govinfo:USCOURTS-njd-1_25-cv-04478-0

UNITED STATES DISTRICT COURT 
DISTRICT OF NEW JERSEY 
 
 
AMY R., 
 
Plaintiff, 
v. 
COMMISSIONER OF SOCIAL 
SECURITY, 
 
Defendant. 
 
 
 
 
No. 25-cv-04478 
 
OPINION 
 
 
APPEARANCES: 
Jennifer Lilley Stonage 
Richard Lowell Frankel 
B
ROSS & FRANKEL 
725 Kenilworth Avenue, Suite 2 
Cherry Hill, NJ 08002 
 
 On behalf of Plaintiff. 
 
Andrew Charles Lynch 
S
OCIAL SECURITY ADMINISTRATION 
LAW & POLICY, PROGRAM LITIGATION 3 
6401 Security Boulevard 
Baltimore, MD 21235 
 
On behalf of Defendant. PageID:
<pageID>
2 
 
O’HEARN, District Judge. 
This matter comes before the Court on Plaintiff Amy R.’s1 (“Plaintiff”) second appeal from 
a denial of Social Security benefits by the Commissioner of Social Security ( “Commissioner”). 
(ECF No. 4). The Court heard argument on May 26, 2026, and entered an Order reversing the 
Commissioner’s decision and awarding benefits. (ECF No. 18). This Opinion supplements the 
Court’s Order. 
I. BACKGROUND 
The Court recites only those facts necessary for its determination. 
A. Administrative History 
Plaintiff filed applications for Disability Insurance Benefits (“DIB”) and Supplemental 
Security Income (“SSI”) on February 20, 2017, alleging disability beginning November 30, 2014. 
(AR 728–29). Her claims were denied initially on July 29, 2017, and upon reconsideration on 
October 6, 2017. (AR 19). Plaintiff then requested a hearing before an Administrative Law Judge 
(“ALJ”). (Id.). 
The ALJ held a hearing on June 10, 2019. (AR 19). Plaintiff appeared and testified, and a 
vocational expert (“VE”) testified. (Id.). On September 11, 2019, the ALJ issued an unfavorable 
decision, finding Plaintiff not disabled within the meaning of the Social Security Act. (AR 728) . 
Plaintiff sought review before the Appeals Council, which denied her request on July 30, 2020, 
rendering the ALJ’s decision the final decision of the Commissioner. (AR 1–6). 
Plaintiff filed an appeal in this District. On July 29, 2021, the Hon. Noel L. Hillman (Ret.) 
entered a consent order reversing the Commissioner’s decision and remanding the matter for 
 
1 Pursuant to this Court’s Standing Order 2021- 10, this Opinion will refer to Plaintiff solely 
by first name and last initial. PageID:
<pageID>
3 
 
further administrative proceedings pursuant to 42 U.S.C. § 405(g). (AR 715–16). On October 13, 
2021, the Appeals Council vacated the Commissioner’s final decision and remanded the case to 
the same ALJ. (AR 719–22). 
The Appeals Council’s remand order identified several deficiencies in the prior 
administrative decision. (Id.). Relevant here, the Council specifically noted that, although the ALJ 
found Plaintiff’s irritable bowel syndrome (“IBS”) to be a severe impairment, the ALJ did not 
adequately explain how that impairment affected Plaintiff’s functioning or how unremarkable 
abdominal findings in the record negated Plaintiff’s reports of IBS symptoms, bathroom 
frequency, and interstitial cystitis. (AR 720). The ALJ was directed to further evaluate Plaintiff’s 
alleged symptoms, including the limiting effects of Plaintiff’s IBS and related impairments. (AR 
721). 
On remand, the ALJ consolidated Plaintiff’s 2017 applications with subsequent Title II and 
Title XVI applications filed in 2020. (AR 728–29). The ALJ held a second hearing on October 16, 
2023, at which Plaintiff again appeared and testified. (AR 728). At this second hearing, a different 
VE testified. (Id.). 
On November 22, 2023, the ALJ issued a second unfavorable decision. (AR 728–58). The 
Appeals Council denied review , making the ALJ’s decision the final decision of the 
Commissioner. (Pl.’s Br., ECF No. 8 at 6). Plaintiff then commenced this action seeking judicial 
review under 42 U.S.C. § 405(g). 
B. Plaintiff’s Background and Testimony 
Plaintiff was born on November 5, 1972. (AR 756) . She was forty -two years old on her 
alleged disability onset date of November 30, 2014, and later changed age categories to an PageID:
<pageID>
4 
 
individual closely approaching advanced age. ( Id.). Plaintiff has at least a high school education 
and past relevant work as a fashion designer and design department manager. (AR 756–57). 
Plaintiff alleges disability based on a combination of physical and mental impairments, 
including degenerative disc disease, adhesive capsulitis affecting both shoulders, IBS, interstitial 
cystitis, major depressive disorder, and post-traumatic stress disorder (“PTSD”). (AR 731). 
Relevant here, with respect to her IBS and interstitial cystitis symptoms, Plaintiff testified 
at the 2019 hearing that she experienced intense stomach pain due to severe constipation, that her 
stomach became distended, and that she needed laxatives to move her bowels. (AR 63–64, 737). 
She described bowel movements as painful and accompanied by colon spasms, gas, and sweating. 
(Id.). She further testified that she could not fully empty her bladder and experienced a burning 
sensation similar to a urinary tract infection that “will never go away.” (Id.). 
At the post-remand hearing on October 16, 2023, Plaintiff testified that her condition had 
worsened. She stated that she had ongoing pain, constipation, and other stomach issues, and that a 
colonic bag had been recommended. (AR 737). She testified that she used the bathroom frequently, 
approximately every thirty to forty-five minutes, and that each time she could be in the bathroom 
for fifteen minutes to more than an hour. (AR 697, 704, 737–38). She also testified that she used 
sanitary pads and sometimes needed assistance getting from the bathroom back to bed. (AR 738). 
At the 2019 hearing, the VE testified that an individual who was off task more than five 
percent of the workday, in addition to ordinary breaks, would be unable to find work. (AR 82). At 
the 2023 hearing, the VE testified that if an individual would be off task for fifteen percent or more 
of the workday that would be work preclusive. (AR 709–10). 
C. Medical History 
Given the extensive administrative record in this case, the Court will briefly summarize the PageID:
<pageID>
5 
 
relevant medical evidence for purposes of this appeal. This recitation is not comprehensive and 
does not address all of Plaintiff’s alleged impairments. 
With respect to Plaintiff’s IBS and gastrointestinal symptoms, treatment records document 
complaints of chronic constipation, abdominal distention, and gas -related pain. In October 2018, 
Anthony Albert-Puleo, M.D., referred Plaintiff to a gastroenterologist. (AR 486). Plaintiff reported 
that, despite increasing lactulose, she had not experienced significant improvement in her 
constipation and had increased left lower quadrant cramping. ( Id.). On examination, she ha d 
abdominal tenderness. (AR 487). She was diagnosed with abdominal distention, gas pain, and IBS 
with constipation. (Id.). Plaintiff reported in February 2019 that, despite laxative use, she was still 
experiencing constipation, abdominal distention, gas-like discomfort, and anal leakage. (AR 617). 
A March 2019 colonoscopy showed a diffuse area of moderate melanosis in the colon and non-
bleeding internal hemorrhoids. (AR 589). 
Later medical evidence continued to document bowel -related symptoms and abnormal 
findings. A November 2021 visit documented prior anorectal manometry showing obstructive 
defecation with paradoxical contractions. (AR 1277) . Plaintiff continued seeking treatment from 
gastrointestinal specialists at Jefferson Health , and those records noted moderate abdominal 
distention and hypoactive bowel sounds. (AR 1197, 1201, 1209) . Plaintiff also sought treatment 
at Cooper Digestive Health Institute for chronic idiopathic constipation, obstructive defecation, 
abdominal distension and pain, and small intestinal bacterial overgrowth (“SIBO”). (AR 1251). At 
a February 2022 exam, her abdomen was again noted to be distended. (AR 1259). Colon x-rays in 
July 2022 showed a moderate -to-severe stool load, while a sitz -marker study showed markers 
throughout the colon, consistent with colonic motility. (AR 743, 1133, 1201). 
Plaintiff’s urinary symptoms were also documented throughout the record. In September PageID:
<pageID>
6 
 
2018, Plaintiff presented to Delaware Valley Urology with a history of pelvic floor spasms for 
approximately ten years, with increased spasms over the preceding weeks. (AR 495). She reported 
a sense of incomplete bladder emptying and was diagnosed with chronic interstitial cystitis. ( AR 
495–96). Her urinary and pelvic symptoms required physical therapy aimed at improving sleep, 
decreasing pain, and managing frequent urination. (AR 503). 
The record also reflects more invasive urinary treatment. On July 27, 2021, Plaintiff 
underwent cystoscopy with bladder overdistension, bladder instillation, and biopsy. (AR 898) . 
Two days later, she complained of bladder pain and underwent a “voiding trial” involving 
catheterization for release of urine. (AR 1058) . A related procedure was performed again on 
August 3, 2021. (AR 1059) . Despite these procedures, Plaintiff continued to report burning and 
pain. (AR 1066). She was also diagnosed with myalgia of the pelvic floor. (AR 1070). 
Plaintiff’s treating providers connected these conditions to functional limitations in 
medical source statements. In 2019, Kristine Sweeney, APN, noted Plaintiff’s IBS and interstitial 
cystitis, among other conditions, and reported that she experienced frequent bowel movements that 
were at times uncontrollable. (AR 581–83).
2 She opined that Plaintiff’s IBS could cause her to be 
off task twenty-five percent or more of the workday and absent more than four days per month. 
(AR 584–86). In 2023, Dr. Albert-Puleo and Lori Proi, FNP, noted symptoms including fecal 
urgency, abdominal distension and pain, anal fissures, and frequent and unpredictable bowel 
movements. (AR 1663–64). 3 They further opined that Plaintiff would require at least seven 
 
2 Although Plaintiff’s brief attributes this opinion to Dr. Albert-Puleo, (ECF No. 8 at 12–13), 
it appears to be signed by Nurse Sweeney, who worked with Dr. Albert-Puleo, and the ALJ referred 
to it as Sweeney’s opinion. (AR 751). Accordingly, the Court will also consider this record as 
Nurse Sweeney’s opinion. 
 
3 The ALJ referred to this record as a joint opinion of both providers and so the Court does 
as well. (See AR 751). PageID:
<pageID>
7 
 
unscheduled restroom breaks per day, lasting at least fifteen to twenty minutes each. (AR 1666). 
II. LEGAL STANDARD 
A. Standard of Review 
In reviewing applications for Social Security disability benefits, this Court has the authority 
to conduct a plenary review of legal issues decided by the ALJ. Knepp v. Apfel , 204 F.3d 78, 83 
(3d Cir. 2000) (citation omitted). In contrast, the Court reviews the ALJ ’s factual findings to 
determine if they are supported by substantial evidence. Sykes v. Apfel, 228 F.3d 259, 262 (3d Cir. 
2000) (citations omitted); see also 42 U.S.C. §§ 405(g), 1383(c)(3). The United States Supreme 
Court has explained this standard as follows: 
Under the substantial-evidence standard, a court looks to an existing administrative 
record and asks whether it contains sufficient evidence to support the agency’ s 
factual determinations. And whatever the meaning of substantial in other contexts, 
the threshold for such evidentiary sufficiency is not high. Substantial evidence, this 
Court has said, is more than a mere scintilla. It means —and means only—such 
relevant evidence as a reasonable mind might accept as adequat e to support a 
conclusion. 
 
Biestek v. Berryhill, 587 U.S. 97, 102–03 (2019) (internal citations, quotation marks, and alteration 
omitted); see also Bailey v. Comm’r of Soc. Sec., 354 F. App’x 613, 616 (3d Cir. 2009). 
The substantial evidence standard is a deferential standard, and an ALJ’s decision cannot 
be set aside merely because a court “ acting de novo might have reached a different conclusion.” 
Hunter Douglas, Inc. v. N .L.R.B., 804 F.2d 808, 812 (3d Cir. 1986) (citations omitted); see also, 
e.g., Fargnoli v. Massanari, 247 F.3d 34, 38 (3d Cir. 2001) (“Where the ALJ’s findings of fact are 
supported by substantial evidence, we are bound by those findings, even if we would have decided 
the factual inquiry differently.”) (citation omitted). “The presence of evidence in the record that 
supports a contrary conclusion does not undermine the Commissioner’s decision so long as the PageID:
<pageID>
8 
 
record provides substantial support for that decision.” Malloy v. Comm’r of Soc. Sec., 306 F. App’x 
761, 764 (3d Cir. 2009) (citation omitted). 
Nevertheless, the Third Circuit cautions that this standard of review is not “a talismanic or 
self-executing formula for adjudication.” Kent v. Schweiker , 710 F.2d 110, 114 (3d Cir. 1983) . 
“The search for substantial evidence is thus a qualitative exercise without which our review of 
social security disability cases ceases to be merely deferential and becomes instead a sham. ” Id. 
The Court has a duty to “‘review the evidence in its totality ,’ and ‘take into account whatever in 
the record fairly detracts from its weight.’” K.K. ex rel. K.S. v. Comm’r of Soc. Sec., No. 17-2309, 
2018 WL 1509091, at *4 (D.N.J. Mar. 27, 2018) (quoting Schonewolf v. Callahan, 972 F. Supp. 
277, 284 (D.N.J. 1997) ). Evidence is not substantial if “ it is overwhelmed by other evidence, ” 
“really constitutes not evidence but mere conclusion,” or “ignores, or fails to resolve, a conflict 
created by countervailing evidence. ” Wallace v. Sec’y of Health & Hum . Servs., 722 F.2d 1150, 
1153 (3d Cir. 1983) (citation omitted). Although an ALJ is not required “to use particular language 
or adhere to a particular format in conducting [the] analysis,” the decision must contain “sufficient 
development of the record and explanation of findings to permit meaningful review. ” Jones v. 
Barnhart, 364 F.3d 501, 505 (3d Cir. 2004) (citation omitted). 
B. Sequential Evaluation Process 
The Commissioner has promulgated a five -step, sequential analysis for evaluating a 
claimant’s disability, as outlined in 20 C.F.R. § 404.1520(a)(4)(i) –(v). The analysis proceeds as 
follows: 
At step one, the ALJ determines whether the claimant is performing “ substantial 
gainful activity[.]” If he is, he is not disabled. Otherwise, the ALJ moves on to step 
two. 
 
At step two, the ALJ considers whether the claimant has any “ severe medically 
determinable physical or mental impairment” that meets certain regulatory PageID:
<pageID>
9 
 
requirements. A “severe impairment ” is one that “ significantly limits [the 
claimant’s] physical or mental ability to do basic work activities[.]” If the claimant 
lacks such an impairment, he is not disabled. If he has such an impairment, the ALJ 
moves on to step three. 
 
At step three, the ALJ decides “whether the claimant’s impairments meet or equal 
the requirements of an impairment listed in the regulations[.] ” If the claimant’s 
impairments do, he is disabled. If they do not, the ALJ moves on to step four. 
 
At step four, the ALJ assesses the claimant ’s “residual functional capacity ” 
(“RFC”) and whether he can perform his “past relevant work.” A claimant’s “[RFC] 
is the most [he] can still do despite [his] limitations.” If the claimant can perform 
his past relevant work despite his limitations, he is not disabled. If he cannot, the 
ALJ moves on to step five. 
 
At step five, the ALJ examines whether the claimant “ can make an adjustment to 
other work[,]” considering his “[RFC,] . . . age, education, and work experience[.]” 
That examination typically involves “one or more hypothetical questions posed by 
the ALJ to [a] vocational expert.” If the claimant can make an adjustment to other 
work, he is not disabled. If he cannot, he is disabled. 
 
Hess v. Comm’r of Soc. Sec., 931 F.3d 198, 201–02 (3d Cir. 2019) (internal citations and footnote 
omitted) (alterations in original). 
On appeal, the plaintiff bears the burden of showing not merely that the ALJ erred, but that the 
error was harmful. Peter G. v. Comm’r of Soc. Sec., No. 23-3797, 2024 WL 3518117, at *3 (D.N.J. 
July 24, 2024); see also Holloman v. Comm’r Soc. Sec., 639 F. App’x 810, 814 (3d Cir. 2016). 
III. ALJ DECISION 
At step one, the ALJ found that Plaintiff had not engaged in substantial gainful activity 
since her alleged onset date of November 30, 2014. (AR 731). 
At step two, the ALJ found that Plaintiff had the following severe impairments: 
degenerative disc disease, adhesive capsulitis, IBS, interstitial cystitis, major depressive disorder, 
and PTSD. (AR 731) . The ALJ found other conditions, including COVID infection and alcohol 
dependence, non-severe. (AR 731–32). PageID:
<pageID>
10 
 
At step three, the ALJ found that none of Plaintiff’s impairments, alone or in combination, 
met or medically equaled a listed impairment. R elevant here, the ALJ found that IBS and 
interstitial cystitis did not meet or equal any listing under Categories 5.00 or 6.00. (AR 732–33). 
Before proceeding to step four, the ALJ assessed Plaintiff’s RFC and found that she could 
perform a reduced range of light work with physical and mental limitations. (AR 736) . In doing 
so, the ALJ acknowledged Plaintiff’s testimony about her frequent and prolonged bathroom use. 
(AR 737–38, 747). He further acknowledged the opinions of Plaintiff’s treating providers , Dr. 
Albert-Puleo and Nurse s Proi and Sweeney, which, as explained above, indicated that Plaintiff 
required frequent restroom breaks and ready access to a bathroom. (AR 751–52). 
The ALJ nevertheless declined to include any limitation for restroom access, unscheduled 
breaks, off -task time, or absenteeism. The ALJ reasoned that Plaintiff’s testimony about the 
intensity, persistence, and limiting effects of her symptoms was not entirely consistent with the 
record, citing what he characterized as “ conservative, albeit multi-form course of treatment,” 
including the lack of documented use of a colonic bag, no emergency -room visits or 
hospitalizations, and some relatively normal examination findings. (AR 738–44). The ALJ 
acknowledged the abnormal gastrointestinal and urinary findings, including abdominal tenderness 
and distention, obstructive defecation with paradoxical contractions, moderate -to-severe stool 
load, and cystoscopy findings. (AR 740–43). But he emphasized that a 2019 colonoscopy showed 
only moderate melanosis and non -bleeding hemorrhoids with an otherwise normal study; that a 
sitz-marker study showed markers throughout the colon consistent with colonic motility; and that 
a bladder biopsy showed “no significant” inflammation of the urothelial mucosa. (AR 743). With 
respect to the medical opinions in the record, the ALJ gave them little weight, again reasoning that 
“the record fails to reveal a repeated pattern of emergency room presentation or hospitalizations; PageID:
<pageID>
11 
 
exam findings of atrophy, contracture, cogwheeling motor deficits, or any noted pain behaviors 
upon exam … .” (AR 751–52). 
The ALJ ultimately concluded that the record evidence did not support limitation s to 
provide additional time for “restroom use, restroom access, off task or work absence limitations.” 
(AR 749). Instead, the ALJ concluded that Plaintiff’s gastrointestinal and urinary symptoms were 
accounted for by the overall RFC and limitations therein. (See AR 744, 748–49). 
At step four, the ALJ found that Plaintiff could not perform her past relevant work as a 
fashion designer or design department manager. (AR 756). 
At step five, relying on the VE testimony, the ALJ found that Plaintiff could perform other 
jobs existing in significant numbers in the national economy, including mail sorter, hand packager, 
and ticket tagger. (AR 757–58). The ALJ therefore concluded that Plaintiff was not disabled from 
November 30, 2014, through the date of the decision. (AR 758). 
IV. DISCUSSION 
In her appeal, Plaintiff makes two principal arguments: 1) that the ALJ failed to comply 
with the remand order and properly consider Plaintiff’s IBS and interstitial cystitis in formulating 
her RFC; and 2) the ALJ failed to assign proper weight to the opinions of treating physicians when 
evaluating Plaintiff’s other impairments. As explained below, because the Court agrees with 
Plaintiff’s first argument
4—and the Commissioner concedes that remand would be appropriate on 
 
4 Plaintiff argues that the failure to comply with the remand order is itself reversible legal 
error. (Pl.’s Br., ECF No. 8 at 25 (citing cases)). While that is correct when a district court remands 
with specific instructions, see Sullivan v. Hudson, 490 U.S. 877, 886 (1989) , here the remand 
instructions came from the Appeals Council, and courts have been divided over whether the failure 
to comply with a remand order of the Appeals Council itself is reversible legal error. See Mor v. 
Kijakazi, No. 21-1730, 2022 WL 73510, at *6 (D.N.J. Jan. 7, 2022). Although the Commissioner 
did not dispute this point, because the Court finds the ALJ’s decision is not supported by 
substantial evidence, it need not decide whether the failure to comply with the Appeals Council 
remand order is reversible error standing alone. PageID:
<pageID>
12 
 
this issue—it need not and does not reach Plaintiff’s second argument. The Court further finds that 
a second remand would be grossly unfair to Plaintiff and an inadequate remedy such that a direct 
award of benefits is appropriate. 
A. The ALJ Failed to Comply with the Remand Order and the RFC Determination 
Is Not Supported by Substantial Evidence 
 
Plaintiff first argues that the ALJ failed to comply with the Appeals Council’s remand order 
and did not sufficiently consider the limiting effects of her IBS and interstitial cystitis in 
formulating the RFC. (Pl.’s Br., ECF No. 8 at 24–30). The Court agrees. 
When this case was previously remanded , the Appeals Council identified a specific 
deficiency in the ALJ’s first decision: although the ALJ had found Plaintiff’s IBS to be a severe 
impairment, he did not explain how that impairment affected Plaintiff’s functioning. The Appeals 
Council further noted that the ALJ had relied on relatively unremarkable abdominal findings but 
had not explained “how those unremarkable findings negated the claimant’s reports of IBS 
symptoms, bathroom frequency and interstitial cystitis.” (AR 720). The Appeals Council therefore 
specifically directed the ALJ, on remand, to evaluate Plaintiff’s alleged symptoms, including the 
limiting effects caused by the claimant’s IBS and related impairments, and to reconsider Plaintiff’s 
RFC with appropriate rationale and specific references to the record. (AR 721). 
On remand, the ALJ acknowledged the issue somewhat more directly. He found both IBS 
and interstitial cystitis to be severe impairments —which necessarily means that he found they 
significantly limited Plaintiff’s ability to work. He also acknowledged Plaintiff’s testimony 
regarding her symptoms and her need to use the bathroom frequently and for prolonged periods , 
as well as the medical opinions consistent with her testimony . Nevertheless, he made no 
assessment or consideration of how those symptoms impacted Plaintiff and again formulated an PageID:
<pageID>
13 
 
RFC that contained no limitation for restroom access, unscheduled breaks, off -task time, or 
absences. 
In doing so, the ALJ did little more than summarily recite the above-noted testimony and 
opinions as well as the medical evidence. T he ALJ again failed to provide any explanation as to 
what, if anything, in the record contradicts Plaintiff’s testimony and the opinions of her treating 
providers that she required frequent and lengthy restroom breaks resulting in a substantial period 
of off-task time. The ALJ’s reasoning, or lack thereof, was virtually the same as in his previous 
decision; he again relied on a few unremarkable exam findings as well as a lack of extreme 
treatment measures. The Commissioner concedes that the first and second decisions of the ALJ in 
this regard are essentially indistinguishable. (Tr. at 6:10–14, 7:4–8, 10:4–8). Thus, as the Appeals 
Council previously indicated, there remains a lack of adequate analysis or explanation in this 
regard. 
The medical record contains significant evidence consistent with Plaintiff’s alleged 
impairments. Plaintiff has long sought treatment for IBS and related symptoms, including seeing 
gastrointestinal specialists. With respect to her urinary symptoms, the record likewis e documents 
Plaintiff’s longstanding complaints of frequent urination and difficulty emptying her bladder . 
Consistent with this evidence, her treating providers opined that Plaintiff needed ready restroom 
access, required unscheduled breaks, would be off task, and would be absent from work at a 
disabling level. Importantly, under the regulations applicable in this case, the opinions of a treating 
physician such as Dr. Albert -Puleo “ are entitled to substantial and at times even controlling 
weight.” E.g., Fargnoli, 247 F.3d at 43 (citing 20 C.F.R. § 404.1527(d)(2)). And an ALJ may not 
disregard a medical opinion from a treating physician “based solely on his own amorphous 
impressions, gleaned from the record and from his evaluation of the claimant ’s credibility .” PageID:
<pageID>
14 
 
Morales v. Apfel, 225 F.3d 310, 318 (3d Cir. 2000) (cleaned up). Judges, including ALJs, “must 
be careful not to succumb to the temptation to play doctor” as “lay intuitions about medical 
phenomena are often wrong.” Schmidt v. Sullivan, 914 F.2d 117, 118 (7th Cir. 1990). 
The ALJ acknowledged some of this evidence and these opinions but instead again pointed 
to evidence in the record which at best can be described as neutral, including a 2019 colonoscopy 
that revealed moderate melanosis of the colon and non- bleeding internal hemorrhoids “with an 
otherwise normal study,” a sitz -marker study “consistent with colonic motility” and a biopsy 
showing “no significant inflammation of the urothelial mucosa.” (AR 743 ). He further relied on 
the lack of extreme treatment such as use of a colonic bag or repeated hospitalization and a lack of 
observed pain behavior. (AR 738, 751–52). But despite the Appeals Council’s specific direction 
to do so, he failed to explain how this evidence negated or contradicted the testimony of Plaintiff 
and her treating providers’ opinions. 
The Court easily concludes that substantial evidence does not support the ALJ’s RFC 
determination. None of the evidence relied on by the ALJ contradicts Plaintiff’s testimony or the 
opinions of her providers about her need for frequent and prolonged use of the restroom . Indeed, 
the sitz -marker study on which the ALJ relies states that while “colonic motility is at least 
somewhat present, [Plaintiff] still may benefit from surgery as she seems to be largely refractory 
to medical therapy. ” (AR 1201). This tends to support Plaintiff’s testimony , not undermine it. 
Similarly, the colonoscopy revealed moderate melanosis —consistent with prolonged use of 
laxatives. In any event, the ALJ relied on this same colonoscopy in his previous decision, (AR 27), 
which, as explained above, the Appeals Council held was insufficient. The same is true here: a 
single, largely normal colonoscopy does not by itself contradict a need for frequent access to a PageID:
<pageID>
15 
 
restroom.5 Likewise, the fact that Plaintiff was not repeatedly hospitalized or did not use a colonic 
bag does not meaningfully address whether she needs to leave a workstation unpredictably to use 
the bathroom. Cf. Wilson v. Astrue , No. 07-0019, 2007 WL 4225507, at *9 (E.D. Pa. Nov. 28, 
2007) (“Simply because Plaintiff is not pursuing a course of surgery does not mean that the level 
or frequency of his treatment is inconsistent with his complaints of pain and other symptom s.”). 
Further, the record reflects that Plaintiff’s urinary symptoms were so severe that she underwent 
catheterization, indicating that significant treatment was sought. 
Other courts have remanded for similar deficiencies. Another court in this District 
remanded where the ALJ failed to address plaintiff’s evidence of needing to use the bathroom at 
least ten times per day which, if credited, could support a finding that she was unable to work in 
the competitive labor market. Williams v. Comm’r, Soc. Sec. Admin., No. 18- 13465, 2019 WL 
4574502, at *3 (D.N.J. Sept. 20, 2019). Another district court similarly remanded because the ALJ 
overlooked or misconstrued evidence concerning urinary frequency, leaving the court unable to 
conduct meaningful review of the RFC and symptom analysis. Souris v. Comm’r of Soc. Sec., No. 
20-00630, 2021 WL 2688480, at *9 (N.D. Ohio June 30, 2021). And the Fourth Circuit has also 
reached a similar conclusion , holding that an ALJ erred by failing to analyze whether the 
claimant’s RFC was affected by her need to work near a restroom and take frequent bathroom 
 
5 The Commissioner points out that Plaintiff’s gastroenterologist recommended a repeat 
colonoscopy in five years, suggesting a lack of urgency. (ECF No. 13 at 7 (citing AR 589) ; Tr. at 
8:9–12). As an initial matter, the ALJ did not proffer this as a reason for discounting Plaintiff’s 
testimony about her symptoms, and it is axiomatic that a court cannot consider the agency’s post-
hoc justifications offered in litigation. E.g., Dixon v. Astrue, No. 08-269, 2010 WL 891239, at *6 
n.4 (W.D. Pa. Mar. 8, 2010) (“[A] reviewing court may only consider the ALJ’s decision on the 
grounds on which it was based without reading into it reasoning or conclusions which are not 
clearly stated.”). Even if the Court were to consider this argument , it still does not contradict 
Plaintiff’s testimony. Neither this Court nor the ALJ is qualified to speculate about the frequency 
at which colonoscopies are required or recommended. PageID:
<pageID>
16 
 
breaks. Dowling v. Comm’r of Soc. Sec. Admin., 986 F.3d 377, 389 (4th Cir. 2021). These cases 
identify the same problem present here: where a limitation for restroom frequency is supported by 
testimony, medical evidence, and opinions—and may be outcome determinative as to disability—
the ALJ must sufficiently explain why that evidence is credited or rejected. 
In his brief, the Commissioner relies on the same evidence discussed above : the 
colonoscopy and sitz-marker study, a finding of no significant urothelial inflammation, and the 
absence of extreme treatment or hospitalization. But, as explained above, this evidence was either 
already rejected by the Appeals Council or, more importantly , does not contradict Plaintiff’s 
testimony about her need for frequent restroom use and time spent in the restroom or the medical 
opinions consistent with her testimony. It does not explain why her IBS and interstitial cystitis —
both of which the ALJ found to be severe—should impose no workplace limitation at all. 
The Commissioner also argues that the ALJ was entitled to rely on not only what the record 
says, but “what it does not say.” (Def.’s Br., ECF No. 13 at 8 (citing Lane v. Comm’r of Soc. Sec., 
100 F. App’x 90, 95 (3d Cir. 2004)). But the cited cases merely stand for the obvious point that an 
ALJ can rely on a lack of objective medical evidence and opinions in finding no disability. Lane, 
100 F. App’x at 95 (“Not one of Lane ’s treating physicians opined that she was unable to work, 
let alone meet the modest demands of sedentary work. This lack of medical evidence is very strong 
evidence that Lane was not disabled.”). Those cases do not support the Commissioner’s argument 
that the ALJ properly relied upon a lack of emergency room treatment or other extreme 
interventions as necessarily contradict ing Plaintiff’s testimony and the opinions of her treating 
providers. 
Indeed, at oral argument, counsel for the Commissioner ultimately conceded that at the 
very least a second remand would be appropriate given the similarities between the two ALJ PageID:
<pageID>
17 
 
decisions. (Tr. at 10:9–14). The Commissioner concedes that the ALJ’s second decision is virtually 
identical to the first with respect to its analysis of Plaintiff’s IBS and interstitial cystitis . (Tr. at 
6:10–12, 7:4–8, 10:4–8). As such, it necessarily failed to comply with the Appeals Council 
directive and cure the deficiencies identified therein. The Commissioner also does not dispute that 
if Plaintiff’s testimony or any one of her providers’ medical opinions were credited, the VE 
testimony would require a finding of disability. (Tr. at 1 3:7–12, 14:16–17:3). Indeed, the second 
VE testified that off -task time of fifteen percent or more would be work preclusive . Plaintiff 
testified that she needed to use the restroom approximately every thirty to forty- five minutes and 
that restroom use could last from fifteen minutes to more than an hour. Her treating providers, Dr. 
Albert-Puleo and Nurse Proi, opined that she would need at least seven restroom breaks lasting at 
least fifteen to twenty minutes each, i.e., about two hours out of a normal workday, and Nurse 
Sweeney further opined that she could be off task for twenty-five percent or more of the workday. 
Crediting any of those opinions or Plaintiff’s testimony would exceed the VE’s off-task threshold. 
Accordingly, the RFC determination is not supported by substantial evidence and the ALJ 
failed to comply with the remand order of the Appeals Council . As explained above, while the 
substantial-evidence standard is highly deferential, evidence is not substantial if “ it is 
overwhelmed by other evidence, ” “really constitutes not evidence but mere conclusion,” or 
“ignores, or fails to resolve, a conflict created by countervailing evidence. ” Wallace, 722 F.2d at 
1153. Here, the ALJ’s decision is best described as a mere conclusion which is unsupported by 
substantial evidence. The ALJ again failed to meaningfully assess the undisputed evidence 
showing Plaintiff’s need for frequent restroom use resulting in off-task time when formulating the 
RFC. Because that evidence is dispositive based on the VE testimony, the error is not harmless. PageID:
<pageID>
18 
 
B. A Direct Award of Benefits Is Appropriate 
Having determined that the ALJ’s decision cannot stand—and the Commissioner having 
conceded that remand would ordinarily be appropriate—the Court must decide whether to remand 
for further administrative proceedings or direct an award of benefits. 
In deciding whether to directly award benefits, a district court should consider 1) the delay 
in the case, including how long the case has been pending and the number of prior appeals and 
remands; and 2) whether the record has been fully developed and substantial evidence supports 
the finding of disability. See, e.g., Podedworny v. Harris, 745 F.2d 210, 221–23 (3d Cir. 1984) ; 
Morales, 225 F.3d at 320; Nunez ex rel. B.P. v. Kijakazi, No. 23-1461, 2024 WL 1482613, at *8–
9 (D.N.J. Mar. 26, 2024); Michelle R. Q. v. Bisignano, 807 F. Supp. 3d 462, 475 (E.D. Pa. 2025). 
An award of benefits “is especially appropriate when the disability determination process has been 
delayed due to factors beyond the claimant ’s control.” Brownawell v. Comm’r of Soc. Sec., 554 
F.3d 352, 358 (3d Cir. 2008). 
While the instances in which a court directly awards benefits are relatively sparse, those 
conditions are satisfied here. This case has been pending for an extraordinary length of time. 
Plaintiff filed her applications in February 2017, more than nine years ago. She has already 
proceeded through two administrative hearings, two ALJ decisions, Appeals Council review, and 
one prior federal-court remand. The delay alone weighs strongly against giving the Commissioner 
yet another opportunity to repair the same defect. The Commissioner estimates it would be at least 
six months to a year before Plaintiff would get a third hearing, let alone a decision and Appeals 
Council review. (Tr. at 18:2). As such, a remand would result in months if not years of additional 
delay for Plaintiff, which weighs in favor of a direct award of benefits. See Allen v. Bowen, 881 
F.2d 37 (3d Cir. 1989) (awarding benefits after less than three years and no previous remand); PageID:
<pageID>
19 
 
Podedworny, 745 F.2d at 223 (awarding benefits after five years and two ALJ decisions ); 
Brownawell, 554 F.3d at 358 (awarding benefits after eight years and two ALJ decisions); Morales, 
225 F.3d at 320 (awarding benefits after ten years and two ALJ decisions).6 
The record (at this point spanning nearly 1700 pages) is also fully developed. On remand, 
the Appeals Council directed the ALJ to obtain additional evidence including consultative 
examinations, further evaluate Plaintiff’s symptoms and opinion evidence, reconsider the RFC, 
and obtain supplemental vocational testimony if warranted. (AR 721–22). The ALJ received 
additional medical records and testimony from both Plaintiff and a new VE. There is no indication 
that additional medical evidence is necessary to resolve the dispositive issue. At most, according 
to the Commissioner, the ALJ could order a consultative examination with a gastrointestin al 
specialist, (Tr. at 15:24–16:2)—which the ALJ could have (and should have if deemed necessary) 
done after the previous remand. 
Nor is this a case in which the Court must speculate about the vocational effect of the 
alleged impairment. As explained above, the Commissioner concedes that the limitations described 
in Plaintiff’s testimony and the opinion of her treating providers , if credited, would exceed the 
VE’s off-task threshold and require a finding of disability. See Michelle R. Q., 807 F. Supp. 3d at 
476 (awarding benefits where, if the ALJ had included a limitation consistent with the medical 
opinions in the record, no jobs would have existed based on the VE’s testimony). 
Allowing a third administrative proceeding would not serve the purpose of further 
developing the record; it would merely give the Commissioner another chance to supply a rationale 
that was required on remand but was inexplicably not provided. The Court declines to make 
 
6 In determining the appropriate remedy, the Court considered whether an order for an 
expedited hearing would be an option. But the Commissioner disputed this Court’s authority to do 
so and clearly stated any order in that regard would likely be appealed. (Tr. at 17:10–14). PageID:
<pageID>
20 
 
Plaintiff wait any longer. See Podedworny, 745 F.2d at 223 (“If it would not be impossible for the 
Secretary to repair the record, it would at least be grossly unfair to give her another chance to do 
so under these circumstances.”). 
Indeed, the only reason the Commissioner could give for the Court not to award benefits 
is that the ALJ is the factfinder and should make that determination. (Tr. at 16:16–20). To be clear, 
the Court is not simply reweighing the evidence. Had the ALJ adequately explained his reasons 
for rejecting contrary testimony, medical evidence, and opinions in the RFC formulation, this 
Court would not disturb his findings. But when an ALJ fails twice to meet the minimal standard 
for articulating his decision, the Court may consider the record evidence an ALJ ignores or neglects 
to consider and award benefits so that the claimant does not need to endure additional 
administrative proceedings and the attendant delay. See Morales , 225 F.3d at 320 ( awarding 
benefits because “the extensive medical record, wrongly rejected by the ALJ ” was substantial 
evidence that the claimant is disabled); Brownawell, 554 F.3d at 358 (awarding benefits when the 
ALJ improperly rejected the opinions of treating physicians). As such, a direct award of benefits 
is the appropriate remedy.
7 
Accordingly, the Court will reverse the Commissioner’s decision and remand solely for the 
calculation and award of benefits. 
 
 
7 The Co mmissioner notes that this case would be automatically assigned to a new ALJ on 
remand. (Tr. at 19:6–8). While that may make an additional remand appropriate in some cases 
where the proceedings have not been so prolonged and additional factfinding is necessary, here, 
as explained above, all the factors heavily weigh in favor of a direct award of benefits. PageID:
<pageID>
21 
 
 
CONCLUSION 
 For the foregoing reasons, the Court REVERSES the final decision of the Commissioner 
and REMANDS solely for a calculation and award of benefits. 
 
 
 ____________________ 
CHRISTINE P. O’HEARN 
United States District Judge 
 
DATED: June 12, 2026 PageID:
<pageID>

Passage view · GavelSight