USCA4 Appeal: 24-1414 Doc: 30 Filed: 01/08/2025 Pg: 1 of 14

UNPUBLISHED

UNITED STATES COURT OF APPEALS FOR THE FOURTH CIRCUIT

No. 24-1414

JASMINE BOULDEN,

Plaintiff - Appellant,

v.

MARTIN J. O’MALLEY, Commissioner of Social Security,

Defendant - Appellee.

Appeal from the United States District Court for the Eastern District of Virginia, at Alexandria. Patricia Tolliver Giles, District Judge. (1:23−cv−00465−PTG−LRV)

Submitted: December 2, 2024 Decided: January 8, 2025

Before KING, WYNN, and THACKER, Circuit Judges.

Affirmed by unpublished per curiam opinion.

ON BRIEF: Clifford M. Farrell, MANRING & FARRELL, Dublin, Ohio, for Appellant. Jessica D. Aber, United States Attorney, Richmond, Virginia, Matthew J. Mezger, Assistant United States Attorney, OFFICE OF THE UNITED STATES ATTORNEY, Alexandria, Virginia, for Appellee.

Unpublished opinions are not binding precedent in this circuit. USCA4 Appeal: 24-1414 Doc: 30 Filed: 01/08/2025 Pg: 2 of 14

PER CURIAM:

Jasmine Boulden appeals the district court’s decision to grant summary judgment to

the Commissioner of Social Security related to the denial of her application for Social

Security disability benefits. She argues that the agency’s Administrative Law Judge

incorrectly evaluated the medical opinions in the record by failing to account for the risk

of absenteeism that her diagnoses posed. We affirm.

I.

Boulden has struggled with bipolar disorder and serious anxiety accompanied by

panic attacks for many years. 1 These diagnoses have made it difficult for her to maintain

steady employment. So, on August 27, 2020, at thirty years old, Boulden filed an

application for supplemental security income, alleging disability beginning on that same

date. 2

In June 2021, clinical psychologist Dr. Robert Verdile met with Boulden to conduct

a consultative psychological evaluation. As relevant here, his written report concluded that

Boulden’s “[p]anic attacks and coping through withdrawal would interfere with work

attendance to a severe degree.” J.A. 2423. 3

The following month, state agency psychologist Dr. Nicole Sampson reviewed the

record for the Social Security Administration and wrote that Boulden’s “ability to perform

activities within a schedule, maintain regular attendance, and be punctual within customary

Boulden also has other mental and physical diagnoses, but they are not relevant 1

for purposes of this appeal. 2 Boulden initially alleged an onset date of June 1, 2016, but later amended the date. 3 Citations to the “J.A.” refer to the Joint Appendix filed by the parties in this appeal.

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tolerances” was “Moderately Limited,” and that “[s]he may have occasional difficulty

focusing and concentrating but in general she can complete a normal work day and work

week,” although “[s]he might miss 1–2 days/month due to depression and anxiety.” J.A.

99. Based on Dr. Sampson’s review, the agency denied Boulden’s claim.

Boulden sought reconsideration, and in December 2021, state agency psychologist

Dr. Eric Oritt reviewed the record for the agency and agreed with Dr. Sampson’s

conclusions. He stated that Boulden “may have occasional difficulty focusing and

concentrating,” “would need a few breaks” during the workday, and may “miss a few days

of work in a month,” but he determined that “she can complete a general work day and

work week.” J.A. 106. The agency again concluded that Boulden was not disabled.

At the same time, during 2021, Boulden needed to reduce certain medications due

to pregnancy, leading to a temporary relapse of some of her symptoms. She was able to

return to the previous dosages of her medications soon after giving birth in early 2022.

Nevertheless, in May 2022, Boulden’s case manager, counselor Matilde Sarmiento Reyes,

completed a “medical source statement” that indicated some serious limitations on her

ability to work. For example, the evaluation stated that Boulden “has a severe and chronic

mental illness,” “benefits from breaks when she feels too depressed and anxious,” is

“[i]ncapable of even low-stress jobs,” and would require extra breaks during a workday.

J.A. 3602–03. Sarmiento Reyes twice indicated that Boulden would be anticipated to be

absent from work “[m]ore than three times a month”; elsewhere, she indicated that the

absences would only be “[a]bout twice a month.” Compare J.A. 3604, and J.A. 3607, with

J.A. 3611.

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Following the agency’s denial of reconsideration, Boulden requested a hearing

before an Administrative Law Judge (“ALJ”), which took place in June 2022. At the

hearing, a vocational expert testified that “three [missed days of work] per month is

considered high absenteeism,” and missing three days per month “would definitely reduce

your chance of continued employment,” because “[m]ost employers may accept one per

month.” J.A. 54–55. For her part, Boulden testified that “when [she] think[s] about

working, . . . [she] go[es] into full panic mode,” and that even without working, she was

having panic attacks “three to four times a week.” J.A. 58–59.

Soon after the hearing, the ALJ issued a decision denying benefits. The ALJ

concluded that Boulden’s “statements concerning the intensity, persistence and limiting

effects of [her] symptoms [were] not entirely consistent with the medical evidence and

other evidence in the record” and were “inconsistent with the longitudinal medical

evidence of record, which [did] not support the degree of alleged impairment, or a finding

of disability.” J.A. 23. Instead, he concluded that Boulden’s bipolar disorder and anxiety

left her with a residual functional capacity that was “limited to performing simple 1–4 step,

routine, repetitive tasks in a low stress work environment, defined as requiring only

occasional decision making and occasional changes in the work setting, where there would

only be occasional contact with co-workers and supervisors, and no contact with the

general public, and which would not require a fast pace or production quotas such as would

customarily be found on an assembly line.” J.A. 22.

To support this conclusion, the ALJ cited sources from the medical record, including

notes from Boulden’s primary-care visits from July 2020 to December 2020 “generally

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show[ing] mental status exams within normal limits, stable mood, and no reports of anxiety

and depression”; September 2021 notes reporting that Boulden’s “mood was up and down,

but mostly okay,” though “[s]he was tearful when discussing a transition to a new

therapist”; October 2021 notes indicating “the need for titration of psychotropic

medications due to pregnancy”; December 2021 notes indicating “that it was unclear if

[Boulden]’s symptoms of depression were related to her pregnancy status”; and March

2022 notes indicating a serious depressive episode, leading Boulden’s provider “to restart

psychotropic medications.” J.A. 24–25.

The ALJ concluded that the “records show[ed] stability in 2020, with an

exacerbation of symptoms with pregnancy,” and noted that Boulden “did not resume [one

of her medications after pregnancy] until . . . approximately April 2022.” J.A. 25–26.

Nevertheless, the ALJ stated, “records show the ability to adhere to a schedule and provide

care for an infant.” J.A. 26. So, the ALJ concluded, “[o]verall, the degree of limitations

alleged is unsupported by the objective record.” Id.

As for the four medical evaluations, while the ALJ found the opinions of Dr.

Sampson, Dr. Oritt, and Dr. Verdile to be “somewhat persuasive,” he concluded that their

opinions were “not fully consistent with objective findings showing [Boulden was] more

functional than indicated” because her “[m]ental status examinations [were] relatively

normal notwithstanding [Boulden’s] report of psychiatric symptoms,” so “she should not

miss work excessively or require additional considerations than those outlined in the

residual functional capacity.” J.A. 26–27. The ALJ found counselor Sarmiento Reyes’s

opinion “not persuasive” because it “appear[ed] to be supported by [Boulden]’s subjective

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report of her limitations and not” Sarmiento Reyes’s “independent objective findings made

over the course of treatment” and was “inconsistent with [Boulden’s] relatively normal

mental status examinations.” J.A. 27.

Having established Boulden’s residual functional capacity, the ALJ turned to the

question of whether Boulden could return to any of her past relevant work and determined

she could not. Nevertheless, the ALJ assessed that, “[c]onsidering [Boulden]’s age,

education, work experience, and residual functional capacity, there [were] jobs that

exist[ed] in significant numbers in the national economy” that she could perform, such as

laundry folder, ticketer/tagger, and routing clerk for sorting mail and packages. J.A. 28

(emphasis omitted). For that reason, the ALJ concluded that Boulden was not disabled.

After the Appeals Counsel denied Boulden’s request for review, she filed a

complaint in district court, arguing that the ALJ failed to properly consider certain required

factors and that he erred by not including an absenteeism limitation in her residual

functional capacity. In a thorough report and recommendation, the magistrate judge

recommended that the district court grant summary judgment to the Commissioner of

Social Security. Boulden filed objections, but the district court overruled her objections

and adopted the report and recommendation. Boulden v. O’Malley, No. 1:23-cv-0465,

, at *1 (E.D. Va. Mar. 8, 2024). Boulden timely appealed.

II.

“The Social Security Act provides benefits to qualifying individuals who have a

disability, as defined by the Social Security Act.” Ard v. O’Malley,

, 615 (4th

Cir. 2024). Under the applicable regulations, the Social Security Administration undertakes

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“a five-step process to determine whether an applicant is disabled.”

(citing 20 C.F.R

§ 404.1520(a)). “The applicant has the burden at the first four steps[.]” Id. at 616. “If the

first three steps do not lead to a conclusive determination [as to whether the claimant is

disabled], the ALJ then assesses the claimant’s residual functional capacity, which is ‘the

most’ the claimant ‘can still do despite’ physical and mental limitations that affect her

ability to work.” Mascio v. Colvin,

(4th Cir. 2015) (emphasis added)

(quoting

(a)(1)).

On review of a denial of Social Security benefits, this Court “must uphold the

Commissioner’s decision ‘when an ALJ has applied correct legal standards and the ALJ’s

factual findings are supported by substantial evidence.’” Rogers v. Kijakazi,

(4th Cir. 2023) (quoting Brown v. Comm’r Soc. Sec. Admin.,

(4th

Cir. 2017)). “In reviewing for substantial evidence, we do not undertake to reweigh

conflicting evidence, make credibility determinations, or substitute our judgment for that

of the ALJ. Where conflicting evidence allows reasonable minds to differ as to whether a

claimant is disabled, the responsibility for that decision falls on the ALJ.” Hancock v.

Astrue,

(4th Cir. 2012) (cleaned up). “Yet even under this deferential

standard, we do not reflexively rubber-stamp an ALJ’s findings. To pass muster, ALJs must

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

Comm’r, Soc. Sec. Admin.,

(4th Cir. 2020) (cleaned up).

Previously, under the “treating physician rule,” ALJs were “required to accord more

weight to the medical opinion of a treating source than to that of a non-treating source when

evaluating conflicting medical opinion evidence.” Siders v. Comm’r of Soc. Sec. Admin.,

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No. 21-2329,

, at *1 (4th Cir. July 12, 2023) (per curiam). But for claims,

like Boulden’s, that were filed on or after March 27, 2017, a new regulation—20 C.F.R.

§ 416.920c—applies. 4 “[U]nder the new regulatory scheme applicable to medical opinion

evidence, an applicant’s ‘treating physicians are not entitled to special deference.’” Booker

v. Kijakazi, No. 22-1828,

, at *1 (4th Cir. May 25, 2023) (per curiam)

(quoting Bowers v. Kijakazi,

(8th Cir. 2022)); see

.920c(a) (“We will not defer or give any specific evidentiary weight, including

controlling weight, to any medical opinion(s) or prior administrative medical finding(s),

including those from your medical sources.”).

Instead, the agency considers all medical opinions using four listed factors—

“supportability,” “consistency,” “relationship with the claimant,” and “specialization”—as

well as “other factors that tend to support or contradict” the opinion.

.920c(c) (capitalization altered). The first two factors—supportability and

consistency—are “[t]he most important,” and the regulations require the agency to “explain

how [it] considered [those two] factors for a medical source’s medical opinions . . . in [its]

determination or decision.”

§ 416.920c(b)(2). By contrast, the agency “may, but [is] not

required to, explain how [it] considered the [other] factors.” Id.

“Supportability is the degree to which a provider supports their opinion with

relevant, objective medical evidence and explanation, and consistency is the degree to

4 While we have not yet addressed this regulation in published authority, we have discussed a parallel regulation that uses the same language,

.1520c. See Oakes v. Kijakazi,

(4th Cir. 2023).

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which a provider’s opinion is consistent with the evidence of other medical and non-

medical sources in the record.” Oakes v. Kijakazi,

(4th Cir. 2023)

(discussing same language in

.1520c(c)(1)–(2)); see

.920c(c)(1)–(2).

III.

On appeal, Boulden argues that the ALJ erred in conducting his supportability and

consistency analysis of the four opinions contained in the record: those of Dr. Verdile, Dr.

Sampson, Dr. Oritt, and counselor Sarmiento Reyes. She contends that all four medical

opinions indicated that she “would have some sort of issue maintaining regular attendance

if employed” and appears to contend that the ALJ erred by rejecting an absenteeism

element in her residual-functional-capacity assessment without adequate explanation.

Opening Br. at 17; see id. at 22.

We disagree. The ALJ recognized that the four opinions each included some

statement related to absenteeism. See J.A. 26–27 (noting that Dr. Sampson “indicated

[Boulden] was moderately limited in her ability to . . . maintain regular attendance”; that

Dr. Oritt “adopted [Dr. Sampson’s] mental opinion”; that Dr. Verdile concluded that

Boulden’s “[p]anic attacks would interfere with work attendance”; and that Sarmiento

Reyes concluded that Boulden “would likely be absent from work more than three times

per month”). But he rejected these views, concluding that Boulden “should not miss work

excessively or require additional considerations than those outlined in the residual

functional capacity.” Id. This was because, in his view, none of the opinions were fully

“consistent with objective findings showing [Boulden] is more functional than indicated”

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because her “[m]ental status examinations are relatively normal notwithstanding her report

of psychiatric symptoms.” J.A. 26.

Boulden argues that the ALJ’s analysis was deficient because he supported this

point with citations to only “one exhibit and four separate pages in that exhibit” out of “a

record that was over 3,600 pages long.” Opening Br. at 31. Further, she notes, those four

pages were notes from a primary care provider, not a mental health specialist. But our

review of the record confirms relatively normal mental status examinations over the course

of years and in treatment notes from a variety of providers, including Boulden’s

psychiatrist, primary care providers, and case managers. The ALJ did not need to cite every

single such source to support his conclusion. E.g., Reid v. Comm’r of Soc. Sec.,

(4th Cir. 2014) (“While the Commissioner’s decision must contain a statement of

the case, in understandable language, setting forth a discussion of the evidence, and stating

the Commissioner’s determination and the reason or reasons upon which it is based, there

is no rigid requirement that the ALJ specifically refer to every piece of evidence in his

decision.” (cleaned up)). And the ALJ did cite significant other record evidence elsewhere

in his opinion, making clear he reviewed the record closely.

In reaching this conclusion, we do not intend to minimize Boulden’s diagnoses. And

we recognize that normal mental status examinations are not necessarily inconsistent with

the notion that employment will cause her to experience panic attacks, which in turn could

lead to absenteeism. After all, a normal mental status examination in a familiar

environment does not preclude the possibility of an acute panic attack brought on by an

unfamiliar one. But the question before us is not whether we would have reached the same

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conclusion as the ALJ if we were in his shoes. See Hancock,

(“[W]e do

not undertake to . . . substitute our judgment for that of the ALJ. Where conflicting evidence

allows reasonable minds to differ as to whether a claimant is disabled, the responsibility

for that decision falls on the ALJ.” (cleaned up)). The ALJ was entitled to draw his own

conclusions from the record evidence. And here, we can trace the ALJ’s reasoning from

that evidence to his conclusion. See Arakas,

.

Additionally, our resolution of this appeal is informed by this Court’s recent

decision in a highly similar case, Turner v. Commissioner of Social Security, No. 23-1760,

(4th Cir. May 30, 2024) (per curiam), which involved the same

appellate counsel for both parties. In that case, claimant Chyanne Turner sought disability

benefits based on mental impairments. Id. at *2. The record included opinions from state

agency psychologists (who agreed that Turner would be able to complete a normal workday

and work week, with one or two problems with attendance and punctuality per month) and

treating psychologists (one of whom opined that Turner’s diagnoses would cause her to be

absent more than three times per month). Id. The ALJ found the former group of opinions

partially persuasive, found the treating psychologists’ opinions not persuasive, and

ultimately denied benefits. Id. at *3. In so concluding, the ALJ noted that Turner’s

testimony was “not entirely consistent” with the evidence, including evidence regarding

her ability to take care of her activities of daily living and seek employment as well as,

notably, her “numerous unremarkable mental status examination findings.” Id.

Like Boulden, on appeal, Turner challenged the ALJ’s omission of “a limitation

relating to absenteeism when calculating her residual functional capacity.” Id. at *1. But

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this Court affirmed, noting that the ALJ had appropriately evaluated the record and

“explained why he found some limitations appropriate and why he rejected other

limitations” and “why he credited some of the [medical] opinions over others.” Id. at *4.

We emphasized that “[c]alculating a claimant’s” residual functional capacity—which,

again, is “the most that a claimant is able to do on a sustained basis despite any limitations

from her physical and mental impairments”—“is the Commissioner’s responsibility and

prerogative, so long as it accurately reflects the record evidence.” Id. at *1, *5.

Boulden’s counsel makes no attempt to distinguish this on-point case, argue that we

should decline to follow it because it is unpublished and therefore not binding, or otherwise

respond to the Commissioner’s invocation of it in his brief. Instead, counsel raises only

unconvincing arguments about supportability and consistency. We have evaluated some of

those arguments above. Two points remain to be addressed.

First, Boulden argues that the four medical opinions were “uncontradicted and

overwhelmingly consistent” regarding absenteeism. Opening Br. at 15; accord id. at 34.

That overstates the case. The opinions were arguably contradicted—as the ALJ believed—

by evidence “show[ing] the ability to adhere to a schedule and provide care for an infant”

and “relatively normal” mental status examinations. J.A. 26. And they were not entirely

consistent with each other. Dr. Verdile and counselor Sarmiento Reyes expressed certainty

that Boulden’s diagnoses would significantly interfere with her ability to attend work. See

J.A. 2423 (Dr. Verdile concluding that “[p]anic attacks and coping through withdrawal

would interfere with work attendance to a severe degree”); J.A. 3604, 3607, 3611

(counselor Sarmiento Reyes stating that absences would either be “[m]ore than three times

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a month” or “[a]bout twice a month”). By contrast, Dr. Sampson and Dr. Oritt expressed

confidence that Boulden could work full days and weeks—and concluded she was not

disabled—while noting a possibility that she might miss some work. See J.A. 99 (Dr.

Sampson concluding that Boulden’s ability to “maintain regular attendance” was

“Moderately Limited” and “[s]he might miss 1–2 days/month due to depression and

anxiety,” but “in general she can complete a normal work day and work week”); J.A. 106

(Dr. Oritt concluding that Boulden “can complete a general work day and work week,”

although her diagnoses “may cause her to miss a few days of work in a month”).

Second, Boulden reads bad faith into the ALJ’s supportability evaluation of the

opinions of Dr. Sampson and Dr. Oritt, in which the ALJ noted that the doctors “supported

their opinions with explanations based on a review of the available records at that time.”

J.A. 26. Boulden contends that the ALJ was “insinuat[ing] that there was evidence

submitted after [the doctors’] reports were completed that would have altered their

opinions,” thus “creat[ing] an escape hatch to safely navigate around any opinions the ALJ

disliked.” Opening Br. at 24–25. The ALJ did no such thing. He merely acknowledged that

the record before him included medical records that Dr. Sampson and Dr. Oritt were not

privy to because they had not yet been produced when they conducted their evaluations,

and recognized that the doctors appropriately supported their opinions based on the

evidence before them. There is nothing sinister in the ALJ’s statement.

IV.

For the foregoing reasons, the district court’s decision granting summary judgment

to the Commissioner is affirmed.

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AFFIRMED

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