Kuntz v. Astrue
Filing
18
ORDER and OPINION affirming final decision. Signed on 04/05/2012 by District Judge Ortrie D. Smith. (Will-Fees, Eva)
IN THE UNITED STATES DISTRICT COURT FOR THE
WESTERN DISTRICT OF MISSOURI
WESTERN DIVISION
DEBRA LYNN KUNTZ,
Plaintiff,
vs.
MICHAEL J. ASTRUE,
Commissioner of Social Security,
Defendant.
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Case No. 11-0480-CV-S-ODS
ORDER AND OPINION AFFIRMING FINAL DECISION
Pending is Plaintiff's request for review of the final decision of the Commissioner
of Social Security denying her disability applications. The Commissioner's decision is
affirmed.
I. BACKGROUND
Plaintiff is a 49-year-old female with past work as an order filler. The ALJ found
Plaintiff suffered from the following severe impairments: degenerative disc disease of
the cervical spine with right shoulder radiculopathy as of November 2008; and mild
asthma.
The ALJ determined that, with certain nonexertional limitations, Plaintiff retained
the ability to perform medium work through September 2008 and light work thereafter.
(Plaintiff was injured in a motor vehicle collision in October 2008.) According to a
vocational expert (VE) who testified at the hearing, a hypothetical worker with abilities
matching those the ALJ found Plaintiff to retain through September 2008 could perform
Plaintiff’s past work as an order filler. The VE also testified that a hypothetical worker
limited to light work with the nonexertional limitations found by the ALJ would be able to
work as an usher, photocopy machine operator, and electrical subassembler. Based on
the VE’s testimony the ALJ found Plaintiff was able to perform her past work through
September 2008 and was thereafter able to make a successful adjustment to other work
that exists in significant numbers in the national economy, precluding a finding of
disability.
II. DISCUSSION
.
The Court must affirm the ALJ's decision if it is supported by substantial evidence
on the record as a whole. Perkins v. Astrue, 648 F.3d 892, 897 (8th Cir. 2011).
Substantial evidence is relevant evidence a reasonable mind would accept as adequate
to support a conclusion. Id. Evidence that both supports and detracts from the ALJ's
decision must be considered. Id. If two inconsistent positions can be drawn from the
evidence, and one of those positions represents the ALJ's decision, it will be affirmed.
Id.
Plaintiff first contends the ALJ’s residual functional capacity (RFC) assessment is
not based on medical evidence. Brief, Doc. 14, p. 17. But in her argument Plaintiff
does not reference the ALJ’s RFC assessment. Rather, she relies on the ALJ’s finding
that Plaintiff’s impairments of anxiety and a history of methamphetamine abuse were
not severe. Id. at p. 18-19. This finding—at step two of the analysis—properly occurred
before the RFC assessment. See 20 C.F.R. § 404.1520(a)(4)(ii), (iv). Plaintiff has not
established that the ALJ’s RFC assessment lacks medical evidence supporting it.
Plaintiff next argues the ALJ’s RFC assessment—which contains no mental
limitations—is not supported by substantial evidence in the record as a whole because
the ALJ failed to consider her Global Assessment of Functioning (GAF) scores and find
mental limitations based on them.1 At least one of her scores was determined by Rick
D. Thomas, PhD, who performed a consultative examination of her. He assessed her
as having a GAF rating of 50.2 He also noted she had another GAF rating of 50 the
1
A GAF score indicates a clinician's judgment of an individual's overall level of
functioning. American Psychiatric Association, Diagnostic and Statistical Manual of
Mental Disorders 32 (4th ed. text rev. 2000).
2
A GAF rating in the 41–50 range reflects an individual with “[s]erious symptoms
(e.g., suicidal ideation, severe obsessional rituals, frequent shoplifting) OR any serious
past year, although it is unclear whether this rating was determined by him or someone
else.
Just because the ALJ did not discuss Plaintiff’s GAF ratings does not mean he
did not consider them. See Craig v. Apfel, 212 F.3d 433, 436 (8th Cir. 2000). And the
ALJ’s RFC assessment is supported by substantial evidence in the record as a whole
notwithstanding Plaintiff’s GAF ratings.
Plaintiff’s medical records span from 2003 to 2010. Plaintiff never received any
treatment from a psychologist, psychiatrist, or counselor. Her treatment consisted of
medications prescribed by her regular physicians. Plaintiff’s responses to this treatment
indicates her impairments were not severe.
First, in 2003 Plaintiff received insomnia medication, and a later note states she
was sleeping well. Two years later she was prescribed Effexor (used to treat
depression and anxiety), although no mental-health symptoms were noted. The record
is unclear what effect Effexor had or how long Plaintiff took it.
December 2005 was when her most frequent complaints began: she reported
depression, crying spells (once), and panic attacks. She was diagnosed with major
depressive disorder and generalized anxiety disorder, and she was treated with
depression medication and Xanax (used to treat anxiety disorder and panic disorder).
But her prescribing doctor discharged her from his care after she appeared at his clinic
in July 2006 demanding an early refill of her Xanax prescription. She was shaking,
speaking loudly, and appeared to be very anxious, so law enforcement was called. A
nurse told Plaintiff she would not receive an early refill, and she jumped out of her chair
and moved toward the nurse. The officer intervened and escorted Plaintiff out of the
clinic. A drug test performed at another location (where Plaintiff attempted to obtain
Xanax earlier that day) showed positive results for amphetamine, methamphetamine,
and THC.
After this incident in July 2006, Plaintiff saw no doctors for her mental health until
Dr. Thomas’ consultative examination on April 20, 2007. Plaintiff’s report of her
impairment in social, occupational, or school functioning (e.g., no friends, unable to
keep a job).” Diagnostic and Statistical Manual of Mental Disorders 34.
medications included no antidepressants or antianxiety drugs; in fact, she told Dr.
Thomas that she was not depressed, that she disagreed with her depression diagnosis
of her previous doctor (who had discharged her), and that she did not want any
behavioral health services. Dr. Thomas’ mental status examination revealed that
Plaintiff maintained good eye contact and showed no overt anxiety or tremors. Plaintiff
did not exhibit psychotic or harmful behavior, and she was able to remember
instructions and maintain concentration and persistence in tasks. Dr. Thomas did
however note that Plaintiff misstated the season (she said it was summer), that she had
problems completing a three-dimensional picture, and that she could not manage her
funds. Dr. Thomas also noted Plaintiff’s short-term memory was impaired and that she
had trouble remembering dates, although he also observed she displayed no memory
problems when detailing her physical complaints. There is little in Dr. Thomas’ report
that seems to justify his GAF rating of 50 for Plaintiff.
Plaintiff’s next medication treatment for mental-health symptoms was over 2
years later, on October 20, 2009. This was approximately 2 months before the ALJ
denied her applications. She reported experiencing panic attacks, lots of crying,
depression, and anxiety, and she was assessed with depression and anxiety disorder.
She was prescribed Celexa (an antidepressant). Evidence indicates however that the
severe symptoms she was reporting were of recent onset. Plaintiff had reported that a
stressful event—the passing of a good friend from an asthma attack—occurred just 2
weeks previously. Also, her neurologist noted during a mental status examination in
September 2009 (the month before) that she was pleasant and cooperative and that her
mood was appropriate and positive. The neurologist additionally noted her attention
span and concentration appeared normal and that she appeared to understand
everyday activities and their consequences, her own personal needs, and her current
medical situation.
After 2 weeks of taking Celexa, Plaintiff reported on November 3, 2009, that her
anxiety was better, although she also reported difficulty going to sleep and midnight
awakening. Clonazepam (brand name Klonopin, used to treat seizures and panic
attacks) was added to Plaintiff’s prescriptions. At her next appointment on December 3,
2009, Plaintiff’s Celexa was increased, but the doctor’s note is unclear as to why this
was done. The only indication is the statement that “[c]urrent medication seems to be
helping only to a small degree,” but this statement also appeared in the November 3
note and does not specify whether it refers to her mental health prescriptions or the
others she was taking. In any event, the increase in her Celexa (with continued use of
Klonopin as needed) apparently was helpful because she did not seek any treatment
again until an eye exam in July 2010. In filling out a form at that appointment asking
about her health, she did not check the blank for mental/emotional problems.
Plaintiff is correct that a GAF rating of 50 indicates serious mental health
symptoms, but given the other evidence in the record the ALJ’s decision not to include
any mental limitations in his RFC assessment is supported by substantial evidence in
the record as a whole.
III. CONCLUSION
The Commissioner’s final decision is affirmed.
IT IS SO ORDERED.
DATE: April 5, 2012
/s/ Ortrie D. Smith
ORTRIE D. SMITH, SENIOR JUDGE
UNITED STATES DISTRICT COURT
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