Salyers v. Colvin

Filing 15

MEMORANDUM OPINION. Signed by Magistrate Judge Pamela Meade Sargent on 09/25/2015. (Bordwine, Robin)

IN THE UNITED STATES DISTRICT COURT
FOR THE WESTERN DISTRICT OF VIRGINIA
BIG STONE GAP DIVISION
JERRY L. SALYERS,
Plaintiff
v.
CAROLYN W. COLVIN,
Acting Commissioner of
Social Security,
Defendant

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Civil Action No. 2:14cv00015
MEMORANDUM OPINION
By: PAMELA MEADE SARGENT
United States Magistrate Judge

I. Background and Standard of Review
Plaintiff, Jerry L. Salyers, (“Salyers”), filed this action challenging the final
decision of the Commissioner of Social Security, (“Commissioner”), denying his
claims for disability insurance benefits, (“DIB”), and supplemental security
income, (“SSI”), under the Social Security Act, as amended, (“Act”), 42 U.S.C.A.
§§ 423 and 1381 et seq. (West 2011 & West 2012). Jurisdiction of this court is
pursuant to 42 U.S.C. §§ 405(g) and 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
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(4th Cir. 1966). “‘If there is evidence to justify a refusal to direct a verdict were the
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 Salyers protectively filed his applications for SSI and
DIB on February 18, 2011, alleging disability as of September 15, 2006, due to
anxiety and anxiety attacks, back problems, blackout spells, memory loss,
headaches, asthma and difficulty with memory and concentration. (Record, (“R.”),
at 197-98, 201-07, 219, 223, 241.) The claims were denied initially and upon
reconsideration. (R. at 111-13, 118-20, 124, 126-28, 130-32, 133-35, 137-39.)
Salyers then requested a hearing before an administrative law judge, (“ALJ”). (R.
at 140-41.) A hearing was held by video conferencing on December 3, 2012, at
which Salyers was represented by counsel. (R. at 33-58.)
By decision dated December 6, 2012, the ALJ denied Salyers’s claims. (R.
at 16-27.) The ALJ found that Salyers met the disability insured status
requirements of the Act for DIB purposes through December 31, 2011. (R. at 18.)
He found that Salyers had not engaged in substantial gainful activity since
September 15, 2006, the alleged onset date. (R. at 18.) The ALJ found that the
medical evidence established that Salyers had severe impairments, namely chronic
back pain; blackout spells; headaches; memory loss; and anxiety, but he found that
Salyers did not have an impairment or combination of impairments that met or
medically equaled one of the listed impairments in 20 C.F.R. Part 404, Subpart P,
Appendix 1. (R. at 18-20.) The ALJ found that Salyers had the residual functional

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capacity to perform medium work 1 requiring no more than one- to two-step job
instructions and no more than occasional interaction with the general public. 2 (R.
at 20.) The ALJ found that Salyers was unable to perform any of his past relevant
work. (R. at 25.) Based on Salyers’s age, education, work history and residual
functional capacity and the testimony of a vocational expert, the ALJ found that a
significant number of jobs existed in the national economy that Salyers could
perform, including jobs as a hand packager, a laundry worker and a salvage
worker. (R. at 25-26.) Thus, the ALJ concluded that Salyers was not under a
disability as defined by the Act and was not eligible for DIB or SSI benefits. (R. at
26-27.) See 20 C.F.R. §§ 404.1520(g), 416.920(g) (2015).
After the ALJ issued his decision, Salyers pursued his administrative
appeals, (R. at 9-12), but the Appeals Council denied his request for review. (R. at
4-8.)3 Salyers then filed this action seeking review of the ALJ’s unfavorable
decision, which now stands as the Commissioner’s final decision. See 20 C.F.R. §§
404.981, 416.1481 (2015). This case is before this court on Salyers’s motion for
summary judgment filed November 21, 2014, and the Commissioner’s motion for
summary judgment filed December 29, 2014.

1

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 someone can perform medium work, he
also can perform light and sedentary work. See 20 C.F.R. §§ 404.1567(c), 416.967(c) (2015).
2

The ALJ placed a number of exertional limitations on Salyers’s work-related abilities.
(R. at 20.) However, because Salyers does not challenge the ALJ’s findings with regard to his
physical impairments, the undersigned will focus on the facts relevant to Salyers’s alleged
mental impairments.
3

By letter dated May 19, 2014, the Appeals Council reported that it had reviewed
additional information related to Salyers’s claims. However, it again found no reason to reopen
and change the ALJ’s unfavorable decision. (R. at 1-2.)
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II. Facts 4
Salyers was born in 1964, (R. at 197, 201), which classifies him as a
“younger person” under 20 C.F.R. §§ 404.1563(c), 416.963(c). He has a tenthgrade education and attended some special education classes. (R. at 224.) Salyers
also has training in the field of masonry. (R. at 37-38, 224.) He has past work
experience as a carpenter, a cook and delivery person for a pizza restaurant, a
general laborer and a helper. (R. at 224.) Salyers testified that he stopped working
in September 2006 after being injured in a motor vehicle accident. (R. at 38.) He
stated that he had severe anxiety attacks, lasting 10 to 15 minutes, and had
difficulty being around people. (R. at 41, 47.) Salyers testified that he took
Klonopin and Lexapro, both of which sometimes helped. (R. at 48.) He testified
that there were no triggers for his panic attacks, but a lot of times he stayed in the
house all day, and he could no longer stand to go in stores. (R. at 41, 48.) Salyers
also testified that he had experienced blackout spells and headaches since the
motor vehicle accident. (R. at 41-42, 50.) Salyers estimated that he had three to
four bad days weekly, during which he would not leave his bedroom. (R. at 51-52.)
Salyers testified that he lived in a camper on his sister’s land, but he would
visit his daughter and grandchildren in a nearby town. (R. at 45.) He stated he
could fix sandwiches for himself, care for his personal hygiene unless his back was
hurting, sometimes take care of basic home maintenance, mow with a riding
mower, change the oil or put brakes on a car, sweep, wash dishes and make the
4

The relevant time period for determining disability in this case is from September 15,
2006, the alleged onset date, through December 6, 2012, the date of the ALJ’s decision, for SSI
purposes, and through December 31, 2011, the date last insured, for DIB purposes. Also, as
previously stated, Salyers challenges only the ALJ’s findings with regard to his mental
impairments. Thus, I will focus on the medical records pertinent thereto.
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bed. (R. at 45-46.) Salyers stated that he enjoyed fishing and deer hunting, which
he had attempted to continue doing, but panicked so badly, he had to return home.
(R. at 45.) He further testified that he enjoyed walking through the woods and
hiking. (R. at 46.)
Mark Hielman, a vocational expert, also was present and testified at
Salyers’s hearing. (R. at 52-58.) Hielman classified Salyers’s past work as a
general construction laborer and as a derrick hand or derrick worker as heavy5 and
semi-skilled, as a carpenter in the construction industry as medium and skilled, as a
cook and delivery person for a pizza restaurant as medium and unskilled and as a
buffering, loader, helper at the marble company as heavy and unskilled. (R. at 5455.) Hielman was first asked to consider a hypothetical individual of Salyers’s age,
education and work history who could perform medium work requiring only oneto two-step job instructions, occasional climbing of ramps and stairs, no climbing
ladders, ropes or scaffolds, occasional balancing, stooping, kneeling, crouching
and crawling and frequently reaching, handling, feeling and fingering objects. (R.
at 55-56.) This individual also should avoid concentrated exposure to vibration and
even moderate exposure to hazards and could have no more than occasional
contact with the general public. (R. at 56.) Hielman testified that such an individual
could not perform any of Salyers’s past work, but could perform other jobs
existing in significant numbers in the national economy, including those of a hand
packager, a laundry worker and a salvage or recycle laborer. (R. at 56-57.)
Hielman next testified that a hypothetical individual who had no useful ability to
interact with co-workers, to deal with the public, to use judgment, to deal with
5

Heavy work involves lifting items weighing up to 100 pounds at a time with frequent
lifting or carrying of items weighing up to 50 pounds. If someone can perform heavy work, he
also can perform medium, light and sedentary work. See 20 C.F.R. §§ 404.1567(d), 416.967(d)
(2015).
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work stresses and to demonstrate reliability and who would be absent from work
more than two days per month could not perform any work. (R. at 57.)
In rendering his decision, the ALJ reviewed records from St. Mary’s
Hospital; Russell County Medical Center; Stone Mountain Health Services; Kristie
Nies, Ph.D., a neuropsychologist; Wellmont Lonesome Pine Hospital; Dr. Joseph
T. Phillips, M.D.; Joseph Leizer, Ph.D., a state agency psychologist; Julie
Jennings, Ph.D., a state agency psychologist; Dr. Danny Minor, M.D.; Park
Avenue Wellness; Bristol Neurological Associates; Dr. Jeff Wallace, M.D.;
Medical Associates of Southwest Virginia; Crystal Burke, a licensed clinical social
worker; East Kentucky Psychological Services, Incorporated; Dr. Victoria Grady,
M.D.; and B. Wayne Lanthorn, Ph.D., a licensed clinical psychologist. Salyers’s
attorney submitted additional evidence from Burke to the Appeals Council. 6
The record shows that Salyers was involved in a motor vehicle accident on
September 5, 2006, for which he received treatment at Russell County Medical
Center. (R. at 277-85.) A past history of “nerves” was noted, and Salyers reported
that he was taking Klonopin. (R. at 279.) He was confused with a headache and
tingling, back pain, neck pain and chest pain. (R. at 277.) Salyers was alert and
fully oriented with a normal mood and affect, and he demonstrated normal
behavior appropriate for his age and the situation. (R. at 278, 280, 389.) It was
noted that Salyers had adequate support systems and could perform all activities of
daily living without assistance. (R. at 280.) He was diagnosed with multiple
6

Since the Appeals Council considered and incorporated this additional evidence into the
record in reaching its decision, (R. at 4-8), this court also must take this evidence into account
when determining whether substantial evidence supports the ALJ’s findings. See Wilkins v.
Sec’y of Dep’t of Health & Human Servs., 953 F.2d 93, 96 (4th Cir. 1991).
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contusions and strains and was discharged home in stable condition with
prescriptions for Lorcet, Flexeril and Phenergan. (R. at 278, 390.)
Salyers treated at Medical Associates of Southwest Virginia from June 22,
2005, through March 20, 2008. (R. at 479-501.) Over this treatment period,
Salyers’s complaints were mostly physical in nature, including back and neck pain,
dizziness and vertigo, headaches, blackout episodes and sinus-related symptoms.
(R. at 485-86, 489-91, 493-95.) However, on November 28, 2006, Dr. Gary S.
Williams, M.D., noted that he was continuing Salyers on Klonopin and Lexapro.
(R. at 489.) On January 30, 2007, Stacey Gipe, P.A.C., a physician’s assistant,
diagnosed Salyers with depression, among other things, despite no such complaints
from Salyers on that date. (R. at 486.) On July 11, 2007, Salyers denied suicidal or
homicidal ideations. (R. at 485.)
On January 24, 2007, Salyers saw Dr. W. Jeffrey Wallace, D.O., an ear, nose
and throat specialist, for his complaints of vertigo. (R. at 477.) A review of
symptoms was positive for “nervous disorder,” among other things. (R. at 477.)
On examination, Salyers was alert and fully oriented and ambulated under his own
power. (R. at 477.) Salyers was diagnosed with vertigo of unknown etiology. (R. at
477.)
When Salyers presented to the emergency department at Lonesome Pine
Hospital on August 10, 2007, after having four near syncopal episodes over the
prior three hours, he was alert and fully oriented with normal speech and cognition.
(R. at 381-82.) His mood and affect were deemed normal, and he was cooperative
and interactive. (R. at 382.)

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On August 13, 2007, Salyers returned to Medical Associates of Southwest
Virginia, where he was diagnosed with anxiety / depression, among other things.
(R. at 484.) On August 28, 2007, Salyers’s chief complaint was episodes of
dizziness and unsteadiness, particularly with turning his head to the right, and
feelings of fogginess in his head at times. (R. at 483.) However, along with
Salyers’s physical diagnoses, Dr. Williams diagnosed a component of anxiety and
depression, and he was continued on Lexapro and Klonopin. (R. at 483.) Dr.
Williams opined that “the situation is certainly not a simple case of ‘malingering,’”
but could be a brain processing problem. (R. at 483.) On February 5, 2008, Salyers
stated that he had been a little bit anxious and mildly depressed due to continued
neurologic symptoms and headaches, resulting in an inability to drive. (R. at 480.)
Gipe diagnosed a history of anxiety / depression in addition to his physical
ailments. (R. at 480.) Gipe continued Salyers on Klonopin, gave him samples of
Lexapro and prescribed Celexa. (R. at 480.)
Salyers saw Dr. Paul Augustine, M.D., at Stone Mountain Health Services,
(“Stone Mountain”), on January 30, 2009, to establish his status as a new patient.
(R. at 296-97.) In addition to physical maladies, Salyers reported anxiety and
insomnia, for which he took Klonopin. (R. at 297.) He was alert and oriented, in
no acute distress and had no focal deficits. (R. at 296.) When Salyers returned to
Dr. Augustine on February 19, 2009, he again was in no distress, stable, alert and
oriented, and he had no focal deficits. (R. at 294.) On May 29, 2009, Salyers
reported that he had some problems with anxiety, depression and insomnia. (R. at
292.) He again was alert and oriented, in no acute distress, and he had no focal
deficits. (R. at 292.) Dr. Augustine diagnosed anxiety and insomnia, for which he
prescribed BuSpar, and depression, for which he prescribed Celexa. (R. at 292.)

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On September 9, 2009, Salyers returned to Stone Mountain, requesting
something for his “nerves.” (R. at 346.) A history of anxiety and depression was
noted, and a review of systems was positive for anxiety. (R. at 346.) Nonetheless,
Salyers was fully oriented. (R. at 345.) He was diagnosed with an anxiety disorder
and was prescribed Klonopin. (R. at 344.) On October 2, October 30, and
November 30, 2009, Salyers was fully oriented and was diagnosed with an anxiety
disorder. (R. at 335-36, 338-39, 341-42.) On January 18, 2010, he again was fully
oriented, but his blood pressure was elevated due to anxiety. (R. at 333.)
Salyers saw Kristie Nies, Ph.D., a neuropsychologist, for an evaluation of
his then-current cognitive and affective functioning at the request of counsel on
February 9, 2010. (R. at 306-12.) He did not appear to have difficulty
understanding or retaining test directions, and Salyers denied significant difficulty
with attention. (R. at 306.) Salyers’s conversational speech was essentially normal,
his affect was appropriate, and his mood was neutral. (R. at 306.) He was fairly
pleasant and cooperative throughout the interview and testing. (R. at 306.) Salyers
reported watching television, sometimes helping with housework and visiting with
family. (R. at 306.) Salyers reported experiencing anxiety attacks all day long and
into the night. (R. at 306.) He further reported an inability to engage in hobbies like
hunting due to physical limitations and having anxiety attacks in the woods. (R. at
306.) He reported that he could maintain hygiene independently, with the
exception of assistance required secondary to back pain. (R. at 307.) Although he
reported a history of recurrent depression, he denied seeing a psychiatrist or
counselor. (R. at 307.) Salyers denied a sad mood and most symptoms of
depression. (R. at 307.) He acknowledged suicidal ideation with a plan, but denied
intention. (R. at 307.) Salyers reported a previous episode of possible mania,
during which he stayed up for six days and had an elevated mood. (R. at 307.) He
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denied frank hallucinations, but reported hearing footsteps and his name and seeing
a black shadow. (R. at 307.) Salyers reported a two and one-half year history of
difficulty controlling excess worry. (R. at 307-08.) He acknowledged symptoms of
panic disorder, including a fear of something bad happening, shakiness, increased
heart rate, shortness of breath, nausea, sweating and difficulty swallowing. (R. at
308.)
Nies administered the Wechsler Adult Intelligence Scale – Fourth Edition,
(“WAIS-IV”), which yielded a full-scale IQ score of 77, placing Salyers in the
borderline range of intellectual functioning. (R. at 309-11.) Salyers scored in the
extremely low range in verbal comprehension, in the low average range in
perceptual reasoning and in working memory and in the average range in
processing speed. (R. at 310.) He completed one self-report mood inventory, on
which he endorsed items consistent with severe levels of depression and anxiety.
(R. at 310.) Salyers was administered two symptom validity tests, on which he
performed below expectation. (R. at 311.) He also performed below expectation on
a validity measure embedded within the test battery. (R. at 311.) Therefore, Nies
concluded that Salyers’s presentation was not credible. (R. at 311.) Salyers’s
inexplicably low performance raised questions as to the validity of all test results,
as well as his self-reported symptoms. (R. at 311.) Nies opined that Salyers could
perform at least as well as the average range scores indicated, and she opined that
it was unlikely the impaired scores were an accurate reflection of Salyers’s
neurological status at that time, but likely reflected psychological issues, such as
secondary gain. (R. at 311.) Nies diagnosed cognitive disorder, not otherwise
specified, by report; major depressive disorder, recurrent, severe, without psychotic
features; generalized anxiety disorder; and rule out bipolar disorder; and she
recommended continued pharmacological treatment. (R. at 311-12.)
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When Salyers returned to Stone Mountain on March 9, 2010, requesting a
Klonopin refill, his anxiety was controlled. (R. at 328.) He was fully oriented with
normal memory, mood and affect, judgment and insight. (R. at 329.) Salyers was
diagnosed with anxiety, was advised to avoid triggers and to continue taking
Klonopin. (R. at 330.) On June 8, 2010, Salyers wished to discuss an increase in
his Klonopin dosage. (R. at 325.) A review of systems was positive for anxiety, but
he was fully oriented with normal memory, mood and affect, judgment and insight.
(R. at 325-26.) Salyers again was diagnosed with anxiety, was advised to avoid
triggers and to continue Klonopin. (R. at 327.) On September 17, 2010, Salyers
requested another Klonopin refill. (R. at 321.) A review of symptoms indicated no
psychiatric symptoms, and he was fully oriented with normal memory, mood and
affect, judgment and insight. (R. at 321-22.) Salyers was diagnosed with anxiety
and was advised to continue Klonopin. (R. at 323.) On December 15, 2010, no
psychiatric symptoms were noted. (R. at 318.) Salyers was fully oriented with
normal memory, mood and affect, judgment and insight, he was diagnosed with
anxiety, and he was continued on Klonopin. (R. at 319-20.)
When Salyers returned to the emergency department at Lonesome Pine
Hospital on January 24, 2011, with complaints of a headache of abrupt onset, he
was alert and fully oriented with normal cognition and speech. (R. at 375-76.) His
mood and affect were normal, and he was cooperative and interactive. (R. at 376.)
Salyers treated at Stone Mountain on February 23, 2011, noting no
psychiatric symptoms. (R. at 315-16, 417-18.) He was fully oriented. (R. at 316,
418.) On March 23, 2011, while the provider noted that Salyers continued to have
a cough, sinus drainage and congestion, his other conditions were “stable.” (R. at
413.) Again, no psychiatric symptoms were noted. (R. at 413.) Nonetheless,
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Salyers was diagnosed with anxiety, and he was continued on Klonopin. (R. at
415.) When Salyers returned on April 12, April 19, and May 4, 2011, no
psychiatric symptoms were noted, and no psychiatric diagnoses were rendered. (R.
at 403-05, 407-12.)
Joseph Leizer, Ph.D., a state agency psychologist, completed a Psychiatric
Review Technique form, (“PRTF”), on April 5, 2011, in connection with Salyers’s
initial disability claim. (R. at 62-63, 72-73.) Leizer found that Salyers had no
restrictions on his activities of daily living, experienced no difficulties maintaining
social functioning, experienced mild difficulties maintaining concentration,
persistence or pace and had not experienced repeated episodes of decompensation
of extended duration. (R. at 62, 72.) Leizer found no evidence of a severe mental
impairment and that Salyers should be able to perform all levels of work. (R. at 63,
73.)
Salyers began seeing Crystal Burke, LCSW, a licensed clinical social worker
at Stone Mountain, on May 23, 2011. (R. at 504.) Salyers reported taking Klonopin
and Lexapro, which was helping him “a little.” (R. at 504.) He stated that he
avoided activities and often withdrew to his bedroom. (R. at 504.) Salyers stated
that he previously enjoyed outdoor activities, hunting and fishing, but no longer
had any desire to do so. (R. at 504.) Salyers was alert and oriented with a depressed
mood and thought content with depressive features. (R. at 504.) Burke opined that
he appeared to have some significant symptoms of depression and panic disorder.
(R. at 504.) They discussed coping strategies, she allowed Salyers to vent, and
Burke encouraged him to take his medications as prescribed. (R. at 504.) Salyers
returned to Burke on June 22, 2011, reporting that he had attempted to go fishing
and also go into a large retail store, but had to leave both due to anxiety and severe
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panic attacks. (R. at 505.) He reported continued isolation, difficulty concentrating
and memory problems. (R. at 505.) Salyers stated that relaxation techniques were
unsuccessful. (R. at 505.) He was alert and oriented with fair grooming and
hygiene, he had a depressed mood, was anxious and had thought content with
depressive features. (R. at 505.) He denied any suicidal ideations. (R. at 505.)
Burke opined that Salyers might benefit from medication adjustments and
continued counseling supports. (R. at 505.)
When Salyers returned to Stone Mountain on June 29, 2011, he reported no
psychiatric symptoms, and he was fully oriented with normal memory, mood and
affect, insight and judgment. (R. at 529-30.) He was diagnosed with anxiety,
among other things, and was continued on Klonopin. (R. at 531.)
Julie Jennings, Ph.D., a state agency psychologist, completed a PRTF in
connection with the reconsideration of Salyers’s disability claim on July 18, 2011.
(R. at 85-86, 97-98.) She made the same findings as psychologist Leizer in April
2011, concluding that Salyers did not suffer from a severe mental impairment. (R.
at 85-86, 97-99.) It again was noted that, although Salyers occasionally felt
nervous, he could perform daily activities without severe limitations. (R. at 91,
103.)
On October 19, 2011, Salyers returned to Burke with complaints of daily
panic attacks and isolating himself because people got on his nerves. (R. at 503.)
He reported no suicidal ideations. (R. at 503.) Salyers’s communication and eye
contact was good. (R. at 503.) He was diagnosed with depression / anxiety, and
stressors and coping techniques were discussed. (R. at 503.) Salyers was advised to
seek out activities and emotional support and use coping techniques for panic
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attacks. (R. at 503.) Salyers also was seen at Stone Mountain on that date for a
follow up. (R. at 526-28.) He complained of a flare up of his “seizure” disorder and
a rash on his left arm. (R. at 526.) All other conditions were deemed “stable.” (R.
at 526.) Salyers did not note any psychiatric symptoms, and he was fully oriented
with normal memory, affect and mood, judgment and insight. (R. at 527.) He was
diagnosed with anxiety and continued on Klonopin. (R. at 528.) On February 13,
2012, Salyers returned for another follow-up appointment, at which time he
reported daily anxiety attacks and social anxiety. (R. at 522-25.) However, Salyers
stated that Lexapro was helping. (R. at 522.) He was diagnosed with uncontrolled
anxiety, and Lexapro was restarted. (R. at 523.) Salyers returned to Stone
Mountain on February 23, 2012, with sinus-related complaints. (R. at 519-21.) He
reported no psychiatric symptoms, and no psychiatric diagnosis was rendered at
that time. (R. at 519, 521.)
On February 27, 2012, Salyers saw Burke, reporting continued panic attacks,
poor sleep and nightmares, among other things. (R. at 503.) He reported he could
not account for time lapses several times weekly, poor concentration and memory
impairment. (R. at 502.) Salyers was alert and oriented, and he denied suicidal or
homicidal ideation. (R. at 503.) He was anxious and reported stress and tension at
home. (R. at 503.) Salyers was diagnosed with a panic disorder and a depressive
disorder, and Burke encouraged him to relax. (R. at 503.)
Salyers returned to Stone Mountain on May 15, 2012, with various
complaints, including experiencing two to three panic attacks daily. (R. at 515-18.)
Nonetheless, he was fully oriented with a normal memory, mood and affect,
judgment and insight. (R. at 516.) Salyers was diagnosed with anxiety, and BuSpar
was prescribed. (R. at 518.)
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On June 15, 2012, Burke completed a mental assessment, indicating that
Salyers had a good ability to understand, remember and carry out simple job
instructions, a fair ability to follow work rules, to function independently and to
understand, remember and carry out both complex and detailed job instructions
and a poor or no ability 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 and concentration, to maintain personal appearance, to behave in an
emotionally stable manner, to relate predictably in social situations and to
demonstrate reliability. (R. at 508-10.) Burke opined that Salyers would be absent
more than two workdays monthly due to his impairments or treatment. (R. at 510.)
She based her findings on Salyers’s diagnoses of panic disorder with agoraphobia;
post-traumatic stress disorder, (“PTSD”); and depressive disorder. (R. at 508.)
Salyers returned to Stone Mountain on June 18, 2012, for a follow up on his
anxiety. (R. at 512-14.) He was fully oriented with a normal memory, mood and
affect, judgment and insight. (R. at 513.) Salyers’s dosage of BuSpar was
increased, and he was advised to taper off Klonopin once his anxiety was better
controlled. (R. at 514.) On July 18, 2012, Salyers continued to complain of anxiety.
(R. at 556-58.) He was fully oriented with normal memory, judgment and insight
and an anxious mood and affect. (R. at 557.) He was diagnosed with unimproved
anxiety, his dosage of BuSpar was increased, and he was again advised to taper the
Klonopin. (R. at 558.)
Salyers returned to Burke on July 25, 2012, reporting good days and bad
days. (R. at 605.) He reported bad panic attacks that were interrupting his sleep,
but Salyers stated that an increased BuSpar dosage had helped some. (R. at 605.)
He further reported some feelings of depression, but he was alert and oriented with
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fair hygiene. (R. at 605.) Burke noted that Salyers appeared depressed and anxious,
and she opined that he continued to exhibit problems with anxiety and depression.
(R. at 605.) They discussed coping strategies, and she allowed Salyers to vent. (R.
at 605.) On October 1, 2012, Salyers reported significant relational stressors after
breaking up with his girlfriend, as well as poor sleep due to pain and anxiety. (R. at
604.) He reported continued daily panic attacks with little relief from medications
and relaxation techniques. (R. at 604.) Salyers denied suicidal ideation, but
reported some sadness regarding hunting season, stating “I just can’t enjoy it.” (R.
at 604.) He stated that he used to hunt daily, but only did so two or three times the
previous year. (R. at 604.) Burke described Salyers as anxious and mildly
depressed. (R. at 604.) She diagnosed depressive disorder, not otherwise specified;
and anxiety state, unspecified; and she encouraged coping strategies. (R. at 604.)
Salyers saw Phil Pack, M.S., a licensed psychological practitioner, for a
psychological evaluation at the request of Disability Determination Services on
July 30, 2012. (R. at 546-51.) Salyers was talkative and participated in the
assessment. (R. at 546.) Salyers reported experiencing anxiety attacks for the
previous 10 years, noting that he sometimes had them “all day long,” and other
times had them at night when he would lie down. (R. at 547.) He alleged that he
had 10 to 15 panic attacks daily. (R. at 547.) However, he was unable to identify
any triggers. (R. at 547.) Salyers reported undergoing monthly counseling for the
previous year and a half and learning relaxation techniques, which sometimes
helped, but he denied inpatient treatment. (R. at 547.) He further reported episodes
of auditory and visual hallucinations, including hearing voices and seeing things in
the yard when nothing was there. (R. at 547.) Salyers denied suicidal ideation. (R.
at 547.)

-16-

Salyers reported driving two to three times weekly, sometimes grocery
shopping, doing laundry and fixing simple meals. (R. at 548.) He stated that he
lived in a camper on his sister’s property because he did not want to be around
people. (R. at 548.) Salyers reported that he liked to hunt and fish in the past, but
no longer did so due to severe panic attacks. (R. at 548.) He reported socializing
with some family members, taking care of his own finances and appointments and
tending to his own self-care without difficulty. (R. at 548.) Salyers’s speech was
clear, and he had good eye contact. (R. at 548.) Overall rapport was easily
established and maintained. (R. at 548.) Pack deemed his concentration and
attention as good, noting that Salyers could remember three of three objects
immediately. (R. at 549.) His mood was described as pleasant and friendly. (R. at
549.) Pack noted that, while Salyers alleged continuous anxiety attacks, he did not
seem to be particularly anxious or experiencing any difficulties on that date. (R. at
549.) Salyers’s rate and pace of speech were within normal limits, and his thought
process was clear and formed with no long-standing issues. (R. at 549.) Salyers’s
insight and judgment into the nature of his difficulties were deemed poor. (R. at
549.)
Pack diagnosed mood disorder, not otherwise specified; rule out personality
disorder; and rule out cognitive disorder, not otherwise specified, by report; and
Salyers’s then-current Global Assessment of Functioning, (“GAF”), 7 score was

7

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.” DIAGNOSTIC
AND STATISTICAL MANUAL OF MENTAL DISORDERS FOURTH EDITION, (“DSM-IV”), 32
(American Psychological Association 1994).
-17-

assessed at 65. 8 (R. at 549-50.) He deferred making a prognosis pending an
updated neurological workup and access to Salyers’s general medical records. (R.
at 550.) Pack concluded that Salyers had a fair ability to understand
straightforward direction and instruction, he could live alone, travel, manage
finances and overall communicate his needs and function in a fairly independent
manner. (R. at 550.) His ability to complete a normal workweek without disruption
from his psychiatric issues was deemed poor, and he seemed to have developed a
chronic pattern of somatic preoccupation and anxiety, although there was likely a
degree of exaggeration to his style and responses. (R. at 550.) Salyers’s ability to
secure and arrange travel and attend to his own shopping, cooking, cleaning,
household chores, money, mail, bills, appointments and self-care were deemed
good. (R. at 550.) On the interview date, Pack opined that Salyers’s mental status
was essentially unremarkable with regard to the general interview. (R. at 551.) On
formal tasks, Salyers presented in somewhat dramatic fashion with regard to his
overall complaints and allegations, and Pack suggested a review of his updated
medical and psychological records. (R. at 551.)
Pack also completed a mental assessment, indicating that Salyers’s abilities
to understand, remember and carry out instructions were not affected by his
impairment. (R. at 543-45.) He found that Salyers was mildly limited in his
abilities to interact appropriately with the public, with supervisors and with coworkers and markedly limited in his ability to respond appropriately to usual work
situations and to changes in a routine work setting. (R. at 544.) He concluded that

8

A GAF score of 61 to 70 indicates “[s]ome mild symptoms … OR some difficulty in
social, occupational, or school functioning … but generally functioning pretty well, has some
meaningful interpersonal relationships.” DSM-IV at 32.
-18-

no other capabilities were affected by Salyers’s impairment. (R. at 544.) Pack
provided no support for his findings. (R. at 543-45.)
On August 18, 2012, Salyers saw Dr. Victoria Grady, M.D., for another
consultative examination at the request of Disability Determination Services. (R. at
563-67.) Among his chief complaints was anxiety, which he began experiencing
approximately 12 to 13 years previously. (R. at 563-64.) Salyers stated that his
anxiety was worsening and described the symptoms as feeling like a heart attack.
(R. at 564.) He stated that he did not want to be around anyone. (R. at 564.)
Salyers stated that he saw a counselor monthly, and his primary care physician
prescribed medications, which helped. (R. at 564.) He reported past suicidal
ideations, but denied any psychiatric hospitalizations or homicidal ideations. (R. at
564.) Salyers stated that he loved to deer hunt, but had “slacked down to doing
nothing” because he had bad panic attacks in the woods. (R. at 564.) He also
reported liking to fish, but stated he had only gone twice that year due to panic
attacks. (R. at 564.) He was alert and fully oriented. (R. at 565.) Dr. Grady
diagnosed anxiety and depression, among other things, and she recommended a
psychiatry or psychology evaluation based on his report of suicidal ideations. (R. at
566.)
On September 18, 2012, Salyers returned to Stone Mountain with continued
complaints of anxiety. (R. at 597-600.) He was fully oriented with normal memory,
mood and affect, insight and judgment, and he made good eye contact. (R. at 598.)
Salyers was diagnosed with anxiety and panic attacks, he was continued on
Lexapro, and his dosage of BuSpar was increased. (R. at 600.)

-19-

On November 13, 2012, B. Wayne Lanthorn, Ph.D., a licensed clinical
psychologist, completed a psychological evaluation of Salyers at the request of
counsel. (R. at 579-88.) Salyers was fully oriented. (R. at 580.) He reported having
undergone counseling with Burke for the previous year and a half. (R. at 582.) He
placed his then-current depression level at an eight or nine on a 10-point scale, but
noted that antidepressant medication helped somewhat. (R. at 583.) Salyers
reported working in his yard, visiting with his children and grandchildren,
performing a minimal amount of housecleaning and socializing with his girlfriend
and family members. (R. at 583.) He reported no longer deer hunting or going into
stores due to panic problems. (R. at 583.) Salyers’s grooming and hygiene were
good, his affect was generally flat and blunt, and he was obviously quite on edge
and tense. (R. at 583.) Overall, his mood could best be described as an agitated
depression. (R. at 583.) Salyers indicated that he heard people talking at times and
heard his name being called. (R. at 583.)
Salyers admitted some suicidal ideation, but denied any plans or intent. (R.
at 583.) He reported erratic to poor short-term memory, but intact long-term
memory, as well as difficulty with concentration and mind wandering. (R. at 584.)
Salyers also reported frequent panic attacks, during which he felt like he was
having a heart attack, and which lasted for 10 to 20 minutes. (R. at 584.) He stated
that his anti-anxiety medication, BuSpar, was only marginally helpful. (R. at 584.)
Salyers reported awakening throughout the night with both pain and anxiety. (R. at
584.) He seemed on edge, and rapport was established only to a fair degree. (R. at
584.) After 10 minutes, Salyers could remember only one out of five words
presented to him earlier. (R. at 584.) He correctly performed serial 7’s, but he
could not interpret any of three commonly used adages. (R. at 584.) He also could
not spell the word “world” either forward or backward. (R. at 584.)
-20-

Lanthorn administered the WAIS-IV, which he believed yielded valid
results, accurately reflecting Salyers’s then-current degree of intellectual
functioning. (R. at 584-85.) Salyers achieved a full-scale IQ score of 66, placing
him in the extremely low range, compared to a 77 obtained in his prior
psychological testing in 2010 with Nies. (R. at 585.) Lanthorn opined that the
difference in scores could be attributed to the passage of time, as well as Salyers’s
report that his condition had deteriorated. (R. at 585.) Salyers earned a verbal
comprehension index of 72, a perceptual reasoning index of 71, and a working
memory index of 74, all placing him in the borderline range, and a processing
speed index of 68, placing him in the extremely low range. (R. at 585.) Lanthorn
also administered the Minnesota Multiphasic Personality Inventory – Second
Edition, (“MMPI-2”), indicating the presence of moderate to severe levels of
emotional distress, problems with concentration, memory deficits and lessened
judgment. (R. at 586.) Testing further indicated that Salyers was quite withdrawn
and spent most of his spare time alone. (R. at 587.) Test results also indicated the
presence of significant and severe depression, which contributed to poor
concentration and social withdrawal. (R. at 587.) Finally, testing indicated that
Salyers had difficulties with worry, anxiety, tension and emotional discomfort, also
contributing to problems with concentration. (R. at 587.) Lanthorn opined that
Salyers’s psychopathology was serious enough that it included confused thinking
and difficulties with logic, as well as impaired judgment. (R. at 587.)
Lanthorn diagnosed Salyers with major depressive disorder, recurrent,
severe; anxiety disorder with both panic attacks and generalized anxiety disorder;
cognitive disorder, not otherwise specified; rule out pain disorder associated with
both psychological factors and general medical conditions; and borderline

-21-

intellectual functioning; and he placed Salyers’s then-current GAF score at 50.9
(R. at 587-88.) He assessed Salyers’s prognosis as “quite guarded” and strongly
recommended continued psychotherapeutic intervention. (R. at 588.) Lanthorn
recommended that Salyers also see a psychiatrist to ensure that all prescribed
psychotropic medications have maximum efficacy. (R. at 588.) He concluded that
Salyers was functioning in the borderline range overall intellectually. (R. at 588.)
Lanthorn noted the 11-point drop in Salyers’s overall full-scale IQ from the current
result and Dr. Nies’s result, which could be an indicator of continuing cognitive
decline, overall. (R. at 588.)
Lanthorn also completed a mental assessment, indicating that Salyers had a
good ability to understand, remember and carry out simple job instructions and to
maintain personal appearance. (R. at 590-92.) He opined that Salyers had a fair
ability to follow work rules, to interact with supervisors, to function independently,
to maintain attention and concentration, to understand, remember and carry out
detailed job instructions, to behave in an emotionally stable manner and to relate
predictably in social situations and a poor or no ability to relate to co-workers, to
deal with the public, to use judgment, to deal with work stresses, to understand,
remember and carry out complex job instructions and to demonstrate reliability.
(R. at 590-91.) Lanthorn opined that Salyers would be absent from work more than
two days monthly due to his impairments or treatment therefor. (R. at 592.) He
based these findings on the diagnoses he had placed upon Salyers. (R. at 590.)
Burke completed another mental assessment of Salyers on January 9, 2013,
finding that he had a good ability to understand, remember and carry out simple
9

A GAF score of 41 to 50 indicates “[s]erious symptoms … OR any serious impairment
in social, occupational, or school functioning. …” DSM-IV at 32.
-22-

job instructions, a fair ability to follow work rules, to understand, remember and
carry out detailed job instructions, to maintain personal appearance, to behave in
an emotionally stable manner, to relate predictably in social situations and to
demonstrate reliability and a poor or no ability to relate to co-workers, to deal with
the public, to use judgment, to interact with supervisors, to deal with work stresses,
to function independently, to maintain attention and concentration and to
understand, remember and carry out complex job instructions. (R. at 616-17.) She
opined that Salyers would be absent from work more than two days monthly due to
his impairments or treatment therefor. (R. at 618.) Burke based her findings on
Salyers’s panic disorder and agoraphobia. (R. at 616.)
Salyers saw Burke a week later on January 16, 2013, with complaints of
daily anxiety attacks and some blackout episodes. (R. at 607-08.) He reported
continuing isolation most of the time. (R. at 607.) Salyers stated that BuSpar did
not help, and he stated several times during the interview that “[m]y nerves are
killing me.” (R. at 607.) Nonetheless, he reported that Klonopin helped sometimes.
(R. at 607.) Salyers reported a lack of usual activities, but stated he enjoyed short
visits with his children. (R. at 607.) He reported poor concentration and memory
and often feeling frustrated. (R. at 607.) Salyers was anxious, and he appeared
frustrated with his health issues. (R. at 607.) He was appropriately dressed and
groomed. (R. at 607.) Salyers’s problem list included generalized anxiety disorder
and transient alteration of awareness. (R. at 608.) He was taking Klonopin and
Celexa. (R. at 608.) Burke diagnosed agoraphobia with panic disorder and
depressive disorder, not elsewhere classified. (R. at 608.) Supportive counseling
and coping strategies were recommended. (R. at 608.)

-23-

III. Analysis
The Commissioner uses a five-step process in evaluating DIB and SSI
claims. See 20 C.F.R. §§ 404.1520, 416.920 (2015). 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 his past relevant
work; and 5) if not, whether he can perform other work. See 20 C.F.R. §§
404.1520, 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. §§ 404.1520(a), 416.920(a) (2015).
Under this analysis, a claimant has the initial burden of showing that he is
unable to return to his past relevant work because of his 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. §§ 423(d)(2)(A), 1382c(a)(3)(A)-(B)
(West 2011 & West 2012); 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).
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
-24-

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),
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. §§
404.1527(c), 416.927(c), if he sufficiently explains his rationale and if the record
supports his findings.
Salyers argues that the ALJ erred by making incomplete findings at step
three of the sequential evaluation process. (Plaintiff’s Memorandum In Support Of
His Motion For Summary Judgment, (“Plaintiff’s Brief”), at 5-6). Specifically,
Salyers argues that the ALJ erred by failing to explain how he determined that
Salyers’s impairments did not satisfy the “paragraph B” criteria of § 12.06, the
listing for anxiety-related disorders. (Plaintiff’s Brief at 5-6.) Salyers also argues
that the ALJ erred by failing to give full consideration to psychologist Lanthorn’s
findings regarding the severity of his mental impairments and their resulting effects
on his ability to work. (Plaintiff’s Brief at 6-8.) As noted above, Salyers does not
challenge the ALJ’s finding as to his physical residual functional capacity.
-25-

After a review of the evidence of record, I find Salyers’s arguments
unpersuasive. Step three of the sequential evaluation requires the ALJ to determine
whether Salyers has an impairment that meets or equals the criteria of a listed
impairment. The burden of making such a showing rests with the claimant. See
Radford v. Colvin, 734 F.3d 288, 291 (4th Cir. 2013) (citing Hancock v. Astrue, 667
F.3d 470, 472-73 (4th Cir. 2012)). It is well-settled that, in order “[f]or a claimant
to show that his impairment matches a listing, it must meet all of the specified
medical criteria. An impairment that manifests only some of those criteria, no
matter how severely, does not qualify.” Sullivan v. Zebley, 493 U.S. 521, 530
(1990) (emphasis in original).
Here, the record shows that the ALJ stated in his decision that Salyers’s
mental impairments, considered singly and in combination, did not meet or
medically equal the criteria of § 12.06. (R. at 19.) Specifically, he found that the
“paragraph B” criteria of § 12.06 were not satisfied. (R. at 19.) Paragraph B of §
12.06 requires that a claimant’s mental impairment result in at least two of the
following: (1) marked restriction of activities of daily living; or (2) marked
difficulties in maintaining social functioning; or (3) marked difficulties in
maintaining concentration, persistence or pace; or (4) repeated episodes of
decompensation, each of extended duration. See 20 C.F.R. Pt. 404, Subpt. P, App.
1, § 12.06(B) (2015). The ALJ found that Salyers was limited as follows: mild
restriction in activities of daily living; moderate difficulties in maintaining social
functioning; moderate difficulties in maintaining concentration, persistence or
pace; and no episodes of decompensation, each of extended duration. (R. at 19.)
The ALJ stated as follows: “[t]his conclusion is supported by the evaluation of
evidence discussed in detail below.” (R. at 19.) In the remainder of the decision,

-26-

the ALJ proceeded to analyze the medical evidence of record, including the
psychological evidence, to determine Salyers’s residual functional capacity.
In particular, the ALJ found that Salyers was limited, to a degree, in his
activities of daily living, but the daily activities he did perform were inconsistent
with his complaints of prolonged and consistent disabling functional limitations.
For instance, the ALJ noted Salyers’s report to neuropsychologist Nies in February
2010, that he watched television, sometimes helped with housework and visited
family. (R. at 21.) Likewise, in July 2012, Salyers informed Pack that he lived
alone in a camper on his sister’s property, drove two to three times weekly, grocery
shopped at times, did laundry, prepared sandwiches, tended to basic self-care
without difficulty and kept up with his own money, mail, bills, appointments and
bank accounts. (R. at 23.) The ALJ also noted that Salyers reported to Dr. Grady in
August 2012 that he went fishing twice that year, and in November 2012, he
informed psychologist Lanthorn that he worked in his yard, visited his children and
grandchildren, cooked on rare occasion, performed some minimal housework, read
and watched television a little and socialized with his girlfriend and family
members. (R. at 22-23.) Lastly, the ALJ noted Salyers’s hearing testimony, in
which he reported driving to see his daughter and grandchildren, living alone in a
camper on his sister’s property, staying at his girlfriend’s at times, eating with his
sister at times, taking care of household chores, fishing, mowing with a riding
mower, changing the oil and brakes on vehicles and walking through the woods.
(R. at 24.) He further reported gong to Walmart with his girlfriend. (R. at 24.) In
further support of his step three determination, the ALJ noted that in May 2009,
despite Salyers’s assertions of anxiety, insomnia and depression, he was alert and
oriented. (R. at 21.) In February 2010, neuropsychologist Nies found that he was
alert and oriented, despite a depressed mood, tearfulness and depressive thought
-27-

content. In June 2011, Salyers was deemed to be alert and oriented with fair
grooming and hygiene, despite his report of having to leave a fishing trip and a
retail store due to anxiety and panic attacks. (R. at 22.) Likewise, in July 2012,
Salyers was deemed alert and oriented with fair grooming and hygiene, despite
depression and anxiousness. (R. at 22.) From September 2009 through September
2012, Salyers’s psychiatric examinations at Stone Mountain were consistently
unremarkable, revealing full orientation and normal memory, mood, affect,
judgment and insight. (R. at 22.) In August 2012, a mental status evaluation was
unremarkable, revealing that Salyers was alert and fully oriented. (R. at 22.) In July
2012, mental status evaluation revealed clear speech, good eye contact, an easily
established and maintained rapport, good concentration, a pleasant and friendly
mood, clear thought processes with no anxiousness or depressive features and no
suicidal ideations or aggressive impulses. (R. at 22.) Finally, in November 2012,
mental status evaluation revealed, among other things, good grooming and
hygiene, good appetite and a fair degree of rapport with no visual hallucinations or
homicidal ideations. (R. at 23-24.) I find that the ALJ’s thorough recitation of the
evidence of record supports his finding at step three of the sequential evaluation
process that Salyers’s impairments do not meet or equal the criteria for the medical
listing for anxiety-related disorders, found at 20 C.F.R., Part 404, Subpart P,
Appendix 1, § 12.06.
Next, I find that the ALJ did not err by failing to give full consideration to
psychologist Lanthorn’s findings regarding the severity of his mental impairments
and their effects on his ability to work. 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 in disability cases. See
McLain, 715 F.2d at 869. The ALJ must generally give more weight to the opinion
-28-

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. §§
404.1527(c)(2), 416.927(c)(2) (2015). Here, Lanthorn is not a treating source of
Salyers. Thus, his opinion is not entitled to “controlling weight” even if supported
by the clinical evidence and even if consistent with the other substantial evidence
of record. Instead, the ALJ must consider the following factors in deciding how
much weight to assign to Lanthorn’s opinion: (1) the length of treatment of the
claimant; (2) the frequency of examination of the claimant; (3) the nature and
extent of the treatment relationship; (4) support of the source’s opinion afforded by
the medical evidence of record; (5) consistency of the opinion with the record as a
whole; and (6) specialization of the source. See 20 C.F.R. §§ 404.1527(c)(2),
416.927(c)(2).
The ALJ stated that he was giving little weight to the clinical findings and
assessments of Lanthorn because they were mainly based on Salyers’s subjective
complaints. (R. at 24.) The court notes that psychologist Lanthorn did, in fact,
administer objective psychological testing to Salyers, including the WAIS-IV and
the MMPI-2, the results of which he deemed valid. The WAIS-IV results yielded a
full-scale IQ score of 66, placing him in the extremely low range of intellectual
functioning, and the MMPI-2 suggested that Salyers was experiencing moderate to
severe levels of emotional distress, problems with concentration, memory deficits,
lessened judgment, social withdrawal, significant and severe depression and
difficulties with worry, anxiety and tension. Lanthorn opined that Salyers had a
good ability to understand, remember and carry out simple job instructions and to
maintain personal appearance, a fair ability to follow work rules, to interact with
supervisors, to function independently, to maintain attention and concentration, to
understand, remember and carry out detailed job instructions, to behave in an
-29-

emotionally stable manner and to relate predictably in social situations and a poor
or no ability to relate to co-workers, to deal with the public, to use judgment, to
deal with work stresses, to understand, remember and carry out complex job
instructions and to demonstrate reliability. He opined that Salyers would be absent
from work more than two days monthly due to his impairments or treatment
therefor. Thus, I find that the ALJ simply incorrectly noted that Lanthorn’s
findings were based mainly on Salyers’s subjective complaints. Nonetheless, for
the reasons that follow, I find that the ALJ did not err by according little weight to
Lanthorn’s opinion.
First, Lanthorn examined Salyers on only one occasion at the request of
counsel. Thus, the length and frequency, as well as the nature and extent of
Lanthorn’s treatment, do not warrant giving his assessment any greater weight.
Second, Lanthorn’s opinion is not supported by the other substantial evidence in
the record. Although Salyers argues that Lanthorn’s opinion is consistent with the
findings of licensed clinical social worker Burke, the ALJ found that Burke’s
opinions were based mainly on Salyers’s subjective complaints. A review of the
records confirms that this is true, as Burke did not employ any type of
psychological testing in evaluating Salyers. Lanthorn’s opinions also are not
supported by psychologist Nies’s opinion that Salyers’s presentation was
noncredible and that his extremely low testing scores and self-reported symptoms
were questionable based on his below expected performance on two symptom
validity tests. Nies concluded that Salyers could perform “at least as well as the
average scores indicated,” and she opined that it was unlikely that the impaired
scores were an accurate reflection of his then-current neurological status, but likely
reflected psychological issues, such as secondary gain.

-30-

Lanthorn’s opinions also are not consistent with psychological practitioner
Pack’s findings, which included that Salyers had good attention and concentration,
displayed a pleasant and friendly mood and, despite Salyers’s allegations of
continuous anxiety attacks, he did not seem to be particularly anxious or
experiencing any difficulties on the date of the interview. Pack further deemed
Salyers’s speech to be normal and his thought process to be clear. Pack assessed a
then-current GAF score of 65, indicating only mild symptoms. Pack concluded that
Lanthorn’s mental status was essentially unremarkable and that he was mildly
limited in his ability to interact appropriately with the public, with supervisors and
with co-workers and markedly limited in his ability to respond appropriately to
usual work situations and to changes in a routine work setting.
Lanthorn’s opinions also are not supported by the largely unremarkable
mental status evaluations or with Salyers’s own reports of activities of daily living,
both as cited above. Furthermore, Lanthorn’s opinions are not supported by the
conservative nature of the treatment of Salyers’s mental impairments. He has
received no emergent, inpatient or outpatient psychiatric treatment, but has been
prescribed medications by his general practitioner and has undergone counseling
with Burke, who recommended relaxation techniques and coping strategies. By
Salyers’s own admissions, some of these medications helped his symptoms. “If a
symptom can be reasonably controlled by medication or treatment, it is not
disabling.” Gross v. Heckler, 785 F.2d 1163, 1166 (4th Cir. 1986).
Lastly, I note that Lanthorn is a specialist in the mental health field, so this
factor does cut in favor of granting more weight to Lanthorn’s opinions. However,
given the other factors just discussed, this factor alone cannot tip the scale in favor
of granting more weight to Lanthorn’s opinions. It is for all of these reasons that I
-31-

find that substantial evidence supports the ALJ’s decision to grant little weight
thereto. Based on the same medical evidence cited, I find that substantial evidence
also supports the ALJ’s mental residual functional capacity finding.
Based on the above reasoning, I conclude that substantial evidence supports
the ALJ’s weighing of the psychological evidence, and I further find that
substantial evidence exists in the record to support the ALJ’s mental residual
functional capacity finding. An appropriate order and judgment will be entered.
DATED:

September 25, 2015.
/s/

Pamela Meade Sargent

UNITED STATES MAGISTRATE JUDGE

-32-