion in Trosper v. Saul, No. 1:20 CV 51
DDN, 2021 WL 1857124 (E.D. Mo. May 10, 2021), as supporting the argument that the Court
should consider in this case whether substantial evidence supports the ALJ’s overall persuasiveness
finding based on the ALJ’s decision and the administrative record as a whole. The district court
in Trosper, after finding that the ALJ “properly articulated” and adequately considered the
supportability and consistency of Dr. Thompson’s opinion,5 then turned to the issue of whether the
ALJ’s persuasiveness conclusion was supported by substantial evidence. See 2021 WL 1857124,
at *5. 	In this context, the district court recognized that the ALJ’s persuasiveness conclusion
“cannot be read in isolation but must be read as part of the overall discussion of plaintiff’s RFC
assessment.” Id. The district court’s analysis in Trosper appears to be consistent with the Eighth
Circuit’s formulation of judicial review in social security cases in Cropper. The Commissioner’s
reliance on Trosper is misplaced here, though, where Plaintiff is not challenging whether the ALJ’s
persuasiveness determination is supported by substantial evidence but whether the ALJ properly
and adequately considered the required supportability and consistency factors in the first instance
5 Specifically, the district court explained of the ALJ’s decision:
[i]n his evaluation of the record evidence the ALJ considered [a Physical Medical Source
Statement] completed by Ms. Pullum-Thompson and found it ‘not persuasive’ because Ms.
Pullum-Thompson did not support her opinion with any specific objective medical
evidence, and it was not consistent with the remainder of the record evidence, including
the plaintiff’s own testimony at the hearing. The ALJ discussed the lack of any objective
record evidence to support the mental limitations assessed by Ms. Pullum-Thompson, as
well as plaintiff’s testimony that she did not require the use of a cane.
2021 WL 1857124, at *5.
Case 3:25-cv-05002-RK Document 11 Filed 02/11/26 Page 8 of 9

9
in light of the articulation requirement.6 	Bonnett applying Lucus—neither of which the
Commissioner discusses in his opposition brief—is thus the more relevant and applicable case.
The Court disagrees with the Commissioner that the ALJ’s mere reference to PA-C
Hendrix’s treatment records elsewhere in the decision is sufficient to satisfy the requirement that
the ALJ consider both the supportability and consistency to evaluate the persuasiveness of a
submitted medical opinion to determine Plaintiff’s RFC. Similarly, the Court disagrees with the
Commissioner that it is sufficient for purposes of judicial review that “a review of [PA-C
Hendrix’s] records show that they do not support her highly restrictive opinions.” (Doc. 9 at 9.)
In short, “the ALJ made no such findings.” Bonnett, 859 F. App’x at 20. Because the ALJ at a
minimum failed to adequately evaluate the supportability of PA-C Hendrix’s opinions as required
by the applicable regulations, remand is required.7
Conclusion
Accordingly, after careful consideration and review, the Court ORDERS that the ALJ’s
decision is REVERSED and REMANDED for reconsideration by the ALJ consistent with the
Court’s order as set out above.
IT IS SO ORDERED.
s/ Roseann A. Ketchmark
ROSEANN A. KETCHMARK, JUDGE
UNITED STATES DISTRICT COURT
DATED: February 11, 2026
6 The Commissioner’s other case citations are unavailing for similar reasons. And the two Eighth
Circuit cases cited by the Commissioner applied the prior framework for evaluating medical opinions
including the “treating physician rule,” and are therefore inapposite under the amended opinion-evaluation
framework set out under §§ 404.4520c and 416.920c. See Bradford v. O’Malley, 104 F.4th 1055, 1060 (8th
Cir. 2024); Perkins v. Astrue, 648 F.3d 892, 899 (8th Cir. 2011); see also Austin v. Kijakazi, 52 F.4th 723,
730 (8th Cir. 2022) (recognizing that prior caselaw considering an ALJ’s decision to credit a non-treating
physician’s opinion over a treating physician’s opinion is “legally inapposite” after the revisions to the
opinion-evaluation regulations).
7 On remand, the ALJ should adequately consider and articulate or explain both the supportability
and consistency factors as to PA-C Hendrix’s opinions as required under §§ 404.1520c(b)(2) and
416.920c(b)(2).
Case 3:25-cv-05002-RK Document 11 Filed 02/11/26 Page 9 of 9