Eddington v. Commissioner of Social Security
Filing
17
MEMORANDUM Opinion and Order affirming the decision of the Administrative Law Judge. Judgment shall be entered in favor of the Defendant Commissioner of Social Security and against Plaintiff Karisha Eddington. Signed by Judge Mark W Bennett on 9/24/2015. (des)
IN THE UNITED STATES DISTRICT COURT
FOR THE NORTHERN DISTRICT OF IOWA
CENTRAL DIVISION
KARISHA EDDINGTON,
No. C 14-3018-MWB
Plaintiff,
vs.
CAROLYN W. COLVIN, Acting
Commissioner of Social Security,
Defendant.
MEMORANDUM OPINION AND
ORDER ON JUDICIAL REVIEW OF
DENIAL OF PLAINTIFF’S
APPLICATION FOR SOCIAL
SECURITY DISABILITY BENEFITS
___________________________
TABLE OF CONTENTS
I.
INTRODUCTION........................................................................... 2
A.
Background .......................................................................... 2
B.
Disability Determinations And The Burden Of Proof ....................... 3
C.
The ALJ’s Findings ................................................................ 6
II.
LEGAL ANALYSIS ........................................................................ 8
A.
The Substantial Evidence Standard ............................................. 8
B.
Discussion .......................................................................... 10
1.
Medical opinions and severe impairments ........................... 10
a.
Applicable standards ............................................ 10
b.
Medical and opinion evidence ................................. 14
c.
The ALJ’s findings .............................................. 18
d.
Analysis ............................................................ 23
2.
Evaluation of subjective allegations .................................. 28
a.
Applicable standards ............................................ 28
b.
The ALJ’s findings .............................................. 30
c.
Analysis ............................................................ 32
III.
CONCLUSION ............................................................................ 36
This matter is before me pursuant to Karisha Eddington’s application for Disability
Insurance benefits under Title XVI of the Act, 42 U.S.C. § 401 et seq. Eddington seeks
judicial review of a final decision of the Commissioner of Social Security (the
Commissioner) denying her application for benefits.
Eddington argues that the
administrative record (AR) does not contain substantial evidence to support the
Commissioner’s decision that she was not disabled during the relevant period of time.
I.
INTRODUCTION
A.
Background
Eddington was 22 years old on her alleged onset date. (At the time of the ALJ’s
decision, she was 26 years old.) Eddington completed high school, where she took some
special education classes, and attended some college. She is not married and has no
children. She has a spare work history, including stints in fast food restaurants and as a
hotel maid. Eddington has mostly lived at home, with one or both of her parents.
However, she has also, at times, lived with her boyfriend.
Eddington filed her application for disability benefits on October 2, 2008.
Eddington alleged she became disabled on September 12, 2004. The Social Security
Administration denied Eddington’s application initially and upon reconsideration.
Eddington appeared for a hearing before Administrative Law Judge (ALJ) Robert Labrum
in 2010.
ALJ Labrum issued a decision denying benefits on October 19, 2010.
Eddington requested review and, on June 8, 2012, the Appeals Council remanded
Eddington’s claim for a supplemental hearing. Eddington appeared for a second hearing
before ALJ Thomas M. Donahue on October 16, 2012. On January 31, 2013, the ALJ
again denied Eddington’s claim. Eddington appealed the ALJ’s decision, but the Appeals
Council denied review. Eddington timely filed the present case on March 31, 2014.
2
On October 21, 2014, Judge O’Brien held a hearing on Eddington’s complaint.
Unfortunately, Judge O’Brien passed away before issuing a ruling and this case was
reassigned to me. I have reviewed the record, along with the audio recording of the
hearing, and now enter the following.
B.
Disability Determinations And The Burden Of Proof
A disability is defined as the inability to engage in any substantial gainful activity
by reason of any medically determinable physical or mental impairment which can be
expected to result in death or that has lasted or can be expected to last for a continuous
period of not less than twelve months. 42 U.S.C. §§ 423(d)(1)(A), 1382c(a)(3)(A); 20
C.F.R. § 416.905. A claimant has a disability when the claimant is “not only unable to
do his previous work but cannot, considering his age, education, and work experience,
engage in any other kind of substantial gainful work which exists . . . in significant
numbers either in the region where such individual lives or in several regions of the
country.” 42 U.S.C. §§ 423(d)(2)(A), 1382c(a)(3)(B).
To determine whether a claimant has a disability within the meaning of the Social
Security Act, the Commissioner follows a five-step sequential evaluation process outlined
in the regulations. 20 C.F.R. § 416.920; see Kirby v. Astrue, 500 F.3d 705, 707 (8th
Cir. 2007). First, the Commissioner will consider a claimant’s work activity. If the
claimant is engaged in substantial gainful activity, then the claimant is not disabled. 20
C.F.R. § 416.920(a)(4)(i).
Second, if the claimant is not engaged in substantial gainful activity, the
Commissioner looks to see “whether the claimant has a severe impairment that
significantly limits the claimant’s physical or mental ability to perform basic work
activities.” Dixon v. Barnhart, 353 F.3d 602, 605 (8th Cir. 2003). “An impairment is
not severe if it amounts only to a slight abnormality that would not significantly limit the
3
claimant’s physical or mental ability to do basic work activities.” Kirby, 500 F.3d at
707; see 20 C.F.R. §§ 416.920(c), 416.921(a).
The ability to do basic work activities is defined as “the abilities and aptitudes
necessary to do most jobs.” 20 C.F.R. § 416.921(b). These abilities and aptitudes
include (1) physical functions such as walking, standing, sitting, lifting, pushing, pulling,
reaching, carrying, or handling; (2) capacities for seeing, hearing, and speaking; (3)
understanding, carrying out, and remembering simple instructions; (4) use of judgment;
(5) responding appropriately to supervision, co-workers, and usual work situations; and
(6) dealing with changes in a routine work setting. Id. § 416.921(b)(1)-(6); see Bowen
v. Yuckert, 482 U.S. 137, 141, 107 S. Ct. 2287, 2291 (1987). “The sequential evaluation
process may be terminated at step two only when the claimant’s impairment or
combination of impairments would have no more than a minimal impact on her ability to
work.” Page v. Astrue, 484 F.3d 1040, 1043 (8th Cir. 2007) (internal quotation marks
omitted).
Third, if the claimant has a severe impairment, then the Commissioner will
consider the medical severity of the impairment. If the impairment meets or equals one
of the presumptively disabling impairments listed in the regulations, then the claimant is
considered disabled, regardless of age, education, or work experience.
20 C.F.R.
§§ 416.920(a)(4)(iii), 416.920(d); see Kelley v. Callahan, 133 F.3d 583, 588 (8th Cir.
1998).
Fourth, if the claimant’s impairment is severe, but does not meet or equal one of
the presumptively disabling impairments, then the Commissioner will assess the
claimant’s residual functional capacity (RFC) to determine the claimant’s “ability to meet
the physical, mental, sensory, and other requirements” of the claimant’s past relevant
work. 20 C.F.R. §§ 416.920(a)(4)(iv), 416.945(a)(4). “RFC is a medical question
defined wholly in terms of the claimant’s physical ability to perform exertional tasks or,
4
in other words, what the claimant can still do despite his or her physical or mental
limitations.” Lewis v. Barnhart, 353 F.3d 642, 646 (8th Cir. 2003) (internal quotation
marks omitted); see 20 C.F.R. § 416.945(a)(1).
The claimant is responsible for
providing evidence the Commissioner will use to make a finding as to the claimant’s
RFC, but the Commissioner is responsible for developing the claimant’s “complete
medical history, including arranging for a consultative examination(s) if necessary, and
making every reasonable effort to help [the claimant] get medical reports from [the
claimant’s] own medical sources.” 20 C.F.R. § 416.945(a)(3). The Commissioner also
will consider certain non-medical evidence and other evidence listed in the regulations.
See id. If a claimant retains the RFC to perform past relevant work, then the claimant is
not disabled. Id. § 416.920(a)(4)(iv).
Fifth, if the claimant’s RFC as determined in Step Four will not allow the claimant
to perform past relevant work, then the burden shifts to the Commissioner to show that
there is other work that the claimant can do, given the claimant’s RFC as determined at
Step Four, and his or her age, education, and work experience. See Bladow v. Apfel,
205 F.3d 356, 358-59 n.5 (8th Cir. 2000). The Commissioner must show not only that
the claimant’s RFC will allow the claimant to make an adjustment to other work, but also
that the other work exists in significant numbers in the national economy. Eichelberger
v. Barnhart, 390 F.3d 584, 591 (8th Cir. 2004); 20 C.F.R. § 416.920(a)(4)(v). If the
claimant can make an adjustment to other work that exists in significant numbers in the
national economy, then the Commissioner will find the claimant is not disabled. If the
claimant cannot make an adjustment to other work, then the Commissioner will find that
the claimant is disabled. 20 C.F.R. § 416.920(a)(4)(v). At Step Five, even though the
burden of production shifts to the Commissioner, the burden of persuasion to prove
disability remains on the claimant. Stormo v. Barnhart, 377 F.3d 801, 806 (8th Cir.
2004).
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C.
The ALJ’s Findings
In this case, the ALJ applied the appropriate methodology and found:
(1)
The claimant has not engaged in substantial gainful
activity since October 2, 2008, the application date (20
C.F.R. § 416.971 et seq.).
(2)
The claimant has the following severe impairments:
pain in the left shoulder joint; a personality disorder;
major depressive disorder; anxiety disorder; attention
deficithyperactivity disorder (20 C.F.R. §
416.920(c)).
(3)
The claimant’s impairments are severe, in combination
if not singly, (20 C.F.R. § 404.1520(c) and §
416.920(c)), in that the claimant is significantly
affected in the ability to perform basic work activities
(20 C.F.R. §§ 404.1521(b) and 416.921(b)).
(4)
The claimant’s history of marijuana use and current
alcohol use do not cause more than minimal limitations
in her ability to perform basic work activity. As such,
the claimant’s substance abuse is found not material to
the determination of disability.
(5)
The claimant does not have an impairment or
combination of impairments that meets or medically
equals the severity of one of the listed impairments in
20 C.F.R. Part 404, Subpart P, Appendix 1 (20 C.F.R.
§§§ 416.920(d), 416.925 and 416.926).
(6)
The claimant’s mental impairments, considered singly
and in combination, do not meet or medically equal the
criteria of listings 12.04 and 12.06.
(7)
Applying “paragraph B,” the claimant has no
difficulties in the activities of daily living, moderate
difficulties in social functioning, moderate difficulties
with regard to concentration, persistence or pace; and
no episodes of decompensation.
Because the
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claimant's mental impairments do not cause at least
two “marked” limitations or one “marked” limitation
and “repeated” episodes of decompensation, each of
extended duration, the "paragraph B" criteria are not
satisfied.
(8)
The “paragraph C” criteria have not been satisfied.
Specifically, the record is devoid of evidence
establishing repeated episodes of decompensation of
extended duration or residual disease process where
increased mental demands would be predicted to cause
the claimant to decompensate. Additionally, the
claimant does not have a history showing an inability
to function outside of a highly supportive living
arrangement.
(9)
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 C.F.R. § 416.967(c) such that she could lift 50
pounds occasionally and 25 pounds frequently. She
could sit and walk for two hours at a time for at least
six of an eight-hour day, and could walk for three
blocks. She would be limited to simple routine tasks
and would need an SVP of 2.
(10)
The objective findings in this case fail to provide strong
support for the claimant’s allegations of disabling
symptoms and limitations. More specifically, the
medical findings do not support the existence of
limitations greater than the above listed residual
functional capacity.
The claimant’s medically
determinable impairments could reasonably be
expected to cause the alleged symptoms; however, the
claimant’s statements concerning the intensity,
persistence and limiting effects of these symptoms are
not credible to the extent they are inconsistent with the
above residual functional capacity assessment.
7
(11)
The claimant inconsistently sought treatment and failed
to follow up on doctor’s instructions. The claimant
also is able to perform the activities of daily living,
including taking care of her ailing mother.
(12)
The psychological evaluation performed by Dr. Eva
Christiansen was entitled to little weight because it was
inconsistent with the record as a whole.
(13)
The assessments of Dr. Rogers and Dr. Bonnstetter
were entitled to some weight.
(14)
The third party evaluations provided by claimant’s
family were not credible.
(15)
Claimant is able to perform past relevant work in the
fast food industry.
(16)
As an alternate Step 5 finding, based on the testimony
of the vocational expert, and considering the claimant’s
age, education, work experience, and residual
functional capacity, the claimant is capable of making
a successful adjustment to other work that exists in
significant numbers in the national economy.
(17)
The claimant was not under a disability, as defined in
the Social Security Act, from October 2, 2008, through
the date of this decision (20 C.F.R. § 404.1520(f) and
20 C.F.R. § 416.920(f)).
AR 11-24.
II.
A.
LEGAL ANALYSIS
The Substantial Evidence Standard
The Commissioner’s decision must be affirmed “if it is supported by substantial
evidence on the record as a whole.” Pelkey v. Barnhart, 433 F.3d 575, 577 (8th Cir.
2006); see 42 U.S.C. § 405(g) (“The findings of the Commissioner of Social Security as
to any fact, if supported by substantial evidence, shall be conclusive . . . .”). “Substantial
8
evidence is less than a preponderance, but enough that a reasonable mind might accept
as adequate to support a conclusion.” Lewis, 353 F.3d at 645. The Eighth Circuit
explains the standard as “something less than the weight of the evidence and [that] allows
for the possibility of drawing two inconsistent conclusions, thus it embodies a zone of
choice within which the [Commissioner] may decide to grant or deny benefits without
being subject to reversal on appeal.” Culbertson v. Shalala, 30 F.3d 934, 939 (8th Cir.
1994).
In determining whether the Commissioner’s decision meets this standard, the court
considers “all of the evidence that was before the ALJ, but it [does] not re-weigh the
evidence.” Vester v. Barnhart, 416 F.3d 886, 889 (8th Cir. 2005). The court considers
both evidence which supports the Commissioner’s decision and evidence that detracts
from it. Kluesner v. Astrue, 607 F.3d 533, 536 (8th Cir. 2010). The court must “search
the record for evidence contradicting the [Commissioner’s] decision and give that
evidence appropriate weight when determining whether the overall evidence in support
is substantial.” Baldwin v. Barnhart, 349 F.3d 549, 555 (8th Cir. 2003) (citing Cline v.
Sullivan, 939 F.2d 560, 564 (8th Cir. 1991)).
In evaluating the evidence in an appeal of a denial of benefits, the court must apply
a balancing test to assess any contradictory evidence. Sobania v. Sec’y of Health &
Human Servs., 879 F.2d 441, 444 (8th Cir. 1989). The court, however, does not
“reweigh the evidence presented to the ALJ,” Baldwin, 349 F.3d at 555 (citing Bates v.
Chater, 54 F.3d 529, 532 (8th Cir. 1995)), or “review the factual record de novo.” Roe
v. Chater, 92 F.3d 672, 675 (8th Cir. 1996) (citing Naber v. Shalala, 22 F.3d 186, 188
(8th Cir. 1994)). Instead, if, after reviewing the evidence, the court finds it “possible to
draw two inconsistent positions from the evidence and one of those positions represents
the Commissioner’s findings, [the court] must affirm the [Commissioner’s] denial of
benefits.” Kluesner, 607 F.3d at 536 (quoting Finch v. Astrue, 547 F.3d 933, 935 (8th
9
Cir. 2008)). This is true even in cases where the court “might have weighed the evidence
differently.” Culbertson, 30 F.3d at 939 (quoting Browning v. Sullivan, 958 F.2d 817,
822 (8th Cir. 1992)). The court may not reverse the Commissioner’s decision “merely
because substantial evidence would have supported an opposite decision.” Baker v.
Heckler, 730 F.2d 1147, 1150 (8th Cir. 1984); see Goff v. Barnhart, 421 F.3d 785, 789
(8th Cir. 2005) (“[A]n administrative decision is not subject to reversal simply because
some evidence may support the opposite conclusion.”).
B.
Discussion
Eddington contends the ALJ’s decision is flawed for two reasons:
1.
The ALJ erred in giving little weight to the opinions of
Dr. Bonnstetter and Dr. Christiansen in concluding
that Eddington’s severe impairments did not meet a
listing criteria and that she had the RFC to return to
work.
2.
The ALJ erred in finding that Eddington’s subjective
allegations were not fully credible.
(docket no. 11)
1.
Medical opinions and severe impairments
a.
Applicable standards
As discussed above, at Step Two, the ALJ must consider whether a medically
determinable impairment is “severe.”
20 C.F.R. § 404.1520(a)(4)(ii).
A severe
impairment is one which “significantly limits [the claimant’s] physical or mental ability
to do basic work activities.” 20 C.F.R. § 404.1520(c). Basic work activities include
physical functions such as walking, standing, sitting, lifting, pushing, pulling, reaching,
carrying or handling; capacities for seeing, hearing and speaking; understanding,
carrying out and remembering simple instructions; use of judgment; responding
10
appropriately to supervision, co-workers and usual work situations; and dealing with
changes in a routine work setting. 20 C.F.R. § 404.1521(b). If the impairment would
have no more than a minimal effect on the claimant’s ability to work, it is not severe.
Page, 484 F.3d at 1043. If the claimant has a severe impairment, then the Commissioner
will consider the medical severity of the impairment. If the impairment meets or equals
one of the presumptively disabling impairments listed in the regulations, then the claimant
is considered disabled, regardless of age, education, or work experience. 20 C.F.R.
§§ 416.920(a)(4)(iii), 416.920(d); see Kelley, 133 F.3d at 588.
If the claimant’s
impairment is severe, but it does not meet or equal one of the presumptively disabling
impairments, then the Commissioner will assess the claimant’s RFC to determine the
claimant’s “ability to meet the physical, mental, sensory, and other requirements” of the
claimant’s past relevant work. 20 C.F.R. §§ 416.920(a)(4)(iv), 416.945(a)(4). The
claimant’s RFC is “what [the claimant] can still do” despite his or her “physical or mental
limitations.” 20 C.F.R. § 404.1545(a)(1). “The ALJ must determine a claimant’s RFC
based on all of the relevant evidence.” Fredrickson v. Barnhart, 359 F.3d 972, 976 (8th
Cir. 2004). The claimant’s RFC “is a medical question,” Lauer v. Apfel, 245 F.3d 700,
704 (8th Cir. 2001), and must be supported by “some medical evidence.” Dykes v. Apfel,
223 F.3d 865, 867 (8th Cir. 2000) (per curiam). The medical evidence should address
the claimant’s “ability to function in the workplace.” Lewis, 353 F.3d at 646. The RFC
determination is not based exclusively on the medical evidence, or on any one physician’s
opinion, but on the record as a whole. Cox v. Astrue, 495 F.3d 614, 619 (8th Cir. 2007).
While the RFC assessment draws from medical sources, it is ultimately an administrative
determination reserved to the Commissioner. Id.
“An ALJ must not substitute his opinions for those of the physician.” Finch, 547
F.3d at 938 (quoting Ness v. Sullivan, 904 F.2d 432, 435 (8th Cir. 1990)). Rather, “it
is the ALJ’s responsibility to determine [the] claimant’s RFC based on all the relevant
11
evidence, including medical records, observations of treating physicians and others, and
claimant’s own description of her limitations.” Jones v. Astrue, 619 F.3d 963, 971 (8th
Cir. 2010) (citing Page, 484 F.3d at 1043). “It is the ALJ’s function to resolve conflicts
among the opinions of various treating and examining physicians. The ALJ may reject
the conclusions of any medical expert, whether hired by the claimant or the government
if they are inconsistent with the record as a whole.” Pearsall v. Massanari, 274 F.3d
1211, 1219 (8th Cir. 2001).
“An ALJ’s failure to consider or discuss a treating
physician’s opinion that a claimant is disabled is error when the record contains no
contradictory medical opinion.” Hogan v. Apfel, 239 F.3d 958, 961 (8th Cir. 2001)
(citing Black v. Apfel, 143 F.3d 383, 386 (8th Cir. 1998)). The ALJ is not required to
mechanically list and reject every possible limitation. McCoy v. Astrue, 648 F.3d 605,
615 (8th Cir. 2011). Furthermore, “[a]n ALJ’s failure to cite specific evidence does not
indicate that such evidence was not considered.” Wildman v. Astrue, 596 F.3d 959, 966
(8th Cir. 2010) (quoting Black v. Apfel, 143 F.3d 383, 386 (8th Cir. 1998)).
Medical opinions can come from a treating source, an examining source, or a nontreating, non-examining source (typically a state agency medical consultant who issues
an opinion based on a review of medical records). Medical opinions from treating
physicians are entitled to substantial weight. Singh v. Apfel, 222 F.3d 448, 452 (8th Cir.
2000). A treating physician's opinion “does not automatically control or obviate the need
to evaluate the record as [a] whole.” Leckenby v. Astrue, 487 F.3d 626, 632 (8th Cir.
2007). Nonetheless, if the ALJ finds that a treating physician’s medical opinion as to the
nature and severity of the claimant’s impairment is “well-supported by medically
acceptable clinical and laboratory diagnostic techniques and is not inconsistent with the
other substantial evidence in [the claimant’s] record, [the ALJ] will give it controlling
weight.” 20 C.F.R. § 416.927(c)(2). “When an ALJ discounts a treating physician’s
opinion, he should give good reasons for doing so.” Brown v. Astrue, 611 F.3d 941,
12
951–52 (8th Cir. 2010). Note, however, that a treating physician’s conclusion that an
applicant is “disabled” or “unable to work” addresses an issue that is reserved for the
Commissioner and, therefore, is not a “medical opinion” that must be given controlling
weight. Ellis v. Barnhart, 392 F.3d 988, 994 (8th Cir.2005).
At the other end of the medical-opinion spectrum are opinions from non-treating,
non-examining sources: “The opinions of non-treating practitioners who have attempted
to evaluate the claimant without examination do not normally constitute substantial
evidence on the record as a whole.” Shontos v. Barnhart, 328 F.3d 418, 427 (8th Cir.
2003). This does not mean, however, that such opinions are to be disregarded. Indeed,
“an ALJ may credit other medical evaluations over that of the treating physician when
such other assessments are supported by better or more thorough medical evidence.”
Prosch v. Apfel, 201 F.3d 1010, 1014 (8th Cir. 2000) (internal quotations and citations
omitted). Unless a treating source’s opinion is given controlling weight, the ALJ “must
explain in the decision the weight given to the opinions of a State agency medical or
psychological consultant.” 20 C.F.R. § 416.927(e)(2)(ii).
In the middle of the spectrum are opinions from consultative examiners who are
not treating sources, but who examined the claimant for purposes of forming a medical
opinion. Normally, the opinion of a one-time consultative examiner will not constitute
substantial evidence, especially when contradicted by a treating physician’s opinion.
Cantrell v. Apfel, 231 F.3d 1104, 1107 (8th Cir. 2000).
Ultimately, it is the ALJ’s duty to assess all medical opinions and determine the
weight to be given these opinions. See Finch, 547 F.3d at 936 (“The ALJ is charged
with the responsibility of resolving conflicts among medical opinions.”); Estes v.
Barnhart, 275 F.3d 722, 725 (8th Cir. 2002) (“[i]t is the ALJ’s function to resolve
conflicts among ‘the various treating and examining physicians.’”) (citing Bentley v.
Shalala, 52 F.3d 784, 785–87 (8th Cir. 1995)).
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b.
Medical and opinion evidence
The medical record in this case is sparse and largely limited to evaluations
conducted for the purpose of disability determination.
Although the record makes
mention of various records that pre-date the application period, the first relevant medical
evidence contained in the record is an evaluation performed by Dr. Melanie Bonnstetter,
Psy. D.
The Commissioner referred Eddington to Dr. Bonnstetter for a mental
evaluation, which was conducted on December 5, 2008. At that time, Eddington was 22
years old. Eddington reported to Dr. Bonnstetter that she did have a primary care
provider and her exclusive medication was a birth control shot. AR 458. Dr. Bonnstetter
reviewed the medical records, interviewed Eddington and her parents, and performed
various tests. Of significance, Eddington admitted to Dr. Bonnstetter that she had two
or three jobs from which she had been fired because “she gets bored or doesn’t feel that
things are fair and as a result becomes argumentative or agitated.” AR 455. Dr.
Bonnstetter found that “patient’s personality functioning is more directly impeding her
ability to work than problems with ADHD and/or intellectual capacity.
It is this
examiner’s opinion that the patient has learned how to ensure her wants/needs are met by
her parents to the point that she is not properly motivated to seek or maintain
employment.” AR 460. Regarding her ADHD, Eddington reported to Dr. Bonnstetter
that she had discontinued taking her medication because she didn’t want to be dependent
on pills. AR 457. Dr. Bonnstetter tested Eddington’s IQ and gave her a full IQ score of
88, which means that Eddington had an IQ in the low average range of intellectual
functioning. AR 460. Dr. Bonnstetter assigned her a GAF score of 55, but noted that
Eddington was not taking any medication which could potentially improve her condition.1
AR 459-460.
A GAF score represents a clinician’s judgment of an individual’s overall ability to
function in social, school or occupational settings, not including impairments due to
1
14
Myrna Tashner, Ed.D., another agency expert, examined the record and provided
a functional capacity assessment on December 26, 2008. Tashner stated that Eddington’s
functional capacity did not meet or exceed the listings. AR 464. In coming to that
conclusion, Tashner cited the fact that Eddington was not currently treating for any
ongoing medical or mental issues and that she could take care of herself on a daily basis.
AR 464.
Sometime in 2010, Eddington fell and injured her shoulder. Her local health care
provider referred her to the University of Iowa Hospital. AR 516. She appeared at the
University of Iowa Hospital for an evaluation on July 1, 2010. The University of Iowa
Hospital did not find any acute issue with the shoulder, and recommended conservative
treatment with pain medication. AR 502. Also in 2010, Eddington presented at the
Community Health Center in Fort Dodge for a variety of routine medical issues, including
ear pain and gastrointestinal issues. AR 509-515. In only one instance does it appear
depression was noted by the doctor. AR 511.
On January 10, 2010, Eddington saw Teresa Anderson, MS, a counselor in Fort
Dodge, Iowa.2 AR 525. Anderson diagnosed Eddington with major depressive disorder
physical or environmental limitations. See American Psychiatric Ass’n, Diagnostic &
Statistical Manual of Mental Disorders 34 (4th ed.) (DSM–IV). On the GAF scale,
numerically higher numbers represent better social functioning, while lower scores
represent poor functioning. For example, a GAF score of 41 to 50 indicates the individual
has serious symptoms (e.g., suicidal ideation, severe obsessional rituals, frequent
shoplifting) or a serious impairment in social, occupational or school functioning (e.g.,
no friends, unable to keep a job). Id. A GAF score of 51 - 60 indicates moderate
symptoms (e.g., flat affect and circumlocutory speech, occasional panic attacks) or
moderate difficulty in social, occupational, or school functioning (e.g., few friends,
conflicts with peers or co-workers). Id.
2
It seems from the text of the counselor’s note that this was a follow up appointment,
but the administrative record does not document what prior relationship Eddington and
Anderson had.
15
and borderline personality disorder. Anderson assigned Eddington a GAF score of 5560 and directed Eddington to a support group.
Id.
Anderson also recommended
individual therapy sessions and directed Eddington to follow up with her primary care
provider regarding her prescriptions. AR 525. Anderson also noted that Eddington took
the prescription Pristiq for depression. Id.
On April 5, 2011, Dan Rogers, Ph.D. evaluated Eddington following a referral
from the Commissioner. Apparently the medical records available to Rogers was the
note from Teresa Anderson, described above. Accordingly, Rogers relied primarily on
the in-person evaluation. Rogers noted that, “[a]lthough [Eddington] used the word
‘depressed’ to describe her usual mood she actually described boredom, lack of spending
money, and concern for her parents, but she did not describe lengthy periods of sadness
or other symptoms of depression. . . She also did not describe symptoms of borderline
personality.” AR 529. Rogers assigned Eddington a GAF score of 65 and concluded
that, “[t]here are no apparent signs of serious mental disorder for [Eddington].” AR
530.
On May 24, 2011, Eddington sought a disability evaluation at Trimark Family
Practice in Fort Dodge, Iowa. AR 497. Dr. Michael Stitt concluded the claimant’s major
problem appeared to be anger management or adult oppositional disorder of some sort.
AR 498. Dr. Stitt stated that, “[t]here is no[t] much on the physical exam to indicate
problems with the shoulder knee or feet.” Id.
On July 22, 2011, Dennis Weis, M.D., performed a record review for the agency,
as did Jennifer Ryan, Ph.D., on July 25, 2011. AR 536-537. Neither found significant
limitations or any reason to reverse the previous agency findings that Eddington is not
disabled. Id.
Eddington presented at the Community Health Center in Fort Dodge for several
more normal health checks in 2011 and 2012, including for a rash (AR 541), a sinus
16
infection (AR 543-544), and bronchitis (AR 566). On October 14, 2011, Eddington
injured her toes. An x-ray revealed no serious damage and the attending doctor directed
Eddington to take over-the-counter pain medication. AR 571-572. On June 20, 2012,
Eddington sought treatment for elbow pain after playing video games. The attending
doctor prescribed her pain medication. AR 560-562. On September 12, 2012, Eddington
sought treatment for rib pain and was prescribed pain medication. AR 555-556.
Eddington saw counselor Teresa Anderson, again, on July 19, 2012. AR 552.
Eddington told Anderson that she was experiencing increased symptoms of depression
and anxiety. Eddington noted that she stopped taking her depression medication and
asked to be re-started on it. AR 551. Anderson diagnosed Eddington with panic disorder
without agoraphobia, major depressive disorder, relationship issues, and chronic,
intermittent, pain. AR 553. Anderson assigned Eddington a GAF score of 51-55 and
referred her for a psychiatric evaluation. Id.
Pursuant to the referral from counselor Anderson, Eddington appeared at the
Berryhill Center for Mental Health in Fort Dodge, Iowa, on August 9, 2012. Dr. Maria
Lozano Celis examined Eddington. Dr. Celis noted that Eddington had previously been
evaluated at Berryhill in 2008. AR 547. Dr. Celis noted that, during that previous
disability evaluation, Dr. Melanie Porter had diagnosed Eddington with ADHD,
depression, and personality disorder. Id. Dr. Celis diagnosed recurrent, moderate,
depressive disorder, childhood onset ADHD, possible personality disorder, and assigned
Eddington a GAF score of 50. AR 549. Dr. Celis recommended that Eddington restart
the depression medication Pristiq and attend a follow-up therapy session. AR 549.
On October 10, 2012, Dr. E. Christiansen, Ph.D., conducted a psychological
evaluation of Eddington. Based on his examination of Eddington, along with a review
of the medical records, Dr. Christiansen diagnosed Eddington with Dysthymia with
episodes of major depression, anxiety disorder, ADHD, mixed personality disorder, and
17
assigned Eddington a GAF score of 50. AR 579-580. Regarding her ability to work,
Dr. Christiansen concluded:
Ms. Eddington’s ability to remember and understand
instructions and procedures should be adequate for her to
handle complex tasks, with no indication that she has ever
functioned at her most competent, and some indications that
without supervision she does not complete basic tasks
competently. She may perform less adequately when
competence at academic tasks is required. Attention and
concentration are challenged and likely to be adequate only
when high-interest activities are present. Pace has been noted
to be slow. Various sources for this slowness are possible and
not well specified by these procedures. Relationships to others
have been conflictual [sic] and ambivalent, with much
difficulty coping with relationship loss or in earlier years
feelings of abandonment. Judgment is questionable. She
should have the ability to adjust to changes in the
environment.
AR 580.
c.
The ALJ’s findings
The ALJ evaluated Eddington’s RFC and found as follows:
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 C.F.R.
§ 416.967(c) such that she could lift 50 pounds occasionally
and 25 pounds frequently. She could sit and walk for two
hours at a time for at least six of an eight-hour day, and could
walk for three blocks. She would be limited to simple routine
tasks and would need an SVP of 2. In making this finding,
the undersigned has considered all symptoms and the extent
to which these symptoms can reasonably be accepted as
consistent with the objective medical evidence and other
evidence, based on the requirements of 20 C.F.R. § 416.929
(incorporating and expanding upon Polaski v. Heckler, 739
F.2d 1320 (8th Cir. 1984)) and SSRs 96-4p and 96-7p. The
18
undersigned has also considered opinion evidence in
accordance with the requirements of 20 C.F.R. 416.927 and
SSRs 96-2p, 96-5p, 96-6p and 06-3p.
AR 13.3 In weighing the medical evidence, the ALJ stated:
Turning to the medical evidence, the objective findings in this
case fail to provide strong support for the claimant’s
allegations of disabling symptoms and limitations. More
specifically, the medical findings do not support the existence
of limitations greater than the above listed residual functional
capacity.
AR 14.
The ALJ then discussed each medical record individually. The ALJ summarized
the opinion of Dr. Bonnstetter, as follows:
Due to the paucity of treatment, the claimant was referred by
the agency for consultative psychological evaluation
performed by Melanie Bonnstetter, Psy. D., in December of
2008 (Exhibit 2F). While in the waiting room prior to the
evaluation, the psychologist noted that the claimant was acting
immaturely, balking at the fact that she would be required to
undergo two hours of evaluation and demanded that her
parents go get her some type of food because she could not
go that long without eating. After initiating the evaluation,
the claimant apologized for her behavior, stating that she had
difficulties dealing with her parents due to the fact that they
are always telling her what to do. During the evaluation, the
claimant reported that she was filing for disability upon the
encouragement of her parents, who apparently did not believe
3
Previously, at Step Three, the ALJ found that Eddington had only moderate limitations
under “paragraph B” and no episodes of decompensation under “paragraph C.”
Accordingly, the ALJ found that Eddington had, at most, moderate limitations regarding
her mental impairments. AR 12-13. As will be discussed more, below, the ALJ also
found Eddington’s own statements about the limited nature of her medical impairments
persuasive. AR 21.
19
she was capable of holding down a job. The claimant reported
being fired from previous jobs because she gets bored or does
not feel that things are fair and becomes argumentative or
agitated. She reported a history of ADHD and difficulties
being around people in general because she did not like being
told what to do, noting that she would become belligerent,
yells, and occasionally has hit walls or damaged property.
She denied any psychiatric hospitalizations and reported
previously being on Ritalin for treatment of ADHD as a child.
She reported graduating from high school describing herself
as a B/C student and attended one year of college, noting that
she left college due to issues with her boyfriend. Regarding
her typical day, the claimant reported watching television,
playing video games, going to the mall with friends, and
hanging out with family.
On mental status examination, the claimant had good personal
hygiene and eye contact. She appeared easily bored and
talked randomly about various stressors in her life. She was
fully oriented, her mood was euthymic, and her affect was
congruent. She spoke clearly and coherently, without
evidence of psychotic symptoms. Notably, she was able to
recall three of three items both immediately and following a
five-minute delay. She was able to complete serial threes but
refused to perform serial sevens. Her judgment and impulse
control were adequate in session and she denied any current
suicidal thoughts. On WAIS-III testing, the claimant obtained
a Verbal Score IQ of 91, a Performance Score IQ of 86, and
a Full Scale Score IQ of 88, which was noted to be in the low
average range of intellectual abilities.
Based on the
evaluation, the psychologist diagnosed the claimant with
ADHD, predominately inattentive type (provisional
diagnosis), history of oppositional defiant disorder,
personality disorder, not otherwise specified (cluster B traits
primary diagnosis), and a Global Assessment of Functioning
(GAF) score of 55. The GAF score is a clinician’s rating, of
an individual’s overall psychological, social and occupational
functioning, on a scale of O to 100. A rating of 55 indicates
moderate symptoms or moderate difficulty in social,
20
occupational, or school functioning (See, American
Psychiatric Association, Diagnostic and Statistical Manual of
Mental Disorders, Fourth Edition, Text Revision pg. 34,
2000). The psychologist further found that the claimant’s
“personality functioning is more directly impeding her ability
to work than problems with ADHD and/or intellectual
capacity.” In addition, the psychologist noted that the
claimant had learned to ensure her needs [were met] through
her parents and found she was “not properly motivated to seek
or maintain employment.” Functionally, the psychologist
opined that the claimant would be able to pick up on social
cues and respond appropriately if she would choose to do so.
In addition, it was found that the claimant would quickly
decompensate [when] treated unfairly or in a hostile manner,
which would impact her ability to use good judgment and
respond appropriately to changes in the workplace. Further,
the psychologist opined that, “she will be able to remember
and understand instructions and procedures. Her ability,
however, to carry out instructions, concentrate or maintain a
reasonable pace largely depends upon her interest in the
activity at hand, her motivation to maintain the employment
and the relationship that she is able to establish with her
supervisor or employer. She can be expected to have
difficulties interacting appropriately with supervisors or
employers who are fairly rigid or who tend to have a more
confrontational style.”
AR 16-17. Regarding Dr. Christiansen, the ALJ stated:
The psychologist found that the claimant’s intellectual
functioning appeared consistent with prior testing, indicating
functioning in the low average range.
Of note, the
psychologist reported some inconsistencies between the
claimant’s historical records and her reported history, noting
that she had previously reported quitting college due to
boyfriend problems but stated during the current interview
that she stopped because she was no longer interested in the
course of study. The psychologist found the evaluation to be
consistent with problems including depressive issues, anxiety
beginning in childhood, and difficulties managing emotional
21
reactions due to personality disorders. Based on this
evaluation, Dr. Christiansen reported diagnoses of dysthymia,
with exacerbations to major depressive disorder episodes,
anxiety disorder, ADHD, mixed personality disorder, and a
GAF score of 50. Regarding the claimant’s ability to perform
work related activities, the psychologist opined that the
“ability to remember and understand instructions and
procedures should be adequate for her to handle complex
tasks, with no indication that she has ever functioned at her
most competent, and some indications that without
supervision she does not complete basic tasks competently.
She may perform less adequately when competence at
academic tasks is required. Attention and concentration are
challenged and likely to be adequate only when high-interest
activities are present. Pace has been noted to be slow.
Various sources for this slowness are possible and not well
specified by these procedures. Relationships to others have
been conflictual [sic] and ambivalent, with much difficulty
coping with relationship loss or in earlier years feelings of
abandonment. Judgment is questionable. She should have
the ability to adjust to changes in the environment.” Dr.
Christiansen opined that the claimant’s “disorders are
disabling because of the overall context of her personality
functioning, which takes place at a primitive, borderline level
that interferes with her taking on independent adult
responsibilities.”
AR 19. The ALJ weighed the various medical opinions and concluded:
Based on the longitudinal mental health findings of record,
the undersigned has afforded the opinions of Dr. Christiansen
little weight, as the finding that the claimant was "disabled"
appeared generally inconsistent with those of the other
examining psychologists of record. More specifically, mental
status evaluations of record indicated generally normal
evaluations, with the claimant having intact attention and
concentration, and adequate judgment and impulse control
during the evaluations (See Exhibits 2F; 13F). Furthermore,
the claimant’s psychiatrist noted a fairly normal mental status
evaluation, including intact memory, attention and
22
concentration within normal limits, ability to perform abstract
thinking, and fair judgment (Exhibit 19F). Notably, Dr.
Rogers found no apparent signs of a serious mental disorder,
noting that she did not appear depressed, did not have a
disabling mental disorder, and no learning disability was
evident during the interview (Exhibit 13F, pg. 4).
Additionally, Dr. Bonnstetter found that the claimant was
“not motivated to seek or maintain employment[,”] indicating
that the claimant could carry out instructions and maintain
concentration when motivated and interested. Consistent with
the findings of Dr. Rogers, Dr. Bonnstetter noted that the
claimant could respond appropriately in social settings if she
chose to do so (Exhibit 2F, pg. 25). Furthermore, the
findings were inconsistent with the claimant’s self-reported
daily activities, indicating that the claimant functioned
independently on a daily basis, inconsistent with the report of
Dr. Christiansen (Exhibit 8E; Hearing Testimony). Based on
the foregoing, the undersigned has afforded little weight to
the opinions of Dr. Christiansen and some weight to the
opinions of Dr. Bonnstetter and Dr. Rogers.
AR 19-20.
d.
Analysis
Eddington’s first argument is that the ALJ erred in giving little weight to the
opinions of Dr. Bonnstetter and Dr. Christiansen in concluding that her severe
impairments did not meet a listing criteria and that she had the residual functional capacity
to return to work. In making that argument, Eddington alleges that: 1) the opinions and
work-related limitations from Dr. Bonnstetter and Dr. Christiansen are materially
different from the ALJ’s mental residual RFC assessment; 2) the ALJ failed to evaluate
the opinions of Dr. Bonnstetter at all; 3) the ALJ’s decision is internally inconsistent
regarding Eddington’s ability to maintain attention and concentration; and 4) the opinions
from Dr. Christiansen and Dr. Bonnstetter are consistent with the record as a whole while
the ALJ’s findings are not supported by substantial evidence in the record as a whole.
23
The second of those claims is clearly without merit. As quoted immediately above,
the ALJ devoted several paragraphs of his opinion to discussing and weighing the records
provided by Dr. Bonnstetter. Accordingly, I will only discuss Eddington’s other three
points. At the outset of my analysis, I repeat the observation of the ALJ that this case
presents a unique situation in that the medical record is almost completely devoid of
treatment notes, especially related to the severe impairments. Rather, the administrative
record is comprised almost entirely of various evaluations conducted specifically for the
purpose of Eddington’s pending disability claim. Thus, this case is far removed from the
‘normal’ RFC case, where the arguments primarily relate to whether the medical source
conclusions, and the ALJ’s RFC finding, are supported by the treatment notes.
Eddington’s first point is that the ALJ’s RFC determination is materially different
from the opinions of Dr. Bonnstetter and Dr. Christiansen. However, this argument is
paradoxical, because Dr. Bonnstetter and Dr. Christiansen’s opinions are materially
different from each other. Dr. Christiansen is, without a doubt, the least conservative in
diagnosing Eddington, offering the conclusion that Eddington is completely disabled.
Meanwhile, the overarching conclusion of Dr. Bonnstetter’s evaluation is that, although
Eddington has low-average intelligence, “the patient’s personality functioning is more
directly impeding her ability to work than problems with ADHD or intellectual
capacity. . . . [T]he patient has learned how to ensure her wants/needs are met by her
parents to the point that she is not properly motivated to seek or maintain employment.”
AR 460. Dr. Bonnstetter went on to say that, “[Eddington] is able to pick up on social
cues and respond to them appropriately when and if she chooses. . . .” Id.
In weighing Eddington’s mental impairments, the ALJ found that she had moderate
difficulties in social functioning and moderate difficulties with regard to concentration,
persistence, and pace. AR 12. Those limitations seem to be somewhat more than what
Dr. Bonnstetter observed, but somewhat less than what Dr. Christiansen observed. It is
24
true that the ALJ’s RFC is not a direct reflection of either medical opinion. But, there is
no requirement under the law that the ALJ must adopt the report of one particular doctor,
especially when, as is the present case, neither doctor was Eddington’s treating source.
Rather, as pointed out by the Commissioner, “the ALJ does not base his residual
functional capacity determination on any one physician’s opinion, even a treating
physician’s opinion, but he bases it on the record as a whole. Cox v. Astrue, 495 F.3d
614, 619 (8th Cir. 2007).” (docket no. 12, p. 7) The fact that the ALJ’s RFC is different
from either Dr. Bonnstetter or Dr. Christiansen’s assessment does not mean that it is not
supported by substantial evidence in the record.
The next point raised by Eddington is that the ALJ made contradictory findings
regarding her ability to maintain concentration. Specifically, Eddington argues that the
ALJ cannot, on one hand, recognize that Eddington has the severe impairment of ADHD,
while, on the other hand, finding Eddington had normal concentration, because ADHD
necessarily impairs attention and concentration.
There are a number of problems with this argument. There is a legally significant
difference between the initial finding of a severe impairment and the RFC finding
regarding the extent said impairment impacts the claimant. The mere fact that the
claimant is diagnosed with what constitutes a severe impairment does not mean that
impairment will render the claimant disabled. The country is full of individuals who
have what could be severe impairments, such as asthma, obesity, or diabetes, but have
never even considered seeking benefits because their symptoms are not limiting. Thus,
the mere fact that the ALJ recognized that Eddington has the severe impairment of
ADHD, but did not find that the ADHD caused a marked limitation is not, in and of
itself, an error. Rather, the proper function of the ALJ in crafting an RFC is to determine
25
whether the claimant has the ability to function in spite of her impairments. That is
exactly what the ALJ did in this case.4
Additionally, there is a factual inconsistency in Eddington’s argument. As set out
in her brief, Eddington argues that, “according to the ALJ, the claimant had intact
attention and concentration. (TR 19).” (docket no. 11, p. 13) The citation provided by
Eddington for that contention is page 19 of the ALJ’s order. On page 19 of his order,
the ALJ does state that the claimant has “intact attention and concentration.” AR 19.
However, that statement is in reference to a previous medical opinion in the record. It
is not the ALJ’s conclusion. Rather, as was noted above, the ALJ concluded that
Eddington had moderate limitations with regard to attention and concentration. Thus,
there is no inconsistency in the ALJ’s order. He noted a severe impairment of ADHD
and found that the ADHD had a moderate impact on Eddington’s concentration and
attention.5
Eddington’s final point is the catch all argument that the ALJ’s medical assessment
and RFC are not supported by substantial evidence. Eddington specifically attacks the
ALJ’s decision to give little weight to the opinion of Dr. Christiansen. Eddington argues
that the ALJ should have found her to have poor judgment and impulse control in crafting
the RFC. The Plaintiff argues that if the ALJ had properly credited Dr. Christiansen’s
opinion, the RFC would have included those additional limitations.
4
As was stated above, Dr. Bonnstetter specifically downplayed Eddington’s ADHD,
finding that her personality had a larger impact on Eddington’s functioning than her
illness did.
5
It is also worth noting that not all the doctors of record diagnosed Eddington with
ADHD. Dr. Rogers examined Eddington without access to the records that showed
Eddington had been diagnosed with ADHD in her youth. Lacking that prior diagnosis,
Rogers did not find Eddington to have ADHD. AR 528-530.
26
The simple fact that Dr. Christiansen provides an opinion contrary to the RFC
does not mean the RFC is invalid. My role is not to reweigh the evidence, but to
determine if the ALJ’s conclusion is supported by substantial evidence. In this case, it
is.
First, Dr. Christiansen is merely a consulting physician.
Even though Dr.
Christiansen examined Eddington, Dr. Christiansen is not entitled to the deferential
weight provided to a long term provider. This is especially true when it appears that the
provider is an outlier whose opinion was sought simply for the purposes of bolstering a
disability claim. There simply is no legal rationale which would compel the ALJ to give
Dr. Christiansen controlling weight in spite of the contrary opinions from the other
medical sources.
Second, the ALJ meticulously cites the medical record in support of his RFC
finding. As was stated above, several times, the ALJ’s RFC relied, in part, on the opinion
of Dr. Bonnstetter, who found that ‘motivation’ and ‘personality’ where Eddington’s
biggest issues. AR 20.
The ALJ noted that Dr. Celis found “claimant’s memory,
attention, and concentration were . . . intact and within normal limits.” AR 18. The
ALJ also cited to Dr. Rogers who stated that, although Eddington considered herself
depressed, “she actually described boredom. . .” AR 17. The ALJ cites the fact that
Dr. Rogers found no serious mental limitations and assigned Eddington the relatively
healthy GAF score of 65. Similarly, the ALJ stated that, although counselor Anderson
diagnosed Eddington with a variety of issues, Anderson cited ‘grief’ as a major
component of Eddington’s sadness and assigned her a GAF score of 55-60. AR 17.
Finally, as will be discussed more below, the ALJ cited Eddington’s inconsistent
treatment and lack of medication to support his RFC. Based on the foregoing, it is clear
that the medical component of the ALJ’s RFC is supported by substantial evidence.
27
2.
Evaluation of subjective allegations
a.
Applicable standards
“The credibility of a claimant’s subjective testimony is primarily for the ALJ to
decide, not the courts.” Pearsall v. Massanari, 274 F.3d 1211, 1218 (8th Cir. 2001).
Accordingly, the court must “defer to the ALJ’s determinations regarding the credibility
of testimony, so long as they are supported by good reasons and substantial evidence.”
Guilliams v. Barnhart, 393 F.3d 798, 801 (8th Cir. 2005). An ALJ may discount a
claimant’s subjective complaints if there are inconsistencies in the record as a whole. Id.
To determine a claimant’s credibility, the ALJ must consider:
(1)
the claimant’s daily activities;
(2)
the duration, intensity, and frequency of pain;
(3)
the precipitating and aggravating factors;
(4)
the dosage, effectiveness, and side effects of
medication; and
(5)
any functional restrictions.
Polaski v. Heckler, 739 F.2d 1320, 1322 (8th Cir. 1984). “‘Acts which are inconsistent
with a claimant’s assertion of disability reflect negatively upon that claimant’s
credibility.’” Heino v. Astrue, 578 F.3d 873, 881 (8th Cir. 2009) (quoting Johnson v.
Apfel, 240 F.3d 1145, 1148 (8th Cir. 2001)).
However, the Eighth Circuit Court of
Appeals has repeatedly stated that “the ability to do activities such as light housework
and visiting with friends provides little or no support for the finding that a claimant can
perform full-time competitive work.” Hogg v. Shalala, 45 F.3d 276, 278-79 (8th Cir.
1995) (citing Harris v. Sec’y of Dep’t of Health and Human Servs., 959 F.2d 723, 726
(8th Cir. 1992)). A claimant need not prove she is bedridden or completely helpless to
be found disabled. Reed v. Barnhart, 399 F.3d 917, 923 (8th Cir. 2005). Yet, the Eighth
Circuit Court of Appeals has also held that “cooking, vacuuming, washing dishes, doing
28
laundry, shopping, driving, and walking, are inconsistent with subjective complaints of
disabling pain.” Medhaug v. Astrue, 578 F.3d 805, 817 (8th Cir. 2009).
With respect to determining whether activities of daily living are inconsistent with
subjective complaints of disability, the ALJ must consider the “quality of the daily
activities and the ability to sustain activities, interest, and relate to others over a period
of time and the frequency, appropriateness, and independence of the activities.” Wagner
v. Astrue, 499 F.3d 842, 852 (8th Cir. 2007) (citing Leckenby v. Astrue, 487 F.3d 626,
634 (8th Cir. 2007)). “Other relevant factors include the claimant’s relevant work
history, and the absence of objective medical evidence to support the complaints.”
Mouser v. Astrue, 545 F.3d 634, 638 (8th Cir. 2008) (quoting Wheeler v. Apfel, 224
F.3d 891, 895 (8th Cir. 2000)). An ALJ may not discount a claimant’s subjective
complaints solely because they are unsupported by objective medical evidence, Halverson
v. Astrue, 600 F.3d 922, 931-32 (8th Cir. 2010), but such evidence is one factor that the
ALJ may consider. Ford v. Astrue, 518 F.3d 979, 982 (8th Cir. 2008). The ALJ need
not explicitly discuss each factor as long as the ALJ acknowledges and considers the
factors before discounting the claimant’s subjective complaints. Goff, 421 F.3d at 791.
“An ALJ who rejects [subjective] complaints must make an express credibility
determination explaining the reasons for discrediting the complaints.” Singh v. Apfel,
222 F.3d 448, 452 (8th Cir. 2000).
When an ALJ explicitly discredits the claimant’s testimony and gives good reason
for doing so, the court should normally defer to the ALJ’s credibility determination.
Gregg v. Barnhart, 354 F.3d 710, 714 (8th Cir. 2003). It is not my role to re-weigh the
evidence. See 42 U.S.C. § 405(g); see also Young v. Apfel, 221 F.3d 1065, 1068 (8th
Cir. 2000) (“[I]f, after reviewing the record, [the Court] find[s] that it is possible to draw
two inconsistent positions from the evidence and one of those positions represents the
[Commissioner’s] findings, [the Court] must affirm the decision of the Commissioner.”)
29
(citations and quotations omitted).
However, in reviewing the ALJ’s credibility
determination, I must consider the evidence that both supports and detracts from the
ALJ’s decision. Perks v. Astrue, 687 F.3d 1086, 1091 (8th Cir. 2012) (citing Ellis v.
Barnhart, 392 F.3d 988, 993 (8th Cir. 2005)). It is not appropriate to reverse the ALJ’s
decision simply because some evidence would support a different conclusion. Perks, 687
F.3d at 1091. An ALJ is not required to discuss every piece of evidence that was
submitted, and an ALJ’s failure to cite specific evidence does not indicate that such
evidence was not considered. Black v. Apfel, 143 F.3d 383, 386 (8th Cir. 1998). I must
defer to the ALJ’s determination regarding the credibility of testimony as long as it is
supported by good reasons and substantial evidence. Id. (citing Pelkey v. Barnhart, 433
F.3d 575, 578 (8th Cir. 2006)).
b.
The ALJ’s findings
At her hearing before the ALJ, and throughout the course of the disability
application process, Eddington maintained that, because of her depressive disorder, low
intelligence, and her ADHD, she is unable to return to work. AR 67-69. The ALJ found
that Eddington’s statements concerning the intensity, persistence, and limiting effects of
her symptoms from her mental impairments were not entirely credible. After referencing
the Polaski factors and examining some of the medical and opinion evidence, the ALJ
found as follows:
After careful consideration of the evidence, the undersigned
finds the claimant’s medically determinable impairments
could reasonably be expected to cause the alleged symptoms;
however, the claimant’s statements concerning the intensity,
persistence, and limiting effects of these symptoms are not
entirely credible to the extent they are inconsistent with the
above residual functional capacity assessment.
AR 20. The ALJ found inconsistencies in the record, stating:
30
Regarding the claimant’s alleged mental impairments, review
of the medical record indicated that the claimant sought rather
limited treatment throughout the period under consideration.
Of note, the claimant reported that she stopped seeking
treatment due to believing her symptoms had resolved after
minimal treatment. The undersigned finds the claimant’s
failure to seek consistent counseling, psychological, or
psychiatric treatment to significantly erode the credibility of
her allegations. Moreover, mental status examinations of
record were generally unremarkable, showing adequate
memory, concentration, attention, and cognitive abilities.
One consultative psychologist found that the claimant failed
to describe any significant mental health symptoms, with
another examining psychologist noting that limitations were
due to the claimant’s lack of motivation (Exhibits 2F; 13F).
AR 21. The ALJ also noted Eddington’s ability to maintain an independent lifestyle,
stating:
In addition, the claimant has generally reported daily activities
that are not limited to the extent one might expect considering
her allegations of disabling symptoms and limitations.
Contrary to her allegations while being examined by Dr.
Christiansen (See Exhibit 21F), the claimant reported having
no problems performing personal care independently (Exhibit
8E, pg. 4). She further reported being able to prepare meals
on a daily basis, perform household chores including
cleaning, laundry, ironing, moving, and raking, driving a car,
going out alone, and shopping in stores for food and other
items (Id. at 5-6). Notably, the claimant testified to caring
for her medically ill mother, preparing meals for her and for
her brother’s children (Hearing Testimony). Socially, she
reported spending time with others, going to the mall, going
to Wal-Mart, watching television, and playing video games.
She reported spending her time hanging out with friends,
going places, and with spending time with her boyfriend.
However, she noted some problems getting along with family,
friends, and neighbors due to “I disagree a lot.” Notably, she
reported doing well with authority figures unless they made
31
her angry (Id. at 7-9). The claimant further reported being
able to follow instructions, being able to handle some kind of
stress, and not liking changes in routine (Id. at 9). Based on
these admitted activities, the undersigned finds that the
claimant can perform work activity consistent with the
assessed residual functional capacity above.
AR 21.
c.
Analysis
Eddington argues the ALJ failed to properly consider her subjective allegations.
In doing so, she makes two main points. She argues that the ALJ failed to articulate his
reasons for discounting her subjective allegations, and she argues the ALJ improperly
discounted the third party reports from her family. The Commissioner, obviously,
disagrees and argues that the ALJ’s ruling is supported by substantial evidence.
Based on my review of the record, I conclude that, for the most part, the ALJ gave
detailed reasons for discounting Eddington’s subjective complaints and limitations. The
ALJ gave at least three separate reasons why Eddington’s subjective allegations are not
supported by the record.6 The ALJ discussed Eddington’s activities of daily living and
noted that she engaged in many activities that do not support her claims of disabling
mental limitations. AR 21. Eddington drives, does errands, and does household chores
such as cleaning and mowing. AR 74. Although Eddington has most often lived with
one or both of her parents, she has lived alone with her romantic partner and with friends.
6
A fourth reason, not discussed by the ALJ, is Eddington’s work history. Eddington’s
work history consists of sporadic employment in hotels and fast food restaurants. She
admitted in the record that she has often lost her jobs because she became “bored.” AR
455. The Eighth Circuit Court of Appeals has recognized that a poor work record prior
to the alleged onset date can be a factor tending to show the claimant lacks motivation to
work. Fredrickson v. Barnhart, 359 F.3d 972, 976 (8th Cir. 2004) (the ALJ properly
considered claimant’s poor work history and low earnings as a credibility factor).
However, because the ALJ did not consider that issue, neither will I.
32
AR 60, 551. Eddington watches television, reads, and plays video games for fun. AR
529. Significantly, Eddington testified about taking care of her disabled mother. AR 71.
Eddington will do errands for her mother, like picking up her nieces and nephews that
her mother babysits, and will also go to her mother’s house to prepare meals for her
mother and her family. AR 70-72, 578.
The Eighth Circuit Court of Appeals has stated that the claimant’s ability to
perform basic life functions can be a factor considered by the ALJ in determining if the
claimant’s allegations are credible. See Baker v. Barnhart, 457 F.3d 882, 893 (8th Cir.
2006) (the Eighth Circuit Court of Appeals considered the fact that the claimant was
capable of full self-care, drove a car every day, shopped, and ran a number of errands as
one factor in determining if claimant’s allegations were credible). However, a “limited
ability to complete light housework and short errands does not mean [a claimant] has ‘the
ability to perform the requisite physical acts day in and day out, in the sometimes
competitive and stressful conditions in which real people work in the real world.’” Tilley
v. Astrue, 580 F.3d 675, 682 (8th Cir. 2009) citing McCoy v. Schweiker, 683 F.2d 1138,
1147 (8th Cir. 1982) (en banc) abrogated on other grounds by Higgins v. Apfel, 222 F.3d
504, 505 (8th Cir. 2000).
In this case, the ALJ properly considered, and cited,
Eddington’s ability to perform basic life tasks as one factor in determining if her
allegations were credible.
The ALJ also noted Eddington’s failure to regularly treat for her various medical
issues. As can be seen in the review of the medical records set out above, there is no
possible, factual dispute that Eddington failed to seek regular medical treatment. Over
the five years’ worth of medical records presently before me, Eddington never sought
regular, and continuing, medical care for her allegedly disabling symptoms. Eddington
only saw her counselor two times over the course of four years. The ALJ properly relied
33
on Eddington’s lack of treatment in his credibility assessment.7 See Mouser v. Astrue,
545 F.3d 634, 638 (8th Cir. 2008), stating, “[t]he ALJ noted that [claimant] did not seek
medical treatment between March 2000 and April 2005. . . The ALJ determined that
such evidence is inconsistent with complaints of persistent and debilitating symptoms. . .
[T]he ALJ’s credibility assessment was proper.” The ALJ also noted Eddington’s noncompliance with medication, specifically, that she never took ADHD medication and quit
taking depression medication when she thought her symptoms improved. AR 21. The
Eighth Circuit Court of Appeals has recognized that non-compliance can be a basis for
discounting a claimant’s credibility. Wagner v. Astrue, 499 F.3d 842, 851 (8th Cir.
2007).
Accordingly, the ALJ properly used it as one factor that weighed against
Eddington’s credibility.
Finally, as was discussed in some detail in the previous section, the ALJ stated
that the medical record did not support Eddington’s allegations. With the exception of
Dr. Christiansen, none of the providers appearing in the record opined that Eddington
had disabling/severe symptoms.
The medical record is replete with references to
Eddington having low normal to normal cognitive function and, at most, moderate issues
with attention, pace, and social functioning. As was discussed above, some providers,
such as Dr. Rogers and Dr. Bonnstetter, specifically opined that many of Eddington’s
issues were related to personality, motivation, and boredom, rather than the severe
impairments of record. It is not my job to reweigh the evidence. Rather, the question is
whether the ALJ gave good reasons for his opinion and whether the opinion is supported
by substantial evidence. In this case, the ALJ gave at least three clear reasons, which
7
In her brief, Eddington argues that her mental issues were the reason she failed to seek
treatment. However, Eddington does not cite evidence to support that argument.
Moreover, there are multiple indications in the record that her parents were willing to
help Eddington seek treatment if she wanted treatment.
34
are supported by citations to the record, that tend to show that the claimant’s subjective
allegations were not credible. Accordingly, the ALJ’s finding is supported by substantial
evidence.
Eddington also argues that the ALJ should have given greater weight to the third
party reports provided by her family. The ALJ gave little weight to the reports provided
by Eddington’s mother, sister, and boyfriend, stating:
The record additionally contains reports submitted by the
claimant’s mother, sister, and significant other (See Exhibits
6E; 13E; 14E; 15E), which are generally supportive of the
claimant’s allegations. However, these reports do not
establish that the claimant is disabled. More specifically, the
claimant’s mother, sister, and significant other are not
medically trained to make exacting observations as to dates,
frequencies, types and degrees of medical signs and
symptoms, or of the frequency or intensity of unusual moods
or mannerisms, the accuracy of the information provided is
questionable. Moreover, by virtue of the relationship with
the claimant, these reports cannot be considered as coming
from disinterested third party witnesses whose statements
would not tend to be colored by affection for the claimant and
a natural tendency to agree with the symptoms and limitations
the claimant alleges. Most importantly, significant weight
cannot be given to the third party report because it, like the
claimant’s allegations, is simply not consistent with the
preponderance of the opinions and observations by medical
doctors in this case, as discussed above.
AR 22. Although the statements of Eddington’s family generally support her subjective
allegations, the ALJ was entitled to discount that corroborating testimony for the same
reason he used to discredit Eddington’s. Eddington has alternately lived with her mother
and her boyfriend, and is often tasked with taking care of her mother. Clearly, they all
have an interest in a disability finding. See Black v. Apfel, 143 F.3d 383, 387 (8th Cir.
2006) (ALJ’s failure to give specific reasons for disregarding testimony of the claimant’s
35
husband was inconsequential, as the same reasons the ALJ gave to discredit claimant
could serve as basis for discrediting the husband). The ALJ provided detailed reasons
for his credibility findings, and those findings are substantially supported by the medical
evidence. Accordingly, I must deny Eddington’s argument.
III.
CONCLUSION
After a thorough review of the entire record and in accordance with the standard
of review I must follow, I conclude that the ALJ’s determination that Eddington was not
disabled within the meaning of the Act is supported by substantial evidence in the record.
Accordingly, the decision of the ALJ is affirmed. Judgment shall be entered in favor of
the Commissioner and against Eddington.
IT IS SO ORDERED.
DATED this 24th day of September, 2015.
______________________________________
MARK W. BENNETT
U.S. DISTRICT COURT JUDGE
NORTHERN DISTRICT OF IOWA
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