Craft v. Astrue
MEMORANDUM AND ORDER: IT IS HEREBY ORDERED that the decision of the Commissioner is affirmed, and plaintiffs Complaint is dismissed with prejudice. Signed by Magistrate Judge Frederick R. Buckles on 10/11/2013. (RAK)
UNITED STATES DISTRICT COURT
EASTERN DISTRICT OF MISSOURI
CRYSTAL LYNN CRAFT,
CAROLYN W. COLVIN,1 Commissioner )
of Social Security,
Case No. 4:12CV248 FRB
MEMORANDUM AND ORDER
This matter is before the Court on plaintiff Crystal Lynn
Craft’s appeal of an adverse decision of the Social Security
All matters are pending before the undersigned
United States Magistrate Judge, with
consent of the parties,
pursuant to 28 U.S.C. § 636(c).
Background and Procedural History
(“DIB”) pursuant to Title II, and Supplemental Security Income
pursuant to Title XVI, of the Social Security Act, 42 U.S.C. §§
401, et seq. (also “Act”), alleging that she became disabled on
October 23, 2008.
(Administrative Transcript (“Tr.”) at 17, 193-
Plaintiff’s applications were denied, and she requested a
Carolyn W. Colvin became the Acting Commissioner of Social
Security on February 14, 2013. Pursuant to Rule 25(d) of the
Federal Rules of Civil Procedure, Carolyn W. Colvin should
therefore be substituted for Michael J. Astrue as the defendant
in this case. No further action needs to be taken to continue
this suit by reason of the last sentence of 42 U.S.C. § 405(g).
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hearing before an administrative law judge (“ALJ”), which was held
on August 5, 2010.
issued an unfavorable decision.
On November 3, 2010, the ALJ
review from defendant agency’s Appeals Council, which denied her
request for review.
The ALJ’s November 3, 2010
decision thus stands as the Commissioner’s final decision subject
to review in this Court.
42 U.S.C. § 405(g).
Evidence Before The ALJ
Plaintiff first responded to questions posed by the ALJ.
Plaintiff testified that she was five feet, five inches tall and
weighed 180 pounds, which represented a 60-pound weight gain. (Tr.
Plaintiff testified that doctors did not know why she had
gained so much weight.
and had no children.
She testified that she was divorced
She stated that she had lived in
a trailer, but was evicted the previous evening.
to explain, plaintiff testified “[w]ell we got in a fight and he
threw a beer bottle at e [sic] and the cops came and it’s his place
so they kicked me out so I slept in my car.”
She had a
valid driver’s license and drove once per week, and had driven
herself to the administrative hearing.
college but did not obtain a degree, explaining that she dropped
out because her brother was killed in a car accident.
She testified that she also dropped out of “Sanford Brown.” (Tr.
She was, however, licensed in cosmetology.
The ALJ asked plaintiff whether she had worked since
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October of 2007, and plaintiff’s attorney stated: “If you don’t
remember just say [INAUDIBLE].”
that she did not remember.
Plaintiff testified that she had applied for unemployment
compensation benefits, and was turned down because she quit her
Plaintiff received food stamps and Medicaid, and
stated that she had received Medicaid since 2006.
The ALJ told plaintiff that there was evidence that she
had worked in 2009 at a company located in Farmington, Missouri,
but plaintiff testified that she could not recall such employment.
She testified that her past employment included
work at Pasta House, at Ryan’s Restaurant as a server, and at
She testified that she left Ryan’s
because her back hurt, and left McDonald’s because she had to have
a thoracotomy and was not permitted the necessary time off.
In 2005 and 2006 she worked for a salon as a hairstylist,
and left this job because of back pain.
through part of 2005 she worked for the State of Missouri as a
corrections officer responsible for custody and control of male
inmates, a job that required her to break up fights and deal with
When asked why she left this job,
plaintiff testified: “I got divorced for the second time and he was
there for like two months longer than I was so one of us had to go
per the captain’s orders.”
In 2003, plaintiff worked for
Macy’s selling purses, and also worked as a cocktail waitress, a
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job she left after obtaining a cosmetology license and beginning
work as a hairstylist.
Plaintiff’s past work
also included jobs as a teacher’s helper at a day care center, a
temporary service employee, a cashier at Goody’s Family Clothing,
a server at Ruby Tuesday’s, a car-hop at Sonic Drive-In, a ticket
agent at an AMC Theater, and a worker at Long John Silver’s.
Plaintiff testified that Long John Silver’s was her
first job and that she had lied about her age to get it (she was
only 15 years of age).
Plaintiff testified that she was incarcerated for seven
months in 2007 for “[b]ad checks and forgery.”
Plaintiff testified that she could not do any of her
prior work on a full-time basis “[b]ecause it hurts too bad and I’m
constantly, I mean I have to take naps constantly because of all
this medicine I’m on I’m exhausted.”
where it hurt, plaintiff testified “[i]t’s mostly my back, my
spine, the right side of my neck, the left side of my back, it goes
around underneath my ribcage on the left hand side, as far as the
back pain goes.
Then I have fibromyalgia which is like my hands,
my knees, my ankles. And then I have osteoarthritis in my knees and
Plaintiff then responded to questions from her attorney.
Plaintiff testified that she had been undergoing treatment for
mental illness for the past eight months.
testified that she felt tired all day, and napped twice per day.
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She took medicine to sleep at night and also used
a CPAP machine, but testified that the machine did not help her
She testified that she had
suicidal thoughts daily, but “would never do anything because of
my, I’m not going to go to hell because I kill myself.”
She testified that she had been married and divorced
She testified that her first husband was
alcoholics, “[a]nd there was like physical and mental abuse in all
Plaintiff testified that the man involved in the
fight she described at the beginning of the hearing was her
boyfriend, and that she had been “laying on the couch and because
I can’t pay the bills because I’m not working he told me I was
inconsiderate and worthless and he just got mad and he had a beer
bottle in his hand and threw the beer bottle at me and it hit me in
So I went outside and called the police, while it’s his
house, so they kicked me out.”
Plaintiff testified that she had a problem with her
temper, and that her temper came out when someone yelled at her or
made her feel closed in.
She testified that she had bipolar
disorder and had good days and bad days.
described a good day as one in which she was happy and felt like
doing the dishes, cleaning house and getting things done, and
testified that she had good days less than one day per week.
She described a bad day as one in which she wanted to sleep all the
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time, did not feel good, wanted to be left alone, and wanted to lay
in bed and cry.
Plaintiff testified that she underwent thoracotomy to
remove a mass, and suffered from post-thoracotomy syndrome.
When asked to explain, plaintiff stated: “[i]t causes me where it
just hurts all the time.
I can’t, I can’t move, I can’t stand very
long, I can’t sit very long.”
testified that she felt like she was suffocating and that it hurt
Plaintiff also testified that she had three bulging discs
in her neck and back, and had epidural injections every two weeks.
She stated that she could sit for 15 to 20 minutes
before she needed to move.
When asked how long she
could stand, she replied: “[o]h five minutes tops and I’m crying.”
She testified that she could lift less than five pounds, but
when her attorney asked her whether she could lift a gallon of
milk, she replied that she could.
told her that that was about eight pounds, and asked plaintiff
whether she could lift two gallons of milk, and plaintiff replied
that she could not.
Plaintiff testified that, if she
woke at 10:00 a.m., she would stay awake until 1:00 or 2:00 p.m.
before taking a three-hour nap.
Plaintiff testified that she suffered from fibromyalgia
and had tingling in her hands, knees and ankles.
She was then asked whether she had pain, and she testified that she
had burning pain every day.
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She testified that she
took morphine and dilaudid for thoracotomy pain, but the medicine
helped with everything.
medications caused tiredness.
She testified that all of her
She testified that she told
her doctors about the tiredness, but they told her that the only
way to avoid the tiredness was to stop taking the medications, and
that was “not possible.”
from a vocational expert.
The ALJ then heard testimony
On April 7, 2008, plaintiff was seen at the Madison
Medical Center Rural Health Clinic by Melinda Fischer, a Family
Plaintiff reported that she
wanted to establish care, and needed medication refills.
Plaintiff reported a history of lower back pain with some
radiation into her lower hips and had x-rays done after a fall from
a horse, but was unable to have follow-up care.
examination, Nurse Fischer noted that plaintiff was alert and
oriented, obese, and in no acute distress.
It is noted that
plaintiff reported “that she just needs overall refills on her
Her neck was supple, there were no findings
relative to her extremities.
Nurse Fischer advised
Additional evidence which was not before the ALJ was
submitted to and considered by the Appeals Council. This
evidence consists of progress notes from Dr. Quadri’s office
dated December 7, 2010 and January 4, 2011. (Tr. 13). The Court
must consider these records 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 1441, 1444 (8th Cir. 1994). For the sake of continuity,
discussion of these records is incorporated with that of the
records before the ALJ at the time of her decision.
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plaintiff to have laboratory testing.
follow up care related to her history of back pain.
Records from Community Counseling Center indicate that
plaintiff was seen on April 16, 2008 with complaints of anxiety and
Plaintiff reported that her medication
Plaintiff was given an increased dosage of an antidepressant and
medicine for sleep, was counseled regarding ways to deal with
anxiety, and told to return in four weeks.
On April 21, 2008, plaintiff returned to the Madison
Medical Center Rural Health Clinic for follow up, stating that she
was there for review of laboratory testing.
wanted to discuss getting back on her medications for chronic
allergies and asthma.
Upon examination, she was alert,
oriented and obese, and in no acute distress.
complaints were noted as allergy symptoms and asthma.
Examination was normal, and plaintiff was advised to return on an
Counseling Center and reported continued anxiety and worry that she
would be denied Medicaid.
could not afford counseling.
increased rejection sensitivity.
she had been denied Medicaid.
Plaintiff stated that she
On her next visit, she
She reported that
She denied self harm, and
stated that her medication was not helping her sleep.
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was given Abilify3 and Lunesta.4
On July 22, 2008, plaintiff saw Steven Mellies, D.O., for
a consultative evaluation due to seizures that began five to six
years ago following a fall from a horse.
reported that her seizures were witnessed by her former husband,
and by her former cell mates during what Dr. Mellies described as
a two-year incarceration.
Plaintiff reported taking
Depakote,5 and stated that it caused quite a bit of weight gain.
Dr. Mellies wrote: “[a]lso more recently there has been some
question as to whether she truly has bipolar disease.
that even one psychiatrist mentioned split personality.”
endometriosis, hypothyroidism, migraine headaches, and pain that
could radiate up and down her spine but not into the extremities
except occasionally her thighs became numb.
“noted that that [sic] if she pops her back it all goes away.”
Physical examination was normal, and neurological
examination was normal, including a normal mental status.
Dr. Mellies’s impression was generalized seizures which
Abilify is used to treat several conditions, and is also
used with an antidepressant to treat depression.
Lunesta is used to treat insomnia.
Depakote, or Valproic Acid, is used alone or in combination
with other drugs to treat certain types of seizures, and to treat
episodes of mania in patients with bipolar disorder. It is also
used to prevent the onset of migraine headaches.
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were nocturnal, and he ordered an MRI and EEG and changed Depakote
July 30, 2008 was normal.
MRI of plaintiff’s brain performed on
Records from Robert Duddy, M.D., indicate that plaintiff
was seen on a few occasions from March 16, 2007 to December 2, 2008
for complaints of foot and ankle pain.
bilateral knee pain.
X-ray of the bilateral knees
Plaintiff was treated with an injection.
On August 29, 2008, plaintiff returned to Community
Counseling Center and reported that she had been taking double the
prescribed dose of Abilify, and felt it worked better. (Tr. 1203).
She reported being irritable, and asked about taking a different
She stated that she did not have time for
counseling because she worked seven days per week to support
herself and her mother and grandmother.
She stated that she
On August 7, 2008, plaintiff saw
Nurse Fischer for
had no time to relax.
follow-up care regarding her knees.
swelling, but was otherwise negative.
An August 12,
An August 13,
2008 x-ray of plaintiff’s cervical spine revealed loss of lordosis,
Zonisamide is an anticonvulsant used to control seizures.
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but was otherwise negative.
Plaintiff returned to Nurse Fischer on August 21, 2008
for follow-up and review of radiological results.
August 26, 2008 MRI of plaintiff’s thoracic spine revealed a cystic
mass at the level of the T5 vertebra, (Tr. 1122), and an MRI of
plaintiff’s lumbar spine performed on that date revealed broad-base
disc bulge changes at the L5/S1 area.
On September 18, 2008, plaintiff saw Murali Macherla,
attributed to falling from a horse in 1998.
Macherla ordered a CT scan and, after plaintiff told him she had
run out of pain medication, prescribed Percocet.7
returned on October 2, 2008 for review of the CT scan, which showed
a possible neurogenic tumor, and it was recommended that the mass
be surgically removed. (Tr. 756).
Plaintiff was admitted to
Southeast Missouri Hospital with a preoperative diagnosis of a
thoracic cystic mass, and underwent thoracoscopy with excision of
the mass on October 14, 2008.
(Tr. 753, 757, 893-94).
had no postoperative complications, and she was discharged on
October 16, 2008 to home in satisfactory condition.
The final pathology report showed that the mass was benign, and the
post-operative diagnosis was listed as simple lymphatic cyst. (Tr.
Percocet, or Acetaminophen with Oxycodone, is used to
relieve moderate to moderately severe pain.
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On October 1, 2008, plaintiff returned to Community
Counseling Center and reported “doing ok” psychologically.
She reported that she injured a tendon in her right foot,
and that she had a spot on her lung.
sleep and appetite were good.
She reported that her
She was given samples of
medication and told to return in three months.
Plaintiff returned to Nurse Fischer on October 9, 2008
for complaints related to a urinary tract infection.
She returned on October 20, 2008 for stitch removal related to a
She returned on November 10, 2008 with
complaints related to vaginitis, (Tr. 1152), and on December 1,
2008 for complaints of pain related to surgery.
x-ray performed on this date was negative.
On January 20, 2009, plaintiff returned to Community
Counseling Center and reported that she was ok psychologically, but
was very tired.
She reported a lung/back mass, and
stated that her foot had healed and she had been back at work for
the past two weeks.
She reported that her mood was ok.
Lunesta was discontinued because of plaintiff’s reports of
tiredness, and she was advised to return in three months.
On March 30, 2010, plaintiff presented to Crider Health
Center and saw psychiatrist Omar Quadri, M.D., for an initial
psychiatric assessment, stating that she was transferring care
because she had relocated to pursue her current boyfriend.
She reported that she had been divorced three times.
She reported that she was always depressed and tired.
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personality disorder and bipolar II disorder.
reported that, as young as nine years of age, she craved attention
and cut herself when she did not get it.
chronic intermittent suicidal thoughts but never attempted due to
She feared loneliness and abandonment,
and stayed in multiple abusive relationships because she preferred
being in a relationship to being alone.
She made frantic
efforts to avoid abandonment, and went to prison for writing bad
checks to the tune of $600,000.00 for her boyfriend who was in the
mafia, stating that she was afraid of him.
impulsiveness and extreme temper “for as long as I can remember.”
She reported sexual abuse between the ages of 9 and 13.
She reported crying a lot, lack of energy, poor motivation
and not wanting to do anything, and that she always had chronic
months in prison.
She was on parole until 2010 after spending 18
She told Dr. Quadri that she had
fibromyalgia, cancer of the spine in remission, COPD, obstructive
sleep apnea and C-PAP use, asthma, hypothyroidism, borderline
diabetes type II, and stomach ulcers.
She attributed her
depression to her brother’s sudden death when she was 18.
Upon mental status examination, Dr. Quadri noted that plaintiff was
casually dressed, polite and cooperative with good eye contact,
sad, depressed, and anxious.
Her responses were logical and goal
directed, she denied suicidal thoughts, intent, plan and urges, had
no thought disorder, had good insight and judgment, and clear
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borderline personality disorder, fibromyalgia, cancer of the spine
in remission, COPD, obstructive sleep apnea with C-Pap use, asthma,
hypothyroidism, borderline type II diabetes, hypertension, stomach
ulcers, and seizure disorder, and he assessed a Global Assessment
of Functioning (“GAF”)8 of 65.
Plaintiff was advised
to seek Provigil9 for excessive daytime tiredness.
Counseling Center and reported that she got married last month and
relocated, and was happy.
She reported working at
She reported “some back pain,” good mood, sleep
and appetite, good energy, concentration, and motivation, but later
reported difficulty getting restful sleep without Lunesta.
On May 4, 2009, plaintiff saw Nurse Fischer, who noted
plaintiff’s current complaints as “back hurts - to breathe, yawn,
ear [infection in both ears].”
A May 19, 2009 MRI of plaintiff’s cervical spine revealed
The GAF score is the clinician’s judgment of the
individual’s overall level of functioning. See Diagnostic and
Statistical Manual of Mental Disorders, Text Revision 34 (4th ed.
2000). GAF scores of 41 to 50 represent serious symptoms or
impairment in social, occupational or school functioning; scores
of 51 to 60 represent moderate symptoms or difficulty in those
areas; and scores of 61 to 70 represent mild symptoms with a
reasonably good level of functioning. (Id.)
Provigil, or Modafinil, is used to treat excessive
sleepiness caused by narcolepsy (a condition that causes
excessive daytime sleepiness) or shift work sleep disorder
(sleepiness during scheduled waking hours and difficulty falling
asleep or staying asleep during scheduled sleeping hours in
people who work at night or on rotating shifts).
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disc arthritic bulge at C3/4, 4/5, and 5/6.
17, 2008 x-ray of plaintiff’s bilateral knees was negative.
A July 30, 2008 EEG was normal.
On June 15, 2009, plaintiff was seen at Greater St. Louis
Neurosurgical Specialists with complaints of pain in her neck and
back, numbness in both arms and legs, and pain in her left breast.
Plaintiff reported that these symptoms began in 2001
and were constant, and reported that she had been “bucked off of a
Plaintiff reported that she smoked less than one
pack of cigarettes per day.
Upon examination, there was no
misalignment or tenderness, there was full range of motion, normal
extremity, negative straight leg raise testing, normal head and
neck with satisfactory range of motion, and adequate strength with
normal stability. (Id.) Plaintiff’s lumbar MRI scan was reviewed,
and it was opined that it revealed moderate degenerative changes at
L2-3, L3-4, L4-5, and L5-S1.
It was noted that
plaintiff’s cervical radiological testing showed straightening of
the lordotic curve.
Plaintiff “was advised that it was
Plaintiff was given Voltaren.10
On July 30, 2009, Single Decisionmaker Christine Mathews
completed a Physical Residual Functional Capacity Assessment. (Tr.
Voltaren (Diclofenac) is an NSAID that is used to relieve
pain, swelling, tenderness, and stiffness.
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Ms. Mathews opined that plaintiff could lift and carry
20 pounds occasionally and 10 pounds frequently; stand and/or walk
and sit for six hours in an eight-hour work day, and push and pull
without limitation. (Tr. 1109). Ms. Mathews opined that plaintiff
could occasionally climb, balance, and stoop, and could frequently
perform all other postural maneuvers.
Also on July 30, 2009, James Morgan, Ph.D. completed a
Psychiatric Review Technique form.
opined that plaintiff’s impairment(s) were not severe, but that
plaintiff did have “borderline personality traits.”
Dr. Morgan opined that plaintiff had mild restriction of
activities of daily living, mild difficulties maintaining social
functioning and maintaining concentration, persistence or pace, and
no repeated episodes of decompensation.
On November 23, 2009, plaintiff saw Vera Lynskey, M.D. to
establish care, and reported complaints of eye twitching and a
She reported that she had “not seen
depression, anxiety and possibly bipolar” disorder. (Id.) She had
also not followed up regarding other conditions.
deformity, and no swelling.
She was not anxious, did
not have obsessive thoughts, had normal insight and judgment, had
normal attention span and concentration, and had no suicidal
On November 29, 2009, plaintiff visited Barnes-Jewish St.
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migraine headache, sore throat, and night sweats.
(Tr. 529, 558).
She reported a history of gastroesophageal reflux disease (“GERD”),
vomiting, and had recently noticed dark black stools.
She reported smoking one-half of one pack of cigarettes daily, and
occasionally drinking alcohol.
(Tr. 561, 564).
she was noted to be in no acute distress, and was described as
lying comfortably in bed.
her extremities with no edema.
She had full range of motion of
(Tr. 561, 564, 567).
Plaintiff was admitted, and testing revealed a kidney stone, and
ulcers and erosions in the distal esophagus, stomach, and duodenum.
Plaintiff was admitted and treated with medication, IV
fluids, and a clear liquid diet, and her symptoms improved.
CT of the abdomen and pelvis was normal.
Hemoglobin levels remained stable throughout hospitalization, and
plaintiff had no further active bleeding.
on December 1, 2009, plaintiff had minimal pain, and was stable.
She was advised to be active as tolerated, follow a regular
diet, and follow up with Dr. Nissing in two weeks.
On December 3, 2009, plaintiff complained of abdominal
pain, and a sonogram revealed a gallstone.
Also in December of 2009, plaintiff complained of postthoracotomy pain and neck pain, and x-ray of plaintiff’s thoracic
X-ray of the cervical spine revealed
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“straightening of the cervical spine, otherwise negative cervical
MRI of the cervical spine performed on
December 11, 2009 revealed mild degenerative disc disease most
notably at C4-5 with resultant disc bulge and thecal sac effacement
without complicating process.
MRI of the thoracic
spine performed on this date revealed mild multilevel degenerative
disc disease, a disc protrusion at T8-9 with no stenosis or
impingement, and was otherwise unremarkable.
On December 4, 2009, plaintiff returned to Dr. Lynskey
with complaints of a migraine and back pain, but denied vomiting,
abdominal pain, diarrhea, and constipation.
reported that the migraine was the same as it had been since her
childhood, and the back pain were the same as in the past.
She had no joint symptoms or neck stiffness.
tender over her spine and had muscle spasm, but normal flexion,
extension, and rotation. (Tr. 479).
She had no cervical, thoracic
or lumbar spine tenderness, and had normal mobility and curvature
in all three areas.
Her extremities were normal.
Neurological examination was normal, and she had no unusual anxiety
or evidence of depression. (Tr. 479-80). She returned on December
9 with complaints of a cough.
On December 14, 2009, plaintiff returned on Barnes-Jewish
St. Peters Hospital with continued complaints of abdominal pain and
Plaintiff ultimately underwent surgical
removal of her gallbladder.
(Tr. 629-30). She returned on January
28, 2010 with complaints related to a gastric ulcer.
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On February 2, 2010, plaintiff returned to Dr. Lynskey
with complaints of a bump on her lip, back pain, vomiting, and
She reported that she had not taken
psychiatric medications for three to four weeks. (Id.)
Her medications were refilled.
She returned on February 16, 2010 with complaints of
fatigue, and Dr. Lynskey referred her for a sleep study.
On February 25, 2010, plaintiff presented to BarnesJewish
Plaintiff complained of feeling sleepy all day and having apnea,
and stated that she had these symptoms for the past seven to eight
Plaintiff reported that she went to bed between
midnight and 2:00 a.m..
On weekdays, she got up at 6:00
a.m., but on weekends she slept until 11:00 a.m.
reported that she woke three or four times during the night, and
took a nap seven days per week.
She reported smoking
one and one-half packs of cigarettes per day, and consuming two to
three colas per day.
Plaintiff reported that she was a very
restless sleeper, a light sleeper, and that she woke in the middle
of the night to use the bathroom and to get a snack or a drink, and
stated that she took sleeping pills.
that she was so sleepy during the day that her work was poor.
She reported that she frequently did not feel sleepy at her
bedtime, and that she functioned best in the evening.
She was diagnosed with mild complex sleep apnea, moderately severe
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instructed to stop smoking.
Use of a bi-level positive airway
A second sleep study performed
on March 13, 2010 revealed excellent response to the BIPAP, and it
was noted that plaintiff should pursue daily exercise, and that her
medications may play a role in the degree of her hypoxemia.
Plaintiff returned in March of 2010 and was observed to have
borderline diabetes, and was instructed to follow a meal plan and
start an exercise program.
She also had an ear
On March 2, 2010, plaintiff returned to Dr. Lynskey “with
paperwork for school” to get a medical leave of absence due to
She expressed frustration
because she continued to gain weight despite watching her diet and
walking for 20 minutes per day, but then admitted to eating fast
Dr. Lynskey prescribed Lunesta, but “reinforced
importance of adequate sleep hygiene with quiet, non-stimulating
environment, no TV [one hour] before bedtime, no smoking [three
hours] before bedtime, etc.”
She advised plaintiff to
pressure, sleep, and behavioral issues, and noted that plaintiff
was “contemplating” this.
She returned on March 9 with
“personal problems” due to exposure to a high risk behavior person.
She returned on March 23, 2010 with complaints of
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requested withdrawal medication. (Tr. 452). She returned on April
15 for review of laboratory testing.
On April 9, 2010, plaintiff was seen at Associates in
Pulmonary and Sleep Medicine, Inc. by Manojpal Dahuja, M.D. for
complaints of long-standing daytime sleepiness and sleep apnea.
She reported taking at least two naps per day.
She reported that she walked for one-half to one mile nearly every
She continued to smoke cigarettes.
diagnosed with mild sleep apnea, it was opined that her opiate and
sleepiness, and it was also noted that her sleep habits were
She was instructed on the basics of good
On April 12, 2010, plaintiff saw Farhat Shereen, M.D. for
complaints of pain in her fingers.
She denied change
in sleep/wake pattern, weight gain, and weight loss.
She had no cervical spine tenderness, and no joint deformity, heat,
swelling, erythema or effusion and full range of motion in her
bilateral shoulders, elbows, feet, and ankles. (Tr. 738). She had
crepitus in her knees but full range of motion in her left knee.
she had mild pain with motion of her cervical spine.
She had no unusual anxiety or evidence of depression, no motor
weakness, and her extremities were normal.
plaintiff’s hands, left foot, left ankle were unremarkable.
Radiographs of plaintiff’s left foot revealed an old
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healed fracture with orthopedic fixation.
of plaintiff’s right ankle revealed mild osteoarthritic changes.
On May 13, 2010, plaintiff returned to Dr. Shereen for
complaints of bilateral knee pain and fibromyalgia syndrome.
Plaintiff reported that she was taking Cymbalta with no side
Musculoskeletal examination revealed no joint deformity, heat,
plaintiff’s bilateral shoulders, hands, hips, feet and ankle, and
in her left elbow.
There were mild findings in plaintiff’s
left knee, and she had restricted range of motion.
She was diagnosed with arthritis of the knees, and injection was
Dr. Shereen opined that plaintiff was not
a good candidate for NSAID drugs and combination narcotics, and
recommended that plaintiff use acetaminophen (Tylenol) for her knee
symptoms, and also recommended that plaintiff undergo physical and
Based upon lab work and plaintiff’s
On June 2, 2010, plaintiff saw Dr. Quadri and reported
that she had a seizure the preceding week.
discussed adding Provigil and reducing Lunesta.
then reported that she was compliant with medications and denied
side effects. (Id.) She denied feeling sad, depressed or anxious,
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reported mood swings, denied
insight and judgment.
suicidal thoughts, and had good
Dr. Quadri’s diagnoses were bipolar
disorder, borderline personality disorder, fibromyalgia, cancer of
the spine in remission, COPD, asthma, hypothyroidism, borderline
diabetes, hypertension, stomach ulcers, and seizure disorder. (Tr.
It is noted that Dr. Quadri advised plaintiff to call with
questions or side effects. (Id.) He provided dietary and exercise
counseling to minimize plaintiff’s risk for diabetes.
adjusted plaintiff’s medications. (Id.)
On June 17, 2010, plaintiff returned to Dr. Dahuja and
complained of significant daytime sleepiness but also complained of
trouble falling asleep at night, and it was thought that “some of
She continued to smoke cigarettes
despite being advised to stop.
She was diagnosed with mild
Plaintiff returned to Dr. Quadri on June 30, 2010 and
advised that Provigil had not been approved by Medicaid.
She reported feeling nervous and anxious, particularly
around people, and that this “comes and goes.”
that she had been in school and around strangers, which made this
She reported feeling depressed and crabby, but
relationship with a boyfriend was going well, and denied anhedonia.
Upon examination, Dr. Quadri noted that plaintiff
presented casually dressed, polite, calm and cooperative with good
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(Id.) He noted that plaintiff’s affect was depressed
with no lability. (Id.)
She had no psychomotor abnormalities, she
had logical and goal directed responses, and she denied suicidal
She had good insight and judgment, she was alert and
oriented times 3 and had clear sensorium.
diagnoses were unchanged.
He prescribed Zoloft,11 Lunesta,
Cymbalta,12 Depakote, and Abilify.
Assessment Of Ability To Do Work-Related Activities (Mental) form.
Dr. Quadri opined that plaintiff had a fair ability
to function independently and maintain attention/concentration, but
had poor to no ability to make all other occupational adjustments.
Dr. Quadri opined that plaintiff had a fair ability to
understand, remember and carry out simple instructions, but had
poor to no ability to make all other performance adjustments.
Dr. Quadri opined that plaintiff had fair ability to
maintain her personal appearance and demonstrate reliability, but
poor to no ability to make all other personal-social adjustments.
He opined that plaintiff could manage benefits in her
own best interests.
On December 7, 2010, plaintiff returned to Dr. Quadri and
Zoloft, or Sertraline, is used to treat depression,
anxiety, and other psychological disturbances.
Cymbalta, or Duloxetine, is used to treat depression,
anxiety, and pain.
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reported that she was unable to keep her sleep mask on her face.
She reported continued irritability, and Dr. Quadri
wrote that plaintiff reported that her daytime sleepiness was
“excessive without Focalin13 but with it she is alert enough and can
She reported significant improvement in energy
level, focus, concentration, and reading comprehension.
Upon examination, plaintiff was calm and cooperative with good eye
She had no psychomotor abnormalities, she gave
logical and goal directed responses,
and she denied suicidal
ideation and hallucinations. (Tr. 1459).
She had good insight and
judgment, she was alert and oriented, and she had clear sensorium.
Dr. Quadri diagnosed plaintiff with bipolar disorder,
borderline personality disorder, fibromyalgia, cancer of the spine
in remission, COPd, asthma, hypothyroidism, borderline diabetes
obstructive sleep apnea.
Dr. Quadri provided dietary and
exercise counseling, and it was noted that he counseled plaintiff
plaintiff to call if she had medication side effects.
On January 4, 2011, plaintiff returned to Dr. Quadri and
reported that she had started a new semester, was getting good
grades, and needed a letter from him so that she could continue to
receive prescriptions for narcotic pain medications.
Focalin (Dexmethylphenidate) is a central nervous system
stimulant used to control symptoms associated with attention
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Dr. Quadri wrote that he would not approve of her being on opioids
long term and that other alternatives should be considered because
of possible counteractions with plaintiff’s other medications, the
presence of sleep apnea, and the associated risk of respiratory
Dr. Quadri also noted that plaintiff was at
high risk for dependence.
Dr. Quadri’s diagnoses and plan
were unchanged from his record of plaintiff’s December 7, 2010
The ALJ’s Decision
The ALJ in this case determined that, while plaintiff
worked after October 23, 2008, her average monthly wages did not
exceed the substantial gainful activity threshold.
degenerative disc and joint disease, obstructive sleep apnea,
affective disorder, and obesity, but that her condition had neither
met nor medically equaled a listed impairment.
ALJ determined that plaintiff retained the residual functional
The ALJ determined that
plaintiff could not perform her past relevant work, considered
vocational expert testimony in determining whether a successful
adjustment to other work could be made, and ultimately concluded
that plaintiff had not been disabled in accordance with the Act.
To be eligible for Disability Insurance Benefits and
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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 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 U.S.C. §§ 423(d)(1)(A), 1382c(a)(3)(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), 1382(a)(3)(b).
Commissioner engages in a five-step evaluation process.
C.F.R. §§ 404.1520 and 416.920; Bowen v. Yuckert, 482 U.S. 137,
The Commissioner begins by deciding whether the
claimant is engaged in substantial gainful activity.
claimant is working, disability benefits are denied.
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.
Commissioner then determines whether the claimant’s impairment(s)
- 27 -
meet or equal any listed in 20 C.F.R., Subpart P, Appendix 1.
claimant’s impairment(s) is equivalent to a listed impairment, she
is conclusively disabled.
At the fourth step, the Commissioner
establishes whether the claimant can perform her past relevant
If so, the claimant is not disabled.
The decision of the Commissioner must be affirmed if it
is supported by substantial evidence on the record as a whole.
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).
evidence is less than a preponderance but enough that a reasonable
person would find adequate to support the conclusion.
Apfel, 240 F.3d 1145, 1147 (8th Cir. 2001).
evidence test,” however, is “more than a mere search of the record
for evidence supporting the Commissioner’s findings.”
Astrue, 498 F.3d 767, 770 (8th Cir. 2007) (internal quotation marks
and citation omitted).
The Court must also consider any evidence
which fairly detracts from the Commissioner’s decision.
498 F.3d at 770; Warburton v. Apfel, 188 F.3d 1047, 1050 (8th Cir.
administrative decision, this Court must affirm that decision even
if the record also supports an opposite decision.
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); see also Pearsall, 274
F.3d at 1217 (citing Young v. Apfel, 221 F.3d 1065, 1068 (8th Cir.
- 28 -
2000) (In the event that two inconsistent conclusions may be drawn
supported by substantial evidence on the record as a whole).
Plaintiff contends that the ALJ erred in assessing her
In support, plaintiff alleges that the ALJ summarily
determined that she lacked credibility due to her statements
regarding shopping and driving. Plaintiff also broadly states that
the ALJ failed to sufficiently address each of the factors outlined
in Polaski v. Heckler, 739 F.2d 1320, 1321-22 (8th Cir. 1984) and
Finally, plaintiff argues that the ALJ failed to
daytime sleepiness. Review of the ALJ’s decision reveals no error.
Before determining the claimant’s residual functional
capacity, the ALJ must evaluate the credibility of the claimant’s
Wagner v. Astrue, 499 F.3d 842, 851 (8th
Cir. 2007) (citing Pearsall, 274 F.3d at 1217). The Commissioner’s
Regulations, and Eighth Circuit
precedent, require an ALJ to
observations by third parties and treating and examining physicians
relating to such matters as the claimant’s daily activities, the
duration, frequency and intensity of the symptoms, precipitating
and aggravating factors, dosage, effectiveness and side effects of
medication, and functional restrictions. 20 C.F.R. §§ 404.1529 and
416.929; Polaski v. Heckler, 739 F.2d 1320, 1321-22 (8th Cir.
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An ALJ may consider the absence of objective medical
evidence to support the complaints, but may not rely solely upon
this factor to discredit the claimant.
See Jones v. Astrue, 619
F.3d 963, 975 (8th Cir. 2010) (citing Mouser v. Astrue, 545 F.3d
634, 638 (8th Cir. 2008)).
While an ALJ is not required to explicitly discuss each
of the foregoing factors, Goff v. Barnhart, 412 F.3d 785, 791 (8th
Cir. 2005), the ALJ is required to acknowledge and consider the
foregoing factors and make an express credibility determination
Renstrom v. Astrue, 680 F.3d 1057, 1067 (8th Cir.
2012) (citing Partee v. Astrue, 638 F.3d 860, 865 (8th Cir. 2011)).
Plaintiff’s suggestion that the ALJ summarily stated that
she lacked credibility is wholly meritless, as is plaintiff’s broad
statement that the ALJ failed to sufficiently address the Polaski
The ALJ in this case wrote that he had considered
plaintiff’s symptoms and the extent to which they could reasonably
be accepted as consistent with the objective and other evidence in
accordance with 20 C.F.R. §§ 404.1529 and 416.929, and SSRs 96-4p
correspond with Polaski and credibility determination.
then noted numerous inconsistencies in the record that detracted
from plaintiff’s credibility.
The ALJ first identified objective medical evidence that
symptoms precluding all work.
While an ALJ may not discount a
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claimant’s subjective complaints based solely upon a lack of
supporting medical evidence, the lack of such evidence is one
factor an ALJ may consider in analyzing a claimant’s credibility.
See Forte v. Barnhart, 377 F.3d 892, 895 (8th Cir. 2004) (holding
that lack of objective medical evidence is a factor an ALJ may
The ALJ discussed plaintiff’s medical treatment, noting
her complaints and diagnoses.
As the ALJ noted, most of the
testing yielded fairly benign results, and most of the physical and
psychiatric examinations yielded fairly normal findings.
ALJ noted, MRI imaging of plaintiff’s cervical and thoracic spine
showed only mild degeneration and, while the thoracic spine imaging
showed disc protrusion, it did not show stenosis.
As the ALJ
noted, lumbar MRI performed in June 2009 showed only moderate
degeneration, 2008 knee imaging was largely normal, and April 2010
imaging of plaintiff’s right ankle was unremarkable except for mild
The ALJ also noted that medical examinations performed
insignificant musculoskeletal and neurological results.
noted that physical examination revealed effusion, limited range of
motion, tenderness and muscle spasm on only one to two occasions
each, and that physical examination mostly yielded normal findings.
The ALJ also noted that mental status evaluations conducted during
October 2008 to April 2009 yielded normal results.
While the lack
important factor, and the ALJ was entitled to consider the fact
- 31 -
that the objective medical evidence did not support the degree of
20 C.F.R. §§ 404.1529(c)(2), 416.929(c)(2);
Kisling v. Chater, 105 F.3d 1255, 1257-58 (8th Cir. 1997); Cruse v.
Bowen, 867 F.2d 1183, 1186 (8th Cir. 1989) (the lack of objective
medical evidence to support the degree of severity of alleged pain
is a factor to be considered).
Continuing with his credibility assessment, the ALJ noted
that evidence in the record that plaintiff drove a vehicle was
inconsistent with her assertions of an inability to sit more than
15 to 20 minutes at a time, and that evidence that she shopped was
inconsistent with her assertions of an inability to stand for a
prolonged period. Also notable is plaintiff’s March 2010 statement
that she walked for 20 minutes each day, (Tr. 460), and her April
2010 statement that she walked one-half to one mile daily.
Also, despite plaintiff’s testimony that she suffered from
debilitating symptoms, her treatment providers consistently advised
assertions, the ALJ was entitled to consider this evidence in
evaluating plaintiff’s credibility.
See Medhaug v. Astrue, 578
shopping, walking, cooking, and household chores are inconsistent
with complaints of disabling pain); Forte, 377 F.3d 896 (activities
such as driving, walking for exercise, shopping, and attending
claimant’s allegations of disabling symptoms).
The ALJ also noted
plaintiff’s report that she had
- 32 -
experienced neck and back pain since 2001, and that plaintiff’s
medical records failed to demonstrate a significant deterioration
since that time.
As the ALJ noted, a condition that was present
but not disabling during working years cannot be used to prove a
present disability, absent evidence of significant deterioration.
Orrick v. Sullivan, 966 F.2d 368, 370 (8th Cir. 1992) (per curiam).
The ALJ also noted that only conservative spinal treatment had been
offered to plaintiff.
See Moore v. Astrue, 572 F.3d 520, 525 (8th
disability inconsistent with complaints of disabling pain).
psychiatric care from May 2009 to February 2010.
See Shannon v.
Chater, 54 F.3d 484, 486 (8th Cir. 1995)(while not dispositive, the
failure to seek treatment may indicate “the relative seriousness of
a medical problem”); see also Novotny v. Chater, 72 F.3d 669, 671
(8th Cir. 1995) (the lack of regular and sustained treatment is a
basis for discounting complaints and is an indication that the
limiting for twelve continuous months).
The ALJ also noted that,
thoughts, she consistently denied such thoughts when questioned by
her treating sources.
Also notable is that, when seeking other
treatment, plaintiff did not consistently complain of the same
spinal and psychiatric symptoms she now alleges are disabling.
When plaintiff reported for counseling in January of 2009, she
reported doing ok psychologically and was working. (Tr. 1205).
- 33 -
April of 2009, she reported that she was happy, newly married, and
working at Ryan’s.
When plaintiff saw Dr. Lynskey in
November of 2009, she reported that she had not had psychiatric
care, she had no anxiety, and had a normal examination.
In April of 2010, Dr. Shereen noted no evidence of anxiety
Also, as is evident from the above
summary of the medical information, when plaintiff sought medical
treatment, she did not routinely report the same musculoskeletal
evaluating subjective complaints, an ALJ may consider that the
claimant did not exhibit complaints regarding an alleged impairment
Stephens v. Shalala, 46 F.3d 37,
while receiving other treatment.
38 (8th Cir. 1995) (per curiam).
The ALJ also noted evidence in the record that plaintiff
sometimes stopped taking her psychiatric medications. Later in his
decision, the ALJ noted that plaintiff did not use the BIPAP as
The record also indicates that plaintiff continued to
smoke cigarettes despite being repeatedly told to stop, even when
treatment was justified by a good reason, and review of the record
“A failure to follow a recommended course of
treatment ... weighs against a claimant’s credibility.”
v. Barnhart, 393 F.3d 798, 802 (8th Cir. 2005).
convicted of forgery.
See Simmons v. Massanari, 264 F.3d 751, 756
- 34 -
(8th Cir. 2001) (upholding negative credibility finding based on
conflicting statements and forgery conviction); see also Federal
The ALJ also observed that plaintiff’s poor work
history reflected a poor work ethic.
from a claimant’s credibility.
A poor work history detracts
Pearsall, 274 F.3d at 1218 (citing
Woolf v. Shalala, 3 F.3d 1210, 1214 (8th Cir. 1993)).
is the fact that plaintiff told Dr. Quadri in 2010 that her medical
history included “cancer of the spine.”
medical evidence to support this report.
There is no
While plaintiff did
undergo surgery in 2008 to remove a mass, testing revealed the mass
was benign, and plaintiff’s post-operative diagnosis was listed as
simple lymphatic cyst.
Exaggerated responses during
claimant’s credibility. Kelley v. Barnhart, 372 F.3d 958, 961 (8th
Plaintiff argues that the ALJ erroneously analyzed her
daytime sleepiness as if it arose from sleep apnea when in fact it
observation that plaintiff had an excellent response to BIPAP use,
plaintiff argues that even if her sleep apnea resolved, she would
continue to suffer daytime sleepiness due to her medications.
Contrary to plaintiff’s argument, the ALJ acknowledged plaintiff’s
The ALJ went on to note evidence from the
record suggesting that plaintiff’s symptoms were self-inflicted;
- 35 -
medication as directed.
As noted above, failure to follow a
Guilliams, 393 F.3d at 802.
The administrative record as a whole supports the ALJ’s
conclusion regarding plaintiff’s allegations of daytime sleepiness.
When plaintiff presented to Barnes-Jewish St. Peters Hospital for
a sleep study in February of 2010, she described her sleep habits,
stating that she went to bed between midnight and 2:00 a.m., and
got up several times at night to consume snacks and drinks.
March and April of 2010, Drs. Lynskey and Dahuja, respectively,
described plaintiff’s sleep habits as irregular and erratic, and
instructed her to improve her sleep hygiene.
Sleep habits such as
these would alone likely cause a person to be sleepy during the
day, and it would seem that a person who was truly motivated to
improve her daytime functioning would choose to observe a healthier
In addition, when she presented for the February 2010
sleep study, plaintiff reported that she had been symptomatic for
the past seven to eight years.
A condition that was present but
not disabling during working years and has not worsened cannot be
used to prove a present disability.
Orrick v. Sullivan, 966 F.2d
368, 370 (8th Cir. 1992) (per curiam); Dixon v. Sullivan, 905 F.2d
237, 238 (8th Cir. 1990).
Finally, the record contains evidence
that plaintiff’s daytime sleepiness was controlled by medication.
On December 7, 2010, plaintiff saw Dr. Quadri.
- 36 -
The progress note
from this visit was submitted to and considered by the Appeals
Council, and made part of the administrative record.
On that date,
sleepiness was “excessive without Focalin but with it she is alert
enough and can function.” (Tr. 1459).
While not alone dispositive
of the issue, this is some evidence that supports the ALJ’s
See Schultz v. Astrue, 479 F.3d 979, 983 (8th Cir.2007)
(an impairment that can be controlled by medication cannot be
Finally, plaintiff’s subjective complaints
of daytime sleepiness were subject to review in light of her
credibility as a whole, and the ALJ properly discredited plaintiff
after undertaking a legally sufficient analysis.
A review of the ALJ’s credibility determination shows
that, in a manner consistent with and required by Polaski, he
considered plaintiff’s subjective complaints on the basis of the
entire record before him, and set forth numerous inconsistencies
detracting from plaintiff’s credibility.
An ALJ may disbelieve
subjective complaints where there are inconsistencies on the record
as a whole.
Battles, 902 F.2d at 660.
Because the ALJ considered
the appropriate factors and gave good reasons for discrediting
plaintiff’s subjective complaints, his credibility determination
will be upheld.
Hogan, 239 F.3d at 962.
Dr. Quadri’s Opinion
In reaching his conclusions regarding plaintiff’s RFC,
the ALJ wrote that he was giving Dr. Quadri’s July 2010 opinion
only slight weight, offering several valid reasons for doing so.
- 37 -
Plaintiff alleges that the ALJ erred in determining plaintiff’s RFC
in that he failed to recognize Dr. Quadri’s status as a treating
psychiatrist, and failed to properly weigh his opinion.
also contends that the ALJ should have included the limitations Dr.
Quadri assessed in finding plaintiff’s RFC.
Review of the ALJ’s
decision reveals no error.
A treating physician’s opinion is generally entitled to
substantial weight, but it does not automatically control, because
the ALJ must evaluate the record as a whole.
Davidson v. Astrue,
501 F.3d 987, 990 (8th Cir. 2007) (citing Charles v. Barnhart, 375
F.3d 777, 783 (8th Cir. 2004)).
According to the Regulations and
to Eighth Circuit precedent, a treating physician’s opinion must be
well-supported by medically acceptable clinical and laboratory
diagnostic techniques, and it must not be inconsistent with the
other substantial evidence in the record.
20 C.F.R. §§ 404.1527,
416.927; Reed v. Barnhart, 399 F.3d 917, 920 (8th Cir. 2005).
the opinion fails to meet these criteria, however, the ALJ need not
Davidson v. Astrue, 578 F.3d 838, 842 (8th Cir. 2009)
(internal citation omitted); see also Rogers v. Chater, 118 F.3d
600, 602 (8th Cir. 1997); Ward v. Heckler, 786 F.2d 844, 846 (8th
Cir. 1986) (If justified by substantial evidence in the record as
a whole, the ALJ can discount a treating physician’s opinion).
When an ALJ discounts a treating physician’s opinion, he should
give “good reasons” for doing so.
Davidson, 501 F.3d at 990
(citing Dolph v. Barnhart, 308 F.3d 876, 878 (8th Cir. 2002)).
Plaintiff’s suggestion that the ALJ failed to recognize
- 38 -
Dr. Quadri’s status as a treating psychiatrist is unfounded.
During the time preceding Dr. Quadri’s July 2010 opinion, plaintiff
saw him on only three occasions.
In his decision, the ALJ
visits, and then discussed Dr. Quadri’s opinion.
The ALJ also
wrote that he had considered opinion evidence in accordance with
the requirements of 20 C.F.R. §§ 404.1527 and 416.927, and SSRs 962p, 96-5p, 96-6p, and 06-3p which address, inter alia, weighing
opinion evidence from treating sources.
explained how he reached his decision to give Dr. Quadri’s opinion
evidence slight weight, offering valid reasons in support.
As the ALJ determined, Dr. Quadri’s opinion evidence was
inconsistent with his own treatment notes.
When Dr. Quadri first
examined plaintiff, he noted that she was sad, depressed and
had good eye contact, logical and goal-directed
plaintiff’s GAF as 65, indicative of only mild symptoms.
plaintiff saw him next, she denied feeling sad, depressed or
anxious, and Dr. Quadri found that her mood was good and her affect
When plaintiff saw him next, she complained mostly
of feeling anxious when around others, such as when she attended
While Dr. Quadri documented a depressed affect with no
Quadri’s treatment records generated after his opinion evidence are
similarly unsupportive: on December
- 39 -
2010 he documented no
abnormalities during mental status examination, and his findings in
January of 2011, when denying plaintiff’s request for assistance in
continuing to receive narcotic pain medication, were similarly
Despite plaintiff’s suggestion to the contrary, the ALJ
did not form his own medical opinion when he observed that Dr.
Quadri’s only abnormal findings were relatively insignificant, nor
did the ALJ ignore any positive findings.
Review of the ALJ’s
decision reveals that he exhaustively analyzed all of the medical
and other evidence of record, and it does not appear that the ALJ
overlooked any evidence.
While Dr. Quadri did, as plaintiff
argues, note some positive findings upon examination, the ALJ was
justified in concluding that such findings failed to justify the
extreme limitations expressed in the opinion evidence.
inconsistent with his treatment notes.
An ALJ is
Davidson, 578 F.3d at 842
(“It is permissible for an ALJ to discount an opinion of a treating
Dr. Quadri’s opinion evidence did not include a narrative
or any explanation of plaintiff’s symptoms, clinical signs, or what
controlling weight only if it is “well-supported by medically
acceptable clinical and laboratory diagnostic techniques and is not
inconsistent with the other substantial evidence in [the] record.”
20 C.F.R. §§ 404.1527(d)(2), 416.927(d)(2).
- 40 -
It therefore appears
that Dr. Quadri’s opinion evidence was based largely on plaintiff’s
subjective allegations, which the ALJ properly discredited after
undertaking a legally sufficient analysis.
An ALJ may discount an
opinion that is based largely on a claimant’s subjective complaints
rather than objective medical evidence.
705, 709 (8th Cir. 2007).
Kirby v. Astrue, 500 F.3d
This is especially so given evidence in
the record that plaintiff exaggerated her complaints to Dr. Quadri,
inasmuch as she told him she had cancer of the spine when in
reality she had a benign mass removed.
Also, as the ALJ observed, Dr. Quadri’s opinion evidence
school, and with the balance of the medical information of record.
As noted above, plaintiff reported in January of 2009 that she was
doing ok psychologically and was working.
In April of
2009, she reported that she was happy, newly married, and working
at Ryan’s, (Tr. 1206), and when she saw Dr. Lynskey in November of
2009, she reported that she had not had psychiatric care, she had
no anxiety, and had a normal examination.
(Tr. 481, 483).
controlling weight to an opinion that is inconsistent with the
other substantial evidence in the record.
Davidson, 578 F.3d at
842; see also Ward, 786 F.2d at 846 (If justified by substantial
evidence in the record as a whole, the ALJ can discount a treating
Plaintiff argues that the ALJ erroneously failed to
- 41 -
assessment and in plaintiff’s testimony.
However, for the reasons
plaintiff’s subjective allegations of pain and other limitations
precluding all work, and properly discounted Dr. Quadri’s opinion
limitations in his analysis of plaintiff’s RFC.
the burden of persuasion to prove disability and demonstrate her
Vossen v. Astrue, 612 F.3d 1011, 1016 (8th Cir. 2010).
Plaintiff herein cannot demonstrate that her functional limitations
are greater than those described in the ALJ’s RFC assessment.
RFC assessment draws from medical sources for support, but RFC is
ultimately an administrative decision reserved to the Commissioner.
Cox v. Astrue, 495 F.3d 614, 619 (8th Cir. 2007) (citations
The specific grounds identified by plaintiff fail to
For all of the foregoing reasons, on the claims
Commissioner’s decision is supported by substantial evidence on the
record as a whole, and should therefore be affirmed.
is substantial evidence to support the decision, reversal is not
different outcome, or because another court could have decided the
Cir.2001); Browning, 958 F.2d at 821.
- 42 -
Commissioner is affirmed, and plaintiff’s Complaint is dismissed
Frederick R. Buckles
UNITED STATES MAGISTRATE JUDGE
Dated this 11th day of October, 2013.
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