Cook v. Colvin (CONSENT)

Filing 15

MEMORANDUM OPINION. Signed by Honorable Judge Terry F. Moorer on 12/24/14. (djy, )

IN THE DISTRICT COURT OF THE UNITED STATES
FOR THE MIDDLE DISTRICT OF ALABAMA
EASTERN DIVISION
WILMA E. COOK,
Plaintiff,
v.
CAROLYN W. COLVIN, Acting
Commissioner of Social Security,
Defendant.

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CIVIL ACTION NO. 3:14cv92-TFM
(WO)

MEMORANDUM OPINION
I. PROCEDURAL HISTORY
The plaintiff, Wilma E. Cook (“Cook”), applied for disability benefits pursuant to
Title II of the Social Security Act, 42 U.S.C. §§ 401 et seq., and for supplemental security

income benefits pursuant to Title XVI of the Social Security Act, 42 U.S.C. § 1381 et seq.,
on October 18, 2011, alleging that she is unable to work because of a disability. Cook’s
application was denied at the initial administrative level. Cook then requested and received
a hearing before an Administrative Law Judge (“ALJ”). Following the hearing, the ALJ
determined that Cook is not disabled. The Appeals Council rejected a subsequent request
for review. The ALJ’s decision consequently became the final decision of the Commissioner
of Social Security (“Commissioner”).1 See Chester v. Bowen, 792 F.2d 129, 131 (11th Cir.
1986).

The parties have consented to the undersigned United States Magistrate Judge

1

Pursuant to the Social Security Independence and Program Improvements Act of 1994, Pub.L. No.
103-296, 108 Stat. 1464, the functions of the Secretary of Health and Human Services with respect to Social
Security matters were transferred to the Commissioner of Social Security.

rendering a final judgment in this lawsuit. The court has jurisdiction over this lawsuit under
42 U.S.C. §§ 405(g) and 1383(c)(3).2 Based on the court’s review of the record in this case
and the briefs of the parties, the court concludes that the decision of the Commissioner is due
to be REVERSED and REMANDED.
II. STANDARD OF REVIEW
Under 42 U.S.C. § 423(d)(1)(A), a person is entitled to disability benefits when the
person 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 . . . .
To make this determination,3 the Commissioner employs a five-step, sequential
evaluation process. See 20 C.F.R. §§ 404.1520, 416.920.
(1) Is the person presently unemployed?
(2) Is the person’s impairment severe?
(3) Does the person's impairment meet or equal one of the specific
impairments set forth in 20 C.F.R. Pt. 404, Subpt. P, App. 1?
(4) Is the person unable to perform his or her former occupation?
(5) Is the person unable to perform any other work within the economy?
An affirmative answer to any of the above questions leads either to the next
question, or, on steps three and five, to a finding of disability. A negative
answer to any question, other than step three, leads to a determination of “not
disabled.”

2

Title 42 U.S.C. §§ 405(g) and 1383(c)(3) allow a plaintiff to appeal a final decision of the
Commissioner to the district court in the district in which the plaintiff resides.
3

A “physical or mental impairment” is one resulting from anatomical, physiological, or
psychological abnormalities which are demonstrable by medically acceptable clinical and laboratory
diagnostic techniques.

2

McDaniel v. Bowen, 800 F.2d 1026, 1030 (11th Cir. 1986).4
The standard of review of the Commissioner’s decision is a limited one. This court
must find the Commissioner’s decision conclusive if it is supported by substantial evidence.
42 U.S.C. § 405(g); Graham v. Apfel, 129 F.3d 1420, 1422 (11th Cir. 1997). “Substantial
evidence is more than a scintilla, but less than a preponderance. It is such relevant evidence
as a reasonable person would accept as adequate to support a conclusion.” Richardson v.
Perales, 402 U.S. 389, 401 (1971). A reviewing court may not look only to those parts of
the record which support the decision of the ALJ but instead must view the record in its
entirety and take account of evidence which detracts from the evidence relied on by the ALJ.
Hillsman v. Bowen, 804 F.2d 1179 (11th Cir. 1986).
[The court must] . . . scrutinize the record in its entirety to determine the
reasonableness of the [Commissioner’s] . . . factual findings . . . No similar
presumption of validity attaches to the [Commissioner’s] . . . legal conclusions,
including determination of the proper standards to be applied in evaluating
claims.
Walker v. Bowen, 826 F.2d 996, 999 (11th Cir. 1987).
III. INTRODUCTION
A. The Commissioner’s Decision
Cook was 46 years old at the hearing before the ALJ, has completed the twelfth grade,
and has a two-year degree in Cosmetology from Opelika State Technical College. R. 32, 43,
48-49. She was also certified as a nurse’s assistant. R. 56.

4

McDaniel v. Bowen, 800 F.2d 1026 (11th Cir. 1986) is a supplemental security income case (SSI).
The same sequence applies to disability insurance benefits. Cases arising under Title II are appropriately
cited as authority in Title XVI cases. See e.g. Ware v. Schweiker, 651 F.2d 408 (5th Cir. 1981) (Unit A).

3

Cook alleges that she became disabled on July 7, 2011, due to depression, memory
loss, personality disorder, fibromyalgia, degenerative disc disease, osteoarthritis, nonobstructive coronary artery disease, mitral valve prolapse with mild mitral regurgitation,
mood disorder, sleep dysfunction, hypertension, scoliosis, acid reflux disease, otitis media,
chronic sinusitis, fatigue, hearing loss, migraine headaches, restless leg syndrome,
neuropathy, and cystitis. R. 53-54, 57-59, 61-63. After the hearing, the ALJ found that
Cook suffers from severe impairments of major depression, recurrent, moderate, chronic;
personality disorder, not otherwise specified; fibromyalgia syndrome/fibrositis; cervical
degenerative disc disease; possible osteoarthritis, knees; nonobstructive coronary artery
disease; hypertension; mitral valve prolapse with mild mitral regurgitation; myocardial
bridge; mood disorder, not otherwise specified; and mild obesity. R. 14. He also found that
she suffers from non-severe impairments of sleep dysfunction associated with sleep stagearousal; cystitis; status post cholecystectomy; mild levoscoliosis; acid reflux disease; bilateral
otitis media and sensorineural hearing loss; chronic maxillary sinusitis; fatigue and malaise;
irritable bowel syndrome; a condition requiring progressive lenses; plantar fasciitis; upper
respiratory infection; migraine headaches; and restless leg syndrome. R. 15. The ALJ found
that Cook is unable to perform her past relevant work, but that she retains the residual
functional capacity (“RFC”) to perform light work. R. 19. Testimony from a vocational
expert led the ALJ to conclude that a significant number of jobs exists in the national
economy that Cook could perform, including work as a laundry sorter, folder, or electrical
assembler. R. 33. Accordingly, the ALJ concluded that Cook is not disabled. Id.
4

IV. DISCUSSION
The sole issue before the court is whether “the Administrative Law Judge committed
reversible error when he substituted his own judgment for the judgment of the medical and/or
psychological professionals.” Doc. No. 12, p. 1. Specifically, Cook asserts that the ALJ
improperly discounted the opinion of Dr. Peggy Thornton, a licensed consultative
psychologist. In addition, she argues the ALJ substituted his judgment for that of mental
health professionals by ignoring and/or mis-characterizing their notes and findings. The
court agrees.
The mental health records indicate that Cook has received extensive mental health
treatment, including frequent home visits by a case manager, monthly sessions with a
counselor, and routine checkups by psychiatrists at Cheaha Regional Mental Health Center
throughout the relevant time period. R. 617-618. On January 11, 2010, a mental health
therapist, Katherine Smith, conducted an initial assessment of Cook, noting that Cook was
emotionally and physically abused by her second husband. R. 435. Cook reported that she
has trouble hearing out of her left ear since her former husband hit the back of her head. Id.
She also reported that she is stressed, upset, worries all the time ,and that she stays to herself
to keep from hurting others’ feelings. R. 436. In addition, she stated that she suffers from
back and knee pain. Id. Cook was diagnosed as suffering from major depression, recurrent,
moderate, chronic; personality disorder, NOS; and “problems [with] primary support, access
to health services, economic.” R. 434. Her affect was restricted, mood was anxious, and her
judgment and insight were average. Id. The therapist formulated three treatment goals for
5

Cook to pursue over the next year. The first and primary goal was to maintain medication
compliance to improve mood and prevent hospitalizations. R. 439. The second goal was to
pursue disability benefits, and the third and final goal was to maintain interests. R. 438.
Throughout the year, the therapist conducted routine mental sessions with Cook. The
therapist discussed Cook’s progress and provided support and encouragement, guidance
concerning her self worth and esteem, and emphasized problem solving in adapting to her
illness. R. 441-446.
On January 3, 2011, the therapist formulated a new master treatment plan for the
following year. The therapist determined Cook’s first goal should be to maintain medication
compliance to improve mood and prevent hospitalizations, specifically noting that a barrier
to reaching this goal is the cost and side effects of medication. R. 449. Her second goal was
to acquire disability benefits, and her third goal was to manage depression. R. 448. Cook
attended mental health sessions with the therapist on a routine basis throughout the year. R.
450-454. The therapist offered support and encouragement, provided guidance concerning
self-esteem, and emphasized problem solving. Id. On several occasions, the therapist noted
Cook’s mood was irritable and/or dysphoric. Id.
In December 2011, Dr. Thornton, the consultative psychologist, conducted a
comprehensive psychological evaluation. R. 507-08. Dr. Thornton noted that Cook’s
medications include Lyrica, Ambien, Requip, Tribenzor, Hyoscyamine, Ultram, Zolpidem
Tartrate, Naproxen, Flexeril, Percocet, Savella, Celexa, Atenolol, Tylenol, and Celebrex.
R. 507. Cook reported that her mother visits once a day and does all the cooking and
6

cleaning, that her concentration problems prevent her from doing chores and managing her
finances, that she avoids social activities, and that she is so depressed sometimes that she
avoids bathing and brushing her teeth. R. 507. Dr. Thornton found that Cook was “fairly
neatly dressed and groomed,” although her hair was uncombed, and that her presentation was
initially irritable. Id. The psychologist also noted the following:
[C]onsiderable confusion was evident. For example, when asked who the
current president is, she was unable to name him, but insisted multiple times
that “Herman Cain will be the next one!” . . . She was fully oriented as to
person, place, time and situation. Her thought processes were logical. She
reported depressive symptoms of frequent crying spells, feeling helpless and
hopeless, low energy, [and] concentration problems, saying “I stay confused
all the time.” . . . She reported she hears voices calling her name and believes
that people are in her house trying to scare her.
R. 507-08. Dr. Thornton conducted a cognitive functioning evaluation and found that Cook’s
short-term memory was impaired and long-term memory was mildly impaired. R. 508. The
psychologist found that Cook would not be able to manage benefits or make appropriate
work decisions “due to her evident confusion” and diagnosed her as suffering from major
depressive disorder, moderate, with psychosis. Id.

On January 3, 2012, a therapist at Cheaha Regional Mental Health Center formulated
a new master treatment plan for Cook. R. 606. The therapist, Cyrilla Beveridge, formulated
three goals: (1) maintain medical compliance to improve mood and prevent hospitalizations;
(2) accept referral to case management and BLS services; and (3) manage her depression.

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R. 606-07. The therapist listed Cook’s diagnoses as Major Depression, recurrent, moderate,
chronic; Personality Disorder, NOS; history of fibromyalgia, high blood pressure, arthritis;
and problems with primary support, access to health services, and economic limitations. Id.
On March 6, 2012, the therapist noted that Cook “appear[ed] depressed in her affect
and demeanor,” that her mood was dysphoric, and that she reported chronic pain. (R. 612).
The therapist provided supportive recovery based treatment and discussed the importance of
staying active and “not avoiding stressful situations because that only creates more stress.”
Id.

She also referred Cook to a case management and basic life support program,

specifically noting that Cook “has multiple medical problems and is in [third] appeal process
for SSI/SSP,” that she “may lose her medical coverage,” and that she “is feeling
overwhelmed.” R. 611.
During a home visit on March 19, 2012, Christine Higgins, a case manager provided
training on community awareness, money management, and communication and/or social
skills. R. 613. Ms. Higgins noted Cook’s concern that her Medicaid benefits would be
terminated. Id. The case manager indicated that supervision was required and that progress
was made. Id. On April 18, 2012, the case manager returned to Cook’s home. R. 615.
Cook received thirty minutes of training on housekeeping skills and thirty minutes of training
on medication management. Id. She noted that Cook took out the trash to the curb and
thawed a package of meat in cold water. Id. The case manager again noted that supervision
was required but that progress was made. Id.
On May 16, 2012, both the case manager and therapist conducted a home visit. The
8

case manager and therapist found that Cook was compliant with her medication regimen. R.
616. In addition, the case manager noted that Cook was recently diagnosed with hearing loss
and was very depressed about the situation. Id.
Cook also received at least three fifteen-minute evaluations by mental health
practitioners at Cheaha Regional Mental Health Center in 2012. On January 5, 2012, Dr.
Castro, a psychiatrist, conducted a “physician medical assessment” in which he noted that
Cook was very depressed and her affect was restricted. Id. His diagnostic impression was
Mood Disorder, NOS.5 R. 610. During an additional session on April 5, 2012, the
psychiatrist diagnosed Cook as suffering from a Mood Disorder, NOS, specifically noting
that Cook “seems so-so.”6 R. 614. On August 2, 2012, Dr. Castro diagnosed Cook as
suffering from a mood disorder on Axis I and “dependent” on Axis II. R. 689. He
recommended that she continue her present course of treatment and follow-up with her
primary therapist. Id.
On October 10, 2012, the case manager completed a State of Alabama Department of
Mental Health and Retardation Utilization and Need Face Sheet. R. 693. The case manager
indicates Cook was diagnosed as suffering from Major Depression on Axis I and Personality
Disorder NOS on Axis II. Id. She circled items indicating that Cook is “seriously mentally
ill” because she “is unemployed, is employed in a shelter setting, or has markedly limited

5

It appears Dr. Castro diagnosed Cook with an additional mental health condition; however, the
psychiatrist’s handwriting is illegible.
6

As previously discussed, Dr. Castro listed an additional mental health condition. The court,
however, is unable to discern the second diagnosis.

9

skills and a poor work history [and] shows severe inability to establish or maintain personal
social support systems” and that she is “high risk” because she is “a person who without
outpatient intervention would become at imminent risk of needing inpatient hospitalization.”
Id. The case manager also listed several unmet needs and problem areas, including Cook’s
difficulty with social interaction, shopping, cooking, home and money management,
communication, assertiveness, community services, vocational skills, medical and dental
care, inadequate income, obtaining groceries or food stamps, and routinely taking
medication.

R. 695. She also indicated Cook’s mental health needs include “memory

deficit, disoriented, or wandering” and that she “is constantly forgetting where things are.”
R. 696.
On October 12, 2012, the therapist at Cheaha Mental Health Center formulated an
individualized case plan with four specific goals. The first goal was to “access psychiatric
services” by “encourag[ing] consumer to comply with [mental health appointments] as
scheduled,” “stress[ing] the importance of taking med[ications] as prescribed and
encourag[ing] client to follow treatment recommended for stability,” “assist[ing] [client]
[with] accessing med[ication] as needed,” and “monitor[ing] consumer’s attendance [with
mental health treatment].” R. 692. The second goal was to access transportation services.
Id. The third goal was to “access entitlements” by “assist[ing] consumer as needed in
applying for all eligible benefits” and “provid[ing] social support on consumer’s behalf as
needed in qualifying for services.” Id. The final goal was to “provide follow-up services”
by “monitor[ing] consumer’s progress according to current stage and assist[ing] as needed
10

for continued community living.” Id.
On January 3, 2013, the therapist formulated a new master treatment plan for the year.
R. 676-77. The therapist determined Cook’s first goal should be to maintain medication
compliance to improve mood a regain motivation to work toward goals and her second goal
should be to work actively and in cooperation with the case manager/BLS to improve her
quality of life. R. 676. The therapist approved a diagnosis of major depression, recurrent,
moderate, chronic; history of fibromyalgia, high blood pressure, arthritis; and limited support
with stress associated with health issues. R. 678. When discussing her long term recovery
goals, Cook indicated her hopes for a disability check and a better place to live and expressed
her thankfulness for having a case manager. Id. The therapist noted that Cook has feelings
of sadness, hopelessness, a loss of interests, worry, and problems sleeping, and that she
“reports staying to herself because she will hurt others feelings.” Id.
During a one-hour session on February 14, 2013, the therapist noted that Cook’s mood
was dysphoric and that “she has been struggling with helping to take care of her mother who
is recovering from extensive surgery and rehabilitation.” R. 741. She also found that Cook
was making good progress with taking her medications as prescribed without reports of side
effects. Id.
On March 4, 2013, both the case manager and therapist conducted a home visit to
monitor Cook’s progress with her medication regimen. R. 682. Cook reported that she was
not taking her medications as directed and that she had not heard anything from the Social
Security office. Id. They returned to Cook’s house on March 11, 2013. R. 683. The
11

therapist noted that Cook’s medications were well organized. Id. During the home visit,
Cook asked the therapist and case manager to assist her with a four-page questionnaire from
her lawyer and that she was “very helpful with dates and times and ... her work record since
she applied for disability.” Id. Cook also gave them a letter from the Health Department
which indicated she would no longer receive Medicaid after March 31, 2013. Id.
During a home visit from both the case manager and therapist on March 13, 2013,
Cook gave them a letter from her lawyer which she believed contained information indicating
a disability check would arrive soon. R. 684. Upon re-reading the letter, Cook realized that
she was incorrect. Id. She reported “that she could only think about the possibility of an
income.” Id. Both the case manager and therapist returned to Cook’s home on March 25,
2013. R. 685. Cook reported that she had taken all of her medication as directed and that
she “is mentally alright.” Id. During the visit, Cook’s right leg and knee were aching and
swollen. Id. Cook indicated her Medicaid benefits would end soon. Id.
In 2013, Cook also received at least two brief evaluations by Dr. Castro. During a
four-minute evaluation on January 3, 2013, the psychiatrist noted that Cook was “stressed”
and that her medication is helpful. R. 688. Dr. Castro diagnosed her as suffering from an
adjustment disorder. Id. During a seven-minute evaluation on April 4, 2013, the psychiatrist
noted that Cook’s affect was restricted, that her condition was “fair,” that she was still
hurting a lot, that she had “severe stressors,” and that her medication is helpful. R. 687. Dr.
Castro again diagnosed Cook with an adjustment disorder and recommended that she
continue on her present course of treatment and follow-up with her primary therapist. Id.
12

On April 10, 2013, both the case manager and therapist at Cheaha Mental Health
Center formulated an individualized case plan with four specific goals: (1) access psychiatric
services; (2) access transportation services; (3) access entitlements; and (4) provide follow-up
services. R. 697. The case manager also completed an additional State of Alabama
Department of Mental Health and Mental Retardation Form indicating that Cook was
diagnosed with Major Depression on Axis I and Personality Disorder NOS on Axis II. R.
698. She also circled items indicating that Cook is “seriously mentally ill” because she “is
unemployed, is employed in a shelter setting, or has markedly limited skills and a poor work
history [and ] shows severe inability to establish or maintain personal social support systems”
and that she is “high risk” because she is “a person who without outpatient intervention
would become at imminent risk of needing inpatient hospitalization.” Id. The case manager
also listed several unmet needs and problem areas, including Cook’s difficulty with social
interaction, shopping, cooking, home and money management, communication skills,
community services, and vocational skills. R. 700. She also indicated that Cook has
difficulty obtaining food, groceries, and medical/dental care, has an inadequate income, is
not always compliant with psychotropic medications, and suffers from “memory deficit,
disoriented, or wandering,” including a tendency to forget information. R. 701.
During a session on April 29, 2013, the therapist noted that Cook’s mood was
dysphoric, her affect was restricted, that she may “have to wait for Medicare for 2 years to
help her assist with the cost of medication,” and that she “is only taking blood pressure
medications and is not able to afford to fill her prescription from Dr. Castro.” R. 729. The
13

therapist and case manager conferred with Cook about other cost-effective alternatives. Id.
The following day, the case manager took Cook to the Roanoke Rural Clinic to help her get
some of her medications. R. 730.
On May 28, 2013, the therapist noted that Cook’s mood was anxious and dysphoric
and her affect was restricted. R. 732. Cook reported that her “biggest stressor is not being
able to afford her medications both psychiatric and medical.” R. 732. The therapist
implemented “relapse prevention strategies and recovery oriented therapies, including ways
to manage stressful situations as they occur as well as importance of being self sufficient.”
R. 732.
On July 2, 2013, both the therapist and case manager went to Cook’s home to monitor
her progress. R. 784. The case manager noted that Cook requested help finding affordable
dental treatment. Id.
On July 8, 2013, the therapist noted that Cook “presented with a sad and flat affect”
with reports of becoming agitated and easily frustrated. R. 733. The therapist noted that
Cook was experiencing painful dental and fibromyalgia problems but was unable to afford
treatment. Id. The therapist conducted cognitive behavioral therapy. Id.
On July 12, 2013, both the therapist and case manager returned to Cook’s home and
discussed her depression regarding her inability to afford medication. R. 785. The case
manager provided Cook with instructions on how to get affordable medication through a
program at Walmart. Id.
During a counseling session on July 16, 2013, the therapist noted that Cook’s mood
14

was anxious, dysphoric, and agitated and that she was experiencing a great deal of dental
pain. R. 789. She also noted that Cook reported that she argued with her boyfriend
frequently and that she was doing a good job of making an effort to be more active. Id. The
therapist implemented cognitive behavioral therapy relating to Cook’s negative thought
patterns and emotions. Id.
On August 1, 2013, a nurse at Cheaha Regional Mental Health Center conducted a
thirty-minute mental health consultation. R. 790. She noted that Cook was compliant with
her medications and that her mood was euthymic. Id. On the same day, Dr. Castro
conducted a fifteen minute mental health assessment. R. 791. He noted that her pain and
depression are present but “not as bad” and a disability hearing was set for the following
week. Id. He diagnosed Cook with an adjustment disorder and recommended that she
continue her present course of treatment and follow-up with her therapist. Id.
On July 23, 2013, the therapist and case manager conducted a home visit to monitor
her progress. R. 786. The case manager noted that a dentist had removed two of Cook’s
teeth. Id. On August 13, 2013, they returned to Cook’s home and discussed her upcoming
disability hearing. R. 798.
During a one-hour consultation on August 9, 2013, the therapist noted that Cook was
“in a significantly dysphoric mood” and reported that her disability hearing did not go well.
R. 797. She also “told [the therapist] for the first time that she occasionally hears voices in
the distance when there is no one actually there [and she] believes it is associated to taking
Perocet (narcotic pain medication) which can cause transient hallucinations.” Id. The
15

therapist advised Cook to discuss the problem with the psychiatrist. Id.
On August 12, 2013, the therapist and case manager returned to Cook’s home. R.
799. Cook reported that she was taking all of her medications and that she was depressed
about the disability hearing and was “almost feeling like giving-up.” Id.
During a one-hour consultation on September 6, 2013, the therapist noted that Cook’s
mood was dysphoric and that she presented with a depressed and somewhat hopeless mood.
R. 794. The therapist noted that Cook’s symptoms of irritable bowel syndrome were likely
associated with anxiety. Id. The therapist and Cook discussed “how Cymbalta hasn’t
seemed to have much effect on her depression nor her pain level and she has been taking it
for two years.” Id. The therapist suggested that Cook “talk with a psychiatrist about whether
or not she is on the most effective medication for her specific symptoms.” Id.
On September 19, 2013, the case manager and therapist conducted a home visit to
monitor Cook’s progress with her medication regimen and determined that she was
compliant. R. 800. Cook reported having constant irritable bowl syndrome and that she was
worried about the social security hearing. Id. On October 1, 2013, the case manager and
therapist returned to Cook’s home. R. 801. Cook reported that she did not feel well due to
her “bowels” and “stress” and expressed her concern that she had heard nothing from her
lawyer. Id. The case manager explained that the claims remain pending for a long time. Id.
On October 10, 2013, Cook went to Hill Crest Associates. R. 804. Dr. Brewer, a
psychiatrist, met with Cook for thirteen minutes. Id. The psychiatrist found no abnormalities
and indicated that her mood was “ok”. Id. He diagnosed Cook with Major Depressive
16

Disorder recurrent and increased her prescription of Cymbalta. R. 805.
On October 14, 2013, the case manager and therapist went to Cook’s home to monitor
her progress with medication. R. 802. They noted that she was having problems with her
bowels and wearing “Depends” and that she expressed concern about the status of her social
security claim. Id.
During a half-hour session on October 17, 2013, Karen McKinney, a therapist at
Cheaha Regional Mental Health Center, noted that Cook’s appearance and affect were
inappropriate and her mood was dysphoric. R. 803. Cook reported that she prefers to be left
alone and that her appetite is excessive. Id. She also stated that she “often do[es] wish[]
[she] could end the hurting and aches and the pain and the lifestyle” and that she “feels like
[she] is on hold due to waiting for a response from SS office for disability.” Id. The therapist
found that Cook had “some suicidal thoughts and no plan” and provided support, education,
and coping skills. R. 803.
On November 7, 2013, Cook returned to Hill Crest Associates. R. 807. Dr. Brewer
conducted a twelve-minute evaluation, noting that Cook’s progress and response to
behavioral and psychotherapeutic treatment was poorly controlled. Id. He diagnosed Cook
with Major Depressive Disorder recurrent. Id. Thus, Cook received mental health treatment
on a routine basis throughout the relevant time period.
Despite the extensive mental health records indicating Cook sought treatment to
overcome her personality disorder and other psychological problems, the ALJ discounted Dr.
Thornton’s finding that Cook would be unable to manage benefits or make appropriate work
17

decisions and her diagnosis that she suffers from major depressive disorder, moderate, with
psychosis. First, the ALJ’s determination that Cook’s primary goal during mental health
treatment was to obtain social security benefits is a mischaracterization of the evidence. The
records of Cook’s sessions with her therapist and case manager indicate that her primary goal
was to improve her mood and prevent hospitalizations and/or to access psychiatric services.
R. 448-49, 606-07, 697. The goal of acquiring disability and/or health benefits, which
incidentally was formulated by the case manager and therapist and not Cook, was secondary
to Cook’s primary goal of improving her mood. Id.
The ALJ’s finding that “the claimant admitted to the therapist she was caring for her
mother following her mother’s surgery” is likewise a mischaracterization of the evidence.
R. 28. The mental health records indicate that, on February 14, 2013, the therapist noted that
Cook “has been struggling with helping to take care of her mother who is recovering from
extensive surgery and rehabilitation.” R. 741. (Emphasis added). This court cannot
conclude that a claimant “struggling” to take care of a family member is in fact an able
caretaker.
The ALJ also discounts both the consultative psychologist’s and therapist’s findings
on the basis that Cook’s meetings with mental health personnel were “little in the way of
remarkable complaints or findings.” R. 28. He further discounts Dr. Thornton’s finding of
psychosis on the basis that Cook “never presented with signs of psychosis before her
providers and she conceded this point.” R. 24. First, the court notes that nothing in the
record indicates that Cook made such a concession. Rather, she speculated during the
18

hearing that the reason she did not mention hearing voices during her therapy sessions on
prior occasions was because she was medicated at the time. R. 55. In addition, the medical
records indicate that Cook takes several medications which may cause serious side effects,
including confusion or other psychological problems.7 It is compelling that the therapist
provided extensive treatment to Cook on a frequent basis throughout the relevant time period
and worked closely with a case manager at Cook’s residence to counsel her on treatment
goals, including social interaction, communication, shopping, home and money management,
and a medication regimen. Under these circumstances, the court cannot conclude that the
ALJ’s discounting of the therapist’s findings based on the lack of remarkable findings is
supported by substantial evidence.
More importantly, nothing in the mental health records indicates that a mental health
specialist such as a doctor of psychiatry or psychology other than Dr. Thornton conducted
a thorough mental health evaluation of Cook. In addition, nothing in the record indicates that
anyone other than the consultative psychologist asked her whether she suffered from auditory
hallucinations, confusion, or other psychotic episodes. Despite Dr. Thornton’s extensive
evaluation of Cook and his psychiatric expertise, the ALJ assumed that Cook mislead the
consultant into believing that she was confused during the session. By discounting Dr.
Thornton’s diagnosis of major depressive disorder moderate with psychosis and her finding
that Cook would be unable to manage benefits or make appropriate work decisions, the ALJ
7

The medication records indicate that Cook was routinely prescribed Cymbalta, Ambien, Neurontin,
Requip, Lyrica, Ultram, Flexeril, Percocet, Hydrochlorothiazide, as well as other medications, and that these
pills or tablets were prescribed to be taken together on a daily or as-needed basis. R. 619-623.

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substituted his judgment for that of the consultative psychologist. While the ALJ is entitled
to make credibility determinations, the ALJ may not substitute his judgment for the
judgments of experts in their field of expertise. Psychologists deal with quintessentially
subjective information with respect to which they must exercise professional, interpretive
judgment. See Hill v. Astrue, No. 1:09cv01-CSC, 2010 WL 1533121, *4 (M.D. Ala. April
15, 2010). Consequently, on remand, the ALJ should consider whether further developing
the record by ordering psychological testing and/or a thorough evaluation by a mental health
specialist to determine the basis of Cook’s mental health problems, including confusion,
would assist him in forming a decision.
Finally, the court concludes that the Commissioner failed to consider Cook’s inability
to afford medical treatment when determining that Cook has the residual functional capacity
to return to her perform light work. The ALJ discredited Cook’s allegations of disabling
symptoms based on her admission to her therapist that she was not taking her medication as
directed. While failure to seek treatment is a legitimate basis to discredit the testimony of
a claimant, it is the law in this circuit that poverty excuses non-compliance with prescribed
medical treatment or the failure to seek treatment. Dawkins v. Bowen, 848 F.2d 1211 (11th
Cir. 1988). The medical records are replete with references to Cook’s inability to afford
treatment. R. 449,611,613, 683, 729-30, 732-33, 785. In addition, Cook testified that the
reason she is not taking the medication as directed is because of finances. R. 79. Despite
notations indicating Cook is uninsured and is unable to afford treatment, the Commissioner
failed to consider whether Cook’s financial condition prevented her from seeking medical
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treatment. Thus, this court cannot conclude that the Commissioner’s discrediting of Cook
based on her failure to seek treatment is supported by substantial evidence.
“Social Security proceedings are inquisitorial rather than adversarial. It is the ALJ’s
duty to investigate the facts and develop the arguments both for and against granting
benefits.” Sims v. Apfel, 530 U.S. 103, 110-111 (2000).
The SSA is perhaps the best example of an agency that is not based to a
significant extent on the judicial model of decisionmaking. It has replaced
normal adversary procedure with an investigatory model, where it is the duty
of the ALJ to investigate the facts and develop the arguments both for and
against granting benefits; review by the Appeals Council is similarly broad.
Id. The regulations also make the nature of the SSA proceedings quite clear.
They expressly provide that the SSA “conducts the administrative review
process in an informal, nonadversary manner.” 20 C.F.R. § 404.900(b).
Crawford & Co. v. Apfel, 235 F.3d 1298, 1304 (11th Cir. 2000).
For these reasons, the court concludes that the Commissioner erred as a matter of law,
and that the case should be remanded for further proceedings.
VI. CONCLUSION
Accordingly, this case will be reversed and remanded to the Commissioner for further
proceedings consistent with this opinion.
A separate order will be entered.
Done this 24th day of December, 2014.

/s/Terry F. Moorer
TERRY F. MOORER
UNITED STATES MAGISTRATE JUDGE

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