Cobb v. Berryhill

Filing 19

MEMORANDUM AND ORDER IT IS HEREBY ORDERED that the relief requested in Plaintiffs Complaint and Brief in Support of Complaint is DENIED. [Doc. 1, 14.]IT IS FURTHER ORDERED that the Court will enter a judgment in favor of the Commissioner affirming the decision of the administrative law judge. Signed by Magistrate Judge Nannette A. Baker on 8/31/18. (CLA)

UNITED STATES DISTRICT COURT
EASTERN DISTRICT OF MISSOURI
NORTHERN DIVISION

MARTIN J. COBB, II,
Plaintiff,
v.
NANCY A. BERRYHILL,
Deputy Commissioner of Operations ,
Defendant.

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Case No. 2:17-CV-63 NAB

MEMORANDUM AND ORDER
This is an action under 42 U.S.C. § 405(g) for judicial review of the Commissioner of
Social Security’s final decision denying Martin J. Cobb, II’s application for disability insurance
benefits and supplemental security income under the Social Security Act, 42 U.S.C. §§ 416, 423
et seq. Cobb alleged disability due to depression, anxiety, bipolar disorder, schizoaffective
disorder, osteoarthritis, herniated discs, slipped vertebrae in back, scoliosis, stage 3 chronic
kidney failure, pain, fatigue, auditory and visual hallucinations, and paranoia. (Tr. 214.) The
parties have consented to the exercise of authority by the undersigned United States Magistrate
Judge pursuant to 28 U.S.C. § 636(c). [Doc. 9.]
Cobb presents one error for review in this appeal. He asserts that the administrative law
judge (ALJ) erred by failing to give controlling weight to the opinions of three treating providers
and one independent medical evaluator. The Commissioner contends that the ALJ’s decision is
supported by substantial evidence in the record as a whole and should be affirmed. The Court
has reviewed the parties’ briefs and the entire administrative record, including the hearing

transcripts and the medical evidence. For the reasons set forth below, the Court will affirm the
Commissioner’s final decision.
Standard of Review
The Social Security Act defines disability as an “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 has lasted or can be expected to last for a continuous period
of not less than 12 months.” 42 U.S.C. §§ 416(i)(1)A), 423(d)(1)(A).
The Social Security Administration (“SSA”) uses a five-step analysis to determine
whether a claimant seeking disability benefits is in fact disabled. 20 C.F.R. §§ 404.1520(a)(1),
416.920(a)(1). First, the claimant must not be engaged in substantial gainful activity. 20 C.F.R.
§§ 404.1520(a)(4)(i), 416.920(a)(4)(i). Second, the claimant must establish that he or she has an
impairment or combination of impairments that significantly limits his or her ability to perform
basic work activities and meets the durational requirements of the Act.
§§ 404.1520(a)(4)(ii), 416.920(a)(4)(ii).

20 C.F.R.

Third, the claimant must establish that his or her

impairment meets or equals an impairment listed in the appendix of the applicable regulations.
20 C.F.R. §§ 404.1520(a)(4)(iii), 416.920(a)(4)(iii). If the claimant’s impairments do not meet
or equal a listed impairment, the SSA determines the claimant’s RFC to perform past relevant
work. 20 C.F.R. §§ 404.1520(e), 416.920(e).
Fourth, the claimant must establish that the impairment prevents him or her from doing
past relevant work. 20 C.F.R. §§ 404.1520(a)(4)(iv), 416.920(a)(4)(iv). If the claimant meets
this burden, the analysis proceeds to step five.

At step five, the burden shifts to the

Commissioner to establish the claimant maintains the RFC to perform a significant number of
jobs in the national economy. Singh v. Apfel, 222 F.3d 448, 451 (8th Cir. 2000). If the claimant

2

satisfied all of the criteria under the five-step evaluation, the ALJ will find the claimant to be
disabled. 20 C.F.R. §§ 404.1520(a)(4)(v), 416.920(a)(4)(v).
The standard of review is narrow. Pearsall v. Massanari, 274 F.3d 1211, 1217 (8th Cir.
2001).

This Court reviews the decision of the ALJ to determine whether the decision is

supported by substantial evidence in the record as a whole. 42 U.S.C. § 405(g). Substantial
evidence is less than a preponderance, but enough that a reasonable mind would find adequate
support for the ALJ’s decision. Smith v. Shalala, 31 F.3d 715, 717 (8th Cir. 1994). The Court
determines whether evidence is substantial by considering evidence that detracts from the
Commissioner’s decision as well as evidence that supports it. Cox v. Barnhart, 471 F.3d 902,
906 (8th Cir. 2006). The Court may not reverse just because substantial evidence exists that
would support a contrary outcome or because the Court would have decided the case differently.
Id. If, after reviewing the record as a whole, the Court finds it possible to draw two inconsistent
positions from the evidence and one of those positions represents the Commissioner’s finding,
the Commissioner’s decision must be affirmed. Masterson v. Barnhart, 363 F.3d 731, 726 (8th
Cir. 2004). The Court must affirm the Commissioner’s decision so long as it conforms to the
law and is supported by substantial evidence on the record as a whole. Collins ex rel. Williams v.
Barnhart, 335 F.3d 726, 729 (8th Cir. 2003).
ALJ Decision
The ALJ found that Cobb had the severe impairments of schizoaffective disorder,
depressed type; major depressive disorder; borderline personality disorder; schizophrenia; and
anxiety. (Tr. 12.) The ALJ determined that Cobb did not have any severe physical impairments.
The ALJ found that Cobb had the residual functional capacity to perform medium work with the
following limitations: (1) simple, repetitive tasks not at a fast pace, (2) occasional interaction

3

with coworkers and the public, (3) limited to isolated work with only occasional supervision, and
(4) limited to work which requires only occasional changes in work tasks. (Tr. 14.) The ALJ
gave little or only partial weight to the medical source statements from Dr. Arvin Abueg and
Advanced Nurse Practitioner Carolyn Greening, a Psychological Evaluation from licensed
psychologist Rebecca Still, and a letter authored by licensed clinical social worker Marilyn Sue
Frankenbach and Advanced Nurse Practitioner Carolyn Greening.
statements from these providers should be given controlling weight.

Cobb asserts that the
The Court will now

evaluate each opinion separately.
Analysis of Medical Opinion Evidence
Dr. Arvin Abueg
On April 1, 2014, Cobb was admitted to the hospital for a suicide attempt where he took
an overdose of his prescription medications. (Tr. 276-317, 344-48, 357-65.) He was in the
intensive care unit for several days and then spent almost a week in the psychiatric unit of the
hospital. (Tr. 276-317, 344-48, 357-65.) After his discharge from the hospital, Cobb established
care with Dr. Arvin Abueg for primary care. The administrative record shows Cobb visited with
Dr. Abueg three times in April and May of 2014.

During the first visit, Cobb’s primary

complaint was blurred vision in both eyes. (Tr. 319-21.) During that visit his mental status
examination was normal. His second visit occurred on May 5, 2014 and Cobb complained of
anxiety and shaky hands. (Tr. 322.) During his third visit on May 28, 2014, Cobb came for a
physical examination and the completion of his disability paperwork. (Tr. 329-31.)
Dr. Abueg’s notes from the May 28th visit indicate that Cobb’s mental status
examination was generally normal, but his mood and affect were anxious. (Tr. 330.) Cobb’s
physical examination results were also normal. (Tr. 330-31.) The medical source statement

4

completed by Dr. Abueg opined about Cobb’s mental and physical impairments. (Tr. 333-335.)
Dr. Abueg opined that Cobb could occasionally lift no more than 10 pounds and stand, walk, and
sit for a maximum of less than 2 hours in an 8 hour work day. (Tr. 333.) He also indicated that
Cobb could only sit or stand for 10 minutes before he needed to change positions and he needed
the opportunity to shift at will. (Tr. 333.) Dr. Abueg indicated that Cobb must also walk around
16 times in an eight hour work day for 15 minutes at a time. (Tr. 333.) Dr. Abueg did not state
what medical findings supported those limitations. (Tr. 333.) Next, Dr. Abueg gave various
postural and manipulative limitations, but again, Dr. Abueg did not reference any medical
findings supporting those limitations, only indicating that “patient can do the above activities
satisfactorily for a period of time.” (Tr. 334.) Dr. Abueg also listed environmental restrictions
indicating that Cobb needed to avoid moderate exposure to extreme heat, cold, and high
humidity. (Tr. 335.) He wrote “Patient has problems on following instructions, especially for
repetitive jobs since he cannot stay on task long enough to do the task as prescribed for
prolonged periods.” (Tr. 335.) Dr. Abueg opined that this was due to Cobb’s “bipolar disorder
type 2 & schizoaffective disorder.” (Tr. 335.) He also opined that Cobb’s impairments would
cause Cobb to be absent from work for more than 4 days per month, to be off task more than
25% of the time, and he needed to take unscheduled breaks every 15-20 minutes for 20 minutes.
(Tr. 336.)
The ALJ gave Dr. Abueg’s medical source statement little weight regarding Cobb’s
physical limitations. (Tr. 16.) The ALJ found that Dr. Abueg did not explain why Cobb would
have such severe physical limitations. The ALJ noted that Dr. Abueg’s notes from Cobb’s May
28th visit state, “He has difficulty holding a full time job not because he is physically unable to

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handle it but because he does not have the mental focus to actually finish his work due to his
mania and psychosis.” (Tr. 16, 329.)
Regarding Dr. Abueg’s evaluation of Cobb’s mental impairments, the ALJ gave partial
weight to the evaluation. (Tr. 16.) The ALJ stated that there was not strong evidence that
Cobb’s mental symptoms were “so significant as to preclude work” and “medical notes do not
contain much in the way of evidence to support his conclusion that mania is a significant
problem.” (Tr. 16.) He also found that “Dr. Abueg’s own notes of the examination on the date
that he provide[d] his opinion show a history of anxiety and irritability, but also showed anxious
but appropriate insight, appropriate judgment regarding everyday activities, and appropriate
judgment in social situations.” (Tr. 16.)
Whether the ALJ grants a treating physician’s opinion substantial or little weight, the
regulations provide that the ALJ must ‘always give good reasons’ for the particular weight given
to a treating physician’s evaluation.” Prosch v. Apfel, 201 F.3d 1010, 1013 (8th Cir. 2000).
“Medical opinions are statements from physicians and psychologists or other acceptable medical
sources that reflect judgments about the nature and severity of a claimant’s impairments,
including symptoms, diagnosis and prognosis, and what the claimant can still do despite her
impairments and her physical or mental restrictions.” 20 C.F.R. §§ 404.1527, 416.927(a)(2) 1.
All medical opinions, whether by treating or consultative examiners are weighed based on
(1) whether the provider examined the claimant; (2) whether the provider is a treating source;
(3) length of treatment relationship and frequency of examination, including nature and extent of
the treatment relationship; (4) supportability of opinion with medical signs, laboratory findings,
and explanation; (5) consistency with the record as a whole; (6) specialization; and (7) other

1

Many Social Security regulations were amended effective March 27, 2017. Per 20 C.F.R. §§ 404.1527, 416.927,
the court will use the regulations in effect at the time that this claim was filed.

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factors which tend to support or contradict the opinion. 20 C.F.R. §§ 404.1527(c), 416.927(c).
Generally, a treating physician’s opinion is given controlling weight, but is not inherently
entitled to it. Hacker v. Barnhart, 459 F.3d 934, 937 (8th Cir. 2006). A treating physician’s
opinion “does not automatically control or obviate the need to evaluate the record as [a] whole.”
Leckenby v. Astrue, 487 F.3d 626, 632 (8th Cir. 2007). A treating physician’s opinion will be
given controlling weight if the opinion is well-supported by medically acceptable clinical and
laboratory diagnostic techniques and is not inconsistent with the other substantial evidence in the
case record. 20 C.F.R. §§ 404, 1527(c)(2), 416.927(c)(2). “Good reasons for assigning lesser
weight to the opinion of a treating source exist where the treating physician’s opinions
themselves are inconsistent or where other medical assessments are supported by better or more
thorough evidence.” Chesser v. Berryhill, 858 F.3d 1161, 1164 (8th Cir. 2017) (internal citations
omitted).
Based on the foregoing, the Court finds that the ALJ properly weighed the medical
opinion evidence from Dr. Abueg. First, while Dr. Abueg was a treating physician, his three
visits with Cobb are not enough time to develop a longitudinal picture of a claimant’s medical
impairments. See e.g. Randolph v. Barnhart, 386 F.3d 835, 840 (8th Cir. 2004) (three visits
insufficient to formulate an opinion of claimant’s ability to function in the workplace). Dr.
Abueg did not treat Cobb for any period during employment and the treatment notes did not
show that he based his opinion about Cobb’s ability to work on anything other than Cobb’s
subjective complaints. Second, Dr. Abueg’s opinion on Cobb’s physical impairments were
inconsistent with the treatment notes from Cobb’s visits and Dr. Abueg failed to identify any
medical findings to support his opinion.

The opinion’s conclusions regarding physical

impairments was also internally inconsistent by stating that Cobb could stand and walk for less

7

than 2 hours total a day, but then stating that he needed to walk around 16 times in an 8 hour day
for fifteen minutes at a time.
Next, the ALJ properly gave partial weight to Dr. Abueg’s opinion regarding Cobb’s
mental impairments. (Tr. 16.) Again, Dr. Abueg treated Cobb three times within two months
after he had been released from the hospital for a suicide attempt. At the time of his treatment,
Cobb was relatively stable and was only exhibiting symptoms of anxiety despite not being on
antipsychotic medication.

Further, treatment notes from the psychiatric nurse practitioner

Carolyn Greening during the same time period indicated that Cobb’s condition, while initially
unstable, was improving and that he was exhibiting moderate symptoms of impairment. (Tr.
381-88.) Therefore, the Court finds that the ALJ’s weighing of Dr. Abueg’s opinion is supported
by substantial evidence in the record as a whole.
Rebecca Still, Licensed Psychologist
At the requests of Cobb’s former counselor, Rebecca Still, a licensed psychologist
conducted a psychological evaluation of Cobb on May 14, 2014. (Tr. 392-401.) This evaluation
occurred approximately a month and a half after Cobb’s April 2014 suicide attempt. The
psychological evaluation included assessments for attentional problems (ADHD Rating Scale),
cognitive functioning (Kaufman Brief Intelligence Test-2nd edition and Wide Range
Achievement Test), the Minnesota Multiphasic Personality Inventory-2nd Edition (MMPI-2), the
Millon Clinical Multiaxial Inventory, Beck Depression Inventory, Culture-Free Self-Esteem
Inventories- 2nd Edition, Multidimensional Anxiety Questionnaire, and Substance Abuse Subtle
Screening Inventory.
The results of the ADHD Rating Scale indicated that his answers were inconsistent and
may be invalid. (Tr. 394.) The intelligence and achievement testing showed that Cobb had

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average intellectual functioning and no specific learning disorder was revealed. (Tr. 394-95.)
The MMPI-2 validity scales suggested that Cobb may have overstated problems, which Still
opined “may be due to an overly self-critical tendency or an effort to let others know of his need
of assistance. There is a possibility that the profile lacks accuracy due to exaggeration or
psychopathology.” (Tr. 395.) The profile suggested he felt troubled by anxiety, depression, and
general distress. (Tr. 395.) There was a very high score in the area of work interference,
suggesting behaviors or attitudes that may interfere with work performance. (Tr. 396.)
The Millon Clinical Multiaxial Inventory showed strong indications of an anxiety
condition and a depressive condition. (Tr. 397.) Cobb scored in the “mild” depression range on
the Beck Depression Inventory.

(Tr. 398.)

The Culture-Free Self-Esteem Inventories test

revealed low self-esteem. (Tr. 398.) The Multidimensional Anxiety Questionnaire reveals
severe clinical anxiety. (Tr. 399.) The Substance Abuse Subtle Screening Inventory classified
Cobb as “non dependent.”
Still diagnosed Cobb with schizoaffective disorder, bipolar type, generalized anxiety
disorder, panic disorder, and avoidant personality disorder. (Tr. 400.) She assessed his global
assessment functioning as 40 (Tr. 400), which indicated some impairment in reality testing or
communication or major impairment in several areas. Diagnostic and Statistical Manual of
Mental Disorders 32 (4th ed. Text Rev. 2000) (“DSM-IV-TR”). The GAF scale is “a numeric
scale used to rate social, occupational, and psychological functioning on a hypothetical
continuum of mental-health illness.” Mabry v. Colvin, 815 F.3d 386, 391 n. 6 (8th Cir. 2016)
(citing Pates-Fire v. Astrue, 564 F.3d 935, 937 n.1 (8th Cir. 2001)). “The scale ranges from zero
to one hundred.” Id. A GAF score is a “subjective determination that represents the clinician’s
judgment of the individual’s overall level of functioning.” Jones v. Astrue, 619 F.3d 963, 973

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(8th Cir. 2010). “The most recent edition of the Diagnostic and Statistical Manual of Mental
Disorders discontinued use of the GAF scale.” Id. Even before the DSM-V discontinued use of
the GAF scores, the Commissioner declined to fully endorse GAF scores for use in social
security and SSI disability programs. Halverson v. Astrue, 600 F.3d 922, 930-31 (8th Cir. 2010).
“GAF scores may be relevant to a determination of disability based on mental impairments. But
an ALJ may afford greater weight to medical evidence and testimony than to GAF scores when
the evidence requires it.” Mabry, 815 F.3d at 391. GAF scores have no direct correlation to the
severity standard used by the Commissioner. Wright v. Colvin, 789 F.3d 847, 855 (8th Cir.
2015) (citing 65 Fed. Reg. 50746, 50764-65). Nevertheless, the Social Security Administration
has stated that GAF scores are considered opinion evidence, even though they should not be
viewed as case determinative. CAROLYN A. KUBITSCHEK & JON C. DUBIN, SOCIAL SECURITY
DISABILITY LAW & PROCEDURE IN FEDERAL COURT, § 5:30, ed. (February 2017 Update) (citing
Administrative Message 13066 (July 22, 2013)).
Still recommended that Cobbs receive regular visits with his doctors for medication and
treatment, counseling, and involvement with Vocational Rehabilitation to help him in developing
goals and a plan for meeting those goals. (Tr. 400-401.) The ALJ did not state what weight, if
any, that he gave to Still’s psychological evaluation. The ALJ’s entire consideration of Still’s
evaluation is below:
Rebecca Still, M. A., a licensed psychologist, performed a
Psychological Evaluation of the claimant on May 14, 2014,
at the request of the claimant’s counselor. Testing indicated
that the MMPI validity scales suggest “some possibility that
he may have overstated [his] problems.” Ms. Still noted
there is a possibility that the profile lacks accuracy due to
exaggeration of psychopathology (Ex. B8F/5). Depression
testing was in the “mild” range (Ex. B8F/8) but with severe
anxiety (Ex. B8F/9). Ms. Still’s recommendations indicated
the claimant could improve his situation with medication
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(Tr. 15.)

adjustment and compliance, along with therapy. Although
Ms. Still assigned a GAF score of 40, as noted, she indicated
testing was likely invalid to some degree due to claimant’s
symptom exaggeration.
The ALJ did not label Still’s entire evaluation as “inaccurate,” he selectively

highlighted Still’s comments regarding the MMPI-2, where she stated Cobb “may have
overstated problems” and “profile may lack accuracy due to exaggeration of psychopathology.”
The Commissioner contends that the ALJ could discount Still’s conclusions based on her own
questions about the testing results.
“A single evaluation by a nontreating psychologist is generally not entitled to controlling
weight.” Teague v. Astrue, 638 F.3d 611, 615 (8th Cir. 2011). “The ALJ is not required to
accept every opinion given by a consultative examiner, however, but must weigh all the evidence
in the record.” Mabry, 815 F.3d at 391. Based on the Court’s review, the ALJ only explicitly
discounted Still’s opinion about the GAF score. The ALJ could discount the GAF score due to
Still’s comments about exaggeration and possibility of overstated problems that would call into
question the accuracy of the MMPI-2 profile. Therefore, the ALJ did not err in discounting
whether the GAF score was accurate based on Still’s own questioning of the results of two of the
tests.
Other Opinion Evidence
Next the Court will address the ALJ’s weighing of the medical source statements and
letter provided by Cobb’s nurse practitioner Carolyn Greening and licensed clinical social
worker Marilyn Frankenbach.
Social Security separates information sources into two main
groups: acceptable medical sources and other sources. It
then divides other sources into two groups: medical sources
and non-medical sources. Acceptable medical sources
include licensed physicians (medical or osteopathic doctors)
and licensed or certified psychologists. According to Social
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Security regulations, there are three major distinctions
between acceptable medical sources and the others: (1) Only
acceptable medical sources can provide evidence to establish
the existence of a medically determinable impairment,
(2) only acceptable medical sources can provide medical
opinions, and (3) only acceptable medical sources can be
considered treating sources,
Sloan v. Astrue, 499 F.3d 883, 888 (8th Cir. 2007) (emphasis in original) (internal citations
omitted). Medical sources include nurse practitioners, physician assistants, licensed clinical
social workers, naturopaths, chiropractors, audiologists, and therapists.” 20 C.F.R. § 416.913(d).
“Information from these other sources cannot establish the existence of a medically determinable
impairment. Instead, there must be evidence from an “acceptable medical source” for this
purpose.” SSR 06-03P, 2006 WL 2329939. Further, these other sources are not entitled to
controlling weight. LaCroix v. Barnhart, 465 F.3d 881, 885-86 (8th Cir. 2006).
“[I]nformation from such other sources, [however], may be based on special knowledge
of the individual and may provide insight into the severity of the impairment(s) and how it
affects the individual’s ability to function.

Id.; 20 C.F.R. §§ 404.1513(d), 416.913(d).

“Evidence provided by ‘other sources’ must be considered by the ALJ; however, the ALJ is
permitted to discount such evidence if it is inconsistent with the evidence in the record.” Lawson
v. Colvin, 807 F.3d 962, 967 (8th Cir. 2015); see also Raney v. Barnhart, 396 F.3d 1007, 1010
(8th Cir. 2005) (in determining what weight to give to other evidence, the ALJ has more
discretion and is permitted to consider any inconsistencies found within the record). Therefore,
the ALJ is required to consider Cobb’s providers’ opinions in evaluating his impairments.
Carolyn Greening, Advanced Nurse Practitioner
Advanced Nurse Practitioner Carolyn Greening treated Cobb for several years. (Tr. 37390, 406-483.) The treatment time period included in the administrative record is from March

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2014 to September 2015. Greening diagnosed Cobb with chronic schizoaffective disorder,
bipolar disorder, anxiety, and chronic insomnia.

Cobb’s mental status examinations with

Greening indicated generally normal examinations, except for anxious or depressed mood and
affect. Greening opined that Cobb had GAF scores between 63-68 during most of his visits. A
GAF score between 61 and 70 indicates mild symptoms or some difficulty in social,
occupational, or school functioning, but generally functioning pretty well, and has some
meaningful interpersonal relationships. DSM-IV-TR at 34. There were a few times when she
assessed that he had serious limitations in social and assessed his score between 50 and 60. On
the GAF scale, a score from 51 to 60 represents moderate symptoms (e.g., flat affect and
circumstantial speech, occasional panic attacks) or moderate difficulty in social, occupational, or
school functioning (e.g., few friends, conflicts with peers or co-workers). DSM-IV-TR at 32-34.
Greening completed two medical source statements (Mental) and co-authored a letter
with Marilyn Frankenbach regarding Cobb’s mental impairments. (Tr. 325-27, 478-79, 481-83.)
The first medical source statement was completed on May 22, 2014, one month after his April
2014 suicide attempt. (Tr. 325-27.) In that statement, Greening indicated that Cobb had extreme
and marked limitations 2 in every area listed, except for interacting appropriately with the public.
(Tr. 325-26) She indicated that he would be absent from work more than four days per month,
he would be off task 25% or more of the time, and would need unscheduled work breaks every
hour for ½ to 1 hour in length due to mood swings and anger. (Tr. 326-27.) She stated that his
recent hospital records from Blessing Hospital supported her assessment. (Tr. 326.) The ALJ

2

The medical source statement defines marked limitation as “There is a serious limitation in this area. There is
substantial loss in the ability to effectively function. An assessment of Marked means the impairment will interfere
with the individual’s ability to perform work-related activities thirty to fifty percent of the time.” (Tr. 325.)
Extreme limitation is defined as “major limitation in this area. There is no useful ability to function in this area. An
assessment of Extreme means the impairment will interfere with the individual’s ability to perform work related
activities more than fifty percent of the time.” (Tr. 325.)

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gave little weight to this assessment because it “referred to the time period immediately
following the claimant’s suicide attempt.” (Tr. 15-16.) The ALJ also noted that his treatment
records show that his condition improved after hospitalization. (Tr. 16.)
The Court finds that the ALJ did not err in giving little weight to Greening’s May 22,
2014 medical source statement (mental). The ALJ could discount the opinion, because it was
during the time period immediately following his suicide attempt and there is no evidence that he
maintained that same level of functioning during the treatment period. Further, during Cobb’s
visit on May 20, 2014, his mental status examination findings were normal, except for a
depressed mood. (Tr. 381-82.) Greening also wrote that the depression was “improving” and his
anxiety and insomnia were stable. (Tr. 382.) She assessed a GAF score of 63 indicating mild
impairment. The ALJ did not err in assigning little weight to this opinion based on the record as
a whole.
Greening’s November 2015 medical source statement mental assessed similar, but
slightly less severe limitations for Cobb. (Tr. 481-83.) In November 2015, she found that he
only had moderate limitations in understanding, remembering, carrying out, and making simple
work related decisions. (Tr. 481.) She opined that he had extreme limitations in understanding,
remembering, carrying out, and making complex work related decisions. (Tr. 481.) Greening
indicated that Cobb had marked limitations in interacting appropriately with the public and
extreme limitations in interacting appropriately with supervisors, co-workers, and responding
appropriately to usual work situations and changes in a routine work setting. (Tr. 481-82.) She
again opined that he would be absent from work more than four days per month and he would be
off task 25% or more of the time. (Tr. 482.) In this assessment, Greening opined that Cobb

14

would need unscheduled work breaks every hour for 15 to 20 minutes 3 in length due to panic
attacks and anxiety. (Tr. 483.) Unlike the May 2014 opinion where she states Cobb’s disability
began May 1, 2009, she wrote that the disability began August 14, 2012. (Tr. 327, 483.)
The ALJ also gave this opinion little weight, because “treatment notes pertaining to visits
with Ms. Greening show the claimant denied suicidal ideation, had relatively normal mental
status examinations, had GAF scores in the range of mild symptoms, and had greatly improved
with medication increases.” (Tr. 17.) The ALJ’s assessment of the Greening’s medical source
statement and treatment notes is consistent with the record before the Court. The ALJ can
always take into consideration that the claimant has improved with medication and other
treatment. The Court finds that the ALJ did not err in assigning little weight to this opinion.
Marilyn Frankenbach, Licensed Clinical Social Worker
Licensed clinical social worker Marilyn Frankenbach provided counseling for Cobb
beginning in January 2015. (Tr. 413-15, 422-438, 450-56.) Frankenbach diagnosed Cobb with
schizoaffective disorder and panic disorder without agoraphobia. She provided counseling for
him, which included his father at times. Her treatment notes indicated that he was stable and
doing well. She gave him GAF scores primarily of 68, with the exclusion of the first visit. On
August 25, 2018, she and Greening authored a letter supporting Cobb’s claim for disability
benefits. (Tr. 478-79.) Frankenbach and Greening’s joint letter noted Cobb’s suicide attempts
over several years and that he is chronically mentally ill. (Tr. 478.) The letter focuses on Cobb’s
progress in a structured setting. The letter states:
He is considered seriously mentally ill, though at the present
time he is maintaining in his current structured environment.
… He has made some progress with learning to use better
coping skills, but nevertheless, it is this therapist’s opinion
3

The Court assumes that Greening meant minutes not hours.

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that he is always going to struggle in outside, less structured
settings than the one he is currently in.

(Tr. 478.)
The ALJ gave little weight to the letter, due to Cobb’s “possible overstatement of
symptoms” and “recent treatment notes showing the claimant’s symptoms had improved
significantly with counseling and medication adjustment.”

(Tr. 17.)

In this case, Cobb’s

treatment notes with Frankenbach and Greening indicate a great improvement from the time of
Cobb’s suicide attempt in April 2014.

There is also evidence to support the providers’

conclusions that Cobb is doing well, because he is in a structured environment living on the farm
with his parents and children. The ALJ did not err in considering that objective medical testing
had shown that there may have been some exaggeration of symptoms and that Cobb overall was
doing very well through medication management and counseling. Because there is substantial
evidence to support the Commissioner’s finding regarding this opinion letter, the Court must
affirm the Commissioner’s finding. Masterson v., 363 F.3d at 726 (if, after viewing the record as
a whole, the Court finds it possible to draw two inconsistent positions from the evidence and one
of those positions represents the Commissioner’s finding, the Commissioner’s decision must be
affirmed).
Conclusion
The Court finds that substantial evidence supports the ALJ’s decision as a whole. As
noted earlier, the ALJ’s decision should be affirmed “if it is supported by substantial evidence,
which does not require a preponderance of the evidence but only enough that a reasonable person
would find it adequate to support the decision, and the Commissioner applied the correct legal
standards.” Turpin v. Colvin, 750 F.3d 989, 992-93 (8th Cir. 2014). The Court cannot reverse

16

merely because substantial evidence also exists that would support a contrary outcome, or
because the court would have decided the case differently. Id. Substantial evidence supports the
Commissioner’s final decision.
Accordingly,
IT IS HEREBY ORDERED that the relief requested in Plaintiff’s Complaint and Brief
in Support of Complaint is DENIED. [Doc. 1, 14.]
IT IS FURTHER ORDERED that the Court will enter a judgment in favor of the
Commissioner affirming the decision of the administrative law judge.

Dated this 31st day of August, 2018.

/s/ Nannette A. Baker
NANNETTE A. BAKER
UNITED STATES MAGISTRATE JUDGE

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