Elizabeth Langston v. Commissioner of Social Security Administration

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UNPUBLISHED
UNITED STATES COURT OF APPEALS
FOR THE FOURTH CIRCUIT
No. 22-1257
ELIZABETH LANGSTON,
Plaintiff - Appellant,
v.
COMMISSIONER OF SOCIAL SECURITY ADMINISTRATION,
Defendant - Appellee.
Appeal from the United States District Court for the District of South Carolina, at
Orangeburg. Kaymani Daniels West, Magistrate Judge. (5:20-cv-03334-KDW)
Submitted: January 20, 2023 Decided: February 3, 2023
Before NIEMEYER and WYNN, Circuit Judges, and MOTZ, Senior Circuit Judge.
Vacated and remanded by unpublished per curiam opinion.
ON BRIEF: W. Daniel Mayes, SMITH, MASSEY, BRODIE, GUYNN & MAYES,
Aiken, South Carolina, for Appellant. Brian C. O’Donnell, Regional Chief Counsel, Victor
Pane, Supervisory Attorney, Office of the General Counsel, SOCIAL SECURITY
ADMINISTRATION, Philadelphia, Pennsylvania; Corey F. Ellis, United States Attorney,
Timothy P. Reiley, Special Assistant Attorney, OFFICE OF THE UNITED STATES
ATTORNEY, Columbia, South Carolina, for Appellee.
Unpublished opinions are not binding precedent in this circuit.
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PER CURIAM:
Elizabeth Langston appeals the district court’s order 1 upholding the
Commissioner’s denial of Langston’s applications for disability insurance benefits and
supplemental security income. On appeal, Langston argues that the Administrative Law
Judge (“ALJ”) erred by giving little weight to the opinion of Langston’s treating physician
and by discounting Langston’s subjective complaints of pain. Because we agree that the
ALJ did not correctly consider Langston’s subjective symptoms, 2 we vacate the district
court’s judgment and direct the court to remand the case to the agency for further
proceedings consistent with this opinion.
We review de novo the district court’s decision to grant summary judgment.
Thomas v. Berryhill, 916 F.3d 307, 311 (4th Cir. 2019). We will affirm if the “ALJ has
applied correct legal standards and the ALJ’s factual findings are supported by substantial
1
The parties consented to the jurisdiction of the magistrate judge.
2
Langston also alleges that the ALJ erred by failing to consider her abdominal pain
when constructing her residual functional capacity (“RFC”). Because this claim (and
certain other sub-claims argued in Langston’s briefs) rest in part on the ALJ’s
determination of the credibility of Langston’s subjective complaints, we do not separately
address them. Further, Langston argues on appeal that the ALJ erred by failing to assess
Langston’s other conditions (such as diverticulitis and chronic pain syndrome) at step two
of the evaluation process, which she contends also impacted her RFC. However, as the
Commissioner notes, Langston raises the step-two claim for the first time on appeal.
Langston referred to these conditions before the district court only in the context of
discussing her RFC. Accordingly, Langston has forfeited consideration of her step-two
claim. See, e.g., United States v. Turner Constr. Co., 946 F.3d 201, 208 (4th Cir. 2019).
And because we remand for further consideration of her RFC on other grounds, we do not
consider her argument that the ALJ failed to properly consider these conditions in the RFC
analysis.
2
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evidence.” Monroe v. Colvin, 826 F.3d 176, 186 (4th Cir. 2016) (internal quotation marks
omitted). “Substantial evidence is that which a reasonable mind might accept as adequate
to support a conclusion. It consists of more than a mere scintilla of evidence but may be
less than a preponderance.” Pearson v. Colvin, 810 F.3d 204, 207 (4th Cir. 2015) (citation
and internal quotation marks omitted). We do not “reweigh conflicting evidence, make
credibility determinations, or substitute our judgment for that of the ALJ”; rather, “[w]here
conflicting evidence allows reasonable minds to differ,” we defer to the Commissioner’s
decision. Hancock v. Astrue, 667 F.3d 470, 472 (4th Cir. 2012) (brackets and internal
quotation marks omitted).
In making a disability determination, the ALJ employs a five-step process,
inquiring:
[A]t 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.
Mascio v. Colvin, 780 F.3d 632, 634 (4th Cir. 2015). If, at step three, the ALJ finds that
the claimant’s impairments match one of the regulations’ listed impairments, then the
claimant is deemed disabled and the analysis ends. Otherwise, the ALJ must determine the
claimant’s RFC before proceeding to steps four and five. Id. at 635. In determining the
RFC, the ALJ “must first identify the individual’s functional limitations or restrictions and
assess his or her work-related abilities on a function-by-function basis, including the
functions listed in the regulations.” Id. at 636 (internal quotation marks omitted). Among
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the listed functions are “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).” Id. at 636 n.5 (internal
quotation marks omitted).
Langston first contends that the ALJ failed to properly consider the opinion of
Douglas Swartz, her treating physician, and improperly gave his opinion little weight.
Swartz opined that Langston was extremely limited in nearly all physical activities due to
her spondylosis and chronic gastrointestinal issues. Swartz’s opinion was a checklist form
and contained no analysis; in addition, Langston’s back and abdominal pain were not
discussed, creating confusion as to whether Langston’s limitations were due to strictly
functional, physical issues or pain or both.
The treating physician rule requires that ALJs give “controlling weight” to a treating
physician’s opinion on the nature and severity of the claimant’s impairment if that opinion
is (1) “well-supported by medically acceptable clinical and laboratory diagnostic
techniques” and (2) “not inconsistent with the other substantial evidence” in the record. 20
C.F.R. § 404.1527(c)(2). 3 “[T]he opinion of a claimant’s treating physician [must] be
given great weight and may be disregarded only if there is persuasive contradictory
evidence.” Coffman v. Bowen, 829 F.2d 514, 517 (4th Cir. 1987).
This regulation has been amended, but the original version is still applicable to
3
Langston’s claim because it was filed prior to March 27, 2017. See 20 C.F.R. § 404.1527.
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Here, the ALJ gave Swartz’s checklist opinion little weight, reasoning that (1) on
the same day Swartz signed his opinion, Langston had an unremarkable physical
examination in the emergency room, aside from mild to moderate abdominal tenderness;
(2) Swartz relied on Langston’s difficult recoveries from surgery, without noting that her
condition improved after recovery; (3) Langston’s weight was stable and her bowel sounds
were consistently normal; (4) Swartz is a family physician, not a gastroenterologist or
orthopedist; and (5) Swartz’s conclusion that Langston’s back condition was disabling
contradicted his own treatment notes from the very next day, when he recorded that
Langston had normal motor strength. Because Swartz’s brief opinion is contradicted by
his own almost-contemporaneous treatment notes as well as examinations by other more
specialized physicians, the ALJ did not err in giving Swartz’s opinion little weight. See
Wood v. Comm’r of Soc. Sec. Admin., No. 21-1905, 2022 WL 997306, at *3 (4th Cir. Apr.
4, 2022) (“Notably, the ALJ gave more weight to [the providers’] contemporaneous
observations and conclusions than to [their] disability forms, which contained certain
conclusory questions and various check-box responses. This was entirely appropriate.”
(citing Anderson v. Astrue, 696 F.3d 790, 794 (8th Cir. 2012) (“[A] conclusory checkbox
form has little evidentiary value when it cites no medical evidence, and provides little to
no elaboration.” (internal quotation marks omitted)))).
Langston next argues that the ALJ improperly considered her subjective complaints
of pain and her corresponding limitations. The regulations prescribe “a two-step analysis
when considering a claimant’s subjective statements about impairments and symptoms.”
Lewis v. Berryhill, 858 F.3d 858, 866 (4th Cir. 2017); see 20 C.F.R. § 404.1529(b)–(c).
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The ALJ first “looks for objective medical evidence showing a condition that could
reasonably produce the alleged symptoms.” Lewis, 858 F.3d at 866. If (as here) the
claimant has such a condition or impairment, then the ALJ must “evaluate the intensity,
persistence, and limiting effects of the claimant’s symptoms to determine the extent to
which they limit the claimant’s ability to perform basic work activities.” Id. The second
step “requires the ALJ to assess the credibility of the claimant’s statements about symptoms
and their functional effects.” Id. But the ALJ may not reject a claimant’s statements about
the intensity or persistence of her pain or its effect on her ability to work solely because
the medical evidence does not substantiate the claimant’s statements. Id. (citing 20 C.F.R.
§ 404.1529(c)(2)). Instead, if the objective medical evidence does not support the
claimant’s statements, the ALJ must “examine the entire case record” when considering
the “intensity, persistence, and limiting effects” of the symptoms. SSR 16-3p, 2017 WL
5180304, at *4 (Oct. 25, 2017). Doing so requires the ALJ to “build an accurate and logical
bridge from the evidence to his conclusion.” Brown v. Comm’r Soc. Sec. Admin., 873 F.3d
251, 269 (4th Cir. 2017).
Here, the ALJ reviewed Langston’s hearing testimony and found that her assertions
about the intensity, persistence, and limiting effects of her symptoms were not entirely
consistent with the medical and other evidence of record. In support, the ALJ noted that,
despite Langston’s complaints of nausea and stomach pain, her weight had actually
increased. The ALJ also relied upon Langston’s reports of her daily activities which
included the ability to “tend to her personal hygiene, cook, wash dishes, dust, wash laundry,
take care of her grandchildren, get her grandchildren to school, drive, take her medications
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independently, shop for groceries, handle her finances, read, visit with her family, and
watch television, activities, which generally reveal functioning at a greater level than
alleged.” J.A. 26. 4 The ALJ termed her daily activities as “representative of a fairly active
lifestyle and . . . not indicative of a significant restriction of activities or constriction of
interests.” J.A. 26. In addition, the ALJ noted that doctors had not been able to find a
physical reason for her abdominal pain, but that it might be caused by long-term opiate use
and abdominal adhesions. J.A. 29. Regarding Langston’s back pain, the ALJ concluded
that, while some mechanical back pain was supported by the objective medical evidence,
Langston’s “rather extreme complaints” were not. J.A. 29. Finally, the ALJ gave a lengthy
recitation of Langston’s medical history, although the ALJ did not provide any analysis as
to the conclusions to be drawn therefrom.
Langston contends that the ALJ erred by disregarding her statements about her
abdominal pain because the ALJ could not find an objective medical explanation for the
intensity of her pain. We agree. See Arakas v. Comm’r, Soc. Sec. Admin., 983 F.3d 83, 96
(4th Cir. 2020) (finding that claimant is entitled to rely exclusively on subjective evidence
to show intensity and extent of pain and fatigue); Lewis, 858 F.3d at 866 (requiring
objective medical evidence to support claimant’s evidence of pain intensity improperly
increased claimant’s burden of proof). Indeed, the ALJ mentioned the lack of an official
diagnosis in the same paragraph in which he noted that the RFC was supported by the
evidence of record. To be sure, the ALJ did not explicitly state that the lack of “cause for
4
Citations to the “J.A.” refer to the Joint Appendix filed by the parties in this appeal.
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abdominal pain” was a primary reason to disregard Langston’s complaints. However, the
placement of this sentence implies that it was strongly related to the ALJ’s consideration
of Langston’s functional capacity. 5 That was error.
Moreover, the ALJ erred by discrediting Langston’s assertions of disabling pain
based largely on her ability to perform daily activities. An ALJ must “build an accurate
and logical bridge” from the evidence to his credibility determination. Brown, 873 F.3d at
269. But in this case, the ALJ failed to explain how Langston’s ability to perform modest
housework (such as cleaning, laundry, and cooking simple meals, with many breaks), drive
(not daily), and enjoy physically undemanding, sedentary hobbies (watching television)
undermined her assertions about her pain. See id. at 269–70 (finding ALJ who noted
claimant’s various activities erred by not acknowledging limited extent of activities or
explaining how they showed claimant could sustain full-time job). In addition, the ALJ
improperly relied upon Langston’s daily activities without also considering her qualifying
statements that her ability to participate in these activities had lessened over time and that,
even back in 2014, she proffered that she could only perform the activities intermittently
and with breaks and rest due to pain and fatigue. See Arakas, 983 F.3d at 99 (holding that
ALJ must consider the extent to which claimant can perform different types of activities).
Given Langston’s testimony that nearly all activities were intermittent and required
5
Moreover, Langston had been prescribed strong narcotics, including morphine, for
nearly a decade to address her pain, which is objective medical evidence supporting her
complaints of extreme pain, even if the cause was unknown.
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numerous breaks, we conclude that substantial evidence does not support the ALJ’s
conclusion that Langston’s daily activities were inconsistent with her subjective complaints
of pain. Moreover, the ALJ did not explain how Langston’s limited activities demonstrated
an ability to persist through an eight-hour workday, five days a week. See id. at 100–01
(noting that the ability to perform household chores, drive, shop, walk for exercise, cook,
and do yard work did not constitute substantial evidence of the ability to work full time in
light of the applicant’s testimony as to her limitations in conducting those activities).
The only other bases provided by the ALJ for rejecting Langston’s testimony
regarding her debilitating pain were the increase in her weight, the fact that some of her
symptoms might be caused by opiate use, and the fact that the medical records did not
mention that Langston used a cane. 6 While increased weight and contradictory evidence
about cane use could support rejecting Langston’s testimony about the extent of her
abdominal and back pain, absent any analysis by the ALJ, these factors are insufficient to
overcome her ongoing complaints of pain, the prescription of strong pain medication, and
her testimony as to her ability to complete daily tasks. Regarding Langston’s use of
narcotics, the ALJ did not provide any discussion as to whether stopping their use would
increase her pain, even if it decreased her GI symptoms. Moreover, if the ALJ believed
that Langston’s GI symptoms were caused by narcotics, it is unclear why the ALJ partially
discounted her complaints of GI issues.
6
Langston testified in 2019 that she used a cane.
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Because the ALJ’s determination that Langston’s daily activities were inconsistent
with her complaints of disabling pain was not supported by substantial evidence and
because the ALJ erred in considering the lack of objective evidence as a primary reason
for rejecting Langston’s subjective complaints, we vacate the district court’s judgment and
remand with instructions to remand the case to the agency for further proceedings
consistent with this opinion. We dispense with oral argument because the facts and legal
contentions are adequately presented in the materials before this court and argument would
not aid the decisional process.
VACATED AND REMANDED
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