Szala v. Commissioner of Social Security

Filing 24

ORDER affirming the Commissioner's decision and directing the clerk to enter judgment in favor of the Commissioner and close the file. Signed by Magistrate Judge Patricia D. Barksdale on 10/27/2015. (LPB)

United States District Court
Middle District of Florida
Jacksonville Division
SHANNON SZALA,
Plaintiff,
NO. 3:14-CV-1140-PDB

v.
COMMISSIONER OF SOCIAL SECURITY,
Defendant.

Order Affirming Commissioner’s Decision
This is a case under 42 U.S.C. §§ 405(g) and 1383(c)(3) to review a final decision
of the Commissioner of the Social Security Administration denying Shannon Szala’s
claim for disability-insurance and supplemental-security income benefits. She seeks
reversal, Doc. 20; the Commissioner, affirmance, Doc. 23. The Court incorporates the
record summarized by the Administrative Law Judge (“ALJ”), Tr. 21, 23–33, Szala,
Doc. 20 at 2–4, and the Commissioner, Doc. 23 at 1–3.
I.

Issue
Szala presents the sole issue of whether the ALJ properly evaluated the

medical opinions of Norman Baldwin, Ph.D., Dawn Fox, Psy.D., and Eduardo
Sanchez, M.D. Doc. 20 at 1–2.
II.

Background
Szala was 32 on the date of the ALJ’s decision. Tr. 52, 240. She last worked in

2007 as a debt collector. Tr. 54, 56. She has a ninth-grade education and no vocational
training but can read, write, and do simple arithmetic. Tr. 53–54, 268. She also has

worked as a front-desk clerk and a van driver. Tr. 55–58, 273. She alleged she had
become disabled in January 1987 due to anxiety, bipolar disorder, borderline
intellectual functioning or retardation, obsessive-compulsive disorder (OCD), and
attention deficit hyperactivity disorder (ADHD). Tr. 240–48, 262–63, 267. Her lastinsured date for her eligibility for disability-insurance benefits was June 30, 2012.
Tr. 263. She proceeded through the administrative process, failing at each level. Tr.
1–3, 18–33, 124–32, 136–41. This case followed. Doc. 1.
III.

Administrative Hearing
The ALJ conducted two hearings. At the first, he explained he wanted a

supplemental consultative exam because he found an initial psychological evaluation
by Peter Knox, Psy. D., contained irreconcilable findings. Tr. 44–45, 483–87. Szala’s
attorney pointed to notes of her treating physician, Dr. Sanchez, but the ALJ found
them unintelligible and thus unhelpful. Tr. 45–46. At the second, Szala, Dr. Baldwin,
and a vocational expert testified. Tr. 52, 58, 61. Dr. Baldwin testified Szala could
work in a supportive environment, which he defined as one with extra supervision
and structure from a supervisor that would accommodate her fluctuations in mood,
but she might struggle in a competitive workplace. Tr. 72–74. The ALJ posed two
hypotheticals to the vocational expert. In the first, the person had no extertional,
postural, environmental, or manipulative limitations; could do only simple, routine,
and repetitive tasks; and could have only occasional contact with the public, coworkers and supervisors. Tr. 113. The vocational expert opined the person could
perform jobs that exist in significant numbers in the national economy (packer,

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cleaner, and laundry sorter). Tr. 113–14. The second hypothetical was identical to the
first except the person would need a supportive environment. Tr. 114. The vocational
expert opined those limitations would prevent competitive employment. Tr. 114
IV.

ALJ’s Decision
At step two, 1 the ALJ found Szala has severe impairments of bipolar disorder

type II (in partial remission) and history of borderline intellectual functioning. Tr. 23.
At step three, he determined her impairments, whether individually or in
combination, did not meet or medically equal the severity of any impairment in the
Listing of Impairments, 20 C.F.R. Part 404, Subpart P, App’x 1. Tr. 24–25. He
considered whether her mental impairments satisfied paragraph B or paragraph C
criteria. 2 Tr. 24–25. He found she had no restrictions in activities of daily living, no

1The

Social Security Administration has established a five-step sequential
process for determining if a person is disabled. 20 C.F.R. §§ 404.1520(a), 416.920(a).
Under the process, the ALJ asks: (1) is the claimant engaged in substantial gainful
activity; (2) does she have a severe impairment or combination of impairments;
(3) does the impairment meet or equal the severity of certain specified impairments
in the Listing of Impairments, 20 C.F.R. Part 404, Subpart P, App’x 1; (4) based on a
residual-functional-capacity assessment, can she perform any of her past relevant
work despite the impairment; and (5) given her residual functional capacity, age,
education, and work experience, are there a significant number of jobs in the national
economy she can perform. Phillips v. Barnhart, 357 F.3d 1232, 1237 (11th Cir. 2004).
2Paragraph

B requires a persistent specified condition and at least two of the
following: (1) marked restriction of activities of daily living; (2) marked difficulty in
maintaining social functioning; (3) marked difficulty in maintaining concentration,
persistence, or pace; and (4) repeated episodes of decompensation, each of extended
duration. 20 C.F.R. Part 404, Subpart P, App’x 1 ¶ 12.04(B). Paragraph C requires a
“[m]edically documented history of a chronic affective disorder of at least 2 years’
duration that has caused more than a minimal limitation of ability to do basic work
activities, with symptoms or signs currently attenuated by medication or psychosocial
support” and one of the following: (1) “[r]epeated episodes of decompensation, each of
extended duration”; (2) “[a] residual disease process that has resulted in such
marginal adjustment that even a minimal increase in mental demands or change in
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episodes of decompensation of extended duration, and moderate difficulties in social
functioning and concentration, persistence, or pace. Tr. 24. He found she had not
established a medically documented history of a chronic organic mental disorder
lasting at least two years that caused more than minimal limitations on work
activities with symptoms or signs attenuated by medication or psychosocial support
and either repeated episodes of decompensation of extended duration, a residual
disease process causing decompensation with even minimal increases in mental
demands or environmental change, or a history of one or more years’ inability to
function outside supportive living arrangement. Tr. 24–25.
After stating he had considered the entire record, the ALJ determined Szala
has the residual functional capacity (RFC) to perform a full range of work at all
exertional levels with the following nonexertional limitations: “the claimant is limited
to performing simple, routine, repetitive tasks and can have only occasional contact
with the public, co-workers and supervisors.” Tr. 25. He gave great weight to Dr.
Sanchez’s opinion that she has difficulty interacting with co-workers but little weight
to Dr. Sanchez’s opinion that she has marked limitations on some social functioning,
finding it inconsistent with his assessment in his letter addressing her impairments
and his treatment. Tr. 27.

the environment would be predicated to cause the individual to decompensate”; or (3)
“[c]urrent history of at least 1 or more years’ inability to function outside a highly
supportive living arrangement, with an indication of continued need for such an
arrangement.” Id. at 12.04(C).
4

The ALJ gave Dr. Fox’s opinions partial weight. Tr. 28. He accepted her
borderline-intellectual-functioning diagnosis as consistent with the objective medical
evidence. Tr. 28. He rejected her opinion that Szala cannot handle the stress of a
routine workday because (1) Dr. Fox was a one-time examining physician relying
almost entirely on Szala’s subjective reports, (2) Dr. Sanchez was Szala’s primary
source of treatment and did not find such extreme limitations, and (3) Szala has past
relevant work indicating she could perform in some work environments long enough
to learn the work and perform work at a substantial gainful activity level. Tr. 28.
The ALJ rejected Dr. Baldwin’s testimony, finding it inconsistent and “all over
the place.” Tr. 29. Dr. Baldwin wavered on whether Szala met a listing for bipolar
disorder and agreed Dr. Knox’s psychological examination did not support a GAF
scale rating of 45 but found a GAF scale rating of 45 to 50 was appropriate based on
her unsubstantiated reports of lack of impulse control. Tr. 29–30. Giving great
consideration to Dr. Sanchez’s records, particularly his statement that Szala’s
symptoms can be controlled with medication, the ALJ found her impairments cannot
be as severe or disabling as alleged because she can tolerate them without taking her
medication. Tr. 30–31. He also determined she could perform simple, routine tasks
with other conditions if she remained compliant with her medication but could
perform no past relevant work. Tr. 31. At step five, he found she could perform the
jobs the vocational expert identified and therefore was not disabled. Tr. 32.

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V.

Standard of Review
A court’s review of an ALJ’s decision is limited to determining whether the ALJ

applied the correct legal standards and whether substantial evidence supports his
findings. Moore v. Barnhart, 405 F.3d 1208, 1211 (11th Cir. 2005). Substantial
evidence “such relevant evidence as a reasonable person would accept as adequate to
support a conclusion.” Id. The court may not decide facts anew, reweigh evidence,
make credibility determinations, or substitute its judgment for the Commissioner’s
judgment. Id.
VI.

Analysis
Szala argues the ALJ erred in rejecting opinions of Drs. Baldwin, Fox, and

Sanchez, contending they supported her claim she could not engage in competitive
work and were consistent with each other and the evidence. Doc. 20 at 1–2. The
Commissioner responds the ALJ gave valid reasons for giving little weight to the
opinions that conflicted with the RFC finding. Doc. 23 at 4.
To decide the weight to give a medical opinion, an ALJ considers the
physician’s examining and treating relationship with the claimant, the opinion’s
supportability and consistency, the physician’s specialization, and any other factor
that supports or contradicts the opinion. 20 C.F.R. §§ 404.1527(c), 416.927(c). An ALJ
must give considerable weight to a treating physician’s opinion unless he shows good
cause for not doing so. Phillips v. Barnhart, 357 F.3d 1232, 1240 (11th Cir. 2004).
Good cause exists if (1) evidence did not bolster the opinion, (2) evidence supported a
contrary finding, or (3) the opinion was conclusory or inconsistent with his own

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medical records. Id. at 1240−41. If an ALJ disregards the opinion, he must clearly
articulate his reasons. Id. Substantial evidence must support those reasons. Id.
A.

Dr. Baldwin
Substantial evidence supports the ALJ’s disregard of Dr. Baldwin’s testimony

that Szala requires a supportive work setting. In summarizing Dr. Baldwin’s
testimony, the ALJ listed several inconsistences: (1) Dr. Baldwin testified Szala
appeared to meet a diagnosis for bipolar disorder II but could not state she met the
listing because there was no objective data, Tr. 71, 3 but later agreed on cross
examination she might meet a listing, Tr. 92; (2) Dr. Baldwin testified Dr. Knox’s
psychological examination was normal other than a somewhat energetic state, Tr.
63–65, 485–87, there was no clear evidence she was exhibiting bipolar symptoms, Tr.
64, and Dr. Knox’s evaluation did not justify a GAF 4 score of 45, Tr. 64–65, but later

Szala quotes Dr. Baldwin’s testimony that she could possibly meet a listing
and argues he consistently testified she would require a supportive working
environment and was “on the cusp” of finding that she met a listing. Doc. 20 at 12–
13. Szala interprets Dr. Baldwin’s testimony differently than the ALJ. This Court
cannot reweigh the evidence. Moore, 405 F.3d at 1211–12; see also Wheeler v. Heckler,
784 F.2d 1073, 1075 (11th Cir. 1986) (“The Secretary, and not the court, is charged
with the duty to weigh the evidence, to resolve material conflicts in the testimony,
and to determine the case accordingly.”).
3

4The

former version of American Psychiatric Association, Diagnostic and
Statistical Manual of Mental Disorders (4th ed. 2000) includes the GAF scale used by
mental-health practitioners to report “the clinician’s judgment of the individual’s
overall level of functioning” and “may be particularly useful in tracking the clinical
progress of individuals in global terms, using a single measure.” Manual at 32−34.
The GAF scale is divided into 10 ranges of functioning, each with a 10-point range in
the GAF scale. Id. at 32. A GAF scale rating of 21–30 indicates behavior considerably
influenced by delusions or hallucinations, or serious impairment in communication
or judgment, or inability to function in almost all areas. Manual at 34. A GAF scale
rating of 31–40 indicates some impairment in reality testing or communication or
major impairment in several areas, such as work or school family relations, judgment,
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testified he would probably assign her a score of 45 to 50 due to impulse control
problems despite agreeing there were no records to indicate an impulse control
problem beyond self-reports, Tr. 69–71; (3) Dr. Baldwin testified she could perform
simple, routine tasks with occasional contact with the public, co-workers, and
supervisors in a supportive environment, and has a reasonable memory and the
ability to concentrate, but would become impulsive and reject limits and rules, Tr. 68,
72–74, but later agreed she has extreme limitations in her ability to interact such
that she could not have occasional contact with others, Tr. 95–96. Tr. 29–30.
Szala argues that, while the ALJ stated he rejected Dr. Baldwin’s testimony
that she required a supportive work setting as inconsistent and “all over the place,”
he did not identify the inconsistent testimony or provide examples of how he was “all
over the place.” Doc. 20 at 13. She further contends the testimony was consistent with

thinking, or mood. Id. A GAF scale rating of 41–50 indicates serious symptoms such
as suicidal ideation or any serious impairment in social, occupational or school
functioning. Id. A GAF scale rating of 51 to 60 indicates moderate symptoms or
moderate difficulty in social, occupational, or school functioning. Id. A GAF scale
rating of 61 to 70 indicates some mild symptoms or some difficulty in social,
occupational, or school functioning, but generally functioning pretty well. Id.
The latest edition of the Manual has abandoned the GAF scale because of “its
conceptual lack of clarity … and questionable psychometrics in routine practice.”
Diagnostic and Statistical Manual of Mental Disorders 16 (5th ed. 2013). Even before
that abandonment, “the Commissioner … declined to endorse the GAF scale for use
in the Social Security and SSI disability programs, and … indicated that GAF scale
ratings have no direct correlation to the severity requirements of the mental disorders
listings.” Wind v. Barnhart, 133 F. App’x 684, 692 n.5 (11th Cir. 2005) (internal
quotations omitted) (citing 60 Fed. Reg. 50746, 50764–65 (Aug. 21, 2000)); see also
McGregor v. Astrue, No. 8:08-cv-2361-T-TGW, 2010 WL 138808, at *3 (M.D. Fla. Jan.
10, 2010) (unpublished) (GAF scale rating carries no meaningful weight).
Nevertheless, the score is useful here to the extent it reveals Dr. Baldwin’s opinions
about the severity of Szala’s limitations generally.
8

the medical records and his opinion of the severity of her impairments and
limitations. Doc. 20 at 13. The Commissioner responds the ALJ’s summary of Dr.
Baldwin’s testimony highlighted many of the inconsistences and demonstrates how
he was “all over the place,” often rambling and failing to respond to questions. Doc.
23 at 16–17.
While the ALJ did not expressly say he was listing inconsistencies, it is
apparent he was doing so. The ALJ clearly articulated why he rejected of Dr.
Baldwin’s testimony—inconsistency—which is a valid consideration in weighing
medical opinions. See 20 C.F.R. §§ 404.1527(c), 416.927(c) (Commissioner may
consider supportability and consistency of opinions); see generally Phillips, 357 F.3d
at 1241 (ALJ may reject opinion that is inconsistent with doctor’s own treatment
notes). In identifying the inconsistences, the ALJ determined Dr. Baldwin did not
sufficiently explain the bases for his opinions because they kept changing.
Substantial evidence supports the ALJ’s inconsistency finding and therefore his
rejection of Dr. Baldwin’s testimony.
B.

Dr. Fox
Substantial evidence supports the ALJ’s decision to give Dr. Fox’s opinions

partial weight. The ALJ found the results of her testing and borderline intellectual
functioning diagnosis consistent with the objective medical evidence and record as a
whole but rejected her conclusion Szala cannot handle routine workday stress and
her GAF scale rating of 45, finding she “is not so severely limited.” Tr. 28, 508−09.
Szala contends the ALJ offered no reason to support the rejection and “the totality of

9

the medical evidence supports Dr. Fox’s opinion,” citing Dr. Baldwin’s testimony and
Dr. Knox’s consultative examination assessing a GAF scale rating of 45. Doc. 20 at
17–18.
Szala contends the ALJ could not discount Dr. Fox’s opinions as a one-time
examining physician because the ALJ specifically ordered her to perform an
examination. Doc. 20 at 18–19. The ALJ, however, did not reject Dr. Fox’s opinions
solely because she examined Szala only once but instead deferred to Dr. Sanchez’s
findings as her treating physician to the extent that Dr. Fox found restrictions greater
than he had. See Crawford v. Comm’r of Soc. Sec., 363 F.3d 1155, 1160 (11th Cir.
2004) (affirming finding that the opinion of a consultative psychologist who examined
the claimant only once “was not entitled to great weight”). Dr. Fox found Szala’s
impairment caused marked limitation in her ability to make judgments on simple
work-related decisions, Tr. 508, while Dr. Sanchez found no functional limitation in
that ability, Tr. 429. Dr. Sanchez also found a moderate limitation in Szala’s ability
to interact appropriately with the general public, Tr. 429, but Dr. Fox found a marked
limitation. Tr. 509. The ALJ appropriately followed Dr. Sanchez’s opinions regarding
her limitations because he was Szala’s treating physician and more familiar with her
limitations. Tr. 28.
As to Dr. Fox’s reliance on Szala’s subjective reports, she argues the ALJ
ignored the testing and mental-status examination Dr. Fox performed. Doc. 20 at 19–
20. She does not identify any particular test she contends supports her impairments
and functional limitations. See generally id. The ALJ observed that Dr. Fox had

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administered the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV). Tr.
28. Dr. Fox described the test as “an individually administered test of intelligence”
and observed that Szala’s scores “consistently fell well below average.” Tr. 514. The
ALJ accepted Dr. Fox’s opinion that she had borderline intellectual functioning. Tr.
28. The WAIS-IV did not address the additional limitations the ALJ rejected. Instead,
in her report, Dr. Fox described Szala’s characterization of her inability to work as a
lack of patience with people, a tendency to hold things in and go into a rage, poor
concentration, and impulsivity. Tr. 28, 511–12. Nevertheless, Dr. Fox observed, as
the ALJ had, that Szala could “care for her children” and “perform household
activities in a normal and reasonable manner.” Tr. 28, 516.
Substantial evidence supports the ALJ’s conclusion that Dr. Fox’s opinions
relating to the severity of Szala’s limitations are based on self-reports, which the ALJ
properly considered in evaluating Dr. Fox’s opinions. See Crawford, 363 F.3d at 1159
(finding substantial evidence supported decision to discount medical opinion
inconsistent with his treatment notes, unsupported by medical evidence, and
appeared to be based primarily on the claimant’s subjective complaints). For example,
while Dr. Fox concludes Szala does not appear capable of withstanding stress, the
basis for such opinion is that Szala “reports a history of decompensation related to
stress.” Tr. 517. Her opinion contains numerous recitations of Szala’s statements and
reports surrounding her symptoms.
Szala criticizes the ALJ’s reliance on Szala’s work history to discount Dr. Fox’s
opinion regarding her ability to work, particularly because she claims she became

11

disabled and unable to work as of the date she filed for benefits in December of 2010,
and because the ALJ later said her poor work history raised a question about whether
her continuing unemployment is due to medical impairments. Doc. 20 at 20–21, Tr.
28, 31. Szala alleges she became disabled in 1987, not 2010. Tr. 21, 240. The ALJ
stated she has past relevant work because it demonstrates she could work long
enough to learn how and to reach a substantial gainful activity level. Tr. 28. That
contradicts Dr. Fox’s conclusion that she could not handle the stress of a workday
routine. Substantial evidence supports that finding; Szala worked as a collections
agent off and on, earning as much as $9,729.72 during one period of employment that
lasted at least six months. Tr. 56–57, 252.
In addressing the ALJ’s evaluation of Dr. Fox’s medical opinions, Szala
observes the ALJ appeared influenced by her age and the resulting length of time for
which she might receive benefits. Doc. 20 at 15–16. At the first hearing, the ALJ
stated:
[O]f course you know the rule is the conclusion only has to be accepted
if supported by adequate medical findings and tests and exams, and it’s
very difficult for me to follow that in his records. It was not difficult, I’ll
be honest, it’s impossible. So, again, I want to take another look. This
lady fight [sic], you know, is not very old and if she goes on the roll she
will probably be there for 40 years, 50 years and I’m not going to bite off
that kind of obligation or make that kind of decision based upon the
record, I don’t feel comfortable with it.
...
So, I don’t feel comfortable with Dr. Knox’s examination on the part of
the (INAUDIBLE), I’m not sure whether Dr. Sanchez’s records support
his conclusion, so I want another CE and I may or may not order an ME
and that will clear it all up.

12

Tr. 46. While Szala suggests the statement indicates bias, she does not make any
argument for reversal on that basis and therefore has waived any such argument. In
any event, in context, the statement expresses only uncertainty about the record and
not inappropriate bias.
Szala suggests the ALJ failed to state the weight he gave Dr. Fox’s opinion that
Szala had no useful ability to interact with supervisors and co-workers. Doc. 20 at 21.
The ALJ’s rejection of Dr. Fox’s limitations regarding the workplace necessarily
included her opinion that Szala had extreme limitations in her ability to interact
appropriately with others in the workplace. Tr. 509. The ALJ also explained his
rejection of the opinion insofar as Dr. Fox’s limitations were more severe than Dr.
Sanchez’s, as explained above. To the extent the ALJ did not expressly state the
weight he gave to Dr. Fox’s opinion regarding interaction with others, an ALJ’s
determination may be implicit if the implication is “obvious to the reviewing court.”
Tieniber v. Heckler, 720 F.2d 1251, 1255 (11th Cir. 1983). The ALJ’s rejection of Dr.
Fox’s opinions regarding Szala’s limitations is apparent in his RFC finding that Szala
could have occasional contact with the public, co-workers and supervisors. Tr. 25.
Thus, the ALJ adequately explained his decision to reject Dr. Fox’s opinions
and substantial evidence supports each of his reasons.
C.

Dr. Sanchez
Szala contends the ALJ improperly disregarded part of Dr. Sanchez’s opinion

that would have supported her claim for benefits—that she had marked limitations
in her ability to work with others, accept instructions, and respond appropriately to

13

criticism—by relying on her non-compliance with medication to conclude she could
work. Doc. 20 at 22. The Commissioner responds the ALJ properly discounted Dr.
Sanchez’s marked limitations because they were inconsistent with his opinion in his
letter and Szala’s treatment. Doc. 23 at 7. In his letter, Dr. Sanchez reported Szala
does well on her medication but is invariably non-compliant with medication for
various reasons, which brings about flare-ups in her condition. Tr. 603–04. He opined
she will have difficulty getting along with others but has intact intellectual and
cognitive functions. Tr. 604. The ALJ did not rely on her failure to take medication
as a basis for denying her benefits, but instead concluded the failure suggests her
symptoms are not as severe as alleged. 5 Tr. 30–31.
The ALJ gave great weight to Dr. Sanchez’s opinion that Szala had difficulty
interacting with others and therefore limited her ability to occasional contact with coworkers in determining her RFC. Tr. 25, 27. The ALJ gave little weight to Dr.
Sanchez’s opinions in his medical impairment questionnaire that Szala had marked
limitations in some areas of social functioning because he found these opinions were
inconsistent with his letter regarding her impairments and his treatment of those
impairments. Tr. 27. Good cause exists to discount Dr. Sanchez’s opinions due to this
inconsistency, see Phillips, 357 F.3d at 1240–41, because he noted in his letter only
that she will have difficulties getting along with co-workers, but not that those
difficulties would be extreme, and indicated that her symptoms including irritability

Szala also argues the ALJ relied on her non-compliance to find she would have
no limitations if she complied with her medications and treatment despite no opinion
to that effect. Doc. 20 at 22. The ALJ, however, did not make that finding.
5

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were reasonably controlled with medication. Tr. 603–04. The ALJ did not err in
providing little weight to Dr. Sanchez’s opinions he found inconsistent. 6
VII.

Conclusion
The Court affirms the Commissioner’s decision denying Szala’s claim for

benefits and directs the clerk to enter judgment in favor of the Commissioner and
close the file.
Ordered in Jacksonville, Florida, on October 27, 2015.

c:

Counsel of Record

6The

Commissioner also contends Dr. Sanchez’s questionnaire opinions were
conclusory. Doc. 23 at 8. The ALJ, however, did not rely on the conclusory nature of
Dr. Sanchez’s opinions as a basis for discounting them. The Court cannot reweigh the
evidence or substitute its judgment for that of the ALJ. See Moore, 405 F.3d at 1211.
15