Lewis v. Colvin

Filing 28

MEMORANDUM AND ORDER - SOCIAL SECURITY BRIEF filed by Plaintiff Valerie K. Lewis ; For the reasons discussed above, the Court finds that the Commissioner's decision is supported by substantial evidence in the record as a whole. Accordingly, IT IS HEREBY ORDERED that the relief sought by plaintiff in her brief in support of complaint [Doc. # 22 ] is denied.. Signed by District Judge Carol E. Jackson on 9/2/14. (KKS)

UNITED STATES DISTRICT COURT
EASTERN DISTRICT OF MISSOURI
EASTERN DIVISION
VALERIE K. LEWIS, on behalf of
L.M.R.J.,
Plaintiff,
vs.
CAROLYN W. COLVIN, Commissioner
of Social Security,
Defendant.

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Case No. 4:13-CV-1169 (CEJ)

MEMORANDUM AND ORDER
This matter is before the Court for review of an adverse ruling by the Social
Security Administration.
I. Procedural History
On April 8, 2010, Valerie Lewis filed an application on behalf of her minor
daughter, plaintiff L.M.R.J., for supplemental security income (SSI) benefits under Title
XVI of the Social Security Act, 42 U.S.C. §§ 1381 et seq. (Tr. 137-140).

The

application alleged that disability began on January 1, 2005. After the application was
denied on initial consideration (Tr. 71-74), plaintiff requested a hearing from an
Administrative Law Judge (ALJ). See Tr. 78-83 (acknowledging request for hearing).
Plaintiff, Lewis, and counsel appeared for a hearing on February 29, 2012. (Tr.
31-69). The ALJ issued a decision on April 12, 2012 denying plaintiff’s application (Tr.
11-26), and the Appeals Council denied plaintiff’s request for review on April 19, 2013.
(Tr. 1-6). Accordingly, this decision stands as the Commissioner’s final decision.

II. Evidence Before the ALJ
A. Disability Application Documents
According to the application for SSI benefits, plaintiff was born in September
1999. (Tr. 137). The Disability Report lists plaintiff’s disabling conditions as attention
deficit hyperactivity disorder (ADHD), Asperger’s syndrome, and obsessive-compulsive
disorder (OCD). Her medications were Zoloft,1 Tenex,2 and Strattera.3 (Tr. 159-166).
In the Supplemental Questionnaire, plaintiff’s mother stated that plaintiff is able to play
video games and use a computer, but that she has difficulties focusing for an extended
period of time.

Plaintiff’s mother wrote that plaintiff challenges authority, is

disrespectful, and “throws fits.” (Tr. 168-169).
According to the Function Report, plaintiff wears eyeglasses for nearsightedness;
has problems speaking clearly, but she can be understood some of the time by people
who do not know her well and most of the time by people who do know her well; is
able to deliver telephone messages, talk with family and friends, repeat stories, tell
jokes accurately, explain why she did something, and use sentences with “because,”
“what if,” and “should have been;” does not have hearing difficulties; is able to

1

Zoloft, or Sertraline, is a member of the SSRA class and is used to treat
depression, obsessive-compulsive disorder, panic attacks, posttraumatic stress
disorder, and social anxiety disorder. It is also used to relieve the symptoms of
premenstrual dysphoric disorder. http://www.nlm.nih.gov/medlineplus/druginfo/
meds/a697048.html (last visited May 2, 2014).
2

Tenex is a brand name for Guanfacine, which is used alone or in combination
with other medications to treat high blood pressure or to control symptoms of ADHD.
http://www.nlm.nih.gov/medlineplus/druginfo/meds/a601059.html (last visited May
2, 2014).
Strattera is a brand name for Atomoxetine, which is used as a part of a total
treatment program to increase the ability to pay attention and decrease
impulsiveness and hyperactivity in children and adults with ADHD.
http://www.nlm.nih.gov/ medlineplus/druginfo/meds/a603013.html (last visited
May 2, 2014).
-2-

progress in learning; is not limited in her physical abilities; is able to make new friends;
generally gets along with adults and teachers; and is able to take care of her personal
needs, such as brushing her teeth, eating, or washing herself, but has difficulties
paying attention and sticking with a task. (Tr. 144-155).
B. School Records
The record contains an Individualized Education Program (IEP) report, dated
April 19, 2011. (Tr. 195-211). Plaintiff was then a 5th grade student in the Laclede
County School District. The report states that plaintiff underwent an initial evaluation
in April 2008, which resulted in a diagnosis of speech impaired-sound system disorder.
This disorder causes her “to display a w/r substitution and a tongue thrust which
results in a distortion of the /s and z/ sounds.” (Tr. 207).

For example, plaintiff

pronounces the words horse as “horth,” stove as “thtove,” and eggs as “eggth.”
Testing revealed that “sound errors [were] occasionally noticed in continuous speech.”
(Tr. 208). Her overall speech intelligibility was judged to be understandable, but
distortions “made her speech have an immature sounding quality.” (Tr. 195, 209). No
concerns were noted in areas of intellectual/cognitive, hearing, or vision (other than
requiring glasses for distance vision).
Plaintiff’s classroom teacher, April Pulley, described plaintiff’s motor skills to be
average, while plaintiff’s mother described them to be of “lower quality.” (Tr. 206).
Pulley described plaintiff’s adaptive behavior to be age-appropriate, while plaintiff’s
mother found her to be “lazy” and “sloppy.” (Tr. 207). Pulley reported that plaintiff
performed at average levels in math, reading, and language, but that “many times her
medicine or home routine [made] her very tired” and that she had trouble staying
awake in class.

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Plaintiff scored average in reading and reading comprehension and her current
grades were listed as a B in language arts, a B- in spelling, a C in math, a B- in
science, and a B+ in social studies. In terms of social and emotional behavior, Pulley
noted the following areas of concern: “defiance of rules, off-task behaviors, attentionseeking behaviors, outbursts of anger, improper interaction with authority, does not
get along well with peers, emotional difficulties and home problems.” (Tr. 209). The
IEP determined that she would participate in regular classes 80% of the time (Tr. 202).
On June 9, 2011, plaintiff’s speech therapist, Lori Hyde, completed an overall
functioning questionnaire for the Social Security Administration (SSA). (Tr. 305-312).
Hyde based her responses on observations that she made during biweekly speech
therapy sessions with plaintiff. Hyde wrote that “during speech class, [plaintiff] always
has trouble focusing. She never seems to know when it is her turn, where we are in
the activity, etc.” Hyde stated that plaintiff is “always lethargic and constantly reports
being tired. She frequently falls asleep during speech. She often makes rude noises
to distract others.” (Tr. 307). In terms of interacting and relating with others, Hyde
wrote that plaintiff “usually just requires reminders that what she is doing/saying are
not appropriate.” (Tr. 308). Hyde also noted that plaintiff sometimes did not exhibit
good personal hygiene. (Tr. 310).
On February 10, 2012, Hyde, completed a questionnaire for the Social Security
Administration. (Tr. 476-483). In regards to acquiring and using information, Hyde
reported that plaintiff had no problems reading or comprehending written material; had
slight problems understanding school/content vocabulary, providing organized oral
explanations and adequate descriptions, and recalling and applying previously learned
material; had obvious problems understanding and participating in class discussions;
and had serious problems comprehending oral instructions. (Tr. 477).
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In terms of attending and completing tasks, Hyde reported that plaintiff had no
problem completing work accurately without careless mistakes; had slight problems
carrying out single-step instructions, organizing her things and school materials, and
completing assignments; had obvious problems paying attention when spoken to
directly, sustaining attention during play/sports activities, focusing long enough to
finish assigned activity or task, carrying out multi-step instructions, waiting to take
turns, and changing from one activity to another without being disruptive; and had
serious problems refocusing to task when necessary, working without distracting
herself or others, and working at a reasonable pace. (Tr. 478).
In terms of interacting and relating with others, Hyde reported that plaintiff had
no problem using adequate vocabulary or grammar to express thoughts/ideas in
everyday conversation; had slight problems respecting/obeying adults in authority,
relating experiences and telling stories, and interpreting meanings of facial
expressions; had obvious problems playing cooperatively with other children, making
and keeping friends, asking permission appropriately, following rules, and taking turns
in a conversation; and had serious problems seeking attention and expressing anger
appropriately and introducing and maintaining relevant and appropriate topics of
conversation. (Tr. 479).
In terms of caring for herself, Hyde reported that plaintiff had no problem caring
for her physical needs, cooperating in or being responsible for taking medications, or
using good judgment regarding personal safety and dangerous circumstances; had
slight problems identifying and appropriately asserting emotional needs, responding
appropriately to changes in own mood, and using appropriate coping skills to meet
daily demands of school environment; and had obvious problems handling frustration
appropriately, being patient, and taking care of personal hygiene. (Tr. 481).
-5-

On February 13, 2012, plaintiff’s 6th grade teacher, Kent Golchert, completed
the same questionnaire. (Tr. 467-473). Golchert wrote that plaintiff was very
independent, would rarely seek extra help on problems and often displayed defiance
when confronted with correction. (Tr. 468). Golchert wrote that plaintiff turned in late
assignments two to three times per month and that she had difficulties making friends
in her grade level. (Tr. 468-470). He stated that she had no problems moving about,
manipulating objects, or caring for herself.
In terms of acquiring and using information, Golchert reported that plaintiff had
slight problems comprehending oral instructions, understanding school/content
vocabulary, reading and comprehending written material, understanding and
participating in class discussions, and learning new material; and had obvious problems
comprehending and doing math problems, providing organized oral explanations and
adequate descriptions, expressing ideas in writing, recalling and applying previously
learned material, and applying problem-solving skills in class discussions. (Tr. 468).
In terms of attending and completing tasks, Golchert reported that plaintiff had
no problems refocusing to task when necessary, carrying out single or multi-step
instructions, waiting to take turns, or changing from one activity to another without
being disruptive; had slight problems focusing long enough to finish an assigned
activity or task, organizing her things or school materials, completing assignments,
working without distracting herself or others, and working at a reasonable pace; had
obvious problems sustaining attention during play/sports activities and completing
work accurately without careless mistakes; and had a very serious problem with paying
attention when spoken to directly. (Tr. 469).
In terms of interacting and relating with others, Golchert reported that plaintiff
had no problems seeking attention or expressing anger appropriately, asking
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permission appropriately, following rules, respecting/obeying adults in authority,
relating experiences and telling stories, using language appropriate to the situation and
listener, taking turns in conversation, and using adequate vocabulary and grammar to
express thoughts/ideas in everyday conversation; had slight problems introducing and
maintaining relevant and appropriate topics of conversation and interpreting meaning
of facial expressions; and had obvious problems playing cooperatively with other
children and making and keeping friends. (Tr. 470).
On February 23, 2012, plaintiff’s 6th grade math and communication arts
teacher, Tracey Huebner, completed the same questionnaire. (Tr. 222-229). Huebner
wrote that plaintiff had “a great personality, however, she struggles to communicate
properly with authoritative adults. She is always tapping/moving around in [the]
classroom. [She] can be outright difficult at times, especially when it is challenging her
to do something she doesn’t want to do at the time.” Huebner wrote that she feels as
if plaintiff “has great potential as a learner if she can learn to control herself and accept
criticism to improve her learning.”
In terms of acquiring and using information, Huebner reported that plaintiff had
no problems comprehending oral instruction or understanding school and content
vocabulary; had slight problems expressing ideas in written form, recalling and
applying previously learned material, and applying problem-solving skills in class
discussions; had obvious problems reading and comprehending written material and
learning new material; and had very serious problems comprehending and doing math
problems, understanding and participating in class discussions, and providing organized
oral explanations. (Tr. 223).
In terms of attending and completing tasks, Huebner reported that plaintiff had
no problems carrying out single-step instructions, waiting to take turns, or working at
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a reasonable pace; had slight problems organizing school materials; had obvious
problems paying attention when spoken to directly, focusing long enough to finish
assigned activity or task, changing from one activity to another without being
disruptive, and completing assignments; had serious problems refocusing to a task
when necessary and carrying out multi-step instructions; and had very serious
problems completing work accurately without careless mistakes and working without
distracting herself or others. (Tr. 224).
In terms of interacting and relating with others, Huebner reported that plaintiff
had no problems asking for permission or introducing and maintaining relevant and
appropriate topics of conversation; had slight problems following rules, relating
experiences and telling stories, using language appropriate to the situation and the
listener, and using adequate vocabulary and grammar to express thoughts/ideas in
general conversation; had obvious problems seeking attention appropriately, taking
turns in a conversation, and interpreting meaning of facial expressions, body language,
hints, or sarcasm; had serious problems making and keeping friends and
respecting/obeying adults in authority; and had very serious problems playing
cooperatively with other children and expressing anger appropriately. (Tr. 225).
In terms of caring for herself, Huebner reported that plaintiff had no problems
caring for physical needs or personal safety; had slight problems taking care of
personal hygiene; had obvious problems being patient, identifying and appropriately
asserting emotional needs, and responding appropriately to changes in her own mood;
had serious problems using appropriate coping skills to meet daily demands of school
environment; and had very serious problems handling frustration appropriately and
knowing when to ask for help. (Tr. 227).
C. Hearing on February 29, 2012
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Richard Cowles, Psy.D., a licensed clinical neuropsychologist, provided testimony
regarding plaintiff’s impairments.

(Tr. 129-136, 35-49).

Dr. Cowles reviewed

plaintiff’s medical record and testified that, in his opinion, plaintiff’s impairments did
not meet or equal any of the medical listings. Dr. Cowles referenced plaintiff’s IEP and
noted that plaintiff was diagnosed with a sound system disorder and ADHD, that her
speech was intelligible despite being affected by a lisp, that she had difficulties staying
awake in class, that it was suspected that she was a victim of sexual abuse, and that
she had a Global Assessment of Functioning (GAF)4 score of 48.5 (Tr. 36). Dr. Cowles
referenced plaintiff’s medical records from September 2009, which stated that plaintiff
had mood swings and was missing school due to somatic complaints. Dr. Cowles
referenced plaintiff’s medical records from February and May 2010, which stated that
she was able to focus and concentrate when on medication, that her tantrums were
manageable, and that her defiance improved. (Tr. 36-37).
Dr. Cowles referred to the February 2011 psychological examination, which
reported that plaintiff received all A’s and one C, and that most of her medical issues
began a year prior to the examination. The examination report diagnosed plaintiff with
mood disorder and child relational problems, and provided her with a GAF score of 60.6
4

The GAF is determined on a scale of 1 to 100 and reflects the clinician’s
judgment of an individual’s overall level of functioning, taking into consideration
psychological, social, and occupational functioning. Impairment in functioning due to
physical or environmental limitations are not considered. American Psychiatric
Association, Diagnostic & Statistical Manual of Mental Disorders - Fourth Edition, Text
Revision 32-33 (4th ed. 2000).
5

A GAF of 41-50 corresponds with “serious symptoms OR any serious
impairment in social, occupational, or school functioning.” American Psychiatric
Association, Diagnostic & Statistical Manual of Mental Disorders - Fourth Edition, Text
Revision 34 (4th ed. 2000).
6

A GAF of 51-60 corresponds with “moderate symptoms (e.g., flat affect and
circumstantial speech, occasional panic attacks) OR difficulty in social, occupational or
school functioning (E.g., few friends, conflicts with peers or co-workers).” American
-9-

(Tr. 37). Dr. Cowles noted that plaintiff’s mother was diagnosed with Borderline
Personality Disorder and that plaintiff had marked difficulties in interacting and relating
to others and less than marked difficulties in acquiring and using information and
attending and completing tasks. (Tr. 38-39).
Dr. Cowles testified that ADHD typically does not cause marked functional
limitations, but that generalized anxiety disorder and mood disorder, depending on
their severity, could cause marked functional limitations. (Tr. 40-41). Dr. Cowles
referenced the questionnaire completed by Lori Hyde and testified that, although her
opinions reflected serious limitations, her opinions were inconsistent with plaintiff’s IQ
score, the opinions of plaintiff’s classroom teachers, and her overall grades. (Tr. 4344).
Plaintiff provided minimal testimony in response to questions posed by the ALJ.
(Tr. 50-53). Plaintiff stated that she used to have a best friend until he moved away,
that she likes school most of the time, that she listens to her parents some of the time,
and that she gets along with her family some of the time. (Tr. 50-52).
Plaintiff’s mother also testified at the hearing.7 (Tr. 53-63). Lewis stated that
there is a noticeable difference in plaintiff’s disposition when does not take her
medication. (Tr. 53-55). Lewis stated that plaintiff does not follow instructions well,
that she needs to be reminded to do her chores, and that she does not clean her room
or brush her teeth. (Tr. 57-58). Lewis believed that plaintiff’s teachers felt sorry for
plaintiff and tended to give her higher grades than she actually deserved. Lewis stated

Psychiatric Association, Diagnostic & Statistical Manual of Mental Disorders - Fourth
Edition, Text Revision 34 (4th ed. 2000).
7

In the hearing transcript and elsewhere in the record, plaintiff’s mother is
identified as “Valerie Jacks.”
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that plaintiff was in special education classes for reading and math and that the
remainder of her classes were regular education. (Tr. 62). Lewis testified that plaintiff
did not have any difficulties using a computer or playing video games, but that plaintiff
tended to play less complicated games. (Tr. 62-63).
Lewis stated that in terms of interacting and relating to people, plaintiff had
difficulties understanding boundaries and social cues. Lewis expressed concern about
plaintiff’s ability to stay on task, follow instructions, and not be a distraction to other
students in school. (Tr. 64). For example, Lewis stated that plaintiff would get upset
and loud when other students would intrude on her desktop space at school. (Tr. 65).
Lewis testified that plaintiff had difficulties getting along with children her own age and
that her classmates had a history of bullying her. (Tr. 66-68).
D. Medical Evidence
On June 15, 2009, plaintiff saw John Hopkins, M.D. at Lebanon Pediatrics for a
follow up regarding her ADHD. (Tr. 232-238). Plaintiff had trouble completing school
assignments, but her overall inattention and impulsivity improved. Lewis reported that
she gave plaintiff a “two-week break” from her medication and noticed an increase in
hyperactivity. Dr. Hopkins discontinued the Strattera prescription and replaced it with
Vyvanse.8 She was instructed to take one caplet per day. On July 31, 2009, plaintiff
returned to Dr. Hopkins with reports that she had not been taking her medication as

8

Vyvanse is a central nervous system stimulant indicated for the treatment of
ADHD. http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=704e4378-ca83-445c8b45-3cfa51c1ecad (last visited May 5, 2014).
-11-

directed. (Tr. 239-241). Dr. Hopkins discontinued Vyvanse and prescribed Adderall XR9
with instructions to take one caplet daily.
On September 8, 2009, plaintiff saw Dr. Hopkins for a follow up appointment.
(Tr. 242-245). Treatment notes state that plaintiff was put back on Strattera because,
despite having some hyperactivity, she tended to be more calm when taking Strattera.
Jacks reported that plaintiff had bouts of nausea and vomiting. Dr. Hopkins prescribed
Ranitidine10 for the nausea.
On September 22, 2009, plaintiff presented to Pathways Community Behavioral
Healthcare (Pathways). (Tr. 253). A multiaxial assessment revealed a diagnosis of
ADHD with a GAF score of 48. (Tr. 269-277). On October 6, 2009, plaintiff returned
to Pathways to meet with counselor Marcia Landers. At the end of the session, they
agreed to continue meeting on a regular basis. (Tr. 253, 267-268). Plaintiff returned
for seven counseling sessions in the remainder of 2009, 27 sessions in 2010, and 21
sessions in 2011. (Tr. 254-262, 382-448). Each session ranged from 30 minutes to
an hour and various topics were discussed, including the divorce of her parents; her
relationship issues with her parents, classmates, and siblings; and her struggles with
school.

Landers noted that plaintiff generally appeared sad, but denied being

depressed. Landers counseled plaintiff on how to process and manage emotions, how
to take responsibility for her actions, and empathy awareness. Landers also counseled

9

Adderall XR is the brand name for a combination of Amphetamine and
Dextroamphetamine, and is used to control symptoms of ADHD.
http://www.nlm.nih.gov/medlineplus/druginfo/meds/a601234.html (last visited May
5, 2014).
10

Ranitidine is used to treat ulcers, gastroesophageal reflux disease; a condition
in which backward flow of acid from the stomach causes heartburn and injury of the
food pipe; and conditions where the stomach produces too much acid.
http://www.nlm.nih.gov/medlineplus/druginfo/meds/a601106.html (last visited May
5, 2014).
-12-

plaintiff’s parents on the importance of getting plaintiff to bed at an appropriate hour,
administering medication on a regular basis, and the need for them to be less
argumentative and more supportive.
On September 29, 2009, plaintiff saw Harcharan Bains, M.D. at Pleasant Hope
Family Medical for the purpose of establishing care. (Tr. 293-296). Dr. Bains listed
plaintiff’s diagnosis as ADHD with OCD and gave her a GAF score of 50. Plaintiff was
prescribed Tenex and Zoloft. On November 3, 2009, plaintiff returned to Dr. Bains for
a follow up appointment. (Tr. 291-292). Treatment notes state that plaintiff was
doing better focusing and completing tasks in school and that she appeared less
depressed. Plaintiff was instructed to continue her current medications.
On February 9, 2010, plaintiff returned to Dr. Bains for a follow up. (Tr. 289290). Treatment notes state that plaintiff was doing very well, made honor roll in
school, and was able to focus and complete tasks. Dr. Bains noted that plaintiff was
not taking Tenex as directed because her mother tended to forget about the evening
dose.

On April 6, 2010, plaintiff returned to Dr. Bains with reports of increased

negative behaviors. (Tr. 286-288). Treatment notes state that plaintiff’s parents were
in the process of a divorce. Dr. Bains discontinued Tenex, prescribed Intuniv,11 and
increased the dosage of Zoloft. On April 27, 2010, plaintiff returned to Dr. Bains with
reports of increased hyperness and impulsiveness. (Tr. 283-284). Treatment notes
state that plaintiff was splitting her time between her the homes of her mother and
father and that she had temper tantrums when at her mother’s home. Dr. Bains
increased the dosage of Intuniv. On May 18, 2010, plaintiff returned to Dr. Bains.

11

Intuniv is a brand name for Guanfacine, which is used alone or in combination
with other medications to treat high blood pressure or to control symptoms of ADHD.
http://www.nlm.nih.gov/medlineplus/druginfo/meds/a601059.html (last visited May
2, 2014).
-13-

Plaintiff reported that since Intuniv’s dosage was increased, she was able to focus and
concentrate at school and complete tasks. (Tr. 281-282). Plaintiff’s mother reported
that plaintiff’s temper tantrums were manageable and that her defiance and
argumentative behavior had improved.
On May 25, 2010, plaintiff saw Dr. Hopkins for a well child visit. Dr. Hopkins
wrote that plaintiff had a healthy exam, that she suffered from ADHD, and that her
depression was stable. (Tr. 366-370). On June 8, 2010, a childhood disability
evaluation form was completed and signed by Steven Akeson, Psy.D., who wrote that
plaintiff had no limitations with acquiring or using information, moving about or
manipulating objects, or caring for herself. Dr. Akeson opined that plaintiff had less
than a marked limitation in attending or completing tasks and in interacting or relating
with others. (Tr. 297-302).
On August 10, 2010, plaintiff returned to Dr. Bains. (Tr. 345-347).

Lewis

reported that plaintiff was unable to focus, concentrate, or complete tasks, but that her
temper tantrums were manageable, her argumentative behavior was somewhat
improved, and that she slept well when she took her medications as directed. Dr.
Bains increased the Strattera dosage from 50mg to 60mg.
On September 11, 2010, plaintiff presented to the emergency room at St. John’s
Breech Regional Medical Center with complaints of abdominal pain. (Tr. 451-460).
Plaintiff underwent a CT scan of the abdomen and pelvis, which revealed normal
results. (Tr. 457, 459-460). Plaintiff was discharged with instructions to drink lots of
liquids and take over the counter magnesium citrate. (Tr. 458).
On September 21, 2010, plaintiff returned to Dr. Bains. Treatment notes state
that plaintiff was able to focus and concentrate, but that she had difficulties staying
awake in class. Lewis stated that she was giving plaintiff 50mg of Strattera on the
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weekends, instead of the prescribed 60mg.

Dr. Bains instructed plaintiff to take

Intuniv in the evenings, instead of the mornings, in order to reduce her fatigue at
school. Dr. Bains instructed plaintiff’s mother to be more complaint in administering
the correct doses of medications. (Tr. 348-350). On October 5, 2010, plaintiff reported
to Dr. Bains that she was less fatigued, was able to focus, and had no behavioral
problems. (Tr. 351-353).
On November 30, 2010, plaintiff reported to Dr. Bains that she was experiencing
increased fatigue at school. Lewis expressed her opinion that plaintiff intentionally fell
asleep when she was frustrated or to be defiant. Treatment notes state that plaintiff
was occasionally aggressive towards younger children at school, but that her grades
were good and that her school had not reported any recent behavioral problems. Dr.
Bains discontinued Intuniv because of the cost and substituted it with Tenex. (Tr. 354355). On January 31, 2011, Lewis reported that plaintiff was no longer falling asleep
at school, but that she was defiant at home and had mild anger outbursts without
aggression. Plaintiff stated that she felt sad and “stupid.” Treatment notes attribute
most of her stress to her parent’s divorce. (Tr.356-357).
On February 15, 2011, plaintiff received a psychological evaluation from Cathy
Grigg, Psy.D., which was requested by plaintiff’s counselor for the purpose of
determining possible treatment needs. (Tr. 316-325). Plaintiff was described to have
good personal hygiene and a cooperative and pleasant demeanor. Plaintiff appeared
reluctant to answer questions and asked to take two 5-minute naps during the testing
process. Lewis told Dr. Grigg that she was diagnosed with Borderline Personality
Disorder, that she took Paxil12 during her entire pregnancy with plaintiff, and that she

12

Paxil is the brand name for Paroxetine and is used to treat depression, panic
disorder, and social anxiety disorder. http://www.nlm.nih.gov/medlineplus/druginfo/
-15-

was emotionally absent during plaintiff’s infancy and early childhood. Lewis reported
that she believed plaintiff was sexually abused by a foster child who once lived in their
home. Plaintiff described her mood as “usually somewhere between happy and sad”
and reported that “sometimes her brain [told] her to do things.” (Tr. 319).
Dr. Grigg wrote that “[g]iven the unstable nature of [plaintiff’s] environment and
the exposure to Borderline Personality Disorder . . . it is possible that the interpersonal
difficulties [plaintiff] presents stem from this dynamic.

This dynamic would also

explain reports of mood swings, aggression, and conduct problems.” (Tr. 323). Dr.
Grigg further stated that medication side effects could also contribute to some of
plaintiff’s general symptoms. Plaintiff’s diagnostic impressions were listed as ADHD,
mood disorder, parent-child relational problems, problems with primary support group,
and problems related to the social environment. She was given a GAF score of 60.13
Dr. Grigg determined that plaintiff did not meet the criteria for OCD, psychosis, or
depression, and that there were no overt symptoms of Asperger’s disorder. (Tr. 324).
Dr. Grigg recommended that plaintiff continue individual counseling with a focus on
social skills, mood symptoms, behavioral concerns, and attachment; that she learn
more adaptive and healthy ways to express emotion; that she involve herself in
activities involving socializing with peers, such as joining a club or a team sport; that
she obtain a neurological evaluation to cancel out any possible brain trauma; that she
undergo more intensive and focused evaluation to rule out asperger’s disorder; and

meds/a698032.html (last visited May 6, 2014).
13

A GAF of 51-60 corresponds with “moderate symptoms (e.g., flat affect and
circumstantial speech, occasional panic attacks) OR difficulty in social, occupational or
school functioning (E.g., few friends, conflicts with peers or co-workers).” American
Psychiatric Association, Diagnostic & Statistical Manual of Mental Disorders - Fourth
Edition, Text Revision 34 (4th ed. 2000).
-16-

that her medication compliance be monitored. Dr. Grigg also suggested family
counseling. (Tr. 325).
On March 22, 2011, plaintiff returned to Dr. Bains. She reported that she was
able to focus and concentrate, but had some drowsiness at school and occasionally felt
sad.

Dr. Bains recommended that plaintiff seek therapy because of her parent’s

divorce. (Tr. 358-359). On May 16, 2011, plaintiff again reported that she was able
to focus and concentrate in school, but that she had frequent episodes of anger.
Plaintiff was again instructed to seek therapy and continue medication as prescribed.
(Tr. 360-361).

On July 11, 2011, plaintiff returned to Dr. Bains.

Plaintiff again

reported that she was able to focus and concentrate, but that she was still experiencing
episodes of anger and outbursts. Treatment notes state that plaintiff’s family would be
relocating and that they would seek another doctor. (Tr. 362-363).
On July 29, 2011, plaintiff saw Dr. Hopkins for the purpose of requesting a
psychiatry referral. Plaintiff stated that she wanted a second opinion regarding her
diagnosis because her mother believed she had asperger’s syndrome. (Tr. 371-372).
A referral was provided and on August 1, 2011, plaintiff presented to Ward Lawson,
Ph.D., at Tri-County Psychological Services. (Tr. 375-379). Dr. Lawson noted that
plaintiff’s mother was on disability due to a diagnosis of Borderline Personality Disorder
and that plaintiff’s adopted sister was also on disability. Dr. Lawson noted that
plaintiff’s parents were foster parents for approximately 100 foster children and that
some of those children, including her three biological siblings, had varying mental
illnesses. Dr. Lawson observed that plaintiff’s mother was “rather transparent about
her motive for the evaluation, that is, [plaintiff] being awarded disability benefits.”
After administering a full mental status exam, Dr. Lawson concluded that plaintiff was
“a mentally ill child, with a mentally ill brother, embedded in a dysfunctional family.”
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Dr. Lawson wrote that a diagnosis of asperger’s disorder was “doubtful” and that the
“more likely problem” was mood disorder.
On February 22, 2012, plaintiff presented to Deborah Walker, Psy.D, for a socialemotional functioning assessment at the request of plaintiff’s attorney. (Tr. 495-498).
Plaintiff scored within an average range for cognitive ability and achievement, while an
attention deficit disorder evaluation revealed a need for clinical intervention.

Dr.

Walker expressed his opinion that plaintiff did not have asperger’s disorder because the
full set of symptoms were not reported by plaintiff’s teachers and that although plaintiff
had a severe social deficit, it was likely due to the severity of her ADHD coupled with
anxiety and mood symptoms. Dr. Walker noted that plaintiff was raised in a chaotic
environment, that her parents were career foster parents, that her mother suffered
from Borderline Personality Disorder, and that without intervention plaintiff is likely to
become more depressed. (Tr. 497). Plaintiff was given a GAF score of 57.
On February 27, 2012, Dr. Walker completed an individual functional assessment
form. Dr. Walker reported that plaintiff had a less than marked14 limitation in acquiring
and using information, moving about and manipulating objects, and caring for herself.
Dr. Walker reported that she had a marked limitation in attending and completing tasks
and an extreme15 limitation in interacting and relating to others. (Tr. 506-507).
On February 28, 2012, Cindy Savage, a “long time family friend,” also completed
an individual functional assessment form. Savage reported that plaintiff had a marked

14

“Marked” is defined as a limitation which interferes seriously with the child’s
ability to independently initiate, sustain, or complete activities noted in a category.
15

“Extreme” is defined as a limitation which interferes very seriously with the
child’s ability to independently initiate, sustain, or complete activities noted in a
category. An extreme limitation is the worst degree of limitation and sometimes
includes a total lack of ability to function in that domain.
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limitation in acquiring and using information and caring for herself and an extreme
limitation in interacting and relating to others and moving about and manipulating
objects. Savage wrote that plaintiff had to be told several times to complete a task,
had to be reminded to stay on task, does not finish projects, does not use her time
wisely, does not know the proper tone of voice to use when interacting, does not know
or respect personal boundaries, does not understand that her actions make others feel
uncomfortable, and has to be told to shower. (Tr. 513-514).
On March 7, 2012, plaintiff saw Darren Facen, M.A. at Pathways. Treatment
notes state that plaintiff was having difficulties concentrating and paying attention, had
temper tantrum outbursts, and that, over the past two months, she was increasingly
defiant. (Tr. 523-526). Plaintiff reported having frequent moments of crying,
loneliness, and sadness. Treatment notes state that plaintiff was “taken to Safe Harbor
for a safe exam after a man (friend of mom) reportedly exposed himself to her.” (Tr.
523). Plaintiff’s diagnosis was listed as ADHD, generalized anxiety disorder, and mood
disorder. She was given a GAF score of 48 (Tr. 526).
On March 28, 2012, Carre Munoz, BA, CSS, TCM, a community support services
worker at Pathways, visited the plaintiff at her mother’s home. (Tr. 530). Plaintiff was
at her father’s house at the time. Munoz and Lewis discussed plaintiff’s symptoms,
family background, and medications. (Tr. 530). Munoz returned to the home on April
3, 2012 to meet with plaintiff. They discussed plaintiff’s school and home life. Munoz
wrote that she would continue to visit with plaintiff in order to build a rapport with the
family and begin working on goals. (Tr. 534). Munoz re-visited the home on June 11,
July 5, July 12, and August 1, 2012. (Tr. 542-453, 546, 553, 568).
On June 11, 2012, plaintiff met with Judith Ovalle Abuabara, M.D. at Pathways
for a medication management appointment. (Tr. 537-541). The treatment plan
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included continuing with Zoloft for anxiety and depressive symptoms, continuing
Concerta ER16 for ADHD, increasing the dosage of Strattera, and continuing Tenex.
On June 14, 2012, plaintiff began therapy sessions with Roxanne Netzler, LPC,
MA. Plaintiff and plaintiff’s father discussed the treatment plan and goals for
counseling. (Tr. 544). Plaintiff continued to meet with Netzler on July 5, 12, 19, and
26 and August 2, 2012. (Tr. 548, 551, 563, 565, 571).
On July 16, 2012, plaintiff presented to Dr. Abuabara for a reevaluation of her
medications. (Tr. 556-559). Dr. Abuabara increased her Zoloft and Strattera dosages,
discontinued Concerta ER and Tenex, and began her on Intuniv.
III. The ALJ’s Decision
In the decision issued on April 12, 2012, the ALJ made the following findings:
1.

Plaintiff was born on September 10, 1999. Plaintiff was an adolescent on
April 7, 2010, the date the application was filed, and is currently an
adolescent.

2.

Plaintiff has not engaged in substantial gainful activity since April 7, 2010,
the application date.

3.

Plaintiff has the following severe impairments: ADHD and speech and
language delays.

4.

Plaintiff does not have an impairment or combination of impairments that
meets or medically equals the severity of one of the listed impairments
in 20 C.F.R. Part 404, Subpart P, Appendix 1.

5.

Plaintiff does not have an impairment or combination of impairments that
functionally equals the severity of the listings (20 C.F.R. 416.924(d) and
416.926(a)).

6.

Plaintiff has not been disabled, as defined in the Social Security Act, since
April 7, 2010, the date the application was filed.

(Tr. 14-26).

16

Concerta is the brand name for Methylphenidate and is used as part of a
treatment program to control symptems of ADHD. http://www.nlm.nih.gov/
medlineplus/druginfo/meds/a682188.html (last visited May 9, 2014).
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IV. Legal Standard
To be eligible for SSI benefits, a claimant must prove that she is disabled.
Pearsall v. Massanari, 274 F.3d 1211, 1217 (8th Cir. 2001). A child under the age of
eighteen will be declared disabled if she “has a medically determinable physical or
mental impairment, which results in marked and severe functional limitations, and
which can be expected to result in death or which has lasted or can be expected to last
for a continuous period of not less than 12 months.” 42 U.S.C. § 1382c(a)(3)(C).
To determine whether a child claimant is disabled, the Commissioner employs
a three-step evaluation process. The Commissioner first determines whether the child
is engaged in substantial gainful activity.

If the child is so engaged, she is not

disabled. Second, the Commissioner determines whether the child has a “severe
impairment.” If the child’s impairment is not severe, she is not disabled. Finally, the
Commissioner determines whether the child’s impairment meets, medically equals, or
functionally equals the severity of an impairment listed in 20 C.F.R. Part 404, Subpart
P, Appendix 1. If the child’s impairment is, medically equals, or functionally equals a
listed impairment, she is disabled under the Act. 20 C.F.R. § 416.924.
In determining functional equivalence, the Commissioner considers the child
claimant’s functioning in broad areas of functioning, or “domains.” The six domains
are: (i) acquiring and using information; (ii) attending and completing tasks; (iii)
interacting and relating with others; (iv) moving about and manipulating objects; (v)
caring for oneself; and (vi) health and physical well-being.

20 C.F.R. §

416.926a(b)(1).
For an impairment to functionally equal a listed disability, it must result in either
a marked limitation in two domains or an extreme limitation in one domain. 20 C.F.R.
§ 416.926a. The Commissioner will find a “marked” impairment in any domain when
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the impairment(s) interferes seriously with the claimant’s ability to independently
initiate, sustain, or complete activities. A “marked” impairment is the equivalent of
functioning found on standardized testing with scores that are a least two, but less
than three, standard deviations below the mean. 20 C.F.R. § 416.923a(e)(2)(i). An
“extreme” limitation is found in a domain when a claimant’s impairment interferes very
seriously with the ability to independently initiate, sustain, or complete activities. It
is the equivalent of functioning found on standardized testing with scores that are at
least three standard deviations below the mean. 20 C.F.R. § 416.926a(e)(3)(i).
The court must affirm the Commissioner’s decision, “if the decision is not based
on legal error and if there is substantial evidence in the record as a whole to support
the conclusion that the claimant was not disabled.” Long v. Chater, 108 F.3d 185, 187
(8th Cir. 1997). “Substantial evidence is less than a preponderance, but enough so
that a reasonable mind might find it adequate to support the conclusion.” Estes v.
Barnhart, 275 F.3d 722, 724 (8th Cir. 2011) (quoting Johnson v. Apfel, 240 F.3d 1145,
1147 (8th Cir. 2011)). The Court may not reverse merely because the evidence could
support a contrary outcome. Id. at 724.
In determining whether the Commissioner’s decision is supported by substantial
evidence, the court reviews the entire administrative record. See Stewart v. Sec. of
Health & Human Servs., 957 F.2d 581, 585-86 (8th Cir. 1992).

The court must

consider any evidence that detracts from the Commissioner’s decision. Warburton v.
Apfel, 188 F.3d 1047, 1050 (8th Cir. 1999).

Where the Commissioner’s findings

represent one of two inconsistent conclusions that may reasonably be drawn from the
evidence, those findings must simply be supported by substantial evidence. Pearsall,
274 F.3d at 1217 (citing Young v. Apfel, 221 F.3d 1065, 1068 (8th Cir. 2000)).
V. Discussion
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Plaintiff contends that the ALJ erred by (1) failing to give proper weight to the
medical opinions of Dr. Walker and Dr. Cowles; (2) finding that plaintiff had less than
a marked limitation in acquiring and using information and attending and completing
tasks; and (3) failing to remand this matter despite the new evidence that was
submitted on appeal. [Doc. #22].
A. Medical Opinions
Dr. Deborah Walker
Plaintiff contends that the ALJ did not give proper weight to the opinion of Dr.
Walker, an examining consultative examiner, who determined that plaintiff had marked
limitations in attending and completing tasks and extreme limitations in interacting and
relating to others.
In his decision, the ALJ stated that he “considered Dr. Walker’s opinion,” but
found that the medical evidence of record did not support such high degrees of
functional restrictions. Instead, the ALJ determined that the evidence of record showed
that a regimen of prescription medication was effective in controlling plaintiff’s
symptoms when the plaintiff took her medication as directed by her physicians. (Tr.
20).
After review of the record and the ALJ’s decision, the Court finds that the ALJ did
not err in giving less than controlling weight to Dr. Walker’s opinion. Dr. Walker saw
plaintiff on only one occasion on February 22, 2012. It is well settled that the report
of a consulting physician who has seen the claimant only once is of little significance
by itself. See Loving v. Dep’t of Health & Human Serv., 16 F.3d 967, 971 (8th Cir.
1994) (allowing an ALJ to discount a one-time evaluation); Turpin v. Bowen, 813 F.2d
165, 170 (8th Cir. 1987) (“The report of a consulting physician who examines a
claimant once does not constitute ‘substantial evidence’ upon the record as a whole.”).
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Furthermore, the ALJ noted that Dr. Walker gave plaintiff a GAF score of 57,
which indicates moderate symptoms, and that Dr. Walker’s general observations in his
report did not support a conclusion of marked or extreme functional limitations,
especially when compared to the rest of the medical record. See Davidson v. Astrue,
578 F.3d 838, 991 (8th Cir. 2009) (An ALJ may assign a medical opinion reduced
weight where, as here, it is inconsistent with other evidence in the record); Kelley v.
Callahan, 133 F.3d 583 (8th Cir. 1998) (The ALJ is entitled to dismiss or disregard
evidence that he or she feels is inconsistent with other evidence).
The ALJ also noted that plaintiff’s speech impairment was adequately managed
through speech therapy and that plaintiff’s ADHD symptoms were controlled when she
took her medication as prescribed. See id. at 846 (“[i]mpairments that are controllable
or amenable to treatment do not support a finding of disability.”). The ALJ referenced
treatment notes from September 2010, November 2010, and February 2011, which
reflected that plaintiff’s focus, concentration, and overall behavior improved when she
took her medication as prescribed. The ALJ also noted that when plaintiff’s mother
failed to administer plaintiff’s medication, treatment notes would document increased
hyperactivity and distractibility. In fact, plaintiff’s mother testified that there is a
noticeable difference in plaintiff’s disposition when does not take her medication. (Tr.
53-55). As a result, substantial evidence of record supports that plaintiff’s conditions
are controlled with medication and, thus, the ALJ did not err in giving less than
controlling weight to Dr. Walker’s one-time evaluation. See Finch v. Astrue, 547 F.3d
933, 938 (8th Cir. 2008) (an ALJ may “reject the opinion of any medical expert where
it is inconsistent with the medical record as a whole.”).
Dr. Cowles

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Plaintiff further contends that the ALJ erred by giving great weight to the opinion
of Dr. Cowles, a non-examining medical expert, who testified at the February 29, 2012
hearing that plaintiff had less than a marked limitation in acquiring information, a
marked limitation in interacting with others, and no other functional limitations.
Dr. Cowles testified that his opinion was based on the medical evidence of
record, including the IEP; treatment notes from 2009 to 2011; Dr. Walker’s
psychological evaluation; and therapy notes. (Tr. 35-39). Dr. Cowles testified that the
overall medical record supported the conclusion that plaintiff had decreased behavioral
issues and was consistently able to focus when she took her medication as directed;
that she did not suffer from depression; and that her speech was intelligible despite her
sound system disorder. Dr. Cowles further noted that plaintiff’s highest GAF score was
60.

Dr. Cowles stated that he did not agree with Dr. Walker’s opinion regarding

plaintiff’s functional limitations because such limitations were not supported by the
medical record or by plaintiff’s generally good grades in school. Dr. Cowles
acknowledged that severe cases of ADHD and mood disorders could cause extreme and
marked limitations, but expressed his belief that plaintiff’s conditions were not severe
enough to warrant such limitations.
The ALJ attributed great weight to Dr. Cowles’ opinion because it was “well
supported by the medical evidence of record.” (Tr. 20). In making a disability
determination, the ALJ shall “always consider the medical opinions in [the] case record
together with the rest of the relevant evidence.” 20 C.F.R. § 404.1527(b). Before
weighing Dr. Cowles’ opinion, the ALJ thoroughly considered the testimony of plaintiff
and plaintiff’s mother, medical treatment notes reflecting that plaintiff’s behavior
improved when on medication, school records regarding plaintiff’s sound system
disorder, the results of two psychological consultative examinations, and plaintiff’s
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elementary school grades and IQ score. It was only after this thorough review of the
record that the ALJ determined that Dr. Cowles’ opinion was supported by the record
evidence as a whole. Thus, the Court finds no error with the ALJ’s treatment of Dr.
Cowles’ opinion.
B. Functional Limitations
Plaintiff contends that the ALJ erred in finding that plaintiff had less than a
marked limitation in acquiring and using information and less than a marked limitation
in attending and completing tasks. (Tr. 21-22).
For an impairment to functionally equal a listed disability, it must result in either
a marked limitation in two domains or an extreme limitation in one domain. 20 C.F.R.
§ 416.926a. A marked impairment interferes seriously with the claimant’s ability to
independently initiate, sustain, or complete activities. 20 C.F.R. § 416.923a(e)(2)(i).
An extreme limitation interferes very seriously with the ability to independently initiate,
sustain, or complete activities. 20 C.F.R. § 416.926a(e)(3)(I). The ALJ’s decision must
be based on substantial evidence in the record as a whole. Long, 108 F.3d at187 (8th
Cir. 1997). The Court may not reverse merely because the evidence could support a
contrary outcome.

Estes, 275 F.3d at 724.

The Court finds that substantial evidence supports the ALJ’s determinations. In
terms of acquiring and using information, the ALJ noted that plaintiff’s grades were
fairly good overall. This observation is supported by the record. As of December 21,
2010, plaintiff earned four B’s and a C and her IQ score was described to be in the
“average” range of intellectual functioning. (Tr. 207, 322). Plaintiff’s IEP showed that
80% of her classes were regular education classes and that despite her speech
disorder, plaintiff had a “conversational level of speech with more than 90% accuracy.”
(Tr. 202, 330).

Dr. Walker opined that plaintiff had a less than marked limitation in
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acquiring and using information and plaintiff’s regular education teacher did not find
plaintiff to have any serious problems. (Tr. 468, 506-507). Plaintiff’s speech therapist
reported that plaintiff had a serious problem comprehending oral instructions and an
obvious problem understanding and participating in class discussions, but that in all
other areas of acquiring and using information, plaintiff had no problems or slight
problems. (Tr. 477). Although plaintiff’s mother testified that plaintiff’s teachers gave
her better grades because they felt sorry for her, this belief is unsupported by the
educational record. Thus, substantial evidence supports the ALJ’s determination that
plaintiff has less than a marked impairment in the area of acquiring and using
information.
In terms of attending and completing tasks, the record is replete with references
regarding plaintiff’s increased ability to focus, concentrate, and stay awake in class
when she takes her medication as directed. See Tr. 36-37, 281,282, 287-292, 348353, 358-363. Physicians repeatedly counseled plaintiff’s mother on the importance
of ensuring that plaintiff is administered her medications as directed. From September
29, 2009 to July 11, 2011, plaintiff regularly reported to her physicians that she was
able to focus and concentrate at school. Id. Additionally, plaintiff’s regular education
teacher and speech therapist did not report very serious problems in this area. Thus,
substantial evidence supports the ALJ’s determination that plaintiff had less than a
marked impairment in attending and completing tasks.
C. Evidence Submitted After the ALJ’s Decision
Plaintiff contends that the Appeals Council did not properly consider the
additional evidence she submitted, which included: (1) a school attendance record for
the dates of May 29, 2012 through June 22, 2012 (Tr. 219); (2) an SSA questionnaire
completed by plaintiff’s teacher, Tracey Huebner, dated February 23, 2012 (Tr. 222-27-

229); and (3) medical records from Pathways, dated June 11, 2012 through August 6,
2012 (Tr. 536-573).
Plaintiff points to the Appeal Council’s denial, which stated: “In looking at your
case, we considered the reasons you disagree with the decision and the additional
evidence listed on the enclosed Order of Appeals Council.

We found that this

information does not provide a basis for changing the [ALJ’s] decision.” (Tr. 1-2).
Plaintiff argues that this conclusory statement shows that no meaningful review was
given of plaintiff’s appeal in this case.
When a plaintiff presents new evidence to the Appeals Council, the regulations
provide that the Appeals Council must evaluate the entire record, including any new
and material evidence that relates to the period before the date of the ALJ’s decision.
20 C.F.R. § 404.970(b); Cunningham v. Apfel, 222 F.3d 496, 500 (8th Cir. 2000). The
newly submitted evidence becomes part of the administrative record, even though the
evidence was not originally included in the ALJ’s record. Id. This Court does not
review the Appeal’s Council’s denial but determines whether the record as a whole,
including the new evidence, supports the ALJ’s determination. Id.
After careful review of the entire record, including the new evidence, the Court
finds that the ALJ’s determination is supported by substantial evidence. The attendance
record, which plaintiff submitted to the Appeals Council, shows that between the dates
of May 29, 2012 through June 22, 2012, plaintiff was absent one and one half days.
This information does not affect the ALJ’s decision. Additionally, the records from
Pathways primarily consist of brief summaries of counseling sessions, in which
plaintiff’s therapist reviewed strategies on how to process emotions, argue less, take
accountability for her actions, and utilize empathy.

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Plaintiff’s parents were also

counseled on how to practice positive parenting skills. Overall, these records do not
reflect any discrepancies with the ALJ’s determination.
Furthermore, the SSA questionnaire completed by plaintiff’s special education
teacher, Tracey Huebner, does not detract from the ALJ’s decision. Similar to plaintiff’s
regular education teacher and speech therapist, Huebner reported that in the area of
acquiring and using information, plaintiff did not have very serious problems. (Tr. 223).
Although Huebner found that, in the area of attending and completing tasks, plaintiff
had very serious problems completing work accurately and working without distracting
herself or others, this opinion is contrary to plaintiff’s regular education teacher and
speech therapist, who reported that she did not have very serious problems in either
of those areas. (Tr. 224, 468-469, 477-478). Furthermore, Huebner only reported five
serious problems out of twenty-three potential problem areas in the categories of
acquiring and using information and attending and completing tasks.
VI. Conclusion
For the reasons discussed above, the Court finds that the Commissioner’s
decision is supported by substantial evidence in the record as a whole.
Accordingly,
IT IS HEREBY ORDERED that the relief sought by plaintiff in her brief in
support of complaint [Doc. #22] is denied.

___________________________
CAROL E. JACKSON
UNITED STATES DISTRICT JUDGE
Dated this 2nd day of September, 2014.

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