Greenwood v. Social Security Administration

Filing 17

MEMORANDUM OPINION AND ORDER reversing the Commissioner's decision, and remanding this case. The remand in this case is a "sentence four" remand. Judgment will be entered for Greenwood. Signed by Magistrate Judge Patricia S. Harris on 4/3/2017. (kdr)

IN THE UNITED STATES DISTRICT COURT
EASTERN DISTRICT OF ARKANSAS
JONESBORO DIVISION
TERRI GREENWOOD

PLAINTIFF

v.

NO. 3:16-cv-00211 PSH

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

DEFENDANT

MEMORANDUM OPINION AND ORDER

Plaintiff Terri Greenwood (“Greenwood”) 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 findings made by an Administrative Law Judge (“ALJ”).
Greenwood maintains that the ALJ’s findings are not supported by substantial
evidence on the record as a whole.1 It is Greenwood’s position that her residual
functional capacity was not properly assessed. She so maintains for two reasons, one of
which has merit. Greenwood maintains that the “meager mental limitations” found by
the ALJ are not supported by the record. See Document 12 at CM/ECF 16. For the reasons
that follow, the Court agrees.
1

The question for the Court 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).

The ALJ is required to assess the claimant’s residual functional capacity, which is
a determination of “the most a person can do despite that person’s limitations.” See
Brown v. Barnhart, 390 F.3d 535, 538-39 (8th Cir. 2004). The assessment is made using all
of the relevant evidence in the record, but the assessment must be supported by some
medical evidence. See Wildman v. Astrue, 596 F.3d 959 (8th Cir. 2010).
Greenwood alleges that she became disabled beginning on January 19, 2010. She
filed her application seeking supplemental security income payments on February 20,
2014, and the ALJ denied the application on June 25, 2015. The Commissioner correctly
maintains that supplemental security income payments are not payable for any period
prior to the filing date of the application seeking such payments. The Commissioner
therefore maintains, and the Court agrees, that the relevant time period in this case is
from the filing date of the application, i.e., February 20, 2014, through the date of the
ALJ’s decision, i.e., June 25, 2015. Although evidence prior to February 20, 2014, is
outside the relevant period, the evidence will nevertheless be reviewed in order to place
Greenwood’s mental limitations in the proper context.
The evidence relevant to Greenwood’s mental impairments reflects that she began
seeing Dr. Larry Felts, M.D. (“Felts”) at least as early as January 19, 2009, for complaints
that included depression, anxiety, panic attacks, and problematic relationships. See
Transcript at 412. At that time, she was taking prescription medication for depression,
anxiety, and psychosis, and the medication was helping to relieve her symptoms.
Greenwood thereafter saw Felts on what appears to have been twenty occasions
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through November 19, 2013. See Transcript at 411 (04/07/2009), 410 (07/06/2009), 409
(10/05/2009), 408 (01/04/2010), 407 (03/29/2010), 406 (06/17/2010), 405 (09/09/2010),
404 (12/02/2010), 403 (02/28/2011), 402 (05/26/2011), 399 (09/21/2011), 398
(12/15/2011), 397 (03/14/2012), 396 (07/10/2012), 395 (09/07/2012), 394 (12/05/2012),
393 (02/28/2013), 392 (05/24/2013), 391 (08/22/2013), 390 (11/19/2013). The progress
notes reflect that although Greenwood continued to complain of depression, anxiety,
panic attacks, and problematic relationships, the severity of her mental problems
fluctuated. Felts repeatedly diagnosed a bipolar disorder and an anxiety disorder and
continued Greenwood on medication for her mental problems.
On February 11, 2014, Felts signed a “To Whom It May Concern” letter in which
he addressed Greenwood’s limitations caused by her mental impairments. In the letter,
he represented the following:

... I have been treating [Greenwood] for Bipolar Disorder Mixed with
Psychotic Features and Anxiety Disorder NOS. She has trouble maintaining
the stability of her mood. Manic irritability, pressured speech, and conflicts
with peers lead to her losing her job as a cafeteria worker in the past. She
gets paranoid at times, as well as anxious, obsessively worried, and
impulsive. Concentration and memory are poor. Panic attacks are less
frequent with the help of medication, but still cause episodes of
hyperventilating, shortness of breath, tachycardia, tremors, etc. Overall,
her condition limits her ability to function at any job. Her condition is
chronic and prognosis is poor.

See Transcript at 388.
Greenwood thereafter saw Felts on what appears to have been five occasions

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between February 17, 2014, and December 9, 2014. See Transcript at 389 (02/17/2014),
387 (03/17/2014), 385 (06/12/2014), 384 (09/10/2014), 383 (12/09/2014). The progress
notes reflect that her mental symptoms stabilized and even improved despite family
difficulties.2 For instance, the June 12, 2014, progress notes reflects that Greenwood was
living by herself and managing her activities of daily living. She reported that Xanax was
helping her panic attacks. See Transcript at 385. The September 10, 2014, progress note
reflects that she was doing better. See Transcript at 384.
On June 3, 2014, Greenwood was seen by Dr. Samuel Hester, Ph.D. (“Hester”) for
a mental diagnostic evaluation. See Transcript at 321-329. He recorded her medical
history and noted, inter alia, her complaints of, inter alia, anxiety and insomnia. She
reported having been sexually and physically abused as a child. She additionally reported
that her father was a “physically abusive alcoholic,” and there was “a lot of drama
always in the family.” See Transcript at 321. She was taking Abilify, Trazodone, Xanax,
Gabapentin, and Mobic, and she reported that the medication “[kept] her symptoms
relatively well controlled.” See Transcript at 321. With specific regard to her anxiety, she
reported that the medication “likely causes more sedation and lethargy rather than
allowing anxiety to occur.” See Transcript at 321-322. Hester observed that Greenwood
was appropriately dressed and groomed, her attitude was good and cooperative, her

2

The December 9, 2014, progress note reflects that Greenwood was having transportation issues,
her sixteen-year-old daughter was pregnant, and Greenwood’s son was incarcerated. See Transcript 383.
During the period, Greenwood was also alleged to have offered to trade Xanax for “pain pills.” See
Transcript at 386. She denied the allegation, though. See Transcript at 45-46.

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mood did not appear to be depressed or anxious, and her affect was “appropriate to
mood” but “seemed a little dulled by all the medications.” See Transcript at 323. He
additionally observed that her speech did not show any abnormalities; her thought
process was logical; and her thought content did not display any “overvalued ideas, no
bizarre obsession, [or] preoccupations.” See Transcript at 324. He observed that she was
alert and fully oriented in all spheres. His diagnoses included the following impairments:
post-traumatic stress disorder, a depressive disorder, and a pain disorder. With respect
to the effects of her mental impairments on her adaptive functioning, he found the
following:

1. How do mental impairments interfere with this person’s day to day
adaptive functioning? ... [Greenwood] was able to drive unfamiliar routes.
[She] was reportedly able to perform most [activities of daily living]
autonomously. She does her own shopping and bill paying. She does not
participate in social groups.
2. Capacity to communicate and interact in a socially adequate manner? ...
[She] has the capacity to communicate and interact in a socially adequate
manner.
3. Capacity to communicate in an intelligible and effective manner? [She]
has the capacity to communicate in an intelligible and effective manner.
4. Capacity to cope with the typical mental/cognitive demands of basic
work-like tasks? [Greenwood] can cope with the mental demands of basic
work tasks.
5. Ability to attend and sustain concentration on basic tasks? [She] has the
ability to attend and sustain concentration on basic tasks.
6. Capacity to sustain persistence in completing tasks? [She] has the ability
to sustain persistence in completing tasks.
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7. Capacity to complete work-like tasks within an acceptable time frame?
[Greenwood] can complete work tasks within an acceptable timeframe
unless pain issues and all the sedating side effects of current medication
regimen slow her too much.

See Transcript at 326-327.
Greenwood saw Felts again on February 20, 2015. See Transcript 434-438. He
recorded her complaints and medical history to include the following:

... Greenwood is a 52-year-old white female who is living alone and in the
process of getting a divorce she’s had chronic difficulties with anxiety and
depression mania and paranoid currently her chief complaint is sleep loss
she says that she is averaging 4 or 5 hours of sleep per night ...
... Greenwood has had chronic problems with back pain she is overweight
and is trying to lose weight instead of having back surgery and she is
watching her diet and walking regularly she plans to have a gastric sleeve
placed to assist in losing weight.
In the past ... Greenwood has had radical mood swings at times she would
be manic with racing thoughts and flight of ideas lots of impulsive behaviors
and at other times she will be down and depressed and socially withdrawn
and fatigued lack of motivation however she is not been suicidal there are
times when she has been paranoid feeling that people are watching here
and talking about her etc. she has panic attacks that have been quite
severe at times currently alprazolam 2 mg 3 times a day has been reducing
the severity and duration of the panic attacks Abilify 5 mg daily at bedtime
is helping with depression and mania and paranoia trazodone has helped
with the depression 150 mg at bedtime seems to be ... working well
however since she is still having trouble sleeping I will add Ambien 10 mg
daily at bedtime she is given a month’s prescription with 2 refills she will
continue individual psychotherapy and return for med management in 3
months.

See Transcript at 434. Felts observed that Greenwood’s grooming was good, her affect
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was appropriate, her mood was euthymic, and her thought process was logical. He also
observed that her orientation was good for person/place/time, her memory and
concentration were good, and her judgment appeared to be normal. He noted that her
activities and/or hobbies included “ministering to others [and] watching TV.” See
Transcript at 435. His diagnoses remained unchanged, i.e., he continued to diagnose a
bipolar disorder and an anxiety disorder, and he continued to treat her with medication.
On April 27, 2015, Felts signed a medical source statement-mental in which he
addressed Greenwood’s mental limitations. See Transcript at 427-428. He opined that she
has extreme limitations in the following two respects: 1) the ability to perform activities
within a schedule, maintain regular attendance, and be punctual with customary
tolerances; and 2) the ability to complete a normal workday and workweek without
interruptions from psychologically based symptoms and to perform at a consistent pace
without an unreasonable number and length of rest periods. He also opined that she has
numerous marked limitations, limitations that include the following: 1) the ability to
remember locations and work-like procedures, 2) the ability to carry out very short
instructions, 3) the ability to maintain attention and concentration for extended periods,
4) the ability to accept instructions and respond appropriately to criticism from
supervisors, and 5) the ability to respond appropriately to changes in the work setting.
Felts opined that Greenwood’s mental impairments would cause her to be absent from
work more than three days a month.

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Greenwood saw Felts again on May 11, 2015. See Transcript 430-433.3 He noted
that she had been psychotic in the past but medication was helping control her
symptoms. He also noted that while her mood swings had grown less severe, “she still has
panic attacks and these get worse if she gets around crowds of people ...” See Transcript
at 430. He observed that her grooming was good, her thought process was logical, and
her memory and concentration were fair. He observed, though, that her affect was
blunted, and her mood was anxious. His diagnoses and medication regimen remained
unchanged.
Greenwood’s medical records were reviewed by state agency medical consultants.
See Transcript at 62-74, 76-91. The consultants opined that Greenwood’s mental
impairments were such that she has mild restrictions in activities of daily living; mild
difficulties in maintaining social functioning; moderate difficulties in maintaining
concentration, persistence, or pace; and had no episodes of decompensation, each of an
extended duration.
Greenwood completed a series of documents in connection with her claim for
supplemental security income payments. See Transcript at 168-176, 177-184, 185-186,
187-188. In the documents, she represented, inter alia, that she has difficulty
remembering,

concentrating,

understanding,

completing

tasks,

and

following

instructions.
3

The progress note refers to a “Caitlin Wood.” See Transcript at 430. The Court assumes that the
reference is a typographical error.

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The record contains a summary of Greenwood’s reportable earnings. See
Transcript at 160-164. The summary reflects that her earnings were minimal between
1978 and 2011, save the years between 1990 and 1992.
Greenwood testified during the administrative hearing. See Transcript at 38-55.
She was born on March 10, 1962, and was fifty-three years old at the time of the hearing.
She has been married five times but now lives by herself. She has a driver’s license but
she does not have an automobile. With respect to Greenwood’s mental state, she
testified that she sees a therapist from Felts’ office once a week. When Greenwood was
asked how she is doing mentally, she answered as follows: “Well, you know, he–I just
take my medicine like I’m supposed to. And, like I said, I live by myself. I guess I’m doing
okay there. You know, I do what he [i.e., Felts] tells me to do.” See Transcript at 44.
When asked how she spends her days, she testified as follows: “Well, I get up, take a
shower, get dressed, eat my breakfast. I’m at home by myself all the time. I don’t have
a vehicle. So I don’t have–I can’t go walk very far or anything. I had to have someone give
me a ride here.” See Transcript at 44. Greenwood later added the following:

... I usually get up, take a shower, and make myself something to eat. And
then I read my Bible. Then I–I’m just at home. You know, I don’t have cable
TV or anything like that. I watch VHS tapes, movies, and read. If I have to
vacuum once a week, I vacuum. I don’t have a lot of picking up to do
because it’s just me. You know, that’s–I don’t have to clean up after a
houseful of people. I’m not able to do that anyway. So I just do what I can.

See Transcript at 52-53.

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The ALJ found at step two of the sequential evaluation process that Greenwood’s
severe impairments include a depressive disorder, an anxiety disorder, and a somatoform
disorder. The ALJ assessed Greenwood’s residual functional capacity and found that she
can perform light work but with the following limitation caused by her mental
impairments: “[she] is limited to detailed, but not complex tasks involving three or four
steps, but with several variables.” See Transcript at 19.4 In so finding, the ALJ gave little
weight to Felts’ opinions because they were “inconsistent with [Greenwood’s] reports,
testimony, and regular psychiatric records.” See Transcript at 23, 24, 25. The ALJ gave
great weight, though, to Hester’s opinions because they were “consistent with
[Greenwood’s] reports and testimony.” See Transcript at 24. The ALJ also gave great
weight to the opinions of the state agency medical consultants.
Greenwood maintains that the meager mental limitations found by the ALJ are not
supported by the record. Greenwood so maintains primarily for two reasons. She first
maintains that the ALJ improperly weighed Felts and Hester’s opinions.
“It is the ALJ’s function to resolve conflicts among the various treating and
examining physicians.” See Bentley v. Shalala, 52 F.3d 784, 785 (8th Cir. 1995) [internal
quotation omitted]. A treating physician’s medical opinions are given controlling weight
if they are well-supported by medically acceptable clinical and laboratory diagnostic
techniques and are not inconsistent with the other substantial evidence. See Choate v.
4

The ALJ found at step four that Greenwood is unable to perform her past relevant work but found
at step five that there is other work she can perform. The ALJ concluded that Greenwood was not disabled.

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Barnhart, 457 F.3d 865 (8th Cir. 2006). The ALJ may discount a treating physician’s
medical opinions and credit a one-time consulting physician’s opinions where the former
renders inconsistent opinions that undermine the credibility of such opinions or where
the latter’s opinions are supported by “better or more thorough medical evidence.” See
Anderson v. Barnhart, 344 F.3d 809, 813 (8th Cir. 2003).
The ALJ’s decision to give little weight to Felts’ opinions but give great weight to
Hester’s opinions is not something the Court takes lightly. A treating physician like Felts
is usually more familiar with a claimant’s medical condition than are other physicians.
See Thomas v. Sullivan, 928 F.2d 255 (8th Cir. 1991). The proposition is certainly true in
this instance as Felts saw Greenwood on what appears to have been twenty-seven
occasions before offering the April 27, 2015, medical source statement, and Hester only
saw Greenwood one time. On the record now before the Court, it cannot be said that
substantial evidence on the record as a whole supports the weight given Felts and
Hester’s opinions. The Court so finds for the following reasons.
First, the reasons the ALJ gave for discounting Felts’ opinions are not particularly
compelling. The ALJ discounted the opinions because they were “inconsistent with
[Greenwood’s] reports, testimony, and regular psychiatric records.” See Transcript at 23,
24, 25. Admittedly, Greenwood’s testimony regarding her mental state was not
remarkable, e.g., she guessed she was doing “okay.” See Transcript at 44. Greenwood’s
reports and the treatment record complied by Felts, though, are consistent with his
opinions that she has significant mental limitations. Time and again, he recorded her
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complaints of depression, anxiety, panic attacks, and problematic relationships. He
obviously credited her complaints because he prescribed strong medication to treat her
symptoms. Her symptoms fluctuated over time, and it is conceivable that her symptoms
were less severe at the time she was seen by Hester. As Greenwood correctly notes, “[i]t
is inherent in psychotic illnesses that periods of remission will occur,” and such periods
do not mean the disability has ceased. See Document 12 at CM/ECF 21 [quoting Andler
v. Chater, 100 F.3d 1389, 1393 (8th Cir. 1996) [internal quotations omitted].
Second, the record as a whole does not establish that Felts rendered inconsistent
opinions about Greenwood’s mental impairments and their affect on her ability to
function. Although it is true that his progress notes contain some unremarkable findings,
his opinions were nevertheless consistent throughout the relevant period. For instance,
in his February 11, 2014, “To Whom It May Concern” letter, he opined, inter alia, that
she has trouble maintaining the stability of her mood; has conflicts with her peers; “gets
paranoid at times, as well as anxious, obsessively worried, and impulsive;” and has
“episodes of hyperventilating, shortness of breath, tachycardia, tremors, etc.” See
Transcript at 388. In his April 27, 2015, medical source statement, he opined that she has
extreme limitations in at least two respects and several marked limitations. See
Transcript at 427-428. In short, this case is not an instance in which a treating physician
has rendered inconsistent opinions. If nothing else, Felts’ opinions have been consistent;
he has consistently opined that Greenwood has significant mental impairments and they
affect her ability to function.
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Third, the record as a whole does not establish that Hester’s opinions are
supported by better or more thorough medical evidence. A fair reading of the report he
prepared following his evaluation of Greenwood reflects that he recorded her medical
history, observed her mental state, and offered his assessment of the effects of her
mental impairments on her adaptive functioning. Although the ALJ can give greater
weight to the opinions of a consulting physician than the opinions of a treating physician,
see Anderson v. Barnhart, 344 F.3d 809 (8th Cir.2003), the consulting physician’s opinions
must be well-supported by medically acceptable clinical and laboratory diagnostic
techniques. In this instance, Hester did no testing, and there is no indication he reviewed
any medical documentation. Hester simply examined Greenwood one time and reached
a different conclusion than Felts.
The opinion evidence in this case is varied and paints substantially different
pictures of Greenwood’s ability to function. Although it is the ALJ’s responsibility to
resolve conflicts among the various opinions, the Court would benefit from the ALJ reevaluating the various opinions of Greenwood’s mental impairments and their effect on
her ability to function in the workplace.
Greenwood additionally challenges the crafting of her residual functional capacity.
Greenwood maintains that “[t]he ALJ found ... Greenwood has virtually no mental
limitations.” See Document 12 at 25. The Court will not devote much attention to her
assertion but agrees that the assessment of her mental residual functional capacity is
flawed and should be re-assessed upon remand.
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The record as a whole establishes that Greenwood has mental impairments, and
the ALJ indeed found that Greenwood’s severe impairments include a depressive
disorder, an anxiety disorder, and a somatoform disorder. The question was not whether
she has mental impairments but the extent to which they impact the most she can do
despite the impairments. The ALJ found that the impairments cause virtually no workrelated limitations as he did not incorporate a meaningful mental limitation into
Greenwood’s residual functional capacity. He simply found that “[she] is limited to
detailed, but not complex tasks involving three or four steps, but with several variables.”
See Transcript at 19.
Substantial evidence on the record as a whole does not support the assessment of
Greenwood’s mental residual functional capacity as she appears to have work-related
limitations caused by mental impairments. For instance, even the state agency medical
consultants opined that Greenwood has moderate difficulties in maintaining
concentration, persistence, or pace, and the ALJ represented that he gave great weight
to their opinions.
It is for the foregoing reason that substantial evidence on the record as a whole
does not support the weight given Felts and Hester’s opinions or the assessment made
of Greenwood’s mental residual functional capacity. A remand is therefore necessary.
Upon remand, the ALJ shall re-assessment Greenwood’s mental residual functional
capacity and, as a part of doing so, re-evaluate the various opinions. If Felts’ opinions
should be discounted, the ALJ shall offer sound reasons for doing so.
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The Commissioner’s decision is reversed, and this case is remanded. The remand
in this case is a “sentence four” remand as that phrase is defined in 42 U.S.C. 405(g) and
Melkonyan v. Sullivan, 501 U.S. 89 (1991). Judgment will be entered for Greenwood.
IT IS SO ORDERED this 3rd day of April, 2017.

UNITED STATES MAGISTRATE JUDGE

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