Biggerstaff v. Colvin

Filing 27

MEMORANDUM AND ORDER : IT IS HEREBY ORDERED that the decision of the ALJ in this matter is AFFIRMED. Signed by Magistrate Judge John M. Bodenhausen on 1/31/17. (ARL)

UNITED STATES DISTRICT COURT
EASTERN DISTRICT OF MISSOURI
EASTERN DIVISION
DARRELL E. BIGGERSTAFF,
Plaintiff,
v.
NANCY A. BERRYHILL,1
Acting Commissioner of Social Security,
Defendant.

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No. 4:16 CV 67 JMB

MEMORANDUM AND ORDER2
Darrell E. Biggerstaff (“Plaintiff”) appeals the decision of the Commissioner of Social
Security (“Defendant”) denying his applications for disability insurance benefits (“DIB”) and
supplemental security income (“SSI”), under Titles II and XVI of the Social Security Act (“the
Act”), 42 U.S.C. §§ 401, et seq. Because Defendant’s decision is supported by substantial
evidence and correctly applies the governing law, it is AFFIRMED. See 42 U.S.C. § 405(g).
I.

Factual Background
At the time of his applications, Plaintiff was 48 years old. Plaintiff alleged disability due

to (1) narcolepsy, (2) “back and foot problems,” and (3) depression. (Tr. 216, 266-67, 519)
According to Plaintiff, his narcolepsy problems began in “1996 or 1997” and became “really
bad” by 1999. (Tr. 266) Plaintiff alleges that his condition precludes his ability to work because
he sleeps up to 14 or 15 hours per day. (Tr. 51-53) The medical evidence before the Court
1

Nancy A. Berryhill is now the Acting Commissioner of Social Security. Pursuant to
Fed. R. Civ. P. 25(d), Ms. Berryhill should be substituted for Carolyn W. Colvin as the defendant
in this suit. No further action needs to be taken to continue this suit by reason of the last
sentence of Section 205(g) of the Social Security Act, 42 U.S.C. § 405(g).
2

All matters are pending before the undersigned United States Magistrate Judge with
consent of the parties, pursuant to 28 U.S.C. § 636(c).

indicates that Plaintiff was periodically treated for narcolepsy from at least September of 2008,
until the administrative hearing in this matter.3 (See, e.g., Tr. 262, 351) Until February of 2013,
however, Plaintiff’s symptoms were severe and apparently poorly controlled due to a lack of
routine care. (Tr. 315) In March of 2013, Plaintiff began using Adderal. As a result, Plaintiff’s
narcolepsy stabilized and his symptoms improved. (Tr. 318, 320, 324) By April 3, 2013,
Plaintiff was “feeling better,” and “sleeping less[].” (Tr. 324) Plaintiff was continued on
Adderall, and instructed to “keep himself active and not [] sit for a long time or lie down during
the day.” (Tr. 326) At a follow-up visit in June of 2013, Plaintiff stated that his “symptoms are
fairly controlled” with Adderall. Plaintiff was “able to carry out activities,” and had “no
complaints.” (Tr. 332) In August of 2013, Plaintiff was “stable on Adderall” (Tr. 341), and in
November of 2013, Plaintiff remained “stable,” and “deni[ed] any complaints” regarding his
narcolepsy. (Tr. 348) Through at least February of 2014, Plaintiff’s narcolepsy remained stable
with Adderall. (Tr. 351)
Plaintiff alleges that he sustained back and foot issues when he fell from a tree in
approximately 1990. (Tr. 267) According to Plaintiff, he suffered compression fractures in his
lower back “from LS to L5” as a result of the fall. (Id.) In the medical records, these injuries are
diagnosed as “pain and dysfunction of [Plaintiff’s] left ankle and foot.” (Tr. 268) There are few
medical records directly dealing with these musculoskeletal issues. For instance, x-rays taken on
January 8, 2013 show only a “small subchondral defect” which “may relate to [Plaintiff’s] prior
trauma,” but there was “no evidence for acute fracture or dislocation.” (Tr. 279) In November
of 2012, Plaintiff’s back issues were evaluated in connection with his disability application. This
evaluation found no evidence of lower extremity atrophy. Plaintiff’s gait was normal, and he
3

The September, 2008 treatment notes appear to be the earliest records. No treatment
notes or medical records from the 1990s were included in the record before this Court.
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was able to walk on toes and heels. Plaintiff’s straight leg raising test produced an abnormal
result, but the examiner questioned the validity of Plaintiff’s response to this test because
Plaintiff “writhed on the exam table complaining of severe back pain during the whole exam.”
(Tr. 268)
Plaintiff also complained of musculoskeletal issues resulting from a moped crash in June
2013. As a result of his moped accident, Plaintiff suffered a skull fracture, right rib fractures,
right clavicle and scapular fractures, and a “floating shoulder.” (Tr. 300) Plaintiff had surgery to
address some of his injuries, and was released in stable condition. (Id.) By July 12, 2013,
diagnostic imaging showed that Plaintiff was healing (Tr. 512), and by August 1, 2013, Plaintiff
had substantially recovered. (Tr. 511) It appears that Plaintiff did not seek any further
musculoskeletal treatment until at least February of 2014. (Tr. 315, 511)
As to Plaintiff’s mental impairment allegations, Plaintiff was diagnosed with Major
Depressive Disorder in January of 2013, by Dr. Karen A. MacDonald, Psy.D. (Tr. 517-19) In
May 2013, Plaintiff was hospitalized for a few days due to suicidal thoughts. (Tr. 283) In June
2013, Plaintiff began treatment with psychiatrist Dr. Radhika Rao, M.D. Dr. Rao treated
Plaintiff several additional times, each of which involved a 15-minute checkup, which appear to
have been mostly for medication management. (See Tr. 377, 382, 387, and 392) These
appointments appear to be the extent of Plaintiff’s treatment for depression.4
II.

Procedural Background
Plaintiff applied for DIB and SSI benefits on October 9, 2012, alleging a disability onset

date of January 1, 2009. (Tr. 20, 216, 267) Plaintiff later amended his alleged onset date to
November 26, 2012. For DIB purposes, Plaintiff’s date last insured was December 31, 2012.
4

The undersigned has reviewed the entire administrative record in this matter. Further
discussion of pertinent medical evidence will be incorporated in the discussion below.
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After Plaintiff’s claims were initially denied (Tr. 91), he requested a hearing before an
administrative law judge (“ALJ”). On June 11, 2014, Plaintiff appeared at the hearing (with
counsel) to testify about his disability and functional limitations.5 (Tr. 37-64) A vocational
expert (“VE”) also testified. (Tr. 64-70)
After receiving Plaintiff’s testimony and evaluating the evidence submitted in the case,
the ALJ issued a decision dated July 10, 2014, denying Plaintiff’s application. (Tr. 20-30)
Plaintiff sought review with the Appeals Council, which denied review on November 16, 2015.
(Tr. 1-5) Having exhausted his administrative remedies, Plaintiff’s complaint is now properly
before this Court. See 42 U.S.C. § 405(g). Plaintiff alleges that the ALJ erred in failing to give
good reasons for giving limited weight to the opinions of three medical sources, and for
improperly discounting Plaintiff’s credibility.
III.

Standard of Review
“To be eligible for [disability] benefits, [Plaintiff] must prove that [he] is disabled ….”

Baker v. Sec’y of Health and Human Servs., 955 F.2d 552, 555 (8th Cir. 1992); see also Pearsall
v. Massanari, 274 F.3d 1211, 1217 (8th Cir. 2001). A disability is defined as the “inability to
engage in any substantial gainful activity by reason of any medically determinable physical or
mental impairment which can be expected to result in death or which has lasted or can be
expected to last for a continuous period of not less than 12 months.” 42 U.S.C. §§ 423(d)(1)(A)
and 1382c(a)(3)(A). A claimant will be found to have a disability “only if his physical or mental
impairments are of such severity that he is not only unable to do his previous work but cannot,
considering his age, education, and work experience, engage in any other kind of substantial

5

The substance of this testimony will be discussed in connection with the Court’s
description of the ALJ’s decision, infra.
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gainful work which exists in the national economy.” 42 U.S.C. §§ 423(d)(2)(A) and
1382c(a)(3)(B); see also Bowen v. Yuckert, 482 U.S. 137, 140 (1987).
Per regulations promulgated by the Commissioner, the ALJ follows a five-step process in
determining whether a claimant is disabled. “During the process the ALJ must determine: ‘1)
whether the claimant is currently employed; 2) whether the claimant is severely impaired; 3)
whether the impairment is, or is comparable to, a listed impairment; 4) whether the claimant can
perform past relevant work; and if not 5) whether the claimant can perform any other kind of
work.’” Andrews v. Colvin, 791 F.3d 923, 928 (8th Cir. 2015) (quoting Hacker v. Barnhart, 459
F.3d 934, 936 (8th Cir. 2006)). “If, at any point in the five-step process the claimant fails to
meet the criteria, the claimant is determined not to be disabled and the process ends.” Id. (citing
Goff v. Barnhart, 421 F.3d 785, 790 (8th Cir. 2005)); see also Martise v. Astrue, 641 F.3d 909,
921 (8th Cir. 2011).
The Eight Circuit has repeatedly emphasized that a district court’s review of an ALJ’s
disability determination is intended to be narrow and that courts should “defer heavily to the
findings and conclusions of the Social Security Administration.” Hurd v. Astrue, 621 F.3d 734,
738 (8th Cir. 2010) (quoting Howard v. Massanari, 255 F.3d 577, 581 (8th Cir. 2001)). The
ALJ’s findings should be affirmed if they are supported by “substantial evidence” on the record
as a whole. See Finch v. Astrue, 547 F.3d 933, 935 (8th Cir. 2008). Substantial evidence is “less
than a preponderance, but enough that a reasonable mind might accept it as adequate to support a
decision.” Juszczyk v. Astrue, 542 F.3d 626, 631 (8th Cir. 2008).
Despite this deferential stance, a district court’s review must be “more than an
examination of the record for the existence of substantial evidence in support of the
Commissioner’s decision.” Beckley v. Apfel, 152 F.3d 1056, 1059 (8th Cir. 1998). The district

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court must “also take into account whatever in the record fairly detracts from that decision.” Id.
Specifically, in reviewing the Commissioner’s decision, a district court is required to examine
the entire administrative record and consider:
1.
2.
3.
4.
5.
6.

The credibility findings made by the ALJ;
Plaintiff’s vocational factors;
The medical evidence from treating and consulting physicians;
Plaintiff’s complaints regarding exertional and non-exertional activities and
impairments;
Any corroboration by third parties of Plaintiff’s impairments;
The testimony of vocational experts when required, including any hypothetical
questions setting forth Plaintiff’s impairments.

Stewart v. Sec’y of Health & Human Servs., 957 F.2d 581, 585-86 (8th Cir. 1992).
Finally, a reviewing court should not disturb the ALJ’s decision unless it falls outside the
available “zone of choice” defined by the evidence of record. Buckner v. Astrue, 646 F.3d 549,
556 (8th Cir. 2011). A decision does not fall outsize that zone simply because this Court might
have reached a different conclusion had it been the original finder of fact. See also McNamara v.
Astrue, 590 F.3d 607, 610 (8th Cir. 2010) (explaining that if substantial evidence supports the
Commissioner’s decision, the court “may not reverse, even if inconsistent conclusions may be
drawn from the evidence, and [the court] may have reached a different outcome.”).
IV.

ALJ’s Decision
In determining that Plaintiff was not disabled, the ALJ followed the five-step process for

evaluating disability applications discussed above. See 20 C.F.R. § 404.1520(a). At step one,
the ALJ found that Plaintiff was not engaged in substantial gainful activity. (Tr. 22) At step
two, the ALJ found that Plaintiff suffered from the following severe impairments: “narcolepsy;
depression; and the residual effects of traumatic injuries.” (Id.) At step three, the ALJ found that

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Plaintiff’s severe impairments do not meet or medically equal the severity of one of the listed
impairments at 20 C.F.R. Part 404, Subpart P, Appendix 1. (Tr. 23) 6
Next, the ALJ determined Plaintiff’s residual functional capacity (“RFC”). After
reviewing the relevant evidence of record, the ALJ found that Plaintiff had the RFC to perform:
[medium work], except he cannot climb ladders, ropes, or scaffolds. He must
avoid hazards such as dangerous machinery and unprotected heights. He cannot
drive as part of his job. He is capable of simple, routine tasks. He can have only
occasional interaction, defined as no more than one-third of the total workday,
with coworkers and supervisors. He is limited to occupations that can be
performed in a non-public work setting where the individual would not be around
members of the general public or required to communicate with them.
(Tr. 24)
In determining Plaintiff’s RFC, the ALJ evaluated Plaintiff’s credibility and the relevant
medical opinion evidence. As to Plaintiff’s credibility, the ALJ found that Plaintiff’s “statements
concerning the intensity, persistence, and limiting effects of [his] symptoms [were] not entirely
credible.” (Tr. 25)
Plaintiff alleged that he was unable to work because he “sleep[s] too much,” and that
even though medication has improved his narcolepsy, he still sleeps 14 to 15 hours per day. (Tr.
51-53) Plaintiff alleged that he occasionally falls asleep spontaneously, and that his depression
causes a “roller coaster” of emotions that impact his social interactions. (Tr. 54) As to physical
impairments, Plaintiff testified that his foot injury still causes foot and leg pain leading to
difficulty standing and walking. (Tr. 55) Plaintiff stated that this injury, combined with a moped
accident in June of 2013, limits him to walking 50 feet, standing for 25 minutes, and lifting half a
gallon of milk. (Tr. 55-56)

6

Plaintiff does not challenge herein any step two findings, or that he did not meet or
equal a listing at step three.
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The ALJ discounted Plaintiff’s subject allegations for several reasons. Regarding
Plaintiff’s narcolepsy, the ALJ found that, upon seeking routine care and treatment in 2013,
Plaintiff’s condition stabilized and improved. (Tr. 25) The ALJ noted that Plaintiff’s
narcolepsy improved with “conservative treatment of Adderal.” (Id.) Moreover, the ALJ noted
that his RFC accounted for the effects of Plaintiff’s narcolepsy by limiting Plaintiff to work that
avoids hazards, climbing, driving, and work that requires no more than simple and routine tasks.
(Id.) Regarding Plaintiff’s back and foot pain, the ALJ noted that the objective medical
evidence, and the conservative nature of treatment received, indicated that Plaintiff’s back and
foot issues were not as severe as Plaintiff claimed. (Tr. 25-26) The ALJ accounted for the
limitations associated with Plaintiff’s back and foot pain in the RFC which limited Plaintiff to,
among other things, medium work. Finally, as to Plaintiff’s depression, again, the ALJ noted
that, after Plaintiff’s one hospital stay, his depression was controlled and stable with conservative
and routine treatment. (Tr. 26) Nonetheless, the ALJ accounted for the limitations associated
with Plaintiff’s depression by limiting him to simple and routine work, with limited interaction
with others. (Id.)
The ALJ also discounted Plaintiff’s credibility due to several general factors. The ALJ
noted that Plaintiff had a poor work history. (Tr. 27) Similarly, the ALJ found “a strong element
of secondary gain to [Plaintiff’s] claim.” (Id.) Finally, the ALJ found that Plaintiff’s infrequent
and conservative treatment history was inconsistent with someone who is totally disabled. (Id.)
Regarding the medical opinion evidence relevant to the issues raised herein, the ALJ gave
“little weight” to the opinions of Dr. Gary Rucker, D.O. (consultative examiner), Dr. Radhika
Rao, M.D. (treating psychiatrist), and Dr. Karen MacDonald, Psy.D. (consultative psychologist).

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Dr. Rucker opined that Plaintiff could stand for only 15 minutes at a time, and walk 50
yards. (Tr. 272) Dr. Rucker also reported that Plaintiff “would have a problem with bending,
stooping, and lifting from the floor.” (Id.) The ALJ discounted Dr. Rucker’s opinions, finding
them internally inconsistent, inconsistent with Plaintiff’s treatment history, and inconsistent with
other medical evidence in the record. (Tr. 27) The ALJ also noted that Dr. Rucker’s opinions
relate to a time period fairly early in Plaintiff’s alleged period of disability. (Tr. 27-28)
Dr. Radhika Rao, M.D., Plaintiff’s treating psychiatrist, rendered an opinion dated April
29, 2014. (Tr. 508-510) Dr. Rao opined that Plaintiff “cannot perform any work.” Dr. Rao
completed a checklist indicating that Plaintiff would have significant limitations in making
“adjustments” in the “occupational,” “performance,” and “personal-social” contexts. (Tr. 50910) The ALJ discounted Dr. Rao’s opinions, finding that the asserted mental limitations were
not consistent with Dr. Rao’s own treatment records and the conservative nature of Plaintiff’s
treatment. (Tr. 28)
Dr. Karen MacDonald, Psy.D., evaluated Plaintiff in January of 2013, and made several
findings. (Tr. 517-20) Dr. MacDonald is the provider who originally diagnosed Plaintiff with
Major Depressive Disorder. Dr. MacDonald concluded that Plaintiff’s depression limited his
intellectual abilities, and she found that Plaintiff’s combined impairments rendered him qualified
for “medical assistance” under Missouri Medicaid rules. (Tr. 520) The ALJ discounted Dr.
MacDonald’s opinion for three reasons. First, Dr. MacDonald never treated Plaintiff. (Tr. 28)
Second, Dr. MacDonald’s disability determination was rendered pursuant to a different set of
regulations. Third, Dr. MacDonald’s own opinion was inconsistent with her own findings. (Id.)
The ALJ determined Plaintiff’s RFC on the basis of the medical evidence, Plaintiff’s
testimony, and the opinion evidence discussed above. After determining Plaintiff’s RFC, at step

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four the ALJ concluded that Plaintiff was “unable to perform any past relevant work,” (Tr. 28),
because the demands of his past work “exceed his residual functional capacity.” (Tr. 29) Based
on the testimony of an independent Vocation Expert (“VE”), at step five the ALJ found that
Plaintiff could find employment as a hand packager, dishwasher, or vehicle cleaner.7 (Tr. 29)
Therefore, the ALJ concluded that Plaintiff was not disabled under the Act. (Tr. 30)
V.

Discussion
As grounds for reversal, Plaintiff argues that the ALJ erred in his assessment of the

various medical opinions offered in this case. Plaintiff also disputes the ALJ’s credibility
finding. As discussed in detail below, the Court finds that the ALJ did not err in this matter. The
ALJ properly considered the relevant medical opinion evidence and gave good reasons for
discounting Plaintiff’s credibility. The ALJ’s decision is supported by substantial evidence on
the record as a whole and will be affirmed.
A.

The Medical Opinion Evidence

The rules regarding treatment of medical opinion evidence vary depending on the nature
of the doctor-patient relationship. For example, the opinion of a treating physician is usually
entitled to “controlling weight” if the opinion “is supported by medically acceptable techniques
and is not inconsistent with substantial evidence in the record.” Julin v. Colvin, 826 F.3d 1082,
1088 (8th Cir. 2016). On the other hand, a treating source’s opinion “may have limited weight if
it provides conclusory statements only, or is inconsistent with the record,” and the ALJ “may
discount or even disregard the opinion where other medical assessments are supported by better
or more thorough medical evidence, or where a treating physician renders inconsistent opinions
that undermine the credibility of such opinions.” Papesh v. Colvin, 786 F.3d 1126, 1132 (8th
7

The VE rendered this opinion in response to a hypothetical question from the ALJ
which described functional limitations consistent with the ALJ’s RFC. (Tr. 66-67)
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Cir. 2015). The rules for weighing medical evidence that is not entitled to controlling weight are
found at 20 C.F.R. § 404.1527(c), and include: (1) whether the medical source has examined the
patient upon whom they are opining; (2) the length of any treating relationship, frequency of
examination, and extent of the treating relationship; (3) whether the opinion is supported by the
objective medical evidence; (4) consistency with the record as a whole; and (5) whether the
doctor is a specialist. § 404.1527(c)(1)-(5). Whatever weight the ALJ assigns, “the ALJ must
give good reasons” for that weight. Holmstrom v. Massanari, 270 F.3d 715, 720 (8th Cir. 2001).
1.

Dr. Rao’s Opinion

Plaintiff first argues that the ALJ gave too little weight to Dr. Rao’s opinions. As
outlined above, Dr. Rao was Plaintiff’s treating psychiatrist. Dr. Rao opined that Plaintiff
“cannot perform any work,” (Tr. 509), and completed a checklist indicating that Plaintiff would
have significant limitations in making “adjustments” in the “occupational,” “performance,” and
“personal-social” contexts. (Tr. 510) The ALJ discounted Dr. Rao’s opinion, finding that it
“stands alone” in its assertion of limitations that were not mentioned in Dr. Rao’s own treatment
records, nor supported by objective testing or reasoning. (Tr. 28)
Plaintiff argues that the ALJ erred for several reasons. First, Plaintiff argues that the ALJ
failed to recognize that Dr. Rao was a treating psychiatrist (instead, the ALJ referred to Dr. Rao
as a treating physician). Plaintiff suggests that the ALJ did not accord sufficient deference to Dr.
Rao’s opinion as a psychiatrist because specialists are entitled to additional deference concerning
matters within their specialty. Second, Plaintiff argues that Dr. Rao’s opinion evidence is
supported by objective medical records and treatment notes. Third, Plaintiff argues that the ALJ
improperly downplayed the multiple Global Assessment of Functioning (“GAF”) scores that Dr.
Rao assigned, which, Plaintiff argues, were indicative of serious problems. Last, Plaintiff argues

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that, even if Dr. Rao’s opinion was not entitled to “controlling” weight, the ALJ still failed to
analyze the opinion according to the factors laid out in 20 C.F.R. § 404.1527(d).
Defendant, on the other hand, contends that Dr. Rao’s opinion was properly discounted,
because it was inconsistent with Dr. Rao’s own treatment notes and other evidence in the record,
and because there were no objective medical findings supporting the level of limitations Dr. Rao
proffered. Defendant also argues that Plaintiff’s conservative treatment history betrayed
allegations of disabling limitations, and that the ALJ’s failure to specify that Dr. Rao was a
treating psychiatrist, as opposed to merely a treating physician was, at most, harmless error.
(ECF No. 24-1 at 10)
In this case, the ALJ properly discounted Dr. Rao’s opinion evidence. Substantial
evidence supports the ALJ’s conclusion that several of Dr. Rao’s contentions were inconsistent
with Dr. Rao’s own treatment notes. For example, Dr. Rao claimed that Plaintiff had “poor or
no[]” ability to be attentive or to concentrate, (Tr. 510), yet Dr. Rao’s treatment records
consistently show that Plaintiff had normal concentration and attention. (See, e.g., Tr. 378, 383)
(noting that Plaintiff’s attention and concentration are within normal limits). Similarly, Dr. Rao
opined that Plaintiff had no ability to understand, remember and carry out either: (1) complex
job instructions; (2) detailed, but not complex job instructions; or even (3) simple job
instructions. (Tr. 510) Yet Dr. Rao’s treatment notes consistently indicate that Plaintiff had an
adequate fund of knowledge, intact abstract reasoning, thought associations within normal limits,
and normal thought content. (Tr. 383-84, 388-89)8 Finally, as Defendant points out, there are no
objective findings in Dr. Rao’s treatment notes to support an opinion that Plaintiff had fair or
poor ability to interact with supervisors, function independently, deal with work stress, follow
8

Also, Dr. Rao’s conclusion in this regard is contradicted by Dr. MacDonald’s opinion.
Dr. MacDonald thought Plaintiff capable of following at least simple instructions. (Tr. 518)
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work rules, or relate to coworkers. Therefore, the ALJ was justified in discounting Dr. Rao’s
opinions. See Davidson v. Astrue, 578 F.3d 838, 842 (8th Cir. 2009)(explaining that “[i]t is
permissible for an ALJ to discount an opinion of a treating physician that is inconsistent with the
physician’s clinical treatment notes”).
The ALJ also considered the conservative nature of Plaintiff’s treatment. Plaintiff’s
treatment with Dr. Rao consisted of only five 15-minute appointments to manage his
medications, and these appointments decreased in frequency over time, with some significant
gaps in office visits. Furthermore, Dr. Rao apparently never recommended Plaintiff undergo
therapy or counseling. (ECF No. 24-1 at 8) (citing Tr. 376-77, 382, 384, 387, 389, 392) Based
on the record, an ALJ could reasonably conclude that Dr. Rao’s treatment was not the type of
intensive treatment that is consistent with the type of disabling limitations Dr. Rao suggested.
Such conservative treatment is a proper ground upon which to discount a physician’s opinion.
See Perkins v. Astrue, 648 F.3d 892, 898-99 (8th Cir. 2011) (holding that an ALJ properly
discounted a treating physician’s opinion where, among other flaws, the treating physician’s
opinion was inconsistent with the conservative nature of the treatment rendered).
Contrary to Plaintiff’s arguments, an ALJ can discount a claimant’s GAF scores. In fact,
the Eighth Circuit recently explained that “GAF scores have limited importance” because they
have “no direct correlation to the severity of the mental disorder listings.” Nowling v. Colvin,
813 F.3d 1110, 1115-16 n. 3 (8th Cir. 2016). More importantly to this case, Plaintiff’s worst
GAF scores—ranging from 25-50 which would normally reflect serious mental impairments—
were taken before Plaintiff began mental health treatment with Dr. Rao in June of 2013; Plaintiff
experienced general improvement with that treatment. (See, e.g., 378, 383-84, 392-94) By April
of 2014, Plaintiff reported that he was “steady and stable.” (Tr. 392) Given the timing of the

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GAF scores and their inconsistency with other, later evidence in the record, as well as the limited
value of such scores, the Court finds that the ALJ did not err in discounting Plaintiff’s scores.
See Wright v. Colvin, 789 F.3d 847, 855 (8th Cir. 2015) (finding that “substantial evidence
support[ed] the ALJ’s decision not to give weight to [claimant’s] GAF score because GAF scores
have no direct correlation to the severity standard used by the Commissioner”) (citing 65
Fed.Reg. 50746, 50764-65); Halverson v. Astrue, 600 F.3d 922, 931 (8th Cir. 2010).
The ALJ would also be justified in discounting Dr. Rao’s opinion evidence to the extent
it was conclusory, in checklist form, and it failed to cite objective evidence in support thereof.
See Toland v. Colvin, 761 F.3d 931, 937 (8th Cir. 2014) (holding that an ALJ may discount a
conclusory medical opinion). Further, the ALJ did not need to credit Dr. Rao’s opinion that
“Patient cannot perform any work,” to the extent that opinion addressed an issue reserved to the
Commissioner. See Miller v. Colvin, 784 F.3d 472, 479 (8th Cir. 2015) (noting that the ultimate
disability determination is reserved to the ALJ). For all of these reasons, substantial evidence
supports the ALJ’s decision to discount Dr. Rao’s opinion.
As to Plaintiff’s contention that this case should be remanded because the ALJ referred to
Dr. Rao as a “treating physician” instead of a “treating psychiatrist,” the undersigned finds that
any error, if there was indeed error, was harmless. It is more likely, however, that the ALJ made,
at most, a simple typographical mistake because both the hearing testimony and Dr. Rao’s
treatment records clearly indicate that the ALJ knew that Dr. Rao was a psychiatrist.
Giving Plaintiff the benefit of the doubt and assuming there was error, any such error was
harmless because it is clear that the ALJ would have discounted Dr. Rao’s opinion even if it were
due more deference because of Dr. Rao’s psychiatric specialty. The undersigned reaches this
conclusion in view of the many reasons the ALJ gave for discounting Dr. Rao, including that the

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opinion was: (1) inconsistent with Dr. Rao’s own treatment notes; (2) unsupported by objective
evidence in the treatment notes and the medical record; (3) inconsistent with the conservative
treatment that Dr. Rao provided; (4) conclusory and in checklist form, without citation of
medical evidence; and (5) on an issue ultimately reserved to the Commissioner. The Court is
convinced that all of these grounds for discounting Dr. Rao’s opinion would have led the ALJ to
discount Dr. Rao’s opinion, even assuming that the ALJ should have accorded slightly more
weight to Dr. Rao as a medical specialist. Because any error in this regard is harmless, remand is
not necessary.
2.

Dr. Rucker’s Opinion

Plaintiff next argues that the ALJ erred in his treatment of Dr. Rucker’s opinion. As
noted above, Dr. Rucker provided a consultative examination of Plaintiff and opined that
Plaintiff could stand for only 15 minutes at a time and walk for only 50 yards. (Tr. 272) Dr.
Rucker also opined that Plaintiff would have issues “bending, stooping, and lifting from the
floor,” as well as “major problem[s]” with getting up for work and staying awake due to
narcolepsy. (Id.) Plaintiff makes several arguments in support of his contention that the ALJ
erred in evaluating this opinion evidence.
First, Plaintiff argues that Dr. Rucker’s conclusions concerning standing, walking, and
lifting requirements were supported by objective medical evidence, and therefore, it was
improper to discount them. Second, Plaintiff argues that the ALJ failed to address the “majority”
of Dr. Rucker’s findings. Next, Plaintiff disputes the ALJ’s finding that Dr. Rucker’s opinion
was inconsistent with Plaintiff’s treatment history, arguing that the ALJ did not reference “any
specific inconsistency.” Lastly, Plaintiff takes issue with the ALJ discounting Dr. Rucker’s
opinion based upon its timing—Plaintiff argues that there was nothing to indicate that Plaintiff’s

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condition would improve, so the fact that the opinion occurred early in the disability period was
irrelevant. Defendant argues that Dr. Rucker’s opinion was properly discounted.
The undersigned finds that substantial evidence supports the ALJ’s treatment of Dr.
Rucker’s opinions. First, the ALJ correctly noted that Dr. Rucker’s opinion was arguably
inconsistent with his own findings. For example, in his physical examination, Dr. Rucker found
that Plaintiff’s “[g]ait is normal without assistive device. This patient is able to walk on toes and
heels.” (Tr. 268) Yet, Dr. Rucker then says that Plaintiff has an “[e]xtreme limp,” and can only
walk for 50 yards.” (Tr. 272) Inconsistency between a doctor’s treatment notes and his or her
opinion evidence is a proper ground upon which to discount that doctor’s opinion. Davidson,
578 F.3d at 842.
Furthermore, and perhaps more significantly, Dr. Rucker’s findings were also
inconsistent with objective imaging performed a month and a half later. Imaging of Plaintiff’s
back revealed “normal alignment of the vertebral bodies,” and “no fracture or subluxation,” but
instead only “mild degenerative disc disease,” and some “mild disc space narrowing and spur
formation.” (Tr. 278) Imaging of Plaintiff’s ankle showed “no evidence for acute fracture or
dislocation.” (Id.) Such inconsistencies between with the objective medical evidence provide a
valid reason to discount a medical opinion. See Cline v. Colvin, 771 F.3d 1098, 1103 (8th Cir.
2014) (discounting a medical opinion where it is inconsistent with medical evidence).
Also, Dr. Rucker’s opinions can reasonably be read to suggest that he was, at least in
part, relying on Plaintiff’s own subjective statements in order to form his opinion. (See Tr. 272,
opining that “if subjective info is true,” Plaintiff’s narcolepsy would cause “major problem[s]”
with getting up for work, and staying awake); (see also Tr. 266, noting that the source for Dr.
Rucker’s information is Plaintiff himself) As discussed below, Plaintiff’s credibility was

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properly discounted, so the ALJ properly discounted Dr. Rucker’s opinion to the extent that it
relied on Plaintiff’s subjective allegations.
Regarding the timing of Dr. Rucker’s opinion, the ALJ’s conclusion that the opinion was,
in effect, premature is supported by substantial evidence. Dr. Rucker’s regarding Plaintiff’s
narcolepsy allegations occurred before Plaintiff received effective treatment. As mentioned
earlier, Plaintiff’s narcolepsy began to improve in March 2013, after he began routine treatment
and Adderall. Dr. Rucker’s evaluation of Plaintiff, meanwhile, took place in November of 2012.
The opinion’s relevance to the narcolepsy issue, therefore, is clearly attenuated.
Finally, Plaintiff was receiving only conservative treatment for physical injuries that were
supposedly disabling. For example, Plaintiff did not seek regular treatment for his foot pain after
Dr. Rucker’s opinion, and as the ALJ noted, Plaintiff sometimes went months at a time without
seeking treatment for his musculoskeletal issues. (Tr. 26) (noting no such treatment between
August, 2013 and February, 2014). This is another valid reason to discount Dr. Rucker’s
opinion. Perkins, 648 F.3d at 898-99.9 Dr. Rucker’s opinion was therefore properly discounted.
3.

Dr. MacDonald’s Opinion

Plaintiff also argues that the ALJ erred in discounting Dr. MacDonald’s opinion. Dr.
MacDonald diagnosed Plaintiff with depression. Dr. MacDonald opined that depression limited
Plaintiff’s mental abilities, and found that Plaintiff qualified for “medical assistance” under
Medicaid. (Tr. 520) First, Plaintiff argues the ALJ improperly discounted Dr. MacDonald
because Dr. MacDonald was not a treating source. Next, Plaintiff alleges the ALJ did not use the
factors listed at 20 C.F.R. § 404.1527(c) to evaluate Dr. MacDonald’s opinion. Third, Plaintiff
9

Plaintiff’s argument in response that the ALJ failed to consider that the conservative
treatment was due to Plaintiff’s inability to afford treatment is unavailing. Although it is true
that Plaintiff did not have medical insurance for a period, he obtained Medicaid by late 2012 (Tr.
39, 48) and yet still underwent the same conservative treatment.
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contests the ALJ’s decision to discount Dr. MacDonald’s decision because it was reached under
Medicaid rules, not Social Security rules. Finally, Plaintiff disputes the ALJ’s contention that
Dr. MacDonald’s “opinion is contrary to her own findings.” Defendant argues that the ALJ
properly discounted Dr. MacDonald’s opinion.
Substantial evidence supports the ALJ’s treatment of Dr. MacDonald’s opinion. First, it
was not error for the ALJ to acknowledge that Dr. MacDonald did not treat Plaintiff, and
therefore give correspondingly less weight to that opinion. Indeed, that is a factor that ALJ’s are
supposed to take into account in assigning weight to a medical opinion under § 404.1527(c), and
this also undercuts Plaintiff’s arguments that the ALJ failed to consider the § 404.1527(c)
factors.
Further, the fact that Plaintiff was entitled to Medicaid is not dispositive of his disability
status under Social Security. The ALJ could take into account the fact that Dr. MacDonald’s
findings were made under a “different set of rules and regulations,” which did not bind the
Commissioner. See Pelkey v. Barnhart, 433 F.3d 575, 579 (8th Cir. 2006) (“[T]he ALJ is not
bound by the disability rating of another agency when he is evaluating whether the claimant is
disabled for purposes of social security benefits.”).
Substantial evidence in the record also supports the ALJ’s conclusion that Dr.
MacDonald’s conclusion that Plaintiff cannot work was inconsistent with her own mental-status
examination of Plaintiff. For example, Dr. MacDonald’s mental-status exam revealed: (1)
Plaintiff exhibited generally normal behavior; (2) he was in the average range for intelligence;
(3) he had the ability to recall and follow simple instructions; (4) he was neat and clean in
appearance; (5) he had adequate eye contact; was cooperative; and (6) he had no difficulty
relating to Dr. MacDonald. (Tr. 518) These findings are at least arguably inconsistent with Dr.

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MacDonald’s opinion that Plaintiff was completely disabled. See Davidson, 578 F.3d at 842
(holding that inconsistency between a doctor’s own treatment notes and his subsequent medical
opinion is a proper ground upon which to discount that doctor’s opinion).
Finally, the objective medical evidence cited in support of the ALJ’s decision to discount
the opinions of Drs. Rao and Rucker is also applicable here. (See, e.g., Tr. 25, discussing and
citing objective medical evidence that does not support disabling limitations caused by Plaintiff’s
narcolepsy); (Tr. 25-26, discussing objective medical evidence, including diagnostic testing, that
fails to support Plaintiff’s allegations of musculoskeletal disability); and (Tr. 26, discussing the
objective medical evidence regarding Plaintiff’s depression, and noting that it does not support
the level of disability claimed by Plaintiff). Because Dr. MacDonald’s opinion was not
consistent with the cited objective medical evidence, the ALJ permissibly discounted the
opinion.
Plaintiff’s argument that Dr. MacDonald’s opinion is supportable due to consistency with
Dr. Rao’s opinion is not persuasive. As discussed above, the ALJ properly discounted each
opinion. The fact that Dr. Rao’s opinion is consistent with Dr. MacDonald’s opinion does not
necessitate a conclusion that Dr. MacDonald’s opinion is entitled to greater weight. Moreover,
as a factual matter Dr. Rao’s opinion and Dr. MacDonald’s opinion are not entirely consistent.
Rather, their respective opinions differ in significant and material respects. Whereas Dr. Rao
thought Plaintiff had no ability to follow even simple instructions, and had severe cognitive
impairments, Dr. MacDonald opined that Plaintiff’s intellectual functioning was “in the average
range,” and his ability to complete complex math problems was “intact.” Attention was
“somewhat impaired,” but he maintained an “ability to recall follow simple instructions.” (Tr.
518) Thus, the ALJ did not err in failing to consider the consistencies between these opinions.

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For all of these reasons, the ALJ properly discounted Dr. MacDonald’s opinion.
B.

Plaintiff’s Credibility

Plaintiff also argues that the ALJ improperly discounted his credibility. In particular,
Plaintiff argues that the ALJ gave “few reasons” for discounting his credibility. (ECF No. 19 at
14) Plaintiff also accuses the ALJ of using “boilerplate language” in his analysis, and placing
too much emphasis on Plaintiff’s activities of daily living. (Id.) Defendant responds by arguing
that the ALJ gave sufficient and proper reasons for discounting Plaintiff’s credibility.
Credibility determinations are “the province of the ALJ, and as long as ‘good reasons and
substantial evidence’ support the ALJ’s evaluation of credibility,” this Court will defer to that
decision. Julin, 826 F.3d at 1086 (quoting Guilliams v. Barnhart, 393 F.3d 798, 801 (8th Cir.
2005)). An ALJ “may decline to credit a claimant’s subjective complaints ‘if the evidence as a
whole is inconsistent with the claimant’s testimony.’” Julin, 826 F.3d at 1086 (quoting Cox v.
Barnhart, 471 F.3d 902, 907 (8th Cir. 2006)). In evaluating Plaintiff’s credibility regarding the
extent of his symptoms, an ALJ must consider all of the evidence, including objective medical
evidence, and evidence relating to the factors enumerated in Polaski v. Heckler, 739 F.2d 1320,
1322 (8th Cir. 1984), including: (1) Plaintiff’s daily activities; (2) the duration, frequency, and
intensity of Plaintiff’s pain; (3) precipitating and aggravating factors; (4) the dosage,
effectiveness, and side effects of medication; and (5) Plaintiff’s functional restrictions. See Julin,
826 F.3d at 1086; see also 20 C.F.R. § 416.929(c). The ALJ, however, need not specifically cite
Polaski, or specifically discuss each Polaski factor. See Goff v. Barnhart, 421 F.3d 785, 791 (8th
Cir. 2005); Strongson v. Barnhart, 361 F.3d 1066, 1072 (8th Cir. 2004).
In this case, the ALJ gave good reasons and substantial evidence supports the ALJ’s
credibility findings. As an initial matter, Plaintiff mischaracterizes the ALJ’s credibility analysis

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as a “conclusory statement.” Plaintiff points to language from the ALJ’s decision holding that
“the credibility of [Plaintiff’s] allegations is weakened by evidence of diverse daily activities,
significant work activity, and inconsistencies between [Plaintiff’s] allegations and the medical
records for the relevant period.” (ECF No. 19 at 14) (quoting Tr. 28) Plaintiff calls this
“boilerplate language.” Plaintiff’s argument in this regard ignores the entirety of the ALJ’s
credibility analysis.
Contrary to Plaintiff’s argument, the ALJ did not simply make a conclusory credibility
finding at the end of his analysis. Rather, the ALJ dedicated several pages of his decision to his
credibility analysis, and cited several pieces of relevant evidence to support his conclusions. (Tr.
25-28) The ALJ methodically considered the relevant medical evidence concerning Plaintiff’s
severe impairments—narcolepsy, foot and back pain, and depression. (Tr. 25-26) Regarding
each impairment, the ALJ noted objective medical evidence that detracted from Plaintiff’s
subjective allegations. A lack of objective medical evidence to support assertions of disabling
pain is a proper ground upon which to discount a plaintiff’s credibility. See Ramirez v. Barnhart,
292 F.3d 576, 584 (8th Cir. 2002); see also 20 C.F.R. § 404.1529 (“Objective medical evidence
[] is a useful indicator to assist us in making reasonable conclusions about the intensity and
persistence of your symptoms and the effect those symptoms, such as pain, may have on your
ability to work.”). The medical evidence here provides substantial evidence supporting the
ALJ’s decision to discount Plaintiff’s credibility.
The ALJ also relied on Plaintiff’s daily activities in discounting Plaintiff’s credibility.
The ALJ noted that Plaintiff had “no appreciable difficulties with personal care activities,” and
“helped with food preparation on a daily basis.” (Tr. 27, citing Tr. 223-24) Plaintiff took part in
major household chores, such as cooking, doing dishes, dusting, and laundry. Also, Plaintiff

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went outside on a daily basis, shopped for groceries, and enjoyed “coffee talk” with friends. (Tr.
27; 224-26) These types of activities, while perhaps not in and of themselves evidence of an
ability to work, when combined with the other evidence the ALJ relied on, are inconsistent with
allegations of complete disability. See Clevenger v. Social Sec. Admin., 567 F.3d 971, 976 (8th
Cir. 2009) (agreeing that activities such as doing laundry, washing dishes, changing sheets,
ironing, preparing meals, driving, attending church, and visiting friends and relatives supported
an ALJ’s decision to discount a plaintiff’s assertions of disabling pain).
Additionally, the ALJ’s conclusion that Plaintiff was receiving less intensive care than
would be expected from a disabled individual was appropriate and supported by the record. As
noted above regarding the medical opinion evidence, Plaintiff received only five 15-minute
sessions with Dr. Rao for routine medication refill. Also, the frequency of Plaintiff’s sessions
with Dr. Rao trailed off toward the beginning of 2014, and Dr. Rao never recommended
additional or more intensive treatment. These are proper grounds upon which to discount
Plaintiff’s credibility. See Moore v. Astrue, 572 F.3d 520, 524-25 (8th Cir. 2009) (holding that it
is appropriate for an ALJ to consider conservative or minimal treatment in assessing credibility).
Finally, the ALJ considered Plaintiff’s poor work history. As the ALJ noted, Plaintiff has
a “very sporadic work history” which calls into question his dedication to seeking work. This is
a proper consideration for the ALJ. See Wildman v. Astrue, 596 F.3d 959, 968-69 (8th Cir.
2010) (discounting a plaintiff’s credibility for, among other reasons, “a sporadic work history
before her disability onset date”).

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In sum, the ALJ gave several legitimate reasons for discounting Plaintiff’s credibility.
Because the ALJ gave good reasons, that determination is entitled to deference by this Court.
Buckner, 646 F.3d at 558.10
VI.

Conclusion
For all of the foregoing reasons, Plaintiff’s arguments are unavailing. The ALJ carefully

evaluated the evidence, cogently articulated his reasons for finding Plaintiff not disabled, and
gave Plaintiff a full and fair hearing. The ALJ’s decision is supported by substantial evidence.
Accordingly,
IT IS HEREBY ORDERED that the decision of the ALJ in this matter is AFFIRMED.
/s/ John M. Bodenhausen
UNITED STATES MAGISTRATE JUDGE
Dated this 31st day of January, 2017

10

Defendant argues that Plaintiff makes a third point—the ALJ’s RFC is not supported
by substantial evidence. After reviewing Plaintiff’s brief, the Court does not see such an
argument. Plaintiff has only raised arguments relating to opinion evidence and his credibility.
Therefore, the undersigned does not have reason to further consider the RFC.
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