White v. Social Security Administration, Commissioner
Filing
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MEMORANDUM OPINION that the decision of the commissioner is doe to be affirmed as more fully set out therein. Signed by Judge C Lynwood Smith, Jr on 10/19/2018. (AHI)
FILED
2018 Oct-19 PM 01:54
U.S. DISTRICT COURT
N.D. OF ALABAMA
UNITED STATES DISTRICT COURT
NORTHERN DISTRICT OF ALABAMA
SOUTHERN DIVISION
CHRISTOL L. WHITE,
Claimant,
vs.
NANCY A. BERRYHILL, Acting
Commissioner, Social Security
Administration,
Defendant.
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Case No. 2:18-cv-0021-CLS
MEMORANDUM OPINION
Claimant, Christol L. White, commenced this action on January 5, 2018,
pursuant to 42 U.S.C. § 405(g), seeking judicial review of a final adverse decision of
the Commissioner, affirming the decision of the Administrative Law Judge (“ALJ”),
and thereby denying her claim for supplemental security income benefits.
The court’s role in reviewing claims brought under the Social Security Act is
a narrow one. The scope of review is limited to determining whether there is
substantial evidence in the record as a whole to support the findings of the
Commissioner, and whether correct legal standards were applied. See Lamb v.
Bowen, 847 F.2d 698, 701 (11th Cir. 1988); Tieniber v. Heckler, 720 F.2d 1251, 1253
(11th Cir. 1983).
Claimant contends that the Commissioner’s decision is neither supported by
substantial evidence nor in accordance with applicable legal standards because the
ALJ improperly considered the opinions of the treating and examining physicians.
Upon review of the record, the court concludes that these contentions are without
merit, and the Commissioner’s decision should be affirmed.
The opinion of a treating physician “must be given substantial or considerable
weight unless ‘good cause’ is shown to the contrary.” Phillips v. Barnhart, 357 F.3d
1232, 1240-41 (11th Cir. 2004) (internal citations omitted). Good cause exists when
“(1) [the] treating physician’s opinion was not bolstered by the evidence; (2) [the]
evidence supported a contrary finding; or (3) [the] treating physician’s opinion was
conclusory or inconsistent with the doctor’s own medical records.” Id. (alterations
supplied). Additionally, the ALJ is not required to accept a conclusory statement
from a medical source, even a treating source, that a claimant is unable to work,
because the decision whether a claimant is disabled is not a medical opinion, but is
a decision “reserved to the Commissioner.” 20 C.F.R. § 416.927(e).
Social Security regulations also provide that, in considering what weight to
give any medical opinion (regardless of whether it is from a treating or non-treating
physician), the Commissioner should evaluate: the extent of the examining or
treating relationship between the doctor and patient; whether the doctor’s opinion can
be supported by medical signs and laboratory findings; whether the opinion is
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consistent with the record as a whole; the doctor’s specialization; and other factors.
See 20 C.F.R. § 416.927(d). See also Wheeler v. Heckler, 784 F.2d 1073, 1075 (11th
Cir. 1986) (“The weight afforded a physician’s conclusory statements depends upon
the extent to which they are supported by clinical or laboratory findings and are
consistent with other evidence as to claimant’s impairments.”).
Claimant first asserts that the ALJ improperly considered the opinion of Dr.
Graham Osula, her treating psychiatrist. Dr. Osula submitted a generalized note
addressed “To Whom It May Concern” on July 6, 2016. He stated claimant’s
diagnoses as major depressive disorder, recurrent, severe, without psychosis;
generalized anxiety disorder; and post traumatic stress disorder. Her medications
included Seroquel for mood swings, Celexa for depression and anxiety, and Xanax
for anxiety. He also stated:
Being her Psychiatrist does not necessarily give me the ability to
categorically state that Ms[.] White cannot be gainfully employed as I
only see her for approximately 30 minutes once every 3 months and as
such I do not have as in[-]depth knowledge of her life and day to day
activities. What I can say is that often, people with some of the
diagnos[e]s that Ms[.] White has are unable to hold gainful employment
and do not function well in settings that require structure, routine,
responsibility, coordination and interaction.
She has also pointed out to me that she is unable to read and was
unable to complete schooling due to being around people. She says she
was put out of school in the 8th grade.
Tr. 740 (alterations supplied).
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Dr. Osula also submitted a “Supplemental Questionnaire” on January 14, 2017.
He indicated that claimant experienced moderate restriction of activities of daily
living; marked difficulty in maintaining social functioning; extreme deficiencies of
concentration, persistence, or pace resulting in frequent failure to complete tasks in
a timely manner; extreme impairment of ability to respond to customary work
pressures; marked impairment of ability to understand, carry out, and remember
instructions in a work setting; marked impairment of ability to respond appropriately
to supervision; marked impairment of ability to respond appropriately to co-workers
in a work setting; and, marked impairment of ability to perform simple and repetitive
tasks in a work setting. Claimant’s limitations had lasted or could be expected to last
for twelve months or longer, and they would persist without consideration of
substance abuse.1
Dr. Osula’s imposition of marked to extreme limitations would tend to indicate
that claimant is unable to work, but the ALJ afforded Dr. Osula’s opinions only little
weight, because they were not supported by the doctor’s own treatment notes or the
other medical evidence.2 Specifically, Dr. Osula’s notes indicate that claimant
experienced improvement in her condition with treatment, and no adverse side effects
1
Tr. 741-42.
2
Tr. 23.
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from her medications.3 Additionally, claimant consistently received normal reports
from mental status examinations when she presented for treatment at the emergency
department or with her regular physician.4 Those conclusions are consistent with
applicable law and supported by substantial evidence of record.
Claimant argues that the ALJ’s decision was improper because claimant’s
medical records reflect that she has ongoing diagnoses of generalized anxiety
disorder, major depressive disorder, and post-traumatic stress disorder, and she
experiences ongoing symptoms of anxiety, fear of abandonment, shame, anger, and
feelings of betrayal. But the mere existence of those diagnoses and symptoms is not
sufficient to establish claimant’s disability. Instead, the relevant consideration is the
effect of claimant’s conditions and symptoms on her ability to perform substantial
gainful work activities. See 20 C.F.R. § 416.905(a) (defining a disability as “the
inability to do 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”). See also Bowen v. Yuckert, 482 U.S. 137, 146 (1987) (“The [Social
Security] Act ‘defines “disability” in terms of the effect a physical or mental
impairment has on a person’s ability to function in the workplace.’”) (quoting Heckler
3
See Tr. 750, 763, 783.
4
See Tr. 295, 323, 349, 368, 377, 412, 433, 453, 516, 519, 523, 595, 599, 604, 615, 620, 627,
632, 636, 653, 658, 668, 673.
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v. Campbell, 461 U.S. 458, 459-60 (1983)) (alteration supplied). The only indication
claimant provides of the effect of her condition on her functional abilities is to point
out that her therapist observed on one occasion that claimant’s anger affected her
relationships.5 That singular statement sheds very little light upon claimant’s ability
to sustain work activity on a continued basis.
Additionally, claimant points to the fact that her therapist assigned her a GAF
score of 48 on July 6, 2016, and indicated that her highest GAF score of the past year
was 50. Both scores represent serious symptoms and serious functional impairments,
but a single GAF score is of limited value in evaluating a claimant’s overall ability
to work. As the United States District Court for the Middle District of Florida stated
in an unpublished but persuasive opinion:
The former version of American Psychiatric Association,
Diagnostic and Statistical Manual of Mental Disorders (4th ed. 2000),
includes the GAF scale used by mental-health practitioners to report “the
clinician’s judgment of the individual’s overall level of functioning” and
“may be particularly useful in tracking the clinical progress of
individuals in global terms, using a single measure.” Manual at 32-34.
The latest edition of the Manual has abandoned the GAF scale because
of “its conceptual lack of clarity . . . and questionable psychometrics in
routine practice.” Diagnostic and Statistical Manual of Mental Disorders
16 (5th ed. 2013). Even before that abandonment, “the Commissioner
. . . declined to endorse the GAF scale for use in the Social Security and
SSI disability programs, and . . . indicated that GAF scores have no
direct correlation to the severity requirements of the mental disorders
listings.” Wind v. Barnhart, 133 Fed. Appx. 684, 692 n.5 (11th Cir.
2005) (internal quotations omitted) (citing 60 Fed. Reg. 50746, 507645
See Tr. 750; doc. no. 9 (claimant’s brief), at 6.
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65 (Aug. 21, 2000)).
In July 2013, the SSA issued Administrative Message (AM)13066, providing its adjudicators, including ALJs, with internal
guidance regarding the interpretation of GAF rating. Soc. Sec. Admin.,
Global Assessment of Functioning (GAF) Evidence in Disability
Adjudication, AM-13066 (July 22, 2013) REV (Oct. 14, 2014). AM13066 acknowledged DSM-5 eliminated the use of GAF but confirmed
that adjudicators will continue to consider GAF scores as opinion
evidence. As with other opinion evidence, however, a GAF needs
supporting evidence to be given much weight. Id. According to AM13066, “the extent to which an adjudicator can rely on the GAF rating
as a measure of impairment severity and mental functioning depends on
whether the GAF rating is consistent with other evidence, how familiar
the rater is with the claimant, and the rater’s expertise.” Id. The SSA
cautions that a “GAF score is never dispositive of impairment severity,”
and an ALJ should “not give controlling weight to a GAF from a
treating source unless it is well[-]supported and not inconsistent with the
other evidence.” Id. AM-13066 explains that because a GAF rating is
only a “snapshot,” it “does not provide a reliable longitudinal picture of
the claimant’s functioning for a disability analysis” unless the clinician
“clearly explains the reasons behind his or her GAF rating, and the
period to which the rating applies.” Id. § E.
Murry v. Commissioner, No. 3:16-CV-48-J-PDB, 2017 WL 894626, at *6 n.10 (M.D.
Fla. Mar. 7, 2017) (alterations in original). It is true that the ALJ did not mention
claimant’s GAF score, but that failure amounts to, at worst, harmless error. The GAF
score is only one piece of evidence bearing on claimant’s disability status, and the
ALJ was entitled to reject it for the same reasons that he rejected Dr. Osula’s
assessment of disabling limitations.
Claimant also argues that the ALJ improperly considered the opinion of
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Michael Holt, Ph.D, the consulting psychologist who examined claimant on January
6, 2015. Claimant reported that she experienced problems with attention, anxiety,
depressed mood, irritability, mood swings, crying spells, fatigue, social withdrawal,
attention, concentration, and memory, but she was not taking any medication at that
time. Claimant presented to the examination with minimally adequate hygiene and
mildly disheveled appearance. She was fidgety and restless, constantly moving her
legs and feet back and forth during the interview. Claimant’s speech, language, and
communication skills were adequate, although she did have some difficulty
understanding complicated questions and instructions. Her mood was nervous, and
her affect was mildly reactive and labile. She was mildly to moderately distressed,
especially when discussing her past abuse. Dr. Holt assessed claimant’s intelligence
as falling within the borderline range, and her working memory and processing speed
skills as falling within the extremely low range. Claimant’s daily activities included
house cleaning, cooking, caring for her children, and watching television. Dr. Holt
assessed claimant as suffering from persistent depressive disorder with major
depressive episodes, post-traumatic stress disorder, oppositional defiant disorder,
tobacco use disorder, and borderline intellectual functioning. She had extremely
limited adaptive and coping resources, and her prognosis was guarded due to the
severity and chronicity of her conditions.
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Dr. Holt observed that claimant’s
motivation and engagement during the clinical examination were minimally adequate.
Dr. Holt concluded that claimant
cannot manage financial benefits because of issues with intellectual
functioning, judgment, and insight. The patient’s mental impairments
are off [sic] at least moderate severity. The patient could not function
adequately in an independent manner.
It is the examiner’s opinion that the claimant’s ability to
understand, remember, and carry out instructions in the workplace is
mildly impaired for simple instructions and moderately impaired for
complex instructions. Her ability to respond appropriately to
supervision, coworkers, and work pressures is markedly impaired.
Tr. 510.
The ALJ afforded Dr. Holt’s opinion “some weight,” because “claimant’s
presentation at the consultative psychological evaluation was not entirely consistent
with the claimant’s presentation in other clinical settings . . . .”6 The ALJ also
observed that claimant’s treating source mental health record showed that she
functioned better under stress and when dealing with others than indicated in Dr.
Holt’s report.7 Claimant argues that the ALJ’s decision was improper for the same
reasons she asserted with regard to Dr. Osula’s opinion: i.e., that she has ongoing
diagnoses and symptoms of mental disorders, that her therapist observed that anger
affected her relationships, and that her GAF score indicated serious symptoms. Those
6
Tr. 23.
7
Id.
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arguments are not persuasive for the same reasons discussed above. Contrary to
claimant’s argument, the court concludes that the ALJ properly articulated reasons
for rejecting Dr. Holt’s assessment, and that the ALJ’s decision was supported by
substantial evidence.
In summary, the court concludes the ALJ’s decision was based upon substantial
evidence and in accordance with applicable legal standards. Accordingly, the
decision of the Commissioner is due to be affirmed. An appropriate judgment will
be entered contemporaneously herewith.
DONE this 19th day of October, 2018.
______________________________
United States District Judge
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