Ford v. Colvin

Filing 17

Judge F. Dennis Saylor, IV: ORDER entered. Memorandum and Order on Plaintiff's Motion for Judgment on the Pleadings and Defendant's Motion to Affirm the Decision of the Commissioner. Plaintiff's motion for judgment on the pleadings reversing the ALJ's decision is DENIED, and defendant's motion for an order to affirm the decision of the Commissioner is GRANTED. (Pezzarossi, Lisa)

UNITED STATES DISTRICT COURT
DISTRICT OF MASSACHUSETTS
____________________________________
)
THOMAS EZEKIEL FORD, IV,
)
)
Plaintiff,
)
)
Civil Action No.
v.
)
16-11976-FDS
)
NANCY A. BERRYHILL,
)
Acting Commissioner of Social Security, )
)
Defendant.
)
____________________________________)
MEMORANDUM AND ORDER ON PLAINTIFF’S MOTION FOR
JUDGMENT ON THE PLEADINGS AND DEFENDANT’S MOTION
TO AFFIRM THE DECISION OF THE COMMISSIONER
SAYLOR, J.
This is an appeal of the final decision of the Commissioner of the Social Security
Administration (“SSA”) denying an application for social security disability insurance (“SSDI”)
and supplemental security income (“SSI”) benefits. Plaintiff Thomas Ezekiel Ford, IV, alleges
disability based on post-traumatic stress disorder, depression, anxiety, and obesity. The
Administrative Law Judge determined that Ford retained a sufficient residual functional capacity
to perform work existing in the national economy, and thus was not disabled under the Social
Security Act, 42 U.S.C. §§ 416(i) and 423(d).
Ford has moved for judgment on the pleadings seeking an order reversing the ALJ’s
decision. He contends that the ALJ (1) failed to give proper weight to certain medical opinion
evidence; (2) made an improper credibility determination that is not supported by substantial
evidence; and (3) failed to properly account for his moderate mental limitations when presenting
a hypothetical question concerning residual functional capacity (“RFC”) to the vocational expert.

Defendant has cross-moved for an order affirming the ALJ’s decision.
For the reasons set forth below, plaintiff’s motion for judgment on the pleadings will be
denied, and defendant’s motion to affirm the ALJ’s decision will be granted.
I.

Background
A.

Educational and Occupational History

Thomas Ezekiel Ford, IV, was born on February 23, 1974, and was 37 years old at the
alleged onset of his disability. (A.R. 46; see A.R. 49). He received a bachelor’s degree in
sociology and comparative international development from Johns Hopkins University and a
master’s degree in political science from American University in Cairo, Egypt. (A.R. 47-48).
From November 2009 to March 2011, Ford worked for the United States Agency for
International Development as a General Development Officer. (A.R. 250, 271, 458). While he
was embedded with the U.S. military in Afghanistan, Ford endured several life-threatening
events, including witnessing enemy explosives cause the death of one soldier and another
soldier’s loss of three limbs. (A.R. 458). Ford then requested a transfer to a different base in
Afghanistan because of job-related stress. (Id.).
Upon his return to the United States in April 2011, Ford worked as a curriculum
development and pre-deployment trainer for International Development Systems (“IDS”), a
defense contractor based in Alexandria, Virginia. (A.R. 271-73). Ford left that job in June 2011,
and then worked as a consulting expert until December 2012. (A.R. 65, 271). He has not
worked since. (Id.).
B.

Medical Evidence
1.

November 2012-November 2013

Ford contends that he suffers from PTSD, depression, anxiety, and obesity. On

2

November 19, 2012, Ford saw Mark Gorman, Ph.D., for an initial mental-health consultation at
the Weight Center at Massachusetts General Hospital (“MGH”). (A.R. 367). According to the
doctor’s report, Ford’s mental status examination (“MSE”) was normal except for diminished
concentration, some guilt, and reports of sleep problems. (A.R. 371). Ford reported that his
stressors were his “work/travel schedule” and “caretaking for parents.” (A.R. 368). He reported
that his current job at IDS required relocation every two to four weeks, so he had avoided
making close, personal connections with his co-workers. (A.R. 370).
Dr. Gorman assessed a Global Assessment of Functioning (“GAF”) score of 71-80 and
diagnosed a major depressive disorder in remission and emotionally-triggered eating in
remission. (A.R. 372).1 He also found that Ford demonstrated active symptoms of posttraumatic stress disorder, such as avoidance and numbing; insomnia, diminished concentration;
and hypervigilance. (A.R. 370). However, Dr. Gorman opined that Ford did not meet the full
diagnostic criteria of PTSD, because he was no longer experiencing flashbacks or intrusive
memories. (A.R. 372). Dr. Gorman supported a referral for psychotherapy if Ford was
interested. (Id.).
Ford saw Elizabeth Goetter, Ph.D., at MGH for a psychiatric intake on December 19,
2012. (A.R. 348). Ford described the multiple traumatic experiences he faced as a civilian aid
worker in Afghanistan. (Id.). Ford’s chief complaint was “sleep issues.” (Id.). Dr. Goetter
noted that Ford experienced emotional and physical reactivity to trauma cues, such as anxiety,
tachycardia, and flushing. (Id.). He reported increased irritability, hypervigilance, and
diminished interest in socializing. (Id.). He stated that his mood had been “fine . . . more stable,

A GAF score evaluates an individual’s overall level of functioning. A GAF score of 71-80 indicates that
“[i]f symptoms are present, they are transient and expectable reactions to psychosocial stressors.” AMERICAN
PSYCHIATRIC ASS’N, DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS (DSM-IV) 34 (4th ed. Text
Revision 2000).
1

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less angry,” but reported depressive episodes in the past, most recently in March through August
2012, that included decreased energy, loss of focus, and passive suicidal ideation. (A.R. 34849). His MSE was within normal limits, apart from a blunted emotional affect. (A.R. 351-52).
Dr. Goetter diagnosed major depressive disorder, recurrent and in remission, generalized anxiety
disorder, and PTSD, assessing a GAF of 55. (A.R. 352).2 She opined that his psychiatric
symptoms were likely exacerbated by numerous psychosocial stressors, including job
dissatisfaction, limited social support, his parents’ failing health, and his own medical concerns.
(A.R. 353).
Ford returned to MGH and saw Heather Kapson, Ph.D. on October 2, 2013. (A.R. 343).
Dr. Kapson noted that Ford’s primary complaint was that his role as his “parents’ primary
caregiver over the last 2 years” had been triggering, and living with them had prevented him
“from working and from engaging in life with [his] spouse,” who lived in Baltimore. (Id.). Ford
again recounted the difficulties of his time in Afghanistan, and noted that his “tour ended by him
visiting his parents and not returning when he saw their health significantly declining.” (Id.).
Dr. Kapson noted that Ford still met the symptoms for PTSD, but his symptoms, as reported by
him, had decreased as compared with his first one-and-a-half years after his return from
Afghanistan. (Id.). His PTSD Checklist score, or PCL score, had improved significantly from
his intake in December 2012. (Id.; A.R. 352).3 Dr. Kapson assessed a GAF score of 55. (A.R.
345). She also diagnosed major depressive disorder, recurrent and mild; generalized anxiety

A GAF score of 51-60 indicates “[m]oderate symptoms (e.g. flat affect and circumstantial speech,
occasional panic attacks) or moderate difficulty in social, occupational, or school function (e.g., few friends,
conflicts with peers or social workers).” DSM-IV at 34.
2

3
A PCL score measures the severity of a patient’s PTSD; a lower score indicates a lesser severity. Ford’s
PCL score was 49 at his initial evaluation with Dr. Goetter on December 19, 2012. (A.R. 352). At his October 2,
2013, evaluation with Dr. Kapson, his PCL score was 35. (A.R. 343). According to estimates of the United States
Department of Veterans Affairs National Center for PTSD, the veteran cutoff for PTSD is a PCL greater than or
equal to 35, and the civilian cutoff is a PCL greater than or equal to 45. (A.R. 346).

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disorder; and adjustment disorder. (Id.). She also noted economic, occupational, and social
support problems. (Id.).
On October 30, 2013, Ford met with Ann R. Stewart, MSW, LICSW, to follow up on his
psychosocial needs. He informed her that his mother had passed away on October 11, 2013.
(A.R. 391). On November 12, 2013, Ford again saw Dr. Kapson and notified her of his recent
decision to move to Baltimore to be with his husband. (A.R. 385). Dr. Kapson noted that he
“appeared visibly relieved,” and expressed “looking forward to being in one place where he can
establish roots, refocus on his career, and build a life with his husband.” (Id.). Ford reported
that he generally felt more stable, but continued to struggle with sleep disturbances, fatigue,
motivation, and difficulty with change overall. (Id.). Ford’s MSE was normal, his PCL score
further improved to 31, and his GAF score was 60. (A.R. 385-86).
2.

State Agency Consultant Disability Determination – Dr. Walcutt

On November 13, 2013, Ford underwent a consultative psychiatric evaluation with Olga
Rossello, M.D., for his SSDI application. (A.R. 397). Ford recounted his experiences in
Afghanistan and reported sleeping problems, an “up and down” mood, irritability, and
concentration problems. (Id.). He reported that he stopped working because it exacerbated his
problems and caused him to be on edge and lose his patience. (A.R. 398). Dr. Rossello noted
that his MSE was normal and that he presented a cooperative attitude, a reactive affect, good
remote memory, and fair insight and judgment. (Id.). Ford reported that his typical day includes
“watch[ing] news, science, history stuff,” and that he could cook, clean, and shop independently.
(A.R. at 398). He stated that his hobbies were “cars [and] working out” and that he enjoyed
reading books about fishing and, for example, works by William Faulkner. (Id.). He explained
that when he goes to the market or mall, “he is comfortable with crowds if he gets in and out,”

5

and socially he “get[s] along with others . . . okay.” (Id.). Dr. Rosello assessed a GAF score of
504 and diagnosed PTSD. (A.R. at 399). She noted that his capability appeared fair and that his
condition could be improved by treatment. (Id.).
On November 25, 2013, Dr. Diana Walcutt, Ph.D., a state agency psychological
consultant, completed a Disability Determination Explanation form after reviewing Ford’s
medical records and Dr. Rosello’s evaluation. (A.R. 84-85, 88). Dr. Walcutt summarized and
cited to Ford’s treatment notes, and noted that Ford “suffers from extreme PTSD symptoms,
violent mood swings [and] insomnia.” (A.R. 86-88). She diagnosed severe anxiety disorder and
severe affective disorders that resulted in mild restriction of activities of daily living, moderate
difficulties in maintaining social functioning, moderate difficulties in maintaining concentration,
persistence, or pace, and one or two repeated episodes of decompensation of extended duration.
(A.R. 87-88). She further determined that despite Ford’s insomnia and moderate difficulty with
sustained concentration, he was able to understand and follow simple and complex instructions,
and he could read, shop, and prepare meals. (A.R. 91). Dr. Walcutt found that Ford experienced
mild to moderate limitations in areas dealing with continuity of performance and social
interactions. (A.R. 92). Ultimately, Dr. Walcutt determined that because Ford had “the ability to
interact and relate with others socially,” could “adequately negotiate in the general community,”
and retained “the capacity to perform simple tasks from a mental health perspective,” he was not
disabled. (A.R. 93).
3.

April 2014-November 2014

After relocating to Maryland, Ford began treatment on April 9, 2014, with Julie Eastin,

A GAF score of 41-50 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 at 34.
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Ph.D. (A.R. 420-25). Ford reported feeling “helpless,” “trapped,” withdrawn from people, and
unable to be proactive. (A.R. 420). He said he felt some anger and had scared himself after
punching a wall during an argument in January 2014. (Id.). He denied any thoughts of suicide,
but expressed that he “accomplished the goals [he] wanted to, and now there[’]s no reason left to
stay here.” (A.R. 423-24). He reported a stressful past few months because of his partner’s
“neediness” and feeling as though “he is a psychologist more than a husband.” (A.R. 421). He
noted that he used to enjoy music, reading, and writing, and that his recent efforts to write again
had been difficult because of his lack of concentration. (A.R. 422). Dr. Easton noted that his
MSE was normal. (A.R. 423). She assessed a PCL score of 70 and diagnosed PTSD. (A.R.
424).
Ford first saw Heather Chase, LCSW, on May 14, 2014. (A.R. 413). She noted that his
MSE presented a neutral affect and low mood, but was otherwise normal. (A.R. 413). Ford
reported difficulty concentrating, intrusive thoughts, guilt, insomnia, grief and loss, and
relational challenges. (Id.). He described thoughts of “not being here anymore,” but denied any
suicidal ideations. (Id.). Ford next met with Chase on May 29, 2014, and appeared “slightly
dysphoric” and “tired,” and became “tearful” in response to Chase’s discussion about coping
skills. (A.R. 412). At his next session on June 5, 2014, Ford presented with a neutral affect at
first, but overall displayed a dysphoric mood and affect. (A.R. 415). Chase performed no MSE.
(Id.). Ford stated that he recently experienced panic when expressing his needs to his husband
and described the grounding coping technique he used in response to that panic. (Id.). At his
fourth session with Chase on June 12, 2014, she noted no significant changes to Ford’s
presentation. (A.R. 417). She discussed more distress-tolerance skills with Ford. (Id.). There
are no treatment notes in the record from Chase after the June 12 appointment, but a behavioral

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health summary indicates Ford saw her 19 more times through November 25, 2014. (A.R. 478).
4.

State Agency Consultant Disability Determination, Dr. Nunez

On June 24, 2014, Jeannie Nunez, Psy.D., a state agency psychological consultant,
reconsidered Ford’s disability determination by reviewing Dr. Walcutt’s DDE and Ford’s
updated medical records. (A.R. 126-38). Dr. Nunez reaffirmed Dr. Walcutt’s conclusion. (A.R.
137-38).
5.

August 2014-January 2015 and Medical Opinions

On August 8, 2014, Ford saw Dr. Douglas Gartrell, M.D., and reported panic symptoms,
poor sleep, feeling unsafe when someone is behind him, some depression, anhedonia, and poor
appetite, energy, concentration, memory, and motivation. (A.R. 505). He reported flashbacks
and being triggered by sound because of his work trauma. (Id.). Dr. Gartrell noted that his MSE
reflected good hygiene; a cooperative attitude; clear speech; good eye contact; normal behavior;
a constricted, sad, and anxious affect; a dysphoric and anxious mood; an organized thought
process with thought content within normal limits; good insight and judgment; and no suicidal
risk. (A.R. 507-08). Dr. Gartrell diagnosed depressive disorder and PTSD, assessed a GAF
score of 60, and prescribed mirtazapine and Xanax. (A.R. 508-09). At an August 29, 2014
follow-up, Ford reported depression (“7/10”), sleeping a lot, anxiety, and isolation. (A.R. 495).
Ford’s MSE remained mostly unchanged, except for the addition of an irritable mood. (Id.).
On September 17, 2014, Chase wrote a letter to Ford’s representative discussing her work
with him since May 2014. (A.R. 432). She opined that Ford’s current symptoms of anxiety and
depression were “significant barriers to his ability to work,” and thus qualified him as disabled.
(Id.). She stated that Ford was working to gradually increase his exposure to crowds and social
settings, but found it “unlikely that [Ford] would be able to tolerate the continued social

8

interaction that comes with a full-time job” and that his challenges with focus and concentration
would render him unable to perform work reliably. (Id.). To support her opinion that Ford’s
“challenges with sleep and fatigue” would make it “difficult for [him] to attend a job on time and
reliably,” Chase cited the fact that he had missed weekly therapy “on a number of occasions” due
to his sleep problems. (Id.). Chase wrote a similar letter on November 20, 2014. (A.R. 472).
Chase also completed a mental assessment form on September 17, 2014, and indicated
that Ford had extreme limitations in his ability to relate to co-workers, deal with the public, deal
with work stressors, and maintain attention/concentration and marked limitations in his ability to
use judgment and understand, remember, and carry out complex job instructions. (A.R. 433-34).
She noted that Ford had mild to moderate limitations in other work capabilities, for example
functioning independently and following work rules. (A.R. 433). She assessed that his
“symptoms would likely make it difficult for [him] to attend work on time, reliably, and on a full
time basis” and “interact with the public and coworkers.” (A.R. 434-435). To support her
assessment, Chase relied on her diagnoses of PTSD and anxiety, as well as his flashbacks,
intrusive thoughts, difficulty sleeping, fatigue, and impaired concentration and memory. (Id.).
At an appointment with Dr. Gartrell on September 26, 2014, Ford reported continuing
sleep problems, depression, and somewhat improved PTSD. (A.R. 497). His MSE remained the
same, except his affect included a tearful affect and his insight improved to good. (A.R. 497-98).
The same day, Dr. Gartrell completed a mental assessment form. (A.R. 436-38). He opined that
Ford had extreme limitations in his ability to deal with work stressors; maintain attention and
concentration; and understand, remember, and carry out complex job instructions. (A.R. 43637). He also assessed marked limitations in Ford’s ability to relate to co-workers; deal with the
public; interact with supervisors; function independently; understand, remember, and carry out

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both detailed and simple job instructions; behave in an emotionally stable manner; relate
predictably in social situations; and demonstrate reliability. (Id.). He supported his opinion with
diagnoses of major depression; PTSD; poor concentration, energy, and motivation; severe
anxiety; poor stress tolerance; anger and irritability; and social impairment. (Id.). He
determined that because Ford met the criteria for major depression, PTSD, and agoraphobia, all
of his “physical or mental work related activity would be grossly impaired by severe depression,
irritability, negative thinking, and anxiety.” (A.R. 438). At the time, Ford was taking the
medications mirtazapine, Xanax, and Buspar. (Id.).5
At his appointment with Dr. Gartrell on October 7, 2014, Ford reported that his mood and
anxiety were improving. (A.R. 499). Dr. Gartrell noted that he had a full range of affect; a
euthymic, dysphoric, and anxious mood; and good concentration/memory, insight, and judgment.
(A.R. 499-500). Dr. Gartrell prescribed trazodone. (A.R. 500).6 On October 17, 2014, Ford
reported that his mood and anxiety continued to improve, his sleep was normalizing, and he was
coping with stress well. (A.R. 501). His MSE remained unchanged, except he also
demonstrated a sad and anxious affect and his concentration/memory was reduced to fair. (A.R.
501-02). On October 28, 2014, Ford reported that his mood was stable, and he was doing well
with anxiety and sleep and having no suicidal ideation. (A.R. 503). His MSE remained mostly

5

Mirtazapine is used to treat depression. Mirtazapine, MAYO CLINIC, http://www.mayoclinic.org/drugssupplements/mirtazapine-oral-route/description/DRG-20067334 (last visited Sept. 17, 2017).
Xanax is used to treat symptoms of anxiety, including anxiety caused by depression. Alprazolam, MAYO
CLINIC, http://www.mayoclinic.org/drugs-supplements/alprazolam-oral-route/description/drg-20061040 (last visited
Sept. 17, 2017).
Buspar is used to treat certain anxiety disorders. Buspirone, MAYO CLINIC, http://www.mayoclinic.org/
drugs-supplements/buspirone-oral-route/description/drg-20062457 (last visited Sept. 17, 2017).
6

Trazodone is used to treat depression. Trazodone, MAYO CLINIC, http://www.mayoclinic.org/drugssupplements/trazodone-oral-route/description/drg-20061280 (last updated Sept. 17, 2017).

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the same, except that he no longer presented a sad affect. (Id.).
Dr. Gartrell submitted a medical report for Ford on January 23, 2015, reporting that he
had “severe dysphoria and anxiety, irritability, poor concentration, and psychomotor retardation”
and suffered symptoms—including flashbacks, increased startle, nightmares, and hyper vigilance
with vague paranoia—related to trauma in Afghanistan. (A.R. at 443). He also noted that Ford
had shown some improvement over time with medication and supportive therapy. (Id.). He
noted that Ford’s sleep and mood had improved the most, but his anxiety and PTSD symptoms
were more persistent. (Id.).
6.

February 2015-March 2015

On February 3, 2015, Ford moved back to Massachusetts after separating from his
husband and returned to treatment at MGH under Dr. Kapson. (A.R. at 476). In a March 11,
2015 letter, Dr. Kapson noted that Ford “continues to experience regular interference in his life
from PTSD symptoms.” (Id.). She indicated that Ford was willing to engage in therapy, and had
already met with her for therapy three times since his return. (A.R. at 476).
C.

Administrative Hearing Testimony

Ford testified before the ALJ at a hearing on August 19, 2015. (A.R. 42). He testified
that his “most serious thing . . . is the sleep issues,” which have made it very difficult for him to
get “more than four hours of sleep” each night since 2011. (A.R. 49). He said his sleep
problems diminished his ability to concentrate, caused him to get frustrated very easily, and
exacerbated his anxiety. (A.R. 49-50). He testified that since 2011 his flashbacks have become
less vivid and he is less responsive to triggers, but his ability to socialize with people has become
worse. (A.R. 50). When the ALJ asked Ford to reconcile his marriage and relocation to
Baltimore with his reported inability to function socially, he responded that “if it weren’t for the

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PTSD, [he] wouldn’t have gotten married,” that “[i]t was . . . a grasp at something,” and that they
are now divorcing and not speaking. (A.R. 50-51).
Ford testified that his PTSD symptoms interfere with his daily living up to 10-15 times a
week, but there are some days when it is “quiet.” (A.R. 51). He told the ALJ that most days he
lies down during the day, for anywhere from thirty minutes to four hours. (A.R. 52). He still
experiences PTSD-related triggers from loud noises including helicopters, loud bangs, and
sirens, and large or unfamiliar crowds. (A.R. 56).
Ford further testified that he lives with his 76-year-old father, who suffers from multiple
sclerosis. (A.R. 52). He noted that although he helps care for his father, his father requires less
care than his mother did. (Id.). He stated that he shops for groceries, does the laundry, and
cooks for his father. (A.R. 53). He testified that although he had not read a book “within the last
four years,” he was “trying to get [his] brain active” so that he could get back to the things he
loves to do, including reading. (Id.). He noted that, apart from his “medical stuff” and “taking
care of [himself] and [his] father,” his “primary hobby” had been trying to lose weight and
working out at the YMCA, a 15-minute walk from his home. (A.R. 53-54). He noted that he
usually goes to the gym and grocery store when it is less crowded because of his social anxiety.
(A.R. 56). He also listens to music and sometimes watches television, but only spends 15-30
minutes each day on the computer because his low concentration causes him to lose patience.
(A.R. 54, 56).
Ford expressed that volunteering is something he “would like to do” and that he was
“trying to figure out ways to rebuild the social part of [his] life.” (A.R. 55). He noted that he
was currently “trying to rebuild basically all of [his] friendships” because over the past two years
they had “all kind of withered” due to his self-isolation. (A.R. 57).

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II.

Procedural History
Ford applied for SSDI and SSI benefits on July 19, 2013, alleging a disability-onset date

of January 1, 2013. (A.R. at 25). He appeared for a hearing before the ALJ on August, 19, 2015.
(A.R. at 44). On August 31, 2015, the ALJ concluded that Ford was not disabled, and on August
2, 2016, the Appeals Council denied his request for review. (A.R. at 1, 35). On October 3, 2016,
Ford filed the present action seeking review of the decision of the Acting Commissioner pursuant
to 42 U.S.C. § 405(g).
III.

Analysis
A.

Standard of Review

Under the Social Security Act, this Court may affirm, modify, or reverse the final
decision of the Commissioner, with or without remanding the case for a rehearing. 42 U.S.C.
§ 405(g). The ALJ’s finding on any fact shall be conclusive if it is supported by substantial
evidence and must be upheld “if a reasonable mind, reviewing the evidence in the record as a
whole, could accept it as adequate to support his conclusion,” even if the record could justify a
different conclusion. Rodriguez v. Sec’y of Health & Human Servs., 647 F.2d 218, 221 (1st Cir.
1981); see also Evangelista v. Sec’y of Health & Human Servs., 826 F.2d 136, 144 (1st Cir.
1987).
It is for the Commissioner, not the reviewing court, to evaluate credibility, draw
inferences from the evidence, and resolve conflicts in the evidence. Rodriguez, 647 F.2d at 222.
While the ALJ must take medical evidence into account, “the determination of the ultimate
question of disability is for [the Commissioner], not for the doctors or for the courts.” Lizotte v.
Sec’y of Health & Human Servs., 654 F.2d 127, 128 (1st Cir. 1981) (quoting Rodriguez, 647
F.2d at 222). Therefore, reversal is warranted only if the ALJ committed a legal error or if the
ALJ’s factual findings fail the substantial-evidence standard. See Roman-Roman v. Comm’r of
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Soc. Sec., 114 F. App’x. 410, 411 (1st Cir. 2004); Ward v. Comm’r of Soc. Sec., 211 F.3d 652,
655 (1st Cir. 2000). Questions of law, to the extent that they are at issue in this appeal, are
reviewed de novo. See Seavey v. Barnhart, 276 F.3d 1, 9 (1st Cir. 2001).
B.

Standard for Entitlement to SSDI or SSI Benefits

To qualify for SSDI or SSI benefits, a claimant must be “disabled” within the meaning of
the Social Security Act. See 42 U.S.C. §§ 1382(a)(1), 1382c(a)(3) (setting forth the definition of
“disabled” in the context of SSI). A claimant is “disabled,” in relevant part, if he or she 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 twelve months.” 42 U.S.C.
§ 1382c(a)(3)(A). The impairment must be severe enough to prevent the claimant from
performing not only past work, but any substantial gainful work existing and available in the
national economy. 42 U.S.C. § 1382c(a)(3)(B); 20 C.F.R. § 416.960(c)(1).
To determine whether a claimant is disabled, the Commissioner applies a five-step
analysis. See 20 C.F.R. §§ 404.1520(a), 416.920(a). The steps proceed as follows:
1) if the applicant is engaged in substantial gainful work activity, the application
is denied; 2) if the applicant does not have, or has not had . . . a severe impairment
or combination of impairments, the application is denied; 3) if the impairment
meets the conditions for one of the ‘listed’ impairments in the Social Security
regulations, then the application is granted; 4) if the applicant's ‘residual
functional capacity’ is such that he or she can still perform past relevant work,
then the application is denied; 5) if the applicant, given his or her residual
functional capacity, education, work experience, and age, is unable to do any
other work, the application is granted.
Seavey, 276 F.3d at 5; see also 20 C.F.R. § 404.1520(a)(4). The claimant has the burden of
production and proof during steps one through four, and the Commissioner has the burden at step
five to offer evidence that other work exists in significant numbers in the national economy that

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the claimant can perform. Freeman v. Barnhart, 274 F.3d 606, 608 (1st Cir. 2001). At step five,
the ALJ assesses the claimant’s RFC in combination with the vocational factors of the claimant’s
age, education, and work experience to determine whether he can “engage in any . . . kind of
substantial gainful work which exists in the national economy.” See 42 U.S.C. §§ 423(d)(2)(A),
1382c(a)(3)(B); 20 C.F.R. § 404.1560(c)(1).
C.

The ALJ’s Findings

In evaluating the evidence, the ALJ followed the five-step process set forth in 20 C.F.R.
§ 404.1520(a)(4) to determine whether Ford had been disabled from January 1, 2013, his alleged
disability onset date, through the date of the decision.
At the first step, he expressly found that Ford had not engaged in substantial gainful
activity since January 1, 2013. (A.R. 27).
At the second step, the ALJ concluded that Ford had the following impairments: obesity,
PTSD, depression, and anxiety. (Id.) Because those impairments more than minimally limit his
ability to perform work-related activities, the ALJ considered them “severe.” (Id.).
At the third step, the ALJ determined that Ford’s impairments, considered separately and
in combination, did not meet or medically equal the severity of any of the listed impairments in
20 C.F.R. Part 404, Subpart P, Appendix 1. (A.R. 28; see 20 C.F.R. § 404.1520(d)). He found
that Ford experienced mild difficulties in activities of daily living, moderate difficulties in social
functioning, and moderate difficulties concerning concentration, persistence, or pace. (A.R. 2829).
At the fourth step, the ALJ determined Ford’s RFC precluded him from performing any
past relevant work. (A.R. 33). He found that he has the RFC to perform a medium level of work,
except that he:

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is unable to sustain complex tasks; is able to perform repetitive one to five-step
tasks; is able to work without supervision; is able to work in the vicinity of
coworkers and tolerate casual contact with coworkers but is unable to perform
tandem tasks; and is unable to perform work requiring him to provide information
to or receive information from the general public; but can tolerate basic,
momentary, casual contact with the public such as taking tickets, checking off
names, or making change.
(A.R. 29). After reviewing the evidence, the ALJ found that Ford’s medically determinable
impairments could reasonably be expected to cause the alleged symptoms. (A.R. 30). However,
he found that his statements concerning the intensity, persistence, and limiting effects of his
symptoms were “not entirely credible,” because they were inconsistent with his substantial
reported activities, treatment notes, and with the record as a whole. (A.R. 30-33). Accordingly,
he gave great weight to the opinions of the reviewing Disability Determination Services medical
and psychological consultants, Dr. Walcutt and Dr. Nunez, and little weight to the opinions of Dr.
Kapson, Dr. Gartrell, and Heather Chase. (A.R. 32-33).
At step five, the ALJ considered Ford’s age, education, work experience, and RFC in
conjunction with the Medical Vocational Guidelines of 20 C.F.R. Part 404, Subpart P, Appendix
2, and concluded that jobs exist in significant numbers in the national economy that he can
perform. (A.R. 33). The ALJ posed the following hypothetical to vocational expert Ruth Baruch:
[C]onsider that the claimant . . . can understand and provide written
instructions . . . [,] can keep and maintain a list, a sign-in sheet, something of that
nature as well . . . [, and] is capable of performing up through the medium level of
work on a sustained basis . . . . He has non-exertional limitations . . . . The
combination, or individually of the effects of his depression, his anxiety, will, at
times, during the day affect his concentration, his memory, his attention to task,
his ability to follow instructions, his ability to conform to changes in the work
environment. As a result he is not capable of sustaining complex tasks. To
compensate, he is clearly capable of performing one to five-step repetitive tasks.
He is able to work without supervision. He is able to work with co-workers,
however, only on a casual basis. . . . Because during the day he’s going to have
deficiencies in his concentration, his attention to task, his ability to follow
instructions, he should not work in tandem with other co-workers . . . . [T]he
same issues that affect his ability to work in tandem affect his ability to work with
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the public.
(A.R. 59-60). Baruch testified that there were jobs for such a hypothetical claimant in the
national economy in significant numbers. (A.R. 61). Based on that response, the ALJ determined
that Ford would be able to perform the requirements of representative unskilled occupations, such
as a bench assembler or mail clerk, which require light work, or a kitchen helper, which requires
medium work. (A.R. 34). Those jobs are available in Massachusetts and the national economy.
(Id.). Accordingly, the ALJ concluded that Ford is not disabled. (Id.).
D.

Plaintiff’s Objections

Ford raises three objections to the ALJ’s findings. He contends that the ALJ (1) failed to
give proper weight to the medical opinion evidence of Dr. Gartrell and Chase; (2) made an
improper credibility determination that is not supported by substantial evidence; and (3) failed to
properly account for his moderate mental limitations when presenting a hypothetical question
concerning his RFC to the vocational expert.
1.

Weighing of Medical Opinion Evidence

Ford contends that the ALJ erred in making its RFC determination by failing to give
significant weight to the medical opinions of his treating physicians. Specifically, he points to the
reports of Dr. Gartrell and Chase, and asserts that the ALJ inappropriately discounted their
opinions in favor of the findings of the state agency psychological consultants, Dr. Walcutt and
Dr. Nunez.
In making an RFC determination, a treating source’s opinion that is “well-supported by
medically acceptable clinical and laboratory diagnostic techniques and is not inconsistent with the
other substantial evidence” may be given controlling weight. 20 C.F.R. § 404.1527(c)(2); see
also Conte v. McMahon, 472 F. Supp. 2d 39, 48 (D. Mass. 2007). ALJs are “granted discretion to

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resolve any evidentiary conflicts or inconsistencies,” and “‘the law in this circuit does not require
ALJs to give greater weight to the opinions of treating physicians.’” Hughes v. Colvin, 2014 WL
1334170, at *8 (D. Mass. Mar. 28, 2014) (quoting Arroyo v. Sec’y of Health & Human Servs., 932
F.2d 82, 89 (1st Cir. 1991)); see also Pagan v. Sec’y of Health & Human Servs., 819 F.2d 1, 3
(1st Cir. 1987) (explaining that medical opinions of treating physicians are not inherently entitled
to greater weight than consulting physicians’ opinions). The regulations permit ALJs to give
lesser weight to an opinion from a treating source where it is “internally inconsistent or
inconsistent with other evidence in the record including treatment notes and evaluations by
examining and nonexamining physicians.” Arruda v. Barnhart, 314 F. Supp. 2d 52, 72 (D. Mass.
2004); see 20 C.F.R. § 404.1527(c)(2)-(4). Opinions that are not given controlling weight are
evaluated based on the length, nature, and extent of the treatment relationship; support from
medical evidence; consistency of the opinion with the record; and specialization of the doctor. 20
C.F.R. § 404.1527(c). The ALJ must also “give good reasons . . . for the weight [he] give[s the]
treating source’s medical opinion.” 20 C.F.R. § 404.1527(c)(2).
The ALJ’s decision to give “less weight” to the opinions of Dr. Gartrell and Chase was
justified. (A.R. 32-33). The ALJ reviewed the reports of both Dr. Gartrell and Chase and
determined that their assessments were not only inconsistent with the record and consulting
physicians’ opinions but were also undermined by their own mostly benign MSEs and treatment
notes. (Id.). Specifically, the ALJ found a disconnect between the severity of Ford’s symptoms,
as described in the record and treatment notes, and the limitations described by Dr. Gartrell and
Chase. He stated that Dr. Gartrell and Chase’s assessments of “numerous marked and extreme
limitations . . . are contradicted by the claimant’s substantial reported activities, which have
included serving as the primary caregiver to his ill parents, maintaining a garden, working out at

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the YMCA, shopping for groceries, preparing meals, doing laundry, using public transportation,
driving, paying bills, and managing financial accounts.” (A.R. 33). The ALJ also pointed to
Chase’s treatment notes that documented findings of “sadness and/or dysphoria[,] but no other
serious mental status abnormalities.” (A.R. 31). That is substantial evidence to support the
ALJ’s assessment of the weight to give to Dr. Gartrell’s and Chase’s opinions.
Moreover, the mere presence of conflicting evidence in the record is insufficient to
overturn the ALJ’s findings when they are otherwise supported by substantial evidence. See
Pagan, 819 F.2d at 3 (finding that “the resolution of such conflicts in the evidence is for the
Secretary”). Thus, even if the evidence Ford points to was required to be given more weight, it
would not allow this Court to rule in his favor unless the evidence the ALJ ultimately relied on
was insufficient or incorrect. See Greene v. Astrue, 2012 WL 1248977, at *3 (D. Mass. Apr. 12,
2012) (explaining that because the court’s standard of review is for substantial evidence, plaintiff
cannot simply point to evidence in the record supporting his position; he must demonstrate that
the evidence relied on by the ALJ is insufficient or incorrect).
Here, the ALJ’s reliance on the opinions of consulting physicians Dr. Walcutt and Dr.
Nunez is likewise supported by substantial evidence. The consulting physicians determined,
based on medical records by Ford’s examining and treating physicians, that he had the capacity
to perform simple tasks with limited interpersonal contact. (A.R. 92-93; A.R. 137-38). The
reports of Dr. Walcutt and Dr. Nunez considered in detail objective and subjective reports of
Ford’s continuing anxiety and insomnia and their negative effects on his mood and cognition.
(A.R. 100-01; A.R. 117-18). Dr. Walcutt and Dr. Nunez found that, despite his moderate mental
and cognitive restrictions, Ford “is responding well to treatment,” “functions in a generally
independent fashion,” “can meet various person needs from a mental standpoint,” and “retains

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the capacity to perform simple tasks from a mental health perspective.” (A.R. 122-23). Based
on Ford’s treatment notes and substantial documented daily activities, it was reasonable for the
ALJ to find Dr. Walcutt’s and Dr. Nunez’s opinions consistent with other substantial evidence in
the record and thus give them significant weight. (A.R. 32).
Ford contends that the ALJ erred by giving the opinions of non-examining physicians
significant weight because they did not address medical evidence generated after June 24, 2014.
(Pl.’s Mem. 14). The opinion of a non-examining consultant cannot serve as substantial
evidence if it is “based on a significantly incomplete record” and fails to account for a
deterioration in the claimant’s condition. Alcantara v. Astrue, 257 F. App’x 333, 334 (1st Cir.
2007). However, the ALJ may rely on older evidence from a non-examining consultant when
the information remains accurate and there have been no appreciable changes in the claimant’s
symptoms or functional limitations in the evidence post-dating the assessment. McNelley v
Colvin, 2016 WL 2941714, at *2 (1st Cir. 2016). Here, the only pieces of evidence that Ford
alleges were not considered are Dr. Gartrell’s and Chase’s opinions, to which the ALJ justifiably
ascribed little weight. In addition, both Dr. Gartrell’s and Chase’s treatment notes indicate that
Ford’s condition improved after June 24, 2014, if anything. It was not until August 8, 2014, that
Dr. Gartrell began treating Ford with medication, and at both his October 7 and October 17, 2014
appointments with Dr. Gartrell, Ford reported that his mood and anxiety were improving, his
sleep was normalizing, and he was coping with stress well. His MSEs also remained mostly
unchanged after June 24, 2014, according to Dr. Gartrell and Chase’s notes. Therefore, the
ALJ’s reliance on the non-examining physicians’ opinions was supported by substantial
evidence.

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2.

Plaintiff’s Credibility

Ford next contends that the ALJ’s basis for finding him “not entirely credible” is not
supported by substantial evidence. Specifically, he contends that the ALJ, in determining his
credibility, improperly found that he stopped working to care for his parents, made inconsistent
statements about reading, was assessed GAF scores that were inconsistent with disability, and
had gaps in treatment.
Because the credibility determination is for the ALJ to make, this Court must accept his
conclusions as long as they are supported by substantial evidence. See Ramirez v. Sec’y of
Health, Educ. & Welfare, 550 F.2d 1286, 1286 (1st Cir. 1977); Musto v. Halter, 135 F. Supp. 2d
220, 226-27 (D. Mass. 2001). When evaluating a plaintiff’s credibility, the ALJ “must make
specific findings as to the relevant evidence he considered in determining to disbelieve the
[claimant].” Da Rosa v. Sec’y of Health & Human Servs., 803 F.2d 24, 26 (1st Cir. 1986).
Alleged functional limitations due to symptoms must be reasonably consistent with medical
evidence and other evidence in the record. 20 C.F.R. § 404.1529. Factors considered in
assessing the severity of symptoms include daily activities; location, duration, frequency, and
intensity of symptoms; type, dosage, effectiveness, and side effects of medication; and treatment
or any other measures used to relieve symptoms. Id.; see also Avery v. Sec’y of Health & Human
Servs., 797 F.2d 19, 29 (1st Cir. 1986). However, an ALJ is not required to specifically discuss
all of these factors in making a decision as long as it is clear from the record as a whole that they
were considered. Deforge v. Astrue, 2010 WL 3522464, at *9 (D. Mass. Sept. 9, 2010).
Here, the ALJ reasonably determined that Ford was not entirely credible. Ford is
incorrect to state that there is no evidence that he stopped working to care for his parents rather
than due to his medical condition. To support his credibility determination, the ALJ referred to

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Dr. Kapson’s treatment notes, which indicated that Ford stopped working in order to care for his
ailing parents. (A.R. 31; A.R. 343). In addition, Dr. Goetter opined that Ford’s symptoms were
exacerbated by numerous psychosocial stressors, including his parents’ failing health and
demanding job. (A.R. 352-53). Ford himself told Dr. Gorman that his “work/travel schedule”
and “caretaking for parents” caused him stress. (A.R. 368).
Ford further faults the ALJ’s alleged reliance on his GAF scores, gaps in treatment, and
inconsistent statements concerning reading. However, Ford misstates the ALJ’s justification.
Although the ALJ did mention those issues, he did not rely solely on them in assessing Ford’s
credibility. Rather, to support his finding that Ford’s symptoms and limitations are not as severe
as alleged, the ALJ mentioned his GAF scores in combination with other medical evidence,
including treatment notes, and his substantial reported activities. (A.R. 29-33); see Bourinot v.
Colvin, 95 F. Supp. 3d 161, 178 (D. Mass. 2015) (citing Administrative Memorandum AM13066) (stating the SSA’s policy that although ALJs can still consider GAF scores as some
evidence, they cannot solely rely on the GAF scores and there must be other supporting
evidence); see also Navedo v. Colvin, 2016 WL 3029943, at *12 (D. Mass. May 25, 2016).
In short, the ALJ’s decision to give Ford’s claims limited weight is supported by
substantial medical evidence and will not be overturned.
3.

RFC Hypothetical

Finally, Ford argues that the ALJ erred by failing to accurately describe all of his mental
limitations when presenting a hypothetical RFC to the vocational expert at the hearing.
Specifically, he contends that the hypothetical used by the ALJ did not include his limitations
due to his moderate difficulties with concentration, persistence, or pace, and stated only that he
was mentally limited to one- to five-step repetitive tasks. The hypothetical posed by the ALJ to

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the vocational expert must include and accurately describe all of the claimant’s relevant
impairments. See Arocho v. Sec’y of Health & Human Servs., 670 F.2d 374, 375 (1st Cir. 1982);
Aho v. Comm’r of Soc. Sec. Admin., 2011 WL 3511518, at *7 (D. Mass. Aug. 10, 2011).
But the ALJ’s hypothetical did include Ford’s mental limitations. In the hypothetical, the
ALJ referred to Ford’s concentration, persistence, or pace restrictions as the reason for his
inability to work in tandem with others and sustain complex tasks. He stated that Ford’s
impairments “affect his concentration, his memory, his attention to task, his ability to follow
instructions, [and] his ability to conform to changes in the work environment.” (A.R. 60). He
later explained that “during the day, [claimant will] have deficiencies in his concentration, his
attention to task, [and] his ability to follow instructions.” (Id.). The hypothetical specifically
accounted for Ford’s moderate concentration, persistence, or pace difficulties beyond the realm
of social functioning. Thus, the ALJ fully accounted for his limitations and committed no error.
IV.

Conclusion
For the foregoing reasons, plaintiff’s motion for judgment on the pleadings reversing the

ALJ’s decision is DENIED, and defendant’s motion for an order to affirm the decision of the
Commissioner is GRANTED.
So Ordered.
/s/ F. Dennis Saylor
F. Dennis Saylor IV
United States District Judge

Dated: September 28, 2017

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