Brittany J. S. v. Bisignano

Background

Brittany J. S. alleges disability beginning April 22, 2020, the date she suffered a heart attack (ST-elevation myocardial infarction) while working as a hospital emergency room receptionist. She was born with Shone's Syndrome, a congenital heart defect, and has a history of aortic repair, aortic valve replacement, ischemic cardiomyopathy with dilation, a stroke in her late teens or early twenties, and ongoing syncopal episodes (episodes in which she loses consciousness). Her alleged severe impairments also include chronic migraines, asthma, obesity, right shoulder degenerative joint disease, chronic pain syndrome, depression, anxiety, bipolar disorder, personality disorder, and posttraumatic stress disorder (PTSD). She takes approximately 20 medications.

After her initial application and request for reconsideration were denied, ALJ JoErin O'Leary held a hearing and issued a decision on April 5, 2023 finding Brittany J. S. not disabled. Brittany J. S. sought review in this court in a prior related proceeding, and pursuant to a joint stipulation, the matter was remanded to the Commissioner. On remand, ALJ Joshua Klasic held a hearing on May 1, 2025, and issued a decision on June 9, 2025, again finding Brittany J. S. not disabled. She then filed the instant complaint on September 24, 2025, seeking reversal and an immediate award of benefits, or in the alternative, another remand.

The ALJ's Decision on Remand

ALJ Klasic conducted the standard five-step sequential disability analysis. He found: (Step 1) no substantial gainful activity since the alleged onset date; (Step 2) multiple severe impairments as listed above; (Step 3) no impairment meeting or equaling a listed impairment. Before Step 4, the ALJ determined Brittany J. S.'s residual functional capacity (RFC) — the most she can still do despite her limitations — finding she could perform sedentary work with numerous restrictions, including no overhead reaching with her dominant right arm, no exposure to unprotected heights or dangerous machinery, limited social interaction, and no production-rate work. At Step 4, the ALJ found she had no past relevant work. At Step 5, relying on vocational expert testimony, the ALJ found she could perform jobs existing in significant numbers in the national economy (sorter, packer, or bench assembler), and therefore was not disabled.

Medical Opinions at Issue

Dr. Neha Sakowski (internal medicine, treating physician): Completed a checkbox disability impairment questionnaire in May 2025, opining that Brittany J. S. could sit or stand for less than one hour in an eight-hour workday, needed to elevate both legs to chest height when seated, could lift no more than five pounds, needed frequent unscheduled breaks, and would be absent more than three times per month. She concluded Brittany J. S. could not work in any capacity.

Dr. Jamie Lohr (treating cardiologist): Completed a cardiac impairment questionnaire in May 2025. She opined that Brittany J. S. could sit for six or more hours per workday (which the ALJ found persuasive), but also that her symptoms would occasionally interfere with attention and concentration, that she would need 20-to-30-minute unscheduled breaks, and would be absent two to three times per month (which the ALJ found unpersuasive).

Leah Streitman, PA-C (certified physician's assistant, mental health): Completed a mental impairment questionnaire in April 2025, identifying marked limitations in Brittany J. S.'s ability to perform activities within a schedule, complete a workday without psychological interruptions, and predicting absences more than three times per month.

The Court's Analysis

Medical Opinion Evidence

Under current Social Security regulations, a treating source's opinion receives no automatic deference and is evaluated for persuasiveness using five factors, the most important of which are (1) supportability (how well the opinion is backed by the source's own evidence and explanations) and (2) consistency (how well the opinion aligns with other evidence in the record). 20 C.F.R. §§ 404.1520c, 416.920c.

The court applied a deferential "zone of choice" standard: as long as the ALJ adequately considered supportability and consistency and substantial evidence supports the conclusions, the court will not reverse even if it might weigh the evidence differently.

Subjective Symptom Testimony

This is where the court found reversible error. When evaluating a claimant's own statements about symptoms, an ALJ must consider the factors identified in Polaski v. Heckler, 739 F.2d 1320 (8th Cir. 1984): daily activities; duration, frequency, and intensity of symptoms; medication dosage, effectiveness, and side effects; precipitating and aggravating factors; and functional restrictions, among other factors. The ALJ need not discuss each factor explicitly, but it must be evident from the decision that the factors were considered.

Brittany J. S. testified extensively about the combined effects of her conditions: random syncopal episodes occurring three to seven times per week, swelling requiring constant leg elevation, inability to lift objects due to weakness and joint instability, severe anxiety triggered by numerous stimuli, and migraines lasting two to three days occurring one to three times per week. Her conditions also frequently contraindicate one another's treatments.

The ALJ's credibility analysis consisted primarily of a boilerplate statement — that her statements were "not entirely consistent with the medical evidence and other evidence in the record" — followed by a summary of objective medical findings. The court found this insufficient. Specifically, the ALJ: - Did not address how Brittany J. S.'s psychological conditions might affect her perception of pain, dizziness, or fatigue; - Did not address how her physical conditions affect her psychological state; - Did not address how certain physical conditions interact with and worsen other physical conditions; - Did not explain how her described daily activities are inconsistent with her claimed limitations; - Did not address whether the combined frequency and unpredictability of her symptoms, including syncope episodes and flare-ups, would result in absenteeism incompatible with competitive employment.

The court concluded the ALJ failed to "build a logical bridge between the evidence and the conclusion," and that the decision on this point was not supported by substantial evidence.

Disposition

The court granted in part and denied in part Brittany J. S.'s request for relief. The court remanded the matter to the Social Security Administration for further administrative proceedings consistent with the order — specifically, proper evaluation of Brittany J. S.'s subjective symptom testimony. The court denied her request for an immediate award of benefits. The Commissioner's request to affirm the ALJ's decision was denied.