Simmons v. Social Security Administration, Commissioner

Filing 15

MEMORANDUM OPINION. Signed by Judge Abdul K Kallon on 12/10/2015. (YMB)

FILED
2015 Dec-10 AM 11:56
U.S. DISTRICT COURT
N.D. OF ALABAMA

UNITED STATES DISTRICT COURT
FOR THE NORTHERN DISTRICT OF ALABAMA
SOUTHERN DIVISION
JUDY ELAINE SIMMONS,

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Plaintiff,

vs.
CAROLYN W. COLVIN, Acting
Commissioner of Social Security,
Defendant.

Civil Action Number
2:15-cv-00631-AKK

MEMORANDUM OPINION
Judy Elaine Simmons brings this action pursuant to Section 205(g) of the
Social Security Act (“the Act”), 42 U.S.C. § 205(g), seeking review of the final
adverse decision of the Commissioner of the Social Security Administration
(“SSA”). This court finds that the Administrative Law Judge (“ALJ”) applied the
correct legal standard and that her decision—which has become the decision of the
Commissioner—is supported by substantial evidence. Therefore, the court
AFFIRMS the decision denying benefits.
I.

Procedural History

Simmons, who had past relevant work experience as an administrative
assistant and a freight clerk, filed her application for Title II Disability Insurance
Benefits on August 6, 2012, alleging an onset date of August 6, 2012 due to
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seizure disorder, chronic migraines/auras, chronic daily headaches, and depression.
(R. 58, 65-66, 179, 183, 184). After the SSA denied her application, Simmons
requested a hearing before an ALJ. (R. 94, 102-07, 119). At the time of the hearing
on October 9, 2013, Simmons was 53 years old, had completed twelfth grade, and
had not engaged in substantial gainful activity since August 6, 2012. (R. 15, 37,
183, 184).
The ALJ subsequently denied Simmons’s claim on November 26, 2013, (R.
10-12, 27), which became the final decision of the Commissioner on February 8,
2015 when the Appeals Council refused to grant review, (R. 1-3). Simmons then
filed this action pursuant to § 205(g) on April 14, 2015. 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);
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
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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.” Martin, 849 F.2d 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.
See Martin, 894 F.2d at 1529. 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
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
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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
sequence:
(1)

whether the claimant is currently unemployed;

(2)

whether the claimant has a severe impairment;

(3)

whether the impairment meets or equals one listed by the Secretary;

(4)

whether the claimant is unable to perform his or her past work; and

(5)

whether the claimant is unable to perform any work in the national
economy.

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
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).

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IV.

The ALJ’s Decision

In performing the five-step analysis, the ALJ found that Simmons had not
engaged in substantial gainful activity since August 6, 2012 and therefore met Step
One. (R. 15). Next, the ALJ found that Simmons satisfied Step Two because she
suffered from the severe impediments of “migraines, seizure disorder, cervical
spondylosis, depression, anxiety, and pain disorder.” Id. The ALJ then proceeded
to the next step and found that Simmons did not satisfy Step Three since she “does
not have an impairment or combination of impairments that meets or medically
equals the severity of one of the listed impairments . . . .” (R. 16). Although the
ALJ answered Step Three in the negative, consistent with the law, see McDaniel,
800 F.2d at 1030, she proceeded to Step Four, where she determined that
Simmons:
has the residual functional capacity [“RFC”] to perform light work as
defined in 20 CFR 404.1567(b) except [Simmons] is able to occasionally
balance, stoop, kneel, crouch, crawl, and climb ramps and stairs but may
never climb ladders, ropes, or scaffolds. She is able to frequently reach to
the right upper extremity in all directions except occasionally reach
overhead with the right upper extremity. She must avoid concentrated
exposure to extreme cold, extreme heat, wetness, humidity, vibration, fumes,
odors, dusts, gases, and poor ventilation. She must avoid hazards. She must
work in an environment with a “moderate noise intensity level” or quieter as
the Selected Characteristics of Occupations defines that term, which gives
examples of light traffic, a grocery store, or a department store. She is able
to work in settings with levels of illumination similar to that found in a
typical office setting. [She] is able to maintain attention and concentration
for 2 hours at a time with normal breaks. She is able to respond
appropriately to supervisors, coworkers, and the public in a work setting.
She must work in an environment that does not have stringent production or
speed requirements and thus may not perform fast-pace assembly line work.
She must work in an environment where changes are infrequent.
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(R. 19). In light of Simmons’s RFC, the ALJ determined that Simmons “is capable
of performing her past relevant work” as an administrative assistant. (R. 26).
Alternatively, in Step Five, the ALJ considered Simmons’s age, education, work
experience, and RFC, and determined that “there are other jobs that exist in
significant numbers in the national economy that [Simmons] also can perform.” Id.
Therefore, the ALJ found that Simmons “has not been under a disability, as
defined in the Social Security Act, from August 6, 2012, through the date of this
decision . . . .” (R. 27).
V.

Analysis

Simmons asserts that the ALJ’s decision regarding her mental health
impairments are not supported by substantial evidence. See doc. 12 at 7-13.
Specifically, she disputes the weight that the ALJ accorded to the opinions of: (1)
Dr. Jon Rogers, Simmons’s consultative psychologist; (2) Dr. Robert Estock, the
Commissioner’s agency reviewing physician; and (3) Ms. Kathy Sechriest,
Simmons’s licensed professional counselor. See id. None of these contentions,
however, establish that the ALJ committed reversible error.
1. The ALJ did not err by affording Dr. Rogers’s opinions and conclusions
“some weight.”
Relying on Eleventh Circuit law that an ALJ “may not arbitrarily substitute
h[er] own hunch or intuition for the diagnoses of a medical professional,” Marbury
v. Sullivan, 957 F.2d 837, 840-41 (11th Cir. 1992), and that “[i]n cases of mental
illness, the opinions of mental health professionals are especially important,”
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Barber v. Barnhart, 459 F. Supp. 2d 1168, 1173 (N.D. Ala. 2006), Simmons
argues that the ALJ erred by affording the medical conclusions and opinions of Dr.
Rogers, the consulting psychologist assigned to Simmons’s case, only “some
weight,” see doc. 12 at 9-10. More specifically, Simmons takes issue with the
ALJ’s disregard of Dr. Rogers’s finding that her mental health impairment is
“severe” and his determination that Simmons has a global assessment functioning
(“GAF”) of 50.1 See id.
To support her contentions, first Simmons disputes the ALJ’s finding that
“Dr. Rogers’s opinion of a severe and serious impairment is internally inconsistent
with his opinion of only a moderate impairment in a work setting,” his mental
health examination overall, and Simmons’s history of limited mental health
treatment. See doc. 12 at 9; (R. 25). However, although Dr. Rogers did find that
Simmons’s mental health impairment was severe, the majority of his observations
focused on the normality of Simmons’s mental health. Indeed, he noted that “her
appearance was good;” “[s]he was dressed appropriately;” [s]he had no remarkable
mannerisms;” “[c]onversation was normal;” “she correctly answered all 3 [math]
problems;” her “judgment was unimpaired;” she “correctly repeat[ed] 5 digits
1

Although Dr. Rogers assigned Simmons a GAF score of 50, “the [SSA] has declined to endorse
the GAF scale for ‘use in the Social Security and SSI disability programs,’ and has indicated that
GAF scores have ‘no direct correlation to the severity requirements of the mental disorders
listings.’” See Wind v. Barnhart, 133 Fed. App’x 684, 692 n.5 (11th Cir. 2005) (citing 65 Fed.
Reg. 50746, 50764-65 (Aug. 21, 2000)). As such, the court will not consider the GAF score in
any depth.
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forward and 3 digits backward;” and she knew the President’s name and the capital
of the United States, among other, similar findings. (R. 432-3). Moreover, Dr.
Rogers opined that “Simmons is able to function independently” even if “[t]he
quality of her daily activities is below average.” (R. 434). While Simmons
struggled with certain aspects of the examination (for example, she was unable to
spell the word “world” backwards, (R. 433)) and while Dr. Rogers diagnosed
Simmons with depression and anxiety, he noted that “[p]hysical (migraines), as
opposed to psychiatric, symptoms appear to be the major obstacle to employment”
and that “[Simmons] should be able to perform most activities of daily living.” (R.
434-35). He also noted that “Simmons’s ability to understand, remember, and carry
out instructions and respond appropriately . . . in a work setting would be
moderately impaired.” (R. 436) (emphasis added). Such findings are by definition
inconsistent with a finding that Simmons’s mental health is “severe,” which the
Commissioner defines as “significantly limit[ing Simmons’s] mental ability to do
basic work activities.” 20 C.F.R. 404.1520(c). The ALJ’s finding, then, that Dr.
Rogers’s findings that Simmons has good judgment, an ability to perform most
actions of daily living and, in particular, only moderate impairment in a work
setting were inconsistent with a finding that she was significantly limited in her
basic work activities is, in fact, supported by substantial evidence.

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The ALJ’s decision to afford only some weight to Dr. Rogers’s finding that
Simmons’s mental health was severely impaired is similarly supported by
Simmons’s limited mental health treatment. Indeed, Simmons has not been seen by
either a psychiatrist or psychologist, (R. 431); is not on medication for depression
or anxiety, (R. 46); told her counselor she stopped working due to epilepsy as
opposed to depression or anxiety, 2 (R. 442); wrote in her migraine journal that she
stopped working due to her migraines, (R. 272); and indicated in her migraine
journal that many of her depressive symptoms were due to migraines or other
health issues as opposed to an underlying psychological problem, (R. 261, 262,
267, 270, 284, 317, 318). Moreover, Simmons only began seeking mental health
treatment from her therapist, Ms. Sechriest, in February 2013, more than six
months after her alleged onset date, see (R. 65, 440), and even then, she only saw
Sechriest on a monthly basis,3 see (R. 46, 50, 440-442); see, e.g., Gray v. Colvin,
2014 WL 3889716, at *4 (Aug. 5, 2014) (allowing an ALJ to consider limited
mental health treatment when assessing weight assigned to medical experts). To
2

As to the credibility of Simmons’s epilepsy complaint, the ALJ noted that Dr. Robert Swillie
“refused to label [Simmons] disabled because of the lack of seizure activity and the claimant’s
continued driving.” (R. 21; 447).
3

Elsewhere in her brief, Simmons objects to the ALJ’s use of Simmons’s limited mental health
treatment to support her finding that Simmons’s mental health impairment does not necessitate a
finding of disability. Simmons argues that her purportedly poor mental health—and, presumably,
resulting poor judgment—is to blame for her limited mental health treatment, so the ALJ was
improper to hold Simmons’s limited treatment against her. See doc. 12 at 11. For reasons
discussed in Sections IV.2 and IV.3, the court rejects this argument and determines that the
ALJ’s decision to consider Simmons’s limited mental health treatment is supported by
substantial evidence.
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the extent that Simmons argues that the inconsistency of her visits to Sechriest are
excused by the fact that her husband could not take time off work to drive her the
long distance to her appointments, Simmons reported (and the ALJ observed) that
Simmons did not change to a more convenient counselor because “[Sechriest]
came recommended,” notwithstanding that other, more accessible counselors were
available in a city as large as Birmingham, Alabama. See (R. 50). The ALJ’s
finding that this explanation discredits the severity of Simmons’s mental health
impairment—and therefore Dr. Rogers’s opinion—is supported by substantial
evidence.
Second, Simmons argues that Dr. Rogers’s opinion that she has “a serious
and severe mental impairment” is not contradicted by any other examining,
treating, or reviewing source and is, in fact, supported by Seichrest’s opinion. See
doc. 12 at 9-10. As a threshold matter, the ALJ owes no deference to Dr. Rogers,
as he is only a consultative psychologist. See, e.g., Crawford v. Comm’r of Soc.
Sec., 363 F.3d 1155, 1160 (11th Cir. 2004) (holding that, because the physician
had examined the claimant “on only one occasion, her opinion was not entitled to
great weight”). More to the point, Simmons’s argument is flawed because, in fact,
Dr. Rogers’s opinion is contradicted by multiple sources, including, as discussed
above, his own observations. Indeed, Dr. Estock noted that Simmons was only
“moderately limited” in her “ability to complete a normal workday and workweek
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without interruptions from psychologically based symptoms,” and he even
recommended that Simmons was “not disabled,” see (R. 80, 83). Additionally,
Sechriest’s treatment notes also contradict Dr. Rogers’s finding that Simmons has
a severe impairment due to depression or anxiety; for example, Simmons reported
that she stopped working due to epilepsy as opposed to depression, and although
Sechriest reported that Simmons cries easily, rarely gets out, and is easily
confused, Sechriest’s treatment notes never indicate that she recommended
Simmons seek treatment beyond the monthly counseling sessions with her. See (R.
440-42).
Finally, as it relates to Dr. Rogers, the court further notes that the ALJ did
not grant Dr. Rogers “no weight” or even “little weight;” indeed, she granted his
opinions “some weight.” See (R. 25). As such, she placed some weight on his
recommendations and reduced Simmons’s RFC accordingly to reflect her “poor
concentration with some deficits on cognitive tasks” by limiting her to work
environment to include “no stringent production or speed requirements,” “fast-pace
assembly work,” or “environments where changes are []frequent.” See (R. 19, 25).
Because the ALJ’s decision to grant “some weight” to Dr. Rogers’s opinion on the
basis that the opinion was inconsistent with other observations in his evaluation—
as well as the fact that his opinion was contradicted by other examiners in the

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record—is supported by substantial evidence, Simmons cannot find relief on this
ground.
2. The ALJ did not err by affording Dr. Estock’s opinions and conclusions
“little weight.”
Simmons also objects to the ALJ’s decision to assign Dr. Estock’s opinion
little weight. As a threshold matter, Dr. Estock is not Simmons’s treating physician
but is merely a consultative examiner; therefore, his opinion is entitled to only
“little weight,” and “taken alone, does not constitute substantial evidence to
support an administrative decision.” See Swindle v. Sullivan, 914 F.2d 222, 226 n.3
(11th Cir. 1990) (citing Broughton v. Heckler, 776 F.2d 960, 962 (11th Cir. 1985)).
Additionally, Dr. Estock’s overarching recommendation regarding Simmons’s
application listed Simmons as “not disabled,” he found that she had only “mild”
restrictions on activities of daily living, and he noted that she had only “moderate”
restrictions both with maintaining concentration, persistence, or pace as well as
maintaining social functioning. (R. 73, 79-81). Other findings—such as that
Simmons is “[n]ot significantly limited” in her ability to perform activities within a
schedule, sustain a regular routine, or ability to maintain socially appropriate
behavior, among other, similar findings—further support Dr. Estock’s finding that
Simmons is not, in fact, disabled. Based on this record, requiring the ALJ to weigh
Dr. Estock’s opinion more heavily and giving it increased deference would seem to
only hurt Simmons’s application for benefits. For this reason alone, the court
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rejects Simmons’s contention that the ALJ erred by failing to assign more weight
to Dr. Estock’s opinion.
Simmons mainly objects to the ALJ’s decision to discredit Dr. Estock based
on Simmons’s limited mental health treatment because “the ALJ failed to consider
the impact of mental illness itself” on Simmons. See doc. 12 at 11. Put differently,
Simmons argues that the ALJ cannot appropriately consider Simmons’s limited
mental health treatment when determining the severity of her impairment because
Simmons’s alleged mental health impairments kept her from seeking treatment. In
support of this position, Simmons points to Sparks v. Barnhart, which noted that
“[c]ourts have long recognized the inherent unfairness of placing emphasis on a
claimant’s failure to seek psychiatric treatment.” 434 F. Supp. 2d 1128, 1135 (N.D.
Ala. 2006). Sparks addressed a claimant who had been treated for anxiety by her
family doctor, referred to a psychiatrist for specialized care, hospitalized in a
psychiatric unit, subjected to electroshock treatments, placed on psychotropic
medication, received a diagnosis of panic disorder with agoraphobia and social
phobia, suffered through multiple anxiety and panic attacks, and was unable to
follow through with recommended mental health treatment such as, for example,
scheduled medication. See id. at 1135-36. The facts in Sparks are not applicable
here, where Simmons has not sought significant mental health treatment at all. In
fact, Simmons’s record establishes, for all intents and purposes, that her mental
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health treatment and symptoms are much less extreme than the claimant’s in
Sparks, so the importance of “consider[ing] the impact of the plaintiff’s mental
health itself” is less applicable. See id. at 1135.
Additionally, if this court were to adopt as a blanket rule Sparks’s holding
that a mental health claimant’s mental treatment history cannot be considered when
determining deference or credibility, it could insulate mental health claimants from
an otherwise searching review and—perhaps more problematically—would
contradict this circuit’s precedent on factors an ALJ may consider when evaluating
the severity of impairments. See, e.g., Watson v. Heckler, 738 F.2d 1169, 1173
(11th Cir. 1984) (holding that, in addition to objective medical evidence, when
evaluating a claimant’s credibility the ALJ may properly consider use of
painkillers, failure to seek treatment, daily activities, conflicting statements, and
demeanor at the hearing); Wolfe v. Chater, 86 F.3d 1072, 1078 (11th Cir. 1996)
(holding that an ALJ may consider treatment that is “entirely conservative in
nature” when discrediting a claimant’s testimony). Simmons offers no binding case
law contradicting these controlling precedents. Additionally, the record wholly
fails to support Simmons’s suggestion that “her failure to follow through with
recommended mental health treatment . . . [was due to] the impact of the mental
illness itself.” See doc. 12 at 11. In fact, Dr. Rogers reported that “Simmons’[s]
judgment was unimpaired” and that “[i]nsight was good,” (R. 434); Simmons
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herself said that the reason she had not sought more aggressive counseling was due
to the time and distance from Sechriest as opposed to her purported mental health
symptoms, (R. 50); and Simmons reported that she was unable to follow
instructions because of her migraines and epilepsy, not her alleged depression or
anxiety, (R 43). Put otherwise, unlike the situation in Sparks, the record here does
not reflect that Simmons’s limited mental health treatment is, in fact, due to the
effects of her purported mental illness.
Simmons also asserts that “it was improper for the ALJ to discredit Dr.
Estock’s opinion because Simmons lacks a history of special education,” as the
“lack of a history of special education does not have any bearing on whether or not
her depression has caused disabling mental limitations.” See doc. 12 at 11.
However, the ALJ examined whether Simmons had a history of special education
when noting that, although Simmons could not perform Serial 7s, she was able to
correctly answer math problems and identify similarities between concepts, so,
among other showings in the record, this fact could not support a limitation to
simple tasks or an RFC that permitted her to miss one to two days of work per
month. See (R. 25). The court notes that Simmons has cited no authority to
substantiate her argument that the ALJ’s decision to consider Simmons’s lack of
special education history when making her credibility determination was not
supported by substantial evidence. As such, the court is not obligated to engage
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with this argument. See N.L.R.B. v. McClain of Georgia, 138 F.3d 1418, 1422
(11th Cir. 1998) (“Issues raised in a perfunctory manner, without supporting
argument and citations to authorities, are generally deemed to be waived.”).
Additionally, the ALJ seems to have merely noted that Simmons’s difficulty with
the Serial 7s was not due to a learning disability, see (R. 184), an observation that
Simmons herself volunteered in her application for disability and that seems
relevant when determining Simmons’s qualification for general employment.
Moreover, to the extent that the ALJ erred in considering Simmons’s special
education history when assigning Dr. Estock’s opinion little weight, such error is
harmless: she appropriately relied on Simmons’s limited mental health treatment as
well as Simmons’s daily activities when determining the deference to grant Dr.
Estock and, ultimately, Dr. Estock opined that Simmons was not actually disabled.
See Caldwell v. Barnhart, 261 F. App’x. 188, 190 (11th Cir. 2008) (noting that the
ALJ’s mistakes are subject to the harmless error rule such that, if the ALJ’s
findings do not contradict his ultimate findings, his decision will stand). Therefore,
Simmons cannot find relief on this ground.
Accordingly, because the ALJ did not commit reversible error by relying on
Simmons’s limited mental health treatment or by considering her lack of special
education history when assigning Dr. Estock’s opinion limited weight, the court
declines to remand on this ground.
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3. The ALJ did not err by affording Ms. Sechriest’s opinions and
conclusions “little weight.”
Simmons also objects to the ALJ’s assignment of little weight to Sechriest’s
opinion that Simmons has “marked” and “extreme” limitations in her ability to
function.4 In support of her argument, Simmons asserts first that the ALJ
improperly stated a medical opinion because the ALJ noted that Sechriest’s
opinions “suggest that [Simmons] should be hospitalized” when Sechriest has not
recommended as much. See doc. 12 at 12; (R. 24). As Simmons put it, “[t]he ALJ’s
rationale improperly assumes that an individual could not have marked or extreme
mental work-related limitations in the absence of any inpatient hospitalizations or
recommendation of the same.” See doc. 12 at 12. However, while Simmons’s
argument could hypothetically be true, the court notes that she cites no case law in
support of this argument and, regardless, it is not true in this instance because the
ALJ’s decision to discount Sechriest’s opinion is supported by substantial
evidence. Importantly, Sechriest is Simmons’s therapist, and, as such, “h[er]
opinions are not an acceptable medical source to establish the existence of a
medical impairment.” See Szilvasi v. Comm’r, 555 Fed. App’x 898, 901 (11th Cir.
2014) (relying on 20 C.F.R. § 404.1513(a), (d)(1)). Sechriest’s opinion is further
4

Specifically, Sechriest stated that Simmons had “marked” limitations in her activities of daily
living; maintenance of social functioning; ability to understand, carry out, and remember
instructions in a work setting, ability to respond appropriately to supervision or co-workers in a
work setting; and ability to perform simple or repetitive tasks in a work setting. (R. 437-38). She
also opined that Simmons had “extreme” deficiencies of concentration, persistence, or pace and
“extreme” impairment of ability to respond to customary work pressures. (R. 437).
Page 17 of 22

discounted, as the ALJ explained, because: (1) Sechriest had a limited treatment
relationship with Simmons; (2) Sechriest’s opinion conflicts with the advice and
counsel she gave Simmons; (3) Sechriest’s opinion conflicts with Simmons’s
limited mental health treatment; and (4) the source of Simmons’s anxiety seems to
derive more from denial of disability rather than a psychological problem. See id.;
(R. 24-25).
The ALJ’s reasons for discounting Sechriest’s opinion are supported by
substantial evidence. First, as discussed above, Sechriest had a limited treatment
relationship with Simmons. Simmons only began seeing her more than six months
after Simmons’s alleged onset date, and, even then, she only saw Sechriest on
roughly a monthly basis. By the time of Simmons’s hearing, Sechriest had seen
Simmons only seven times. (R. 440-42). Moreover, as the ALJ pointed out,
Sechriest counsels Simmons and her husband together, and frequently the
counseling sessions include discussion of Simmons’s husband’s mental health
issues as well as Simmons’s. 5 Id. Second, Sechriest’s “marked” and “extreme”
5

In a supplemental submission to the Appeals Council, Sechriest explained, “Mr. Simmons
corroborates the information [Simmons] relates to me and shares his own objective observations
in sessions.” (R. 488); see Ingram v. Comm’r of Soc. Sec., 496 F.3d 1253, 1162 (11th Cir. 2007)
(“[W]hen a claimant properly presents new evidence to the Appeals Council, a reviewing court
must consider whether that new evidence renders the denial of benefits erroneous.”). Although
there is some evidence to support Sechriest’s contention, Sechriest’s treatment notes, however,
indicate that she was also administering therapy to Simmons’s husband; she recounted,
“Husb[and] talked about his history of anxiety which is strongly in family history,” “Will talk
about early childhood memories of both [spouses] next session,” and “Husb[and] admits
p[atient]’s dep[ression] gets him down sometimes.” See (R. 441-42). Because Sechriest’s
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diagnoses conflict with the advice and counsel she gave Simmons—her treatment
notes do not reflect a recommendation that Simmons visit a psychologist or
psychiatrist, begin taking medication, or seek therapy more often than roughly
once per month.6 See Wolfe, 86 F.3d at 1078 (holding that an ALJ may consider
treatment that is “entirely conservative in nature”). Sechriest’s treatment notes
additionally reflect that Simmons stopped working “due to epilepsy” and that
Simmons’s depressive symptoms are likely “due to chronic pain” as opposed to an
underlying psychological issue.7 (R. 442). Finally, as discussed at length above,
Simmons’s limited mental health treatment overall—that she has not seen a
psychiatrist, is not on medication, sees a counselor no more often than monthly,

assertion that Simmons’s husband only attends to corroborate her stories is not supported by
Sechriest’s own treatment notes, this supplemental evidence cannot support reversal of the ALJ’s
decision.
6

Sechriest’s notes reflect that Simmons “expressed suicidal ideations around Xmas but states she
won’t do it” and—even then—Sechriest did not document that she recommended any type of
more aggressive treatment. See (R. 442). Presumably, by the time Sechriest began seeing
Simmons a few months after this reported incident, she believed Simmons’s mental health to be
sufficiently stable.
7

Assuming for the sake of argument that Simmons’s depressive symptoms are caused by pain
from her migraines, Simmons’s noncompliance with her migraine treatment undermines her
assertions as to the severity of her purported depression symptoms. Put differently, if the pain of
her migraines indeed caused Simmons significant depression, the court surmises that Simmons
would have been compliant on her migraine treatment regimen. As the ALJ pointed out,
Simmons’s “doctor wants her to take a pill daily [for her migraines], whether she has her
migraines or not, but [Simmons] only takes medication when she has an aura . . . . Her
noncompliance and lack of follow-up generally undermine her credibility.” (R. 22, 46, 48-49);
see also Brown v. Astrue, 298 Fed. App’x 851, 853 (11th Cir. 2008) (“The administrative law
judge could consider [the claimant’s] failure to comply with a treatment regimen as a factor in
assessing [his] credibility.”) (citing Ellison v. Barnhart, 355 F.3d 1272, 1275-76 (11th Cir.
2003)).
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and other, similar facts—further substantiates the ALJ’s determination. Put simply,
no basis exists to reverse the ALJ’s decision to discredit Sechriest’s opinion.
As her final contention of error related to Sechriest, Simmons argues that the
ALJ committed reversible error by finding that Sechriest’s “[t]reatment records
indicate that [Simmons’s] anxiety seems to stem from the prospect of getting
denied disability, rather than from psychological symptoms.” See doc. 12 at 12
(citing (R. 24)). In denying Simmons’s claim, the ALJ noted that “[s]essions [with
Sechriest] focused on anxiety related to the claimant’s denied disability claim”
rather than an underlying psychological impairment. See (R. 23, 24). Objecting to
this observation, Simmons argues that “when an individual sincerely believes they
can no longer perform the work they have done for many years, the prospect of
being denied disability benefits is a valid cause for anxiety” and notes that
“Sechriest’s notes also illustrate other triggers for Simmons’[s] anxiety
symptoms.” See doc. 12 at 12-13. Simmons’s argument is logically flawed.
Simmons cannot argue that the ALJ should have deemed her disabled simply
because her anxiety about not receiving disability benefits is supposedly disabling.
If such an anxiety could form the basis for a disability claim, every claimant would
arguably qualify as disabled. In any event, Sechriest’s treatment notes do reflect a
preoccupation with Simmons’s disability claim; in all but one therapy session,
Sechriest mentioned Simmons’s disability application and, at times, focused on
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Simmons’s anxiety surrounding her application. See (R. 440-42) (noting, for
example, that Simmons was “[a]nxious waiting for word on S[ocial] S[ecurity]
[d]isability” or that she was “anxious, fearing she’ll be turned down again”).
Although, as Simmons points out, the ALJ does also mention additional triggers
for Simmons’s depressive symptoms, those triggers serve to undermine her claim,
as Sechriest writes, “P[atient] depressed [with] her many health issues” and “She’s
always been emotional [and] is depressed, likely due to chronic pain.” See (R.
440). Moreover, Sechriest’s treatment notes—as well as her follow up evidentiary
submission—relate Simmons’s anxiety as significantly stemming from loud noises
(for example, that Simmons “can’t stay long at a restaurant where there are lots of
people and noise,” (R. 440)), and the ALJ has already accommodated for this
limitation by restricting her RFC to include only jobs with a “‘moderate noise
intensity level’ or quieter.” See (R. 19).
Therefore, based on this record—namely, that Sechriest’s opinion was belied
by her limited treatment history with Simmons, with her advice and counsel to
Simmons, by Simmons’s limited mental health treatment overall, and by the fact
that it appeared Simmons’s anxiety seemed focused on her disability application—
the ALJ was entitled to give Sechriest’s opinions little weight.

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VI.

Conclusion

Based on the foregoing, the court concludes that the ALJ’s determination
that Simmons is not disabled is supported by substantial evidence and that the ALJ
applied proper legal standards in reaching this determination. Therefore, the
Commissioner’s final decision is AFFIRMED. A separate order in accordance
with the memorandum of decision will be entered.
DONE the 10th day of December, 2015.

_________________________________
ABDUL K. KALLON
UNITED STATES DISTRICT JUDGE

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