UNPUBLISHED

UNITED STATES COURT OF APPEALS

FOR THE FOURTH CIRCUIT

No. 22-1257

ELIZABETH LANGSTON,

 Plaintiff - Appellant,

v.

COMMISSIONER OF SOCIAL SECURITY ADMINISTRATION,

 Defendant - Appellee.

Appeal from the United States District Court for the District of South Carolina, at 

Orangeburg. Kaymani Daniels West, Magistrate Judge. (5:20-cv-03334-KDW)

Submitted: January 20, 2023 Decided: February 3, 2023

Before NIEMEYER and WYNN, Circuit Judges, and MOTZ, Senior Circuit Judge.

Vacated and remanded by unpublished per curiam opinion.

ON BRIEF: W. Daniel Mayes, SMITH, MASSEY, BRODIE, GUYNN & MAYES, 

Aiken, South Carolina, for Appellant. Brian C. O’Donnell, Regional Chief Counsel, Victor 

Pane, Supervisory Attorney, Office of the General Counsel, SOCIAL SECURITY 

ADMINISTRATION, Philadelphia, Pennsylvania; Corey F. Ellis, United States Attorney,

Timothy P. Reiley, Special Assistant Attorney, OFFICE OF THE UNITED STATES 

ATTORNEY, Columbia, South Carolina, for Appellee.

Unpublished opinions are not binding precedent in this circuit.

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PER CURIAM:

Elizabeth Langston appeals the district court’s order1 upholding the 

Commissioner’s denial of Langston’s applications for disability insurance benefits and 

supplemental security income. On appeal, Langston argues that the Administrative Law 

Judge (“ALJ”) erred by giving little weight to the opinion of Langston’s treating physician 

and by discounting Langston’s subjective complaints of pain. Because we agree that the 

ALJ did not correctly consider Langston’s subjective symptoms,

2 we vacate the district 

court’s judgment and direct the court to remand the case to the agency for further 

proceedings consistent with this opinion.

We review de novo the district court’s decision to grant summary judgment. 

Thomas v. Berryhill, 916 F.3d 307, 311 (4th Cir. 2019). We will affirm if the “ALJ has 

applied correct legal standards and the ALJ’s factual findings are supported by substantial 

1 The parties consented to the jurisdiction of the magistrate judge.

2 Langston also alleges that the ALJ erred by failing to consider her abdominal pain 

when constructing her residual functional capacity (“RFC”). Because this claim (and 

certain other sub-claims argued in Langston’s briefs) rest in part on the ALJ’s 

determination of the credibility of Langston’s subjective complaints, we do not separately 

address them. Further, Langston argues on appeal that the ALJ erred by failing to assess 

Langston’s other conditions (such as diverticulitis and chronic pain syndrome) at step two 

of the evaluation process, which she contends also impacted her RFC. However, as the 

Commissioner notes, Langston raises the step-two claim for the first time on appeal. 

Langston referred to these conditions before the district court only in the context of 

discussing her RFC. Accordingly, Langston has forfeited consideration of her step-two

claim. See, e.g., United States v. Turner Constr. Co., 946 F.3d 201, 208 (4th Cir. 2019). 

And because we remand for further consideration of her RFC on other grounds, we do not 

consider her argument that the ALJ failed to properly consider these conditions in the RFC

analysis.

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evidence.” Monroe v. Colvin, 826 F.3d 176, 186 (4th Cir. 2016) (internal quotation marks 

omitted). “Substantial evidence is that which a reasonable mind might accept as adequate 

to support a conclusion. It consists of more than a mere scintilla of evidence but may be 

less than a preponderance.” Pearson v. Colvin, 810 F.3d 204, 207 (4th Cir. 2015) (citation 

and internal quotation marks omitted). We do not “reweigh conflicting evidence, make 

credibility determinations, or substitute our judgment for that of the ALJ”; rather, “[w]here 

conflicting evidence allows reasonable minds to differ,” we defer to the Commissioner’s 

decision. Hancock v. Astrue, 667 F.3d 470, 472 (4th Cir. 2012) (brackets and internal 

quotation marks omitted).

In making a disability determination, the ALJ employs a five-step process, 

inquiring:

[A]t 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.

Mascio v. Colvin, 780 F.3d 632, 634 (4th Cir. 2015). If, at step three, the ALJ finds that 

the claimant’s impairments match one of the regulations’ listed impairments, then the 

claimant is deemed disabled and the analysis ends. Otherwise, the ALJ must determine the 

claimant’s RFC before proceeding to steps four and five. Id. at 635. In determining the 

RFC, 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 basis, including the 

functions listed in the regulations.” Id. at 636 (internal quotation marks omitted). Among 

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the listed functions are “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).” Id. at 636 n.5 (internal 

quotation marks omitted). 

Langston first contends that the ALJ failed to properly consider the opinion of 

Douglas Swartz, her treating physician, and improperly gave his opinion little weight. 

Swartz opined that Langston was extremely limited in nearly all physical activities due to 

her spondylosis and chronic gastrointestinal issues. Swartz’s opinion was a checklist form 

and contained no analysis; in addition, Langston’s back and abdominal pain were not 

discussed, creating confusion as to whether Langston’s limitations were due to strictly 

functional, physical issues or pain or both. 

The treating physician rule requires that ALJs give “controlling weight” to a treating 

physician’s opinion on the nature and severity of the claimant’s impairment if that opinion 

is (1) “well-supported by medically acceptable clinical and laboratory diagnostic 

techniques” and (2) “not inconsistent with the other substantial evidence” in the record. 20 

C.F.R. § 404.1527(c)(2).3

 “[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.” Coffman v. Bowen, 829 F.2d 514, 517 (4th Cir. 1987). 

3 This regulation has been amended, but the original version is still applicable to 

Langston’s claim because it was filed prior to March 27, 2017. See 20 C.F.R. § 404.1527.

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Here, the ALJ gave Swartz’s checklist opinion little weight, reasoning that (1) on 

the same day Swartz signed his opinion, Langston had an unremarkable physical 

examination in the emergency room, aside from mild to moderate abdominal tenderness; 

(2) Swartz relied on Langston’s difficult recoveries from surgery, without noting that her 

condition improved after recovery; (3) Langston’s weight was stable and her bowel sounds 

were consistently normal; (4) Swartz is a family physician, not a gastroenterologist or 

orthopedist; and (5) Swartz’s conclusion that Langston’s back condition was disabling 

contradicted his own treatment notes from the very next day, when he recorded that 

Langston had normal motor strength. Because Swartz’s brief opinion is contradicted by 

his own almost-contemporaneous treatment notes as well as examinations by other more 

specialized physicians, the ALJ did not err in giving Swartz’s opinion little weight. See 

Wood v. Comm’r of Soc. Sec. Admin., No. 21-1905, 2022 WL 997306, at *3 (4th Cir. Apr. 

4, 2022) (“Notably, the ALJ gave more weight to [the providers’] contemporaneous 

observations and conclusions than to [their] disability forms, which contained certain 

conclusory questions and various check-box responses. This was entirely appropriate.” 

(citing Anderson v. Astrue, 696 F.3d 790, 794 (8th Cir. 2012) (“[A] conclusory checkbox 

form has little evidentiary value when it cites no medical evidence, and provides little to 

no elaboration.” (internal quotation marks omitted)))). 

Langston next argues that the ALJ improperly considered her subjective complaints 

of pain and her corresponding limitations. The regulations prescribe “a two-step analysis 

when considering a claimant’s subjective statements about impairments and symptoms.” 

Lewis v. Berryhill, 858 F.3d 858, 866 (4th Cir. 2017); see 20 C.F.R. § 404.1529(b)–(c). 

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The ALJ first “looks for objective medical evidence showing a condition that could 

reasonably produce the alleged symptoms.” Lewis, 858 F.3d at 866. If (as here) the 

claimant has such a condition or impairment, then the ALJ must “evaluate the intensity, 

persistence, and limiting effects of the claimant’s symptoms to determine the extent to 

which they limit the claimant’s ability to perform basic work activities.” Id. The second 

step “requires the ALJ to assess the credibility of the claimant’s statements about symptoms 

and their functional effects.” Id. But the ALJ may not reject a claimant’s statements about 

the intensity or persistence of her pain or its effect on her ability to work solely because 

the medical evidence does not substantiate the claimant’s statements. Id. (citing 20 C.F.R. 

§ 404.1529(c)(2)). Instead, if the objective medical evidence does not support the 

claimant’s statements, the ALJ must “examine the entire case record” when considering 

the “intensity, persistence, and limiting effects” of the symptoms. SSR 16-3p, 2017 WL 

5180304, at *4 (Oct. 25, 2017). Doing so requires the ALJ to “build an accurate and logical 

bridge from the evidence to his conclusion.” Brown v. Comm’r Soc. Sec. Admin., 873 F.3d 

251, 269 (4th Cir. 2017).

Here, the ALJ reviewed Langston’s hearing testimony and found that her assertions 

about the intensity, persistence, and limiting effects of her symptoms were not entirely 

consistent with the medical and other evidence of record. In support, the ALJ noted that, 

despite Langston’s complaints of nausea and stomach pain, her weight had actually 

increased. The ALJ also relied upon Langston’s reports of her daily activities which 

included the ability to “tend to her personal hygiene, cook, wash dishes, dust, wash laundry, 

take care of her grandchildren, get her grandchildren to school, drive, take her medications 

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independently, shop for groceries, handle her finances, read, visit with her family, and 

watch television, activities, which generally reveal functioning at a greater level than 

alleged.” J.A. 26.

4

 The ALJ termed her daily activities as “representative of a fairly active 

lifestyle and . . . not indicative of a significant restriction of activities or constriction of 

interests.” J.A. 26. In addition, the ALJ noted that doctors had not been able to find a 

physical reason for her abdominal pain, but that it might be caused by long-term opiate use 

and abdominal adhesions. J.A. 29. Regarding Langston’s back pain, the ALJ concluded 

that, while some mechanical back pain was supported by the objective medical evidence, 

Langston’s “rather extreme complaints” were not. J.A. 29. Finally, the ALJ gave a lengthy 

recitation of Langston’s medical history, although the ALJ did not provide any analysis as 

to the conclusions to be drawn therefrom. 

Langston contends that the ALJ erred by disregarding her statements about her 

abdominal pain because the ALJ could not find an objective medical explanation for the 

intensity of her pain. We agree. See Arakas v. Comm’r, Soc. Sec. Admin., 983 F.3d 83, 96 

(4th Cir. 2020) (finding that claimant is entitled to rely exclusively on subjective evidence 

to show intensity and extent of pain and fatigue); Lewis, 858 F.3d at 866 (requiring 

objective medical evidence to support claimant’s evidence of pain intensity improperly 

increased claimant’s burden of proof). Indeed, the ALJ mentioned the lack of an official 

diagnosis in the same paragraph in which he noted that the RFC was supported by the 

evidence of record. To be sure, the ALJ did not explicitly state that the lack of “cause for 

4 Citations to the “J.A.” refer to the Joint Appendix filed by the parties in this appeal.

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abdominal pain” was a primary reason to disregard Langston’s complaints. However, the 

placement of this sentence implies that it was strongly related to the ALJ’s consideration 

of Langston’s functional capacity.5

 That was error.

Moreover, the ALJ erred by discrediting Langston’s assertions of disabling pain 

based largely on her ability to perform daily activities. An ALJ must “build an accurate 

and logical bridge” from the evidence to his credibility determination. Brown, 873 F.3d at 

269. But in this case, the ALJ failed to explain how Langston’s ability to perform modest 

housework (such as cleaning, laundry, and cooking simple meals, with many breaks), drive 

(not daily), and enjoy physically undemanding, sedentary hobbies (watching television) 

undermined her assertions about her pain. See id. at 269–70 (finding ALJ who noted 

claimant’s various activities erred by not acknowledging limited extent of activities or 

explaining how they showed claimant could sustain full-time job). In addition, the ALJ 

improperly relied upon Langston’s daily activities without also considering her qualifying 

statements that her ability to participate in these activities had lessened over time and that, 

even back in 2014, she proffered that she could only perform the activities intermittently 

and with breaks and rest due to pain and fatigue. See Arakas, 983 F.3d at 99 (holding that 

ALJ must consider the extent to which claimant can perform different types of activities). 

Given Langston’s testimony that nearly all activities were intermittent and required 

5 Moreover, Langston had been prescribed strong narcotics, including morphine, for 

nearly a decade to address her pain, which is objective medical evidence supporting her 

complaints of extreme pain, even if the cause was unknown.

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numerous breaks, we conclude that substantial evidence does not support the ALJ’s 

conclusion that Langston’s daily activities were inconsistent with her subjective complaints 

of pain. Moreover, the ALJ did not explain how Langston’s limited activities demonstrated

an ability to persist through an eight-hour workday, five days a week. See id. at 100–01 

(noting that the ability to perform household chores, drive, shop, walk for exercise, cook, 

and do yard work did not constitute substantial evidence of the ability to work full time in 

light of the applicant’s testimony as to her limitations in conducting those activities).

The only other bases provided by the ALJ for rejecting Langston’s testimony 

regarding her debilitating pain were the increase in her weight, the fact that some of her 

symptoms might be caused by opiate use, and the fact that the medical records did not 

mention that Langston used a cane.6

 While increased weight and contradictory evidence 

about cane use could support rejecting Langston’s testimony about the extent of her 

abdominal and back pain, absent any analysis by the ALJ, these factors are insufficient to 

overcome her ongoing complaints of pain, the prescription of strong pain medication, and 

her testimony as to her ability to complete daily tasks. Regarding Langston’s use of 

narcotics, the ALJ did not provide any discussion as to whether stopping their use would 

increase her pain, even if it decreased her GI symptoms. Moreover, if the ALJ believed 

that Langston’s GI symptoms were caused by narcotics, it is unclear why the ALJ partially 

discounted her complaints of GI issues. 

6 Langston testified in 2019 that she used a cane. 

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Because the ALJ’s determination that Langston’s daily activities were inconsistent 

with her complaints of disabling pain was not supported by substantial evidence and 

because the ALJ erred in considering the lack of objective evidence as a primary reason 

for rejecting Langston’s subjective complaints, we vacate the district court’s judgment and 

remand with instructions to remand the case to the agency for further proceedings 

consistent with this opinion. We dispense with oral argument because the facts and legal 

contentions are adequately presented in the materials before this court and argument would 

not aid the decisional process.

VACATED AND REMANDED

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