Tankersley v. Colvin

Filing 16

ORDER and OPINION reversing and remanding the decision of the Commissioner. The Clerk is DIRECTED to enter final judgment in Plaintiff's favor. Signed by Magistrate Judge Alan J. Baverman on 3/26/2018. (btql)

IN THE UNITED STATES DISTRICT COURT
FOR THE NORTHERN DISTRICT OF GEORGIA
ATLANTA DIVISION
DOUGLAS TANKERSLEY,

:
:
Plaintiff,
:
:
v.
:
:
COMMISSIONER, SOCIAL
:
SECURITY ADMINISTRATION, :
:
1
:
Defendant.

CIVIL ACTION FILE NO.
1:17-cv-00140-AJB

O R D E R A N D O P I N I O N2
Plaintiff Douglas Tankersley (“Plaintiff”) brought this action pursuant to
section 205(g) of the Social Security Act, 42 U.S.C. § 405(g), to obtain judicial review
of the final decision of the Commissioner of the Social Security Administration (“the

1

Nancy A. Berryhill was the Acting Commissioner of Social Security
beginning January 23, 2017. However, her acting status ended as a matter of law
pursuant to the Federal Vacancies Reform Act, 5 U.S.C. § 3345 et seq. Pursuant to
Fed. R. Civ. P. 17(d), a public officer who sues or is sued in an official capacity may
be designated by official title rather than by name. Since Ms. Berryhill no longer is the
Acting Commissioner, the Clerk is DIRECTED to identify Defendant by the official
title rather than by name.
2

The parties have consented to the exercise of jurisdiction by the
undersigned pursuant to 28 U.S.C. § 636(c) and Rule 73 of the Federal Rules of Civil
Procedure. (See Dkt. Entries dated 1/13/17). Therefore, this Order constitutes a final
Order of the Court.
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Commissioner”) denying his application for Disability Insurance Benefits (“DIB”)
under the Social Security Act.3 For the reasons below, the undersigned REVERSES
the final decision of the Commissioner AND REMANDS the case to the
Commissioner for further proceedings consistent with this opinion.
I.

PROCEDURAL HISTORY
Plaintiff filed an application for DIB on June 6, 2013, alleging disability

commencing on January 1, 2010.

[Record (hereinafter “R”) 182].

Plaintiff’s

application was denied initially and on reconsideration. [See R81-110]. Plaintiff then
requested a hearing before an Administrative Law Judge (“ALJ”). [R122-23]. An

3

Title II of the Social Security Act provides for federal Disability Insurance
Benefits. 42 U.S.C. § 401 et seq. Title XVI of the Social Security Act,
42 U.S.C. § 1381, et seq., provides for Supplemental Security Income Benefits for the
disabled (“SSI”). Title XVI claims are not tied to the attainment of a particular period
of insurance eligibility. Baxter v. Schweiker, 538 F. Supp. 343, 350 (N.D. Ga. 1982).
Otherwise, the relevant law and regulations governing the determination of disability
under a claim for DIB are nearly identical to those governing the determination under
a claim for SSI.
Wind v. Barnhart, 133 Fed. Appx. 684, 690 n.4
th
(11 Cir. June 2, 2005) (citing McDaniel v. Bowen, 800 F.2d 1026, 1031 n.4
(11th Cir. 1986)). In general, the legal standards to be applied are the same regardless
of whether a claimant seeks DIB, to establish a “period of disability,” or to recover
SSI, although different statutes and regulations apply to each type of claim.
See 42 U.S.C. § 1383(c)(3) (establishing that the judicial provisions of
42 U.S.C. § 405(g) are fully applicable to claims for SSI). Therefore, to the extent that
the Court cites to SSI cases, statutes, or regulations, they are equally applicable to
Plaintiff’s DIB claims.
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evidentiary hearing was held on April 2, 2015. [R41-80]. The ALJ issued a decision
on June 26, 2015, denying Plaintiff’s application on the ground that he had not been
under a “disability” from the alleged onset date through the date of the decision.
[R21-40]. Plaintiff sought review by the Appeals Council and amended the alleged
onset date to February 1, 2013. [R283-90]. The Appeals Council denied Plaintiff’s
request for review on December 2, 2016, making the ALJ’s decision the final
decision of the Commissioner. [R1-6].
Plaintiff then initiated action in this Court on January 12, 2017, seeking review
of the Commissioner’s decision. [Doc. 1]. The answer and transcript were filed on
May 24, 2017. [See Docs. 6, 7]. On June 23, 2017, Plaintiff filed a brief in support of
his petition for review of the Commissioner’s decision, [Doc. 10]; on July 24, 2017,
the Commissioner filed a response in support of the decision, [Doc. 11]; and on
August 1, 2017, Plaintiff filed a reply brief in support of his petition for review,
[Doc. 12]. Court-ordered oral argument took place on March 15, 2018. [Doc. 15].
The matter is now before the Court upon the administrative record, the parties’
pleadings, the parties’ briefs, and the parties’ oral arguments, and it is accordingly ripe
for review pursuant to 42 U.S.C. § 405(g).

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II.

STANDARD FOR DETERMINING DISABILITY
An individual is considered disabled for purposes of disability benefits if he is

unable 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
12 months.” 42 U.S.C. § 423(d)(1)(A). The impairment or impairments must result
from anatomical, psychological, or physiological abnormalities which are
demonstrable by medically accepted clinical or laboratory diagnostic techniques and
must be of such severity that the claimant is not only unable to do previous work but
cannot, considering age, education, and work experience, engage in any other kind of
substantial

gainful

work

that

exists

in

the

national

economy.

42 U.S.C. § 423(d)(2)-(3).
The burden of proof in a Social Security disability case is divided between the
claimant and the Commissioner. The claimant bears the primary burden of establishing
the existence of a “disability” and therefore entitlement to disability benefits.
See 20 C.F.R. § 404.1512(a). The Commissioner uses a five-step sequential process
to determine whether the claimant has met the burden of proving disability.
See 20 C.F.R. § 404.1520(a); Doughty v. Apfel, 245 F.3d 1274, 1278 (11th Cir. 2001);
4
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Jones v. Apfel, 190 F.3d 1224, 1228 (11th Cir. 1999). The claimant must prove at step
one

that

he

is

not

undertaking

substantial

gainful

activity.

See 20 C.F.R. § 404.1520(a)(4)(i). At step two, the claimant must prove that he is
suffering from a severe impairment or combination of impairments that significantly
limits

his

ability

to

perform

basic

work-related

activities.

See 20 C.F.R. § 404.1520(a)(4)(ii). At step three, if the impairment meets one of the
listed impairments in Appendix 1 to Subpart P of Part 404 (Listing of Impairments),
the claimant will be considered disabled without consideration of age, education, and
work experience. See 20 C.F.R. § 404.1520(a)(4)(iii). At step four, if the claimant is
unable to prove the existence of a listed impairment, he must prove that his impairment
prevents performance of past relevant work. See 20 C.F.R. § 404.1520(a)(4)(iv). At
step five, the regulations direct the Commissioner to consider the claimant’s residual
functional capacity, age, education, and past work experience to determine whether the
claimant

can

perform

other

work

besides

past

relevant

work.

See

20 C.F.R. § 404.1520(a)(4)(v). The Commissioner must produce evidence that there
is other work available in the national economy that the claimant has the capacity to
perform. Doughty, 245 F.3d at 1278 n.2. To be considered disabled, the claimant must
prove an inability to perform the jobs that the Commissioner lists. Id.
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If at any step in the sequence a claimant can be found disabled or not disabled,
the

sequential

evaluation

See 20 C.F.R. § 404.1520(a)(4).

ceases

and

further

inquiry

ends.

Despite the shifting of burdens at step five, the

overall burden rests on the claimant to prove that he is unable to engage in any
substantial gainful activity that exists in the national economy.

Doughty,

245 F.3d at 1278 n.2; Boyd v. Heckler, 704 F.2d 1207, 1209 (11th Cir. 1983),
superseded by statute on other grounds by 42 U.S.C. § 423(d)(5), as recognized in
Elam v. R.R. Ret. Bd., 921 F.2d 1210, 1214 (11th Cir. 1991).
III.

SCOPE OF JUDICIAL REVIEW
A limited scope of judicial review applies to a denial of Social Security benefits

by the Commissioner. Judicial review of the administrative decision addresses three
questions: (1) whether the proper legal standards were applied; (2) whether there was
substantial evidence to support the findings of fact; and (3) whether the findings of fact
resolved the crucial issues. Washington v. Astrue, 558 F. Supp. 2d 1287, 1296
(N.D. Ga. 2008); Fields v. Harris, 498 F. Supp. 478, 488 (N.D. Ga. 1980). This Court
may not decide the facts anew, reweigh the evidence, or substitute its judgment for that
of the Commissioner. Dyer v. Barnhart, 395 F.3d 1206, 1210 (11th Cir. 2005). If
substantial evidence supports the Commissioner’s factual findings and the
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Commissioner applies the proper legal standards, the Commissioner’s findings are
conclusive. Lewis v. Callahan, 125 F.3d 1436, 1439-40 (11th Cir. 1997); Barnes v.
Sullivan, 932 F.2d 1356, 1358 (11th Cir. 1991); Martin v. Sullivan,
894 F.2d 1520, 1529 (11th Cir. 1990); Walker v. Bowen, 826 F.2d 996, 999
(11th Cir. 1987) (per curiam); Hillsman v. Bowen, 804 F.2d 1179, 1180 (11th Cir. 1986)
(per curiam); Bloodsworth v. Heckler, 703 F.2d 1233, 1239 (11th Cir. 1983).
“Substantial evidence” means “more than a scintilla, but less than a
preponderance.” Bloodsworth, 703 F.2d at 1239. It means such relevant evidence as
a reasonable mind might accept as adequate to support a conclusion, and it must be
enough to justify a refusal to direct a verdict were the case before a jury. Richardson
v. Perales, 402 U.S. 389, 401 (1971); Hillsman, 804 F.2d at 1180; Bloodsworth,
703 F.2d at 1239. “In determining whether substantial evidence exists, [the Court]
must view the record as a whole, taking into account evidence favorable as well as
unfavorable to the [Commissioner’s] decision.” Chester v. Bowen, 792 F.2d 129, 131
(11th Cir. 1986) (per curiam). Even where there is substantial evidence to the contrary
of the ALJ’s findings, the ALJ decision will not be overturned where “there is
substantially supportive evidence” of the ALJ’s decision.

Barron v. Sullivan,

924 F.2d 227, 230 (11th Cir. 1991). In contrast, review of the ALJ’s application of
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legal principles is plenary. Foote v. Chater, 67 F.3d 1553, 1558 (11th Cir. 1995);
Walker, 826 F.2d at 999.
Also, a “court must consider evidence not submitted to the [ALJ] but considered
by the Appeals Council when that court reviews the Commissioner’s final decision.”
Ingram v. Comm’r of Soc. Sec. Admin., 496 F.3d 1253, 1258 (11th Cir. 2007). In
reviewing this additional evidence, the court must evaluate whether this “new evidence
renders the denial of benefits erroneous.” Id. at 1262. This means that the court must
“determine whether the Appeals Council correctly decided that the ‘[ALJ’s] action,
findings, or conclusion is [not] contrary to the weight of the evidence currently of
record.’ ” Id. at 1266-67 (quoting 20 C.F.R. § 404.970(b)).
IV.

STATEMENT OF FACTS4
A.

Background

Plaintiff was born on February 22, 1961, [R81], and therefore was fifty-one
years old on the amended alleged onset date, [R284], and was fifty-four years old when
the ALJ issued her adverse decision, [R35]. He has a GED, [R223], and past work as
a letter carrier, postal clerk, and custodian, [R49, 72-73, 223]. He alleges disability

4

In general, the records referenced in this section are limited to those
deemed by the parties to be relevant to this appeal. [See Docs. 10-12].
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due to heart disease, coronary artery disease, atherosclerosis,5 degenerative joint
disease, hypertension, herniated discs, status post cervical fusion, generalized anxiety
disorder, panic attacks, and bipolar disorder. [R45, 222].
B.

Lay Testimony

In his testimony before the ALJ, Plaintiff stated that he had physical therapy
when his back first started bothering him, but when he did not see any improvement
over a course of about three months, he was referred to pain management. [R58]. He
reported that he still had pain in his neck, left shoulder, and lower left back near the
tailbone, radiating almost to the knee, [R58-59], and that his medications included

5

Atherosclerosis is characterized by irregularly distributed lipid deposits
in the innermost portions of large- and medium-sized arteries. The deposits block
blood flow. PDR Med. Dictionary 162 (1st ed. 1995).
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Percocet,6 Klonopin,7 Neurontin,8 Niravam,9 Lexapro,10 Coreg,11 and Benicar,12

6

Percocet is a combination of oxycodone and acetaminophen and is a
narcotic analgesic used to relieve moderate-to-severe pain. MedlinePlus, Oxycodone,
https://medlineplus.gov/druginfo/meds/a682132.html (last visited 3/26/18).
7

Klonopin (clonazepam) is a benzodiazepine that is used to control certain
types of seizures and to relieve panic attacks. MedlinePlus, Clonazepam,
https://medlineplus.gov/druginfo/meds/a682279.html (last visited 3/26/18).
8

Neurontin (gabapentin) is an anticonvulsant medication that is often used
to relieve nerve pain.
MedlinePlus, Gabapentin,
https://medlineplus.gov/druginfo/meds/a694007.html (last visited 3/5/18).
9

Niravam (alprazolam) is a benzodiazepine typically used to treat anxiety
disorders and panic disorder.
Medline Plus, Alprazolam,
https://medlineplus.gov/druginfo/meds/a684001.html (last visited 3/26/18).
10

Lexapro (escitalopram) is used to treat depression and generalized anxiety
disorder. It is in a class of antidepressants called selective serotonin reuptake
inhibitors (SSRIs) and works by increasing the amount of serotonin in the brain.
MedlinePlus, Escitalopram, https://medlineplus.gov/druginfo/meds/a603005.html (last
visited 3/26/18).
11

Coreg (carvedilol) is a beta blocker. It is used to treat heart failure and
high blood pressure and is also used to treat people who have had a heart attack. It
works by relaxing the blood vessels and slowing the heart rate to improve blood flow
and decrease blood pressure.
MedlinePlus, Carvedilol,
https://medlineplus.gov/druginfo/meds/a697042.html (last visited 3/26/18).
12

Benicar (olmesartan) is in a class of medications called angiotensin II
receptor antagonists and is used to treat high blood pressure. It works by blocking the
action of certain natural substances that tighten the blood vessels, allowing the blood
to flow more smoothly and the heart to pump more efficiently. MedlinePlus,
Olmesartan, https://medlineplus.gov/druginfo/meds/a603006.html (last visited
3/26/18).
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[R53, 56-57]. He indicated that the pain in his back was generally constant and that
any physical activity made his pain worse. [R68]. He stated that without medication,
his low-back pain was at eight on a ten-point scale and his shoulder pain was at about
four or five; that with medication, his lower-back pain was at five; and that medication
did not really affect the pain in his shoulder. [R60]. He also indicated that ice on his
lower back and sitting with a pillow behind his back could take the lower-back pain
away for sometimes thirty minutes or longer. [R60-61]. Plaintiff further stated that he
had received relief from epidural injections but that they had become less effective
over time. [R53]. He also indicated that a C5-C7 cervical discectomy13 and fusion
surgery he had in 2014 relieved some of his shoulder pain but that he was still
recovering. [R52-53, 61].
Plaintiff testified that he had retired from the postal service at the end of
January 2013. [R47, 69]. He stated that his back was causing him so much pain that
he was unable to do the custodial work he was assigned to do. [R69]. The postmaster
who was there at the time had assigned a temporary employee to do Plaintiff’s
custodial work and allowed Plaintiff to do things for her like filing. [R69]. When that

13

A discectomy is the “[e]xcision, in part or whole, of an intervertebral
disk.” PDR Med. Dictionary 491 (1st ed. 1995).
11
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postmaster was leaving, Plaintiff took the opportunity to accept early retirement
because he was afraid he would lose his job and not have anything. [R69-70].
Plaintiff described himself as “pretty much sedentary,” stated that just about any
kind of physical activity made his pain worse, and indicated that he did not do much
because he was physically unable to do much. [R62]. He reported that he could walk
for about ten minutes and stand for about fifteen minutes; that he is in pain when he
sits for about thirty-five minutes in church; that the surgeon told him not to lift
anything heavier than a gallon of milk after his surgery; and that he avoided bending
“at all costs.” [R62-64, 67]. He also indicated that he did not have problems with
personal care or dressing except for putting on his shoes, which required bending.
[R64].
Plaintiff stated that he could not clean his house completely and would do things
like wash dishes or put them into the dishwasher in spurts—he would perform the
activity and then sit for a while until the pain subsided. [R62]. He reported that he
watched television sometimes and read a lot of books, [R62], and could use a
microwave oven, cook things like pasta and frozen vegetables on the stove top, shop
for groceries approximately every two weeks, do laundry, fold clothing, take out the
garbage, change bed linen with assistance, use a Swiffer and vacuum, attend church
12
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services and Sunday school weekly, and manage his finances, [R49, 65-66]. Plaintiff
testified that although he no longer owned a car, he could still drive, and he drove to
the hearing in his mother’s car. [R48]. He stated that he would also drive to doctor’s
appointments and to church on Wednesdays and Sundays. [R48].
Plaintiff indicated that he periodically has panic attacks where he shakes and
gets really nervous; sometimes it happens two or three days in a row and then not for
another month. [R70]. He stated that every day he has episodes where he has
difficulty concentrating: he will need to read a paragraph three or four times and can
hardly concentrate through an entire television show. [R68]. He also stated that he has
a lot of insomnia. [R67].
C.

Administrative Records

Plaintiff’s work-history report indicates that he worked for the postal service as
a letter carrier, clerk, and custodian for nearly twenty-two years, until
January 31, 2013. [R214]. Earnings records show no income after 2013. [R210].
In an adult function report Plaintiff completed on July 23, 2013, he reported that
he had lived alone in his house since May 15, 2013, when his wife died. [R231]. He
described a typical day as awakening, having breakfast, taking medicine, icing his
back, walking around the house or backyard, watching television on occasion, visiting
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in person or over the phone with his mom, feeding his cats, and reading books.
[R231]. He also indicated that he went to church on Sundays. [R231].
Plaintiff stated that he was able to maintain his personal care with no problem,
would set his own reminders to take medicine, could do laundry, fold clothes, and put
dishes in the dishwasher, could prepare sandwiches and microwavable or stove-top
meals, could drive, would shop every two weeks for groceries, and could pay bills,
count change, and use a checkbook, but he asked family or friends to do his yard work.
[R232-34]. He indicated that he had a fear of bankruptcy and was lonely since his wife
died. [R237].
In a disability report dated October 21, 2013, Plaintiff indicated that he was
extremely depressed and was having a hard time coping with his anxiety. [R244]. He
also stated that because stress gets to him easily and causes him to have panic attacks,
he tries to do only simple tasks and to avoid complex chores. [R248].
In a report dated November 16, 2013, Plaintiff reported essentially the same
activities and limitations that he had reported in July. [R257]. He also indicated that
his neck was a problem, that it caused his left arm to be numb, and that he might need
surgery. [R257].

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D.

Medical Records

Plaintiff presented to Atlanta Heart Associates on July 22, 2011, for follow up
on his atherosclerosis and hyperlipidemia. [R313]. It was noted that Plaintiff was
doing well, with no cardiac symptoms; that he was maintaining his usual level of
activity; and that he reported doing reasonably well. [R314].
Plaintiff saw Kusuma S. Rao, M.D., for psychiatric follow up on
September 7, 2011. [R445-46]. Plaintiff was concerned because 3,000 postal workers
had been laid off in Georgia in the last week, and he was afraid that postal jobs would
vanish altogether. [R445]. Dr. Rao noted that his concern appeared justified. [R445].
Notes from the mental-status examination indicate that Plaintiff was sensitive, his
facial expression was fearful, and he felt persecuted. [R445]. Dr. Rao assessed a GAF
score of 80-7114; opined that Plaintiff’s symptoms were transient reactions to
psychosocial stressors; and continued Plaintiff on Lexapro. [R446-47].
14

The Global Assessment of Functioning (“GAF”) is a numeric scale
(0 through 100) that considers psychological, social, and occupational functioning on
a hypothetical continuum of mental-health illness. Diagnostic and Statistical Manual
of Mental Disorders 32-34 (4th ed., Text Revision, 2000) (“DSM-IV-TR”). A GAF
score in the range of 71 to 80 indicates that “[i]f symptoms are present, they are
transient and expectable reactions to psychosocial stressors (e.g., difficulty
concentrating after family argument); no more than slight impairment in social,
occupational, or school functioning (e.g., temporarily falling behind in schoolwork).”
Id. at 34.
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Plaintiff saw Dr. Rao for psychiatric follow up on November 2, 2011.
[R443-44]. Dr. Rao noted that Plaintiff was sick with high blood pressure, had been
working too much, and had to take time off work after having chest pain. [R444]. A
mental-status examination was unremarkable. [R444]. Dr. Rao assessed a GAF score
of 70-6115; opined that Plaintiff had “[m]ild symptoms or difficulties, but generally
functioning pretty well, conflicts”; and continued medication. [R444].
Plaintiff returned Dr. Rao for psychiatric follow up on November 30, 2011.
[R360-61, 442-43]. Dr. Rao noted that Plaintiff was still going through extreme stress
on the job and suggested that Plaintiff consider early retirement in order to prevent
stress-induced heart attacks.

[R360, 442].

A mental-status examination was

unremarkable. [R360-61, 443]. Dr. Rao assessed a GAF score of 80-71; opined that
Plaintiff’s symptoms were transient reactions to psychosocial stressors; and continued
medication. [R360, 443].
Plaintiff presented to Atlanta Heart Associates on December 1, 2011, for follow
up on his atherosclerosis and hyperlipidemia. [R309]. It was noted that Plaintiff was
15

A GAF score between 61 and 70 indicates “[s]ome mild symptoms
(e.g., depressed mood and mild insomnia) OR some difficulty in social, occupational,
or school functioning (e.g., occasional truancy, or theft within the household), but
generally functioning pretty well, has some meaningful interpersonal relationships.”
DSM-IV-TR at 34.
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doing well, with no cardiac symptoms; that he was maintaining his usual level of
activity; and that he reported doing reasonably well. [R310].
Plaintiff saw Dr. Rao for psychiatric follow up on December 29, 2011.
[R359-60, 441-42]. It was noted that Plaintiff did not show any concern about possible
job loss since he was open to accepting retirement at any time. [R359, 441]. A
mental-status examination was unremarkable. [R359-60, 441-42]. Dr. Rao assessed
a GAF score of 80-71, specified that the score indicated transient symptoms and
reactions to psychosocial stressors, and continued medication. [R360, 442].
Plaintiff returned to Dr. Rao for psychiatric follow up on January 25, 2012.
[R440]. Plaintiff reported that he had a few chest pains over the weekend. [R440].
Dr. Rao noted that Plaintiff was dealing with a hectic work schedule and a
home-improvement project that may have taken a toll on him. [R440]. Dr. Rao
assessed a GAF score of 70-61; specified that the score indicated “[m]ild symptoms or
difficulties, but generally functioning pretty well, conflicts”; and suggested that
Plaintiff try working part time until his stress cleared. [R441]. She also continued
medication. [R440].
Plaintiff visited Dr. Rao on February 22, 2012. [R356, 438-39]. He stated that
he was feeling better since a house repair was finished and that he did not have any
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stress on the job since he had a conference with his supervisor. [R356, 438].
Mental-status examination was unremarkable. [R357, 439]. Dr. Rao assessed a GAF
score of 70-61; specified that the score indicated “[m]ild symptoms or difficulties, but
generally functioning pretty well, conflicts”; and continued medication. [R357, 439].
Plaintiff presented to Atlanta Heart Associates on March 1, 2012, for follow up
on his atherosclerosis and hyperlipidemia. [R306]. It was noted that Plaintiff was
doing well, with no cardiac symptoms; that he was maintaining his usual level of
activity; and that he reported doing reasonably well. [R306].
Plaintiff had a lumbar-spine MRI on March 8, 2012. [R368-69]. The imaging
revealed degenerative changes, including disc desiccation and spondylosis16 at every
level. [R368]. It was noted that Plaintiff had no significant central spinal stenosis17
but did have moderate-to-severe disc space narrowing at L3-L4; severe facet

16

“Spondylosis” refers to stiffening vertebra and is “often applied
nonspecifically to any lesion of the spine of a degenerative nature.” PDR Med.
Dictionary 1656 (1st ed. 1995).
17

“Spinal stenosis” causes narrowing in the spinal canal, which in turn puts
pressure on the nerves and spinal cord and can cause pain. MedlinePlus, Spinal
Stenosis, https://medlineplus.gov/spinalstenosis.html (last visited 3/26/18).
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hypertrophy18 bilaterally at L4-5; mild-to-moderate foraminal stenosis19 bilaterally at
L4-5 and L5-S1; and small left foraminal to extra-foraminal disc bulging at L2-3
abutting the left L2 nerve root. [R368-69].
Plaintiff visited Dr. Rao on March 21, 2012, for refills of medication.
[R355, 437]. He presented no new problems. [R355, 437]. Mental-status examination
was unremarkable. [R355-56, 437-38]. Dr. Rao assessed a GAF score of 70-61 and
specified that the score indicated “[m]ild symptoms or difficulties, but generally
functioning pretty well, conflicts.” [R356, 438].
Plaintiff returned to Dr. Rao for psychiatric follow up on April 18, 2012.
[R354-55]. He reported that he had been unable to work for a week due to hip pain.
[R354]. Dr. Rao discussed with him that because of his declining health, he might
need to consider early retirement.

[R354].

A mental-status examination was

18

Facet joints are situated between the stacked vertebrae and typically lie
behind the spinal nerves as they emerge from the central spinal canal. The two facet
joints and intervertebral disc at each level of the spine allow for motion between the
vertebral bodies.
KnowYourBack.org., Anatomy of the Spine (Bones),
https://www.spine.org/KnowYourBack/Resources/AnatomySpine (last visited
3/26/18). “Hypertrophy” refers to abnormal enlargement. J.E. Schmidt, M.D.,
Attorneys’ Dictionary of Medicine, Illustrated H-258, J-19-20 (46th ed. 2012).
19

“Foraminal stenosis” is a narrowing of a nerve opening where a nerve root
leaves the spinal canal.
MedlinePlus, Foraminotomy,
https://medlineplus.gov/ency/article/007390.htm (last visited 3/26/18).
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unremarkable except for a fearful facial expression and agitated motor behavior.
[R354]. Dr. Rao assessed a GAF score of 70-61; specified that the score indicated
“[m]ild symptoms or difficulties, but generally functioning pretty well, conflicts”; and
continued medication. [R354].
Plaintiff presented to pain specialist Pickens A. Patterson III, M.D., on
April 30, 2012, with complaints of back and leg pain. [R770]. Notes indicate that the
pain started four to five months earlier; that Plaintiff presently rated the pain at eight
on a ten-point scale; that the pain traveled from the low back down the left leg into the
foot; and that Lortab20 helped the pain. [R770]. Dr. Patterson scheduled Plaintiff for
selective lumbar epidural steroid injections. [R770].
Dr. Patterson administered selective L2 and L5 epidural steroid injections on
May 4, 2012. [R772].
Notes from Dr. Patterson’s office dated May 14, 2012, indicate that Plaintiff
complained of left-leg pain that he rated at eight on a ten-point scale, with nine at its
worst and five at its best. [R768]. It was noted that Plaintiff was improving

20

Lortab is an opioid pain medication that contains a combination of
acetaminophen and hydrocodone and is used to relieve moderate-to-severe pain.
Drugs.com, Lortab, http://www.drugs.com/lortab.html (last visited 3/26/18).
20
AO 72A
(Rev.8/8
2)

approximately fifty percent with epidural steroid injections, that Lortab was helping,
and that ice packs also relieved pain. [R768].
At a visit to Dr. Rao on May 16, 2012, Plaintiff reported that he had broken his
shoulder and had been on medical leave for two weeks. [R352-53, 434-35]. He was
concerned about the pain in his shoulder and the length of time he had to work before
retirement. [R352, 434]. Dr. Rao encouraged him to discuss earliest time of retirement
if a package was offered to him. [R352, 434]. A mental-status examination was
unremarkable. [R353, 435]. Dr. Rao assessed a GAF score of 70-61; specified that the
score indicated “[m]ild symptoms or difficulties, but generally functioning pretty well,
conflicts”; and continued medication. [R353, 435].
At a visit to Atlanta Heart Associates on May 31, 2012, Plaintiff’s chief
complaints were anxiety, chest pain, shortness of breath, and fatigue. [R302]. He also
complained of chronic low-back pain. [R302]. It was noted that Plaintiff was doing
well, with no cardiac symptoms, [R302]; that he was exercising sporadically, [R303];
that he was maintaining his usual level of activity, [R304]; and that he stated he was
doing reasonably well, [R304].
Plaintiff returned to Dr. Patterson with complaints of lumbar pain on
June 4, 2012. [R391-92]. He reported receiving sixty- to seventy-percent relief from
21
AO 72A
(Rev.8/8
2)

an injection he received on May 18, 2012, but he said he had good and bad days and
had trouble sleeping most nights because of pain, particularly in his left lower back.
[R391]. He reported that his pain level was at five or six on a ten-point pain scale.
[R391]. Examination was unremarkable. [R391-92]. Dr. Patterson assessed lumbar
radiculopathy21 and herniated disc syndrome; started Plaintiff on Lortab and Neurontin;
and scheduled him for more epidural injections. [R391].
Plaintiff saw Dr. Rao for psychiatric follow-up on June 15, 2012. [R351-52].
It was noted that Plaintiff complained less of sleep and anger problems and was having
fewer work absences since his pain had become tolerable. [R351]. A mental-status
examination was unremarkable. [R351-52]. Dr. Rao assessed a GAF score of 70-61;
specified that the score indicated “[m]ild symptoms or difficulties, but generally
functioning pretty well, conflicts”; and continued medication. [R351-52].

21

Radiculopathy is an alternate name for a herniated (slipped) disk, which
occurs when all or part of the softer center of a spinal disk is forced through a
weakened part of the exterior of the disk, forming a protruding mass and placing
pressure on nearby nerves.
Mayo Clinic, Herniated Disk,
http://www.mayoclinic.org/diseases-conditions/herniated-disk/home/ovc-20271246
(last visited 3/26/18); MedlinePlus, Herniated Disk,
https://medlineplus.gov/ency/article/000442.htm (last visited 3/26/18); J.E. Schmidt,
M.D., Attorneys’ Dictionary of Medicine, Illustrated H-115 (46th ed. 2012).
22
AO 72A
(Rev.8/8
2)

Plaintiff returned to Dr. Patterson for follow up on his lumbar pain on
July 9, 2012. [R386-87]. Although he complained of pain in his left leg, his pain level
that day was at one; he reported that he had some good days due to shots and was
sleeping better; and he reported eighty-percent overall improvement after his third
injection. [R386]. Examination was unremarkable. [R386-87]. Dr. Patterson assessed
lumbar radiculopathy and herniated disc syndrome and refilled Plaintiff’s Norco22 and
Neurontin. [R386].
Plaintiff visited Dr. Rao on July 13, 2012. [R350, 432]. He denied any new pain
problems and reported that he was not taking early retirement.

[R350, 432].

Mental-status examination was unremarkable. [R350, 432]. Dr. Rao assessed a GAF
score of 80-71; specified that the score indicated transient symptoms and reactions to
psychosocial stressors; and continued medication. [R351, 433].
Plaintiff returned to Dr. Patterson with complaints of lumbar pain on
August 6, 2012. [R384-85]. He stated that his pain had flared earlier that week, but
he rated the pain on the date of his appointment at three on a ten-point pain scale.
[R384]. Examination was unremarkable. [R384-85]. Dr. Patterson assessed lumbar
22

Norco is a combination drug containing acetaminophen and hydrocodone.
MedlinePlus, Hydrocodone
Combination
Products,
https://medlineplus.gov/druginfo/meds/a601006.html (last visited 3/26/18).
23
AO 72A
(Rev.8/8
2)

radiculopathy and herniated disc syndrome; increased Plaintiff’s Norco prescription
and continued him on Neurontin; prescribed water therapy; and scheduled Plaintiff for
more epidural injections. [R384].
Plaintiff returned to Dr. Rao for psychiatric follow-up on August 10, 2012.
[R349, 431]. Plaintiff complained that his back pain caused him to miss work and
stated that he feared that he might need surgery. [R349, 431]. Dr. Rao noted that
Plaintiff’s facial expression was fearful, his motor behavior was decreased, his mood
and affect were labile,23 and he was restless. [R349, 431]. She assessed a GAF score
of 70-61; specified that the score indicated “[m]ild symptoms or difficulties, but
generally functioning pretty well, conflicts”; and continued medication. [R349, 431].
Dr. Patterson administered a therapeutic lumbar transforaminal epidural
injection on August 15, 2012.

[R381].

It was noted that Plaintiff had been

unresponsive to nonsteroidal anti-inflammatory medication and physical therapy; he
had failed conservative treatment; he had experienced sixty-percent improvement for
two to three weeks following the previous procedure; and the epidural was necessary

23

“Lability” refers to instability; in psychology or psychiatry, it denotes
“free and uncontrolled mood or behavioral expression of the emotions.” PDR Med.
Dictionary 926 (1st ed. 1995).
24
AO 72A
(Rev.8/8
2)

in order to decrease pain and enable Plaintiff to better tolerate physical therapy.
[R381-82].
Plaintiff returned to Dr. Rao for psychiatric follow-up on September 7, 2012.
[R430]. He reported that he had gone back to work after receiving multiple spinal
injections and was happy to be able to pay his bills. [R430]. He denied nightmares
and insomnia, and mental examination was normal. [R430]. Dr. Rao assessed a GAF
score of 70 and continued Plaintiff’s medication for depression. [R430].
Plaintiff visited Dr. Patterson on September 28, 2012, with complaints of lumbar
pain he rated at three to four on a ten-point scale. [R377, 379]. Examination was
unremarkable, and it was noted that Plaintiff was “doing well with increased function
and quality of life.” [R377-79]. Dr. Patterson diagnosed lumbar radiculopathy and
low-back pain and refilled Plaintiff’s Lortab and Neurontin. [R379].
Plaintiff returned to Dr. Rao for psychiatric follow-up on October 5, 2012.
[R429]. He denied that pain in his hip continued to cause him to be absent from work
and expressed concerns about his daughter’s graduation ceremony.

[R429].

Mental-status examination was unremarkable except for Dr. Rao’s note that Plaintiff
had a sad facial expression. [R429-30]. Dr. Rao assessed a GAF score of 70-61;

25
AO 72A
(Rev.8/8
2)

specified that the score indicated “[m]ild symptoms or difficulties, but generally
functioning pretty well, conflicts”; and continued medication. [R430].
Plaintiff visited Dr. Patterson on November 30, 2012, for low-back pain.
[R373]. It was noted in Plaintiff’s medical history that his baseline activities included
walking, standing, cooking, light housework, and heavy housework but that he was
unable to stand or sit for long periods, bend, or sleep. [R373]. It was also noted that
Plaintiff was doing better since his last office visit; he had minimal pain in his low
back, rated at three on a ten-point scale; Neurontin and Lortab were effective; and
Plaintiff was receiving about seventy-percent relief. [R373]. Upon examination, it
was noted that although Plaintiff had some lumbar tenderness to palpation, his gait was
normal, his lumbar was unremarkable, and he had full strength and range of motion.
[R373]. Dr. Patterson diagnosed lumbar radiculopathy and lumbar spondylosis without
myelopathy24 and refilled Plaintiff’s Lortab and Neurontin. [R374].
Plaintiff returned to Dr. Patterson on December 28, 2012, for low-back pain.
[R411, 413]. It was noted in Plaintiff’s medical history that Plaintiff’s baseline

24

Myelopathy describes any neurologic deficit related to the spinal cord,
usually due to compression of the spinal cord by disc material in the cervical spine.
D.J. Seidenwurm, American Journal of Neuroradiology, May 2008, 29 (5) 1032-1034,
available at http://www.ajnr.org/content/29/5/1032 (last visited 3/26/18).
26
AO 72A
(Rev.8/8
2)

activities included walking, standing, cooking, light housework, and heavy housework,
but that Plaintiff was unable to stand or sit for long periods, bend, or sleep.
[R411, 413]. It was also noted that Plaintiff’s pain was rated at five on a ten-point
scale, and his Neurontin and Lortab helped his pain. [R411, 413]. Examination was
unremarkable. [R411, 413]. Dr. Patterson diagnosed low-back pain and lumbar
spondylosis without myelopathy and refilled Plaintiff’s Lortab and Neurontin. [R411].
Plaintiff returned to Dr. Rao for psychiatric follow up on January 2, 2013.
[R344-45, 590-91]. Plaintiff reported that he was upset and concerned because his
wife had suddenly become sick and unable to work. [R345, 590]. His mental-status
examination was unremarkable except for Dr. Rao’s observations that Plaintiff’s facial
expression was sad and that his mood and affect were anxious. [R345, 591]. Dr. Rao
assessed a GAF score of 70-61; specified that the score indicated “[m]ild symptoms or
difficulties, but generally functioning pretty well, conflicts”; continued medication;
and noted the need for Plaintiff to cut down on stressors. [R345, 591].
A review of systems during a follow-up visit to Atlanta Heart Associates taking
place on February 14, 2013, indicated anxiety and stress. [R295, 529]. Physical
examination was unremarkable. [R296, 530].

27
AO 72A
(Rev.8/8
2)

Plaintiff returned to Dr. Patterson on February 22, 2013, for low-back pain.
[R409]. It was noted in Plaintiff’s medical history that Plaintiff’s baseline activities
included walking, standing, cooking, light housework, and heavy housework, but that
Plaintiff was unable to stand or sit for long periods, bend, or sleep. [R409]. It was also
noted that Plaintiff had been able to rest better with less pain since his retirement; his
pain was rated at three on a ten-point scale; and his Neurontin and Lortab were
effective. [R409]. Upon examination, it was noted that Plaintiff’s lumbar was
remarkable only for some spasm and tenderness to palpation and his gait was normal.
[R409]. Dr. Patterson diagnosed low-back pain and lumbar spondylosis without
myelopathy and refilled Plaintiff’s Lortab and Neurontin. [R410].
Plaintiff returned to Dr. Rao on March 1, 2013. [R424]. He reported being hurt
and disappointed with his daughter.

[R424].

Mental-status examination was

unremarkable except for notes that Plaintiff’s facial expression was sad. [R425].
Dr. Rao assessed a GAF score of 60-5125; specified that the score indicated “[m]oderate

25

A GAF score between 51 and 60 indicates “[m]oderate symptoms
(e.g., flat affect and circumstantial speech, occasional panic attacks) OR moderate
difficulty in social, occupational, or school functioning (e.g., few friends, conflicts
with peers or co-workers).” DSM-IV-TR at 34.
28
AO 72A
(Rev.8/8
2)

symptoms or difficulties (few friend[s], conflict with peers)”; continued medication;
and recommended that Plaintiff bring his daughter to their next session. [R425].
Plaintiff returned to Dr. Patterson on March 22, 2013, with complaints of
low-back pain that was shooting down his left leg to the knee. [R407]. It was noted
that Plaintiff’s pain level averaged five on a ten-point scale; that it had increased with
a flare over the past three days after he raked the yard; that Plaintiff was stressed with
his wife’s illness; and that the pain was improved by Neurontin, Lortab, and ice.
[R407]. Dr. Patterson also noted that Plaintiff was starting back to work in the next
month and that his baseline activities included walking, standing, cooking, light
housework, and heavy housework, but that Plaintiff was unable to stand or sit for long
periods, bend, or sleep.

[R407-08].

Dr. Patterson diagnosed lumbarsacral

radiculopathy and noted that Plaintiff had adequate refills. [R408].
Notes from a visit to Dr. Patterson taking place on April 19, 2013, indicate that
Plaintiff had low-back pain shooting down to the knee in his left leg that was at an
average severity of four on a ten-point scale. [R404]. It was noted that Plaintiff’s wife
needed a heart transplant and that Plaintiff was under stress. [R404-05]. Plaintiff’s
medical history states that his baseline activities included walking, standing, cooking,
light housework, and heavy housework but that he was unable to stand for long
29
AO 72A
(Rev.8/8
2)

periods, sit for long periods, sleep, or bend. [R404]. Examination was unremarkable.
[R405]. Dr. Patterson assessed lumbar spondylosis without myelopathy and continued
Neurontin and Lortab. [R405].
Plaintiff saw Dr. Rao for psychiatric follow up on May 28, 2013.
[R340, 586-87]. Dr. Rao noted that Plaintiff was extremely concerned about his wife,
who was in and out of the hospital. [R340, 586]. A mental-status examination was
normal except for notes indicating that Plaintiff’s facial expression was sad, his motor
behavior was agitated, and his mood and affect were labile. [R340, 586]. Dr. Rao
assessed Plaintiff with a GAF score of 60-51; specified that the score indicated
“[m]oderate symptoms or difficulties (few friend[s], conflicts with peers)”; and
continued medication. [R340-41, 586-87].
At a visit to Atlanta Heart Associates taking place on June 20, 2013, it was noted
that Plaintiff complained of chronic back pain and was under stress due to the loss of
his wife. [R292, 469, 526].
Dr. Rao completed a mental-impairment questionnaire on June 20, 2013.
[R337-39]. She stated that Plaintiff’s most recent mental-status examination took place
on May 26, 2013, and that his orientation, affect, mood, memory, insight, judgment,
and impulse control were normal, but that he appeared anxious and was preoccupied
30
AO 72A
(Rev.8/8
2)

with his wife’s death. [R337-38]. Dr. Rao diagnosed bipolar disorder and panic
attacks without agoraphobia26 and observed that Plaintiff was “doing well on
medication.” [R338]. She also opined that Plaintiff had normal ability to understand,
remember, and carry out simple instructions, get along with the public, supervisors,
and co-workers, deal with changes in the work setting, and make simple work-related
decisions; he was unlikely to decompensate or become unable to function under stress;
and he was competent to handle funds. [R338-39].
Plaintiff returned to Dr. Patterson on June 21, 2013, with complaints of low-back
pain that was shooting down his left leg to the knee. [R402]. It was noted that
Plaintiff’s baseline activities included walking, standing, cooking, light housework,
and heavy housework and that his pain was improved by Neurontin, Lortab, and ice,
but that his pain averaged seven on a ten-point scale, and Plaintiff was unable to stand
or sit for long periods, bend, or sleep. [R402]. Dr. Patterson diagnosed lumbago,27

26

Agoraphobia is a mental disorder often associated with panic attacks. It
is characterized by an irrational fear of leaving the familiar setting of home or
venturing into the open. PDR Med. Dictionary 38 (1st ed. 1995).
27

“Lumbago” describes pain in the mid and lower back; the term does not
specify the cause of the pain. PDR Med. Dictionary 998 (1st ed. 1995).
31
AO 72A
(Rev.8/8
2)

lumbar spondylosis without myelopathy, and low-back pain. [R402]. He refilled
Plaintiff’s Neurontin and Lortab. [R403].
Plaintiff returned to Dr. Patterson on June 26, 2013, with complaints of low-back
pain that was shooting down his left leg to the knee. [R400]. It was noted that
Plaintiff’s baseline activities included walking, standing, cooking, light housework,
and heavy housework and that his pain was improved by Neurontin, Lortab, and ice,
but that his pain averaged seven on a ten-point scale and was at eight that day, and
Plaintiff was unable to stand or sit for long periods, bend, or sleep.

[R400].

Dr. Patterson diagnosed lumbar spondylosis without myelopathy and injected
Plaintiff’s lumbar facet joints. [R400]. When contacted on June 27, 2013, Plaintiff
reported that he was able to lie down without pain, sleep longer without pain, and had
increased range of motion and activity level. [R400, 403].
Plaintiff returned to Dr. Patterson on July 10, 2013, with complaints of low-back
pain that was shooting down his left leg to the knee. [R396]. It was noted that
Plaintiff’s baseline activities included walking, standing, cooking, light housework,
and heavy housework and that his pain was improved by Neurontin, Lortab, and ice,
but that his pain averaged seven on a ten-point scale, and Plaintiff was unable to stand
or sit for long periods, bend, or sleep. [R396]. Dr. Patterson diagnosed lumbar
32
AO 72A
(Rev.8/8
2)

spondylosis without myelopathy; completed a radiofrequency ablation of the
lumbosacral region28; and refilled Plaintiff’s Lortab and Neurontin. [R396]. The
treatment notes also indicate that Plaintiff’s wife had died in May. [R396].
Plaintiff returned to Dr. Rao for psychiatric follow up on July 23, 2013.
[R420-21, 584-85]. Dr. Rao noted that Plaintiff was unhappy because of the death of
his wife, back problems that were causing physical limitations in his ability to work,
and financial problems. [R420, 584]. A mental-status examination was normal.
[R420, 584]. Dr. Rao assessed Plaintiff with a GAF score of 70-61; specified that the
score indicated “[m]ild symptoms or difficulties, but generally functioning pretty well,
conflicts”; and continued medication. [R420-21, 584-85].
David E. Massey, Ph. D., reviewed the record and issued an opinion on
August 2, 2013. [R86-87]. He stated that he gave controlling weight to the opinion
Dr. Rao issued on June 20, 2013, and found that Plaintiff’s mental impairments were
not severe. [R87].

28

In this context, ablation is a procedure used to destroy the function of
nerve tissue, thereby decreasing pain signals from that specific area. WebMD,
Radiofrequency
Ablation
for
Arthritis
Pain,
https://www.webmd.com/pain-management/radiofrequency-ablation#1-2 (last visited
3/26/18); PDR Med. Dictionary 3 (1st ed. 1995).
33
AO 72A
(Rev.8/8
2)

Dr. Rao also completed a mental-impairment questionnaire on August 2, 2013.
[R449-54]. She opined that Plaintiff was “seriously limited”—defined as having “a
noticeable difficulty . . . from 11 to 20 percent of the workday or work week”—in his
ability to maintain regular attendance, sustain an ordinary routine without special
supervision, make simple work-related decisions, and complete a normal workday
without interruptions from psychologically based symptoms. [R451]. She also found
that Plaintiff was “limited but satisfactory”—defined as having a noticeable difficulty
“no more than 10 percent of the workday or work week” in his ability to remember
work-like procedures, understand and remember very short and simple instructions,
maintain attention for two-hour segments, work in coordination with or in proximity
to others without being unduly distracted, ask simple questions or request assistance,
accept instructions and respond appropriately to criticism from supervisors, get along
with co-workers or peers without unduly distracting them or exhibiting behavioral
extremes, respond appropriately to changes in a routine work setting, deal with normal
work stress, be aware of normal hazards and take appropriate precautions, understand
and remember detailed instructions, carry out detailed instructions, set realistic goals
or make plans independently of others, deal with stress of semiskilled and skilled work,
interact appropriately with the general public, maintain socially appropriate behavior,
34
AO 72A
(Rev.8/8
2)

adhere to basic standards of neatness and cleanliness, travel in unfamiliar places, and
use public transportation. [R451-42]. Dr. Rao further opined that Plaintiff’s mental
impairments resulted in none-to-mild restrictions in his activities of daily living, ability
to maintain social functioning and concentration, persistence, or pace, and that she did
not expect any episodes of decompensation within the following twelve months.
[R453]. Dr. Rao also opined that Plaintiff’s psychiatric condition exacerbates his pain,
that he would miss one day per month of work, and that his prognosis was poor, and
she assigned a GAF score of 50.29 [R449, 452, 454].
Plaintiff saw Dr. Rao for psychiatric follow up on August 20, 2013. [R583].
Plaintiff reported that he felt God was watching over him because a financial problem
had resolved on its own. [R583]. A mental-status examination was unremarkable.
[R583]. Dr. Rao assessed a GAF score of 70-61; specified that the score indicated
“[m]ild symptoms or difficulties, but generally functioning pretty well, conflicts”; and
continued medication. [R584-85].

29

A GAF score between 41 and 50 indicates “[s]erious symptoms
(e.g., suicidal ideation, severe obsessional rituals, frequent shoplifting) OR any serious
impairment in social, occupational, or school functioning (e.g., no friends, unable to
keep a job).” DSM-IV-TR at 34.
35
AO 72A
(Rev.8/8
2)

On September 16, 2013, Dr. Patterson completed a lumbar-spine medical-source
statement. [R461-64]. Dr. Patterson stated that Plaintiff had low-back pain radiating
primarily to the left leg, that the pain averaged seven on a ten-point scale, and that the
pain was worsened by prolonged sitting, standing, walking, or lifting greater than
fifteen to twenty pounds. [R461]. He opined that because of his impairments, Plaintiff
could only sit for twenty minutes and stand for thirty minutes at a time for about two
hours each in an eight-hour workday; could occasionally climb stairs or lift less than
ten pounds; could rarely twist, stoop, or bend; could never crouch, squat, or climb
ladders; would need to shift his position at will; would need to take unscheduled
breaks about four times a day for ten minutes each; would be off-task fifteen percent
of the day; and would miss about two days of work each month. [R462-64].
Plaintiff saw Dr. Rao for psychiatric follow up on September 17, 2013.
[R625-26]. He reported that he was tearful and depressed whenever he missed his wife
but that he was seeing the light at the end of the tunnel with regard to his many
difficulties and was especially excited that he might be able to adjust his mortgage
payments. [R625]. A mental-status examination was normal except for notes
indicating that Plaintiff’s facial expression was sad, his motor behavior was agitated,
and his content of thought was suspicious. [R625]. Dr. Rao assessed Plaintiff with a
36
AO 72A
(Rev.8/8
2)

GAF score of 60-51; specified that the score indicated “[m]oderate symptoms or
difficulties (few friend[s], conflicts with peers); and continued medication. [R625-26].
Plaintiff presented to Atlanta Heart Associates on September 26, 2013, for
review of diagnostic testing. [R465]. He also complained of chronic back pain and
was noted to have stress and anxiety. [R465]. It was noted that Plaintiff was doing
well, with no cardiac symptoms; that he was maintaining his usual level of activity; and
that he reported doing reasonably well. [R465-66].
Reviewing physician Arthur Lesesne, M.D., completed a physical residual
functional capacity assessment on October 7, 2013. [R88-90]. He found that Plaintiff
could lift and carry up to fifty pounds occasionally and twenty-five pounds frequently,
could stand and/or walk six hours per eight-hour day, could sit six hours per eight-hour
day with normal breaks, could climb ramps and stairs occasionally, and could balance,
stoop, kneel, crouch, and crawl frequently, but could never climb ladders, ropes, and
scaffolds and must avoid concentrated exposure to extreme heat, extreme humidity,
unprotected heights, and dangerous moving machinery. [R103-04].
Plaintiff saw Dr. Rao for psychiatric follow up on October 15, 2013.
[R581, 624-25, 855]. Plaintiff reported that his financial situation was dire and that he
had come close to losing his house. [R581, 624, 855]. A mental-status examination
37
AO 72A
(Rev.8/8
2)

was normal. [R581, 624, 855]. Dr. Rao assessed Plaintiff with a GAF score of 70-61;
specified that the score indicated “[m]ild symptoms or difficulties, but generally
functioning pretty well, conflicts”; and continued medication. [R581, 624-25, 855-56].
A cervical-spine MRI taken on October 26, 2013, indicated central canal
stenosis at C5-6, along with spondylotic changes at C5-6 and C6-7, an osteophyte
complex narrowing the left lateral recess at C6-7, and bilateral foraminal stenosis at
C5-6 and C6-7. [R593-94]. It was also observed that at C5-6 there was narrowing of
the central canal “8.4 mm AP at the level of the disc” and severe osseous stenosis of
the bilateral intervertebral neuroforamina. [R593].
Dr.

Rao

completed

another

mental-impairment

questionnaire

on

November 11, 2013. [R578-80]. She indicated that Plaintiff’s mood was anxious with
racing thoughts, that he had abnormal impulse control and a low tolerance for stress,
and that his ability to make simple work-related decisions was abnormal due to
increased panic attacks. [R578-80]. She also noted that while Plaintiff had been on
medication for a long time, he still had ups and downs. [R578-80].
Plaintiff saw Dr. Rao for psychiatric follow up on November 12, 2013.
[R854-55]. Plaintiff reported that he was “down” and not doing well because it was
his wedding anniversary. [R854]. He also indicated that he did not have any capacity
38
AO 72A
(Rev.8/8
2)

to apply for a new job because his shoulder and neck pain had taken a toll on him.
[R854]. A mental-status examination was unremarkable. [R854]. Dr. Rao assessed
a GAF score of 70-61; specified that the score indicated “[m]ild symptoms or
difficulties, but generally functioning pretty well, conflicts”; and continued medication.
[R854-55].
Plaintiff was evaluated by Shahram Rezaiamiri, M.D., a neurosurgeon, on
November 26, 2013. [R597-98]. Plaintiff complained of left-arm pain that had
persisted for two months, as well as numbness and tingling radiating down the back
of his left arm into his fingers. [R597]. A review of systems indicated shortness of
breath, joint stiffness, neck pain, feeling hot or cold, cough, back pain, and anxiety.
[R598]. Plaintiff was observed to constantly hold and massage his left arm. [R598].
Lumbar-spine range of motion was normal; aside from 4/5 weakness in the triceps and
biceps, strength was normal; there was no tenderness other than in the left paraspinal
area; and Plaintiff’s gait was normal. [R598]. Dr. Rezaiamiri assessed moderately
severe radiculopathy involving the left arm with moderate weakness in the triceps and
biceps. [R598]. He recommended a series of steroid injections and stated that if
symptoms did not improve, a cervical discectomy and fusion at C5-7 would be

39
AO 72A
(Rev.8/8
2)

recommended. [R598]. He noted that he discussed the surgery with Plaintiff “but only
as [a] last resort.” [R598].
Plaintiff saw Dr. Rao for psychiatric follow up on December 10, 2013.
[R622-23]. Plaintiff stated that the holidays had been extremely difficult because he
missed his wife and that he was willing to wait until after the holidays for neck surgery
because of ongoing treatment from the pain-management clinic.

[R622].

A

mental-status examination was unremarkable except for depressed mood and affect.
[R622]. Dr. Rao assessed a GAF score of 70-61; specified that the score indicated
“[m]ild symptoms or difficulties, but generally functioning pretty well, conflicts”; and
continued medication. [R622-23].
Reviewing physician William Gore, Ph. D., completed a psychiatric review
technique and mental residual functional capacity assessment on December 17, 2013.
[R100-01]. He found no restrictions in Plaintiff’s activities of daily living but found
that Plaintiff had moderate difficulties in maintaining social functioning and
concentration, persistence, or pace.

[R101].

Dr. Gore indicated that he gave

controlling weight to Dr. Rao’s opinion of June 20, 2013, given her treating
relationship with Plaintiff. [R101]. Dr. Gore concluded that Plaintiff could remember
simple one- or two-step instructions; attend to simple, repetitive tasks for two-hour
40
AO 72A
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blocks of time; make simple work-related decisions; and respond to minor changes
with minimal supervision; but should not work with the public or in the stress of close
coordination with others, although he could do so within a non-stressful routine.
[R106].
Reviewing physician Howard Colier, M.D., completed a physical residual
functional capacity assessment on December 21, 2013. [R102-05]. He found that
Plaintiff was able to lift and carry up to fifty pounds occasionally and twenty-five
pounds frequently, able to stand and/or walk six hours per eight-hour day, able to sit
six hours per eight-hour day with normal breaks, able to stoop and climb ramps and
stairs occasionally, and could balance, kneel, crouch, and crawl frequently, but could
never climb ladders, ropes, and scaffolds and must avoid concentrated exposure to
extreme heat, extreme humidity, unprotected heights, and dangerous moving
machinery. [R103-04].
A review of systems during a visit to Atlanta Heart Associates taking place on
December 26, 2013, indicated anxiety and stress. [R614].
Plaintiff saw Dr. Rao for psychiatric follow up on January 7, 2014.
[R621-22, 852-53]. Plaintiff reported that he had been in a car accident and that while
he was not hurt, his car was not driveable, and he had no other car to drive.
41
AO 72A
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2)

[R621, 852].

He also reported that he had been denied disability benefits.

[R621, 852]. Dr. Rao observed that Plaintiff was made extremely anxious by ongoing
crises, “yet free of any delusions or hallucinations or suicidal tendencies.”
[R621, 852]. A mental-status examination was normal. [R621, 852]. Dr. Rao assessed
Plaintiff with a GAF score of 60-51; specified that the score indicated “[m]oderate
symptoms or difficulties (few friend[s], conflicts with peers); and continued
medication. [R621-22, 852-53].
Plaintiff presented to Dr. Rezaiamiri on January 8, 2014, for a six-week follow
up after two epidural steroid injections into the cervical spine. [R596]. Plaintiff
reported very good relief from the injections: he denied any numbness or tingling and
stated that the pain was only at two or three on a ten-point pain scale, he was very
pleased with the outcome of the injections, and he wished to continue with
conservative therapy. [R596].
Plaintiff returned to Dr. Patterson on January 20, 2014. [R658]. It was noted
that Plaintiff had cervical and lower-back pain that radiated into his left shoulder and
left leg down to the knee and was at eight on a ten-point scale; that he was unable to
stand for long periods, sit for long periods, sleep, or bend; and that conservative
treatment (physical therapy, chiropractic treatment, NSAIDS, oral medications, and
42
AO 72A
(Rev.8/8
2)

home exercises) had failed. [R658].

Dr. Patterson assessed lumbago and lumbar

spondylosis without myelopathy and administered lumber facet joint injections.
[R658].
Plaintiff returned to Dr. Patterson to undergo radiofrequency ablation for
treatment of lumbago on February 10, 2014. [R697-98]. It was noted that Plaintiff had
chronic pain; that he had been treated with nonsteriodal anti-inflammatories and
physical therapy and had failed conservative treatment; and that he had received facet
injections in order to decrease pain, enable him to better tolerate physical therapy, and
determine that he was a candidate for radiofrequency ablation. [R697]. It was noted
that his pain level was at eight before the procedure and was at zero after the
procedure. [R698].
Plaintiff saw Dr. Rao for psychiatric follow up on March 4, 2014.
[R619, 850-51]. Plaintiff was observed to be excited about his daughter’s upcoming
wedding and relieved about money he received from filing his late wife’s tax return.
[R619, 850]. A mental-status examination was unremarkable. [R619, 850]. Dr. Rao
assessed a GAF score of 70-61; specified that the score indicated “[m]ild symptoms or
difficulties, but generally functioning pretty well, conflicts”; and continued medication.
[R619-20, 851].
43
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On March 25, 2014, upon Dr. Patterson’s referral, Plaintiff presented to Cindy
Demestihas, M.D., at Piedmont Hospital’s emergency room with complaints of a
headache that had been constant for two days. [R604-07]. Plaintiff rated the pain at
seven on a ten-point scale. [R604]. Upon examination, it was noted that Plaintiff
had 4/5 motor strength in his left arm from chronic neck pain. [R605]. Dr. Demestihas
opined that the headache was probably related to radiculopathy. [R607].
A review of systems during a visit to Atlanta Heart Associates taking place on
March 27, 2014, indicated anxiety and stress. [R611]. It was also noted that Plaintiff
complained of low-back pain and had been recently treated for occipital neuralgia30
with local shots. [R611]. Plaintiff was observed to be doing well, with no cardiac
symptoms. [R611]. It was also noted that he remained stable and was maintaining his
usual level of activity. [R612].

30

Occipital neuralgia is a distinct type of headache characterized by piercing
throbbing, or electric-shock-like chronic pain in the upper back, back of the head, and
behind the ears, usually on one side of the head. The location of the pain is related to
the areas supplied by the occipital nerves, which run from the area where the spinal
column meets the neck, up to the scalp at the back of the head. The pain is caused by
irritation or injury to the nerves. Nat’l Inst. of Neurological Disorders & Stroke,
O c c i p i t a l
N e u r a l g i a
I n f o r m a t i o n
P a g e ,
https://www.ninds.nih.gov/Disorders/All-Disorders/Occipital-Neuralgia-InformationPage (last visited 3/26/18).
44
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Plaintiff saw Dr. Rao for psychiatric follow up on April 1, 2014.
[R618, 849-50]. Plaintiff stated that he had too many scares about his health and
described waking up with neck pain so intense that he had to call an ambulance and
receive injections. [R618, 849]. A mental-status examination was unremarkable.
[R618, 849]. Dr. Rao assessed a GAF score of 70-61; specified that the score indicated
“[m]ild symptoms or difficulties, but generally functioning pretty well, conflicts”; and
continued medication. [R618-19, 850].
At a visit to Dr. Patterson’s office taking place on April 2, 2014, it was noted
that Plaintiff had one-hundred-percent relief from an occipital block, had better sleep,
and was more active. [R725]. Plaintiff also reported cervical pain into his left
shoulder with tingling in his arm, but he rated the pain at two on a ten-point scale and
reported that although he had filled the Percocet prescription he received at the
emergency room, he had not taken any. [R725].
Plaintiff visited Dr. Patterson on May 23, 2014, with complaints of cervical pain.
[R789]. It was noted in Plaintiff’s medical history that he was unable to stand or sit
for long periods, bend, or sleep, and that his pain averaged six on a ten-point scale, but
notes also indicate that he reported continued sixty-percent improvement with cervical
epidural steroid injections administered on May 7, 2014. [R789, 793]. Upon
45
AO 72A
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examination, it was noted that Plaintiff had cervical pain with flexion, extension, and
rotation bilaterally; positive Spurling’s31; lumbar/thoracic difficulty with side axial
loading; and pain with minimal lumbar extension; but that he also had a normal gait.
[R789]. Dr. Patterson diagnosed cervical radiculopathy and lumbar spondylosis
without myelopathy; increased Plaintiff’s Neurontin; and prescribed Norco and
hydrocodone. [R790].
Plaintiff returned to Dr. Patterson on June 20, 2014. [R787-88]. He described
left cervical pain radiating into his left shoulder and down the left upper extremity that
averaged ten out of ten on the pain scale and had become “unbearable.” [R787].
Plaintiff also reported associated weakness, poor sleep, anxiety, and fatigue. [R787].
Dr. Patterson noted again that Plaintiff had failed conservative treatment. [R787]. He
recommended that Plaintiff follow up with Dr. Rezaiamiri and noted that his
medications needed to be adjusted due to “severity of pain.” [R787-88]. Dr. Patterson
diagnosed cervical radiculopathy, refilled Plaintiff’s Neurontin, stopped Norco, and
prescribed a combination acetaminophen-oxycodone tablet. [R788].

31

The Spurling’s maneuver is a technique used for evaluating cervical nerve
root impingement. The test is considered positive when the maneuver elicits “typical
radicular arm pain.”
MediLexicon, Spurling Test,
http://www.medilexicon.com/dictionary/90833 (last visited 3/26/18).
46
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Plaintiff returned to Atlanta Heart Associates on June 26, 2014, for follow up
of atherosclerosis and hyperlipidemia. [R805]. It was noted that he had anxiety and
stress, complained of neck pain, and was going to see a surgeon the following day.
[R805]. It was also noted that Plaintiff was maintaining his usual level of activity and
stated that he was doing reasonably well. [R806].
Plaintiff visited Dr. Rezaiamiri on June 27, 2014, with complaints of pain in his
left shoulder, left neck, and left arm that was not relieved by two Percocet tablets.
[R778]. It was noted that Plaintiff had undergone three cervical epidural steroid
injections by Dr. Patterson, all with short benefits, and that he knew that he needed
surgery and that other measures would not be successful, but that he wanted to wait
until later in the year to have surgery. [R778]. Dr. Rezaiamiri also stated that it would
be decided about three weeks prior to surgery whether to perform surgery at one or two
levels. [R778].
Plaintiff returned to Dr. Patterson on July 18, 2014, for follow-up on cervical
pain. [R785-86]. He reported that the pain was at nine on a ten-point scale, and it was
noted that Plaintiff was unable to stand for long periods, sleep, or bend. [R785].
Dr. Patterson diagnosed cervical radiculopathy and cervical disc displacement and
refilled Plaintiff’s prescription for acetaminophen-oxycodone. [R786].
47
AO 72A
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Plaintiff returned to Dr. Patterson on August 15, 2014, for low-back pain and
neck pain. [R782]. It was noted in Plaintiff’s medical history that Plaintiff’s baseline
activities included walking, standing, cooking, light housework, and heavy housework,
but that Plaintiff was unable to stand or sit for long periods, bend, or sleep. [R782].
He rated his pain at seven on a ten-point scale, and it was noted that his Neurontin and
Lortab helped his pain. [R782]. Upon a review of systems, it was noted that Plaintiff’s
lumbar was remarkable for muscle stiffness and that he had tingling numbness, trouble
sleeping, serious depression, high stress level, and sleep disturbances. [R782].
General examination was unremarkable. [R783]. Dr. Patterson diagnosed cervical
radiculopathy and refilled Plaintiff’s Neurontin and acetaminophen-oxycodone tablets.
[R783].
Plaintiff saw Dr. Rao for psychiatric follow up on September 17, 2014. [R844].
Plaintiff expressed disappointment that he had to continue to wait for social security
benefits. [R844]. A mental-status examination was unremarkable. [R844]. Dr. Rao
assessed a GAF score of 70-61; specified that the score indicated “[m]ild symptoms or
difficulties, but generally functioning pretty well, conflicts”; and continued medication.
[R845].

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AO 72A
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2)

Plaintiff returned to Atlanta Heart Associates on September 18, 2014, for
follow-up of atherosclerosis and hyperlipidemia. [R802]. It was noted that he
complained of low-back pain and had anxiety and stress. [R802]. It was also noted
that Plaintiff was maintaining his usual level of activity and stated that he was doing
reasonably well. [R803-04].
Plaintiff saw Dr. Rao for psychiatric follow up on October 15, 2014. [R843-44].
Dr. Rao noted that Plaintiff was still having financial problems and had a hectic four
weeks because he had to care for his mother after her second knee surgery. [R843].
A mental-status examination was unremarkable. [R843-44]. Dr. Rao assessed a GAF
score of 70-61; specified that the score indicated “[m]ild symptoms or difficulties, but
generally functioning pretty well, conflicts”; and continued medication. [R844].
Plaintiff presented to Atlanta Heart Associates on December 15, 2014, for
cardiac clearance to proceed with anticipated surgery. [R798]. He complained
primarily of left-arm pain, and it was noted that he had been diagnosed with
cervical-spine disc disease. [R798]. He also complained of low-back pain and was
noted to have stress and anxiety. [R799]. It was noted that Plaintiff had no cardiac
symptoms; was maintaining his usual level of activity; and reported doing reasonably
well. [R800]. It was determined that his cardiac status was stable for surgery. [R800].
49
AO 72A
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On December 23, 2014, Dr. Rezaiamiri performed a cervical discectomy and
fusion at C5-6-7. [R818-19].
Plaintiff presented to Atlanta Heart Associates on March 19, 2015, for follow
up of atherosclerosis and hyperlipidemia. [R795]. He also complained of chronic back
pain and was noted to have stress and anxiety. [R795]. It was noted that Plaintiff had
no cardiac symptoms, was maintaining his usual level of activity, and reported doing
reasonably well. [R796].
Plaintiff returned to Dr. Patterson on July 10, 2015, with complaints of neck and
lower-back pain that he rated at seven on a ten-point scale. [R824]. It was noted that
Plaintiff’s baseline activities included walking, standing, cooking, light housework,
and heavy housework but that he was unable to stand or sit for long periods, bend, or
sleep. [R824]. Upon examination, it was noted that Plaintiff had lumbar facet pain,
worse with facet loading maneuver, but his gait was normal. [R828]. Dr. Patterson
diagnosed cervicalgia32 and lumbar spondylosis without myelopathy and refilled
Neurontin, acetaminophen-oxycodone, and cyclobenzaprine hydrochloride.33 [R828].
32

“Cervicalgia” refers generally to neck pain. See J.E. Schmidt, M.D.,
Attorneys’ Dictionary of Medicine, Illustrated A-227, C-171 (46th ed. 2012).
33

Cyclobenzaprine, a muscle relaxant, is used with rest, physical therapy,
and other measures to relax muscles and relieve pain and discomfort caused by strains,
50
AO 72A
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E.

Vocational-Expert Testimony

A vocational expert (“VE”) also testified before the ALJ. [R71-79]. The VE
was asked about the working capabilities of a person of Plaintiff’s age, education, and
work experience, who is able to lift and carry up to fifty pounds occasionally and
twenty-five pounds frequently, able to stand and/or walk six hours per eight-hour day,
able to sit six hours per eight-hour day with normal breaks, able to climb ramps, and
stairs occasionally, and can stoop, kneel, crouch, crawl frequently, but can never climb
ladders, ropes, or scaffolds and must avoid concentrated exposure to extreme heat,
extreme humidity, unprotected heights, and dangerous moving machinery. [R75-76].
The VE opined that the person would be able to perform Plaintiff’s past work as a
custodian (heavy work, as typically performed; medium work, as performed by
Plaintiff), letter carrier (light), or postal clerk (light), [R72-73], and that such a person
with Plaintiff’s transferable skills would be able to perform work as an appointment
clerk (sedentary), order clerk (sedentary), or information clerk (sedentary),
[R73-74, 76]. The VE further testified that the person could still perform the past work
and the identified work if the person were able to concentrate for two hours at a time

sprains, and other muscle injuries.
MedlinePlus, Cyclobenzaprine,
https://medlineplus.gov/druginfo/meds/a682514.html (last visited 3/26/18).
51
AO 72A
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in an eight-hour workday with normal breaks and if the person were off-task ten
percent of the time, but that the person could not meet the production requirements of
work if he required a rest period of ten minutes per hour or if he were off-task twenty
percent of the workday. [R76-78].
V.

ALJ’S FINDINGS
The ALJ made the following findings of fact and conclusions of law:
1.

The claimant meets the insured status requirements of the Social
Security Act through December 31, 2017.

2.

The claimant engaged in substantial gainful activity during the
following periods: January 1, 2010, the alleged onset date, through
January 31, 2013. (20 CFR 404.1520(b) and 404.1571 et seq.).

...
3.

However, there has been a continuous 12-month period(s) during
which the claimant did not engage in substantial gainful activity.
The remaining findings address the period(s) the claimant did not
engage in substantial gainful activity.

...
4.

The claimant has the following severe impairment: degenerative
disc disease. (20 CFR 404.1520(c)).

...
5.

The claimant does not have an impairment or combination of
impairments that meets or medically equals the severity of one of
52

AO 72A
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the listed impairments in 20 CFR Part 404, Subpart P, Appendix 1.
(20 CFR 404.1520(d), 404.1525 and 404.1526).
...
6.

After careful consideration of the entire record, the undersigned
finds that the claimant has the residual functional capacity to
perform medium work as defined in 20 CFR 404.1567(c) except
that he can lift fifty pounds occasionally and twenty-five pounds
frequently. The claimant can stand, walk, or sit six hours in an
eight-hour workday each. The claimant can occasionally climb
ramps or stairs; but can never climb ladders, ropes, or scaffolds.
The claimant can frequently stoop, kneel, crouch, or crawl. He
must avoid concentrated exposure to extreme heat, extreme
humidity, unprotected heights, and dangerous moving machinery.
Due the claimant’s condition, he would be off task for up to 10%
of the workday.

...
7.

The claimant is capable of performing past relevant work as a
Letter Carrier and as a Custodian. This work does not require the
performance of work-related activities precluded by the claimant’s
residual functional capacity. (20 CFR 404.1565).

...
8.

The claimant has not been under a disability, as defined in the
Social Security Act, from January 1, 2010, through the date of this
decision. (20 CFR 404.1520(f)).

[R26-34].

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In explaining the weight she assigned to the various mental-health opinions, the
ALJ stated that she gave “great weight” to Dr. Rao’s treating opinion of June 20, 2013,
because she found it consistent with Dr. Rao’s findings throughout the record, “which
generally show[ed] largely normal mental status examinations and minimal mental
health symptoms”; she gave “little weight” to Dr. Rao’s opinion of August 2, 2013,
that Plaintiff was seriously limited in maintaining regular attendance, sustaining a
routine, making simple decisions, was unable to meet the competitive standards of
performing at a consistent pace, and would be absent from work one day per month
because of the issues, because the limitations were inconsistent with Dr. Rao’s
concurrent opinion that Plaintiff had only mild restriction in her activities of daily
living, social functioning, and concentration, and the limitations were substantially
more restrictive than the opinions stated in Dr. Rao’s June opinion; she assigned
“marginal weight” to Dr. Rao’s opinion of November 11, 2013, that Plaintiff had a low
tolerance for stress, had issues making simple decisions, and was somewhat likely to
decompensate, because the opinion drew significantly greater limitations from findings
similar to those appearing in the June opinion, did not specify how Plaintiff’s ability
to make decisions would be limited, and was inconsistent with the treatment notes
cited in the opinion; she assigned “some weight” to the GAF ratings because they were
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“mere snapshots” of Plaintiff’s functioning at the time and because the longitudinal
mental-health record largely consisted of mental-status results within normal limits;
she gave “great weight” to Dr. Massey’s reviewing opinion of August 2, 2013, that
Plaintiff had no restrictions in activities of daily living, no restrictions in social
functioning, mild restrictions to concentration, persistence, or pace, and no episodes
of decompensation because it was consistent with the objective record reflecting no
substantial psychological issues; and she assigned “little weight” to Dr. Gore’s
reviewing opinion of December 17, 2013, that Plaintiff had moderate restrictions in the
areas of social functioning and concentration and could follow rules, remember simple
one-to-two-step instructions, make simple work-related decisions, and respond to
minor changes in work routine but should not work with the public or with the stress
of close coordination with others because the opinion was not consistent with the
record. [R31-32]. In explaining the weight she assigned to the various opinions
regarding Plaintiff’s physical limitations, the ALJ stated that she gave “little weight”
to Dr. Patterson’s treating opinion of September 16, 2013, that Plaintiff could sit,
stand, or walk two hours in an eight-hour day, would need to shift positions at will,
could occasionally lift less than ten pounds and could rarely lift or carry ten pounds,
could never perform a number of postural activities, would be off task fifteen percent
55
AO 72A
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2)

of the workday, and would be absent two times per month because the opinion was
“not consistent with the overall record, including imaging reports revealing no
significant central spinal stenosis”; she assigned “great weight” to Dr. Lesesne’s
reviewing opinion of October 7, 2013, that Plaintiff could perform medium work,
never climb ladders, ropes, or scaffolds, could occasionally climb ramps or stairs,
could frequently perform other postural activities, and must avoid concentrated
exposure to extreme heat, humidity, and hazards, because the opinion was consistent
with the record; and she assigned “great weight” to Dr. Colier’s reviewing opinion of
December 21, 2013, containing similar limitations plus the limitation to occasionally
stooping, because the opinion was consistent with the record. [R31-32].
VI.

CLAIMS OF ERROR
Plaintiff argues that the ALJ made numerous reversible errors in her

consideration of the opinion evidence. [Doc. 10 at 10-23]. As to the opinions of
physical limitation, Plaintiff first contends that the ALJ impermissibly cherry-picked
the record when she found, based on her perception that imaging reports revealed no
significant central spinal stenosis, that Dr. Patterson’s notes were not consistent with
the overall record, [R32]. [Doc. 10 at 11]. He points out that the same MRI revealed
other significant abnormalities, [R368-69]; that contrary to the ALJ’s assertion, the
56
AO 72A
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2)

October 2013 MRI did show central canal stenosis, [R593-94]; and that the ALJ cited
no evidence to support her apparent belief that central canal stenosis is more important
than the other abnormalities revealed by the MRIs. [Doc. 10 at 11-12]. He also
contends that Dr. Patterson’s opinions are “well supported” by his treatment notes
indicating that Plaintiff had tried various conservative treatments; was unable to stand
or sit for long periods, or sleep, or bend; and received only temporary relief from the
many epidural steroid injections, therapeutic facet blocks, and radiofrequency ablation
procedures he underwent from 2012 through 2014, [R373, 379, 381-82, 396, 400, 407,
409, 634, 636, 640, 644, 648, 650, 656, 658, 697-98, 785-89], and are consistent with
the treatment notes from Piedmont Hospital, [R604-05], and Dr. Rezaiamiri, who
ultimately performed a cervical discectomy and fusion at C5-6-7 in December 2014,
[R597-98, 778, 787-88, 818-19]. [Doc. 10 at 12-14]. Second, Plaintiff contends that
the ALJ erred by failing to explain why she found he would be off-task only ten
percent of the time, [R30], particularly since Dr. Patterson opined that Plaintiff would
be off-task fifteen percent of the day, [R464], and the VE testified that being off-task
for sixteen percent of the day would preclude work activities but being off-task for ten
percent of the day would not, [R77-79]. [Doc. 10 at 14-15]. Third, Plaintiff argues
that the ALJ’s explanation that the reviewing opinions are consistent with the record
57
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2)

and Plaintiff’s admissions regarding his activities of daily living, [R31], does not
supply substantial evidence for assigning “great weight” to the reviewing opinions
because the reviewing opinions are not consistent with the treatments notes and
conclusions of Dr. Patterson and Dr. Rezaiamiri, and Plaintiff’s daily activities are
extremely limited. [Doc. 10 at 15]. Fourth, Plaintiff argues that because the most
recent reviewer, [R94-99], did not have the opportunity to review any of the 2014
treatment notes indicating continued pain and non-conservative treatment, [R598, 631,
634, 636, 640, 644, 648, 652, 658, 778, 787, 789, 793], the reviewing opinions were
stale. [Doc. 10 at 15-16]. Fifth, Plaintiff contends that the ALJ erred by failing to
resolve the conflict between the reviewing opinions as to Plaintiff’s ability to stoop and
adopting the older, less-restrictive opinion into the RFC, [R29, 31, 89, 103], despite
Dr. Patterson’s opinion that Plaintiff could rarely stoop, [R463], Plaintiff’s testimony
that he avoided bending “at all costs,” [R64], and an Agency ruling recognizing that
medium work usually requires frequent bending and stooping, Social Security
Ruling (“SSR”) 83-10, 1983 WL 31251 at *6. [Doc. 10 at 16-17].
As to the opinions of mental limitations, Plaintiff argues first that it was error
for the ALJ to discount Dr. Rao’s later opinions as inconsistent with June 2013 notes
without considering the diagnosis of bipolar disorder, which inherently signals mood
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AO 72A
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2)

variability. [Doc. 10 at 18-19 (comparing [R31-32] with [R337-40, 449-54, 578-80])].
He also suggests that the ALJ’s note discounting Dr. Rao’s November 2013 opinion
because it is not “entirely specific” about how Plaintiff’s ability to make decisions
would be limited, [R32, 578-80], was improper because degree of specificity of a
treating source’s findings is not a factor supporting giving the findings little weight,
20 C.F.R. § 404.1527(c)(2)-(6), and the lack of specificity did not stop the ALJ from
giving great weight to similar findings made by Dr. Rao in June 2013, [R31, 337-39].
[Doc. 10 at 20]. Second, Plaintiff argues that when the ALJ failed to include any
mental limitations in the RFC, [R29], she disregarded well-supported limitations
suggested by the June 2013 opinion to which she did assign great weight, [R337-40].
[Doc. 10 at 20-21]. Third, Plaintiff argues that the ALJ erred by giving greater weight
to the reviewing opinion of Dr. Massey, [R31, 82-87], over the reviewing opinion of
Dr. Gore, [R31, 101, 105-07], because Dr. Gore reviewed the record later, when it had
been more thoroughly developed, and the ALJ failed to acknowledge that Dr. Gore’s
opinion is consistent with Dr. Rao’s August 2013 findings. [Doc. 10 at 21-22].
Additionally, Plaintiff argues that if he were limited to simple, sedentary work,
he would be unable to perform his past work or any of the other work identified by the
VE and would be disabled by application of the Medical-Vocational Guidelines, based
59
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2)

on his age and education. [Doc. 10 at 17, 22-23 (citing 20 C.F.R. pt. 404, subpt. P,
app. 2, Rule 201.14))].
In response, the Commissioner argues that the ALJ provided good reasons,
supported by substantial evidence, for discounting Plaintiff’s treating physicians’
opinions in favor of the state agency reviewing opinions. [Doc. 11 at 8-24]. In
response to Plaintiff’s first argument, she contends that the ALJ properly considered
and discounted Dr. Patterson’s opinion, [R461-64], as the ALJ acknowledged
Dr. Patterson’s treating history and imaging showing degenerative changes, but
nevertheless assigned Dr. Patterson’s opinion little weight based on the imaging
showing no significant central spinal stenosis and on her finding that the overall record
did not support Dr. Patterson’s limitations, [R30, 32, 368-69, 373, 377-80, 384-87,
391-92, 403, 405, 409, 411, 413, 768]. [Doc. 11 at 9-11]. The Commissioner also
argues that the complaints of cervical pain and the cervical imaging performed after
Dr. Patterson rendered his opinion does not support Dr. Patterson’s opinion that
Plaintiff’s lumbar spine condition was disabling, and she suggests that 2014 notes
show that Plaintiff received sufficient relief from cervical injections, [R596, 631, 725].
[Doc. 11 at 9, 12]. The Commissioner also points out that Dr. Patterson noted
Plaintiff’s subjective symptoms and argues that a claimant’s subjective symptoms are
60
AO 72A
(Rev.8/8
2)

not an acceptable basis for an opinion. [Doc. 11 at 11 (citing 20 C.F.R. § 404.1527(c);
Crawford v. Comm’r of Soc. Sec., 363 F.3d 1155, 1159-60 (11th Cir. 2004); Lacina v.
Comm’r, Soc. Sec. Admin., 606 Fed. Appx. 520, 528 (11th Cir. Apr. 1, 2015))]. The
Commissioner also contends that Dr. Patterson’s opinion is undermined by the
conservative treatment rendered before the opinion, [R30, 741]; the fact that Plaintiff
worked through much of the period during which Dr. Patterson treated Plaintiff prior
to rendering the opinion, [R47, 210, 214]; and Dr. Patterson’s treatment notes
indicating that Plaintiff’s baseline activities included walking, standing, cooking, and
light and heavy housework and that although Plaintiff had recently retired, he was
starting back at work in April 2013, [R373, 396, 400, 402, 404, 497-09, 411, 413].
[Doc. 11 at 11-12]. Additionally, the Commissioner argues that Dr. Patterson’s
opinion is inconsistent with record treatment notes of other providers showing normal
gait, range of motion, and back examination, [R30, 466, 598]. [Doc. 11 at 12]. The
Commissioner also contends that the ALJ did not impermissibly cherry-pick evidence,
as she stated that she considered the entire record, and it is not necessary for an ALJ
to discuss each piece of evidence so long as it can be determined that the claimant’s
entire medical condition has been considered pursuant to the proper regulatory and
statutory requirements.

[Doc. 11 at 13].
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With regard to Plaintiff’s second

argument—that the ALJ failed to explain her findings regarding the percentage of time
Plaintiff would be off task—the Commissioner contends that the ALJ properly
discounted Dr. Patterson’s opinion that Plaintiff would be off task fifteen percent of
the workday and that the RFC determination is reserved to the ALJ.
[Doc. 11 at 13-14]. As to Plaintiff’s arguments regarding the ALJ’s weighting of the
reviewing opinions, the Commissioner argues that the ALJ properly assigned those
opinions greater weight than Dr. Patterson’s opinion because they were consistent with
the record and Plaintiff’s admitted daily activities, including maintaining his personal
care, putting on shoes, preparing complete meals, performing household chores in
thirty-minute increments without assistance, driving, shopping in stores for food or
clothing, and attending church, [R62, 232-35, 251-54]; they were rendered without any
less information regarding future neck and shoulder complaints and future surgery than
Dr. Patterson had, [R88-90, 102-05, 774-77]; and the ALJ stated that she considered
the entire record. [Doc. 11 at 14-16]. She also suggests that there is no legal authority
that precludes an ALJ from giving considerable weight to a physician’s opinion if the
physician did not review all of the evidence. [Doc. 11 at 16]. With regard to the
reviewers’ conflicting opinions regarding Plaintiff’s ability to stoop, the Commissioner
argues that the ALJ did not err, as she discussed Plaintiff’s treatment record and noted
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that there was some support for postural restrictions, [R30], and she was not
specifically required to discuss in greater detail Dr. Colier’s opinion that Plaintiff
would be able to only occasionally stoop, [R103]. [Doc. 11 at 16-17].
With regard to Plaintiff’s argument concerning the ALJ’s evaluation of her
mental impairments, the Commissioner points out that the ALJ expressly considered
that Dr. Rao’s GAF assessments ranged from 50 to 70 and that GAF scores of 50
indicate serious issues, [R32], and argues that in considering the range of GAF scores
along with the other evidence, she fulfilled her obligation to consider the evidence as
a whole. [Doc. 11 at 19-20]. The Commissioner further asserts that the failure to
address the diagnosis of bipolar disorder was not error because diagnoses do not
establish work-related limitations, [id. at 21], and that the ALJ did not err in
discounting Dr. Rao’s November 2013 opinion that Plaintiff had a low tolerance for
stress and an abnormal ability to deal with changes in the work setting due to panic
attacks, [R578-80], because the opinion was conclusory and conflicted with treatment
notes from her most recent visit, [R32, 581]. [Doc. 11 at 22-23]. Finally, with regard
to the weight assigned the reviewing opinions, the Commissioner argues that the ALJ
did not err in her consideration of Dr. Gore’s opinion, [R106], as Dr. Rao’s
August 2013 opinion actually stated that Plaintiff had limited but satisfactory skills in
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interacting with others and had only mild restrictions in social functioning, [R457], and
Dr. Rao’s notes around that time show mild symptoms, friendly and cooperative
behavior, and no discussion regarding stress of social interaction, [R420-21], and that
she did not err by assigning great weight to Dr. Massey’s opinion because the ALJ had
the benefit of reviewing other later opinions and evidence and found them consistent
with Dr. Massey’s opinion. [Doc. 11 at 23-24].
After careful consideration of the ALJ’s decision, the parties’ arguments, and the
evidence of record, the Court concludes that the decision of the Commissioner is due
to be reversed and remanded for further consideration. As an initial matter, the Court
finds that the opinions of the state agency reviewing physicians, Dr. Lesesne and
Dr. Colier, [R102-05], to which the ALJ assigned “great weight” and credited over the
opinion of treating pain specialist Dr. Patterson, [R31-32], are, as a matter of law,
insufficient to serve as substantial evidence to support the decision of the
Commissioner. “The Social Security Act ‘contemplates that disability hearings will
be individualized determinations based on evidence adduced at a hearing.’ ” Miles v.
Chater, 84 F.3d 1397, 1400 (11th Cir. 1996) (quoting Heckler v. Campbell,
461 U.S. 458, 467 (1983)). The hearing must be “both full and fair.” Miles, id.
Among the Commissioner’s responsibilities in ensuring that the hearing was full and
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fair is an obligation to respond to a request for review of an administrative decision
with an answer that includes a certified copy of the transcript of the record “including
the evidence upon which the findings and decision complained of are based.”
42 U.S.C. § 405(g).
Here, the Court’s review of the opinions of Dr. Lesesne and Dr. Colier reveals
that they rely on a consultative examination by Alexander N. Dorman and an
associated x-ray that are inconsistent with other evidence appearing in the record and
are not themselves contained in the record. (See [R90, 104] (Dr. Lesesne’s and
Dr. Colier’s assignment of “some weight” to the opinion of consultative examiner
Dr. Dorman and reference to an associated lumbar-spine x-ray)). According to the
reviewing opinions, Dr. Dorman performed a consultative examination on
August 30, 2013, during which Plaintiff had an x-ray of the lumbar spine that showed
mild disc space narrowing at L3-L4 and L5-S1 and purportedly stated that he was not
going to a pain clinic or anticipating any surgical procedure. [R90, 104]. This
conflicts with record evidence indicating that Plaintiff underwent an MRI on
March 8, 2012, that showed moderate-to-severe disc space narrowing at L3-L4, severe
facet hypertrophy bilaterally at L4-5, mild-to-moderate foraminal stenosis bilaterally
at L4-5 and L5-S1, and small left foraminal to extra-foraminal disc bulging at L2-3
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abutting the left L2 nerve root, [R368-69]; that Plaintiff had been seeing Dr. Patterson
consistently since at least April 2012, [R373-74, 377-79, 381-82, 384-87, 391-92,
404-05, 407-11, 413, 768, 770, 772]; and that by August 30, 2013, Plaintiff had already
received multiple lumbar epidural injections, [R772 (injections on May 4, 2012); R386
(July 9, 2012, notes on Plaintiff’s condition after his third round of injections); R381
(injections on August 15, 2012)]. The Court has been unable to locate Dr. Dorman’s
opinion or the associated x-ray in the record, and despite the Court’s having provided
the Commissioner with notice and an opportunity to respond, [see Docs. 14, 15], the
Commissioner has also been unable to point to a record containing Dr. Dorman’s
opinion or the associated x-ray.
It is true that Plaintiff failed to raise the issue of the missing
consultative-examiner opinion and therefore arguably waived it. See Sanchez v.
Comm’r of Soc. Sec., 507 Fed. Appx. 855, 856 n.1 (11th Cir. Feb. 8, 2013) (holding that
challenges not explicitly asserted were effectively abandoned); Outlaw v. Barnhart,
197 Fed. Appx. 825, 827 n.3 (11th Cir. Aug. 10, 2006) (per curiam) (holding that a
claim was waived where its proponent did not supply an argument or provide a citation
to authority about the claim); Jones v. Comm’r of Soc. Sec., 181 Fed. Appx. 767, 770
(11th Cir. May 12, 2006) (holding that only the arguments asserted before the district
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court were preserved for appeal) (citing Jones, 190 F.3d at 1228). Be that as it may,
the Court did provide the Commissioner with notice and an opportunity to be heard on
the issue. [See Docs. 14, 15]. Moreover, the notion that an appellate court will not
consider an issue that has not been properly raised is a “is not a jurisdictional limitation
but merely a rule of practice,” and the Eleventh Circuit Court of Appeals has permitted
issues to be raised for the first time on appeal under certain circumstances, among
them, where the issue “involves a pure question of law, and if refusal to consider it
would result in a miscarriage of justice”; where “the interest of substantial justice is at
stake”; or “where the proper resolution is beyond any doubt.” Access Now, Inc. v. Sw.
Airlines Co., 385 F.3d 1324, 1332 (11th Cir. 2004) (punctuation omitted). In this case,
where the ALJ’s decision relies heavily on opinions of reviewing physicians over a
contrary opinion of a treating physician, [R31, 32]; the opinions of the reviewing
physicians in turn rely heavily on a consultative examination and x-ray evidence,
[R90, 104], that conflict with other imaging, [R368-69], treatments notes, [R373-74,
377-79, 381-82, 384-87, 391-92, 404-05, 407-11, 413, 768, 770, 772], and the opinion
of the treating physician, [R461-64]; and the unfavorable consultative examination and
x-ray are nowhere to be found, it can hardly be said that the claimant’s right to a full
and fair hearing has not been violated. This is particularly true here, where Plaintiff
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is an individual closely approaching advanced age and therefore may be disabled by
application of the Medical-Vocational Guidelines under a marginally more restrictive
RFC. See 20 C.F.R. pt. 404, subpt. P, app. 2, Rule 201.14. Thus, the Court finds that
the case is subject to remand in the interest of substantial justice.
Additionally, even if it were not so clear that Plaintiff’s right to a full and fair
review of the administrative decision was not violated by the omission of the opinion
of consultative examiner Dr. Dornan and the x-ray accompanying the opinion, the
Court agrees with Plaintiff that there are numerous other errors supplying grounds for
reversal. Plaintiff’s arguments regarding the medical record and opinion evidence of
his physical impairments are particularly well taken. Where an ALJ gives the opinion
of a treating physician less than controlling weight, she must clearly articulate reasons
establishing good cause for doing so. 20 C.F.R. §§ 404.1527(c)(2), 416.927(c)(2);
Somogy v. Comm’r of Soc. Sec., 366 Fed. Appx. 56, 63 (11th Cir. Feb. 16, 2010) (citing
Lewis, 125 F.3d at 1440)); see also SSR 96-2p. Good cause exists when: (1) the
treating physician’s opinion was not bolstered by the evidence; (2) the evidence
supported a contrary finding; or (3) the treating physician’s opinion was conclusory or
inconsistent with the doctor’s own medical records.

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Phillips v. Barnhart,

357 F.3d 1232, 1241 (11th Cir. 2004). As Plaintiff points out, the ALJ did not supply
good cause for assigning “little weight” to Dr. Patterson’s treating opinion.
The ALJ stated that she accorded Dr. Patterson’s opinion “little weight” because
it was “not consistent with the overall record, including imaging reports revealing no
significant central spinal stenosis.” [R32]. Review of the referenced MRI shows,
however, that while it revealed “no significant central spinal stenosis,” it did indicate
degenerative changes, including disc desiccation and spondylosis at every level;
moderate-to-severe disc space narrowing at L3-L4; severe facet hypertrophy bilaterally
at L4-5; mild-to-moderate foraminal stenosis bilaterally at L4-5 and L5-S1; and small
left foraminal to extra-foraminal disc bulging at L2-3 abutting the left L2 nerve root.
[R368-69].

Tellingly, while the ALJ generally noted that the MRI revealed

degenerative changes, she did not acknowledge the numerous indications that
abnormalities were severe. [R30]. And while it is true that Plaintiff did work for
several months after the MRI was taken, it also bears remark that Dr. Patterson’s notes
around that time indicate that working was one of the factors that aggravated Plaintiff’s
pain, [see, e.g., R373, 409, 411, 413], and that Dr. Rao’s notes indicate that she
recommended that he consider early retirement because of his declining health, [R354].
Likewise, while Dr. Patterson did note that Plaintiff planned to return to work in
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April 2013, [R407-08], the Court finds no indication in the earnings records or
anywhere else that Plaintiff was actually able to do so, [see, e.g., R189-90, 195]. In
order to determine that the ALJ’s decision was supported by substantial evidence, it
must be clear the that ALJ took into account evidence both favorable and unfavorable
to his opinion. See McCruter v. Bowen, 791 F.2d 1544, 1548 (11th Cir. 1986) (holding
that an administrative decision is not supported by “substantial evidence” where the
ALJ acknowledges only the evidence favorable to the decision and disregards contrary
evidence). Here, the ALJ impermissibly cherry-picked evidence favorable to his
opinion while ignoring significant evidence favorable to Plaintiff’s claim.
The ALJ’s discussion of the treatment record is also far from straightforward,
as she acknowledges that conservative treatments were unsuccessful and that Plaintiff
ultimately underwent cervical surgery in December 2014, but then bases her
conclusion that Plaintiff was capable of medium work on the grounds that in late 2013
and early 2014 he “pursued conservative treatment options that provided a substantial
amount of relief.” [R30]. Obviously, conservative treatment was not successful.
[See R598 (recommendation that Plaintiff undergo a series of steroid injections); 611
(notes regarding Plaintiff’s receipt of injections for occipital nerve pain); 658 (lumbar
facet joint injections); 697-98 (radiofrequency nerve ablation); 778 (notes of multiple
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cervical epidural steroid injections, all with short benefits); 818-19 (cervical
discectomy and fusion)]. A decision cannot be said to be supported by substantial
evidence when it relies on statements that are patently untrue. Flentroy-Tennant v.
Astrue, No. 3:07-cv-101-J-TEM, 2008 WL 876961, at *6, 8 (M.D. Fla. Mar. 27, 2008)
(An “ALJ is required to build an accurate and logical bridge from the evidence to his
or her conclusion.”); Baker v. Barnhart, No. 03 C 2291, 2004 WL 2032316, at *8
(N.D. Ill. Sept. 9, 2004) (same).
The Court additionally agrees with Plaintiff that even were the ALJ’s reasoning
sufficient to support crediting the reviewing physicians opinions over Dr. Patterson’s
opinion as of the date they were rendered (a finding the undersigned does not reach),
the opinions could not serve as substantial evidence to support the RFC because they
did not take into account significant evidence supportive of Plaintiff’s claims. As
Plaintiff points out, Dr. Lesesne’s opinion was issued in October 2013, and
Dr. Colier’s opinion was issued in December 2013, and does not note reviewing any
records post-dating the consultative opinion purportedly rendered by Dr. Dorman in
August 2013. [R88-90, 102-05]. As a consequence, the reviewers arrived at their
determinations that Plaintiff could perform a restricted range of medium work without
review of records showing that the cervical-spine MRI taken on October 26, 2013,
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indicated central canal stenosis at C5-6, along with spondylotic changes at C5-6 and
C6-7, an osteophyte complex narrowing the left lateral recess at C6-7, and bilateral
foraminal stenosis at C5-6 and C6-7, and showed that at C5-6 there was narrowing of
the central canal “8.4 mm AP at the level of the disc” and severe osseous stenosis of
the bilateral intervertebral neuroforamina, [R593-94]; that in November 2013,
Dr. Rezaiamiri diagnosed moderately severe radiculopathy involving the left arm with
moderate weakness in the triceps and biceps and was already contemplating that
surgery might be necessary, [R597-98]; that Plaintiff underwent multiple spinal
injections and nerve ablation, [R596, 658, 697-98, 611]; that in March 2014, the
radiculopathy became so severe that it required hospitalization, [R604-07]; or that in
December 2014, Plaintiff underwent a cervical discectomy and fusion at C5-6-7,
[R818-19]. The Commissioner makes no attempt to show that a medical source
rendered a physical RFC in light of this evidence. [See Doc. 12, passim]. Simply put,
the opinions of Dr. Lesesne and Dr. Colier—the only medical opinions of Plaintiff’s
physical limitations to which the ALJ assigned significant weight—are stale.
And while it is clear that the ALJ did in fact review both MRIs, as well as notes
indicating that Plaintiff had multiple injections, nerve ablation treatments, and cervical
surgery, an ALJ “cannot act as both judge and physician.” Rease v. Barnhart,
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422 F. Supp. 2d 1334, 1374 (N.D. Ga. 2006) (citing Marbury v. Sullivan,
957 F.2d 837, 840-41 (11th Cir. 1992)); id. at n.54 (“When medical findings merely
diagnose the claimant’s impairments without relating those impairments to specific
residual functional capacities, the Commissioner may not make that connection
himself.”).34
For all of these reasons, the undersigned finds that the ALJ failed to evaluate
Plaintiff’s impairments according to the proper legal standards or support her
conclusions with substantial evidence. Accordingly, the matter is due to be remanded
for further consideration and development of the record.35

34

For similar reasons, the ALJ’s reliance on Dr. Massey’s opinion of
Plaintiff mental functioning, which was issued on August 2, 2013, [R85-87], without
the benefit of Dr. Rao’s later opinions, the repeated diagnoses of bipolar disorder, or
the record evidence showing that Plaintiff consistently complied with medication and
returned for mental-health treatment, [R420-21, 449-54, 578-81, 583-85, 618, 621-26,
843-44, 849-50, 852-56], is insufficient to serve as substantial evidence of Plaintiff’s
mental limitations.
35

Because the case is so clearly reversible on these grounds, the Court need
not—and does not—not reach Plaintiff’s other arguments.
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VII. CONCLUSION
For the reasons above, the Court REVERSES the final decision of the
Commissioner and REMANDS the case for further proceedings consistent with this
opinion. The Clerk is DIRECTED to enter final judgment in Plaintiff’s favor.
IT IS SO ORDERED and DIRECTED, this the 26th day of March, 2018.

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