PAULINE S. v. FRANK BISIGNANO, Commissioner of Social Security
No. 2:25-cv-00322-EFS
United States District Court, Eastern District of Washington
March 06, 2026
PageID.3537
EASTERN DISTRICT OF WASHINGTON
PAULINE S.,1 Plaintiff, v. FRANK BISIGNANO, Commissioner of Social Security, Defendant.
No. 2:25-cv-00322-EFS
ORDER REVERSING THE ALJ’S DENIAL OF BENEFITS, AND REMANDING FOR FURTHER PROCEEDINGS
Due to a back injury, arthritis, anxiety, vertigo, a heart condition, and carpal tunnel syndrome, Plaintiff Pauline S. claims that she is unable to work fulltime and applied for disability insurance benefits.
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I. Background
In November 2019, Plaintiff filed applications for benefits under Title 2, claiming disability beginning January 28, 2016, based on the physical and mental impairments noted above.2
After the agency denied Plaintiff benefits, ALJ Palachuk held a telephone hearing in May 2022, at which Plaintiff appeared with her representative.3 Plaintiff and a vocational expert testified.4
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Plaintiff then filed suit in this Court, and after consideration, the Court remanded the case for further proceedings.7 The Appeals Council issued an Order remanding the case to a hearing office, consistent with the Court’s decision.8
On March 19, 2025, Plaintiff and her attorney appeared via video for a hearing before ALJ Evangeline Mariano-Jackson (“the ALJ”).9 Plaintiff and a vocational expert testified at the hearing.10 After the hearing, the ALJ issued a decision denying benefits.11
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- The opinions of state agency evaluators Louis Martin, MD, and Myron Watkins, MD, to be not persuasive.
- The 2018 opinions of consultative examiner Ryan Massoud, DO, to be not persuasive.
- The 2020 opinions of consultative examiner David Fine, PA-C, to be partially persuasive.
- The November 2020 opinions of consultative examiner Thomas Genthe, PhD, to be persuasive.
- The January 2018 opinions of consultative examiner Dr. Genthe to be not persuasive.
- The opinions of state agency evaluators Eugene Kester, MD, and Julian Lev, PhD, to be persuasive.
The ALJ also found the third-party function report completed by Plaintiff’s spouse to be not entirely consistent with the medical
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- Plaintiff last met the insured status requirements of the Social Security Act on March 31, 2021.
- Step one: Plaintiff had not engaged in substantial gainful activity from January 28, 2016, the alleged onset date, through March 31, 2021, her date last insured.
- Step two: Plaintiff had the following medically determinable severe impairments: coronary artery disease, status post surgery; bilateral hand osteoarthritis; bilateral carpal tunnel syndrome; degenerative joint disease of lumbar spine and radiculopathy; morbid obesity; anxiety; and agoraphobia.
- Step three: Plaintiff did not have an impairment or combination of impairments that met or medically equaled the severity of one of the listed impairments.
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RFC: Plaintiff had the RFC to perform light work with the following exceptions:
lift/carry 20 pounds occasionally and 10 pounds frequently, stand/walk 6 hours out of an 8-hour day, and sit 6 hours out of an 8-hour day with normal breaks. Occasionally balance, stoop, kneel, crouch, crawl, and climb ramps and/or stairs; can never climb ladders, ropes, or scaffolds; occasionally push and/or pull with the bilateral upper and lower extremities; occasionally reach overhead with the bilateral upper extremities; frequently but not constantly handle, finger, and feel with the bilateral upper extremities; can never be exposed to vibration or extreme cold/heat; can tolerate occasional exposure to fumes, odors, dusts, gases, poor ventilation, and other pulmonary irritants; can never work at unprotected heights or around moving mechanical parts or heavy machinery; can understand, remember, and carryout simple instructions; can deal with less than occasional changes in a routine work setting; and can tolerate occasional interaction with the public.
- Step four: Plaintiff has no past relevant work.
- Step five: in the alternative, considering Plaintiff’s RFC, age, education, and work history, Plaintiff could perform work that existed in significant numbers in the national economy, such as a cleaner, housekeeper (DOT 323.687-
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Plaintiff timely requested review of the ALJ’s decision by this Court.15
II. Standard of Review
The ALJ’s decision is reversed “only if it is not supported by substantial evidence or is based on legal error,”16 and such error impacted the nondisability determination.17 Substantial evidence is “more than a mere scintilla but less than a preponderance; it is such
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III. Analysis
Plaintiff seeks relief from the denial of disability on four grounds. She argues the ALJ erred when evaluating the medical opinions, in imposing an RFC at the light exertional level; ;in formulating an incomplete hypothetical to the VE, and when evaluating Plaintiff’s subjective complaints. As is explained below, the Court concludes that the ALJ erred in her evaluation of the medical opinion evidence and that the ALJ’s analysis contains consequential error.
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Plaintiff argues the ALJ erred in her evaluation of the medical opinions.19 Specifically, Plaintiff argues that the ALJ erred in failing to address the opinions of Dr. Genthe that Plaintiff would have difficulty obtaining and maintaining employment, and provided flawed reasoning when discounting PA Fine’s opinions limiting Plaintiff to sedentary work.
1. Standard
The ALJ was required to consider and evaluate the persuasiveness of the medical opinions and prior administrative medical findings.20 The factors for evaluating the persuasiveness of medical opinions and prior administrative medical findings include,
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a. 2022 Testimony
On May 12, 2022, Plaintiff appeared with her attorney for a telephone hearing before ALJ Palachuk.25 Plaintiff testified, and vocational expert, William Weiss, testified.26 Plaintiff testified that at the time of the hearing she was fifty years old and that she had completed to the seventh grade and only attended one month of classes in the eighth grade before dropping out.27 She said she did not get a GED and had been married since 2002.28 She was living with her husband, her nineteen-year-old daughter, and her nineteen-year-old niece.29 She said that in 2016 she was working full-time but left that job when she went for a test and was sent for open-heart surgery.30
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Plaintiff testified that her family cooks and that everyone cleans, and that she has problems with her grip where things will slide out of her hands.40 She said she has problems with fine manipulation and gets help from her family.41 Plaintiff said she gets very anxious being around people and that her doctor gave her something to make her less
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Plaintiff said her attention is limited and she cannot watch a thirty-minute show and can only read about one page, and has taken Omega 3 supplements.45 Plaintiff said that she and her family use post it notes and a board in the kitchen to write down reminders for her.46 She said she can only exert herself for about fifteen to twenty minutes and then needs a break.47 While on the phone for the hearing, she had
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b. 2024 Testimony
On March 19, 2025, Plaintiff and her attorney appeared via video for a hearing before ALJ Evangeline Mariano-Jackson.51 The ALJ advised Plaintiff to relate her answers to questions to the period of January 28, 2016, through March 31, 2021.52 Plaintiff testified that she completed the seventh grade and one month of eighth grade and had no further education.53 She was born in 1971 and was presently 53 years old.54 She is married and has 5 children but only her 22 year-old
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She said that during the relevant period she could lift a gallon of milk but would drop things and that her hands were hard to open and close.58 She said that her problems using her hands have worsened but even then she dropped things and was not able to pick up a coin from a table.59 She said she does not wear button up shirts and that her husband had to hook her bra for her.60 She gets swelling in her hands, fingers, and joints, and that she felt tingling and numbness when she
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Plaintiff said she could stand for up to 15 minutes before having to sit down due to pain her back caused from lumbar spine injuries sustained in an auto accident.63 She said she suffered from pain and numbness radiating from her low back/buttocks and down her leg.64 She said she could walk for about one block and could sit for about 20 minutes without needing to get up and move around.65 She had swelling in her legs and ankles during the relevant period at issue and took furosemide66 (Lasix) to reduce the swelling in her legs but said it
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Plaintiff testified that she must change positions throughout the day and alternates between sitting, standing, and walking every 15 minutes.69 She said that in an average week she had to lay down twice due to back pain.70 She said that during the relevant period her husband, daughter, and niece would help with the household chores such as cooking, cleaning, and caring for the dog.71 She said they lifted heavy things such as dog food and that her husband and daughter accompany her when she shops.72
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Plaintiff testified that she was anxious in crowds and that twice a week she had to leave stores and go home, despite the fact that she was taking medication for anxiety.76 Her medication helped a little but she still had problems with anxiety and focusing.77 She could not watch a full TV show or read a book and had to put a board with reminders in her kitchen.78 She was taking aspirin, meclizine, meloxicam,
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Plaintiff stated that since her open-heart surgery she had been treated with medication only and did not think she had any symptoms.83 She was not sure if her fatigue was related to her heart and described it as being tired and weak throughout the day.84
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On September 11, 2019, Plaintiff presented to Matthew Hardy, DO, with complaints of issues with her hands.85 She said that she had problems with her hands for the last year, they had recently worsened significantly, she could not grasp things without pain, and she had to use a heating pad for pain.86 On examination, she had decreased grip strength.87 Plaintiff also had a positive Tinel’s sign and Phalen’s sign, left worse than right, and was diagnosed with carpal tunnel syndrome, bilaterally and prescribed braces.88
On February 6, 2020, Plaintiff presented to Dr. Hardy for follow up and with complaints of imbalance.89 On examination, Plaintiff had
On November 14, 2020, Plaintiff presented to David Fine, PA, at the request of the Commissioner for a consultative examination.91 Plaintiff reported a history of open-heart surgery 4 years prior; mid and low back pain since 2000 after fracturing her L1, L2, and L3 vertebrae in an MVA; and bilateral hand pain progressively worsening since 2018.92 On examination, Plaintiff’s gait was non-antalgic and she was able to squat to 3/4; there were gross deformities in her hands and they appeared arthritic; the grip in her left hand was slightly decreased; range of motion in the shoulders was slightly decreased, and range of motion was decreased in her knees, hips and lumbar spine.93
At a January 11, 2021 physical therapy appointment, Plaintiff was noted to report significant wrist pain, right greater than left.99
On February 25, 2021, Plaintiff underwent a nerve conduction study which was slightly abnormal with finding of C8-T1 radiculopathy without evidence of ongoing denervation.102 An MRI was recommended to assess possible nerve root impingement at C7-T1 or T1-T2.103
On March 8, 2021, Plaintiff presented to Dr. Hardy, who noted on examination that she had cervical radiculopathy bilaterally with spurring, and positive Faber’s on right.104 Dr. Hardy referred Plaintiff
Although not directly relevant to the period at issue, Plaintiff was noted in 2024 by Nina Flavin, MD, to have advanced deformity of her hands with “classic Heberden nodes” in both hands as well as enlarged PIP joints, and erosion of the second metacarpal head, and an “overall pattern of erosion” that was “most consistent with osteoarthritis, as there is degenerative narrowing and osteophyte formation in the IP joints.”107
4. Analysis
The Court will address the ALJ’s evaluation of both PA Fine’s opinions regarding both lifting and carrying, and standing/walking/sitting, and Dr. Genthe’s mental-health opinions.
PA Fine examined Plaintiff on November 14, 2020.108 PA Fine’s findings were that Plaintiff was able to rise and sit without problem and had a non-antalgic gait.109 PA Fine noted that Plaintiff could make a fist and could pick up a paperclip, but noted that her hands had a gross deformity and showed outward signs of arthritis and that her grip was slightly decreased on the left.110 PA Fine also noted a mild to moderate lordosis in the lumbar spine, as well as decreased range of motion; slightly decreased range of motion of the hips; and normal range of motion in the knees and ankles.111 Straight leg raising was positive on the right in the supine position.112 PA Fine diagnosed
The ALJ found PA Fine’s opinion partially persuasive and in doing so stated the following reasoning:
Examination of the claimant’s upper extremities was remarkable for arthritic appearing hands bilaterally (Ex.
10F-4). Nevertheless, the claimant could touch her thumb to all fingertips on both hands, make a fist bilaterally, use either hand to pick up paperclips from a flat surface, button buttons, and zip zippers. Bilateral finger motion was within the normal limits. While left grip strength was slightly decreased (Ex. 10F-5), light touch sensation remained intact. Taken as a whole, Mr. Fine assessed degenerative joint disease of the lumbar spine with radiculopathy and bilateral hand pain/stiffness (Ex. 10F-7). Mr. Fine opined that the claimant can lift/carry fifteen pounds occasionally and five pounds frequently, stand/walk four hours in an eight-hour workday with a likely ability to stand for two hours at a time, walk five hours in an eight-hour workday with a likely ability to walk for one hour at a time, and sit six hours in an eight-hour workday with a likely ability to sit for three hours at a time (Ex. 10F-9). He further indicated that the claimant’s ability to grip, handle, finger, and feel was “good.”
The undersigned has considered Mr. Fine’s opinion, and she found it partially persuasive when determining the above residual functional capacity. She first notes that Mr. Fine observed that the claimant’s hands appeared crooked (Ex. 10F-2) and arthritic in appearance bilaterally (Ex. 10F-4). Nevertheless, the claimant could touch her thumb to all fingertips on both hands, make a fist bilaterally, use either hand to pick up paperclips from a flat surface, button buttons, and zip zippers. Bilateral finger motion was within the normal limits. While left grip strength was slightly decreased (Ex. 10F-5), light touch sensation remained intact.
While the undersigned agrees that lifting/carry limitations are warranted (in part) by the claimant’s hand functioning, she does not agree that Mr. Fine’s findings preclude the claimant from light exertional level work. As noted by Mr. Fine, the claimant demonstrated only slightly decreased grip strength and otherwise remained capable of tasks requiring
dexterity. When reviewing the cumulative record, the undersigned noted that February 2021 electrodiagnostic testing was negative for any evidence of left or right median neuropathy, ulnar neuropathy, or peripheral neuropathy (Ex. 14F-33). Accordingly, the undersigned has limited the claimant to light exertional level work with frequent handling, fingering, and feeling with the bilateral upper extremities.116
The ALJ then further reasoned that PA Fine’s opinions as to Plaintiff’s ability to sit, stand, and walk were not persuasive. The ALJ went on to provide the following reasoning:
Turning to the remainder of Mr. Fine’s opinion, that the claimant can stand/walk four hours in an eight-hour workday (with a likely ability to stand for two hours at a time), walk five hours in an eight-hour workday (with a likely ability to walk for one hour at a time), and sit six hours in an eight-hour workday (with a likely ability to sit for three hours at a time) (Ex. 10F-9), the undersigned finds it unpersuasive as it is unsupported by Mr. Fine’s noted examination findings and the cumulative record. As noted by Mr. Fine, the claimant was ambulatory with a non-antalgic gait and capable of transitioning on and off the examination table without assistance (Ex. 10F-3).
When asked, the claimant demonstrated a full range of cervical motion (Ex. 10F-6). No pain was elicited with palpation. The claimant demonstrated decreased ranges of lumbar motion (Ex. 10F-6). Mild to moderate lordosis of the lumbar spine was noted; however, no pain was elicited with palpation. Straight leg testing was positive on the right at
seventy degrees in the supine position. Mild lower extremity discomfort was noted with lumbar range of motion testing (Ex. 10F-7).117
The Court finds that the ALJ’s reasoning is deficient both as to PA Fine’s opinions regarding lifting and carrying, and PA Fine’s opinions regarding standing, walking, and sitting. Regarding Plaintiff’s ability to lift and carry, the ALJ ignores the crucial fact that on examination PA Fine found that Plaintiff had an obvious deformity in her hands indicating at least moderate arthritis. This is consequential because that objective finding supports PA Fine’s opinions regarding Plaintiff’s limitation to lifting and carrying no more than 15 pounds.
The ALJ erred in her analysis of the consistency factor when evaluating PA Fine’s opinions. While the ALJ recited that Plaintiff retained a certain level of dexterity in her hands, she failed entirely to discuss the fact that PA Fine found weakness in Plaintiff’s wrists. A lifting and carrying restriction would not be primarily dependent upon dexterity, but rather on strength. PA Fine’s examination indicated
Similarly, the ALJ’s reasoning as to the consistency of PA Fine’s opined standing, walking, and sitting limitations is flawed. While the ALJ properly recites that Plaintiff’s examination indicated decreased range of motion in the lumbar spine, mild to moderate lordosis of the lumbar spine, and a positive straight leg raising, she fails to acknowledge that based on those findings PA Fine diagnosed degenerative joint disease of the lumbar spine with radiculopathy.118
Straight leg raising is indicative of a nerve root impingement.119 As noted previously, there is no indication that the ALJ has medical training which would allow her to interpret the raw medical data and make her own medical
The ALJ’s reasoning is also flawed as to the supportability factor. Plaintiff’s treatment for carpal tunnel was first noted on September 11, 2019, when she first reported to Dr. Hardy that she had pain in her hands since approximately September 2018 but it had significantly worsened recently and he found her positive for Tinel’s and Phalen’s signs.121 In the following two years, Plaintiff was noted on several occasions to have positive Tinel’s signs and Phalen’s sign and an objective nerve conduction study confirmed the diagnosis of carpal tunnel syndrome.122 Rather than discuss those findings, the ALJ
In short, the medical record is clear that in 2021, when examined by PA Fine, Plaintiff suffered from carpal tunnel syndrome bilaterally, as well as a least a moderate deformity to her metacarpal joints due to osteoarthritis. While the record is clear that Plaintiff’s ability to use her hands was extremely limited by 2023 and 2024, it is less clear what Plaintiff’s ability was to handle and finger in 2021, prior to her date last insured.
The Court concludes that remand is warranted for the ALJ to properly develop the record and to obtain medical expert testimony as to Plaintiff’s physical limitations during the period at issue.
Dr. Genthe rendered two opinions regarding the limitations assessed as a result of Plaintiff’s mental impairments, the first in January 2018125 and the second in November 2020.126 In her prior appeal to this Court, Plaintiff’s arguments focused on the latter November 2020 opinions, and the Court addressed only Dr. Genthe’s 2020 opinions. Plaintiff alleged that the ALJ erred by finding that Dr. Genthe’s November 2020 opinions were persuasive but then formulating an RFC in conflict with Dr. Genthe’s opinion that until her condition was adequately treated with medication Plaintiff did not appear to be adequately targeting interfering symptoms, which are likely to interfere with her ability to initiate or maintain future employment.127
In the prior Order remanding the case for further proceedings, the Court directed that the ALJ more properly articulate her
The ALJ addressed Dr. Genthe’s November 2020 opinion as follows:
Taken as a whole, Dr. Genthe assessed agoraphobia (Ex. 11F-5). Additional notations read, “Based on general observations and her mental status, [Pauline] is likely able to understand and remember short, simple instructions. She is unlikely able
to understand and remember detailed instructions. She is likely able to carry out short, simple instructions in a reasonable amount of time. She is likely unable to carry out detailed or complicated instructions in a reasonable amount of time. She is likely able to maintain attention and concentration for brief periods of time, but unlikely for extended periods of time. She is likely able to perform simple work-like activities at a consistent pace. She is unlikely able to respond appropriately to changes in the work setting. She is able to maintain a regular work schedule and complete a normal 40-hour work-week based on the aforementioned criteria” (Ex. 11F 5-6).131
Plaintiff is correct that the ALJ did not address the fact that Dr. Genthe opined that Plaintiff’s symptoms are likely to interfere with her ability to obtain and maintain employment. Additionally, the ALJ recited Dr. Genthe’s statement that Plaintiff’s thought content was abnormal but did not address the inconsistent prior statement that it was not.
To the extent that the Court has remanded the case for consideration of PA Fine’s opinions, the ALJ will be required to reconsider the medical opinions in general. The Court suggests that the ALJ more properly articulate his or her findings regarding the
5. Summary
Because the ALJ did not give good reasons for her evaluation of the medical opinions in the record, a remand is warranted. On remand, the ALJ is directed to properly consider the medical evidence and, to develop the record further by ordering a consultative examination or calling a medical expert to testify as to Plaintiff’s physical and mental impairments.
B. Plaintiff’s Subjective Complaints, Step-Five Findings and Formulated RFC: The Court finds these issues moot.
Plaintiff argues the ALJ failed to properly assess her subjective complaints. As discussed above, the ALJ failed to consider the medical record as a whole when considering the medical opinions. Because the Court has remanded the case for consideration of the record as a whole, the ALJ will be required to consider the credibility of Plaintiff’s subjective complaints, to formulate an RFC based on those finding and to make findings at Step Five.
Plaintiff submits a remand for payment of benefits is warranted. The decision whether to remand a case for additional evidence, or simply to award benefits, is within the discretion of the court.”132 When the court reverses an ALJ’s decision for error, the court “ordinarily must remand to the agency for further proceedings.”133
The Court finds that further development of the record is necessary for a proper disability determination. The ALJ should obtain medical expert testimony, properly consider the opinion evidence and testimony, and make findings at each of the five steps of the sequential evaluation process.
Accordingly, IT IS HEREBY ORDERED:
1. The ALJ’s nondisability decision is REVERSED, and this matter is REMANDED to the Commissioner of Social Security for further proceedings pursuant to sentence four of 42 U.S.C. § 405(g).
2. The Clerk’s Office shall TERM the parties’ briefs, ECF Nos. 16 and 18, enter JUDGMENT in favor of Plaintiff, and CLOSE the case.
IT IS SO ORDERED. The Clerk’s Office is directed to file this order and provide copies to all counsel.
DATED this 6th day of March, 2026.
EDWARD F. SHEA
Senior United States District Judge