Martin v. Social Security Administration

Filing 16

FINDINGS AND RECOMMENDATION recommending that Martin's complaint be dismissed and judgment be entered for the Commissioner. Objections due within 14 days of this Recommendation. Signed by Magistrate Judge Patricia S. Harris on 1/8/2019. (jbh)

IN THE UNITED STATES DISTRICT COURT
EASTERN DISTRICT OF ARKANSAS
NORTHERN DIVISION

LEANNA S. MARTIN
v.

PLAINTIFF
NO. 1:18-cv-00004 JM/PSH

NANCY A. BERRYHILL, Acting Commissioner
of the Social Security Administration

DEFENDANT

FINDINGS AND RECOMMENDATION
INSTRUCTIONS

The following proposed Findings and Recommendation have been sent to United
States District Judge James M. Moody Jr. You may file written objections to all or part
of this Recommendation. If you do so, those objections must: (1) specifically explain
the factual and/or legal basis for your objection, and (2) be received by the Clerk of
this Court within fourteen (14) days of this Recommendation. By not objecting, you may
waive the right to appeal questions of fact.

DISPOSITION
Plaintiff Leanna S. Martin (“Martin”) began this case by filing a complaint
pursuant to 42 U.S.C. 405(g). In the complaint, she challenged the final decision of the
Acting Commissioner of the Social Security Administration (“Commissioner”), a decision
based upon the findings of an Administrative Law Judge (“ALJ”).
Martin maintains that the ALJ’s findings are not supported by substantial
evidence on the record as a whole.1 Specifically, Martin maintains that her residual
functional capacity was erroneously assessed and offers two reasons why: 1) the ALJ
gave insufficient reasons for discounting a consulting physician’s opinions, and 2) the
ALJ did not consider the possibility that Martin’s failure to consistently keep her mental
health treatment appointments was itself due to her mental impairments.
The record reflects that Martin was born on September 12, 1979, and was thirtyfive years old on November 1, 2014, the alleged onset date. She filed applications for
disability insurance benefits and supplemental security income payments on January 5,
2015, and alleged that she was disabled as a result of, inter alia, mental impairments.
The medical evidence relevant to Martin’s mental impairments reflects that she
sought medical attention for them prior to the alleged onset date. For instance, Martin
saw Dr. Donald Wright, M.D., (“Wright”) on January 13, 2014, complaining of worsening
depression/anxiety and reported being easily upset by trivial events. See Transcript at
484-488. Wright discontinued Martin on citalopram and began her on sertraline.

The question at bar is whether the ALJ’s findings are supported by substantial evidence on the
record as a whole. “Substantial evidence means less than a preponderance but enough that a reasonable
person would find it adequate to support the decision.” See Boettcher v. Astrue, 652 F.3d 860, 863 (8th
Cir. 2011).
1

2 

Martin saw Wright again on June 16, 2014. See Transcript at 492-496. Martin
continued to report problems with depression and anxiety. Wright discontinued Martin
on sertraline and began her on fluoxetine.
On September 23, 2014, Martin was seen by Dr. Tammy Berke, Ph.D., (“Berke”)
for a mental health evaluation. See Transcript at 459-466. Berke recorded Martin’s
presenting problems to be as follow:
I have a big problem being around big crowds. I have a problem with anger.
I don’t have any drug problems. I have real bad panic attacks. They can
hit me when I am driving or just sitting. I think I have some depress[ion].
I just don’t want to be around anyone or go any [where], even family. I
have never been like this before and I don’t know why it hit me. I have
gained weight and it affects my self esteem. She states that she obsesses
alot. Her husband is 50. She has always felt threatened by his previous
wife, who died from a homicidal suicidal event her BF. She died 7-8 [years]
ago. She states that she still obsesses over her, afraid that her husband
still loves her. She [has] always been worried that he could have been
seeing his ex wife while they were married.
...
She states remembering panic attacks starting about 4 yrs. The first panic
attack she had[,] she had to go to the emergency room. She found out at
age 12 that her father was not her real father. He drank a lot and was
mean. She may have a real issue of not knowing of her bio father. She
started having anxiety around people about 4 years. Went through a
period of drinking around 21-30. She has 2 children, daughters age 14 and
9. She has been married 13 years. Depression started about 3 years ago.
See Transcript at 461. Martin’s mood/affect was appropriate but sad, and her thought
process was within normal limits. She was not a risk of harm to herself or others, and
she expressed no homicidal ideations. Berke diagnosed a panic disorder and a major
depressive disorder. Although Berke assigned Martin a Global Assessment of Functioning
(“GAF”) of fifty, Berke believed Martin’s condition could respond favorably to therapy.

3 

After the alleged onset date, Martin continued to seek medical attention for her
mental impairments. For instance, Martin continued to see Berke for individual therapy
and saw her on December 3, 2014. See Transcript at 457-458. Berke recorded Martin’s
presenting problems to be as follow: “She has increased stressors, taking care of [her]
mother and grandmother. Panic attacks have been 2-3X a day. She went to work
parttime as a cashier. ‘I am ready to [quit]. It is non stop, gets off task, can’t remember
things, can’t focus on the job.’” See Transcript at 457. Martin was oriented as to person,
place, and time. Her affect was concurrent with her mood, her appearance was clean
and groomed, and she was medication compliant. Berke encouraged Martin to utilize,
inter alia, relaxation skills, muscular relaxation, deep breathing, self-calming, and
cognitive self-talk to help lessen the severity of her symptoms.
The following day, Jennie Dawson, A.N.P, (“Dawson”) prepared a mental health
evaluation of Martin. See Transcript at 453-456. Martin’s appearance was neat/clean;
her affect was appropriate, although her mood was depressed; her thought process was
intact; and she reported no suicidal or homicidal ideations. A panic disorder and a major
depressive disorder were diagnosed, and she was assigned a GAF of fifty. The following
assessment of Martin’s mental state was offered:
Pt endorse sx past 4 yrs and receiving tx per pcp for panic without warning
several times daily; depression with social isolation, lack of motivation,
mood lability, racing thoughts nightly that affect sleeping-getting about 4
hrs nightly average, rates depression and anxiety 8:10 daily average with
10 severe, mood swings daily and becomes angered and then self isolates.
She feels most of this is coming from not know[ing] who her father is. She
is motivated to get past this and hopes this will resolv[e].
See Transcript at 455.

4 

Martin saw Berke again on December 18, 2014. See Transcript at 451-452. Martin
reported sleeping well with trazodone. She also reported that her other medications
have helped reduced her panic attacks and anxiety. Berke additionally noted that
Martin reported the following:
She is still emotionally [haunted] by the fact that when she was 11-12, she
found out that [her] father was not her bio father. She has 2 sisters from
her bio mother [and her father] is now [her] step father. She is not
recovered from the fact that he used to beat her and treated her different
than her 2 sisters. They were never abused. She witness[ed] alot of
domestic violence with her step father beating her mother.
See Transcript at 451. Martin was oriented as to person, place, time, and situation. Her
affect was concurrent with her mood, and she was medication compliant. She reported
two to three panic attacks a day and noted that the Christmas season had brought about
an increase in her level of stress. Berke continued to encourage Martin to utilize nonmedical techniques to help lessen the severity of her symptoms.
Martin saw Berke again on February 3, 2015. See Transcript at 449-450. Martin
reported that her grandmother had died since the last time Martin saw Berke. Martin
reported that she was with her grandmother at the time of death, and Martin’s father
was with them, acting inappropriately and saying rude things. Martin was oriented as
to person, place, time, and situation. Her affect was concurrent with her mood, and
she was medication compliant. Martin reported having three to four panic attacks a
day. She reported that the attacks hit her “hard and quick,” and she could sometime
feel them coming on because her hands would start to sweat, and her heart would begin
racing. See Transcript at 449. Berke continued to recommend the use of non-medical
techniques to help lessen the severity of the symptoms.
5 

Martin continued to see Berke and/or Dawson throughout 2015 and on into 2016.
See Transcript at 596-597 (04/30/2015), 594-595 (04/30/2015), 592-593 (05/18/2015),
590-591 (05/28/2015), 588-589 (09/17/2015), 586-587 (12/16/2015), 584-585
(12/16/2015), 580-583 (12/16/2015), 578-579 (03/31/2016), 576-577 (03/31/2016),
572-575 (04/18/2016). The progress notes from the presentations are generally
consistent with the progress notes from the earlier presentations. Specifically, Martin
continued to complain of panic attacks and problems stemming from her family and
other relationships. She was nevertheless oriented as to person, place, time, and
situation; and her affect continued to be concurrent with her mood. Although Martin
had been medication compliant, Berke observed in a December 16, 2015, progress note
that Martin had stopped taking her medication during an approximately two to three
month period “due to interfering with her heart [arrhythmia].” See Transcript at 584.
Berke also observed the following in the progress note: “She has missed several
appointments ‘due to lack of motivation to get off the couch and out of the house.’ She
states she has been either in bed or on the couch sleeping excessively and not leaving
home for the last 2-3 months.” See Transcript at 584.
On October 11, 2016, Berke discharged Martin from therapy. See Transcript at
729-730. Berke provided the following reasons for discharging Martin: “discharged due
to lack of participation in therapy and missed therapist. Last seen for therapy in March
2016. She has not shown for 2 therapy appointments without calling since then. It has
been discussed with her several times that she must be participating in therapy to
receive medication management services ...” See Transcript at 729. Berke also noted
the following in her discharge summary:

6 

[Martin] has expressed fears that her ex husband sexually molested her
daughter and has tried to terminate her daughter’s visitations. She has
reported this and it has been unfounded. She continues to express this as
a primary source of anger, anxiety, and depressions. She has attended 7
therapy sessions over the last 2 years. She states she wants therapy so she
can continue to get her medications, but she does not follow through with
making or keeping appointments. She has made little progress due to her
not participating in therapy. She reported in March worsening of symptoms
due to [finding?] out that mother has cancer and [daughter] “trying to
strangle herself at school.” [Daughter] is in counseling at Dayspring. She
last reported that panic attacks have worsened and she has phobia of
leaving home. However, she has failed to follow through with therapy and
when asked about it, she will make excuses and still state she has to have
therapy. She wants to stay in medication management.
See Transcript at 729-730.
On May 14, 2015, Martin was seen by Dr. Nancy Bunting, Ph. D., (“Bunting”) for
a mental status and evaluation of adaptive functioning. See Transcript at 566-570.
Bunting summarized Martin’s allegations of present mental illness and history of
psychiatric treatment in the following manner:
[Martin] stated that she has had anxiety/panic attacks for 5 years and it
has interfered with working because she cannot concentrate.
[Martin’s] only suicide attempt was by overdose at the age of 13, and her
last suicidal thoughts were at that time. She has homicidal ideation, but
no plans. Her appetite is normal, and her weight is stable. With her
medication her sleep is “better,” and she usually sleeps for 6 hours at
night. [Martin] takes no naps. She reported a history of nightmares (i.e.
wakes crying) 1 x 2-3 months for the last year. She has no history of true
mood cycles. When she gets really nervous, her hands and feet sweat, she
feels dizzy, and it is hard to breathe. These now occur 2-3 x month. Her
energy level is “not good,” and she rated it at 3 on a scale of 1=puddle on
the floor/cannot move to 10=energizer bunny. She said that her
concentration varies. She gets out of the house 1 x week.
[Martin] has no history of treatment for drug or alcohol abuse or
psychiatric hospitalization. Her only outpatient counseling has been
seeing someone at HRA since November 2015. She now sees the therapist
1 x month.
7 

[Martin] did bring her medications. These included: venlafaxine 75 mg 1 x
day from J. Thompson and Abilify 10 mg 1 x day and clonazepam 1 mg 3 x
day PRN from J. Davidson, APRN. [Martin] has been on these for 3 weeks.
She takes these regularly and has no problems with them. She did not
know if they helped.
[Martin] reported no obstacles that prevented her from receiving mental
health treatment.
See Transcript at 566. Martin’s mood was anxious; her affect was flat; but her thoughts
were logical, relevant, and goal directed. Bunting diagnosed a mild neurocognitive
disorder and a generalized anxiety disorder. With respect to Martin’s adaptive
functioning, Bunting opined the following:
[Martin] can do all of her self-care routines. ...
[Martin] drove by herself to the appointment today. She now will drive by
herself only in Mountain Home because she cannot handle traffic. She can
shop by herself if she takes her clonazepam to control her anxiety. She
does not presently use a check book, and she previously had problems
with one. She has no difficulties counting change. She does not pay bills
on time and this is “getting worse” as she does not want to. She does
household chores including laundry, washing dishes, sweeping, vacuuming
(sometimes depending on mood), and cleaning. She no longer cooks as she
does not “feel” like it. She spends her time watching television, listening
to the radio and other music, and using the internet for finding recipes,
facebook, and Pinterest. She enjoys cooking and fishing (big smile),
especially as they have just gotten a pontoon boat.
[Martin] reported she gets along with her husband “good.” She is in
contact with her half-sisters. Her mother and stepfather are still alive,
live in ND, and she is in contact with them. She has no friends, and she is
not involved in church or any other groups. She has contact with her
neighbors.
[Martin] communicated and interacted in a socially adequate manner for
a superficial conversation.
[Martin] sometimes could communicate in an intelligible and effective
manner.

8 

[Martin’s] performance on serial 3s was poor. She counted backwards from
20 adequately. Her immediate recall was adequate, and her digit span
was in the borderline range. She has little capacity to cope with the
cognitive demands of basic work like tasks. She has a history of being able
to deal with co-workers and bosses by her report. She has the ability to
deal with the public in routine and superficial interactions only based on
her behavior in the interview. She can not handle some work stress or
changes at this time as her anxiety is fueled by clear cognitive deficits.
She can follow instructions from supervisors if given one at a time.
[Martin] could attend and sustain her concentration in the interview which
focused on herself. ... Her concentration does not appear[] adequate for
basic tasks in light of the other cognitive deficits seen in this interview.
[Martin] was able to persist in the interview. She is capable of doing this
for at least short periods of time. Her frustration tolerance is limited by
the cognitive deficits seen in this interview.
[Martin] is not able to complete work like tasks within an acceptable
timeframe.
See Transcript at 569-570. Bunting believed Martin gave her best level of effort and
cooperation and noted no indications of malingering or exaggeration.
Martin testified during the administrative hearing about her mental impairments.
See Transcript at 60-78, 86-88. She completed the eleventh grade in school but never
received a high school diploma or completed a high school equivalency diploma
program. She experiences panic attacks and has difficulty being around large groups of
people. She has taken clonazepam for panic attacks and diazepam, trazadone, and
citalopram for depression and anxiety, although she was not taking them at the time of
the hearing. When Martin was asked why she stopped keeping her mental health
treatment appointments, she answered as follows:
CLMT: Because I’ve had a lot of death in my family on my husband’s
side. His mother had passed, and I was very close to her. And—

9 

ALJ: Well, don’t you think Health—that’s what therapy is for, for
situations such as that?
CLMT: Yeah, but I couldn’t get out of bed on a lot of them days.
Depression and—
ALJ: Okay. Well, the notes say that over a two year therapy period,
you went seven times, and then you wouldn’t call them back to fill in the
appointments, or missed all your appointments.
CLMT: Yes. I have a hard time of getting up on a daily basis.
See Transcript at 69. Martin has had thoughts of suicide because she believes she cannot
“live [her] life;” she cannot “enjoy it with [her] kids because [she is] in so much pain.”
See Transcript at 70. She cannot cope with basic work-like tasks and cannot cope with
stress. If she were to work, she would work very slow and not within an acceptable
timeframe. She hopes to re-start individual therapy after she has had a period to
recover from the death of her mother-in-law.
Martin’s husband also testified during the administrative hearing. See Transcript
at 78-86. He has had to leave work on occasion to assist Martin after one of her panic
attacks. They occur so often that the family is prevented from visiting loved ones. He
has noticed that she has difficulty focusing, concentrating, and remembering.
Martin’s medical records were reviewed by state agency medical consultants.
See Transcript at 98-113, 114-129, 132-148, 149-165. With respect to her mental
capabilities, they agreed that she is capable of performing work-related activities
involving the following: “[Martin] is able to perform work where interpersonal contact
is incidental to work performed, e.g., assembly work; complexity of tasks is learned
and performed by rote, few variables, little judgment; supervision required is simple,
direct, and concrete.” See Transcript at 110, 162.
10 

At step two of the sequential evaluation process, the ALJ found that Martin’s
severe impairments include a general anxiety disorder, a major depressive disorder,
and a mild cognitive disorder. The ALJ assessed Martin’s residual functional capacity
and found that Martin is capable of performing sedentary work but with the following
restrictions caused by her mental impairments: “... [Martin] can perform simple,
routine tasks with occasional changes in routine work setting; she can have superficial
contact with the public or coworkers, ... limited to meet and greet type situations.”
See Transcript at 21. In making the assessment, the ALJ gave little weight to Bunting’s
opinions because they were inconsistent with her own findings and observations and
were inconsistent with the other medical evidence. With regard to Bunting’s diagnosis
of a mild neurocognitive disorder, the ALJ found that “[n]o treating source diagnosed
the condition and [Martin] “regularly was oriented to person, place, time, and
situation.” See Transcript at 24. The ALJ also noted that the results of Bunting’s
examination were “unique in that [Martin] appeared only a little anxious without any
depression leading to the failure of ... Bunting to include social limitations.” See
Transcript at 24. In making the assessment, the ALJ also gave significant weight to the
opinions of the state agency medical consultants. At step four, the ALJ found that
Martin is unable to perform her past relevant work. The ALJ found at step five, though,
that there are other jobs Martin can perform. As a result, the ALJ concluded that Martin
was not disabled for purposes of the Social Security Act.
Martin maintains that the ALJ’s findings are not supported by substantial
evidence on the record as a whole. Martin so maintains, in part, because the ALJ gave
insufficient reasons for discounting Bunting’s opinions.

11 

The ALJ is required to assess the claimant’s residual functional capacity, which
is a determination of the most the claimant can do despite her limitations. See Brown
v. Barnhart, 390 F.3d 535 (8th Cir. 2004). The assessment is made using all the relevant
evidence in the record and must be supported by “‘medical evidence that addresses
the claimant’s ability to function in the workplace.’” See Id. at 539 [quoting Lewis v.
Barnhart, 353 F.3d 642, 646 (8th Cir. 2003)].
As a part of considering the medical evidence, the ALJ must weigh the various
medical opinions in the record. See Wagner v. Astrue, 499 F.3d 842 (8th Cir. 2007). The
ALJ may reject the opinion of a medical expert if the opinion is “inconsistent with the
medical record as a whole,” see Bentley v. Shalala, 52 F.3d 784, 787 (8th Cir. 1995), or
the medical expert renders inconsistent opinions that undermine the credibility of the
opinions, see Choate v. Barnhart, 457 F.3d 865 (8th Cir. 2006). As a general proposition,
the opinions of a treating medical expert are accorded greater weight than the opinions
of a consulting medical expert, whose opinions are typically given limited weight. See
Anderson v. Heckler, 738 F.2d 959 (8th Cir. 1984). The opinions of the medical experts
who examined the claimant are generally accorded greater weight than the opinions of
medical experts who did not examine the claimant. See Wildman v. Astrue, 596 F.3d
959 (8th Cir.2010).
The manner in which an ALJ resolves a conflict in the medical evidence will be
disturbed only if it falls outside the “available zone of choice.” See Hacker v. Barnhart,
459 F.3d 934, 936 (8th Cir. 2006) [internal quotation omitted]. A decision is not outside
the “available zone of choice” simply because the court may have reached a different
conclusion had it been the finder of fact. See Id.

12 

The reasons the ALJ gave for discounting Bunting’s opinions are supported by
substantial evidence on the record as a whole and within the “available zone of choice.”
The undersigned so finds for two reasons.
First, the ALJ could and did discount Bunting’s opinions because they are
inconsistent with Bunting’s own testing and observations. Bunting opined that Martin’s
mental impairments give rise to difficulties coping with the cognitive demands of basic
work-like tasks, an inability to handle some work stress or changes, difficulties
concentrating, and an inability to complete work-like tasks within an acceptable
timeframe. While it is true that Martin’s performance on “serial 3s” was poor and her
“digit span” was in the borderline range, she could count backwards from twenty, had
an adequate “immediate recall, and could name the current President of the United
States and his three predecessors. Bunting noted that Martin can perform her self-care
routines, drive an automobile, shop by herself if she takes her medication, and count
change despite having some difficulty using a checkbook. Bunting also noted that Martin
spends time using the internet for finding recipes and using Facebook. Bunting opined
that Martin cannot handle some work stress or changes as “her anxiety is fueled by
clear cognitive deficits,” but the evidence supporting the finding is scant.
Although Bunting observed that Martin’s mood was anxious and her affect flat,
Bunting also observed that Martin’s thoughts were logical, relevant, and goal directed.
Martin reported getting along with her husband and having contact with her family and
neighbors, although she had no friends. She reported the ability to deal with coworkers, bosses, and “the public in routine and superficial interactions.” It is also
telling, as the ALJ noted, that Bunting imposed few social limitations upon Martin.

13 

Second, the ALJ could and did discount Bunting’s opinions because they are
inconsistent with the record as a whole. Although Bunting found that Martin had
limitations caused by a mild neurocognitive disorder, it does not appear that Berke,
Dawson, or the state agency medical consultants made similar findings. For instance,
although Berke and Dawson consistently diagnosed depression, anxiety, and a panic
disorder, Berke and Dawson do not appear to have identified any limitations caused by
a neurocognitive disorder. In fact, Berke opined on at least two occasions that Martin
does not have a neurocognitive disorder. See Transcript at 573, 581. Berke and Dawson
consistently observed that Martin was oriented as to person, place, time, and situation,
and her affect was typically concurrent with her mood. It is also worth noting that
Martin was able to complete the eleventh grade in school.
Bunting found that Martin has limitations caused by depression, anxiety, and a
panic disorder, a finding supported by Berke, Dawson, and the state agency medical
consultants and adopted in part by the ALJ. The question for the ALJ was not whether
Martin has such limitations; the question was the extent to which the limitations impact
the most Martin can do despite the limitations. Bunting, Berke, and Dawson all noted
Martin’s tragic history, e.g., a history of abuse and neglect, having lived in a household
where her mother was abused, the knowledge that her father was not her biological
father, fears that her daughter had been sexually molested and had attempted to harm
herself, and the death of close family members. Nevertheless, Berke and Dawson,
unlike Bunting, identified few limitations on Martin’s ability to perform work-related
activities because of her agonizing history, and many of her problems appear to have
been situational in nature.

14 

Martin was seen on a number of occasions by medical professionals other than
Berke and Dawson for complaints not involving Martin’s mental status. The progress
notes from those presentations nevertheless shed some light on Martin’s mental status
and are inconsistent with Bunting’s opinions. Martin was repeatedly observed to have a
normal mood and affect, an intact memory, no deficits in memory or concentration,
and oftentimes denied having any anxiety. See Transcript at 436, 442, 690, 697, 701,
704-705, 722, 725, 741-742, 749-750.
Whether the ALJ grants a physician’s opinions substantial or little weight, the
ALJ must always give good reasons for the weight given the opinions. Here, the ALJ
gave good reasons for the manner in which he weighed Bunting’s opinions.
Martin faults the ALJ for failing to consider the possibility that Martin’s failure
to consistently keep her mental health treatment appointments was itself due to her
mental impairments. In support of the assertion, Martin cites the Court to Pate-Fires v.
Astrue, 564 F.3d 935 (8th Cir.2009). In that case, the claimant suffered from a severe
bipolar disorder that caused manic behavior, homicidal threats, paranoid delusions,
significantly impaired insight, and a complete denial of the impairment. “Although
there was overwhelming evidence in the record expressly indicating that the claimant's
severe mental disorder caused her noncompliance with psychiatric medication, the ALJ
held that such noncompliance was not justified.” See Wildman v. Astrue, 596 F.3d 959,
966 (8th Cir. 2010). The Court of Appeals reversed, “concluding that the ALJ's decision
failed to recognize that the claimant's noncompliance was a manifestation of her
schizoaffective disorder and that noncompliance with psychiatric medication is
common among persons with such disorders.” See Id.

15 

The ALJ in this instance gave little attention to the possibility that Martin’s
failure to consistently keep her mental health treatment appointments was itself due
to her mental impairments. The ALJ’s failure to give extensive attention to such a
possibility, though, does not warrant a remand.
“Whether severe mental illness has resulted in justifiable noncompliance is a
fact-intensive issue.” See Hensley v. Colvin, 829 F.3d 926, 935 (8th Cir. 2016). Because
it is, the decision in Pate-Fires has, on occasion, been distinguished. For instance, it
has been distinguished on the ground that a claimant’s mental impairments are not as
extreme as the claimant’s mental impairments were in Pate-Fires, see Guthrie v.
Colvin, 2014 WL 5023508 (W.D.Ark. 2014), and when there is no evidence linking a
claimant’s mental limitations to her noncompliance, see Wildman v. Astrue, supra.
The case at bar is distinguishable from Pate-Fires in two respects. First, there is
little evidence that Martin’s depression, anxiety, and panic attacks cause the type of
manic behavior, homicidal threats, paranoid delusions, significantly impaired insight,
and a complete denial of the impairment as was present in Pates-Fires. Although Martin
experiences severe panic attacks, the symptoms were not chronic.
Second, there is not “overwhelming evidence in the record” expressly indicating
that Martin’s severe mental impairments cause her noncompliance with psychiatric
treatment. Instead, there is conflicting evidence on the question of whether her
depression, anxiety, and panic attacks cause her noncompliance. For instance, she
testified that she was too depressed to get out of bed to attend treatment. Bunting
noted, though, that Martin reported no obstacles preventing her from receiving mental
health treatment.

16 

The undersigned is obligated to consider evidence that both supports and
detracts from the ALJ's decision. See Goff v. Barnhart, 421 F.3d 785 (8th Cir. 2005). “If,
after reviewing the record, the [C]ourt finds it is possible to draw two inconsistent
positions from the evidence and one of those positions represents the ALJ's findings,
the [C]ourt must affirm the ALJ's decision.” See Id. at 789 [citing Pearsall v. Massanari,
274 F.3d 1211, 1217 (8th Cir.2001)]. The case at bar is such an instance. It is possible
to construe the evidence in such a way as to find that Martin’s failure to attend mental
health treatment is a result of her mental impairments. It is also possible to construe
the evidence in such a way as to find that her failure to do so is not the result of her
mental impairments. Because it is possible to draw two inconsistent positions from the
evidence, this case should not be remanded.
On the basis of the foregoing, there is substantial evidence on the record as a
whole to support the ALJ’s findings. The undersigned recommends that Martin’s
complaint be dismissed, all requested relief be denied, and judgment be entered for
the Commissioner.
DATED this 8th day of January, 2019.

________________________________________
UNITED STATES MAGISTRATE JUDGE

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