Garrett v. Social Security Administration

Filing 16

REPORT AND RECOMMENDATION: It is recommended that Plaintiff's motion for judgment on the administrative record (DE 14) be GRANTED and that this case be REMANDED pursuant to sentence four of 42 U.S.C. § 405(g) for additional consideration of Plaintiff's claims. Signed by Magistrate Judge Barbara D. Holmes on 1/29/2016. (DOCKET TEXT SUMMARY ONLY-ATTORNEYS MUST OPEN THE PDF AND READ THE ORDER.)(eh)

IN THE UNITED STATES DISTRICT COURT
MIDDLE DISTRICT OF TENNESSEE
NASHVILLE DIVISION

ANDREA L. GARRETT
v.
CAROLYN W. COLVIN,
Acting Commissioner of Social Security

)
)
)
)
)
)

No. 3:14-2391

To: The Honorable Aleta A. Trauger, District Judge

REPORT AND RECOMMENDATION
Plaintiff filed this action pursuant to 42 U.S.C. § 405(g) to obtain judicial review of the final
decision of the Commissioner of Social Security (“Commissioner”) that denied Plaintiff’s claim for
a period of disability, Disability Insurance Benefits (“DIB”), and Supplemental Security Income
(“SSI”), as provided by the Social Security Act (“the Act”). The case is currently pending on
Plaintiff's motion for judgment on the administrative record (Docket Entry No. 14),1 to which
Defendant has filed a response (Docket Entry No. 15).
Upon review of the administrative record as a whole and consideration of the parties’ filings,
the Court recommends that Plaintiff’s motion for judgment on the administrative record (Docket
Entry No. 14) be GRANTED, the decision of the Social Security Administration be reversed, and
this matter be remanded for further administrative proceedings consistent with this Report.

1

Plaintiff labels this document, “brief in support of complaint for review.” Docket Entry
No. 14 at 1. This document is effectively a motion for judgment on the administrative record,
however, as was ordered by the Court. Docket Entry No. 13 at 1.

I. INTRODUCTION
Plaintiff protectively filed for a period of disability, DIB, and SSI on May 28, 2009. See
Transcript of the Administrative Record (Docket Entry No. 11),2 at 56-57. She alleged a disability
onset date of July 26, 2011. AR 35. Plaintiff asserted that she was unable to work because of
anxiety related disorders and gastroesophageal reflux disease (“GERD”). AR 52-55. Plaintiff filed
an additional claim for DIB on April 19, 2010, in which she claimed that she was unable to work due
to migraines and affective disorders. AR 58. Plaintiff again filed claims for DIB and SSI on
August 9, 2011, in which she claimed she was unable to work because of affective disorders and
anxiety related disorders. AR 60-61.
Plaintiff’s applications were denied initially and upon reconsideration. AR 56-63. After
submitting a request for a hearing before an administrative law judge (“ALJ”), Plaintiff appeared
with counsel and testified at a hearing before ALJ Shannon H. Smith on September May 22, 2013.
AR 6. On July 26, 2013, the ALJ issued a decision unfavorable to Plaintiff. AR 32-34. On
October 28, 2014, the Appeals Council denied Plaintiff’s request for review of the ALJ’s decision,
AR 1-4, thereby making the ALJ’s decision the final decision of the Commissioner. This civil action
was thereafter timely filed, and the Court has jurisdiction. 42 U.S.C. § 405(g).

2

The Transcript of the Administrative Record is hereinafter referenced by the abbreviation
“AR” followed by the corresponding page number(s). All other filings are hereinafter referenced
by the abbreviation “DE” followed by the corresponding docket entry number and page number(s),
where appropriate.
2

II. THE ALJ FINDINGS
The ALJ issued an unfavorable decision on January 6, 2012. AR 14-24. Based upon the
record, the ALJ made the following enumerated findings:
1.

The claimant meets the insured status requirements of the Social Security Act
through December 31, 2015.

2.

The claimant has not engaged in substantial gainful activity since July 26,
2011, the alleged onset date (20 CFR 404.1571 et seq., and 416.971 et seq.).

3.

The claimant has the following severe impairments: generalized anxiety
disorder, panic disorder, major depressive disorder, and migraines (20 CFR
404.1520(c) and 416.920(c)).

4.

5.

6.

7.

8.

***
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 CFR Part 404, Subpart P, Appendix 1 (20 CFR 404.1520(d), 404.1525,
404.1526, 416.920(d), 416.925 and 416.926).
***
After careful consideration of the entire record, the undersigned finds that the
claimant has the residual functional capacity to perform a full range of work
at all exertional levels but with the following nonexertional limitations: she
can understand, remember, and carry out simple tasks; sustain concentration,
persistence, and pace for two hours with normal breaks spread throughout the
day; interact with others appropriately, but would do better with things rather
than people; and adapt to occasional changes in the workplace and in job
duties.
***
The claimant is unable to perform any past relevant work (20 CFR 404.1565
and 416.965).
***
The claimant was born on November 11, 1980 and was 30 years old, which
is defined as a younger individual age 18-49, on the alleged disability onset
date (20 CFR 404.1563 and 416.963).
The claimant has at least a high school education and is able to communicate
in English (20 CFR 404.1564 and 416.964).
3

9.

Transferability of job skills is not material to the determination of disability
because using the Medical-Vocational Rules as a framework supports a
finding that the claimant is “not disabled,” whether or not the claimant has
transferable job skills (See SSR 82-41 and 20 CFR Part 404, Subpart P,
Appendix 2).

10.

Considering the claimant’s age, education, work experience, and residual
functional capacity, there are jobs that exist in significant numbers in the
national economy that the claimant can perform (20 CFR 404.1569,
404.1569(a), 416.969 and 416.969(a)).
***

11.

The claimant has not been under a disability, as defined in the Social Security
Act, from July 26, 2011, through the date of this decision (20 CFR
404.1520(g) and 416.920(g)).

AR 37-47.

III. REVIEW OF THE RECORD
The parties and the ALJ have thoroughly summarized and discussed the medical and
testimonial evidence contained in the administrative record. Accordingly, the Court will discuss
those matters only to the extent necessary to analyze the parties’ arguments.

IV. DISCUSSION AND CONCLUSIONS OF LAW
A. Standard of Review
The determination of disability under the Act is an administrative decision. The only
questions before this Court upon judicial review are: (i) whether the decision of the Commissioner
is supported by substantial evidence, and (ii) whether the Commissioner made legal errors in the
process of reaching the decision. 42 U.S.C. § 405(g). See Richardson v. Perales, 402 U.S. 389, 401,

4

91 S. Ct. 1420, 28 L. Ed. 2d 842 (1971) (adopting and defining substantial evidence standard in
context of Social Security cases); Kyle v. Comm’r Soc. Sec., 609 F.3d 847, 854 (6th Cir. 2010);
Landsaw v. Sec’y of Health & Human Servs., 803 F.2d 211, 213 (6th Cir. 1986).
Substantial evidence is defined as “more than a mere scintilla” and “such relevant evidence
as a reasonable mind might accept as adequate to support a conclusion.” Richardson, 402 U.S. at
401 (quoting Consol. Edison Co. v. NLRB, 305 U.S. 197, 229, 59 S. Ct. 206, 83 L. Ed. 126 (1938));
Rogers v. Comm’r of Soc. Sec., 486 F.3d 234, 241 (6th Cir. 2007). The Commissioner’s decision
must be affirmed if it is supported by substantial evidence, “even if there is substantial evidence in
the record that would have supported an opposite conclusion.” Blakely v. Comm’r of Soc. Sec., 581
F.3d 399, 406 (6th Cir. 2009) (quoting Key v. Callahan, 109 F.3d 270, 273 (6th Cir. 1997)); Jones
v. Comm’r of Soc. Sec., 336 F.3d 469, 477 (6th Cir. 2003); Her v. Comm’r of Soc. Sec., 203 F.3d
388, 389-90 (6th Cir. 1999)).
The 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). A
reviewing court may not try the case de novo, resolve conflicts in evidence, or decide questions of
credibility. See Garner v. Heckler, 745 F.2d 383, 387 (6th Cir. 1984) (citing Myers v. Richardson,
471 F.2d 1265, 1268 (6th Cir. 1972)). The Court must accept the ALJ’s explicit findings and final
determination unless the record as a whole is without substantial evidence to support the ALJ’s
determination. 42 U.S.C. § 405(g). See, e.g., Houston v. Sec’y of Health & Human Servs., 736 F.2d
365, 366 (6th Cir. 1984).

5

B. Determining Disability at the Administrative Level
The claimant has the ultimate burden of establishing an entitlement to benefits by proving
her “inability to engage in any substantial gainful activity by reason of any medically determinable
physical or mental impairment which can be expected to result in death or which has lasted or can
be expected to last for a continuous period of not less than 12 months.” 42 U.S.C. § 423(d)(1)(A).
The asserted impairment(s) must be demonstrated by medically acceptable clinical and laboratory
diagnostic techniques. See 42 U.S.C. §§ 423(d)(3) and 1382c(a)(3)(D); 20 CFR §§ 404.1512(a), (c),
and 404.1513(d). “Substantial gainful activity” includes not only previous work performed by the
claimant, but also, considering the claimant’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 the claimant lives, or whether a specific job vacancy
exists, or whether the claimant would be hired if she applied. 42 U.S.C. § 423(d)(2)(A).
In the proceedings before the Social Security Administration, the Commissioner must employ
a five-step, sequential evaluation process in considering the issue of the claimant’s alleged disability.
See Heston v. Comm’r of Soc. Sec., 245 F.3d 528, 534 (6th Cir. 2001); Abbot v. Sullivan, 905 F.2d
918, 923 (6th Cir. 1990). First, the claimant must show that she is not engaged in “substantial
gainful activity” at the time disability benefits are sought. Cruse v. Comm’r of Soc. Sec., 502 F.3d
532, 539 (6th Cir. 2007); 20 CFR §§ 404.1520(b), 416.920(b). Second, the claimant must show that
she suffers from a severe impairment that meets the twelve month durational requirement. 20 CFR
§§ 404.1520(a)(4)(ii), 416.920(a)(4)(ii). See also Edwards v. Comm’r of Soc. Sec., 113 F. App’x
83, 85 (6th Cir. 2004). Third, if the claimant has satisfied the first two steps, the claimant is
presumed disabled without further inquiry, regardless of age, education, or work experience, if the
6

impairment at issue either appears on the regulatory list of impairments that are sufficiently severe
as to prevent any gainful employment, or equals a listed impairment. Combs v. Comm’r of Soc. Sec.,
459 F.3d 640, 643 (6th Cir. 2006); 20 CFR §§ 404.1520(d), 416.920(d). A claimant is not required
to show the existence of a listed impairment in order to be found disabled, but such a showing results
in an automatic finding of disability that ends the inquiry. See Combs, supra; Blankenship v. Bowen,
874 F.2d 1116, 1122 (6th Cir. 1989).
If the claimant’s impairment does not render her presumptively disabled, the fourth step
evaluates the claimant’s residual functional capacity in relation to her past relevant work. Combs,
supra. “Residual functional capacity” (“RFC”) is defined as “the most [the claimant] can still do
despite [her] limitations.” 20 CFR § 404.1545(a)(1). In determining a claimant’s RFC, for purposes
of the analysis required at steps four and five, the ALJ 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), (5)(B); Foster v. Bowen, 853 F.2d 483, 490 (6th
Cir.1988). At the fourth step, the claimant has the burden of proving an inability to perform past
relevant work or proving that a particular past job should not be considered relevant. Cruse, 502
F.3d at 539; Jones, 336 F.3d at 474. If the claimant cannot satisfy the burden at the fourth step,
disability benefits must be denied because the claimant is not disabled. Combs, supra.
If a claimant is not presumed disabled but shows that past relevant work cannot be
performed, the burden of production shifts at step five to the Commissioner to show that the
claimant, in light of the claimant’s RFC, age, education, and work experience, can perform other
substantial gainful employment and that such employment exists in significant numbers in the
national economy. Longworth v. Comm’r of Soc. Sec., 402 F.3d 591, 595 (6th Cir. 2005) (quoting
7

Walters v. Comm’r of Soc. Sec., 127 F.3d 525, 529 (6th Cir. 1997)). See also Felisky v. Bowen,
35 F.3d 1027, 1035 (6th Cir. 1994). To rebut a prima facie case, the Commissioner must come
forward with proof of the existence of other jobs a claimant can perform. Longworth, 402 F.3d at
595. See also Kirk v. Sec’y of Health & Human Servs., 667 F.2d 524, 528 (6th Cir. 1981), cert.
denied, 461 U.S. 957, 103 S. Ct. 2428, 77 L. Ed. 2d 1315 (1983) (upholding the validity of the
medical-vocational guidelines grid as a means for the Commissioner of carrying his burden under
appropriate circumstances). Even if the claimant’s impairments prevent the claimant from doing
past relevant work, if other work exists in significant numbers in the national economy that the
claimant can perform, the claimant is not disabled. Rabbers v. Comm’r of Soc. Sec., 582 F.3d 647,
652 (6th Cir. 2009). See also Tyra v. Sec’y of Health & Human Servs., 896 F.2d 1024, 1028-29 (6th
Cir. 1990); Farris v. Sec’y of Health & Human Servs., 773 F.2d 85, 88-89 (6th Cir. 1985); Mowery
v. Heckler, 771 F.2d 966, 969-70 (6th Cir. 1985).
If the question of disability can be resolved at any point in the sequential evaluation process,
the claim is not reviewed further. 20 CFR § 404.1520(a)(4). See also Higgs v. Bowen, 880 F.2d
860, 863 (6th Cir. 1988) (holding that resolution of a claim at step two of the evaluative process is
appropriate in some circumstances).

C. The ALJ’s Five-Step Evaluation of Plaintiff
The ALJ in this case resolved Plaintiff’s claim at step five of the five-step process. The ALJ
found that Plaintiff met the first two steps, AR 37, but found at step three that Plaintiff was not
presumptively disabled because she did not have an impairment or combination of impairments that
met or medically equaled the severity of one of the listed impairments in 20 CFR Part 404,
8

Subpart P, Appendix 1. AR 38-39. At step four, the ALJ found that Plaintiff’s impairments
rendered her unable to perform any past relevant work, AR 46, thus triggering the fifth step of the
inquiry. At step five, the ALJ found that Plaintiff’s RFC allowed her to perform a full range of work
with certain limitations as set out in the ALJ’s findings, AR 39-46, and that, considering her age,
education, work experience, and RFC, there are jobs that exist in significant numbers in the national
economy that Plaintiff can perform. AR 46-47.

D. Plaintiff’s Assertions of Error
Plaintiff contends that the ALJ erred by: (1) failing to properly evaluate and assess the
credibility of Plaintiff’s statements; (2) failing to provide sufficiently specific reasons for rejecting
the opinions of Dr. Brandon Robbins and Brandee Madden; (3) failing to discuss the impact of
Plaintiff’s migraines and headaches on her ability to work; (4) failing to properly address Plaintiff’s
symptoms during her questioning of the vocational expert; and (5) disregarding relevant evidence
regarding Plaintiff’s condition. DE 14 at 14-35. Plaintiff argues that the Commissioner’s decision
should therefore be reversed and benefits awarded, or in the alternative, that this case be remanded
for further administrative proceedings pursuant to sentence four of 42 U.S.C. § 405(g).
Sentence four of 42 U.S.C. § 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 [Commissioner’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
9

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 claimant’s entitlement to benefits. Faucher v. Secretary, 17 F.3d
171, 176 (6th Cir. 1994). See also Newkirk v. Shalala, 25 F.3d 316, 318 (1994). Plaintiff’s
arguments are addressed below:

1. Whether the ALJ failed to properly evaluate Plaintiff’s credibility.
Plaintiff asserts that the ALJ “cherry-picked select portions of the medical record” in order
to discredit her allegations regarding the extent of her symptoms. DE 14 at 22-23. Plaintiff provides
four sub-arguments in support of her assertion that the ALJ improperly considered her credibility.
First, Plaintiff argues that the ALJ failed to provide any support for her assessment that Plaintiff’s
allegations regarding the extent of her mental impairment symptoms are “only partially credible.”
Id. at 14; AR 45. Plaintiff points to the ALJ’s reliance on medical notes documenting her treatment
with Mental Health Cooperative, AR 51, and contends that the ALJ improperly concluded that
Plaintiff’s symptoms were less severe than she alleged based on two notes in the record indicating
“some brief moments of minor improvement” in her condition. DE 14 at 16. Second, Plaintiff
argues that the ALJ’s finding that her statements regarding the frequency of her migraine headaches
were unsupported by the record ignores the majority of the medical notes contained in the record.
Id. at 17. Plaintiff references numerous notes in the record that she contends support her statements
concerning the severity of her migraine symptoms. Id. Third, Plaintiff argues that the ALJ
improperly accused her of medication noncompliance without seeking the reasons for such behavior,
in violation of Social Security Ruling (“SSR”) 96-7p. Id. at 19. Finally, Plaintiff argues that the ALJ
10

mis-characterized her daily activities and erroneously concluded that such activities demonstrated
a greater capacity for social interaction and concentration than was alleged. Id. at 20.
The ALJ stated the following with respect to the severity of Plaintiff’s mental impairments,
which include generalized anxiety disorder, panic disorder, and major depressive disorder:
While [Plaintiff] has experienced one inpatient psychiatric admission during the
period in question, and at times reported fairly frequent panic attacks, review of her
medical records, especially her records from the Mental Health Cooperative, fails to
support her contention that she has panic attacks at the alleged frequency. Further,
her records from the Mental Health Cooperative show that she has reported positive
improvement from medication.
AR 45. Plaintiff claims that there is no suggestion in the ALJ’s summary of her treatment at Mental
Health Cooperative, AR 43-45, that Plaintiff has exaggerated the frequency of her symptoms. DE 14
at 14-15. Plaintiff also disputes the ALJ’s finding that Plaintiff reported improvement of her
symptoms with medication, arguing that she instead demonstrated minor improvement on only one
occasion immediately following her hospitalization for psychiatric evaluation. Id. at 16. Defendant
concedes that the ALJ’s opinion does not reference any specific notes from Mental Health
Cooperative in support of her opinion, but argues that the record as a whole indicates that Plaintiff
“was able to generally behave appropriately” during her home visits with a case manager, and that
the frequency of Plaintiff’s alleged panic attacks is not supported. DE 15 at 6.
It is the responsibility of the ALJ, and not the reviewing court, to evaluate the credibility of
a claimant. Rogers, 486 F.3d at 247 (internal citations omitted). The ALJ’s determination of
credibility is accorded great weight and deference because the ALJ has the opportunity to observe
the claimant’s demeanor while testifying. Jones, 336 F.3d at 476 (citing Walters, 127 F.3d at 528).
However, the ALJ is not permitted to base her credibility determination solely on an “intangible or

11

intuitive notion about an individual’s credibility.” Id. (quoting SSR 96-7p, 1996 WL 374186, at *4).
Instead, the ALJ must explain her credibility determination in a way that is “sufficiently specific to
make clear to the individual and to any subsequent reviewers the weight the adjudicator gave to the
individual’s statements and the reasons for that weight.” SSR 96-7p, 1996 WL 374186, at *2.
“[B]lanket assertions that the claimant is not believable will not pass muster, nor will explanations
as to credibility which are not consistent with the entire record and the weight of the relevant
evidence.” Rogers, 486 F.3d at 248. The issue is therefore whether the ALJ’s explanation for
partially discrediting Plaintiff’s testimony is supported by substantial evidence in the record. Jones,
336 F.3d at 476.
During her hearing before the ALJ, Plaintiff stated that she experiences panic attacks at least
one or two times per week. AR 19. The ALJ expressed her disbelief of such frequency based on
Plaintiff’s medical records, emphasizing that the records from Mental Health Cooperative did not
support Plaintiff’s claims regarding the frequency of her panic attacks. AR 45. Although the ALJ
provided a summary of Plaintiff’s treatment at Mental Health Cooperative in her opinion, AR 43-45,
the Court sees no evidence in this summary suggesting that Plaintiff’s claims regarding the frequency
of her panic attacks are not credible. The Court therefore turns to the actual record of Plaintiff’s
treatment with Mental Health Cooperative.
On July 5, 2012, Plaintiff advised Dr. Franklin Drummond with Mental Health Cooperative
that she experienced a panic attack each day. AR 1446. On August 20, 2012, Plaintiff reported that
she was unable to go to a store without having a panic attack. AR 1451. On August 22, 2012,
Plaintiff reported “frequent panic attacks.” AR 1453. She reported continued panic attacks on
September 5, 2012. AR 1454. On both September 10 and September 18, 2012, Plaintiff reported
12

that “nothing [had] changed” with respect to her mental health. AR 1455-56. On September 26,
2012, Plaintiff reported that it was difficult to leave her home due to fear of experiencing a panic
attack. AR 1458. On October 15, 2012, Plaintiff reported that she had “been getting out of the home
more and [had] been driving around more,” AR 1460, and on November 7, 2012, she reported
having “less panic and anxiety.” AR 1462. However, on November 27, 2012, Plaintiff stated that
she was “experiencing a lot of depression and anxiety.” AR 1463. She also “continue[d] to voice
anxiety and panic attacks” on December 5, 2012. AR 1464.
Based on the foregoing, the Court cannot agree with the ALJ that the records from Mental
Health Cooperative are inconsistent with the alleged frequency of Plaintiff’s panic attacks. Plaintiff
testified that she experienced at least one or two panic attacks per week. AR 19. The numerous
records from Mental Health Cooperative indicate that Plaintiff consistently complained of frequent
panic attacks to her providers. There is only one record, dated November 7, 2012, indicating that
Plaintiff may have been experiencing less anxiety. AR 1462. The record does not state, however,
that the number of panic attacks she was experiencing each week had decreased. Additionally, the
next two records from Mental Health Cooperative, dated November 27 and December 5, 2012,
indicate that Plaintiff was experiencing increased anxiety. AR 1463-64. As such, the Court finds
nothing in the Mental Health Cooperative notes that contradicts Plaintiff’s statements regarding the
frequency of her panic attacks.
The ALJ also referenced Plaintiff’s “reported positive improvement from medication” in the
Mental Health Cooperative records as a basis for discounting her credibility. AR 45. The ALJ relies
on the aforementioned note from November 7, 2012, in which Plaintiff “reported better mood despite
continued anxiety and nightmares.” AR 44, 1462. The ALJ also noted that during a December 5,
13

2012 visit at Mental Health Cooperative, Plaintiff reported that she had not been taking her
medication, which resulted in “increased irritability, anxiety and insomnia,” according to her
provider. AR 1464.
Notably, there is some evidence in the record that Plaintiff was noncompliant with her
medication prescriptions over the course of her treatment. In addition to the previously discussed
note from December 5, 2012, the ALJ referenced Plaintiff’s failure to take Prazosin prescribed by
her provider, as documented in a note from August 22, 2012. AR 43, 1453. A note from
September 5, 2012 indicates that Plaintiff “only started the increase in [medication] a day ago,” and
that Plaintiff was advised to take the medication as prescribed “for a longer trial.” AR 43, 1454.
During a subsequent visit with her case manager on September 24, 2012, Plaintiff admitted that she
had increased her dosage of Seroquel without being told to do so by her provider. AR 44, 1457-58.
The ALJ also referenced records from Plaintiff’s inpatient hospitalization in June of 2012, in which
it was noted that Plaintiff had not been taking her prescribed medication. AR 43, 1273-75, 1299.
Despite these examples, Plaintiff repeatedly reported that she was compliant with her medication
regimen. AR 1456-57, 1459-60, 1463, 1465, 1467-69, 1471.
In addition to improvement with medication and noncompliance, the ALJ partially discounted
Plaintiff’s credibility based on her mental functioning scores and her daily activities:
[T]reatment records show fairly consistent global assessment of functioning scores
in the range suggestive of moderate symptoms, aside from when she was hospitalized
when off medication and using marijuana. Additionally, the [Plaintiff’s] activities
suggest that she is less limited from a mental standpoint then [sic] she alleges. She
cares for her young son, including driving him to school and helping him with his
homework. She regularly interacts with friends and family. She displays ability to
care for her own hygiene and while she denied doing household chores, evidence
from the notes of her case manager at Mental Health Cooperative tends to suggest
otherwise. She manages her own finances. She plays card games with family on
14

Sunday’s [sic] when they come over to visit per testimony. These activities tend to
suggest greater capacity for social interaction and concentration than alleged.
AR 45. Plaintiff argues that her statements of the severity of her symptoms are supported by the
overall record. DE 14 at 16. Plaintiff claims that she was only “able to drive herself to one
appointment, which was one minor notation of improvement.” Id. at 15. Plaintiff also argues that
any “small improvements” in her condition were temporary in light of her complaint that she “was
sleeping a lot because she did not know how else to handle the stress.” Id. at 15-16, 1465. The
Court also notes that Plaintiff’s complaint to her case manager that she was sleeping more frequently
in order to cope with stress, AR 1465, was reported on the same day that she admitted to her provider
that she was not taking her prescribed medication. AR 1464-65. The ALJ discussed this
noncompliance in her opinion. AR 44.
Nevertheless, despite the ALJ’s discussion of Plaintiff’s occasional noncompliance with her
medication, the Court does not find that there is substantial evidence in the record to support the
ALJ’s determination of Plaintiff’s credibility. The ALJ lays out several reasons for discounting
Plaintiff’s credibility, but the majority of those reasons are either exaggerated or contradicted by
other evidence in the record. The ALJ states that the Plaintiff showed “fairly consistent” global
assessment of functioning (“GAF”) scores that suggested she suffered from only moderate
symptoms. AR 45. The ALJ discounts Plaintiff’s GAF score of 30 during her hospitalization, which
the ALJ attributes to Plaintiff’s being “off medication and using marijuana.” AR 45. However, even
discounting this GAF score, which suggests severe symptoms, the ALJ ignored other records
indicating that Plaintiff was again assigned a GAF score of 30. AR 332. In fact, Plaintiff was
assigned a GAF score of 30 the month prior to her hearing before the ALJ. AR 6, 332. As discussed

15

in greater detail below, the ALJ appears to have completely disregarded this significant piece of
evidence.
The ALJ also based her credibility determination on Plaintiff’s daily activities, which were
characterized as caring for her young son, driving him to school, interacting with friends and family,
and doing household chores. AR 45. However, the ALJ ignored substantial evidence in the record
suggesting that Plaintiff struggles significantly with each of these activities. There are numerous
examples in the record documenting Plaintiff’s difficulty in caring for her son, including frequent
reliance on friends and family to help her. AR 20, 21, 213, 219, 304, 1460. Additionally, Plaintiff
stated during her hearing that she only drives “sometimes,” and that other times her mother has to
drive her to appointments. AR 21. She further noted that she avoids attempting to drive when she
feels anxiety because she was involved in an accident caused by a panic attack. AR 21. Plaintiff
also repeatedly complained of poor interactions with family and friends, AR 1448, 1450-52, 1455,
1460, and was diagnosed with agoraphobia. AR 1452-53, 1456-58. Plaintiff specifically noted that
she was increasingly involved in confrontations with other people, AR 1458, and that a family
member had even demanded that she move out of the house. AR 1461. This represents significant
evidence that contradicts the stated basis for the ALJ’s credibility finding.
Moreover, the ALJ stated that “while [Plaintiff] denied doing household chores, evidence
from the notes of her case manager at Mental Health Cooperative tends to suggest otherwise.” AR
45. However, the Mental Health Cooperative notes on which she relies clearly show that Plaintiff
was living in a home with numerous other people, including her mother, grandmother, and uncle.
AR 1448, 1456, 1460. The ALJ appears to believe that none of the other family members in the
house are capable of doing household chores, instead implying that Plaintiff has lied about not doing
16

such chores and drawing a negative inference therefrom. The Court does not agree with this line of
reasoning.
The ALJ’s credibility finding is entitled to deference because of her unique opportunity to
observe the claimant. Buxton v. Halter, 246 F.3d 762, 773 (6th Cir. 2001). Moreover, if an ALJ’s
decision is supported by substantial evidence, reversal would not be warranted even if substantial
evidence would support the opposite conclusion. Ulman v. Comm’r of Soc. Sec., 693 F.3d 709, 714
(6th Cir. 2012). However, this standard clearly requires that the ALJ’s decision be supported by
substantial evidence. In light of the foregoing evidence, the Court finds that the ALJ’s decision
regarding Plaintiff’s credibility is not supported by substantial evidence and should therefore be
remanded for additional consideration.

2. Whether the ALJ provided sufficient reasons for rejecting the opinions of
Dr. Brandon Robbins and Brandee Madden.
Plaintiff next asserts that the ALJ failed to provide sufficient reasons for rejecting the
opinions of Dr. Brandon Robbins, a consultative medical examiner, and Brandee Madden, a nurse
practitioner and Plaintiff’s primary provider. DE 14 at 25. Plaintiff argues that although
Dr. Robbins was not a treating source, “the same principles requiring an explanation for rejecting
his opinion should stand.” Id. Plaintiff, quoting 20 C.F.R. § 404.1527(c)(2),3 also argues that the
ALJ must give more weight to opinions from treating sources because such sources “are likely to be
the medical professionals most able to provide a detailed, longitudinal picture of [the claimant’s]
medical impairment(s) and may bring a unique perspective to the medical evidence that cannot be
obtained from the objective medical findings alone . . . .” Id. at 26.
3

Plaintiff incorrectly cites 20 C.F.R. § 404.1527(d)(2).
17

As an initial matter, the Court notes that nurse practitioners fall into the category of “other
sources” which are not considered “acceptable medical sources” as defined by the Act. See Cruse
v. Comm’r of Soc. Sec., 502 F.3d 532, 541 (6th Cir. 2007). Pursuant to 20 C.F.R. § 404.1513(d), a
claimant may nevertheless introduce evidence from such other sources in order to “show the severity
of [the claimant’s] impairment(s) and how it affects [the claimant’s] ability to work.” Additionally,
SSR 06–03p provides that:
[s]ince there is a requirement to consider all relevant evidence in an individual’s case
record, the case record should reflect the consideration of opinions from medical
sources who are not “acceptable medical sources” and from “non-medical sources”
who have seen the claimant in their professional capacity. Although there is a
distinction between what an adjudicator must consider and what the adjudicator
must explain in the disability determination or decision, the adjudicator generally
should explain the weight given to opinions from these “other sources,” or otherwise
ensure that the discussion of the evidence in the determination or decision allows a
claimant or subsequent reviewer to follow the adjudicator’s reasoning, when such
opinions may have an effect on the outcome of the case.
SSR 06-03p, 2006 WL 2329939, at *6 (emphasis added). As such, Plaintiff’s reliance on SSR 962p, which requires that the ALJ provide “specific reasons for the weight given to the treating
source’s opinion,” SSR 96-2p, 1996 WL 374188, at *5, is misplaced.
Nevertheless, the Court must consider whether the ALJ properly considered the opinions of
the nurse practitioner and Dr. Robbins. In giving “little weight” to both sources, the ALJ stated the
following:
Dr. Robbins’ suggestion that the [Plaintiff’s] anxiety symptoms would likely prevent
her from keeping a regular work schedule is inconsistent with his examination of the
[Plaintiff], the rest of his opinion, and the [Plaintiff’s] activities, which included
caring for a young child. The nurse practitioner’s opinion claimed repeated
decompensations [sic] that are not documented in Mental Health Cooperative
treatment records, and suggested that the [Plaintiff] would have rather marked
functional limitations in many vocationally relevant areas. These suggestions are

18

inconsistent with her Mental Health Cooperative records, her documented activities,
and her performance on examination.
AR 45-46. The only part of Dr. Robbins’ medical source statement rejected by the ALJ appears to
be his opinion that Plaintiff’s “symptoms of anxiety would likely prevent her from keeping a regular
work schedule.” AR 1139. The ALJ stated that this opinion is inconsistent with his examination
of Plaintiff and the remainder of his opinion, which states the following:
The [Plaintiff] is experiencing mild to moderate symptoms of depression and anxiety.
Specific cognitive deficits include moderate impairments in concentration. Longterm memory appears intact. The [Plaintiff’s] intellectual abilities most likely fall
in the Low Average Range. Due to her anxiety, she would require longer than
normal to learn new tasks due to concentration and attention problems. Practical
judgment and reasoning is not significantly impaired and would be adequate to make
simple, work-related decisions. The [Plaintiff’s] symptoms of anxiety would likely
prevent her from keeping a regular work schedule. She displayed adequate social
behavior during this examination and would be able to interact appropriately with
coworkers and supervisors within a work environment.
AR 1139. Additionally, Dr. Robbins stated that Plaintiff “demonstrates the mental and emotional
capabilities to understand and manage her own money.” AR 1139. Dr. Robbins also diagnosed
Plaintiff with panic disorder without agoraphobia, major depressive order of “mild severity,” and
GAF score of 55. AR 1139.
The Court agrees with the ALJ’s assessment that Dr. Robbins’ opinion that Plaintiff’s anxiety
“would likely prevent her from keeping a regular work schedule” is not necessarily supported by the
remainder of his opinion. He noted only mild to moderate symptoms of anxiety, as well as “adequate
social behavior” that suggests that Plaintiff would be able to interact appropriately with other
employees. AR 1139. His findings that Plaintiff’s intellectual abilities are in the average range and
that she has only “moderate” deficits in concentration further undermines his opinion that she would
be unable to have a normal work schedule. AR 1139.
19

However, the ALJ also based her decision to discount Dr. Robbins’ opinion on Plaintiff’s
“activities, which included caring for a young child.” AR 45-46. Plaintiff argues that this
assessment is improper because the ALJ “over exaggerated the independence with which [Plaintiff]
cares for her son.” DE 14 at 24. Plaintiff references several examples in the record of Plaintiff
reporting that she receives assistance from her friends and family caring for her son. Id.; AR 21,
213, 219, 304. She estimated that her brother, cousins, and friends come to her residence three to
five times each week to help her with her son. AR 220. She stated that her son’s behavior makes
her “panicky” and “nervous,” and that her mother or grandmother are subsequently forced to deal
with him. AR 21. In addition to these examples, Plaintiff stated to her case manager on October 15,
2012 that although she had considered moving back to Indianapolis, she was hesitant because she
“would not have anyone around to help her with her son . . . .” AR 1460. Despite these numerous
examples of difficulty, the ALJ based her rejection of Dr. Robbins’ opinion, in part, on Plaintiff’s
ability to care for her son. AR 45-46. This reasoning, however, is not supported by the overall
record, and the ALJ failed to address any of this conflicting evidence.
It is well settled that an ALJ “can consider all the evidence without directly addressing in
[her] written decision every piece of evidence submitted by a party.” Kornecky v. Comm’r of Soc.
Sec., 167 F. App’x 496, 507-08 (6th Cir. 2006) (quoting Loral Defense Systems-Akron v. N.L.R.B.,
200 F.3d 436, 453 (6th Cir. 1999)). However, while an ALJ “need not discuss every piece of
evidence in the record,” she is not permitted to ignore evidence that is contrary to her ruling. Craig
v. Colvin, No. 3:12-CV-00333, 2014 WL 1287178, at *12 (M.D. Tenn. Mar. 28, 2014) (internal
citation omitted). In the instant case, the ALJ ignored significant evidence that Plaintiff was
frequently unable to care for her son without assistance from family and friends. Therefore, the
20

Court finds that the weight given to the opinion of Dr. Robbins is not supported by substantial
evidence.
Plaintiff also argues that the ALJ improperly discounted the opinion of Brandee Madden, a
nurse practitioner who served as Plaintiff’s treating provider. Plaintiff claims that the ALJ failed to
provide good reasons for effectively rejecting the opinion of Ms. Madden. DE 14 at 26. Defendant
correctly notes, however, that the opinion of a nurse practitioner is not an “acceptable medical
source” pursuant to 20 C.F.R. § 404.1513(d). Information from such sources “cannot establish the
existence of a medically determinable impairment.” SSR 06-03p, 2006 WL 23299939, at *2.
Nevertheless, the ALJ “generally should explain the weight given to opinions” from other sources
such as nurse practitioners, Id., at *6, especially when the nurse practitioner has served as the
claimant’s treating provider, as is the case with Ms. Madden.
The ALJ explained that she discounted Ms. Madden’s opinion because she relied on multiple
acts of decompensation by Plaintiff that were not documented in the record. AR 46. She further
stated that Ms. Madden’s suggestion that Plaintiff would have “rather marked functional limitations
in many vocationally relevant areas” was inconsistent with the Mental Health Cooperative records,
Plaintiff’s documented activities, and her “performance on examination.” AR 46.
The ALJ’s comment regarding decompensation ostensibly refers to a mental impairment
questionnaire completed by Ms. Madden on May 22, 2013, in which she indicated that Plaintiff had
experienced four or more episodes of decompensation within a twelve month period, with each
episode lasting at least two weeks. AR 1511. The Court notes with interest that the questionnaire
also prompted Ms. Madden to provide the following information:

21

If within one year your patient had more than three episodes of decompensation of
shorter duration than two weeks or less frequent episodes of decompensation of
longer duration than two weeks, please give the approximate dates of each episode
of decompensation.
AR 1511. Ms. Madden did not provide a response to this prompt, which suggests that Plaintiff has
experienced at least four episodes of decompensation within a one-year period, all of which lasted
more than two weeks in duration. Such episodes are described as “exacerbations or temporary
increases in symptoms or signs accompanied by a loss of adaptive functioning,” and can be
demonstrated by “an exacerbation of symptoms or signs that would ordinarily require increased
treatment or a less stressful situation.” AR 1511.
The Court shares the ALJ’s skepticism of the severity of the episodes of decompensation
implicitly suggested by Ms. Madden, as this appears to contradict Plaintiff’s own testimony, in which
she stated that she experiences panic attacks once or twice per week, with each one lasting between
thirty to forty-five minutes “on a good day,” and up to ninety minutes. AR 19. Plaintiff also testified
that as a result of depression, she experiences “crying spells” approximately twice a week, with each
one lasting between thirty minutes and one hour. AR 25. Plaintiff has not suggested that any of
these episodes has lasted more than two weeks. Plaintiff also fails to point to any evidence
suggesting such severity in any of the Mental Health Cooperative records.
However, the Court is unable to discern the ALJ’s reasoning in her statement that
Ms. Madden’s opinion is inconsistent with Plaintiff’s “documented activities” and her “performance
on examination.” AR 46. As discussed supra, the ALJ mis-characterized the extent to which
Plaintiff can independently care for her son, and the ALJ provides no other examples of
“documented activities” that contradict Ms. Madden’s opinion.

22

With respect to Plaintiff’s

“performance on examination,” the Court is again unable to understand the ALJ’s meaning, as she
does not specify which examination demonstrates such inconsistencies. Under the section of the
mental impairment questionnaire entitled, “DSM-IV Multiaxial Evaluation,” Ms. Madden lists
Plaintiff’s Axis I diagnosis as “panic disorder.” AR 1507. This diagnosis does not contradict
Ms. Madden’s mental impairment questionnaire findings.
Additionally, the Court fails to see evidence in the Mental Health Cooperative notes that
demonstrates inconsistency with Ms. Madden’s finding, as the ALJ opined. The “marked functional
limitations” cited by the ALJ in her opinion appear to reference three sections in the questionnaire
regarding Plaintiff’s mental abilities to do unskilled work, semiskilled and skilled work, and
“particular types of jobs.” AR 1509-10. Ms. Madden indicated that Plaintiff’s mental abilities were
“unable to meet competitive standards” in numerous areas, including dealing with normal work
stress, accepting instructions and responding appropriately to criticism from supervisors, and
interacting appropriately with the general public. AR 1509-10. Despite the ALJ’s opinion
otherwise, this appears to be supported by the Mental Health Cooperative records, which include
numerous examples of Plaintiff’s struggles with social interaction, anxiety, and anger. In 2012,
Plaintiff was discharged from Skyline Madison hospital due to anger issues with the staff. AR 144546. Plaintiff also claimed that she gets angry without provocation, AR 1448, has a short temper and
does not enjoy going out in public, AR 1449, and reported having “violent feelings” towards people.
AR 1446. She has previously “isolated” herself in order to avoid confrontations with other people,
AR 1452, admits that she becomes irritable and “cannot control herself,” AR 1457, and has
expressed problems dealing with loud noises. AR 1455. Plaintiff has reported social anxiety and

23

difficulty leaving her home. AR 1458. The Court also notes that Plaintiff’s case manager
recommended anger management on multiple occasions. AR 1465, 1467.
Defendant argues that the ALJ was correct to discount the opinion of Ms. Madden because
she misunderstood the definition of a period of decompensation. DE 15 at 13. The Court agrees that
Ms. Madden’s indication that Plaintiff has experienced four or more episodes of decompensation
lasting at least two weeks within a one-year period is not supported by evidence. However, this
misstatement was a response to one of the myriad of questions contained in the mental impairment
questionnaire. AR 1507-12. Additionally, and more significantly, the ALJ’s stated reasons for
discounting Ms. Madden’s opinion also included the Mental Health Cooperative records, Plaintiff’s
documented activities, and her “performance on examination.” AR 46. As previously discussed,
the Mental Health Cooperative notes appear to support, not contradict, Ms. Madden’s findings.
Moreover, the ALJ mis-characterized both the extent to which Plaintiff is able to drive and her
ability to independently care for her son. The ALJ points to no other documented activities that
contradict Ms. Madden’s findings. Furthermore, the ALJ is unclear in her statement that Plaintiff’s
“performance on examination” contradicts Ms. Madden’s opinion. While opinions from “other
sources” are not entitled to any special deference, Hill v. Comm’r of Soc. Sec., 560 F. App’x 547,
550 (6th Cir. 2014), an ALJ’s failure to adequately address other source opinions or articulate the
reasons for rejecting such opinions justifies remand “where the failure prevents the reviewing Court
from assessing whether the administrative decision is supported by substantial evidence or otherwise
deprives the claimant of a substantial right.” Sears v. Colvin, No. 1:11-CV-0096, 2015 WL
3606800, at *6 (M.D. Tenn. June 8, 2015). The Court finds that the ALJ in the instant case failed

24

to adequately address and articulate her reasons for discounting Brandee Madden’s opinion, thus
necessitating a remand of this case.

3. Whether the ALJ failed to discuss the impact of Plaintiff’s migraines on her
ability to perform and maintain employment.
Plaintiff next argues that, despite the ALJ’s finding that Plaintiff’s migraines represent a
severe impairment, the ALJ failed to discuss the impact that such migraines would have on
Plaintiff’s ability to work. Plaintiff points to numerous records that she claims document the
consistency of her migraines and headaches, and asserts that the ALJ failed to provide any discussion
as to why this condition would not prevent Plaintiff from maintaining employment. DE 14 at 27-28.
Plaintiff claims that although she testified during her hearing that she experienced migraines at least
two to three times per month, the record repeatedly demonstrates that she suffered migraines at least
two times per week. Id. at 28; AR 16. Plaintiff notes the significance of this frequency, as the
vocational expert testified that there would not be any full-time competitive employment available
to an individual who was forced to miss three days of work per month due to migraines. DE 14 at
28; AR 29. Plaintiff also argues that the ALJ erred in not finding that the frequency and severity of
her migraines equals Listing 11.03.
The ALJ stated the following with respect to Plaintiff’s migraines:
[W]hile the [Plaintiff’s] records confirm that she has migraine headaches, the record
fails to support the alleged frequency of migraine headaches. While there were a few
periods when she reported several migraines in a short period, she also went lengthy
periods of time without complaining of migraines. Further, she testified that they
only occur a few times a month and last a few hours, so even the alleged frequency
is not particularly limiting. Her treatment records also suggest that sumatriptan is
helpful with respect to her migraines.

25

AR 45. Despite Plaintiff’s contention otherwise, the record indicates that Plaintiff’s alleged
migraines occur less frequently than they have in the past. Plaintiff points to her 2009 statement that
she “wakes up daily” with migraines that last at least two hours, and that such episodes occur
“several times a day.” DE 14 at 27; AR 212. However, as noted by the ALJ, Plaintiff testified in
2013 that she experiences migraines approximately two to three times per month. AR 16. She also
testified that the migraines may last for a couple of hours depending on whether another individual
is able to bring her the medication prescribed to alleviate her symptoms.4 AR 18. Moreover, the ALJ
references evidence indicating that Plaintiff’s migraine symptoms are improved with sumatriptan.
AR 1499.
Furthermore, the Court sees no error in the ALJ’s finding that Plaintiff’s migraines do not
equal Listing 11.03 found in 20 C.F.R. Part 404, Subpart P, Appendix 1. The ALJ noted Plaintiff’s
testimony that she experiences migraines approximately two to three times per month. AR 38.
Listing 11.03, which pertains to epilepsy but was found by the ALJ to represent the impairment
listing most similar to migraine headaches, AR 38, specifically requires a showing that such
symptoms “[occur] more frequently than once weekly in spite of at least 3 months of prescribed
treatment.” 20 C.F.R. Part 404, Subpart P, Appendix 1 § 11.03. Plaintiff claims that the ALJ failed
to consider the entire record of Plaintiff’s documented migraines, DE 14 at 29-30, ostensibly relying
on records such as the previously discussed 2009 statement indicating daily migraines. AR 212.
However, Plaintiff asks the Court to ignore what appears to be an improvement in Plaintiff’s
condition, as evidenced by her testimony in May of 2013 indicating a significant decrease in the

4

In light of the alleged severity of these migraines, the Court questions why Plaintiff does
not appear to carry her migraine medication on her person. AR 18.
26

frequency of Plaintiff’s migraines. AR 38. Accordingly, the Court finds that substantial evidence
supports the ALJ’s finding that Plaintiff’s migraines do not equal Listing 11.03, and similarly finds
no error in the ALJ’s discussion of Plaintiff’s migraines.

4. Whether the ALJ improperly failed to address Plaintiff’s panic attacks,
crying spells, and migraines in questioning the vocational expert.
Plaintiff contends that the ALJ erred by failing to address her panic attacks, crying spells, and
migraines to the vocational expert. DE 14 at 31. Plaintiff also notes that the ALJ failed to present
the vocational expert with any questions regarding the need for unscheduled breaks in order to attend
to symptoms of anxiety and depression. Id. at 31-32. Therefore, Plaintiff argues, her “limitations
were not fully conveyed to the vocational expert.” DE 14 at 32-33.
Both parties acknowledge that although an ALJ does not need to list a claimant’s medical
conditions, any hypothetical posed to the vocational expert must reference all of a claimant’s
limitations. Webb v. Comm’r of Soc. Sec., 368 F.3d 629, 633 (6th Cir. 2004). The ALJ provided the
following limitations in her first hypothetical question posed to the vocational expert regarding
Plaintiff’s ability to perform past work:
In our first hypothetical we would have an individual with no exertional limitations.
This individual would be able to understand, remember and carry out simple and
detailed, but not complex tasks, could maintain concentration, persistence and pace
for two-hour intervals with normal breaks spread throughout the day, would be able
to interact with others appropriately but would do better with things rather than
people, and could adapt to occasional changes in the work place and job duties.
AR 28. After the vocational expert opined that Plaintiff would not be able to perform any past work,
the ALJ presented a second hypothetical that included “the same basic parameters, however this
individual would be limited to just simple tasks.” AR 28.
27

The Court notes that there appears to be some confusion in the opinion as to which
limitations were deemed credible by the ALJ. The ALJ stated that she “affords greater weight to the
State agency psychological consultants’ assessments . . . ,” AR 46, yet the only State agency
psychological assessment discussed in the ALJ’s opinion was provided by Dr. Brandon Robbins.5
AR 1137-40. And as previously discussed, the ALJ “affords little weight to the [opinion] of
Dr. Robbins,” due to his suggestion that Plaintiff would likely be unable to have a regular work
schedule. AR 45-46.
Although not discussed in the opinion, the ALJ instead relied heavily on the “mental residual
functional capacity assessment” form completed by psychologist Kari Kennedy. Dr. Kennedy opined
that Plaintiff was “not significantly limited” in her ability to carry out detailed instructions and
interact appropriately with the general public. AR 1156-57. Dr. Kennedy also found that Plaintiff
was “moderately limited” in her ability to maintain attention and concentration for extended periods
and respond appropriately to changes in the work setting. AR 1156-57. These opinions appear to
have formed the basis of the limitations presented in the ALJ’s hypothetical questions.
Defendant is correct that an ALJ is only required to incorporate limitations into a hypothetical
question that she finds credible. DE 15 at 16 (citing Casey v. Sec’y of Health & Human Servs., 987
F.2d 1230, 1235 (6th Cir. 1993)). However, as discussed supra, the ALJ failed to provide adequate
reasons for finding that the limitations expressed by both Dr. Robbins and Brandee Madden were
not credible. Furthermore, as discussed infra, the ALJ ignored significant evidence from a separate
governmental agency regarding the extent of Plaintiff’s limitations. Because these opinions and
5

The ALJ also discussed the opinion of Dr. Mark Allen, a radiologist who examined Plaintiff
at the request of the State agency. AR 41; AR 1132-36. However, Dr. Allen’s examination included
a physical evaluation and not a psychological inquiry.
28

additional evidence will be revisited and a new hearing conducted upon remand, the Court need not
rule on the validity of the questions presented to the vocational expert. The issue of whether the
hypothetical questions posed by the ALJ during the 2013 hearing adequately conveyed Plaintiff’s
limitations is therefore moot.

5. Whether the ALJ violated SSR 06-03p by ignoring evidence supporting
disability.
Plaintiff’s final assertion of error alleges that the ALJ disregarded relevant evidence
supporting a finding of disability. Specifically, Plaintiff argues that the ALJ failed to consider the
“finding of incapacitation” by the Tennessee Department of Human Services (“DHS”), which
granted her “Families First” benefits. DE 14 at 34-35; AR 330, 332. Plaintiff argues that this failure
violated SSR 06-03p, which requires that the ALJ “evaluate all the evidence in the case record that
may have a bearing on [the Commissioner’s] determination or decision of disability, including
decisions by other governmental and nongovernmental agencies.” DE 14 at 34.
Defendant argues in response that the ALJ “was well aware that Plaintiff was receiving
medical assistance benefits,” as evidenced by her discussion of Plaintiff’s use of the medication
Seroquel. DE 15 at 16. Defendant further argues that the ALJ’s citation to Exhibit 27E, which
includes documents approving Plaintiff’s Families First benefits by DHS, adequately demonstrates
that the ALJ considered this disability form. DE 15 at 17.
Neither party appears to have noticed that the ALJ stated in her opinion that Plaintiff’s
income “was essentially limited to her son’s supplemental security income benefits and Families
First benefits.” AR 44. The ALJ was therefore aware that Plaintiff was receiving Families First

29

benefits, as noted by Defendant. Nevertheless, the Court agrees with Plaintiff that the ALJ failed
to consider the DHS determination in reaching her decision. Although an ALJ is not required to
defer to the judgments of a state agency, Moore v. Colvin, No. 3:14-cv-1525, 2015 WL 1648985, at
*6 (M.D. Tenn. Apr. 13, 2015), SSR 06-03p mandates that “[e]vidence of a disability by another
governmental or nongovernmental agency cannot be ignored and must be considered.” The Court
is unpersuaded by Defendant’s argument that the ALJ’s single reference to Exhibit 27E proves her
consideration of the decision. A simple contextual analysis indicates that the ALJ was not
referencing the DHS decision in citing Exhibit 27E. The ALJ states in her opinion that she “affords
little weight to the opinions of Dr. Robbins and a treating nurse practitioner from the Mental Health
Cooperative (Exs. 27E; 24F; 40F).” AR 45. The ALJ is clearly referencing the first two pages of
Exhibit 27E, which represent nurse practitioner Brandee Madden’s opinion regarding the extent of
Plaintiff’s impairments. AR 328-29. This is supported by the fact that the other two exhibits cited
in the ALJ’s statement, Exhibits 24F and 40F, represent Dr. Robbins’ report and Ms. Madden’s
mental impairment questionnaire, respectively. AR 1137-40; 1507-12. There is no reference to the
DHS decision.
Additionally, despite the ALJ’s reference to Plaintiff’s receipt of Families First benefits,
AR 44, the opinion completely ignores relevant evidence found in the form containing the DHS
decision. For one, the DHS decision, which was reached in April of 2013, shows a GAF score of
30. AR 332. The ALJ’s decision, dated July 26, 2013, states that “treatment records show fairly
consistent [GAF] scores in the range suggestive of moderate symptoms, aside from when she was
hospitalized when off medication and using marijuana.” The ALJ therefore believed that, with the
exception of Plaintiff’s hospitalization in June of 2012, at which point she was assessed a GAF score
30

of 30, AR 1273, Plaintiff’s GAF scores only demonstrated “moderate symptoms.” However, this
ignores the GAF score of 30 determined by DHS the month before Plaintiff’s hearing. AR 6, 332.
Additionally, the DHS decision specifically states that “medical evidence establish[es] an
impairment that substantially reduces or eliminates the [Plaintiff’s] ability to support and/or care for
his/her children[.]” AR 332. Despite this finding, the ALJ based her decision that Plaintiff is not
disabled largely on Plaintiff’s ability to care for her son. In fact, the ALJ made this reference in
support of her decision three times. AR 45-46. The ALJ thus ignored a significant piece of evidence
that contradicted the basis for her decision. As previously discussed, the ALJ does not have to
discuss each individual piece of evidence in the record, but she cannot ignore evidence that is
contrary to her ruling. Craig, 2014 WL 1287178, at *12. Accordingly, the Court remands this case
for additional consideration of the DHS decision.
Inaccuracies, incomplete analysis, and unresolved conflicts of evidence can serve as a basis
for remand. Karger v. Comm’r of Soc. Sec., 414 F. App’x 739, 749 (6th Cir. 2011). Based on the
lack of substantial evidence in support of the ALJ’s credibility determination, the ALJ’s failure to
provide sufficient reasons for rejecting the opinions of Dr. Brandon Robbins and Brandee Madden,
and the ALJ’s failure to consider relevant evidence from another governmental agency supporting
a finding of disability, the Court finds that the record in this case has not been fully and fairly
developed. It is therefore recommended that this case be remanded for rehearing to include further
consideration of the aforementioned opinions and the DHS decision. On remand, the ALJ should
provide additional discussion of Plaintiff’s credibility, the supportability of the opinions of
Dr. Robbins and Ms. Madden, and the DHS findings regarding Plaintiff’s application for Families
First benefits.
31

V. RECOMMENDATION
For the above stated reasons it is recommended that Plaintiff’s motion for judgment on the
administrative record (DE 14) be GRANTED and that this case be REMANDED pursuant to
sentence four of 42 U.S.C. § 405(g) for additional consideration of Plaintiff’s claims.
ANY OBJECTIONS to this Report and Recommendation must be filed with the Clerk of
Court within fourteen (14) days of service of this Report and Recommendation and must state with
particularity the specific portions of this Report and Recommendation to which objection is made.
Failure to file written objections within the specified time can be deemed a waiver of the right to
appeal the District Court’s Order regarding the Report and Recommendation. See Thomas v. Arn,
474 U.S. 140, 106 S. Ct. 466, 88 L. Ed.2d 435 (1985); United States v. Walters, 638 F.2d 947 (6th
Cir. 1981).

Respectfully Submitted,

BARBARA D. HOLMES
United States Magistrate Judge

32