Roberts v. Astrue

Filing 25

MEMORANDUM AND ORDER: IT IS HEREBY ORDERED that the final decision of the Commissioner is affirmed, and plaintiff's Complaint is dismissed with prejudice. A separate Judgment in accordance with this Memorandum and Order is entered this same date. Signed by Magistrate Judge Noelle C. Collins on 7/22/2014. (JMC)

UNITED STATES DISTRICT COURT
EASTERN DISTRICT OF MISSOURI
SOUTHEASTERN DIVISION

DEBRA K. ROBERTS,
Plaintiff,
v.
CAROLYN W. COLVIN, Acting
Commissioner of Social Security,
Defendant.

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No. 1:12CV177 NCC

MEMORANDUM AND ORDER
This is an action under 42 U.S.C. § 405(g) for judicial review of the
Commissioner’s final decision denying Debra K. Roberts’ application for disability
insurance benefits under Title II of the Social Security Act, 42 U.S.C. §§ 401, et
seq. All matters are pending before the undersigned United States Magistrate
Judge, with consent of the parties, pursuant to 28 U.S.C. § 636(c). Because the
Commissioner’s final decision is supported by substantial evidence on the record
as a whole, it is affirmed.
I. Procedural History
On January 7, 2010, the Social Security Administration denied plaintiff
Debra K. Roberts’ November 3, 2009, application for disability insurance benefits
(DIB) in which she claimed she became disabled on December 31, 2003, because

of depression and a heart condition. (Tr. 77, 79-82, 155; Suppl. Tr. 607-13.) Upon
plaintiff’s request, a hearing was held before an administrative law judge (ALJ) on
March 15, 2011, at which plaintiff and a vocational expert testified. (Tr. 34-75.)
On June 15, 2011, the ALJ issued a decision denying plaintiff’s claim for benefits
finding that, during her period of insured status, plaintiff was able to perform work
as it exists in significant numbers in the national economy, and specifically, office
cleaner, maid, and small parts assembler. (Tr. 7-19.) On August 29, 2012, upon
review of additional evidence, the Appeals Council denied plaintiff’s request for
review of the ALJ's decision. (Tr. 1-5.) The ALJ's determination thus stands as
the final decision of the Commissioner. 42 U.S.C. § 405(g).
In the instant action for judicial review, plaintiff claims that the ALJ’s
decision is not supported by substantial evidence on the record as a whole and
specifically argues that the ALJ failed to consider all of the relevant evidence of
record in determining her credibility and mental residual functional capacity
(RFC). Plaintiff also claims that the ALJ erred in discounting the opinions
rendered by her treating psychiatrist. Plaintiff requests that the final decision be
reversed and that the matter be remanded for further consideration. For the reasons
that follow, the ALJ did not err in his determination.1
1

The undersigned has reviewed the entirety of the administrative record in determining whether
the Commissioner’s adverse decision is supported by substantial evidence. However, inasmuch
as plaintiff challenges the decision only as it relates to her mental impairment and not as it relates
to any physical impairment, the recitation of specific evidence in this Memorandum and Order is
-2-

II. Relevant Testimonial Evidence Before the ALJ
A.

Plaintiff’s Testimony
At the hearing on March 15, 2011, counsel clarified that plaintiff’s date last

insured for Title II purposes was June 30, 2005, and that plaintiff must establish
disability on or before that date. (Tr. 38.)
At the time of the hearing, plaintiff was fifty-eight years of age. Plaintiff has
a college degree in health information management. (Tr. 39.)
Plaintiff’s Work History Report shows that plaintiff worked as a medical
office administrator from 1990 to 1998. From 1998 to 2003, plaintiff was selfemployed doing medical billing. From 2003 to 2006, plaintiff worked as a
substitute teacher. (Tr. 162.) Plaintiff testified that she was self-employed on a
part-time basis for three or four months in 2006 performing medical billing, with
the goal that she would take over the billing responsibilities for the respective
doctor. (Tr. 43, 45.) Plaintiff testified that the doctor did not keep her on because
it was not a “good fit.” (Tr. 44.) Plaintiff testified that she is also a member of the
board of directors for her husband’s commercial construction business, but that she
has no duties with this position. (Tr. 46.)
Plaintiff testified that she has experienced depression since she was fifteen
or sixteen years of age and became unable to work beginning in 2003 because of
limited to only that evidence relating to the issues raised by plaintiff on this appeal.
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her inability to organize and remember things. (Tr. 47, 61.) Plaintiff testified that
she did not apply for disability benefits until 2009 because she did not feel well
enough to undertake the application process. Plaintiff testified that new
medication provided in 2009 “perked [her] up” enough to proceed. (Tr. 47-48.)
Plaintiff testified that she first underwent mental health treatment in the late
1990s but began consistently receiving such treatment in 2003. (Tr. 48.) Plaintiff
testified that she has been prescribed different medications and underwent shock
treatment in 2003. Plaintiff testified that her doctor has recommended that she
undergo additional shock treatments. (Tr. 50.)
Plaintiff testified that, during the relevant period of alleged disability, she
experienced problems with racing and suicidal thoughts as well as crying spells,
stress, and anxiety. Plaintiff testified that she also had panic attacks during which
her mouth would become dry, she would feel sick to her stomach, and she could
not stand up. (Tr. 60-63.)
Plaintiff testified that she raised her son during the relevant period and
attended his high school football games when she felt well enough to go. Plaintiff
testified that her son played football all four years of high school and that she
attended about half of his games. (Tr. 54-55.) Plaintiff testified that she did not
volunteer for any school functions because she had difficulty interacting with
people. (Tr. 58.) Plaintiff testified that she maintained her home during the
-4-

relevant period but did not shop for groceries because it involved leaving the
house. Plaintiff testified that she left the house once every week or two and only
when she absolutely had to. (Tr. 55.) Plaintiff testified that someone came to deep
clean her house every two weeks. (Tr. 61.)
Plaintiff testified that she engaged in no hobbies or activities during the
relevant period because she “slept for five years” (Tr. 57), sleeping up to twenty
hours a day (Tr. 58). Plaintiff testified that she would try to watch television or
read a book but could not remember content. (Tr. 61.) Plaintiff testified that she
would go seven to ten days without showering. (Tr. 59-60.) Plaintiff testified that
she experienced bad days four or five days a week, resulting in her staying in her
pajamas and lying on the couch. Plaintiff testified that she could go to the grocery
store and do laundry on good days. (Tr. 62.) Plaintiff testified that her current
medication helps keep her awake. (Tr. 52-53.)
Plaintiff testified that her work as a substitute teacher during the relevant
period involved her responding to a telephone call the morning that the school
needed a teacher. Plaintiff testified that she accepted approximately every other
call to teach. (Tr. 56-57.)
Plaintiff testified that she has not vacationed in the past ten years. Plaintiff
testified that she was recently able to engage in some gardening the previous
summer when she was given her new medication that perked her up. (Tr. 57-58.)
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B.

Testimony of Vocational Expert
James M. Englund, Jr., a vocational expert, testified at the hearing in

response to questions posed by the ALJ and counsel.
Mr. Englund classified plaintiff’s past work as a medical biller as sedentary
and skilled; and as a medical office administrator as light and skilled as actually
performed by plaintiff, and sedentary as generally performed in the economy. (Tr.
68.)
The ALJ asked Mr. Englund to assume an individual with plaintiff’s
education and past relevant work experience and to further assume the individual
had no exertional limitations but was limited to simple, routine tasks in a low stress
environment with only occasional decision making or occasional changes in the
work setting, and only occasional interaction with the public and coworkers and
supervisors. Mr. Englund testified that such a person could not perform plaintiff’s
past relevant work but could perform other work such as office cleaner, of which
24,000 such jobs exist in the State of Missouri; maid, of which 10,000 such jobs
exist in the State of Missouri; and small parts assembler, of which 15,000 such jobs
exist in the State of Missouri. (Tr. 70-71.)
The ALJ then asked Mr. Englund to assume the same individual with the
same limitations, with one change being that the person was limited to no decision
making. Mr. Englund testified that such a person could perform the work as
-6-

previously described and at the same numbers as previously set out. Mr. Englund
testified that the person would not be able to perform such work, or any other
work, if maintaining quotas was required. (Tr. 71-72.)
In response to counsel’s question, Mr. Englund testified that a person who
missed work two or three days a month on an unscheduled basis would not be able
to maintain any type of employment. (Tr. 72-73.)
III. Relevant Medical Records Before the ALJ
Plaintiff visited Dr. Luis Giuffra on May 28, 2003, and complained of
feeling anxious and irritable with increased negativity. Plaintiff reported having a
history of major depressive disorder and that she had tried many antidepressant
medications in the past, including Prozac, Wellbutrin SR (WSR), Paxil, Celexa,
and Sinequan. Plaintiff reported that her sleep and appetite were okay. Plaintiff
reported her mood to change very quickly and that she had racing thoughts.
Plaintiff reported having crying spells and occasional death wishes. Mental status
examination showed plaintiff to be calm and cooperative. Plaintiff’s mood was
euthymic, and her insight and judgment were noted to be fair. Dr. Giuffra noted
plaintiff to meet numerous criteria for adult attention deficit disorder (ADD). Dr.
Giuffra questioned whether plaintiff had bipolar disorder or ADD. Plaintiff was
assigned a Global Assessment of Functioning (GAF) score of 70.2 Plaintiff was
2

A GAF score considers “psychological, social, and occupational functioning on a hypothetical
-7-

prescribed Lamictal3 and was instructed to return in one month. (Tr. 249.)
On June 9, 2003, plaintiff reported to Dr. Giuffra that she felt better but was
agitated. (Tr. 249.) On June 25, plaintiff reported that she had “calmed down
tremendously” and was doing better. Plaintiff reported that she continued to be
“quick to tears,” but her husband noted improvement. Mental status examination
was normal in that plaintiff was well dressed and groomed; had logical and
sequential flow of thought; clear sensorium; no suicidal or homicidal ideations; and
no psychosis. Plaintiff was noted to be euthymic. Dr. Giuffra noted that plaintiff
had three children with her and that she planned to take them to Six Flags.
Plaintiff was prescribed Lamictal, WSR, and Trazodone4 and was instructed to
return in six weeks. (Tr. 248.)
On August 29, 2003, plaintiff reported to Dr. Giuffra that she was really
down. Plaintiff reported having occasional crying spells and passive death wishes.
Mental status examination showed plaintiff to have a dysthymic affect but was
otherwise normal with no changes from the previous exam. Plaintiff reported
continuum of mental health/illness.” Diagnostic and Statistical Manual of Mental Disorders,
Text Revision 34 (4th ed. 2000). A GAF score of 61 to 70 indicates some mild symptoms (e.g.,
depressed mood and mild insomnia) or some difficulty in social, occupational, or school
functioning (e.g., occasional truancy, or theft within the household), but generally functioning
pretty well, has some meaningful interpersonal relationships.
3

Lamictal is used to treat bipolar disorder. Medline Plus (last revised Feb. 1, 2011)< http://
www.nlm.nih.gov/medlineplus/druginfo/meds/a695007.html>.
4

Trazodone is used to treat depression. Medline Plus (last revised Jan. 15, 2014)< http://www.
nlm.nih.gov/medlineplus/druginfo/meds/a681038.html>.
-8-

being out of a job. Plaintiff reported having some functioning difficulties with her
medications. Dr. Giuffra noted that plaintiff stopped taking Trazodone on her own.
Dr. Giuffra instructed plaintiff to continue with WSR and to increase her dosage of
Lamictal. She was prescribed Abilify5. (Tr. 247.)
On September 19, 2003, plaintiff reported to Dr. Giuffra that she felt great
for two weeks but was currently “very bad” and felt more depressed and anxious.
Plaintiff reported having poor sleep. Dr. Giuffra instructed plaintiff to discontinue
Abilify. Seroquel6 and an antidepressant, Effexor, were prescribed. (Tr. 247.)
Plaintiff visited Dr. Giuffra on October 9, 2003, and reported that she was
somewhat better but continued to be depressed. Plaintiff reported having
anhedonia and that she spent most of her time in bed. Plaintiff reported that she
did not want to do anything with her family. Plaintiff reported having a low
appetite, increased sleep, and increased death wishes. Plaintiff reported not having
any crying spells. Mental status examination showed plaintiff to have a dysthymic
mood but was other normal. Plaintiff reported that she got along well with her
husband and son. Plaintiff was noted to tolerate her medications well. Dr. Giuffra
5

Abilify is used to treat episodes of mania in persons with bipolar disorder, and is used with an
antidepressant when the antidepressant alone does not control symptoms of depression. Medline
Plus (last revised May 16, 2011)< http://www.nlm.nih.gov/medlineplus/druginfo/meds/
a603012.html>.

6

Seroquel is used to treat bipolar disorder as well as with other medications to treat depression.
Medline Plus (last revised Apr. 15, 2014)< http://www.nlm.nih.gov/medlineplus/druginfo/meds/
a698019.html>.
-9-

noted plaintiff to have stopped taking Seroquel because it made her too sleepy.
Plaintiff was instructed to discontinue WSR and to increase her dosages of
Lamictal and Effexor. (Tr. 246.)
On November 13, 2003, plaintiff reported to Dr. Giuffra that she was doing
poorly. Plaintiff had no suicidal ideations. (Tr. 246.)
Plaintiff visited Dr. Giuffra on December 5, 2003, and reported that she was
more depressed and slept all of the time. Anhedonia was noted, and plaintiff
reported that she did not want to leave the house. Dr. Giuffra also noted
psychomotor retardation. Plaintiff expressed that she did not “want to live like
this.” Plaintiff’s mood was dysthymic, but mental status examination was
otherwise normal. Dr. Giuffra determined to admit plaintiff for ECT (electroconvulsive therapy). (Tr. 244.)
Plaintiff was admitted to St. John’s Mercy Medical Center on December 5,
2003, with an admitting diagnosis of major depression and a GAF score of 30.7 It
was noted that plaintiff’s depression was worsening, and she had failed numerous
antidepressants. It was also noted, however, that plaintiff had been poorly
compliant with her medication. Plaintiff was noted to be spending most of her
time in bed and to have hypersomnia. Plaintiff received three ECT treatments and
7

A GAF score of 21-30 indicates behavior that is considerably influenced by delusions or
hallucinations, or serious impairment in communication or judgment (e.g., sometimes
incoherent, acts grossly inappropriately, suicidal preoccupation), or inability to function in
almost all areas (e.g., stays in bed all day, no job, home, or friends).
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medication management during her hospitalization, from which she obtained some
improvement. Upon discharge, plaintiff agreed to continue with ECT on an
outpatient basis. Plaintiff was discharged on December 12, 2003, with a diagnosis
of major depression and a GAF score of 50.8 Plaintiff’s discharge medications
included Effexor and Lamictal. Plaintiff was scheduled to return for outpatient
ECT on December 15, 2003. (Tr. 191-214.)
Between December 15, 2003, and January 9, 2004, plaintiff underwent five
outpatient ECT treatments. (Tr. 577-95.)
Plaintiff visited Dr. Giuffra on January 14, 2004, who noted plaintiff to be
taking a lower dosage of Effexor. (Tr. 244.) On January 19, plaintiff reported
feeling about fifty percent better, and plaintiff’s husband reported that she
continued to improve. Plaintiff reported eating better and not spending much time
in bed. Plaintiff had no death wishes. It was noted that plaintiff had been able to
do some work at home. Dr. Giuffra noted plaintiff’s mood to continue to be
dysthymic, but mental status examination was otherwise normal. A determination
was made to hold off on additional ECT treatments, and plaintiff was made aware
of the risk of relapse. It was also noted that plaintiff was now taking Lithobid.9
8

A GAF score of 41-50 indicates serious 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).

9

Lithobid is used to treat bipolar disorder. Medline Plus (last revised Mar. 15, 2014)< http://
www.nlm.nih.gov/medlineplus/druginfo/meds/a681039.html>.
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Plaintiff was instructed to continue with Effexor. Nortriptyline (NT), an
antidepressant, was prescribed. (Tr. 243.)
Plaintiff returned to Dr. Giuffra on February 9, 2004, and reported that she
could not work. Plaintiff’s husband reported that she had improved but was not
100 percent. It was noted that plaintiff slept well and had an increased appetite,
but that her energy was low. Plaintiff’s mood was noted to be dysthymic. Plaintiff
was instructed to continue with her current medications, and Provigil10 was
prescribed. (Tr. 242.)
On April 22, 2004, plaintiff reported to Dr. Giuffra that she was “much,
much better” and that she liked her “way of thinking.” Some continued anhedonia
was noted. Mental status examination was normal, and plaintiff’s mood was
euthymic. Plaintiff reported that she continued to spend extra time in bed, but that
she was much improved in that regard. Plaintiff was instructed to increase her
dosage of Provigil and to continue with her other medications. (Tr. 241.)
On June 24, 2004, plaintiff reported to Dr. Giuffra that she was functioning
but did not feel right. Plaintiff reported being distractible, unable to make
decisions, irritable, and isolating herself from friends and family. Plaintiff reported
that she was unable to work. Plaintiff reported her sleep to be okay, but that her
10

Provigil is used to treat excessive sleepiness caused by narcolepsy. Medline Plus (last revised
Nov. 20, 2012)< http://www.nlm.nih.gov/medlineplus/druginfo/meds/a602016.html>.

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energy was low and her appetite had decreased. Plaintiff was instructed to
discontinue Provigil, and Concerta11 was prescribed. Plaintiff was continued on
her other medications and was instructed to return in eight weeks. (Tr. 240.)
Plaintiff reported to Dr. Giuffra on August 19, 2004, that she was better and
continued to improve but that she continued to have problems focusing. Plaintiff
reported needing a midday nap. Plaintiff reported not being able to work more
than two hours doing paperwork. Plaintiff reported her sleep to be okay, but that
her energy was low and her appetite had decreased. Plaintiff had no crying spells
and no death wishes. Mental status examination showed plaintiff to be mildly
dysthymic but was otherwise normal. Plaintiff was continued on her medications
and was instructed to return in two months. (Tr. 239.)
On October 19, 2004, plaintiff reported to Dr. Giuffra that she felt nervous
all the time, could not make decisions, had a poor memory, was anhedonic, and
had headaches. (Tr. 239.) On October 21, Dr. Giuffra noted plaintiff’s voice to be
flat. Plaintiff reported that she was not working, felt quickly overwhelmed, and
was very nervous. Plaintiff reported having occasional panic attacks. Plaintiff
reported that she did not shower daily and that she felt people looked at her funny.
Plaintiff reported being indecisive as shown by her taking one hour to dress
11

Concerta is used to treat narcolepsy. Medline Plus (last revised Mar. 15, 2014)< http://
www.nlm.nih.gov/medlineplus/druginfo/meds/a602016.html>.

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because she does not know what to wear, and not knowing what to buy when in the
grocery store. Plaintiff was instructed to continue with Concerta and NT.
Cymbalta12 was prescribed. All other medications were discontinued. Plaintiff
was instructed to return in one month. (Tr. 238.)
On January 26, 2005, plaintiff reported to Dr. Giuffra that she was doing
better and was no longer taking Concerta. Dr. Giuffra noted plaintiff to be in better
spirits and to be euthymic. Mental status examination was normal. Plaintiff
reported her sleep to be okay, and her appetite was good. Plaintiff reported that
she may have a job in a doctor’s office. Plaintiff was instructed to continue with
Cymbalta and NT and to return in three months. (Tr. 237.)
On April 27, 2005, plaintiff reported to Dr. Giuffra that she was doing well
overall and did not feel depressed. Mental status examination was normal.
Plaintiff was noted to be working doing collections for doctors. Plaintiff was
continued on her medications and was instructed to return in three months. (Tr.
236.)
On July 26, 2005, plaintiff reported to Dr. Giuffra that her sleep, appetite,
energy level, and mood were all okay. Plaintiff reported frequently needing to take
a nap. Plaintiff reported having no crying spells. It was noted that plaintiff worked
12

Cymbalta is used to treat depression and generalized anxiety disorder. Medline Plus (last
revised Feb. 15, 2013)< http://www.nlm.nih.gov/medlineplus/druginfo/meds/a604030.html>.

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doing collections for four doctors. Mental status examination was normal.
Plaintiff was instructed to continue with her medications and to return for follow
up in six months. (Tr. 235.)
On October 19, 2005, plaintiff reported to Dr. Giuffra that she felt down
again. Dr. Giuffra instructed plaintiff to increase her Cymbalta and to decrease her
dosage of NT. (Tr. 235.) On November 7, plaintiff reported that the adjustment to
her medication made her feel better and that she seldom felt sadness. Plaintiff
reported her sleep to be poor, however. Plaintiff was prescribed Lunesta.13 On
November 17, plaintiff reported that she was not doing well and was tired.
Plaintiff was instructed to discontinue NT. On December 7, plaintiff reported that
she slept all the time, was sad, and felt “drugged” and in a cloud. Plaintiff was
instructed to decrease her dosage of Cymbalta. Carbamazepine (CBZ)14 was
prescribed. (Tr. 234.)
In 2006, plaintiff consulted and/or visited Dr. Giuffra on nine occasions. In
January and April, plaintiff reported feeling better, being no longer depressed, and
having applied for a job. In August and September, plaintiff reported not doing
well and having crying spells. Dr. Giuffra noted that plaintiff would not undergo
additional ECT treatments. In October and at the end of 2006, plaintiff reported
13

Lunesta is used to treat insomnia. Medline Plus (last revised Oct. 1, 2008)< http://www.
nlm.nih.gov/medlineplus/druginfo/meds/a605009.html>.
14

Carbamazepine is used to treat bilpolar-I disorder. Medline Plus (last revised July 16, 2012)
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feeling better, less depressed, and becoming more active. Throughout this period,
Dr. Giuffra monitored and adjusted plaintiff’s medications. Plaintiff’s mental
status examinations continued to be normal, with occasional dysthymia noted. (Tr.
227-33.)
In a Physician Statement of Disability completed on August 11, 2006, for
plaintiff’s insurance company, Dr. Giuffra reported that he had been treating
plaintiff since May 28, 2003, for chronic, severe major depression from which she
suffered marked limitations in that she was unable to engage in stress situations or
engage in interpersonal relations. Dr. Giuffra opined that plaintiff was unable to
perform the duties of any occupation and first became disabled in January 2004.
(Tr. 271-72.)
In 2007, plaintiff consulted and/or visited Dr. Giuffra on four occasions. In
February, plaintiff reported that it was difficult to leave her house. In April,
plaintiff reported experiencing increased sleep, crying spells, and distractibility.
Dr. Giuffra completed another Physician Statement of Disability for plaintiff’s
insurance company on April 13 in which he reported plaintiff’s condition to be
unchanged and that plaintiff was totally disabled from any occupation and would
be indefinitely. By September, plaintiff reported feeling better and that she had
discontinued some of her medications on her own. Throughout this period, Dr.
<http://www.nlm.nih.gov/medlineplus/druginfo/meds/a682237.html>.
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Giuffra monitored and adjusted plaintiff’s medications. Plaintiff’s mental status
examinations continued to be normal, with occasional dysthymia noted. (Tr. 22326, 276.)
From February through August 2008, plaintiff visited Dr. Giuffra on three
occasions and reported not doing well in that she did not leave her house, it took
effort to do anything, and she experienced increased sleep and anxiety. It was
noted during this period that plaintiff’s husband was against additional ECT
treatments. In August, Dr. Giuffra completed another Physician Statement of
Disability for plaintiff’s insurance company in which he reported plaintiff’s
condition to be unchanged and that plaintiff was totally disabled from any
occupation and would be indefinitely. In October, plaintiff reported that she was
doing well and was alert, and Adderall15 was prescribed. In December, plaintiff
reported doing well and that her mood was much improved with Adderall.
Throughout this period, Dr. Giuffra monitored and adjusted plaintiff’s medications.
Plaintiff’s mental status examinations continued to be normal, with occasional
dysthymia noted. (Tr. 218-22, 278.)
Plaintiff visited Dr. Giuffra on two occasions in 2009–in February and May.
Plaintiff was doing better and it was noted that she was working doing billing for a
15

Adderall is used to control symptoms of attention deficit hyperactivity disorder. Medline Plus
(last revised Aug. 1, 2010)< http://www.nlm.nih.gov/medlineplus/druginfo/meds/a601234.
html>.
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doctor. (Tr. 216-17.)
Dr. Giuffra completed another Physician Statement of Disability for
plaintiff’s insurance company on September 18, 2009, in which he reported
plaintiff’s condition to have improved. Dr. Giuffra continued to opine that plaintiff
was totally disabled from any occupation and would be indefinitely. (Tr. 280.)
On January 7, 2010, James Morgan, Ph.D., a psychological consultant with
disability determinations, completed a Psychiatric Review Technique Form in
which he indicated that there was insufficient evidence to determine the extent to
which plaintiff was affected by her mental impairment during the period from
December 31, 2003, to June 30, 2005. (Tr. 260-70.)
On February 25, 2010, Dr. Giuffra completed a Mental RFC Questionnaire
in which he reported plaintiff’s current GAF score to be 50, with her highest GAF
score within the previous year to be 50. Dr. Giuffra noted plaintiff’s long history
of difficult-to-treat depression with chronic waxing and waning of the illness and
occasional periods of improvement. Dr. Giuffra opined that, for an indeterminate
amount of years, plaintiff was unable to meet competitive standards in
remembering work-like procedures, maintaining attention for two-hour segments,
maintaining regular attendance and punctuality within customary and usually strict
tolerances, sustaining an ordinary routine without special supervision, completing a
normal workday and workweek without interruptions from psychologically-based
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symptoms, performing at a consistent pace without an unreasonable number and
length of rest periods, dealing with work stress, setting realistic goals, making
plans independently of others, and dealing with stress of semiskilled and skilled
work. Dr. Giuffra further opined that plaintiff also experienced serious but not
preclusive limitations in her ability to understand, remember, and carry out very
short and simple instructions; work in coordination with or proximity to others
without being unduly distracted; make simple work-related decisions; accept
instructions and respond appropriately to criticism from supervisors; get along with
coworkers or peers without unduly distracting them or exhibiting behavioral
extremes; respond appropriately to changes in a routine work setting; understand,
remember, and carry out detailed instructions; interact appropriately with the
general public; and maintain socially appropriate behavior. (Tr. 281-85.)
Between January and October 2010, plaintiff visited Dr. Giuffra on four
occasions, who noted plaintiff to generally be doing okay. Plaintiff was continued
on her medications throughout this period. (Tr. 299-302.)
Between May 2008 and November 2010, plaintiff visited her general
practitioners at Kneibert Clinic for various physical conditions, including
cardiovascular follow up, back pain, chest pain, rashes, and allergies. During these
visits, plaintiff’s diagnosed conditions of depression and anxiety were noted as
well as her prescribed medications for such. (Tr. 303-421.)
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On February 21, 2011, Sandy Reese, a family nurse practitioner with
Cardiovascular Consultants of Cape Girardeau completed a Physical RFC
Questionnaire in which she noted that, in addition to her physical impairments,
plaintiff had severe anxiety and poor memory as well as a long history of
depression with multiple medications and episodes of psychiatric counseling. FNP
Reese reported that plaintiff’s mental condition had waxed and waned, and opined
that the condition would remain chronic. (Tr. 526.)
IV. Records Submitted to the Appeals Council16
In a letter addressed to “To Whom It May Concern” and dated August 8,
2011, Dr. Giuffra wrote that plaintiff “was unable to sustain work at an employable
pace between 2003 and 2005” and that he observed plaintiff on several occasions
to have significant residual symptoms of depression during that time. Dr. Giuffra
wrote that “[t]he fact that, at times, her mental status examination appears to be
close to normal should not be interpreted as indicating that she has the functional
ability to sustain the stressors of a regular job.” (Tr. 599.)
Dr. Giuffra completed a Mental RFC Questionnaire that same date in which
he reported on and rendered his opinion relating to plaintiff’s mental impairment
during the period of 2003 to 2005. In the Questionnaire, Dr. Giuffra reported
16

In making its determination to deny review of the ALJ’s decision, the Appeals Council
considered additional evidence which was not before the ALJ. The Court must consider this
additional evidence in determining whether the ALJ's decision was supported by substantial
evidence. Frankl v. Shalala, 47 F.3d 935, 939 (8th Cir. 1995); Richmond v. Shalala, 23 F.3d
- 20 -

plaintiff’s GAF score to be 50 and that plaintiff had a fair and/or incomplete
response to medication therapy and ECT treatments. Dr. Giuffra reported that
plaintiff experienced pronounced fatigue as a side effect of her medications. Dr.
Giuffra reported that plaintiff’s impairment was severe, disabling, chronic, and had
frequent exacerbations. As symptoms of plaintiff’s impairment, Dr. Giuffra
reported that plaintiff exhibited anhedonia, appetite disturbance, decreased energy,
thoughts of suicide, feelings of guilt or worthlessness, impairment in impulse
control, persistent anxiety, mood disturbance, difficulty thinking or concentrating,
persistent disturbances of mood or affect, change in personality, paranoid thinking,
isolation, pathologically inappropriate suspiciousness or hostility, easy
distractibility, memory impairment, sleep disturbance, oddities of thought or
behavior, and recurrent severe panic attacks. Dr. Giuffra opined that plaintiff had
no useful ability to function with respect to her ability to maintain regular
attendance and be punctual within customary and strict tolerances, to work in
coordination with or proximity to others without being unduly distracted, to
complete a normal workday and workweek without interruptions from
psychologically-based symptoms, to perform at a consistent pace without an
unreasonable number and length of rest periods, to accept instructions and respond
appropriately to criticism from supervisors, to respond appropriately to changes in
1441, 1444 (8th Cir. 1994).
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a routine work setting, to deal with normal work stress, to carry out detailed
instructions, to deal with stress of semiskilled and skilled work, to travel in
unfamiliar places, and to use public transportation. Dr. Giuffra further opined that
plaintiff was unable to meet competitive standards in her ability to remember
work-like procedures; understand, remember, and carry out very short and simple
instructions; maintain attention for two-hour segments; sustain an ordinary work
routine without special supervision; make simple work-related decisions; ask
simple questions or request assistance; get along with coworkers or peers without
unduly distracting them or exhibiting behavioral extremes; be aware of normal
hazards and take appropriate precautions; understand and remember detailed
instructions; set realistic goals or make plans independently of others; interact
appropriately with the general public; and maintain socially appropriate behavior.
Dr. Giuffra reported that plaintiff’s impairment or treatment would have caused her
to be absent from work more than four days a month. (Tr. 601-04.)
V. The ALJ's Decision
The ALJ found that plaintiff met the insured status requirements of the
Social Security Act through June 30, 2005. The ALJ found plaintiff not to have
engaged in substantial gainful activity since December 31, 2003. The ALJ found
that, through June 30, 2005, plaintiff had major depressive disorder that was
partially controlled by medication, but that plaintiff did not have an impairment or
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combination of impairments that met or medically equaled an impairment listed in
20 C.F.R. Part 404, Subpart P, Appendix 1. The ALJ found that, prior to June 30,
2005, plaintiff had the RFC to perform work except for “doing more than simple,
routine tasks and in a low stress environment and with no decision-making and
only occasional interaction with co-workers, supervisors or the general public.”
(Tr. 18.) The ALJ found that plaintiff was unable to perform any of her past
relevant work. Considering plaintiff’s age, education, work experience, and RFC
as of June 30, 2005, the ALJ determined vocational expert testimony to support a
finding that plaintiff could perform other work existing in significant numbers in
the national economy, and specifically, office cleaner, maid, and small parts
assembler. The ALJ thus found that plaintiff was not under a disability at any time
beginning on or before June 30, 2005. (Tr. 18-19.)
VI. Discussion
To be eligible for DIB under the Social Security Act, plaintiff must prove
that she is disabled. Pearsall v. Massanari, 274 F.3d 1211, 1217 (8th Cir. 2001);
Baker v. Secretary of Health & Human Servs., 955 F.2d 552, 555 (8th Cir. 1992).
The Social Security Act defines disability 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 which has lasted or
can be expected to last for a continuous period of not less than 12 months." 42
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U.S.C. § 423(d)(1)(A). An individual will be declared disabled "only if [her]
physical or mental impairment or impairments are of such severity that [she] is not
only unable to do [her] previous work but cannot, considering [her] age, education,
and work experience, engage in any other kind of substantial gainful work which
exists in the national economy." 42 U.S.C. § 423(d)(2)(A).
To determine whether a claimant is disabled, the Commissioner engages in a
five-step evaluation process. See 20 C.F.R. § 404.1520; Bowen v. Yuckert, 482
U.S. 137, 140-42 (1987). The Commissioner begins by deciding whether the
claimant is engaged in substantial gainful activity. If the claimant is working,
disability benefits are denied. Next, the Commissioner decides whether the
claimant has a “severe” impairment or combination of impairments, meaning that
which significantly limits her ability to do basic work activities. If the claimant's
impairment(s) is not severe, then she is not disabled. The Commissioner then
determines whether claimant's impairment(s) meets or equals one of the
impairments listed in 20 C.F.R., Subpart P, Appendix 1. If claimant's
impairment(s) is equivalent to one of the listed impairments, she is conclusively
disabled. At the fourth step, the Commissioner establishes whether the claimant
can perform her past relevant work. If so, the claimant is not disabled. Finally, the
Commissioner evaluates various factors to determine whether the claimant is
capable of performing any other work in the economy. If not, the claimant is
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declared disabled and becomes entitled to disability benefits.
The decision of the Commissioner must be affirmed if it is supported by
substantial evidence on the record as a whole. 42 U.S.C. § 405(g); Richardson v.
Perales, 402 U.S. 389, 401 (1971); Estes v. Barnhart, 275 F.3d 722, 724 (8th Cir.
2002). Substantial evidence is less than a preponderance but enough that a
reasonable person would find it adequate to support the conclusion. Johnson v.
Apfel, 240 F.3d 1145, 1147 (8th Cir. 2001). This “substantial evidence test,”
however, is “more than a mere search of the record for evidence supporting the
Commissioner’s findings.” Coleman v. Astrue, 498 F.3d 767, 770 (8th Cir. 2007)
(internal quotation marks and citation omitted). “Substantial evidence on the
record as a whole . . . requires a more scrutinizing analysis.” Id. (internal quotation
marks and citations omitted).
To determine whether the Commissioner's decision is supported by
substantial evidence on the record as a whole, the Court must review the entire
administrative record and consider:
1.

The credibility findings made by the ALJ.

2.

The plaintiff's vocational factors.

3.

The medical evidence from treating and consulting physicians.

4.

The plaintiff's subjective complaints relating to exertional and
non-exertional activities and impairments.

5.

Any corroboration by third parties of the plaintiff's
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impairments.
6.

The testimony of vocational experts when required which is
based upon a proper hypothetical question which sets forth the
claimant's impairment.

Stewart v. Secretary of Health & Human Servs., 957 F.2d 581, 585-86 (8th Cir.
1992) (internal citations omitted). The Court must also consider any evidence
which fairly detracts from the Commissioner’s decision. Coleman, 498 F.3d at
770; Warburton v. Apfel, 188 F.3d 1047, 1050 (8th Cir. 1999). However, even
though two inconsistent conclusions may be drawn from the evidence, the
Commissioner's findings may still be supported by substantial evidence on the
record as a whole. Pearsall, 274 F.3d at 1217 (citing Young v. Apfel, 221 F.3d
1065, 1068 (8th Cir. 2000)). “[I]f there is substantial evidence on the record as a
whole, we must affirm the administrative decision, even if the record could also
have supported an opposite decision.” Weikert v. Sullivan, 977 F.2d 1249, 1252
(8th Cir. 1992) (internal quotation marks and citation omitted); see also Jones ex
rel. Morris v. Barnhart, 315 F.3d 974, 977 (8th Cir. 2003).
Plaintiff claims that the ALJ failed to consider all of the relevant evidence of
record in determining her credibility and mental RFC by discounting the opinions
rendered by her treating psychiatrist and by improperly focusing only on plaintiff’s
isolated episodes of improvement. For the following reasons, the ALJ committed
no legal error, and his decision is supported by substantial evidence on the record
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as a whole.
A.

Opinion Evidence
In evaluating opinion evidence, the Regulations require the ALJ to explain

in the decision the weight given to any opinions from treating sources, non-treating
sources, and non-examining sources. See 20 C.F.R. § 404.1527(f)(2)(ii).17 The
Regulations require that more weight be given to the opinions of treating
physicians than other sources. 20 C.F.R. § 404.1527(d)(2). A treating physician's
assessment of the nature and severity of a claimant's impairments should be given
controlling weight if the opinion is well supported by medically acceptable clinical
and laboratory diagnostic techniques and is not inconsistent with other substantial
evidence in the record. Id.; see also Forehand v. Barnhart, 364 F.3d 984, 986 (8th
Cir. 2004). This is so because a treating physician has the best opportunity to
observe and evaluate a claimant's condition,
since these sources are likely to be the medical professionals most
able to provide a detailed, longitudinal picture of [a claimant's]
medical impairment(s) and may bring a unique perspective to the
medical evidence that cannot be obtained from the objective medical
findings alone or from reports of individual examinations, such as
consultative examinations or brief hospitalizations.
20 C.F.R. § 404.1527(d)(2).
When a treating physician's opinion is not given controlling weight, the
17

Citations to 20 C.F.R. § 404.1527 are to the 2011 version of the Regulations, which was in
effect at the time the ALJ rendered the final decision in this cause. This Regulation’s most
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Commissioner must look to various factors in determining what weight to accord
the opinion. 20 C.F.R. § 404.1527(d)(2). Such factors include the length of the
treatment relationship and the frequency of examination, the nature and extent of
the treatment relationship, whether the treating physician provides support for his
findings, whether other evidence in the record is consistent with the treating
physician's findings, and the treating physician's area of specialty. Id. The
Regulations further provide that the Commissioner “will always give good reasons
in [the] notice of determination or decision for the weight [given to the] treating
source's opinion.” Id.
The ALJ here discounted the opinion evidence rendered by Dr. Giuffra in his
statements to plaintiff’s insurance company and his February 2010 Mental RFC
Questionnaire because his opinions were inconsistent with his treatment notes
made immediately after each outpatient visit during the relevant period. The ALJ
noted that, in these contemporaneous notes, Dr. Giuffra consistently described
plaintiff to have a normal mental state and that, other than plaintiff’s isolated ECT
treatment in December 2003-January 2004, plaintiff’s overall treatment consisted
of routine office visits every two months and medication management with noted
improvement. Indeed, as noted by the ALJ, by April 2005, plaintiff reported that
she was doing well overall and did not feel depressed. While plaintiff argues that
recent amendment, effective March 26, 2012, reorganizes the subparagraphs relevant to this
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the ALJ improperly relied upon this note to find plaintiff not disabled, a review of
the record in toto shows this note to be similar to numerous other notations in
plaintiff’s treatment records during the relevant period where plaintiff reported
being better, was euthymic, consistently yielded normal mental status
examinations, and had resumed working. Because the extreme limitations
expressed in Dr. Giuffra’s insurance statements and RFC Questionnaire are
contrary to the multiple mental status examinations which revealed no signs of
psychological abnormalities during the relevant period, the ALJ did not err in
discounting Dr. Giuffra’s opinions regarding plaintiff’s mental abilities during this
period. Halverson v. Astrue, 600 F.3d 922, 930 (8th Cir. 2010); 20 C.F.R. §
404.1528(b) (signs of psychological abnormalities include abnormalities of
behavior, mood, thought, memory, and orientation and must be shown by
observable facts). See also Davidson v. Astrue, 578 F.3d 838, 842 (8th Cir. 2009)
(permissible for ALJ to discount opinion of treating physician that is inconsistent
with the physician's clinical treatment notes); Hacker v. Barnhart, 459 F.3d 934,
937 (8th Cir. 2006); Hogan v. Apfel, 239 F.3d 958, 961 (8th Cir. 2001) (where
limitations set out in a treating physician’s assessment “stand alone” and were
“never mentioned in [the physician’s] numerous records or treatment” nor
supported by “any objective testing or reasoning,” ALJ’s decision to discount
discussion but does not otherwise change their substance.
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treating physician’s statement is not error).
Although plaintiff contends that her complaints during this period were
consistent with her claim of disability, a claimant’s statement of symptoms alone is
not enough to establish a disabling mental impairment. 20 C.F.R. § 404.1528(a).
“[O]bservable facts that can be medically described and evaluated” are required.
20 C.F.R. § 404.1528(b). Other than Dr. Giuffra’s occasional observation of
plaintiff’s dysthymic mood, no observable facts of a psychological abnormality are
shown in Dr. Giuffra’s treatment notes.
Dr. Giuffra’s August 2011 letter and RFC Questionnaire submitted to the
Appeals Council do not alter this result. While Dr. Giuffra wrote that plaintiff’s
near-normal mental status examinations “should not be interpreted as indicating
that she has the functional ability to sustain the stressors of a regular job,” a
medical source’s opinion that a claimant is unable to work involves an issue
reserved for the Commissioner and is not the type of opinion that the
Commissioner must credit. Renstrom v. Astrue, 680 F.3d 1057, 1065 (8th Cir.
2012); Ellis v. Barnhart, 392 F.3d 988, 994-95 (8th Cir. 2005). Regardless, Dr.
Giuffra’s statement does not change the contemporaneous record evidence that
shows no recorded observable facts of a psychological abnormality during the
relevant period. To the extent Dr. Giuffra’s August 2011 RFC Questionnaire lists
extreme limitations, and indeed limitations more extreme than those expressed in
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his February 2010 RFC Questionnaire, there continues to be no contemporary
evidence of such limitations during the relevant period. As such, the ALJ’s
reasons to discount Dr. Giuffra’s opinions would continue to apply to the extreme
limitations set out in the August 2011 RFC Questionnaire.
Accordingly, it cannot be said that the ALJ’s reasons to discount Dr.
Giuffra’s opinion evidence are not supported by substantial evidence. Halverson,
600 F.3d at 931. Because the ALJ provided good reasons that are supported by
substantial evidence on the record as a whole, this Court must defer to the ALJ’s
determination. Renstrom, 680 F.3d at 1063-64.
B.

Periods of Improvement
Nor can it be said that the ALJ focused only on plaintiff’s isolated periods of

improvement to find her not disabled. A review of the ALJ’s decision shows him
to have considered plaintiff’s reports of low energy, crying spells, inability to make
decisions, and excessive sleeping when he weighed the evidence before him
regarding plaintiff’s functional abilities during the relevant period. As discussed
above, however, the ALJ also noted plaintiff’s consistent normal mental status
examinations; that she tolerated her medications; that her medication regimen
improved her condition such that she was not suicidal, was no longer depressed as
of April 2005, and was doing well overall; that she was stable enough to work as a
substitute teacher; and that her office visits every two months were sufficient for
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her overall treatment. While plaintiff’s symptoms waxed and waned between
appointments, as is expected with mental impairments, see Miller v. Heckler, 756
F.2d 679, 681 n.2 (8th Cir. 1985), the longitudinal picture shows plaintiff to have
been, for the most part, appropriately logical and sequential in flow of thought, to
have normal content of thought, to be well dressed and groomed, to have clear
sensorium, and to have normal rate and rhythm of speech. Indeed, the medical
evidence of record shows nearly all of plaintiff’s mental status examinations to
show no abnormalities. E.g., Halverson, 600 F.3d at 930. Given that a claimant's
level of mental functioning may seem relatively adequate (or, conversely, rather
poor) at a specific time, proper evaluation of the impairment must take into
account the claimant's level of functioning “over time.” 20 C.F.R., Part 404,
Subpart P, Appendix 1, § 12.00(D)(2). This is what the ALJ did here.
A review of the ALJ’s decision shows him not to have focused only on
isolated instances of plaintiff’s improvement to find her not disabled. To the
contrary, the ALJ properly considered the longitudinal evidence of record in
determining the extent to which plaintiff’s mental impairment affected her ability
to engage in work-related activities prior to June 30, 2005. The ALJ did not err in
this consideration. While a contrary conclusion may have been reached on this
same evidence, it cannot be said that the ALJ’s determination was not supported by
substantial evidence. See Moore v. Astrue, 623 F.3d 599, 603 (8th Cir. 2010);
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England v. Astrue, 490 F.3d 1017, 1022 (8th Cir. 2007).
C.

Credibility Determination
Plaintiff also claims that the ALJ erred by focusing on her isolated periods of

improvement to discount her subjective complaints of disabling symptoms. For
the following reasons, the ALJ did not err.18
In determining the credibility of a claimant’s subjective complaints, the ALJ
must consider all evidence relating to the complaints, including the claimant’s
prior work record and third party observations as to the claimant's daily activities;
the duration, frequency and intensity of the symptoms; any precipitating and
aggravating factors; the dosage, effectiveness and side effects of medication; and
any functional restrictions. Halverson, 600 F.3d at 931; Polaski v. Heckler, 739
F.2d 1320, 1322 (8th Cir. 1984) (subsequent history omitted). While an ALJ need
not explicitly discuss each Polaski factor in his decision, he nevertheless must
acknowledge and consider these factors before discounting a claimant’s subjective
complaints. Wildman v. Astrue, 596 F.3d 959, 968 (8th Cir. 2010).
When, on judicial review, a plaintiff contends that the ALJ failed to properly
consider her subjective complaints, “the duty of the court is to ascertain whether
the ALJ considered all of the evidence relevant to the plaintiff's complaints . . .
18

In a letter dated March 29, 2011, plaintiff’s husband described the effects of plaintiff’s mental
impairment that he observed from 2003 to 2005. (Tr. 573-74.) In his written decision, the ALJ
partially discredited the statements made in this letter. (Tr. 17.) Plaintiff does not challenge this
determination.
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under the Polaski standards and whether the evidence so contradicts the plaintiff's
subjective complaints that the ALJ could discount his or her testimony as not
credible.” Masterson v. Barnhart, 363 F.3d 731, 738-39 (8th Cir. 2004). It is not
enough that the record merely contain inconsistencies. Instead, the ALJ must
specifically demonstrate in his decision that he considered all of the evidence. Id.
at 738; see also Cline v. Sullivan, 939 F.2d 560, 565 (8th Cir. 1991). Where an
ALJ explicitly considers the Polaski factors but then discredits a claimant’s
complaints for good reason, the decision should be upheld. Hogan, 239 F.3d at
962. The determination of a claimant’s credibility is for the Commissioner, and
not the Court, to make. Tellez v. Barnhart, 403 F.3d 953, 957 (8th Cir. 2005);
Pearsall, 274 F.3d at 1218.
Here, the ALJ set out numerous inconsistencies in the record upon which he
found plaintiff’s subjective complaints not to be entirely credible. First, the ALJ
noted plaintiff to have worked as a substitute teacher during the relevant period,
observing that such work is not the kind of “low stress” job a person with a severe,
uncontrolled mental impairment could perform. The record also shows plaintiff to
have worked doing medical billing during this period and indeed to have reported
within one month of June 2005 that she was working for as many as four doctors.
See Dunahoo v. Apfel, 241 F.3d 1033, 1038-39 (8th Cir. 2001) (seeking work and
working at a job while applying for benefits are activities inconsistent with
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subjective complaints of disabling symptoms). The ALJ also noted that, other than
plaintiff’s isolated hospitalization for ECT, she was never hospitalized for any
mental treatment nor received any treatment beyond prescription medication that
was monitored every two or three months. E.g., Dukes v. Barnhart, 436 F.3d 923,
928 (8th Cir. 2006) (absence of hospitalizations, limited treatment, and
employment during relevant period properly considered in credibility
determination). The ALJ also noted plaintiff’s medication regimen to be constant
and consistent throughout the relevant period, although the record shows plaintiff
to have demonstrated some noncompliance with such regimen by discontinuing
some medications of her own volition. See Holley v. Massanari, 253 F.3d 1088,
1092 (8th Cir. 2001) (evidence of noncompliance may be considering in evaluating
claimant’s subjective complaints). The ALJ also noted that despite plaintiff’s
testimony that she was not well enough to apply for social security DIB until
2009–although she claimed being disabled since December 2003–the evidence
showed that she nevertheless filed disability claims with her private insurer prior to
2009 and was able to work as a part-time substitute teacher during such time,
demonstrating that her belated filing may be based on something other than a belief
that she was severely incapacitated. Statements that are inconsistent with the
record provide valid reason, in themselves, to discredit a claimant’s subjective
complaints. See Ply v. Massanari, 251 F.3d 777, 779 (8th Cir. 2001) (per curiam).
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Finally, as discussed above, the ALJ noted that objective medical evidence did not
support the severity of plaintiff’s complaints to the extent she claimed she was
unable to engage in any work-related activity during the relevant period. These
reasons to discount plaintiff’s subjective complaints are supported by substantial
evidence on the record as a whole.
Contrary to plaintiff’s assertion, the ALJ did not merely view isolated
evidence of plaintiff’s improved condition to discredit her complaints. Instead, a
review of the decision shows that the ALJ examined the longitudinal record and
discredited plaintiff’s subjective complaints based on the inconsistencies
throughout. In a manner consistent with and as required by Polaski, the ALJ
considered plaintiff’s subjective complaints on the basis of the entire record and set
out numerous inconsistencies that detracted from her credibility. Because the
ALJ’s determination not to credit plaintiff’s subjective complaints is supported by
good reasons and substantial evidence, this Court must defer to the ALJ’s
credibility determination. Renstrom, 680 F.3d at 1065; Goff v. Barnhart, 421 F.3d
785, 793 (8th Cir. 2005); Vester v. Barnhart, 416 F.3d 886, 889 (8th Cir. 2005).
VII. Conclusion
For the reasons set out above on the claims raised by plaintiff on this appeal,
the ALJ’s determination that plaintiff was not disabled on or prior to June 30,
2005, is supported by substantial evidence on the record as a whole, and plaintiff’s
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claims of error should be denied. Inasmuch as there is substantial evidence to
support the Commissioner's decision, this Court may not reverse the decision
merely because substantial evidence exists in the record that would have supported
a contrary outcome or because another court could have decided the case
differently. Gowell v. Apfel, 242 F.3d 793, 796 (8th Cir. 2001); Browning v.
Sullivan, 958 F.2d 817, 821 (8th Cir. 1992). See also Buckner v. Astrue, 646 F.3d
549, 556 (8th Cir. 2011).
Therefore,
IT IS HEREBY ORDERED that the final decision of the Commissioner is
affirmed, and plaintiff’s Complaint is dismissed with prejudice.
A separate Judgment in accordance with this Memorandum and Order is
entered this same date.

/s/ Noelle C. Collins
UNITED STATES MAGISTRATE JUDGE

Dated this 22nd day of July, 2014.

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