King v. Astrue

Filing 26

MEMORANDUM OPINION: denying 13 MOTION by Lorraine King for Summary Judgment, granting Defendant's 17 MOTION for Judgment on the Pleadings, affirming the final decision of the Commissioner, and DISMISSING this matter from the docket of this Court. Signed by Magistrate Judge R. Clarke VanDervort on 7/8/2011. (cc: attys; any unrepresented party) (slr)

IN THE UNITED STATES DISTRICT COURT
FOR THE SOUTHERN DISTRICT OF WEST VIRGINIA
BECKLEY DIVISION
LORRAINE KING,
Plaintiff,
v.
MICHAEL J. ASTRUE,
Commissioner of Social Security,
Defendant.

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CIVIL ACTION NO. 5:09-01515

MEMORANDUM OPINION
This is an action seeking review of the decision of the Commissioner of Social Security
denying Plaintiff's application for Disability Insurance Benefits (DIB) and Supplemental Security
Income (SSI), under Titles II and XVI of the Social Security Act, 42 U.S.C. §§ 40 - 433, 13811383f. This case is presently pending before the Court on Plaintiff’s Motion for Summary Judgment
(Document No. 13.) and Defendant’s Motion for Judgment on the Pleadings. (Document No. 17.)
Both parties have consented in writing to a decision by the United States Magistrate Judge.
(Document Nos. 7 and 8.).
The Plaintiff, Lorraine King (hereinafter referred to as “Claimant”), filed applications for
DIB and SSI on July 25, 2007 (protective filing date), alleging disability as of July 19, 2007, due
to “[f]ibromyalgia, arthritis, heart condition, thyroid no longer working, depression, stress, high
blood pressure, sinus tac[hyc]ardia, high cholesterol, asthma/breathing problems, dry eyes, memory
loss, [and] acid reflux.” (Tr. at 9, 140-44, 145-49, 172.) The claims were denied initially and upon
reconsideration. (Tr. at 92-94, 95-97, 104-06, 107-09.) On June 7, 2008, Claimant requested a
hearing before an Administrative Law Judge (ALJ). (Tr. at 110-12.) The hearing was held on

February 12, 2009, before the Honorable Mark A. O’Hara. (Tr. at 35-91.) By decision dated
April 28, 2009, the ALJ determined that Claimant was not entitled to benefits. (Tr. at 9-34.) The
ALJ’s decision became the final decision of the Commissioner on October 23, 2009, when the
Appeals Council denied Claimant’s request for review. (Tr. at 1-5.) On December 16, 2009,
Claimant brought the present action seeking judicial review of the administrative decision pursuant
to 42 U.S.C. § 405(g). (Document No. 2.)
Under 42 U.S.C. § 423(d)(5), a claimant for disability has the burden of proving a disability.
See Blalock v. Richardson, 483 F.2d 773, 774 (4th Cir. 1972). A disability is defined as the
"inability to engage in any substantial gainful activity by reason of any medically determinable
impairment which can be expected to last for a continuous period of not less than 12 months . . . ."
42 U.S.C. § 423(d)(1)(A).
The Social Security Regulations establish a "sequential evaluation" for the adjudication of
disability claims. 20 C.F.R. §§ 404.1520, 416.920 (2008). If an individual is found "not disabled"
at any step, further inquiry is unnecessary. Id. §§ 404.1520(a), 416.920(a). The first inquiry under
the sequence is whether a claimant is currently engaged in substantial gainful employment. Id.
§§ 404.1520(b), 416.920(b). If the claimant is not, the second inquiry is whether claimant suffers
from a severe impairment. Id. §§ 404.1520(c), 416.920(c). If a severe impairment is present, the
third inquiry is whether such impairment meets or equals any of the impairments listed in Appendix
1 to Subpart P of the Administrative Regulations No. 4. Id. §§ 404.1520(d), 416.920(d). If it does,
the claimant is found disabled and awarded benefits. Id. If it does not, the fourth inquiry is whether
the claimant's impairments prevent the performance of past relevant work. 20 C.F.R. §§ 404.1520(e),
416.920(e). By satisfying inquiry four, the claimant establishes a prima facie case of disability. Hall

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v. Harris, 658 F.2d 260, 264 (4th Cir. 1981). The burden then shifts to the Commissioner, McLain
v. Schweiker, 715 F.2d 866, 868-69 (4th Cir. 1983), and leads to the fifth and final inquiry: whether
the claimant is able to perform other forms of substantial gainful activity, considering claimant's
remaining physical and mental capacities and claimant's age, education and prior work experience.
20 C.F.R. §§ 404.1520(f), 416.920(f) (2008). The Commissioner must show two things: (1) that the
claimant, considering claimant’s age, education, work experience, skills and physical shortcomings,
has the capacity to perform an alternative job, and (2) that this specific job exists in the national
economy. McLamore v. Weinberger, 538 F.2d 572, 574 (4th Cir. 1976).
When a claimant alleges a mental impairment, the Social Security Administration “must
follow a special technique at every level in the administrative review process.” 20 C.F.R.
§§ 404.1520a(a) and 416.920a(a). First, the SSA evaluates the claimant’s pertinent symptoms, signs
and laboratory findings to determine whether the claimant has a medically determinable mental
impairment and documents its findings if the claimant is determined to have such an impairment.
Second, the SSA rates and documents the degree of functional limitation resulting from the
impairment according to criteria as specified in 20 C.F.R. §§ 404.1520a(c) and 416.920a(c). Those
sections provide as follows:
(C) Rating the degree of functional limitation. (1)Assessment of functional
limitations is a complex and highly individualized process that requires us to
consider multiple issues and all relevant evidence to obtain a longitudinal picture of
your overall degree of functional limitation. We will consider all relevant and
available clinical signs and laboratory findings, the effects of your symptoms, and
how your functioning may be affected by factors including, but not limited to,
chronic mental disorders, structured settings, medication and other treatment.
(2) We will rate the degree of your functional limitation based on the extent
to which your impairment(s) interferes with your ability to function independently,
appropriately, effectively, and on a sustained basis. Thus, we will consider such
factors as the quality and level of your overall functional performance, any episodic
limitations, the amount of supervision or assistance you require, and the settings in
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which you are able to function. See 12.00C through 12.00H of the Listing of
Impairments in appendix 1 to this subpart for more information about the factors we
consider when we rate the degree of your functional limitation.
(3) We have identified four broad functional areas in which we will rate the
degree of your functional limitation: Activities of daily living; social functioning;
concentration, persistence, or pace; and episodes of decompensation. See 12.00C of
the Listings of Impairments.
(4) When we rate the degree of limitation in the first three functional areas
(activities of daily living, social functioning; and concentration, persistence, or pace),
we will use the following five-point scale: None, mild, moderate, marked, and
extreme. When we rate the degree of limitation in the fourth functional area
(episodes of decompensation), we will use the following four-point scale: None, one
or two, three, four or more. The last point on each scale represents a degree of
limitation that is incompatible with the ability to do any gainful activity.
Third, after rating the degree of functional limitation from the claimant’s impairment(s), the SSA
determines their severity. A rating of “none” or “mild” in the first three functional areas (activities
of daily living, social functioning; and concentration, persistence, or pace) and “none” in the fourth
(episodes of decompensation) will yield a finding that the impairment(s) is/are not severe unless
evidence indicates more than minimal limitation in the claimant’s ability to do basic work activities.
20 C.F.R. §§ 404.1520a(d)(1) and 416.920a(d)(1).1 Fourth, if the claimant’s impairment(s) is/are
deemed severe, the SSA compares the medical findings about the severe impairment(s) and the

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20 C.F.R. Pt. 404, Subpt. P, App. 1, § 12.04, provides that affective disorders, including
depression, will be deemed severe when (A) there is medically documented continuous or
intermittent persistence of specified symptoms and (B) they result in two of the following: marked
restriction of activities of daily living; marked difficulties in maintaining social functioning; marked
difficulties in maintaining concentration, persistence or pace; or repeated episodes of
decompensation , each of extended duration or (C) there is a medically documented history of a
chronic affective disorder of at least 2 years’ duration that has caused more than a minimal limitation
of ability to do basic work activities with symptoms currently attenuated by medication or
psychosocial support and (1) repeated extended episodes of decompensation; (2) a residual disease
process resulting in such marginal adjustment that a minimal increase in mental demands or change
in the environment would cause decompensation; or (3) a current history of 1 or more years’
inability to function outside a highly supportive living arrangement, and the indication of a
continued need for such an arrangement.
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rating and degree and functional limitation to the criteria of the appropriate listed mental disorder
to determine if the severe impairment(s) meet or are equal to a listed mental disorder. 20 C.F.R.
§§ 404.1520a(d)(2) and 416.920a(d)(2). Finally, if the SSA finds that the claimant has a severe
mental impairment(s) which neither meets nor equals a listed mental disorder, the SSA assesses the
Claimant’s residual functional capacity. 20 C.F.R. §§ 404.1520a(d)(3) and 416.920a(d)(3). The
Regulation further specifies how the findings and conclusion reached in applying the technique must
be documented at the ALJ and Appeals Council levels as follows:
At the administrative law judge hearing and the Appeals Council levels, the written
decision issued by the administrative law judge and the Appeals Council must
incorporate the pertinent findings and conclusions based on the technique. The
decision must show the significant history, including examination and laboratory
findings, and the functional limitations that were considered in reaching a conclusion
about the severity of the mental impairment(s). The decision must include a specific
finding as to the degree of limitation in each of the functional areas described in
paragraph (c) of this section.
20 C.F.R. §§ 404.1520a(e)(2) and 416.920a(e)(2).
In this particular case, the ALJ determined that Claimant satisfied the first inquiry because
she had not engaged in substantial gainful activity since the alleged onset date, July 19, 2007. (Tr.
at 12, Finding No. 2.) Under the second inquiry, the ALJ found that Claimant suffered from obesity,
osteoarthritis, and fibromyalgia, which were severe impairments.2 (Tr. at 12, Finding No. 3.) At the
third inquiry, the ALJ concluded that Claimant’s impairments did not meet or equal the level of
severity of any listing in Appendix 1. (Tr. at 28, Finding No. 4.) The ALJ then found that Claimant

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The ALJ noted that Claimant had the diagnosis of fibromyalgia but did not have “the
documentation of the medical signs and findings required to support the diagnosis[.]” (Tr. at 12.)
Noting that the mere diagnosis of fibromyalgia did “not generally preclude the work within the
parameters of the stated residual functional capacity[,]” the ALJ nevertheless “treated the [C]laimant
as having fibromyalgia that [was] severe under the regulations.” (Tr. at 13.)
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had a residual functional capacity to perform work at the light and medium levels of exertion, as
follows:
[C]laimant has the residual functional capacity to perform light and medium work
as defined in 20 CFR 404.1567(c) and 416.967(c) that involves only occasional
crawling and climbing of ladders, ropes, and scaffolds and no more than frequent
crouching, kneeling, stooping, balancing, and climbing of ramps and stairs and that
avoids concentrated exposure to extreme heat, extreme cold, humidity, vibrations,
fumes, odors, dusts, gases, poor ventilation, or workplace hazards (such as moving
machine parts and unprotected heights).
(Tr. at 30, Finding No. 5.) At step four, the ALJ found that Claimant could return to her past relevant
work as a cashier, retail manager, and pencil sharpener assembler. (Tr. at 31, Finding No. 6.)
Additionally, on the basis of testimony of a Vocational Expert (“VE”) taken at the administrative
hearing, the ALJ found that Claimant could perform jobs as a laundry worker and packer/bagger at
the medium exertional level and as an assembler and a laundry worker at the light exertional level.
(Tr. at 32.) Additionally, the ALJ found that in the absence of the VE’s testimony and Claimant’s
past relevant work, “the DDS ‘Medical/Vocational Analysis’ at Exhibit 18E would support a denial
under the applicable medical vocational rules.” (Tr. at 33.) On these bases, benefits were denied. (Tr.
at 33, Finding No. 7.)
Scope of Review
The sole issue before this Court is whether the final decision of the Commissioner denying
the claim is supported by substantial evidence. In Blalock v. Richardson, substantial evidence was
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. If there is evidence to justify a refusal to direct
a verdict were the case before a jury, then there is ‘substantial evidence.’

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Blalock v. Richardson, 483 F.2d 773, 776 (4th Cir. 1972) (quoting Laws v. Celebrezze, 368 F.2d
640, 642 (4th Cir. 1966)). Additionally, the Commissioner, not the Court, is charged with resolving
conflicts in the evidence. Hays v. Sullivan, 907 F.2d 1453, 1456 (4th Cir. 1990). Nevertheless, the
Courts “must not abdicate their traditional functions; they cannot escape their duty to scrutinize the
record as a whole to determine whether the conclusions reached are rational.” Oppenheim v. Finch,
495 F.2d 396, 397 (4th Cir. 1974).
A careful review of the record reveals the decision of the Commissioner is supported by
substantial evidence.
Claimant’s Background
Claimant was born on March 16, 1957, and was 51 years old at the time of the administrative
hearing, February 12, 2009. (Tr. at 10, 42, 140, 145.) Claimant had a high school education and was
able to communicate in English. (Tr. at 10, 171, 179.) In the past, she worked as a cashier, a fast
food cook, a pencil sharpener assembler, and a retail manager. (Tr. at 10, 31, 173.)
The Medical Record
The Court has reviewed all the evidence of record, including the medical evidence, and will
summarize it below as it relates to Claimant’s claims regarding her mental impairments.
Rainelle Medical Center:
Claimant sought treatment from Dr. Singareddy and his associates at Rainelle Medical
Center from August 10, 2007, through November 20, 2008. (Tr. at 312-22, 323-34, 344-55, 391-404,
405-33, 492-99, 519-21.) Claimant first was examined on August 10, 2007, by Dr. Mary Lou
Fragile, D.O. (Tr. at 319-22.) At that time, Claimant was being prescribed Spiriva Handi-Haler 18
mcg, Aspirin 81 mg, Atenolol 50 mg, Celebrex 200 mg, and Premarin .625 mg. (Tr. at 319.)

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Claimant reported a history of arthritis, hypothyroidism, hypertension, asthma, hyperlipidemia,
fibromyalgia, rapid heart rate, dry eyes, and a depressive disorder. (Id.) On physical exam, Claimant
weighed 176 pounds and stood 62 inches in height. (Tr. at 320.) Her blood pressure was 148/84 and
her pulse was 92, which was indicated as regular. (Id.) Dr. Fragile noted that Claimant’s mood and
affect were normal. (Tr. at 321.) Dr. Fragile assessed hypothyroidism, hypertension, hyperlipidemia,
a history of sinus tachycardia, depressive disorder NOS, anxiety, myalgia and myositis, symptomatic
menopause, and arthritis. She reduced Claimant’s Celebrex to 100 mg; gave her samples of Diovan
for hypertension, Lipitor for hyperlipidemia, and Premarin for fibromyalgia. (Tr. at 322.)
On September 13, 2007, Dr. Fragile noted that Claimant was being examined for
preventative maintenance. (Tr. at 312.) Claimant presented with back, joint, and muscle pain, as well
as myalgia. (Tr. at 313.) Dr. Fragile observed that Claimant’s gait and station were normal, that she
was able to heel and toe walk without difficulty, and that her mood and affect were described as
normal. (Tr. at 314.) Dr. Fragile prescribed Chantix to aid in smoking cessation and assessed
hypertension and fibromyalgia. (Tr. at 314-15.)
Dr. Sanjay Singareddy, M.D., examined Claimant on November 1, 2007, for complaints of
sinusitis. (Tr. at 352-55.) Dr. Singareddy noted that there were no present complaints of back or joint
pain. (Tr. at 353.) On physical exam, Dr. Singareddy noted that Claimant was not in acute distress,
that she had normal gait and station, and that her mood and affect were normal. (Tr. at 353-54.)
Dr. Singareddy assessed acute sinusitis and prescribed medications. (Tr. at 354.) Dr. Fragile
examined Claimant again on November 27, 2007, for complaints of depression, of acute onset. (Tr.
at 348.) Claimant reported a persistent pattern of depression for eleven years, which had been
increasing. (Id.) She reported feelings of sadness, nervousness, and tiredness, associated with the

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death of a loved on. (Id.) She additionally reported difficulty sleeping, early morning awakening,
episodes of spontaneous crying, excessive sweating, lack of energy, loss of libido, marital problems,
palpitations, and use of sedatives. (Id.) Physical examination of Claimant essentially was normal.
(Tr. at 349-50.) Dr. Fragile assessed depressive disorder NOS and prescribed Effexor XR 150mg
and referred her to Seneca Health Services. (Tr. at 350.)
Dr. Fragile next examined Claimant on January 15, 2008, for complaints of neck pain, with
a two week gradual onset. (Tr. at 401.) Claimant also reported pain behind both ears, a possible sinus
infection, and headaches. (Tr. at 401-02.) Dr. Fragile noted that Claimant’s mood and affect were
depressed but that her physical exam, with the exception of some neck tenderness and
lymphadenopathy, essentially was normal. (Tr. at 403.) She assessed fatigue, hypertension, and
lymphadenopathy NOS, and ordered blood work. (Tr. at 403-04.)
On February 22, 2008, Pamela Butcher, D.O., conducted a follow-up examination of
Claimant. (Tr. at 397-98.) Claimant reported that she felt well and had no complaints except for a
decreased energy level and poor sleep, with only five hours of sleep per night. (Tr. at 397.)
Dr. Butcher noted that Claimant was compliant with her treatment and experienced no side effects
from her medication. (Id.) She assessed hypertension and noted that Claimant’s condition had
improved. (Tr. at 398.) On March 14, 2008, Claimant reported however, that she did not feel well
and that her decreased energy level was worsening. (Tr. at 391.) Dr. Butcher noted that Claimant
had myalgia and assessed hypertension and fatigue. (Tr. at 392-93.) Dr. Butcher’s treatment notes
indicate the Claimant’s condition remained the same on March 8, 2008. (Tr. at 405-07.)
Claimant returned to Dr. Fragile on July 9, 2008, with complaints of back pain of gradual
onset. (Tr. at 411.) Claimant reported that she had joined a weight loss program and had been

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walking, but experienced back pain and her knees going out, with the right knee worse than the left.
(Id.) A review of systems revealed fatigue, hearing loss and decreased hearing, hypertension and
palpitations, joint pain, back pain, myalgia, syncope, and depression. (Tr. at 412.) On exam,
Claimant was neither depressed nor anxious, and presented with normal gait and station. (Tr. at 413.)
The physical exam essentially was normal. (Id.) Dr. Fragile assessed an unspecified vitamin D
deficiency, hypertension, syncope and collapse, hearing loss, arthritis of the right knee, back pain,
and hypothyroidism. (Tr. at 413-14.) She referred Claimant to Dr. Othman3 for the syncope and to
Dr. Christopher Lee White4 for the hearing loss. (Tr. at 413.) Claimant’s condition appeared to have

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Claimant was examined on September 5, 2008, by Dr. Joe O. Othman, M.D., a neurologist,
on the July 14, 2008, referral from Dr. Fragile due to a syncopal episode that resulted in a motor
vehicle accident. (Tr. at 470-73, 474-76, 477.) Claimant reported that she had a motor vehicle
accident on April 3, 2008. (Tr. at 470.) The woman she hit stated that it appeared Claimant had
blacked out, but Claimant had no memory of the event. (Id.) She thought that she may have fallen
asleep because she had been tired prior to the accident. (Id.) Claimant reported that she had been
having headaches that started suddenly and caused her to become nauseated and vomited. (Id.)
Going to sleep relieved her headaches. (Id.) Physical examination essentially was normal. (Tr. at
471-72.) Dr. Othman concluded that Claimant suffered from excessive daytime sleepiness, but did
not think that she suffered true syncope. (Tr. at 472.) Dr. Othman ordered an EEG, a sleep study,
an MRI of the head, and instructed Claimant not to drive until her follow up appointment. (Tr. at
472, 474.)
The MRI of Claimant’s head was normal. (Tr. at 467-68, 516.) At a follow up appointment
on September 26, 2008, Claimant reported that she felt fine and was not having headaches. (Tr. at
467.) She also reported that she did not believe that she could do a sleep study, and mentioned that
she took a pill to help her sleep. (Id.) Claimant also reported that she was under a lot of stress, had
fibromyalgia, and had uncontrolled problems with her thyroid. (Id.) Dr. Othman noted nothing
abnormal on examination, diagnosed headaches, and discharged Claimant. (Id.)
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Dr. Christopher White, D.O., examined Claimant on September 4, 2008, for complaints of
bilateral hearing problems and a bursting in her right ear. (Tr. at 478-88.) Claimant reported that she
had bilateral hearing loss for many years with occasional tinnitus and an occasional sensation of
imbalance, which problems had worsened recently. (Tr. at 478.) Dr. White noted that Claimant had
significant noise exposure as a factory worker without hearing protection devices. (Id.) Physical
exam revealed an exophytic lesion on the left nostril, which Dr. White found suspicious in
appearance. (Id.) An audiogram revealed likely mild sensory neural hearing loss. (Id.) Her pure
tones however, did not correlate with her speech reception thresholds. (Id.) A nasal endoscopy failed
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remained unchanged on May 5, 2008. (Tr. at 409-10.) An x-ray of Claimant’s lumbar spine on
July 9, 2008, revealed dextroscoliosis and x-rays of her right knee revealed no evidence of fracture
or dislocation. (Tr. at 415.)
On September 9, 2008, Dr. Singareddy completed a form General Physical (Adults) on
behalf of the West Virginia Department of Health and Human Resources. (Tr. at 488-89.)
Dr. Singareddy noted that Claimant had, inter alia, decreased knee range of motion and crepitation.
(Tr. at 488.) He indicated that Claimant experienced pain resulting from fibromyalgia, arthritis of
the bilateral knees, and back problems. (Tr. at 489.) He reported her diagnoses as arthritis,
hypothyroidism, and fibromyalgia. (Id.) Dr. Singareddy opined that Claimant was not able to work
due to her chronic pain and that any physical activity should be avoided. (Id.) He did not consider
her a candidate for vocational rehabilitation. (Id.)
Dr. Singareddy next examined Claimant on October 28, 2008, having last been examined
by Dr. Fragile on July 9. (Tr. at 492-94.) Claimant reported that she did not feel well and had a
decreased energy level, but was sleeping well and had a normal appetite. (Tr. at 492.) She stated that
she exercised seven days per week and slept on average seven hours per night. (Id.) On examination,
Dr. Singareddy noted that Claimant’s mood was depressed, but failed to note any deficiencies on
physical exam. (Tr. at 493.) He prescribed Diovan HCT 320-25mg for hypertension, Amitriptyline
HCI 50mg for depressive disorder, Clonazepam 1mg for anxiety, Lyrica 100mg for fibromyalgia,

to reveal a nasopharyngeal mass and she had only slight postnasal drip. (Id.) Dr. White assessed an
eustachian tube dysfunction and sensory neural hearing loss. (Id.) He prescribed Nasonex and
directed Claimant to return in three weeks for a repeat audiotympanogram. (Id.) Dr. White noted that
if the effusion persisted, he was going to consider tube placement. (Id.) On October 20, 2008, the
results of her audiogram essentially were unchanged and she had a mild degree of hearing loss
bilaterally. (Tr. at 490-91.)
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and Sprivia HandiHaler 18mcg for chronic obstructive pulmonary disease/chronic airway
obstruction. (Tr. at 493-94.) Dr. Singareddy discontinued her Cymbalta. (Tr. at 494.)
On November 20, 2008, Claimant again was examined by Dr. Singareddy. (Tr. at 519-20.)
Claimant reported that she felt well with the exception of decreased energy and poor sleep. (Tr at
519.) Physical exam revealed joint pain, bilateral knee stiffness, and a depressed mood and affect.
(Tr. at 520.) Dr. Singareddy assessed depressive disorder NOS. (Id.)
Rainelle Physical Therapy:
Claimant underwent physical therapy at Rainelle Physical Therapy from July 16, 2008,
through February 2, 2009. (Tr. at 418, 428-33, 495, 497-99, 522-48.) She initially was discharged
on October 6, 2008, with her therapist, Robert Schuetz, LPT, having noted that she declined followup due to money problems. (Tr. at 495.) Claimant re-initiated physical therapy and her last progress
summary of record, dated, February 2, 2009, revealed that Claimant rated her back and knee paint
at a level four out of ten, and reported that she was feeling better. (Tr. at 541.) On exam, Robert
Schuetz, LPT, noted that Claimant was doing better with decreased pain and increased range of
motion strength. (Id.) Claimant had 4/5 gross tone and was ambulatory with good posture. (Id.) Her
therapy included five minutes on the stationary bike, ten minutes on the treadmill, wall weights at
17.5 pounds for 30 repetitions. (Id.) She also was doing 30 ball squats and crunches at 7.5 lbs for
30 repetitions. (Id.) Mr. Schuetz noted that Claimant was directed to continue physical therapy three
times a week for an additional four to six weeks so that she could be functional with her daily
activities with no pain, or with decreased pain. (Id.)

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Physical Residual Functional Capacity Assessments:
On October 16, 2007, Dr. A. Rafael Gomez, M.D, a state agency reviewing physician,
completed a form Physical Residual Functional Capacity Assessment. (Tr. at 335-42.) Dr. Gomez
opined that Claimant’s myalgias and arthralgias rendered her capable of performing medium
exertional level work with frequent limitations in climbing ramps and stairs, balancing, stooping,
kneeling, and crouching and occasional limitations in climbing ladders, ropes, and scaffolds; and
crawling. (Tr. at 336-37.) Dr. Gomez further opined that Claimant should avoid concentrated
exposure to vibration and workplace hazards such as moving machinery and heights. (Tr. at 339.)
He noted that Claimant was not fully credible in that she had “multiple allegations which are not
supported by the medical findings.” (Tr. at 340.) He further noted that besides obesity, her physical
exams were within normal limits, and that she was being treated for depression and anxiety. (Id.)
On May 2, 2008, Dr. Rabah Boukhemis, M.D., a state agency reviewing physician,
completed a further form Physical Residual Functional Capacity Assessment. (Tr. at 441-48.)
Dr. Boukhemis opined that Claimant’s alleged fibromyalgia and severe depression, resulted in her
ability to perform work at the medium exertional level. (Tr. at 441-42.) Regarding the fibromyalgia,
Dr. Boukhemis noted that though Claimant had vague diffuse discomfort, there were no clear criteria
available establishing fibromyalgia. (Tr. at 442.) Dr. Boukhemis assessed frequent postural
limitations with the exception of occasional climbing ladders, ropes, and scaffolds, and crawling.
(Tr. at 443.) Dr. Boukhemis also opined that Claimant should avoid concentrated exposure to
temperature extremes, humidity, vibrations, environmental irritants, and workplace hazards. (Tr. at
445.) In reaching his opinions, Dr. Boukhemis acknowledged Claimant’s allegations of increased
memory loss, constant pain primarily in her joints, stomach pain, depression, and weight gain. (Tr.

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at 446.) Nevertheless, Dr. Boukhemis opined that Claimant’s allegations were out of proportion to
the medical evidence and that most of her complaints were mental. (Id.)
Dr. Samar Sankari, M.D.:
Claimant was treated by Dr. Samar Sankari, M.D., from April 30, 2008, through October 30,
2008, for her hypothyroidism. (Tr. at 500-13.) On April 30, Dr. Sankari noted that Claimant was
diagnosed with hypothyroidism one year ago by another physician and was prescribed
Levothyroxine 50mg and at the time of her present exam, was taking Synthroid 50mg. (Tr. at 507,
509.) She noted Claimant’s medical history to include fibromyalgia for 11 years, hypertension for
six years, hyperlipidemia for four years, and a recent diagnosis of vitamin D deficiency. (Tr. at 507.)
Dr. Sankari diagnosed possible Hashimoto’s Disease and increased her Synthroid to 75mg. (Tr. at
508.) An ultrasound of Claimant’s head and neck on May 8, 2008, revealed a mildly enlarged
thyroid of irregular echogenicity and a small cyst in the mid pole region of the right thyroid. (Tr. at
506.) Claimant’s condition remained essentially unchanged on July 30, 2008, and October 30, 2008.
(Tr. at 500, 504.)
Mental Impairments:
Psychological Evaluation - Judith Lucas, M.A.:
On November 5, 2007, Judith M. Lucas, M.A., a licensed psychologist, conducted a
psychological evaluation of Claimant. (Tr. at 356-58.) Claimant reported that she had moved to West
Virginia in August, 2007. (Tr. at 356.) She indicated that she felt worthless and had been depressed
for six years, with an increase in severity over the last year and a half. (Id.) Claimant stated that she
would cry, did not want to do anything, became angry more easily but kept it in, and experienced
excessive nervousness and worry. (Id.) Mental status exam revealed that Claimant’s affect was

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restricted and her mood depressed. (Tr. at 357.) She exhibited logical and organized thought
processes, had normal judgment and fair insight, and normal immediate and remote memory. (Id.)
Her recent memory was moderately deficient. (Id.) Ms. Lucas observed that Claimant exhibited no
excessive movement or any evidence of delusions, preoccupations, or obsessions. (Id.) Ms. Lucas
diagnosed major depressive disorder NOS and anxiety disorder NOS. (Tr. at 358.) She opined that
Claimant’s social functioning, concentration, persistence, and pace were within normal limits (Tr.
at 357-58.) Ms. Lucas reported Claimant’s daily activities to have included: visiting her brother,
talking to her children, occasionally reading, sitting on the couch, doing dishes, placing clothes in
the washer, occasionally cooking but noted that her husband usually cooked, seldom cleaned,
watched the evening news, and showered and dressed herself with assistance from her husband. (Tr.
at 357.)
Mental Residual Functional Capacity Assessment:
Dr. Timothy Saar, Ph.D., completed a form Mental Residual Functional Capacity Assessment
(Tr. at 360-63.) and a form Psychiatric Review Technique (Tr. at 364-77.), on November 15, 2007.
Dr. Saar opined that Claimant’s major depressive and anxiety disorders moderately limited her
ability to understand, remember, and carry out detailed instructions. (Tr. at 360-62.) He noted that
the evidence did not support severe mental limitations and that Claimant was capable of performing
of variety of repetitive work-like activities. (Tr. at 362.) He further opined that Claimant’s mental
impairments resulted in only mild limitations of activities of daily living and maintaining social
functioning, concentration, persistence, or pace. (Tr. at 374.) He found no evidence of episodes of
decompensation, each of extended duration. (Id.)

15

Seneca Health Services, Inc.:
Claimant sought treatment from Seneca Health Services, Inc., from November 20, 2007,
through January 24, 2008. (Tr. at 378-85.) On December 20, 2007, Claimant voluntarily presented
at Seneca and was examined by P. Michelle O’Dell, PA-C, for an initial psychiatric evaluation to
render diagnosis and treatment recommendations. (Tr. at 384-85.) Claimant reported poor sleep and
energy, and lack of motivation. (Tr. at 384.) Claimant had been prescribed Effexor two weeks earlier
by her treating physician, and Claimant reported that the Effexor was beneficial. (Id.) Mental status
exam revealed a broad affect and euthymic mood, connected and logical thought processes, no
evidence of delusions or preoccupations, intact insight and judgment, and an appropriate behavior
and demeanor. (Tr. at 385.) Ms. O’Dell diagnosed major depressive disorder, recurrent, mild and
assessed a Global Assessment of Functioning (“GAF”) of 60.5 (Id.) She continued Claimant on
Effexor at 150mg daily and the Ativan. (Id.) She prescribed Elavil 50mg for sleeplessness. (Id.)
Claimant returned to Ms. O’Dell on January 24, 2008, for medication management. (Tr. at 382-83.)
Claimant reported that the Elavil was ineffective in addressing sleeplessness, and she continued to
report fatigue, lack of energy, and a lack of motivation and sadness. (Tr. at 382.) Mental status
examination remained unchanged, as did Ms. O’Dell’s diagnosis. (Id.) Ms. O’Dell discontinued the
Elavil and prescribed Klonopin 1mg. (Id.) She instructed Claimant to use Ativan on an as needed
basis, and decreased Effexor XR to 75mg daily for a week and then to begin Cymbalta 30mg daily

5

The Global Assessment of Functioning (“GAF”) Scale is used to rate overall psychological
functioning on a scale of 0 to 100. A GAF of 51-60 indicates that the person has moderate
symptoms, or moderate difficulty in social, occupational, or school functioning. American
Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders (“DSM-IV”) 32 (4th
ed. 1994).
16

for one week, which was then increased to 60mg. (Id.) Ms. O’Dell also prescribed Lyrica 75mg. (Tr.
at 383.)
On February 22, 2008, Claimant reported to Julie Hanna, PA-C, that she stayed extremely
tired all the time and that she was so fatigued that she could hardly do anything. (Tr. at 380.)
Claimant also reported that her Synthroid 50mcg was not working and that she continued to
experience dry and brittle hair that fell out, as well as dry skin, depression, fatigue, and memory loss.
(Id.) On mental status examination, Claimant’s affect was constricted and her mood was euthymic.
(Id.) All other facets remained unchanged. (Id.) Ms. Hanna diagnosed major depressive disorder,
recurrent, mild; and anxiety disorder. (Id.) Claimant was continued on her medications. (Tr. at 381.)
On March 11, 2008, Claimant reported some mild depression and symptoms associated with the
hypothyroidism. (Tr. at 378.) Claimant’s affect was restricted and her mood was mildly dysthymic.
(Id.) Diagnoses and treatment remained unchanged. (Tr. at 378-79.)
Mental Status Examination - Tina Fontenot, M.S.:
Tina Fontenot, M.S, a licensed psychologist, completed a mental status examination on
Claimant on April 15, 2008. (Tr. at 434-38.) Claimant stated that she left her husband last Friday.
(Tr. at 434.) Ms. Fontenot described Claimant as cooperative with a serious attitude. (Id.) Claimant
reported that she had been depressed for two years due to the pain that she suffered. (Tr. at 435.)
Claimant reported sleep disturbances in the form of initial insomnia, intermittent awakenings, and
terminal insomnia. (Id.) She also reported poor appetite, daily low energy and fatigue, and feelings
of hopelessness and helplessness. (Id.) Mental status exam revealed a depressed mood and tearful
affect, normal stream of thought, and no evidence of delusions or obsessive compulsive behaviors.
(Tr. at 436.) Her insight was fair, her judgment was within normal limits, as was her immediate

17

memory. (Id.) Claimant’s recent memory was severely deficient and her remote history was
moderately deficient. (Id.) Claimant’s concentration was moderately deficient, but her pace and
persistence were within normal limits. (Id.) Claimant made good eye contact but cried on and off
throughout the evaluation. (Tr. at 437.)
Claimant reported her activities to have included visiting her brother daily and taking care
of his laundry, shopping for groceries with her husband, sitting on the couch, and watching very
little television. (Tr. at 437.) Claimant stated that her husband did the dishes, cooked, and paid the
bills. (Id.) Ms. Fontenot diagnosed dysthymic disorder, anxiety disorder NOS, and panic disorder
without agoraphobia. (Id.) Ms. Fontenot gave Claimant a poor prognosis but found that she was
capable of managing her finances. (Id.)
Evidence Submitted to the Appeals Council:
Claimant’s counsel submitted treatment records from Seneca, dated December 20, 2007,
through June 5, 2009. (Tr. at 554-73.) On December 20, 2007, Ms. O’Dell examined Claimant on
her reports of poor sleep and energy, lack of motivation, and anxiety. (Tr. at 556.) Mental status
exam revealed a broad affect and euthymic mood, intact insight and judgment, and satisfactory
attention. (Tr. at 557.) Ms. O’Dell diagnosed major depressive disorder, recurrent, mild and assessed
a GAF of 60. (Id.) Claimant was continued on Effexor 150mg and Ativan as needed. (Id.) For
sleeplessness, Ms. O’Dell prescribed Elavil 50mg. (Id.)
On March 11, 2008, Claimant reported that she was very tired and had many symptoms of
hypothyroidism. (Tr. at 562.) Claimant’s affect was restricted and her mood was mildly dysthymic.
(Id.) Ms. Hanna continued Claimant’s diagnoses and medications. (Id.) Claimant returned to
Ms. Hanna on June 5, 2008, and reported that she was separated from her husband, sleeping only

18

four hours at night, that her fibromyalgia pain had increased, and that she was under significant
stress. (Tr. at 564.) Claimant’s affect was broad and her mood euthymic. (Tr. at 565.) Ms. Hanna
continued her diagnoses and assessed a GAF of 65.6 (Id.) Claimant was continued on Cymbalta
60mg, her Lyrica was increased to 150mg twice daily for fibromyalgia, and her Klonopin was
increased to 2mg at bedtime to help with her sleep. (Id.)
More than a year later, Claimant reinitiated her treatment at Seneca on June 1, 2009. (Tr. at
566-68.) Dr. Jewell observed on mental status exam that Claimant’s affect generally was dysthymic,
with a congruent mood. (Tr. at 567.) Claimant stated that she felt depressed. (Id.) Her thought
process and content was normal, with no evidence of delusions, preoccupations, or hallucinations.
(Id.) Dr. Jewell noted that she was alert and oriented and had intact insight and judgment. (Id.) He
diagnosed major depressive disorder, recurrent and generalized anxiety disorder. (Id.) Dr. Jewell
also assessed a GAF of 54. (Id.) Dr. Jewell began titrating Claimant off the Effexor XR by giving
her Pristiq 50mg twice daily. (Id.) He continued the Clonazepam 1mg and told her to return in one
week. (Id.)
On June 4, 2009, Claimant’s mood was anxious and depressed. (Tr. at 569.) Mike McDaniel,
M.A., a licensed psychologist, administered the Beck Depression Inventory - II, which suggested
a severe level of depressive features, as well as the Beck Anxiety Inventory, which suggested a
severe level of anxiety symptomatology. (Id.) On mental status exam, Claimant had adequate
judgment and insight, a fair appetite, intact memory, and an anxious and depressed mood. (Id.)

6

A GAF of 61-70 indicates that the person has some mild symptoms or “some difficulty in
social, occupational, or school functioning (e.g., occasional truancy, or theft within the household),
but generally functioning pretty well, has some meaningful interpersonal relationships.” American
Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders (“DSM-IV”) 32 (4th
ed. 1994)
19

Mr. McDaniel diagnosed depressive disorder, recurrent, moderate; anxiety disorder NOS; and
assessed a GAF of 50.7 (Tr. at 570.) On June 5, 2009, Claimant presented with a full affect and
euthymic mood. (Tr. at 571.) Dr. Noel Jewell, M.D., diagnosed major depressive disorder and
anxiety disorder NOS, and started Claimant on Diazepam 5mg as needed for anxiety and Celexa
20mg a day. (Id.)
EMG and Nerve Conduction Study - Dr. Othman:
On May 21, 2009, Dr. Othman conducted an EMG and Nerve Conduction Study of
Claimant’s bilateral upper extremities, which revealed mild bilateral carpal tunnel syndrome with
the right greater than the left. (Tr. at 576-77.)
Dr. Pradip C. Thakkar, M.D.:
Claimant treated with Dr. Pradip C. Thakkar, M.D., from September 14, 2001, through
February 20, 2009. (Tr. at 577-81.) Claimant first presented to Dr. Thakkar on September 14, 2001,
with a two year history of chronic joint pain, tiredness, and lethargy. (Tr. at 577.) He noted that she
has been diagnosed with possible Lupus, osteo-arthritis, or degenerative osteo-arthritis. (Id.)
Claimant complained of generalized weakness and fatigue, some morning stiffness that improves
throughout the day, a fair appetite, and some pain in both legs. (Id.) On physical exam, Dr. Thakkar
noted tender point of the fibromyalgia at the “suprascapular, costs chondral, elbow, and popliteal
area.” (Id.) He did not observe any obvious osteo-arthritis in the peripheral joints. (Id.) He assessed
fibromyalgia and prescribed Celebrex 200mg and Elavil 10mg, as well as hypertension. (Tr. at 578.)

7

A GAF of 41-50 indicates that the person has some serious symptoms “(e.g., suicidal
ideation, severe obsessional rituals, frequent shoplifting)” or “any serious impairment in social,
occupational, or school functioning (e.g., no friends, unable to keep a job).” American Psychiatric
Association, Diagnostic and Statistical Manual of Mental Disorders (“DSM-IV”) 32 (4th ed. 1994)
20

On September 27, 2001, Dr. Thakkar noted that Claimant’s lupus blood test was normal. (Tr.
at 580.) Claimant reported that she felt better with the Celebrex and indicated that she had more
energy than before. (Id.) Dr. Thakkar continued Claimant’s medications and instructed her to return
in four months. (Id.) Claimant returned for a follow-up visit on February 20, 2002. (Tr. at 581.)
Claimant reported no improvement in her chronic lower leg pain and reported that she has cold feet.
(Id.) Dr. Thakkar noted that she had slight hyperemia of peripheral vascular disease, but observed
no selling of her extremities. (Id.) He assessed peripheral vascular disease, acute sinusitis, and
hypertension. (Id.)
Piedmont Health Care:
Claimant treated with Dr. Duncan A. McCall, M.D., a rheumatologist at Piedmont
HealthCare, from March 13, 2000, through June 15, 2001. (Tr. at 582-98.) On March 13, 2000,
Claimant reported intermittent pain in the ribs and pain and swelling in the hands, elbows, knees,
and feet. (Tr. at 582.) The pain was worse in the mornings and gradually improved into the evening.
(Id.) Diagnostic tests were all normal and the non-steroidal anti-inflammatory medications were of
no benefit. (Id.) Claimant also reported an erythematous and pruritic rash as well as red and painful
eyes. (Id.) Dr. McCall diagnosed “probable inflammatory arthropathy, rule out dermatomyositis
versus lupus versus rheumatoid arthritis or a seronegative spondyloarthropathy. (Tr. at 583.) He
ordered laboratory testing and prescribed Prednisone 5mg for one week, which was to be decreased
to one 5mg tablet a day. (Id.)
On April 18, 2000, Dr. McCall noted that all of Claimant’s inflammatory markers were
negative, though he believed she had possible inflammatory arthropathy. (Tr. at 586.) He noted
however, that Claimant’s history indicated that her arthropathy was episodic in nature. (Id.)

21

Therefore, Dr. McCall placed her on a trial of Medrol 4mg, as well as Flexeril because she presented
with multiple tender trigger points. (Id.) On June 6, 2000, Dr. McCall noted that Claimant had
probable connective tissue disease. (Id.) She presented with a rash on her face associated with
significant muscle and joint pain. (Id.) He prescribed Plaquenil. (Id.)
Claimant returned to Dr. McCall on July 18, 2000, with a flare up of her “episodic
inflammatory arthropathy.” (Tr. at 588.) Claimant next returned to Dr. McCall on March 19, 2001,
with another episode of arthropathy. (Id.) She reported that she stopped taking Plaquenil in
December because it was of no benefit to her. (Id.) She also reported continued flare ups with mostly
myalgias and fatigue. (Id.) Claimant was taking Mobic without any benefit. (Id.) Dr. McCall
therefore, prescribed Colchicine. (Id.) He noted that Claimant’s “inflammatory markers at her last
visit were again normal. It may be of some benefit to treat this more as a fibromyalgia variant.” (Id.)
Greenbrier Valley Medical Center:
On May 10, 2009, Claimant presented at Greenbrier Valley Medical Center with complaints
of arthritis and fibromyalgia pain. (Tr. at 610.) She reported that the pain was located across her
thorax, bilateral upper extremities, neck, back, and ankles, and she rated the pain at a level eight out
of ten. (Tr. at 607, 610.) Claimant was taking Lyrica, Elavil, and Diclofenac for her pain, which had
not been helping. (Tr. 610) Physical exam revealed that Claimant was alert, interactive, and in no
acute distress. (Id.) She was tender to palpation across the interior and posterior portions of her
thorax, hips, and knees, but was ambulatory without difficulty. (Tr. at 607, 610.) Dr. Patrick Thomas
Ryan, M.D., assessed exacerbation of Claimant’s fibromyalgia and osteoarthritis, and administered
a dose of Toradol 60mg. (Tr. at 610-11.) After 15 minutes, Dr. Ryan noticed a mild improvement
in her pain, and discharged her with instructions to follow up with Dr. Singareddy in three to five

22

days. (Tr. at 611.)
Mental Residual Functional Capacity Assessment - Dr. Noel Jewell, M.D.:
On June 24, 2009, Dr. Noel B. Jewell, M.D., completed a form Mental Residual Functional
Capacity Questionnaire. (Tr. at 613-20.) Dr. Jewell noted Claimant’s diagnoses as mild major
depressive disorder with a GAF of 58. (Tr. at 615.) Supporting clinical findings included a depressed
interest, feelings of guilt or worthlessness, generalized persistent anxiety, difficulty thinking or
concentrating, psychomotor agitation or retardation, memory impairment, sleep disturbance, and
decreased caring. (Tr. at 615-16.) He further noted that Claimant was treated with Celexa 20mg and
Diazipan 5mg, and that her response to treatment was “good.” (Tr. at 615.) Dr. Jewell opined that
Claimant’s prognosis was chronic and fair. (Id.) Dr. Jewell opined that Claimant’s abilities and
aptitudes needed to do unskilled, semiskilled, and skilled work were seriously limited but not
precluded. (Tr. at 617-18.) He further opined that Claimant’s ability to use public transportation was
seriously limited but not precluded, but that her ability to interact appropriately with the general
public, maintain socially appropriate behavior, adhere to basic standards of neatness and cleanliness,
and travel in unfamiliar places was limited but satisfactory. (Tr. at 618.) Dr. Jewell believed that
Claimant’s psychiatric condition exacerbated her fibromyalgia and emotionally-linked pain. (Id.)
He also opined that on average, Claimant’s impairments and treatment would cause her to miss
about one day per month of work and that her conditions were expected to last at least twelve
months. (Tr. at 619.)
Claimant’s Challenges to the Commissioner’s Decision
Claimant alleges that the Commissioner’s decision is not supported by substantial evidence
because the ALJ erred in failing to accord proper weight to the opinions of her treating physician,

23

Dr. Singareddy. (Document No. 14 at 10-13.) Specifically, Claimant takes issue with the ALJ having
rejected Dr. Singareddy’s opinions because “they were submitted to influence the disability factfinding process,” and asserts that such reasoning “defies both law and logic.” (Id. at 12.) Claimant
asserts that “[i]t makes absolutely no sense, and under the regulations it is patently not a cognizable
basis upon which to predicate the rejection of a treating physician’s opinion.” (Id.)
In response, the Commissioner asserts that the ALJ properly did not give controlling weight
to Dr. Singareddy’s opinions because they were outside his area of expertise, were not well
explained, and failed to find support in his own treatment records. (Document No. 17 at 7-8.) The
Commissioner points out that Claimant was examined by Dr. Singareddy only a few times and his
treatment notes were void of any musculoskeletal examinations. (Id. at 8.) The Commissioner further
asserts that Dr. Singareddy’s opinions are refuted by Claimant’s progress in physical therapy and
his own routine follow-up treatment notes. (Id.) Finally, the Commissioner notes that Dr. Singareddy
himself, reported in February, 2009, that Claimant reported only minor complaints and that she
considered her medications to have been effective. (Id.) Consequently, the Commissioner asserts that
the AlJ’s decision not to accord significant weight to the opinions of Dr. Singareddy is supported
by substantial evidence. (Id. at 8, 10.)
Claimant also alleges that the ALJ’s RFC determination is not supported by substantial
evidence because he failed to consider properly the opinions of Dr. Singareddy. (Document No. 14
at 13-21.)
Analysis.
1. Treating Physician Opinion.
“RFC represents the most that an individual can do despite his or her limitations or

24

restrictions.” See Social Security Ruling 96-8p, 61 Fed. Reg. 34474, 34476 (1996). Pursuant to SSR
96-8p, the RFC assessment “must be based on all of the relevant evidence in the case record,”
including “ the effects of treatment” and the “limitations or restrictions imposed by the mechanics
of treatment; e.g., frequency of treatment, duration, disruption to routine, side effects of medication.”
Looking at all the relevant evidence, the ALJ must consider the claimant’s ability to meet the
physical, mental, sensory and other demands of any job. 20 C.F.R. §§ 404.1545(a), 416.945(a)
(2009). “This assessment of your remaining capacity for work is not a decision on whether you are
disabled, but is used as the basis for determining the particular types of work you may be able to do
despite your impairment(s).” Id. “In determining the claimant's residual functional capacity, the ALJ
has a duty to establish, by competent medical evidence, the physical and mental activity that the
claimant can perform in a work setting, after giving appropriate consideration to all of her
impairments.” Ostronski v. Chater, 94 F.3d 413, 418 (8th Cir. 1996).
Opinions on a claimant’s Residual Functional Capacity are issues that are reserved to the
Commissioner. The Regulations state that:
We use medical sources, including your treating source, to provide evidence,
including opinions, on the nature and severity of your impairment(s). Although we
consider opinions from medical sources on issues such as whether your
impairment(s) meets or equals the requirements of any impairment(s) in the Listing
of Impairments in appendix 1 to subpart P of part 404 of this chapter, your residual
functional capacity . . . or the application of vocational factors, the final
responsibility for deciding these issues is reserved to the Commissioner.
See 20 C.F.R. § 416.927(e)(2) (2009).
In determining what a claimant can do despite his limitations, the SSA must consider
the entire record, including all relevant medical and nonmedical evidence, such as
a claimant's own statement of what he or she is able or unable to do. That is, the
SSA need not accept only physicians’ opinions. In fact, if conflicting medical
evidence is present, the SSA has the responsibility of resolving the conflict.

25

Diaz v. Chater, 55 F.3d 300, 306 (7th Cir. 1995) (citations omitted).
The Regulations state that opinions on these issues are not medical opinions as described in
the Regulation dealing with opinion evidence (20 C.F.R. §§ 404.1527(a)(2) and 416.927(a)(2));
rather, they are opinions on issues reserved to the Commissioner. 20 C.F.R. §§ 404.1527(e) and
416.927(e). For that reason, the Regulations make clear that “[w]e will not give any special
significance to the source of an opinion on issues reserved to the Commissioner. . . .” Id.
§§ 404.1527(e)(3) and 416.927(e)(3). The Regulations further provide that “[f]or cases at the
Administrative Law Judge hearing or Appeals Council level, the responsibility for deciding your
residual functional capacity rests with the Administrative Law Judge or Appeals Council.” See 20
C.F.R. §§ 404.1545 and 416.946 (2009). However, the adjudicator must still apply the applicable
factors in 20 C.F.R. § 416.927(d) when evaluating the opinions of medical sources on issues
reserved to the Commissioner. See Social Securing Ruling (“SSR”) 96-5p, 61 FR 34471, 34473
(1996).
Social Security Ruling 96-5p makes a distinction between an RFC assessment, which is “the
adjudicator’s ultimate finding of ‘what you can still do despite your limitations,’” and a “‘medical
source statement,’ which is a ‘statement about what you can still do despite your impairment(s)’
made by an individual’s medical source and based on that source’s own medical findings.” Id. SSR
96-5p states that “[a] medical source statement is evidence that is submitted to SSA by an
individual’s medical source reflecting the source’s opinion based on his or her own knowledge,
while an RFC assessment is the adjudicator’s ultimate finding based on a consideration of this
opinion and all the other evidence in the case record about what an individual can do despite his or
her impairment(s).” Adjudicators “must weigh medical source statements under the rules set out in

26

20 C.F.R. § 416.927, providing appropriate explanations for accepting or rejecting such opinions.”
Id. at 34474.
Every medical opinion received by the ALJ must be considered in accordance with the
factors set forth in 20 C.F.R. §§ 404.1527(d) and 416.927(d) (2009). These factors include: (1)
length of the treatment relationship and frequency of evaluation, (2) nature and extent of the
treatment relationship, (3) supportability, (4) consistency, (5) specialization, and (6) various other
factors. Additionally, the Regulations state that the Commissioner “will always give good reasons
in our notice of determination or decision for the weight we give your treating source’s opinion.”
Id. §§ 404.1527(d)(2) and 416.927(d)(2).
Under §§ 404.1527(d)(1) and 416.927(d)(1), more weight is given to an examiner than to a
non-examiner. Sections 404.1527(d)(2) and 416.927(d)(2) provide that more weight will be given
to treating sources than to examining sources (and, of course, than to non-examining sources).
Sections 404.1527(d)(2)(I) and 416.927(d)(2)(I) state that the longer a treating source treats a
claimant, the more weight the source’s opinion will be given. Under §§ 404.1527(d)(2)(ii) and
416.927(d)(2)(ii), the more knowledge a treating source has about a claimant’s impairment, the more
weight will be given to the source’s opinion. Sections 404.1527(d)(3), (4) and (5) and 416.927(d)(3),
(4), and (5) add the factors of supportability (the more evidence, especially medical signs and
laboratory findings, in support of an opinion, the more weight will be given), consistency (the more
consistent an opinion is with the evidence as a whole, the more weight will be given), and
specialization (more weight given to an opinion by a specialist about issues in his/her area of
specialty). Unless the ALJ gives controlling weight to a treating source’s opinion, the ALJ must
explain in the decision the weight given to the opinions of state agency psychological consultants.

27

20 C.F.R. §§ 404.1527(f)(2)(ii) and 416.927(f)(2)(ii) (2009). The ALJ, however, is not bound by any
findings made by state agency medical or psychological consultants and the ultimate determination
of disability is reserved to the ALJ. Id. §§ 404.1527(f)(2)(I) and 416.927(f)(2)(I).
In evaluating the opinions of treating sources, the Commissioner generally must give more
weight to the opinion of a treating physician because the physician is often most able to provide “a
detailed, longitudinal picture” of a claimant’s alleged disability. See 20 C.F.R. §§ 404.1527(d)(2),
416.927(d)(2) (2009). Nevertheless, a treating physician’s opinion is afforded “controlling weight
only if two conditions are met: (1) that it is supported by clinical and laboratory diagnostic
techniques and (2) that it is not inconsistent with other substantial evidence.” Ward v. Chater, 924
F. Supp. 53, 55 (W.D. Va. 1996); see also, 20 C.F.R. §§ 404.1527(d)(2), 416.927(d)(2) (2009). The
opinion of a treating physician must be weighed against the record as a whole when determining
eligibility for benefits. 20 C.F.R. §§ 404.1527(d)(2), 416.927(d)(2) (2009). Ultimately, it is the
responsibility of the Commissioner, not the court to review the case, make findings of fact, and
resolve conflicts of evidence. Hays v. Sullivan, 907 F.2d 1453, 1456 (4th Cir. 1990). As noted
above, however, the Court must not abdicate its duty to scrutinize the record as a whole to determine
whether the Commissioner’s conclusions are rational. Oppenheim v. Finch, 495 F.2d 396, 397 (4th
Cir. 1974).
If the ALJ determines that a treating physician’s opinion should not be afforded controlling
weight, the ALJ must then analyze and weigh all the evidence of record, taking into account the
factors listed in 20 C.F.R. §§ 404.1527 and 416.927(d)(2)-(6).
In his decision, and as summarized above, the ALJ noted that Dr. Singareddy examined
Claimant on only three occasions, November 2007, October 2008, and November 2008. ( Tr. at 16-

28

17, 23, 25.) With the exception of some depression, and complaints of decreased energy, knee pain,
and stiffness, Dr. Singareddy’s review of symptoms was negative for musculoskeletal, neurological,
or psychiatric symptoms. (Id.) The ALJ noted that Dr. Singareddy rendered his first opinion in
September 2008, after having last examined Claimant approximately ten months prior. (Tr. at 23.)
The ALJ found that Dr. Singareddy’s opinion was not supported by the treatment notes before and
after his opinion. (Id.) To that extent the ALJ stated that Dr. Singareddy “adopted an advocacy role
early on with little longitudinal perspective of the [C]laimant’s medical and functional condition and
status when he completed the form.” (Id.) The ALJ further concluded that the form was based on
Claimant’s “self-assessment and subjective complaints.” (Id.) The undersigned notes that the
additional treatments from Dr. Singareddy’s associates at Rainelle Medical Center, as summarized
above, likewise did not support Dr. Singareddy’s opinion.
The ALJ further noted that Dr. Singareddy rendered his second opinion in February, 2009,
two weeks after Claimant’s administrative hearing. (Tr. at 24-25.) The ALJ determined however,
that his opinion, which essentially rendered Claimant capable of performing less than sedentary
activities, was contrary to physical therapy notes that indicated Claimant was lifting more than five
pounds and was doing some squatting and crouching. (Id.) The ALJ therefore concluded that neither
Dr. Singareddy’s treatment notes, nor the medical record as a whole reflected a debilitating
musculoskeletal disorder, and to the extent that Claimant had a musculoskeletal disorder, it was
episodic in nature, as demonstrated in the ALJ’s chart. (Tr. at 24-26.) Regarding Dr. Singareddy’s
opinions as to Claimant’s mental capabilities, the ALJ determined that as a general practitioner,
psychiatric impairments were beyond Dr. Singareddy’s expertise. (Tr. at 25.) Furthermore, the ALJ

29

noted that contrary to Dr. Singareddy’s opinion, the record did not reflect any incapability on
Claimant’s part to maintain her personal appearance. (Id.)
In view of the foregoing, the Court finds that the ALJ properly considered Dr. Singareddy’s
opinions according to the factors set forth in the Regulations, but found that his opinions were not
entitled to significant weight. As discussed above, Dr. Singareddy’s stringent opinions were
inconsistent with his treatment notes, the treatment notes of the other physicians at his place of
practice, and were inconsistent with the opinions of the state agency reviewing physicians, as
summarized above. The record is void of any radiological evidence that supported Dr. Singareddy’s
opinions. Though the ALJ stated early in his decision that Dr. Singareddy’s opinion that was
submitted after the administrative hearing was submitted “to influence the disability fact-finding
process,” the ALJ specifically qualified such statement to the delay in its receipt. (Tr. at 9.)
Regarding Claimant’s mental impairments, the ALJ properly determined that opinions on such
issues were beyond Dr. Singareddy’s expertise and that Claimant’s depression with occasional
anxiety was sporadic in complaints and limited in treatment. (Tr. at 27.) Dr. Singareddy’s treatment
notes likewise did not suggest severe debilitating mental impairments and his opinion as to the same
was contrary to the GAF scores that indicated only mild to moderate symptoms.
Accordingly, in view of the foregoing, the Court finds that the ALJ properly considered
pursuant to the Regulations, that the opinions of Dr. Singareddy were not entitled to significant
weight.
2. Residual Functional Capacity Assessment.
Claimant asserts that because the ALJ failed to consider properly Dr. Singareddy’s opinions,
his RFC assessment therefore, is flawed. (Document No. 14 at 13-21.) The Court has determined

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that the ALJ’s decision not to accord significant weight to Dr. Singareddy’s opinions was supported
by substantial evidence. Nevertheless, the Court has reviewed the ALJ’s RFC assessment and has
determined that it, too, is supported by substantial evidence.
As the Commissioner points out, Claimant’s lack of credibility was crucial to the ALJ’s RFC
assessment. Regarding Claimant’s physical impairments, the ALJ summarized the medical notes that
established episodic musculoskeletal complaints. (Tr. at 24-27, 30-31.) Despite such episodic
complaints, Claimant continued to exercise seven days a week and was able to function at the light
to moderate level as part of her physical therapy. The records submitted to the Appeals Council did
not add to or detract from the ALJ’s decision. The medical record failed to support Claimant’s
severe complaints and reports of limitation and at times, Claimant’s reports were inconsistent. To
the extent that Claimant had limitations, the ALJ incorporated postural limitations in his RFC
assessment, as well as limitations regarding her respiratory problems. (Tr. at 30.)
Regarding Claimant’s mental impairments, the ALJ summarized the medical evidence which
established that her mental-related complaints were sporadic in nature as well, and focused on
stressful periods in her life such as her divorce. (Tr. at 27-28, 30-31.) Her mental examinations
essentially were normal with some mild to moderate limitations, as summarized above.
Consequently, contrary to Claimant’s allegations, the ALJ properly found that the longitudinal
record did not demonstrate severe mental impairments of a twelve month duration. (Tr. at 28.) To
the extent that Claimant had any limitations resulting from her mental impairments, the ALJ
precluded Claimant from workplace hazards and limited her balancing, too. (Tr. at 30.) The ALJ
concluded that Claimant attempted to minimize her level of activities and exaggerated her symptoms
and limitations. (Tr. at 31.)

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Accordingly, the Court found that the ALJ’s decision to not accord significant weight to the
opinions of Dr. Singareddy was supported by substantial evidence. Consequently, Claimant’s second
argument that the ALJ’s RFC assessment was flawed due to his failure to accord the appropriate
weight to Dr. Singareddy’s opinions, is without merit. Nevertheless, the Court reviewed the ALJ’s
RFC assessment and found that it was made pursuant to the Regulations and caselaw, and therefore,
is supported by substantial evidence.
After a careful consideration of the evidence of record, the Court finds that the
Commissioner’s decision is supported by substantial evidence. Accordingly, by Judgment Order
entered this day, the Plaintiff’s Motion for Summary Judgment (Document No. 13.) is DENIED,
Defendant’s Motion for Judgment on the Pleadings (Document No. 17.) is GRANTED, the final
decision of the Commissioner is AFFIRMED, and this matter is DISMISSED from the docket of
this Court.
The Clerk of this Court is directed to provide copies of this Memorandum Opinion to counsel
of record.
ENTER: July 8, 2011.

R. Clarke VanDervort
United States Magistrate Judge

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