BUNTING v. BISIGNANO

IN THE UNITED STATES DISTRICT COURT
FOR THE MIDDLE DISTRICT OF NORTH CAROLINA
DEBORAHB.,
Plaintiff,
v.
FRANK BISIGNANO, 1
Commissioner of Social Security,
Defendant.
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1:25CV32
MEMORANDUM OPINION AND RECOMMENDATION
OF UNITED STATES MAGISTRATE JUDGE
Plaintiff Deborah B. ("Plaintiff") brought this action pursuant to Section 205(g) of the
Social Security Act (the "Act"), as amended (42 U.S.C. § 405(g)), to obtain judicial review of a
final decision of the Commissioner of Social Security denying her claim for Disability
Insurance Benefits ("DIB") under Title II of the Act. 	The parties have filed cross-motions
for judgment, and the administrative record has been certified to the Court for review.
I. 	PROCEDURAL HISTORY
Plaintiff protectively filed her application for DIB on January 31, 2014, alleging a
disability onset date of December 30, 2013. (Tr. at 383.) 2 Her application was denied initially
1 The United States Senate confirmed Frank Bisignano as the Commissioner of Social Security on May 6, 2025,
and he took the oath of office on May 7, 2025. Pursuant to Rule 25(d) of the Federal Rules of Civil Procedure,
Frank Bisignano should be substituted as the Defendant in this suit. Neither the Court nor the parties need
take any further action to continue this suit by reason of the last sentence of section 205(g) of the Social Security
Act, 42 U.S.C. § 405(g).
2 Transcript citations refer to the Sealed Administrative Record [Doc. #3].
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(Tr. 	at 19 5) 	and upon reconsideration 	(Tr. at 202). 	Thereafter, Plaintiff requested an
administrative hearing de novo before an Administrative Law Judge ("ALJ"). (Tr. at 210.) On
March 21, 2017, Plaintiff, along with her attorney, attended the subsequent telephone hearing,
at which both Plaintiff and an impartial vocational expert testified. (Tr. at 112-24.) Following
this hearing, the ALJ concluded that Plaintiff was not disabled within the meaning of the Act.
(Tr. at 152.) However, on July 16, 2018, the Appeals Council vacated the ALJ's July 5, 2017
decision and remanded the case for a new hearing. 	(Tr. at 168.)
Plaintiff's second administrative hearing was held on November 21, 2018. 	(Tr. at 79-
111.) This hearing again resulted in a finding that Plaintiff was not disabled under the Act (Tr.
at 171), and Plaintiff again filed a request for review the Appeals Council (Tr. at 329.) 	In an
Order dated September 16, 2019, the Appeals Council determined that Plaintiff's second,
March 15, 2019 hearing decision, like the 2017 decision, was not supported by substantial
evidence. 	(Tr. at 190-92.) 	Accordingly, the Council vacated the decision and once again
remanded the case for a new hearing. (Tr. at 190.)
Plaintiff's third administrative hearing took place on May 21, 2020 (Tr. at 42-75) and
again resulted in an unfavorable decision (Tr. at 15). 	On November 19, 2020, the Appeals
Counsel denied Plaintiff's request for review of that decision, thereby making the ALJ's
conclusion the Commissioner's final decision for purposes of judicial review (Tr. at 1-6).
Plaintiff filed a civil action in this Court on January 18, 2021. 	(See Civil Docket Case
# 1:21CV49.) After reviewing Plaintiff's arguments, the Acting Commissioner filed a Motion
to Remand the case to the agency. (See Tr. at 1951.) On September 29, 2022, the Court issued
an 	Order 	and Judgment reversing 	the 	third, 	unfavorable 	administrative 	decision 	and
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remanding the case to the agency for further proceedings. 	(Tr. at 1959-61.) 	In light of the
Court's Order, the Appeals Council vacated the hearing decision and remanded the case for
yet another hearing. 	(Tr. at 1945.)
Plaintiff attended her fourth disability hearing on October 19, 2023. As at her previous
hearings, Plaintiff was represented by an attorney, and both Plaintiff and an impartial
vocational expert testified. 	(Tr. at 1842-1890.) 	Following the hearing, the ALJ once again
concluded that Plaintiff was not disabled under the Act. (Tr. at 1814.) Although Plaintiff filed
exceptions to the ALJ's unfavorable decision with the Appeals Council (Tr. at 2129), the
Council ultimately declined to assume jurisdiction (Tr. at 1799), and Plaintiff filed the instant
civil action on January 14, 2025.
II. 	LEGAL STANDARD
Federal law "authorizes judicial review of the Social Security Commissioner's denial of
social security benefits." Hines v. Barnhart, 453 F.3d 559, 561 (4th Cir. 2006). However, the
scope of review of such a decision is "extremely limited." Frady v. Harris, 646 F.2d 143, 144
(4th Cir. 1981). "The courts are not to try the case de novo." Oppenheim v. Finch, 495 F.2d
396, 397 (4th Cir. 197 4). 	Instead, "a reviewing court must uphold the factual findings of the
ALJ if they are supported by substantial evidence and were reached through application of the
correct legal standard." 	Hancock v. Astrue, 667 F.3d 470, 472 (4th Cir. 2012) (internal
quotation omitted).
"Substantial evidence means 'such relevant evidence as a reasonable mind might accept
as adequate to support a conclusion."' 	Hunter v. Sullivan, 993 F.2d 31, 34 (4th Cir. 1993)
(quoting Richardson v. Perales, 402 U.S. 389, 390 (1971)). 	"It consists of more than a mere
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scintilla of evidence but may be somewhat less than a preponderance." Mastro v. Apfel, 270
F.3d 171, 176 (4th Cir. 2001) (internal citations and quotation marks omitted). 	"If there is
evidence to justify a refusal to direct a verdict were the case before a jury, then there is
substantial evidence." Hunter, 993 F.2d at 34 (internal quotation marks omitted).
"In reviewing for substantial evidence, the court should not undertake to re-weigh
conflicting evidence, make credibility determinations, or substitute its judgment for that of the
[AIJ]." 	Mastro, 270 F.3d at 176 (internal brackets and quotation marks omitted). 	''Where
conflicting evidence allows reasonable minds to differ as to whether a claimant is disabled, the
responsibility for that decision falls on the ALJ." Hancock, 667 F.3d at 472. "The issue before
[the reviewing court], therefore, is not whether [the claimant] is disabled, but whether the
ALJ's finding that [the claimant] is not disabled is supported by substantial evidence and was
reached based upon a correct application of the relevant law." 	Craig v. Chater, 76 F.3d 585,
589 (4th Cir. 1996).
In undertaking this limited review, the Court notes that "[a] claimant for disability
benefits bears the burden of proving a disability." Hall v. Harris, 658 F.2d 260, 264 (4th Cir.
1981). In this context, "disability" means the "'inability to engage in 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 12 months."' Id. (quoting 42 U.S.C. § 423(d)(1)(A)).3
3 "The Social Security Act comprises two disability benefits programs. The Social Security Disability Insurance
Program (SSDI), established by Title II of the Act as amended, 42 U.S.C. § 401 et seq., provides benefits to
disabled persons who have contributed to the program while employed. The Supplemental Security Income
Program (SSI), established by Title XVI of the Act as amended, 42 U.S.C. § 1381 et seq., provides benefits to
indigent disabled persons. 	The statutory definitions and the regulations promulgated by the Secretary for
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"The Commissioner uses a five-step process to evaluate disability claims." 	Hancock,
667 F.3d at 472 (citing 20 C.F.R. §§ 404.1520(a)(4); 416.920(a)(4)). 	"Under this process, the
Commissioner asks, 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 her past relevant work; and (5) if not,
could perform any other work in the national economy." Id.
A finding adverse to the claimant at any of several points in this five-step sequence
forecloses a disability designation and ends the inquiry. 	For example, "[t]he first step
determines whether the claimant is engaged in 'substantial gainful activity.' If the claimant is
working, benefits are denied. The second step determines if the claimant is 'severely' disabled.
If not, benefits are denied." Bennett v. Sullivan, 917 F.2d 157, 159 (4th Cir. 1990).
On the other hand, if a claimant carries his or her burden at the first two steps, and if
the claimant's impairment meets or equals a "listed impairment" at step three, "the claimant
is disabled." 	Mastro, 270 F.3d at 177. 	Alternatively, if a claimant clears steps one and two,
but falters at step three, i.e., "[i]f a claimant's impairment is not sufficiently severe to equal or
exceed a listed impairment," then "the ALJ must assess the claimant's residual functional
capacity ('RFC')." 	Id. at 179.4 Step four then requires the ALJ to assess whether, based on
determining disability, see 20 C.F.R. pt. 404 (SSDI); 20 C.F.R. pt. 416 (SSI), governing these two programs are,
in all aspects relevant here, substantively identical." Craig, 76 F.3d at 589 n.1.
4 "RFC is a measurement of the most a claimant can do despite [the claimant's] limitations." Hines, 453 F.3d
at 562 (noting that administrative regulations require RFC to reflect claimant's "ability to do sustained work-
related physical and mental activities in a work setting on a regular and continuing basis ... [which] means 8
hours a day, for 5 days a week, or an equivalent work schedule" (internal emphasis and quotation marks
omitted)). The RFC includes both a "physical exertional or strength limitation" that assesses the claimant's
"ability to do sedentary, light, medium, heavy, or very heavy work," as well as "nonexertional limitations
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that RFC, the claimant can "perform past relevant work"; if so, the claimant does not qualify
as disabled. Id. at 179- 80. However, if the claimant establishes an inability to return to prior
work, the analysis proceeds to the fifth step, which "requires the [Government] to prove that
a significant number of jobs exist which the claimant could perform, despite [the claimant's]
impairments." 	Hines, 453 F.3d at 563. 	In making this determination, the AL] must decide
"whether the claimant is able to perform other work considering both [the claimant's RFC]
and [the claimant's] vocational capabilities (age, education, and past work experience) to adjust
to a new job." 	Hall, 658 F.2d at 264-65. 	If, at this step, the Government cannot carry its
"evidentiary burden of proving that [the claimant] remains able to work other jobs available
in the community," the claimant qualifies as disabled. Hines, 453 F.3d at 567.
III. 	DISCUSSION
In the present case, the AL] found that Plaintiff had not engaged in substantial gainful
activity from her alleged onset date, December 30, 2013, through her date last insured for
purposes ofDIB, March 31, 2017. The ALJ therefore concluded that Plaintiff met her burden
at step one of the sequential evaluation process. 	(Tr. at 1819.) At step two, the ALJ further
determined that Plaintiff suffered from the following severe impairments:
[D]egenerative disc disease of the lumbar and thoracic spine; osteoarthritis;
peripheral neuropathy; migraine headaches, and obesity[.]
(Tr. at 1819.) The ALJ found at step three that none of the impairments identified at step two,
individually or in combination, met or equaled a disability listing. 	(Tr. at 1822-23.) The ALJ
(mental, sensory, or skin impairments) ." Hall, 658 F.2d at 265. "RFC is to be determined by the ALJ only after
[the ALJ] considers all relevant evidence of a claimant's impairments and any related symptoms (e .g., pain)."
Hines, 453 F.3d at 562-63.
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therefore assessed Plaintiffs RFC and determined that she could perform light work with the
following, additional limitations:
[Plaintiffj could sit six hours of an eight-hour workday, with the need to
alternate to standing for five to 10 minutes after every two hours of sitting. She
could stand and/ or walk for six hours in an eight-hour workday, with the need
to alternate to sitting at the workstation for five to ten minutes after every hour
of standing/walking. She frequently could reach overhead with her right upper
extremity. She frequently could climb stairs and ramps, but never climb ladders,
ropes, or scaffolds. 	She frequently could balance and stoop, and occasionally
kneel, crouch, or crawl. She never could be exposed to unprotected heights or
vibration, and could have occasional exposure to moving mechanical parts.
(Tr. at 1823.) Based on this determination and the testimony of a vocational expert, the ALJ
determined at step four of the analysis that, during the time period at issue, Plaintiff remained
capable of performing her past relevant work as a small products assembler. (Tr. at 1828.) In
the alterative, the ALJ further found at step five that, given Plaintiffs age, education, work
experience, RFC, and the testimony of the vocational expert as to these factors, she could
perform other jobs available in significant numbers in the national economy. (Tr. at 1828-29.)
Therefore, the ALJ concluded that Plaintiff was not disabled under the Act at any time
between December 30, 2013 and March 31, 2017. 	(Tr. at 1829-30.)
Plaintiff now raises four challenges to the ALJ's decision. 	Specifically, she contends
that the ALJ erred by (1) finding Plaintiff "capable of performing past relevant work that was
not substantial gainful activity," (2) "failing to apply all of the factors required by 20 C.F.R.
404.1527(c) to evaluate the opinion of a treating physician," (3) improperly discounting
Plaintiffs reports of disabling migraine symptoms, and (4) "failing to establish that the ALJ
obtained sworn testimony from either "\vitness" at Plaintiff's hearing. (Pl.'s Br. [Doc. #8] at 3-
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4.) 	After a thorough review of the record, the Court finds that none of these contentions
merit remand.
A. Past relevant work
Plaintiff first argues that, at step four of the sequential analysis, the ALJ erred in finding
Plaintiff capable of past relevant work that was not substantial gainful activity. 	Under the
regulations, past work experience is only considered "relevant" when it is (1) work that done
within the past 15 years, (2) was substantial gainful activity, and (3) lasted long enough for [the
claimant] to learn to do it. 20 C.F.R. § 404.1560(b)(1). The 15-year requirement encompasses
the earlier of (1) the 15 years immediately prior to the disability hearing or (2) the 15 years
prior to the date the claimant last met the disability insured status requirements. Social Security
Ruling ("SSR") 82-62, Titles II and XVI: A Disability Claimant's Capacity to do Past Relevant
Work, in General, 1982 WL 31389, at *2 (1982). 	In the present case, Plaintiff testified that
she performed the job of a small products assembler for six months beginning in 2010, which
was within the relevant 15-year period. 	(Tr. 	at 1828.) 	When evaluating the 	second
requirement, whether Plaintiffs work activity qualifies as substantial gainful activity ("SGA"),
the regulations provide that the claimant's earnings represent the "primary consideration." 20
C.F.R. § 404.1574(a)(1). 	The agency's earnings guidelines set out the minimum amount a
claimant must have earned in a given calendar year in order to create a presumption that she
performed substantial gainful activity during that year. 	See 20 C.F.R. § 404.1574(b)(2); see
also Soc. 	Sec. Admin. 	Program Operations Manual Syst. 	("POMS") § DI 10501.015B
(providing table of monthly SGA earnings thresholds for calendar years 1978 through 2025).
Plaintiff argues that her work as a small products assembler fails to meet the requirements of
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past relevant work at this step, because her earnings in 2010 and 2011 did not meet the earnings
guidelines. 	(PL Br. at 10.)
Even if Plaintiff is correct, her argument fails to provide a basis for remand. In addition
to finding Plaintiff capable of her past relevant work at step four, the ALJ made an alternative
finding at step five of the sequential analysis. 	Specifically, the ALJ found at step five that,
given Plaintiffs age, education, work experience, RFC, and the testimony of the vocational
expert as to these factors, she could perform other jobs available in significant numbers in the
national economy. 	(Tr. at 1828-29.) Plaintiff does not challenge any of the jobs identified at
this later step. Accordingly, any error at step four proves harmless.
B. Treating physician's opinion
Plaintiff next contends that the ALJ failed to properly evaluate the medical opinion
evidence submitted by Plaintiff's treating physician, Dr. Douglas E. Shultz. For Title II claims,
such as this one, that are filed, or considered filed, before March 24, 2017, ALJs must evaluate
the medical opinion evidence in accordance with 20 C.F.R. § 404.1527(c). Brown v. Comm'r
Soc. Sec., 873 F.3d 251, 255 (4th Cir. 2017). 	"Medical opinions" are "statements from
acceptable medical sources that reflect judgments about the nature and severity of your
impairment(s), including your symptoms, diagnosis and prognosis, what you can still do
despite impairment(s), and your physical or mental restrictions." Id . 	While the regulations
mandate that the ALJ evaluate each medical opinion presented to her, generally "more weight
is given 'to the medical opinion of a source who has examined you than to the medical opinion
of a medical source who has not examined you."' Brown, 873 F.3d at 255 (quoting 20 C.F.R.
§ 404.1527(c)). 	In addition, under what is commonly referred to as the "treating physician
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rule," the AL] generally accords the greatest weight-controlling weight-to the well-
supported opinion of a treating source as to the nature and severity of a claimant's impairment,
based on the ability of treating sources to:
provide a detailed, longitudinal picture of [the claimant's] medical impairment(s)
[which] may bring a unique perspective to the ~edical evidence that cannot be
obtained from the objective medical findings alone or from reports of individual
examinations, such as consultative examinations or brief hospitalizations.
20 C.F.R. § 404.1527 (c) (2). However, if a treating source's opinion is not "well-supported by
medically acceptable clinical and laboratory diagnostic techniques" or is "inconsistent with
other substantial evidence in [the] case record," it is not entitled to controlling weight. 	20
C.F.R. § 404.1527(c)(2); see also Social Security Ruling ("SSR") 96 -2p, 1996 WL 374188, at *4;
Brown, 873 F.3d at 256; Craig. 76 F.3d at 590; Mastro, 270 F.3d at 178. 5 	If it is not given
controlling weight, the opinion must be evaluated and weighed using all of the factors provided
in 20 C.F.R. § 404.1527(c)(2)-(6), 	including (1) the length of the treatment relationship, (2)
the frequency of examination, (3) the nature and extent of the treatment relationship, (4) the
supportability of the opinion, (5) the consistency of the opinion with the record, (6) whether
the source is a specialist, and (7) any other factors that may support or contradict the opinion.
The Fourth Circuit confirmed the application of the treating physician rule in Arakas
v. Commissioner, 983 F.3d 83 (4th Cir. 2020) and Dowling v. Commissioner, 986 F.3d 377
(4th Cir. 2021). 	In Arakas, the Fourth Circuit "emphasized that the treating physician rule is
5 For claims filed after March 27, 2017, the regulations have been amended and several of the prior Social
Security Rulings, including SSR 96-2p, have been rescinded. 	The new regulations provide that the Social
Security Administration "will not defer or give any specific evidentiary weight, including controlling weight, to
any medical opinion(s) or prior administrative medical finding(s), including those from your medical sources."
20 C.F.R. § 404.1520c. However, the claim in the present case was filed before March 27 , 2017, and the Court
has therefore analyz ed Plaintiffs claims pur suant to the treating physician rule set out above.
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a robust one: 	'[T]he opinion of a claimant's treating physician [must] be given great weight
and may be disregarded only if there is persuasive contradictory evidence."' Arakas, 983 F.3d
at 107 (quoting Coffman v. Bowen, 829 F.2d 514, 517 (4th Cir. 1987)). Thus, "the opinion
must be given controlling weight unless it is based on medically unacceptable clinical or
laboratory diagnostic techniques or is contradicted by the other substantial evidence in the
record." Id. (emphasis in original). Similarly, in Dowling, the Fourth Circuit emphasized that
even if a "medical opinion was not entitled to controlling weight, it does not follow that the
ALJ had free reign to attach whatever weight to that opinion that he deemed fit. The ALJ was
required to consider each of the six 20 C.F.R. § 404.1527 (c) factors before casting [the treating
physician] opinion aside." 	Dowling, 986 F.3d at 385. 	''While an ALJ is not required to set
forth a detailed factor-by-factor analysis in order to discount a medical opinion from a treating
physician, it must nonetheless be apparent from the ALJ's decision that he meaningfully
considered each of the factors before deciding how much weight to give the opinion." Id.
In this case, Plaintiff presented a letter from Dr. Schultz dated November 6, 2018. (Tr.
at 1695.) 	Dr. Schultz, an internal medicine specialist, explained that Plaintiff had been "a
patient in [his] practice since later 2015" and was generally seen there twice a month for her
myriad medical issues. 	(Tr. at 1695.) 	Dr. Schultz identified Plaintiffs impairments as
including, but "not limited to diverticulitis, degenerative disk disease of the lumbar spine,
osteoarthritis, venous insufficiency of the lower extremities with pins and needles and pain
sensations, painful varicose veins, urinary tract infections, tachycardia, iron deficiency anemia,
[and] chronic fatigue." 	(Tr. at 1695.) 	Crucially, in terms of Plaintiffs functional limitations,
Dr. Schultz opined, in full, as follows:
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It is my opinion, based on the medical history and face to face visits with
[Plaintiff,] that she is unable to work at any type of meaningful employment.
She most certainly cannot sit for any length of time, nor with her back and
arthritis issues, could she stand for any period of time. With all of her medical
problems combined, she is not able to work in the foreseeable future.
(Tr. at 1695.)
The ALJ gave Dr. Schultz's opinion no weight. In doing so, he explained that
the opinion of complete debilitation-the inability to sit or stand for any period
of time-finds no 	support whatsoever in the record. 	Rather, 	[Plaintiffj
consistently reported independent activities of daily living, including caring full
time for her elderly mother. 	This would not be possible if [Plaintiffj was
essentially bedridden, as set forth by Dr. Schultz. 	This level of debilitation
similarly is inconsistent with observations showing [Plaintiffj to be healthy
appearing and in no acute distress, and ambulation with a normal gait, with
negative straight leg raise, and normal strength, range of motion, sensation,
coordination, and reflexes.
(Tr. at 1827) (internal citations omitted).
Plaintiff now contends that the ALJ failed to "meaningfully consider each of the
factors" provided in 20 C.F.R. § 404.1527(c)(2)-(c)(6) when discounting Dr. Schultz's opinion.
Dowling, 986 F.3d at 385. The Court disagrees. 	First, as set out in 20 C.F.R. § 404.1527(d),
opinions on some issues are not considered medical opinions, "but are, instead, opinions on
issues reserved to the Commissioner because they are administrative findings 	that are
dispositive of a case." 	For example, "[a] statement by a medical source that [a claimant is]
'disabled' or 'unable to work' does not mean that [the agency] will determine [that the claimant]
is disabled." 	20 C.F.R. § 404.1527 (d) (1). In fact, no "special significance" is assigned to such
opinions. 20 C.F.R. § 404.1527(d)(3). Here, the ALJ noted Dr. Shultz's statement that Plaintiff
"is unable to work at any type of meaningful employment." These are opinions on an issue
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reserved to the Commissioner, for which the treating physician deference would not apply.
As the AL] observed,
[T]here is no indication that Dr. Schultz has the vocational tra1n1ng and
qualifications to opine as to the availability of work. The vocational expert does
have such qualifications, and testified [Plaintiffj is able to perform work as set
out.
(Tr. at 1827.)
Moreover, as noted by the AL], the opinions posited by Dr. Schultz indicate "complete
debilitation." Specifically, as discussed by the ALJ, Dr. Schultz opined that Plaintiff "'cannot
sit for any length of time' and is unable to 'stand for any period of time."' (Tr. at 1827.) The
ALJ concluded that these opinions were "patently absurd." 	(Tr. At 1827.) 	The ALJ
specifically acknowledged that Dr. Schultz was Plaintiffs "own medical source" (Tr. at 1827),
and repeatedly cited to Dr. Schultz's treatment records over time, 6 clearly acknowledging their
treatment relationship. 	Dr. Schultz himself clearly noted that he had been seeing Plaintiff
6 For example, the ALJ specifically cited and discussed Dr. Shultz's examinations of Plaintiff in 2016 and 2017,
noting that "examination findings were relatively benign." (Tr. at 1825, citing Tr. at 1508, 1534; see also Tr. at
1824, citing Tr. at 1506; Tr. at 1825, citing Tr. at 1507; Tr. at 1825, citing Tr. at 1510.) 	The ALJ also cited to
Dr. Shultz's treatment notes reflecting that Plaintiff "referred to her migraines as stable, and she often denied
headaches." (Tr. at 1826, citing Tr. at 1215, 1464, 1516.) The ALJ also cited to Dr. Shultz's treatment notes
reflecting that Plaintiff "repeatedly told providers that she was her elderly mother's primary full-time caregiver."
(Tr. at 1821, citing Tr. at 14F, 30F; Tr. at 1865, citing Tr. at 1457-59.) The ALJ also generally cited to Dr.
Shultz's treatment notes reflecting "conservative treatment history, showing good control of her conditions
with medication, only mild imaging findings, physical examinations showing normal strength and range of
motion with no significant neurological deficits, and extensive reported activities of daily living." (Tr. at 1827,
citing Tr. at 14F.) Similarly, the ALJ cited Dr. Schultz's treatment notes reflecting that Plaintiff was "alert and
oriented, pleasant and cooperative, and appropriately groomed and dressed, with normal mood and affect,
intact memory and concentration, and no apparent cognitive deficits; along with independent activities of daily
living, including cooking, shopping, housework, self-care, and caring for her mother." (Tr. at 1820, 1821-22,
citing Tr. at 26F, 30F.) 	The ALJ also cited to Dr. Schultz's treatment notes reflecting that "observations
generally showed independent ambulation with a normal gait, and good overall strength and range of motion,
with no mention of decreased grip strength or manipulative skills" and "no indication that a provider
recommended the use of an assistive device." (Tr. at 1822, citing Tr. at 14F; Tr . at 1827, citing Tr. at 14F.)
Thus, the ALJ's discussion fully acknowledges the length, nature, and extent of Plaintiff's treatment with Dr.
Shultz.
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since 2015 and saw her at least once a month, usually twice a month . (Tr. at 1695.) The ALJ
did not question the length and nature of the 	treatment relationship or the frequency of
examination. 	Notably, as set out above, the ALJ determined that Dr. Schultz's "opinion of
complete debilitation-the inability to sit or stand for any period of time-finds no support
whatsoever in the record." 	(Tr. at 1827.) 	The ALJ then went on to explain how drastically
Plaintiffs clinical findings, activities of daily living, and other medical opinion evidence
contradicted Dr. Schultz's statements. 	(Tr. at 1827.) As explained by the ALJ:
[Plaintiff] consistently reported independent activities of daily living, including
caring full time for her elderly mother. This would not be possible if [Plaintiff]
was essentially bedridden, as set forth by Dr. Schultz. This level of debilitation
similarly is inconsistent with observations showing [Plaintiff] to be healthy
appearing and in no acute distress, and ambulating with a normal gait, with
negative straight leg raise, and normal strength, range of motion, sensation,
coordination, and reflexes.
(Tr. at 1827.) 	Thus, the ALJ found that Dr. Shultz's opinions lack support and consistency
with the record. 	As noted above, "an ALJ is not required to set forth a detailed factor-by-
factor analysis in order to discount a medical opinion from a treating physician" where, like
here, it is "apparent from the ALJ's decision that he meaningfully considered each of the
factors before deciding how much weight to give the opinion." Dowling, 986 F.3d at 385. In
the present case, the ALJ clearly acknowledged Dr. Shultz as Plaintiffs treating physician, with
reference to his treatment records over the relevant period, but nevertheless made clear that
the other factors set out in 20 C.F.R. § 404.1527(c), even if completely favorable to Plaintiff,
failed to override the opinion's lack of support and lack of consistency with the record. 	As
such, Plaintiff identifies no basis for remand.
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C. Migraines
Plaintiff next argues that, in assessing her RFC, the ALJ failed to include any RFC
restrictions to account for the limiting effects of Plaintiffs frequent migraine headaches or, in
the alternative, sufficiently explain the absence of such restrictions. Plaintiff contends that she
presented ample evidence of her ongoing migraine symptoms during the time period at issue,
including light sensitivity, intractable pain, and extended recovery times.
Notably, the ALJ included migraines among Plaintiffs severe impairments at step two
of the sequential analysis, and then specifically explained that the RFC limitation to "light work
with environmental, manipulative, and postural limitations, and a sit/ stand option ... also
would prevent injury from potential migraine symptoms." 	(Tr. at 1827.) 	Thus, the RFC
included restrictions to account for Plaintiffs migraine headaches. The ALJ further concluded
that "the record as a whole-the medical evidence, the opinion evidence, and the claimant's
testimony-supports a finding that the claimant retained the ability to perform work activity
within the limitations described in the residual functional capacity assessment." (Tr. at 1827.)
With respect to Plaintiffs allegation of additional limitations due to her symptoms, 	the AlJ
found that Plaintiffs "statements concerning the intensity, persistence and limiting effects of
these symptoms are not entirely consistent with the medical evidence and other evidence in
the record for the reasons explained in this decision." 	(Tr. at 1824.)
Plaintiff asserts that the ALJ erred in finding Plaintiffs statements regarding the
limiting effects of her headaches less than fully consistent with the medical evidence and other
evidence of record. 	Under the applicable regulations, the ALJ's decision must "contain
specific reasons for the weight given to the individual's symptoms, be consistent with and
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supported by the evidence, and be clearly articulated so the individual and any subsequent
reviewer can assess how the adjudicator evaluated the individual's symptoms." Social Security
Ruling 16-3p, Titles II and XVI: Evaluation of Symptoms in Disability Claims, SSR 16-3p,
2017 WL 5180304 (Oct. 25, 2017) ("SSR 16-3p"); see also 20 C.F.R. § 404.1529. 	In Arakas,
983 F.3d 83, the Fourth Circuit clarified the procedure an ALJ must follow when assessing a
claimant's statements:
When 	evaluating 	a 	claimant's 	symptoms, 	ALJs 	must 	use 	the 	two-step
framework set forth in 20 C.F.R. § 404.1529 and SSR 16-3p, 2016 WL 1119029
(Mar. 16, 2016). First, the ALJ must determine whether objective medical
evidence presents a "medically determinable impairment" that could reasonably
be 	expected 	to 	produce 	the 	claimant's 	alleged 	symptoms. 	20 	C.F.R.
§ 404.1529(6); SSR 16-3p, 2016 WL 1119029, at *3.
Second, after finding a medically determinable impairment, the ALJ must assess
the intensity and persistence of the alleged symptoms to determine how they
affect the claimant's ability to work and whether the claimant is disabled. See 20
C.F.R. § 404.1529(c); SSR 16-3p, 2016 WL 1119029, at *4. 	At this step,
objective evidence is not required to find the claimant disabled. SSR 16-3p, 2016
WL 1119029, at *4-5. 	SSR 16-3p recognizes that "[s]ymptoms cannot always
be 	measured 	objectively 	through 	clinical 	or 	laboratory 	diagnostic
techniques." Id. at *4. Thus, the ALJ must consider the entire case record and
may "not disregard an individual's statements about the intensity, persistence,
and limiting effects of symptoms solely because the objective medical evidence
does not substantiate" them. Id. at *5.
983 F.3d at 95. 	Thus, the second part of the test requires the ALJ to consider all available
evidence, including Plaintiff's statements about her pain, in order to evaluate "the intensity
and persistence of the claimant's pain, and the extent to which it affects her ability to work."
Craig, 76 F.3d at 595. This approach facilitates the ALJ's ultimate goal, which is to accurately
determine the extent to which Plaintiff's pain or other symptoms limit her ability to perform
basic work activities. Relevant evidence for this inquiry includes Plaintiff's "medical history,
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medical signs, and laboratory findings," Craig, 76 F.3d at 595, as well as the following factors
set out in 20 C.F.R. § 416.929(c)(3) and 20 C.F.R. § 404.1529(c)(3):
(i) 	[Plaintiff's] daily activities;
(ii) 	The location, duration, frequency, and intensity of [plaintiff's] pain or
other symptoms;
(iii) 	Precipitating and aggravating factors;
(iv) 	The type, dosage, effectiveness, and side effects of any medication
[Plaintiff] take[s] or [has] taken to alleviate [her] pain or other symptoms;
(v) 	Treatment, other than medication, [Plaintiff] receive[s] or [has] received
for relief of [her] pain or other symptoms;
(vi) 	Any measures [Plaintiff] use[s] or [has] used to relieve [her] pain or other
symptoms (e.g., lying flat on [her] back, standing for 15 to 20 minutes
every hour, sleeping on a board, etc.); and
(vii) 	Other 	factors 	concerning 	[Plaintiff's] 	functional 	limitations 	and
restrictions due to pain or other symptoms.
In the present case, the ALJ provided more than conclusory statements discounting Plaintiff's
testimony. 	As instructed by the regulations, the ALJ considered the entire case record and
explained his reasons for deviating from Plaintiff's statements regarding the impact of her
migraine symptoms on her ability to work. 	This explanation was provided throughout the
ALJ's RFC discussion. 	During her 2020 hearing, Plaintiff testified that "she experienced
severe migraine headaches at least once a week, which required her to lie in a dark room for
much of the day." 	(Tr. at 1824, 51.) 	In addition, Plaintiff testified that "her migraines were
accompanied by nausea and vomiting." 	(Tr. at 1824, 51-52.) 	In contrast, at her most recent
hearing, Plaintiff testified that she experienced ocular-or optical-migraines during the time
period at issue, which she described as lasting approximately 30 minutes, during which she
experienced blind spots and flashing lights in her field of vision. 	(Tr. at 1879-80.)
The ALJ acknowledged that Plaintiff had a history of migraine headaches, "dating to
at least 2011." (Tr. at 1826, citing Tr. at 541,677, 685, 855). However, the ALJ further noted
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that MRI and CT imaging of Plaintiffs brain was "unremarkable." 	(Tr. at 1826, citing Tr. at
541, 805, 1184). Moreover, the ALJ noted as follows:
Severe migraines with nausea/vomiting were treated with injections ofToradol
and Phenergan, which resolved her symptoms. 	Otherwise, [Plaintiffj received
little migraine-specific treatment. Nevertheless, severe migraines were reported
only infrequently; [Plaintiffj referred to her migraines as stable, and she often
denied 	headaches. 	Additionally, 	the 	record 	shows 	no 	observation 	of
photophobia or phonophobia.
(Tr. at 1826) (internal citations omitted).
Plaintiff disputes the sufficiency of the ALJ's explanation. In particular, she argues that
her brain imaging results had no bearing on the existence or severity of her migraines, but
were instead intended to rule out non-migraine sources for her headaches. This is true, but is
relevant to the ALJ's analysis for the same reason, to rule out other potential causes or
impairments. Plaintiff further contends that many of the records cited by ALJ as indicating
that Plaintiff denied headaches were in the context of treatment unrelated to migraines. This
is also true, but nevertheless reflects the lack of headache at those times. Moreover, Plaintiff
fails to successfully refute the ALJ's finding that, overall, Plaintiff "received little migraine-
specific treatment." 	(Tr. at 1826.) As set out above, and emphasized in the Commissioner's
brief, Plaintiff bears the burden of proving disability through step four of the sequential
analysis. 	In the present case, Plaintiff argues that, "in addition to sometimes requiring pain
injections, [she] generally took various pain medications to treat her migraine headaches,
including Toradol, Tramadol, Diclofenac, and Topamax, [along with] other medication such
as Metoprolol0 and Promethazine HCl for nausea" which "were prescribed by multiple
different medical providers." 	(Pl.'s Reply Br. [Doc. #11] at 3-4) (citing Tr. at 539, 685, 688,
741, 743, 1014, 1117, and 1120). Plaintiff therefore contends that "the ALJ was simply wrong
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in stating that [Plaintiffj otherwise received little migraine-specific treatment." (Pl.'s Reply Br.
at 4.)
A review of the records cited by Plaintiff reveals no basis to disturb the ALJ's findings.
Of the eight transcript pages highlighted by Plaintiff, five involve three treatment notes, all
pre-dating Plaintiff's alleged disability period (Tr. at 539, 685, 688, 741, 743) (April 2011,
December 2011, and April 2012, more than a year and a half before the December 2013 alleged
onset date), and the other three (two of which are duplicates) involve a single instance in
February 2015 in which Plaintiff admittedly failed to pick up her Tramadol prescription (Tr.
at 1014, 1117, 1120). These records fail to undermine the ALJ's migraine findings as Plaintiff
now suggests. 	In fact, this record provides ample support for the ALJ's conclusion that
Plaintiff "received little migraine-specific treatment" during the relevant period. (Tr. at 1826.)
As noted by the ALJ, she also described her migraines as "stable" during the relevant period.
(Tr. at 1826, 1028.)
To the extent that Plaintiff further argues that the ALJ wrongly concluded that "the
record shows no observation of photophobia or phonophobia" (Pl.'s Reply Br. at 4) (citing
Tr. at 1826), she again provides no evidence to the contrary. 	In fact, she acknowledges that
"[t]he records cited by the AIJ document that on two occasions, [Plaintiffj reported during a
migraine or ocular migraine that she was not light sensitive." 	(Pl.'s Reply Br. at 5) (citing Tr.
at 527, 1014, 1117). Plaintiff's argument appears to stem from a single note during migraine
treatment in 2012 in which it was noted that she was lying in the exam room with the lights
out. (Pl.'s Reply Br. at 5) (citing Tr. at 685). However, this record predates Plaintiff's alleged
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onset date by more than 20 months and fails to unambiguously connect Plaintiffs behavior
with photophobia.
Overall, the Court finds that substantial evidence supports the ALJ's findings regarding
Plaintiffs migraine headaches. 	Whether the ALJ could have reached a different conclusion
based on the evidence is irrelevant. 	The sole issue before the Court is whether substantial
evidence supports the ALJ's decision. See Blalock v. Richardson, 483 F.2d 773, 775 (4th Cir.
1972) ("[I]he language of § 205(g) precludes a de novo judicial proceeding and requires that the
court uphold the Secretary's decision even should the court disagree with such decision as
long as it is supported by 'substantial evidence."') . 	While Plaintiff disagrees with the ALJ's
determination, it is not the function of this Court to re-weigh the evidence or reconsider the
ALJ's determinations if they are supported by substantial evidence. As noted above, "[w]here
conflicting evidence allows reasonable minds to differ as to whether a claimant is disabled, the
responsibility for that decision falls on the ALJ." Hancock, 667 F.3d at 472 (internal brackets
and quotation omitted). Thus, the issue before the Court is not whether a different fact-finder
could have drawn a different conclusion, or even "whether [Plaintiff] is disabled," but rather,
"whether the ALJ's finding that [Plaintiff] is not disabled is supported by substantial evidence
and was reached based upon a correct application of the relevant law." Craig, 76 F.3d at 589.
Here, the ALJ provided sufficient analysis to allow the Court to follow his reasoning, and there
is sufficient evidence to support the ALJ's determination. 	Accordingly, the Court finds no
basis for remand.
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D. Swearing of witnesses
Finally, Plaintiff contends that, during her most recent administrative hearing, the ALJ
failed to properly administer an oath or affirmation to the Plaintiff or the vocational expert,
both of whom testified. 	(Pl.'s Br. at 24-34.) 	The regulations instruct that all witnesses "will
testify under oath or affirmation unless the administrative law judge finds an important reason
to excuse them from taking an oath or affirmation." 	20 C.F.R. § 404.950(e) . The Hearings,
Appeals, and Litigation Law Manual ("HALLEX") includes a nearly identical requirement,
providing that, "[g]enerally, an administrative law judge (ALJ) will take all testimony provided
at the hearing under oath or affirmation, unless the ALJ finds that there is an important reason
not to." HALLEX § I-2-6-54(A).
In the present case, as Plaintiff correctly notes, the transcript of her October 19, 2023
telephonic hearing does not expressly include the administration of an oath or affirmation to
either Plaintiff or the vocational expert. 	However, the certified transcript does include a
statement, prior to the beginning of testimony by both witnesses, indicating that the oath or
affirmation was first administered. In fact, at each of the administrative hearings in this case,
the transcripts note that Plaintiff, "having been first duly sworn, testified as follows[,]" and
that the vocational expert, "having been first duly sworn, testified as follows." 	(See Tr. at 48,
69, 84, 105, 116, 122, 1849, 1881, 1980, 2001, 2025, and 2046.) 	This is consistent with the
Commissioner's explanation that "[b]y routine practice, the oath is not transcribed verbatim";
rather, the transcript only indicates that the witnesses received it. 	(Def.'s Br. [Doc. #10] at
19 .) The Commissioner further explained that, "[t]hrough certification of the transcript and
stating that all witnesses were administered the oath, the transcriber is certifying that the
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administered oath was heard." 	(Def.'s Br . at 19.) 	Nothing in the regulations or agency
guidance cited by Plaintiff requires more explicit evidence regarding swearing of witnesses,
nor does Plaintiff point to any case law to this effect. Accordingly, Plaintiffs final argument
provides no basis for remand.
IT IS THEREFORE RECOMMENDED that the Commissioner's decision finding
no disability be AFFIRMED, that Plaintiff's Dispositive Brief [Doc. #8] be DENIED, that
Defendant's 	Dispositive 	Brief 	[Doc. 	#10] 	be 	GRANTED, 	and 	that 	this 	action 	be
DISMISSED with prejudice.
This, the 26 th day of February, 2026.
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