REPORT AND RECOMMENDATION

MARTIN C. CARLSON, Magistrate Judge.

I. Introduction

The Social Security Act provides a social safety net for children who face profoundly disabling physical or emotional impairments. In order to qualify for disability benefits, a child must have "a medically determinable physical or mental impairment, which results in marked and severe functional limitations, and which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months." 42 U.S.C. § 1382c(a)(3)(C)(i). The Commissioner has interpreted this statutory provision in regulations which provide that a child whose condition meets, or medically or functionally equals, the criteria of a listed impairment must be found disabled. 20 C.F.R. § 416.924(a). When determining this issue of childhood disability, there are six domains of functioning which an Administrative Law Judge (ALJ) must consider: (1) Acquiring and Using Information; (2) Attending and Completing Tasks; (3) Interacting and Relating with Others; (4) Moving about and Manipulating Objects; (5) Caring for Yourself; and (6) Health and Physical Well-Being. 20 C.F.R. § 416.926a(b)(1)(i)-(vi). In order to establish disability, an ALJ must conclude that a child exhibits either a "marked" limitation in two of these six domains, or an "extreme" limitation in any single domain. 20 C.F.R. § 416.926a(d).

In many of these childhood disability cases, the testimony of the child's mother is an integral part of any disability analysis. A mother's testimony plays a uniquely important role in this disability analysis for several reasons. First, a child's mother is often the primary care giver for the child, and by virtue of that daily nurturing role is uniquely well-suited to identify and describe the child's strengths and limitations. In short, in many childhood disability cases there is simply no better witness to a child's needs than the person who daily meets those needs, the child's mother.

At the same time, the close consanguinity which makes a mother's testimony extremely valuable in a childhood disability case may present a distorted perspective, since a mother's affection for a child may color her perceptions of that child's abilities and disabilities. This potentially distorting influence of a mother's love also strongly cautions in favor of careful consideration of a mother's testimony by an ALJ in any childhood disability case.

Given the cardinal importance of this testimony to a fully informed assessment of a childhood disability case, it is typically incumbent upon an ALJ to carefully analyze and assess this parental testimony as part of the disability evaluation process. It follows, therefore, that a decision which neglects to address this crucial component of proof in a childhood disability case can rarely be sustained on appeal.

So it is here.

In this case Christina Porter filed a claim for disability benefits on behalf of her son, C.L.T.R. Ms. Porter also testified at length before the ALJ describing the significant limitations that C.L.T.R. faced due to autism spectrum disorder, ADHD, oppositional defiant disorders and other anxiety disorders in all of these six realms of functioning that are relevant to a childhood disability determination. Yet, while the ALJ found that C.L.T.R. had marked limitations in one of these spheres of activity, and concluded that he suffered measureable limitations in three other domains of behavior, the ALJ denied this application for disability benefits without ever mentioning in any fashion the testimony of C.L.T.R.'s mother.

In our view, more is needed here before we may assess whether the ALJ's decision was supported by substantial evidence. At a minimum the ALJ must address, and analyze, this material evidence which was never mentioned in the initial decision denying benefits to C.L.T.R. Accordingly, for the reasons set forth below, it is recommended that this case be remanded to the Commissioner for further proceedings.

II. Statement of Facts and of the Case

On November 10, 2014, an application for supplemental security income benefits was filed on behalf of C.L.T.R. alleging that he had become disabled in July of 2014. (Tr. 19.) C.L.T.R. was born on March 13, 2002, and was 12 years ago at the time of this disability application. (Tr. 22.) In this application, CLTR alleged, and the ALJ found, that he suffered from an array of emotional impairments, including ADHD (attention deficit hyperactivity disorder), autism spectrum disorders, oppositional defiant disorders, and generalized anxiety disorders. (Tr. 22.)

A hearing was held on C.L.T.R.'s disability application before an ALJ on March 26, 2016. (Tr.35-65.) C.L.T.R.'s mother, Christina Porter, testified at this hearing, and described in detail the challenges her son faced in five of the six of the domains of functioning that must be assessed by an ALJ in a childhood disability case. For example, with respect to the domains of acquiring and using information, as well as the domain of attending and completing tasks, Ms. Porter explained that her son's teachers would frequently become frustrated because of the necessity of repeatedly instructing C.L.T.R. on the same materials. (Tr. 47.) Ms. Porter also explained that her son was taken out of chorus because he had fallen behind in his schoolwork; (Tr. 50), had persistent difficulty completing homework; (Tr. 53-4), and was easily distracted at school. (Tr. 57-8.)

As for C.L.T.R.'s ability to interact and relate with others, Ms. Porter described at length the multiple social challenges her son faced, including the recurrent bullying he was subjected to due to his limitations in social function. (Tr. 51-3.) Ms. Porter also graphically described C.L.T.R.'s limitations in terms of his ability to care for himself, testifying that at the age of 13 C.L.T.R. was unable to bathe himself, needed help brushing his teeth, was unable to select clothing without help, could not engage in toileting without assistance, and as a result frequently soiled his garments. (Tr. 54-6.)

Finally, with respect to the domain of health and physical well-being, Ms. Porter described frequent fluctuations on C.L.T.R.'s part between episodes of hyperactivity and periods of complete lethargy. In fact, according to Porter her son had experienced lethargy and fallen asleep in the course of the ALJ proceedings. (Tr. 59.)

Substantial evidence supported Ms. Porter's testimony concerning her son's limitations in these five domains of functioning. For example, with respect to her report that C.L.T.R. struggled with task completions and acquiring and using information, one his teachers wrote in 2014 that, C.L.T.R. "has a very difficult time focusing during class. I often have to redirect him on an assignment, repeat directions, and remind him to continue working" (Tr. 383). Another teacher observed that "[h]e does not listen to directions the first time given; he needs to be redirected." (Id.) Both the 2014 and 2015 IEPs prepared in C.L.T.R.'s case concluded that his "disability affects his involvement and progress in the general education curriculum by limiting his ability to focus on the instruction being provided." (Tr. 196, 384.) In March of 2015, his English teacher reported that C.L.T.R. "rarely pays attention, never follows classroom procedures, so every day it's like I'm reteaching him what to do at the beginning of class. He's either hyperactive or lethargic. He used to be good about doing his work outside of class, but he never gets it completed anymore. His organization skills are a mess; I've reorganized his binder multiple times. I see him in Study Skills every other day, and I have to remind him to do school work—he'll read the entire time." (Tr. 195.)

Likewise, his technology education teacher reported that "academically he is struggling. He seems to be absent-minded. He simply draw[s] or laid his head on the desk," and that C.L.T.R. "taps his pencils, making noises, etc. Other students are getting upset with him." (Tr. 195-96). C.L.T.R.'s reading teacher, in turn, reported that "he has been sleeping and having a hard time staying awake and keeping up with his school work. [C.L.T.R.] has failed a quiz because he was sleeping" and that a week prior, he had been "very energetic and dancing, singing, and making noises. He was so distracting that he had to be moved to an area where he was alone." (Id.) His math teacher stated that C.L.T.R. "does not stay on task in class. He is very easily distracted. He has not been completing his homework lately. [C.L.T.R.] has a difficult time taking notes and following them. Even when the teacher gives him the notes he had a hard time following them" (Tr. 196). Taken together, these observations from academicians confirmed his mother's testimony concerning C.L.T.R.'s challenges in the domains of acquiring knowledge, task completion, relating with others, hygiene and well-being.

Ms. Porter's testimony was also consistent with some of the medical evidence in this case including a February 16, 2015 evaluation of C.L.T.R. conducted by a licensed psychologist, Robert J. Meacham, M.S., who observed that "[C.L.T.R.] has a long history of being inattentive in school," "is easily distracted throughout the school day," and "will become preoccupied with a certain object or interest to the exclusion of paying attention to anything else" (Tr. 321). In a subsequent report dated August 3, 2015, Mr. Meacham noted that "[C.L.T.R.] will `zone out' when he is academically frustrated," that "he continues to be easily distracted throughout the school day," that "his organization to task is very poor," that he "engages in frequent episodes of `daydreaming'," that he "continues to easily become preoccupied with objects of interest to the exclusion of paying attention to anything else," that he "engages in `noisemaking' which interferes with his classmates' ability to focus and concentrate," and that "at lunch, he displays `bizarre behavior, using his finger as a utensil and licking food from it." (Tr. 426.)

It was against this backdrop that the ALJ issued a decision on April 25, 2016, denying C.T.L.R.'s application for disability benefits. (Tr. 19-31.) In this decision, the ALJ found that C.L.T.R. suffered from the following severe impairments: ADHD (attention deficit hyperactivity disorder), autism spectrum disorders, oppositional defiant disorders, and generalized anxiety disorders. (Tr. 22.) The ALJ concluded, however, that C.L.T.R. did not suffer from an impairment or combination of impairments which functionally equaled the severity of any Social Security listing. (Tr. 22-31.)

In reaching this conclusion the ALJ determined the issue of functional equivalence to a listing by assessing C.L.T.R.'s degree of impairment in six domains of functioning: (1) Acquiring and Using Information; (2) Attending and Completing Tasks; (3) Interacting and Relating with Others; (4) Moving about and Manipulating Objects; (5) Caring for Yourself; and (6) Health and Physical Well-Being. 20 C.F.R. § 416.926a(b)(1)(i)-(vi). Under this functional equivalence analysis, if the ALJ found that C.L.T.R. exhibited either a "marked" limitation in two of these six domains, or an "extreme" limitation in any single domain he would be deemed disabled. 20 C.F.R. § 416.926a(d).

Guided by this analytical paradigm, in this case the ALJ first found that C.L.T.R. suffered from a marked impairment when it came to interacting and relating to others. (Tr. 28.) With respect to C.L.T.R.'s limitations in acquiring and using information, attending and completing tasks, and caring for himself, the ALJ found that C.L.T.R. was impaired but that his impairments had a less than marked limitation on his ability to function in these domains. (Tr. 25-27, 29-30.) The ALJ further concluded that C.L.T.R. faced no limitations when it came to his physical well-being and manipulating objects. (Tr. 29, 30-1.)

The ALJ's decision was noteworthy in several respects. First, the ALJ's finding that C.L.T.R. experienced a marked limitation in social interaction placed C.L.T.R. on the threshold of a disability finding since if the ALJ found that C.L.T.R. exhibited a "marked" limitation in two of these six domains he would be deemed disabled. 20 C.F.R. § 416.926a(d). However, while acknowledging significant challenges that C.L.T.R. faced in at least three other domains of functioning—acquiring knowledge, task completion, and the ability to care for himself—the ALJ concluded that none of these limitations were "marked".

Remarkably, the ALJ reached these conclusions without ever referring to the testimony of C.L.T.R.'s mother at any point in this decision. Thus, the ALJ's decision did not address, analyze or even allude to the testimony of the person closest to C.L.T.R., his mother, the person who had daily addressed his needs and witnessed firsthand both his abilities and his disabilities. Based upon this incomplete analysis, however, the ALJ concluded that C.L.T.R. did not satisfy the juvenile disability criteria under the Act since he did not display marked impairments in at least two domains of functioning, and denied this claim. (Tr. 30-1.)

This appeal followed. (Doc. 1.) This case is fully briefed by the parties, (Docs. 9, 10 and 11) and is, therefore, ripe for resolution. For the reasons set forth below, we find that the ALJ's failure to even acknowledge, much less address, the testimony of C.L.T.R.'s mother is a material shortcoming in this case which decision does not provide an adequate basis justifying the conclusions concerning the degree of C.L.T.R.'s impairment in these various domains. Therefore, we recommend that this case be remanded for further consideration and reconciliation of this evidence.

III. Discussion

A. Child Disability Claims: Initial Burdens of Proof, Persuasion and Articulation for the ALJ

The legal standards which govern an ALJ's consideration of a childhood disability claim under the Act are familiar ones.

The Social Security Act provides that in order to qualify for disability benefits, a child must have "a medically determinable physical or mental impairment, which results in marked and severe functional limitations, and which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months." 42 U.S.C. § 1382c(a)(3)(C)(i). The Commissioner has interpreted this statutory provision in regulations which provide that a child whose condition meets, medically equals, or functionally equals the criteria of a listed impairment must be found disabled. Similarly, a child whose impairment(s) do not meet or equal (medically or functionally) the listing criteria contained in 20 C.F.R. Part 404, Subpart P, Appendix 1 is not disabled. 20 C.F.R. § 416.924(a).

Under these regulations, when determining the issue of functional equivalence to a listed impairment, there are six domains of functioning which an ALJ must consider: (1) Acquiring and Using Information; (2) Attending and Completing Tasks; (3) Interacting and Relating with Others; (4) Moving about and Manipulating Objects; (5) Caring for Yourself; and (6) Health and Physical Well-Being. 20 C.F.R. § 416.926a(b)(1)(i)-(vi). In order to establish a disabling level of functional equivalence to a listed impairment, an ALJ must conclude that a child exhibits either a "marked" limitation in two of these six domains, or an "extreme" limitation in any single domain. 20 C.F.R. § 416.926a(d). The Commissioner defines a "marked" limitation as one which:

20 C.F.R. § 416.926a(e)(2).

The Commissioner then defines an "extreme" limitation as one which:

20 C.F.R. § 416.926a(e)(3).

The ALJ's disability determination must also meet certain basic procedural and substantive requirements. Most significant among these legal benchmarks is a requirement that the ALJ adequately explain the legal and factual basis for this disability determination. Thus, in order to facilitate review of the decision under the substantial evidence standard, the ALJ's decision must be accompanied by "a clear and satisfactory explication of the basis on which it rests." Cotter v. Harris, 642 F.2d 700, 704 (3d Cir. 1981). In addition, "[t]he ALJ must indicate in his decision which evidence he [or she] has rejected and which he [or she] is relying on as the basis for his [or her] finding." Schaudeck v. Comm'r of Soc. Sec., 181 F.3d 429, 433 (3d Cir. 1999). This burden of articulation applies with particular force to an ALJ's assessment and evaluation of conflicting evidence like the testimony of C.L.T.R.'s mother an others. Thus, "[w]hen a conflict in the evidence exists, the ALJ may choose whom to credit but `cannot reject evidence for no reason or for the wrong reason.'" Plummer v. Apfel, 186 F.3d 422, 429 (3d Cir. 1999) (quoting Mason v. Shalala, 994 F.2d 1058, 1066 (3d Cir. 1993)).

B. Substantial Evidence Review — the Role of This Court

Once the ALJ has made a disability determination the task of reviewing that decision falls to the Court under a carefully defined standard of review. When reviewing the Commissioner's final decision denying a claimant's application for benefits, this Court's review is limited to the question of whether the findings of the final decision-maker are supported by substantial evidence in the record. See 42 U.S.C. §405(g); 42 U.S.C. §1383(c)(3); Johnson v. Comm'r of Soc. Sec., 529 F.3d 198, 200 (3d Cir. 2008); Ficca v. Astrue, 901 F.Supp.2d 533, 536 (M.D. Pa. 2012). Substantial evidence "does not mean a large or considerable amount of evidence, but rather such relevant evidence as a reasonable mind might accept as adequate to support a conclusion." Pierce v. Underwood, 487 U.S. 552, 565 (1988). Substantial evidence is less than a preponderance of the evidence but more than a mere scintilla. Richardson v. Perales, 402 U.S. 389, 401 (1971). A single piece of evidence is not substantial evidence if the ALJ ignores countervailing evidence or fails to resolve a conflict created by the evidence. Mason v. Shalala, 994 F.2d 1058, 1064 (3d Cir. 1993).

In addition, the Court's review must ensure that there is an adequate explanation provided by the ALJ for the decision reached in a claimant's case. This means that the ALJ's disability determination must also meet certain legal benchmarks. Most significant among these legal benchmarks is a requirement that the ALJ adequately explain the legal and factual basis for this disability determination. Thus, in order to facilitate review of the decision under the substantial evidence standard, the ALJ's decision must be accompanied by "a clear and satisfactory explication of the basis on which it rests." Cotter v. Harris, 642 F.2d 700, 704 (3d Cir. 1981). Conflicts in the evidence must be resolved and the ALJ must indicate which evidence was accepted, which evidence was rejected, and the reasons for rejecting certain evidence. Id. at 706-707. In addition, "[t]he ALJ must indicate in his decision which evidence he has rejected and which he is relying on as the basis for his finding." Schaudeck v. Comm'r of Soc. Sec., 181 F.3d 429, 433 (3d Cir. 1999). Thus, "[w]hen a conflict in the evidence exists, the ALJ may choose whom to credit but `cannot reject evidence for no reason or for the wrong reason.'" Plummer v. Apfel, 186 F.3d 422, 429 (3d Cir. 1999) (quoting Mason v. Shalala, 994 F.2d 1058, 1066 (3d Cir. 1993)). In such instances where material evidence is rejected for no reason, a remand for further proceedings is often necessary. Likewise, when an ALJ's decision rests solely upon essentially unreviewable, conclusory assertions, this burden of articulation is not met. Burnett v. Comm'r of Soc. Sec. Admin., 220 F.3d 112, 119 (3d Cir. 2000).

This rule also applies to an ALJ's credibility determinations. An ALJ's findings based on the credibility of a claimant are to be accorded great weight and deference, since an ALJ is charged with the duty of observing a witness' demeanor and credibility. Frazier v. Apfel, No. 99-CV-715, 2000 WL 288246, at *9 (E.D.Pa. Mar. 7, 2000) (quoting Walters v. Comm'r of Soc. Sec., 127 F.3d 525, 531 (6th Cir. 1997)). However, in order to aid ALJs in this task of assessing claimant credibility, the Social Security Rulings and Regulations provide a framework under which a claimant's subjective complaints are to be considered. 20 C.F.R. § 404.1529; SSR 96-7p, 1996 SSR LEXIS 4. First, symptoms, such as pain or fatigue, will only be considered to affect a claimant's ability to perform work activities if such symptoms result from an underlying physical or mental impairment that has been demonstrated to exist by medical signs or laboratory findings. 20 C.F.R. § 404.1529(b); SSR 96-7p, 1996 SSR LEXIS 4. During this credibility assessment, the ALJ must determine whether the claimant's statements about the intensity, persistence or functionally limiting effects of his or her symptoms are substantiated based on the ALJ's evaluation of the entire case record. 20 C.F.R. § 404.1529(c); SSR 96-7p, 1996 SSR LEXIS 4. This includes, but is not limited to: medical signs and laboratory findings, diagnosis and other medical opinions provided by treating or examining sources, and other medical sources, as well as information concerning the claimant's symptoms and how they affect his or her ability to work. Id. Thus, to assist in the evaluation of a claimant's subjective symptoms, the Social Security Regulations identify seven factors which may be relevant to the assessment of the severity or limiting effects of a claimant's impairment based on a claimant's symptoms. 20 C.F.R. §§ 404.1529(c)(3). These factors include: activities of daily living; the location, duration, frequency, and intensity of the claimant's symptoms; precipitating and aggravating factors; the type dosage, effectiveness, and side effects of any medication the claimant takes or has taken to alleviate his or her symptoms; treatment, other than medication that a claimant has received for relief; any measures the claimant has used to relieve his or her symptoms; and, any other factors concerning the claimant's functional limitations and restrictions. Id.; see George v. Colvin, No. 4:13-CV-2803, 2014 U.S. Dist. LEXIS 150897, 2014 WL 5449706, at *4 (M.D. Pa. Oct. 24, 2014); Cano-Martinez v. Colvin, No. 3:14-CV-1090, 2015 U.S. Dist. LEXIS 132233, 2015 WL 5781202, at *8-9 (M.D. Pa. Sept. 30, 2015).

These same principles apply to an ALJ's credibility determinations as they relate to statements made by a claimant's family and friends, like the testimony provided by C.L.T.R.'s mother in this case. When evaluating such evidence "ALJs should consider `such factors as the nature and extent of the relationship, whether the evidence is consistent with other evidence, and any other factors that tend to support or refute the evidence' when evaluating evidence from non-medical sources such as family or friends." Zirnsak v. Colvin, 777 F.3d 607, 612 (3d Cir. 2014) (quoting SSR 06-03p, 2006 WL 2329939, at *1 (Aug. 9, 2006)). Moreover:

Zirnsak v. Colvin, 777 F.3d 607, 612 (3d Cir. 2014)(emphasis added.)

Thus in this setting an ALJ's burden of articulation includes a responsibility to acknowledge, address, and analyze, third-party disability reports and testimony.

C. Harmless Error Analysis

Finally, in Social Security appeals courts may also apply harmless error analysis when assessing the sufficiency of an ALJ's decision. Seaman v. Soc. Sec. Admin., 321 F. App'x 134, 135 (3d Cir. 2009). "Under the harmless error rule, an error warrants remand if it prejudices a party's `substantial rights.' An error implicates substantial rights if it likely affects the outcome of the proceeding, or likely affects the `perceived fairness, integrity, or public reputation of [the] proceedings.'" Hyer v. Colvin, 72 F.Supp.3d 479, 494 (D. Del. 2014).

D. The ALJ's Failure to Acknowledge, Address, or in any way Analyze the Testimony of C.L.T.R.'s Mother Compels a Remand

In this case we believe that the complete failure to acknowledge, assess, or analyze the testimony of C.L.T.R.'s mother compels a remand. While we are mindful of the deferential standard of review which applies to judicial review of the findings of an ALJ in a Social Security appeal, it is also well-settled that the ALJ's decision must be accompanied by "a clear and satisfactory explication of the basis on which it rests." Cotter v. Harris, 642 F.2d 700, 704 (3d Cir. 1981). Therefore, conflicts in the evidence must be resolved and the ALJ must indicate which evidence was accepted, which evidence was rejected, and the reasons for rejecting certain evidence. Id. at 706-707. Further when considering family member testimony, like the testimony provided by C.L.T.R.'s mother in this case, it is axiomatic that "the ALJ must specifically identify and explain what evidence he found not credible and why he found it not credible. Adorno v. Shalala, 40 F.3d 43, 48 (3d Cir. 1994) (citing Stewart v. Sec'y of Health, Education and Welfare, 714 F.2d 287, 290 (3d Cir. 1983)); see also Stout v. Comm'r, 454 F.3d 1050, 1054 (9th Cir. 2006) (stating that an ALJ is required to provide `specific reasons for rejecting lay testimony')." Zirnsak v. Colvin, 777 F.3d 607, 612 (3d Cir. 2014).

In this case, the ALJ's decision completely neglected to mention, discuss, analyze or acknowledge the person who was potentially the single most critical witness in this case, C.L.T.R.'s mother. C.L.T.R.'s mother, Christina Porter, testified at this hearing, and described in detail the challenges her son faced in five of the six of the domains of functioning that must be assessed by an ALJ in a childhood disability case. For example, with respect to the domains of acquiring and using information, as well as the domain of attending and completing tasks, Ms. Porter explained that her son's teachers would frequently become frustrated because of the necessity of repeatedly instructing C.L.T.R. on the same materials. (Tr. 47.) Ms. Porter also explained that her son was taken out of chorus because he had fallen behind in his schoolwork; (Tr. 50), had persistent difficulty completing homework; (Tr. 53-4), and was easily distracted at school. (Tr. 57-8.) As for C.L.T.R.s ability to interact and relate with others, Ms. Porter detailed the multiple social challenges her son faced, including the recurrent bullying he was subjected to due to his limitations in social function. (Tr. 51-3.) Ms. Porter also graphically described C.L.T.R.'s limitations in terms of his ability to care for himself, testifying that at the age of 13, C.L.T.R. was unable to bathe himself, needed help brushing his teeth, was unable to select clothing without help, could not engage in toileting without assistance, and as a result frequently soiled his garments. (Tr. 54-6.) Finally, in the domain of health and physical well-being, Ms. Porter described frequent fluctuations on C.L.T.R.'s part between episodes of hyperactivity and periods of complete lethargy. In fact, according to Ms. Porter her son had experienced lethargy and fallen asleep in the course of the ALJ proceedings. (Tr. 59.)

Recognizing the cardinal importance of the evaluation of this parental testimony to a fully-informed disability decision in a childhood disability case, we conclude that the ALJ's complete failure to acknowledge this testimony runs afoul of the rule that when assessing third party reports that "the ALJ must specifically identify and explain what evidence he found not credible and why he found it not credible. Adorno v. Shalala, 40 F.3d 43, 48 (3d Cir. 1994) (citing Stewart v. Sec'y of Health, Education and Welfare, 714 F.2d 287, 290 (3d Cir. 1983)); see also Stout v. Comm'r, 454 F.3d 1050, 1054 (9th Cir. 2006) (stating that an ALJ is required to provide `specific reasons for rejecting lay testimony')." Zirnsak v. Colvin, 777 F.3d 607, 612 (3d Cir. 2014). Moreover, in this case, where the ALJ found that C.L.T.R. had marked limitations in one domain of functioning, a reassessment of his capabilities in any one of the five remaining domains could change the outcome of this case since if the ALJ found that C.L.T.R. exhibited a "marked" limitation in two of these six domains he would be deemed disabled. 20 C.F.R. § 416.926a(d). Given that: (1) Ms. Porter testified regarding limitations experienced by her son in four other domains of functioning; (2) significant evidence from other witnesses supported a number of these limitations; and (3) the ALJ found that C.L.T.R. suffered limitations in three other domains even without addressing his mother's testimony, we cannot find that the total failure to acknowledge this evidence was a harmless error. Quite the contrary, if the ALJ has erred in the assessment of any one of these five remaining domains by completely neglecting to consider the testimony of C.L.T.R.'s mother, then that error warrants remand since it prejudices C.L.T.R.'s "substantial rights," in that it may likely affect the outcome of the proceeding, or the perceived fairness, integrity, or public reputation of the proceedings. See Hyer v. Colvin, 72 F.Supp.3d 479, 494 (D. Del. 2014). Indeed, such errors in the analysis of multiple domains of functioning could be outcome-determinative and change the course of this case. Therefore, this error cannot be deemed harmless.

Taken together, these analytical shortcomings sufficiently undermine confidence in the outcome reached here that we conclude that a remand is necessary to fully reassess this evidence. Because the Court has found grounds for remand based upon the failure to fully assess the evidence provided by C.L.T.R.'s mother, we need not address the remaining arguments advanced in this appeal. To the extent that any other error occurred, it may be remedied on remand. Yet, while case law calls for a remand and further proceedings by the ALJ in this case, nothing in our opinion should be construed as suggesting what the outcome of that final and full analysis should be. Rather, that final assessment must await a thorough consideration and development of all of the evidence by the ALJ.

IV. Recommendation

Accordingly, because we find that the ALJ's decision is not supported by substantial evidence, IT IS RECOMMENDED that the plaintiff's request for a new administrative hearing should be GRANTED, the final decision of the Commissioner denying this claim should be vacated, and this case should be remanded to the Commissioner to conduct a new administrative hearing pursuant to sentence four of 42 U.S.C. §405(g). IT IS FURTHER RECOMMENDED that final judgment should be entered in favor of the plaintiff and against the Commissioner of Social Security.

The parties are further placed on notice that pursuant to Local Rule 72.3:

Failure to file timely Objections to the foregoing Report and Recommendation may constitute a waiver of any appellate rights.