Yingling v. Social Security Administration

Filing 20

REPORT AND RECOMMENDATION: The undersigned recommends that Plaintiff's Motion for Judgment on the Administrative Record be DENIED, and that the decision of the Commissioner be AFFIRMED. Signed by Magistrate Judge E. Clifton Knowles on 6/20/2014. (DOCKET TEXT SUMMARY ONLY-ATTORNEYS MUST OPEN THE PDF AND READ THE ORDER.)(eh)

IN THE UNITED STATES DISTRICT COURT
FOR THE MIDDLE DISTRICT OF TENNESSEE
NASHVILLE DIVISION
DENISE YINGLING,

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

Civil Action No. 3:13-0041
Judge Nixon / Knowles

REPORT AND RECOMMENDATION
This is a civil action filed pursuant to 42 U.S.C. §§ 405(g) and 1383(c)(3), to obtain
judicial review of the final decision of the Commissioner of Social Security finding that Plaintiff
was not disabled and denying Plaintiff Disability Insurance Benefits (“DIB”) and Supplemental
Security Income (“SSI”), as provided under the Social Security Act (“the Act”), as amended.
The case is currently pending on Plaintiff’s Motion for Judgment on the Administrative Record.
Docket No. 12. Defendant has filed a Response, arguing that the decision of the Commissioner
was supported by substantial evidence and should be affirmed. Docket No. 15. Plaintiff has
subsequently filed a Reply. Docket No. 17.
For the reasons stated below, the undersigned recommends that Plaintiff’s Motion for
Judgment on the Administrative Record be DENIED, and that the decision of the Commissioner
be AFFIRMED.

1

I. INTRODUCTION
Plaintiff completed her applications for DIB and SSI on March 13, 2009 and April 15,
2009 respectively, alleging that she had been disabled since June 14, 2008, due to depression and
anxiety, high blood pressure, diabetes, fibromyalgia, “DDD low back,” chronic pain, sleep
apnea, irritable bowel syndrome, and stress incontinence. Docket No. 10, Attachment (“TR”),
TR 112, 114, 148. Plaintiff’s applications were denied both initially (TR 53, 54) and upon
reconsideration (TR 55, 56). Plaintiff subsequently requested (TR 75) and received (TR 85) a
hearing. Plaintiff’s hearing was conducted on November 1, 2011, by Administrative Law Judge
(“ALJ”) Claire R. Strong. TR 34. Plaintiff and vocational expert (“VE”), Lisa Courtney,
appeared and testified. Id.
On November 29, 2011, the ALJ issued a decision unfavorable to Plaintiff, finding that
Plaintiff was not disabled within the meaning of the Social Security Act and Regulations. TR 1533. Specifically, the ALJ made the following findings of fact:
1.

The claimant met the insured status requirements of the
Social Security Act through March 31, 2010.

2.

The claimant has not engaged in substantial gainful activity
since June 14, 2008, the alleged onset date (20 C.F.R.
404.1571 et seq., and 416.971 et seq.).

3.

The claimant has the following severe impairments:
obesity; hypertension; hyperlipidemia; type II diabetes
mellitus; degenerative arthritis; fibromyalgia; anxiety;
depression; and disorder of the right wrist (20 C.F.R.
404.1520(c) and 416.920(c)).

4.

The claimant does not have an impairment or combination
of impairments that meets or medically equals the severity
of one of the listed impairments in 20 C.F.R. Part 404,
Subpart P, Appendix 1 (20 C.F.R. 404.1520(d), 404.1525,
404.1526, 416.920(d), 416.925 and 416.926).
2

5.

After careful consideration of the entire record, the
undersigned finds that the claimant has the residual
functional capacity to perform light work as defined in 20
C.F.R. 404.1567(b) and 416.967(b) that is limited to lifting
and/or carrying up to twenty pounds occasionally and ten
pounds frequently; standing and/or walking six hours in an
eight-hour workday; sitting eight hours in an eight-hour
workday; limited squatting, limited exposure to heat,
humidity, climbing, heights, wrist motion, and forceful
grip; can understand and remember simple and detailed
tasks; can sustain adequate persistence and pace for simple
and low level detailed tasks for two-hour segments; may
experience some, but not substantial, difficulty dealing with
general public; can interact and get along with coworkers
and supervisors; can adapt and respond to changes in a
routine work setting given reasonable support; and can
make/set work-related plans and goals.

6.

The claimant is unable to perform any past relevant work
(20 C.F.R. 404.1565 and 416.965).

7.

The claimant was born on April 10, 1952 and was 56 years
old, which is defined as an individual closely approaching
advanced age, on the alleged disability onset date.
Applying the age categories non-mechanically, the
claimant is currently an individual of advanced age (20
C.F.R. 404.1563 and 416.963).

8.

The claimant has at least a high school education and is
able to communicate in English (20 C.F.R. 404.1564 and
416.964).

9.

The claimant has acquired work skills from past relevant
work (20 C.F.R. 404.1568 and 416.968).

10.

Considering the claimant’s age, education, work
experience, and residual functional capacity, the claimant
has acquired work skills from past relevant work that are
transferrable to other occupations with jobs existing in
significant numbers in the national economy (20 C.F.R.
404.1569, 404.1569(a), 404.1568(d), 416.969, 416.969(a),
and 416.968(d)).

11.

The claimant has not been under a disability, as defined in
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the Social Security Act, from June 14, 2008, through the
date of this decision (20 C.F.R. 404.1520(g) and
416.920(g)).
TR 20-28.
On December 5, 2011, Plaintiff timely filed a request for review of the hearing decision.
TR 14. On December 28, 2012, the Appeals Council issued a letter declining to review the case
(TR 1-3), thereby rendering the decision of the ALJ the final decision of the Commissioner.
This civil action was thereafter timely filed, and the Court has jurisdiction. 42 U.S.C. § 405(g).
If the Commissioner’s findings are supported by substantial evidence, based upon the record as a
whole, then these findings are conclusive. Id.
II. REVIEW OF THE RECORD
The parties and the ALJ have thoroughly summarized and discussed the medical and
testimonial evidence of Record. Accordingly, the Court will discuss those matters only to the
extent necessary to analyze the parties’ arguments.
III. CONCLUSIONS OF LAW
A. Standards of Review
This Court’s review of the Commissioner’s decision is limited to the record made in the
administrative hearing process. Jones v. Secretary, 945 F.2d 1365, 1369 (6th Cir. 1991). The
purpose of this review is to determine (1) whether substantial evidence exists in the record to
support the Commissioner’s decision, and (2) whether any legal errors were committed in the
process of reaching that decision. Landsaw v. Secretary, 803 F.2d 211, 213 (6th Cir. 1986).
“Substantial evidence” means “such relevant evidence as a reasonable mind would accept
as adequate to support the conclusion.” Her v. Commissioner, 203 F.3d 388, 389 (6th Cir. 1999)

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(citing Richardson v. Perales, 402 U.S. 389, 401 (1971)). “Substantial evidence” has been
further quantified as “more than a mere scintilla of evidence, but less than a preponderance.”
Bell v. Commissioner, 105 F.3d 244, 245 (6th Cir. 1996) (citing Consolidated Edison Co. v.
N.L.R.B., 305 U.S. 197, 229, 59 S.Ct. 206, 216, 83 L.Ed. 126 (1938)).
The reviewing court does not substitute its findings of fact for those of the Commissioner
if substantial evidence supports the Commissioner’s findings and inferences. Garner v. Heckler,
745 F.2d 383, 387 (6th Cir. 1984). In fact, even if the evidence could also support a different
conclusion, the decision of the Administrative Law Judge must stand if substantial evidence
supports the conclusion reached. Her, 203 F.3d at 389 (citing Key v. Callahan, 109 F.3d 270,
273 (6th Cir. 1997)). If the Commissioner did not consider the record as a whole, however, the
Commissioner’s conclusion is undermined. Hurst v. Secretary, 753 F.2d 517, 519 (6th Cir. 1985)
(citing Allen v. Califano, 613 F.2d 139, 145 (6th Cir. 1980) (citing Futernick v. Richardson, 484
F.2d 647 (6th Cir. 1973))).
In reviewing the decisions of the Commissioner, courts look to four types of evidence:
(1) objective medical findings regarding Plaintiff’s condition; (2) diagnosis and opinions of
medical experts; (3) subjective evidence of Plaintiff’s condition; and (4) Plaintiff’s age,
education, and work experience. Miracle v. Celebrezze, 351 F.2d 361, 374 (6th Cir. 1965).
B. Proceedings At The Administrative Level
The claimant carries the ultimate burden to establish an entitlement to benefits by
proving his or her “inability to engage in any substantial gainful activity by reason of any
medically determinable physical or mental impairment which can be expected to last for a
continuous period of not less than 12 months.” 42 U.S.C. § 423(d)(1)(A). “Substantial gainful

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activity” not only includes previous work performed by Plaintiff, but also, considering Plaintiff’s
age, education, and work experience, any other relevant work that exists in the national economy
in significant numbers regardless of whether such work exists in the immediate area in which
Plaintiff lives, or whether a specific job vacancy exists, or whether Plaintiff would be hired if he
or she applied. 42 U.S.C. § 423(d)(2)(A).
At the administrative level of review, the claimant’s case is considered under a five-step
sequential evaluation process as follows:
(1) If the claimant is working and the work constitutes substantial
gainful activity, benefits are automatically denied.
(2) If the claimant is not found to have an impairment which
significantly limits his or her ability to work (a “severe”
impairment), then he or she is not disabled.
(3) If the claimant is not working and has a severe impairment, it
must be determined whether he or she suffers from one of the
“listed” impairments1 or its equivalent. If a listing is met or
equaled, benefits are owing without further inquiry.
(4) If the claimant does not suffer from any listing-level
impairments, it must be determined whether the claimant can
return to the job he or she previously held in light of his or her
residual functional capacity (e.g., what the claimant can still do
despite his or her limitations). By showing a medical condition
that prevents him or her from returning to such past relevant work,
the claimant establishes a prima facie case of disability.
(5) Once the claimant establishes a prima facie case of disability,
the burden shifts to the Commissioner to establish the claimant’s
ability to work by proving the existence of a significant number of
jobs in the national economy which the claimant could perform,
given his or her age, experience, education, and residual functional
capacity.

1

The Listing of Impairments is found at 20 C.F.R., Pt. 404, Subpt. P, App. 1.
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20 C.F.R. §§ 404.1520, 416.920 (footnote added). See also Moon v. Sullivan, 923 F.2d 1175,
1181 (6th Cir. 1990).
The Commissioner’s burden at the fifth step of the evaluation process can be satisfied by
relying on the medical-vocational guidelines, otherwise known as “the grid,” but only if the
claimant is not significantly limited by a nonexertional impairment, and then only when the
claimant’s characteristics identically match the characteristics of the applicable grid rule.
Otherwise, the grid cannot be used to direct a conclusion, but only as a guide to the disability
determination. Id. In such cases where the grid does not direct a conclusion as to the claimant’s
disability, the Commissioner must rebut the claimant’s prima facie case by coming forward with
particularized proof of the claimant’s individual vocational qualifications to perform specific
jobs, which is typically obtained through vocational expert testimony. See Varley v. Secretary,
820 F.2d 777, 779 (6th Cir. 1987).
In determining residual functional capacity for purposes of the analysis required at stages
four and five above, the Commissioner is required to consider the combined effect of all the
claimant’s impairments; mental and physical, exertional and nonexertional, severe and
nonsevere. See 42 U.S.C. § 423(d)(2)(B).
C. Plaintiff’s Statement Of Errors
Plaintiff contends that the ALJ: (1) included vague and ambiguous language in her
residual functional capacity assessment which did not clearly identify the vocationally relevant
mental limitations resulting from Plaintiff’s impairments, and did not explain the rationale
behind her finding that Plaintiff could perform sustained work activity; (2) misrepresented and/or
mischaracterized the evidence and failed to give proper weight to the opinion of Plaintiff’s

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treating mental health provider; and (3) failed to follow appropriate step five regulations and
resolve apparent inconsistencies between testimony of the vocational expert and the Dictionary
of Occupational Titles. Docket No. 12-1 at 1-3. Accordingly, Plaintiff maintains that, pursuant
to 42 U.S.C. § 405(g), the Commissioner’s decision should be reversed, or in the alternative,
remanded. Id.
Sentence four of § 405(g) states as follows:
The court shall have power to enter, upon the pleadings and
transcript of the record, a judgment affirming, modifying, or
reversing the decision of the Commissioner of Social Security,
with or without remanding the cause for a rehearing.
42 U.S.C. §§ 405(g), 1383(c)(3).
“In cases where there is an adequate record, the Secretary’s decision denying benefits can
be reversed and benefits awarded if the decision is clearly erroneous, proof of disability is
overwhelming, or proof of disability is strong and evidence to the contrary is lacking.” Mowery
v. Heckler, 771 F.2d 966, 973 (6th Cir. 1985). Furthermore, a court can reverse the decision and
immediately award benefits if all essential factual issues have been resolved and the record
adequately establishes a plaintiff's entitlement to benefits. Faucher v. Secretary, 17 F.3d 171,
1. Residual Functional Capacity
Plaintiff argues that the ALJ erred in using vague and ambiguous language in her residual
functional capacity (“RFC”) assessment which did not clearly identify the vocationally relevant
mental limitations resulting from Plaintiff’s impairments, and did not explain the rationale
behind her finding that Plaintiff could perform sustained work activity. Docket No. 12-1 at 1112. With regard to her argument that the ALJ erred in using vague and ambiguous language in
her RFC assessment, Plaintiff contends that characterizations such as “limited” or “some
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difficulty,” used by the ALJ in reference to Plaintiff’s abilities to perform certain functional
movements and deal with the general public, were too ambiguous to adequately explain the
abilities and limitations of Plaintiff in the work place. Id. at 12. Plaintiff asserts that such
ambiguity “falls short of the required function-by-function assessment,” and renders the ALJ’s
hypothetical questions posed to the Vocational Expert unclear. Id. at 12-13.
Defendant responds that there is no requirement for specificity of diction in this regard,
and notes that Plaintiff has cited no authority for her proposition to the contrary. Docket No. 15
at 12-13. Defendant further argues that because the State agency consultants used the terms in
their assessments and because Plaintiff’s attorney did not object to the ALJ’s use of the terms at
the hearing, the ALJ’s use of this language was permissible. Id. Finally, Defendant contends that
the ALJ properly discussed in detail the objective medical evidence of record, the opinion
evidence of record, and the hearing testimony, and explained how that evidence supported her
determination that Plaintiff could perform sustained work activity. Id. at 10.
Plaintiff, in her Reply, reiterates her assertion that these terms were “too vague” and
“undefined” for the required function-by-function assessment. Docket No.17 at 1-2. Plaintiff
also reiterates her contention that this “ambiguity” afforded the Vocational Expert too much
room for interpretation when rendering her opinion in response to the ALJ’s hypothetical
questions. Id. at 2. Plaintiff attributes the failure to object to such language at the hearing to her
having a different attorney representing her at the hearing. Id.
“Residual Functional Capacity” is defined as the “maximum degree to which the
individual retains the capacity for sustained performance of the physical-mental requirements of
jobs.” 20 C.F.R. Pt. 404, Subpt. P, App. 2 § 200.00(c). With regard to the evaluation of physical

9

abilities in determining a claimant’s Residual Functional Capacity, the Regulations state:
When we assess your physical abilities, we first assess the nature and
extent of your physical limitations and then determine your residual
functional capacity for work activity on a regular and continuing
basis. A limited ability to perform certain physical demands of work
activity, such as sitting, standing, walking, lifting, carrying, pushing,
pulling, or other physical functions (including manipulative or
postural functions, such as reaching, handling, stooping or
crouching), may reduce your ability to do past work and other work.
20 C.F.R. § 404.1545(b).
The ALJ in the case at bar ultimately determined that Plaintiff retained the RFC to
perform light work with additional limitations. TR 21-22. Specifically, the ALJ found that
Plaintiff was:
limited to lifting and/or carrying up to twenty pounds occasionally
and ten pounds frequently; standing and/or walking six hours in an
eight-hour workday; sitting eight hours in an eight-hour workday;
limited squatting, limited exposure to heat, humidity, climbing,
heights, wrist motion, and forceful grip; can understand and
remember simple and detailed tasks; can sustain adequate
persistence and pace for simple and low level detailed tasks for
two-hour segments; may experience some, but not substantial,
difficulty dealing with general public; can interact and get along
with coworkers and supervisors; can adapt and respond to changes
in a routine work setting given reasonable support; and can
make/set work-related plans and goals.
Id.
Although Plaintiff contends that the ALJ did not explain the rationale behind her finding
that Plaintiff could perform sustained work activity, the ALJ specifically considered the
Disability Reports, Work History Reports, Function Report, and Pain Questionnaire; treatment
records from Dr. Dunn, Dr. Knapp, the Madison Family Clinic, United Neighborhood Health
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Services, Meharry Medical Clinic, and Centerstone Mental Health Center (“Centerstone”);
assessments from Dr. Davis, Dr. Johnson, Dr. Sailors, Dr. Ryan, Dr. Paul, Dr. Lawrence; and
Plaintiff’s testimony. TR 21-27. As can be seen, the ALJ evaluated the objective and
testimonial evidence of record when reaching Plaintiff’s RFC determination, and the Regulations
do not require more.
Despite Plaintiff’s assertion that the ALJ used vague and ambiguous language in the
hypothetical questions posed to the VE, the ALJ used the language contained within the
assessments of Dr. Davis, Dr. Johnson, and Dr. Paul. TR 529, 533, 539. For example, Dr.
Davis, in his medical assessment, noted that Plaintiff had the “postural limitations” of “limited”
squatting and the “other physical/environmental limitations” of “limited” heat/humidity (TR
533), while in her assessment, Dr. Johnson checked the box for “limited” handling/gross
manipulation (TR 539). Dr. Paul stated that Plaintiff could, “with some but not substantial
difficulty,” perform low level tasks and deal with the general public. TR 529. Although Plaintiff
objects to the ALJ’s usage of “limited” and “some difficulty” in the hypothetical questions
presented to the vocational expert, as has been demonstrated, this diction came from assessments
of record (TR 529, 533, 539), which significantly, the VE had reviewed (see TR 45, 47-50).
Because it is proper for the ALJ to include information from the record in the proffered
hypothetical questions to the VE, and because the information included by the ALJ in the case at
bar came directly from the record, the ALJ’s questions were valid, as was the reliance upon the
VE’s answers thereto. See Felisky v. Bowen, 35 F.3d 1027, 1036 (6th Cir. 1994); Hardaway v.
Secretary, 823 F.2d 922, 927-928 (6th Cir. 1987); and Varley v. Secretary, 820 F.2d 777, 779 (6th
Cir. 1987). Accordingly, Plaintiff’s argument fails.

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2. Weight Accorded to Opinion of Plaintiff’s Treating Mental Health Providers
Plaintiff argues that the ALJ erred in not according greater weight to the opinions of her
treating mental health providers from Centerstone Mental Health Center (“Centerstone”). Docket
No. 12-1 at 18-19. Specifically, Plaintiff maintains that the ALJ erred in discounting several
Tennessee Clinically Related Group (“CRG”) evaluations completed by Centerstone staff. Id. at
13. Plaintiff contends that the CRGs should have been accorded more weight because they were
completed by people who had treated her for years, and because the CRGs were supported by her
Centerstone treatment notes. Id. at 18. Plaintiff asserts that these CRGs show significant mental
limitations, and that the ALJ erred in “discrediting these opinions, or parts thereof, without
adequate consideration of what this evidence actually shows.” Id. at 13. Plaintiff argues that “the
ALJ misrepresented and/or mischaracterized this evidence in her finding that they were
internally inconsistent, and in supporting her finding that Dr. Paul’s assessment was consistent
with Plaintiff’s mental health treatment records.” Id., citing TR 25-26. Plaintiff concedes that
the assessments indicate “moderate limitations,” but contends that it is not the same definition of
“moderate” that is used in the SSA. Id. at 17. Plaintiff maintains that the specific language used
to describe the severity of the limitations should be more controlling than the characterization of
the severity itself. Id. Plaintiff also argues that the ALJ discounted and mischaracterized
Plaintiff’s GAF scores when noting that the evidence suggested “moderate limitations” rather
than “marked limitations,” resulting in the ALJ’s according too much weight to the findings of
Dr. Paul. Id. at 16-17.
Defendant responds that, while the ALJ has a duty to consider evidence from all
acceptable medical sources, there is no requirement that the ALJ provide “an express discussion
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of each factor [discussed in 20 C.F.R. §§ 404.1527(c), 416.927(c)] in evaluating opinion
evidence from other sources.” Docket No. 15 at 15. Defendant argues that the ALJ considered
and expressly discussed the Centerstone treatment records, including the opinions provided by
the mental health providers, and incorporated them into her RFC assessment. Id. at 15-16.
Defendant notes that, contrary to Plaintiff’s assertion, the ALJ accepted, in large part, the
opinions of the Centerstone providers regarding her functional limitations. Id. at 16.
With regard to her argument that the ALJ “mischaracterized and/or misrepresented”
evidence from Centerstone regarding her limitations, Defendant argues that Plaintiff has offered
no evidence to suggest that she suffered “marked” rather than “moderate” limitation. Id. at 17.
Defendant contends that, in fact, the ALJ’s findings were consistent with the Centerstone
assessments. Id. Defendant further contends that, contrary to Plaintiff’s assertion, the ALJ did
consider her GAF scores, which were somewhat inconsistent with the “more detailed functional
assessments in the record.” Id. at 17-18. Defendant argues that the ALJ properly considered
Plaintiff’s Centerstone records, and accorded appropriate weight to the CRG forms and the GAF
scores, given the nature of the other opinions and evaluations of record. Id. at 18.
Plaintiff replies that the language present in the notes to the CRG evaluation indicates
“marked” limitations rather than “moderate” limitations. Docket No. 17 at 2-3. Specifically,
Plaintiff points to the following language in the notes:
[R]egular or frequent problems with performing daily routine
activities and unable to perform these up to acceptable standards
without frequent assistance; limited integration in the community,
with little or no use of natural supports and/or marginal capacity to
take part in a variety of social activities or manage herself in
relationship to others and/or demonstrates aggressive episodes
with limited ability to self manage behavior; regular or frequent
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difficulty with concentration and can complete simple tasks within
timeframes but needs prompting and help; and regular or frequent
difficulty in accepting and adjusting to change, as adaptation will
require some intervention.
Id. at 2-3, citing TR 552-53.
Plaintiff reiterates her contention that her GAF scores indicate serious symptoms, and
that the ALJ failed to adequately address these scores in her ruling. Id. at 3-4.
With regard to the evaluation of medical evidence, the Code of Federal Regulations
states:
Regardless of its source, we will evaluate every medical
opinion we receive. Unless we give a treating source’s opinion
controlling weight under paragraph (d)(2) of this section, we consider
all of the following factors in deciding the weight we give to any
medical opinion.
(1) Examining relationship. Generally, we give more weight
to the opinion of a source who has examined you than to the opinion
of a source who has not examined you.
(2) Treatment relationship. Generally, we give more weight
to opinions from your treating sources, since these sources are likely
to be the medical professionals most able to provide a detailed,
longitudinal picture of your medical impairment(s) and may bring a
unique perspective to the medical evidence that cannot be obtained
from the objective medical findings alone or from reports of
individual examinations, such as consultative examinations or brief
hospitalizations. If we find that a treating source’s opinion on the
issue(s) of the nature and severity of your impairment(s) is wellsupported by medically acceptable clinical and laboratory diagnostic
techniques and is not inconsistent with the other substantial evidence
in your case record, we will give it controlling weight. When we do
not give the treating source’s opinion controlling weight, we apply
the factors listed in paragraphs (d)(2)(i) and (d)(2)(ii) of this section,
as well as the factors in paragraphs (d)(3) through (d)(6) of this
section in determining the weight to give the opinion. ...
(3) Supportability. The more a medical source presents
relevant evidence to support an opinion, particularly medical signs
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and laboratory findings, the more weight we will give that opinion.
The better an explanation a source provides for an opinion, the more
weight we will give that opinion. ...
(4) Consistency. Generally, the more consistent an opinion
is with the record as a whole, the more weight we will give to that
opinion.
(5) Specialization. We generally give more weight to the
opinion of a specialist about medical issues related to his or her area
of specialty than to the opinion of a source who is not a specialist.
...
20 C.F.R. § 416.927(d) (emphasis added). See also 20 C.F.R. § 404.1527(d).
The ALJ must articulate the reasons underlying his decision to give a medical opinion a
specific amount of weight.2 See, e.g., 20 C.F.R. § 404.1527(d); Allen v. Commissioner, 561 F.3d
646 (6th Cir. 2009); Wilson v. Commissioner, 378 F.3d 541, 544 (6th Cir. 2004). The reasons
must be supported by the evidence and must be sufficiently specific so as to make clear to any
subsequent reviewers the weight the ALJ gave to the treating source medical opinion and the
reasons for that weight. SSR 96-2p.
The Sixth Circuit has held that, “provided that they are based on sufficient medical data,
the medical opinions and diagnoses of treating physicians are generally accorded substantial
deference, and if the opinions are uncontradicted, complete deference.” Howard v.
Commissioner, 276 F.3d 235, 240 (6th Cir. 2002)(quoting Harris v. Heckler, 756 F.3d 431, 435

2

There are circumstances when an ALJ’s failure to articulate good reasons for the weight
accorded to medical opinions may constitute harmless error: (1) if a treating source opinion is so
patently deficient that the ALJ could not possibly credit it; (2) if the ALJ adopts the opinion or
makes findings consistent with the opinion; and/or (3) if the ALJ has complied with the goal of
20 C.F.R. §1527(d), by analyzing the physician’s contradictory opinions or by analyzing other
opinions of record. See, e.g., Friend v. Commissioner, 375 Fed. Appx. 543, 551 (6th Cir. April
28, 2010); Nelson v. Commissioner, 195 Fed. Appx. 462, 470-72 (6th Cir. 2006); Hall v.
Commissioner, 148 Fed. Appx. 456, 464 (6th Cir. 2006).
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(6th Cir. 1985)). If the ALJ rejects the opinion of a treating source, he is required to articulate
some basis for rejecting the opinion. Shelman v. Heckler, 821 F.2d 316, 321 (6th Cir. 1987). The
Code of Federal Regulations defines a “treating source” as:
[Y]our own physician, psychologist, or other acceptable medical
source who provides you or has provided you, with medical
treatment or evaluation and who has, or has had, an ongoing
treatment relationship with you.
20 C.F.R. § 404.1502.
As a preliminary matter, Plaintiff argues that the ALJ erred in not according greater
weight to the opinions of her treating mental health providers from Centerstone. But the specific
points of contention she raises relate to the ALJ’s evaluation and characterization of her GRG
assessments and GAF scores, which were completed by a variety of mental health providers, the
majority of whom are not “acceptable medical sources” who can provide “medical opinions” as
defined by the Regulations. Compare TR 243-512, 545-592, 655-761, 781-797, with 20 C.F.R.
404.1513(a),(d), 404.1527(a)(2), 416.913(a),(d), 416.927(a)(2); SSR 06-3p. As such, while the
ALJ should consider those records because she must consider the evidence in its entirety, they
are not entitled to the deference due evidence from treating physicians, and she is not bound to
accord those opinions any specific weight.
As noted, Plaintiff contends that the ALJ erred by not explicitly stating the weight
accorded to her July 2009 and June 2010 CRGs (TR 552-554, 729-731) and the reasons therefor.
Docket Nos. 12-1, 17. Plaintiff concedes that the CRGs at issue indicate “moderate” limitations,
as stated by the ALJ, but argues that the specific language used in the CRGs to describe her
limitations demonstrates “significant and substantial limitations which are much more indicative
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of ‘marked’ limitations as that term is defined by SSA.” Docket No. 17 at 3. Plaintiff contends
that the ALJ should have looked at the description of her limitations, rather than the
characterization used, particularly because: (1) her low GAF scores are consistent with the
“significant and substantial limitations” described in the CRGs; (2) the CRGs were completed by
mental health providers who had treated her for years; and (3) the CRGs were consistent with,
and supported by, her Centerstone treatment notes. Id. Plaintiff acknowledges that the ALJ
mentioned these CRGs in her decision, but argues that the ALJ “failed to make any finding
whatsoever with regarding [sic] to the weight given to these assessments, much less provide any
rationale for rejecting these assessments.” Docket No. 12-1, at 16.
With regard to the CRGs at issue, the ALJ stated:
A Consumer Related Group form was completed in July 2009,
which showed only moderate mental limitations; however, the
claimant’s GAF score still reflected 45. The claimant continued to
report minimal relief with medication. Exhibit 8F.
...
At follow up appointments in June and August 2010, the claimant
stated that she was unsure whether the medication was helping.
Despite treatment alternatives, the claimant chose to stay with her
current regime. The claimant was assessed with only moderate
mental limitations, but her GAF score remained 45. Exhibit 14F,
15F.
TR 25, citing 545-592, 655-743.
While the ALJ is required to consider the entirety of the evidence of record, reach a
reasoned decision, and articulate the basis for that decision, there is no requirement that the ALJ
discuss in her decision each and every piece of evidence in the record or the weight accorded
thereto, particularly when, as discussed above, that evidence comes from sources that are not
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“acceptable medical sources” capable of rendering “medical opinions.”
In the case at bar, after noting that Plaintiff had sporadically sought mental health
treatment beginning in 2005 and had “reinitiated” care with Centerstone in September 2008, the
ALJ accurately discussed Plaintiff’s Centerstone care between September 2008 and June 2011.
TR 25-26, citing 243-512, 545-592, 655-761, 781-797. Contrary to Plaintiff’s assertion, the ALJ
did not misrepresent or mischaracterize the evidence therefrom. There is nothing improper with
the ALJ’s discussion of Plaintiff’s Centerstone records.
Additionally, when discussing the evidence relating to Plaintiff’s mental limitations, the
ALJ recounted Plaintiff’s testimony and subjective complaints, as well as the opinion of State
agency psychological consultant Dr. Paul. TR 26, citing 513-530. The ALJ also noted that Dr.
Paul’s opinion had been affirmed at the reconsideration level by Dr. Lawrence. Id., citing 611.
After discussing the evidence of record pertaining to Plaintiff’s mental limitations, the
ALJ stated:
The undersigned finds the assessment by Dr. Paul to be consistent
with the mental health treatment records, which consistently reflect
no more than moderate limitations once the claimant began
medication. The GAF score never changed from the initial
assessment and was in conflict with the subsequent moderate
findings. The claimant’s allegations of greater functional
limitations are not consistently reflected in the treatment records.
Therefore, the specific limitations opined by Dr. Paul have been
incorporated into the residual functional capacity.
In sum, the record documents the claimant’s severe impairments of
. . . anxiety; [and] depression . . . . Consideration has been given to
these impairments as reflected in the residual functional capacity.
However, the functional restrictions alleged by the claimant are not
entirely credible, as they have been found to be disproportionate to
the clinical findings. The claimant’s subjective complaints have
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been accepted, as far as they were supported by the objective
evidence and the record as a whole. Her impairments are limiting;
however, not disabling. The record simply does not support the
claimant’s allegations of disability.
TR 26-27.
As can be seen, the ALJ explained that she accepted the opinions and limitations that
were consistent with, and supported by, the record, and discounted those that were not. The ALJ
discussed the evidence of record, reached a reasoned decision, and articulated the basis for that
decision; the Regulations do not require more. Plaintiff’s contention that the ALJ erred by not
explicitly noting the weight accorded to her July 2009 and June 2010 CRGs and the reasons
therefore, fails.
Plaintiff next contends that the ALJ did not adequately consider her GAF scores. Docket
No. 12-1. GAF scores, however, are not determinative of disability for Social Security purposes,
and the Social Security Administration has declined to endorse the GAF scale for “use in the
Social Security and SSI disability programs.” See Revised Medical Criteria for Evaluating
Mental Disorders and Traumatic Brain Injury, 65 Fed. Reg. 50746-01 (August 21, 2000).
Moreover, the Social Security Administration has indicated that GAF scores have no “direct
correlation to the severity requirements in [the] mental disorders listings.” Id. Although “the
GAF is a test used by mental health practitioners with respect to planning treatment and tracking
the clinical progress of an individual in global terms, the ALJ is not bound to consider its results
at the exclusion of other medically reliable evidence.” Alvarez v. Barhart, 2002 WL 31466411,
at *8 (W.D.Tex. October 2, 2002). Nor is a GAF score determinative of an individual’s RFC
assessment. Id. (“A GAF score is not a rating typically relied upon with respect to assessing an

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individual’s RFC under the Act.”); see also Howard v. Commissioner, 276 F.3d 235, 241 (6th
Cir. 2002)(GAF score is not essential in assessing RFC).
Although there is no requirement that the ALJ discuss Plaintiff’s GAF scores, and GAF
scores are not determinative of disability for Social Security purposes or determinative of an
individual’s RFC assessment, the ALJ in the case at bar, when discussing Plaintiff’s Centerstone
treatment records, did, in fact, discuss Plaintiff’s low GAF scores. TR 25. Specifically, the ALJ
noted, inter alia, that Plaintiff’s September 2008 GAF score was “estimated at 45 with marked
limitations”; her July 2009 GAF score “still reflected 45”; her June and August 2010 GAF score
“remained 45.” Id. The ALJ’s decision demonstrates that she was aware of, and considered,
Plaintiff’s GAF scores, and the Regulations do not require more. Plaintiff’s argument on this
point likewise fails.
The ALJ properly considered the objective and testimonial evidence of record relating to
Plaintiff’s mental limitations, reached a reasoned decision, and properly explained the rationale
for her decision. Plaintiff’s claims regarding the ALJ’s evaluation of her Centerstone records
fail.

3. Step Five Evaluation
Plaintiff contends that the ALJ erred in her consideration of the evidence during step five
of the sequential evaluation. Docket No. 12-1 at 19. Specifically, Plaintiff argues that the ALJ
erroneously found that she had skills transferrable to three sedentary jobs, and further failed to
adequately question the VE regarding the “amount or ease of transition” to the lines of work

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proposed, as required by the medical-vocational guidelines, or “grids,” found in 20 C.F.R.§
404.1568(d). Id. at 20. Plaintiff additionally argues that the stated jobs are “at least somewhat
inconsistent with the ALJ’s RFC finding,” but “this inconsistency was never addressed or
resolve[d] in the testimony or the ALJ’s decision.” Id. at 20-21. Plaintiff contends that the three
identified jobs require frequent handling, and two of them require occasional fingering with the
third requiring constant fingering, which are inconsistent requirements with the ALJ’s finding
that Plaintiff had limited wrist motion and forceful grip. TR 21.
Defendant responds that the ALJ is not bound by the grids since she found that Plaintiff’s
impairments limited her to less than a full range of light work. Docket No. 15 at 20. Defendant
contends that, accordingly, the ALJ is to use the grids as a framework for decision-making and
can rely upon the VE’s testimony regarding the type of skills that Plaintiff acquired in her past
work and the degree of transferability of those skills to other work available in significant
numbers in the national economy. Id. Defendant asserts that the VE explicitly testified that a
limitation on the amount of wrist motion and forceful grip that an individual could perform
would erode the occupational base and she appropriately decreased the numbers of available jobs
in her testimony to account for those limitations. Id. at 21. Defendant contends, therefore, that
the ALJ properly accepted the VE’s testimony. Id. Defendant maintains that the ALJ’s findings
were supported by substantial evidence, reached through the application of the correct legal
standards, and should stand. Id. at 20.
Plaintiff, in her Reply, reiterates her assertions that the ALJ failed to properly apply the
Regulations of 20 C.F.R. § 404.1568(d) and erroneously found that she had transferrable skills to
three sedentary occupations without evaluation or consideration of this Regulation and its
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requirements. Docket No. 17 at 4-5.
As explained above, the Commissioner has the burden at step five of the sequential
evaluation process of establishing the claimant’s ability to work by proving the existence of a
significant number of jobs in the national economy that the claimant could perform, given his or
her age, experience, education, and residual functional capacity. 20 C.F.R. §§ 404.1520,
416.920. See also Moon v. Sullivan, 923 F.2d 1175, 1181 (6th Cir. 1990). The Commissioner’s
burden at step five can be satisfied by relying on the grid rules only if Plaintiff is not
significantly limited by nonexertional impairments, such as mental limitations, manipulative
limitations or environmental limitations. Abbot v. Sullivan, 905 F.2d 918, 926 (6th Cir. 1990). In
the presence of nonexertional limitations that would preclude the application of the grid
regulations, “expert testimony would be required to satisfy the Secretary’s burden of proof
regarding the availability of jobs which this particular claimant can exertionally handle.” Kirk v.
Secretary, 667 F.2d 524, 531 (6th Cir. 1983). In other words, the ALJ may rely on the testimony
of a vocational expert in response to a hypothetical question as substantial evidence of the
existence of a significant number of jobs that the claimant is capable of performing as long as the
hypothetical question accurately represents the claimant’s limitations. See Varley, 820 F.2d at
779 (quoting O’Banner v. Secretary, 587 F.2d 321, 323 (6th Cir. 1978)).
As noted, the ALJ in the case at bar determined that Plaintiff did, in fact, have
nonexertional impairments (TR 25-27), the presence of which precludes the application of the
grid regulations (Kirk, 667 F.2d 531). Thus, “expert testimony would be required to satisfy the
Secretary’s burden of proof regarding the availability of jobs which [Plaintiff could] exertionally
handle.” Id.
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At Plaintiff’s hearing, the ALJ, after explaining that she would “assume your testimony is
based on your knowledge, education, training and experience and is consistent with the
Dictionary of Occupational Titles, unless you tell me otherwise,” asked the VE if she was
“familiar with the claimant’s vocational background.” TR at 45. After receiving an affirmative
answer from the VE, the ALJ then asked the VE to “identify the claimant’s work performed
within the past 15 years.” Id. After the VE discussed Plaintiff’s past work, the ALJ asked the
VE whether Plaintiff had acquired any transferrable skills. TR 46. The VE responded:
A

She does have transferrable skills because she - - what I
call general office skills. She answered the phone and did
some data entry and she made reservations. So I put - - I
said she does have transferrable skills to jobs such as a
receptionist.
...

A

. . . Receptionist, appointment clerk and just data entry
clerk.

Id.
The ALJ then posed the following hypothetical questions to the VE, all of which
incorporated Plaintiff’s nonexertional limitations, as well as Plaintiff’s age, education, work
experience, and postural limitations. See TR 45-50.
Q

. . . First hypothetical is based on [Exhibit] 6F and 5F.
Assume a person of the claimant’s age, advanced age, with
a 12th-grade education and work experience as you’ve
described who’s able to lift and carry up to 20 pounds
occasionally, 10 pounds frequently, stand and/or walk for
six hours, sit for eight hours. Postural limitations is limited
squatting.
Physical and environmental limitations, limited heat,
humidity, climbing, heights and wrist motion and forceful
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grip.
...
5F says there were five categories that were marked
moderately limited and the assessment is the following.
The individual can understand and remember simple and
detailed tasks, individual can with some, but not substantial
difficulty, sustain adequate persistence and pace for simple
and low-level detailed tasks for two-hour segments across
normal work day and work week. Individual can
experience some, but not substantial difficulty dealing with
the general public, can interact and get along with
coworkers and supervisors, can adapt and respond to
changes in a routine work setting, given reasonable
support, can make and set work-related plans and goals.
Could that individual do any of the claimant’s past relevant
work?
A

Well, because of the - - mainly because of the mental, the
past work as a caretaker has precluded the definition
because it was medium. The night auditor was skilled and
both the customer service rep at light and sedentary were
both SVP of 5 and 6, so they’re skilled and would be
precluded under this RFC.

Q

Okay, would there be other work existing in the regional
and national economy that individual could perform?

A

Yes. In fact, those skills that transfer to sedentary - - to
perform- - well, in my opinion, definitely the appointment
clerk 237.367-010. It’s sedentary. The SVP is only three,
so it’s a low-level semi-skilled work. And there would be - at least 3,500 for Tennessee and 75,000 from the United
States. There’s a lot of those type of jobs.
Now the receptionist, I think in some occupational settings
that that could still be a job. It’s semi-skilled and sedentary
and the DOT code is 237.367-038. But because the SVP is
four and because of maybe a little more sustained contact
with the public asking questions, I don’t think all those, so
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we’re kind of limited to places that aren’t as large, you
know, not great big office setting or something like that.
But I still think, you know, reasonably about 1,500, 1,600
for the region would still be available and 45,000 for the
Untied States, because there’s just a ton of those out there.
And then the data entry, there’s not very much contact with
the public. So I think it would be available and that is
203.582-054, it’s sedentary, the SVP is four, but - - and
because of that four, I’ll knock down the number some. I
would say at least 2,000 would be available in the region. I
don’t think they really cause any forceful grip. It’s not a
part of it, wrist motion, somewhat, but I am knocking the
numbers way down, probably 75 percent. So 2,000 for the
region and about 35,000 for the United States.
...
Q

Okay. So appointment clerk was the first [job],
receptionist, the second and data entry, third.

A

Right. . . . And those are ones utilizing skills from her past
work.

Q

All right, thank you. All right. Next hypothetical is based
on [Exhibit] 7F and 5F. 7F says individual could lift up to
20 pounds occasionally, 10 pounds frequently, could
stand/or walk about six hours, could sit about six hours,
push and/or pull was unlimited, limited in gross
manipulation of the right upper extremity to frequently and
then 5F is what I gave you in the prior hypothetical. . . . So
could that individual do any of the claimant’s past relevant
work?

A

Those jobs I was - - with what she’s using the tools and
process of the trade, the transferrable skills jobs, I cited
under one - - would still be available under two.

TR 47-50.
Plaintiff’s representative at the hearing then posed her own hypothetical question to the

25

VE as follows:
Q

If as [Plaintiff] testified, she would have to take a nap every
day for 1-1/2 hours to 2 hours, would that have an impact
on any of these jobs?

A

If such an individual would have to lie down that many
times they’d lose their job, even if they got it because they
couldn’t keep up with their work. They be fired. [sic].

TR 50.
As can be seen, the ALJ’s hypothetical questions properly included both Plaintiff’s
exertional and nonexertional limitations. Moreover, as can be seen, the VE explicitly
acknowledged Plaintiff’s mental and physical limitations (including those of her wrist and her
ability to grip) and specifically articulated that she was significantly reducing the number of
available jobs to reflect those additional limitations. Additionally, the VE explicitly considered
the exertional and SVP levels of the stated jobs and noted whether and why Plaintiff’s past
relevant work and the stated available positions would be appropriate for each of the
hypothetical claimants. The ALJ, therefore, properly relied on the VE’s answer to the
hypothetical questions to prove the existence of a significant number of jobs in the national
economy that Plaintiff could perform. See Felisky v. Bowen, 35 F.3d 1027, 1036 (6th Cir. 1994);
Hardaway v. Secretary, 823 F.2d 922, 927-928 (6th Cir. 1987); and Varley, 820 F.2d at 779.
Accordingly, Plaintiff’s claim fails.
IV. RECOMMENDATION
For the reasons discussed above, the undersigned recommends that Plaintiff’s Motion for
Judgment on the Administrative Record be DENIED, and that the decision of the Commissioner
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be AFFIRMED.
Under Rule 72(b) of the Federal Rules of Civil Procedure, any party has fourteen (14)
days after service of this Report and Recommendation in which to file any written objections to
this Recommendation with the District Court. Any party opposing said objections shall have
fourteen (14) days after service of any objections filed to this Report in which to file any
response to said objections. Failure to file specific objections within fourteen (14) days of
service of this Report and Recommendation can constitute a waiver of further appeal of this
Recommendation. See Thomas v. Arn, 474 U.S. 140, 106 S.Ct. 466, 88 L. Ed. 2d 435 (1985),
reh’g denied, 474 U.S. 1111 (1986); 28 U.S.C. § 636(b)(1); Fed. R. Civ. P. 72.

________________________________
E. CLIFTON KNOWLES
United States Magistrate Judge

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