PUBLISHED

UNITED STATES COURT OF APPEALS

FOR THE FOURTH CIRCUIT

No. 15-1098

GEORGE G. MONROE,

Plaintiff - Appellant,

v.

CAROLYN W. COLVIN, Acting Commissioner of Social Security,

Defendant - Appellee.

Appeal from the United States District Court for the Eastern 

District of North Carolina, at Wilmington. Louise W. Flanagan, 

District Judge. (7:13-cv-00074-FL)

Argued: May 10, 2016 Decided: June 16, 2016

Before TRAXLER, Chief Judge, GREGORY, Circuit Judge, and Joseph 

F. ANDERSON, Jr., Senior United States District Judge for the 

District of South Carolina, sitting by designation.

Reversed and remanded with instructions by published opinion. 

Chief Judge Traxler wrote the opinion, in which Judge Gregory 

and Senior Judge Anderson concurred.

ARGUED: William Lee Davis, III, Lumberton, North Carolina, for 

Appellant. Marc David Epstein, SOCIAL SECURITY ADMINISTRATION, 

Baltimore, Maryland, for Appellee. ON BRIEF: Thomas G. Walker, 

United States Attorney, R.A. Renfer, Jr., Assistant United 

States Attorney, OFFICE OF THE UNITED STATES ATTORNEY, Raleigh, 

North Carolina, for Appellee.
2

TRAXLER, Chief Judge:

George Monroe appeals the Social Security Administration’s 

denial of his applications for disability insurance benefits 

(DIB) and supplemental security income (SSI). Because we 

conclude that the administrative law judge erred by not 

conducting a function-by-function analysis of Monroe’s 

limitations and by not adequately explaining his decision, we 

reverse and remand.

I.

In October 2007, Monroe filed applications for DIB and SSI, 

alleging disability beginning December 8, 2006, due to uveitis1; 

back pain, breathing and memory problems; anxiety; depression; 

and blackouts. 

His applications were denied initially and on 

reconsideration in 2008, and he requested a hearing before an 

administrative law judge. Following the hearing, the ALJ (Judge 

Leopold) denied the applications as well. In 2011, however, the 

Appeals Council granted Monroe’s request for review, vacated 

Judge Leopold’s decision, and remanded to an ALJ for a new 

decision that would include determinations on several specific 

 1 Dorland’s Illustrated Medical Dictionary defines “uveitis” 

as “an inflammation of part or all of the uvea, the middle 

(vascular) tunic of the eye, and commonly involving the other 

tunics (the sclera and cornea, and the retina).” Dorland’s 

Illustrated Medical Dictionary 1798 (27th ed. 1988).
3

issues. The Appeals Council decision noted that Monroe had 

filed subsequent DIB and SSI claims on May 7, 2010, and the 

decision specified that the ALJ on remand was to associate the 

files and issue a new decision on all claims.

A second ALJ (Judge Allen) then held a supplemental hearing 

in late 2011. He subsequently found that Monroe was not 

disabled from December 8, 2006, to February 7, 2012, the date of 

his decision. 

Monroe lost his administrative appeal and filed a complaint 

in district court. Considering cross-motions for judgment on 

the pleadings, a United States magistrate judge issued a 

memorandum and recommendation (M&R). In the M&R, the magistrate 

judge recommended that the district court deny Monroe’s motion, 

grant the Commissioner’s motion, and affirm the denial of 

benefits. The district court indeed granted the Commissioner’s 

motion, thereby upholding the benefits denial. Monroe has now 

appealed.

Legal Background

Before discussing the evidence in the record and the ALJ’s 

analysis thereof, we begin with an overview of the five-step 

sequential evaluation that ALJs must use in making disability 

determinations. The applicable Social Security Administration 

regulations set out the five-step process in significant detail. 
4

We recently summarized the process in Mascio v. Colvin, 780 F.3d 

632 (4th Cir. 2015):

[T]he ALJ asks at step one whether the claimant has 

been working; at step two, whether the claimant’s 

medical impairments meet the regulations’ severity and 

duration requirements; at step three, whether the 

medical impairments meet or equal an impairment listed 

in the regulations; at step four, whether the claimant 

can perform her past work given the limitations caused 

by her medical impairments; and at step five, whether 

the claimant can perform other work.

Id. at 634. The burden is on the claimant to make the requisite 

showing at the first two steps, see Bowen v. Yuckert, 482 U.S. 

137, 146 n.5 (1987), and if he fails to carry that burden, he is 

determined not to be disabled. At the third step, the burden 

remains on the claimant, see Pass v. Chater, 65 F.3d 1200, 1203 

(4th Cir. 1995), and he can establish his disability if he shows 

that his impairments match a listed impairment, see Mascio, 780 

F.3d at 634-35. 

However, if the claimant fails at that step, the ALJ then 

must determine the claimant’s residual functional capacity 

(RFC), “which is ‘the most’ the claimant ‘can still do despite’ 

physical and mental limitations that affect h[is] ability to 

work.” Id. at 635 (quoting 20 C.F.R. § 416.945(a)(1)). In 

making this assessment, the ALJ “‘must first identify the 

individual’s functional limitations or restrictions and assess 

his or her work-related abilities on a function-by-function 
5

basis, including the functions’ listed in the regulations.”2 Id.

at 636 (quoting Social Security Ruling 96-8p, 61 Fed. Reg. 

34,474, 34,475 (July 2, 1996)). Only after such a function-byfunction analysis may an ALJ express RFC “‘in terms of the 

exertional levels of work.’” Id. (quoting SSR 96-8p, 61 Fed. 

Reg. at 34,475).

In determining a claimant’s RFC, the ALJ must consider 

“‘all of [the claimant’s] medically determinable impairments of 

which [the ALJ is] aware,’ including those not labeled severe at 

step two.” Id. at 635 (quoting 20 C.F.R. § 416.945(a)(2)). He 

also must “consider all [the claimant’s] symptoms, including 

pain, and the extent to which [his] symptoms can reasonably be 

accepted as consistent with the objective medical evidence and 

 2 The listed functions include

the claimant’s (1) physical abilities, “such as 

sitting, standing, walking, lifting, carrying, 

pushing, pulling, or other physical functions 

(including manipulative or postural functions, such as 

reaching, handling, stooping, or crouching)”; (2) 

mental abilities, “such as limitations in 

understanding, remembering, and carrying out 

instructions, and in responding appropriately to 

supervision, coworkers, and work pressures in a work 

setting”; and (3) other work-related abilities 

affected by impairments “such as skin impairment(s), 

epilepsy, impairment(s) of vision, hearing or other 

senses, and impairment(s) which impose environmental 

restrictions.”

Mascio v. Colvin, 780 F.3d 632, 636 n.5 (4th Cir. 2015) (quoting 

20 C.F.R. § 416.945(b)-(d)).
6

other evidence.” 20 C.F.R. § 404.1529(a); see 20 C.F.R. 

§ 416.929(a). “When the medical signs or laboratory findings 

show that [the claimant has] a medically determinable 

impairment(s) that could reasonably be expected to produce [his] 

symptoms, such as pain, [the ALJ] must then evaluate the 

intensity and persistence of [the claimant’s] symptoms so that 

[the ALJ] can determine how [his] symptoms limit [his] capacity 

for work.” 20 C.F.R. §§ 404.1529(c)(1), 416.929(c)(1).

Once the ALJ has determined the claimant’s RFC, the ALJ 

then proceeds to step four, where the burden rests with the 

claimant to show that he is not able to perform his past work. 

See Bowen, 482 U.S. at 146 n.5; Mascio, 780 F.3d at 635. If he 

successfully makes that showing, the process proceeds to step 

five. See Mascio, 780 F.3d at 635.

“At step five, the burden shifts to the Commissioner to 

prove, by a preponderance of the evidence, that the claimant can 

perform other work that ‘exists in significant numbers in the 

national economy,’ considering the claimant’s residual 

functional capacity, age, education, and work experience.” Id.

(quoting 20 C.F.R. §§ 416.920(a)(4)(v), 416.960(c)(2), 

416.1429). “The Commissioner typically offers this evidence 

through the testimony of a vocational expert responding to a 

hypothetical that incorporates the claimant’s limitations.” Id. 

If the Commissioner satisfies that burden, then the claimant is 
7

found to be not disabled and his benefits application is denied. 

See id. 

Testimony

Having provided this background, we will now summarize the 

evidence before the ALJ, as it is relevant to this appeal, 

including testimony, medical records, and other evidence. Then 

we will discuss the ALJ’s analysis, before moving on to address 

the legal issues Monroe raises.

At the time of the hearing in late 2011, Monroe was 32. He 

testified he left high school in his senior year because of 

daytime tiredness, confusion, and seizures. His work record was

spotty in his early years after school.

He reported that in 2007, when he was 27, he was working as 

a dockworker when he went temporarily blind in his left eye. He 

testified he was nodding off and falling asleep and having 

memory lapses and blackouts, and was diagnosed with sarcoidosis. 

He went to see Dr. Somnath Naik, underwent a sleep study, and 

was diagnosed with narcolepsy3 and sleep apnea. 

Monroe testified that he uses a continuous positive airway 

pressure (CPAP) machine. He testified that the CPAP had “done a 

little . . . but there’s always a vague like drifting type 

 3 Dorland’s Illustrated Medical Dictionary defines 

“narcolepsy” as “recurrent, uncontrollable, brief episodes of 

sleep, often associated with hypnagogic hallucinations, 

cataplexy, and sleep paralysis.” Dorland’s, at 1098. 
8

feeling . . . at all times” and he also “still ha[s] sleep 

problems sometimes like I drift off and just nod off and fall to 

sleep.” A.R. 87. Monroe testified regarding the spaced-out 

feeling that, when it is happening, he really needs to just wait 

for it to pass. He stated that Dr. Naik wanted to prescribe him 

medication but that he could not afford it.4

Asked to describe his episodes of extreme sleepiness or 

blackouts, Monroe testified:

I can say that the fatigue is usually pretty extreme. 

I do better sometimes when I can get a little more 

rest but I . . . work at the storehouse, I can be 

sitting and I’ll just drift off, I’ll just nod off. 

And as far as the seizures they stated them as absence 

seizures a while back. I basically just freeze up, I 

can even be talking to somebody and I’ll just freeze. 

And I . . . had to grow to notice it myself because 

you know if it’s happening to you I didn’t really 

notice it at first . . . .

A.R. 93. Monroe testified that the episodes happen “about two 

or three times a day.” A.R. 93. He said they seem more 

prevalent when “there’s a lot going on, if there’s a little 

confusion or if I’m where I have to move back and forth a lot.” 

A.R. 94. He also testified that he had fallen asleep while 

driving before as well. Monroe reported that he usually can 

only wait out these episodes until they pass. 

 4 Monroe’s attorney, in her opening statement at the 

hearing, represented that Monroe’s then-recent medical records 

were “quite sparse” because he had not had insurance and was 

going without treatment. A.R. 69.
9

Monroe also testified that he suffered from chronic 

bronchitis. He reported having problems sustaining his breath

and he stated that he thought he could walk a block, but he 

would have to walk slowly. He claimed that even folding clothes 

sometimes tires him out so much that he needs to sit to catch 

his breath. He stated that he volunteers at a church and during 

the day he sits down and rests at least three or four times a 

day, usually for a few minutes.

He also testified that he suffered from neck and back pain 

as a result of multiple automobile accidents. And he reported 

chest and knee pain as well.

Regarding his eye problems, Monroe represented that they

were under control, although he still had some problems at 

times. He also reported that anxiety and depression, which had 

been problems for him in the past, were under control.

A vocational expert (VE) also testified at the hearing. In 

questioning the VE, the ALJ described the following hypothetical 

person:

Now, if you assume a hypothetical individual who has 

the same age, education and work experience as the 

claimant and has an RFC to perform light exertional 

work. This individual should only have occasional 

climbing of stairs or ramps, only occasional bending, 

balancing, stooping, crawling, kneeling or couching. 

This individual should never climb ropes, ladders or 

scaffolds, this individual should avoid occupations 

with hazardous machinery and concentrated exposure to 

fumes. This individual would be limited to simple, 
10

routine, repetitive tasks and would need to work in a 

well lit environment.

A.R. 107. The VE testified that such a hypothetical person 

could not perform any of Monroe’s past work, either as Monroe 

actually performed it or as it is performed in the national 

economy. However, the VE testified that there were jobs that 

such a person could perform. The VE specifically identified the 

jobs of cashier, sales attendant, and cafeteria attendant. 

When questioned by Monroe’s attorney, the VE testified that 

if the hypothetical person the ALJ described “need[ed] to take a 

break approximately three to four times a day voluntarily and 

then is having also two to three times a day moments where he 

either falls asleep or . . . blacks out and . . . goes off task 

for . . . five to ten minutes at a time,” he would not be able 

to sustain competitive employment and “that would be excessive 

breaks.” A.R. 110. 

Medical Records

In light of the issues presented on appeal, we will limit 

our discussion of the medical records primarily to those 

relating to Monroe’s episodes of fatigue and loss of 

consciousness and to Monroe’s mental limitations. 

Dr. Naik treated Monroe in early 2008. A January 2008 

record from Dr. Naik noted that Monroe reported a “history of 

blacking out spells and headaches”; that Monroe “state[d] his 
11

symptoms have been present . . . at least for 15 years including 

symptoms of excessive daytime sleepiness and sleep attacks and 

symptoms of cataplexy”; and that he had a “history of asthma for 

20 years,” a “history of seizure disorder,” and a “[h]istory of 

obstructive sleep apnea disorder for 20 years.” A.R. 550.5 The 

record states, “The patient also gives symptoms of cataplexy 

where he has had mild generalized weakness as if he is going to 

fall, though he was conscious. These episodes occurred when he 

was excited or laughing, which is classic for cataplexy, but he 

never had fall.” A.R. 551. 

Dr. Naik’s “impression” stated in part, “Symptoms of 

uncontrollable sleep and daytime confusional episodes and 

symptoms of cataplexy which goes with diagnosis of narcolepsy 

with cataplexy and symptoms of obstructive sleep apnea 

disorder.” A.R. 552. The report indicated Dr. Naik would “send 

[Monroe] for diagnostic sleep study followed by MSLT testing6

 5 Dorland’s Illustrated Medical Dictionary defines 

“cataplexy” as “a condition in which there are abrupt attacks of 

muscular weakness and hypotonia triggered by an emotional 

stimulus such as mirth, anger, fear, or surprise” and notes that 

“[i]t is often associated with narcolepsy.” Dorland’s, at 282.

6 An MSLT is a full-day test consisting of five scheduled 

naps that tests for excessive daytime sleepiness related to 

narcolepsy or hypersomnia. See Sleep Education, Multiple Sleep 

Latency Test (MSLT) – Overview and Facts, 

http://www.sleepeducation.org/disease-detection/multiple-sleeplatency-test/overview-and-facts (saved as ECF opinion 

attachment).
12

where MSLT will be done if sleep study is negative for 

obstructive sleep apnea disorder. This is to rule out 

narcolepsy.” A.R. 552 (footnote added). The report also noted, 

“His symptoms of cataplexy narcolepsy diagnosis [are] definite. 

The patient obviously is disabled to work and should not work 

until his problems are fixed because he ha[s] [a] high risk of 

getting hurt on the job or hurting somebody else and he also 

should not drive due to his symptoms [until] these symptoms are 

fully evaluated and taken care of.” A.R. 552. 

Monroe underwent a sleep study on February 7, 2008. 

Concerning the results, Dr. Naik observed, “Mildly reduced sleep 

efficiency with significantly decreased N3 stage,7 mildly reduced 

REM sleep. Patient appears to have mainly central apneas during 

CPAP titration. However, these were corrected with high CPAP 

pressures.” A.R. 611. Dr. Naik recommended “CPAP at 8cm of 

water by using heated humidification and by using full face 

mask.” A.R. 611. He also stated, “If patient has symptoms of 

restless leg syndrome or periodic limb movement disorder, 

 7 “The two main types of sleep are rapid-eye-movement (REM) 

sleep and non-rapid-eye-movement (NREM) sleep.” Healthy Sleep –

Natural Patterns of Sleep, 

http://healthysleep.med.harvard.edu/healthy/science/what/sleeppatterns-rem-nrem (saved as ECF opinion attachment). “NREM 

sleep can be broken down into three distinct stages: N1, N2, and 

N3.” Id. Stage N3 is “the deepest stage of NREM.” Id.
13

treatment of that may improve sleep efficiency and sleep 

architecture.” A.R. 611.

A treatment note from Dr. Naik from the day after the study

indicated that Monroe continued to be sleepy and fatigued and

that he had been turned down for government assistance paying 

for medications. The note reported that a pulmonary function 

test on January 21, 2008, produced normal results. Dr. Naik’s 

impression was “[m]ild obstructive apnea disorder with excessive 

daytime sleepiness with symptoms of narcolepsy and cataplexy 

with excessive daytime sleepiness.” A.R. 612. The record 

stated that Dr. Naik planned for Monroe to “repeat [the] sleep 

study” using a CPAP and undergo “MSLT testing to evaluate for 

continue[d] daytime sleepiness to see if the patient does have 

narcolepsy.” A.R. 612. The report stated that after testing, 

[Monroe] might benefit from [an] agent like 

venlafaxine for cataplexy. He also would benefit from 

[an] agent like modafinil for excessive daytime 

sleepiness, but . . . he needs financial help. Note 

will be given to take to social services to assess for 

financial help of his medical treatment and further 

evaluation by doing repeat sleep study and MSLT 

testing. In meantime, [Monroe] is cautioned . . . 

not to drive long distance[s] and [to] stop driving 

when he is sleepy. . . . Neurological evaluation also 

will be helpful to make sure he does not have partial 

complex seizures causing passing out episodes. 

A.R. 613.

Monroe underwent a second sleep study on April 1, 2008. 

Dr. Naik observed, “Good sleep efficiency with good sleep stages 
14

with increased REM sleep stage” and “[n]o significant periodic 

limb movement disorder.” A.R. 656.

The day after the second study, Monroe underwent MSLT 

testing using a CPAP machine. Dr. Naik’s impression from the 

testing was “Abnormal multiple sleep latency testing with short 

sleep latency period and more than 2 SOREMPS. In view that the 

patient has symptoms of cataplexy, this strongly favors the 

diagnosis of narcolepsy with cataplexia. Patient has very good 

sleep efficiency and had poor control of his sleep apnea 

disorder based on preceding sleep study on CPAP.” A.R. 657. 

Several months later, on September 28, 2008, Monroe was 

admitted to the Southeastern Regional Medical Center for mental 

distress and medication management. A record from Dr. Audrea 

Marchant noted that Monroe was “very focused on having 

narcolepsy” and that he reported having “sleep attacks of at 

least 60 seconds in duration,” which frequently occurred while 

he was driving. A.R. 674, 676. She also reported that Monroe 

was “focused on seizures” and “confusion.” A.R. 674 (internal 

quotation marks omitted). 

Based on his complaints, a neurologist, Dr. Indra Gatiwala, 

was brought in for a consultation. A report from Dr. Gatiwala 

stated that, considering Monroe’s complaints, “[w]e will make 

sure that [Monroe] had completed the MSLT and sleep study to 

evaluate for narcolepsy, cataplexy, and obstructive sleep 
15

apnea.” A.R. 681. The report also recommended several tests, 

including an “EEG awake and asleep to rule out complex partial 

seizures.” A.R. 681. Following the EEGs, the results of which 

Dr. Gatiwala described as “normal,” A.R. 690, Dr. Gatiwala

concluded that there was “no evidence for any seizure activity 

of any kind,” A.R. 677. Apparently because he was unaware that 

Monroe had already undergone sleep studies and an MSLT earlier 

in the year, A.R. 679 (“He was sent for the MSLT and sleep 

study, but it was never completed.”), Dr. Gatiwala “noted that 

the narcolepsy testing was incomplete,” A.R. 677. 

Monroe was discharged from Southeast Regional on October 1. 

Dr. Merchant’s discharge summary noted, 

There was no time, whether the patient was working in 

one-to-one or was social on the unit, where he 

presented with any type of sleep attack, drop attack, 

or period of staring into space that would be 

consistent with absence seizures. He did at no time 

display any symptoms that would be consistent with 

complex partial seizures. When assured that he likely 

did not have seizures or narcolepsy, the patient began 

to complain of “significant difficulty breathing.” 

A.R. 677. But testing did not support that Monroe was having 

trouble breathing either. Dr. Merchant noted that she “informed 

[Monroe] that there was absolutely no functional impairment 

noted during this hospitalization and that would not support his 

request for disability.” A.R. 678. 

Related to his second DIB and SSI applications, Monroe 

underwent two consultative examinations in December 2010. A 
16

December 11, 2010, report from Dr. Morton Meltzer indicated that 

Monroe had continued to complain of daily seizures and that he

had reported that he could not return to one of his past jobs 

until he had been “cleared of the seizures for at least six 

months.” A.R. 837. Dr. Meltzer stated that what Monroe “seems 

to describe is more narcolepsy [than seizures because] he just 

falls asleep.” A.R. 837. 

Shortly thereafter, Monroe underwent another consultative 

examination with a Dr. Ferriss Locklear. Monroe reported to Dr. 

Locklear that he had been diagnosed with sleep apnea and 

narcolepsy, that he uses a CPAP machine, and that he falls 

asleep easily if he is driving.

Regarding Monroe’s mental limitations, two particular 

reports are relevant. Ashley L. Booth, M.A., Licensed 

Psychological Associate, and Henry William Link, Ph.D., Licensed 

Practicing Psychologist, conducted a consultative examination of 

Monroe on January 11, 2008, as a result of his initial DIB and

SSI applications, and determined that Monroe “appeared 

marginally low in terms of reliably and safely mastering 

directions and procedures” and that his “ability to sustain 

attention, efforts, and constructive interpersonal relationships 

over time in goal-oriented activities was . . . moderately low.” 

A.R. 558. In contrast, Dr. Meltzer opined after his 

consultative examination, conducted on December 11, 2010, that 
17

Monroe was “able to understand, retain, and follow instructions” 

and able to “sustain attention to perform simple repetitive 

tasks.” A.R. 839. 

Additionally, state agency medical consultants determined 

in relation to Monroe’s second DIB and SSI applications that 

Monroe was mentally limited in the following ways: (1) he was 

“[m]oderately limited” in his “ability to understand and 

remember detailed instructions” in that he could only 

“understand and carry out s/r/r tasks for [two–hour] periods 

during [a normal] workday,” A.R. 144, 159; (2) he was 

“moderately limited” in his “ability to carry out detailed 

instructions” and in his “ability to complete a normal workday 

and workweek without interruptions from psychologically based 

symptoms and to perform at a consistent pace without an 

unreasonable number and length of rest periods” in that Monroe 

could “make simple work related decisions psych based s/s will 

intrude but rarely,” A.R. 144-45, 159-60; he was “[m]oderately 

limited” in his “ability to interact appropriately with the 

general public” in that he could “accept supervision and 

interact [with] coworkers” but “would work best in 

enviro[n]ments that d[id] not require frequent interpersonal 

contacts,” A.R. 145, 160; and he was “[m]oderately limited” in 

his “ability to respond appropriately to changes in the work 
18

setting,” although he could “adapt to simple change and avoid 

hazards,” A.R. 145, 160-61. 

ALJ’s Opinion

The ALJ issued his decision in early 2012 and determined 

that Monroe was not disabled during the relevant time period. 

The ALJ found that Monroe met his burden at step one to show he

had not been working. At step two, he found that Monroe had the 

following severe, medically determinable impairments: sleep 

apnea, narcolepsy, myalgias, uveitis, anxiety, and mood 

disorder.8 At step three, the ALJ determined that none of 

Monroe’s impairments nor any combination thereof met or 

medically equaled any of the impairments in the Listing of 

Impairments.

The ALJ next determined that Monroe had the RFC to perform 

“light work,”9 except that “he should climb stairs or ramps 

 8 A claimant has a severe impairment if an impairment or 

combination of impairments significantly limits his physical or 

mental ability to perform basic work activities. See 20 C.F.R. 

§§ 404.1520(c), 404.1521(a), 416.920(c), 416.921(a).

9 “Light work” is defined in the regulations as involving

lifting no more than 20 pounds at a time with frequent 

lifting or carrying of objects weighing up to 10 

pounds. Even though the weight lifted may be very 

little, a job is in this category when it requires a 

good deal of walking or standing, or when it involves 

sitting most of the time with some pushing and pulling 

of arm or leg controls. To be considered capable of 

performing a full or wide range of light work, [the 

(Continued)
19

occasionally,” “should never climb ropes or ladders,” “is 

limited to occasional bending, balancing, stooping, crawling, 

kneeling, or crouching,” “should avoid hazardous machinery and 

concentrated exposure to fumes,” “is restricted to work in a 

well-lit environment,” and “is limited to simple, routine, and 

repetitive tasks.” A.R. 16. The ALJ recognized that this 

determination was in conflict with some of Monroe’s testimony 

regarding his symptoms and resulting functional limitations. 

Although the ALJ found that Monroe’s claimed symptoms could 

reasonably be expected to be caused by the impairments that the 

ALJ found, the ALJ nonetheless found that Monroe’s “statements 

concerning the intensity, persistence and limiting effects of 

these symptoms [were] not credible to the extent they [were] 

inconsistent with the” RFC that the ALJ had described. A.R. 17. 

Most relevant to this appeal is the ALJ’s analysis 

concerning the severe impairments of sleep apnea and narcolepsy. 

As to these impairments, the ALJ stated the following:

The claimant has a history of respiratory problems. 

While these conditions may cause the claimant some 

discomfort, they do not preclude work. In January 

2008, he complained of excessive daytime sleepiness. 

At that time, the claimant reported having a history 

of sleep apnea and narcolepsy. A pulmonary function 

 

claimant] must have the ability to do substantially 

all of these activities.

20 C.F.R. §§ 404.1567(b), 416.967(b).
20

test, taken earlier that month, had yielded normal 

results. Upon examination, the claimant’s respiratory 

system was also within normal limits. At that time, 

sleep testing showed evidence of moderate obstructive 

sleep apnea and periodic limb [movement] disorder. He 

was then diagnosed with mild obstructive apnea 

disorder with excessive daytime sleepiness with 

symptoms of narcolepsy. One month later, a sleep 

study indicated that the claimant had mildly reduced 

sleep efficiency with significantly decreased [N3] 

stage, mildly reduced REM sleep. The claimant’s 

treating physician . . . then recommended treating the 

claimant’s condition with a continuous positive airway 

pressure machine (CPAP) (Ex.18F). From that point 

forward, his conditions were controlled with 

conservative treatment. In September 2008, the 

claimant underwent electroencephalography [EEG], after 

complaining of confusion and narcolepsy. The study 

yielded normal results. Since then, the claimant has 

not reported any exacerbations of [his] condition. At 

a consultative examination in December 2010, he 

reported that he continued to use a CPAP machine. 

Upon examination, however, the claimant’s respiratory 

system was normal. He was then diagnosed with a 

history of sleep apnea and narcolepsy. (Ex.33F). The 

claimant has not reported any exacerbations of his 

condition, since then. The undersigned considered the 

claimant’s subjective complaints and the objective 

evidence in determining the residual functional

capacity. As such, the undersigned finds that the 

claimant’s resulting limitations are consistent with 

the residual functional capacity.

A.R. 17.

The ALJ also noted later in his opinion that Monroe had 

“alleged that he was unable to work because of . . . sleep 

apnea,” but in fact that “condition is controlled.” A.R. 19. 

The ALJ cited the fact that Dr. Naik “consistently described the 

claimant’s sleep apnea as mild or moderate.” A.R. 19.
21

As for the limitations resulting from Monroe’s myalgias, 

eye problems, anxiety, and mood disorder, the ALJ found that 

they were “consistent with” with the RFC that the ALJ had 

described. A.R. 18, 19, 20. 

The ALJ also addressed evidence in the record concerning 

Monroe’s mental limitations. Regarding Mr. Booth and Dr. Link’s 

January 2008 determination that Monroe “appeared marginally low, 

in terms of mastering basic directions or procedures reliably 

and safely” and that his “ability to sustain attention, efforts, 

and constructive interpersonal relationships over time in goaloriented activities was moderately low,” the ALJ stated simply 

that he gave it “limited weight” because “the objective evidence 

or the claimant’s treatment history did not support” it. A.R. 

19-20. On the other hand, the ALJ noted that Dr. Meltzer’s 

subsequent December 2010 consultative examination, which 

produced the opinion that Monroe “was able to understand, retain 

and follow instructions” and “able to sustain attention to 

perform simple, repetitive tasks,” was “supported by the 

objective evidence.” A.R. 20. Accordingly, he gave it “some 

weight, to the extent that it [was] consistent with the” RFC 

that the ALJ had identified. A.R. 20. Finally, the ALJ 

considered the state agency medical consultants, whom he 

identified as having “opined that [Monroe] had mild limitations 

in activities of daily living and maintaining social 
22

functioning” and “a moderate limitation in concentration, 

persistence, and pace.” A.R. 20. The ALJ stated simply that 

the opinions were “supported by the objective evidence and the 

claimant’s subjective complaints” and that the he gave them 

“significant weight.” A.R. 20.

At step four, considering the RFC that the ALJ had 

identified, he determined that Monroe was unable to perform his 

past work. However, based on the testimony of the vocational 

expert, the ALJ determined that jobs did exist in the national 

economy for a person with Monroe’s age, education, work 

experience, and RFC. He therefore determined that Monroe was 

not disabled, and he denied his application for benefits.

II.

We review de novo a district court’s decision on a motion 

for judgment on the pleadings. See Korotynska v. Metropolitan

Life Ins. Co., 474 F.3d 101, 104 (4th Cir. 2006). A district

court will affirm the SSA’s disability determination “when an 

ALJ has applied correct legal standards and the ALJ’s factual 

findings are supported by substantial evidence.” Bird v. 

Commission of Soc. Sec. Admin., 699 F.3d 337, 340 (4th Cir. 

2012).

Monroe argues that the ALJ committed several legal errors 

in analyzing the record before him. 
23

A.

Monroe first argues that Judge Allen erred in not affording 

great weight to the findings Judge Leopold made regarding his 

severe impairments in the now-vacated 2010 decision. We 

disagree.

The fact that the Appeals Council vacated Judge Leopold’s 

decision and remanded for a new decision is dispositive here. 

The SSA treats the doctrine of res judicata as applying when it 

has “made a previous determination or decision . . . on the same 

facts and on the same issue or issues, and this previous 

determination or decision has become final by either 

administrative or judicial action.” 20 C.F.R. §§ 404.957(c)(1), 

416.1457(c)(1) (emphasis added); see Lively v. Secretary of 

Health and Human Servs., 820 F.2d 1391, 1392 (4th Cir. 1987) 

(“Congress has clearly provided by statute that res judicata

prevents reappraisal of both the Secretary’s findings and his 

decision in Social Security cases that have become final.”). 

Here, Judge Leopold’s decision, having been vacated, never 

became final, and thus the doctrine of res judicata did not 

apply.

Monroe maintains that our decisions in Lively and Albright 

v. Commissioner of the Social Security Administration, 174 F.3d 

473 (4th Cir. 1999), and Social Security Acquiescence Ruling 00-

1(4), 65 Fed. Reg. 1936-01 (Jan. 12, 2000), require a different 
24

result. That is not the case, however. Interpreting Albright

and Lively, Acquiescence Ruling 00-1(4) explained that “where a 

final decision of SSA after a hearing on a prior disability 

claim contains a finding required at a step in the sequential 

evaluation process for determining disability, SSA must consider 

such finding as evidence and give it appropriate weight in light 

of all relevant facts and circumstances when adjudicating a 

subsequent disability claim involving an unadjudicated period.”10 

65 Fed. Reg. at 1938 (emphasis added). Nothing in that rule, or 

in our circuit precedent, indicates that findings in prior nonfinal decisions are entitled to any weight. See 20 C.F.R. 

§§ 404.981, 416.1481 (“The Appeals Council’s decision, or the 

decision of the [ALJ] if the request for review is denied, is 

binding unless you or another party file an action in Federal 

district court, or the decision is revised.” (emphasis added)). 

Accordingly, Judge Allen did not err in considering Monroe’s 

applications de novo. 

B.

Monroe next maintains that the ALJ erred in not determining 

his RFC using a function-by-function analysis. We agree.

 10 Monroe fails to come to terms with the finality 

requirement and simply omits the language pertaining to finality 

when he quotes the SSA’s Acquiescence Ruling.
25

The process for assessing RFC is set out in Social Security 

Ruling 96-8p. See Mascio, 780 F.3d at 636. Under that ruling, 

the “‘assessment must first identify the individual’s functional 

limitations or restrictions and assess his or her work-related 

abilities on a function-by-function basis, including the 

functions’ listed in the regulations.” Id. (quoting SSR 96-8p, 

61 Fed. Reg. at 34,475). Only after such a function-by-function 

analysis may an ALJ express RFC “‘in terms of the exertional 

levels of work.’” Id. (quoting SSR 96-8p, 61 Fed. Reg. at 

34,475). We have explained that expressing the RFC before 

analyzing the claimant’s limitations function by function 

creates the danger that “‘the adjudicator [will] overlook 

limitations or restrictions that would narrow the ranges and 

types of work an individual may be able to do.’”11 Id. at 636 

(quoting SSR 96-8p, 61 Fed. Reg. at 34,476). 

By expressing Monroe’s RFC first and only then concluding 

that the limitations caused by Monroe’s impairments were 

consistent with that RFC, the ALJ made this very error and 

thereby created the danger that the ruling identifies. The 

error is most concerning regarding Monroe’s alleged episodes of 

 11 Expressing a claimant’s RFC in exertional terms without 

conducting a function-by-function analysis also could lead the 

adjudicator to “‘find that the individual has limitations or 

restrictions that he or she does not actually have.’” Mascio, 

780 F.3d at 636 (quoting SSR 96-8p, 61 Fed. Reg. at 34,476).
26

loss of consciousness and fatigue. Monroe testified that he 

would lose consciousness about two or three times per day and 

would need to take several breaks during the day because of 

fatigue. The ALJ indeed found that Monroe had the severe 

impairments of sleep apnea and narcolepsy, and he concluded that 

Monroe’s impairments could reasonably be expected to cause his 

claimed symptoms. Nevertheless, he never made specific findings 

about whether Monroe’s apnea or narcolepsy would cause him to 

experience episodes of loss of consciousness or fatigue 

necessitating breaks in work and if so, how often these events 

would occur. See SSR 96-8p, 61 Fed. Reg. at 34,478 (“In all 

cases in which symptoms, such as pain, are alleged, the RFC 

assessment must . . . [i]nclude a resolution of any 

inconsistencies in the evidence as a whole” and “[s]et forth a 

logical explanation of the effects of the symptoms, including 

pain, on the individual’s ability to work”). Rather, he simply 

concluded that Monroe was capable of light work (with the 

exceptions he identified) and that Monroe’s claimed symptoms 

were “not credible to the extent they are inconsistent with” the 

RFC the ALJ identified.12 A.R. 17; see also A.R. 19 (ALJ’s 

finding that Monroe’s “allegations are not fully credible”).

 12 In Mascio, we criticized the use by the ALJ of similar 

language, noting that it got “things backwards by implying that 

ability to work is determined first and is then used to 

(Continued)
27

We have not adopted a rule of per se reversal for errors in 

expressing the RFC before analyzing the claimant’s limitation 

function by function. See Mascio, 780 F.3d at 636. However, we 

have held that “remand may be appropriate where an ALJ fails to 

assess a claimant’s capacity to perform relevant functions, 

despite contradictory evidence in the record, or where other 

inadequacies in the ALJ’s analysis frustrate meaningful review.” 

Id. (alterations and internal quotation marks omitted). We 

conclude that this is just such a case. 

Because the ALJ never determined the extent to which Monroe 

actually experienced episodes of loss of consciousness and 

extreme fatigue, we cannot determine whether the hypothetical 

questions posed to the VE included all of Monroe’s functional 

limitations, as they needed to do in order to be useful. See

Hines v. Barnhart, 453 F.3d 559, 566 (4th Cir. 2006) (“In order 

for a vocational expert’s opinion to be relevant or helpful, it 

must be based upon a consideration of all other evidence in the 

record, and it must be in response to proper hypothetical 

questions which fairly set out all of claimant’s impairments.” 

 

determine the claimant’s credibility.” 780 F.3d at 639 

(internal quotation marks omitted). On remand, the ALJ should 

assess Monroe’s credibility in the context of the function-byfunction analysis of the limitations caused by Monroe’s 

impairments, which the ALJ will then use to determine Monroe’s 

RFC.
28

(alteration and internal quotation marks omitted)). On remand, 

the ALJ will need to consider Monroe’s narcolepsy and apnea, and 

all of his other physical and mental impairments, severe and 

otherwise, and determine, on a function-by-function basis, how 

they affect his ability to work. Only once the ALJ has 

conducted such an analysis will he be able to move on to steps 

four and five, concerning Monroe’s ability to perform past work 

and his ability to perform other work that exists in significant 

numbers in the national economy. See Mascio, 780 F.3d at 636. 

C.

Independent from the aforementioned flaw in the ALJ’s 

analysis, Monroe also contends that the ALJ did not 

satisfactorily explain his decision to partly discredit Monroe’s 

testimony regarding the symptoms and functional limitations 

resulting from his impairments. Relatedly, Monroe maintains 

that the ALJ did not satisfactorily explain his decision to not 

rely on certain medical records that Monroe contends support his 

testimony.13 We agree that the ALJ’s opinion lacks the specific 

analysis that would allow for meaningful review.

Social Security Ruling 96-8p explains that the RFC 

“‘assessment must include a narrative discussion describing how 

 13 20 C.F.R. §§ 404.1527(c) and 416.927(c) describe how 

medical opinions are to be weighed in determining entitlement to 

disability benefits.
29

the evidence supports each conclusion, citing specific medical 

facts (e.g., laboratory findings) and nonmedical evidence (e.g., 

daily activities, observations).’” Id. (quoting SSR 96-8p, 61 

Fed. Reg. at 34,478; see also Clifford v. Apfel, 227 F.3d 863, 

872 (7th Cir. 2000) (observing that the ALJ “must build an 

accurate and logical bridge from the evidence to his 

conclusion”). We have held that “[a] necessary predicate to 

engaging in substantial evidence review is a record of the basis 

for the ALJ’s ruling,” including “a discussion of which evidence 

the ALJ found credible and why, and specific application of the 

pertinent legal requirements to the record evidence.” Radford 

v. Colvin, 734 F.3d 288, 295 (4th Cir. 2013). 

1.

The ALJ cited evidence that he appeared to believe tended 

to discredit Monroe’s testimony regarding his claimed episodes 

of loss of consciousness and fatigue. However, he failed to 

“build an accurate and logical bridge from the evidence to his 

conclusion” that Monroe’s testimony was not credible. Clifford, 

227 F.3d at 872. The facts the ALJ cited were as follows:

The claimant has a history of respiratory problems. 

While these conditions may cause the claimant some 

discomfort, they do not preclude work. In January 

2008, he complained of excessive daytime sleepiness. 

At that time, the claimant reported having a history 

of sleep apnea and narcolepsy. A pulmonary function 

test, taken earlier that month, had yielded normal 

results. Upon examination, the claimant’s respiratory 

system was also within normal limits. At that time, 
30

sleep testing showed evidence of moderate obstructive 

sleep apnea and periodic limb [movement] disorder. He 

was then diagnosed with mild obstructive apnea 

disorder with excessive daytime sleepiness with 

symptoms of narcolepsy. One month later, a sleep 

study indicated that the claimant had mildly reduced 

sleep efficiency with significantly decreased stage, 

mildly reduced REM sleep. The claimant’s treating 

physician . . . then recommended treating the 

claimant’s condition with a continuous positive airway 

pressure machine (CPAP) (Ex.18F). From that point 

forward, his conditions were controlled with 

conservative treatment. In September 2008, the 

claimant underwent electroencephalography [EEG], after 

complaining of confusion and narcolepsy. The study 

yielded normal results. Since then, the claimant has 

not reported any exacerbations of [his] condition. At 

a consultative examination in December 2010, he 

reported that he continued to use a CPAP machine. 

Upon examination, however, the claimant’s respiratory 

system was normal. He was then diagnosed with a 

history of sleep apnea and narcolepsy. (Ex.33F). The 

claimant has not reported any exacerbations of his 

condition, since then. The undersigned considered the 

claimant’s subjective complaints and the objective 

evidence in determining the residual functional

capacity. As such, the undersigned finds that the 

claimant’s resulting limitations are consistent with 

the residual functional capacity.

A.R. 17. The ALJ also noted Dr. Naik “consistently described 

the claimant’s sleep apnea as mild or moderate.” A.R. 19.

Simply put, the ALJ does not indicate how any of the facts 

he cited show that Monroe did not lose consciousness two or 

three times daily or suffer extreme fatigue. Although Monroe at 

times described his problems as blackouts and seizures, 

significant evidence in the record suggests that Monroe’s 

symptoms were caused by narcolepsy, see, e.g., A.R. 657 (Dr. 

Naik’s conclusion that the MSLT results “strongly favor[ed] the 
31

diagnosis of narcolepsy with cataplexia”); A.R. 837 (Dr. 

Meltzer’s conclusion that Monroe’s explanation of his symptoms 

“seems to describe . . . more narcolepsy [than seizures because] 

he just falls asleep”), and the ALJ found that narcolepsy was a 

severe impairment of Monroe’s. In citing “normal” results from 

pulmonary and respiratory tests and an EEG, the ALJ did not 

explain why he believed these results had any relevance to the 

question of what symptoms Monroe suffered from narcolepsy.14 Nor 

does the ALJ explain why he believed that the intensity of 

Monroe’s apnea had any relevance to that question. 

As for the ALJ’s statement that Monroe started using a CPAP 

machine and “[f]rom that point forward, his conditions were 

controlled with conservative treatment,” A.R. 17, it is hard to 

know what the ALJ meant. To the extent that the ALJ meant that 

use of the CPAP was successful in reducing or eliminating his 

fatigue episodes of loss of consciousness, he does not cite any 

 14 Dr. Naik, after all, was aware of all of the test results 

other than the EEG when he determined that the MSLT results 

“strongly favor[ed] the diagnosis of narcolepsy with 

cataplexia.” A.R. 657. And the records seemed to indicate that

Dr. Gatiwala ordered the EEG to rule out “complex partial 

seizures,” as opposed to narcolepsy. See A.R. 681 (Dr. Gatiwala 

ordered EEGs “to rule out complex partial seizures”); see also 

A.R. 613 (report from Dr. Naik indicating that MSLT would test 

for narcolepsy and that neurological evaluation would help rule 

out partial complex seizures). 

 
32

evidence for that conclusion.15 In fact, Monroe has consistently 

reported that use of the CPAP has not significantly helped those 

problems, and that was his testimony as well. On remand, if the 

ALJ decides to discredit Monroe’s testimony regarding his 

episodes of loss of consciousness and fatigue, it will be 

incumbent on him to provide a clearer explanation of his reasons 

for doing so, such that it will allow meaningful review of his 

decision. 

2.

Another significant example of the ALJ’s failure to 

“‘include a narrative discussion describing how the evidence 

supports each conclusion’” Mascio, 780 F.3d at 636 (quoting SSR 

96-8p, 61 Fed. Reg. at 34,478, concerns his explanation of the 

varying degrees of weight he gave to differing opinions 

concerning Monroe’s conditions and limitations. For example, 

regarding Monroe’s mental impairments, the ALJ noted that Dr. 

Link and Mr. Booth’s report concluded that Monroe “appeared 

marginally low, in terms of mastering basic directions or 

procedures reliably and safely” and that his “ability to sustain 

attention, efforts, and constructive interpersonal relationships 

over time in goal-oriented activities was moderately low.” A.R. 

 15 Nor did the ALJ even mention that Monroe’s testimony and 

Dr. Naik’s medical records indicated that Dr. Naik wanted to 

treat Monroe with medication but that Monroe could not afford 

it.
33

19-20. The ALJ stated that he gave that opinion only “limited 

weight” based on a determination that “the objective evidence or 

the claimant’s treatment history did not support the 

consultative examiner’s findings.” A.R. 20. However, the ALJ 

did not specify what “objective evidence” or what aspects of 

Monroe’s “treatment history” he was referring to. As such, the 

analysis is incomplete and precludes meaningful review. The ALJ 

gave similarly conclusory analysis of other opinions. See, 

e.g., A.R. 20 (“The undersigned gives the consultative 

examiner’s findings some weight, to the extent that it is 

consistent with the residual functional capacity. The 

consultative examiner’s opinion is supported by the objective 

evidence.”); A.R. 20 (“The undersigned gives this opinion, some 

weight to the extent that it is consistent with the residual 

functional capacity. The objective evidence supports the 

consultative examiner’s findings.”); A.R. 20 (“The undersigned 

also gives this opinion some weight. The consultative examiner 

opinion is consistent with the objective evidence and other 

opinions of record, such as the first consultative physical 

examination.”); A.R. 20 (“The undersigned gives the state agency 

findings limited weight. After reviewing the objective 

evidence, the undersigned finds that the claimant’s limitations 

are more consistent with a light level of exertion.”); A.R. 20 

(“The undersigned gives the state agency consultants[’] findings 
34

significant weight. The state agency findings are supported by 

the objective evidence and the claimant’s subjective 

complaints.”). Without more specific explanation of the ALJ’s 

reasons for the differing weights he assigned various medical 

opinions, neither we nor the district court can undertake 

meaningful substantial-evidence review. See Radford, 734 F.3d 

at 295.

III.

For the foregoing reasons, we reverse the district court’s 

judgment and remand with instructions to vacate the denial of 

Monroe’s application for benefits and remand for further 

administrative proceedings.

REVERSED AND REMANDED WITH INSTRUCTIONS