Paneto v. Commissioner of Social Security

Filing 17

MEMORANDUM OPINION. Signed by Judge Stephanie A. Gallagher on 3/10/2025. (heps, Deputy Clerk)

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

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

March 10, 2025

LETTER ORDER
Lauren P. v. Leland Dudek, Commissioner, Social Security Administration1
Civil No. 24-0480-SAG

Re:

Dear Counsel:
On February 19, 2024, Plaintiff Lauren P. (“Plaintiff”) petitioned the Court to review the
Social Security Administration’s (“SSA’s” or “Commissioner’s” or “Defendant’s”) final decision
to deny her claim for Social Security benefits. ECF 1. I have considered the record in this case
(ECF 9) and the parties’ filings (ECFs 12, 15-16). I find that no hearing is necessary. See D. Md.
Loc. R. 105.6. The Court must uphold the decision of the SSA if it is supported by substantial
evidence and if the SSA 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 REVERSE the
Commissioner’s decision and REMAND the case for further consideration. This letter explains
why.
I.

PROCEDURAL BACKGROUND

On September 16, 2020, Plaintiff filed a Title II application for Disability Insurance
Benefits (“DIB”) and a Title XVI application for Supplemental Security Income (“SSI”) benefits,
alleging a disability onset date of November 1, 2019. Tr. 207-19. Plaintiff’s claims were denied
initially and on reconsideration. Tr. 113-22, 125-36. On January 25, 2023, an Administrative Law
Judge (“ALJ”) held a hearing. Tr. 40-65. Following the hearing, on March 9, 2023, the ALJ
determined that Plaintiff was not disabled within the meaning of the Social Security Act 2 during
the relevant time frame. Tr. 14-39. The Appeals Council denied Plaintiff’s request for review, Tr.
1-6, so the ALJ’s decision constitutes the final, reviewable decision of the SSA, Sims v. Apfel, 530
U.S. 103, 106-07 (2000); see also 20 C.F.R. § 422.210(a).
II.

THE ALJ’S DECISION
Under the Social Security Act, disability is defined as the “inability to engage in any

1

Plaintiff filed this case against the Commissioner of Social Security on February 19, 2024.
ECF 1. Leland Dudek became the Acting Commissioner of Social Security on February 16,
2025. Accordingly, Commissioner Dudek has been substituted as this case’s Defendant pursuant
to Federal Rule of Civil Procedure 25(d). See Fed. R. Civ. P. 25(d).
2

42 U.S.C. §§ 301 et seq.

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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); 20 C.F.R.
§§ 404.1505(a), 416.905(a). The ALJ is required to evaluate a claimant’s disability determination
using a five-step sequential evaluation process. See 20 C.F.R. §§ 404.1520, 416.920. “Under this
process, an ALJ evaluates, in sequence, whether the claimant: ‘(1) worked during the alleged
period of disability; (2) had a severe impairment; (3) had an impairment that met or equaled the
requirements of a listed impairment; (4) could return to [their] past relevant work; and (5) if not,
could perform any other work in the national economy.’” Kiser v. Saul, 821 F. App’x 211, 212
(4th Cir. 2020) (citation omitted) (quoting Hancock v. Astrue, 667 F.3d 470, 472 (4th Cir. 2012)).
Here, at step one, the ALJ determined that Plaintiff had “not engaged in substantial gainful
activity since November 1, 2019, the alleged onset date[.]” Tr. 20. The ALJ then made findings
specific to the relevant time periods for Plaintiff’s two applications: November 1, 2019 through
her date last insured, December 31, 2020, for her DIB application, and September 16, 2020 through
the date of the opinion for her SSI application. The ALJ’s findings for both time periods are
identical.
Specifically, at step two, the ALJ found that Plaintiff suffered from the severe impairments
of “status post total left knee replacement surgery, bilateral knee osteoarthritis, and obesity[.]” Tr.
20, 27. The ALJ also determined that all of Plaintiff’s other impairments, including hypertension,
epistaxis, hyperlipidemia, gastroesophageal reflux disease, and endometrial cancer, were nonsevere impairments. Tr. 20-21, 27-28.
At step three, the ALJ determined that Plaintiff did “not have an impairment or combination
of impairments that meets or medically equals the severity of one of the listed impairments in 20
CFR Part 404, Subpart P, Appendix 1[.]” Tr. 22, 30. Despite these impairments, the ALJ
determined that Plaintiff retained the residual functional capacity (“RFC”) to:
perform sedentary work as defined in 20 CFR 404.1567(a), lifting and carrying 10
pounds occasionally and less than 10 pounds frequently; standing and walking for
2 hours in an 8 hour day; and, sitting for 6 hours in an 8 hour day. She can perform
work that occasionally requires balancing, stooping, kneeling, crouching, crawling,
and climbing, but no work that requires the use of ladders, ropes, and scaffolds.
Tr. 23, 30.
The ALJ further determined that Plaintiff was able to perform her past relevant work as an
Order Clerk (DOT3 #249.362-026), as it is generally performed. Tr. 34. Therefore, the ALJ
The “DOT” is the Dictionary of Occupational Titles. “The Dictionary of Occupational Titles,
and its companion, Selected Characteristics of Occupations Defined in the Revised Dictionary of
Occupational Titles . . . , are [SSA] resources that list occupations existing in the economy and
explain some of the physical and mental requirements of those occupations. U.S. Dep’t of
Labor, Dictionary of Occupational Titles (4th ed. 1991); U.S. Dep’t of Labor, Selected
3

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concluded that Plaintiff has not been disabled “from November 1, 2019 through the date last
insured[,] . . . [and] since September 16, 2020[.]” Tr. 27, 35.
III.

LEGAL STANDARD

The scope of the Court’s review is limited to determining whether substantial evidence
supports the ALJ’s factual findings and whether the decision was reached through the application
of the correct legal standards. See Coffman v. Bowen, 829 F.2d 514, 517 (4th Cir. 1987). “The
findings of the [ALJ] . . . as to any fact, if supported by substantial evidence, shall be conclusive .
. . .” 42 U.S.C. § 405(g). Substantial evidence is “evidence which a reasoning mind would accept
as sufficient to support a particular conclusion.” Laws v. Celebrezze, 368 F.2d 640, 642 (4th Cir.
1966). It is “more than a mere scintilla . . . and somewhat less than a preponderance.” Id. In
conducting the “substantial evidence” inquiry, this Court’s review is limited to whether the ALJ
analyzed the relevant evidence and sufficiently explained their findings and rationale in crediting
the evidence. See, e.g., Sterling Smokeless Coal Co. v. Akers, 131 F.3d 438, 439–40 (4th Cir.
1997); DeLoatche v. Heckler, 715 F.2d 148, 150 (4th Cir. 1983) (“Judicial review of an
administrative decision is impossible without an adequate explanation of that decision by the
[ALJ].”).
IV.

ANALYSIS

Plaintiff offers two arguments. First, Plaintiff argues that the RFC is not supported by
substantial evidence because the ALJ failed to properly evaluate the medical opinions from her
treating physician, Dr. Chika Victoria Egbe. ECF No. 12, at 14. Second, Plaintiff argues that the
RFC is not supported by substantial evidence because the ALJ failed to properly evaluate
Plaintiff’s subjective testimony regarding the intensity, persistence, and limiting effects of her
symptoms. Id. at 19-20. Defendant contests both points. ECF No. 15 at 5, 11.
Plaintiff’s first argument is dispositive. An ALJ “must follow certain procedures when
assessing the weight to which medical opinions are entitled.” Adrianna S. v. Comm’r of Soc. Sec.,
No. SAG-20-3136, 2022 WL 112034, at *1 (D. Md. Jan. 12, 2022) (citing 20 C.F.R. §§ 404.1520c,
416.920c). The ALJ must “articulate . . . how persuasive [the ALJ] finds each medical opinion.”
Id. (citing 20 C.F.R. §§ 404.1520c(b), 416.920c(b)). Because “[s]upportability and consistency
are the most important factors when considering the persuasiveness of medical opinions,” the ALJ
must “explain how [he] considered [these] factors.” Id. “Supportability generally refers to ‘the
objective medical evidence and supporting explanations provided by a medical source.’” Id.
(quoting 20 C.F.R. §§ 404.1520c(c)(1), 416.920c(c)(1)). “Strictly speaking, ‘supportability’
concerns an opinion’s reference to diagnostic techniques, data collection procedures/analysis, and
other objective medical evidence.” Carlos F. v. Kijakazi, No. 22-2049-BAH, 2023 WL 3293086,
at *3 (D. Md. May 5, 2023) (internal quotation marks and citation omitted); see also Mary W. v.
Comm'r of Soc. Sec., No. 20-5523, 2022 WL 202764, at *10 (S.D. Ohio Jan. 24, 2022) (“For the
ALJ to have adequately discussed the supportability of ... opinions, the ALJ needed to evaluate
Characteristics of Occupations Defined in the Revised Dictionary of Occupational Titles
(1993).” Pearson v. Colvin, 810 F.3d 204, 211 n.1 (4th Cir. 2015).

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what the [physicians] said they based their opinions on—not simply how their opinions compared
to the record evidence as a whole, which only goes to ... consistency[.]”).
“Consistency” is the extent to which the opinion is consistent with the evidence from other
medical sources and nonmedical sources in the claim". 20 C.F.R. §§ 404.1520c(c)(2),
416.920c(c)(2). Supportability and consistency “must be considered independently[.]” Carlos F.,
2023 WL 3293086, at *3; see also Duane H. v. Kijakazi, No. JMC-20-3673, 2021 WL 8314949,
at *3 (D. Md. Dec. 29, 2021) (recognizing that to consider supportability “in conjunction with”
consistency “would conflate the nuances of those factors”). Supportability is not considered
independently when the ALJ only analyzes “the consistency of an opinion with other opinions
from the . . . rest of the record[.]” Timeka M. v. Kijakazi, No. 22-3194-BAH, 2023 WL 5804645,
at *3 (D. Md. Sept. 6, 2023). Instead, the ALJ “must assess the relevance of ‘the objective medical
evidence and supporting explanations presented by a medical source’ to the ultimate finding
advanced by that medical expert.” Id. (quoting 20 C.F.R. § 404.1520c(c)(1)).
Dr. Egbe issued three opinions in this case: a mental functional capacity assessment on
January 5, 2023, a physical medical source statement on January 5, 2023, and a January 19, 2023
letter attesting that Plaintiff could not serve jury duty. The ALJ evaluated those opinions as
follows, cutting and pasting the below analyses at multiple points in the opinion4:
The undersigned considered the opinion of Chika Egbe, M.D., the claimant's
medical source, who indicated on January 5, 2023 on a mental functional capacity
assessment that since May 24, 2022 the claimant has no limitation in understanding
and memory, minimal to moderate limitation in sustained concentration and
persistence and in social interaction, and that the claimant would be expected to be
off task 10% to 15% of the work day (Exhibits 7F; 9F/21-23). While the finding of
no limitation in understanding and memory is supported by the record, the finding
of moderate limitation in sustained concentration and persistence and in social
interaction is not supported by and consistent with the record, which reveals
typically normal mental status examination findings and the progress notes
generally indicating the claimant’s mental health symptoms, while exacerbated at
times, especially when flying, are controlled with routine primary care treatment.
Moreover, there is no documentation indicating inpatient, partial inpatient or
outpatient psychiatric treatment, psychotherapy or emergency department
treatment for an exacerbation of mental health symptoms. Further, the claimant
reported that she is able to shop in stores and by computer, prepare simple meals,
take care of pets without assistance, read, watch television, and use the internet.
Accordingly, the undersigned finds this opinion to be mostly not persuasive.

It strikes this Court as unusual that so much of the ALJ’s analysis for DIB and SSI in this case
was identical, given the very minimal overlap between the two time windows. For example, Dr.
Egbe’s analyses only cover the period after May 24, 2022 and would seemingly have little to no
bearing on Plaintiff’s DIB application.
4

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Tr. 25-26, 33.
The undersigned also considered the January 19, 2023 opinion of Dr[.] Egbe, who
indicated in a letter that the claimant is not able to serve jury duty as she is not able
to sit for prolonged periods and she does not have the ability to concentrate as
required for court proceedings (Exhibit 9F/4). Initially, the undersigned notes that
Dr. Egbe did not provide an assessment of the specific functional limitations
associated with sitting. Moreover, Dr. E[gb]e’s finding that the claimant has
limitations in concentrating is not supported by and consistent with the record,
including the typically normal mental status examination findings and the progress
notes generally indicating the claimant’s mental health symptoms, while
exacerbated at times, especially when flying, are controlled with routine primary
care treatment. In addition, there is no documentation indicating inpatient, partial
inpatient or outpatient psychiatric treatment, psychotherapy or emergency
department treatment for an exacerbation of mental health symptoms. Further, the
claimant reported that she is able to shop in stores and by computer, prepare simple
meals, take care of pets without assistance, read, watch television, and use the
internet. Accordingly, the undersigned finds this opinion to be not persuasive.
Tr. 26, 33.
The undersigned considered the opinion of Chika Egbe, M.D., the claimant's
medical source, who indicated on January 5, 2023 on a medical source statement
and onset date questionnaire that since May 24, 2022 the claimant has been capable
of lifting and/or carrying twenty (20) pounds frequently, but never fifty (50)
pounds, sitting sixty (60) minutes, standing and/or walking thirty (30) minutes at
one time, sitting eight (8) hours and standing and/or walking one (1) hour total in
an eight (8) hour work day with changing positions at will from sitting, standing or
walking, frequent balancing or stooping, occasional kneeling or crouching, and
would likely be absent from work once or twice per month (Exhibits 6F; 9F/15-17).
The undersigned acknowledges that Dr. Egbe is a treatment provider for the
claimant. However, these findings are not consistent with the record that reveals
physical examination findings indicating normal gait despite the claimant's
complaints of knee pain post total left knee replacement, the claimant's conservative
treatment history for knee pain post total left knee replacement, primarily consisting
of physical therapy and occupational therapy while hospitalized for a bacteria
infection related to the total left knee replace surgery and the use of topical
medication and ibuprofen. In addition, the claimant has reported that she is able to
travel by plane, shop in stores, and take care of pets without assistance.
Accordingly, the undersigned is not persuaded by this opinion.
Tr. 27, 34.
At no point in the lengthy opinion does the ALJ summarize Dr. Egbe’s findings during her
personal examinations of Plaintiff. For example, during a visit on May 24, 2022, Dr. Egbe noted

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Plaintiff’s complaints of right knee pain and walking limitations and made a referral to an
orthopedist. Tr. 2057. Dr. Egbe also noted that Plaintiff “stays in bed a lot” and is “feeling
overwhelmed and depressed given life stressors” including handling the affairs of her deceased
relatives. Id. On June 26, 2022, Dr. Egbe noted that Plaintiff’s “depression/grief” and fatigue
were worsening, noting that Plaintiff” has several life stressors and limited mobility from knee
pain as contributing factors.” Tr. 2452. The report also noted that Plaintiff’s osteoarthritis of her
left knee was “[l]imiting [her] quality of life.” Id. Again on September 13, 2022, Dr. Egbe
reported that Plaintiff’s depression/grief was worsening and offered to look into therapy options
at Hopkins, noting that Plaintiff “declines pharmacotherapy for now.” Tr. 2415. The ALJ neither
assessed “objective medical evidence and supporting explanations presented by” Dr. Egbe’s
opinion, 20 C.F.R. § 404.1520c(c)(1), nor Dr. Egbe’s “diagnostic techniques, data collection
procedures/analysis, and other objective medical evidence[,]” Carlos F., 2023 WL 3293086, at *3
(internal quotation marks and citation omitted). In other words, the ALJ failed to consider how
Dr. Egbe’s treatment notes factored into the opinion’s conclusions. Importantly, the ALJ did not
make it “apparent . . . that he meaningfully considered [supportability] before deciding how much
weight to give [Dr. Egbe’s] opinion[.]” Dowling, 986 F.3d 377 at 385.
Moreover, the ALJ’s conclusion that Plaintiff’s “mental health symptoms . . . are controlled
with routine primary care treatment,” Tr. 26, 33, is undermined by Dr. Egbe’s treatment notes.
The treatment notes repeatedly reflect that her symptoms were worsening and that Dr. Egbe was
seeking to refer her for more specialized assistance.
Remand is warranted because “[h]ad the ALJ properly considered the supportability of [Dr.
Egbe]’s opinion, [he] may have come to a different determination of the weight [Dr. Egbe’s]
opinion should be given.” Charles H. v. Kijakazi, No. 22-3331-BAH, 2023 WL 5984150, at *4
(D. Md. Sept. 14, 2023); see also Brenda B. v. Kijakazi, No. 22-2837-BAH, 2023 WL 5721609,
at *4 (D. Md. Sept. 5, 2023) (ordering remand where the ALJ failed to properly consider the
supportability of a medical opinion); Timeka M., 2023 WL 5804645, at *4 (same); Carlos F., 2023
WL 3293086, at *4 (same). Had there been a different weight given to Dr. Egbe’s opinions, the
ALJ could “have altered Plaintiff’s RFC,” Timeka M., 2023 WL 5804645, at *4, or “changed the
ultimate disability determination[,]” Carlos F., 2023 WL 3293086, at *4.
Remand is also warranted for failure to evaluate consistency. Specifically, the ALJ failed
to “properly evaluate[] the consistency of [Dr. Egbe]’s medical opinion with other medical
evidence in the record.” Kadian Ophelia W-R. v. Kijakazi, No. GLS-22-2458, 2023 WL 4421190,
at *5 (D. Md. July 10, 2023); see also Ellen C. v. Comm’r, Soc. Sec. Admin., No. SAG-22-1698,
2023 WL 2163644, at *3 (D. Md. Feb. 22, 2023) (finding that the ALJ failed to properly evaluate
the consistency of a medical opinion because the ALJ did not explain how the plaintiff’s “reported
activities of daily living are inconsistent with [the doctor]’s findings”); Selina M. v. Kijakazi, No.
GLS-21-2943, 2023 WL 2034292, at *4-5 (D. Md. Feb. 16, 2023) (finding that the ALJ failed to
properly evaluate the consistency of a medical opinion because the ALJ did not analyze evidence
that supported the opinion). In Kadian, Ellen C., and Selina M., the court ordered remand because
the ALJ failed to consider evidence contradicting his conclusion that a medical opinion was not

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consistent with the record. See Kadian, 2023 WL 4421190, at *5; Ellen C., 2023 WL 2163644, at
*2-3; Selina M., 2023 WL 2034292, at *4-5.
Although the ALJ is not required to refer to every piece of evidence when rendering his
decision, he must provide a reasoned basis for rejecting evidence that runs contrary to his ultimate
conclusion. Reid v. Comm'r Soc. Sec., 769 F.3d 861, 865 (4th Cir. 2014); see also Dotson ex rel.
T.W. v. Astrue, No. SAG–10–2066, 2012 WL 1911110, at *4 (D. Md. May 24, 2012) (“An ALJ
must affirmatively reject that contradictory evidence and explain h[is] rationale for so
doing”); Smith v. Heckler, 782 F.2d 1176, 1181 (4th Cir. 1986) (same). When the record contains
evidence that contradicts an ALJ's conclusion, an ALJ who fails to analyze such evidence and
explain his basis for rejecting it precludes meaningful review on appeal. See, e.g., Davis v. Colvin,
No. TMD-13-3376, 2015 WL 390708, at *4 (D. Md. Jan 27, 2015).
The issue with the ALJ’s “consistency” finding is his failure to explain how the plaintiff’s
“reported activities of daily living are inconsistent with [Dr. Egbe]’s findings.” Ellen C., 2023 WL
2163644, at *3. Specifically, the ALJ fails to explain how Plaintiff’s ability to shop, prepare simple
meals, take care of pets, read, watch television, and use the internet have any bearing on the
limitations in Dr. Egbe’s opinion. See Sharmaine W. v. Kijakazi, No. TJS-21-2716, 2022 WL
4545843, at *3 (D. Md. Sept. 29, 2022) (finding that the ALJ’s failure to explain how the plaintiff’s
daily activities had any bearing on the limitations in the doctor’s opinion precluded a finding that
the doctor’s opinion was inconsistent with such activities). It is also important to remember that,
“[w]hen assessing the effect of [a] claimant[‘s] activities of daily living on their physical RFC,
ALJs must be careful not to place too much emphasis on simple tasks that are insufficiently
indicative of a claimant's ability to do work existing in the national economy.” Eiker v. Astrue,
No. CBD-11-3584, 2013 WL 2149755, at *3 (D. Md. May 15, 2013). This is because “the ability
to engage in some light activity does not necessarily translate into the ability to do substantial
gainful activity.” Andrew M. v. Kijakazi, No. CBD-20-2858, 2022 WL 971078, at *8 (D. Md.
Mar. 31, 2022). In a case like this involving a combination of physical and mental impairments,
the ability to perform activities that can be done in a sedentary position (like reading or watching
television), and the ability to perform relatively quick tasks involving limited spurts of physical or
mental exertion, do not necessarily support the notion that a claimant is capable of sustained light
work for an eight-hour workday. The ALJ failed to provide an adequate explanation for his
contention that Plaintiff’s activities of daily living are inconsistent with the limitations noted by
Dr. Egbe.
Because the case is being remanded on other grounds, I need not address Plaintiff’s other
arguments, which the ALJ is free to consider on remand. Additionally, in remanding for further
explanation, the Court expresses no opinion as to whether the ALJ’s conclusion regarding
Plaintiff’s entitlement to benefits is correct.
V.

CONCLUSION

For the reasons set forth herein, pursuant to sentence four of 42 U.S.C. § 405(g), the SSA’s
judgment is REVERSED due to inadequate analysis. The case is REMANDED for further
proceedings in accordance with this opinion. The clerk is directed to CLOSE this case.

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Despite the informal nature of this letter, it should be flagged as a Memorandum Opinion.
A separate implementing Order follows.
Sincerely yours,
/s/
Stephanie A. Gallagher
United States District Judge