H-L. v. Bisignano

Background

Lori H-L. applied for Social Security disability insurance benefits (DIB) in September 2021, alleging disability with an onset date of July 31, 2019 — the date she was injured at work. The Social Security Administration (SSA) denied her application on July 1, 2022, and denied reconsideration on March 1, 2023. A hearing was held before an Administrative Law Judge (ALJ) on October 25, 2023, at which Lori H-L., then 53 years old, testified remotely.

ALJ's Five-Step Analysis

The ALJ applied the standard five-step sequential evaluation under 20 C.F.R. § 404.1520:

- Step 1: The ALJ found Lori H-L. had not engaged in substantial gainful activity since her injury date. - Step 2: The ALJ found the following severe impairments: right shoulder injury with rotator cuff tear; complex regional pain syndrome of the right upper extremity; resting tremor; lumbar degenerative disc disease; post-concussive syndrome; chronic migraines; chronic pain syndrome; fibromyalgia; generalized anxiety disorder; mood disorder; adjustment disorder; post-traumatic stress disorder; and somatic symptom disorder. - Step 3: The ALJ concluded that none of her impairments, individually or in combination, met or medically equaled a listed impairment, including Listing 11.02 (epilepsy, the most analogous listing for primary headache disorders). - RFC (pre-step 4): The ALJ determined Lori H-L. had the residual functional capacity (RFC) — meaning the most she could still do despite her impairments — to perform light work with significant physical restrictions (limited overhead reaching, no ladder or scaffold climbing, no crawling, no exposure to heights or heavy machinery) and mental limitations (simple instructions, occasional changes in work setting). - Step 4: The ALJ found she could not perform any past relevant work. - Step 5: The ALJ found she could perform other jobs existing in significant numbers nationally — merchandise marker, inspector and hand packager, and production assembler — and therefore concluded she was not disabled.

The SSA Appeals Council denied review, making the ALJ's decision the Commissioner's final decision. Lori H-L. then filed this federal court action under 42 U.S.C. § 405(g).

Standard of Review

Judicial review is limited to two questions: (1) whether the ALJ committed legal error, and (2) whether the decision is supported by substantial evidence — meaning more than a scintilla, or "such relevant evidence as a reasonable mind might accept as adequate to support a conclusion." Biestek v. Berryhill, 587 U.S. 97, 103 (2019). The court must examine the full record, including evidence both supporting and detracting from the ALJ's decision, but may not reweigh the evidence. If the record supports two different conclusions and one matches the ALJ's, the court must affirm.

Issues Raised and Rulings

1. RFC and Somatic Symptom Disorder (Basis for Remand)

Lori H-L. raised two interrelated arguments about the RFC determination, both focused on somatic symptom disorder — a recognized severe impairment in which a person genuinely believes physical symptoms are more severe than objective clinical evidence supports.

Under Social Security Ruling (SSR) 16-3p, once an ALJ finds that a claimant has a medically determinable impairment that could reasonably be expected to produce the alleged symptoms (as the ALJ did here), the ALJ must evaluate the intensity, persistence, and limiting effects of those symptoms across the full record. Under Eighth Circuit precedent (Nowling v. Colvin, 813 F.3d 1110 (8th Cir. 2016)), where a claimant has a somatoform disorder, the ALJ may not reject her subjective experiences without an express credibility finding, and must set forth that determination with enough detail to inform a reviewing court of which reported limitations the ALJ accepted.

The court found the ALJ failed this standard in three ways:

First, the ALJ made only passing reference to somatic symptom disorder despite classifying it as a severe impairment, and provided no discussion of how it might affect Lori H-L.'s perception of other symptoms. The ALJ observed that her treatment and symptom reports were "out of proportion" to her subjective complaints — yet that disproportion is precisely what somatic symptom disorder predicts, and the ALJ failed to explain the disorder's impact on that apparent mismatch.

Second, the ALJ's consistency findings (substituting for a credibility analysis under updated SSR 16-3p terminology) relied on activities that the court found were minimal, heavily accommodated, or merely aspirational: gardening described in the record as a future goal or done with neighbor and family assistance; a vague notation that Plaintiff was "very busy over the holidays"; plans to work a farm or generate side income with no evidence of actual activity; a deer hunting trip described as "modified"; and a home exercise program noted to be limited by ongoing complex regional pain syndrome.

Third, the ALJ failed to address Lori H-L.'s specific testimony about severe limitations: showering only once every two weeks because water on skin caused extreme pain; losing substantial weight (from 195 lbs. in 2020 to 120 lbs. at the hearing) due to difficulty preparing food; and spending several hours at a time lying in a dark room, which she testified would prevent a full 40-hour work week.

The court agreed with Lori H-L. that the ALJ "mischaracterized minimal, heavily accommodated activities as evidence of work capacity" and that the ALJ failed to adequately account for the difficulty with which she conducted those activities. The court ordered remand for further consideration consistent with SSR 16-3p.

2. Step-Three Listing Analysis — Listing 11.02 (Remanded on Derivative Grounds)

Because there is no specific listing for migraines, SSR 19-4p directs ALJs to evaluate whether a primary headache disorder medically equals Listing 11.02 (epilepsy). The ALJ concluded Lori H-L.'s headaches did not equal Listing 11.02, stating the record did not show the required frequency, duration, or interference with functioning.

The court remanded this issue because: (a) the step-three analysis appeared to rely on the same RFC findings being reconsidered on remand; (b) the ALJ's discounting of provider notes documenting frequent, severe headaches — including neurologist Dr. Ana Patricia Groeschel's notation of "daily headaches" spiking to migraines more than 15 days per month, and Dr. Michael Jordan's notation of 4–6 migraines per week — appeared to rest on the same consistency/credibility determination being sent back; and (c) in a footnote, the court observed the ALJ may have erred by considering whether Lori H-L. met Listing 11.02's seizure criteria exactly, rather than whether her headaches equaled the listing's general severity criteria.

The court also noted the ALJ's discounting of Dr. Jane Bailey's vision-related findings — on the ground that Lori H-L. was not consistently following up for vision therapy — may be undermined by evidence in the same provider note that Lori H-L. reported ongoing symptoms and intended to schedule additional appointments.

3. Closed Period of Disability (Declined Without Prejudice)

Lori H-L. argued the ALJ failed to consider whether she was entitled to a "closed period" of disability — a finding of disability for a defined past period even if she has since improved. The court declined to reach this argument on the current record but directed the ALJ on remand to also consider whether any 12-month period existed in which Lori H-L. was entitled to benefits.

Disposition

The court granted Lori H-L.'s request for relief (Docket No. 6), denied the Commissioner's opposition (Docket No. 12), and remanded the case to the Commissioner pursuant to sentence four of 42 U.S.C. § 405(g) for further administrative proceedings consistent with the order. Judgment was directed to be entered accordingly.