Brianna M. v. Bisignano

UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF RHODE ISLAND
BRIANNA M.,
Plaintiff,
v.
FRANK BISIGNANO,
Commissioner,
Social Security Administration,
Defendant.
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No. 25-cv-504-JJM-AEM
MEMORANDUM AND ORDER
JOHN J. MCCONNELL, JR., United States District Court Chief Judge.
Plaintiff Brianna M. brings this action pursuant to 42 U.S.C. §§ 405(g) and
1383(c)(3), seeking to reverse the decision of Frank Bisignano, the Commissioner of
the 	Social 	Security 	Administration 	(“the 	Commissioner”), 	in 	which 	he 	denied
Brianna’s claim for Title XVI Supplemental Security Income (“SSI”) benefits. 	ECF
No. 10. In response, the Commissioner moves this Court to enter an order, affirming
his decision. ECF No. 11.
After a thorough review of the record, and for the reasons stated below, the
Court GRANTS Brianna’s Motion to Reverse and DENIES the Commissioner’s
Motion to Affirm.
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I. 	BACKGROUND
In 2014, Brianna applied for SSI benefits, alleging disability due to muscle
weakness,1 anxiety, and depression. ECF No. 10 at 2-3. She was found to be disabled
as of July 17, 2014. 2
	Id. at 3. 	She was awarded SSI based on the opinion of State
agency medical consultant3 Erik Purins, M.D., who opined that Brianna’s disability
resulted in a residual functional capacity (“RFC”) 4 of a reduced range of sedentary
work,5 which allowed for only occasional use of her hands for fingering and handling.6
Id. at 4; ECF No. 11 at 2.
1 Brianna specifically alleged congenital neuropathy, which results in muscle
weakness in the hands and feet. ECF No. 11 at 2.
2 This is referred to as the comparison point decision (“CPD”) date, which is
“[t]he most recent favorable decision that [the claimant is] disabled or continue[s] to
be disabled.” 20 C.F.R. § 416.994a(c).
3 	SSA 	regulations 	empower 	State 	agency 	medical 	consultants 	to 	make
disability determinations.
	See 20 C.F.R. § 416.913a(a); 20 C.F.R. § 416.1015(c). 	A
“State agency medical consultant” is “a member of a team that makes disability
determinations in a State agency, or who is a member of a team that makes disability
determinations for [the SSA].” 	20 C.F.R. § 416.1016(a). 	This individual must be a
licensed physician. 20 C.F.R. § 416.1016(b).
4 An “RFC is an assessment of an individual’s ability to do sustained work-
related physical and mental activities in a work setting on a regular and continuing
basis.” 	SSR 96–8p, 1996 WL 374184, at *1 (S.S.A. July 2, 1996). 	“A ‘regular and
continuing basis’ means 8 hours a day, for 5 days a week, or an equivalent work
schedule.”
Id. Additionally, an “RFC is not the
least an individual can do despite his
or her limitations or restrictions, but the
most.”
	Id. (emphasis in original);
see also
20 C.F.R. § 416.945(a)(1).
5 “Sedentary work” is defined as work that “involves lifting no more than 10
pounds at a time and occasionally lifting or carrying articles like docket files, ledgers,
and small tools.” 	20 C.F.R. § 416.967(a). 	Though these jobs generally “involve[ ]
sitting, a certain amount of walking and standing is often necessary in carrying out
job duties.”
Id.
6 These are terms of art. “Fingering” means having the ability to pick, pinch,
or otherwise work primarily with the fingers. 	SSR 85–15, 1985 WL 56857, at *7
(S.S.A. Jan. 1, 1985). 	“Handling” refers to the ability to seize, hold, grasp, turn, or
otherwise work primarily with the whole hand or hands.
Id.
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Seven years later, on June 15, 2021, Brianna was deemed no longer disabled.
Id.; ECF No. 10 at 3. 	State agency medical consultant, Henry Laurelli, M.D.,
determined that Brianna had experienced medical improvement such that she could
perform a range of light work. 	ECF No. 11 at 2. 	A second State agency medical
consultant, Elaine Hom, M.D., affirmed Dr. Laurelli’s assessment.
Id. Dr. Hom cited
Brianna’s testimony that she could lift at least twenty pounds, as well as medical
reports that she could lift her forty-pound child over her head, stand for two hours,
and regularly jog, lift weights, and do sit-ups and push-ups.
	Id. 	As a result of this
determination, the Commissioner terminated Brianna’s SSI benefits.
Id.; ECF No. 10
at 3.
A disability hearing officer 7 reconsidered this decision on Brianna’s request
and reaffirmed the Commissioner’s conclusion that Brianna was no longer entitled to
SSI. ECF No. 10 at 3. Brianna thereafter filed a written request for a hearing before
an administrative law judge (“ALJ”).
	Id. 	In a decision dated October 4, 2022, ALJ
Timothy Belford also determined that Brianna’s disability had ended on June 15,
2021, and that she had not become disabled since then.
Id.
Brianna appealed this decision to the Appeals Council, which sided with her
and vacated ALJ Belford’s order.
	Id. 	The Appeals Council remanded with specific
instructions 	to: 	(1) 	further 	consider 	whether 	Brianna’s 	medical 	condition 	had
improved, and if so, whether she is currently disabled; (2) re-evaluate the medical
7 A disability hearing officer is an experienced disability examiner tasked with
reviewing a disability determination that the claimant appeals.
	See 20 C.F.R. §
416.1415;
see also 20 C.F.R. § 416.1414.
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opinions provided in Brianna’s case; and (3) if warranted, obtain evidence from a
vocational expert and resolve any conflicts between the expert’s testimony and
information provided in the
Dictionary of Occupational Titles and its companion
publication, the
Selected Characteristics of Occupations.8 Tr. 175-76.
On remand, the case was assigned to a different ALJ, Kate Dana (“the ALJ”).
ECF No. 10 at 3. 	In a decision dated September 25, 2024, the ALJ concluded that
Brianna was no longer disabled because her medical condition had improved.
Id. at 4;
ECF No. 11 at 3. 	In rendering this decision, the ALJ relied heavily on Dr. Laurelli
and Dr. Hom’s 2021 medical opinions. 	ECF No. 10 at 8-9. 	Furthermore, based on
Brianna’s age, work experience, education, 9 improved RFC, and the testimony of
vocational expert Ed Calandra, the ALJ found that Brianna could perform a range of
light work that would allow her to work in a significant number of jobs in the national
economy. ECF No. 10 at 5; ECF No. 11 at 3.
Brianna appealed this decision as well, but this time the Appeals Council
denied her request for review. ECF No. 10 at 3. This suit followed shortly thereafter.
8 The
Dictionary of Occupational Titles and the
Selected Characteristics of
Occupations are resources that list occupations existing in the economy and explain
some of the physical and mental requirements of those occupations.
	Pearson v.
Colvin, 810 F.3d 204, 205 n.1 (4th Cir. 2015) (citing U.S. Dep’t of Labor, Dictionary
of Occupational Titles (4th ed. 1991); U.S. Dep’t of Labor, Selected Characteristics of
Occupations Defined in the Revised Dictionary of Occupational Titles (1993)). 	The
SSA has a general policy of relying on these resources in helping make their
determinations.
See SSR 00–4p, 2000 WL 1898704, at *1-4 (S.S.A. Dec. 4, 2000).
9 As of June 15, 2021, Brianna was twenty-four years old with a high school
education and no past relevant work. ECF No. 10 at 5.
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II. 	STANDARD OF REVIEW
“The 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). 	“[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 “means—and means only—‘such relevant evidence as a reasonable mind
might accept as adequate to support a conclusion.’”
	Id. (quoting
Consol. Edison Co.
v. NLRB, 305 U.S. 197, 229 (1938)).
The Court “must uphold the Secretary’s findings . . . if a reasonable mind,
reviewing the evidence in the record as a whole, could accept it as adequate to support
[their] conclusion.”
	Rodriguez v. Sec’y of Health & Hum. Servs., 647 F.2d 218, 222-
23 (1st Cir. 1981) (citing
Consol. Edison Co., 305 U.S. at 229). If substantial evidence
supports the Commissioner’s decision, the Court should affirm it, “even if the record
arguably could justify a different conclusion . . . .”
Rodriguez Pagan v. Sec’y of Health
& Hum. Servs., 819 F.2d 1, 3 (1st Cir. 1987) (citing
Lizotte v. Sec’y of Health & Hum.
Servs., 654 F.2d 127, 128 (1st Cir. 1981)). 	That said, the ALJ’s findings are “not
conclusive when derived by ignoring evidence, misapplying the law, or judging
matters entrusted to experts.”
Nguyen v. Chater, 172 F.3d 31, 35 (1st Cir. 1999).
As a final note, “[t]he First Circuit has stated that courts should ensure ‘a just
outcome’ in Social Security disability claims.”
	Santa v. Astrue, 924 F. Supp. 2d 386,
391-92 (D.R.I. 2013) (quoting
Pelletier v. Sec’y of Health, Educ. & Welfare, 525 F.2d
158, 161 (1st Cir. 1975)). 	“[T]he Social Security Act is to be construed liberally to
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effectuate 	its 	general 	purpose 	of 	easing 	the 	insecurity 	of 	life.”
	Rodriguez 	v.
Celebrezze, 349 F.2d 494, 496 (1st Cir. 1965) (citing
Page v. Celebrezze, 311 F.2d 757
(5th Cir. 1963)).
III. 	APPLICABLE LAW
The law defines disability as the inability to do any substantial gainful activity
by reason of any medically determinable physical or mental impairment that can be
expected to result in death or that 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)(B); 20
C.F.R. § 416.905. The impairment must be severe, making the claimant unable to do
previous work, or any other substantial gainful activity that exists in the national
economy. 42 U.S.C. § 1382c(a)(3)(B); 20 C.F.R. §§ 416.905-11.
A. 	The Five-Step Evaluation and Medical Improvement Standards
In evaluating an initial disability claim, the ALJ must follow a five-step
process.
See 20 C.F.R. §§ 416.920(a)(4)(i)-(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, 433, 440-41 (1st Cir. 2020).
Once a claimant has been found to be disabled, her eligibility for benefits must
be periodically reviewed at a continuing disability review (“CDR”) to determine
whether her disability is ongoing. 	20 C.F.R. § 416.990(d). 	If the claimant has
experienced medical improvement to the point where she is able to engage in
substantial gainful activity, then she is no longer considered disabled, and her SSI
benefits will be terminated. 	42 U.S.C. § 1382c(a)(4);
see also 20 C.F.R. §§ 416.920,
416.994.
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“Medical improvement” is defined as “any decrease in the medical severity of
[the claimant’s] impairment(s) which was present at the time of the most recent
favorable medical decision that [she was] disabled or continue[s] to be disabled.” 20
C.F.R. § 416.994(b)(1). ALJs evaluate medical improvement cases based on an eight-
step process.
See 20 C.F.R. §§ 416.994(b)(5)(i)-(viii).
B. 	The ALJ’s Duty to Develop the Record
ALJs have a “duty to investigate the facts and develop the arguments both for
and against granting benefits.”
	Sims v. Apfel, 530 U.S. 103, 111 (2000) (citing
Richardson v. Perales, 402 U.S. 389, 400-401 (1971));
see also Rackliff v. Berryhill,
No. 1:16-cv-00250-JHR, 2017 WL 2266796, at *4 (D. Me. May 22, 2017) (“The First
Circuit has recognized that administrative law judges have a general duty to develop
the record . . . .”). Indeed, where an ALJ fails to fully develop the factual record, the
ALJ commits legal error, and remand is appropriate.
See, e.g.,
Tegan S. v. Saul, 546
F. Supp. 3d 162, 170 (D.R.I. 2021);
Ruggiero v. Bisignano, No. 23-cv-12245-DLC, ---
F. Supp. 3d ----, 2026 WL 893751, at *7 (D. Mass. Mar. 31, 2026).
In some cases, there may be insufficient evidence to determine whether a
claimant has or continues to suffer from a disability. 	In these instances, federal
regulations provide that the ALJ may recontact the claimant’s medical source,
request additional existing evidence, order that the claimant undergo a consultative
examination, or ask the claimant or others for more information.
	See 20 C.F.R. §
416.920b(b)(2). 	The action taken by the ALJ will “depend on the nature of the . . .
insufficiency.”
	Id. 	If “despite efforts to obtain additional evidence, the evidence is
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insufficient to determine whether [the claimant] is disabled, [the ALJ] will make a
determination 	or 	decision 	based 	on 	the 	evidence 	[they] 	have.” 	20 	C.F.R. 	§
416.920b(b)(3).
C. 	Opinion Evidence and Reliance on Experts
ALJs generally lack the qualifications necessary to interpret raw data in a
medical record by themselves.
	Manso-Pizarro v. Sec’y of Health & Hum. Servs., 76
F.3d 15, 17 (1st Cir. 1996) (citing
Perez v. Sec’y of Health & Hum. Servs., 958 F.2d
445, 446 (1st Cir. 1991);
Gordils v. Sec’y of Health & Hum. Servs., 921 F.2d 327, 329
(1st Cir. 1990)). For this reason, when evaluating a disability claim, “an expert’s RFC
evaluation is ordinarily essential unless the extent of functional loss, and its effect on
job performance, would be apparent even to a lay person.”
Santiago v. Sec’y of Health
& Hum. Servs., 944 F.2d 1, 7 (1st Cir. 1991). There are a few exceptions that permit
the ALJ to render “common-sense judgments about functional capacity based on
medical findings, as long as the [ALJ] does not overstep the bounds of a lay person’s
competence and render a medical judgment.”
Gordils, 921 F.2d at 329. However, “[i]f
the medical evidence is such that a ‘reasonable mind might accept [it] as adequate to
support a conclusion’ of disability, the ALJ cannot rest on his untutored lay analysis
to interpret it otherwise.”
	Katherine P. v. Kijakazi, No. 21-427-JJM, 2022 WL
3224851, at *5 (D.R.I. Aug. 10, 2022),
report and recommendation adopted by text
order (D.R.I. Aug. 25, 2022) (quoting
Sherry B. v. Saul, No. 20-140-JJM-PAS, 2021
WL 508517, at *2 (D.R.I. Feb. 11, 2021)).
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In a similar vein, the opinions of medical experts do not constitute “substantial
evidence and cannot be relied upon [by the ALJ] if the experts were not ‘privy to parts
of [plaintiff’s] medical record [which] detracts from the weight that can be afforded
their opinions.’”
Matthew R. v. Bisignano, No. 24-231-MSM, 2025 WL 2319074, at *3
(D.R.I. Aug. 12, 2025),
report and recommendation adopted, 2025 WL 2663227 (Sept.
17, 2025) (quoting
Ruben M. v. Saul, No. 19-119-MSM, 2020 WL 39037, at *9 (D.R.I.
Jan. 3, 2020),
report and recommendation adopted, 2020 WL 555186 (D.R.I. Feb. 4,
2020)). “In particular, an ALJ cannot rely on a medical expert’s opinion if the expert
did not see documents indicating that the claimant’s condition is materially different
from what the expert found based on what he did see.”
	Matthew R., 2025 WL
2319074, at *3 (citing
Virgen C. v. Berryhill, No. 16-480-WES, 2018 WL 4693954, at
*2-3 (D.R.I. Sept. 30, 2018)).
In these cases, “substantial evidence of material symptom worsening that the
non-examining experts did not see requires remand.”
Matthew R., 2025 WL 2319074,
at *3 (citing
Sandra C. v. Saul, No. 18-375-JJM, 2019 WL 4127363, at *6 (D.R.I. Aug.
30, 2019),
report and recommendation adopted by text order (D.R.I. Sept. 16, 2019)).
“If the ‘[c]ourt does not know whether the non-examining state agency physicians
would have rendered the same . . . opinions if they had all of the medical evidence,’
remand is necessary.”
	Id. (quoting
Mary K v. Berryhill, 317 F. Supp. 3d 664, 668
(D.R.I. 2018));
see also Kayla G. v. Kijakazi, No. 21-443-PAS, 2022 WL 3368600, at
*2 (D.R.I. Aug. 16, 2022).
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On the other hand, there are some circumstances in which the ALJ may rely
on non-examining expert findings, “despite post-file-review evidence, as long as the
ALJ considered the post-file-review evidence and makes a commonsense finding that
the pre- and post-file-review records are sufficiently similar such that the post-file
review material does not . . . detract from the weight to be afforded to the expert
findings.”
	Matthew R., 2025 WL 2319074, at *4 (citing
Jennifer F. v. Saul, No. 19-
547-MSM, 	2020 	WL 	6488706, 	at 	*6-7 	(D.R.I. 	Sept. 	16, 	2020),
	report 	and
recommendation adopted, 2020 WL 6487813 (D.R.I. Nov. 4, 2020);
Michele S. v. Saul,
No. 19-65-WES, 	2019 	WL 	6242655, 	at 	*8 	(D.R.I. 	Nov. 	22, 	2019),
	report 	and
recommendation adopted by text order (D.R.I. Dec. 13, 2019)). In other words, expert
opinions “may not be rejected as stale unless the claimant sustains [her] burden of
demonstrating that the post-file-review evidence reveals a ‘sustained (and material)
worsening’ of the claimant’s impairments that the ALJ ignored.”
	Matthew R., 2025
WL 2319074, at *3 (quoting
Jennifer F., 2020 WL 6488706, at *6).
IV. 	DISCUSSION
Here, Brianna argues that the ALJ in her case erred by failing to appropriately
develop the record and by impermissibly interpreting raw medical data. ECF No. 10
at 2. As mentioned, Dr. Laurelli and Dr. Hom provided a pair of medical opinions in
2021 in which they concluded that Brianna was no longer disabled because she had
experienced medical improvement. When the ALJ considered Brianna’s SSI claim in
2024, Brianna submitted hundreds of pages of additional medical records that Dr.
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Laurelli and Dr. Hom had not had the opportunity to consider when they rendered
their opinions three years prior. ECF No. 10 at 9;
see also ECF No. 11 at 5.
Despite this, the ALJ stated at the hearing that Dr. Laurelli and Dr. Hum’s
2021 opinions were entitled to “considerable evidentiary weight.” 	Tr. 29. 	The ALJ
acknowledged that, in the years following their opinions, Brianna had submitted
additional medical records that neither of the State agency medical consultants had
reviewed.
	Id. 	Nevertheless, the ALJ determined that this new evidence “[did] not
warrant a change in the weight afforded to [Dr. Laurelli and Dr. Hum’s] opinions.”
Id.
The primary issue here, then, is whether Dr. Laurelli or Dr. Hum would have
rendered the same medical opinions had they seen and considered Brianna’s newly
submitted medical records (the so-called “post-file-review record”). Indeed, if this new
information demonstrated substantial evidence of material symptom worsening in
Brianna’s case, then Dr. Laurelli and Dr. Hum’s 2021 opinions would effectively be
rendered stale.
	See Matthew R., 2025 WL 2319074, at *3;
Jennifer F., 2020 WL
6488706, at *6-7;
Michele S., 2019 WL 6242655, at *8.
The post-file-review record that Brianna submitted contains 442 additional
pages 	of 	material, 	which 	amounts 	to 	approximately 	55.25% 	of 	the 	total
administrative record. 	ECF No. 10 at 9. 	Included in the post-file-review record are
documents pertaining to two EMG tests10 that Brianna underwent in January and
10 An EMG, or electromyography, test is “a diagnostic procedure to assess the
health 	of 	muscles 	and 	the 	nerve 	cells 	that 	control 	them.” 	Mayo 	Clinic,
Electromyography
	(EMG), 	https://www.mayoclinic.org/tests-
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September of 2022. Tr. 951-52. In her decision, the ALJ relied on these EMGs as a
basis for concluding that Brianna had experienced medical improvement.
See Tr. 27.
The ALJ summed up Brianna’s EMG testing as follows: “Objective neurological
testing performed in January 2022 revealed no electrodiagnostic evidence of large
fiber polyneuropathy, though updated testing in September 2022 indicated only
slightly reduced MUAP of the proximal muscle of the left upper extremity, not
polyneuropathy, and left muscle biopsy showed no pathology.”
Id.
Upon review, the Court finds that it was error for the ALJ to have relied on
this post-file-review information as a basis for concluding that Brianna was no longer
disabled. For one thing, making an RFC determination based on EMG testing does
not strike the Court as the sort of “common-sense judgment about functional
capacity” that an ALJ would be able to normally render on her own.
	Gordils, 921
F.2d at 329;
see also Matthew R., 2025 WL 2319074, at *4. 	This Court—and other
courts within this circuit—have previously held that EMG findings are of the type of
complex medical records that ALJs are usually not entitled to assess as laypersons.
See, e.g.,
June B. v. Bisignano, No. 24-245-MRD, 2025 WL 1939087, at *8-9 (D.R.I.
July 14, 2025);
Audrey P. v. Saul, No. 20-92-MSM, 2021 WL 76751, at *9 (D.R.I. Jan.
8, 2021);
Mason v. Berryhill, 245 F. Supp. 3d 327, 331-32 (D. Mass. 2017) (holding
that the ALJ improperly discredited opinions of claimant’s treating physicians and
substituted his own interpretation of EMG tests).
procedures/emg/about/pac-20393913 [https://perma.cc/J8JD-DX2V] (last visited Apr.
20, 2026).
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What is more, the ALJ erred by improperly cherry-picking certain evidence
from the record.
	See, e.g.,
June B., 2025 WL 1939087, at *8;
Audrey P., 2021 WL
76751, at *10. 	The ALJ notably omitted crucial pieces of information from her
analysis that suggest that the results from Brianna’s EMG tests are far from
conclusive on the issue of medical improvement. As an example, Brianna’s treating
physician, Benjamin Weistrop, M.D., wrote of the January 2022 EMG:
There is no electrodiagnostic evidence of a large fiber polyneuropathy
seen on this study. 	On the needle EMG portion of the test, slightly
reduced motor unit action potential amplitudes are seen in proximal
muscles 	in 	the 	left 	upper 	extremity, 	however 	there 	are 	no 	other
myopathic features observed.
	These findings are subtle and should be
interpreted 	with 	great 	caution, 	however 	an 	underlying 	myopathic
process affecting the left upper extremity cannot be fully excluded.
Tr. 952 (emphasis added). Another one of Brianna’s physicians, Kara Stavros, M.D.,
said of the September 2022 EMG:
[Brianna] recently underwent additional workup with EMG and muscle
biopsy which was unrevealing
. I would like her to be evaluated at MGH
for another opinion on the underlying neurologic cause of her symptoms.
She is seeing genetics again next month to see if any additional testing
options exist.
Id. at 951 (emphasis added). 	Dr. Weistrop and Dr. Stavros’ notes urge caution in
interpreting Brianna’s EMG testing and suggest that Brianna’s medical condition
required further evaluation. Put another way, the notes show far more nuanced and
incomplete opinions regarding Brianna’s condition than the ALJ made them out to
be in her decision.
The cherry-picking did not end there. 	The ALJ also cited a September 2022
doctor’s note for the proposition that Brianna had “denied any hand cramping, denied
muscle pain or spasm, denied any numbness or tingling in the hands or feet.” Tr. 27
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(citing
id. at 952). 	The ALJ failed to recognize, however, that the same note listed
Brianna’s complaints of occasional hand stiffness, occasional tripping, and her
inability to lift more than twenty pounds and walk more than ten minutes without
taking a break due to right knee pain.
Id. at 952.
The ALJ also mentioned Brianna’s May 2024 diagnosis with Ehlers Danlos
Syndrome11 in her decision.
Id. at 27. The ALJ specifically referenced findings made
by Brianna’s rheumatologist, Lewena Maher, M.D., who opined that Brianna’s “exam
findings . . . revealed normal gait and full 5/5 strength in the upper and lower
extremities with intact sensation.”
	Id. (citing
id. at 1022). 	According to the ALJ,
these findings further demonstrated that Brianna was no longer disabled, as they
showed that she “has the capacity to perform light work” and “reasonably support[ed]
the conclusion that [Brianna] can frequently perform pushing, pulling, handling, and
fingering with the upper extremities.”
Id. at 28.
But it was also error for the ALJ to rely so heavily on this raw medical data to
make such a determination. As at least one other court within this circuit has pointed
out, Ehlers Danlos Syndrome is “a relatively complex condition” that “the ALJ,
without a supporting medical expert opinion” is generally ill-equipped to assess as a
layperson.
Linee P. v. Kijakazi, No. 1:22-cv-00242-JAW, 2023 WL 2674398, at *3 (D.
11 Ehlers Danlos Syndrome “is a group of hereditary disorders that affect
connective tissues and are generally characterized by joint hypermobility (overly
flexible joints) and stretchy, fragile skin.”
Shisslak v. Saul, No. 19-10768-PBS, 2020
WL 607156, at *1 n.2 (D. Mass. Feb. 7, 2020).
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Me. Mar. 29, 2023). 	This Court agrees. 	This type of information is best left for a
medical expert to interpret, not an ALJ.
The ALJ also cherry-picked findings from Dr. Maher’s notes. 	As before, the
ALJ omitted key parts of Dr. Maher’s opinion that tend to cut against a finding of
medical improvement in Brianna’s case:
Patient’s physical exam findings, 4/5 Beighton score, she meets both
major criteria of the Brighton score, along with multiple minor criteria
qualifies this patient with a diagnosis of Ehlers Danlos syndromes.
There are multiple subtypes of Ehlers Danlos. It will [be] important for
us to connect with her geneticist to test for mutations in the COL5A1 or
COL5A2 gene, or in COL1A1, however others may exist. Treatment for
Ehlers Danlos is supportive, including joint protective habits such as
repeatedly hyperextending joints and
daily activities that may put her
at risk of such, and physical therapy with a specialist in hypermobility.
She also may require cardiac and ophthalmologic screening given
elevated risk of valvular disorders, aortic root dilation, and retinal
detachment respectively.
Tr. 1022 (emphasis added).
Based on the foregoing, the Court cannot say whether Dr. Laurelli or Dr. Hum
would have rendered the same medical opinions had they seen Brianna’s post-file-
review evidence.
See Matthew R., 2025 WL 2319074, at *3;
Mary K v. Berryhill, 317
F. Supp. 3d at 668;
Kayla G., 2022 WL 3368600, at *2. 	Though the ALJ considered
this evidence when making her decision, it cannot fairly be said that she, as a
layperson, made “a commonsense finding that the pre- and post-file-review records
are sufficiently similar such that the post-file review material does not . . . detract
from the weight to be afforded to the expert findings.”
Matthew R., 2025 WL 2319074,
at *4;
see also Jennifer F., 2020 WL 6488706, at *6-7;
Michele S., 2019 WL 6242655,
at *8.
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The Commissioner resists this conclusion, arguing that “the relevant medical
evidence was expressed in relatable terms . . . that are not too raw for a lay ALJ to
decipher without expert assistance.” 	ECF No. 11 at 8-9. 	The Court disagrees. 	Too
much of the post-file-review evidence—the EMG tests, the physicians’ notes, the
Ehlers Danlos diagnosis—consisted of complex medical information that, as other
courts have recognized, a layperson is simply not equipped to analyze.
See, e.g.,
June
B., 2025 WL 1939087, at *8-9;
Audrey P., 2021 WL 76751, at *9;
Mason v, 245 F.
Supp. 3d at 331-32;
Linee P., 2023 WL 2674398, at *3. Perhaps with the insight of a
medical expert, this new information could very well constitute substantial evidence
of material symptom worsening in Brianna’s case. But no expert reviewed this new
information—only the ALJ did, and that was erroneous. Additionally, the ALJ’s error
in interpreting raw medical data was exacerbated by her improper cherry-picking of
Brianna’s medical records to reach the conclusion that Brianna was no longer
disabled.
	See, e.g.,
June B., 2025 WL 1939087, at *8;
Audrey P., 2021 WL 76751, at
*10. This too was error.
In sum, the Court finds that the ALJ’s decision was not based on substantial
evidence, as is required under 42 U.S.C. § 405(g), because the ALJ relied exclusively
on the medical opinions of Dr. Laurelli and Dr. Hom, neither of whom had the full
administrative record before them, including the extensive post-file-review record.
As such, the Court remands this matter to the Commissioner. The Commissioner is
instructed to seek a medical expert to assess whether Brianna’s post-file-review
evidence constitutes material symptom worsening.
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V. 	CONCLUSION
For the reasons stated, the Court GRANTS Brianna’s Motion to Reverse (ECF
No. 10) and DENIES the Commissioner’s Motion to Affirm (ECF No. 11). The Court
remands this case to the Commissioner for further action consistent with this Order.
IT IS SO ORDERED.
s/John J. McConnell, Jr.
_________________________________
JOHN J. MCCONNELL, JR.
Chief Judge
United States District Court
April 22, 2026
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