Court Opinion

ID: 9400701
Source: CourtListenerOpinion
Date Created: 2023-06-08 21:01:03.499201+00
Date Added: 2024-06-11T17:19:47.377907
License: Public Domain

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                                               PUBLISHED

                               UNITED STATES COURT OF APPEALS
                                   FOR THE FOURTH CIRCUIT

                                               No. 21-2421

        RENARD T. OAKES,

                             Plaintiff - Appellant,

                      v.

        KILOLO KIJAKAZI, Acting Commissioner of Social Security,

                             Defendant - Appellee.

        Appeal from the United States District Court for the Eastern District of North Carolina, at
        Raleigh. Robert T. Numbers, II, Magistrate Judge. (5:20-cv-00542-RN)

        Argued: January 25, 2023                                           Decided: June 7, 2023

        Before KING and RUSHING, Circuit Judges, and FLOYD, Senior Circuit Judge.

        Reversed and remanded by published opinion. Senior Judge Floyd wrote the opinion in
        which Judge King joined. Judge Rushing wrote a separate dissenting opinion.

        ARGUED: Karl Osterhout, OSTERHOUT BERGER DISABILITY LAW, LLC,
        Oakmont, Pennsylvania, for Appellant. Natasha Todman McKay, SOCIAL SECURITY
        ADMINISTRATION, Baltimore, Maryland, for Appellee. ON BRIEF: Michael F.
        Easley, Jr., United States Attorney, OFFICE OF THE UNITED STATES ATTORNEY,
        Raleigh, North Carolina; Keeya M. Jeffrey, Special Assistant United States Attorney,
        SOCIAL SECURITY ADMINISTRATION, Baltimore, Maryland, for Appellee.
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        FLOYD, Senior Circuit Judge:

               Plaintiff-Appellant Renard T. Oakes sought disability benefits from the Social

        Security Administration in 2018. He primarily based his application on pain in his lower

        back, hips, legs, knees, and feet, as well as on hypertension. Throughout the administrative

        process, and upon review in federal district court, Oakes was denied benefits. He now

        appeals. For the reasons that follow, we reverse and remand for reconsideration of Oakes’s

        benefit eligibility.

                                                     I.

               Oakes applied for disability benefits in August 2018, alleging a disability that began

        in September 2016. According to Oakes, pain regularly shoots from his lower back down

        his legs, preventing him from either standing or sitting for too long. At times, it causes

        weakness in his legs. Due to this pain, he spends a typical day watching television in his

        recliner, occasionally attempting to perform chores “with breaks.” A.R. 18. Despite his

        years-long struggle with this issue, Oakes’s medical record is exceedingly sparse—he

        explains that he lacks insurance and cannot afford medical treatment in its absence. The

        totality of record medical evidence relating to his condition includes two emergency room

        visits and one administratively ordered consultative examination by M.A. Samia, M.D.

               The Social Security Administration (SSA) denied him benefits at the initial and

        reconsideration stages, and he requested a review hearing before an administrative law

        judge (ALJ). The ALJ also denied him benefits. In so doing, the ALJ followed the

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        sequential five-step process prescribed by the Federal Code for evaluating alleged

        disabilities. See 20 C.F.R. § 404.1520(a).

               At step one of this process, an ALJ considers a claimant’s work activity, if any. If

        the claimant is performing “substantial gainful activity,” then he is not disabled. Id.

        § 404.1520(a)(4)(i). At step two, the ALJ considers the medical severity of the impairment.

        Id. § 404.1520(a)(4)(ii).    If the claimant fails to meet certain severity or duration

        requirements, then he is not disabled. Id. At step three, the ALJ again considers the

        medical severity of the impairment—this time determining whether the alleged impairment

        meets or equals a qualifying impairment listed in the regulations at 20 C.F.R. § 404. Id.

        § 404.1520(a)(4)(iii). If his impairment is listed, then the claimant is deemed disabled—if

        not, the ALJ proceeds to step four. Id. At step four, the ALJ assesses the claimant’s

        residual functional capacity and past relevant work. Id. § 404.1520(a)(4)(iv). If the

        claimant can still perform his past relevant work at his residual functional capacity, then

        he is not disabled—but if he cannot, the ALJ proceeds to step five. Id. At step five, the

        ALJ considers its previous residual-functional-capacity determination in tandem with the

        claimant’s age, education, and work experience “to see if [he] can make an adjustment to

        other work. If [he] can make an adjustment to other work, [he] is not disabled.” Id.

        § 404.1520(a)(4)(v). During the first four steps of the analysis, the burden of proof lies

        with the claimant, then it shifts to the SSA at step five. Lewis v. Berryhill, 858 F.3d 858,

        861 (4th Cir. 2017).

               Here, at step one, the ALJ determined that Oakes had not engaged in substantial

        gainful activity since 2016, and proceeded to step two. At step two, the ALJ determined

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        that Oakes suffered from the following severe impairments: “hypertension, gout, arthritis[,]

        . . . and back pain with bilateral sciatica.” A.R. 16. At step three, the ALJ concluded that

        Oakes’s impairments are not listed impairments under 20 C.F.R. § 404. At step four, the

        ALJ determined that Oakes had the residual functional capacity to perform medium work,

        defined by the ability to lift “no more than 50 pounds at a time with frequent lifting or

        carrying of objects weighing up to 25 pounds. If someone can do medium work, . . . [he]

        can also do sedentary or light work.” Id. § 404.1567(c). The ALJ further concluded that,

        based on a medium-work capacity, Oakes could perform his past work as a cook. At step

        five, the ALJ determined that Oakes’s residual functional capacity also permitted him to

        fill other “unskilled[,] medium occupations,” including the positions of laundry worker,

        linen room attendant, marker, and bagger. A.R. 18. Given these conclusions, the ALJ

        determined that Oakes was not entitled to disability benefits.

               Following issuance of the ALJ’s decision, Oakes requested review by the SSA’s

        Appeals Council. The Appeals Council denied his request. Consequently, the ALJ’s

        decision became the SSA’s final decision in his case. Oakes subsequently commenced an

        action in district court, seeking review of the SSA’s final decision. Both sides moved for

        summary judgment, and the district court affirmed the SSA’s final decision—denying

        Oakes’s motion and granting the SSA’s. Oakes timely appealed to this Court.

               Oakes now contends that the district court erred by affirming the ALJ’s final

        decision because: (1) the ALJ improperly discounted the opinion of Dr. Samia, thereby

        excluding from its residual-functional-capacity analysis Oakes’s use of an ambulatory

        device; (2) the ALJ failed to properly consider Oakes’s subjective complaints; and (3) the

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        ALJ improperly found that the daily activities to which Oakes testified were inconsistent

        with his claim of disability. The SSA responds that the ALJ reasonably discounted Dr.

        Samia’s opinion, properly considered Oakes’s subjective complaints, and properly

        considered Oakes’s daily activities.

                                                    II.

               This Court upholds a Social Security disability determination if “(1) the ALJ applied

        the correct legal standards and (2) substantial evidence supports the ALJ’s factual

        findings.”      Arakas v. Comm’r, Soc. Sec. Admin., 983 F.3d 83, 94 (4th Cir. 2020)

        (simplified). Substantial evidence is “more than a mere scintilla” and “[i]t means—and

        means only—such relevant evidence as a reasonable mind might accept as adequate to

        support a conclusion.” Biestek v. Berryhill, 139 S. Ct. 1148, 1154 (2019) (quotations

        omitted). The threshold is “not high” and defers to the ALJ, “who has seen the hearing up

        close.” Id. at 1154, 1157. “‘In reviewing for substantial evidence, we do not undertake to

        re-weigh conflicting evidence, make credibility determinations, or substitute our judgment’

        for the ALJ’s.” Arakas, 983 F.3d at 95 (quoting Craig v. Chater, 76 F.3d 858, 589 (4th

        Cir. 1996)). But “even under this deferential standard, we do not ‘reflexively rubber-stamp

        an ALJ’s findings.’” Id. (quoting Lewis, 858 F.3d at 870). “To pass muster, ALJs must

        build an accurate and logical bridge from the evidence to their conclusions.”            Id.

        (simplified).

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                                                     III.

                                                      A.

               First, the ALJ improperly discounted Dr. Samia’s opinion. The way in which ALJs

        review medical-opinion evidence changed on March 27, 2017, following the promulgation

        of 20 C.F.R. § 404.1520c. See Dowling v. Comm’r of Soc. Sec. Admin., 986 F.3d 377, 384

        n.8 (4th Cir. 2021). For claims filed prior to that date, 20 C.F.R. § 404.1527 still applies.

        Id. Oakes filed his claim post-promulgation of 20 C.F.R. § 404.1520c, so we review for

        the ALJ’s proper application of the new regulation. Under the new regulation, when

        determining the persuasiveness of medical opinions, an ALJ must consider the following

        factors: (1) supportability; (2) consistency; (3) a physician’s relationship with the claimant;

        (4) a physician’s specialization; and (5) other factors, like a physician’s familiarity with

        the evidentiary record or their understanding of the SSA’s policies and evidentiary

        requirements. 20 C.F.R. § 404.1520c(c)(1)–(5). Of these factors, supportability and

        consistency are the most important. Id. § 404.1520c(a), (b)(2). Supportability is the degree

        to which a provider supports their opinion with relevant, objective medical evidence and

        explanation, and consistency is the degree to which a provider’s opinion is consistent with

        the evidence of other medical and non-medical sources in the record.                        Id.

        § 404.1520c(c)(1)–(2).

               In the course—and aftermath—of this persuasion analysis, an ALJ will render a

        disability determination based on the available evidence when that evidence is consistent

        and sufficient.   20 C.F.R. § 404.1520b(a).         Conversely, an ALJ will not render a

        determination when the available evidence is incomplete, insufficient, or inconsistent. Id.

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        § 404.1520b(b). Evidence is incomplete or insufficient “when it does not contain all the

        information [that the ALJ] need[s] to make [its] determination.”          Id.   Evidence is

        inconsistent “when it conflicts with other evidence, contains an internal conflict, [or] is

        ambiguous.” Id. If the available evidence suffers from any of these inadequacies, an ALJ

        will determine “the best way” to resolve the issue, which may include one or more of four

        paths forward: (1) recontacting a medical source for clarification; (2) requesting additional

        existing evidence; (3) asking the claimant to undergo a consultative examination; or (4)

        asking the claimant or others for more information. Id. § 404.1520b(b)(2)(i)–(iv). * If

        “there are inconsistencies in the evidence that [the ALJ] cannot resolve or when, despite

        efforts to obtain additional evidence, the evidence is insufficient to determine whether [a

        claimant is] disabled, [the ALJ] will make a determination or decision based on the

        evidence [it possesses].” Id. § 404.1520b(b)(3).

               Here, the persuasiveness of Dr. Samia’s opinion is a close question. First, with

        respect to § 404.1520c(c)’s supportability factor, the ALJ seemed to conclude that Dr.

        Samia premised his determination that Oakes should use an ambulatory device on only

        Oakes’s subjective complaints, and not on any objective medical evidence. It is true that

        the opinion offers little direct or explicit explanation underpinning the recommendation of

        an ambulatory device’s use. But it is likewise true that Dr. Samia diagnosed Oakes with

        arthritis, and that imaging of Oakes’s spine showed “severe narrowing” of one spinal disk,

        “moderate narrowing” of another spinal disk, and “[p]rominent hypertrophic degenerative

               *
                Notably, this Court has not previously considered the precise implications of
        § 404.1520b(b)(2)(i)–(iv).
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        changes” in Oakes’s lower lumbar facet joints. A.R. 254. These imaging results supported

        the impression that Oakes suffered from multi-level disk disease.

               Of course, neither this Court nor an ALJ may determine that such conditions render

        an ambulatory device medically necessary—medical experts should render such

        conclusions. But to give such short shrift to Dr. Samia’s device recommendation as only

        supported by subjective complaints fails to sufficiently recognize the objective aspects of

        Dr. Samia’s diagnosis. Nor does it “build an accurate and logical bridge” between the

        evidence of Oakes’s objective ailments and the ALJ’s conclusion. Arakas, 983 F.3d at 95

        (simplified).

               To the extent that Dr. Samia’s justification for his ambulatory-device

        recommendation was ambiguous, the medical record is incomplete and the ALJ should

        have “take[n] additional actions” to seek clarification. 20 C.F.R. § 404.1520b(b). As

        previously noted, the medical record in Oakes’s case is extremely sparse. According to

        him, his lack of finances and insurance prevented him from seeking the medical attention

        necessary to more ably document his conditions and support his disability claim. It was

        for this reason that the ALJ ordered a consultative examination from Dr. Samia in the first

        place (at Oakes’s request). Although it is not the within the purview of an ALJ to help a

        claimant accumulate favorable evidence in an advocative capacity, this Court has “long

        recognized that the administrative hearing process is not an adversarial one, and an ALJ

        has a duty to investigate the facts and develop the record.” Pearson v. Colvin, 810 F.3d

        204, 210 (4th Cir. 2015) (citing Cook v. Heckler, 783 F.2d 1168, 1173–74 (4th Cir. 1986)).

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               Accordingly, when an administratively ordered consultative examiner’s opinion

        contains what ought to be an easily clarified ambiguity on a key issue, it logically follows

        that an ALJ must engage in a simple § 404.1520b(b)(2) inquiry. As discussed, the

        regulations clarify that “[w]hen there are inconsistencies in the evidence that we cannot

        resolve or when, despite efforts to obtain additional evidence, the evidence is insufficient

        to determine whether [a claimant is] disabled, we will make a determination or decision

        based on the evidence we have.” 20 C.F.R. § 404.1520b(b)(3). Here, it cannot be said that

        the insufficiency in the record could not be resolved or that the ALJ reasonably endeavored

        to obtain additional evidence to remedy it. Thus, the ALJ’s determination based only on

        the evidence that it possessed was woefully premature.

               Of course, the scheduling of a consultative examination is itself a remedial action

        under the new regulations. See id. § 404.1520b(b)(2)(iii). But to schedule such an

        examination only to immediately dismiss its results on easily curable grounds amounts to

        a half-hearted execution of regulations intended to discern the truth of one’s claim. To be

        sure, our position is not to be understood as requiring layer upon layer of remediation—

        each seeking to patch the inadequacies of the last—until a claimant receives benefits. But

        when a remedial measure is itself plagued by easily remedied inadequacies, it cannot be

        said that an ALJ applies sound legal principles by simply giving up.

               Much of the same general analysis also applies to § 404.1520c(c)’s consistency

        factor. The ALJ concluded that Dr. Samia’s recommendation that Oakes use an ambulatory

        device was inconsistent with other medical evidence in the record because, during two

        emergency room visits in 2018, examiners found that Oakes did not suffer from abnormal

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        gait, diminished range of motion, or neurological deficits.       But viewing the three

        examiners’ respective gait and mobility conclusions in a vacuum does not evince a logical

        bridge between the evidence and the ALJ’s conclusion that Dr. Samia’s opinion is

        inconsistent. Although the gait and mobility determinations differed, one emergency-room

        examiner also found that Oakes suffered from “[c]hronic midline low back pain with

        bilateral sciatica.” A.R. 239. The other emergency-room examiner similarly diagnosed

        Oakes with “[a]cute exacerbation of chronic low back pain” and “[b]ilateral sciatica.” A.R.

        250. Thus, each of the three examiners diagnosed Oakes with extremely similar objective

        ailments. This consistency is important, particularly when Dr. Samia’s examination of

        Oakes was the most recent—taking place about nine months after the emergency-room

        visits—and was the only one of the three examinations to include spinal imaging.

               Nothing in the record expressly reconciles the differing mobility conclusions

        between 2018 and 2019, but it seems reasonable to believe that perhaps Oakes’s objective

        ailments worsened during that time, thereby impacting his mobility. To be sure, neither

        this Court nor an ALJ may infer a medical diagnosis—like symptom progression. But

        when insufficient evidence prevents an ALJ from soundly determining whether providers’

        opinions are consistent, a § 404.1520b(b)(2) inquiry by the ALJ could remedy the

        uncertainty with relative ease. If given the opportunity, Dr. Samia could discuss whether

        the passage of time between 2018 and 2019 could explain Oakes’s apparently deteriorated

        gait and mobility, particularly given his undisputed, objective diagnoses of sciatica, disk

        disease, and arthritis.

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               Thus, the ALJ’s conclusion that Dr. Samia’s opinion was inconsistent with those of

        the emergency-room physicians ignored the nuanced consistencies across examinations,

        and the role that the passage of time could play in reconciling the opinions. A simple

        inquiry could have resolved any ambiguities, and in the absence of clarity on the issues of

        consistency and supportability with respect to the three medical examinations, it cannot yet

        be said that substantial evidence supports the denial of benefits.

                                                     B.

               Second, the ALJ improperly considered Oakes’s subjective complaints. When

        evaluating a claimant’s subjective complaints, “ALJs must use the two-step framework set

        forth in 20 C.F.R. § 404.1529 and SSR 16-3p.” Arakas, 983 F.3d at 95 (citation omitted).

        First, “the ALJ must determine whether objective medical evidence presents a ‘medically

        determinable impairment’ that could reasonably be expected to produce the claimant’s

        alleged symptoms.” Id. (simplified). Second, after finding a medically determinable

        impairment, “the ALJ must assess the intensity and persistence of the alleged symptoms to

        determine how they affect the claimant’s ability to work and whether the claimant is

        disabled.” Id. (simplified). Objective evidence is not required at this second step. Id.

        (simplified). Rather, the ALJ must consider the entire case record, including the claimant’s

        subjective statements about intensity, persistence, and limiting effects of symptoms—even

        if objective medical evidence does not substantiate them. Id. (simplified).

               Despite a history of pushback on subjective-statement reliance by the SSA, this

        Court allows a claimant to rely exclusively on subjective evidence in proving the second

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        part of the test. Id. (simplified). Because a claimant is entitled to “rely exclusively on

        subjective evidence to prove that [his] symptoms [are] so continuous and/or severe that

        they prevented [him] from working,” an ALJ applies the incorrect legal standard in

        discrediting complaints “based on [a] lack of objective evidence corroborating them.” Id.

        at 96 (simplified).

               Here, the ALJ failed to adequately consider Oakes’s subjective complaints. At step

        one of the two-step framework, there is no dispute that Oakes established a medically

        determinable impairment. All three of the medical examinations in the record—including

        those on which the ALJ ultimately relied—reflect some sort of back impairment, and the

        ALJ itself concluded that Oakes suffers from hypertension, gout, arthritis, and back pain

        with bilateral sciatica.

               At step two, the ALJ failed to adequately consider the intensity and persistence of

        Oakes’s pain. Instead, following a recitation of facts, the ALJ baldly stated that “the

        claimant’s subjective complaints and alleged limitations were not persuasive.” A.R. 17.

        The ALJ’s only other mentions of Oakes’s subjective complaints arose in the context of

        factual recitations referencing Oakes’s hearing testimony and portions of Dr. Samia’s

        opinion, but these were not accompanied by any symptom analysis.            Furthermore,

        regarding the latter, the ALJ seemed to conclude that Dr. Samia improperly based his

        ambulatory-device recommendation on subjective complaints alone. Such an exclusive

        basis for a medical opinion is, indeed, improper. See Craig, 76 F.3d at 590. But the ALJ

        never addressed the fact that disability benefits can be awarded on the sole basis of an

        objective impairment and derivative subjective pain, regardless of whether a physician

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        properly supported their opinion on a tangential issue—here, the necessity of an

        ambulatory device for mobility.

               In other words, the ALJ’s opinion denying benefits seems to revolve around its

        rejection of Dr. Samia’s opinion that Oakes requires an ambulatory device. But the law

        does not require that a claimant need an ambulatory device to qualify for disability.

        Separate and apart from his literal mobility, Oakes can qualify for benefits if he is in

        sufficient pain. The ALJ failed to meaningfully address this theory of qualification such

        that this Court may engage in judicial review. See Cook, 783 F.2d at 1172 (“Administrative

        determinations are required to be made in accordance with certain procedures which

        facilitate judicial review.”). The ALJ likewise made no mention of the intensity or

        persistence of Oakes’s complaints in analyzing his residual functional capacity. On this

        issue, “lack of explanation requires remand.” Mascio v. Colvin, 780 F.3d 632, 640 (4th

        Cir. 2015).

                                                     C.

               Third, the ALJ improperly considered whether Oakes’s daily activities were

        inconsistent with his claim of disability.      ALJs may consider daily activities when

        evaluating symptoms, including pain. 20 C.F.R. § 404.1529(c)(3)(i). But an ALJ errs in

        extrapolating from daily and life activities that a claimant has increased residual functional

        capacity, or, in other words, has the “ability to do sustained work-related activities on a

        regular and continuing basis—i.e., 8 hours a day, for 5 days a week, or an equivalent work

        schedule.” Arakas, 983 F.3d at 100 (simplified). For years, this Court has “bemoaned the

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        tendency of ALJs to overstate claimants’ Residual Functional Capacities and ability to

        work based on their daily activities.” Id. at 101 (citations omitted). This Court also

        recognizes that “disability claimants should not be penalized for attempting to lead normal

        lives in the face of their limitations.” Id. (simplified). Rather, “[b]eing able to live

        independently and participate in the everyday activities of life empowers people with

        disabilities and promotes their equal dignity. In pursuing those ends, disability claimants

        should not have to risk a denial of Social Security benefits.” Id. Furthermore, “[a]n ALJ

        may not consider the type of activities a claimant can perform without also considering the

        extent to which [he] can perform them.” Woods v. Berryhill, 888 F.3d 686, 694 (4th Cir.

        2018).

                 Here, the ALJ seems to have improperly considered Oakes’s daily activities. In its

        opinion, the ALJ noted Oakes’s ability to “cook, do laundry, drive[,] and walk

        independently” when explaining why it found Dr. Samia’s opinion regarding Oakes’s

        limited mobility to be unpersuasive. A.R. 16. Ultimately, the ALJ did not expressly

        consider Oakes’s daily activities when determining Oakes’s residual functional capacity.

        But it based its residual-functional-capacity analysis on its skepticism of Dr. Samia’s

        opinion, so, for all intents and purposes, evidence of daily activities influenced the capacity

        analysis—even if indirectly.

                 Furthermore, although the ALJ noted that Oakes performs some activities

        punctuated by necessary “breaks,” A.R. 15, and that he has “five out of seven bad days,”

        id., it seemed to provide these details only in the contexts of offering general background

        and seeking to undermine Dr. Samia’s opinion. Thus, it did not meaningfully consider the

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        extent to which Oakes can perform daily activities for purposes of his residual functional

        capacity. See Woods, 888 F.3d at 694. In other words, even if the ALJ properly considered

        whether daily activities undermined Dr. Samia’s opinion, it likewise should have separately

        and more deeply considered them in the capacity context. As with other issues above,

        “lack of explanation requires remand.” Mascio, 780 F.3d at 640.

                                                    IV.

               We certainly acknowledge the deference with which we must treat decisions of the

        SSA when sound legal standards are applied and substantial evidence supports the

        conclusions reached. But we cannot condone a determination of the SSA devoid of

        sufficient explanation such that we may engage in meaningful judicial review. We likewise

        remain troubled by the tension here between an applicant’s sparse medical record and an

        ALJ’s dismissive treatment of a consultative examination ordered to remedy precisely that

        issue—particularly where the ALJ did not engage in regulatorily permitted remedial

        measures. Given these concerns, at this stage, it can neither be said that the ALJ applied

        sound legal standards, nor that substantial evidence supports a denial of benefits. Thus, we

        reverse and remand for additional administrative proceedings consistent with this opinion.

                                                                   REVERSED AND REMANDED

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        RUSHING, Circuit Judge, dissenting:

               The administrative law judge (ALJ) applied the correct legal standards, and

        substantial evidence supported her factual findings. So I would affirm the magistrate

        judge’s decision granting judgment for the Commissioner. * See Arakas v. Comm’r, Soc.

        Sec. Admin., 983 F.3d 83, 94 (4th Cir. 2020); 42 U.S.C. § 405(g).

               After reviewing Oakes’s evidence, conducting a hearing, ordering a post-hearing

        consultative examination by an additional doctor, studying that doctor’s report, and

        receiving a response to that report from Oakes’s attorney, the ALJ concluded that “the

        record contains sufficient information to make a decision” on Oakes’s disability claim.

        A.R. 10. The ALJ determined that Oakes had not been disabled from September 2016

        through November 2019 and that he was capable of performing his past relevant work as a

        cook, as well as other jobs that exist in significant numbers in the national economy.

               Before our Court, Oakes challenges the ALJ’s decision not to include an ambulatory

        device among the limitations the ALJ articulated when determining Oakes’s residual

        functional capacity. Oakes argues that the ALJ erred by finding the opinion of the

        consultative examiner—Dr. Samia—unpersuasive on this point and, consequently,

        formulating a residual functional capacity that contradicted Dr. Samia’s assessment of

        Oakes’s limitations.

               The ALJ applied the correct legal standard for assessing the persuasiveness of

        medical opinions, focusing on the “most important factors” of “supportability” and

               *
                The parties consented to have the case decided by a United States Magistrate Judge
        pursuant to 28 U.S.C. § 636(c).
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        “consistency.” 20 C.F.R. § 404.1520c(b)(2), (c)(1), (c)(2). At no point did the ALJ find

        Dr. Samia’s report “ambiguous” or “incomplete.” Maj. Op. at 8. Rather, she found his

        opinion about Oakes’s need for an ambulatory device unsupported by his own examination

        of Oakes and inconsistent with the other medical examinations in the record. The duty to

        weigh the evidence and resolve conflicts in the record “rests with the ALJ, not with a

        reviewing court,” and the ALJ fulfilled that duty here. Smith v. Chater, 99 F.3d 635, 638

        (4th Cir. 1996).

               Substantial evidence supported the ALJ’s assessment of Oakes’s limitations, even

        if this Court would have reached a different conclusion in the first instance. In September

        2019, Dr. Samia examined Oakes and diagnosed him with high blood pressure and arthritis

        that predominantly bothered his back, left hip, and left knee. Regarding the arthritis, Dr.

        Samia reported that Oakes expressed “subjective discomfort” when moving his lower

        extremities, that his left knee was “tender to palpation,” and that he reported taking only

        ibuprofen for his pain. A.R. 255–257. Dr. Samia assessed Oakes as having full strength—

        “5/5”—in his upper extremities and slightly diminished strength—“4/5”—in his lower

        extremities, an “acceptable” range of motion, and a “shuffling gait with mild to moderate

        limping when bearing weight on left lower extremity.” A.R. 257. In his report, Dr. Samia

        also noted that Oakes confirmed he was able to “walk without assistance,” “take a walk,”

        “walk a block,” sit, stand, “raise arms overhead,” cook, do laundry, dress himself, and

        drive. A.R. 255. Oakes also reported owning a cane and a walker, which he used

        “predominantly outside of the house.” A.R. 255.

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               The other two medical assessments in the record are from Oakes’s emergency room

        visits in 2018. In May 2018, Oakes visited the emergency room with back pain that

        radiated down his legs.       He reported taking over-the-counter pain medication and

        occasionally his wife’s Percocet. The examining physician observed that Oakes’s back

        was tender but he retained a “full range of motion,” “normal motor function,” “normal

        sensory function,” and “normal gait.” A.R. 239. Oakes was diagnosed with chronic

        midline low back pain with bilateral sciatica and prescribed prednisone and Percocet for

        pain. He returned to the emergency room in December 2018, reporting radiating back pain

        “similar to” his May visit. A.R. 249. He exhibited pain in the lumbar back but “no bony

        tenderness, no swelling, no edema and no deformity.” A.R. 250. On examination, his

        range of motion was “normal,” his strength was “normal,” and his gait was “steady.” A.R.

        250–251. He was diagnosed with acute exacerbation of chronic low back pain and again

        prescribed pain medication.

               This record supports the ALJ’s rejection of Dr. Samia’s opinion that Oakes

        “appear[s]” to need “an assistive device” for “both ambulation or balance” and “may have

        difficulty with rough and uneven surfaces as well as inclines, declines or stairs.” A.R. 257.

        The ALJ found this opinion unsupported by Dr. Samia’s own examination, which indicated

        “no major deficits to strength or range of motion,” despite Oakes’s back and leg pain, and

        which also reported that Oakes could “walk independently,” cook, and do laundry, among

        other tasks. A.R. 16. The ALJ also found Dr. Samia’s opinion inconsistent with the two

        medical exams that occurred outside the benefits evaluation process, during which Oakes

        displayed a full range of motion, normal strength and gait, and no neurological deficits,

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        despite his reported back and leg pain. The ALJ further observed that Oakes had not sought

        any treatment for his back pain since December 2018. Considering all this evidence, plus

        Oakes’s own testimony and imagery of his lumbar spine, the ALJ concluded that “the

        record does not support [Oakes’s] alleged loss of function.” A.R. 17. That may not be the

        only possible conclusion from the record evidence, but it certainly is a permissible one.

               Nor does anything about the ALJ’s analysis suggest that she discounted Oakes’s

        subjective reports of pain. Indeed, the ALJ didn’t question the reality or severity of his

        pain but instead reasoned from the medical records and other evidence that his pain did not

        result in major deficits to his strength, range of motion, or ability to ambulate. That was

        the relevant question for assessing Oakes’s claims about the limiting effects of his

        symptoms. See 20 C.F.R. § 404.1529. For example, the ALJ noted that even when Oakes’s

        subjective pain had brought him to the emergency room, he was found to have a normal

        gait, strength, and range of motion in his extremities. The regulations do not permit the

        ALJ to accept a claimant’s subjective statements to the exclusion of the rest of the record.

        See id. Thus, the ALJ correctly considered all of the available evidence in evaluating how

        Oakes’s pain affected his ability to work.

               Because it is not the role of the reviewing court to reweigh conflicting evidence or

        substitute its judgment for that of the ALJ, I would affirm the Commissioner’s decision

        denying Oakes’s application for disability benefits. I therefore respectfully dissent.

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