Asaro v. Colvin

Filing 22

MEMORANDUM: For the reasons set forth above, the Commissioners decision is not supported by substantial evidence on the record as a whole. The decision of the Commissioner is therefore reversed under Sentence 4 of 42 U.S.C. § 405(g) and this c ase is remanded for further proceedings consistent with this opinion. Because the current record does not conclusively demonstrate that plaintiff is disabled, it would be inappropriate for the Court to award plaintiff benefits at this time. An appropriate Judgment Order is issued herewith. Signed by Magistrate Judge David D. Noce on 2/17/15. (JAB)

UNITED STATES DISTRICT COURT
EASTERN DISTRICT OF MISSOURI
EASTERN DIVISION

LAURA ASARO,
Plaintiff,
v.
CAROLYN W. COLVIN, Acting
Commissioner of Social Security,
Defendant.

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No. 4:13CV2165 DDN

MEMORANDUM
Plaintiff Laura Asaro brings this action under 42 U.S.C. §§ 405(g) and 1383(c)(3) for
judicial review of the Commissioner’s final decision denying her application for supplemental
security income (SSI) under Title XVI of the Social Security Act, 42 U.S.C. §§ 1381, et seq. All
matters are pending before the undersigned United States Magistrate Judge, with consent of the
parties, pursuant to 28 U.S.C. § 636(c). Because the Commissioner’s final decision is not
supported by substantial evidence on the record as a whole, it is reversed.
I. Procedural History
On January 24, 2011, plaintiff applied for SSI claiming she became disabled on May 31,
2009, because of depression, heart conditions, lumps in the breast, high cholesterol, anxiety, and
high blood pressure.

(Tr. 111-16, 169.)

On initial consideration, the Social Security

Administration denied plaintiff’s claim for benefits. (Tr. 52, 56-60.) A hearing was held before
an administrative law judge (ALJ) on June 21, 2012, at which plaintiff and a vocational expert
testified. (Tr. 27-45.) The ALJ issued a decision denying plaintiff’s claim for benefits on July
25, 2012, finding plaintiff able to perform work as it exists in significant numbers in the national
economy. (Tr. 8-22.) On August 28, 2013, the Appeals Council denied plaintiff’s request to
review the ALJ’s decision. (Tr. 1-5.) The ALJ’s decision stands as the final decision of the
Commissioner. 42 U.S.C. § 405(g).
In the instant action for judicial review, plaintiff claims that the ALJ’s decision is not
supported by substantial evidence on the record as a whole, arguing specifically that the ALJ

erred in discounting the opinion of her treating psychiatrist, Dr. Desai. Plaintiff also contends
that the ALJ’s determination of her residual functional capacity (RFC) is not supported by any
medical evidence of record and that the ALJ failed to cite any evidence to support his RFC
findings. Plaintiff requests that the final decision be reversed and that she be awarded benefits,
or that the matter be remanded for further proceedings. For the following reasons, the matter
will be remanded for further consideration.

II. Testimonial Evidence Before the ALJ
A.

Plaintiff’s Testimony
At the hearing on June 21, 2012, plaintiff testified in response to questions posed by the

ALJ and counsel.
At the time of the hearing, plaintiff was forty-four years of age. Plaintiff is a high school
graduate. (Tr. 29.) Plaintiff stands five feet, four inches tall and weighs 170 pounds. (Tr. 33.)
Plaintiff lives in an apartment with her boyfriend. (Tr. 40.)
Plaintiff testified that she previously worked full time at fast food restaurants, performing
work as a cashier and cook. (Tr. 29-30.) Plaintiff testified that she was fired from her last job at
McDonald’s because she could not perform closing duties on account of chest pain. (Tr. 32.)
Plaintiff testified that she last worked from August 2011 to May 2012, part-time in a school
cafeteria. (Tr. 29-31.) Plaintiff testified that such work ended because the school year ended and
also because of difficulties performing her duties. When plaintiff left this employment, she was
working from 6:30 a.m. to 1:30 p.m. with a thirty-minute break. Plaintiff testified that she was
uncertain whether she would be physically or emotionally able to return to this work in the fall.
(Tr. 31.)
Plaintiff testified that she could not work full time in the school cafeteria because of
depression. Plaintiff testified that she was affected by the meanness of her coworkers and the
children and sometimes had to leave her duty station to call and talk to her case worker in order
to calm down or to take medication. Plaintiff testified that she did not like to take medication
while at work because it made her confused and interrupted her job performance. (Tr. 35.)
Plaintiff testified that she had approximately ten meltdowns at work during the school year but
that some coworkers recognized that she had a problem and would let her sit for a while. (Tr.
37.) Plaintiff also testified, however, that working sometimes took her mind off of her problems
-2-

such that she did not experience problems with depression or anxiety while working. (Tr. 33.)
Plaintiff testified that her depression causes her to be afraid of everything. She does not
like to be out in public and is fearful in crowds. Plaintiff testified that she is afraid to leave her
home, fearing that something will happen. Plaintiff is also afraid she will be unable to work,
causing her to become homeless again. Plaintiff testified that she does not drive because of her
fear of being in an accident. Plaintiff testified that she must be with someone while shopping
and does not feel safe otherwise. (Tr. 35, 41-42.)
Plaintiff testified that she experiences depression every day and paces between her bed
and couch. Plaintiff testified that she has panic and/or anxiety attacks when she thinks about her
situation or is confronted with her emotions.

Plaintiff testified that she cries during such

episodes and gets angry and short of breath. Plaintiff also experiences chest pain during such
episodes for which she takes nitroglycerine and then calls for an ambulance. Plaintiff testified
that she has experienced such attacks while at work. (Tr. 36-37.) Plaintiff testified that her
doctor has diagnosed her with bipolar disorder. (Tr. 39-40.)
Plaintiff testified that she has a short attention span and her mind wanders. Plaintiff
testified that her children need to touch her when talking to her in order to get her attention.
Plaintiff has difficulty following directions, staying focused while reading, and remembering
things. (Tr. 37.) She does not watch television because of her inability to focus. (Tr. 41.)
Plaintiff testified that her heart races and she experiences chest pain when she is upset,
nervous, or anxious. Plaintiff had stent placement in 2004 and currently takes medication for
high cholesterol. (Tr. 33-35.) Plaintiff testified that her heart continues to race and that such
condition has been attributed to an aggravated nerve around the stent for which an ablation has
been suggested. Plaintiff testified that her episodes of a racing heart last from fifteen to twenty
minutes and that medication given at the hospital relieves the symptoms. Plaintiff testified that
she has had one- or two-day stays at the hospital and has been told at discharge that the condition
is related to her anxiety disorder. (Tr. 38.)
Plaintiff testified that she also has pain in her feet, which makes it difficult sometimes to
get out of bed. (Tr. 34.) Plaintiff testified that she walks on her tiptoes because of the pain she
experiences when the bottom of her feet touch the floor. Plaintiff testified that she can stand for
about fifteen minutes but cannot do much walking. (Tr. 38-39.)
Plaintiff testified that she takes medication for her conditions and experiences no side
-3-

effects. (Tr. 39.)
Plaintiff testified that she has worked with a case manager for about a year from whom
she receives help in obtaining services from the community, such as food pantry assistance and
getting to doctor’s appointments. Plaintiff testified that she also calls her case manager when she
is having a meltdown. Plaintiff testified that her mother lives nearby and visits two or three
times a week, during which time she cooks for plaintiff. Plaintiff testified that she otherwise
cooks quick, microwavable meals. (Tr. 40-41.)
B.

Vocational Expert Testimony
Dr. John McGowan, a vocational expert, testified at the hearing in response to questions

posed by the ALJ and counsel.
The ALJ asked Dr. McGowan to consider an individual of plaintiff’s age, education, and
past work experience and who could
lift and carry 20 pounds occasionally, 10 pounds frequently, requires a sit/stand
option, which she can change positions at will. Can occasionally climb stairs and
ramps, never ropes, ladders and scaffolds. Can occasionally stoop, crouch and
kneel. Should avoid concentrated exposure to unprotected heights. In addition,
this hypothetical claimant is able to understand, remember and carry out at least
simple instructions and non-detailed tasks. Can adapt to routine, simple work
changes and can perform work at a normal pace without production quotas.
(Tr. 42-43.) Dr. McGowan testified that the sit/stand option would prevent the performance of
plaintiff’s past relevant work as a fast food worker but that other work could be performed, such
as school bus monitor, of which 1,020 such jobs exist in the State of Missouri and 79,280
nationally; and children’s attendant, of which 810 such jobs exist in the State of Missouri and
21,400 nationally. (Tr. 43.)
Counsel then asked Dr. McGowan to consider the same individual, but that she was also
limited to less than occasional contact with the general public, supervisors, and coworkers. Dr.
McGowan testified that such a person could not perform the jobs to which he previously
testified. Counsel then asked Dr. McGowan to assume the individual would be off task for an
average of five to ten minutes every hour, to which Dr. McGowan testified that such a person
would probably be let go if such behavior happened regularly. (Tr. 44-45.)

-4-

III. Medical Evidence Before the ALJ
On July 9, 2010, plaintiff was admitted to the emergency room at St. Alexius Hospital
with complaints of intermittent heart palpitations. It was noted that plaintiff had been admitted
earlier that same date with the same complaint but left without evaluation. An ECG from her
earlier admittance was abnormal in that it showed septal infarct. Plaintiff’s current symptoms
resolved prior to her arrival at the emergency room. Plaintiff reported that she had medication to
take daily for the palpitations but was not compliant.

Physical examination was normal.

Plaintiff was diagnosed with cardiac rhythm disturbance and was prescribed Atenolol.1 Plaintiff
was instructed to take her medication and to follow up with a doctor within one week. (Tr. 27988, 296-99.)
Plaintiff was admitted to the emergency room at St. Louis University (SLU) Hospital on
July 20, 2010, with complaints of a sudden onset of chest pain associated with dizziness,
shortness of breath, and lightheadedness. Plaintiff reported in the emergency room that she had
not experienced similar symptoms in the past. The current pain resolved while plaintiff was in
the emergency room. Plaintiff reported having previously had a myocardial infarction in 2004
with stent placement. Plaintiff’s current medications were noted to be nitroglycerin and aspirin.
Examination was unremarkable. Results of ECG testing were normal. (Tr. 220-26, 252-53.)
Plaintiff was admitted to the hospital for this episode of chest pain. Upon admission,
plaintiff reported that she had similar symptoms two weeks prior for which she went to St.
Alexius Hospital and was prescribed Atenolol and Metoprolol.2 Plaintiff also reported having
numbness and pain in her hands. Plaintiff’s history of anxiety was noted. Chest x-rays showed
minimal right pleural effusion versus pleural thickening. Repeat ECG testing showed mild
regurgitation, sinus bradycardia, and findings consistent with mild pulmonary hypertension.
Plaintiff was diagnosed with chest pain, non-cardiac; coronary artery disease; and
hyperlipidemia.

Plaintiff was discharged to home on July 21 with instructions to see an

outpatient physician. (Tr. 227-51, 254-55.)
Plaintiff was admitted to the emergency room at St. Alexius Hospital on July 31, 2010.
1

Atenolol is used to treat high blood pressure and to prevent angina. Medline Plus (last revised
July 1, 2010)<http://www.nlm.nih.gov/medlineplus/druginfo/meds/a684031.html>.
2

Metoprolol is used to treat high blood pressure and to prevent angina. Medline Plus (last
revised July 1, 2010)<http://www.nlm.nih.gov/medlineplus/druginfo/meds/a682864.html>.
-5-

ECG testing in the ambulance on the way to the hospital yielded normal results. Plaintiff was
noted as stable in the emergency room. She left without being seen. (Tr. 272-78.)
During an admission to St. Alexius Hospital in October 2010 for complaints of
abdominal pain, plaintiff was noted as stable from a cardiac standpoint. (Tr. 321-22.)
On November 1, 2010, plaintiff was transported by ambulance to SLU Hospital with
complaints of chest pain. It was noted that EMS personnel treated plaintiff for supraventricular
tachycardia (SVT) while in transit to the hospital, and plaintiff’s symptoms resolved. Given
plaintiff’s multiple hospital admissions for SVT, an ablation procedure was offered but plaintiff
declined because of lack of insurance. Physical examination was normal. Chest x-rays were
normal. An ECG showed septal infarct. An echocardiogram showed mild regurgitation and
abnormal left ventricular systolic function with mild hypokinesis. (Tr. 334-64.)

Plaintiff

returned to the SLU Hospital emergency room on November 23, 2010, with complaints of fast
heartbeat.

Examination was normal.

ECG was unchanged from prior studies. Plaintiff’s

symptoms resolved and she was discharged in stable condition. Plaintiff’s diagnosis upon
discharge was paroxysmal SVT. (Tr. 329-33.)
Plaintiff was admitted to the emergency room at St. Alexius Hospital on January 6, 2011,
with complaints of a sudden onset of chest pain and intermittent palpitations.

Plaintiff’s

symptoms resolved in the emergency room. Plaintiff was noted as mildly anxious. Physical
examination was normal. ECG testing showed no change from previous studies. Plaintiff was
discharged that same date in improved condition and with a diagnosis of anxiety disorder. (Tr.
458-69.)
Plaintiff visited Dr. Vani Pachalla at Grace Hill Neighborhood Health Services (Grace
Hill) the following day and reported having recurrent palpitations. Plaintiff also reported feeling
depressed and being unable to sleep. Plaintiff’s current medications were noted to include
Tylenol-3, Naproxen,3 Metoprolol, nitroglycerin, and aspirin. Physical examination was normal.
Plaintiff was diagnosed with benign hypertension, coronary atherosclerosis, paroxysmal SVT,
and anxiety. Plaintiff’s medications were refilled, and she was prescribed Valium4 and Lipitor.
3

Naproxen is used to relieve pain, tenderness, swelling, and stiffness caused by arthritis
conditions and joint pain caused by inflammation. Medline Plus (last revised July 15, 2014)
<http://www.nlm.nih.gov/medlineplus/druginfo/meds/a682864.html>.

4

Valium is used to relieve anxiety, muscle spasms, and seizures. Medline Plus (last reviewed
-6-

(Tr. 370-72.)
Plaintiff was transported by ambulance to the emergency room at St. Alexius Hospital on
February 15, 2011, with complaints of chest pain and shortness of breath. Plaintiff’s symptoms
resolved in the emergency room and she left against medical advice. (Tr. 443-57.)
On February 25, 2011, Robert Cottone, Ph.D., a psychological consultant for disability
determinations, completed a Psychiatric Review Technique Form in which he opined that
plaintiff’s anxiety caused mild limitations in activities of daily living and in maintaining social
functioning; moderate limitations in maintaining concentration, persistence, or pace; and resulted
in no repeated episodes of decompensation of extended duration. (Tr. 381-91.) In a Mental RFC
Assessment completed that same date, Dr. Cottone opined that, in the domain of Understanding
and Memory, plaintiff was moderately limited in her ability to understand and remember detailed
instructions, but was otherwise not significantly limited.

In the domain of Sustained

Concentration and Persistence, Dr. Cottone opined that plaintiff was moderately limited in her
ability to carry out detailed instructions, maintain attention and concentration for extended
periods, complete a normal workday and workweek without interruptions from psychologicallybased symptoms, and perform at a consistent pace without an unreasonable number and length of
rest periods.

In the domain of Social Interaction, Dr. Cottone opined that plaintiff was

moderately limited in her ability to accept instructions and respond appropriately to criticism
from supervisors, and to get along with coworkers or peers without distracting them or exhibiting
behavioral extremes, but was otherwise not significantly limited. In the domain of Adaptation,
Dr. Cottone opined that plaintiff was moderately limited in her ability to respond appropriately to
changes in the work setting but was otherwise not significantly limited. Dr. Cottone concluded
that plaintiff was capable of simple work with low stress and changes in routine environment.
(Tr. 392-94.)
On March 22, 2011, plaintiff visited Dr. Joseph Ruwitch, a cardiologist at St. Louis
ConnectCare, for evaluation of SVT, stent placement, chest pain, and shortness of breath.
Plaintiff’s current medications were noted to include Lipitor, Metoprolol, nitroglycerine, and
Trazodone.5 Plaintiff reported having had stents placed in 2004, having panic attacks for two
Oct. 1, 2010)<http://www.nlm.nih.gov/medlineplus/druginfo/meds/a682047.html>.
5

Trazodone is used to treat depression. Medline Plus (last revised Jan. 15, 2014)<http://www.
nlm.nih.gov/medlineplus/druginfo/meds/a681038.html>.
-7-

years, and having chest pain with lifting or with stress.

Upon examination, Dr. Ruwitch

diagnosed plaintiff with coronary artery disease, severe lipid disorder, and recurrent SVT. A
holter monitor was prescribed, and a stress test was ordered. (Tr. 478-80.)
Plaintiff visited Dr. Pachalla at Grace Hill on May 9, 2011, and complained of having
joint pain in her elbows, ankles, and pelvis; headaches; and depression with anxiousness, fearful
thoughts, poor concentration, sleeplessness, and depressed mood. Physical examination was
unremarkable.

Plaintiff was prescribed Amitriptyline for headaches6 and was referred for

counseling. Plaintiff was also prescribed Valium, Trazodone, Metoprolol, and Lipitor. (Tr. 497500.)
Plaintiff underwent a stress test on June 8, 2011, which showed small to moderate
perfusion abnormality of mild severity present in the anterior and inferior walls. It was noted
that ventricular systolic function was normal without regional wall motion abnormalities.
Overall, the stress test was determined to be normal. (Tr. 471-73.) The results of holter monitor
testing showed normal rate variability. (Tr. 474.)
On June 17, 2011, plaintiff visited Anita Tsay, MSW, LCSW, at BJC Behavioral Health
with complaints of lashing out when angry, suicidal thoughts when depressed, panic attacks,
sleep disturbances, and crying spells. Plaintiff reported having periods of depression since she
was eighteen years of age after her uncle’s suicide.

Plaintiff also reported that she was

previously involved in a violent relationship and that her youngest daughter had been sexually
molested by her mother’s boyfriend. Plaintiff reported having depression and anxiety most of
her life but that her symptoms recently worsened when she lost her job. Plaintiff reported that
she also has had panic attacks once a month for about two years. Plaintiff reported going to the
emergency room during such attacks because she thinks she is having a heart attack. Plaintiff
also reported having recently heard voices telling her to harm herself. Ms. Tsay diagnosed
plaintiff with major depressive disorder, recurrent, severe without psychotic features; panic
disorder with agoraphobia; and anxiety disorder. A Global Assessment of Functioning (GAF)
score of 45 was assigned,7 and an appointment was made with a psychiatrist. (Tr. 423-28.)

6

Amitriptyline is also used to treat symptoms of depression. Medline Plus (last revised Aug. 1,
2010)<http://www.nlm.nih.gov/medlineplus/druginfo/meds/a682388.html>.

7

"According to the Diagnostic and Statistical Manual of Mental Disorders 32 (4th ed.
-8-

Plaintiff visited Dr. Rachel Morel, a psychiatrist, on June 30, 2011, for evaluation.
Plaintiff reported being depressed and that her condition worsened within the past month after
being fired from her job for excessive absences. Plaintiff reported being afraid to leave her
house, having daily crying spells, and having paralyzing anxiety. Plaintiff reported her fears
began about five years prior when her son’s friend was found shot to death on her mother’s
doorstep. Plaintiff also reported being molested as a child. Plaintiff reported current feelings of
worthlessness, guilt, and hopelessness. Plaintiff reported having called EMS because of heart
attack symptoms but that she was actually having panic attacks. Dr. Morel noted plaintiff’s
current medications to include Valium and Trazodone.

Mental status examination showed

plaintiff to be goal directed and to have a logical thought process.

Plaintiff’s mood was

depressed and her affect was tearful. Plaintiff denied any suicidal or homicidal ideations.
Plaintiff’s insight and judgment were fair, and Dr. Morel determined plaintiff had an average
intelligence. Dr. Morel diagnosed plaintiff with major depressive disorder, recurrent, severe
without psychosis; and panic disorder with agoraphobia. A GAF score of 35 was assigned.8
Plaintiff was instructed to discontinue Valium and Trazodone, and Klonopin9 and Remeron10
were prescribed. Plaintiff was instructed to return in two weeks. (Tr. 420-22.)
Plaintiff visited Dr. Pachalla at Grace Hill on July 12, 2011, with complaints of
depression, arthritis pain in her ankles, and heel pain. Dr. Pachalla noted plaintiff was seeing a
psychiatrist for her depression. Plaintiff was diagnosed with plantar fasciitis and was instructed
Text Revision 2000) [DSM-IV-TR], the [GAF] is used to report 'the clinician's judgment of the
individual's overall level of functioning,'" Hudson v. Barnhart, 345 F.3d 661, 663 n.2 (8th Cir.
2003), and consists of a number between zero and 100 to reflect that judgment, Hurd v. Astrue,
621 F.3d 734, 737 (8th Cir. 2010). A GAF score between 41 and 50 indicates serious symptoms
(e.g., suicidal ideation, severe obsessional rituals, frequent shoplifting) or any serious impairment
in social, occupational, or school functioning (e.g., no friends, unable to keep a job). DSM-IVTR at 34.
8

A GAF score between 31 and 40 indicates some impairment in reality testing or
communication (e.g., speech is at times illogical, obscure, or irrelevant) or major impairment in
several areas, such as work or school, family relations, judgment, thinking, or mood (e.g.,
depressed man avoids friends, neglects family, and is unable to work). DSM-IV-TR at 34.
9

Klonopin is used to relieve panic attacks. Medline Plus (last revised July 1, 2010)<http://
www.nlm.nih.gov/medlineplus/druginfo/meds/a682279.html>.
10

Remeron is used to treat depression. Medline Plus (last revised Feb. 15, 2013)<http://www.
-9-

to exercise and apply ice to the affected area. (Tr. 491-93.)
Plaintiff returned to Dr. Morel with her case manager on July 25, 2011,11 and reported
some improvement but that she continued to feel anxious and angry. Plaintiff reported that her
fiancé sometimes leaves to get a break from her ranting. Plaintiff reported wanting to get better
but that it was difficult because of her anger. Dr. Morel increased plaintiff’s dosage of Remeron.
(Tr. 417-19, 422.)
On August 8, 2011, plaintiff visited Dr. Morel and reported that her mood and anxiety
were not responding to the medications. Plaintiff reported increased anxiety because of her
anticipated eviction. Plaintiff reported that she recently got a job as a cafeteria worker because
of her need to pay rent, but was worried about her mood with such work. Mental status
examination report showed plaintiff was disheveled in appearance. Plaintiff was cooperative.
Plaintiff’s mood was self-described as “horrible” and her affect was labile. Plaintiff was alert
and oriented times four. She was noted to be fidgety. Dr. Morel noted that plaintiff needed
medication management to quickly stabilize her mood given her upcoming job. Remeron and
Klonopin were discontinued and Lexapro,12 Valium and Abilify13 were prescribed. Plaintiff was
instructed to return in one week. (Tr. 414-16, 419.)
During a telephone call on August 15, 2011 Dr. Morel noted plaintiff was having a panic
attack with tremor. Plaintiff reported that she had her first day of work, which went fine until her
boss told her to come in earlier than scheduled. Dr. Morel noted plaintiff calmed down while
talking on the telephone. An upcoming appointment was noted. (Tr. 416.)
Plaintiff visited Dr. Morel on August 18, 2011 and reported mild improvement but that
she continued to have crying spells. Plaintiff reported being able to handle work and that she had
not had a panic attack since her first day. Mental status examination showed plaintiff alert and
oriented times four.

Plaintiff’s appearance was fair and she was noted to be cooperative.

nlm.nih.gov/medlineplus/druginfo/meds/a697009.html>.
11
Plaintiff’s case manager accompanied plaintiff to this and each subsequent visit to Dr. Morel.
12

Lexapro is used to treat depression and generalized anxiety disorder. Medline Plus (last
revised Apr. 13, 2012)<http://www.nlm.nih.gov/medlineplus/druginfo/meds/a603005.html>.

13

Abilify is used to treat the symptoms of schizophrenia, episodes of mania or mixed episodes in
bipolar disorder, and depression when symptoms cannot be controlled by an antidepressant
alone. Medline Plus (last revised May 16, 2011)<http://www.nlm.nih.gov/medlineplus/druginfo/
meds/a603012.html>.
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Plaintiff’s mood was self-described as “terrible” and her affect was tearful.

Dr. Morel

determined increased her Lexapro for its anti-anxiety effects. Plaintiff’s dosage of Abilify was
also increased to help with irritability and hopelessness. Trazodone was prescribed for sleep.
Plaintiff was continued on Valium. (Tr. 410-11, 413.)
Plaintiff returned to Dr. Morel on September 1, 2011, and reported decompensation since
her last visit with decreased sleep, increased anxiety, and worsening irritability relating to her
receiving an eviction notice. Plaintiff reported the Trazodone to make her more tired but that it
did not help her fall asleep. Plaintiff reported that her job was great and that she wished she
could be there more than at home. Plaintiff reported her anxiety increased after about four hours
of work, which prevented her from working full time. Plaintiff’s mental status was unchanged.
Plaintiff’s dosage of Trazodone was increased. (Tr. 407-09, 412.)
On September 19, 2011 plaintiff reported to Dr. Morel that she was extremely depressed
and felt that her medications were not working. Plaintiff reported that she moved back in with
her mother and was more angry and irritable. Plaintiff was hopeful that her new job would
become long term and help her get back on her feet. Plaintiff reported that she stopped taking
Abilify because of gastrointestinal distress. Plaintiff also reported adjusting her medication
dosages helped her calm down during the day. Dr. Morel discontinued Valium because of
concerns that plaintiff was becoming addicted to the medication. Trazodone was increased and
Abilify was discontinued.

Plaintiff was instructed to continue with her other medications.

Plaintiff was referred for counseling. (Tr. 404-06, 409.)
Plaintiff returned to Dr. Morel on October 3, 2011, and reported continued struggles.
Plaintiff reported having a low mood and continued trouble with sleep but that her anxiety had
improved with an increase in Trazodone.

Mental status examination showed plaintiff was

cooperative and well groomed with fair eye contact. Plaintiff was tearful. Plaintiff’s thought
process was goal directed and logical, and her insight and judgment were fair. Therapy was
recommended, but plaintiff requested that housing be secured before beginning therapy. Dr.
Morel continued in her diagnoses of major depressive disorder, recurrent, severe; and panic
disorder. Plaintiff was also continued in her GAF score of 45. Plaintiff was instructed to
continue with her current medications. (Tr. 400.)
Plaintiff returned to Dr. Pachalla at Grace Hill on October 11, 2011, and complained of
worsening right ankle pain and reported that it was difficult for her to walk. Plaintiff reported
- 11 -

the pain worsened with climbing stairs, movement, walking, and standing but that aspirin,
elevation, and heat relieved the pain.

Plaintiff reported that wearing a brace also helped.

Plaintiff also complained of mild back pain as well as wrist and elbow pain.

Physical

examination showed severe pain about the right foot and ankle with reduced range of motion
about the left ankle. It was noted that plaintiff could bear weight but with significant pain.
Plaintiff was prescribed Vicodin14 and was instructed to use crutches and follow up with a foot
doctor. X-rays were ordered. (Tr. 485-87.)
On October 31, 2011, plaintiff visited Dr. Morel and reported no change. Plaintiff
reported that she stopped taking Lexapro because of diarrhea. Plaintiff’s mood was okay, but
she reported continued anxiousness while living with her mother. Plaintiff reported doing well
with her job and that she was happy with that circumstance. Plaintiff reported feeling no
depression or anxiety while at work. Mental status examination showed plaintiff’s mood was
euthymic. Lexapro was discontinued, and Cymbalta15 was prescribed. Plaintiff was instructed to
continue with her other medications as prescribed. (Tr. 398.)
Plaintiff returned to Dr. Morel on January 11, 2012, and reported doing okay. Plaintiff
reported having daytime sedation with Trazodone. Plaintiff also reported having side effects
with Cymbalta, and Dr. Morel prescribed Zoloft instead.16 Seroquel was also prescribed.17 Dr.
Morel noted plaintiff was tearful, and plaintiff reported having had a meltdown at work when her
boss wanted to assign her more responsibility. Dr. Morel continued in her diagnoses of major
depressive disorder and panic disorder, as well as her GAF score of 45. Dr. Morel informed
plaintiff of her upcoming transfer to another facility, upon which plaintiff became emotional but
was understanding. (Tr. 396.)
14

Vicodin is used to relieve moderate to severe pain. Medline Plus (last revised May 15, 2013)
<http://www.nlm.nih.gov/medlineplus/druginfo/meds/a601006.html>.
15

Cymbalta is used to treat depression and generalized anxiety disorder. Medline Plus (last
revised July 15, 2014)<http://www.nlm.nih.gov/medlineplus/druginfo/meds/a604030.html>.
16

Zoloft is used to treat depression, obsessive-compulsive disorder, post-traumatic stress
disorder, and social anxiety disorder. Medline Plus (last revised Apr. 13, 2012)<http://www.
nlm.nih.gov/medlineplus/druginfo/meds/a697048.html>.
17

Seroquel is used to treat the symptoms of schizophrenia, bipolar disorder, and depression.
Medline Plus (last revised Apr. 15, 2014)<http://www.nlm.nih.gov/medlineplus/druginfo/meds/
a698019.html>.
- 12 -

On February 8, 2012, plaintiff reported no changes to Dr. Morel. Plaintiff reported that
her sleep and her mood were okay. Dr. Morel noted plaintiff was tearful. Mental status
examination was otherwise unremarkable. Plaintiff was instructed to increase her dosage of
Seroquel. Dr. Morel continued her diagnoses and GAF score. (Tr. 397.)
Plaintiff visited Dr. Manikant Desai, a psychiatrist, on March 5, 2012. Dr. Desai noted
plaintiff’s history included depression, anger, and panic attacks. Dr. Desai diagnosed plaintiff
with bipolar disorder and panic disorder and assigned a GAF score of 50.
18

Plaintiff was

19

prescribed Cymbalta, Lamictal, Topamax, and Seroquel, and was instructed to return in two
weeks. (Tr. 507-08.) On March 20, plaintiff reported to Dr. Desai that she felt okay but tired.
Plaintiff was instructed to decrease her dosage of Seroquel. (Tr. 506.)
Plaintiff returned to Grace Hill in April 2012 with complaints of bilateral foot pain about
the heel, aggravated by walking and standing. Podiatrist John Harness noted plaintiff walked
with an antalgic gait with partial weight bearing on the left side using crutches. Dorsiflexion of
the ankles was noted as limited, bilaterally. Palpation and compression were painful. Plaintiff
was diagnosed with plantar fascial fibromatosis, and an injection of lidocaine was administered.
Plaintiff was instructed to rest, reduce her activity, elevate her feet, stretch, apply ice, and obtain
arch supports. (Tr. 482-84.)
Plaintiff visited Dr. Desai on April 25, 2012, who noted plaintiff was nervous and upset.
Plaintiff reported that she was scared because she would be out of a job after the school year.
Plaintiff was panicky and anxious.

Plaintiff also reported that she had been yelling and

screaming. Plaintiff was instructed to increase her dosage of Topamax. (Tr. 505.)
On May 14, 2012, plaintiff returned to Grace Hill and reported that her heel pain was
worsening. (Tr. 481.)
On May 30, 2012, plaintiff reported to Dr. Desai that she was depressed and had crying
spells. Plaintiff reported her mood was “up and down.” Plaintiff reported that she was not
18

Lamictal is used to increase the time between episodes of depression, mania, and other
abnormal moods in persons with bipolar disorder. Medline Plus (last revised Feb. 1, 2011)
<http://www.nlm.nih.gov/medlineplus/druginfo/meds/a695007.html>.

19

Topamax is used to treat certain types of seizures and to relieve the pain of migraine
headaches. Medline Plus (last revised May 16, 2011)<http://www.nlm.nih.gov/medlineplus/
druginfo/meds/a697012.html>.
- 13 -

currently working. Dr. Desai instructed plaintiff to increase her dosage of Seroquel. (Tr. 504.)
In a letter dated June 4, 2012, Dr. Harness wrote that plaintiff’s activity was restricted to
no prolonged standing or other ambulatory activity, and that she could not return to work until
August 2012. (Tr. 511.)
In a Mental Medical Source Statement (MMSS) dated June 11, 2012, Dr. Desai opined
that, in the domain of Understanding and Memory, plaintiff was markedly limited in her ability
to remember locations and work-like procedures, and in her ability to understand and remember
detailed instructions. Plaintiff was opined to be moderately limited in her ability to understand
and remember very short and simple instructions. In the domain of Sustained Concentration and
Persistence, Dr. Desai opined that plaintiff was extremely limited in her ability to maintain
attention and concentration for extended periods, work in coordination with or proximity to
others without being distracted by them, complete a normal workday and workweek without
interruption from psychologically-based symptoms, and perform at a consistent pace without an
unreasonable number and length of rest periods. Plaintiff was opined to be markedly limited in
her ability to carry out detailed instructions, perform activities within a schedule, maintain
regular attendance, be punctual within customary tolerances, and sustain an ordinary work
routine without special supervision; and moderately limited in her ability to carry out very short
and simple instructions, and make simple work-related decisions. With Social Interaction, Dr.
Desai opined that plaintiff was markedly limited in her ability to interact appropriately with the
general public, accept instructions and respond appropriately to criticism from supervisors,
maintain socially appropriate behavior, and adhere to basic standards of neatness and cleanliness;
and moderately limited in her ability to ask simple questions or request assistance.

With

Adaptation, plaintiff was opined to experience marked or extreme limitations in all areas,
including extreme limitations in responding appropriately to changes in the work setting. (Tr.
509-10.)

IV. The ALJ's Decision
The ALJ found that plaintiff had not engaged in substantial gainful activity since January
24, 2011, the date of application for SSI.20

The ALJ found plaintiff’s anxiety disorder,

20

The ALJ noted that plaintiff’s earnings from her work in the school cafeteria were below the
level required for such work to be considered substantial gainful activity.
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tachycardia, obesity, and plantar fasciitis were severe impairments, but that she did not have an
impairment or combination of impairments that met or medically equaled an impairment listed in
20 C.F.R. Part 404, Subpart P, Appendix 1. (Tr. 13-17.) The ALJ found that plaintiff had the
RFC to perform light work except that she was
limited to 20 pounds occasional and ten pounds frequent lifting/carrying; with an
option to sit/stand as needed and to change positions at will; occasional climbing
of ramps and stairs; no climbing of ropes, ladders, and scaffolds; occasional
stooping, crouching, and kneeling; need to avoid concentrated exposure to
unprotected heights; with the ability to understand, remember, and carry out at
least simple instructions and non-detailed tasks, adapt to routine/simple work
changes, and perform work at a normal pace without production quotas.
(Tr. 17.) The ALJ determined plaintiff was unable to perform any of her past relevant work.
Considering plaintiff’s age, education, work experience, and RFC, the ALJ decided that the
vocational expert testimony indicated that plaintiff could perform other work as it exists in
significant numbers in the national economy, and specifically, school bus monitor and children’s
attendant. The ALJ therefore found that plaintiff was not disabled after January 24, 2011. (Tr.
20-22.)

V. Discussion
To be eligible for SSI under the Social Security Act, plaintiff must prove that she is
disabled. Pearsall v. Massanari, 274 F.3d 1211, 1217 (8th Cir. 2001); Baker v. Secretary of
Health & Human Servs., 955 F.2d 552, 555 (8th Cir. 1992). The Social Security Act defines
disability as the "inability to engage in any substantial gainful activity by reason of any
medically determinable physical or mental impairment which can be expected to result in death
or which has lasted or can be expected to last for a continuous period of not less than 12
months." 42 U.S.C. § 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. § 1382c(a)(3)(B).
To determine whether a claimant is disabled, the Commissioner engages in a five-step
evaluation process. See 20 C.F.R. § 416.920; Bowen v. Yuckert, 482 U.S. 137, 140-42 (1987).
The Commissioner begins by deciding whether the claimant is engaged in substantial gainful
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activity. If the claimant is working, disability benefits are denied. Next, the Commissioner
decides whether the claimant has a “severe” impairment or combination of impairments,
meaning that which significantly limits her ability to do basic work activities. If the claimant's
impairment(s) is not severe, then she is not disabled. The Commissioner then determines
whether claimant's impairment(s) meets or equals one of the impairments listed in 20 C.F.R.,
Subpart P, Appendix 1.

If claimant's impairment(s) is equivalent to one of the listed

impairments, she is conclusively disabled. At the fourth step, the Commissioner decides whether
the claimant can perform her past relevant work. If so, the claimant is not disabled. Finally, the
Commissioner evaluates various factors to determine whether the claimant is capable of
performing any other work in the economy. If not, the claimant is declared disabled and
becomes entitled to disability benefits.
The decision of the Commissioner must be affirmed if it is supported by substantial
evidence on the record as a whole. 42 U.S.C. § 405(g); Richardson v. Perales, 402 U.S. 389,
401 (1971); Estes v. Barnhart, 275 F.3d 722, 724 (8th Cir. 2002). Substantial evidence is less
than a preponderance but enough that a reasonable person would find it adequate to support the
conclusion. Johnson v. Apfel, 240 F.3d 1145, 1147 (8th Cir. 2001). This “substantial evidence
test,” however, is “more than a mere search of the record for evidence supporting the
Commissioner’s findings.” Coleman v. Astrue, 498 F.3d 767, 770 (8th Cir. 2007) (internal
quotation marks and citation omitted). “Substantial evidence on the record as a whole . . .
requires a more scrutinizing analysis.” Id. (internal quotation marks and citations omitted).
To determine whether the Commissioner's decision is supported by substantial evidence
on the record as a whole, the Court must review the entire administrative record and consider:
1.

The credibility findings made by the ALJ.

2.

The plaintiff's vocational factors.

3.

The medical evidence from treating and consulting physicians.

4.

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

5.

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

6.

The testimony of vocational experts when required which is
based upon a proper hypothetical question which sets forth the
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claimant's impairment.
Stewart v. Secretary of Health & Human Servs., 957 F.2d 581, 585-86 (8th Cir. 1992) (internal
citations omitted). The Court must also consider any evidence which fairly detracts from the
Commissioner’s decision. Coleman, 498 F.3d at 770; Warburton v. Apfel, 188 F.3d 1047, 1050
(8th Cir. 1999). However, even though two inconsistent conclusions may be drawn from the
evidence, the Commissioner's findings may still be supported by substantial evidence on the
record as a whole. Pearsall, 274 F.3d at 1217 (citing Young v. Apfel, 221 F.3d 1065, 1068 (8th
Cir. 2000)). “[I]f there is substantial evidence on the record as a whole, we must affirm the
administrative decision, even if the record could also have supported an opposite decision.”
Weikert v. Sullivan, 977 F.2d 1249, 1252 (8th Cir. 1992) (internal quotation marks and citation
omitted); see also Jones ex rel. Morris v. Barnhart, 315 F.3d 974, 977 (8th Cir. 2003).
In this action, plaintiff argues that the ALJ improperly weighed the opinion evidence
rendered by her treating psychiatrist, Dr. Desai. Plaintiff also contends that the ALJ’s RFC
findings are not based upon any medical evidence and that the ALJ failed to cite to any medical
evidence to support the findings. For the following reasons, the matter will be remanded for
further proceedings.
After finding at Step 3 of the sequential analysis that plaintiff’s impairment did not meet
the criteria for listing level disability, the ALJ assessed her RFC. A claimant’s RFC is the most
she can do despite her physical or mental limitations. Masterson v. Barnhart, 363 F.3d 731, 737
(8th Cir. 2004). The ALJ bears the primary responsibility for assessing a claimant’s RFC based
on all relevant, credible evidence in the record, including medical records, the observations of
treating physicians and others, and the claimant’s own description of her symptoms and
limitations. Goff v. Barnhart, 421 F.3d 785, 793 (8th Cir. 2005); Eichelberger v. Barnhart, 390
F.3d 584, 591 (8th Cir. 2004); 20 C.F.R. § 416.945(a). Because a claimant’s RFC is a medical
question, some medical evidence must support the ALJ’s RFC determination. Vossen v. Astrue,
612 F.3d 1011, 1016 (8th Cir. 2010); Eichelberger, 390 F.3d at 591; Hutsell v. Massanari, 259
F.3d 707, 711-12 (8th Cir. 2001). As such, the ALJ must “consider at least some supporting
evidence from a [medical professional]” and should obtain medical evidence that addresses the
claimant’s ability to function in the workplace. Hutsell, 259 F.3d at 712 (internal quotation
marks and citation omitted). An ALJ’s RFC assessment which is not properly informed and
supported by some medical evidence in the record cannot stand. Id.
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A review of the ALJ’s RFC analysis here shows it consists only of discrediting plaintiff’s
subjective complaints and discrediting the medical evidence of record, including evidence of
emergency room visits, Dr. Desai’s June 2012 MMSS, and BJC Behavioral Health’s GAF
scores. Other than discrediting plaintiff’s subjective complaints and this medical evidence of
record, the ALJ engaged in no discussion or analysis of any evidence as it related to plaintiff’s
RFC, that is, what she is able to do despite her impairments. Drawing a conclusion regarding
credibility is not equivalent to demonstrating by medical evidence that a claimant has the RFC to
perform certain work-related activities. Estabrook v. Apfel, 14 F. Supp. 2d 1115, 1122 (S.D.
Iowa 1998), cited approvingly in Graham v. Colvin, No. 4:12-cv-00863-SPM, 2013 WL
3820613, at *7 (E.D. Mo. July 23, 2013) (memorandum opinion). Instead, the ALJ’s RFC
assessment must discuss and describe how the evidence supports each conclusion and must cite
specific medical facts and nonmedical evidence in doing so, as well as resolve any material
inconsistencies or ambiguities in the evidence of record. Soc. Sec. Ruling (SSR) 96-8p, 1996
WL 374184, at *7 (Soc. Sec. Admin. July 2, 1996). The ALJ failed to engage in this process
here. In the absence of any thoughtful discussion or analysis by the ALJ, this Court would be
required to weigh the evidence in the first instance or review the factual record de novo in order
to find whether the ALJ’s RFC assessment is supported by substantial evidence on the record as
a whole. This the Court cannot do. See Naber v. Shalala, 22 F.3d 186, 188 (8th Cir. 1994).
Instead of looking to medical evidence to support his RFC determination, the ALJ
appeared to rely heavily on plaintiff’s performance of part-time work as a cafeteria helper in
finding plaintiff had the RFC to perform work-related activities. In his RFC analysis, the ALJ
repeatedly referred to this work, noting that plaintiff was “working regularly” and was able to
“sustain[] employment . . . throughout the school year,” and that such work demonstrated
plaintiff being “quite functional” and having an “ability to work.” (Tr. 19.) While part-time
work can be considered substantial activity under 20 C.F.R. § 416.972(a) and may be relevant to
the credibility of a claimant’s subjective claims that she is unable to work, see Goff, 421 F.3d at
792, only a claimant’s ability to perform full time work will permit an ALJ to render a decision
of not disabled. Bladow v. Apfel, 205 F.3d 356, 359 (8th Cir. 2000). In addition, if a claimant
performs work under special conditions – such as requiring and receiving special assistance from
coworkers in performing the work, or being allowed to take frequent rest periods – the ability to
perform such work does not necessarily show that the claimant is able to perform substantial
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activity. 20 C.F.R. § 416.973(c).
Here, while the ALJ emphasized in his RFC analysis that plaintiff was able to work as a
cafeteria helper, his decision does not reflect that he considered whether plaintiff was able to do
so because of special accommodations or conditions provided on the job. The record shows that
plaintiff’s coworkers permitted her to sit and take breaks because they understood her problems
and knew that her feet hurt. The record also shows that plaintiff periodically left her duty station
to call her case manager or to take medication. In addition, plaintiff reported to her first treating
psychiatrist, Dr. Morel, that her anxiety heightened after about four hours of work; and the
record shows that plaintiff experienced an exacerbation of anxiety symptoms when a change in
work routine was proposed, such as a change in hours or a change in responsibility. A review of
the evidence of record in toto suggests that plaintiff may have worked under special conditions
and in circumstances not conducive to an RFC finding that she had the “ability to do sustained
work-related physical and mental activities in a work setting on a regular and continuing basis[,]
. . . mean[ing] 8 hours a day, for 5 days a week, or an equivalent work schedule.” SSR 96-8p,
1996 WL 374184, at *1 (defining RFC). As noted above, however, the ALJ did not address this
circumstance.
Also, the ALJ’s RFC analysis fails to cite any credited medical evidence that addresses
plaintiff’s ability to perform work-related activities on a regular and continuing basis, rendering
the decision unclear as to the medical basis, if any, for the ALJ’s assessment of the degree to
which plaintiff’s impairments affect her RFC. Lauer v. Apfel, 245 F.3d 700, 705 (8th Cir. 2001);
SSR 96-8p, 1996 WL 374184, at *7.

Because the ALJ must articulate the medical and

other evidence upon which he bases his RFC determination, and he failed to do so here, it cannot
be said that the RFC determination is supported by substantial evidence on the record as a whole.
Nor can it be said that the ALJ’s determination to accord no weight to Dr. Desai’s June
2012 MMSS is supported by substantial evidence on the record as a whole. The opinion of a
treating physician is accorded special deference under the Regulations and is normally entitled to
great weight. Vossen, 612 F.3d at 1017; 20 C.F.R. § 416.927(c)(2). Although a treating
physician’s opinion should not ordinarily be disregarded, Jenkins v. Apfel, 196 F.3d 922, 924-25
(8th Cir. 1999), an ALJ may discount or disregard the opinion of a treating physician where other
medical assessments are supported by better or more thorough medical evidence, or where the
physician renders inconsistent opinions that undermine their credibility. Anderson v. Astrue, 696
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F.3d 790, 793 (8th Cir. 2012). Inconsistency with other substantial evidence alone is a sufficient
basis upon which to discount a treating physician’s opinion. Goff, 421 F.3d at 790-91. The ALJ
must “always give good reasons in [the] notice of determination or decision for the weight [given
to the] treating source's opinion.” 20 C.F.R. § 416.927(c)(2).
Here, the ALJ disregarded Dr. Desai’s opinions and accorded them no weight, finding
them to be “grossly exaggerated,” inconsistent with record evidence and his own treatment notes,
based on only four visits in a three-month period, and conclusory. These reasons do not provide
a sound basis to disregard this treating psychiatrist’s opinions in their entirety.
The ALJ first states that Dr. Desai’s opinions are “grossly exaggerated” inasmuch as a
person with such limitations would likely be hospitalized. (Tr. 19.) However, an “ALJ’s
reliance on . . . his own beliefs as to what the medical evidence should show do[es] not constitute
substantial evidence” to support a conclusion that a claimant has the RFC to perform workrelated activities. Fowler v. Bowen, 866 F.2d 249, 252 (8th Cir. 1989). The medical evidence
here shows plaintiff had visited hospital emergency rooms on at least nine occasions in an eightmonth period with symptoms consistent with what emergency room personnel considered to be
an anxiety disorder. Plaintiff’s emergency room visits did not cease until she began receiving
consistent psychiatric treatment from Dr. Morel and Dr. Desai; but even with such treatment,
plaintiff continued to exhibit symptoms determined by these psychiatrists to be indicative of
serious or major impairments in functioning. Throughout her treatment, plaintiff remained
tearful with continued anxiety and depression, and medication management provided little relief
as demonstrated by repeated changes and adjustments to plaintiff’s psychotropic medications.
This evidence likewise shows that Dr. Desai’s opinions were not so inconsistent with
other substantial medical evidence of record such that his opinion should be disregarded. Dr.
Desai’s observations and treatment of plaintiff are consistent with that of Dr. Morel, whom
plaintiff visited on no less than ten occasions in the eight-month period immediately preceding
Dr. Desai’s assumption of her psychiatric care. With Dr. Desai, plaintiff received medication for
bipolar disorder but nevertheless continued to exhibit panicky and anxious symptoms, with
crying spells and periods of yelling/screaming noted. As with Dr. Morel, plaintiff exhibited a
transient response to the medication regimen prescribed by Dr. Desai, with changes and
adjustments continuing to be made.
Likewise, given the consistency of plaintiff’s symptoms and her ineffective response to
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the treatment rendered by her treating psychiatrists – with the totality of such treatment, on this
record, spanning twelve months – the ALJ’s statement that Dr. Desai’s three-month treatment of
plaintiff provided an insufficient basis to demonstrate that her diagnosed conditions would
continue at the rated severity for twelve months (Tr. 20) is not supported by the record.
Finally, the ALJ accorded no weight to Dr. Desai’s opinions for the reason that they were
made in conclusory fashion in a checklist and were not consistent with his own treatment notes.
(Tr. 20.) While opinions expressed in checklist format have little evidentiary value when they
are accompanied by no elaboration or citation to medical evidence for support, Wildman v.
Astrue, 596 F.3d 959, 964 (8th Cir. 2010), such opinions should not be disregarded in their
entirety on this basis when other medical evidence supports their conclusions. Cf. Johnson v.
Astrue, 628 F.3d 991, 994-95 (8th Cir. 2011) (ALJ may discount conclusory opinions in
checklist MSS if contradicted by other objective medical evidence in the record). Further, the
ALJ’s reliance on the MMSS’s purported inconsistency with Dr. Desai’s treatment notes does
not constitute a good reason to disregard this opinion evidence given the ALJ’s previous finding
that “Dr. Desai’s handwritten notes are largely illegible[.]” (Tr. 15.) See Shackleford v. Astrue,
No. 4:10CV2175 AGF, 2012 WL 918864, at *10 (E.D. Mo. Mar. 19, 2012) (duty to develop
record may include seeking clarification from treating physician if portions of medical record
that are crucial to plaintiff’s claim are illegible); McBeth v. Astrue, No. 08-CV-05097-NKL,
2009 WL 3834798, at *7 (W.D. Mo. Nov. 13, 2009) (ALJ not free to discount treating
physician’s opinion when physician’s treatment notes were illegible and ALJ failed re-contact
physician for clarification).
There are no other medical assessments in this record that are supported by better or more
thorough medical evidence to justify disregarding Dr. Desai’s opinions. Nor did Dr. Desai
render inconsistent opinions such that their credibility is undermined. Nor does the record show
that Dr. Desai’s opinions are inconsistent with other substantial evidence to such a degree that
his opinions should be disregarded in their entirety. As such, it cannot be said that the ALJ’s
decision to accord no weight to the opinions expressed in Dr. Desai’s June 2012 MMSS is
supported by substantial evidence on the record as a whole.
Therefore, for all of the foregoing reasons, this matter must be remanded for further
proceedings. The ALJ on remand must reconsider the weight given to the opinions of Dr. Desai
in light of the totality of the evidence of record. Vossen, 612 F.3d at 1017. If additional
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information directly related to Dr. Desai’s medical opinion is needed for such reconsideration,
the ALJ is permitted to re-contact Dr. Desai in order to resolve any inconsistency or
insufficiency in the evidence received from him. 77 FR 10651-01, at *10652, 2011 WL 7404303
(Soc. Sec. Admin. Feb. 23, 2012). The ALJ is also permitted to order medical examinations and
tests in order for him to make an informed decision regarding the extent to which plaintiff’s
physical and mental impairments, both severe and non-severe, affect her ability to perform workrelated activities. Dozier v. Heckler, 754 F.2d 274, 276 (8th Cir. 1985); 20 C.F.R. § 416.917.
Upon receipt of any such additional information, the ALJ shall reconsider the record as a whole,
including the medical and nonmedical evidence of record as well as plaintiff’s own description
of her symptoms and limitations, and reassess plaintiff’s RFC. Such reassessed RFC shall be
based on substantial medical evidence in the record and shall be accompanied by a discussion
and description of how the evidence supports each RFC conclusion. Cox v. Astrue, 495 F.3d
614, 619 (8th Cir. 2007); SSR 96-8p, 1996 WL 374184, at *7.

VI. Conclusion
For the reasons set forth above, the Commissioner’s decision is not supported by
substantial evidence on the record as a whole. The decision of the Commissioner is therefore
reversed under Sentence 4 of 42 U.S.C. § 405(g) and this case is remanded for further
proceedings consistent with this opinion. Because the current record does not conclusively
demonstrate that plaintiff is disabled, it would be inappropriate for the Court to award plaintiff
benefits at this time.
An appropriate Judgment Order is issued herewith.

______/S/ David D. Noce
______
UNITED STATES MAGISTRATE JUDGE

Signed February 17, 2015.

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