Claire C. v. Bisignano

UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF RHODE ISLAND
CLAIRE C., 	:
Plaintiff, 	:
:
v. 	: 	C.A. No. 25-330-PAS
:
FRANK BISIGNANO, 	:
Commissioner of the Social Security 	:
Administration, 	:
Defendant. 	:
MEMORANDUM AND ORDER
PATRICIA A. SULLIVAN, United States Magistrate Judge.
On April 2, 2023, Plaintiff Claire C., a “younger” individual who graduated from high
school but has limited past work history, filed an application for Supplemental Security Income
(“SSI”) under the Social Security Act. Tr. 15. Plaintiff alleged disability beginning on July 1,
2021, based on a herniated disc; as her application proceeded, other impairments were
considered, including depression and anxiety disorders, obesity and rosacea with vision
complications. Tr. 15, 89, 98, 102, 249. An administrative law judge (“ALJ”) recognized as
severe lumbar back disorder, as well as depression and anxiety disorders. Tr. 18. While he
acknowledged the impairments of obesity and rosacea with vision complications, the ALJ found
both to be non-severe. Id. Weighing the evidence of record, including administrative
findings/opinions of three non-examining experts (two physicians, Drs. Mark Mahoney and
Henry Laurelli, and one psychologist, Dr. Michelle Olson), the report of a consulting examiner
(psychologist Dr. Romina Dragone-Hyde) and the references in the treating notes of the
orthopedist, Dr. William Brennan, a nurse practitioner and a physician’s assistant, the ALJ found
Case 1:25-cv-00330-PAS Document 13 Filed 04/30/26 Page 1 of 15 PageID #:
<pageID>

2
that Plaintiff retained the physical RFC 1 to perform light work with additional postural and
environmental limitations, and the mental RFC to do simple, routine, repetitive work, with only
simple decisions, only occasional changes in work setting, no assembly-line type work and
limited social interaction. Tr. 20. Based on this RFC and the testimony of a vocational expert
(“VE”), the ALJ found that Plaintiff was not disabled at any relevant time. Tr. 26-27.
Plaintiff challenges the ALJ’s decision for three reasons. First, Plaintiff argues that the
ALJ failed to analyze the supportability and consistency of the non-examining experts’ prior
administrative findings. ECF No. 10 at 5-7. Second, Plaintiff challenges the ALJ’s Step-Two
determination that rosacea with vision complications is non-severe. Id. at 7-10. Third, Plaintiff
contends that the ALJ erred in failing to order a consulting examination to test Plaintiff’s level of
cognitive functioning (for example, her IQ). Id. at 10-12. In reliance on these arguments,
Plaintiff has moved to reverse the decision of the Commissioner and to remand the case for
further proceedings. Id. at 13. Defendant has filed a counter motion for an order affirming the
Commissioner’s decision. ECF No. 12. Both motions are before me on consent pursuant to 28
U.S.C. § 636(c).
I. 	Standard of Review
As long as the correct legal standard is applied, “[t]he findings of the Commissioner of
Social Security as to any fact, if supported by substantial evidence, shall be conclusive.” 42
U.S.C. §§ 405(g), 1383(c)(3); see Purdy v. Berryhill, 887 F.3d 7, 13 (1st Cir. 2018).
“[W]hatever the meaning of ‘substantial’ in other contexts, the threshold for such evidentiary
sufficiency is not high.” Biestek v. Berryhill, 587 U.S. 97, 103 (2019). Substantial evidence
1 RFC refers to “residual functional capacity.” It is “the most you can still do despite your limitations,” taking into
account “[y]our impairment(s), and any related symptoms, such as pain, [that] may cause physical and mental
limitations that affect what you can do in a work setting.” 20 C.F.R. § 416.945(a)(1).
Case 1:25-cv-00330-PAS Document 13 Filed 04/30/26 Page 2 of 15 PageID #:
<pageID>

3
“means – and means only – such relevant evidence as a reasonable mind might accept as
adequate to support a conclusion.” Id. (internal quotation marks omitted). It is more than a
scintilla and must do more than merely create a suspicion of the existence of a fact. Irlanda Ortiz
v. Sec’y of Health & Hum. Servs., 955 F.2d 765, 769 (1st Cir. 1991) (per curiam). Further,
while “more than a scintilla of evidence is required to meet the benchmark, a preponderance of
evidence is not.” Clark v. Kijakazi, 673 F. Supp. 3d 119, 122 (D.N.H. 2023) (cleaned up). The
determination of substantiality is based on an evaluation of the record as a whole. Frustaglia v.
Sec’y of Health & Hum. Servs., 829 F.2d 192, 195 (1st Cir. 1987) (per curiam); Brown v. Apfel,
71 F. Supp. 2d 28, 30 (D.R.I. 1999), aff’d, 230 F.3d 1347 (1st Cir. 2000) (per curiam); see Parker
v. Bowen, 793 F.2d 1177, 1180 (11th Cir. 1986) (per curiam) (court must consider evidence
detracting from evidence on which Commissioner relied).
Once the Court concludes that the decision is supported by substantial evidence, the
Commissioner must be affirmed, even if the Court would have reached a contrary result as finder
of fact. Rodriguez Pagan v. Sec’y of Health & Hum. Servs., 819 F.2d 1, 3 (1st Cir. 1987) (per
curiam). The Court’s role in reviewing the Commissioner’s decision is limited. Brown, 71 F.
Supp. 2d at 30. The Court does not reinterpret or reweigh the evidence or otherwise substitute its
own judgment for that of the Commissioner. Thomas P. v. Kijakazi, C.A. No. 21-00020-WES,
2022 WL 92651, at *8 (D.R.I. Jan. 10, 2022), adopted by text order (D.R.I. Mar. 31, 2022). If
the Court finds either that the Commissioner’s decision is not supported by substantial evidence,
or that the Commissioner incorrectly applied the law relevant to the disability claim, the Court
may remand a case to the Commissioner for a rehearing under Sentence Four of 42 U.S.C. §
405(g). Allen v. Colvin, C.A. No. 13-781L, 2015 WL 906000, at *8 (D.R.I. Mar. 3, 2015).
II. 	Disability Determination
Case 1:25-cv-00330-PAS Document 13 Filed 04/30/26 Page 3 of 15 PageID #:
<pageID>

4
The law defines disability as the inability to do any 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
twelve months. 42 U.S.C. § 1382c(a)(3). The impairment must be severe, making the claimant
unable to do previous work, or any other substantial gainful activity which exists in the national
economy. Id.; 20 C.F.R. §§ 416.905-06, 416.909-11.
A. 	The Five-Step Evaluation
The ALJ must follow five steps in evaluating a claim of disability. 20 CFR § 416.920.
First, if a claimant is working at a substantial gainful activity, the claimant is not disabled. Id.
§ 416.920(a)(4)(i). Second, if a claimant does not have any impairment or combination of
impairments that significantly limit physical or mental ability to do basic work activities, then
the claimant does not have a severe impairment and is not disabled. Id. § 416.920(a)(4)(ii).
Third, if a claimant’s impairments meet or equal an impairment listed in 20 C.F.R. Part 404,
Appendix 1, the claimant is disabled. Id. § 416.920(a)(4)(iii). Fourth, if a claimant’s
impairments do not prevent doing past relevant work, the claimant is not disabled. Id. §
416.920(a)(4)(iv). Fifth, if a claimant’s impairments (considering RFC, age, education and past
work) prevent doing other work that exists in the local or national economy, a finding of disabled
is warranted. Id. § 416.920(a)(4)(v). The claimant bears the burden of proof at Steps One
through Four, but the Commissioner bears the burden at Step Five. Sacilowski v. Saul, 959 F.3d
431, 434 (1st Cir. 2020); see Ulitsch v. U.S. Soc. Sec. Admin., No. 24-cv-00074-PB, 2025 WL
691054, at *4 (D.N.H. Mar. 4, 2025) (“claimant bears the burden at the first four steps to prove
by a preponderance of the evidence that they are disabled”).
B. 	Opinion Evidence
Case 1:25-cv-00330-PAS Document 13 Filed 04/30/26 Page 4 of 15 PageID #:
<pageID>

5
Under 20 C.F.R. § 416.913(a)(2) a medical opinion is defined as “a statement from a
medical source about what [the claimant] can still do despite . . . impairment(s) and whether
[they] have one or more impairment-related limitations or restrictions.” See Charlene C. v.
Frank Bisignano, C.A. No. 1:24-cv-00354-MSM-AEM, 2025 WL 1543950, at *1 (D.R.I. May
30, 2025) (alterations in original). An ALJ must consider the persuasiveness of all medical
opinions in a claimant’s case record. See 20 C.F.R. § 416.920c. The most important factors to
be considered when the Commissioner evaluates the persuasiveness of a medical opinion are
supportability and consistency; these are usually the only factors the ALJ is required to
articulate. 20 C.F.R. § 416.920c(b)(2); Elizabeth V. v. O’Malley, C.A. No. 23-00459-WES,
2024 WL 1460354, at *3 (D.R.I. Apr. 4, 2024), adopted by text order (D.R.I. Apr. 19, 2024).
Supportability refers to the quantum of relevant objective medical evidence and supporting
explanations presented by a medical source to support the medical opinion or prior
administrative medical findings; consistency refers to the degree to which a medical opinion or
prior administrative medical finding is consistent with the evidence from other medical sources
and nonmedical sources in the claim. 20 C.F.R. § 416.920c(c)(1)-(2). A medical opinion
lacking adequate supporting evidence, or one that is inconsistent with evidence from other
sources, is not persuasive regardless of who made the medical opinion. See Amanda B. v.
Kijakazi, C.A. No. 21-308MSM, 2022 WL 3025752, at *2 (D.R.I. Aug. 1, 2022), adopted, 2022
WL 18910865 (D.R.I. Nov. 7, 2022). Further, a medical opinion must address the claimant’s
ability to function as limited by an impairment; thus, the ALJ may refuse to credit a medical
opinion on an issue reserved for the Commissioner, such as one opining only that the claimant is
“disabled.” Roberts v. Apfel, 248 F.3d 1127, 2000 WL 1881911, at *1 (1st Cir. Dec. 28, 2000)
Case 1:25-cv-00330-PAS Document 13 Filed 04/30/26 Page 5 of 15 PageID #:
<pageID>

6
(unpublished table decision) (per curiam); Redley W. v. Kijakazi, C.A. No. 23-00072-WES,
2023 WL 6057447, at *7 (D.R.I. Sept. 18, 2023), adopted by text order (D.R.I. Oct. 3, 2023).
III. 	Background
A. 	Plaintiff’s History
Plaintiff had an abusive childhood but completed high school with placement in special
education and attended college for one year. Tr. 45-46, 439. She has a driver’s license but no
car. Tr. 19. She has worked in food service and at daycare facilities, but not at a level sufficient
to constitute past relevant work. Tr. 18, 26, 236. For many years, including during the period of
alleged disability, she worked at home making crafts and selling them on-line from her “Etsy
store,” although this was not lucrative work (her best year yielded $700). She testified that she
had not sold anything for a couple of years. Tr. 50-51. Plaintiff lives alone, although near
“friends,” in a second-floor apartment (requiring her to walk upstairs), cares for her cat, shops in
stores and gets help from a friend. Tr. 44-45, 90, 439-41.
B. 	Plaintiff’s Physical Conditions
Plaintiff’s encounters with her primary care physician assistant reflect treatment for
weight concerns, skin issues (rosacea) and depression/anxiety. Tr. 363-74, 585-607. These
records contain no mention of vision blurring or difficulty seeing. They also reflect the
provider’s observation that “[c]ognition [is] normal.” E.g., Tr. 588. Throughout the period in
issue, Plaintiff treated with a dermatology provider for rosacea impacting her face, scalp and
trunk. Tr. 376-87, 448-64. The dermatology records also make no mention of any vision issue.
On February 14, 2024, Plaintiff had one encounter with an optometrist based on Plaintiff’s
complaint of her eyes not focusing for a few hours, which she reported had happened “a couple
times.” Tr. 465. Noting Plaintiff’s history of rosacea, the optometrist found her vision
Case 1:25-cv-00330-PAS Document 13 Filed 04/30/26 Page 6 of 15 PageID #:
<pageID>

7
unimpaired but diagnosed “bleph[aritis],”2 for which he suggested the use of eye wipes and eye
drops with follow up in one year. Id. After this appointment, vision issues are not mentioned
again except in passing to a mental health therapist a week after she saw the optometrist3 and in
connection with her SSI application.4
Plaintiff’s primary complaint on SSI application was her lumbar spine difficulties; at the
hearing, she testified that she cannot work because she cannot lift weights or climb up and down
a stepstool. Tr. 52-53, 89. For most of the period in issue, Plaintiff’s lumbar spine issue was
treated at Ortho RI, primarily by Dr. William Brennan, whose diagnosis of disc herniation was
accepted by the ALJ. Tr. 324-25; see Tr. 22, 24-25. Pursuant to his treating notes, Dr. Brennan
opined that Plaintiff cannot lift more than twenty pounds, which limitation was adopted in the
non-examining experts’ RFC and accepted by the ALJ. Tr. 20, 25, 92, 103, 571. Otherwise, Dr.
Brennan relied on an MRI and physical examination to find generally mild pain, with minimally
antalgic or non-antalgic gait and some limits on motion; he prescribed occasional injections
(which were successful, “good result with injection,” Tr. 327), heating pad, home exercise
including walking, occasional referrals for physical therapy,5 and over-the-counter medication.
Tr. 318-37, 348-49, 354-55, 570-73. Apart from flare ups increasing Plaintiff’s pain level to
2 According to the National Institute for Health, blepharitis is an inflammatory condition affecting the eyelid.
www.ncbi.nlm.nih.gov/sites/books/NBK459305/ (last visited on Apr. 30, 2026).
3 These notes reflect: “[p]ast medical/ psych hx: no change, patient reports ‘trouble with eyes recently’ [and] reports
she ‘went to eye doctor and was prescribed eye drops.’” Tr. 559.
4 In subjective statements in support of her application, Plaintiff referenced vision concerns. For example, Plaintiff
told the consulting examination psychologist that she “has also been having problems with her vision.” Tr. 440. In
her first function report, Plaintiff made no claim of vision issues, Tr. 233, but in the second, she claimed issues with
seeing and that “my eyesight is fuzzy and blepharitis irritates and clouds my eyes.” Tr. 255, 260. During the ALJ
hearing, Plaintiff testified that she has eye issue flares (which happens up to twice a week and lasts for two to three
days) during which she cannot see to read, look at screens or watch television. Tr. 67-71. Plaintiff’s attorney
argued that she is “almost blind.” Tr. 38.
5 According to the 2024 physical therapy notes, Plaintiff reported inter alia “feeling good” and that the “exercises
have been helping her back pain.” Tr. 487, 493.
Case 1:25-cv-00330-PAS Document 13 Filed 04/30/26 Page 7 of 15 PageID #:
<pageID>

8
mild-to-moderate caused by spending time in a car and due to weather, Dr. Brennan observed
“improvement,” that Plaintiff was “overall still doing fairly well,” and “stable.” Tr. 326, 330,
333, 354, 493.
At one appointment on May 17, 2023, Dr. Brennan noted a slight increase in pain – from
mild to moderate – due to performing chores at home; he prescribed an injection and a “[h]ome
therapy walking program.” Tr. 348-49. Without further explanation, this note includes:
“[re]mains disabled.” Tr. 349. By the next appointment, on June 22, 2023, Dr. Brennan found
Plaintiff to be stable, with non-antalgic gait and intermittent pain. Tr. 354-55. Importantly, at
virtually every appointment with Dr. Brennan, including one (on February 5, 2024)
contemporaneous with Plaintiff’s single encounter with the optometrist, Dr. Brennan’s treating
notes contain his survey of Plaintiff’s medical complaints in a “Review of Systems,” which
consistently include the notation regarding Plaintiff’s eyes: “[t]he patient denies any blurred
vision, double vision or vision loss.” E.g., Tr. 332, 354, 572.
C. 	ALJ’s Consideration of Plaintiff’s Physical Conditions
The ALJ considered the non-examining expert physicians’ findings and RFC
explanations, which reflect that they are supported by Dr. Brennan’s treating notes. Tr. 91, 93,
100, 104. That is, apart from Dr. Brennan’s conclusory statement (“[re]mains disabled”), which
the ALJ properly rejected as both unsupported and an opinion on a matter reserved to the
Commissioner, Tr. 25,6 these experts’ RFC findings are based on and are consistent with Dr.
Brennan’s findings on physical examination. Tr. 93, 104. Further, the ALJ’s RFC mirrors these
experts’ RFC findings, except that it is somewhat more limiting in that, partially crediting
6 This aspect of the ALJ’s analysis is consistent with applicable law that such an unadorned opinion on a matter
reserved for the Commissioner is “‘inherently neither valuable nor persuasive.’” Redley W. v. Kijakazi, C.A. No.
23-00072-WES, 2023 WL 6057447, at *8 (D.R.I. Sept. 18, 2023) (quoting 20 C.F.R. § 416.920b(c)).
Case 1:25-cv-00330-PAS Document 13 Filed 04/30/26 Page 8 of 15 PageID #:
<pageID>

9
Plaintiff’s testimony, Tr. 25-26, the ALJ added postural limits and environmental limits that
these experts had not included. Compare Tr. 20, with Tr. 93, 104. Apart from Dr. Brennan’s
notation that Plaintiff “[re]mains disabled,” the record contains no medical opinion from any
source reflecting greater physical limitations than those found by the ALJ.
D. 	Plaintiff’s Mental Health Conditions
Although Plaintiff’s application made no reference to work-impactful mental health
symptoms, the existence of such impairments became evident by the reconsideration phase of the
administrative proceedings, resulting in a consultative examination by Dr. Dragone-Hyde and a
mental health psychiatric review technique (“PRT”) and RFC analysis by Dr. Olson. For mental
health, Plaintiff had been seen at Angell Street Psychiatry in 2020 and 2021; she was diagnosed
with anxiety and prescribed medication; these providers did not note any cognition concerns. Tr.
313-17. After a period when mental health treatment was provided by her primary care provider,
in October 2023, Plaintiff attended a mental health partial hospitalization program at Butler
Hospital with treatment for anxiety and depression. Tr. 403-34. These treating notes
consistently reflect that “[i]ntellectual functioning: [a]ppears average.” E.g., 408, 415, 424. In
2024, Plaintiff received mental health treatment from Revive Therapeutic where the most recent
notes (from July 2024) reflect mental health observations within normal limits including average
intellectual capacity (e.g., Tr. 529). Tr. 523-65. The primary care provider’s treating note
submitted after the ALJ’s hearing reflects “[m]ajor depressive disorder in partial remission” as
the reason for reduction of prescribed medication while treatment for anxiety with medication
was continued. Tr. 600.
E. 	ALJ’s Consideration of Plaintiff’s Mental Health Conditions
Case 1:25-cv-00330-PAS Document 13 Filed 04/30/26 Page 9 of 15 PageID #:
<pageID>

10
The ALJ considered the findings of the non-examining mental health expert, Dr. Olson,
who examined the record and performed a PRT review, with an explanation making clear that
her analysis was supported by her examination of the treating record, including the record from
Butler Hospital, which reflects that Plaintiff improved with treatment; the ALJ also considered
the Dragone-Hyde consulting report; and the ALJ considered other evidence, such as that
Plaintiff had completed some college. Tr. 19- 20, 23-25, 105-06. As reflected in her RFC
findings, Dr. Olson disagreed with Dr. Dragone-Hyde’s finding of limited ability to follow
simple instructions.7 Tr. 105-06. Accepting Dr. Olson’s expert findings, the ALJ rejected this
aspect of the Dragone-Hyde opinion. Tr. 24. Except for Dr. Dragone-Hyde’s finding that
Plaintiff’s ability to follow simple instructions was “fair,” Tr. 441, which Dr. Olson expressly
considered and rejected based on her expert review of the “overall MER [Medical Evidence of
Record],” Tr. 105, the record contains no opinion from any source reflecting greater mental
limitations than those found by the ALJ.
IV. 	Analysis
A. 	ALJ’s Approach to Non-Examining Experts’ Findings
Plaintiff’s first argument relies on the ALJ’s failure to use the terms “supportability”8 and
“consistency” 9 in the portion of his decision finding “generally persuasive” the three non-
7 Dr. Dragone-Hyde’s report opines to the “appear[ance]” of borderline to low average intelligence, recommends IQ
and achievement testing, and observes that the ability to follow simple instructions was only “fair.” Tr. 438-42.
8 20 C.F.R. § 416.920c(c)(1) defines the supportability analysis: “Supportability. The more relevant the objective
medical evidence and supporting explanations presented by a medical source are to support his or her medical
opinion(s) or prior administrative medical finding(s), the more persuasive the medical opinions or prior
administrative medical finding(s) will be.”
9 20 C.F.R. § 416.920c(c)(2) defines the consistency analysis: “Consistency. The more consistent a medical
opinion(s) or prior administrative medical finding(s) is with the evidence from other medical sources and
nonmedical sources in the claim, the more persuasive the medical opinion(s) or prior administrative medical
finding(s) will be.”
Case 1:25-cv-00330-PAS Document 13 Filed 04/30/26 Page 10 of 15 PageID #:
<pageID>

11
examining experts’ prior administrative findings.10 The operative regulation stipulates that these
are the “most important factors” and that the ALJ is required to articulate how these factors were
considered in assessing the persuasiveness of such findings. 20 C.F.R. § 416.920c(b)(2) (“we
will explain how we considered the supportability and consistency factors for a medical source’s
medical opinions or prior administrative medical findings in your determination or decision”).
Based on this deficiency, Plaintiff contends that the case must be remanded. ECF No. 10 at 6;
see Martinez v. Kijakazi, No. 3:20-cv-30151-KAR, 2021 WL 5054477, at *9-11 (D. Mass. Oct.
29, 2021) (remanding case because ALJ’s rejection of treating source RFC opinion failed to
include consistency analysis, leaving court unable to ascertain whether ALJ found material
differences between opinion and other care providers’ contemporaneous observations of her
impairments and limitations).
The Commissioner defends the ALJ’s approach arguing that, although the terms
“supportability” and “consistency” were not used, the decision’s detailed discussion of these
experts’ findings, focusing both on how they are supported and how they are consistent with the
balance of the record, reveals that both factors were appropriately considered. ECF No. 12 at 5-
8. This argument relies on cases holding that an ALJ need not use the words “consistency” and
“supportability” to fulfill his obligation to consider these factors. Id. (citing Marshall v.
Bisignano, No. 1:24-cv-11431-JEK, 2025 WL 2207245, at *5 (D. Mass. Aug. 4, 2025)); see
Darling v. Kijakazi, No. 22-35594, 2023 WL 4103935, at *2 (9th Cir. June 21, 2023) (“An ALJ
is not required to incant the ‘magic words’ of ‘supportability’ and ‘consistency’ in his
findings.”); Zaborowski v. Comm’r of Soc. Sec., 115 F.4th 637, 639 (3d Cir. 2024) (same).
10 In contrast, the ALJ’s decision specifically articulates supportability and consistency in his analysis of Dr.
Dragone-Hyde’s consultative examination opinions. Tr. 25.
Case 1:25-cv-00330-PAS Document 13 Filed 04/30/26 Page 11 of 15 PageID #:
<pageID>

12
I agree. As the Commissioner points out, the ALJ’s analysis of the findings of the expert
physicians, Drs. Mahoney and Laurelli, explicitly references that they were relying on the
treating records showing a spinal disorder (including an MRI), but with pain rated as mild,
negative straight leg raise bilaterally, which resulted in their RFC findings. ECF No. 12 at 6
(citing Tr. 22-23). Similarly, the ALJ’s analysis of the findings of the expert psychologist Dr.
Olson explicitly references her reliance on “claimant’s records,” and the “overall medical
evidence,” resulting in the finding that Plaintiff retained the ability to understand simple work
instructions with other moderate mental limitations. Tr. 24. In short, it is clear that the ALJ
appropriately performed the supportability/consistency analysis, despite his failure to use the
terms. Further, the ALJ’s decision details his basis for affording little or no weight to the
evidence that is inconsistent with the non-examining expert findings. 11 Thus, the Court is not
left to guesswork to determine whether the ALJ had a “sufficient rationale” for the decision.
Martinez, 2021 WL 5054477, at *9 (internal quotation marks omitted). While it would certainly
have been preferable for the supportability/consistency terms to have been used, their omission is
not error in the circumstances here.
B. 	ALJ’s Step-Two Determination Regarding Rosacea with Vision
Complications
Plaintiff challenges the ALJ’s Step Two determination that “rosacea with vision
complications” was non-severe. Tr. 18. The ALJ appropriately supported this aspect of the
11 That is, the ALJ’s decision fully explains his rejection of the arguably inconsistent Brennan opinion that Plaintiff
“[re]mains disabled.” Tr. 25. Similarly, the ALJ appropriately amplified his reliance on Dr. Olson’s finding that
Plaintiff is able to follow simple instructions by setting out the evidence inconsistent with Dr. Dragone-Hyde’s
finding of possibly borderline cognition, including, for example, Plaintiff’s education (high school with some
college) and the longitudinal treating evidence from both Butler Hospital and the primary care provider that
Plaintiff’s observed cognitive capacity was “average” or “normal.” Tr. 19, 22-23.
Case 1:25-cv-00330-PAS Document 13 Filed 04/30/26 Page 12 of 15 PageID #:
<pageID>

13
decision with substantial evidence, including the conservative treatment12 of this complaint based
on a single visit to an optometrist, the optometrist’s notation that the eye episodes lasted just a
few hours and had happened just “a couple times before” and (most importantly) the
optometrist’s finding of no vision impairment, as well as the utter absence of any evidence from
other treating sources that this impairment was even mentioned (except in passing to a therapist)
or of any medical evidence that this impairment actually impacted any aspect of Plaintiff’s
ability to function. Tr. 18, 465. This evidence as marshaled by the ALJ directly rebuts not only
Plaintiff’s attorney’s argument that Plaintiff is almost blind, but also Plaintiff’s subjective
statements that the episodes impacting vision extend over two to three days each, have been
occurring for a decade and make her unable to read or see a screen. Tr. 18, 38, 41, 67-71; see
Sacilowski, 959 F.3d at 441 (without evidence to directly rebut claimant’s testimony nor other
reason to question its credibility, statements should be taken as true).
The Court finds no error in the ALJ’s Step-Two finding that rosacea with vision
complications was non-severe during the period in issue.
C. 	ALJ’s Failure to Order Cognitive Consultative Examination
Plaintiff contends that the ALJ erred in failing to order a consultative examination to test
Plaintiff’s level of cognitive functioning (for example, measuring her IQ and achievements).
This argument rests on Dr. Dragone-Hyde’s observation based on her one-time consultative
examination that “estimate of intelligence appears to be within the borderline to low average
range,” with the recommendation of “IQ and achievement testing to determine her cognitive
capabilities.” Tr. 439, 442. During the ALJ hearing, Plaintiff asked the ALJ to consider
cognitive testing, Tr. 80, to which the ALJ responded, “I’m not sure that’s warranted here.” Id.
12 The recommended treatment is reflected on a single page – eye wipes, a prescription for eye drops and follow up
in a year. Tr. 465.
Case 1:25-cv-00330-PAS Document 13 Filed 04/30/26 Page 13 of 15 PageID #:
<pageID>

14
The ALJ then confirmed with Plaintiff that she had been able to live alone with her cat for
twenty years and ruled: “I think I’ll go with what I have. If there’s a change, I will certainly let
you know.” Id. In the decision, the ALJ confirmed that he treated Plaintiff’s inquiry as a request
for a post-hearing cognitive consultative evaluation and declined to order such an examination in
light of Dr. Dragone-Hyde’s report having already been procured. Tr. 15 n.1.
It is within the ALJ’s discretion to decide whether to order a consultative examination if
the claimant’s medical sources cannot or will not provide sufficient medical evidence or to
resolve an inconsistency in the evidence. 20 C.F.R. §§ 416.917, 416.919a(b). The ALJ is not
required to order a consultative examination unless the record establishes that such an
examination is necessary to enable the ALJ to render an informed decision. Renee P. v. Dudek,
C.A. No. 24-00379-MSM, 2025 WL 1263713, at *4 (D.R.I. May 1, 2025), adopted, 2025 WL
2795503 (D.R.I. May 27, 2025). Here, the record reflected not only Plaintiff’s ability to live
alone with her cat for many years, her educational attainments and her ability to earn up to $700
per year from operating her Etsy store, but also is replete with clinical observations that
Plaintiff’s cognitive functioning is average or normal. Tr. 363 (coherent and rational thinking);
Tr. 407-08, 415, 418, 421, 424, 432 (intact memory and average intellectual functioning); Tr.
427, 442 (intact memory); Tr. 432 (intact memory and average intellectual functioning); Tr. 588
(cognition normal). With this evidence providing ample support for the ALJ’s decision that
cognitive testing was not necessary, the Court finds no abuse of discretion in the ALJ’s decision
to decline to order another consultative examination to procure it.
V. 	Conclusion
Having reviewed the entirety of this record mindful that it is the Court’s “job . . . to . . .
review the record and determine whether a reasonable mind . . . could accept it as adequate to
Case 1:25-cv-00330-PAS Document 13 Filed 04/30/26 Page 14 of 15 PageID #:
<pageID>

15
support [the ALJ’s] conclusion,” Burton v. Kijakazi, Civil Action No. 21-cv-11916-ADB, 2023
WL 2354901, at *8 (D. Mass. Mar. 3, 2023) (internal quotation marks omitted), the Court finds
that remand is not appropriate and affirms the ALJ’s well-supported and legally-correct decision.
Based on the foregoing, Plaintiff’s Motion to Reverse the Decision of the Commissioner (ECF
No. 10) is DENIED and Defendant’s Motion for an Order Affirming the Decision of the
Commissioner (ECF No. 12) is GRANTED. The Court is directed to enter judgment in favor of
Defendant.
/s/ Patricia A. Sullivan
PATRICIA A. SULLIVAN
United States Magistrate Judge
April 30, 2026
Case 1:25-cv-00330-PAS Document 13 Filed 04/30/26 Page 15 of 15 PageID #:
<pageID>