Gaddison v. Social Security Administration, Commissioner
Filing
16
MEMORANDUM OPINION. Signed by Judge Abdul K Kallon on 3/13/2019. (AFS)
FILED
2019 Mar-13 AM 11:35
U.S. DISTRICT COURT
N.D. OF ALABAMA
THE UNITED STATES DISTRICT COURT
FOR THE NORTHERN DISTRICT OF ALABAMA
MIDDLE DIVISION
BRITTNEY LASHAE
GADDISON,
Plaintiff,
v.
NANCY A. BERRYHILL,
Commissioner, SSA,
Defendant.
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Civil Action Number
4:17-cv-01512-AKK
MEMORANDUM OPINION
Brittney Gaddison brings this action pursuant to Section 405(g) of the Social
Security Act, 42 U.S.C. § 405(g), seeking review of the Administrative Law
Judge’s denial of disability insurance benefits, which has become the final decision
of the Commissioner of the Social Security Administration (“SSA”). For the
reasons explained below, the court affirms the decision.
I.
Procedural History
Gaddison filed her application for Disability Insurance Benefits (“DIB”) on
July 24, 2014 asserting that she suffered from a disability beginning on March 1,
2013, which she later amended to June 27, 2014, due to bipolar disorder. R. 19,
24, 98, 167. After the SSA denied her application, Gaddison requested a formal
hearing before an ALJ. R. 95, 107, 118. Ultimately, the ALJ issued a decision
finding that Gaddison was not disabled. R. 37. The Appeals Council affirmed,
rendering the ALJ’s decision the final decision of the Commissioner.
R. 1.
Gaddison was 17 years old on the date of her application and 18 years old on the
date of the Commissioner’s final decision. R. 19, 178. Gaddison filed this action
pursuant to § 405(g) of the Act, 42 U.S.C. § 405(g). Doc. 13.
II.
Standard of Review
First, federal district courts review the SSA’s findings of fact under the
“substantial evidence” standard of review. 42 U.S.C. §§ 405(g), 1383(c); 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 Martin, 894 F.2d at 1529 (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. (internal citations omitted).
If supported by substantial evidence, the court must affirm the Commissioner’s
factual findings, even if the evidence preponderates against the Commissioner. Id.
Credibility determinations are the province of the ALJ. Moore v. Barnhart,
405 F.3d 1208, 1212 (11th Cir. 2005). However, “[t]he testimony of a treating
physician must ordinarily be given substantial or considerable weight unless good
2
cause is shown to the contrary,” and the failure of the Secretary “to specify what
weight is given to a treating physician’s opinion and any reason for giving it no
weight” constitutes reversible error. MacGregor v. Bowen, 786 F.2d 1050, 1053
(11th Cir. 1986). Courts have found good cause to discount a treating physician’s
report when it is “not accompanied by objective medical evidence, . . . wholly
conclusory,” or “inconsistent with [the physician’s] own medical records.” Lewis
v. Callahan, 125 F.3d 1436, 1440 (11th Cir. 1997); Edwards v. Sullivan, 937 F.2d
580, 583 (11th Cir. 1991). In contrast to the opinion of a treating physician, “the
opinion of a nonexamining physician is entitled to little weight if it is contrary to
the opinion of the claimant’s treating physician.” Broughton v. Heckler, 776 F.2d
960, 962 (11th Cir. 1985).
Second, federal courts review the SSA’s conclusions of law de novo, see
Bridges v. Bowen, 815 F.2d 622, 624 (11th Cir.1987), and “[f]ailure to apply the
correct legal standards is grounds not for remand but, for reversal.” Lamb v.
Bowen, 847 F.2d 698, 701 (11th Cir. 1988). No presumption attaches to either the
ALJ’s choice of legal standard or to the ALJ’s application of the correct legal
standard to the facts. Id.
Finally, reviewing courts have the power “to enter, upon the pleadings and
transcript of the record, a judgment affirming, modifying, or reversing the decision
of the Commissioner of Social Security, with or without remanding the cause for a
rehearing.” 42 U.S.C. § 405(g) (emphasis added).
3
III.
Statutory and Regulatory Framework
An individual applying for DIB bears the burden of proving that she is
disabled. Moore, 405 F.3d at 1211. To qualify, 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) and 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).
For applicants who have attained age 18, determination of disability under
the Act requires a five step analysis. See 20 C.F.R. § 404.1520(a)-(f); 20 C.F.R. §
416.920. Specifically, the Commissioner must determine, in sequence:
(1)
(2)
(3)
(4)
(5)
whether the claimant is doing substantial gainful activity;
whether the claimant has a severe impairment;
whether the impairment meets or is medically equivalent to 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 economy, based on his residual functional capacity.
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
4
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).
For applicants under age 18, determination of disability under the Act
requires a three step analysis. 20 C.F.R. § 416.924(a). Specifically, the
Commissioner must determine in sequence:
(1) whether the claimant is working;
(2) whether the claimant has a severe impairment; and
(3) whether the impairment meets or equals one listed by the Secretary.
Parks ex rel. D.P. v. Comm’r, Soc. Sec. Admin., 783 F.3d 847, 850 (11th Cir.
2015). In determining whether an impairment equals a severe impairment, the ALJ
must assess the claimant on six domains:
(1) acquiring and using information;
(2) attending and completing tasks;
(3) interacting and relating with others;
(4) moving about and manipulating objects;
(5) caring for himself; and
(6) health and physical well-being
Id. at 851 (citing 20 C.F.R. §§ 416.926a(a), (b)(1), (d)). The claimant must
establish that she suffers from an “extreme” limitation in one of the domains, or a
“marked” limitation in two of the domains. Id. (citing 20 C.F.R. § 416.926a(a)).
5
In cases where an individual attains age 18 after filing a disability
application but before the Commissioner has made a determination or decision on
whether the individual is disabled, the Commissioner uses the three step analysis of
20 C.F.R. § 416.924 for the period during which the individual was under age 18,
and the five step analysis of 20 C.F.R. § 416.920 for the period starting with the
day the individual attains age 18. 20 C.F.R. § 416.924(f).
IV.
The ALJ’s Decision
In performing the three step analysis for the period before Gaddison attained
age 18, the ALJ found that Gaddison had not engaged in substantial gainful
activity since July 24, 2014, and therefore met Step One. Doc. 6-3 at 21, 25. Next,
the ALJ found that Gaddison satisfied Step Two because she suffered from a
“severe impairment” caused by bipolar disorder. Id. at 25 (citing 20 C.F.R. §
416.924(c)). Finally, the ALJ found that Gaddison did not have an impairment or
combination of impairments that met or medically equaled one of the impairments
listed in the regulations for presumptive disability (i.e. the six domains), or that
functionally equaled the listings. Id. at 28-35.
Therefore, the ALJ found that
Gaddison was not disabled under the Act prior to attaining age 18. Id. at 35.
With respect to the period beginning age 18, Gaddison again satisfied Step
One as she had not engaged in substantial gainful activity since July 24, 2014.
Doc. 6-3 at 25. Next, at Step Two, the ALJ found that Gaddison continued to have
a severe impairment or combination of impairments, and had not developed any
6
new impairments since attaining age 18. Id. at 35. At Step Three, the ALJ
concluded that Gaddison’s mental impairment did not meet the severity or
medically equal the severity of one of the impairments listed in 20 C.F.R. Pt. 404,
Subpt. P, App. 1, § 12.04, for depressive, bipolar and related disorders. Id. at 25,
36.
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 Gaddison had no past relevant work and has the residual functional
capacity (“RFC”) to perform a full range of work at all exertional levels, except
that Gaddison should have infrequent workplace changes, occasional interactions
with the public, and instructions that are simple and lack detail. Id. at 36-37. The
ALJ then proceeded to step five, where based on Gaddison’s RFC, age, prior work
experience, and the Vocational Expert’s (“VE”) testimony, the ALJ concluded that
Gaddison could perform work that exists in significant numbers in the national
economy, including work as a housekeeper, hand packager, and poultry worker. Id.
at 37-38. Therefore, the ALJ concluded that Gaddison was not disabled under the
Act subsequent to attaining age 18. Id. at 38.
V.
Analysis
Gaddison contends that the ALJ erred by failing to (1) make any findings of
her credibility; (2) clearly state the grounds to discredit her examining psychologist
Dr. David Wilson; and (3) use substantial evidence in finding that her bipolar
7
disorder failed to rise to a marked level. Doc. 13 at 20-30. Lastly, Gaddison
argues that the Appeals Council failed to consider new submissions from the
Cherokee-Etowah-DeKalb (“CED”) Mental Health Center. Id. at 30-33. The court
addresses these issues in turn.
A. Whether ALJ Failed to Properly Discredited Gaddison’s Credibility
“The ALJ can make credibility determinations regarding a claimant’s
subjective complaints and must provide specific reasons for the credibility
finding.” Ring v. Berryhill, 241 F. Supp. 3d 1235, 1245 (N.D. Ala. 2017), aff’d
sub nom., Ring v. Soc. Sec. Admin., Comm’r, 728 F. App’x 966 (11th Cir. 2018).
Although the “credibility determination does not need to cite particular phrases or
formulations . . . [,] it cannot merely be a broad rejection that is not enough to
enable the reviewing court to conclude that the ALJ considered the medical
condition as a whole.” Id. (citing Dyer v. Barnhart, 395 F.3d 1206, 1210 (11th Cir.
2005)).
In reaching a decision, the ALJ must consider “all of the available
evidence, including [the claimant’s] medical history, the medical signs and
laboratory findings, and statements about how . . . symptoms affect [the claimant].”
20 C.F.R. § 404.1529. However, because a claimant has “voluminous case records
containing many types of evidence from different sources, it is not administratively
feasible for [the ALJ] to articulate in each determination or decision how [the ALJ]
considered all of the factors for all of the medical opinions and prior administrative
medical findings in [the claimant’s] case record.” 20 C.F.R. § 416.920(c). Thus
8
“[a] lack of an explicit credibility finding [only] becomes a ground for remand
when credibility is critical to the outcome of the case.” Foote, 67 F.3d at 1560
(emphasis added).
1. Subjective Pain Testimony
Gaddison maintains the ALJ failed to properly assess her credibility based
on her pain testimony and a school evaluation from guidance counselor Denisse
Lumpkin.
Doc. 13 at 20-24.
To establish a disability via testimony about
symptoms, Gaddison must provide “(1) evidence of an underlying medical
condition; and (2) either (a) objective medical evidence confirming the severity of
the alleged [symptom]; or (b) that the objectively determined medical condition
can reasonably be expected to give rise to the claimed [symptom].” Wilson v.
Barnhart, 284 F.3d 1219, 1225 (11th Cir. 2002).
In assessing Gaddison’s
symptoms, the ALJ must consider: “the objective medical evidence; [Gaddison’s]
daily activities; the location, duration, frequency, and intensity of [Gaddison’s]
symptoms; precipitating and aggravating factors; the type, dosage, effectiveness,
and side effects of medication taken to relieve the symptoms; treatment, other than
medication, for the symptoms; any other measure used to relieve the symptoms;
and any other factors concerning functional limitations and restrictions due to the
symptoms.” Sims v. Comm’r of Soc. Sec., 706 F. App’x 595, 603–04 (11th Cir.
2017) (citing § 404.1529(c)(3)). Although explicit findings as to credibility are not
required, “the implication must be obvious to the reviewing court.’” Dyer, 395
9
F.3d at 1210 (quoting Foote, 67 F.3d at 1562). Thus, an ALJ must offer a “clearly
articulated credibility finding with substantial supporting evidence in the record,”
MacGregor v. Bowen, 786 F.2d 1050, 1054 (11th Cir.1986).
Turning to the specifics here, after reviewing the record of evidence of
Gaddison’s treatment history, the ALJ cited the appropriate standard in evaluating
“the intensity, persistence, and limiting effects of [Gaddison’s] symptoms to
determine the extent to which they limit [Gaddison’s] ability to do basic work
activities.” Doc. 6-3 at 26 (citing 20 CFR § 404.1529). As the ALJ noted,
“whenever statements about . . . the pain or other symptoms are not substantiated
by objective medical records, the [ALJ] must make a finding on the credibility of
the statements based on a consideration of the entire case record.” Id. The ALJ in
fact reviewed the entire record, and ultimately found that “the limitations arising
from [Gaddison’s] bipolar symptoms did not rise to the marked level in any
domain.” Id. Contrary to Gaddison’s contention, a review of the record, including
objective medical evidence and Gaddison’s reported daily activities (see 20 C.F.R.
§ 416.929(c)), supports the ALJ’s findings.
Gaddison’s subjective testimony about her bipolar symptoms indicated that
she suffered from blackouts due to anxiety, emotional triggers, angry outbursts,
trouble sleeping, changes in eating patterns, and inability to concentrate. Doc. 13
at 20-24. Although these symptoms may cause some limitations, the ALJ found
that the medical record failed to support the extent and severity of the limitations
10
Gaddison described.
With respect to blackouts, for example, the ALJ asked
Gaddison to specify when she experiences blackouts and severe anxiety, and
Gaddison responded “when [she] is around a lot of people.” R. 62. In discrediting
this testimony, the ALJ noted that despite anxiety issues Gaddison developed a
friendship with a neighbor, had a boyfriend, and told her counselor that she
enjoyed working at a fast food restaurant. Doc. 6-3 at 35-36. Moreover, as the
ALJ noted, Gaddison’s education records indicated that she was able to function in
the classroom and her difficulties in expressing herself decreased as she adjusted to
her new school.
Id. at 32; R. 250-256 (Teacher Genia Fry noted that after
Gaddison transferred Gaddison experienced no problems or only slight problems in
the six domain categories).
Regarding Gaddison’s testimony about emotional shifts and lethargy, the
ALJ implicitly noted the inconsistency in Gaddison’s testimony about when her
“depression got so bad that [she] couldn’t bring [herself] to get out of bed.” R. 65.
The ALJ noted that although Gaddison reported difficulties in getting out of bed at
her grandmother’s home, she was able to attend school on a consistent basis when
she lived with her friend’s family. See R. 65-67 (ALJ during the hearing: “Q: But
what I’m trying to understand is why you were able to [get out of bed despite
depression] at your friend’s house? A: Because I was forced to . . . I was forced to
. . . by [friend’s mother]”).
Gaddison’s grandmother also testified that on days
where Gaddison struggled to get out of bed, she “just left [Gaddison] alone and
11
then she finally got up and seemed, you know, that she was – she was getting,
getting to herself and she said I’m going to take my medicine.” R. 76.
The
evidence about Gaddison’s actions at her friend’s home support the ALJ’s decision
to discredit this part of Gaddison’s testimony.
With respect to Gaddison’s contention about her anger outbursts, the ALJ
noted that in February 2016 guidance counselor Denisse Lumpkin indicated that
Gaddison has a “severe problem with expressing anger appropriately” and a “very
serious problem” in handling frustration appropriately. R. 265-271. However, the
ALJ discredited this testimony, in part, because when the ALJ asked Gaddison
whether she had “trouble getting along with the authority figures in your life . . .
anyone else at the school,” Gaddison responded with “No ma’am.” R. 64.
Gaddison’s medical records also indicate that Gaddison’s anger symptoms are not
as debilitating as she testified. As the ALJ pointed out, during a May 2015 CED
Mental Health Center visit, Gaddison noted that she experienced “increased
symptoms of her bipolar disorder when she went off her medications,” but she
realized that these symptoms decreased when she is on medications and that she
needed to continue taking them. Doc. 6-3 at 28, 36; R. 517-534. The ALJ noted
also that although Gaddison experienced significant challenges arising from her
bipolar disorder, Gaddison also “worked hard to overcome and deal with her
depression, anger, and other symptoms by seeking appropriate treatment and using
various coping skills and techniques she practiced with her therapist.” Doc. 6-3 at
12
36. Indeed, as explained in detail in Section B, infra, regular visits at the CED
Mental Health Center indicate that although Gaddison described challenges in
meeting her treatment goals to manage anger outbursts, she also noted progress in
using coping techniques such as writing in her journal, breathing, and using selfaffirmations. See R. 517-534.
Finally, although Gaddison complained of an inability to concentrate, the
ALJ discredited this testimony because school records indicate that Gaddison made
“fairly good grades – B’s and C’s” while carrying a regular class load. R. 537.
See R. 272, 274, 296 (Southside High School Transcripts indicating a grade point
average around 76 between 2013 and 2016); see also R. 205 (Gaddison’s
grandmother report that “[Gaddison] makes good grades in school but has had hard
time paying attention and understanding subjects and sometimes doesn’t pay any
attention when people are talking to her”). The ALJ also noted that Gaddison was
on track to graduate and expressed interests in careers in the Army, as a veterinary
technician, or as a pet groomer. Doc. 6-3 at 36.
In short, Gaddison’s record, including her assessments 1 and academic
performance, belie her subjective complaints.
The ALJ properly cited to
substantial evidence in the record to discredit Gaddison’s testimony about the
severity of her bipolar disorder symptoms. Therefore, the decision of the ALJ is
1
In her Self-Assessment Function Report, Gaddison indicated that despite limitations on her
social functioning she had no limitations on her daily activities, ability to communicate, and
ability to take care of her personal needs and safety. R 182-184.
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due to be affirmed. Lowery v. Soc. Sec. Admin., Comm’r, 729 F. App’x 801 (11th
Cir. 2018) (affirming the ALJ who found “that limitations to which claimant
testified were far in excess of those which reasonably would be expected from the
objective clinical findings and were not consistent with all of the other evidence of
record”).
B. Whether the ALJ Erred by Giving Limited Weight to the Opinion of
Dr. David Wilson
Gaddison next challenges the weight the ALJ gave to the opinion of Dr.
Wilson, a psychiatrist she visited once at her lawyer’s request, contending that the
ALJ failed to state with “some measure of clarity” the reasons she gave little
weight to Dr. Wilson’s opinion.
Doc. 13 at 24-28.
“Medical opinions are
statements from acceptable medical sources that reflect judgments about the nature
and severity of [a claimant’s] impairment(s),” including symptoms, diagnosis and
prognosis, and a claimant’s abilities and restrictions. 20 C.F.R. § 416.927. “An
ALJ may not reject an opinion if the claimant went to the doctor at the request of
her attorney . . . [and] the purpose for which a report was obtained does not provide
a legitimate basis for rejecting it.” Rice v. Comm’r of Soc. Sec., 611 F. App’x 665,
666 (11th Cir. 2015).
In weighing medical opinions, an ALJ may offer little
weight to a physician based on several factors, including: (1) whether the medical
opinion is from a treating source who can provide a detailed, longitudinal picture
of a claimant’s medical impairments; (2) length of treatment; (3) nature and extent
14
of the treatment relationship; (4) supportability; and (5) consistency. See 20 C.F.R.
§ 404.1527(c)(1)-(2).
In contrast to the opinion of a physician who has regularly
treated a claimant, a one-time examiner is generally “not entitled to the deference
due to a treating medical source.” See Crawford v. Comm’r, Soc. Sec., 363 F.3d
1155, 1160 (11th Cir. 2004) (“The ALJ correctly found that, because [the doctor]
examined [the claimant] on only one occasion, her opinion was not entitled to great
weight.”).
Turning to the specifics, Dr. Wilson performed a consultative psychological
evaluation where Gaddison shared her experiences with trauma and challenges in
controlling her anger. Based on this evaluation, Dr. Wilson opined that although
Gaddison is “intelligent with good verbal skills,” her “ability to withstanding the
pressures of day to day occupational functioning is highly impaired.” R. 539. Dr.
Wilson also completed a medical source form where he circled “No” on several
questions to indicate that Gaddison cannot understand or carry out simple
instructions, maintain attention for at least two hours, perform activities within a
schedule and be punctual, sustain an ordinary routine without special supervision,
adjust to routine and infrequent work changes, respond appropriately to criticism
from supervisors, interact appropriately with co-workers, and maintain socially
appropriate behavior. R. 540. He also opined that Gaddison would experience
high absenteeism since he expected her to miss thirty days out of a thirty day
period due to her psychological symptoms. Id.
15
The ALJ gave Dr. Wilson’s opinion little weight due to its “inconsisten[cy]
with [Gaddison’s] CED treatment records and with her school records and teacher
questionnaires.” Doc. 6-3 at 37. In challenging the ALJ’s decision, Gaddison
merely reiterates Dr. Wilson’s findings and notes its consistency with teacher
evaluations and her hospitalization for suicidal ideation in December 2015. Doc.
6-3 at 37. These contentions overlook that the overall record supports the ALJ’s
decision to give little weight to Dr. Wilson’s opinion. As an initial matter, a
medical source form is conclusory and has limited probative value. Indeed, several
courts have criticized “form reports” such as the one Dr. Wilson provided, see R.
540, in which a physician merely checks off a list of symptoms without providing
an explanation of the evidence that supports her decision. See Wilkerson ex rel.
R.S. v. Astrue, 2012 WL 2924023, at *3 (N.D. Ala. July 16, 2012) (“form report
completed by Dr. Morgan and submitted by [plaintiff]’s counsel consisted of a
series of conclusory ‘check-offs’ devoid of any objective medical findings”);
Mason v. Shalala, 994 F.2d 1058, 1065 (3d Cir. 1993) (“Form reports in which a
physician’s obligation is only to check a box or fill in a blank are weak evidence at
best[.]”); Foster v. Astrue, 410 F. App’x 831, 833 (5th Cir. 2011) (holding use of
“questionnaire” format typifies “brief or conclusory” testimony); Hammersley v.
Astrue, 2009 WL 3053707, at *6 (M.D. Fla. Sept. 18, 2009) (“[C]ourts have found
that check-off forms . . . have limited probative value because they are conclusory
and provide little narrative or insight into the reasons behind the conclusions”).
16
Here, Dr. Wilson circled answer choices indicating that Gaddison would not be
able to function in the workplace. R. 540. Although he summarized Gaddison’s
medical record in his psychological evaluation, he devoted one paragraph to offer
his impressions and failed to explain his conclusion that “[Gaddison’s] ability to
withstand the pressures of day to day occupational functioning is highly impaired.”
R. 535-539.
Second, as the ALJ noted, Gaddison’s CED Mental Health Center records
are clearly at odds with Dr. Wilson’s opinion. Despite her fluctuating treatment
progress, all of her visits with the CED therapist indicate that Gaddison appeared
to have a “neat” appearance, “normal” affect, and proper orientation in time, place,
person, and situation. R. 83-85; 353-357; 526-535. During the relevant period
prior to turning 18, Gaddison’s CED records reflect, as the ALJ noted, that she
made progress on her treatment goals despite her fluctuating symptoms.
For
example, in April 2014, she “report[ed] no suicidal or homicidal thoughts in over
three years,” felt stable on her medications, made fair treatment progress, and
continued counseling. R. 353. Next, in July 2014, her Global Assessment of
Functioning (“GAF”) 2 score was 56 despite little progress on managing her bipolar
2
“A GAF score is a subjective determination that represents the clinician’s judgment of the
individual’s overall level of functioning . . . A score between 41 and 50 indicates serious
symptoms or ‘any serious impairment in social, occupational, or school functioning’ . . . A score
between 51 and 60 indicates only moderate symptoms or ‘moderate difficulty in social,
occupational, or school functioning’ . . . A score between 61 and 70 indicates only mild
symptoms or ‘some difficulty in social, occupational, or school functioning.’” McGriff v.
17
symptoms. Gaddison also reported that practice techniques with her therapist were
helpful, and she experienced improvements with self-esteem and denied
suicidal/homicidal thoughts. R. 533. In September 2014, Gaddison’s GAF score
had increased to 58, her “bipolar symptoms have improved to three times a month
with one episode of depression,” and she mentioned making friends and not having
depressive symptoms except on the day of the therapy visit. R. 531. In October
2014, Gaddison reported only making “mild” progress toward her goals but added
that she was “coping effectively,” denied suicidal or homicidal ideation, and was
“utilizing journaling and reading as coping methods for mood stabilization.” R.
530. Finally, in February 2015, Gaddison made “minimal progress” on her goals
but reported that her anger outbursts had declined to only four times a month rather
than on a daily basis. R. 355. As the ALJ noted, these records do not support Dr.
Wilson’s findings that Gaddison is unable to withstand the pressures of a
workplace environment.
Moreover, as to Gaddison’s contention that the ALJ mistakenly relied on her
medical records prior to her turning 18 in assessing Dr. Wilson’s opinion, doc. 14
at 25, even after Gaddison turned 18 in April 2015, the record3 still does not
Comm’r, Soc. Sec. Admin., 654 F. App'x 469, 471–72 (11th Cir. 2016) (internal citations
omitted).
3
Gaddison devotes a substantial portion of her brief describing her hospitalizations. The ALJ
also noted that the hospital discharge records indicated that Gaddison left stable, that her
symptoms increased without medications, and that she can “function reasonably well” when she
follows her treatment plan of medications, regular counseling, and coping techniques. Doc. 6-3
18
support Dr. Wilson’s opinion. The post-age 18 records also show that despite
fluctuating symptoms, Gaddison continued to make some progress on the same
treatment plan. Gaddison’s post-age 18 CED Mental Health Center records
indicate in chronological order that in May 2015, Gaddison’s “symptoms increased
due to being out of medication” but she went “back on medication” and “knows
she needs medication and will continue to take it.” R. 525.
Gaddison also
indicated during this visit a desire to work on the negative thoughts, and her GAF
score was 58. Id. Next, in June 2015, Dr. Richard Grant notes that Gaddison had a
normal sleep pattern, fair insight and judgment, logical thought process, adequate
attention, fair appetite and fair energy, appropriate behavior, and adequate weight.
R. 524. In July 2015, Gaddison reported “minimal” progress toward her goals and
struggles with controlling anger outbursts, but that she is starting to use coping
skills, and that she developed a new friendship with a neighbor who she “is able to
visit . . . and talk [to] when she becomes angry.” R. 523. When Gaddison returned
two months later, although the friendship with her neighbor had ended and she
reported minimal progress on her treatment goals, Gaddison’s GAF score was 59,
she described her long-term goals of becoming a veterinarian, and she was
encouraged to use techniques to improve her mood. R. 522. In December 2015,
at 29. The court also notes that two of her three hospitalizations occurred prior to Gaddison’s
alleged onset date of disability – Emergency Walk-In in November 2010, R. 322, and Mountain
View Hospitalization in August 2012, R. 92.
19
Gaddison again made minimal progress toward her goals and she was encouraged
to use coping skills to improve her self-esteem and monitor her depressive
symptoms. R. 517. Finally, in February 2016, she made no progress on her
treatment goals but her therapist recommended that she use “positive coping skills”
in order to decrease mood swings, R. 83. To summarize, as the ALJ noted, even
the post-age 18 medical entries are inconsistent with Dr. Wilson’s opinion that
Gaddison’s ability to handle the daily pressures of a job is highly impaired.
R.
535-539.
In addition to the medical records, Gaddison’s school records are also
inconsistent with the opinion of Dr. Wilson. For example, Dr. Wilson opined that
in a “30 day period” Gaddison would “fail to report to work 30 days due to her
psychological symptoms.” R. 540. However, school records indicate that in one
of her classes Gaddison only missed 20 days in a school year.
R. 255.
The
school records are consistent with Gaddison’s grandmother’s report that Gaddison
misses around one day a week of school, R. 198-206, and Gaddison’s admission
that she is able to get out of bed and go to school when she is forced to do so. R.
65-67.
Gaddison’s regular and consistent attendance is reflected in the ALJ’s
finding that Gaddison consistently earned grades in the average range and is on
track to graduate from high school. R. 272, 274, 296.
Finally, the teacher evaluations also undermine Dr. Wilson’s opinion,
indicating that Gaddison struggled initially after transferring to the school but
20
made progress during subsequent school years. Doc. 6-3 at 34. For example, in
October 2012, teacher Cheryl French noted that Gaddison looked “unclean and
disheveled” and had a “very serious problem” with respect to cooperation and
caring for personal physical needs.
See also R. 250, 293. Although Gaddison
cites to this record in support of her disability, the ALJ noted that Gaddison’s
“alleged onset date in the current case is more than 20 months after [these teacher
forms were] completed.”
Doc. 6-3 at 28.
The ALJ also noted that teacher
evaluations “completed in February 2016, approximately 10 months after the
[Gaddison] turned 18” indicate improved functioning — Gaddison had no
problems with acquiring and using info, attending and completing tasks, and
following rules and obeying adults, but continued to struggle with making and
keeping friends as well as handling frustration. Id. at 29 (citing R. 250-271).
Put simply, the ALJ cited multiple reasons to support her decision to give
Dr. Wilson’s opinion little weight. Therefore, the ALJ did not commit error or
substitute her opinion for that of a medical doctor. See Beegle v. Soc. Sec. Admin.,
Comm’r, 482 F. App’x 483, 488 (11th Cir. 2012) (finding that the ALJ did not
improperly substitute her own medical opinion for that of a doctor when
“substantial evidence supports the weight that she assigned to the opinion”).
Accordingly, her decision to give Dr. Wilson’s opinion little weight is due to be
affirmed.
21
C. Whether the ALJ Used Sufficient Evidence in Finding that
Gaddison’s Bipolar Disorder Did Not Rise to a Marked Level
Gaddison also alleges that the ALJ failed to fully consider Dr. Wilson and
Denisse Lumpkin’s opinions in finding Gaddison does not meet Listing 12.04. As
explained below, substantial evidence supports the ALJ’s decision that Gaddison’s
impairment did not meet or medically equal any of the six functional domains used
for claimants before age 18 and Listing 12.04 used for claimants after age 18.
1. The Substantial Evidence Supports the ALJ’s Finding that
Gaddison’s Impairment Does Not Rise to the Marked Level in Any
of the Six Functional Domains.
For the period before Gaddison turned 18, the ALJ considered whether
Gaddison had severe limitations that affected at least two of the six domains
evaluating daily functioning or an extreme limitation that affects one domain. See
20 C.F.R. § 416.926(a). Upon review of Gaddison’s education record, academic
performance, and teacher evaluations, the ALJ found that Gaddison (i) had some
“academic difficulties and challenges, but at no point has she had any restriction in
acquiring and using information rising to the marked level;” (ii) could reasonably
be expected to have some distraction and lack of focus but the restrictions in
attending and completing tasks does not rise to the marked level; (iii) could interact
and relate with others without marked limitations; (iv) had no limitations in terms
of moving about and manipulating objects; (v) had significant difficulties in caring
for herself but she was on track to graduate from high school and worked with her
22
therapist to address her mood swings; and (vi) had no limitations in health and
physical well-being. Doc. 6-3 at 29-35. Gaddison challenges these findings. For
the reasons stated below, the court finds that the ALJ’s decision is supported by the
substantial evidence.
As an initial matter, in arguing that these findings are in error, Gaddison
broadly rejects the ALJ’s finding but does not cite the specific domains she
contends she meets. It seems Gaddison’s contention of error is based solely on one
February 2016 evaluation from guidance counselor Denisse Lumpkin who ranked
Gaddison as having a serious problem with personal hygiene, expressing anger,
and asking permission appropriately, and an obvious problem with following class
rules and respecting adult authority. R. 267, 269. Lumpkin’s questionnaire offers
limited insight because Lumpkin admits that she met with Gaddison “once or twice
a month” during her senior and junior years. R. 265. In contrast, two teachers who
interacted with Gaddison on a daily basis noted in February 2016 that Gaddison
had no problem with acquiring and using information, expressing anger
appropriately, and only a slight problem with taking care of personal hygiene. See
R. 250, 254, 261 (evaluations from Gaddison’s government and band teachers).
Moreover, teacher questionnaires in general provide limited insight as they do “not
explain what distinguishes between slight, obvious, or serious problems or how
these designations might correspond to ‘less than marked,’ ‘marked,’ or ‘extreme’
ratings as defined in the regulations.” Beavers v. Soc. Sec. Admin., Comm’r, 601 F.
23
App’x 818, 823 (11th Cir. 2015). Indeed, the ALJ cautioned against placing too
much reliance on the snapshot description of Gaddison, who had just transferred
into Southside High School after attending “22 different schools” and experienced
a difficult transition initially. Doc. 6-3 at 26. As the ALJ noted, Gaddison remained
on track to graduate and her social behavior improved between her transfer in
October 2012 and February 2016 as reflected in her teacher’s evaluations. Id. See
R. 250, 254, 261. In short, based on this record, Gaddison has failed to establish
that her impairments rise to the marked level in any of the six domains.
2. The Substantial Evidence Supports the ALJ’s Finding that
Gaddison’s Impairments Did Not Meet or Medically Equal Listing
12.04.
The ALJ also considered whether Gaddison met the requirements after
turning 18 in April 2015. The substantial evidence supports the ALJ’s findings
that Gaddison’s contention that she meets the Listing rests solely on a counselor’s
evaluation that Gaddison had a serious problem with hygiene, seeking permission,
and anger management. See doc. 13 at 28. However, the counselor only met with
Gaddison twice a month, and the teachers who saw Gaddison on a daily basis
noted that her problems with hygiene and anger management were not serious. R.
250, 254, 261.
To determine whether an impairment or combination of impairments meets
or medically equals the severity of a listed impairment in 20 C.F.R. Part 404,
Subpart B, Appendix 1. 20 C.F.R. §§ 404.1520(d), 404.1525, 404.1526, “a
24
claimant must have a diagnosis included in the Listings and must provide medical
reports documenting that the conditions meet the specific criteria of the Listings
and the duration requirement.” Wilson, 284 F.3d at 1224. Moreover, “to show that
his impairment matches a listing, it must meet all of the specified medical
criteria[;] [a]n impairment that manifests only some of those criteria, no matter
how severely, does not qualify.” Sullivan v. Zebley, 493 U.S. 521, 530 (1990)
(emphasis in original). A claimant cannot equal a listing by “showing that the
overall functional impact of his unlisted impairment or combination of
impairments is as severe as that of a listed impairment.” Id. at 531. Ultimately,
“the claimant bears the burden of proving that he is disabled, and, consequently, he
is responsible for producing evidence in support of his claim.” Ellison v. Barnhart,
355 F.3d 1272, 1276 (11th Cir. 2003); see also 20 C.F.R. § 416.912(c) (stating
“[the claimant] must provide medical evidence showing that [the claimant has] an
impairment(s) and how severe it is during the time” the claimant alleges a
disability).
To meet Listing 12.04A of 20 C.F.R. 404, Subpart P, Appendix 1, Gaddison
must demonstrate medical documentation of bipolar disorder, which is
characterized by three or more of the following: “pressured speech, flight of ideas,
inflated self-esteem, decreased need for sleep, distractibility, involvement in
activities that have a high probability of painful consequences that are not
recognized; or increase in goal-directed activity or psychomotor agitation.” In
25
addition to Paragraph A, Gaddison must also satisfy Paragraph B or C.4 Paragraph
B is met with extreme 5 or marked 6 limitation in two of the following areas of
mental functioning: “(i) Understand, remember, or apply information; (ii) Interact
with others; (iii) Concentrate, persist, or maintain pace; and (iv) Adapt or manage
oneself.” Id. at 12.04B.
The ALJ found that Gaddison did not meet Listing 12.04, noting that the
medical record only supported that Gaddison’s “psychological symptoms result in
moderate restriction in activities of daily living, moderate difficulties in
maintaining social functioning, and moderate difficulties in maintaining
concentration, persistence or pace.” Doc. 6-3 at 35. The ALJ pointed out also the
absence of “decompensation episodes that have lasted for at least [two weeks].”
Id. at 34. To reach this decision, the ALJ reviewed Gaddison’s CED Mental
Health Center records (as discussed in detail in Section B, supra) which indicated
that she “remained reasonably stable” with outpatient counseling and medication
management. Doc. 6-3 at 36-37. The ALJ also reviewed Gaddison’s GAF score,
which fluctuated in the 50s range and indicated that Gaddison had “moderate
symptoms” or “moderate difficulty in social, occupational, or school functioning.”
4
Gaddison does not specific whether she meets Paragraph B or Paragraph C. However, a review
of the record indicates that she is attempting to satisfy Paragraph B since there is no evidence
that Gaddison has an inability to function outside a highly supportive living arrangement.
5
“Extreme limitation [indicates that the claimant is] not able to function in this area
independently, appropriately, effectively, and on a sustained basis.” Id. at 12.00F(2)(e).
6
“Marked limitation [indicates that the claimant’s] functioning in this area independently,
appropriately, effectively, and on a sustained basis is seriously limited.” Id. at 12.00F(2)(d).
26
Id. See also American Psychiatric Association, Diagnostic and Statistical Manual
of Mental Disorders 34 (5th ed. 2013). Finally, the ALJ noted that although
Gaddison was admitted to Mountain View Hospital in December 2015 for anxiety,
suicidal thoughts, verbal aggression, and impulsive behaviors, Gaddison’s
depression symptoms improved at discharge, she had a GAF score of 52, and she
resumed CED outpatient counseling and medication management. Id.
3. The ALJ Properly Considered Gaddison’s Limitations during the
VE’s Testimony.
Finally, Gaddison maintains that the ALJ failed to fully account for
Gaddison’s impairments and limitations in the hypothetical the ALJ posted to the
VE. In this respect, Gaddison appears to argue the ALJ’s decision is not supported
by substantial evidence because the ALJ failed to “consider all of [Gaddison’s]
severe impairments” during the VE testimony and “show that [Gaddison] could
perform other gainful employment in the economy.” Pendley v. Heckler, 767 F.2d
1561, 1563 (11th Cir. 1985). Indeed, this Circuit has “held that unless there was
vocational expert testimony concerning the availability of jobs for a person with
the claimant’s educational level, work skills and experience and physical
limitations, the decision of the ALJ, based significantly on the expert testimony,
would be unsupported by substantial evidence.” Id. See also id. at 1562 (“Where
an ALJ relies significantly on the testimony of a VE to find that other jobs exist in
the national economy that a Claimant can perform, but fails to include all the
27
Claimant’s limitations in the hypothetical question, the Eleventh Circuit has held
that the final decision is not supported by substantial evidence.”).
A review of the record shows that the ALJ posed a series of hypotheticals to
the VE accounting for Gaddison’s RFC.7 See, e.g., R. 79-81 (ALJ’s hypothetical
regarding “occasional interaction with the general public and frequent interaction
with coworkers and supervisors and would be capable of sustaining attention,
concentration for at least two hour blocks of time with normal breaks throughout
an eight-hour day,” . . . “[if] we continue with that same individual but I now add
some additional social restrictions in that the individual should have no interaction
with the general public meaning that the job itself would not require interaction
with the public, . . . the job requirements itself and occasional interaction with
coworkers and supervisors which they’re around them throughout the work day but
have only occasional conversations and interpersonal interactions”). In light of the
ALJ’s RFC findings, which are consistent with the medical record, the court
cannot conclude, as Gaddison suggests, that the ALJ erred by failing to incorporate
all aspects of Dr. Wilson’s unsupported opinion in the hypothetical posed to the
VE. See Crawford, 363 F.3d at 116 (finding that the ALJ was not required to
include findings in the hypothetical that the ALJ had properly rejected as
unsupported). After all, the ALJ is not required to “pore over every piece of
7
The ALJ determined that Gaddison has the RFC to perform a full range of work at all
exertional levels, except with limitations on simple instructions, infrequent workplace changes,
and occasional interactions with the public. Doc. 6-3 at 36.
28
medical opinion evidence they find persuasive and extract every discrete point of
the opinion for inclusion in absurdly lengthy hypotheticals that could easily stretch
over several pages of hearing transcript. Nothing in the law requires that result.”
Caldwell v. Berryhill, 2017 WL 694233, at *5 (M.D. Ala. Feb. 21, 2017).
Moreover, Gaddison also fails to point to what specific limitations the ALJ
failed to include in the questions to the VE. In any event, “[t]he hypothetical
questions need only include the claimant’s impairments, not each and every
symptom of the claimant.” Ingram v. Comm’r of Soc. Sec. Admin., 496 F.3d 1253,
1270 (11th Cir.2007) (internal citation omitted). There is no error here because the
ALJ found that Gaddison’s “moderate difficulties restricted [her] ability to work to
the extent that [she] could only comprehend and perform simple routine tasks and
interact with others occasionally, and the [ALJ] included those limitations in the
hypothetical question.” Kunz v. Comm’r of Soc. Sec., 539 F. App’x 996 (11th Cir.
2013).
D. Whether the Appeals Council Failed to Properly Consider Submitted
Evidence
Finally, Gaddison contends that the Appeals Council (“AC”) rejected new
relevant, material evidence indicating Gaddison’s continued treatment for
depression. Doc. 13 at 33. Generally, a claimant may present new evidence in
support of her application at each stage of the administrative process. Ingram, 496
F.3d at 1261 (citing 20 C.F.R. § 404.900(b)). The AC must review a case if the
29
claimant submits additional evidence that is new, material, and relates to the period
on or before the date of the hearing decision, and if “there is a reasonable
probability that the additional evidence would change the outcome of the
decision.” 20 C.F.R. § 404.970(a)(5). See also Hargress v. Soc. Sec. Admin.,
Comm’r, 883 F.3d 1302, 1309 (11th Cir. 2018) (quoting 20 C.F.R. § 404.970(b),
416.1470(b)) (“Evidence is material if a reasonable possibility exists that the
evidence would change the administrative result.”).
After the ALJ issued her decision, Gaddison submitted new records to the
AC, which she contends undermine the ALJ’s decision. As an initial matter,
Gaddison merely references the new evidence and argues that the AC’s decision
was perfunctory adherence, see doc. 13 at 31, which is insufficient to “carr[y] her
burden to show that these records create a reasonable probability that the ALJ’s
decision would be changed.” See Caldwell v. Colvin, 2014 WL 2765820, at *4
(M.D. Ala. June 18, 2014). Moreover, the AC correctly explained why it did not
consider the new evidence, i.e. Gaddison’s therapy notes from CED Mental Health
Center, dated February 1, 2016 to July 20, 2016, stating that the records did “not
show a reasonable probability that it would change the outcome of the decision.”
R. 2 (citing 20 C.F.R. § 404.970(a)(5)). See also Hargress, 883 F.3d at 1309
(affirming decision because the new records did “not create a reasonable
possibility . . . the evidence would change the administrative result”).
Indeed,
similar to the medical record from the relevant period, as discussed in Section B,
30
supra, the new therapy notes indicate that Gaddison makes fluctuating progress
toward her goals in managing anger outbursts, that her therapist continues to
recommend “positive coping skills,” and that her appearance, affect, and
orientation remained unchanged. R. 83 – 87. In fact, the June 2016 Physician’s
Evaluation, which indicates that Gaddison had a normal sleep pattern, fair insight
and judgment, logical thought process, adequate attention and concentration, fair
appetite and energy, and appropriate behavior, undercuts Gaddison’s contention
that the new records would lead to a different result. R. 85. Finally, the July 2016
therapy notes, which indicate that Gaddison experienced anger outbursts at home
causing the family’s landlord to be concerned, are also not helpful as her therapist
recommended only that Gaddison use a “diary or journal to write more animated
feelings down . . . and encouraged her to use coping skills.” R. 87. Therefore,
because the ALJ has already discussed at length the fluctuating progress that
Gaddison has made, nothing in the new records show a “reasonable possibility that
the new evidence would change the administrative outcome.” Hyde v. Bowen, 823
F.2d 456, 458 (11th Cir. 1987).
Lastly, because the ALJ decided the case through July 25, 2016, the AC
correctly declined to review Gaddison’s August 2016 record which is not related to
the period at issue. R. 2. “The AC normally must consider evidence that was not
presented to the ALJ when that evidence is new, material, and chronologically
relevant. See Washington v. Soc. Sec. Admin., Comm’r, 806 F.3d 1317, 1320 (11th
31
Cir. 2015). Evidence is chronologically relevant if it “relates to the period on or
before the date of the [ALJ] hearing decision,” 20 C.F.R. §§ 404.970(b),
416.1470(b), and is “material” when it is “relevant and probative so that there is a
reasonable possibility that it would change the administrative result.” Milano v.
Bowen, 809 F.2d 763, 766 (11th Cir. 1987). In light of Gaddison’s failure to
explain why the August 2016 record is chronologically and materially relevant, the
court finds that the AC properly declined to review the record. See Mitchell v.
Comm’r, Soc. Sec. Admin., 771 F.3d 780, 783 (11th Cir. 2014) (finding that the AC
is not required “to provide a detailed discussion of a claimant’s new evidence when
denying a request for review”).
VI. Conclusion
Based on the foregoing, the court concludes that the ALJ’s determination is
supported by substantial evidence, and that the ALJ applied proper legal standards
in reaching his decision. Therefore, the Commissioner’s final decision is
AFFIRMED. A separate order in accordance with the memorandum of decision
will be entered.
DONE the 13th day of March, 2019.
_________________________________
ABDUL K. KALLON
UNITED STATES DISTRICT JUDGE
32
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