United States District Court, E.D. North Carolina, Southern Division
TERRENCE W. BOYLE, UNITED STATES DISTRICT JUDGE
cause comes before the Court on cross-motions for judgment on
the pleadings. A hearing was held on these matters before the
undersigned on March 21, 2017, at Raleigh, North Carolina.
For the reasons discussed below, the decision of the
Commissioner is reversed.
brought this action under 42 U.S.C. §§ 405(g) and
1383(c)(3) for review of the final decision of the
Commissioner denying his claim for child's insurance
benefits based on disability (CDB) and supplemental security
income (SSI). Plaintiff protectively filed for CDB and SSI on
May 8, 2012, alleging disability since January 1,
1996. After initial denials, a hearing was held
before an Administrative Law Judge (ALJ) who considered
plaintiffs claim de novo. The ALJ issued an
unfavorable ruling, and the decision of the ALJ became the
final decision of decision of the Commissioner when the
Appeals Council denied plaintiffs request for review.
Plaintiff then timely sought review of the Commissioner's
decision in this Court.
the Social Security Act, 42 U.S.C. §§ 405(g), and
1383(c)(3), this Court's review of the Commissioner's
decision is limited to determining whether the decision, as a
whole, is supported by substantial evidence and whether the
Commissioner employed the correct legal standard.
Richardson v. Perales, 402 U.S. 389, 401 (1971).
Substantial evidence is "such relevant evidence as a
reasonable mind might accept as adequate to support a
conclusion." Johnson v. Barnhart, 434 F.3d 650,
653 (4th Cir. 2005) (per curiam) (internal quotation and
individual is considered disabled if he is unable "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
[twelve] months." 42 U.S.C. § 1382c(a)(3)(A). The
Act further provides that an individual "shall be
determined to be under a disability only if his physical or
mental impairment or impairments are of such severity that he
is not only unable to do his previous work but cannot,
considering his age, education, and work experience, engage
in any other line of substantial gainful work which exists in
the national economy." 42 U.S.C. § 1382c(a)(3)(B).
issued by the Commissioner establish a five-step sequential
evaluation process to be followed in a disability case. 20
C.F.R. §§ 404.1520(a)(4), 416.920(a)(4). The
claimant bears the burden of proof at steps one through four,
but the burden shifts to the Commissioner at step five.
See Bowen v. Yuckert, 482 U.S. 137, 146 n.5 (1987).
If a decision regarding disability can be made at any step of
the process the inquiry ceases. See 20 C.F.R.
§§ 404.1520(a)(4), 416.920(a)(4).
one, if the Social Security Administration determines that
the claimant is currently engaged in substantial gainful
activity, the claim is denied. If not, then step two asks
whether the claimant has a severe impairment or combination
of impairments. If the claimant has a severe impairment, it
is compared at step three to those in the Listing of
Impairments ("Listing") in 20 C.F.R. Pt. 404,
Subpt. P, App. 1. If the claimant's impairment meets or
medically equals a Listing, disability is conclusively
presumed. If not, at step four, the claimant's residual
functional capacity (RFC) is assessed to determine if the
claimant can perform his past relevant work. If so, the claim
is denied. If the claimant cannot perform past relevant work,
then the burden shifts to the Commissioner at step five to
show that the claimant, based on his age, education, work
experience, and RFC, can perform other substantial gainful
work. If the claimant cannot perform other work, then he is
found to be disabled. See 20 C.F.R. §
one, the ALJ determined that plaintiff, who was born on
November 19, 1992, had not attained the age of twenty-two as
of December 15, 2010, and that he had not engaged in
substantial gainful activity since the first day of the
relevant time period. Plaintiffs neurofibromatosis was
considered a severe impairment at step two but was not found
alone or in combination with any other impairment to meet or
equal a Listing at step three. The ALJ concluded that
plaintiff had the RFC to perform a reduced range of sedentary
work. Specifically, the ALJ found that plaintiff could lift
and carry up to ten pounds occasionally and lesser amounts
frequently, sit for six hours of an eight-hour day, stand and
walk occasionally, but must alternate sitting and standing
every hour. The ALJ found that plaintiff had no past relevant
work but that, considering plaintiffs age, education, and
RFC, there were jobs that existed in significant numbers in
the national economy which plaintiff could perform, including
assembler, quality control examiner, and grader/sorter. Thus,
the ALJ determined that plaintiff was not disabled from
December 15, 2010, through the date of her decision, July 31,
ALJ's decision in this instance is not supported by
substantial evidence. An ALJ makes an RFC assessment based on
all of the relevant medical and other evidence. 20 C.F.R.
§ 404.1545(a). An RFC should reflect the most that a
claimant can do, despite the claimant's limitations.
Id. An RFC finding should also reflect the
claimant's ability to perform sustained work-related
activities in a work setting on regular and continuing basis,
meaning eight-hours per day, five days per week. SSR 96-8p;
Hines v. Barnhart, 453 F.3d 559, 562 (4th Cir.
erred in relying on the "lack of treatment records
regularly documenting abnormal findings" in determining
that plaintiffs neurofibromatosis did not cause symptoms to
the extent alleged by plaintiff. Tr. 45. Although the ALJ
stated that she recognized that plaintiffs medical record was
sparse following his loss of Medicaid insurance at the age of
eighteen in 2012, and notes that she does not "view any
lack of treatment in a negative light, " she goes on to
rely on the absence of treatment records as evidence that
plaintiffs claims regarding his symptoms and limitations are
not supported. Id. This circular logic is untenable
and the ALJ's conclusions based thereon are not supported
by substantial evidence.
Pressley examined plaintiff as a consultative examiner in
2010 and 2012 and as a private physician in 2014. Tr. 331;
437; 443. In 2010, Dr. Pressley noted that she believed
plaintiff to have serious discomfort and to be limited to a
sedentary activity which would allow him alternate between
sitting and standing. Tr. 336. In 2012, Dr. Pressley again
examined plaintiff, noting that in the past year he had
surgeries due to his neurofibromatosis and that plaintiff had
headaches everyday as well as back and leg pain due to tumors
and surgeries. Tr. 439. Dr. Pressley noted that plaintiff
used to be her private patient and that the information he
had provided was true, that he would need time off work for
surgeries, that he would only be able to do sedentary
activities and would need to be permitted to get up and move
frequently. Tr. 442. Dr. Pressley noted that in the last few
years plaintiff had had "an increasing number of large
tumors develop . . . and this can make his prognosis
worrisome." Id. In 2014, Dr. Pressley again
examined plaintiff, noting that he was having problems with
his hip, that plaintiffs bones are weakened by tumors, and
that plaintiff appeared to have fractured his fifth
metacarpal though he had not sought treatment for it due to
his lack of insurance. Tr. 447.
Schuett, plaintiffs treating orthopedist, performed an
arthroscopic shoulder reconstruction in September 2010, Tr.
377, excised a mass from plaintiffs right wrist in April
2011, Tr. 359, excised multiple masses from plaintiffs back