Franklin v. Colvin

Filing 18

MEMORANDUM: For the reasons set forth above, pursuant to Sentence 4 of 42 U.S.C. § 405(g), the decision of the Commissioner is reversed and the case is remanded for further proceedings consistent with this memorandum opinion. An appropriate Judgment Order is issued herewith. Signed by Magistrate Judge David D. Noce on 8/22/16. (JAB)

UNITED STATES DISTRICT COURT
EASTERN DISTRICT OF MISSOURI
EASTERN DIVISION

SHANNON R. FRANKLIN,
Plaintiff,
v.
CAROLYN W. COLVIN,
Acting Commissioner of Social Security,
Defendant.

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No. 4:15 CV 894 DDN

MEMORANDUM
This action is before the court for judicial review of the final decision of the
defendant Commissioner of Social Security denying the application of plaintiff Shannon
R. Franklin for disability insurance benefits under Title II of the Social Security Act (the
Act), 42 U.S.C. § 401, et seq. The parties have consented to the exercise of plenary
authority by the undersigned United States Magistrate Judge pursuant to 28 U.S.C. §
636(c).
For the reasons set forth below, pursuant to Sentence 4 of 42 U.S.C. § 405(g), the
final decision of the Commissioner is reversed and the case is remanded to the defendant
Commissioner for further proceedings consistent with this memorandum opinion.

I. BACKGROUND
Plaintiff was born on May 30, 1972. (Tr. 148.) He filed his application on June
29, 2012. He alleges he became disabled on November 4, 2011 due to type 2 diabetes,
depression, and back, knee, and shoulder problems.

(Tr. 148-54, 179.) Plaintiff’s

application was denied, and he requested a hearing before an ALJ. (Tr. 99.)

The ALJ denied his application following a hearing, and the Appeals Council
declined further review. (Tr. 1, 15, 51.) Thus, the decision of the ALJ stands as the final
decision of the Commissioner.

II. MEDICAL AND OTHER HISTORY
Plaintiff saw internist John A. Garcia, M.D. from December 2009 through April
2011 for attention deficit hyperactivity disorder (ADHD), lumbago or pain in the muscles
and joints of the lower back, muscle spasms, and anxiety. Plaintiff stated that he had
been on Adderall, used to treat ADHD, for years. Dr. Garcia refilled Adderall and
prescribed Tramadol, for lumbago; Soma, for muscle spasms; and Valium, for anxiety.
On August 3, 2011, plaintiff stated that he was doing well on his medications. (Tr. 22836.)
On April 26, 2012, plaintiff was seen at Wayne Medical Center with complaints of
shoulder and back pain. Plaintiff had recently moved to the area and was advised that he
would receive no medication until his past medical records were reviewed. (Tr. 264-65.)
On May 4, 2012, plaintiff returned to Wayne Medical Center for chronic lumbar
pain. Primary care physician Andrew Gayle, M.D., conducted a physical examination
and ordered x-rays. Plaintiff became upset with Dr. Gayle when advised that Dr. Garcia
would not prescribe certain medications and stated that he would seek care elsewhere.
(Tr. 239-41.)
On August 28, 2012, plaintiff saw family practitioner Guy Roberts, D.O., for a
consultative disability examination. Plaintiff complained of chronic pain and anxiety.
Upon examination, plaintiff’s mental status was alert, he was oriented to person, place,
and time, and his affect and demeanor were appropriate. When asked why he was unable
to work, plaintiff cited pain in his back and shoulders and that he thought he might have
diabetes. Dr. Roberts noted that plaintiff’s pain was subjective and that he had never
pursued treatment for diabetes. Dr. Roberts’s assessment was chronic pain syndrome and
anxiety. He concluded that plaintiff’s physical examination did not warrant disability to
any degree. (Tr. 252-56.)
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On August 30, 2012, plaintiff was admitted to Mineral Area Regional Medical
Center for severe depressed feelings and suicidal ideations.

Internist Parthasarathi

Marapareddigari, M.D., diagnosed plaintiff with newly diagnosed type 2 diabetes,
depression with suicidal ideation, and anxiety disorder. Plaintiff reported he had been on
a downhill slide for several years due to his illnesses, and the loss of his job, automobile,
and home. As a result, plaintiff was now considering suicide. Plaintiff attempted suicide
as a teen by hanging. Dr. Marapareddigari noted that plaintiff was tearful, expressed
suicidal ideation, and appeared depressed. Dr. Marapareddigari prescribed Glucotrol XL
and metformin, both used to treat diabetes.

Additionally, Dr. Marapareddigari

recommended treatment for anxiety with a psychiatrist after plaintiff’s blood sugar was
controlled. Plaintiff’s discharge diagnoses were bipolar affective disorder, depressed
episode, and uncontrolled diabetes. (Tr. 288-91, 324, 334.)
On September 3, 2012, plaintiff was transferred to the psychiatric inpatient unit at
Southeast Hospital. Plaintiff told psychiatrist John T. Lake, M.D., that he believed he
had bipolar disorder after conducting research on it. Plaintiff also complained of pain in
his lower back, shoulders, and knees, and expressed hopefulness regarding his recent
application for disability insurance benefits. Dr. Lake reported that plaintiff asked what
forms he would be willing to fill out for plaintiff and seemed more motivated about that
than about getting real treatment. Dr. Lake noted that plaintiff was “very vague about his
symptomology, very matter-of-fact, as if he [was] reading it from a textbook.” (Tr. 324.)
Plaintiff claimed to be paranoid, but Dr. Lake noted that he did not appear paranoid or
suspicious at all, nor did plaintiff describe symptoms suggestive of psychosis. Upon
admission, Dr. Lake believed that plaintiff was malingering in order to obtain disability
because he did not appear nearly as distressed as he reported. (Tr. 325.)
Plaintiff was discharged on September 6, 2012. His discharge diagnoses were
bipolar affective disorder type 2, depressed episode, and non-insulin dependent diabetes.
His discharge diagnosis did not include rule out malingering. By discharge, plaintiff’s
mood had improved and stabilized, and he had a low suicide risk assessment. (Tr. 32427.)
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On October 22, 2012, plaintiff saw psychiatrist Michael Stotler, M.D. Plaintiff
reported his recent psychiatric hospitalization. He reported severe social anxiety that
interfered with his ability to leave the house and see doctors. His mood cycled quickly
from anger to depression to mania with recurrent crying spells and suicidal ideation.
Plaintiff reported racing thoughts, paranoia, which he described as people judging him,
and self-consciousness, which had caused him to get into fights in the past. On mental
status examination, Dr. Stotler observed that plaintiff’s mood and affect was depressed
and anxious. He diagnosed bipolar affective disorder, type 1, depressed, moderate;
general anxiety disorder; and ADHD. Dr. Stotler assessed a Global Assessment of
Functioning (GAF) score of 44, indicating “serious” symptoms.

Dr. Stotler increased

plaintiff’s Tegretol, an anticonvulsant, and Celexa, an anti-depressant, and changed his
anxiety medication from Ativan to Klonopin. (Tr. 285-86.)
On December 6, 2012, plaintiff saw primary care doctor Thomas Spiro, M.D.
Plaintiff’s diabetes was under control. Dr. Spiro prescribed Ultram, for pain; Soma, for
muscle spasms; and Xanax, for anxiety. (Tr. 342-43.)
Plaintiff saw Dr. Stotler again on December 19, 2012. He reported that his anger
had decreased and that his moods were much more stable. Tegretol, for bipolar disorder,
had provided some relief, and he had some days of feeling better. Plaintiff stated that his
depression and anxiety were still severe and that he left the house only if he took extra
anxiety medication. Dr. Stotler observed plaintiff’s mood and affect was depressed and
anxious. Dr. Stotler increased Klonopin, and added Adderall, for ADHD. (Tr. 283-85.)
Plaintiff visited Dr. Spiro on December 20, 2012, complaining of chronic pain and
anxiety. Dr. Spiro noted that plaintiff’s diabetes was controlled with medication. He
prescribed hydrocodone for pain. (Tr. 348.)
On December 21, 2012, plaintiff was admitted to Mineral Area Regional Medical
Center for a self inflicted stab wound that required stitches on his right wrist. Plaintiff
had stabbed himself in the wrist with a steak knife while in a manic state during an
argument with his son. Plaintiff reported a long history of impulsive behavior, ADHD,
physical aggression with violence, and prior suicide attempts. He reported compliance
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with medication. Bello Adejoh, M.D., a psychiatrist, noted that plaintiff’s insight and
judgment were impaired.

Dr. Adejoh noted that plaintiff had difficulty with

comprehension, but had good vocabulary and knowledge regarding his illness,
particularly describing technical medical terms. Plaintiff reported sexual abuse as a child,
which he thought had “totally impacted” his life. (Tr. 306.) Dr. Adejoh’s impression
was schizoaffective disorder, bipolar disorder, intermittent explosive disorder, and
impulse control disorder. He admitted plaintiff for therapy. (Tr. 304-08.)
Dr. Adejoh sought a consultation from critical care specialist Martin Grissom,
M.D.

Dr. Grissom noted that plaintiff was positive for depression, anxiety, anger,

suicidal or homicidal ideations, and panic attacks. He also noted that plaintiff was alert
and oriented, pleasant and cooperative, and had insight into his volatility. Plaintiff told
Dr. Grissom he was waiting for disability so he could collect Medicaid and a disability
check. Dr. Grissom diagnosed major depression, suicidal ideation with suicidal gesture;
insulin-dependent diabetes; explosive personality; and chronic pain syndrome.

He

concluded plaintiff’s prognosis was guarded. (Tr. 308.)
During his hospitalization plaintiff participated in individual and group
psychotherapy and recreational activities. He was discharged on December 26, 2012. By
discharge, plaintiff’s mood had improved significantly. He was well groomed, calm, and
cooperative, and denied suicidal or homicidal ideation, auditory and visual hallucinations,
and had fair insight and judgment. Dr. Adejoh’s discharge diagnoses were schizoaffective disorder, bipolar type; intermittent explosive disorder; impulse control disorder;
Cluster B personality trait; obesity, arthritis; and type 2 diabetes. He assigned a GAF
score of 40, indicating some impairment in reality testing or communication or major
impairment in several areas, such as work or school, family relations, judgment, thinking,
or mood. (Tr. 322.)
On January 11, 2013, plaintiff saw Dr. Stotler.

He described his recent

hospitalization after cutting his wrist a few weeks ago. Plaintiff reported continued
depression and crying spells.

Dr. Stotler thought that plaintiff’s medications were

helping, but observed that his mood and affect was depressed and anxious. Plaintiff had
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normal speech, logical thought process and good insight, judgment, grooming, and eye
control. Dr. Stotler changed his antidepressant from Celexa to Prozac. He discontinued
Tegretol, temazepam, and Klonopin, and started Valium. He assigned a GAF score of
44, indicating “serious” symptoms. (Tr. 260, 282-83.)
Dr. Stotler completed a medical source statement on February 12, 2013. He
diagnosed bipolar affective disorder, depressed type; general anxiety disorder; and
ADHD. Dr. Stotler found, among other things, that plaintiff had “extreme” limitations
coping with stress, functioning independently, maintaining reliability, maintaining
regular attendance and being punctual, completing a normal workday and workweek
without interruptions from symptoms, maintaining attention and concentration for
extended periods, performing at a consistent pace without an unreasonable number and
length of rest periods. (Tr. 257-60.)
Plaintiff saw Dr. Spiro for follow up and medication refills on February 7, 2013.
Dr. Spiro noted that plaintiff was “doing OK.” (Tr. 355, 358.)
On April 4, 2013, plaintiff saw Dr. Stotler.

He reported recurrent suicidal

ideations, usually following a stressor, social anxiety, and self-mutilation. For example,
he had impulsively cut a tattoo off of his arm. He had continued depression with crying
spells. His medications were helping. Plaintiff had reduced his dose of Saphris, an
antipsychotic medication, due to excessive sedation. Plaintiff reported an increased
tolerance to Valium. Dr. Stotler observed that his mood and affect was depressed and
anxious. Dr. Stotler increased Prozac, decreased Saphris, and started propranolol, for
high blood pressure. (Tr. 280-81.)
On July 2, 2103, plaintiff was hospitalized at St. Anthony’s Medical Center for a
suicide attempt. His family had found him unconscious, surrounded by pill bottles.
Plaintiff reported he took several extra pills and that he had a history of impulsive
behavior. He reported a history of aggression, violence, and prior suicide attempts;
quickly becoming suspicious of people in a social setting; loss of emotional control; and
feelings of hopelessness. (Tr. 424-26.) Psychiatrist Sofia Grewal, M.D., noted that
plaintiff was restless and fidgety. She noted that his speech was pressured, his mood was
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anxious and constricted, his affect was constricted, his thought content was suicidal, and
his judgment was limited. Dr. Grewal diagnosed bipolar disorder, mixed; recurrent major
depression; psychotic disorder, not otherwise specified; schizoaffective disorder; and
social maladjustment. Plaintiff was discharged on July 5, 2013. Plaintiff’s GAF score
upon discharge was 41-50, indicating “serious” symptoms, and his prognosis was “fair.”
(Tr. 407-11.)
On November 7, 2013, plaintiff was admitted to St. Mary’s Health Center after he
stabbed himself in the forearm with a steak knife and reportedly overdosed on Xanax and
Soma. Plaintiff denied current suicidal thoughts. He stated that he has problems if he
does not take his psychiatric medications, but that he had not been taking medications
because he could not afford them. He was discharged on November 8, 2013. Upon
discharge, psychiatrist Vadim Baram, M.D., noted that plaintiff was alert and oriented,
not in acute distress, and that he denied suicidal or homicidal ideations. Dr. Baram
diagnosed bipolar disorder, type 1, uncontrolled diabetes, chronic neuropathy, and
assigned a GAF score of 40. Upon discharge, plaintiff’s condition was “fair” and his
prognosis was “questionable,” and depended on community support, medication
management, and psychotherapy. (Tr. 267, 272-74.)
Plaintiff saw Dr. Stotler on November 11, 2013. He reported his recent suicide
attempt, crying spells, and financial stress. He stated that his blood glucose was very
high and that his anger was out of control, precipitating most of his problems. Dr. Stotler
observed that plaintiff’s speech was rapid and excessive, and his mood and affect was
depressed and anxious. His medications included Adderall, Lithium, used to treat the
manic episode of a manic depression; melatonin; propranolol, a betablocker; Prozac, an
antidepressant; Saphris, an antipsychotic; Valium, for anxiety, as well as diabetes
medications.

Dr. Stotler increased his Lithium and Prozac. He assigned a GAF score of

44. (Tr. 277-80.)
On August 20, 2014, approximately seven months following the ALJ’s denial of
his application, plaintiff submitted additional evidence to the Appeals Council that
included a mental medical source statement completed by S. Bashyal, M.D., a
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psychiatrist. Dr. Bashyal opined that plaintiff had extreme limitations with respect to
behaving in an emotionally stable manner. (Tr. 8-9.)
ALJ Hearing
The ALJ conducted a hearing on December 19, 2013. Plaintiff appeared and
testified to the following. (Tr. 51-87.) He is forty-one years old. He has a ninth grade
education and lives in an apartment with his disabled wife and twenty-one-year-old son.
He has past work as a commercial truck driver but stopped working in November 2011
due to his physical and mental impairments. He has difficulties working due to road
rage, confrontations with his boss, and fist fights at work. (Tr. 55-58.)
His mental problems date to childhood when he was prescribed Ritalin but was
eventually expelled from school. At the time of the hearing, he was taking medications,
including Saphris, Prozac, Lithium, propranolol, and Xanax. Saphris helps control his
mood swings but makes him sleep excessively and his jaw click. He did not take his
Saphris the day of the hearing because it puts him in a coma-like state and he would not
have been able to make it to the hearing. (Tr. 60-62.)
He has extreme anxiety, depression, and paranoia, as well as lower back pain, and
therefore does not leave the house much. His anger has resulted in self-harm and suicidal
issues.

He does not really understand his behavior, such as stabbing himself or

overdosing on pills. He believes that his mental health issues are worsening with age.
However, his medications are effective and his condition would be worse without them.
He believed that his condition was improving with medication. (Tr. 63-67.)
He is diabetic and has difficulty controlling his blood sugar. He has tingling in his
feet. He has problems with his left shoulder and is unable to reach in all directions or lift
much. He has back pain that incapacitates him for two to three weeks at a time and that
occurred about three times in the past year. (Tr. 67-72.)
He prepares his own meals. He does laundry once a week, but does not do other
household chores. He can go to the grocery store but cannot lift more than a twelve-pack
of soda. He can sit and browse the internet for fifteen minutes at a time. (Tr. 73-75.)

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He cannot perform full-time work because he cannot be on his feet for eight hours
or perform a sitting job due to his lower back pain. (Tr. 76-77.)
Decision of the ALJ
On January 13, 2014, the ALJ determined that plaintiff was not disabled. At Step
One, the ALJ found plaintiff had not performed substantial gainful activity since his
November 4, 2011 alleged onset date of disability.

At Step Two, the ALJ found

plaintiff’s severe impairments were: degenerative joint disease of the shoulder;
degenerative disk disease of the lumbar spine; diabetes; and “psychiatric conditions
variously diagnosed as different disorders including depression.”

(Tr. 20.) At Step

Three, the ALJ found plaintiff did not have an impairment or combination of impairments
that met or medically equaled an impairment listed in 20 CFR Part 404, Subpart P,
Appendix 1. At Step Four, the ALJ found that plaintiff had the residual functional
capacity to perform a range of unskilled, sedentary work. With this residual functional
capacity, the ALJ found plaintiff was unable to perform past relevant work. At Step Five,
the ALJ found there were jobs that existed in significant numbers in the national
economy that the claimant could perform. Therefore, the ALJ found that plaintiff was
not disabled within the meaning of the Act. (Tr. 20-28.)

III. GENERAL LEGAL PRINCIPLES
The court’s role on judicial review of the Commissioner’s decision is to determine
whether the Commissioner’s findings comply with the relevant legal requirements and
are supported by substantial evidence in the record as a whole. Pates-Fires v. Astrue, 564
F.3d 935, 942 (8th Cir. 2009). “Substantial evidence is less than a preponderance, but is
enough that a reasonable mind would find it adequate to support the Commissioner’s
conclusion.” Id. In determining whether the evidence is substantial, the court considers
evidence that both supports and detracts from the Commissioner’s decision. Id. As long
as substantial evidence supports the decision, the court may not reverse it merely because
substantial evidence exists in the record that would support a contrary outcome or

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because the court would have decided the case differently. See Krogmeier v. Barnhart,
294 F.3d 1019, 1022 (8th Cir. 2002).
To be entitled to disability benefits, a claimant must prove that he is unable to
perform any substantial gainful activity due to a medically determinable physical or
mental impairment that would either result in death or which has lasted or could be
expected to last for at least twelve continuous months. 42 U.S.C. §§ 423(a)(1)(D),
(d)(1)(A), 1382c(a)(3)(A); Pate-Fires, 564 F.3d at 942. A five step regulatory framework
is used to determine whether an individual is disabled. 20 C.F.R. § 404.1520(a)(4); see
also Bowen v. Yuckert, 482 U.S. 137, 140-42 (1987) (describing the five-step process);
Pates-Fires, 564 F.3d at 942 (same).
Steps One through Three require the claimant to prove (1) he is not currently
engaged in substantial gainful activity, (2) he suffers from a severe impairment, and (3)
his disability meets or equals a listed impairment. 20 C.F.R. § 404.1520(a)(4)(i)-(iii). If
the claimant does not suffer from a listed impairment or its equivalent, the
Commissioner’s analysis proceeds to Steps Four and Five.

Step Four requires the

Commissioner to consider whether the claimant retains the RFC to perform past relevant
work. Id. § 404.1520(a)(4)(iv). The claimant bears the burden of demonstrating that he is
no longer able to return to his past relevant work. Pates-Fire, 564 F.3d at 942. If the
Commissioner determines the claimant cannot return to his past relevant work, the
burden shifts to the Commissioner at Step Five to show the claimant retains the RFC to
perform other work that exists in significant numbers in the national economy. Id.; 20
C.F.R. § 404.1520(a)(4)(v).

IV. DISCUSSION
Plaintiff argues that the ALJ erred (1) at Step Two in failing to determine his
actual mental diagnoses; and (2) in giving “little weight” to the opinion of treating
psychiatrist Michael Stotler, M.D. This court agrees.

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1. Step Two of the Sequential Evaluation Process
At Step Two, the ALJ found plaintiff had the following severe impairments,
“psychiatric conditions variously diagnosed as different disorders including depression.”
(Tr. 20.) The ALJ committed error at Step Two by failing to determine the exact nature
of plaintiff’s mental diagnoses.

Because the ALJ erred at Step Two in failing to

determine plaintiff’s precise mental diagnoses, the ALJ was unable to properly evaluate
his residual functional capacity. This would have required analysis of plaintiff’s signs
and symptoms from bipolar affective disorder, general anxiety disorder, ADHD,
intermittent explosive disorder, impulse control disorder, Cluster B personality trait, and
chronic pain syndrome. (Tr. 256, 348, 355.)

On remand, the ALJ must determine

plaintiff’s precise mental diagnoses, which may include bipolar affective disorder,
general anxiety disorder, ADHD, intermittent explosive disorder, impulse control
disorder, Cluster B personality trait, and chronic pain syndrome.

2. Opinion of Treating Psychiatrist Michael Stotler, M.D.
Plaintiff argues that the ALJ erred in giving “little weight” to the opinion of
treating psychiatrist, Michael Stotler, M.D. This court agrees. A treating physician’s
opinion is given controlling weight if it “is well-supported by medically acceptable
clinical and laboratory diagnostic techniques and is not inconsistent with the other
substantial evidence in [a claimant's] case record.” 20 C.F.R. § 404.1527(d)(2); see also
SSR 962p, 1996 WL 374188, at *2 (Social Security Administration, July 2, 1996).
Unless the treating physician’s opinion is unsupported by medically acceptable clinical or
diagnostic date, the opinion of a treating physician is “entitled to great weight.” Coleman
v. Astrue, 498 F.3d 767, 770 (8th Cir. 2007).

A physician's statement that is not

supported by diagnoses based on objective evidence will not support a finding of
disability. Edwards v. Barnhart, 314 F.3d 964, 967 (8th Cir. 2003). See Perks v. Astrue,
687 F.3d 1086, 1092 (8th Cir. 2012) (ALJ may discount a physician’s opinion if the
opinion is internally inconsistent).

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In this case, the ALJ stated he gave Dr. Stotler’s opinion “little weight” for several
reasons. The ALJ noted that Dr. Stotler treated plaintiff on only three occasions during
the period between October 22, 2012 and February 12, 2013, the date of his medical
source statement. Second, the ALJ stated that Dr. Stotler’s examinations did not support
his opinion because he usually noted plaintiff appeared depressed and anxious, but also
noted that plaintiff was alert, oriented, well-groomed, logical and coherent with
appropriate dress and good eye contact. Third, the ALJ stated that Dr. Stotler’s opinion
was not supported by other examinations that revealed the claimant was alert, oriented,
calm, well-groomed and in no apparent distress. The ALJ stated that one examiner noted
that plaintiff’s affect and demeanor were appropriate. He also stated that Dr. Stotler’s
opinion was “contrary to the concerns of some that the claimant exaggerated his
symptoms.” (Tr. 26.)
If the ALJ discounts a treating physician’s opinion, he should give “good reasons”
for doing so. Davidson v. Astrue, 501 F.3d 987, 990 (8th Cir. 2007); 20 CFR §
404.1527(c)(2). The ALJ did not give good reasons here.
Dr. Stotler saw plaintiff on three occasions prior to his medical source statement.
His observations were consistent with the recurrent symptoms of bipolar affective
disorder and anxiety. Dr. Stotler was the only treating source who provided an opinion
regarding plaintiff’s ability to function in the workplace. His opinion was consistent with
his own notes and treatment, which included modifications to multiple medications.
Moreover, Dr. Stotler’s opinion was not inconsistent with the other substantial evidence
of record, including four psychiatric hospitalizations. (Tr. 267-74, 288, 304-22, 407-24.)
See Nevland v. Apfel, 204 F.3d 853, 858 (8th Cir. 2000) (absent information from the
treating sources, it is not possible to ascertain a claimant’s ability to work without
engaging in medical conjecture); Dixon v. Barnhart, 324 F.3d 997 (8th Cir. 2003) (ALJ
may not draw upon his own inferences from medical reports.)
The ALJ noted that Dr. Stotler observed that plaintiff’s mood and affect were
depressed and anxious, supporting a finding that Dr. Stotler’s treatment notes were
consistent with his opinion that plaintiff suffered from bipolar affective disorder and
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anxiety.

However, the ALJ failed to provide support for his conclusion that the

symptoms of bipolar affective disorder or anxiety were inconsistent with being alert,
oriented, well-groomed, logical, coherent or appropriately dressed with good eye contact.
(Tr. 26.) This constitutes medical conjecture on the part of the ALJ. The very nature of
bipolar disorder is that people with the disease experience fluctuations in their symptoms,
so any single notation that a patient is feeling better or has had a “good day” does not
imply that the condition has been treated. Scott v. Astrue, 647 F.3d 734, 740 (7th Cir.
2011).
For example, the ALJ stated, “[o]n December 21, 2012, Mineral Area Regional
Medical Center admitted the claimant after he stabbed his wrist during an argument with
his son. Examination did not reveal signs indicative of his reported symptoms, and he
reported his mood to be good. He was discharged December 26, 2012 (Exhibit 10F).”
(Tr. 24.)
However, contrary to the ALJ’s statement, Dr. Adejoh described plaintiff's act as a
“suicide attempt,” and stated that his insight and judgment were impaired, and that a five
to seven day hospital admission was warranted. (Tr. 304-05.) Critical care specialist Dr.
Grissom also agreed that plaintiff’s condition warranted in-patient hospitalization. (Tr.
312.) Thus the ALJ erred in concluding that the admitting examination did not reveal
signs indicative of a suicide attempt requiring in-patient hospitalization.
The ALJ also concluded that Dr. Stotler’s opinion was not supported by “other
examinations,” referencing treatment notes from December 2009 through December 21,
2011. (Tr. 26, 228-36.) On December 21, 2011, plaintiff reported that Adderall would
“wear off around noon.” The provider who signed this treatment note diagnosed ADHD,
lumbago, muscle spasms, and anxiety, and confirmed that another provider had refilled
Adderall, Soma, and Valium. (Tr. 229.) This treatment note does not provide support to
discredit Dr. Stotler’s opinion.
The ALJ also referenced the physical consultative evaluation from Guy Roberts,
D.O., in which Dr. Roberts diagnosed chronic pain syndrome and anxiety, and found no
physical reason why plaintiff could not work. (Tr. 256.) This physical evaluation from a
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consulting examiner does not provide support for the ALJ’s decision to discredit the
opinion of Dr. Stotler. See Kirby v. Astrue, 500 F.3d 705, 709 (8th Cir. 2007) (opinion
of consulting physician less valuable than that of treating physician and not entitled to
special weight afforded opinion of treating physician).
The third reason given by the ALJ for his reason to discredit Dr. Stotler’s opinion
was that Dr. Stotler’s opinion was “contrary to the concerns of some that [plaintiff]
exaggerated his symptoms.” (Tr. 26.) The record evidence shows that Dr. John Lake,
the psychiatrist who examined plaintiff upon his September 3, 2012 hospital admission,
was the only person who questioned plaintiff’s motive. Specifically, upon his September
3, 2012 admission, Dr. Lake diagnosed bipolar affective disorder and rule-out
malingering. He assessed a GAF score of 45-50. Upon discharge on September 6, 2012,
Dr. Lake diagnosed bipolar affective disorder, depressed episode. Notably, at discharge,
Dr. Lake did not diagnose malingering or state that he wanted to rule-out malingering.
(Tr. 324-27.) Because Dr. Lake removed the diagnosis of rule-out malingering from his
final diagnosis, the ALJ’s theory that “some” were concerned about malingering is not
supported by the record evidence as a whole. The court notes the ALJ used the word
“some,” in reference to one physician, even though no other treating source questioned
plaintiff’s motives.
The ALJ also rejected Dr. Stotler’s opinion without properly considering the
factors set forth in 20 C.F.R. § 404.1527(c)(1)-(6), specifically, Dr. Stotler’s specialty in
psychiatry, and the fact that Dr. Stotler was aware of plaintiff’s other treatment, including
his psychiatric hospitalizations and suicide attempts. (Tr. 279, 282, 285.) Dr. Stotler’s
familiarity with the other information in plaintiff’s case record was a relevant factor that
the ALJ should have considered when determining the weight to afford his opinion. See
20 CFR § 404.1527(c)(6) (factors to consider include length and frequency of physicianpatient relationship, the nature and extent of the treatment relationship, supportability,
consistency, expertise, and other factors.) The record evidence here contained no other
medical assessments that were “supported by better or more thorough medical evidence”
than that of Dr. Stotler. See Bentley v. Shalala, 52 F.3d 784, 785-86 (8th Cir. 1995).
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For all of the above reasons, the court concludes the decision of the ALJ is not
supported by substantial evidence on the record as a whole.

V. CONCLUSION
For the reasons set forth above, pursuant to Sentence 4 of 42 U.S.C. § 405(g), the
decision of the Commissioner is reversed and the case is remanded for further
proceedings consistent with this memorandum opinion.
An appropriate Judgment Order is issued herewith.

/s/ David D. Noce
k
UNITED STATES MAGISTRATE JUDGE
Signed on August 22, 2016.

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