Wigfall v. Colvin

Filing 23

MEMORANDUM AND ORDER..IT IS HEREBY ORDERED that the decision of the Commissioner is reversed, and this case is remanded for further proceedings consistent with this Memorandum and Order. Signed by District Judge Catherine D. Perry on 3/22/17. (MRS)

UNITED STATES DISTRICT COURT
EASTERN DISTRICT OF MISSOURI
SOUTHEASTERN DIVISION
GERRISHA WIGFALL,
Plaintiff,
v.
NANCY A. BERRYHILL,
Acting Commissioner of Social Security,1
Defendant.

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No. 1:15 CV 230 CDP

MEMORANDUM AND ORDER
Plaintiff Gerrisha Wigfall brings this action under 42 U.S.C. § 405(g),
seeking judicial review of the Commissioner’s denial of her application for child’s
supplemental security income (SSI) under Title XVI of the Social Security Act, 42
U.S.C. §§ 1381, et seq. Because the Commissioner’s final decision is not
supported by substantial evidence on the record as a whole, I will reverse the
decision and remand for further proceedings.
I. Procedural History
An application for child’s benefits was filed on Wigfall’s behalf on
December 18, 2012, claiming that she became disabled on January 1, 2008.
Wigfall was 15 years old when her application was filed. The Social Security
1

On January 20, 2017, Nancy A. Berryhill became the Acting Commissioner of Social Security.
Under Fed. R. Civ. P. 25(d), Berryhill is automatically substituted for former Acting
Commissioner Carolyn W. Colvin as defendant in this action.

Administration denied Wigfall’s application on March 25, 2013. A hearing was
held before an administrative law judge (ALJ) on April 22, 2014, at which Wigfall
and her mother testified. On August 13, 2014, the ALJ denied Wigfall’s claim for
benefits, finding Wigfall’s severe impairments of major depressive disorder, posttraumatic stress disorder (PTSD), social anxiety disorder, and anxiety disorder
NOS not to meet or medically equal a listed impairment, nor functionally equal a
listed impairment. On October 8, 2015, the Appeals Council denied Wigfall’s
request for review of the ALJ’s decision. The ALJ’s decision is thus the final
decision of the Commissioner. 42 U.S.C. § 405(g).
In this action seeking judicial review of the Commissioner’s final decision,
Wigfall, now an adult, argues that the ALJ improperly discounted the opinion of
her treating psychiatrist and erred in finding that she did not meet a listed
impairment.
II. Legal Standard
A claimant under the age of eighteen is considered disabled and eligible for
SSI under the Social Security Act if she “has a medically determinable physical or
mental impairment, which results in marked and severe functional limitations, and
which can be expected to result in death or which has lasted or can be expected to
last for a continuous period of not less than 12 months.” 42 U.S.C. §
1382c(a)(3)(C)(i).
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The Commissioner is required to undergo a three-step sequential evaluation
process when determining whether a child is entitled to SSI benefits. First, the
Commissioner must determine whether the child is engaged in substantial gainful
activity. If not, the Commissioner must then determine whether the child’s
impairment, or combination of impairments, is severe. Finally, if the child’s
impairment(s) is severe, the Commissioner must determine whether it meets,
medically equals, or functionally equals the severity of an impairment listed in
Appendix 1 of Subpart P of Part 404 of the Regulations. 20 C.F.R. § 416.924(a);
Garrett ex rel. Moore v. Barnhart, 366 F.3d 643, 647 (8th Cir. 2004). If the
impairment(s) meets or medically equals a Listing, the child is disabled. Garrett,
366 F.3d at 647. If a child’s impairment does not meet or medically equal a listed
impairment, the Commissioner will assess all functional limitations caused by the
child’s impairment to determine whether the impairment functionally equals the
listings. 20 C.F.R. § 416.926a. If this analysis shows the child not to have an
impairment which is functionally equal in severity to a listed impairment, the ALJ
must find the child not disabled. Oberts o/b/o Oberts v. Halter, 134 F. Supp. 2d
1074, 1082 (E.D. Mo. 2001).
To functionally equal a listed impairment, the child’s condition must result
in an “extreme” limitation in one domain of functioning or “marked” limitations in
two domains. 20 C.F.R. § 416.926a(a). The domains are “broad areas of
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functioning intended to capture all of what a child can or cannot do.” 20 C.F.R. §
416.926a(b)(1). The six domains used by the Commissioner in making this
determination are: 1) Acquiring and Using Information; 2) Attending and
Completing Tasks; 3) Interacting and Relating with Others; 4) Moving About and
Manipulating Objects; 5) Caring for Oneself; and 6) Health and Physical WellBeing. Id.
A child-claimant has a “marked” limitation in a domain when her
impairment(s) interferes seriously with [her] ability to independently
initiate, sustain, or complete activities. [Her] day-to-day functioning
may be seriously limited when [her] impairment(s) limits only one
activity or when the interactive and cumulative effects of [her]
impairment(s) limit several activities. “Marked” limitation also
means a limitation that is “more than moderate” but “less than
extreme.”
20 C.F.R. § 416.926a(e)(2)(i). A child has an “extreme” limitation when the
impairment “interferes very seriously with [the child’s] ability to independently
initiate, sustain, or complete activities.” 20 C.F.R. § 416.926a(e)(3). In
determining whether a child-claimant’s functioning may be marked or extreme, the
Commissioner is to review all the evidence of record and “compare [the child’s]
functioning to the typical functioning of children [the child’s] age who do not have
impairments.” 20 C.F.R. § 416.926a(f)(1); see also 20 C.F.R. § 416.926a(b) (in
determining child-claimant’s functioning, Commissioner looks “at how
appropriately, effectively and independently [the child] perform[s] [his] activities
compared to the performance of other children [the child’s] age who do not have
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impairments.”); 20 C.F.R. § 416.924a(b)(5).
The Commissioner’s findings are conclusive upon this Court if they are
supported by substantial evidence. 42 U.S.C. § 405(g); Young v. Shalala, 52 F.3d
200 (8th Cir. 1995) (citing Woolf v. Shalala, 3 F.3d 1210, 1213 (8th Cir. 1993)).
Substantial evidence is less than a preponderance but enough that a reasonable
person would find it adequate to support the conclusion. Briggs v. Callahan, 139
F.3d 606, 608 (8th Cir. 1998). In evaluating the substantiality of the evidence, I
must consider evidence which supports the Commissioner’s decision as well as any
evidence which fairly detracts from the decision. McNamara v. Astrue, 590 F.3d
607, 610 (8th Cir. 2010). Where substantial evidence supports the Commissioner’s
decision, I must affirm, even if a different conclusion may be drawn from the
evidence. Id.
III. Evidence Before the ALJ
A.

Testimonial Evidence
At the hearing on April 22, 2014, Wigfall and her mother testified in

response to questions posed by counsel and the ALJ. Wigfall was 17 years old and
in the eleventh grade at the time of the hearing. She weighed 308 pounds. She
failed English the year before but took it again on credit recovery and passed. She
has trouble staying focused and awake. Wigfall was suspended from school twice
during the school year for arguing with other students. She is irritable and gets
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angry easily. Since her grandmother died, she has daily mood swings, anxiety, and
depression. Wigfall has been hospitalized twice for depression, most recently in
November of 2013, when she was hospitalized at Center Pointe for suicidal
thoughts. She has been on different medications for depression without noticing
much improvement, but she cannot currently afford medication or counseling.
She has a treating psychiatrist and has problems with posttraumatic stress disorder.
She has never had a job. (Tr. 32-43).
Wigfall’s mother testified that Wigfall cannot get along with others and that
she sits in her room in the dark all the time. Wigfall was sexually molested as a
five year old and as a school-aged child. Wigfall was given medication for her
irritability, but it did not help much and caused side effects. Wigfall went to live
with her father because her mood swings made her too difficult for her mother to
handle. (Tr. 43-52).
B.

Medical Evidence
1. Hospitalizations
Wigfall was hospitalized for four days in November of 2012 for depression,

anxiety, anger, flashbacks, and suicidal ideation. She was reluctant to talk but
admitted being sexually abused by a family friend about five years prior and as a
very young child. She was also removed from her mother’s care at one point
because her mother physically abused her. She was diagnosed with mood disorder,
-6-

not otherwise specified, depression with much repressed trauma, possible temporal
lobe hyperfunction aggravating the anger problems, obesity, and sexual abuse as a
child. Her GAF score was 40 during her stay and 55 upon discharge. Wigfall was
prescribed Paxil, Terileptal, and Trazodone. Her prognosis was “cautiously
optimistic.” (Tr. 161-83).
Wigfall was hospitalized a second time for suicidal ideation between
November 19, 2013 and November 27, 2013, upon the request of her treating
psychiatrist, Laura Huffman, M.D. Wigfall reported increased depression and
persistent thoughts of killing herself. She cut her left wrist and burned her right
hand with a cigarette lighter. She was feeling down, sad, and overwhelmed, with
feelings of hopelessness and worthlessness. Her diagnosis upon discharge was
suicidal ideation, acute depression, and PTSD. Her GAF score upon admission
was 30 and 75 at discharge. Wigfall’s mood at the time of her discharge was noted
to be “excited.” She was prescribed Wellbutrin. (Tr. 221-28).
2. Treatment with Therapist Hunter
After her first hospitalization, Wigfall began treatment with therapist Joe
Hunter, M.A., L.P.C., L.C.S.W. in November of 2012. Wigfall reported being
sexually molested by a family friend at age five and then later by one of her sister’s
friends. She also reported being removed from her mother’s care because her
mother physically abused her with telephone and electrical cords. She reported
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“going off on” her sister. Wigfall admitted that she likes to remember her abuse
during these times because it makes her angrier. Her mood was “up and down”
and she liked to be alone. (Tr. 194, 197-200).
In December, Wigfall told Hunter that she “lost it” with another student and
that she likes “losing it” because people “back off and leave her alone.” (Tr. 193).
In January of 2013, Wigfall admitted having a “battle controlling her temper.” She
talked about being sexually and physically abused and stated her anger “helped her
to survive” and “became her friend and the one thing she could count on.” (Tr.
188).
During her February 2013 visit, Wigfall reported having issues with her
choir teacher and her mom. (Tr. 217). In May, Wigfall told Hunter that “a lot”
had happened over the last month and that it was “all bad.” She said that she was
raped by a nineteen year old boy while at a friend’s house. She reported the rape
to her school counselor, who called Wigall’s mother to come to the school. When
Wigfall’s mother arrived, she and Wigfall got into an argument. Hunter noted that
Wigfall had poor eye contact and her mood was depressed. Wigfall said she was
hurt, angry, and depressed, with thoughts of hopelessness. (Tr. 212). The next
week, Wigfall was still having problems with her mother and was still upset and
angry, but she denied cutting herself since her last session. (Tr. 211).
In July of 2013, Wigfall’s mother told Hunter that Wigfall’s attitude had
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become so bad that she called police on her and kicked her out of the house. The
police declined to press charges against Wigfall, however, because of all the
scratches and bruises on her. Wigfall went to live with her father briefly, but then
returned to her mother. She expressed a desire to live with her aunt in Florida, but
Wigfall’s mother said she did not have money for that. Wigfall became angry at
her mother and accused her mother of spending all the family’s money at the
casino boat. (Tr. 209). The next week, Wigfall reported to Hunter that she had
withdrawn to her room and obsessed about the men who abused her. Hunter noted
that Wigfall was depressed. (Tr. 208).
3. Treatment with Laura Huffman, M.D.
Wigfall began seeing psychiatrist Lara Huffman, M.D. on November 15,
2012, after being hospitalized for suicidal ideation. Wigfall discussed her history
of abuse and difficulties getting along with others. Wigfall admitted “blowing up”
at others and significant mood swings caused by medications. Wigfall stated she
worries constantly and has bouts of sadness. She was continued on Paxil and
advised to continue individual therapy. (Tr. 196). During her next visit with Dr.
Huffman on December 13, 2012, Wigfall’s continued mood swings were noted.
She reported not sleeping well and that she was “barely passing” English.
Dyslexia was suspected. Dr. Huffman prescribed Abilify and referred Wigfall for
testing for dyslexia and sleep apnea. (Tr. 192).
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Wigall saw Dr. Huffman again on January 10, 2013. At that time, Wigfall
reported that her mood had gotten worse and that she was getting picked on and
had been going on “rages.” She could not sleep at night and was sleepy during the
day. Mental status examination revealed Wigfall was depressed with suicidal
ideation. Dr. Huffman suspected that the inability to sleep was a side effect of
Abilify, so she discontinued it and all medications to establish baseline mood and
sleep patterns. (Tr. 189). At her next visit on January 24, 2013, Wigfall stated that
she preferred staying in bed in the dark, that any good mood did not last long, and
that she wakes up irritable and ready to fight. She reported waking up frequently
throughout the night and falling asleep in school. She was easily agitated and in
bad moods “a lot” with suicidal ideation. Mental status examination revealed a sad
affect, decreased eye contact with lots of sighing, and increasing depression. Dr.
Huffman noted that Wigfall was experiencing increasing symptoms of depression
and prescribed a trial of Lamictal for unstable mood and insomnia. (Tr. 187).
During her February 7, 2013 visit, Wigfall reported that things were “ok, not
that bad.” She reported occasional passive suicidal ideation. Wigfall still had
difficulty with reading comprehension and had five failing grades on her report
card. Mental status examination revealed Wigfall’s mood was down and her affect
was restricted. Dr. Huffman discontinued Lamictal because it gave Wigfall a rash
and scheduled her for DNA testing. (Tr. 185).
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In March, Wigfall’s mother told Dr. Huffman that Wigfall’s grades had
dropped and that she was increasingly irritable. Her diagnosis was emotional
disorder and victim of childhood sexual and physical abuse. Wigfall told Dr.
Huffman she was having nightmares, bad moods, was irritated easily, isolative, and
down in the dumps. She reported continued difficulty sleeping. Mental status
examination revealed decreased eye contact, soft speech, and irritable and
depressed mood, and sad affect. Dr. Huffman prescribed Viibryd because Wigfall
experienced unacceptable side effects on numerous other medications. (Tr. 216).
On April 2, 2013, Wigfall reported frequent passive suicidal ideation. Her
mood switched “a lot” and she had trouble sleeping. Wigfall complained of
hearing a beeping noise that no one else could hear. Her mood upon examination
was euthymic. Dr. Huffman continued the trial of Viibryd, noting that it was
possible Wigfall was nonresponsive to SSRIs. Dr. Huffman stated that Wigfall’s
baseline risk of harming herself or others was elevated due to her history of abuse.
(Tr. 214). On April 25, 2013, Wigfall saw Dr. Huffman again. She had been off
Viibryd because she was taking antibiotics and during that time became very angry
and got in trouble at school. Wigfall had been having suicidal thoughts, but
reported feeling happy the day of her visit. She complained of seeing a “silver
flash” in her eye that no one else could see. Dr. Huffman discussed the results of
Wigfall’s DNA test, which revealed that Wigfall was at an increased risk of side
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effects while on SSRIs. Wigfall’s current diagnosis was depression, anxiety, and
victim of childhood sexual abuse. Her medication was continued. (Tr. 213).
On May 23, 2013, Wigfall told Dr. Huffman that she wanted to hurt herself,
make scars, and do “stupid stuff” because injuring herself made her forget about
her problems for a few minutes. She reported having a physical fight with her
mother and moving out, but was staying with her mother again temporarily.
Wigfall had stopped taking Viibryd because she was not living with her mother,
and her mother stated that the medication was ineffective anyway. Dr. Huffman
continued her prescription for Viibryd but was unsure whether Wigfall would refill
it because Wigfall indicated that she would be spending the summer with friends or
in Florida. Dr. Huffman observed small areas of scarring on Wigfall’s left hand,
but Wigfall denied having suicidal thoughts. (Tr. 210).
Dr. Huffman next saw Wigfall on July 25, 2013. Her diagnosis was
depression, anxiety, and victim of childhood sexual and physical abuse. Wigfall
reported she had not slept for three days and felt “hyper” all the time, but that her
mood was good. Wigfall stopped taking Viibryd because it made her dizzy and
nauseous. She was given a trial of melatonin to help with her sleep issues. (Tr.
207).
On November 7, 2013, Wigfall’s mother called Dr. Huffman to report that
Wigfall had been cutting her wrists and arms and had stopped all medications due
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to side effects. Dr. Huffman advised hospitalization, and Wigfall was
subsequently hospitalized for suicidal ideation for eight days. (Tr. 206).
On January 17, 2014, Dr. Huffman completed a childhood disability
evaluation form indicating that Wigfall had “marked” limitations in the areas of
interacting and relating with others, caring for herself, and health and physical
well-being. She indicated that Wigfall suffered from mood disorder with
components of depression and anxiety, frequent insomnia, frequent depressed
mood with thoughts of suicide, frequent conflicts with parents including some
physical aggression, and unhealthy coping mechanisms with a high risk of sexual
and behavioral acting out due to her history of physical and sexual abuse. Dr.
Huffman believed Wigfall to be a high risk for risky behaviors because of her
history of abuse, and a very high risk for chronic depression and anxiety as an
adult. Dr. Huffman opined that Wigfall needed ongoing medical and
psychological treatment. Her opinion was based on direct observation and
treatment, functional testing, and psychological and psychiatric evaluation. (Tr.
264-66).
4. Consultative Examination by Paul Rexcoat, Ph.D.
Wigfall was examined by consultative psychologist Paul Rexcoat on March
7, 2013. Dr. Rexcoat noted that Wigfall described significant symptoms of major
depression and PTSD during examination. He concluded that Wigfall had few
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limitations in her activities of daily living because she does dishes and cleans the
kitchen and bathroom and then watches two to three hours of television daily. She
knows how to cook and do laundry. Dr. Rexcoat opined that Wigfall had few
limitations in the area of social functioning because Wigfall stated that she has two
female friends she sees outside of school. He also stated that “she usually gets
along well with other students and teachers.” However, Dr. Rexcoat found
“serious limitations” in the area of school functioning because Wigfall was in a
special education reading program, was in a credit recovery program, and was
getting F’s on her report card. He assigned Wigfall a GAF score of 49 and his
prognosis was “guarded because of her depression and her problems in school.”
(Tr. 202-04).
5. Treatment with Bootheel Counseling Services
Wigfall sought treatment with Bootheel Counseling Services following her
in-patient hospitalization in November of 2013. Her first session was on
December 13, 2013, with clinical therapist Kellee Foote, MSW, LCSW. Wigfall
reported her history of sexual and physical abuse, her feelings of anger and suicidal
ideation, self-harm, her hospitalizations, her difficulties sleeping and relating with
others, her anxiety and diagnosis of PTSD, and her difficulties using psychotropic
medication due to side effects. Wigfall stated that she “loved [herself] for real” but
could not elaborate on what that meant. Foote also noted that Wigfall had been
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diagnosed with “cannabis dependence” due to her “reported daily use of
marijuana.” Foote does not indicate who diagnosed Wigfall with cannabis
dependence, but Wigfall stated that she smoked marijuana to relax her with no
desire to stop using. Following Wigfall’s initial visit, Foote listed Wigfall’s
strengths as “photography, poems, make up, attire” with her limitations being
“support system [and] social environment.” Axis I diagnostic impressions were
PTSD and cannabis dependence. Her thought content was noted to be unrealistic
and she had fair judgment and poor insight. Foote assigned Wigfall a GAF score
of 51. (Tr. 252-62).
Wigfall was evaluated by psychiatrist Barbara Willis, M.D., of Bootheel
Counseling Services on December 30, 2013. Wigfall reported symptoms of
depression, including isolation and irritability, with mood swings, insomnia, poor
concentration, and feelings of hopelessness and helplessness. Wigfall reported a
great deal of anxiety and endorsed easy startle response, avoidance reaction, and
alexithymia. Wigfall reported not taking her Wellbutrin for several days because
she left it at her father’s house. Wigfall stated that she began smoking marijuana at
age 16 and smokes five blunt per day. Wigfall admitted cutting and burning
herself. Dr. Willis observed Wigfall to be neatly groomed, but quite irritable and
oppositional, and only moderately cooperative with fair eye contact. Wigfall
“copped an attitude” when asked about substance abuse and psychotropic
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medications. She displayed mood swings. She was alert and oriented and
performed the serial sevens. Wigfall’s impulse control ranged from good to poor,
and her judgment and insight were poor. The remaining results of the mental
status examination were otherwise within normal limits. Wigfall’s diagnosis was
major depression recurrent, PTSD, social anxiety, specific phobias, cannabis
dependence, anxiety NOS, with a history of sexual and physical abuse. Dr. Willis
assigned Wigfall a GAF score of 46 and recommended outpatient substance
treatment, continuation of Wellbutrin, and lab work. (Tr. 248-51).
Wigfall had a second session with Foote on January 2, 2014. During the
session, Wigfall complained that she did not like Dr. Willis or the fact that Dr.
Willis told her mother about her marijuana use. Wigfall stated that she did not
want to see Dr. Willis again or go to substance abuse therapy. She became
emotional and uncommunicative, with decreased eye contact and some crying.
Wigfall’s speech was soft and hesitant, and her judgment and insight were poor.
(Tr. 247).
6. Consultative Opinions of Linda Nixon, M.D. and Marsha Toll, Psy.D.
On March 20, 2013, as part of the initial denial of Wigfall’s claim, a
Disability Determination Explanation form was completed. Wigfall’s claim for
benefits was considered by two non-examining consultants, Marsha Toll, Psy.D.,
and Linda Nixon, M.D. According to this form, these non-examining consultants
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concluded that Wigfall had a marked limitation in the domain of interacting and
relating with others, but less than marked limitations in the domains of acquiring
and using information, and health and physical well-being. (Tr. 54-61). The ALJ
relied on this form as medical evidence supporting his determination that Wigfall
was not disabled.
C.

School Records
Wigfall’s school records reflect a 2.1 GPA for the 2011-12 school year and a

1.9 GPA in the 2012-13 school year, with an F in Biology. (Tr. 141-43). Wigfall
was in a credit recovery program and her medical records noted difficulties with
reading. Wigfall does not receive special services.
IV. The ALJ’s Decision
In his written decision, the ALJ determined that Wigfall had not engaged in
substantial gainful activity since the date of application, December 12, 2012. He
further found that Wigfall’s impairments of major depressive disorder, PTSD,
social anxiety disorder, and anxiety disorder NOS were severe but, without
explanation, determined that they did not meet or medically equal the severity of
an impairment listed in 20 C.F.R. Part 404, Subpart P, Appendix 1. (Tr. 17). The
ALJ also found Wigfall’s severe impairments not to functionally equal the severity
of the listings, specifically finding that Wigfall had less than marked limitations in
the domains of Interacting and Relating with Others, Caring for Herself, and
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Health and Physical Well-Being, with no limitations in the remaining domains.
The ALJ thus found that Wigfall was not disabled. (Tr. 13-26.)
V. Discussion
Wigfall contends that the ALJ erred by failing to explain why her
impairments did not meet or medically equal the criteria in Listed Impairment
112.04 for mood disorders, which is characterized by either continuous or
intermittent persistence of at least five symptoms of major depressive syndrome 2
and results in marked limitations in age-appropriate social and personal
functioning. 20 C.F.R. Part 404, Subpart P, Appendix 1, § 112.04. Wigfall also
contends the ALJ erred in discounting the opinion of her treating psychiatrist, Dr.
Huffman.
On January 17, 2014, treating psychiatrist Dr. Huffman opined that Wigfall
had marked limitations in the areas of interacting and relating with others, caring
for herself, and health and physical well-being. She indicated that Wigfall suffered
from mood disorder with components of depression and anxiety, frequent
insomnia, frequent depressed mood with thoughts of suicide, frequent conflicts
with parents including some physical aggression, and unhealthy coping
mechanisms with a high risk of sexual and behavioral acting out due to her history

2

These symptoms include depressed or irritable mood, markedly diminished interest or pleasure
in almost all activities, weight increase, sleep disturbance, fatigue or loss of energy, feelings of
worthlessness or guilt, difficulty thinking or concentrating, or suicidal thoughts or acts.
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of physical and sexual abuse. Dr. Huffman believed Wigfall to be a high risk for
risky behaviors because of her history of abuse, and a very high risk for chronic
depression and anxiety as an adult. Dr. Huffman believed that Wigfall needed
ongoing medical and psychological treatment. Her opinion was based on direct
observation and treatment on at least 11 occasions, functional testing, and
psychological and psychiatric evaluation. (Tr. 264-66).
The ALJ assigned Dr. Huffman’s opinion “little weight” for the following
reasons:
[T]he claimant has been carrying a full load of classes, which would be
inconsistent with the allegation that she was unable to pay attention and
could not cope with life. Her grades were adequate at the time of the
hearing and the claimant was not being treated for any mental impairments
or taking any psychotropic medications. Because the domain assessments
by Dr. Huffman are inconsistent with the medical and other evidence of
record as a whole, her opinion is given little weight.
(Tr. 20). Instead, the ALJ relied upon the opinions of two non-examining
consultants, Linda Nixon and Marhsa Toll, who reviewed Wigfall’s records in
March of 2013 in connection with the initial denial of her claim and concluded that
Wigfall had a marked limitation in one domain, that of Interacting with and
Relating to Others, and a less than marked limitation in the domain of Health and
Well Being. The ALJ concluded that their opinions regarding less than marked
limitations were supported by the records, but that their opinions regarding marked
limitations in social interactions were not supported as inconsistent with the
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findings of examining consultant Dr. Rexcoat. Dr. Rexcoat, a consulting
psychologist, evaluated Wigfall once in March of 2013 and concluded that Wigfall
had few limitations in the area of social functioning. (Tr. 20).
With respect to Wigfall’s mental impairments, the ALJ found as follows:
Overall, the claimant’s presentation in therapy is inconsistent with the
descriptions of severe mental symptoms, most of which appear to be
confined to a six-month period between December 2012 and May 2013,
indicating that even if the symptoms were disabling, they did not last a full
12 months as the Social Security Act requires. Additionally, apart from Dr.
Huffman’s inconsistent opinion . . . none of the treating providers have
offered the conclusion that the claimant was disabled by any impairment or
combination of mental or physical impairments.
(Tr. 19). The ALJ concluded that Wigfall “is functional and has a normal GAF”
when she is “compliant with medications and treatment.” (Tr. 20). He discounted
Wigfall’s GAF scores of 46 and 51 in December of 2013, finding that they had
“not been repeated” and that she was “functional in school and at home, with no
further hospitalizations or emergency department visits for any psychological
condition.” (Tr. 20).
“It is the ALJ’s function to resolve conflicts among the various treating and
examining physicians.” Estes v. Barnhart, 275 F.3d 722, 725 (8th Cir. 2002)
(internal quotation marks and citation omitted). “The opinion of a treating
physician is accorded special deference under the social security regulations.”
Prosch v. Apfel, 201 F.3d 1010, 1012–13 (8th Cir. 2000). The opinions and
findings of the plaintiff’s treating physician are entitled to “controlling weight” if
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that opinion is “‘well-supported by medically acceptable clinical and laboratory
diagnostic techniques and is not inconsistent with the other substantial evidence in
[the] record.’” Id. (quoting 20 C.F.R. § 404.1527(d)(2)). “Although a treating
physician’s opinion is entitled to great weight, it does not automatically control or
obviate the need to evaluate the record as a whole.” Hogan v. Apfel, 239 F.3d
958, 961 (8th Cir. 2001). An ALJ may “discount or even disregard the opinion of
a treating physician where other medical assessments are supported by better or
more thorough medical evidence, or where a treating physician renders
inconsistent opinions that undermine the credibility of such opinions.” Prosch,
201 F.3d at 1013 (internal quotation marks and citations omitted); Cox v. Barnhart,
471 F.3d 902, 907 (8th Cir.2006) (holding that an ALJ may give a treating doctor’s
opinion limited weight if it is inconsistent with the record). An ALJ is entitled to
give less weight to the opinion of a treating doctor where the doctor’s opinion is
based largely on the plaintiff’s subjective complaints rather than on objective
medical evidence. Kirby v. Astrue, 500 F.3d 705, 709 (8th Cir.2007) (citing
Vandenboom v. Barnhart, 421 F.3d 745, 749 (8th Cir.2005)). Whether the ALJ
grants a treating physician’s opinion substantial or little weight, the ALJ must
“always give good reasons” for the particular weight given to a treating physician’s
evaluation. 20 C.F.R § 404.1527(d)(2).
The ALJ’s decision to discount Dr. Huffman’s opinion and his findings
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regarding the severity of Wigfall’s mental impairments are not supported by
substantial evidence on the record as a whole. Here, the ALJ substantially erred
when determining that Dr. Huffman’s opinion was entitled only to slight weight
because it was allegedly inconsistent with Wigfall’s “adequate” grades. Yet Dr.
Huffman never opined that Wigfall had marked limitations in the domains of
Acquiring and Using Information or Attending and Completing Tasks. Instead,
Dr. Huffman found that Wigfall was markedly limited in her interactions with
others, ability to care for herself, and health and physical well-being, areas which
are not contradicted by Wigfall’s so-called “adequate” grades. Moreover, the ALJ
exaggerated Wigfall’s school performance, as she earned only a 2.1 GPA for the
2011-12 school year and a 1.9 GPA in the 2012-13 school year, with an F in
Biology. (Tr. 141-43). The substantial evidence of record does not support the
ALJ’s determination that Wigfall had no marked limitations because she was
performing adequately in school. Wigfall was in a credit recovery program for
English and her medical records noted difficulties with reading. Consulting
psychologist Dr. Rexcoat determined that Wigfall had serious limitations in the
area of school functioning because of her reading problems and poor grades,
calling her prognosis “guarded because of her depression and her problems in
school.” (Tr. 202-04). Contrary to the ALJ’s finding, Dr. Huffman’s opinion is
not undermined by Wigfall’s school performance.
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The ALJ further erred when he concluded that Dr. Huffman’s opinion was
entitled to only slight weight as inconsistent with the medical and other evidence of
record. The ALJ determined that Wigfall’s symptoms were inconsistent with
severe mental limitations, and that any disabling symptoms only lasted from
December of 2012 until May of 2013. He also determined that Dr. Huffman’s
opinion was inconsistent because no other treating providers offered an opinion
that Wigfall was disabled. The ALJ’s finding is contradicted by substantial
evidence on the record as a whole, which demonstrates that Wigfall experienced
severe symptoms of mental impairments as early as November of 2012, when she
was hospitalized for depression, anxiety, anger, flashbacks, and suicidal ideation.
She was prescribed psychotropic medications and discharged with a “cautiously
optimistic” prognosis. Wigfall then began regular treatment with psychiatrist Dr.
Huffman and therapist Hunter. Dr. Huffman noted Wigfall’s extreme difficulties
with mood swings, anger, sleep difficulties, and side effects from her medication
during her first visit in November of 2012.
Contrary to the ALJ’s findings, Wigfall’s severe symptoms continued well
past May of 2013. Wigfall’s depressed mood with suicidal ideation, sleep
difficulties, mood swings, and difficulties taking her psychotropic medication were
reported regularly by Wigfall not only through the time period cited by the ALJ,
but also in April of 2013, when Dr. Huffman noted frequent passive suicidal
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ideation, trouble sleeping, euthymic mood, and hearing a beeping sound no one
else could hear.
At the end of April, Wigfall’s suicidal thoughts and mood swings remained,
and Wigfall reported seeing a “silver flash” in her eye that no one else could see.
Her diagnosis at the end of April was depression, anxiety, and victim of childhood
sexual abuse. Despite her problems with side effects, Wigfall’s psychotropic
medications were continued. During Wigfall’s visit with Dr. Huffman in May of
2013, Wigfall admitted cutting and hurting herself to forget about her problems,
and Dr. Huffman observed scars on Wigfall’s left hand. Wigfall got into a
physical fight with her mother and moved in with her father, so she was unable to
continue getting her medication. In July, she had stopped taking her psychotropic
medication because it made her dizzy and nauseous. Wigfall reported continued
sleep disturbances and was “hyper.” In November of 2013, Wigfall was cutting
her wrists and arms, and Dr. Huffman recommended hospitalization. Wigfall was
subsequently hospitalized for eight days for suicidal ideation. Wigfall reported
increased depression and persistent thoughts of killing herself. She cut her left
wrist and burned her right hand with a cigarette lighter. She reported feeling
down, sad, and overwhelmed, with feelings of hopelessness and worthlessness.
Her diagnosis upon discharge on November 27, 2013, was suicidal ideation, acute
depression, and PTSD. She was prescribed Wellbutrin.
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Following her discharge from the hospital in November of 2013, Wigfall
received treatment from Bootheel Counseling Services. Wigfall met with Dr.
Willis for one session at the end of December and reported symptoms of
depression, including isolation and irritability, mood swings, insomnia, poor
concentration, and feelings of hopelessness and helplessness. She had anxiety, an
easy startle response, avoidance reaction, and alexithymia. Wigfall was irritable
and oppositional, and only moderately cooperative with fair eye contact. Wigfall
displayed mood swings during the session and a bad attitude when questioned
about her use of marijuana. Her impulse control ranged from good to poor, and her
judgment and insight were poor. Dr. Willis diagnosed major depression recurrent,
PTSD, social anxiety, specific phobias, cannabis dependence, anxiety NOS, with a
history of sexual and physical abuse.
The ALJ’s finding that Wigfall did not experience severe mental symptoms
after March of 2013 is flatly contradicted by the medical evidence of record,
including numerous treatment records from her treating psychiatrists and the
medical records from her two hospitalizations for suicidal ideation. These records
show that Wigfall’s symptoms were increasing, not decreasing, despite regular
treatment and eventually resulted in a second, extended hospitalization at the end
of November. That Wigfall’s symptoms were improving upon discharge from the
hospital does not support the ALJ’s determination regarding the severity of
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Wigfall’s mental impairments. “Although the mere existence of symptom-free
periods may negate a finding a disability when a physical impairment is alleged,
symptom-free intervals do not necessarily compel such a finding when a mental
disorder is the basis of a claim.” Andler v. Chater, 100 F.3d 1389, 1393 (8th Cir.
1996). “Symptom-free intervals and brief remissions are generally of uncertain
duration and marked by the impending possibility of relapse.” Id. This is certainly
true where the reports of improvement are made upon release from in-patient
psychiatric care. The ALJ erred by failing to take into account the cyclical nature
of mental impairments and the fact that Wigfall’s disability hearing took place only
a few months after her last hospitalization. That she may have appeared
asymptomatic to the ALJ at the hearing does not undermine the substantial medical
evidence of record demonstrating Wigfall’s persistent and severe mental
symptoms, and it was error for the ALJ to substitute his own judgment for that of
Wigfall’s treating psychiatrist on this issue. An ALJ may not substitute his own
opinions for the opinions of medical professionals. Ness v. Sullivan, 904 F.2d 432,
435 (8th Cir. 1990); see also Pate–Fires v. Astrue, 564 F.3d 935, 946–47 (8th Cir.
1995) (ALJ may not “play doctor”).
Although Wigfall’s therapists are not “acceptable medical sources” under

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the regulations,3 their treatment notes may still be properly considered as other
medical evidence as they are consistent with Dr. Huffman’s opinion regarding
Wigfall’s limitations. Therapist Hunter began seeing Wigfall at the same time as
Dr. Huffman, and his treatment notes are consistent with Dr. Huffman’s opinion
regarding the severity of Wigfall’s limitations. His notes reflect Wigfall’s issues
with anger over her extensive sexual and physical abuse, her problems getting
along and relating with other students, teachers, and family members, mood
swings, depression, feelings of hopelessness and suicidal thoughts, self-harming,
and obsessive thoughts about her abusers. His observations are consistent with
those of Therapist Foote, who saw Wigfall twice – once in December of 2013 and
once in January of 2014. Like many of Hunter’s sessions with Wigfall, Foote’s
sessions took place during the time period in which the ALJ concluded that Wigfall
was no longer experiencing severe mental symptoms. She found Wigfall had
unrealistic thought content, poor judgment and insight decreased eye contact,
tearful affect, and soft and hesitant speech. Contrary to the ALJ’s findings, this

To establish a disability or impairment, the Social Security Administration requires “evidence
from acceptable medical sources.” 20 C.F.R. § 416.913(a). Such acceptable medical sources
include licensed physicians, licensed or certified psychologists, licensed optometrists, licensed
podiatrists, and qualified speech language pathologists. Id. “In addition to evidence from the
acceptable medical sources listed in paragraph (a) of this section, [the Commissioner] may also
use evidence from other sources . . . .” Id. § 416.913(d) (emphasis added). Other sources include
social workers such as therapists Hunter and Foote. Id. § 416.913(a). The ALJ had the option to
consider their opinions here because they were consistent with the opinion from Dr. Huffman,
Wigfall’s treating psychiatrist. Crawford v. Colvin, 809 F.3d 404, 408 (8th Cir. 2015).
3

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evidence is not inconsistent with Dr. Huffman’s opinion.
The ALJ also improperly discounted Dr. Huffman’s opinion because, “apart
from” her, none of Wigfall’s treating providers opined that she was disabled. Dr.
Huffman was the only treating provider who rendered an opinion regarding
Wigfall’s limitations. She was Wigfall’s primary treating psychiatrist, with a
lengthy treatment history which included regular counseling sessions with her and
a therapist, psychotropic therapy, diagnostic testing and lab work, and her eventual
recommendation that Wigfall be hospitalized in November of 2013 for her
symptoms. Given Dr. Huffman’s specialized field of practice and the length and
nature of her treatment history with Wigfall, she was in the best position to render
an opinion as to Wigfall’s limitations and it was error for the ALJ to discount it
merely because Wigfall could not offer bolstering opinions from other treating
psychiatrists. The regulations do not impose such an impractical and onerous
burden on claimants, and it was error for the ALJ to do so here. Certainly, no
treating physician ever rendered an opinion that Wigfall was not disabled, and
none of the medical records from Wigfall’s treating providers are inconsistent with
Dr. Huffman’s opinion, either. The only other treating psychiatrist to see Wigfall
was Dr. Willis, who treated Wigfall once on December 30, 2013. During that visit,
Wigfall reported symptoms of depression, including isolation and irritability, with
mood swings, insomnia, poor concentration, and feelings of hopelessness and
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helplessness. She had a lot of anxiety, an easy startle response, and alexithymia.
Wigfall admitted cutting and burning herself. Although she was noted to be neatly
groomed, she was quite irritable and oppositional, only moderately cooperative
with fair eye contact, and displayed poor attitude and mood swings. Her impulse
control ranged from good to poor, and her judgment and insight were poor. Dr.
Willis diagnosed major depression recurrent, PTSD, social anxiety, specific
phobias, cannabis dependence, anxiety NOS, with a history or sexual and physical
abuse, and she assigned Wigfall a GAF score at that time of 46. Dr. Willis’
findings are consistent with Dr. Huffman’s opinion regarding Wigfall’s marked
limitations.
The ALJ substantially erred in discounting the opinion of Wigfall’s treating
psychiatrist in favor of those offered by Drs. Nixon and Toll, non-examining
consultants who merely reviewed some of Wigfall’s medical records in connection
with the initial denial of her claim. “The opinions of non-treating practitioners
who have attempted to evaluate the claimant without examination do not normally
constitute substantial evidence on the record as a whole.” Shontos v. Barnhart,
328 F.3d 418, 427 (8th Cir. 2003). This is especially true here, where the nonexamining consultants only reviewed Wigfall’s medical records through March of
2013, but Wigfall’s significant mental symptoms continued well past that date and
included an eight-day hospitalization for suicidal ideation in November of 2013.
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Even without all of the records they still found Wigfall had a marked limitation in
the domain of interacting and relating with others, just like Dr. Huffman. Yet the
ALJ disregarded this portion of their opinions as inconsistent with the opinion of
an examining consultant. “As a general matter, the report of a consulting physician
who examined a claimant once does not constitute substantial evidence upon the
record as a whole, especially when contradicted by the evaluation of the claimant’s
treating physician.” Wagner v. Astrue, 499 F.3d 842, 849 (8th Cir. 2007) (internal
quotation marks and citation omitted). Dr. Rexcoat, who examined Wigfall once
in March of 2013, found that Wigfall had few limitations in social functioning, but
serious limitations in school functioning and a “guarded” prognosis. Dr. Rexcoat’s
opinion suffers from the same deficiency as those of Drs. Nixon and Toll, namely,
that it was rendered with only limited consideration of Wigfall’s worsening mental
symptoms. Like the non-examining consultants, even without all of the relevant
medical evidence Dr. Rexcoat still found Wigfall to be seriously limited in some
aspects of her functioning. Once again, the ALJ chose to ignore Dr. Rexcoat’s
findings which suggested that Wigfall had serious limitations in any domain,
preferring instead to “play doctor” by substituting his own opinions for that of the
medical professionals. In doing so, he substantially erred. See Pate–Fires, 564
F.3d at 946–47. An “ALJ’s reliance on . . . his own beliefs as to what the medical
evidence should show do[es] not constitute substantial evidence” to support a
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conclusion that a claimant is not disabled. Fowler v. Bowen, 866 F.2d 249, 252
(8th Cir. 1989).
The ALJ also improperly discounted Dr. Huffman’s opinion regarding the
severity of Wigfall’s limitations because he concluded that Wigfall “is functional
and has a normal GAF” when she is “compliant with medications and treatment.”
He discounted Wigfall’s GAF scores of 46 and 514 in December of 2013, finding
that they had not “been repeated” and that Wigfall was not taking psychotropic
medications at the time of the hearing. The ALJ’s findings with respect to
Wigfall’s GAF scores are contrary to the substantial evidence on the record as a
whole. The most recent GAF scores in the record at the time of the hearing in
April of 2014 were those assigned by Dr. Willis (46) and therapist Foote (51) in
December of 2013, and there is no evidence in the record suggesting that Wigfall’s
GAF scores had been assessed or were improved after that time period. That
Wigfall’s low GAF scores of December 2013 had not been repeated simply
because they had not been measured in the four months prior to the hearing is not
evidence that Wigfall’s symptoms were improving or that she suffered from no
marked limitations.
4

“[A] GAF of 41-50 indicates that the individual has serious symptoms or any serious
impairment in social occupational or school functioning.” Nowling v. Colvin, 813 F.3d 1110,
1115 (8th Cir. 2016). “In recent years, the agency has recognized, and we have noted, that GAF
scores have limited importance.” Id. However, “GAF scores may be relevant to a determination
of disability based on mental impairments.” Mabry v. Colvin, 815 F.3d 386, 391 (8th Cir. 2016).
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To the extent the ALJ implies that Wigfall’s December 2013 GAF scores
were an aberration and not indicative of her true GAF scores, this conclusion is
contrary to the substantial evidence on the record as a whole. Wigfall’s GAF score
upon admission to the hospital in November of 2012 was 40 and upon discharge
was 55. Her GAF score upon admission to the hospital in November of 2013 was
30. Dr. Rexcoat assigned Wigfall a GAF score of 49 in March of 2013. The only
“normal” GAF score (75) Wigfall received was upon her discharge from the
hospital in November of 2013 after an eight day stay for suicidal ideation. Yet less
than one month later, it had fallen to previous levels. Wigfall’s GAF scores from
December of 2013 are entirely consistent with her other GAF scores and Dr.
Huffman’s opinion regarding the severity of Wigfall’s limitations, and the ALJ’s
contrary finding is not supported by substantial evidence on the record as a whole.
The ALJ’s finding that Wigfall’s symptoms were not disabling when she
was “compliant with medications and treatment” is also not supported by
substantial evidence in the record as a whole. Throughout her treatment with Dr.
Huffman, Wigfall was placed on – and taken off – a myriad of psychotropic
medications because they were ineffective and caused severe side effects. The
frequency and severity of Wigfall’s sensitivity to psychotropic medications
eventually led Dr. Huffman to order DNA testing for Wigfall, which revealed an
increased risk of side effects while on SSRIs. The only evidence of non- 32 -

compliance with medications was either due to severe side effects or the inability
of Wigfall (a child) to obtain her medication because of cost or unstable living
conditions. Wigfall testified that she was not on medication or seeking mental
health treatment at the time of the hearing because she did not have Medicaid.
While the failure to seek or remain compliant with treatment is a factor an ALJ
may properly consider, here the ALJ substantially erred by refusing to consider the
debilitating side effects from medication as well as Wigfall’s inability to afford or
obtain treatment when determining the nature and severity of her limitations. See
Polaski v. Heckler, 739 F.2d 1320, 1322 (8th Cir. 1994) (ALJ should consider
dosage, effectiveness, and side effects of medication when evaluating claim);
Johnson v. Bowen, 866 F.2d 274, 275 (8th Cir. 1989) (lack of resources may justify
failure to follow prescribed course of treatment).
Here, the ALJ improperly discounted the opinion of Wigfall’s treating
psychiatrist that Wigfall suffered from marked limitations in the domains of Caring
for Oneself, Health and Physical Well-Being, and Interacting and Relating with
Others. In so doing, he substantially erred. Because the ALJ’s opinion is not
supported by substantial evidence on the record as whole, it is reversed and this
case is remanded for further proceedings consistent with this opinion. Upon
remand, the ALJ is also directed to consider whether Wigfall’s impairments meet
or medically equal the criteria in Listed Impairment 112.04 for mood disorders.
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Although the record strongly suggests that Wigfall is disabled, I cannot
conclusively say that she is.
VI. Conclusion
Because the Commissioner’s final decision that Wigfall is not disabled is not
supported by substantial evidence on the record as a whole, it is reversed and this
case is remanded for further proceedings consistent with this opinion.
Accordingly,
IT IS HEREBY ORDERED that the decision of the Commissioner is
reversed, and this case is remanded for further proceedings consistent with this
Memorandum and Order.
A separate Judgment is entered herewith.

____________________________________
CATHERINE D. PERRY
UNITED STATES DISTRICT JUDGE

Dated this 22nd day of March, 2017.

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