Camron v. Astrue

Filing 28

MEMORANDUM OPINION - The Commissioner's decision is vacated, and this matter is remanded for further findings consistent with this opinion. A separate order will be entered in accordance with this memorandum opinion.Ordered by Senior Judge Lyle E. Strom. (TCL )

IN THE UNITED STATES DISTRICT COURT FOR THE
DISTRICT OF NEBRASKA
MARY A. CAMRON,

)
)
Plaintiff,
)
)
v.
)
)
CAROLYN W. COLVIN,
)
Acting Commissioner of Social )
Security Administration,
)
)
Defendant.
)
______________________________)

8:12CV229

MEMORANDUM OPINION

This matter is before the Court for judicial review of
a final decision of the defendant Acting Commissioner of the
Social Security Administration (“Commissioner”) pursuant to 42
U.S.C. § 405(g) of the Social Security Act.

The Commissioner

denied plaintiff’s application for a period of disability and
disability insurance benefits, finding plaintiff was not under a
disability at any time from the amended alleged onset date,
October 1, 2008, to the date last insured, December 31, 2010.
Upon review, the Court finds the Commissioner’s decision is not
supported by substantial evidence in the record as a whole and
should be vacated and remanded for further findings consistent
with this memorandum opinion.
I.

Background and Procedural History.
As an initial matter, it must be noted that although

the Administrative Law Judge (“ALJ”) found that Ms. Camron had
several severe impairments, namely, “diabetes and degenerative

disc disease.

Mental – mood disorder, post-traumatic stress

disorder, personality disorder not otherwise specified, and
polysubstance dependence in partial remission” (Tr. 21), Ms.
Camron is primarily challenging the Commissioner’s determination
that her mental disabilities do not render her disabled (Tr.
1033, 1040).

The Court, likewise, will consider Ms. Camron’s

mental impairments.

Because Ms. Camron has amended her alleged

onset date to October 1, 2008 (Tr. 1032), the Court will focus
its review on Ms. Camron’s medical history and other pertinent
facts relating to her alleged impairments from October 1, 2008,
forward.
Ms. Camron was previously awarded disability benefits
on May 1, 2001, but the award ceased in May 2004 due to medical
improvement.

Ms. Camron applied for this second round of

disability benefits on October 27, 2004.

In connection with her

application, on March 11, 2005, Ms. Camron was evaluated by Linda
Schmechel, Ph.D., a state agency reviewing provider, who
completed a Psychiatric Review Technique (Tr. 404-417) based on
the information then available in Ms. Camron’s record,
but not on an examination of Ms. Camron.1

Dr. Schmechel based

her medical disposition on the categories of affective disorders

1

Dr. Schmechel’s evaluation occurred over three years prior
to Ms. Camron’s amended alleged onset date, October 1, 2008.
Nevertheless, because the ALJ gave “substantial weight” to Dr.
Schmechel’s evaluation in the opinion under review, the Court
will consider the evaluation as well.
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(“depression”), personality disorders (“borderline, histrionic”),
and substance addiction disorders (“Abuse at present.
in Remission”) (Tr. 404).

Somewhat

Dr. Schmechel stated that Ms. Camron

had no limitations regarding restrictions of daily living, and
moderate limitations as to difficulties in maintaining social
functioning and concentration, persistence, or pace (Tr. 414).
Dr. Schmechel found that Ms. Camron had had one or two episodes
of decompensation, each of extended duration (Id.).
On March 17, 2005, the Commissioner denied Ms. Camron’s
October 2004 claim initially (Tr. 65), and on June 10, 2005, the
Commissioner denied the claim on reconsideration (Tr. 63).

An

ALJ held a hearing on Ms. Camron’s application on January 25,
2007 (Tr. 1075-1148), and denied benefits on November 15, 2007
(“2007 ALJ Decision,” Tr. 53-62).
Ms. Camron appealed the 2007 ALJ Decision to the
Appeals Council.

As part of her appeal, she included a

psychological evaluation by Beverly Doyle, Ph.D., dated January
25, 2008, a little over eight months prior to the amended onset
date (“2008 Doyle Report,” Tr. 661-668).
examined Ms. Camron.

Dr. Doyle personally

Dr. Doyle’s DSM Multiaxial Classification

included the following:

Axis I - Major Depressive Disorder,

recurrent, Generalized Anxiety Disorder, and Polysubstance

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dependence (by history); Axis II - Personality disorder with
borderline features; Axis V - GAF 452 (Tr. 662).
Dr. Doyle stated that Ms. Camron had “extreme
limitation” in the “ability to deal with work stress,” defined as
follows:

“There is major limitation in this area.

useful ability to function in this area” (Tr. 663).

There is no
Similarly,

Dr. Doyle reported that Ms. Camron was extremely limited in “the
ability to complete a normal workday and workweek without
interruptions from psychologically based symptoms and to perform
at a consistent pace without an unreasonable number and length of
rest periods,” and in “the ability to accept instructions and
respond appropriately to criticism from supervisors or coworkers” (Tr. 664).

Dr. Doyle stated that Ms. Camron was

moderately limited in “the ability to perform activities within a
schedule, maintain regular attendance, and be punctual within
customary tolerances” (Id.).
On September 25, 2008, Ms. Camron was admitted to
Lasting Hope Recovery Center, a psychiatric facility, on transfer
from an emergency room, after cutting herself on the wrist (Tr.

2

“The GAF is a numeric scale ranging from zero to one
hundred used to rate social, occupational and psychological
functioning ‘on a hypothetical continuum of mental
health-illness.’”• Pate-Fires v. Astrue, 564 F.3d 935, 937 n.1
(8th Cir. 2009) (quoting Diagnostic and Statistical Manual of
Mental Disorders, 32 (4th ed. Am. Psychiatric Ass'n 1994) (DSM
IV)).

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955).

Upon admission, psychiatrist Roger Pentzien, MD, noted

that Ms. Camron had a laceration “with 13 stitches [in the] left
wrist” (Tr. 958).

Dr. Pentzien listed Ms. Camron’s diagnoses

upon admission as follows:

Axis I - Mood disorder, marijuana

abuse versus alcohol abuse depression; Axis II - deferred; Axis V
- GAF 20 (Id.).

Upon discharge five days later, Dr. Pentzien

listed Ms. Camron’s diagnoses as follows:

Axis I - Mood

disorder, not otherwise specified, Polysubstance abuse (cannabis
and alcohol); Axis II - Deferred; Axis V - GAF 55 (Tr. 949).

Dr.

Pentzien stated that the prognosis was fair (Tr. 952).
Following her stay at Lasting Hope, Ms. Camron received
treatment on several occasions in late 2008 - 2009 from
psychiatrist Rajeev Chaturvedi, MD, at Lutheran Family Services.
At the initial evaluation on November 5, 2008, Dr. Chaturvedi
listed Ms. Camron’s diagnoses as follows:

Axis I - Bipolar I

Disorder with psychotic features; Axis II - Deferred; Axis V GAF 40 (Tr. 1022).

Dr. Chaturvedi prescribed several medications

for Ms. Camron and recommended follow up in four weeks (Id.).
In the next office visit note, dated January 6, 2008
[sic; apparently 2009], Dr. Chaturvedi states that Ms. Camron
“was clearly overwhelmed.
anxious, depressed.

Her speech was pressured.

Affect was liable.

marked with flight of ideas” (Tr. 1023).

Mood

Thought process was
Dr. Chaturvedi noted

Ms. Camron’s “severe financial problems” in obtaining her

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medications (Id.).
as follows:

Dr. Chaturvedi listed Ms. Camron’s diagnoses

Axis I - Bipolar I Disorder with psychotic features;

Axis II - Deferred; Axis V - GAF 40 (Tr. 1024).
On March 11, 2009, Dr. Chaturvedi again describes the
financial difficulties Ms. Camron was experiencing in acquiring
the medications that he had prescribed for her (Tr. 1019).
Chaturvedi listed Ms. Camron’s diagnoses as follows:

Dr.

Axis I -

Bipolar I Disorder with psychotic features; Axis II - Deferred;
Axis V - GAF 40 (Tr. 1019).
On May 13, 2009, Dr. Chaturvedi states that Ms. Camron
“reports continuing having occasional auditory hallucinations command in nature but command does not involve instructions to
hurt herself or others” (Tr. 1018).
Camron’s diagnoses as follows:

Dr. Chaturvedi listed Ms.

Axis I - Bipolar I Disorder with

psychotic features; Axis II - Deferred; Axis V - GAF 40-45 (Id.).
On June 10, 2009, Dr. Chaturvedi states that Ms. Camron
is “getting treatment for Bipolar Type I Disorder with psychotic
features” (Tr. 1017).

He states, “She continues to have auditory

hallucinations of derogatory abusive language using voice calling
her name” (Id.).

“She also has significant paranoia and

interprets regular behavior of other people with paranoid things
as people are talking about her” (Id.).
On July 22, 2009, Dr. Chaturvedi states that Ms. Camron
is “getting treatment for Bipolar Type I Disorder with psychotic

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features” (Tr. 1016).

He states, “She has had auditory

hallucinations in the past, cutting behavior, multiple suicide
attempts and disassociated behavior.

The patient reports that

she has very little or no idea of the incidents such as cutting
on hand or jumping out of the vehicle at 20-30 mph or falls that
she has sustained injury from” (Id.).

“She and her family,

including her boyfriend, are concerned about these things and the
risk of injury” (Id.).
The last office visit note is dated August 19, 2009,
wherein Dr. Chaturvedi states that Ms. Camron is “getting
treatment for Bipolar Type I Disorder with psychotic features”
(Tr. 1015).

He again describes some of Ms. Camron’s financial

difficulties in obtaining her medications (Id.).

A Lutheran

Family Services administrator later reported that Ms. Camron was
later “discharged [from Lutheran Family Services treatment] due
to no shows for appointments and non-payment for services” (Tr.
1014).
On June 23, 2010, the Appeals Council remanded the 2007
ALJ Decision (Tr. 29-33).

As part of the remand process dictated

by the Appeals Council, Ms. Camron was evaluated for both
physical and psychological disability.

On August 19, 2010, the

physical examiner, Meryl Severson II, MD, diagnosed Ms. Camron
with diabetes mellitus, stable degenerative disc disease, bipolar

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personality disorder, history of drug and alcohol abuse, and
other less significant problems (Tr. 671).
In a report dated August 22, 2010, the psychological
examiner, Lindsey Hauser, Psy.D., stated that Ms. Camron reported
that she was no longer taking her psychiatric medications due to
financial problems (Tr. 680).

Dr. Hauser stated, “Ms. Camron

appears to suffer from moderate restriction in activities of
daily living due to mood dysregulation and past traumas” (Tr.
681).

“It appears that Ms. Camron’s behavioral, emotional, and

social functioning will deteriorate with distress and change in
her environment as her history suggests past hospitalizations due
to increased stressors” (Id.).

“Ms. Camron’s ability to carry

out short and simple instructions under ordinary supervision
appears to be below average given her observed poor memory”
(Id.).

“If Ms. Camron were to be awarded funds by the state,

given her history of substance use, she ought to be granted a
payee” (Id.).
Dr. Hauser noted that Ms. Camron had moderate
limitations in the ability to make judgments on simple and
complex work-related decisions and the ability to interact
appropriately with supervisors and coworkers (Tr. 683).
Otherwise, her limitations were noted as mild (Id.).
Dr. Hauser listed Ms. Camron’s diagnoses as follows:
Axis I - posttraumatic stress disorder, R/O mood disorder, NOS,

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alcohol, cannabis, and methamphetamine dependence in full
remission (by report); Axis II - R/O borderline personality
disorder; Axis V - GAF 60 (Tr. 681).

Dr. Hauser stated, “The

prognosis for Ms. Camron is fair with proper mental health
services and medication compliance” (Id.).
Ms. Camron was seen on three occasions in October and
November 2010 for therapy at Heartland Counseling Services (Tr.
993-1008).

On the first occasion, October 20, 2010, the

precipitating problem was listed as “Mood swings - bi-polar” and
the precipitating event was listed as “Does not have meds” (Tr.
1001).3

In the interpretive summary, the practitioner stated,

“Mary reports she needs her medication to prevent relapse as she
tends to self-medicate w/alcohol & illegal drugs” (Tr. 1007).
“Mary is supportive of a referral to community support, as she is
in need of assistance with transportation, housing, med
management, and med assistance.

Mary reports she feels she is

losing hope and feels her symptoms worsening” (Id.).

The

practitioner recommended outpatient mental health care, community
support services (crisis), a psychiatric referral, and a
voc/rehab agency (Tr. 1008).
Camron’s diagnoses as follows:

The practitioner listed Ms.
Axis I - Bipolar + most recent

3

Two mental health practitioners signed the interview
report, but neither signature is legible.
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depression, severe with psychotic features; Axis II - Deferred;
Axis V - GAF 30 (Id.).
On October 28, 2010, Ms. Camron was seen again at
Heartland Counseling Services for therapy.

The progress note

states, “Mary discussed & processed the symptoms of bipolar and
her need for medication.

Mary appears insightful as she

identifies her need for meds and need for housing to reduce
chaos” (Tr. 998).

Finally, after a visit on November 17, 2010,

the treatment plan stated that Ms. Camron’s presenting problem
was “Hearing voices - medications someone to talk to, figure
things out, anger, frustration, mood swing, social skills,
crying” (Tr. 994).

Referrals for additional services included

psychiatric, community support, and voc/rehab (Tr. 995).
On November 19, 2010, just a few weeks before the
remand hearing, Ms. Camron was again evaluated by Beverly Doyle,
Ph.D. (“2010 Doyle Report,” Tr. 982-991).
examined Ms. Camron.

Dr. Doyle personally

Dr. Doyle’s DSM Multiaxial Classification

this time included the following:

Axis I - post traumatic stress

disorder, cannabis and alcohol abuse in early full remission,
polysubstance dependence in full remission, major depressive
disorder, recurrent, severe with psychotic features; Axis II personality disorder with borderline features; Axis V - GAF 55
(Tr. 984).

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Again, Dr. Doyle stated that Ms. Camron had “extreme
limitation,” defined as “There is major limitation in this area.
There is no useful ability to function in this area” in the
“ability to deal with work stress” (Tr. 989).

Similarly, Dr.

Doyle reported that Ms. Camron was extremely limited in “the
ability to complete a normal workday and workweek without
interruptions from psychologically based symptoms and to perform
at a consistent pace without an unreasonable number and length of
rest periods” and “the ability to get along with co-workers or
peers without distracting them or exhibiting behavioral extremes”
(Tr. 990, 991).

Dr. Doyle stated that Ms. Camron was markedly

limited in “the ability to accept instructions and respond
appropriately to criticism from supervisors or co-workers,” “the
ability to perform activities within a schedule, maintain regular
attendance, and be punctual within customary tolerances,” and
“the ability to interact appropriately with the general public”
(Tr. 990, 991).

Dr. Doyle indicated that Ms. Camron has “marked

difficulties in maintaining concentration, persistence, or pace
resulting in failure to complete tasks in a timely manner (in
work setting or elsewhere)” (Tr. 991).
A different ALJ held the remand hearing on Ms. Camron’s
application on November 29, 2010 (Tr. 1025-1074).

At the

hearing, Ms. Camron amended her onset date for her alleged onset
of disability to October 1, 2008 (Tr. 1032).

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Ms. Camron was born on March 19, 1971.

At the time of

the 2010 ALJ remand hearing, she was separated from her husband
(Tr. 1035).

Her three children were ages twenty-two, twenty, and

eighteen in 2010 (Tr. 1036).

Ms. Camron did not raise the

children; the two oldest were raised by their father (not Ms.
Camron’s husband), and the youngest was in the care of Ms.
Camron’s sister at the time of the hearing because Ms. Camron had
been determined to be mentally unstable (Id.).
Ms. Camron dropped out of high school but eventually
earned her GED as an adult (Tr. 1035).

Ms. Camron testified that

she has never held a steady job; the longest she had held a job
was about six months (Tr. 1037).

She has worked as a cook, a

bartender, and a “CAN” [sic - likely CNA] (nursing) (Tr. 1037-38,
1042).

Ms. Camron testified that she has been hospitalized

several times for suicide attempts (Tr. 1038-41).

Although Ms.

Camron has had problems with drugs and alcohol in the past, she
testified that she had not been using drugs and alcohol since the
amended alleged onset date, October 1, 2008 (Tr. 1041).
Ms. Camron did work briefly after the alleged onset
date in 2009, at the Scoreboard Restaurant, but she testified
that she was fired “because I was throwing things around the
kitchen.

I don’t remember throwing nothing around the kitchen

but that’s what Diana told me I did and she don’t work there
anymore” (Tr. 1042).

The Chairman of the Board of the Scoreboard

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Restaurant, Homer Uehling, signed a work performance assessment,
stating that neither of Ms. Camron’s supervisors, including
Diana, still work there, and that he was satisfied with Ms.
Camron’s work and would rehire her (Tr. 283-87).

Yet Ms. Camron

testified that she “hardly ever seen” Mr. Uehling and that he
only came in when something needed to be fixed (Tr. 1042, 1049).
After that, she “started cooking for Pheasant Bonanza” but
“couldn’t handle the stress and they were expecting way too much
from one person” (Tr. 1043).
Ms. Camron lives with her brother and other relatives,
thirteen people, “all bipolar” (Tr. 1045).
food stamps (Tr. 1042).

Her only benefit is

She occupies herself all day by mostly

staying in her room but sees her boyfriend in a mental
institution once a week (Tr. 1045).
housework (Id.).

She helps a bit with the

Ms. Camron testified that when she takes her

psychiatric medications, “I was on meds for awhile and I was
still going through the same thing I’m going through” (Tr. 1072).
Also testifying at the 2010 remand hearing was Dr.
Thomas England, a medical expert.

Dr. England performed a review

of Ms. Camron’s record as provided to him by the Commissioner; he
had “not had any contact with” Ms. Camron and was testifying from
a remote location (Tr. 1054, 1028).

Dr. England testified that

he had reviewed the record up through Exhibit 35F, which included
the records from Ms. Camron’s Lasting Hope admission in September

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2008 (Tr. 2051).

Thus Dr. England had not reviewed the 2008-2009

records from Lutheran Family Services (Dr. Chaturvedi, Exhibit
37F) or the 2010 records from Heartland Counseling Services
(Exhibit 36F), because these records were received by the ALJ on
December 21, 2010, after the hearing (Tr. 1009, 995).
Consequently, Dr. England testified that “the first difficulty I
would have is that she from [October] of ‘08 to the present, of
course I don’t have any mental health treatment notes other than
the two CE’s in the record, so other than those I don’t have much
information to go on formally” (Tr. 1052).

Dr. England repeated

this opinion later in his testimony: “Well of course since then
[October 2008] we’ve only had two as CE’s, two episodes or
instances of mental health contact” (Tr. 1063).
Nevertheless, Dr. England gave his opinion in a
narrative fashion: “With respect to diagnosis I would say that
the record certainly historically reflects a diagnosis in several
categories, I would consider 12.04 affective disorder (Tr. 1052).
“And if we look . . . 12.08 personality disorder which I think is
probably primary and 12.09 substance abuse disorders” (Tr. 1053).
“With respect to the 12.04 condition, the record reports really
has [sic] not indicated a bipolar mood disorder with any degree
of regularity” (Id.).

“I suspect based on the overall record

that the mood disorder is likely the diagnosis” (Id.).

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As to Ms. Camron’s limitations, Dr. England stated, “I
would say activities of daily living appear to be generally
mildly impaired certainly historically, more so of course with
substance use” (Tr. 1056-57).

“Social functioning I would say

appears to be moderately impaired, again, more so with substance
use it would appear” (Tr. 1057).

Dr. England testified that none

of the criteria showed marked limitations “if she’s in treatment
and not using” (Id.).

Dr. England stated he would not give great

weight to the extreme limitations noted by Dr. Doyle because in
his opinion, Ms. Camron’s functioning was higher when in
treatment and abstinent, and the extreme limitations were
inconsistent with Dr. Doyle’s 2010 GAF of 55 (Tr. 1058).

Dr.

England said he would disregard Dr. Doyle’s extreme limitations
“without any other information” (Id.).

Dr. England stated that

there had been “some” low GAF scores but “I don’t know if I would
say multiple” (Tr. 1059).

Dr. England testified that Ms. Camron

could “definitely” handle unskilled work with limited social
interaction when in treatment (Id.).
Next, a vocational expert testified at the hearing.
The ALJ posed a hypothetical for a person with a few enumerated
physical limitations and
then from a mental standpoint
please consider only unskilled
work, . . . work that is routine
and repetitive, does not require
extended concentration or
attention; doesn’t require dealing
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with job changes or setting goals.
And social interaction is no more
than occasional, it can be brief or
superficial, up to occasional with
co-workers, supervisors, and
general public
(Tr. 1066).

The vocational expert identified thousands of such

jobs “in the four state region” (Tr. 1067), as well as thousands
of such jobs with a sedentary physical limitation (Tr. 1068).
Ms. Camron’s representative also posed two
hypotheticals to the vocational expert.

The first was to

assume for the non-exertional
limitation the claimant has a
marked limitation which is defined
as a serious limitation in this
area. There is a substantial loss
in the ability to effectively
function. Assume that that
limitation is markedly limited in
the ability to deal with work
stress, which includes the normal
pace of work expected by employers
with deadlines, quotas, and so
forth. The person has a marked
limitation in the ability to handle
work stresses described . . .
(Tr. 1069).

The vocational expert stated that these limitations

“would eliminate all occupations” (Id.).

Next, the

representative asked the vocational expert to assume
there’s a marked limitation in the
ability to complete a normal work
day and a work week without
interruptions from psychologically
based symptoms and to perform at a
consistent pace without an
unreasonable number and length of
rest periods. Would that affect

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her ability to do past work or
other work?
(Tr. 1070).

The vocational expert answered, “Yes” (Id.).

On February 9, 2011, the second ALJ also issued an
unfavorable opinion affirming the denial of Ms. Camron’s
disability claims (“2011 ALJ Decision,” Tr. 18-28).

The ALJ

evaluated Ms. Camron’s claim under the Commissioner’s five-step
sequential process.

See 20 C.F.R. § 404.1520(a).

At step one,

the ALJ found that Ms. Camron had not engaged in substantial
gainful activity from her amended alleged onset date, October 1,
2008, through her date last insured, December 31, 2010 (Tr. 20).
At step two, the ALJ found that Ms. Camron’s
impairments, diabetes, degenerative disc disease, mood disorder,
post-traumatic stress disorder, personality disorder not
otherwise specified, and polysubstance dependence in partial
remission, were severe (Tr. 21).

The ALJ also noted, “the

claimant testified she is alleging disability primarily due to
her mental impairments, which are listed above as severe
impairments” (Id.).
At step three, the ALJ found that Ms. Camron’s
impairments, singly or in combination, did not meet one of the
listed impairments found in 20 C.F.R. Part 404, Subpart P,
Appendix 1 (Id.).
Next, the ALJ determined that Ms. Camron had a residual
functional capacity
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to lift and carry 20 pounds
occasionally and 10 pounds
frequently; stand, sit, or walk for
6 hours in an 8-hour day; and
occasionally climb, balance, stoop,
kneel, crouch, and crawl. She
needed to avoid concentrated
exposure to vibrations and hazards.
Due to her mental impairments, the
claimant was limited to unskilled
work that is routine, repetitive,
and does not require extended
concentration or attention, dealing
with job changes, or setting goals
and involves social interaction
that can be brief or superficial
but no more than occasional with
co-workers, supervisors, and the
general public.
(Tr. 22-23).

While the ALJ found that Ms. Camron’s “medically

determinable impairments could reasonably be expected to cause
the alleged symptoms,” the ALJ found that Ms. Camron’s
“statements concerning the intensity, persistence, and limiting
effects of these symptoms are not credible to the extent they are
inconsistent with the above residual functional capacity
assessment” (Tr. 23-24).
The ALJ then summarized the various medical reports in
the record, including several from before the amended alleged
onset date, and also including those from Dr. Chaturvedi and
Heartland Counseling Services that had not been available to Dr.
England at the hearing.

In particular, the ALJ stated that the

2008 and 2010 Doyle Reports, including the opinion that “the
claimant’s mental impairments caused moderate, marked, and

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extreme limitations in functioning” were “not consistent with the
evidence or the overall record,” and so Dr. Doyle’s opinions
“[are] not given great weight” (Tr. 25).
After summarizing the opinion of the testifying medical
expert, Dr. England, the ALJ stated, “Dr. England did not agree
with Dr. Doyle’s opinion because historically with treatment and
abstinence the claimant’s functioning has been higher and extreme
limitations are inconsistent with the GAF scores of record” (Tr.
26).

In addition, “Dr. Hauser’s assessment is given some weight

but more weight is given to Dr. England’s expert medical opinion
because it is based on his review of the entire record and it is
supported by his professional expertise and the record as a
whole” (Id.).
Even though Dr. Schmechel’s report dated from 2005,
more than three years before the amended alleged onset date, the
ALJ stated, “The State agency psychological consultant Linda
Schmechel, Ph.D., determined that the claimant’s mental
impairments caused no more than moderate functional limitations”
(Tr. 26).

“Her assessment is consistent with the record both at

the time of her review and through the date of this decision, It
is given substantial weight” (Id.).
Finally, as to Ms. Camron’s work performance, the ALJ
gave the evaluation by Mr. Uehling substantial weight.

While

noting that “the claimant testified that she rarely saw Mr.

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Uehling,” the ALJ stated that “there is no persuasive evidence
from additional employment sources indicating her work
performance was not adequate in the past” (Tr. 26).

Despite this

statement, at step four, the ALJ found that Ms. Camron was unable
to perform any past relevant work (Id.).
At step five, the ALJ found that “considering the
claimant’s age, education, work experience, and residual
functional capacity, there were jobs that existed in significant
numbers in the national economy that the claimant could have
performed” (Tr. 27).

Consequently, the ALJ concluded the

unfavorable decision by stating, “The claimant was not under a
disability, as defined in the Social Security Act, at any time
from October 1, 2008, the alleged onset date, through December
31, 2010, the date last insured” (Tr. 28).
On February 16, 2011, Ms. Camron requested review of
the 2011 ALJ Decision by the Appeals Council (Tr. 13).

On May 9,

2012, the Appeals Council declined Ms. Camron’s request for
review (Tr. 7); thus the 2011 ALJ Decision is now the final
decision of the Commissioner.

Ms. Camron timely filed a

complaint with the United States District Court for the District
of Nebraska on July 2, 2012, for review of the February 9, 2011,
ALJ decision (Filing No. 1).

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II.

Standard of Review.
When reviewing an ALJ’s decision, the Court “must

determine ‘whether the ALJ’s decision complies with the relevant
legal requirements and is supported by substantial evidence in
the record as a whole.’”

Martise v. Astrue, 641 F.3d 909, 920

(8th Cir. 2011) (quoting Halverson v. Astrue, 600 F.3d 922, 929
(8th Cir. 2010)).

“Substantial evidence” is:

relevant evidence that a reasonable
mind might accept as adequate to
support a conclusion. Substantial
evidence on the record as a whole,
however, requires a more
scrutinizing analysis. In the
review of an administrative
decision, the substantiality of
evidence must take into account
whatever in the record fairly
detracts from its weight. Thus,
the court must also take into
consideration the weight of the
evidence in the record and apply a
balancing test to evidence which is
contradictory.
Id. at 920-21.

“‘If, after reviewing the record, the court finds

it is possible to draw two inconsistent positions from the
evidence and one of those positions represents the ALJ’s
findings, the court must affirm the ALJ’s decision.’” Partee v.
Astrue, 638 F.3d 860, 863 (8th Cir. 2011) (quoting Goff v.
Barnhart, 421 F.3d 785, 789 (8th Cir. 2005)).

The Court may not

reverse the ALJ’s decision “simply because [the Court] would have
come to a different conclusion.”

Teague v. Astrue, 638 F.3d 611,

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614 (8th Cir. 2011) (citation omitted).

“The claimant bears the

burden of proving disability.” Id. at 615.
Residual Functional Capacity (“RFC”) is the most a
claimant can do despite physical and mental limitations caused by
her impairments, including any related symptoms. 20 C.F.R.
§ 404.1545(a).

“RFC is the individual’s maximum remaining

ability to do sustained work activities in an ordinary work
setting on a regular and continuing basis,” which means “8 hours
a day, for 5 days a week, or an equivalent work schedule.”
S.S.R. 96-8p, 1996 WL 374184, at *2 (Soc. Sec. Admin. July 2,
1996) (emphasis removed).

“The ALJ should determine a claimant’s

RFC based on all the relevant evidence, including the medical
records, observations of treating physicians and others, and an
individual’s own description of [her] limitations.”

Davidson v.

Astrue, 578 F.3d 838, 844 (8th Cir. 2009) (quoting Lacroix v.
Barnhart, 465 F.3d 881, 887 (8th Cir. 2006)).
III.

Discussion.
On appeal, Ms. Camron asserts three primary arguments:

(1) “the ALJ did not give adequate consideration to the numerous
GAF scores of 45 and below even while Plaintiff was receiving
treatment and medication” (Filing No. 19, at 11); (2) the ALJ’s
reliance on the opinion of “paper-review physician Dr. Schmechel
(which predated Plaintiff’s alleged onset date by over three
years)” and on the opinion of “paper-review medical advisor (Dr.

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England) who appeared at hearing” was “inappropriate” (Tr. 1314); and (3) the ALJ did not consider all the factors that would
go into Ms. Camron’s compliance or non-compliance with treatment
recommendations (Filing No. 19, at 14).

Because the Court finds

substantial evidence does not support the weight given by the ALJ
to the opinions of Drs. Schmechel and England in the development
of Ms. Camron’s RFC, the Court does not address Ms. Camron’s
remaining arguments.
The Court first notes that the Appeals Council
directed, “Upon remand the [ALJ] will: . . . Obtain evidence from
a medical expert specializing in mental health to clarify the
nature and severity of the claimant’s mental impairments” (Tr.
32).

Consequently, Dr. Hauser evaluated Ms. Camron in August

2010, post-remand.

Yet the ALJ then only afforded Dr. Hauser’s

opinion “some weight” in favor of Dr. England’s opinion (Tr. 26).
As a medical expert, Dr. England had performed a review of Ms.
Camron’s record only.

Unlike Dr. Hauser, he “had never had any

contact with” Ms. Camron and, since he was testifying from a
remote location, did not observe her personally when she
testified on the day of the hearing (Tr. 1054, 1028).
More importantly, Dr. England’s opinion was based on a
factually inaccurate conclusion:

the very first sentence of his

testimony reads, “Yes, the first difficulty I would have is that
she from [October] of ‘08 to the present, of course I don’t have

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any mental health treatment notes other than the two CE’s [courtordered reports from Drs. Severson and Hauser] in the record, so
other than those I don’t have much information to go on formally”
(Tr. 1052).

Dr. England emphasized this fact later in his

testimony (Tr. 1063).

As noted above, this inaccuracy is due to

the unfortunate fact that Dr. England could not review the
records from Lutheran Family Services (Dr. Chaturvedi, Exhibit
37F) or Heartland Counseling Services (Exhibit 36F), because
these records were not provided to the ALJ until December 21,
2010, after the hearing (Tr. 1009, 995).

As a result, as far as

Dr. England was aware, Ms. Camron sought no treatment after her
September 2008 admission to Lasting Hope, where she had presented
with thirteen stitches in her wrist (Tr. 958).
Yet unbeknownst to Dr. England, Ms. Camron saw Dr.
Chaturvedi on an ongoing basis for many months after October
2008.

Even while in treatment and on medications prescribed by

Dr. Chaturvedi, Ms. Camron continued to experience psychiatric
symptoms, including auditory hallucinations, and to be assessed
GAF scores in the 40's.
Dr. England also concluded,

“With respect to the 12.04

condition, the record reports really has [sic] not indicated a
bipolar mood disorder with any degree of regularity” (Tr. 1053).
This statement is similarly questionable when considered in the
context of the record as a whole, that is, with treating

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psychiatrist Dr. Chaturvedi’s repeated diagnosis of “Bipolar I
Disorder with psychotic features” (Tr. 1022, 1024, 1019, 1018,
1017, 1016, and 1015).

Finally, Dr. England indicated that there

had been “some” low GAF scores but “I don’t know if I would say
multiple” (Tr. 1059).

Yet Dr. Chaturvedi assessed Ms. Camron

with GAF scores in the 40's on multiple occasions, as noted
above.
In the discussion regarding the formulation of Ms.
Camron’s RFC, the ALJ stated, “Dr. England did not agree with Dr.
Doyle’s opinion because historically with treatment and
abstinence the claimant’s functioning has been higher and extreme
limitations are inconsistent with the GAF scores of record” (Tr.
26).

The Court cannot say whether or not this statement would

hold true had Dr. England had access to Dr. Chaturvedi’s records
(and to the records from Heartland Counseling Services).

In

addition, the ALJ stated, “Dr. Hauser’s assessment is given some
weight but more weight is given to Dr. England’s expert medical
opinion because it is based on his review of the entire record
and it is supported by his professional expertise and the record
as a whole” (Id.).

This statement is problematic, since Dr.

England’s opinion is not, in fact, based on a “review of the
entire record.”

Again, the Court cannot say whether Dr.

England’s testimony that Ms. Camron could “definitely” handle
unskilled work with limited social interaction when in treatment

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would change had he had the opportunity to review the entire
record, including the records reflecting the times when Ms.
Camron was actually in treatment with Dr. Chaturvedi and
Heartland Counseling Services.

Thus, the Court finds that remand

is warranted.
The ALJ also gave great weight to Dr. Schmechel’s 2005
report, which was formulated more than three years before the
amended alleged onset date.

Like Dr. England’s opinion, Dr.

Schmechel’s report obviously did not address any of the medical
reports from October 1, 2008, onward, including that of Dr.
Chaturvedi.

The Court finds that the ALJ did not adequately

explain why the dated opinion of Dr. Schmechel should be given
greater weight than that of Dr. Doyle, who examined Ms. Camron
twice, and Dr. Hauser, who examined Ms. Camron at the behest of
the Appeals Council.
Based on the foregoing, the Court finds that the ALJ’s
development of Ms. Camron’s RFC is not supported by substantial
evidence based on the record as a whole.

Further analysis of Ms.

Camron’s claim is necessary to determine whether she is capable
of full-time work.

Accordingly, the Court will remand the matter

for further findings.
IV.

Conclusion.
The Commissioner’s decision is vacated, and this matter

is remanded for further findings consistent with this opinion.

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A

separate order will be entered in accordance with this memorandum
opinion.
DATED this 24th day of June, 2013.
BY THE COURT:
/s/ Lyle E. Strom
______________________________
LYLE E. STROM, Senior Judge
United States District Court

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