Searching over 5,500,000 cases.


searching
Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.

Engquist v. Berryhill

United States District Court, D. Minnesota

March 21, 2018

Brenda Engquist, Plaintiff,
v.
Nancy A. Berryhill, Acting Commissioner of Social Security, Defendant.

          Frederick J. Daley, Jr., and Edward C. Olson, Disability Attorneys of Minnesota for Plaintiff; and

          Pamela Marentette, Assistant United States Attorney for Defendant.

          ORDER

          Tony N. Leung United States Magistrate Judge

         I. INTRODUCTION

         Plaintiff Brenda Engquist brings the present action, contesting Defendant Commissioner of Social Security's denial of her application for disability insurance benefits (“DIB”) under Title II of the Social Security Act, 42 U.S.C. §§ 401-34, and supplemental security income (“SSI”) under Title XVI of the Social Security Act, 42 U.S.C. § 1381. The parties have consented to a final judgment from the undersigned United States Magistrate Judge in accordance with 28 U.S.C. § 636(c) and D. Minn. LR 7.2. This matter is before the Court on the parties' cross motions for summary judgment. For the reasons set forth below, the Court denies Plaintiff's motion and grants Defendant's motion.

         II. BACKGROUND

         A. Procedural History

         Plaintiff filed the instant action for DIB and SSI on February 25, 2014, alleging a disability onset date of January 1, 2013. Plaintiff alleges impairments of: migraines; degenerative tissue in back; fibromyalgia; post-traumatic stress disorder; major depression; and generalized anxiety disorder. Plaintiff was found not disabled on May 21, 2014. That finding was affirmed upon reconsideration. Plaintiff then requested a hearing before an Administrative Law Judge. A hearing was held February 23, 2016 and, on March 14, 2016, the ALJ issued a decision denying Plaintiff's claim for benefits. Plaintiff sought review of the ALJ's decision through the Appeals Council, which denied her request for review. Plaintiff then sought review in this Court.

         B. Administrative Hearing and ALJ Decision

         The ALJ found that Plaintiff had the severe impairments of: “obesity; neck and back pain associated with degenerative changes of the cervico-thoracic and lumbro-sacral spine; hip pain associated with bilateral trochanteric bursitis; right shoulder pain; and fibromyalgia.” (Tr. 35). The ALJ next found and concluded that Plaintiff does not have an impairment or combination of impairments that meets or medically equals the severity of one of the listed impairments in 20 C.F.R. pt. 404, subpt. P, app. 1. (Tr. 42). The ALJ looked at Listings 1.02 (major dysfunction of a joint), 1.04 (disorders of the spine), 6.05 (chronic kidney disease), 5.05 (chronic liver disease), and 11.03 (epilepsy). (Tr. 42). Following this, the ALJ found Plaintiff to have the residual functioning capacity (“RFC”) to perform a range of light work as defined in 20 C.F.R. §§ 404.1567(b), 416.967(b), except she is “limited to no more than occasional overhead reaching bilaterally; she is limited to no more than occasional bending, twisting, crouching and crawling; and she is precluded from working on ladders and ropes and doing balancing activities.” (Tr. 43). The ALJ next concluded that Plaintiff could perform past relevant work as a courier. (Tr. 54). Accordingly, Plaintiff was found not disabled from January 1, 2013 through March 14, 2016. (Tr. 55).

         III. ANALYSIS

         A. Legal Standard

         Disability benefits are available to individuals who are determined to be under a disability. 42 U.S.C. §§ 423(a)(1), 1381a; accord 20 C.F.R. §§ 404.315, 416.901. An individual is considered to be disabled if she is unable “to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment 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. §§ 423(d)(1)(A), 1382c(a)(3)(A); see also 20 C.F.R. § 404.1505(a). This standard is met when a severe physical or mental impairment, or impairments, renders the individual unable to do her previous work or “any other kind of substantial gainful work which exists in the national economy” when taking into account her age, education, and work experience. 42 U.S.C. §§ 423(d)(2)(A), 1382c(a)(3)(B); see also 20 C.F.R. § 404.1505(a). Disability is determined according to a five-step, sequential evaluation process. 20 C.F.R. §§ 404.1520(a)(4), 416.920(a)(4).

To determine disability, the ALJ follows the familiar five-step process, considering whether: (1) the claimant was employed; (2) she was severely impaired; (3) her impairment was, or was comparable to, a listed impairment; (4) she could perform past relevant work; and if not, (5) whether she could perform any other kind of work.

Halverson v. Astrue, 600 F.3d 922, 929 (8th Cir. 2010) (citing 20 C.F.R. §§ 404.1520(a)(4), 416.920(a)(4)). In general, the burden of proving the existence of disability lies with the claimant. 20 C.F.R. § 404.1512(a); Thomas v. Sullivan, 928 F.2d 255, 260 (8th Cir. 1991).

         This Court reviews whether the ALJ's decision is supported by substantial evidence in the record as a whole. Boettcher v. Astrue, 652 F.3d 860, 863 (8th Cir. 2011) (citing Harris v. Barnhart, 356 F.3d 926, 928 (8th Cir. 2004)); 42 U.S.C. § 405(g). “Substantial evidence means less than a preponderance but enough that a reasonable person would find it adequate to support the decision.” Boettcher, 652 F.3d at 863 (citing Guilliams v. Barnhart, 393 F.3d 798, 801 (8th Cir. 2005)). This standard requires the Court to “consider the evidence that both supports and detracts from the ALJ's decision.” Perks v. Astrue, 687 F.3d 1086, 1091 (8th Cir. 2012) (citing Ellis v. Barnhart, 393 F.3d 988, 993 (8th Cir. 2005)).

         The ALJ's decision “will not [be] reverse[d] simply because some evidence supports a conclusion other than that reached by the ALJ.” Perks, 687 F.3d at 1091 (citing Pelkey v. Barnhart, 433 F.3d 575, 578) (8th Cir. 2006)). “If, after reviewing the record, the court finds it is possible to draw two inconsistent positions from the evidence and one of those positions represents the [ALJ's] findings, the court must affirm the [ALJ's] decision.” Pearsall v. Massanari, 274 F.3d 1211, 1217 (8th Cir. 2001). In reviewing the record for substantial evidence, the Court may not substitute its own judgment or findings of fact for that of the ALJ. Hilkemeyer v. Barnhart, 380 F.3d 441, 445 (8th Cir. 2004); Woolf v. Shalala, 3 F.3d 1210, 1213 (8th Cir. 1993). Likewise, courts “defer to the ALJ's determinations regarding the credibility of testimony, so long as they are supported by good reasons and substantial evidence.” Pelkey, 433 F.3d at 578.

         B. Plaintiff's Mental Impairments and Medical Opinions

         The ALJ concluded Plaintiff's mental impairments-considered under Listings 12.04 (affective disorders) and 12.06 (anxiety related disorders)-“have not caused [Plaintiff] to be subject to more than minimal limitation in her ability to perform basic mental work activities for a continuous period of at least 12 months.” (Tr. 35). Accordingly, the ALJ deemed Plaintiff's mental impairments as not severe. (Tr. 35-36). In so doing, the ALJ discussed Plaintiff's activities of daily living, social functioning, and concentration, persistence, and pace, finding mild limitation in all three categories, as well as noting Plaintiff experienced no episodes of decompensation. (Tr. 35-36).

         Plaintiff's primary argument underpinning her action in this Court is that the ALJ erred in finding that none of her mental impairments were severe, discounting the opinions of Plaintiff's treatment providers and two state agency psychological consultants in the process. (ECF No. 19, at 20-29). Plaintiff asserts the ALJ ignored evidence that did not support a decision that Plaintiff's mental impairments are not severe and that no medical opinion in the record supports such a decision.

         1. Legal Standard

         Under 20 C.F.R. §§ 404.1527(c), 416.927(c), medical opinions from treating sources are weighed using several factors: (1) the examining relationship; (2) the treatment relationship, such as the (i) length of the treatment relationship and frequency of examination and the (ii) nature and extent of the treatment relationship; (3) supportability; (4) consistency; (5) specialization; and (6) other factors. If a treating source's medical opinion on the nature and severity of a claimant's impairments is “well-supported by medically acceptable clinical and laboratory diagnostic techniques and is not inconsistent with the other substantial evidence in [the] case record, ” it is given controlling weight. 20 C.F.R. §§ 404.1527(c)(2), 416.927(c)(2). Treating sources are defined as licensed physicians, licensed or certified psychologists, licensed optometrists, licensed podiatrists, and qualified speech-language pathologists. 20 C.F.R. §§ 404.1513(a), 416.913(a). “A treating physician's opinion that a claimant is disabled or cannot be gainfully employed gets no deference because it invades the province of the Commissioner to make the ultimate disability determination.” House v. Astrue, 500 F.3d 741, 745 (8th Cir. 2007). An ALJ “may give a treating doctor's opinion limited weight if it provides conclusory statements only.” Samons v. Astrue, 497 F.3d 813, 818 (8th Cir. 2007) (citing Chamberlain v. Shalala, 47 F.3d 1489, 1494 (8th Cir. 1995)). And “[a] treating physician's own inconsistency may . . . undermine his opinion and diminish or eliminate the weight given his opinions.” Hacker v. Barnhart, 459 F.3d 934, 937 (8th Cir. 2006) (citing Prosch v. Apfel, 201 F.3d 1010, 1013 (8th Cir. 2000)).

         2. The Medical Opinions

         Licensed Psychologist David Kearn completed a “Statement in Support of Disability (Mental)” form on January 24, 2014. (Tr. 412-15). Kearn estimated Plaintiff had a current GAF score of 50 and was unable to sustain full-time employment, particularly due to chronic, moderate to severe pain as well as acute anxiety symptoms. (Tr. 412). Kearn indicated Plaintiff's symptoms increased in severity starting January 2013. (Tr. 412). Kearn also completed a form entitled “Physician's Statement of Mental Impairments” on January 24, 2014. (Tr. 413-14). Kearn noted Plaintiff's current GAF was 50, with her highest GAF in the last year as 55. (Tr. 413). Kearn indicated Plaintiff had no or mild difficulty with remembering locations and work-like procedures, understanding and remembering very simple instructions, carrying out simple instructions, sustaining an ordinary routine without special instructions, and making simple work-related decisions. (Tr. 413). Kearn indicated Plaintiff had moderate difficulty in understanding and remembering complex instructions, dealing with stress of semi-skilled and skilled work, and working in coordination with or proximity to others without distraction. (Tr. 413). Kearn indicated Plaintiff had marked difficulty in maintaining attention and concentration for extended periods, maintaining regular attendance and being punctual, completing a normal workday/week without interruption from impairments, and performing at a consistent pace without unreasonable number of rests. (Tr. 413). Kearn noted Plaintiff had the following signs and symptoms due to her psychological impairments: appetite disturbance with weight change; sleep disturbance; mood disturbance; emotional lability; anhedonia; feelings of guilt/worthlessness; difficulty thinking or concentrating; social withdrawal or isolation; blunt, flat, or inappropriate affect; decreased energy; intrusive recollections of a traumatic experience; generalized persistent anxiety; and irritability. (Tr. 413). Kearn indicated Plaintiff would have no or mild difficulty with asking simple questions or requesting assistance, being aware of normal hazards and taking appropriate precautions, and ability to understand, carry out, and remember simple instructions. (Tr. 413). Kearn indicated Plaintiff would have moderate difficulty responding appropriately to changes in routine work setting and accepting instructions and responding appropriately to criticism. (Tr. 413). Kearn indicated Plaintiff would have marked difficulty interacting appropriately with the public, interacting appropriately with co-workers/supervisors, and maintaining attention and concentration for extended periods. (Tr. 413). Kearn indicated Plaintiff experiences episodes of deterioration or decompensation due to acute onset of anxiety symptoms with feelings of panic and physical symptoms. (Tr. 414). Kearn reported Plaintiff would be off task due to her impairments 25% or more of the workday and would miss four or more days of work per month due to her impairments. (Tr. 414). Kearn did not indicate that Plaintiff's impairment met any of the Listed Impairments. (Tr. 414). Nor did Kearn list any symptoms or limitations that would affect Plaintiff's ability to work. (Tr. 414).

         In evaluating Plaintiff's initial disability claim on May 21, 2014, the state psychological consultant, Licensed Psychologist Judy Strait, Psy.D. assessed Plaintiff's affective disorders and anxiety disorders as severe. (Tr. 100, 114). In looking at the “B” criteria of the Listings, Dr. Strait opined Plaintiff had mild restriction on activities of daily living, moderate difficulties in maintaining social functioning, moderate difficulties in maintaining concentration, persistence, or pace, and no episodes of decompensation. (Tr. 100, 114). In assessing Plaintiff's RFC, Dr. Strait noted Plaintiff's

cognition is intact and concentration is impaired. She will have difficulty with complex tasks and demanding work environments. Her social functioning is reduced and she may not work well with the general public. She may work best alone or in a small, familiar group. Adaption is moderately impaired. [Plaintiff] retains the capacity to perform routine, 2-step tasks on a sustained basis. . . . The totality of the evidence does not reflect marked psych-related impairments.

(Tr. 105, 119).

         On June 10, 2014, Dr. Joseph Richmond completed a form entitled “Medical Source Statement (Mental).” (Tr. 508-11). Dr. Richmond noted Plaintiff was diagnosed with PTSD and generalized anxiety disorder. (Tr. 508). Dr. Richmond rated Plaintiff as having a GAF score of 45 to 50, with 45 to 50 being her highest for the past year. (Tr. 508). Dr. Richmond noted Plaintiff had symptoms of: poor memory; sleep disturbance; mood disturbance; emotional lability; anhedonia or pervasive loss of interests; paranoia or inappropriate suspiciousness; feelings of guilt/worthlessness; difficulty thinking or concentrating; social withdrawal or isolation; decreased energy; generalized persistent anxiety; and irritability. (Tr. 508). Dr. Richmond noted Plaintiff's chronic pain exacerbates her mood symptoms. (Tr. 508, 510). Dr. Richmond noted Plaintiff was not taking any prescribed medications to treat her symptoms because “they made symptoms worse in the past.” (Tr. 509). Dr. Richmond estimated Plaintiff would be off-task at work 25% or more per workday and would be absent from work four or more days per month. (Tr. 509). Dr. Richmond indicated Plaintiff would have moderate difficulties understanding and remembering very simple instructions and carrying out simple instructions. (Tr. 509-10). Dr. Richmond noted Plaintiff would have marked difficulties in: remembering locations and work-like procedure; understanding and remembering complex instructions; maintaining attention and concentration for extended periods; sustaining an ordinary routine without special instructions; making simple work-related decisions; performing at a consistent pace without unreasonable rests; and completing a normal workday or workweek without interruption. (Tr. 509-10). Dr. Richmond indicated Plaintiff would have extreme difficulties maintaining regular attendance and being punctual, dealing with stress of semi-skilled and skilled work, and working in coordination with/proximity to others without distraction. (Tr. 509-10). In relation to responding to supervisors and co-workers, Dr. Richmond indicated Plaintiff would have moderate difficulties asking simple questions or requesting assistance. (Tr. 510). Dr. Richmond indicated Plaintiff would have marked difficulties accepting instructions and responding appropriately to criticism from supervisors, getting along with coworkers and peers without distracting them or exhibiting behavioral extremes, maintaining socially appropriate behavior in a work setting, adhering to basic standards of neatness and cleanliness, responding appropriately to changes in routine work setting, and being aware of normal hazard and taking appropriate precautions. (Tr. 510). Dr. Richmond indicated Plaintiff would have extreme difficulties interacting appropriately with the public. (Tr. 510). With respect to other functional limitations, Dr. Richmond noted Plaintiff would have moderate restriction on activities of daily living, marked difficulties with social functioning, and constant difficulties with concentration, persistence, or pace. (Tr. 510). Dr. Richmond indicated Plaintiff has continuous episodes of decompensation, indicating Plaintiff experienced such episodes three times monthly, or 36 times in the past year. (Tr. 511). Dr. Richmond noted Plaintiff's impairments had been present since age 15. (Tr. 511).

         Licensed Social Worker Annette Huff completed a form entitled “Medical Source Statement (Mental)” on June 23, 2014. (Tr. 512-15). Huff indicated Plaintiff had: poor memory; sleep disturbance; personality change; mood disturbance; emotional lability; recurrent panic attacks; anhedonia or pervasive loss of interests; paranoia or inappropriate suspiciousness for safety of daughter and self; feelings of guilt/worthlessness; difficulty thinking or concentrating; social withdrawal or isolation; decreased energy; obsessions or compulsions; intrusive recollections of a traumatic experience; generalized persistent anxiety; and irritability. (Tr. 512). Huff noted Plaintiff had no noted deficits in intellectual functioning. (Tr. 513). Huff opined Plaintiff would be off task 25% or more per workday and would miss 4 or more days of work per month due to her ailments. (Tr. 513). Huff opined Plaintiff had marked difficulties remembering locations and worklike procedure, understanding and remembering very simple instructions, carrying out simple instructions, making simple work-related decisions, and completing a normal workday or workweek without interruption. (Tr. 513-14). Huff opined Plaintiff had extreme difficulties understanding and remembering complex instructions, maintaining attention and concentration for extended periods, sustaining an ordinary routine without special instructions, dealing with stress of semi-skilled and skilled work, working in coordination with/proximity to others without distraction, and performing at a consistent pace without unreasonable rests. (Tr. 513-14). Huff indicated her opinion was based on observation and no testing had been performed. (Tr. 514). Regarding interactions with others, Huff opined Plaintiff had no or mild difficulty adhering to basic standards of neatness and cleanliness. (Tr. 514). Huff indicated Plaintiff had moderate difficulties being aware of normal hazards and taking appropriate precautions. (Tr. 514). Huff indicated Plaintiff had marked difficulties interacting appropriately with the public, getting along with coworkers and peers without distracting them or exhibiting behavioral extremes, and maintaining socially appropriate behavior in a work setting. (Tr. 514). Huff noted Plaintiff had extreme difficulties accepting instructions and responding appropriately to criticism from supervisors and responding appropriately to changes in routine work setting. (Tr. 514). Turning to functional limitations, Huff opined Plaintiff had marked difficulties in activities of daily living, moderate difficulties in maintaining social functions, and constant difficulties in concentration, persistence, or pace. (Tr. 514). Huff did not know if Plaintiff had any episodes of decompensation. (Tr. 515).

         In evaluating Plaintiff's disability claim on reconsideration on November 10, 2014, the state psychological consultant, Dr. Mary Sullivan, assessed Plaintiff's affective disorders and anxiety disorders as severe. (Tr. 131, 151). In looking at the “B” criteria of the Listings, Dr. Sullivan opined Plaintiff had mild restriction on activities of daily living, moderate difficulties in maintaining social functioning, moderate difficulties in maintaining concentration, persistence, or pace, and no episodes of decompensation. (Tr. 131, 151). In assessing Plaintiff's RFC, Dr. Sullivan found there were no significant changes to Plaintiff's mental impairments, affirming Dr. Strait's RFC initial-stage assessment. (Tr. 137, 157).

         3. Discussion

         At the onset, the Court notes Huff is not considered an “acceptable medical source” but instead an “other source” that the ALJ may use as evidence to show the severity of Plaintiff's impairments. 20 C.F.R. §§ 404.1513(d)(1), 406.913(d)(1). Because therapists and licensed social workers are not “acceptable medical sources, ” but instead “other medical sources, ” their opinions are not entitled to the greater weight afforded treating sources. Lacroix v. Barnhart, 465 F.3d 881, 886 (8th Cir. 2006). While therapists and licensed social workers like Huff are not generally entitled to treating-source weight, they are entitled to consideration. Id.; 20 C.F.R. §§ 404.1513(d)(1), 406.913(d)(1). “In determining what weight to give ‘other medical evidence, ' the ALJ has more discretion and is permitted to consider any inconsistencies found within the record.” Raney v. Barnhart, 396 F.3d 1007, 1010 (8th Cir. 2005); Tindell v. Barnhart, 444 F.3d 1002, 1005 (8th Cir. 2006); cf. Social Security Ruling 06-03p, 71 Fed.Reg. 45593, 45596 (stating that more weight may be given to the opinion of a medical source who is not an acceptable medical source if “he or she has seen the individual more often than the treating source and has provided better supporting evidence and a better explanation for his or her opinion.”). The factors set forth in 20 C.F.R. §§ 404.1527(c), 416.927(c), while directed at treating sources, can be applied when weighing opinion evidence from “other sources.” SSR 06-03p, 71 Fed.Reg at 45595.

         As noted, the ALJ concluded Plaintiff's mental impairments are not severe. In reaching this conclusion, the ALJ assigned “little evidentiary weight” to the opinions of the non-examining state agency psychological consultants, (Tr. 36), and the opinions of licensed psychologist David Kearn, (Tr. 37-38), psychiatrist Dr. Joseph Richmond, (Tr. 37-38), and licensed social worker Annette Huff, (Tr. 38), as these opinions were not generally consistent with the evidence overall, particularly with Plaintiff's adult function report submitted in April 2014. (Tr. 36-42). The Court finds that the ALJ weighed the opinions of Kearn, Dr. Richmond, Huff, and the state agency psychological consultants in accordance with 20 C.F.R. §§ 404.1527(c), 416.927(c). Moreover, the weight given to each of these opinions by the ALJ is supported by substantial evidence in the record as a whole. The Court now turns to the factors found in 20 C.F.R. §§ 404.1527(c), 416.927(c).

         a. Examining and Treating Relationship

         There is no indication Kearn had any treating or examining relationship with Plaintiff. While Kearn appears to work with Dr. Richmond, (see Tr. 415), there are no treatment notes from Kearn in the record found by the Court, referenced by the ALJ, or cited by the parties. Instead, it appears Kearn's sole interaction with Plaintiff's mental health treatment was the drafting of his statement supporting her disability application. “The opinions of non-treating practitioners who have attempted to evaluate the claimant without examination do not normally constitute substantial evidence on the record as a whole.” Shontos v. Barnhart, 328 F.3d 418, 427 (8th Cir. 2003) (citing Jenkins v. Apfel, 196 Fed. 922, 925 (8th Cir. 1999)). Likewise, the state agency psychological consultants evaluated Plaintiff without examination. As such, the non-examining nature of Plaintiff's relationship with Kearn and the state agency psychologists serve as an unfavorable factor when weighing their opinions.

         Conversely, Dr. Richmond and Huff both had extensive treatment relationships with Plaintiff. Dr. Richmond saw Plaintiff for therapy sessions approximately every two months. Huff saw Plaintiff much more frequently, often conducting therapy on a weekly or biweekly basis. As such, the examining and treatment relationships of Dr. Richmond and Huff are favorable when weighing their opinions.

         b. Supportability and Consistency

         The Court now turns to the supportability and consistency of the opinions. The ALJ primarily discounted all opinions based on their inconsistency with Plaintiff's self-completed Adult Function Report, dated April 16, 2014. (Tr. 317-24). The Court agrees that the medical opinions diverge from Plaintiff's self-reported abilities contained in the Adult Function Report.

         Plaintiff indicated she does not follow written instructions well, needing to be shown how to do something and needing to read the instructions many times, but that with respect to spoken instructions, Plaintiff reported she could follow simple, one to two step instructions; with more complex instructions being difficult. (Tr. 322). Dr. Richmond opined that Plaintiff would have moderate difficulties understanding and remembering very simple instructions and carrying out simple instructions. Huff opined Plaintiff would have marked difficulties understanding, remembering, and carrying out very simply instructions. Conversely, Kearn indicated Plaintiff had no or mild difficulty with remembering locations and work-like procedures, understanding and remembering very simple instructions, carrying out simple instructions, sustaining an ordinary routine without special instructions, and making simple work-related decisions. The state psychological consultants also opined that Plaintiff could perform routine, two-step tasks on a sustained basis.

         Plaintiff reported interacting daily with her boyfriend, her daughter twice per month when she visits, and telephone calls about twice per month with her daughter. (Tr. 321). Plaintiff reported having problems getting along with others due to pain: “I don't take the time. The pain is so great. I just don't care to interact. People get on my nerves.” (Tr. 322). Plaintiff reported having no problems getting along with authority figures and never being fired from a job because of problems getting along with others. (Tr. 323). Although, Plaintiff did report she has fears “about a lot of things, ” including being in crowds due to panic attacks and being around customers when she worked. (Tr. 323). Dr. Richmond and Kearn opined Plaintiff would have moderate difficulties in interacting with supervisors, marked difficulty in accepting instructions from supervisors, and extreme difficulties working in coordination or in proximity to others and interacting with the public. Kearn indicated Plaintiff would have marked difficulty interacting appropriately with the public and interacting appropriately with co-workers/supervisors. Dr. Richmond indicated Plaintiff would have marked difficulties accepting instructions and responding appropriately to criticism from supervisors, and getting along with coworkers and peers, as well as extreme difficulties interacting appropriately with the public. Huff opined Plaintiff would have extreme difficulties working in coordination or in proximity to others, marked difficulties interacting appropriately with the public, getting along with coworkers and peers without distracting them, and extreme difficulties interacting with supervisors. The state psychological consultants opined Plaintiff's social functioning is reduced in that she may not work well with the public, but she could perform in small, familiar groups. Undercutting the opinions that Plaintiff could not work well with others, Plaintiff worked as a cashier from November 2012 to November 2013 for 7.5 hours per day for two days per week. (Tr. 325-26). In this position, she supervised one to two people for half of her shift. (Tr. 326). Supervision of others denotes an ability to interact with others that detracts from the opinions to the contrary.

         Plaintiff reported no difficulties handling her finances. (Tr. 319). Plaintiff watches television and does crossword puzzles. (Tr. 321). Also, Plaintiff reported she could pay attention for 30 minutes and does not finish what she starts. (Tr. 322). Plaintiff stated, however, that it is pain, rather than any mental health concern, that makes tasks difficult such as memory, concentration, following instructions, and getting along with others. (Tr. 322). Indeed, when asked to describe her ailments, Plaintiff described them as physical in nature-back and neck pain that makes all physical activities difficult, including walking and sitting, and daily headaches. (Tr. 317). Plaintiff reported not needing reminders to take care of her personal needs or to take medicine, although she does forget sometimes. (Tr. 319). Dr. Richmond and Kearn indicated Plaintiff had marked difficulty in maintaining attention and concentration for extended periods. Huff opined Plaintiff would be off task 25% or more per workday and had extreme difficulties maintaining attention and concentration for extended periods. Plaintiff's reported activities and abilities detract from the opinions expressing marked and extreme difficulties maintaining attention and concentration.

         Plaintiff reported some difficulties in dressing herself; showering three to four times per week, but “[d]epression makes it hard [and] it is just difficult and painful” because her “[b]alance is off” and it hurts to lift her arms up. (Tr. 318). Dr. Richmond indicated Plaintiff would have marked difficulty in adhering to basic standards of neatness and cleanliness and maintaining socially appropriate behavior. Throughout Plaintiff's visits with her treatment providers, however, Plaintiff was well-groomed and appropriately behaved. Moreover, Huff opined Plaintiff had no or mild difficulty in this area.

         Kearn indicated Plaintiff experiences episodes of deterioration or decompensation due to acute onset of anxiety symptoms with feelings of panic and physical symptoms. Dr. Richmond indicated Plaintiff has continuous episodes of decompensation, indicating Plaintiff experienced such episodes three times monthly, or 36 times in the past year. Conversely, Huff did not know if Plaintiff had any episodes of decompensation and the state agency psychological consultants found no episodes of decompensation. Nor does the record show any hospitalizations related to mental health concerns.

         These inconsistencies between the medical opinions and Plaintiff's self-reported capabilities and limitations detract from the opinions' value. And in looking at the medical record as a whole, the Court concludes the ALJ did not err in concluding the extreme limitations opined by Dr. Richmond and Huff, as well as Kearn and the state psychological consultants, are unsupported by the record.

         On March 15, 2013, Plaintiff saw nurse practitioner SuZan Chandler on complaints of feeling ill for the past seven days. (Tr. 397-400). During this visit, Plaintiff reported her “[a]nxiety is bad right now.” (Tr. 397). On examination, Plaintiff's thought content appeared normal and she appeared anxious. (Tr. 398). Chandler only treated Plaintiff's physical ailments. (Tr. 398-400). One week later, on March 22, 2013, Plaintiff saw Chandler reporting she had a panic attack the night prior where she could not breath or swallow. (Tr. 401). Plaintiff reported not beginning the albuterol inhaler she was prescribed the week earlier to treat her breathing symptoms because “she's too afraid.” (Tr. 401). Chandler prescribed a trial of lorazepam[1] for Plaintiff's anxiety/depression to last for approximately one month, as well as recommending therapy with a psychologist. (Tr. 403). On April 10, 2013, Plaintiff saw Chandler for a follow-up. (Tr. 405-07). Plaintiff reported some panic attacks and taking the lorazepam and using puzzle books to focus, which helps. (Tr. 405). Plaintiff reported she cannot go to work due to the panic attacks, unable to “deal with people, ” and feeling “really angry” sometimes and out of control of her life. (Tr. 405). Chandler prescribed Prozac[2] to treat Plaintiff's anxiety depression and Plaintiff was directed to begin therapy. (Tr. 406-07). Plaintiff saw Chandler for a follow-up on April 22, 2013. (Tr. 408-10). Plaintiff reported she had not started her Prozac because she “was confused and anxious about what may happen when she starts [it].” (Tr. 408). Plaintiff reported “[l]ots going on at home” as she was getting ready to move to a new home and was “greatly looked forward” to it. (Tr. 408). Plaintiff agreed to start her Prozac that day. (Tr. 410).

         Plaintiff saw nurse practitioner Sandra Moore on October 1, 2013 after a recent consultation concerning her back/neck pain. (Tr. 488-90). Moore noted Plaintiff's issues with lack of sleep and depression, noting “[s]he has several issues to work through that may be contributing to her chronic pain.” (Tr. 488). Plaintiff was “tearful at times discussing her mental health.” (Tr. 488). When Moore asked Plaintiff to “prioritize the things that bother her the most [Plaintiff] indicate[d] lack of sleep and pain.” (Tr. 488). Plaintiff had a PHQ score for 17, indicating moderately severe depression, and a GAD score of 16, indicating severe anxiety. (Tr. 488). On examination, Plaintiff was well groomed, had appropriate attire, and good hygiene. (Tr. 489). Plaintiff had avoidant eye contact, her speech was unremarkable, she was oriented to person, place, and time, her mood was sad and anxious, and her insight and judgment were fair. (Tr. 489). Moore's analysis was fibromyalgia with contributions from depression and anxiety. (Tr. 489). Moore noted Plaintiff was “extremely anxious about taking medication to treat her symptoms, ” but she agreed to a reduced dose of Cymbalta[3] and was referred to counseling. (Tr. 489).

         Plaintiff saw Dr. David Spight on October 23, 2013 for follow-up to a therapy referral. (Tr. 440). Plaintiff noted she had been prescribed Cymbalta “but has not started it because of the potential side effects.” (Tr. 440). Dr. Spight “had a long discussion [with Plaintiff] about the fact that most medications have a plethora of potential side effects; however, with that being said she may not experience any of those side effects.” (Tr. 440). Dr. Spight also informed Plaintiff that if she has any side effects, she can notify Moore, who initially prescribed the medication. (Tr. 440). Dr. Spight recommended Plaintiff start the Cymbalta and return to physical therapy. (Tr. 440).

         On October 24, 2013, Plaintiff saw Huff for a diagnostic assessment. (Tr. 451-53). Plaintiff endorsed symptoms of: sadness; mood swings; racing thoughts; difficulty concentrating; distractibility; indecisiveness; memory problems; loneliness; avoiding people; muscle tension; fatigue; sleep disturbance; sense of helplessness; hopelessness; restlessness; worthlessness; trembling; worrying; fear; panic episodes resulting from flashback memories, daydreams, and nightmares of past traumatic experiences; financial strain; and unresolved conflict with family. (Tr. 451, 453). Huff rated Plaintiff as having extreme anxiety and severe depression. (Tr. 452). Huff also assessed a PHQ9 score of 22, indicating a high level of depression. (Tr. 452). On examination, Plaintiff appeared comfortable, had depressed mood, flat affect, normal speech, and was fully oriented. (Tr. 452). Plaintiff's judgment and insight were intact, and her intelligence was rated as high. (Tr. 452). Huff summarized her impression, noting Plaintiff “jumped directly into core issues which have motivated her to seek services offering direct and honest details of clearly difficult information. [Plaintiff] demonstrate[d] insightful understanding and clear thinking about the childhood and life events creating her emotional disturbance.” (Tr. 452). Plaintiff's thought process was logical and organized and she had no evidence of delusions or hallucinations. (Tr. 452). Huff's diagnosis was: major depressive disorder, recurrent, severe without psychotic features; and posttraumatic stress disorder. (Tr. 453).

         Plaintiff saw Huff for therapy on October 31, 2013. (Tr. 462). Plaintiff was tense and withdrawn. (Tr. 462). During therapy, Plaintiff “identified trauma triggers in [her] relationship with [her] mother.” (Tr. 462). Huff and Plaintiff developed a treatment plan with long-term goals to stabilize Plaintiff's mood, relieve/resolve traumatic images, and repair self-esteem/image. (Tr. 454; see also Tr. 458).

         Plaintiff saw Huff for therapy on November 5, 2013. (Tr. 463). Plaintiff reported some progress in her mental health status. (Tr. 463). Plaintiff was tense, heavy-hearted, and sad, noting her mind continually races and ruminates. (Tr. 463). Plaintiff reported ...


Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.