C LYNWOOD SMITH, Jr., District Judge.
Claimant Dana Pruitt commenced this action on July 3, 2013, pursuant to 42 U.S.C. § 405(g), seeking judicial review of a final adverse decision of the Commissioner, affirming the decision of the Administrative Law Judge ("ALJ"), and thereby denying her claim for a period of disability, disability insurance, and supplemental security income benefits. For the reasons stated herein, the court finds that the Commissioner's ruling is due to be affirmed.
The court's role in reviewing claims brought under the Social Security Act is a narrow one. The scope of review is limited to determining whether there is substantial evidence in the record as a whole to support the findings of the Commissioner, and whether correct legal standards were applied. See Lamb v. Bowen, 847 F.2d 698, 701 (11th Cir. 1988); Tieniber v. Heckler, 720 F.2d 1251, 1253 (11th Cir. 1983).
Claimant contends that the Commissioner's decision is neither supported by substantial evidence nor in accordance with applicable legal standards. Specifically, claimant asserts that the ALJ improperly considered the opinions of the treating, examining, and consultative medical providers, and improperly considered claimant's failure to follow prescribed treatment. Upon review of the record, the court concludes that those contentions are not correct.
The opinion of a treating physician "must be given substantial or considerable weight unless `good cause' is shown to the contrary." Phillips v. Barnhart, 357 F.3d 1232, 1240-41 (11th Cir. 2004) (internal citations omitted). Good cause exists when "(1) [the] treating physician's opinion was not bolstered by the evidence; (2) [the] evidence supported a contrary finding; or (3) [the] treating physician's opinion was conclusory or inconsistent with the doctor's own medical records." Id. (alterations supplied). Additionally, the ALJ is not required to accept a conclusory statement from a medical source, even a treating source, that a claimant is unable to work, because the decision whether a claimant is disabled is not a medical opinion, but is a decision "reserved to the Commissioner." 20 C.F.R. § 416.927(e). Social Security regulations also provide that, in considering what weight to give any medical opinion (regardless of whether it is from a treating or non-treating physician), the Commissioner should evaluate: the extent of the examining or treating relationship between the doctor and patient; whether the doctor's opinion can be supported by medical signs and laboratory findings; whether the opinion is consistent with the record as a whole; the doctor's specialization; and other factors. See 20 C.F.R. § 404.1527(d). See also Wheeler v. Heckler, 784 F.2d 1073, 1075 (11th Cir. 1986) ("The weight afforded a physician's conclusory statements depends upon the extent to which they are supported by clinical or laboratory findings and are consistent with other evidence as to claimant's impairments.").
Dr. Brian Thomas, a clinical neuropsychologist, conducted a consultative examination on December 10, 2010. Dr. Thomas noted that claimant had no history of mental health treatment, but had instead been prescribed mental health medications by her medical doctors. On examination, Dr. Thomas noted the following:
Dr. Thomas's diagnoses were major depression and social anxiety disorder. He also made the following functional observations: "Ability to perform routine repetitive tasks appears adequate but persistence is questionable. Ability to interact with coworkers appears questionable/poor. Ability to sustain attention appears adequate. Ability to handle funds if so assigned appears questionable. Prognosis for improvement over the next 12 months appears fair with treatment."
The ALJ afforded Dr. Thomas's opinion only little weight because it was "vague and gives no specific limitations."
Dr. Alan Blotcky, a clinical psychologist, conducted a second consultative psychological evaluation on March 15, 2011. Claimant informed Dr. Blotcky that she had panic disorder without agoraphobia since age 11, and that she usually had three or four panic attacks every week. She also reported that she had been struggling with "constant and unwavering" depression for two years. She had been taking Zoloft and Klonopin, both of which were prescribed by her cardiologist, for four months, and she also was taking Xanax that was prescribed by her family physician. With regard to her daily activities, claimant reported spending most of her time caring for her sons and resting. She did not cook or do housework, but instead relied on her mother to perform those and other household functions for her. She did not have any hobbies or special interests, and while she had a driver's license, she did not have a car. She visited with her grandparents, a brother, and two friends on a regular basis.
On intellectual function testing, claimant obtained a Verbal Comprehension Index of 74, a Perceptual Reasoning Index of 75, a Working Memory Index of 77, a Processing Speed Index of 79, and a Full Scale IQ of 71, placing her at the lower end of the borderline range of intellectual functioning. She also earned a score of 39 on the Beck Depression Inventory, "indicating the presence of severe depression."
Dr. Blotcky also completed a Medical Source Opinion Form (Mental) on March 24, 2011. He indicated that claimant had moderate impairment of her ability to use judgment in simple, one- or two-step, work-related decisions, her ability to understand, remember, and carry out simple, one- or two-step instructions, and her ability to maintain social functioning; marked impairment of her ability to respond appropriately to supervisors and co-workers, her ability to use judgment in detailed or complex work-related situations, her ability to deal with changes in a routine work setting, her ability to understand, remember, and carry out detailed or complex instructions, her ability to respond to customary work pressures, and her ability to maintain concentration or pace for periods of at least two hours; and extreme impairment of her ability to respond appropriately to customers or other members of the general public, and her ability to maintain activities of daily living. Once again, Dr. Blotcky indicated that claimant could manage benefits in her own best interest.
The ALJ assigned no weight to Dr. Blotcky's opinion, because
Dr. Keith Morrow, D.O., claimant's treating family physician, provided a sworn statement on December 13, 2011. He testified that his office records, including those pertaining to claimant's medical history, had been lost in a tornado several months earlier.
The ALJ afforded Dr. Morrow's opinion "some" weight, due to his long-term treating relationship with claimant and his ability to personally assess claimant's subjective complaints.
The ALJ gave great weight to the opinions of the state agency medical consultants. On December 14, 2010, Dr. Robert Estock completed a Psychiatric Review Technique form, on which he indicated that claimant suffered from major depression
With two exceptions, the ALJ found that Dr. Estock's opinion was "consistent with the objective medical evidence of record and the claimant's alleged activities of daily living."
The ALJ also was persuaded by the opinions of Dr. Mark Oberlander, a clinical psychologist who testified as a mental health expert during the administrative hearing. Dr. Oberlander largely agreed with Dr. Estock. He testified that claimant would have the ability to engage in simple, repetitive activities, but she could not understand, execute, or remember complex or detailed instructions. Claimant would have moderate impairment of her ability to maintain attention and concentration, her capacity to engage in work activities that require a rapid pace, her ability to interact appropriately with the general public, her capacity to accept instructions and respond appropriately to criticism from supervisors, and her ability to accept realistic goals and make plans independently of others. She could tolerate occasional independent decision making, occasional changes in the work setting, and occasional interaction with members of the public. She would have moderate impairment of activities of daily living, appropriate social interactions, and attending, concentrating, and remembering.
Upon review of the ALJ's findings with regard to the medical opinions, the court concludes that the ALJ adequately articulated her reasons for the weight she assigned to each opinion, and that the ALJ's conclusions were both in accordance with applicable law and supported by substantial evidence. Claimant criticizes the ALJ for pointing out that much of Dr. Morrow's testimony consisted of summary responses to counsel's leading questions, stating that "[t]he decision by the ALJ to
The ALJ also did not err in giving more weight to the opinions of Dr. Estock, the non-examining state agency physician, and Dr. Oberlander, the medical expert who testified during the administrative hearing, than he gave to Dr. Morrow's opinion. Social Security regulations provide that the opinions of state agency psychological consultants are entitled to substantial consideration. See 20 C.F.R. §§ 404.1527(e)(2)(i) & 416.927(e)(2)(i) (stating that, while the ALJ is not bound by the findings of a State Agency psychological consultant, the ALJ should consider such a consultant to be both "highly qualified" and an "expert" in Social Security disability evaluation). See also Oldham v. Schweiker, 660 F.2d 1078, 1084 (5th Cir. 1981) ("The Secretary was justified in accepting the opinion of Dr. Gordon, a qualified reviewing physician, that was supported by the evidence, and in rejecting the conclusory statement of Dr. Harris, a treating physician, that was contrary to the evidence."); Surber v. Commissioner of Social Security Administration, No. 3:11-cv-1235-J-MCR, 2013 WL 806325, *5 (M.D. Fla. March 5, 2013) (slip copy) ("State agency medical consultants are non-examining sources who are highly qualified physicians and experts in Social Security disability evaluation, and their opinions may be entitled to great weight if supported by evidence in the record.").
Claimant also argues that the ALJ improperly considered her failure to seek more aggressive treatment in evaluating her credibility. The ALJ's findings regarding claimant's treatment history are as follows:
Additionally, when discussing the GAF score assessed by Dr. Blotcky, the ALJ stated that if claimant received mental health treatment, her GAF score would be expected to improve.
It appears that the ALJ may have confounded two separate standards for considering a claimant's failure to follow treatment. On the one hand, Social Security regulations provide that a claimant's treatment history is a permissible factor for evaluating a claimant's credibility. See 20 C.F.R. §§ 404.1529(3)(v), 416.929(3)(v). As an entirely separate matter, the regulations also inform claimants that "[i]n order to get benefits, you must follow treatment prescribed by your physician if this treatment can restore your ability to work." 20 C.F.R. §§ 404.1530(a), 416.930(a) (alteration supplied). If a claimant does not "follow the prescribed treatment without a good reason, [the Commissioner] will not find [him] disabled or blind or, if [he is] already receiving benefits, [the Commissioner] will stop paying [him] benefits." 20 C.F.R. §§ 404.1530(b), 416.930(b)(alterations supplied). The scope of acceptable "good reasons" is very limited and includes reasons such as:
20 C.F.R. §§ 404.1530(c), 416.930(c).
While the ALJ cited §§ 404.1530 and 416.930, it does not appear that she actually found claimant to be non-disabled as a result of claimant's failure to follow treatment. If that had been the ALJ's decision, she likely would have made findings that the evidence supported claimant's disability, but nonetheless concluded that claimant was non-disabled as a result of her failure to follow treatment that would restore claimant's ability to work. Instead, all of the ALJ's findings relate to the effect of claimant's failure to follow treatment on the ALJ's evaluation of claimant's credibility. Thus, despite the ALJ's citation of §§ 404.1530 and 416.930, it appears that the ALJ actually considered claimant's failure to obtain treatment under §§ 404.1529(3)(v) and 416.929(3)(v) instead. As such, claimant's reliance on Social Security Ruling 82-59 is misplaced, as that Ruling concerns disability determinations under §§ 404.1530 and 416.930.
Claimant also asserts that the ALJ improperly considered her failure to seek additional treatment in light of the fact that she was unable to afford such treatment. It is true that "poverty excuses [a claimant's] noncompliance" with medical treatment. Dawkins v. Bowen, 848 F.2d 1211, 1213 (11th Cir. 1988) (alteration supplied). Thus, "while a remediable or controllable medical condition is generally not disabling, when a `claimant cannot afford the prescribed treatment and can find no way to obtain it, the condition that is disabling in fact continues to be disabling in law.'" Id. (quoting Taylor v. Bowen, 782 F.2d 1294, 1298 (5th Cir. 1986)) (emphasis supplied). Here, there is no evidence that claimant attempted to obtain care despite her lack of medical insurance and inability to afford treatment. To the contrary, claimant testified during the administrative hearing that she had not sought counseling from a psychologist or social worker because she was ashamed to try, and because the thought of seeking counseling made her "feel more worse than I already do."
Finally, claimant argues that it was improper for the ALJ to hold claimant's failure to seek treatment against her, because claimant's inability to seek proper treatment for her mental disorders might have been the result of the mental disorders themselves. Claimant relies upon Judge Guin's opinion in Bennett v. Barnhart, 288 F.Supp.2d 1246 (N.D. Ala. 2003). There, Judge Guin held that a claimant's failure to follow her treating physician's recommendation to seek additional treatment from a psychiatrist was "insufficient to allow a rational fact finder to conclude the plaintiff did not suffer depression at a disabling level as described by the two consulting psychologists." Id. at 1254-55. Specifically, one of the consultative examiners had noted that the claimant's failure to maintain an active involvement in mental therapy was evidence of her impaired insight and judgment. Id. at 1255. As Judge Guin explained, "the symptoms of mental disorders often include an inability to seek out the treatment and help necessary to treat such disorders." Id.
Other Circuit Courts of Appeal have held, like Judge Guin, that a claiamnt's lack of medical treatment for a mental disorder cannot serve as a basis for finding that the disorder was not severe. See Nguyen v. Chater, 100 F.3d 1462, 1465 (9th Cir. 1996) ("[T]he fact that claimant may be one of millions of people who did not seek treatment for a mental disorder until late in the day is not a substantial basis on which to conclude that Dr. Brown's assessment of claimant's condition is inaccurate.") (alteration supplied); Blankenship v. Bowen, 874 F.2d 1116, 1124 (6th Cir. 1989) ("Appellant may have failed to seek psychiatric treatment for his mental condition, but it is a questionable practice to chastise one with a mental impairment for the exercise of poor judgment in seeking rehabilitation."); Beasich v. Commissioner of Social Security, 66 F. App'x 419, 429 (3rd Cir. 2003) (quoting Nguyen and Blankenship). The Eleventh Circuit, in contrast, has repeatedly considered a claimant's failure to seek mental health treatment as a basis for rejecting a finding of mental disability. See, e.g., Moncrief v. Astrue, 300 F. App'x 879, 881 (11th Cir. 2008); Baxter v. Barnhart, 165 F. App'x 802, 805 (11th Cir. 2006); Ogranaja v. Commissioner of Social Security, 186 F. App'x 848, 849-50 (11th Cir. 2006). In light of those Eleventh Circuit decisions, this court declines to follow the lead of the persuasive authority in Bennett. It was not improper for the ALJ to consider claimant's failure to seek mental health treatment in evaluating the seriousness of claimant's mental health condition. Moreover, the ALJ's conclusions about claimant's mental abilities were supported by substantial evidence.
Based on the foregoing, the court concludes the ALJ's decision was based upon substantial evidence and in accordance with applicable legal standards. Accordingly, the decision of the Commissioner is AFFIRMED. Costs are taxed against claimant. The Clerk is directed to close this file.