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4th Cir.: State disability findings may deserve substantial weight

An administrative law judge erred in according little weight to a North Carolina Department of Health and Human Services determination that the Social Security claimant qualified as disabled. The ALJ also didn’t consider the limited extent to which the claimant could perform daily activities.


Billie Jean Woods appeals the Social Security Administration’s denial of her application for disability insurance benefits.

In the years leading up to her alleged disability onset date, Woods held various production and manufacturing jobs that required her to lift up to 50 pounds and to walk, stand, and crouch for seven hours or more per day. In 2010, Woods began exhibiting symptoms consistent with inflammatory arthritis, osteoarthritis, and fibromyalgia. She also began experiencing persistent pain that limited her ability to perform her job. Her symptoms progressed over the next three years. She stopped working in April 2013 and applied for Social Security benefits.

After the Administration initially denied her application, Woods sought a hearing before an Administrative Law Judge. She presented medical records from Dr. Aasheim (her primary care physician), Dr. de Wit (her rheumatologist through January 2013), and a prior decision from the North Carolina Department of Health and Human Services that Woods was disabled and entitled to Medicaid benefits. The ALJ also reviewed the opinions of Drs. Burgess and Pardoll, who conducted consultative examinations at the state agency’s request, and Dr. Clayton, the state agency medical consultant who reviewed Woods’s medical record but did not treat or examine her in person. Woods also testified and submitted disability questionnaires.

After reviewing the evidence, the ALJ found that Woods did not meet the legal definition of “disabled” and denied her claim for Social Security disability insurance benefits. Woods has appealed, ultimately reaching this court.

Weight of state agency decision

This court has not yet addressed the precise weight an ALJ must give to a state agency’s disability determination. However, in Bird v. Comm’r of Soc. Sec. Admin., 699 F.3d 337 (4th Cir. 2012), the court held that a Veterans Affairs disability rating was entitled to substantial weight because “the purpose and evaluation methodology of” the respective federal agencies’ disability determinations are “closely related.”

This logic also applies to the North Carolina agency’s disability decisions. Both the state agency and Social Security disability insurance benefits “serve the same governmental purpose of providing benefits to persons unable to work because of a serious disability.” Moreover, the state agency defines “Medicaid to the Disabled” as a “program of medical assistance for individuals under age 65 who meet Social Security’s definition of disability.” As a result, a “person who receives Social Security based on disability meets the disability requirement for Medicaid,” although he or she must still “apply for Medicaid and must meet all other eligibility requirements.” Therefore, the Administration must give substantial weight to” a disability decision by the North Carolina Department of Health and Human Services.

Of course, an ALJ may deviate from this default rule if appropriate. The court holds, consistent with other circuits, that an ALJ may accord such a decision less-than-substantial weight if he or she gives persuasive, specific, valid reasons for doing so that are supported by the record. For example, an ALJ could explain which aspects of the prior agency decision he finds not credible and why, describe why he finds other evidence more credible, and discuss the effect of any new evidence made available after the state agency issued its decision. This list is not exclusive, but the point is that the ALJ must adequately explain his reasoning.

The ALJ in this case concluded that the state agency decision deserved only “little weight,” because “a determination made by another agency that you are disabled or blind is not binding on us.” This generic explanation, which could apply to every state agency decision, is neither persuasive nor specific. Thus, the ALJ did not adequately justify his decision to accord the state agency decision less than the substantial weight it generally deserves.

The Commissioner argues that because the ALJ’s decision as a whole makes clear that he considered the same evidence on which the state agency decision relied, the ALJ didn’t need to refer expressly to that evidence. While it may be that the ALJ considered this evidence in deciding both which doctors and evidence to credit and whether the state agency decision deserved substantial weight, this court’s review cannot rest on such guesswork.

Residual function capacity

Woods also contends that the ALJ did not adequately perform the residual function capacity assessment. In performing this assessment, an ALJ must both identify evidence that supports his conclusion and build an accurate and logical bridge from that evidence to his conclusion. Woods is correct that the ALJ did not do so here.

The ALJ concluded that Woods could perform “medium work” and summarized evidence that he found credible, useful, and consistent. But the ALJ never explained how he concluded — based on this evidence — that Woods could actually perform the tasks required by “medium work,” such as lifting up to 50 pounds at a time, frequently lifting or carrying up to 25 pounds, or standing or walking for six hours. On remand, the ALJ should remedy this error.

Analyzing claimants’ activities

Woods further argues that the ALJ erred in finding her not credible because her “daily activities are not those typically associated with an individual alleging the pain, severity, and limitations as posed by the claimant.” An ALJ may not consider the type of activities a claimant can perform without also considering the extent to which she can perform them, but the ALJ here did just that.

For example, the ALJ noted that Woods can “maintain her personal hygiene, cook, perform light household chores,” “shop,” “socialize with family members, and attend church services on a regular basis.” But the ALJ didn’t consider Woods’s statements that she can’t button her clothes, has trouble drying herself after bathing, and sometimes needs help holding a hairdryer; that she can prepare simple meals but has trouble cutting, chopping, dicing, and holding silverware or cups; it takes her all day to do laundry; she shops only for necessities, and that process takes longer than normal; when she reads to her grandchildren, they have to turn the pages because of severe pain in her hands; and that some days, she spends the entire day on the couch.

Medical opinions

In this case, the ALJ’s discussion of certain expert opinions was at times conclusory or sparse. On remand, this court cautions the ALJ to provide better explanations in support of these types of determinations.

The court is also skeptical about the ALJ’s rationale for according great weight to the opinion of Dr. Clayton — who did not personally examine or treat Woods — while at the same time discounting the opinions of the doctors who did examine and treat her.  Clayton concluded that Woods could lift up to 50 pounds (something none of her treating physicians believed she was capable of), but failed to explain how he arrived at that specific number. The same is true of his conclusion that Woods can sit or stand for six hours in an eight-hour workday. There is no record evidence that Clayton is a specialist due additional deference. The ALJ should consider these potential shortcomings on remand in deciding what weight to accord Clayton’s opinion.

Vacated and remanded with instructions.

Woods v. Berryhill, Case No. 17-1500, Apr. 26, 2018. 4th Cir. (Motz), from WDNC at Asheville (Cogburn). Charlotte W. Hall for Appellant; Leo Rufino Montenegro for Appellee. VLW No. 018-2-082, 16 pp.

VLW 018-2-082