Adame v. Bisignano

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IN THE UNITED STATES DISTRICT COURT
FOR THE SOUTHERN DISTRICT OF TEXAS
BROWNSVILLE DIVISION
ENRIQUE A. JR., 	§
Plaintiff, 	§
§
v. 	§ 	CIVIL ACTION NO. 1:25-cv-122
§
FRANK BISIGNANO, 	§
Commissioner of Social Security, 	§
Defendant. 	§
REPORT AND RECOMMENDATION
IN SUPPORT OF REVERSING THE COMMISSIONER’S DECISION AND
REMANDING TO SOCIAL SECURITY ADMINISTRATION
I. 	Synopsis
Enrique A. Jr. applied for social security benefits, claiming mental impairments keep
him from working. His benefits were denied and he filed this appeal. He claims the
Administrative Law Judge (“ALJ”) failed to supportability factors when deciding the
persuasiveness of his treating psychotherapist’s medical opinion. The issue before the
Court is whether the ALJ’s findings are supported by substantial evidence. This Court finds
they are not. For this reason, it is recommended that the Court remand this case to the
Social Security Administration for further consideration.
II. 	Jurisdiction
This Court retains jurisdiction pursuant to 42 U.S.C. § 405(g) to review a final
decision of the Commissioner for social security disability insurance claims arising under
Title II of the Social Security Act, 42 U.S.C. § 421. This Court retains jurisdiction pursuant
to 42 U.S.C. 1383(c) to review a final decision of the Commissioner for supplemental
security income claims arising under Title XVI of the Social Security Act. Venue is
appropriate because Enrique A. Jr. resides in Cameron County, Texas. Dkt. No. 1 at 1; Dkt.
No. 8-6 at 3; 42 U.S.C. § 405(g); 28 U.S.C. § 124(b)(6).
United States District Court
Southern District of Texas
ENTERED
April 06, 2026
Nathan Ochsner, Clerk
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III. 	Standard of Review
The Court’s review of the Commissioner’s decision is limited to determining
whether the decision was supported by substantial evidence and whether the relevant legal
standards were applied in reaching this decision. Anthony v. Sullivan, 954 F.2d 289, 292
(5th Cir. 1992). Substantial evidence is that which is relevant and sufficient for a reasonable
mind to accept as adequate to support a conclusion. Spellman v. Shalala, 1 F.3d 357, 360
(5th Cir. 1993) (citing Richardson v. Perales, 402 U.S. 389, 401 (1971)). Substantial
evidence is more than a mere scintilla, but less than a preponderance. Moore v. Sullivan,
919 F.2d 901, 904 (5th Cir. 1990).
“Under the substantial-evidence standard, a court looks to an existing administrative
record and asks whether it contains ‘sufficient evidence’ to support the agency’s factual
determinations.” Biestek v. Berryhill, 139 S. Ct. 1148, 1154 (2019). When applying the
substantial evidence standard, a court does not “reweigh the evidence in the record, not try
the issues de novo, nor substitute [its] judgment for that of the [Commissioner’s].” Johnson
v. Bowen, 864 F.2d 340, 343 (5th Cir. 1988). “Conflicts within the evidence are not for the
court to resolve.” Selders v. Sullivan, 914 F.2d 614, 617 (5th Cir. 1990). The ALJ’s
decision must stand or fall on the rationale set forth in the ALJ’s opinion. Newton v. Apfel,
209 F.3d 455, 458 (5th Cir. 2000). If the Commissioner’s findings use the relevant legal
standards and are supported by substantial evidence, the findings are conclusive and so
must be affirmed. 42 U.S.C. § 405(g); Brown v. Apfel, 192 F.3d 492, 496 (5th Cir. 1999).
IV. 	Disability Determination Process
Title II of the Social Security Act provides benefits to individuals with a disability.
42 U.S.C. § 423(d)(1)(A); Heckler v. Campbell, 461 U.S. 458, 459-61 (1983). The Social
Security Act defines disability as “the inability to engage in any substantial gainful activity
by reason of any medically determinable physical or mental impairment which can be
expected to result in death, or which has lasted or can be expected to last for a continuous
period of not less than 12 months.” Id.
A claimant is not entitled to benefits under Titles II and XVI of the Social Security
Act unless they are disabled as defined by the Act. 42 U.S.C. 423(d)(1)(A); Heckler v.
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Campbell, 461 U.S. 458, 459-61 (1983). The law and implementing regulations governing
benefits under both Titles, broadly known as Social Security Disability Insurance and
Supplemental Security Income are consistent with one another. Barnhart v. Thomas, 540
U.S. 20, 24 (2003); Greenspan v. Shalala, 38 F. 3d 232, 236 (5th Cir. 1994).
A claimant seeking Social Security benefits bears the burden of proving a disability
as defined by the Social Security Act, 20 C.F.R. § 416.920(a)(4). A claimant satisfies that
burden, when he or she demonstrates a physical or mental impairment which lasts at least
twelve months and precludes that person from pursuing any substantial gainful activity. 20
C.F.R. § 416.920(a)(4)(ii). Once the claimant proves disability as defined by the Social
Security Act, the administrative law judge utilizes a five-step sequential process to
determine whether the claimant can perform substantial gainful activity. This five-step
process is set forth in 20 C.F.R. §§ 404.1520(b)-(f), 416.920(b)-(f). If an individual is found
disabled at any point in the sequential review, further inquiry is unnecessary as the person
is entitled to benefits. 20 C.F.R. §§ 404.1520(a), 416.920(a). The initial burden of proof
lies with the claimant in the first four steps and the burden shifts to the Commissioner at
the fifth step. Bowling v. Shalala, 36 F.3 rd 431, 435 (5th Cir. 1994). The steps are as follows:
1. 	At step one, the claimant must not be presently working at any substantial gainful
activity, or work activity involving the use of significant physical or mental abilities
for pay or profit. 20 C.F.R. §§ 404.1527, 416.972.
2. 	At step two, the claimant must have a severe impairment or a severe combination
of impairments. 20 C.F.R. §§ 404.1520(c), 416.920(c); Stone v. Heckler, 752 F.2d
1099, 1101 (5th Cir. 1985), cited in Loza v. Apfel, 219 F.3d 378, 392 (5th Cir. 2000).
3. 	At step three, disability will be found if the impairment or combination of
impairments meets or equals an impairment listed in the Listing of Impairments, 20
C.F.R. Pt. 404, Subpt. P, App. 1. 20 C.F.R. §§ 404.1520(d), 416.920(d).
4. 	At step four, the impairment or impairments must prevent the claimant from
returning to past relevant work. 20 C.F.R. §§ 404.1520(e), 416.920(e).
5. 	At step five, if the claimant’s impairment prevents past work, the ALJ considers the
claimant's residual functional capacity, age, education, and past work experience to
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determine if any other work can be performed. 20 C.F.R. § § 404.1520(f),
416.920(f); Crowley v. Apfel, 197 F.3d 194, 197-98 (5th Cir. 1999).
Residual functioning capacity, which is determined between the third and fourth
steps, “is an administrative assessment of the extent to which an individual’s medically
determinable impairment(s), including any related symptoms, such as pain, may cause
physical or mental limitations or restrictions that may affect his or her capacity to do work-
related physical and mental activities.” Irby v. Barnhart, 180 Fed. App’x 491, 493 (5th Cir.
2006) (unpub.) (citing Social Security Ruling (“SSR”) 96-8p).1
When a mental impairment is present, the ALJ must “first evaluate [claimant’s]
pertinent symptoms, signs, and laboratory findings to determine whether [claimant has] a
medically determinable mental impairment.” 20 C.F.R. § 404.1520a(b)(1); See also 20
C.F.R. § 404.1520a; Boyd v. Apfel, 239 F.3d 698, 705 (5th Cir. 2001) (determining merits
of mental disability claims). If the ALJ determines that the claimant has a medically
determinable mental impairment, then the ALJ must use a special technique to evaluate the
severity of the impairment. To do so, the ALJ evaluates the degree of functional limitation
resulting from the impairment in four separate areas deemed essential for work: (1)
understand, remember, or apply information; (2) interact with others; (3) concentrate,
persist, or maintain pace; and (4) adapt or manage oneself. 20 C.F.R. §§ 404.1520a(b)(2)–
(c)(4). These limitations can be rated “none, mild, moderate, marked, [or] extreme.” 20
C.F.R. § 416.920a(c)(4).
If the degree of functional limitation is “none” or “mild” in each of the four areas,
the ALJ must find the impairment “not severe,” which generally concludes the analysis
and terminates the proceedings. 20 C.F.R. § 404.1520a(d)(1). If the mental impairment is
“severe,” under §§ 404.1520a(c)(4) and (d)(1)(2), the ALJ must then determine if it meets
or equals a listed mental disorder under Appendix 1. See 20 C.F.R. § 404.1520a(d)(2). If
the impairment is severe but does not reach the level of a listed disorder, then the ALJ must
1 “The Social Security Administration’s rulings are not binding on this court, but they may be consulted
when the statute at issue provides little guidance. The Fifth Circuit has frequently relied upon the rulings
in evaluating ALJ’s decisions.” Myers v. Apfel, 238 F.3d 617, 620 (5th Cir. 2001).
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conduct the RFC assessment as outlined above in step five. 20 C.F.R. § 404.1520a(d)(3).
V. 	Background
a. 	Administrative Procedural History
Enrique A. Jr. filed for disability insurance benefits and supplemental security
income on January 6, 2021, alleging a disability onset date of July 25, 2019. Dkt. No. 8-4
at 2. These applications were initially denied on September 13, 2021. Dkt. No. 8-5 at 2, 7.
They were denied again upon reconsideration on September 29, 2022. Dkt. No. 8-5 at 19,
25. Thereafter, Enrique A. Jr. filed a written request for a hearing before an ALJ. Dkt. No.
8-5 at 29. Enrique A. Jr.’s request was granted, and a hearing before ALJ Hiral Patel was
held telephonically on June 5, 2023.2 Dkt. No. 8-3. The ALJ issued an unfavorable decision
on July 3, 2023, finding Enrique A. Jr. was not disabled within the meaning of the relevant
legal standards and denying both disability insurance benefits and supplemental security
income. Dkt. No. 8-4 at 46, 65.
This negative decision was appealed, and the Appeals Council remanded the case
to the same ALJ for a new hearing. Dkt. No. 8-4 at 71. The second hearing was held on
April 29, 2024. Dkt. No. 8-3 at 89. The ALJ issued an unfavorable decision on May 29,
2024, again finding that Enrique A. Jr. was not disabled within the meaning of the relevant
legal standards and denying both disability insurance benefits and supplemental security
income. Dkt. No. 8-3 at 25, 49. Enrique A. Jr. again requested the Appeals Council either
reverse the ALJ’s decision or remand the case to a different ALJ. Dkt. No. 8-7 at 148. The
Appeals Council denied further review. Dkt. No. 8-3 at 10. The ALJ’s May 2024 decision
represents the final determination of the Commissioner and is ripe for judicial review.3
On June 13, 2025, Enrique A. Jr. initiated this action challenging the denial of
benefits and seeking reversal of the Commissioner’s decision. Dkt. No. 1.
2 The full transcript of this administrative proceeding is available at Docket Number 8-1, pages 33-58.
3 When the Appeals Council declines review of the Administrative Law Judge’s decision, the decision of
the ALJ constitutes the final decision of the Commissioner, and the ALJ’s factual findings and legal
conclusions are imputed to the Commissioner. See Higginbotham v. Barnhart, 405 F.3d 332, 336 (5th Cir.
2005).
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b. Factual History
Enrique A. Jr. was approximately 34 years-old at the time of his alleged disability
onset date. Dkt. No. 8-3 at 47. He claims his current disability status stems from depressive,
bipolar, and related disorders. Dkt. No. 8-4 at 3. He also claims problems with his back. Id.
His employment history reflects work experience as a meat clerk, store laborer, fast food
worker, jailer, home attendant, and salesclerk. Dkt. No. 8-3 at 46. Enrique A. Jr. claims he
stopped working because of his listed conditions, including incidents where he could not
get along with coworkers. Dkt. No. 8-3 at 79-80.
i. 	First Hearing Testimony
In the first hearing before the ALJ, Enrique A. Jr. testified to several difficulties
associated with his mental health. He testified to experiencing disassociation and qualified
this as a symptom resulting from his mental health disorders which prevents him from
working. 	Dkt. 	No. 	8-3 	at 	68. 	He 	also 	explained 	that 	he 	experiences 	episodes 	of
disassociation which also led to panic attacks. Dkt. No. 8-3 at 68. In regard to his memory,
he stated his “memory is not okay[,]” describing difficulty completing tasks and forgetting
tasks he already compled as well as difficulty remembering to take his medicine. Dkt. No.
8-3 at 71. He also testified to experiencing problems with understanding instructions. Dkt.
No. 8-3 at 71.
He described antisocial behavior, stating he doesn’t socialize or attend social
gatherings. Dkt. No. 8-3 at 72. He testified to issues with his personal hygiene, finding
bathing “very hard.” Dkt. No. 8-3 at 74. He stated he does not complete any household
chores. Dkt. No. 8-3 at 74. He testified to “sporadic” alcohol use and prior use of cocaine.
Dkt. No. 8-3 at 76. He stated that while he worked for his cousin, he would just complete
tasks like taking out the trash and organizing things in the back yard. Dkt. No. 8-3 at 77.
He elaborated on his difficulties collaborating with coworkers, describing two
incidents where he got aggressive with a coworker. Dkt. No. 8-3 at 79-80. He testified that
his condition also causes him to be absent from work frequently. Dkt. No. 81. He testified
that he does not take care of his two kids. Dkt. No. 8-3 at 82. He stated that for three years
he had a psychotherapy appointment once a week with Dr. Flowers though he missed some
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appointments. Dkt. No. 8-3 at 84.
Vocational expert (“VE”), Dr. Julia Gutierrez, also testified at the review hearing.
VE Gutierrez answered hypothetical questions about limitations of an individual of Enrique
A. Jr.’s age, education, and work experience. Dkt. No. 8-3 at 85-87. Applying the
limitations proposed by the ALJ in which the individual would be off task at least 15
percent of the workday and would be absent two or more days a month, VE Gutierrez found
that these limitations would preclude competitive employment. Dkt. No. 8-3 at 79-80.
ii. 	Second Hearing Testimony
In the second hearing before the ALJ, Enrique A. Jr. testified that his living situation
had changed, now living with his mother, and his mother provided him with help and
support to take care of himself. Dkt. No. 8-3 at 97. He also testified to more severe
difficulties with his personal hygiene and depressive symptoms, stating he “can’t function.
. . can’t get out of bed.” Dkt. No. 8-3 at 98. He testified to seeing and hearing “things” that
talk to him but no one else sees. Dkt. No. 8-3 at 98. He stated that he experiences this even
when he takes his medication. He also testified to being diagnosed as bipolar with
psychosis as well as “schizoaffective.” Dkt. No. 8-3 at 98. He stated that he has to be
remined to take his medication. Dkt. No. 8-3 at 99.
He testified to experiencing suicidal tendencies every day. Dkt. No. 8-3 at 100. In
the time between the two hearings, he testified to a suicide attempt for which he was
arrested, sent to county jail, and then admitted into a psychiatric hospital. Dkt. No. 8-3 at
100. He testified starting a training for working with road construction but only did so for
eight days before being fired for having an altercation with his manager. Dkt. No. 8-3 at
102. He stated he was not focused on his job duties because he was seeing things. Dkt. No.
8-3 at 102. He testified to a worsening memory, stating he leaves appliances on and that he
doesn’t do any cooking or cleaning. Dkt. No. 8-3 at 102-103. He testified again to antisocial
behavior and staying away from his family. Dkt. No. 8-3 at 104.
Vocational expert (“VE”), Guillermo Pena, also testified at the review hearing. VE
Pena answered hypothetical questions about limitations of an individual of Enrique A. Jr.’s
age, education, and work experience. Dkt. No. 8-3 at 85-87. Applying the limitations
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proposed by the ALJ in which the individual would be off task at least 15 percent of the
workday and would be absent two or more days a month, VE Pena found that these
limitations would preclude competitive employment. Dkt. No. 8-3 at 87.
iii. 	Medical Evidence – State Agency Psychological Consultants
As a part of the disability determination process, state agency consultants reviewed
Enrique A. Jr.’s medical records covering mental health concerns. Dkt. No. 8-4 at 4.
At the initial level, the state agency consultant found him to have the following
medically 	determinable 	impairments, 	“Depressive, 	Bipolar, 	and 	Related 	Disorders”
marking them as severe. Dkt. No. 8-4 at 6. The state agency consultant found the following
mental limitations to be at a moderation level: understand, remember, or apply information;
interact with others; concentrate, persist, or maintain pace; adapt or manage oneself. Dkt.
No. 8-4 at 6. Concerning the Mental Residual Functioning Capacity (MRFC), the state
agency consultant at the initial level found Enrique A. Jr. able to understand, remember,
carry out only simple instructions; make simple decisions and concentrate for extended
periods; interact adequately with co-workers and supervisors; and respond appropriately to
changes in routine work settings. Dkt. No. 8-4 at 10.
At the reconsideration level, the state agency consultant found Enrique A. Jr. to have
the following medically determinable impairments, “Depressive, Bipolar, and Related
Disorders” marking them as severe. Dkt. No. 8-4 at 27. The state agency consultant found
the following mental limitations to be at a mild level: understand, remember, or apply
information; the following mental limitations to be at a moderate level: interact with others;
concentrate, persist, or maintain pace; adapt or manage oneself. Dkt. No. 8-4 at 27.
Concerning 	the 	Mental 	Residual 	Functioning 	Capacity 	(MRFC), 	the 	state 	agency
consultant at the reconsideration level found Enrique A. Jr. able to understand, remember,
carry out detailed but not complex instructions; make decisions; attend and concentrate for
extended periods with occasional difficulty; accept instructions; respond appropriately to
changes in routine work setting. The state agency consultant at the reconsideration level
also added that Enrique A. Jr. would work best with occasional contact with the public,
coworkers, and supervisors and that Enrique A. Jr. would need assistance with goal setting.
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Dkt. No. 8-4 at 32.
iv. 	Third Party Function Report
Enrique A. Jr.’s former fiancée filed a function report to describe “how the disabled
person’s illnesses, injuries, or conditions limit his/her activities.” Dkt. No. 8-7 at 3. She
stated that he has “major depression, anxiety, PTSD . . . has social anxiety, gets easily
annoyed, frustrated and is short-tempered.” Dkt. No. 8-7 at 3. She stated that he does not
take care of their daughters except “light work – feeding them.” Dkt. No. 8-7 at 7. She
states she does everything for their daughters. Dkt. No. 8-7 at 7. She also stated that he
does not prepare his own meals. Dkt. No. 8-7 at 8. She states that he cannot go out alone
because he will get distracted and the task won’t get done. Dkt. No. 8-7 at 9. She also states
that if he does the shopping he will not take more than 30 minutes because of social anxiety.
Dkt. No. 8-7 at 9. She states he has problems getting along with family, friends, neighbors,
and others. Dkt. No. 8-7 at 11.
v. 	Dr. Flowers’s Report
On October 4, 2021, Dr. Flowers, Enrique A. Jr.’s psychotherapist, filed a “Medical
Statement and Functional Assessment.” Dkt. No. 8-9 at 574-582.4 Dr. Flowers identified
the following conditions for which she provided Enrique A. Jr. with treatment: General
Anxiety Disorder; Major Depressive Disorder; and Posttraumatic Stress Disorder. Dkt. No.
8-9 at 574. Dr. Flowers described the treatment she provided to Enrique A. Jr. as
medication and psychotherapy. Dkt. No. 8-9 at 574. She provided a prognosis of “good.”
Dkt. No. 8-9 at 574. Next, she described the following general effects of the conditions,
which 	include 	intrusive 	thoughts, 	insomnia, 	poor 	concentration, 	irritability, 	and
distractibility. Dkt. No. 8-9 at 574.
Dr. Flowers opined that if Enrique A. Jr. returned to any type of full-time
employment, he would be absent for more than 5 days a month due to his disability. Dkt.
No. 8-9 at 575. Dr. Flowers also opined that Enrique A. Jr.’s disabling conditions or the
treatment for these conditions would cause his productivity to be affected such that he
4 Although the record contains many of Dr. Flower’s medical notes on Enrique A. Jr., this medical
report is the report which the ALJ refers to and finds unpersuasive in his opinion. Dkt. No. 8-3 at 45.
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would be expected to be off task from work on average of more than 15% of a normal work
day should he attempt to return to any type of full time employment. Dkt. No. 8-9 at 575.
Dr. Flowers opined that Enrique A. Jr. suffers from an extreme limitation of one, or
marked limitation of two, in the following areas of mental functioning concerning
depressive, bipolar and related disorders; anxiety and/or obsessive-compulsive disorders;
and trauma and/or stressor related disorders: understanding, remembering or applying
information; interacting with others; concentrating, persisting or maintaining peace; and
adapting or managing oneself. Dkt. No. 8-9 at 576, 577, 578. Dr. Flowers also opined that
in regard to those three disorders, Enrique A. Jr. suffers from the disorders which are
serious and persistent, or that Enrique A. Jr. has a medically documented history of the
existence of the disorder over a period of at least 2 years, and there is evidence of both:
medical treatment, mental health therapy, and that Enrique A. Jr. has minimal capacity to
adopt to changes in his environment. Dkt. No. 8-9 at 576, 577, 579.
Dr. Flowers indicated that for most of the stated work limitations related to
psychiatric state, Enrique A. Jr.’s ability would be markedly impaired. Dkt. No. 8-9 at 580-
81.
c. 	Commissioner’s Decision
Using 	the 	Social 	Security 	Administration’s 	established 	five-step 	sequential
evaluation 	process 	for 	determining 	whether 	an 	individual 	is 	disabled 	under 	20
C.F.R.§404.1520(a), the ALJ determined Enrique A. Jr. is not disabled. Dkt. No. 8-3 at 28-
49.
At step one, the ALJ found that Enrique A. Jr. met the insured status requirements
of the Social Security Act through June 30, 2024. Dkt. No. 8-3 at 30. The ALJ also found
that Enrique A. Jr. did not engage in substantial gainful activity since her alleged disability
onset date, January 4, 2020. Id.
At step two, the ALJ noted the following mental severe impairments: major
depressive disorder, generalized anxiety disorder, posttraumatic stress disorder (PTSD),
and borderline personality disorder. Dkt. No. 8-3 at 31.
At step three, the ALJ found Enrique A. Jr.’s mental impairments, considered singly
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and in combination, do not meet or medically equal the criteria of listings 12.04, 12.06,
12.08, and 12.15. Dkt. No. 8-3 at 31.
At step four, the ALJ found Enrique A. Jr. is unable to perform any past relevant
work. Dkt. No. 8-3 at 46.
At step five, the ALJ found that Enrique A. Jr.’s RFC allows him “to perform light
work as defined in 20 CFR 404.1567(b) and 416.967(b) except the claimant can frequently
balance, stoop, kneel, crouch, crawl, and climb ramps and stairs and occasionally climb
ladders, 	ropes, 	or 	scaffolds; 	he 	can 	understand, 	remember, 	and 	carry 	out 	simple
instructions; the claimant can occasionally interact with supervisors and coworkers and
never with the public; he can deal with occasional changes in a routine work setting; and
the claimant can make simple work-related decisions.” Dkt. No. 8-3 at 33. The ALJ
determined that Enrique A. Jr.’s “medically determinable impairments could reasonably
be expected to cause some of the alleged symptoms; however, the claimant’s statements
concerning the intensity, persistence and limiting effects of these symptoms are not entirely
consistent with the medical evidence of record.” Dkt. No. 8-3 at 34.
Specific to the issue before the Court, as to Enrique A. Jr.’s mental impairments, the
ALJ found the claimant’s reports, testimony, and the objective medical evidence indicate
that he maintains the ability to perform sedentary work with the limitations set forth in the
claimant’s residual functional capacity. Dkt. No. 8-3 at 45.
The ALJ found the opinion of Dr. Flowers, the state agency consultant at the initial
level, the agency consultant at the reconsideration level, and that of his former fiancée
unpersuasive. Dkt. No. 8-3 at 45-46.
VI. 	Analysis
a. 	Statement of Issues
The specific issue raised on appeal by Enrique A. Jr. is that the ALJ failed to
properly evaluate the medical opinion of his treating psychotherapist, Dr. Jasmine Flowers.
Enrique A. Jr. argues: “The ALJ failed to consider the supportability factor when deciding
the persuasiveness of treating psychotherapist Dr. Flowers’s medical opinion, and the
ALJ’s consistency finding was not supported by substantial evidence.” Dkt. No. 11 at 19.
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In response, the Commissioner contends the ALJ sufficiently found Dr. Flowers’s opinion
unpersuasive and explained how he considered the requisite factors of supportability and
consistency. Dkt. No. 19 at 3.
b. Court’s Findings
The Court finds it cannot determine that substantial evidence supported the ALJ’s
finding that Enrique A. Jr. is not disabled within the meaning of the Social Security Act.
The ALJ erred in rejecting the medical opinion of Dr. Flowers without analyzing the
supportability and consistency of the opinion.
An ALJ is required to consider the persuasiveness of medical opinions. 20 C.F.R. §
404.1520c(b). In determining the persuasiveness of the medical opinion, the ALJ considers
five factors: (1) supportability; (2) consistency; (3) the source’s relationship with the
claimant; (4) the source’s specialty and (5) other factors including the source’s familiarity
with other evidence in the claim, including whether the source considered new evidence
received after the source made the medical opinion. 20 C.F.R. § 404.1520c(c). The most
important factors in evaluating persuasiveness of a medical opinion are supportability and
consistency. 20 C.F.R. § 404.1520c(b)(2). An ALJ is required to explain how she
considered the supportability and consistency factors for a medical source opinion. Id.
Further, the ALJ “must provide the Court with an ‘adequate discussion’ of his
reasons for finding a particular medical opinion to be persuasive or unpersuasive.”
Cooley v. Comm'r of Soc. Sec., 587 F. Supp. 3d 489, 499 (S.D. Miss. 2021).
The measuring stick for an “adequate discussion” is whether the ALJ's
persuasiveness explanation enables the court to undertake a meaningful
review of whether his finding with regard to the particular medical opinion
was supported by substantial evidence, . . . and does not require the Court to
merely speculate about the reasons behind the ALJ's persuasiveness finding
or lack thereof . . . .
Id.
The ALJ found the medical opinion of Jasmine Flowers, Ph. D. issued on October
4, 2021, unpersuasive. Dkt. No. 8-3 at 45. The ALJ provides two reasons for this
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conclusion: First, the ALJ considers Dr. Flowers’s opinion to overstate the claimant’s
mental limitations and is inconsistent with the evidence of record. Id. Second, the ALJ
refers to the lack of exam findings or an explanation in the report. Id. From this, the Court
cannot discern how the ALJ considered the “supportability” of medical record evidence,
such as the other notes provided by Dr. Flowers and Enrique A. Jr.’s own testimony at the
two hearings. Cooley v. Comm'r of Soc. Sec., 587 F. Supp. at 500.
Although the ALJ states Dr. Flowers’s opinion is inconsistent with the evidence of
record, the ALJ makes no reference to the several other documented notes from Dr.
Flowers included in the record. These omitted psychotherapy notes support Dr. Flowers’s
assessment and opinion given on October 4, 2021. See Loza v. Apfel, 219 F.3d 378, 394
(5th Cir. 2000) (stating “the ALJ must consider all the record evidence and cannot ‘pick
and choose’ only the evidence that supports his position.”). Additionally, the ALJ did not
analyze the objective medical evidence supporting Dr. Flowers’s finding that Enrique A.
Jr. would miss more than five days of work per month and would have marked impairments
in most areas of mental functionality. Given that the ALJ omitted consideration of these
notes, objective medical evidence which supports Dr. Flowers’s opinion, “the Court is left
unable to meaningfully review the ALJ's explanation as it relates to supportability.” Miles
v. Kijakazi, 2025 WL 39790, at *12 (E.D. La. Jan. 7, 2025) (concluding the same based on
ALJ’s omission to psychotherapy notes upon evaluation of doctor’s medical opinion).
Further, although the ALJ the describes other evidence in the record, the ALJ does
not seem to consider evidence in the record as a whole. In its entirety, the record includes
several notes and reports on Enrique A. Jr.’s mental health and conditions which show
Enrique A. Jr.’s treatment with Dr. Flowers. But the ALJ did not provide any detail about
how Dr. Flowers’s medical opinion was wholly inconsistent with the entre record. Cooley,
587 F. Supp. 3d at 499. Given this, it is unclear to the Court how the ALJ found Dr.
Flowers’s opinion wholly inconsistent with the entire record. Id. For this reason, it is
unclear to the Court how Dr. Flowers’s medical opinion lacked any consistency with the
record as a whole. Id. This obscurity leaves a gap in the ALJ’s discussion of Dr. Flowers’s
medical opinion, which leaves the Court unable to build a logic bridge between the
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evidence of the ALJ’s finding. Id. The absence of the logic bridge means the Court cannot
review whether the ALJ’s finding is supported by substantial evidence.
A proper analysis of Dr. Flowers’s opinion, as opposed to discounting Dr. Flowers’s
conclusions 	because 	other 	evidence 	in 	the 	record 	in 	part 	shows 	otherwise, 	could
conceivably have included the limitation requiring Enrique A. Jr. to miss work for more
than five days per month alongside the effects of having marked impairments in most areas
of mental functionality. In fact, the VE at each hearing found that an individual off task at
least 15 percent of the workday absent two or more days a month would be precluded from
finding competitive employment. Considering this, it is possible that if the ALJ had
properly considered Dr. Flowers’s medical opinion by analyzing the objective medical
evidence which supported it, the ALJ’s mental RFC determination could have been
different. For this reason, the ALJ’s failure to provide a proper supportability analysis of
the medical opinion is prejudicial.
In reviewing the ALJ’s persuasiveness determination, a court looks for a sufficient
explanation of consistency and supportability to allow a court to undertake a meaningful
review of whether the reasoning is supported by substantial evidence. Ramirez v. Saul, No.
SA-20-CV-00457-ESC, 2021 WL 2269473, at *6 (W.D. Tex. June 3, 2021). However, a
point-by-point discussion of every opinion review is not always required. Silva v. Kijakazi,
No. 22-51045, 2023 WL 3723628, at *1 (5th Cir. May 30, 2023) (citing Audler v. Astrue,
501 F.3d 446, 448 (5th Cir. 2007). “Generally, there are no formalistic rules governing how
an ALJ must articulate his decision.” Hubbard v. Comm’r of Soc. Sec.,2022 WL 196296,
at *4 (N.D. Tex. Jan. 21, 2022). Rather, “[a]t a minimum, the ALJ’s discussion must give
enough reasons to permit meaningful judicial review. Id. (citing Kinney v. Astrue, 2009
WL 2981907, at *3 (N.D. Tex. Aug. 28, 2009), rec. adopted, 2009 WL 2981907, at *1
(N.D. Tex. Sept. 17, 2009)).
Review of the ALJ’s opinion shows this Court that the ALJ rejected Dr. Flowers’s
medical opinion without analyzing the supportability and consistency of Dr. Flowers’s
opinion. Because of this, the Court cannot undertake a meaningful review of whether the
ALJ’s findings were supported by substantial evidence.
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VII. 	Recommendation
Accordingly, it is RECOMMENDED that the Court
(1) REVERSE and REMAND the case to the Social Security Administrations for
further consideration consistent with this opinion; and
(2) Direct the District Clerk to close this case.
VIII. 	Notice to the Parties
The parties have fourteen (14) days from the date of being served with a copy of
this Report and Recommendation in which to file written objections, if any, with the United
States District Judge assigned to this case. 28 U.S.C. § 636(b)(1). When filing an objection,
a party must object to specific facts or legal findings in this Report and Recommendation.
The District Judge is not required to consider frivolous, conclusive, or general objections.
Battle v. United States Parole Comm’n, 834 F.2d 419, 421 (5th Cir. 1987).
If any party fails to timely object to any factual or legal findings in this Report and
Recommendation, the District Judge is not required to conduct a de novo review of the
record before adopting these findings. If the District Judge chooses to adopt such findings
without conducting a de novo review of the record, the parties may not attack those findings
on appeal, except on the grounds of plain error. Alexander v. Verizon Wireless Servs.,
L.L.C., 875 F.3d 243, 248 (5th Cir. 2017).
Signed on April 6, 2026.
__________________________
Karen Betancourt
United States Magistrate Judge
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