Duncan v. Colvin

Filing 19

MEMORANDUM OPINION. Signed by Magistrate Judge Pamela Meade Sargent on 10/1/2014. (Bordwine, Robin)

IN THE UNITED STATES DISTRICT COURT
FOR THE WESTERN DISTRICT OF VIRGINIA
BIG STONE GAP DIVISION
KARLY A. DUNCAN,
Plaintiff

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

Civil Action No. 2:13cv00028
MEMORANDUM OPINION
By: PAMELA MEADE SARGENT
United States Magistrate Judge

I. Background and Standard of Review
Plaintiff, Karly A. Duncan, (“Duncan”), filed this action challenging the
final decision of the Commissioner of Social Security, (“Commissioner”),
determining that she was not eligible for supplemental security income, (“SSI”),
under the Social Security Act, as amended, (“Act”), 42 U.S.C.A. § 1381 et seq.
(West 2012). Jurisdiction of this court is pursuant to 42 U.S.C. § 1383(c)(3). This
case is before the undersigned magistrate judge upon transfer by consent of the
parties pursuant to 28 U.S.C. § 636(c)(1).

The court’s review in this case is limited to determining if the factual
findings of the Commissioner are supported by substantial evidence and were
reached through application of the correct legal standards. See Coffman v. Bowen,
829 F.2d 514, 517 (4th Cir. 1987). Substantial evidence has been defined as
“evidence which a reasoning mind would accept as sufficient to support a
particular conclusion. It consists of more than a mere scintilla of evidence but may
be somewhat less than a preponderance.” Laws v. Celebrezze, 368 F.2d 640, 642
(4th Cir. 1966). ‘“If there is evidence to justify a refusal to direct a verdict were the
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case before a jury, then there is “substantial evidence.’”” Hays v. Sullivan, 907
F.2d 1453, 1456 (4th Cir. 1990) (quoting Laws, 368 F.2d at 642).
The record shows that Duncan protectively filed her application 1 for SSI2 on
January 6, 2010, alleging disability as of January 11, 2010, 3 due to bipolar
disorder, problems with her back, right shoulder and right knee, depression and
anxiety. (Record, (“R.”), at 35, 292-97, 309, 314, 344.) The claims were denied
initially and on reconsideration. (R. at 213-15, 219-21, 224-25, 227-29, 231-33.)
Duncan then requested a hearing before an administrative law judge, (“ALJ”). (R.
at 234-35.) The hearing was held on January 18, 2012, at which Duncan was
represented by counsel. (R. at 27-98.)

By decision dated January 27, 2012, the ALJ denied Duncan’s claim. (R. at
15-26.) The ALJ found that Duncan had not engaged in substantial gainful activity
since January 6, 2010, the date of her application. (R. at 17.) The ALJ determined
that the medical evidence established that Duncan suffered from severe
1

Duncan also protectively filed an application for disability insurance benefits, (“DIB”),
on January 6, 2010. (R. at 292-93.) However, it was determined that Duncan did not qualify for
DIB because she had not worked long enough. (R. at 207-09.)
2

On September 5, 2008, Duncan protectively filed applications for SSI and DIB alleging
disability beginning October 20, 2004. These claims were denied initially and upon
reconsideration. (R. at 172-74, 178-80, 183-85, 189-91, 194-96, 198-202, 204-05.) A hearing
was held on November 30, 2009. (R. at 108.) By decision dated December 18, 2009, the ALJ
denied Duncan’s claims. (R. at 108-22.) The Appeals Council denied Duncan’s request for
review. (R. at 167-70.) There is no indication that Duncan pursued any further action concerning
this denial.
3

At her hearing, Duncan amended her alleged disability date to January 11, 2010. (R. at
35.) Although Duncan listed October 20, 2004, and December 19, 2009, as her alleged onset date
in her applications for DIB and SSI, she confirmed at her hearing that it was January 11, 2010.
(R. at 35, 292, 294.)

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impairments, including bipolar disorder, depression, anxiety disorder, degenerative
disc disease, degenerative joint disease of the right shoulder and substance abuse,
but he found that Duncan did not have an impairment or combination of
impairments listed at or medically equal to one listed at 20 C.F.R. Part 404,
Subpart P, Appendix 1. (R. at 17-18.) The ALJ found that Duncan had the residual
functional capacity to perform simple, routine, repetitive sedentary work 4 that did
not require more than occasional climbing, balancing, stooping, kneeling,
crouching, crawling and reaching overhead with her right upper extremity, that
required only frequent handling with her right upper extremity, that did not require
concentrated use of moving machinery and exposure to unprotected heights and
that allowed only occasional interaction with the public and co-workers. (R. at 19.)
The ALJ found that Duncan was unable to perform her past relevant work. (R. at
24.) Based on Duncan’s age, education, work history and residual functional
capacity and the testimony of a vocational expert, the ALJ found that Duncan
could perform other jobs existing in significant numbers in the national economy,
including jobs as an addresser, a general office clerk and a ticket checker. (R. at
24-25.) Therefore, the ALJ found that Duncan was not under a disability as defined
under the Act and was not eligible for benefits. (R. at 25.) See 20 C.F.R. §
416.920(g) (2013).

After the ALJ issued his decision, Duncan pursued her administrative
appeals, but the Appeals Council denied her request for review. (R. at 1-5.) Duncan
then filed this action seeking review of the ALJ’s unfavorable decision, which now
4

Sedentary work involves lifting items weighing up to 10 pounds with occasional lifting
or carrying of articles like docket files, ledgers and small tools. Although a sedentary job is
defined as one which involves sitting, a certain amount of walking and standing is often
necessary in carrying out job duties. Jobs are sedentary if walking and standing are required
occasionally and other sedentary criteria are met. See 20 C.F.R. § 416.967(a) (2013).
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stands as the Commissioner’s final decision. See 20 C.F.R. § 416.1481 (2013). The
case is before this court on Duncan’s motion for summary judgment filed January
6, 2014, and the Commissioner’s motion for summary judgment filed February 10,
2014.
II. Facts 5
Duncan was born in 1979, (R. at 292, 294, 309), which classifies her as a
“younger person” under 20 C.F.R. § 416.963(c). Duncan has a high school
education. (R. at 315.) Duncan has past work as a cashier, a waitress, a
convenience store clerk and an assembly worker. (R. at 83-84, 316.) Duncan
testified at her hearing that she was incarcerated in April 2008 for prescription
fraud. (R. at 64-65.) She stated that she abused prescription medication until she
went to jail.6 (R. at 65.) Duncan stated that she had never been able to keep a job
for more than two or three months at a time because she did not like being in
public around people and she did not want to talk to people. (R. at 73.)

AnnMarie Cash, a vocational expert, also was present and testified at
Duncan’s hearing. (R. at 81-97.) Cash was asked to consider an individual of
Duncan’s age, education and work experience, who had the residual functional

5

Duncan does not challenge the ALJ’s finding with respect to her alleged physical
impairments. Therefore, the discussion of the medical evidence will be limited to those records
pertaining to Duncan’s mental health.
6

On October 29, 2009, Dr. Bentley told Duncan that due to her drug screen being
positive for cannabis and her noncompliance with pill count, narcotics would no longer be
prescribed for her. (R. at 990.)
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capacity to perform simple, routine, repetitive medium work 7 that was free of fastpaced production requirements and that required only occasional interaction with
the public and co-workers. (R. at 84.) Cash stated that there was a significant
number of jobs that existed that such an individual could perform, including jobs
as a dishwasher, a food prep worker and a stock clerk. (R. at 85-86.) Cash was
asked to consider the same individual, but who had the residual functional capacity
to perform simple, routine, repetitive light 8 work that required no more than
occasional climbing, balancing, stooping, kneeling, crouching and crawling, and
that did not require concentrated use of moving machinery and exposure to
protected heights or more than occasional interaction with the public. (R. at 87.)
Cash stated that such an individual could perform Duncan’s past work as an
assembler. (R. at 87.) She also stated that other jobs existed in significant numbers
that such an individual could perform, including work as a silverware wrapper and
a stock clerk. (R. at 88.) Cash was asked to consider the same individual who could
perform simple, routine, repetitive sedentary work that allowed only occasional
climbing, balancing, stooping, kneeling, crouching and crawling, frequently
reaching in any direction, including overhead, with the right upper extremity, who
should avoid concentrated use of moving machinery and exposure to unprotected
heights and who could have only occasional interaction with the public and coworkers. (R. at 89-90.) She stated that such an individual could perform other jobs
that existed in significant numbers, including jobs as an addresser, a general office
clerk and a ticket checker. (R. at 91.) Cash stated that these jobs also would be
7

Medium work involves lifting items weighing up to 50 pounds at a time with frequent
lifting or carrying of items weighing up to 25 pounds. If an individual can do medium work, she
also can do sedentary and light work. See 20 C.F.R. § 416.967(c) (2013).
8

Light work involves lifting items weighing up to 20 pounds at a time with frequent
lifting or carrying of items weighing up to 10 pounds. If someone can perform light work, she
also can perform sedentary work. See 20 C.F.R. § 416.967(b) (2013).
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available for an individual who required a sit/stand option and who could perform
only occasional handling. (R. at 93.) She stated that there would be no jobs
available that such an individual could perform should they miss more than two
days of work per month, who would be off task 20 percent of the time and who
would have no useful ability to deal with work stress or to demonstrate reliability.
(R. at 94-95.)

In rendering his decision, the ALJ reviewed records from Louis Perrott,
Ph.D., a state agency psychologist; Eugenie Hamilton, Ph.D., a state agency
psychologist; Dr. Gale Jackson, M.D.; Dr. Uzma Ehtesham, M.D., a psychiatrist;
Dr. Kevin Blackwell, D.O.; B. Wayne Lanthorn, Ph.D., a licensed clinical
psychologist; Norton Community Hospital; Bristol Regional Medical Center; Wise
County Behavioral Health Services; and Dr. Jody Bentley, M.D.

The reports contained in the record show that Duncan has suffered from
substance abuse and psychological problems for years. In 2003, Duncan was
treated at Norton Community Hospital for a drug overdose resulting in respiratory
failure. (R. at 397-99.) A urine drug screen was positive for the use of
benzodiazepines, tricyclics, antidepressants, opiates and marijuana. (R. at 399.)
The admission note states that Duncan suffered from depression. (R. at 398.) The
note also states that Duncan was found unresponsive at home with an empty Xanax
prescription bottle that had been filled the same day. (R. at 398.) Duncan later
denied any suicide attempt. (R. at 397.)

Duncan was involuntarily committed for inpatient psychiatric treatment in
March 2006. (R. at 1028-30.) A toxicology screen performed on Duncan earlier
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that same month was positive for the use of amphetamines, barbiturates,
benzodiazepines, cocaine, opiates and tricyclics. (R. at 494.) A screen performed in
January 2006 was positive for the use of marijuana in addition to morphine and
benzodiazepines. (R. at 625.) Upon admission for inpatient treatment, Duncan
admitted that she had been abusing her prescribed Lortab and Xanax. (R. at 1028.)
Duncan stated, “I have a drug problem.” (R. at 1035.) She also admitted to
smoking marijuana and drinking alcohol on occasion. (R. at 1035, 1040.) Upon
intake, one of Duncan’s goals for the hospitalization was “complete detox.” (R. at
1044.) Duncan was discharged five days later. (R. at 1026-27.)

It appears the effort to wean Duncan off her dependence on Lortab failed,
however, because she returned to using opiates without a valid prescription within
a few months. (R. at 739, 741.) She also admitted to continued use of marijuana.
(R. at 741, 748.) Duncan, again, entered inpatient detoxification at The Laurels in
February 2008. (R. at 725, 727.) At the time of her admission, Duncan tested
positive for the use of opiates, benzodiazepines, marijuana and methamphetamine.
(R. at 727.) Duncan left six days later against medical advice. (R. at 727.)

After leaving The Laurels, Duncan returned to treatment at Wise County
Behavioral Health Services. (R. at 762-64.) Upon intake, Duncan stated that she
had recently been convicted for prescription fraud and had spent 42 days in jail
before being placed on probation. (R. at 762.) Duncan stated that she recently had
tested positive for the use of cocaine and feared that she might be returned to jail.
(R. at 764.) Duncan stated that she began abusing opiates by snorting them from
the age of 18 until a month prior. (R. at 763.) She also stated that she had smoked
marijuana since age 13 and snorted cocaine since age 19. (R. at 763.) Duncan was
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diagnosed with opioid abuse, antisocial behavior disorder and cocaine abuse. (R. at
763.)

On March 15, 2009, Dr. Kevin Blackwell, D.O., examined Duncan at the
request of Disability Determination Services. (R. at 819-22.) Dr. Blackwell noted
that Duncan was alert, cooperative and oriented with good mental status. (R. at
820.)

A May 28, 2009, Discharge Summary noted that Duncan had a positive drug
screen on admission. (R. at 872.) This was likely due to the fact that Duncan
returned to the use of Lortab in early May 2009 after it was prescribed by Dr. Jody
Bentley, M.D. (R. at 1069.) It appears Dr. Bentley intended to treat Duncan with
Lortab on a short-term basis pending referral to pain management. (R. at 1067,
1069.) Duncan, however, never attended her pain management referral. (R. at
1059.) On October 27, 2009, Dr. Bentley told Duncan he would no longer
prescribe narcotic pain medicine for her due to her drug screen being positive for
the use of marijuana and her noncompliance with pill counts. (R. at 1059.)

For her complaints of depression and anxiety, Duncan primarily treated with
Dr. Uzma Ehtesham, M.D., a psychiatrist. (R. at 1001-11, 1337-51, 1355-62, 147590, 1515-22.) Upon her initial evaluation by Dr. Ehtesham on September 15, 2008,
Duncan did not disclose her long history of substance abuse or her recent drugrelated conviction. (R. at 777, 794.) In fact, Duncan denied any previous substance
abuse history. (R. at 777, 792.)

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Mental status examinations by Dr. Ehtesham generally showed that
Duncan’s mood appeared depressed or anxious, but she had fair insight, intact
judgment, goal-oriented thought processes and no hallucinations or suicidal or
homicidal ideation. (R. at 1001-03, 1006, 1008, 1010, 1016, 1018, 1071, 1073,
1075, 1086, 1088, 1090, 1342, 1344, 1346, 1348, 1350, 1355, 1357, 1359, 1361,
1475, 1477, 1479, 1481, 1483, 1485, 1487, 1489, 1515, 1517, 1519, 1521.)
Duncan was cooperative and appropriately groomed, her speech was normal, and
she displayed normal psychomotor skills. (R. at 1002, 1006, 1008, 1338, 1344,
1346, 1348, 1350, 1355, 1357, 1359, 1361, 1475, 1477, 1479, 1481, 1483, 1485,
1487, 1489, 1515, 1517, 1519, 1521.) Dr. Ehtesham assessed Duncan’s anxiety on
a scale of one to 10, and consistently concluded that her anxiety ranked between
two and five; and Dr. Ehtesham’s treatment notes also indicated that Duncan’s
symptoms were stable and improved with medication. (R. at 1006, 1008, 1010,
1016, 1018, 1071, 1073, 1075, 1086, 1088, 1090, 1092, 1338, 1342, 1344, 1346,
1348, 1350, 1355, 1357, 1359, 1361, 1475, 1477, 1479, 1481, 1483, 1485, 1487,
1489, 1515, 1517, 1519, 1521.)

With no knowledge of Duncan’s prior substance abuse, Dr. Ehtesham
returned Duncan to the use of Xanax in October 2008. (R. at 786.) It appears Dr.
Ehtesham continued to prescribe Xanax during the period relevant to Duncan’s
current claim. (R. at 800-08, 1374.)

On April 23, 2010, Dr. Ehtesham completed a mental assessment indicating
that Duncan had a seriously limited ability to function independently, to
understand, remember and carry out complex job instructions and to maintain
personal appearance. (R. at 1020-22.) She indicated that Duncan had no useful
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ability to follow work rules, to relate to co-workers, to deal with the public, to use
judgment, to interact with supervisors, to deal with work stresses, to maintain
attention/concentration, to understand, remember and carry out detailed and simple
job instructions,9 to behave in an emotionally stable manner, to relate predictably
in social situations and to demonstrate reliability. (R. at 1020-21.) Dr. Ehtesham
opined that Duncan was permanently disabled. (R. at 1022.)

On June 25, 2010, Dr. Ehtesham completed a Mental Status Evaluation
Form for Disability Determination Services. (R. at 1337-41.) Dr. Ehtesham
reported that Duncan suffered from bipolar disorder with psychotic features. (R. at
1337.) She found that Duncan’s ability to have a relationship with family, friends
and co-workers was impaired. (R. at 1337.) She reported that Duncan was suicidal
and could become violent without medications. (R. at 1338, 1340.) Duncan’s
thought content and organization was described as illogical, and it was noted that
she experienced confusion at times. (R. at 1338-39.) It was noted that Duncan’s
ability to remember and concentrate had decreased, and her judgment and fund of
knowledge was considered poor. (R. at 1338-39.)

On August 16, 2010, Dr. Ehtesham completed a mental assessment
indicating that Duncan had a seriously limited ability to use judgment, to interact
with supervisors and to understand, remember and carry out complex job
instructions. (R. at 1366-68.) She opined that Duncan had no useful ability to
follow work rules, to relate to co-workers, to deal with the public, to deal with
work stresses, to function independently, to maintain attention/concentration, to
understand, remember and carry out detailed and simple job instructions, to
9

Dr. Ehtesham’s assessment makes no effort to explain her opinion that Duncan was
more proficient at complex job instructions than detailed or simple job instructions.
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maintain personal appearance, to behave in an emotionally stable manner, to relate
predictably in social situations and to demonstrate reliability. (R. at 1366-67.) Dr.
Ehtesham opined that Duncan was permanently disabled. (R. at 1368.)

On September 6, 2011, Dr. Ehtesham completed a mental assessment
indicating that Duncan had no useful ability to make any occupational,
performance or personal/social adjustments. (R. at 11491-93.) Dr. Ehtesham again
opined that Duncan was permanently disabled. (R. at 1493.)

On January 9, 2012, Duncan reported that her depression had decreased and
was stable on medication. (R. at 1515.) That same day, Dr. Ehtesham completed a
mental assessment indicating that Duncan had a seriously limited ability to relate
to co-workers, to interact with supervisors, to understand, remember and carry out
complex job instructions and to maintain personal appearance. (R. at 1512-14.) She
opined that Duncan had no useful ability to follow work rules, to deal with the
public, to use judgment, to deal with work stresses, to function independently, to
maintain attention/concentration, to understand, remember and carry out detailed
and simple job instructions, to behave in an emotionally stable manner, to relate
predictably in social situations and to demonstrate reliability. (R. at 1512-14.) Dr.
Ehtesham opined that Duncan was permanently disabled. (R. at 1514.)

On March 12, 2010, Louis Perrott, Ph.D., a state agency psychologist,
completed a Psychiatric Review Technique form, (“PRTF”), indicating that
Duncan suffered from an affective disorder. (R. at 137.) He found that Duncan had
mild restrictions on her ability to perform activities of daily living. (R. at 137.)
Perrott opined that Duncan had moderate difficulties in maintaining social
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functioning and in maintaining concentration, persistence or pace. (R. at 137.) He
also opined that Duncan had experienced one or two episodes of decompensation
for an extended duration. (R. at 137.)

Perrott completed a mental assessment indicating that Duncan was
moderately limited in her ability to maintain attention and concentration for
extended periods, to perform activities within a schedule, maintain regular
attendance and be punctual within customary tolerances, to work in coordination
with or in proximity to others without being distracted by them, to complete a
normal workday and workweek without interruptions from psychologically based
symptoms and to perform at a consistent pace without an unreasonable number and
length of rest periods, to interact appropriately with the public, to accept
instructions and respond appropriately to criticism from supervisors, to get along
with co-workers or peers without distracting them or exhibiting behavioral
extremes, to maintain socially appropriate behavior and to adhere to basic
standards of neatness and cleanliness and to respond appropriately to changes in
the work setting. (R. at 140-42.)

On July 12, 2010, Eugenie Hamilton, Ph.D., another state agency
psychologist, completed a PRTF indicating that Duncan suffered from an affective
disorder. (R. at 156-57.) She found that Duncan had mild restrictions on her ability
to perform activities of daily living. (R. at 156.) Hamilton opined that Duncan had
moderate difficulties in maintaining social functioning and in maintaining
concentration, persistence or pace. (R. at 156.) She also opined that Duncan had
experienced one or two episodes of decompensation for an extended duration. (R.
at 156.)
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Hamilton completed a mental assessment indicating that Duncan was
moderately limited in her ability to maintain attention and concentration for
extended periods, to perform activities within a schedule, maintain regular
attendance and be punctual within customary tolerances, to work in coordination
with or in proximity to others without being distracted by them, to complete a
normal workday and workweek without interruptions from psychologically based
symptoms and to perform at a consistent pace without an unreasonable number and
length of rest periods, to interact appropriately with the public, to accept
instructions and respond appropriately to criticism from supervisors, to get along
with co-workers or peers without distracting them or exhibiting behavioral
extremes, to maintain socially appropriate behavior and to adhere to basic
standards of neatness and cleanliness and to respond appropriately to changes in
the work setting. (R. at 160-61.)

On October 12, 2010, B. Wayne Lanthorn, Ph.D., a licensed clinical
psychologist, evaluated Duncan at the request of Duncan’s attorney. (R. at 137081.) The Wechsler Adult Intelligence Scale - Fourth Edition, (“WAIS-IV”), was
administered, and Duncan obtained a full-scale IQ score of 71. (R. at 1371.) The
Minnesota Multiphasic Personality Inventory – 2, (“MMPI-2”), was administered,
and Lanthorn noted that Duncan responded in a “somewhat random or unselective
manner” to items toward the end. (R. at 1378.) Lanthorn noted that the MMPI-2
profile was to be interpreted with caution due to possibly being invalid. (R. at
1378.) Duncan reported that she had not consumed alcoholic beverages for the past
two years. (R. at 1373.) She stated that, previously, she consumed alcohol on a
daily basis and often times would consume as much as a fifth of liquor per day. (R.
at 1373.) Duncan reported that in the past, she used cannabis and pain pills illicitly,
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but that she had not used these for several years. (R. at 1373.) Duncan did not
report that she previously had abused Xanax and was continuing to take it.
Lanthorn diagnosed bipolar I disorder, most recent episode depressed, severe with
psychotic features; panic disorder without agoraphobia; post-traumatic stress
disorder, chronic; alcohol dependence in sustained full remission; and borderline
intellectual functioning. (R. at 1379-80.) Lanthorn assessed Duncan’s then-current
Global Assessment of Functioning, (“GAF”), score at 50. 10 (R. at 1380.) Lanthorn
reported that Duncan would have serious difficulties in her ability to function in
gainful employment. (R. at 1381.)

Lanthorn completed a mental assessment indicating that Duncan had a
satisfactory ability to understand, remember and carry out simple job instructions.
(R. at 1382-84.) He opined that Duncan had a seriously limited ability to follow
work rules, to function independently, to maintain attention/concentration, to
understand, remember and carry out detailed instructions and to maintain personal
appearance. (R. at 1382-83.) Lanthorn found that Duncan had no useful ability to
relate to co-workers, to deal with the public, to use judgment, to interact with
supervisors, to deal with work stresses, to understand, remember and carry out
complex job instructions, to behave in an emotionally stable manner, to relate
predictably in social situations and to demonstrate reliability. (R. at 1382-83.)
Lanthorn opined that Duncan would miss more than two days of work a month due
to her impairments. (R. at 1384.)
10

The GAF scale ranges from zero to 100 and “[c]onsider[s] psychological, social, and
occupational functioning on a hypothetical continuum of mental health-illness.” A GAF score of
41-50 indicates that the individual has “[s]erious symptoms ... OR any serious impairment in
social, occupational, or school functioning....” DIAGNOSTIC AND STATISTICAL MANUAL OF
MENTAL DISORDERS FOURTH EDITION, ("DSM-IV"), 32 (American Psychiatric Association
1994).
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From July 2011 through December 2011, Dr. Gale Jackson, M.D., reported
that Duncan was oriented to person, place and time, her insight and judgment were
intact, and her affect was normal. (R. at 1525, 1528, 1531, 1534.)

III. Analysis

The Commissioner uses a five-step process in evaluating SSI claims. See 20
C.F.R. § 416.920 (2013); see also Heckler v. Campbell, 461 U.S. 458, 460-62
(1983); Hall v. Harris, 658 F.2d 260, 264-65 (4th Cir. 1981). This process requires
the Commissioner to consider, in order, whether a claimant 1) is working; 2) has a
severe impairment; 3) has an impairment that meets or equals the requirements of a
listed impairment; 4) can return to her past relevant work; and 5) if not, whether
she can perform other work. See 20 C.F.R. § 416.920. If the Commissioner finds
conclusively that a claimant is or is not disabled at any point in this process, review
does not proceed to the next step. See 20 C.F.R. § 416.920(a) (2013).

Under this analysis, a claimant has the initial burden of showing that she is
unable to return to her past relevant work because of her impairments. Once the
claimant establishes a prima facie case of disability, the burden shifts to the
Commissioner. To satisfy this burden, the Commissioner must then establish that
the claimant has the residual functional capacity, considering the claimant’s age,
education, work experience and impairments, to perform alternative jobs that exist
in the national economy. See 42 U.S.C.A. § 1382c(a)(3)(A)-(B) (West 2003 &
Supp. 2014); McLain v. Schweiker, 715 F.2d 866, 868-69 (4th Cir. 1983); Hall, 658
F.2d at 264-65; Wilson v. Califano, 617 F.2d 1050, 1053 (4th Cir. 1980).
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Duncan argues that the ALJ improperly determined her mental residual
functional capacity. (Plaintiff’s Memorandum In Support Of Her Motion For
Summary Judgment, (“Plaintiff’s Brief”), at 5-7.) In particular, Duncan argues that
the ALJ erred by failing to adhere to the treating physician rule and accord
controlling weight to the opinion of Dr. Ehtesham. (Plaintiff’s Brief at 5-7.)
Duncan also argues that the ALJ erred by failing to give full consideration to the
findings of Lanthorn, who assessed her mental impairments and their impact on her
ability to work. (Plaintiff’s Brief at 5-7.) As noted above, Duncan does not
challenge the ALJ’s findings as to her physical impairments or her physical
residual functional capacity.

As stated above, the court’s function in this case is limited to determining
whether substantial evidence exists in the record to support the ALJ’s findings.
This court must not weigh the evidence, as this court lacks authority to substitute
its judgment for that of the Commissioner, provided her decision is supported by
substantial evidence. See Hays, 907 F.2d at 1456. In determining whether
substantial evidence supports the Commissioner’s decision, the court also must
consider whether the ALJ analyzed all of the relevant evidence and whether the
ALJ sufficiently explained his findings and his rationale in crediting evidence. See
Sterling Smokeless Coal Co. v. Akers, 131 F.3d 438, 439-40 (4th Cir. 1997).

Thus, it is the ALJ’s responsibility to weigh the evidence, including the
medical evidence, in order to resolve any conflicts which might appear therein.
See Hays, 907 F.2d at 1456; Taylor v. Weinberger, 528 F.2d 1153, 1156 (4th Cir.
1975). Furthermore, while an ALJ may not reject medical evidence for no reason
or for the wrong reason, see King v. Califano, 615 F.2d 1018, 1020 (4th Cir. 1980),
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an ALJ may, under the regulations, assign no or little weight to a medical opinion,
even one from a treating source, based on the factors set forth at 20 C.F.R. §
416.927(c), if he sufficiently explains his rationale and if the record supports his
findings.

Duncan argues that the ALJ erred by failing to give the assessments of Dr.
Ehtesham and Lanthorn controlling weight. (Plaintiff’s Brief at 5-7.) After a
complete review of the evidence of record, I find Duncan’s argument unpersuasive.
The ALJ must consider objective medical facts and the opinions and diagnoses of
both treating and examining medical professionals, which constitute a major part
of the proof of disability cases. See McLain, 715 F.2d at 869. The ALJ must
generally give more weight to the opinion of a treating physician because that
physician is often most able to provide “a detailed, longitudinal picture” of a
claimant’s alleged disability. 20 C.F.R. § 416.927(c)(2) (2013). However,
“[c]ircuit precedent does not require that a treating physician’s testimony ‘be given
controlling weight.’” Craig v. Chater, 76 F.3d 585, 590 (4th Cir. 1996) (quoting
Hunter v. Sullivan, 993 F.2d 31, 35 (4th Cir. 1992) (per curiam)). In fact, “if a
physician’s opinion is not supported by clinical evidence or if it is inconsistent
with other substantial evidence, it should be accorded significantly less weight.”
Craig, 76 F.3d at 590.

Based on my review of the record, I find that substantial evidence exists to
support the ALJ’s decision to not give controlling weight to the opinions of Dr.
Ehtesham and Lanthorn. The ALJ noted that he was giving little weight to the
opinions of Dr. Ehtesham because they were not supported by the other evidence
contained in the file and also were inconsistent with her own treatment notes. (R. at
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23.) The ALJ further noted that he was giving some weight to Lanthorn’s opinion
regarding Duncan’s ability to handle simple instructions. (R. at 23.) However, the
ALJ noted that little weight was given to Lanthorn’s opinion overall, as Duncan
had the stomach flu on the day of the examination, and Lanthorn noted that testing
results could be invalid based on Duncan’s performance on the MMPI-2. (R. at 23,
1378.)

The fact that Duncan was not honest with these providers concerning her
long substance abuse history would be basis enough for the ALJ’s rejection of their
opinions. Also, the internal inconsistencies in Dr. Ehtesham’s mental assessments
support the ALJ’s rejection of these opinions. These providers’ extreme mental
restrictions also are not supported by their own evaluation and treatment notes.
Mental status examinations generally showed that Duncan’s mood appeared
depressed or anxious, but she had fair insight, intact judgment, goal-oriented
thought processes and no hallucinations or suicidal or homicidal ideation. (R. at
1001-03, 1006, 1008, 1010, 1016, 1018, 1071, 1073, 1075, 1086, 1088, 1090,
1342, 1344, 1346, 1348, 1350, 1355, 1357, 1359, 1361, 1475, 1477, 1479, 1481,
1483, 1485, 1487, 1489, 1515, 1517, 1519, 1521.) Duncan was cooperative and
appropriately groomed, her speech was normal and she displayed normal
psychomotor skills. (R. at 1002, 1006, 1008, 1338, 1344, 1346, 1348, 1350, 1355,
1357, 1359, 1361, 1475, 1477, 1479, 1481, 1483, 1485, 1487, 1489, 1515, 1517,
1519, 1521.) Dr. Ehtesham assessed Duncan’s anxiety on a scale of one to ten, and
consistently concluded that her anxiety ranked between two and five; and Dr.
Ehtesham’s treatment notes also indicated that Duncan’s symptoms were stable
and improved with medication. (R. at 1006, 1008, 1010, 1016, 1018, 1071, 1073,
1075, 1086, 1088, 1090, 1092, 1338, 1342, 1344, 1346, 1348, 1350, 1355, 1357,
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1359, 1361, 1475, 1477, 1479, 1481, 1483, 1485, 1487, 1489, 1515, 1517, 1519,
1521.) In March 2009 Dr. Blackwell noted that Duncan was alert, cooperative and
oriented with good mental status. (R. at 820.) From July 2011 through December
2011, Dr. Jackson reported that Duncan was oriented to person, place and time, her
insight and judgment were intact and her affect was normal. (R. at 1525, 1528,
1531, 1534.) Furthermore, the ALJ relied upon the opinions of the state agency
psychologists, who found that Duncan was capable of meeting the basic demands
of competitive work on a sustained basis despite her mental impairments. (R. at
24.)

Based on this, I find that substantial evidence supports the weighing of the
psychological evidence by the ALJ. That being so, I further find that substantial
evidence supports the ALJ’s finding as to Duncan’s mental residual functional
capacity and his finding that she was not disabled. An appropriate order and
judgment will be entered.
DATED:

October 1, 2014.
/s/

Pamela Meade Sargent
UNITED STATES MAGISTRATE JUDGE

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