Knotts v. Commissioner, Social Security

Filing 39

ORDER denying 31 Defendant's Motion for Summary Judgment; reversing in part the Commissioner's judgment and remanding the case for further proceedings. Signed by Magistrate Judge Stephanie A Gallagher on 11/14/2017. (bmhs, Deputy Clerk)

UNITED STATES DISTRICT COURT
DISTRICT OF MARYLAND
CHAMBERS OF
STEPHANIE A. GALLAGHER
UNITED STATES MAGISTRATE JUDGE

101 WEST LOMBARD STREET
BALTIMORE, MARYLAND 21201
[phone]
Fax [phone]

November 14, 2017
LETTER TO COUNSEL
RE:

Thomas S. Knotts v. Commissioner, Social Security Administration;
Civil No. SAG-16-3561

Dear Counsel:
On October 26, 2016, Plaintiff Thomas S. Knotts petitioned this Court to review the
Social Security Administration’s final decision to deny his claim for Disability Insurance
Benefits. [ECF No. 1]. I have considered the Commissioner’s Motion for Summary Judgment,
Mr. Knotts’s reply, and the other documents and letters filed by both parties. [ECF Nos. 23, 26,
31, 37]. I find that no hearing is necessary. See Loc. R. 105.6 (D. Md. 2016). This Court must
uphold the decision of the Agency if it is supported by substantial evidence and if the Agency
employed proper legal standards. See 42 U.S.C. §§ 405(g), 1383(c)(3); Craig v. Chater, 76 F.3d
585, 589 (4th Cir. 1996). Under that standard, I will deny the Commissioner’s motion, reverse
the judgment of the Commissioner, and remand the case to the Commissioner for further analysis
pursuant to sentence four of 42 U.S.C. § 405(g). This letter explains my rationale.
Mr. Knotts filed a claim for Disability Insurance Benefits (“DIB”) on March 1, 2011,
alleging a disability onset date of July 1, 2010. (Tr. 84-85). His claim was denied initially and
on reconsideration. (Tr. 75-76, 80-83). A hearing was held on January 27, 2015, before an
Administrative Law Judge (“ALJ”). (Tr. 736-83). Following the hearing, the ALJ determined
that Mr. Knotts was not disabled within the meaning of the Social Security Act during the
relevant time frame. (Tr. 17-28). The Appeals Council (“AC”) denied Mr. Knotts’s request for
further review, (Tr. 6-9), so the ALJ’s decision constitutes the final, reviewable decision of the
Agency.
The ALJ found that Mr. Knotts suffered from the severe impairments of chronic
obstructive pulmonary disease (COPD), learning disorder, mild sleep apnea, obesity, mild
degenerative disc disease, and depression. (Tr. 19). Despite these impairments, the ALJ
determined that Mr. Knotts retained the residual functional capacity (“RFC”) to:
perform light work as defined in 20 CFR 404.1567(b) with the following
additional limitations: he can only occasionally climb stairs or ramps, but never
ladders, ropes, or scaffolds; he is limited to simple, repetitive tasks with only
occasional changes in routine; he cannot tolerate exposure to extreme heat,
extreme cold, extreme humidity, airborne irritants such as dusts, odors, gases, or
poor ventilation; and he can only perform work at a language level of one.

Thomas S. Knotts v. Commissioner, Social Security Administration;
Civil No. SAG-16-3561
November 14, 2017
Page 2
(Tr. 21). After considering the testimony of a vocational expert (“VE”), the ALJ determined that
Mr. Knotts could perform two jobs existing in the national economy and that, therefore, he was
not disabled. (Tr. 27-28).
Mr. Knotts raises several arguments in opposition to the Commissioner’s motion for
summary judgment: (1) that the ALJ’s holding runs afoul of the Fourth Circuit’s decision in
Mascio v. Colvin, 780 F.3d 632, 638 (4th Cir. 2015); (2) that the ALJ did not properly consider
the opinion of Dr. Merrion; (3) that the ALJ did not provide support for the finding that Mr.
Knotts could perform jobs at language level one; (4) that the ALJ did not account for Mr.
Knotts’s need to use a home nebulizer every four hours; and (5) that the ALJ made an improper
adverse credibility determination. I concur with Mr. Knotts’s first two arguments, and thus
remand is appropriate. In remanding for additional explanation, I express no opinion as to
whether the ALJ’s ultimate conclusion that Mr. Knotts is not entitled to benefits is correct.
Starting with the successful arguments, in Mascio, the United States Court of Appeals for
the Fourth Circuit determined that remand was appropriate for three distinct reasons, including,
as pertinent to this case, the inadequacy of the ALJ’s evaluation of “moderate difficulties” in
concentration, persistence, or pace. 780 F.3d at 638. At step three of the sequential evaluation,
the ALJ determines whether a claimant’s impairments meet or medically equal any of the
impairments listed in 20 C.F.R. Part 404, Subpart P, Appendix 1. Listings 12.00 et seq. pertain
to mental impairments. 20 C.F.R. Pt. 404, Subpt. P, App. 1 § 12.00. The relevant listings
therein consist of: (1) a brief statement describing a subject disorder; (2) “paragraph A criteria,”
which consists of a set of medical findings; and (3) “paragraph B criteria,” which consists of a
set of impairment-related functional limitations. Id. § 12.00(A). If both the paragraph A criteria
and the paragraph B criteria are satisfied, the ALJ will determine that the claimant meets the
listed impairment. Id.
Paragraph B consists of four broad functional areas: (1) activities of daily living; (2)
social functioning; (3) concentration, persistence, or pace; and (4) episodes of decompensation.
The ALJ employs the “special technique” to rate a claimant’s degree of limitation in each area,
based on the extent to which the claimant’s impairment “interferes with [the claimant’s] ability
to function independently, appropriately, effectively, and on a sustained basis.” 20 C.F.R. §
404.1620a(c)(2). The ALJ uses a five-point scale to rate a claimant’s degree of limitation in the
first three areas: none, mild, moderate, marked, or extreme. Id. § 404.1620a(c)(4). To satisfy
paragraph B, a claimant must exhibit either “marked” limitations in two of the first three areas,
or “marked” limitation in one of the first three areas with repeated episodes of decompensation.
See, e.g., 20 C.F.R. Pt. 404, Subpt. P, App. 1 § 12.02. Marked limitations “may arise when
several activities or functions are impaired, or even when only one is impaired, as long as the
degree of limitation is such as to interfere seriously with [the claimant’s] ability to function.” Id.
§ 12.00(C).
The functional area of “concentration, persistence, or pace refers to the ability to sustain
focused attention and concentration sufficiently long to permit the timely and appropriate
completion of tasks commonly found in work settings.” Id. § 12.00(C)(3). Social Security

Thomas S. Knotts v. Commissioner, Social Security Administration;
Civil No. SAG-16-3561
November 14, 2017
Page 3
regulations do not define limitations in concentration, persistence, or pace “by a specific number
of tasks that [a claimant is] unable to complete.” Id. The regulations, however, offer little
guidance on the meaning of “moderate” limitations.
The Fourth Circuit remanded Mascio because the hypothetical the ALJ posed to the
VE—and the corresponding RFC assessment—did not include any mental limitations other than
unskilled work, despite the fact that, at step three of the sequential evaluation, the ALJ
determined that the claimant had moderate difficulties in maintaining concentration, persistence,
or pace. 780 F.3d at 637-38. The Fourth Circuit specifically held that it “agree[s] 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.” Id.
at 638 (quoting Winschel v. Comm’r of Soc. Sec., 631 F.3d 1176, 1180 (11th Cir. 2011)) (internal
quotation marks omitted). In so holding, the Fourth Circuit emphasized the distinction between
the ability to perform simple tasks and the ability to stay on task, stating that “[o]nly the latter
limitation would account for a claimant’s limitation in concentration, persistence, or pace.” Id.
Although the Fourth Circuit noted that the ALJ’s error might have been cured by an explanation
as to why the claimant’s moderate difficulties in concentration, persistence, or pace did not
translate into a limitation in the claimant’s RFC, it held that absent such an explanation, remand
was necessary. Id.
In the instant case, the ALJ found that Mr. Knotts had moderate difficulties in the area of
concentration, persistence, or pace. (Tr. 20). The entirety of the analysis states:
Here both the claimant and the medical evidence are again in agreement. The
claimant described some trouble in this area, and his treating mental health
providers and the other psychologists who evaluated him seem to have found this
to be consistent. Difficulties with memory were noted, for example, although the
claimant did retain some functioning (since he reported being able to watch TV
without difficulty).
Id. According to 20 CFR § 404.1520a(c)(2), the rating of “moderate difficulties” is supposed to
represent the result of application of the following technique:
We will rate the degree of your functional limitation based on the extent to which
your impairment(s) interferes with your ability to function independently,
appropriately, effectively, and on a sustained basis. Thus, we will consider such
factors as the quality and level of your overall functional performance, any
episodic limitations, the amount of supervision or assistance you require, and the
settings in which you are able to function.
20 CFR § 404.1520a(c)(2). Once the technique has been applied, the ALJ is supposed to include
the results in the opinion as follows:

Thomas S. Knotts v. Commissioner, Social Security Administration;
Civil No. SAG-16-3561
November 14, 2017
Page 4
At the administrative law judge hearing and Appeals Council levels, the written
decision must incorporate the pertinent findings and conclusions based on the
technique. The decision must show the significant history, including examination
and laboratory findings, and the functional limitations that were considered in
reaching a conclusion about the severity of the mental impairment(s). The
decision must include a specific finding as to the degree of limitation in each of
the functional areas described in paragraph (c) of this section.
Id. § 404.1520a(e)(4). The cursory analysis provided by the ALJ in Mr. Knotts’s case fails to
fulfill these requirements. It appears that the ALJ believed Mr. Knotts to have moderate
difficulties in concentration, persistence, and pace, instead of mild or no difficulties. Moreover,
that belief is substantiated by the psychological evaluation of Dr. Merrion. Dr. Merrion
determined, in relevant part, that “[t]he claimant lacks persistence due to lethargy and his pace
was slow.” (Tr. 300). Dr. Merrion also found that Mr. Knotts “has a mildly impaired ability to
deal with the normal stressors and demands encountered in competitive employment because of
his very limited language-based skills and deteriorating memory[.]” (Tr. 304). Similarly,
another examiner, Dr. Hales, noted that Mr. Knotts exhibited “a tendency to become mildly
distracted” and determined that his “symptoms do appear to impact functioning in a significant
manner.” (Tr. 392-93). Despite this medical evidence, the ALJ’s RFC assessment includes no
limitation to deal with Mr. Knotts’s impairment in the ability to concentrate or maintain a pace of
work over an eight-hour workday. In light of this inadequacy, I must remand the case to the
Commissioner for further analysis consistent with the Fourth Circuit’s mandate in Mascio. On
remand, the ALJ should consider whether the RFC assessment needs to be changed in order to
accommodate Mr. Knotts’s moderate limitation under the dictates of Mascio.
In light of the remand described above, Mr. Knotts’s remaining arguments need not be
addressed in detail. On remand, however, the ALJ should also (1) determine whether Mr.
Knotts’s reading abilities measure up to a Language level of one;1 (2) assess the veracity of Mr.
Knotts’s testimony that he requires use of a home nebulizer multiple times per day; and (3)
ensure that the opinion contains an adequate assessment of Mr. Knotts’s credibility, citing to
objective and non-objective evidence of record.
For the reasons set forth above, Defendant’s Motion for Summary Judgment, (ECF No.
31), is DENIED. Pursuant to sentence four of 42 U.S.C. § 405(g), the Commissioner’s judgment
is REVERSED IN PART due to inadequate analysis. The case is REMANDED for further
proceedings in accordance with this opinion. The Clerk is directed to CLOSE this case.

1

This assessment is particularly critical, given the VE’s testimony that, if Mr. Knotts cannot work at a Language
level of one, no jobs would be available to him. (Tr. 780). Moreover, it appears that at least one of the jobs
identified by the VE in this case may require a Language level of two, and thus may have been identified in error.
Pl. Mot. Exh. B.

Thomas S. Knotts v. Commissioner, Social Security Administration;
Civil No. SAG-16-3561
November 14, 2017
Page 5

Despite the informal nature of this letter, it should be flagged as an opinion and docketed
as an order.
Sincerely yours,
/s/
Stephanie A. Gallagher
United States Magistrate Judge