Billie J. Woods v. Nancy Berryhill , 888 F.3d 686 ( 2018 )

PUBLISHED
UNITED STATES COURT OF APPEALS
FOR THE FOURTH CIRCUIT
No. 17-1500
BILLIE J. WOODS,
Plaintiff - Appellant,
v.
NANCY A. BERRYHILL, Acting Commissioner of Social Security,
Defendant - Appellee.
Appeal from the United States District Court for the Western District of North Carolina,
at Asheville. Max O. Cogburn, Jr., District Judge. (1:16-cv-00058-MOC-DLH)
Argued: March 20, 2018 Decided: April 26, 2018
Before MOTZ, TRAXLER, and DIAZ, Circuit Judges.
Vacated and remanded with instructions by published opinion. Judge Motz wrote the
opinion, in which Judge Traxler and Judge Diaz joined.
ARGUED: Charlotte W. Hall, CHARLES T. HALL LAW FIRM, P.C., Raleigh, North
Carolina, for Appellant. Leo Rufino Montenegro, SOCIAL SECURITY
ADMINISTRATION, Baltimore, Maryland, for Appellee. ON BRIEF: Leah F.
Golshani, Special Assistant United States Attorney, SOCIAL SECURITY
ADMINISTRATION, Baltimore, Maryland; Jill Westmoreland Rose, United States
Attorney, Gill Beck, Assistant United States Attorney, OFFICE OF THE UNITED
STATES ATTORNEY, Charlotte, North Carolina, for Appellee.
DIANA GRIBBON MOTZ, Circuit Judge:
Billie Jean Woods appeals the Social Security Administration’s denial of her
application for disability insurance benefits. Because we conclude that the
Administrative Law Judge erred by not according adequate weight to a prior disability
determination by the North Carolina Department of Health and Human Services, we
vacate and remand.
I.
Before turning to the facts of this case, we set forth the framework that an
Administrative Law Judge (“ALJ”) must use to determine a claimant’s eligibility for
Social Security disability insurance benefits.
“Disability” means “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). To determine whether an
individual is disabled, ALJs use the “five-step sequential evaluation process” outlined in
the Social Security Administration’s (“SSA”) regulations. 20 C.F.R. § 404.1520(a)(4).
“[T]he ALJ asks at step one whether the claimant has been working; at step two, whether
the claimant’s medical impairments meet the regulations’ severity and duration
requirements; at step three, whether the medical impairments meet or equal an
impairment listed in the regulations . . . .” Mascio v. Colvin, 780 F.3d 632, 634 (4th Cir.
2015); see 20 C.F.R. § 404.1520(a)(4). If the ALJ cannot make a conclusive
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determination at the end of the third step, the ALJ must then determine the claimant’s
residual function capacity, meaning the most a claimant can still do despite “all of the
claimant’s medically determinable impairments of which the ALJ is aware, including
those not labeled severe at step two.” Mascio, 780 F.3d at 635 (brackets and internal
quotation marks omitted); see 20 C.F.R. §§ 404.1520(a)(4); 404.1545(a). Only once the
ALJ has identified the claimant’s “functional limitations or restrictions” and assessed the
claimant’s “work-related abilities on a function-by-function basis” may the ALJ express
the claimant’s residual function capacity “in terms of the exertional levels of work,
sedentary, light, medium, heavy, and very heavy.” SSR 96-8p, 61 Fed. Reg. 34,474,
34,475 (July 2, 1996); see 20 C.F.R. § 404.1567 (defining exertional levels).
After the ALJ determines the claimant’s residual function capacity, the ALJ
proceeds to step four, where the claimant must show that she cannot perform her past
work. 20 C.F.R. § 404.1520(a)(4). If the claimant makes that showing, the burden shifts
to the SSA to prove at step five that the claimant is capable of performing other work, in
light of her residual function capacity, age, education, and work experience, that “exists
in significant numbers in the national economy.” Id. §§ 404.1560(c); 404.1520(c). If the
SSA satisfies that burden, the ALJ will find the claimant not disabled and deny her
application for benefits. See id. § 404.1520(a)(4).
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II.
A.
In the years leading up to her alleged disability onset date, Woods held various
production and manufacturing jobs that required her to lift up to 50 pounds and to walk,
stand, and crouch for seven hours or more per day. In 2010, Woods began exhibiting
symptoms consistent with inflammatory arthritis, osteoarthritis, and fibromyalgia. She
also began complaining of persistent pain that limited her ability to perform her job. Her
symptoms progressed over the next three years, and in April 2013, Woods stopped
working. The next month, Woods applied for Social Security disability insurance
benefits.
The SSA initially denied her application and her petition for reconsideration.
Woods then requested a hearing before an ALJ.
Before the ALJ, Woods presented medical records from Dr. Aasheim (her primary
care physician), Dr. de Wit (her rheumatologist through January 2013), and a prior
decision by the North Carolina Department of Health and Human Services (“NCDHHS”)
that found that Woods was disabled and entitled to Medicaid benefits. The ALJ also
reviewed the opinions of Drs. Burgess and Pardoll, who conducted consultative
examinations at NCDHHS’s request, and Dr. Clayton, the state agency medical
consultant who reviewed Woods’s medical record but did not treat or examine her in
person. In addition, Woods submitted disability questionnaires and testified before the
ALJ.
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We briefly summarize the relevant evidence from each source.
• Beginning in 2010, Drs. de Wit and Aasheim documented various
symptoms consistent with inflammatory arthritis, osteoarthritis, and
fibromyalgia. In early 2013, both doctors concluded that because of her
condition, Woods “should not do heavy manual labor” as required by her
current job. In November 2013, Dr. Aasheim concluded that Woods could
occasionally lift up to ten pounds but frequently could not lift any weight,
she could stand one of eight hours, could sit one of eight hours, and could
occasionally balance independently, but could not climb, stoop, crouch,
kneel, or crawl.
• The NCDHHS decision found that Woods was eligible to receive Medicaid.
The state hearing officer noted that Woods had several positive laboratory
results and physical exams that supported her claims of pain. That officer
also found that Woods’s testimony at the state hearing was “wholly
credible and substantiated the alleged disabilities.”
• Dr. Burgess, who conducted a physical consultation, concluded that
Woods’s “ability to perform work-related activities such as bending,
stooping, lifting, walking, crawling, squatting, carrying, traveling, pushing
and pulling heavy objects . . . appears to be mildly to moderately
impaired . . . . Claimant’s insight into and description of limitations
appears not inconsistent with the objective findings.”
• Dr. Pardoll, who conducted a psychological consultation, found that
although Woods has “few mental health symptoms that interfere with her
social and occupational functioning,” it did not “appear that she would be
able to tolerate the stressors and pressures associated with a day to day
work activity since she is experiencing a lot of pain.”
• Dr. Clayton, the state agency’s non-treating, non-examining consultant,
found Woods’s “[a]llegations and statements . . . partially credible,” but
concluded that the “evidence does not support the level of limitations
alleged.” He also concluded that Woods could occasionally lift 50 pounds
and frequently lift 25 pounds, and could stand or sit for six hours of an
eight-hour workday. Thus, he found that Woods could perform medium
work.
• Woods wrote in her disability questionnaires that her typical activities
varied daily depending on her pain. For example, although she could
“prepare simple meals,” it was difficult to “cut, chop, or dice.” Woods also
testified before the ALJ that she could lift approximately three to four
pounds, could comfortably sit or stand for 20 minutes, walked with a limp
and otherwise had poor balance and stumbled frequently, and had limited
grip strength and dropped things “consistently.”
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B.
After reviewing the evidence, the ALJ found that Woods did not meet the legal
definition of “disabled” and denied her claim for Social Security disability insurance
benefits. At step one, the ALJ found that Woods was not employed since her onset date.
At step two, he concluded that her impairments were “severe.” Because her impairments
did not meet the requirements of step three, the ALJ proceeded to the residual function
capacity assessment.
The ALJ began his assessment of Woods’s residual function capacity by
summarizing the relevant medical evidence. For example, the ALJ found that certain
tests showed only “mild degenerative changes” and that some reports indicated that
Woods did not display other typical signs of her alleged impairments, such as swollen
joints. The ALJ then concluded that Woods’s “medically determinable impairments
could reasonably be expected to cause the alleged symptoms,” but that her “statements
concerning the intensity, persistent and limiting effects of these symptoms are not
entirely credible.” In support of this adverse credibility finding, the ALJ noted that
Woods’s “daily activities are not those typically associated with an individual alleging
the pain, severity, and limitations as posed by the claimant.” The ALJ also identified the
relative weight he accorded to the various medical experts: great weight to Dr. Clayton,
some-to-great weight to Dr. Pardoll, some weight to Dr. Burgess, little weight to Drs.
Aasheim and de Wit, and little weight to the NCDHHS decision. Based on this evidence,
the ALJ found — consistent with Dr. Clayton’s opinion — that Woods had the residual
function capacity to perform “medium work” (subject to certain exceptions).
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At step four, the ALJ concluded that Woods “is capable of performing past
relevant work in production of manufacturing textiles,” as that work “does not require the
performance of work-related activities precluded by” her residual function capacity. At
step five, he found that “other jobs exist[] in the national economy that [Woods] is also
able to perform,” like janitorial work. The ALJ therefore concluded that Woods did not
meet the legal definition of “disabled” and denied her application for benefits.
C.
After exhausting her administrative appeals, Woods filed this action against the
Acting Commissioner of Social Security. The parties filed cross-motions for summary
judgment, and a magistrate judge recommended granting the Commissioner’s motion,
denying Wood’s motion, and affirming the denial of benefits. The district court adopted
this recommendation in full. Woods now appeals.
III.
We review de novo a district court’s grant of summary judgment. Martin v. Lloyd,
700 F.3d 132, 135 (4th Cir. 2012). “We will affirm the Social Security Administration’s
disability determination ‘when an ALJ has applied correct legal standards and the ALJ’s
factual findings are supported by substantial evidence.’” Mascio, 780 F.3d at 634.
(quoting Bird v. Comm’r of Soc. Sec. Admin., 699 F.3d 337, 340 (4th Cir. 2012)).
We first address the ALJ’s treatment of the prior NCDHHS disability decision.
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A.
A disability decision by another entity does not bind the SSA. See 20 C.F.R
§ 404.1504. But in considering a claim for Social Security disability insurance benefits,
an ALJ must still “evaluate all the evidence in the case record that may have a bearing on
our determination or decision of disability, including decisions by other governmental
and nongovernmental agencies.” SSR 06-03P, 71 Fed. Reg. 45,593, 45,596 (Aug. 9,
2006). Accordingly, the ALJ “should explain the consideration given to these decisions
in the notice of decision for hearing cases.” Id. at 45,597. 1 Thus, we have previously
held that in an SSA disability proceeding, “the [prior] disability determination of a state
administrative agency is entitled to consideration.” DeLoatche v. Heckler, 715 F.2d 148,
150 n.1 (4th Cir. 1983).
This court has not yet addressed the precise weight an ALJ must give to a state
agency’s disability determination. In a related context, however, we have held that “in
making a disability determination, the SSA must give substantial weight to a [Veterans
Affairs] disability rating.” Bird, 699 F.3d at 343. That is so because “the purpose and
evaluation methodology of” the SSA and VA disability determinations are “closely
related.” Id. Accordingly, “a disability rating by one of the two agencies is highly
relevant to the disability determination of the other agency.” Id.
1
This regulation only applies to claims filed before March 27, 2017. See 82 Fed.
Reg. 5,844, 5,848 (Jan. 18, 2017); 20 C.F.R. § 404.1504. For claims filed on or after
March 27, 2017, ALJs must still consider the existence of disability decisions by other
governmental or nongovernmental entities, and any evidence underlying those decisions,
but are no longer required “to provide written analysis about how they consider the
decisions from other governmental agencies.” 82 Fed. Reg. at 5,848.
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We see no reason why this logic does not also apply to NCDHHS disability
decisions. Both NCDHHS and Social Security disability insurance benefits “serve the
same governmental purpose of providing benefits to persons unable to work because of a
serious disability.” Id. (describing purpose of Social Security disability insurance
benefits); see NCDHHS, Aged, Blind, and Disabled Medicaid Manual § 200 (2008)
(defining “Medicaid” as “A program to assist eligible . . . disabled [individuals] . . . with
the cost of medical care”). Moreover, NCDHHS defines “Medicaid to the Disabled” as a
“program of medical assistance for individuals under age 65 who meet Social Security’s
definition of disability.” Id. (emphasis added); see also id. § 2525. As a result, a “person
who receives Social Security based on disability meets the disability requirement for
Medicaid,” although he or she must still “apply for Medicaid and must meet all other
eligibility requirements.” Id. § 2525. “Because the purpose and evaluation methodology
of both programs are closely related, . . . . in making a disability determination, the SSA
must give substantial weight to” an NDCHHS disability decision. Bird, 699 F.3d at 343.
Of course, an ALJ may deviate from this default rule and accord an NCDHHS
disability decision less than “substantial weight” if “the record before the ALJ clearly
demonstrates that such a deviation is appropriate.” Id. We have not previously defined
what an ALJ must do to satisfy this standard. We now conclude, consistent with our
sister circuits, that in order to demonstrate that it is “appropriate” to accord less than
“substantial weight” to an NCDHHS disability decision, an ALJ must give “persuasive,
specific, valid reasons for doing so that are supported by the record.” McCartey v.
Massanari, 298 F.3d 1072, 1076 (9th Cir. 2002) (describing standard for VA decisions);
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Chambliss v. Massanari, 269 F.3d 520, 522 (5th Cir. 2001) (per curiam) (explaining that
ALJs need not give great weight to VA disability determinations “if they adequately
explain the valid reasons for not doing so”).
For example, an ALJ could explain which aspects of the prior agency decision he
finds not credible and why, describe why he finds other evidence more credible, and
discuss the effect of any new evidence made available after NCDHHS issued its decision.
This list is not exclusive, but the point of this requirement — and of these examples — is
that the ALJ must adequately explain his reasoning; otherwise, we cannot engage in a
meaningful review. See Radford v. Colvin, 734 F.3d 288, 295 (4th Cir. 2013) (explaining
that because we review an ALJ’s factual findings for substantial evidence, an ALJ’s
decision must generally “include a discussion of which evidence the ALJ found credible
and why, and specific application of the pertinent legal requirements to the record
evidence”).
B.
The ALJ in this case concluded that the NCDHHS decision deserved only “little
weight.” Because this is less than the “substantial weight” such decisions are generally
due, we must consider whether the ALJ adequately justified this “deviation.”
The entirety of the ALJ’s reasoning on this point is as follows:
The undersigned has considered the State of North Carolina
Department of Health and Human Services’ ruling finding the
claimant met the criteria for Medicaid eligibility (Exhibit 11E).
However, Social Security Ruling 06-03p states that:
“[a] decision by any . . . other governmental
agency about whether you are disabled to blind is
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based on its rules and is not our decision about
whether you are disabled or blind. We must make a
disability or blindness determination based on social
security law. Therefore, a determination made by
another agency that you are disabled or blind is not
binding on us.”
As such, the undersigned assigns this ruling little weight, as each
program is independent and distinct enough to make it possible that
even a disabled Medicaid recipient can be denied SSA benefits.
Moreover, the Medicaid determination specifically states that “this
decision in no way affects any pending or future claims for Social
Security or Supplemental Security Income benefits.”
This generic explanation, which could apply to every NCDHHS decision, is neither
persuasive nor specific. See McCartey, 298 F.3d at 1076. Thus, the ALJ did not
adequately justify his decision to accord the NCDHHS decision less than the substantial
weight it generally deserves.
The Commissioner raises two arguments for the ALJ’s contrary approach. First,
the Commissioner suggests that the NCDHHS hearing officer did not actually consider
the “same underlying evidence” as the ALJ because the state hearing officer’s report did
not discuss Dr. Clayton’s opinion. See Bird, 699 F.3d at 343; Appellee Br. at 15. 2 Of
course, where a prior decision does not rely on substantially the same underlying
evidence, such as where a state issued its disability decision a number of years before the
claimant applied for Social Security disability insurance benefits, the state decision may
2
That the NCDHHS report does not specifically refer to Dr. Clayton’s opinion
does not necessarily mean that the hearing officer did not consider it. Nothing in the
record indicates that Dr. Clayton’s opinion — which the state agency ordered and which
Dr. Clayton produced five months before NCDHHS issued its disability decision — was
not available to the NCDHHS hearing officer.
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not be entitled to substantial weight. If that is the case, however, the ALJ must explain
these facts. The ALJ’s opinion here never mentioned this alleged issue.
Second, the Commissioner argues that because the ALJ’s decision as a whole
makes clear that he considered the same evidence on which the NCDHHS decision relied,
the ALJ did not need to refer expressly to that evidence in discussing the NCDHHS
decision. We cannot agree. It may well be that the ALJ considered this evidence in
deciding both which doctors and evidence to credit and whether the NCDHHS decision
deserved substantial weight. But meaningful review cannot rest on such guesswork. See
DeLoatche, 715 F.2d at 150 (“It may be, of course, as the Secretary suggests on appeal,
that the ALJ considered all of these factors and proposed to himself cogent reasons for
disregarding them. However, on this record we cannot so determine.”).
We therefore conclude that the ALJ erred in failing to adequately explain why he
accorded the prior NCDHHS disability decision less than substantial weight. For this
reason, we must vacate the decision and remand the case to the ALJ.
IV.
Woods raises several other challenges to the ALJ’s decision. Because these issues
may recur on remand, we address them now. See Bird, 699 F.3d at 342–43.
A.
First, Woods contends that the ALJ did not adequately perform the residual
function capacity assessment. In performing this assessment, an ALJ “must include a
narrative discussion describing how the evidence supports each conclusion, citing
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specific medical facts (e.g., laboratory findings) and nonmedical evidence (e.g., daily
activities, observations).” Mascio, 780 F.3d at 636 (quoting SSR 96-8p, 61 Fed. Reg. at
34,478) (internal quotation marks omitted). In other words, the ALJ must both identify
evidence that supports his conclusion and “build an accurate and logical bridge from
[that] evidence to his conclusion.” Monroe v. Colvin, 826 F.3d 176, 189 (4th Cir. 2016)
(quoting Clifford v. Apfel, 227 F.3d 863, 872 (7th Cir. 2000)) (internal quotation marks
omitted).
We agree with Woods that the ALJ did not do so here. The ALJ concluded that
Woods could perform “medium work” and summarized evidence that he found credible,
useful, and consistent. But the ALJ never explained how he concluded — based on this
evidence — that Woods could actually perform the tasks required by “medium work,”
such as lifting up to 50 pounds at a time, frequently lifting or carrying up to 25 pounds, or
standing or walking for six hours. See SSR 83-10, 1983 WL 31251, at *6 (Jan. 1, 1983).
The ALJ therefore failed to build an “accurate and logical bridge” from the evidence he
recounted to his conclusion about Woods’s residual function capacity. On remand, the
ALJ should remedy this error.
B.
Woods also contends that the ALJ erred in finding Woods not credible because her
“daily activities are not those typically associated with an individual alleging the pain,
severity, and limitations as posed by the claimant.”
An ALJ may not consider the type of activities a claimant can perform without
also considering the extent to which she can perform them. See Brown v. Commissioner,
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873 F.3d 251, 263 (4th Cir. 2017). The ALJ here did just that. For example, the ALJ
noted that Woods can “maintain her personal hygiene, cook, perform light household
chores,” “shop,” “socialize with family members, and attend church services on a regular
basis.” But the ALJ did not consider Woods’s statements that she cannot button her
clothes, has trouble drying herself after bathing, and sometimes needs help holding a
hairdryer; that she can prepare simple meals but has trouble cutting, chopping, dicing,
and holding silverware or cups; it takes her all day to do laundry; she shops only for
necessities, and that process takes longer than normal; when she reads to her
grandchildren, they have to turn the pages because of severe pain in her hands; and that
some days, she spends the entire day on the couch.
On remand, the ALJ should consider not just the type of Woods’s daily activities,
but also the extent to which she can perform them in assessing her credibility.
C.
Finally, we note two additional problems with the ALJ’s analysis as it pertains to
his weighting of the various medical opinions.
An ALJ must include “a narrative discussion describing how the evidence
supports” his “explanation of the varying degrees of weight he gave to differing opinions
concerning [the claimant’s] conditions and limitations.” Monroe, 826 F.3d at 190
(internal quotation marks and citation omitted). In this case, the ALJ’s discussion of
certain expert opinions was at times conclusory or sparse. For example, the ALJ gave Dr.
Burgess’s opinion “some weight” because “it is rather vague and general in nature,” but
did not discuss what aspects of that opinion he found overly vague. Cf. id. at 191
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(finding insufficient the explanation that the “consultative examiner opinion is consistent
with the objective evidence and other opinions of record” even though the ALJ had
recounted various medical evidence earlier in his opinion). On remand, we caution the
ALJ to provide better explanations in support of these types of determinations.
We are also skeptical about the ALJ’s rationale for according great weight to the
opinion of Dr. Clayton — who did not personally examine or treat Woods — while at the
same time discounting the opinions of the doctors who did examine and treat her. In
general, an ALJ should accord “more weight to medical opinions from [a claimant’s]
treating sources, since these sources are likely to be the medical professionals most able
to provide a detailed, longitudinal picture of [a claimant’s] medical impairment(s).” 20
C.F.R. § 404.1527(c)(2); id. § 404.1527(c)(1) (stating the same presumption for
examining sources). An ALJ may, however, credit the opinion of a non-treating, non-
examining source where that opinion has sufficient indicia of “supportability in the form
of a high-quality explanation for the opinion and a significant amount of substantiating
evidence, particularly medical signs and laboratory findings; consistency between the
opinion and the record as a whole; and specialization in the subject matter of the
opinion.” Brown, 873 F.3d at 268; see 20 C.F.R. § 404.1527(c).
It is not clear to us that Dr. Clayton’s opinion satisfies this standard. For example,
Dr. Clayton concluded that Woods could lift up to 50 pounds (something none of her
treating physicians believed she was capable of), but failed to explain how he arrived at
that specific number. The same is true of his conclusion that Woods can sit or stand for
six hours in an eight-hour workday. As the ALJ himself acknowledged, these
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conclusions conflict with the opinions of Drs. Burgess, de Wit, Aasheim, and with
Woods’s own testimony. Nor is there any evidence in the record that Dr. Clayton is a
specialist and therefore due additional deference. The ALJ should consider these
potential shortcomings on remand in deciding what weight to accord the opinion of Dr.
Clayton, and any other non-treating, non-examining physicians.
V.
For the foregoing reasons, we vacate the judgment of the district court and remand
the case with instructions to vacate the denial of benefits and remand for further
administrative proceedings consistent with this opinion.
VACATED AND REMANDED WITH INSTRUCTIONS
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