Case Name in Social Security Case - Unavailable

UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF NEW HAMPSHIRE
Demianna Natarelli
v. 	Case No. 23-cv-542-SM-AJ
Martin O’Malley, Commissioner,
Social Security Administration
Report and Recommendation
Demianna Natarelli moves, pursuant to 42 U.S.C. § 405(g),
to reverse the Commissioner’s decision denying her applications
for Disability Insurance Benefits under Title II and
Supplemental Security Income under Title XVI of the Social
Security Act. In support, she contends that the Administrative
Law Judge (“ALJ”) erred in his evaluation of the medical opinion
evidence, which resulted in an erroneous finding that she was
able to do her past work as a fast-food serving manager and, for
that reason, she was not disabled. The Acting Commissioner moves
to affirm.
For the reasons discussed, the district judge should grant
Natarelli’s motion and deny the Commissioner’s motion.
Standard of Review
When reviewing the Commissioner’s decision pursuant to
§ 405(g), the court “is limited to determining whether the ALJ
deployed the proper legal standards and found facts upon the
proper quantum of evidence.” 	Nguyen v. Chater, 172 F.3d 31, 35
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(1st Cir. 1999); accord Sacilowski v. Saul, 959 F.3d 431, 437
(1st Cir. 2020). 	Questions of law are reviewed de novo. 	Seavey
v. Barnhart, 276 F.3d 1, 9 (1st Cir. 2001). The ALJ’s factual
findings must be affirmed if they are supported by substantial
evidence. Biestek v. Berryhill, --- U.S. ---, 139 S. Ct. 1148,
1153 (2019). Substantial evidence is “more than a mere
scintilla” and means “such relevant evidence as a reasonable
mind might accept as adequate to support a conclusion.” 	Id. at
1154 (cleaned up). The court must affirm the ALJ’s findings,
even if the record could support a different conclusion, when “a
reasonable mind, reviewing the evidence in the record as a
whole, could accept it as adequate to support [the ALJ’s]
conclusion.” Irlanda Ortiz v. Sec’y of Health & Human Servs.,
955 F.2d 765, 769 (1st Cir. 1991); accord Purdy v. Berryhill,
887 F.3d 7, 13 (1st Cir. 2018).
Background
A. 	Physical Impairment
Natarelli was treated for back pain and other physical
symptoms, beginning in 2021 at Appledore Medical Group following
an onset of pain in January of 2021. Despite Natarelli’s
complaints of pain and weakness, the diagnostic testing showed
mostly normal results and, at most, mild degenerative changes.
An MRI done in September of 2021 showed a small annular disc
tear and mild disc bulge with no canal narrowing or neural
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impingement. Physicians recommended physiatry and physical
therapy.
B. 	Mental Health Treatment
Natarelli received treatment for mental health issues
beginning in 2019. Melissa French, APRN PMHNP, provided mental
health care and managed Natarelli’s medications.1 By October of
2021, Natarelli had been diagnosed with post-traumatic stress
disorder, generalized anxiety disorder, and major depressive
disorder. She was later diagnosed with panic disorder.
C. 	Procedural Background
On August 31, 2021, Natarelli filed applications for
benefits under Title II and Title XVI, alleging disability since
January 27, 2021. She was 22 years old when she applied.
Natarelli has worked as a waitress and a personal care
assistant, and she owns and operates a photography studio.
As part of the state administrative proceedings, Robert Su
Prescott, PhD, conducted a consultative mental examination on
February 18, 2022. In evaluating Natarelli’s level of mental
functioning at that time, Dr. Prescott found that Natarelli
could understand and remember basic work-like instructions, make
adequate judgments for work-related decisions, and control her
1 APRN stands for “Advanced Practice Registered Nurse” and
PMHNP stands for “Psychiatric Mental Health Nurse Practitioner.”
See www.registerednursing.org/aprn,
www.aanpcert.org/certs/pmhnp.
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behavior while working as long as she was in lower stress work
environments. He also found, however, that for interaction with
others Natarelli would have distress if working with too many
people and for concentration, persistence, and pace, she could
focus for short to moderate periods but not for extended
periods. As part of the administrative findings, state agency
psychologist, Russel Phillips, PhD., completed a Psychiatric
Review Technique, assessing Natarelli’s mental residual
functional capacity based on a review of her records. Dr.
Phillips found that Natarelli was moderately limited in several
functional areas, including the abilities to maintain attention
and concentration for extended periods, to maintain regular
attendance, to interact with the public, and to respond
appropriately to changes in the work setting.
D. 	Hearing and Decision
The ALJ held a hearing on Natarelli’s applications on May
15, 2023, by “online video.” AR at 17. Natarelli participated in
the hearing and was represented by counsel. A vocational expert
also participated in the hearing. The ALJ asked the vocational
expert for her opinion on jobs a person could do with
hypothetical physical limitations but no mental limitations, and
the vocational expert responded that the person could do
Natarelli’s previous work as a fast-food manager and as a sales
clerk. The vocational expert also testified that there were
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other jobs that person could do. When the ALJ added mental
limitations that the claimant could do “simple and detailed
tasks,” could sustain concentration for periods of two hours,
and tolerate occasional contact with the general public, the
vocational expert ruled out Natarelli’s previous work but said
that the person could do the other jobs she identified, such as
a mail clerk, a house cleaner, and an assembler.
The ALJ issued the decision a few weeks later. He found
that Natarelli had severe impairments due to degenerative disc
disease in the cervical and lumbar spine and obesity. 	The ALJ
did not find any severe mental impairments. He found that
Natarelli was able to do her past work as a fast-food manager,
and for that reason, was not disabled. Natarelli sought review
by the Appeals Council, which was denied, making the ALJ’s
decision the Commissioner’s final decision.
Discussion
Natarelli contends that the ALJ did not properly address
the medical opinion evidence in the record. With respect to
opinions pertaining to her mental limitations, Natarelli
contends that the ALJ erred in not finding depressive disorder
and panic disorder as severe impairments and contends that
substantial evidence is lacking to support the ALJ’s finding
that she could do her past work. The Commissioner argues, to the
contrary, that the ALJ properly assessed the medical opinions,
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correctly found that Natarelli’s anxiety was not a severe
impairment, and properly found based on substantial evidence
that she was not disabled. Because the court concludes that the
ALJ erred in his evaluation of the medical opinion evidence of
mental functioning, it is not necessary to address other issues
that Natarelli raises in support of her motion to reverse and
remand.
A. 	Burdens of Proof
To be eligible for benefits under Title II and Title XVI of
the Social Security Act, a claimant must show that she is
disabled, meaning that she is unable “to engage in any
substantial gainful activity by reason of any medically
determinable physical or mental impairment . . . which has
lasted or can be expected to last for a continuous period of not
less than twelve months.” 42 U.S.C. §§ 423(d)(1)(A) &
1382c(a)(3)(A). “An ALJ employs a five-step test to determine if
an individual is disabled within the meaning of the Social
Security Act” that asks “questions that are sequential and
iterative, such that the answer at each step determines whether
progression to the next is warranted.”2 Sacilowski, 959 F.3d at
2 At Step One the ALJ determines whether the claimant is
currently engaging in substantial gainful activity, and, if not,
at Step Two, whether the claimant has a severe impairment.
§§ 404.1520(a)(4)(i) & (ii). If at Step Two the ALJ finds a
severe impairment, the ALJ determines at Step Three whether the
impairment meets or medically equals an entry in the Listing of
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433. 	The steps are provided in the Social Security regulations,
20 C.F.R. § 404.1520(a)(4); 20 C.F.R. 416.920(a)(4).3
B. Step Two Findings
At Step Two, the ALJ must determine whether a claimant
possesses a severe impairment. 20 C.F.R. § 404.1520(a)(4)(ii).
Step Two is a “de minimis screening device” for “groundless
claims” and for “applicants whose impairments are so minimal
that, as a matter of common sense, they are clearly not
Impairments, which results in a finding of disability if a
Listing is met. § 404.1520(a)(4)(iii). If the impairment does
not meet or medically equal a listed impairment, between Step
Three and Step Four, the ALJ assesses the claimant’s residual
functional capacity to determine whether she has the capacity to
work despite her limitations. 	20 C.F.R. §§ 404.1520(a)(4) &
404.1545(a).
At Step Four, the ALJ determines whether the claimant’s
residual functional capacity is sufficient to allow her to
perform any of her past relevant work. 	§ 404.1520(a)(iv).If
not, at Step Five, the ALJ determines whether, in light of the
claimant’s residual functional capacity, age, education, and
work experience, she can make an adjustment to other work
available in the national economy. § 404.1520(a)(4)(v)). 	The
claimant bears the burden of showing she is disabled through the
first four steps, but at Step 5 the Commissioner must provide
evidence to show that there are jobs in the national economy
that the claimant can do. Sacilowski, 959 F.3d at 434.
320 C.F.R. Part 404 applies to claims for disability
insurance benefits, while 20 C.F.R. Part 416 applies to claims
for supplemental security income, but the regulations provide
the same five-step analytical framework and are otherwise the
same for purposes of the issues in this case. 	See Reagan v.
Sec'y of Health & Human Servs., 877 F.2d 123, 124 (1st Cir.
1989). For that reason, the court will refer to Part 404 in the
citations to the regulations.
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disabled.” McDonald v. Sec'y of Health and Human Servs., 795
F.2d 1118, 1122–23 (1st Cir. 1986). If the ALJ finds at least
one severe impairment at Step Two, which necessarily causes the
analysis to continue, any error is harmless as long as the ALJ
considers the limitations caused by all impairments, regardless
of their severity, in assessing the residual functional
capacity. Liam S. v. O'Malley, No. CV 23-00194-WES, 2024 WL
260816, at *7 (D.R.I. Jan. 24, 2024); Conrad v. Kijakazi, 666 F.
Supp. 3d 161, 172 (D. Mass. 2023).
For that reason, even if the ALJ in this case missed severe
impairments at Step Two, that error would be harmless, as long
as the ALJ properly assessed Natarelli’s residual functional
capacity in light of all of her limitations, physical and
mental.
C. Residual Functional Capacity
The ALJ assessed Natarelli to have the residual functional
capacity to do light work with certain climbing and postural
limitations but without any limitations due to mental health
impairment. The ALJ did not expressly consider the diagnosed
mental health impairments of anxiety, panic disorder, or
depression, and instead referred generally to the analysis of
severity at Step Two.4 Natarelli contends that the Step Two
4 In fact, the ALJ identified only anxiety as a mental
health limitation, despite the other diagnoses in the record.
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analysis was erroneous because the ALJ rejected the medical
opinions about her mental health limitations and impermissibly
substituted his own opinion.
Because a residual functional capacity is an administrative
assessment rather than a medical finding, the ALJ may “piece
together the relevant medical facts from the findings and
opinions of multiple physicians.” Evangelista v. Sec'y of Health
& Hum. Servs., 826 F.2d 136, 144 (1st Cir. 1987); accord Social
Security Ruling (SSR) 96-8p, 1996 WL 374184, at *2 (July 2,
1996); Purdy v. Berryhill, 887 F.3d 7, 14 (1st Cir. 2018). An
ALJ, as a lay person, however, is not qualified to interpret
functional capacity from raw medical data or substitute his own
opinion for the opinion of a medical source, although he may
make findings about functional capacity based on common sense in
circumstances within a lay-person’s competence. Kimball v.
Kijakazi, Case No. 21-cv-943-LM, 2022 WL 270819, at *8 (D.N.H.
July 7, 2022); Curtis v. Kijakazi, 2022 DNH 041, 2022 WL 994500,
at *5 (D.N.H. Mar. 29, 2022).
The record includes medical opinion evidence about
Natarelli’s functional limitations due to mental health
impairments from her treating provider, Nurse French; an
examining state agency consultant, Dr. Prescott; and a state
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agency consultant who did not examine Natarelli, Dr. Phillips.5
The ALJ stated that there were no mental status examinations in
the record, which the Commissioner acknowledges was wrong. Doc.
no. 7-1, at 5 n.2. Nurse French provided mental status results
as part of her treatment notes, and Dr. Prescott provided mental
status examination results in the Comprehensive Psychological
Profile.
Nurse French also completed a “Mental Residual Functional
Capacity Assessment.” Dr. Prescott examined Natarelli for
purposes of completing the “Comprehensive Psychological
Profile,” and Dr. Phillips provided a “Psychiatric Review
Technique” as part of the state agency determination. In those
opinions, Nurse French and Dr. Phillips found moderate
limitations in Natarelli’s ability to sustain concentration and
complete a workday and work week, in her ability to interact
with the general public, and her ability to respond to changes
in the work setting. Similarly, Dr. Prescott found that
Natarelli would experience distress if she were around too many
5 Another state agency consultant, Dr. Landerman, reviewed
Natarelli’s records for purposes of reconsideration. AR at 92-
93. Dr. Landerman found that although there was medical evidence
of depression and anxiety, the record was insufficient to assess
Natarelli’s limitations. Id. On remand, it may be appropriate to
request an opinion from an impartial psychological expert to
augment the record. See Diane K. v. Kijakazi, 2023 WL 8713695,
at *6 (D.R.I. Dec. 18, 2023).
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people and that she could not sustain focus and attention for
extended periods.
Despite the consistency of the medical opinions in the
record as to Natarelli’s moderate limitations due to mental
impairments, the ALJ found, to the contrary, that Natarelli had
only mild limitations in each area of mental functioning.6 In
support, the ALJ cited Natarelli’s ability to prepare simple
meals, clean, help with her girlfriend’s daughter, interact
socially, and work to set up a website for her photography
business and her statements on her function report that she
could follow instructions, get along with authority figures, and
handle changes in routine for the most part.7
As such, the ALJ formulated his own opinion of Natarelli’s
functional abilities in place of the functional assessments in
the medical opinions. The ALJ did not need a single medical
opinion to support his functional capacity assessment, and he
6 Although the opinions also included findings that
Natarelli’s mental health limitations were severe, within the
meaning of Step Two, that finding is not relevant for purposes
of the ALJ’s determination. 20 U.S.C. § 404.1520b(c).
7 In the motion to affirm, the Commissioner cites other
evidence in the record to support the ALJ’s evaluation. The
court, however, reviews the ALJ’s analysis based on the grounds
cited by the ALJ and not based on “the Commissioner’s subsequent
ad-hoc justification in its papers.” Dunsford v. Commissioner of
Social Security, 2023 WL 2242083, at *7 (N.D.N.Y. Feb. 27,
2023); see also Libin v. Berryhill, 2018 DNH 129, 2018 WL
3085206, at *2 (D.N.H. June 22, 2018).
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could have relied on parts of different opinions if those
existed. But here, the ALJ lacked supporting medical opinions
and findings for Natarelli’s mental limitations in functional
capacity, and he simply substituted his own opinion for the
record opinions. Therefore, the ALJ’s mental residual functional
capacity assessment is flawed by the erroneous evaluation of the
medical opinions and does not provide substantial evidence to
support the ALJ’s finding that Natarelli was not disabled.
Conclusion
For the foregoing reasons, the district judge should grant
the plaintiff’s motion to reverse and remand (doc. no. 6) and
deny the Commissioner’s motion to affirm (doc. no. 7). The case
should be remanded for further administrative proceedings
pursuant to Sentence Four of § 405(g).
Any objections to this Report and Recommendation must be
filed within fourteen days of receipt of this notice. See Fed.
R. Civ. P. 72(b)(2). The fourteen-day period may be extended
upon motion. 	Only those issues raised in the objection to this
Report and Recommendation are subject to review in the district
court. See Sch. Union No. 37 v. United Natl Ins. Co., 617 F.3d
554, 564 (1st Cir. 2010). Any issues not preserved by such
objection(s) are precluded on appeal. See id. 	Failure to file
any objections within the specified time waives the right to
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appeal the district court's order. See Santos-Santos v. Torres-
Centeno, 842 F.3d 163, 168 (1st Cir. 2016).
______________________________
Andrea K. Johnstone
United States Magistrate Judge
April 22, 2024
cc: 	Christopher Roundy, Esq.
Candace H. Lawrence, Esq.
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