Bonnilyn Mascio v. Carolyn Colvin , 780 F.3d 632 ( 2015 )


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  •                                PUBLISHED
    UNITED STATES COURT OF APPEALS
    FOR THE FOURTH CIRCUIT
    No. 13-2088
    BONNILYN A. MASCIO,
    Plaintiff − Appellant,
    v.
    CAROLYN W. COLVIN, Acting Commissioner of Social Security,
    Defendant – Appellee,
    and
    MICHAEL J. ASTRUE, Commissioner of Social Security,
    Defendant.
    Appeal from the United States District Court for the Eastern
    District of North Carolina, at Elizabeth City.     Louise W.
    Flanagan, District Judge. (2:11-cv-00065-FL)
    Argued:   December 11, 2014                 Decided:   March 18, 2015
    Before AGEE, DIAZ, and FLOYD, Circuit Judges.
    Reversed and remanded with instructions by published opinion.
    Judge Diaz wrote the opinion, in which Judge Agee and Judge
    Floyd joined.
    ARGUED: David J. Cortes, ROBERTI, WITTENBERG, LAUFFER, WICKER &
    CINSKI, P.A., Durham, North Carolina, for Appellant.     Mark J.
    Goldenberg, SOCIAL SECURITY ADMINISTRATION, Baltimore, Maryland,
    for Appellee.     ON BRIEF: Thomas G. Walker, United States
    Attorney, R.A. Renfer, Jr., Assistant United States Attorney,
    OFFICE OF THE UNITED STATES ATTORNEY, Raleigh, North Carolina,
    for Appellee.
    2
    DIAZ, Circuit Judge:
    Bonnilyn         Mascio          appeals         the       Social           Security
    Administration’s      denial     of     her     application         for   supplemental
    security     income    benefits.          Because       we     conclude      that    the
    administrative law judge erred by not conducting a function-by-
    function   analysis,    by     ignoring       (without       explanation)        Mascio’s
    moderate      limitation       in      her      ability        to     maintain        her
    concentration, persistence, or pace, and by determining Mascio’s
    residual functional capacity before assessing her credibility,
    we reverse and remand.
    I.
    A.
    Mascio     alleges        that     she      is     disabled          from     severe
    degenerative     disc       disease,         carpal     tunnel        syndrome,      and
    adjustment    disorder. 1       In     2008,    an    administrative         law    judge
    (“ALJ”) found that Mascio was not disabled, but the district
    1
    An “adjustment disorder” is “a disorder the essential
    feature of which is a maladaptive reaction to an identifiable
    psychological stress, or stressors, that occurs within weeks of
    the onset of the stressors and persists for as long as 6 months;
    the maladaptive nature of the reaction is indicated by
    impairment in occupational (including school) functioning, or in
    usual social activities or relationships with others, or with
    symptoms that are in excess of a normal or expectable reaction
    to the stressor.” Stedman’s Medical Dictionary 259610 (28th ed.
    2006).
    3
    court reversed and the case was remanded to a second ALJ for
    another hearing and disability determination.                       The second ALJ
    found    that   Mascio   was    not   disabled     from     March    15,   2005,    to
    November 30, 2009. 2         Mascio lost her administrative appeal and
    filed    a   complaint   in    the    district     court,    which     granted     the
    Commissioner’s motion for judgment on the pleadings and upheld
    the denial of benefits.         This appeal followed.
    B.
    We review de novo a district court’s decision on a motion
    for judgment on the pleadings.               Korotynska v. Metro. Life Ins.
    Co., 
    474 F.3d 101
    , 104 (4th Cir. 2006).                     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.”                    Bird v. Comm’r
    of Soc. Sec. Admin., 
    699 F.3d 337
    , 340 (4th Cir. 2012).                      Mascio
    does not dispute the ALJ’s factual findings but argues that the
    ALJ made four legal errors by (1) not conducting a function-by-
    function     analysis;   (2)    not    including     Mascio’s       concentration,
    persistence,     or   pace     limitation     in   his    hypothetical      to     the
    vocational expert; (3) determining Mascio’s residual functional
    capacity before assessing her credibility; and (4) not applying
    2
    While her first appeal was pending, the Social Security
    Administration approved Mascio’s application for benefits from
    an onset date of December 1, 2009.
    4
    the so-called “great weight rule” to Mascio’s subjective claims
    of pain.
    Before      turning       to   Mascio’s         arguments,      we    provide     an
    overview of the five-step sequential evaluation that ALJs use to
    make disability determinations.
    C.
    The Social Security Administration regulations describe the
    five-step     process     in    detail.         See    20    C.F.R.    § 416.920(a)(4)
    (2014).      To summarize, the 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; at step
    four, whether the claimant can perform her past work given the
    limitations caused by her medical impairments; and at step five,
    whether the claimant can perform other work.
    The    first      four    steps     create      a     series    of    hurdles     for
    claimants to meet.          If the ALJ finds that the claimant has been
    working (step one) or that the claimant’s medical impairments do
    not   meet     the      severity     and    duration          requirements         of   the
    regulations (step two), the process ends with a finding of “not
    disabled.”        At    step     three,    the     ALJ      either    finds    that     the
    claimant     is   disabled      because     her    impairments        match    a    listed
    5
    impairment       or    continues          the    analysis.             The    ALJ       cannot    deny
    benefits at this step.
    If    the    first     three       steps       do    not    lead       to    a    conclusive
    determination,         the    ALJ    then        assesses        the    claimant’s         residual
    functional capacity, which is “the most” the claimant “can still
    do    despite”      physical        and    mental       limitations           that       affect       her
    ability to work.          
    Id. § 416.945(a)(1).
                       To make this assessment,
    the    ALJ    must      “consider          all    of       [the     claimant’s]           medically
    determinable impairments of which [the ALJ is] aware,” including
    those not labeled severe at step two.                        
    Id. § 416.945(a)(2).
    The ALJ then moves on to step four, where the ALJ can find
    the claimant not disabled because she is able to perform her
    past work.         Or, if the exertion required for the claimant’s past
    work exceeds her residual functional capacity, the ALJ goes on
    to step five.
    At    step     five,   the     burden          shifts      to    the   Commissioner            to
    prove, by a preponderance of the evidence, that the claimant can
    perform other work that “exists in significant numbers in the
    national       economy,”            considering             the        claimant’s          residual
    functional capacity, age, education, and work experience.                                         
    Id. §§ 416.920(a)(4)(v);
    416.960(c)(2); 416.1429.                                 The Commissioner
    typically      offers        this    evidence          through         the    testimony          of    a
    vocational expert responding to a hypothetical that incorporates
    the    claimant’s       limitations.              If       the    Commissioner           meets    her
    6
    burden, the ALJ finds the claimant not disabled and denies the
    application for benefits.
    In this case, at step one, the ALJ determined that Mascio
    had not been working.           At step two, he found that Mascio had
    four       severe     impairments--degenerative      disc     disease,     carpal
    tunnel syndrome, adjustment disorder, and a history of substance
    abuse--that, alone or together, met the regulations’ duration
    requirement.            At   step   three,   he     decided    that      Mascio’s
    impairments did not meet or equal any of the impairments listed
    in the regulations.
    The ALJ then found that Mascio had the residual functional
    capacity to perform “light work,” 3 except that she was further
    limited to “chang[ing] between sitting and standing every 30
    minutes       (‘sit/stand      option’);     only    occasional         climbing,
    balancing,      bending,     stooping,   crouching   or     crawling;    no     more
    than       frequent    fingering;   no   exposure     to    hazards      such    as
    3
    The regulations define light work as
    lifting no more than 20 pounds at a time with frequent
    lifting or carrying of objects weighing up to 10
    pounds.   Even though the weight lifted may be very
    little, a job is in this category when it requires a
    good deal of walking or standing, or when it involves
    sitting most of the time with some pushing and pulling
    of arm or leg controls.   To be considered capable of
    performing a full or wide range of light work, [the
    claimant] must have the ability to do substantially
    all of these activities.
    20 C.F.R. § 416.967(b).
    7
    unprotected      heights    or    dangerous      machinery;       and,       due    to   her
    adjustment disorder, only unskilled work.”                      A.R. 492.          At step
    four, he concluded that Mascio could not perform her past work
    based on her residual functional capacity.                        Finally, at step
    five,     he    found   that     Mascio       could     perform       other    work      and
    therefore was not disabled.
    II.
    With    this    background       in     mind,     we    turn     to        Mascio’s
    contentions of error.
    A.
    Mascio first argues that the ALJ erred in assessing her
    residual       functional     capacity    because        he    did     not    conduct     a
    function-by-function analysis.                We agree that, on the facts of
    this case, the ALJ’s failure to perform this analysis requires
    remand.
    Mascio’s argument rests on Social Security Ruling 96-8p, 4
    which     explains      how      adjudicators         should         assess        residual
    functional capacity.             The Ruling instructs that the residual
    functional       capacity      “assessment        must        first     identify         the
    individual’s functional limitations or restrictions and assess
    4
    The Ruling’s title is “Policy Interpretation Ruling Titles
    II and XVI: Assessing Residual Functional Capacity in Initial
    Claims.”
    8
    his   or   her   work-related       abilities       on    a    function-by-function
    basis, including the functions” listed in the regulations. 5                        SSR
    96-8p, 61 Fed. Reg. 34,474, 34,475 (July 2, 1996).                        “Only after
    that may [residual functional capacity] be expressed in terms of
    the exertional levels of work, sedentary, light, medium, heavy,
    and very heavy.”          
    Id. The Ruling
    further explains that the
    residual    functional          capacity       “assessment       must     include     a
    narrative discussion describing how the evidence supports each
    conclusion,      citing   specific        medical      facts     (e.g.,    laboratory
    findings)      and   nonmedical        evidence       (e.g.,    daily     activities,
    observations).”      
    Id. at 34,478.
    Mascio     contends       that    the     ALJ      did    not    follow    these
    procedures.      The Commissioner responds that Mascio’s argument is
    “moot” because the ALJ found at step four that Mascio could not
    perform her past work.             We, however, find the Commissioner’s
    argument    unconvincing        because    ALJs     clearly      use    the   residual
    5
    The listed functions are the claimant’s (1) physical
    abilities,   “such   as   sitting,    standing,  walking,  lifting,
    carrying,   pushing,    pulling,   or    other  physical  functions
    (including manipulative or postural functions, such as reaching,
    handling, stooping or crouching)”; (2) mental abilities, “such
    as limitations in understanding, remembering, and carrying out
    instructions, and in responding appropriately to supervision,
    coworkers, and work pressures in a work setting”; and (3) other
    work-related abilities affected by impairments “such as skin
    impairment(s), epilepsy, impairment(s) of vision, hearing or
    other senses, and impairment(s) which impose environmental
    restrictions.” 20 C.F.R. § 416.945(b)-(d).
    9
    functional capacity finding at steps four and five.                              See 
    id. at 34,475-76;
    see also 
    id. at 34,476
    (“At step 5 of the sequential
    evaluation process, . . . [w]ithout a careful consideration of
    an    individual’s     functional        capacities      to   support         [a   residual
    functional capacity] assessment based on an exertional category,
    the adjudicator may either overlook limitations or restrictions
    that would narrow the ranges and types of work an individual may
    be able to do, or find that the individual has limitations or
    restrictions that he or she does not actually have.” (emphasis
    added)).
    Alternatively,          the    Commissioner    urges        us    to   join      other
    circuits that have rejected a per se rule requiring remand when
    the     ALJ   does    not      perform     an   explicit       function-by-function
    analysis.      See, e.g., Cichocki v. Astrue, 
    729 F.3d 172
    , 177 (2d
    Cir. 2013) (per curiam) (citing cases from the Sixth, Seventh,
    Eighth, and Ninth Circuits).                 We agree that a per se rule is
    inappropriate        given     that    remand    would   prove          futile     in   cases
    where the ALJ does not discuss functions that are “irrelevant or
    uncontested.”        
    Id. But declining
    to adopt a per se rule does
    not end our inquiry.             In that regard, we agree with the Second
    Circuit that “[r]emand may be appropriate . . . where an ALJ
    fails    to   assess       a    claimant’s      capacity      to    perform        relevant
    functions,     despite         contradictory     evidence      in       the   record,     or
    10
    where     other     inadequacies          in       the     ALJ’s     analysis        frustrate
    meaningful review.”          
    Id. We find
    this to be such a case.
    Here, the ALJ has determined what functions he believes
    Mascio can perform, but his opinion is sorely lacking in the
    analysis needed for us to review meaningfully those conclusions.
    In   particular,       although         the    ALJ        concluded       that   Mascio    can
    perform      certain      functions,          he       said    nothing      about      Mascio’s
    ability     to    perform     them       for       a    full   workday.          The   missing
    analysis     is   especially       troubling             because    the     record     contains
    conflicting        evidence        as     to           Mascio’s     residual        functional
    capacity--evidence that the ALJ did not address.
    For     example,       the        administrative             record     includes     two
    residual functional capacity assessments (Exhibits 12F and 20F)
    by   state       agency     disability         examiners.             These      assessments
    conflict with each other.                 Exhibit 12F states that Mascio can
    lift 50 pounds, but Exhibit 20F limits her to 20 pounds.                                   Yet
    the ALJ’s findings are more consistent with Exhibit 20F, about
    which   he    said     nothing.           To   make        matters     worse,       the   ALJ’s
    discussion of Exhibit 12F trails off right where he was poised
    to announce the weight he intended to give it:
    
    11 A. 496
    (emphasis added).
    Because we are left to guess about how the ALJ arrived at
    his     conclusions       on    Mascio’s         ability     to   perform       relevant
    functions      and   indeed,      remain     uncertain       as   to   what     the   ALJ
    intended, remand is necessary.
    B.
    Mascio    next    argues     that    the      ALJ    presented      a   legally
    insufficient hypothetical to the vocational expert. 6                           The ALJ
    asked the expert if jobs existed for a hypothetical person with
    Mascio’s age, education, and work experience, where the claimant
    is “limited to light work but [can] sit or stand at will about
    every     30     minutes,      and   [can]       do   only    occasional        postural
    activities       such    as    balancing,    stooping,        kneeling,     crouching,
    6
    We find it appropriate to address Mascio’s other alleged
    errors because they could recur on remand.
    12
    crawling and climbing; [but cannot be] expos[ed] to hazardous
    conditions such as heights or moving machinery; and can do . . .
    frequent fingering.”           A.R. 586.        Notably, the hypothetical said
    nothing about Mascio’s mental limitations.
    The vocational expert responded that there were unskilled,
    light work jobs for that person, including office helper, order
    caller, and warehouse checker. 7             The ALJ’s hypothetical, together
    with the vocational expert’s unsolicited addition of “unskilled
    work,”      matched    the    ALJ’s     finding    regarding      Mascio’s   residual
    functional capacity.           Thus, the hypothetical was incomplete only
    if   the     ALJ    failed     to   account       for   a   relevant    factor     when
    determining Mascio’s residual functional capacity.                      According to
    Mascio,      that     is   precisely      what     happened--the       ALJ   did   not
    consider her mental limitations despite crediting at step three
    Mascio’s diagnosis of an adjustment disorder and also finding
    that       Mascio   had      moderate     difficulties       in    maintaining     her
    concentration, persistence, or pace as a side effect of her pain
    medication.
    7
    Although the ALJ’s hypothetical said nothing about
    “unskilled work,” the expert added that limitation to her
    response. The regulations define unskilled work as “work which
    needs little or no judgment to do simple duties that can be
    learned on the job in a short period of time.”       20 C.F.R.
    § 416.968(a).
    13
    The Commissioner argues that the ALJ properly excluded any
    limitation for concentration, persistence, or pace because the
    ALJ (1) disbelieved Mascio’s need for pain medication because
    she   had   been   convicted   of   selling   her   prescription   pain
    medication and had lied to her doctor about using marijuana; and
    (2) disbelieved Mascio’s claim that her pain medication caused
    daytime fatigue because she never sought treatment for this side
    effect. 8
    As to the first point, the ALJ’s analysis does not go as
    far as the Commissioner’s does.          The ALJ concluded only that
    Mascio’s conviction and lie “make[] her statements that her pain
    is as limiting as she has alleged less credible.”            A.R. 496
    (emphasis added).     The ALJ did not find that she suffered from
    no pain or that she never took medication for it.
    As to the second point, it is true that the ALJ concluded
    that Mascio’s allegation that her pain caused daytime fatigue
    was “less credible” because she did not complain about this side
    effect to her doctors.     A.R. 496.     But this leaves us to wonder
    8
    The Commissioner also says that the ALJ properly excluded
    the limitation for concentration, persistence, or pace because
    Mascio did not attend five scheduled follow-up appointments with
    a mental health counselor.    But those appointments related to
    her adjustment disorder, not side effects from pain medication.
    And, despite Mascio not following up for treatment, the ALJ
    credited Mascio’s adjustment disorder as requiring a limitation
    to unskilled work.
    14
    if the ALJ found her claim of fatigue partially or completely
    incredible, particularly since the ALJ elsewhere concluded that
    Mascio’s pain medication “impacts her thought processes.”                              A.R.
    491.    We think this inconsistency needs to be explained.
    In addition, we agree with other circuits that an ALJ does
    not    account    “for    a    claimant’s          limitations       in   concentration,
    persistence, and pace by restricting the hypothetical question
    to simple, routine tasks or unskilled work.”                      Winschel v. Comm’r
    of Soc. Sec., 
    631 F.3d 1176
    , 1180 (11th Cir. 2011) (joining the
    Third, Seventh, and Eighth Circuits).                   As Mascio points out, the
    ability to perform simple tasks differs from the ability to stay
    on    task.      Only    the     latter       limitation       would      account   for   a
    claimant’s limitation in concentration, persistence, or pace.
    Perhaps    the      ALJ     can        explain    why      Mascio’s       moderate
    limitation in concentration, persistence, or pace at step three
    does    not    translate       into    a      limitation   in        Mascio’s    residual
    functional capacity.             For example, the ALJ may find that the
    concentration, persistence, or pace limitation does not affect
    Mascio’s      ability    to    work,     in    which    case    it     would    have   been
    appropriate to exclude it from the hypothetical tendered to the
    vocational expert.            See 
    id. at 1181.
             But because the ALJ here
    gave no explanation, a remand is in order.
    15
    C.
    Next, Mascio contends that the ALJ erred by determining her
    residual functional capacity before assessing her credibility.
    We   agree        that     the   ALJ     erred,      and   that     the    error   was    not
    harmless.
    Mascio’s argument stems from the ALJ’s use of the following
    language in his opinion:
    After careful consideration of the evidence, the
    undersigned   finds  that   the  claimant’s  medically
    determinable impairments could reasonably be expected
    to cause the alleged symptoms; however, the claimant’s
    statements concerning the intensity, persistence and
    limiting effects of these symptoms are not credible to
    the extent they are inconsistent with the above
    residual functional capacity assessment.
    A.R.       495.       We    agree      with     the    Seventh      Circuit     that     this
    boilerplate 9 “gets things backwards” by implying “that ability to
    work       is   determined       first    and   is    then    used    to    determine     the
    claimant’s credibility.”               Bjornson, 671 F.3d at645.
    The        boilerplate      also    conflicts         with    the     agency’s     own
    regulations, which direct the ALJ to “determine the extent to
    which       [the     claimant’s]         alleged      functional          limitations    and
    restrictions due to pain or other symptoms can reasonably be
    9
    As the government concedes, this language comes from a
    template “drafted by the Social Security Administration for
    insertion into any administrative law judge’s opinion to which
    it pertains.”   Bjornson v. Astrue, 
    671 F.3d 640
    , 644-45 (7th
    Cir. 2012).
    16
    accepted as consistent with the medical signs and laboratory
    findings    and       other     evidence       to    decide       how    [the    claimant’s]
    symptoms    affect       [his    or     her]       ability       to   work.”         20   C.F.R.
    § 416.929(a).          Thus, the ALJ here should have compared Mascio’s
    alleged functional limitations from pain to the other evidence
    in the record, not to Mascio’s residual functional capacity.
    The boilerplate also suggests that the ALJ acted contrary
    to the agency’s rulings.                Social Security Ruling 96-8p defines
    residual functional capacity as “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.”           SSR 96-8p, 61 Fed. Reg. at 34,475 (emphasis
    added).         And    when     explaining          that    the       residual    functional
    capacity    “assessment          must    be     based       on    all    of    the    relevant
    evidence in the case record,” Ruling 96-8p’s illustrative list
    includes    “[e]ffects          of     symptoms,         including       pain,       that    are
    reasonably attributed to a medically determinable impairment.”
    
    Id. at 34,477
    (second emphasis added).                        Thus, a claimant’s pain
    and residual functional capacity are not separate assessments to
    be compared with each other.                       Rather, an ALJ is required to
    consider a claimant’s pain as part of his analysis of residual
    functional capacity.
    17
    The ALJ’s error would be harmless if he properly analyzed
    credibility elsewhere.             But here, the ALJ did not.                 The ALJ gave
    three    reasons       for    rejecting       Mascio’s      statements        as   to    pain:
    Mascio        (1)   had     not    complied        with    follow-up     mental         health
    treatment; (2) had lied to her doctor about using marijuana; and
    (3)     had     been      convicted     for     selling      her    prescription         pain
    medication.
    The first reason has nothing to do with pain.                          With respect
    to the second and third reasons, the ALJ concluded that they
    made Mascio’s “statements that her pain is as limiting as she
    has    alleged      less     credible.”         A.R.      496.     Yet   in    determining
    Mascio’s residual functional capacity, the ALJ chose to credit
    some, but not all, of her statements.
    For example, Mascio testified that “she cannot walk more
    than about 100 feet, can stand for only 30 minutes, and can only
    lift about 15 pounds.”                 A.R. 495.           It appears that the ALJ
    credited the second statement, by including the sit/stand option
    in his finding as to residual functional capacity.                             But despite
    Mascio’s assertion that she was limited in her ability to walk
    and lift, the ALJ found that Mascio could perform “light work,”
    which includes lifting up to 20 pounds and performing “a good
    deal    of     walking.”          20   C.F.R.      § 416.967(b)      (defining          “light
    work”).        Nowhere, however, does the ALJ explain how he decided
    which of Mascio’s statements to believe and which to discredit,
    18
    other than the vague (and circular) boilerplate statement that
    he did not believe any claims of limitations beyond what he
    found   when    considering   Mascio’s      residual      functional      capacity.
    The ALJ’s lack of explanation requires remand.
    D.
    Lastly,     Mascio   maintains        that    the   ALJ     erred     by     not
    following the so-called “great weight rule” when evaluating her
    alleged pain.       We conclude that no such rule exists in this
    circuit, and we are not persuaded to adopt it.
    According to Mascio, ALJs must afford “great weight” to
    subjective evidence regarding a claimant’s allegation that she
    suffers from debilitating pain whenever it is uncontradicted or
    supported by substantial evidence.                 She relies on two of our
    unpublished decisions to support this proposition.                     See Felton-
    Miller v. Astrue, 459 F. App’x 226, 229 n.1 (4th Cir. 2011);
    Smith v. Astrue, 457 F. App’x 326, 329 (4th Cir. 2011).
    Of course, unpublished opinions in this circuit do not bind
    us.     Moreover, Mascio misreads the cases.                  Right before the
    language   from    Felton-Miller   and       Smith    that    Mascio      quotes    to
    support her argument, we noted that our cases have recognized
    “that   subjective    evidence   may     be    entitled      to   great    weight.”
    Felton-Miller, 459 F. App’x at 229 n.1 (emphasis added); Smith,
    457 F. App’x at 329 (emphasis added).                Read in context, we were
    not articulating a per se rule requiring that ALJs afford great
    19
    weight to subjective evidence or else be reversed.                           Rather, we
    were     merely     stating    the    obvious--that           an       ALJ   faced     with
    uncontradicted       subjective      evidence    of       a    claimant’s       pain    is
    likely to credit that evidence if the ALJ otherwise finds the
    claimant credible.          See Combs v. Weinberger, 
    501 F.2d 1361
    , 1363
    (4th Cir. 1974).           Similarly, an ALJ evaluating a record with
    substantial evidence to support a claimant’s pain allegations
    may well credit that evidence.
    We   also    note   that   adopting     Mascio’s        prescriptive          “great
    weight      rule”   would     conflict    with      the       regulations       and    the
    deference owed to the agency.             The regulations direct an ALJ to
    take into account “all of the available evidence,” not only the
    claimant’s pain allegations.               20 C.F.R. § 416.929(c)(1).                   In
    addition, this court must affirm an ALJ’s determination when
    supported by substantial evidence.               Bird v. Comm’r of Soc. Sec.
    Admin., 
    699 F.3d 337
    , 340 (4th Cir. 2012).                         And it is possible
    for    substantial     evidence      to   support     both         a   claimant’s      pain
    allegations and the ALJ’s decision that the claimant’s pain does
    not affect her ability to work to the extent that the claimant
    alleges.      Because Mascio’s proposed “great weight rule” is both
    unnecessary and unworkable, we decline to adopt it.
    20
    III.
    For   the   reasons   given,   we     reverse   the   district   court’s
    judgment and remand with instructions to vacate the denial of
    benefits and remand for further administrative proceedings.
    REVERSED AND REMANDED WITH INSTRUCTIONS
    21