1:24-cv-00276•Case Name in Social Security Case - Unavailable
Testo completo
1 IN THE UNITED STATES DISTRICT COURT FOR THE WESTERN DISTRICT OF NORTH CAROLINA ASHEVILLE DIVISION 1:24-cv-00276-MOC-WCM APRIL SPRINGSTON, ) ) Plaintiff, ) MEMORANDUM AND ) RECOMMENDATION v. ) ) COMMISSIONER OF THE SOCIAL ) SECURITY ADMINISTRATION, ) ) Defendant. ) _______________________________ ) This matter has been referred to the undersigned pursuant to 28 U.S.C. § 636 for the entry of a recommendation. I. Procedural Background On September 14, 2021, April Springston (“Plaintiff”) filed an application for disability insurance benefits. Transcript of the Administrative Record (“AR”) 269-276. Plaintiff alleges disability beginning August 31, 2018. Id. On April 15, 2024, following an administrative hearing at which Plaintiff appeared and testified, an Administrative Law Judge (“ALJ”) issued an unfavorable decision. AR 11-23. That decision is the Commissioner’s final decision for purposes of this action. Case 1:24-cv-00276-MOC-WCM Document 8 Filed 02/20/26 Page 1 of 11
2 II. The ALJ’s Decision The ALJ found that Plaintiff had the severe impairments of carpal tunnel syndrome, obesity, bipolar disorder, depression, and anxiety. AR 16. After determining that Plaintiff’s impairments did not meet or medically equal any of the listed impairments, the ALJ found that Plaintiff had the residual functional capacity (“RFC”): to perform medium work… except the claimant can perform frequent bilateral handling and fingering; work is limited to simple, routine, and repetitive tasks, performed in a work environment free of fast-paced production requirements (no assembly line work), involving only simple, work-related decisions, and with few, if any, work place changes; the claimant is capable of learning simple vocational tasks and completing them at an adequate pace with persistence in a vocational setting; the individual can perform simple tasks for two hour blocks of time with normal rest breaks during an eight hour work day; with only occasional interaction with the public and coworkers. AR 18. Applying this RFC, the ALJ found that Plaintiff could perform other jobs that exist in significant numbers in the national economy such that Plaintiff was not disabled. AR 22-23. III. Plaintiff’s Allegation of Error Plaintiff contends that when developing the RFC, the ALJ erred in his consideration of the opinions of Dr. Todd L. Morton, a licensed psychologist who completed a Comprehensive Clinical Psychological Evaluation of Plaintiff, Case 1:24-cv-00276-MOC-WCM Document 8 Filed 02/20/26 Page 2 of 11
3 and Dr. Joseph Malancharuvil, a Board Certified Clinical Psychologist who provided live testimony during the administrative hearing. IV. Standard of Review A claimant has the burden of proving that he or she suffers from a disability, which is defined as a medically determinable physical or mental impairment lasting at least 12 months that prevents the claimant from engaging in substantial gainful activity. 20 C.F.R. §§ 404.1505(a); 416.905(a). The regulations require the Commissioner to evaluate each claim for benefits using a five-step sequential analysis. 20 C.F.R. §§ 404.1520; 416.920. The burden rests on the claimant through the first four steps to prove disability. Monroe v. Colvin, 826 F.3d 176, 179 (4th Cir. 2016). If the claimant is successful at these steps, then the burden shifts to the Commissioner to prove at step five that the claimant can perform other work. Mascio v. Colvin, 780 F.3d 632, 635 (4th Cir. 2015); Monroe, 826 F.3d at 180. Under 42 U.S.C. § 405(g), judicial review of a final decision of the Commissioner denying disability benefits is limited to whether substantial evidence exists in the record as a whole to support the Commissioner’s findings, and whether the Commissioner’s final decision applies the proper legal standards. Hines v. Barnhart, 453 F.3d 559, 561 (4th Cir. 2006). When a federal district court reviews the Commissioner’s decision, it does not “re-weigh conflicting evidence, make credibility determinations, or substitute [its] Case 1:24-cv-00276-MOC-WCM Document 8 Filed 02/20/26 Page 3 of 11
4 judgment for that of the [Commissioner].” Craig v. Chater, 76 F.3d 585, 589 (4th Cir. 1996). Accordingly, the issue before the Court is not whether Plaintiff is disabled but, rather, whether the Commissioner’s decision that she is not disabled is supported by substantial evidence in the record and based on the correct application of the law. Id. V. Discussion An ALJ is required to consider and articulate how persuasive he or she finds each medical opinion to be, and, in doing so, to consider numerous factors including “supportability” and “consistency.” See 20 C.F.R. §§ 404.1520c(a) & (c); 416.920c(a) & (c). “Supportability is the degree to which a provider supports their opinion with relevant, objective medical evidence and explanation, and consistency is the degree to which a provider's opinion is consistent with the evidence of other medical and non-medical sources in the record.” Oakes v. Kijakazi, 70 F.4th 207, 212 (4th Cir. 2023) (citation omitted); see also Bright v. Saul, No. 1:19CV504, 2020 WL 4483008, at *3 (M.D.N.C. Aug. 4, 2020) (“Supportability is an internal check that references objective medical evidence and supporting explanations that come from the source itself. Consistency is an external check that references evidence from other medical and nonmedical sources”). Here, Dr. Morton completed a Comprehensive Clinical Psychological Evaluation of Plaintiff on May 3, 2023 and also submitted a Medical Source Case 1:24-cv-00276-MOC-WCM Document 8 Filed 02/20/26 Page 4 of 11
5 Statement (“MSS”). AR 804-811. Dr. Morton indicated that Plaintiff had marked limitations in her ability to make judgments regarding simple and complex work-related decisions, understand and remember complex instructions, carry out complex instructions, interact appropriately with supervisors and coworkers, and respond to usual work situations and changes in a routine work setting. AR 804-805. Dr. Morton also indicated that Plaintiff had an extreme limitation in her ability to interact with the public. AR 805. Dr. Morton concluded that Plaintiff would have “severe impairment in her ability to maintain her attention on a simple repetitive task for an extended period of time” and “moderate to severe impairment in her ability to maintain a pace of work that most employers require.” AR 811. Finally, Dr. Morton stated that Plaintiff had “poor coping skills due to bipolar disorder and therefore…the day-to-day stress of a full-time work week would result in significant increases in her symptoms of anxiety, mania, and paranoia.” Id. In contrast, during the administrative hearing, Dr. Malancharuvil testified that while Plaintiff had a diagnosis of bipolar disorder and posttraumatic stress disorder, Plaintiff would have “none to mild” impairment when processing information, performing activities of daily living, or following simple instructions. AR 37. Additionally, Dr. Malancharuvil opined that Plaintiff would have mild to moderate limitations in social functioning; concentrating, persisting, or maintaining pace; and adapting to work or a Case 1:24-cv-00276-MOC-WCM Document 8 Filed 02/20/26 Page 5 of 11
6 work-like setting. Id. When asked about Dr. Morton’s opinion, Dr. Malancharuvil testified that he did not believe the limitations identified by Dr. Morton were consistent with Plaintiff’s mental status or the “overall picture of the claimant’s mental functions.” AR 38. In support of that view, Dr. Malancharuvil referenced specific treatment records which he characterized as reflecting Plaintiff’s “essentially functional” and “essentially intact” mental status. AR 40. The ALJ found that Dr. Morton’s opinion was “not persuasive at all with the totality of the evidence” and stated: As [Dr. Malancharuvil] discussed, the claimant’s mental status examinations throughout most of the record [have] shown normal mental status examinations. [Dr. Malancharuvil] found Dr. Morton’s conclusions not to be warranted by the overall medical evidence; [Dr. Morton] gave [Plaintiff] marked limitations which are not warranted in social interaction. [Plaintiff] has a functional mental status per Exhibit 1F/4). [Plaintiff] also has intact mental functioning at Exhibit 2F/5 and 3F/7. [Plaintiff] was manic and sleepless for 3 days when she said she had mania; however, she tested positive for PCP at the time and marijuana. [Plaintiff] has also shown functional mental capacity at 7F/6 and was mentally intact at 8F/8. (Testimony). AR 21. Significantly, in discussing the persuasiveness of Dr. Morton’s opinions, the ALJ cited the same medical records that Dr. Malancharuvil cited during the administrative hearing, and it appears that the ALJ discounted Dr. Case 1:24-cv-00276-MOC-WCM Document 8 Filed 02/20/26 Page 6 of 11
7 Morton’s opinions based primarily (if not completely) on Dr. Malancharuvil’s testimony, which the ALJ found to be “overall persuasive” and “consistent with the totality of the medical evidence.” AR 21. However, although the records cited by Dr. Malancharuvil include some normal findings with respect to Plaintiff’s mental status, those same records also include abnormal findings. See e.g., AR 39, AR 492-494 (December 17, 2018 treatment note listing Plaintiff’s “total depression screen score” as “critical” and recording Plaintiff’s mood as “dysthymic, anxious,” her affect as “constricted” and nearly tearful, and indicating that Plaintiff was “distractible”); AR 610 (September 13, 2021 treatment note indicating that Plaintiff was oriented to situation, time, place, and person; exhibited normal attention and concentrating ability; and was alert with intact memory; also reflecting Plaintiff’s apathetic mood and constricted affect); see also AR 641, 644, 653, 669 (treatment notes reflecting Plaintiff’s apathetic or labile mood and constricted, flat, or sullen affect); AR 773 (January 4, 2022 treatment note indicating that Plaintiff’s speech, affect, and thought context were unremarkable, and that she was oriented to person and place with normal memory and normal judgment and insight but that her thought progression was disorganized). Further, some of these same records include recommendations for more intense mental health treatment. See AR 610 (September 13, 2021 treatment Case 1:24-cv-00276-MOC-WCM Document 8 Filed 02/20/26 Page 7 of 11
8 note that includes the assessment that Plaintiff was “[s]trongly encouraged to consider hospitalization and talk to her husband about it, [due to] poor self care, prolonged severe depression”); AR 774-775 (January 4, 2022 treatment note recommending that Plaintiff meet with mobile crisis to assist with transfer to in-patient hospitalization). It is not apparent that either Dr. Malancharuvil or the ALJ considered information contained in the treatment notes cited by Dr. Malancharuvil that is arguably inconsistent with Dr. Malancharuvil’s opinion (and in turn the ALJ’s opinion) that Plaintiff’s mental status was essentially functional or intact. Additionally, as Plaintiff points out, other medical records indicate that Plaintiff exhibited abnormalities on mental status exams. See e.g., Doc. 5 at 9 (citing, inter alia, AR 503 (December 12, 2018 treatment note reflecting Plaintiff’s mood as depressed and anxious and affect as “tearful, at other times, incongruent, laughs at times,” and that Plaintiff was distractible and that her memory was impaired); AR 534-535 (October 26, 2018 treatment note reflecting that Plaintiff exhibited rapid speech, a “depressed, mixed, hypomanic, labile, anxious” mood, that her affect was tearful, anxious, and “laughing at other times,” that her thought process was highly circumstantial, and that she had an impaired memory, lack of insight, and moderate impairment in her judgment)). Case 1:24-cv-00276-MOC-WCM Document 8 Filed 02/20/26 Page 8 of 11
9 “[T]he substantial evidence standard ‘presupposes ... a zone of choice within which the decisionmakers can go either way, without interference by the courts. An administrative decision is not subject to reversal merely because substantial evidence would have supported an opposite decision.’” Dunn v. Colvin, 607 F. App’x 264, 274 (4th Cir. 2015) (quoting Clarke v. Bowen, 843 F.2d 271, 272-73 (8th Cir. 1988)). At the same time, “[a]n ALJ has the obligation to consider all relevant medical evidence and cannot simply cherrypick facts that support a finding of nondisability while ignoring evidence that points to a disability finding.” Lewis v. Berryhill, 858 F.3d 858, 869-70 (4th Cir. 2017) (remand appropriate because the same medical records that contained the “normal” findings relied upon by the ALJ also included notations that plaintiff presented with constant pain and was given a steroid injection); see also Arakas v. Comm’r, Social Security Admin., 983 F.3d 83, 99 (4th Cir. 2020) (vacating ALJ's decision where ALJ cherry picked certain facts and misstated and mischaracterized other material facts). In sum, when weighing the evidence, the ALJ cannot ignore material evidence that is contrary to his or her decision. Here, the ALJ cited evidence that supported his conclusion, but did not acknowledge or discuss seemingly contrary information, even though such information appeared in some of the treatment records upon which the ALJ relied. See Jennifer B. v. O'Malley, No. 2:23-CV-00503, 2024 WL 4248782, at Case 1:24-cv-00276-MOC-WCM Document 8 Filed 02/20/26 Page 9 of 11
10 *9 (S.D.W. Va. Aug. 27, 2024), report and recommendation adopted sub nom., Baisden v. O'Malley, No. 2:23-CV-00503, 2024 WL 4245445 (S.D.W. Va. Sept. 19, 2024) (“the ALJ's selective reliance upon periodically ‘normal’ examination findings without a fulsome discussion of conflicting evidence is particularly concerning because it arises in the context of mental-health impairments— including a diagnosis of recurring depressive episodes. The Fourth Circuit has expressly stated that mental impairments tend to be characterized by waxing and waning symptoms—and an ALJ is obligated to consider the effect of a claimant's mental-health impairments over time in a sustained, full-time work environment.”) (citing Testamark v. Berryhill, 736 F. App'x 395, 398 (4th Cir. 2018)). VI. Recommendation The undersigned therefore RESPECTFULLY RECOMMENDS that the Commissioner’s decision be VACATED, and that this matter be REMANDED for further administrative proceedings. Signed: February 20, 2026 Case 1:24-cv-00276-MOC-WCM Document 8 Filed 02/20/26 Page 10 of 11
11 Time for Objections The parties are hereby advised that, pursuant to Title 28, United States Code, Section 636, and Federal Rule of Civil Procedure 72(b)(2), written objections to the findings of fact, conclusions of law, and recommendation contained herein must be filed within fourteen (14) days of service of same. Responses to the objections must be filed within fourteen (14) days of service of the objections. Failure to file objections to this Memorandum and Recommendation with the presiding District Judge will preclude the parties from raising such objections on appeal. See Thomas v. Arn, 474 U.S. 140, 140 (1985); United States v. Schronce, 727 F.2d 91, 94 (4th Cir. 1984). Case 1:24-cv-00276-MOC-WCM Document 8 Filed 02/20/26 Page 11 of 11
Ti chiedi come si applica questo testo alla tua situazione?
Consulenza gratuita, senza impegno
Descrivi la tua situazione. Il nostro team ti ricontatterà via e-mail per la tua consulenza.
Continua la tua ricerca in ChatGPT o Claude
Collega Omnilex per cercare nel corpus legale dal tuo assistente IA.