Ehlers v. Berryhill
MEMORANDUM AND ORDER: IT IS HEREBY ORDERED that the decision of the Commissioner is AFFIRMED, and Plaintiffs Complaint is DISMISSED with prejudice. A separate judgment will accompany this Order.. Signed by District Judge John A. Ross on 9/16/19. (KKS)
UNITED STATES DISTRICT COURT
EASTERN DISTRICT OF MISSOURI
ANDREW SAUL, 1
Acting Commissioner of Social Security,
Case No. 4:18-CV-01010 JAR
MEMORANDUM AND ORDER
This is an action under 42 U.S.C. § 405(g) for judicial review of the Commissioner of
Social Security's final decision denying Plaintiff Molly Ehlers's application for disability
insurance benefits under Title II of the Social Security Act, 42 U.S.C. §§ 401, et seq. For the
reasons set forth below, the Commissioner's decision will be affirmed. 2
Andrew Saul is now the Commissioner of Social Security. Pursuant to Rule 25(d) of the
Federal Rules of Civil Procedure, Andrew Saul should be substituted for Acting Commissioner
Nancy A. Berryhill 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. §
Plaintiff expressed concern in her briefing regarding her lack of legal representation in
this appeal and requests in her reply brief that the Court assign counsel. As the Court stated in its
Order dated October 3, 2018, "There is no constitutional right or statutory right to appointed
counsel in civil cases." Phillips v. Jasper County Jail, 437 F .3d 791, 794 (8th Cir. 2006). Here,
Plaintiff competently raised her legal challenges to the ALJ's decision and properly briefed them
for the Court's consideration. As stated previously, the issues in this social security case are not
overly complex and the record medical evidence is limited in time and scope. Thus, to the extent
Plaintiff requests appointment of counsel, that request will be denied.
On January 16, 2015, Plaintiff protectively filed an application for disability insurance
benefits under Title II of the Social Security Act, 42 U.S.C. §§ 401, et seq. Plaintiff was 27
years old at the time of filing, and she alleged disability beginning May 17, 2014 through March
31, 2016, the date she was last insured.
The claim was initially denied on March 25, 2015. Thereafter, Plaintiff requested, and
was granted, a hearing before an Administrative Law Judge ("ALJ"), which took place on
December 9, 2016. On May 30, 2017, the ALJ issued a written decision upholding the denial of
benefits. Plaintiff requested review of the ALJ's decision by the Appeals Council. On April 16,
2018, the Appeals Council denied her request for review. Thus, the decision of the ALJ stands
as the final decision of the Commissioner. See Sims v. Apfel, 530 U.S. 103, 107 (2000).
Decision of the ALJ
The ALJ determined that Plaintiff meets the insured status requirements of the Social
Security Act through March 31, 2016, and had not engaged in substantial gainful activity since
May 17, 2014, the alleged onset date of disability. The ALJ found Plaintiff had the severe
impairments of narcolepsy, bipolar disorder, and mood disorder, but that no impairment or
combination of impairments met or medically equaled the severity of one of the listed
impairments in 20 C.F.R. Part 404, Subpart P, Appendix 1.
Plaintiff also claimed disability due to anemia, polycystic ovarian syndrome, arthritis,
scoliosis, and sickle cell anemia. The ALJ concluded that Plaintiff's anemia was not among
Plaintiff's disabling impairments because a March 2015 examination reflects that Plaintiff
reported that her anemia had corrected itself. Likewise, the ALJ concluded that there was no
evidence in the record to suggest that Plaintiff was diagnosed with sickle cell anemia.
As to the polycystic ovarian syndrome, the ALJ noted that Plaintiff had not listed this
condition among her disabling impairments in her application and failed to provide evidence that
the condition imposes any work-related limitations.
With regard to Plaintiff's arthritis and
scoliosis, the ALJ concluded that there were no records from any medical professional
diagnosing Plaintiff with these conditions, and the imaging of her knee and cervical spine were
insufficient to establish a medically determinable impairment,
The ALJ determined that Plaintiff had the residual functional capacity ("RFC") to
perform medium work, except she was precluded from climbing ladders, ropes or scaffolds; she
was unable to work around unprotected heights or dangerous machinery; she was precluded from
driving automobile equipment and working around large bodies of water or open flames; she
could perform simple, routine tasks involving no more than simple, short instructions and simple
work related decisions with few workplace changes; she could engage in occasional and nontransactional interaction with the general public; and she could sustain concentration and
attention for two-hour periods.
The ALJ found Plaintiff unable to perform any past relevant work; however, based on her
age, education, work experience, and RFC, the ALJ determined there were jobs that existed in
significant numbers in the national economy that Plaintiff could perform, including cleaner II,
hand packager, and silver wrapper. Thus, the ALJ concluded that Plaintiff had not been under a
disability from the alleged onset date of May 17, 2014 through March 31, 2016, the date last
The following is a summary of the relevant evidence before the ALJ.
The ALJ held a hearing in this matter on December 9, 2016, in Mobile, Alabama, where
Plaintiff was residing at the time. The ALJ heard testimony from Plaintiff and Gail E. Jarrell, an
impartial vocational expert. Plaintiff was represented by counsel at the hearing.
Plaintiff testified at the hearing as follows. Plaintiff has an associate's degree and has
held several different jobs. Most recently she was employed as a housekeeping supervisor with
Marriott Hotels from 2011 to May 2014. In 2006 and 2007, Plaintiff worked in the floral
department at Randall Foods and Drugs. In 2007, she also worked the register at Bucky's Ltd.
Plaintiff was employed as a filing clerk at South Shore Medical Center between 2005 and 2007,
and that employment was secured through her school.
Plaintiff began treating with James Hunter, M.D., for her narcolepsy after she and her
family moved for her husband's job. Plaintiff's husband is a member of the military and is
deployed for periods of time. Plaintiff initially had trouble with the medication-Adderallprescribed for her narcolepsy. However, she eventually switched to Vyvanse, which has been
treating her symptoms. Plaintiff discontinued Vyvanse between December 2015 and August
2016, while she was pregnant with twins (between December 2015 and August 2016). The twins
were born prematurely, and Plaintiff suffered from postpartum depression.
The Court's standing Case Management Order in social security cases requires the parties
to file a statement of facts. The parties are not in compliance with that requirement. The Court
notes that Plaintiff is representing herself and grants her some leeway. However, there is no
excuse for the Commissioner's noncompliance. Future failure to comply with Case Management
Orders may result in the Court issuing sanctions, including striking the Commissioner's answer
to the claimant's brief.
Plaintiff relies heavily on her husband for assistance with housework and the children; it
was her testimony that she did the "bare minimum" when she was home alone. When asked by
the ALJ whether Plaintiff was the primary caregiver at home, she responded "I would say my
husband is, more than I am." (Tr. at 13).
Since the twins were born, Plaintiff stated that her husband had been given special hours
so that he was able to be at home more often. While her husband was at work, she drove her
four-year-old son to school, where she was also a "room mother" at, his classroom. Then, she
took care of the twins, who were six months old on the day of the hearing.
Before the twins were born, Plaintiff's husband was deployed for weeks at a time, and
Plaintiff, with the aid of a nanny, cared for her son, who was three years old at the time. The
nanny would take care of the house and do the dishes and the laundry.
Plaintiff primarily experiences excessive daytime sleepiness and fatigue. She describes
her condition as being "half asleep at all times." (Tr. 23). However, at night, she has trouble
falling asleep and generally feels sad and depressed. Plaintiff would take naps when she was
employed, and she stated "And back then, I didn't even realize that disability was an option, so I
thought that I just had to do whatever I could do to make it work." (Tr. at 24-25). Plaintiff and
her husband and children traveled to Texas in November 2016 to attend Plaintiff's high school
reunion. Plaintiff is able to drive and has no physician-imposed driving restrictions.
Testimony of Vocational Expert
The ALJ asked vocational expert, Gail Elizabeth Jarrell, the following questions:
All right. For hypothetical number one, let's assume an individual the claimant's
age, education and vocational experience. The individual can perform medium
work. Based on the diagnosis of narcolepsy, no climbing of ladders, ropes or
No work around unprotected heights or dangerous machinery. No driving of
automotive equipment. No work around large bodies of water or open flames. Can
perform unskilled work, simple, routine tasks involving no more than simple,
And simple work related decisions with few workplace changes. Occasional and
non-transactional interaction with the general public. Can sustain concentration
and attention for two hour periods. Could the individual perform the claimant's
No, because the only job that was unskilled is with the public, retail cashier.
Is there other work in the national economy you can identify?
(Tr. 32). The vocational expert then went on to identify the jobs of agricultural worker, hand
packager, and cleaner II.
When the ALJ posed a second hypothetical leaving all previous
limitations in place but adding limitations of the inability to sustain concentration and attention
for two hour periods because of excessive sleeping due to narcolepsy symptoms, the vocational
expert testified that the individual would be unemployable.
Upon examination by Plaintiff's counsel, counsel asked the vocational expert to assume
the same limitations posed in the second hypothetical but add that the individual would be
routinely late for work. The vocational expert responded that her opinion would be that the
individual would not be able to maintain employment.
The ALJ summarized Plaintiff's medical records in her decision.
These and other
pertinent records are discussed as part of the analysis.
The Social Security Act defines as disabled a person who is "unable 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 twelve months." 42 U.S.C. § 1382c(a)(3)(A); see
also Brantley v. Colvin, 2013 WL 4007441, at *2 (E.D. Mo. Aug. 2, 2013). The impairment
must be "of such severity that [the claimant] is not only unable to do his 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, regardless of whether such work
exists in the immediate area in which she lives, or whether a specific job vacancy exists for her,
or whether she would be hired if she applied for work." 42 U.S.C. § 1382c(a)(3)(B).
Under the Social Security Act, the Commissioner has established a five-step process for
determining whether a person is disabled. 20 C.F.R. §§ 416.920(a), 404.1520(a). "Ifa claimant
fails to meet the criteria at any step in the evaluation of disability, the process ends and the
claimant is determined to be not disabled." Gojf v. Barnhart, 421 F.3d 785, 790 (8th Cir. 2005)
(quoting Eichelberger v. Barnhart, 390 F.3d 584, 590-91 (8th Cir. 2004)). First, the claimant
must not be engaged in "substantial gainful activity." 20 C.F.R. §§ 416.920(a), 404.1520(a).
Second, the claimant must have a "severe impairment," defined as "any impairment or
combination of impairments which significantly limits [claimant's] physical or mental ability to
do basic work activities." 20 C.F.R. §§ 416.920(c), 404.1520(c). "The sequential evaluation
process may be terminated at step two only when the claimant's impairment or combination of
impairments would have no more than a minimal impact on [his or] her ability to work." Page v.
Astrue, 484 F.3d 1040, 1043 (8th Cir. 2007) (quoting Caviness v. Massanari, 250 F.3d 603, 605
(8th Cir. 2001).
Third, the claimant must establish that his or her impairment meets or equals an
impairment listed in the Regulations. 20 C.F.R. §§ 416.920(d), 404.1520(d). If the claimant has
one of, or the medical equivalent of, these impairments, then the claimant is per se disabled
without consideration of the claimant's age, education, or work history. Id.
Before considering step four, the ALI must determine the claimant's residual functional
20 C.F.R. §§ 404.1520(e), 416.920(e).
RFC is defined as "the most a
claimant can do despite [her] limitations." Moore v. Astrue, 572 F.3d 520, 523 (8th Cir. 2009)
(citing 20 C.F.R. § 404.1545(a)(l)). At step four, the ALJ determines whether the claimant can
return to her past relevant work, by comparing the claimant's RFC with the physical and mental
demands of the claimant's past relevant work. 20 C.F.R. §§ 404.1520(a)(4)(iv), 404.1520(!),
416.920(a)(4)(iv), 416.920(!); McCoy v. Astrue, 648 F.3d 605, 611 (8th Cir. 2011). If the
claimant can still perform past relevant work, she will not be found to be disabled; if the claimant
cannot, the analysis proceeds to the next step. Id.
At step five, the ALJ considers the claimant's RFC, age, education, and work experience
to see if the claimant can make an adjustment to other work in the national economy. 20 C.F.R.
§§ 416.920(a)(4)(v). If the claimant cannot make an adjustment to other work, then she will be
found to be disabled. 20 C.F.R. §§ 416.920(a)(4)(v), 404.1520(a)(4)(v). Through step four, the
burden remains with the claimant to prove that she is disabled. Brantley, 2013 WL 4007441, at
*3 (citation omitted). At step five, the burden shifts to the Commissioner to establish that the
claimant maintains the RFC to perform a significant number of jobs within the national
economy. Id. "The ultimate burden of persuasion to prove disability, however, remains with the
Meyerpeter v. Astrue, 902 F. Supp. 2d 1219, 1229 (E.D. Mo. 2012) (citations
The Court's role on judicial review is to determine whether the ALJ's findings are
supported by substantial evidence in the record as a whole. Pate-Fires v. Astrue, 564 F.3d 935,
942 (8th Cir. 2009). In determining whether the evidence is substantial, the Court considers
evidence that both supports and detracts from the Commissioner's decision. Andrews v. Colvin,
791 F.3d 978, 983 (8th Cir. 2015); Cox v. Astrue, 495 F.3d 614, 617 (8th Cir. 2007). 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 because the
Court would have decided the case differently. See Krogmeier v. Barnhart, 294 F.3d 1019, 1022
(8th Cir. 2002).
To determine whether the ALJ's final decision is supported by substantial evidence, the
Court is required to review the administrative record as a whole and to consider:
( 1) The findings of credibility made by the ALJ;
(2) The education, background, work history, and age of the claimant;
(3) The medical evidence given by the claimant's treating physicians;
(4) The subjective complaints of pain and description of the claimant's physical
activity and impairment;
(5) The corroboration by third parties of the claimant's physical impairment;
(6) The testimony of vocational experts based upon prior hypothetical questions
which fairly set forth the claimant's physical impairment; and
(7) The testimony of consulting physicians.
Brandv. Sec'y ofDept. ofHealth, Educ. & Welfare, 623 F.2d 523,527 (8th Cir. 1980).
In her appeal of the Conunissioner's decision, Plaintiff argues that the ALJ's decision
regarding her RFC is not supported by substantial evidence in the record. Specifically, Plaintiff
claims that the ALJ erred in finding that her severe impairments did not include anemia,
polycystic ovarian syndrome ("PCOS"), postural orthostatic tachycardia syndrome, arthritis,
scoliosis, or cataplexy. 4 She also maintains that the ALJ's RFC determination is not supported
by the medical evidence of record or the opinions of Plaintiff's treating physician, Dr. Hunter, or
the consulting psychologist, Pamela Starkey, Psy.D.
1. The ALJ's Evaluation oflmpairments
As previously stated, the Commissioner uses a five-step evaluation to determine if a
claimant is disabled.
20 C.F.R. § 416.920(a)(4). Step two of the evaluation states that a
claimant is not disabled if her impairments are not "severe." Kirby v. Astrue, 500 F.3d 705, 70708 (8th Cir. 2007) (citing 20 C.F.R. § 416.920(a)(4)). "An impairment is not severe ifit amounts
only to a slight abnormality that would not significantly limit the claimant's physical or mental
ability to do basic work activities." Id (citations omitted). If the impairment would have no
more than a minimal effect on the claimant's ability to work, then it does not satisfy the
requirement of step two.
Page v. Astrue, 484 F.3d 1040, 1043 (8th Cir. 2007).
It is the
claimant's burden to establish that his impairment or combination of impairments are severe.
Kirby, 500 F.3d at 708. Severity is not an onerous requirement for the claimant to meet, but it is
also not a toothless standard, and the Eighth Circuit has upheld on numerous occasions the
Commissioner's finding that a claimant failed to make this showing. Id. (citing cases).
Here, Plaintiff did not meet her burden of proving that she has a severe impairment, or
combination of impairments, resulting from anemia, PCOS, postural orthostatic tachycardia
syndrome ("POTS"), arthritis, scoliosis, and cataplexy. 5 Plaintiff first claims she suffers from
Cataplexy is a transient attack of extreme generalized muscular weakness, often
precipitated by an emotional response, such as surprise, fear or anger. McNeil v. Astrue, No. 4:10
CV 2305 DDN, 2011 WL 2621705, at *1 (E.D. Mo. July 5, 2011) (citing Stedman's Medical
Dictionary, 324 (28th ed.2006)).
The Court notes that Plaintiff did not list any of these alleged impairments as medical
conditions limiting her ability to work in her disability application. (Ex. 2E at 2).
the severe impairment of anemia. Plaintiff was treated for anemia in October 2014, and her
physician directed her to take an iron supplement but noted that her lightheadedness was also
caused by her narcolepsy medication. In March 2015, Plaintiff told Dr. Starkey that her anemia
had corrected itself. Although Plaintiff argues that she has cyclical anemia6 and that it has not
resolved, there is no evidence in medical record indicating such an impairment.
Although the record reflects that Plaintiff had PCOS, there is no support in the medical
record for Plaintiffs claim that irregular menstrual cycles and "hormone irregularities" would
cause difficulties with understanding, remembering, or applying information, interacting with
others, concentrating, persisting, or maintaining pace, or adapting or managing herself.
Moreover, there is nothing linking the condition to any limitations, and Plaintiffs own belief that
PCOS plays "a huge role in [her] ability to function day-to-day and among society" is, by itself,
insufficient to establish a disabling impairment. See Guilliams v. Barnhart, 393 F.3d 798, 803
(8th Cir. 2005) ("an ALJ's finding must be supported by some medical evidence").
As to Plaintiffs alleged scoliosis and arthritis, the record contains only imaging results
from a cervical spine MRI conducted on December 18, 2013 and imaging of Plaintiffs left knee.
The results were unremarkable and insufficient to establish a medically determinable impairment
without an evaluation by a medical professional. Although Plaintiff contends that she treated
with a chiropractor, no such records were before the ALJ or this Court, and thus cannot be
Plaintiff also argues that cataplexy should have been an additional impairment. Upon
review of the ALJ' s decision, it appears that the ALJ did not evaluate cataplexy as a condition
The ALJ evaluated Plaintiffs claims of anemia and sickle cell anemia. With regard to
sickle cell anemia, the ALJ concluded that there is no evidence to suggest that such a diagnosis
exists. Plaintiff agrees and states that the treating physician may have misinterpreted Plaintiff
saying "cyclical anemia" for "Sickle Cell Anemia." (Doc. No. 14 at 3).
separate and distinct from narcolepsy, but instead as a symptom occurring in conjunction with
Here, the medical records reflect no conclusive diagnosis of cataplexy. Dr. Hunter's
records suggest that Plaintiff may have cataplexy, and his medical source statement reflects that
Plaintiffs history of hypnagogic hallucinations and episodes are "almost certainly" cataplexy.
(Ex. 20F at 1).
However, it appears that the ALJ considere~ Plaintiffs cataplexy and its
symptoms are part of her evaluation of Plaintiffs narcolepsy. Therefore, although not analyzed
as a separate medical condition, the record reflects that the ALJ considered Plaintiffs cataplexy
in making her determination that Plaintiffs narcolepsy was a severe impairment, and the record
supports the ALJ's overall conclusion the condition was being managed with medication. Brown
v. Colvin, 825 F.3d 936, 940 (8th Cir. 2016) ("The ALJ's failure to identify and analyze the
appropriate listing, although error, may not by itself require reversal so long as the record
otherwise supports the ALJ's overall conclusion.").
Lastly, Plaintiff in her brief asks if she "may be allowed to enter new record of [her]
diagnosis of postural orthostatic tachycardia syndrome." (Doc. No. 14 at 4). It appears, although
Plaintiff does not specifically state, that this diagnosis occurred after the ALJ entered her
decision and is relevant to Plaintiffs complaints of fatigue and dizziness.
The Court may review evidence submitted after the ALJ issues her decision if it is new
Bergmann v. Apfel, 207 F.3d 1065, 1069 (8th Cir. 2000).
"[T]o qualify as
"material," the additional evidence must not merely detail after-acquired conditions or postdecision deterioration of a pre-existing condition." Bergmann v. Apfel, 207 F.3d 1065, 1069-70
(8th Cir. 2000). Here, Plaintiff does not direct the Court to any portion of the record addressing
this diagnosis, nor does she submit additional medical records in support. Further, she does not
explain or provide any evidence of how the diagnosis would provide a basis for the Court to
reverse the ALJ's decision. Thus, it will not be considered by the Court.
The Court concludes that the ALJ did not err when it determined that Plaintiffs anemia,
arthritis, scoliosis, and PCOS were non-severe impairments. Further, the diagnosis of postural
orthostatic tachycardia syndrome is not before the Court and does not qualify as new and
material evidence. Thus, the Court will not reverse the ALJ's decision on that basis.
2. Medical Opinion Evidence
In her appeal of the Commissioner's decision, Plaintiff argues that the ALJ improperly
evaluated the medical opinion evidence. Specifically, she argues the ALJ improperly assigned
"no weight" to the opinion of treating physician Dr. Hunter and partial weight to psychological
consultant Dr. Starkey. In determining whether the ALJ properly considered the medical opinion
evidence, the Court's role is limited to reviewing whether substantial evidence supports this
determination, and not deciding whether the evidence supports the claimant's view of the
evidence. See Brown v. Astrue, 611 F.3d 941, 951 (8th Cir. 2010); Brown v. Colvin, No.
4:13CV01693 SPM, 2014 WL 2894937, at *5 (E.D. Mo. June 26, 2014).
Generally, "[a] treating physician's opinion regarding an applicant's impairment will be
granted controlling weight, provided the opinion is well-supported by medically acceptable
clinical and laboratory diagnostic techniques and is not inconsistent with the other substantial
evidence in the record." Reece v. Colvin, 834 F.3d 904, 908-09 (8th Cir. 2016) (citation
omitted). Although a treating physician's opinion is usually entitled to great weight, it "do[es]
not automatically control, since the record must be evaluated as a whole." Id. at 909 (citation
omitted). "The ALJ may discount or disregard such an opinion if other medical assessments are
supported by superior medical evidence, or if the treating physician has offered inconsistent
opinions." Id. (quoting Hamilton v. Astrue, 518 F.3d 607, 610 (8th Cir. 2008)). "Whether the
ALJ gives the opinion of a treating physician great or little weight, the ALJ must give good_
reasons for doing so." Id. (citing 20 C.F.R. § 404.1527(d)(2)).
Here, Dr. Hunter provided two medical source statements with similar assessments of
Plaintiff's condition. He opined that Plaintiff had all the manifestations ofnarcolepsy, including
difficulty waking up in the morning and excessive daytime sleepiness, even with stimulant
therapy. He noted that Plaintiff had a history of hypnagogic hallucinations and episodes, which
are almost certainly cataplexy, .where her muscles would go limp. Dr. Hunter concluded that
Plaintiff was "totally and permanently disabled" and that Plaintiff was incapable of performing
any work due to her difficulty in getting up consistently in the morning and her inability to stay
awake at work. Dr. Hunter stated that although Plaintiff was improving on stimulant therapy, he
had been unable to find an optimum dose due to the side effects of the medications.
The ALJ assigned no weight to Dr. Hunter's conclusory statement that Plaintiff was
permanently disabled. This determination comports with controlling social security law. See 20
C.F.R. §§ 404.1527(d), 416.927(d) ("A statement by a medical source that you are 'disabled' or
'unable to work' does not mean that we will determine that you are disabled."); Fentress v.
Berryhill, 854 F.3d 1016, 1020 (8th Cir. 2017) (holding that a physician's opinion that a claimant
is incapable of gainful employment is often not entitled to significant weight).
Upon review of Dr. Hunter's treatment records, it appears that although it took Plaintiff
some time to find a medication and dosage that was effective in treating her narcolepsy
symptoms, she reported in August 5, 2015, that Vyvanse and lmiprarnine had been helpful and
that she planned to go back to school in the spring. Hensley v. Colvin, 829 F.3d 926, 933-34
(8th Cir. 2016) ("If an impairment can be controlled by treatment or medication, it cannot be
Further, Plaintiff did not seek treatment for her narcolepsy while
pregnant, and she even discontinued taking her medications during that period, reporting to Dr.
Hunter that she was feeling "fine" without it. Thus, Dr. Hunter's statement that he had been
unable to identify an optimum dose to control Plaintiff's narcolepsy is inconsistent with his more
recent treatment notes.
See Milam v. Colvin, 794 F.3d 978, 983 (8th Cir. 2015) ("A treating
physician's own inconsistency may undermine his opinion and diminish or eliminate the weight
given his opinions.").
On March 13, 2015, Pamela Starkey, Psy.D., performed a mental examination of
Plaintiff. Dr. Starkey noted Plaintiff's failure to dress herself unless necessary, showering once
or twice per week, and occasionally washing dishes and doing laundry. Dr. Starkey diagnosed
Plaintiff with major depressive disorder and generalized anxiety disorder, with a prognosis for a
favorable response to treatment as fair, but more difficult due to Plaintiff's reported narcolepsy
and hypersomnia. Dr. Starkey then determined that Plaintiff's functional capacity to be a
follows: (1) ability to understand simple, concrete instructions appeared adequate; (2) ability to
remember and carry out simple, concrete instructions appeared mild to moderately impaired; (3)
ability to respond appropriately to supervision appeared adequate; (4) ability to respond
appropriately to coworkers appeared adequate; and (5) ability to manage common work
pressures appears significantly impaired. (Ex. 15F).
The ALJ gave partial weight to the assessment of Dr. Starkey that Plaintiff had an
adequate ability to understand simple, concrete instructions; is mild to moderately impaired in
remembering and carrying out simple concrete instructions; and can respond appropriately to
supervisors and co-workers. The ALJ determined that these conclusions were consistent with the
results of the ALJ's own in-person examination of Plaintiff.
However, the ALJ gave no weight to Dr. Starkey's assessment that Plaintiff was
significantly impaired in managing common work pressures. The ALJ reasoned that Plaintiff
was able to undergo stressful fertility treatments and was the primary caregiver for her three
children. Thus, the ALJ concluded Plaintiff's activities of daily living demonstrate that she is
capable of managing common workplace pressures.
Dr. Starkey is a one-time evaluating psychologist. In contrast to a treating physician,
"[a] one-time evaluation by a non-treating psychologist is not entitled to controlling weight."
McJames v. Barnhart, 365 F. Supp. 2d 1018, 1031 (E.D. Mo. 2005) (quoting Clarkv. Apfel, 141
F.3d 1253, 1256 (8th Cir. 1998). A consulting physician's evaluation must be evaluated in light
of the other evidence in the record. See Clark v. Apfel, 141 F.3d 1253, 1256 (8th Cir. 1998)
(holding that IQ scores were properly disregarded where they resulted from one-time assessment
of non-treating psychologist and were inconsistent with claimant's daily activities, and other
medical records made no mention of intellectual impairment).
Upon review of the record, the Court concludes that the ALJ did not err in the weight
assigned to Dr. Starkey's assessment. It appears that Dr. Starkey's assessment was largely based
on Plaintiff's subjective complaints, which are inconsistent with Plaintiff's activities of daily
living. Further, Dr. Starkey's assessment took place in 2015, before Plaintiff had the twins.
More recent records from October 2016 demonstrate that Plaintiff has been caring for three
young children by herself while her husband is deployed for weeks at a time. Plaintiff took on
the role of room mother in her son's class and was involved in organizing a Halloween event for
the coast guard unit families.
Further, Plaintiff reported taking better care of herself, including
hygiene, and attending her high school reunion in Texas. This supports the ALJ's assignment of
partial weight to Dr. Starkey's assessment of Plaintiff's functional limitations.
3. Plaintiff's Credibility
Plaintiff argues the ALJ erred in her credibility evaluation and RFC determination by
finding that Plaintiff's activities of daily living were inconsistent with her claims of disability.
Deference is given to the ALJ' s conclusion with regard to credibility determinations. Moore v.
Astrue, 572 F.3d 520, 524 (8th Cir. 2009).
In evaluating a claimant's credibility, the ALJ should consider the claimant's daily
activities; the duration, frequency, and intensity of the symptoms; precipitating and aggravating
factors; dosage, effectiveness, and side effects of medication; and functional restrictions. Polaski
v. Heckler, 739 F.2d 1320, 1322 (8th Cir.1984). The ALJ may discount subjective complaints if
there are inconsistencies in the record as a whole. Choate v. Barnhart, 457 F.3d 865, 871 (8th
Cir. 2006) (citing Wheeler v. Apfel, 224 F.3d 891, 895 (8th Cir. 2000)). The ALJ must make
express credibility determinations and set forth the inconsistencies which led to his or her
The Court will uphold an ALJ's credibility findings, so long as they are
adequately explained and supported. Ellis, 392 F.3d at 996.
The ALJ opined that in spite of Plaintiff's narcolepsy, she had a driver's license, was able
to drive, and had not been restricted from driving by any physician. The ALJ noted that in June
2015, Plaintiff reported feeling "fine" after being taken off Imipramine, and in August 2016,
Plaintiff reported that her narcolepsy was "fine" when she went off the medication during her
pregnancy. The ALJ also relied on treatment notes from August 2015, which reflected Plaintiff's
narcolepsy medications were helpful and that Plaintiff intended to go back to school in the
With regard to Plaintiff's mental impairments, the ALJ determined that Plaintiff's
condition was responsive to medication and improved over time. See Renstrom v. Astrue, 680
F.3d 1057, 1066 (8th Cir. 2012) (conditions which can be controlled by treatment are not
disabling). Further, the ALJ noted that Plaintiff stated in July 2015 that she would only agree to
commence therapy if it would help her get disability benefits. The ALJ relied on a treatment
note from November 2016, in which Plaintiff indicated she was feeling positive; that her
expression was not affecting her negatively; and that she was trying to be more socially active
and take better care of her personal hygiene. Thus, the ALJ determined that in comparing the
objective medical evidence to Plaintiff's subjective complaints, Plaintiff was more capable than
alleged. The ALJ concluded that Plaintiff "is able to care for her children, manage stressful
situations, and perform a wide range of activities of daily living."
Plaintiff contends that the ALJ's evaluation of her current situation is inaccurate and
refuted by the record. Plaintiff argues that her husband, not Plaintiff, is the primary caregiver in
the family and maintains that she does the bare minimum to survive and care for her children.
She describes a home life in which her husband works full time, takes care of the children,
manages all household duties, including cooking, cleaning, and laundry, and helps Plaintiff with
her medications. She describes her role as caregiver as laying on the couch, feeding her children,
and changing their diapers.
She claims that "Things have not been easy. We have been
struggling for so long just hoping for a little light at the end of the tunnel." (Doc. No. 19 at 6).
The Court, upon careful review of the record, finds that the evidence in this case supports
the ALJ' s credibility determination. Although Plaintiff claims that she is merely surviving, the
Court finds her description of daily life difficult to reconcile in light of the undisputed evidence
that Plaintiff is at times the sole caregiver for her three young children while her husband is
deployed, whether for one week or several weeks at a time. Heino v. Astrue, 578 F.3d 873, 881
(8th Cir. 2009) (subjective complaints of disabling physical and mental limitations were
inconsistent with claimant's daily activities as primary caregiver for two special-needs children
and doing household chores); Steed v. Astrue, 524 F.3d 872, 876 (8th Cir. 2008) (no error in
discounting credibility where self-reported limitations were inconsistent with medical evidence
and daily activities, including housework, caring for child, cooking and driving).
Further, it appears that Plaintiff's social activities are increasing, her narcolepsy is
controlled by medication, and her mental health issues are either responding to medication or
have resolved for the time being. In fact, Plaintiff declined attending therapy to treat her mental
health concerns. See Partee v. Astrue, 638 F.3d 860, 864 (8th Cir. 2011) (holding that the failure
to seek mental treatment is a relevant consideration when evaluating a claimant's mental
impairment). Plaintiff was able to be a room mother at her son's school, she participated in
organizing a Halloween event, and she attended a high school reunion. Moreover, there is no
evidence in the record that Plaintiff has been restricted from any activity, such as driving or
working, by a physician. Cf Bailey v. Astrue, No. Cl 1-0005, 2012 WL 135588, at *13 (N.D.
Iowa Jan. 17, 2012) (reversing the ALJ's denial of benefits in part because the claimant, who
was diagnosed with narcolepsy, was restricted by her physician from working more than 4 hours
in a regular workday). This demonstrates to the Court the ability to perform a level of activity
above that described by Plaintiff.
Thus, although the Court acknowledges that Plaintiff may well be experiencing difficult
circumstances at home, the record supports the ALJ's determination that Plaintiff's statements
regarding the persistence, intensity, and limiting effects of her medical conditions is not entirely
consistent with the medical evidence and other evidence in the record.
For the foregoing reasons, the Court finds the ALJ's decision is supported by substantial
evidence contained in the record as a whole, and, therefore, the Commissioner's decision should
IT IS HEREBY ORDERED that the decision of the Commissioner is AFFIRMED, and
Plaintiffs Complaint is DISMISSED with prejudice. A separate judgment will accompany this
Dated this I 6th day of September, 20 I 6.
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