Thomas v. Social Security Administration, Commissioner
MEMORANDUM OPINION. Signed by Judge Abdul K Kallon on 10/16/2014. (PSM)
2014 Oct-16 AM 11:19
U.S. DISTRICT COURT
N.D. OF ALABAMA
IN THE UNITED STATES DISTRICT COURT
FOR THE NORTHERN DISTRICT OF ALABAMA
AARON THOMAS, II,
CAROLYN W. COLVIN, Acting
Commissioner of Social Security,
Civil Action Number
Plaintiff Aaron Thomas, II brings this action pursuant to Section 205(g) of
the Social Security Act (“the Act”), 42 U.S.C. § 405(g), seeking review of the
adverse decision of the Administrative Law Judge (“ALJ”), which has become the
final decision of the Commissioner of the Social Security Administration (“SSA”).
For the reasons stated below, the court finds that the ALJ applied the correct legal
standards and that her decision is supported by substantial evidence. Therefore,
the court affirms the decision denying benefits.
I. Procedural History
Thomas applied for Title XVI Supplemental Security Income (“SSI”) on
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March 18, 2011, (R. 158), alleging a disability onset date of February 25, 2011,
id., due to mental illness, (R. 176). After the SSA denied his application on May
26, 2011, (R. 108–13), Thomas requested a hearing, (R. 117–19). At the time of
the hearing on August 6, 2012, Thomas was twenty-one-years old,1 (R.78), had a
limited education, (R. 79), and had no past relevant work experience,
(R. 103). Thomas has not engaged in substantial gainful activity since the alleged
onset date2 . (R. 72).
The ALJ denied Thomas’ claim on August 31, 2012, (R. 67–84), which
became the final decision of the Commissioner when the Appeals Council refused
to grant review on August 5, 2013, (R. 50–53). Thomas then filed this action
pursuant to section 1631 of the Act, 42 U.S.C. § 1383(c)(3). Doc. 1.
II. Standard of Review
The only issues before this court are whether the record contains substantial
evidence to sustain the ALJ’s decision, see 42 U.S.C. § 405(g); Walden v.
Schweiker, 672 F.2d 835, 838 (11th Cir. 1982), and whether the ALJ applied the
correct legal standards, see Lamb v. Bowen, 847 F.2d 698, 701 (11th Cir. 1988);
The ALJ’s opinion erroneously lists Thomas’ age at the time of the hearing as 20.
The ALJ’s opinion erroneously lists February 25, 2011 as the application date. C.f. (R.
158) (Thomas’ SSI application, listing March 18, 2011 as the application date and February 25,
2011 as the alleged onset date).
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Chester v. Bowen, 792 F.2d 129, 131 (11th Cir. 1986). Title 42 U.S.C. §§ 405(g)
and 1383(c) mandate that the Commissioner’s “factual findings are conclusive if
supported by ‘substantial evidence.’” Martin v. Sullivan, 894 F.2d 1520, 1529
(11th Cir. 1990). The district court may not reconsider the facts, reevaluate the
evidence, or substitute its judgment for that of the Commissioner; instead, it must
review the final decision as a whole and determine if the decision is “reasonable
and supported by substantial evidence.” See id. (citing Bloodsworth v. Heckler,
703 F.2d 1233, 1239 (11th Cir. 1983)).
Substantial evidence falls somewhere between a scintilla and a
preponderance of evidence; “[i]t is such relevant evidence as a reasonable person
would accept as adequate to support a conclusion.” Id. at 1529 (quoting
Bloodsworth, 703 F.2d at 1239) (other citations omitted). If supported by
substantial evidence, the court must affirm the Commissioner’s factual findings
even if the preponderance of the evidence is against the Commissioner’s findings.
Id. While the court acknowledges that judicial review of the ALJ’s findings is
limited in scope, it notes that the review “does not yield automatic affirmance.”
Lamb, 847 F.2d at 701.
III. Statutory and Regulatory Framework
To qualify for disability benefits, a claimant must show “the inability to
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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 twelve
months.” 42 U.S.C. § 423(d)(1)(A); 42 U.S.C. § 416(i)(I)(A). A physical or mental
impairment is “an impairment that results from anatomical, physiological, or
psychological abnormalities which are demonstrated by medically acceptable
clinical and laboratory diagnostic techniques.” 42 U.S.C. § 423(d)(3).
Determination of disability under the Act requires a five step analysis. 20
C.F.R. § 404.1520(a)-(f). Specifically, the Commissioner must determine in
whether the claimant is currently unemployed;
whether the claimant has a severe impairment;
whether the impairment meets or equals one listed by the Secretary;
whether the claimant is unable to perform his or her past work; and
whether the claimant is unable to perform any work in the national
McDaniel v. Bowen, 800 F.2d 1026, 1030 (11th Cir. 1986). “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
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than step three, leads to a determination of ‘not disabled.’” Id. at 1030 (citing 20
C.F.R. § 416.920(a)-(f)). “Once a finding is made that a claimant cannot return to
prior work the burden shifts to the Secretary to show other work the claimant can
do.” Foote v. Chater, 67 F.3d 1553, 1559 (11th Cir. 1995) (citation omitted).
IV. The ALJ’s Decision
In performing the Five Step sequential analysis, the ALJ initially
determined that Thomas had not engaged in substantial gainful activity since the
alleged onset of his disability, and therefore met Step One. (R. 72). Next, the ALJ
acknowledged that Thomas’ severe impairments of paranoid schizophrenia,
psychotic disorder, obesity, and cannabis abuse met Step Two. Id. The ALJ then
proceeded to the next step and found that Thomas did not satisfy Step Three since
he “does not have an impairment or combination of impairments that meets or
medically equals one of the listed impairments . . . .” (R. 74). Although the ALJ
answered Step Three in the negative, consistent with the law, see McDaniel, 800
F.2d at 1030, the ALJ proceeded to Step Four, where she determined that Thomas:
has the residual functional capacity to perform medium work as defined in
20 CFR 416.967(c) except that he can lift and/or carry 50 pounds
occasionally and 25 pounds frequently. He can sit for six hours over the
course of an eight-hour workday. He can stand and/or walk for six hours
over the course of an eight-hour workday. He can occasionally climb
ladders, ropes and scaffolds; frequently climb ramps and stairs; balance,
stoop, crouch, kneel and crawl. He can perform simple, routine and
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repetitive tasks; maintain attention/concentration for 2-hour periods at a
time. He can perform jobs involving casual and non-confrontation[al]
supervision. He can make simple work-related decisions; perform jobs that
do not require close cooperation with coworkers; adapt to routine and
infrequent workplace changes; and perform jobs that do not require
interacting with the general public as a job duty. He will also miss a day of
work a month.
(R. 76). Lastly, in Step Five, the ALJ considered Thomas’ age, education, work
experience, and RFC, and determined, based on the Medical Vocational
Guidelines found in 20 C.F.R. Part 404, Subpart P, Appendix 2, section 203.25
and on the testimony of a vocational expert (“VE”), that “there are jobs that exist
in significant numbers in the national economy that [Thomas] can perform.” (R.
79). Because the ALJ answered Step Five in the negative, he determined that
Thomas was not disabled. Id.
The court now turns to Thomas’ contentions that (1) the ALJ erred by
failing to properly evaluate the opinion evidence provided by Dr. Rachel Julian,
Thomas’ treating physician and (2) the ALJ erred by failing to properly consider
Thomas’ impairments in combination. The court will examine each contention in
A. The ALJ properly afforded little weight to Dr. Julian’s opinion
Thomas first contends that the ALJ erred by failing to properly evaluate the
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opinion evidence provided by Dr. Julian, Thomas’ treating physician. Doc. 11 at 7.
“[T]he testimony of a treating physician must be given substantial or considerable
weight unless ‘good cause’ is shown to the contrary.” Lewis v. Callahan, 125 F.3d
1436, 1440 (11th Cir. 1997) (citing MacGregor v. Bowen, 786 F.2d 1050, 1053
(11th Cir. 1986)). “‘Good cause’ exists when the: (1) treating physician’s opinion
was not bolstered by the evidence; (2) evidence supported a contrary finding; or
(3) treating physician’s opinion was conclusory or inconsistent with the doctor’s
own medical records.” Phillips v. Barnhart, 357 F.3d 1232, 1241 (11th Cir. 2004)
(citing Lewis, 125 F.3d at 1440). “When electing to disregard the opinion of a
treating physician, the ALJ must clearly articulate its reasons.” Id. (citing Lewis,
125 F.3d at 1440).
On June 21, 2012, Dr. Julian prepared a supplemental questionnaire
intended to “answer certain questions about [Thomas’] residual function capacity.”
(R. 301). Dr. Julian indicated that Thomas exhibited “marked” “deficiencies of
concentration, persistence or pace resulting in frequent failure to complete tasks in
a timely manner,” id., “impairment of ability to respond to customary work
pressures,” id., and limitations to his ability to “[r]espond appropriately to coworkers” and “[p]erform repetitive tasks in a work setting,” (R. 302). She
indicated that he exhibited “moderate” “restriction of activities of daily living,”
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(R. 301), “difficulty in maintaining social functioning,” id., and limitations to his
ability to “[u]nderstand, carry out, and remember instructions,” “[r]espond
appropriately to supervision,” id., and “[p]erform simple tasks in a work setting,”
(R. 302). She also indicated that Thomas’ limitations had either lasted or could be
expected to last for twelve months or longer, that she did not perform a
psychological evaluation of Thomas in conjunction with completing the
questionnaire, and that the level of severity described in the questionnaire
“appl[ied] without consideration of substance abuse.” Id.
The ALJ rejected Dr. Julian’s opinion regarding Thomas’ limitations. In
doing so, the ALJ noted that Dr. Julian’s:
opinion is inconsistent with her treatment notes as well as the findings and
conclusions of other mental health professionals. Moreover, her opinion is
inconsistent with the nature and type of treatment the claimant has received.
For instances, a treatment note dated January 19, 2012, reflects that Dr.
Julian treats the claimant with Amantadine and Risperdal. On the same
occasion, the claimant reported only experiencing a few episodes of
auditory hallucinations and only while sleeping. The claimant’s father also
reported that the claimant was doing well. An April 18, 2012 treatment
note reflects that the claimant enjoyed participating in activities such as
working out, playing basketball and watching television. He also reported
working on a GED. Dr. Julian noted that the claimant seemed fairly stable.
The aforementioned observations are more consistent with a GAF of 60 as
Dr. Myers opined . . . than they are with a finding of “marked” limitations in
various function domains as Dr. Julian concluded.
(R. 78) (citations omitted).
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Thomas contends that Dr. Julian’s opinion is “fully consistent with her
treatment notes” because those “records continue to document increased sleep
difficulty, abnormal appetite, and auditory and visual3 hallucinations despite
increased medications.4 ” Doc. 11 at 7 (citing (R. 289–300)). This is a misleadingly
limited account of Dr. Julian’s treatment notes.
The record contains Thomas’ medical records generated in connection to
four office visits with Dr. Julian. At his initial appointment, Dr. Julian conducted a
mental status exam, which yielded largely normal results5 , (R. 295), and performed
a more specific Folstein mini-mental status exam, on which Thomas scored
twenty-nine out of a possible total of thirty points, (R. 296). During this and
subsequent visits, Thomas described a variety of daily activities, including
attending church, playing basketball, spending time with friends, going to dance
clubs, watching television, and using the Internet. (R. 289, 294). Critically,
While Dr. Julian’s notes contain multiple notations that Thomas reported auditory
hallucinations, generally while he slept, see (R. 289, 292, 293, and 300), the court can find no
indication that Thomas ever reported experiencing visual hallucinations.
During Thomas’ first appointment with Dr. Julian, on July 11, 2011, she increased his
dosage of Risperdal from two milligrams to four milligrams. (R. 298). The record does not
indicate the reason for this increase and, consequently, it is not evidence supporting the degree of
impairment opined by Dr. Julian.
The exam noted Thomas’ clean appearance, cooperative demeanor, normal speech and
motor skills, slightly impaired but congruent to content affect, normal cognitive functioning, and
reports of auditory hallucinations. (R. 295).
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Thomas repeatedly told Dr. Julian that he was working on obtaining a G.E.D. and
that his long-term goals included attending college and finding a job. (R. 289, 291,
and 299). During the second office visit, Dr. Julian noted that Thomas was
“improving,” (R. 291), during the third she noted that Thomas’ father reported that
Thomas was “doing well,” (R. 289), and during the fourth she noted that Thomas
was “fairly stable,” (R. 299). This is not to say the record indicates that Thomas
suffered no adverse effects caused by his mental illness. To the contrary, he
repeatedly reported that he experienced trouble sleeping, (R. 289, 292, 295, and
299), and also reported experiencing auditory hallucinations while sleeping or
trying to sleep, (R. 289, 292, and 295), although he denied experiencing auditory
hallucinations at his most recent appointment, (R. 299). However, these adverse
effects, while significant, do not account for the severe degree of limitations
opined by Dr. Julian, and certainly do not support those limitations when placed in
context alongside the degree of cognitive function and account of Thomas’ day-today activities described in Dr. Julian’s treatment notes. In sum, the ALJ did not err
in affording little weight to Dr. Julian’s opinion because it is inconsistent with Dr.
Julian’s own medical records.6 See Phillips, 357 F.3d at 1241.
Thomas also contends that the ALJ erred by declining to afford Dr. Julian’s opinion
substantial weight because “Dr. Julian opined that her opinion was given without a psychological
evaluation,” doc. 11 at 7 (citing (R. 78)), and that “Dr. Julian would not be required to get a
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Thomas argues that Dr. Julian’s opinion is “supported” by medical records
from the Taylor Hardin Secure Medical Facility, doc. 11 at 7–8, where Thomas
underwent inpatient treatment for approximately a month in late 2010 and early
2011, (R. 255–263), and where healthcare providers assigned him a Global
Assessment of Functioning (GAF) score of 50, (R. 255), indicating serious
symptoms or serious impairments in social, occupational, or school functioning,
doc. 11 at 8 (citing Diagnostic and Statistical Manual of Mental Disorders, 4th
ed.). This argument falls short for several reasons. First, as explained above, the
ALJ properly afforded Dr. Julian’s opinion little weight because it was
inconsistent with Dr. Julian’s own medical records, which is an independent and
sufficient basis for disregarding Dr. Julian’s opinion regardless of whether there is
evidence in the record that might support it. See Martin, 894 F.2d at 1529 (“Even
if the evidence preponderates against the Secretary’s factual findings, [a court]
must affirm if the decision reached is supported by substantial evidence.”).
Second, as discussed above, Dr. Julian’s medical records, which reference a
psychological evaluation because she is [Thomas’] treating psychiatrist [and not] a onetime
evaluat[or], id. However, in her opinion, the ALJ noted that “[t]he fact that Dr. Julian rendered
her opinion without having first obtained a psychological evaluation of the claimant does not
alone warrant affording her findings little weight.” (R. 78). To the extent that the lack of a
psychological evaluation influenced the ALJ’s findings, and, assuming without deciding that
such an influence amounted to error, it is harmless error because, as explained above and as the
ALJ herself noted, Dr. Julian’s “opinion is inconsistent with her treatment notes as well as the
findings and conclusions of other mental health professionals.” Id.
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treatment period subsequent to Thomas’ stay at Taylor Hardin, do not reflect the
degree of functional limitations indicated by the Taylor Hardin records. Third, on
May 6, 2011, five months after his release from Taylor Hardin, Thomas underwent
a psychological evaluation by Renee Myers, Ph. D., a consulting examiner, who
assigned him a GAF of 60, (R. 266), indicating that she believed he was subject to,
at most, moderate limitations,7 doc. 12 at 8 (citing Diagnostic and Statistical
Manual of Mental Disorders, 4th ed.). In sum, the Taylor Hardin records do not
provide support for affording Dr. Julian’s opinion greater weight because they are
inconsistent with the rest of the medical record, including Dr. Julian’s medical
Finally, Thomas argues that even in light of the inconsistencies described
above, the ALJ was not “free to dismiss Dr. Julian’s opinion out of hand” in light
of Social Security Ruling 96-5p, which states “[f]or treating sources, the rules
require that we make every reasonable effort to recontact such sources for
clarification when the provide opinions on issues reserved to the Commissioner
and the basis for such opinions are not clear to us.” Doc. 11 at 8 (citing SSR 96-
Dr. Myers’ opinion provides additional support for the ALJ’s decision to afford Dr.
Julian’s opinion little weight. See Phillips, 357 F.3d at 1241(citing Lewis, 125 F.3d at 1440)
(good cause for rejecting a treating physician’s opinion exists when the opinion “was not
bolstered by the evidence”).
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5p). This argument is a nonstarter because Dr. Julian did not “provide opinions on
issues reserved to the commissioner.” See 20 C.F.R. § 416.920(d) (identifying
issues reserved to the Commissioner, such as opinions as to whether a plaintiff is
disabled, meets a Listing, or has a certain residual functional capacity, i.e.
“administrative function that are dispositive of a case”); c.f. (R. 301–02) (Dr.
Julian’s supplemental questionnaire, described pp. 7–8, supra). Moreover,
pursuant to new regulations, which were in effect at the time of Thomas’ hearing
and the ALJ’s decision8 , the decision whether to recontact a treating source is now
entirely within the discretion of the ALJ. 20 C.F.R. § 416.920b(c)(1). Simply put,
the ALJ was under no obligation to recontact Dr. Julian.
In the final analysis, substantial evidence supported the ALJ’s decision to
afford little weight to Dr. Julian’s opinion, and, pursuant to the applicable law, the
ALJ did not err by failing to recontact Dr. Julian.
B. The ALJ properly considered Thomas’ impairments in combination
Thomas argues that the ALJ failed to consider his impairments in
combination with each other because “the ALJ’s analysis stops at whether
The regulations in question took effect on March 26, 2012. See How We Collect and
Consider Evidence of Disability, 77 Fed. Reg. 10,651, 10,651 (Feb. 23, 2012). Thomas’ hearing
before the ALJ took place on August 6, 2012, (R. 85), and she issued her opinion on August 31,
2012, (R. 67).
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[Thomas’] conditions meet a medical listing, fail[ed] to consider [Thomas’]
impairments beyond this step of the sequential evaluation process, and fail[ed] to
properly consider [Thomas’] hallucinations and obesity at all.” Doc. 11 at 9. As a
preliminary matter, Thomas’ contention that “the ALJ’s analysis stops at whether
[Thomas’] conditions meet a medical listing” is unfounded. See (R. 76–80) (the
ALJ’s analysis pursuant to Steps Four and Five of the Five Step sequential
analysis). As to the rest of Thomas’ argument, aside from his conclusory
contention that the ALJ “fail[ed] to properly consider [Thomas’] hallucinations
and obesity at all,” Thomas engages in no discussion or analysis of the ALJ’s
decision. Instead, he cites to a string of cases in support of his general contention,
along with some general tenets of Social Security law, doc. 11 at 9–11, and
concludes that “the ALJ’s decision is not based upon substantial evidence”
because “[b]ased on the medical evidence of record and the opinion from treating
psychiatrist, Dr. Julian, [Thomas] should have been found ‘disabled’ by the ALJ,”
id. at 11. Unfortunately, this is essentially the exact argument the court rejected in
Part V.A. For this reason alone, Thomas’ argument the ALJ failed to consider his
impairments in combination is due to be rejected. See Shinseki v. Sanders, 556
U.S. 396, 409 (2009) (“[T]he burden of showing that an error is harmful normally
falls upon the party attacking the agency’s determination.”); N.L.R.B. v. McClain
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of Ga., Inc., 138 F.3d 1418, 1422 (11th Cir. 1998) (citing Cont’l Tech Serv., Inc. v.
Rockwell Int’l Corp, 927 F.2d 1198, 1199 (11th Cir. 1991)) (“Issues raised in a
perfunctory manner, without supporting arguments and citation to authorities, are
generally deemed to be waived.”).
That said, turning to the merits of Thomas’ contention, the court notes that
in this circuit, an ALJ’s statement that she has considered the combined effect of a
claimant’s impairments at step three is sufficient to establish that she has
considered the combined effect of a claimant’s impairments throughout the Five
Step sequential analysis. See Hutchinson v. Astrue, 408 F. App’x 324, 327 (11th
Cir. 2011) (citing Jones v. Dep’t of Health and Human Servs, 941 F.2d 1529, 1533
(11th Cir. 1991)). Here, the ALJ stated that Thomas “does not have an impairment
or combination of impairments that meets or medically equals the severity of one
of the listed impairments . . . .” (R. 74). Consequently, pursuant to the law of this
circuit, she adequately considered Thomas’ impairments in combination.
To the extent that Thomas’ argument that the ALJ completely failed to
consider his obesity and hallucinations is a separate argument from his contention
that she failed to consider his impairments in combination, it also falls short. The
ALJ discussed Thomas’ reports of hallucinations throughout her opinion. See (R.
72) (noting that upon admission at Taylor Hardin, Thomas “reported a history of
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auditory and visual hallucinations”); (R. 74) (noting that Dr. Julian’s treatment
records indication Thomas “had a few episodes of audio hallucinations, only when
sleeping”). She also noted that Thomas’ obesity9 was a severe impairment. (R. 72).
For these reasons, Thomas’ argument that the ALJ completely failed to consider
his obesity and hallucinations lacks merit.
Based on the foregoing, the court concludes that the ALJ’s determination
that Thomas is not disabled is not supported by substantial evidence and applied
incorrect legal standards. Therefore, the Commissioner’s final decision is
remanded for further proceedings consistent with this opinion. The court will enter
a separate order in accordance with this memorandum of decision.
DONE this 16th day of October, 2014.
ABDUL K. KALLON
UNITED STATES DISTRICT JUDGE
Although Thomas (erroneously) contends that the ALJ failed to consider his obesity, the
court notes that absolutely nowhere in the record does he claim that his obesity, either alone or in
combination with his other impairments, impedes his ability to work. See (R. 155–66) (Thomas’
application for benefits); (R. 195–202) (Thomas’ self-prepared function report); (R. 85–107)
(transcript of Thomas’ hearing before the ALJ).
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