THOMAS B. SMITH, Magistrate Judge.
The Plaintiff brings this action pursuant to the Social Security Act ("Act"), as amended, 42 U.S.C. § 405(g), to obtain judicial review of a final decision of the Commissioner of the Social Security Administration ("Commissioner") denying her claim for disability insurance benefits ("DIB") and supplemental security income ("SSI") under the Act.
I have reviewed the record, including the administrative law judge's ("ALJ") decision, the exhibits, the administrative record, the transcript of the hearing, and the pleadings and memoranda submitted by the parties. For the reasons that follow, I respectfully recommend that the Commissioner's final decision in this case be affirmed, pursuant to sentence four of 42 U.S.C. § 405(g).
Plaintiff filed for DIB and SSI benefits on August 16, 2007. (Tr. 22). She alleges disability beginning on August 1, 2006 due to limited comprehension, insomnia, bipolar disorder, attention deficit hyperactivity disorder ("ADHD"), depression, and anxiety disorder. (Tr. 143, 152). She was 24 years old on her alleged disability onset date. (Doc. 26 at 2). She reported past work as a cook, burger flipper, and grocery store bagger. (Tr. 181). Her application was denied initially and on reconsideration. (Tr. 19-22). On April 22, 2010, at Plaintiff's request, a hearing was held before the ALJ who issued a decision on May 21, 2010, finding Plaintiff was not disabled. (Tr. 22-29; 37-68). On March 30, 2012, the Appeals Council denied Plaintiff's timely request for review. (Tr. 8-10). She has exhausted her administrative remedies and this case is now ripe for consideration under 42 U.S.C. § 405(g).
On May 21, 2006, Plaintiff reported having an asthma attack to Tina Pait-Paellitteri, R.N. (T. 279). On examination, Nurse Pait-Paellitteri found that Plaintiff appeared anxious. (T. 279). On May 22, 2006, Plaintiff complained of anxiety to Dennis Natale, M.D. (T. 277). Dr. Natale diagnosed Plaintiff as suffering from an anxiety reaction with hyperventilation. (T. 278).
On November 15, 2006, Josette Romain, M.D. diagnosed Plaintiff with bipolar disorder. (T. 345). On May 1, 2007 Jay Chanmugam, D.O. diagnosed Plaintiff with anxiety. (T. 287). On June 12, 2007, Plaintiff was treated at Family Psychiatric Service. She exhibited decreased energy, concentration, and motivation, and she was found to be depressed and impulsive. (Doc. 343). She was diagnosed with bipolar disorder. (
Plaintiff returned to Family Psychiatric Service again on September 18, 2007 where she was diagnosed with bipolar disorder. (T. 342). On November 29, 2007, she was evaluated by consultative examiner Malcolm J. Graham, III, Ph. D. (T. 346-49). On examination, Dr. Graham found Plaintiff "could recall one out of four words after five minutes[,] but her effort on this task was felt to be quite marginal." (T. 347). Dr. Graham diagnosed Plaintiff with bipolar disorder, intermittent explosive disorder, and asthma. (T. 348).
On December 21, 2007, State Agency review physician Alan Harris, Ph. D., completed a mental RFC assessment form and psychiatric review technique form on Plaintiff. (T. 350-67). Dr. Harris diagnosed her with bipolar disorder. (T. 357). Dr. Harris opined that Plaintiff had mild restriction of activities of daily living; moderate difficulties in maintaining social functioning; and moderate difficulties in maintaining concentration, persistence, or pace. (T. 364).
Dr. Harris also opined that Plaintiff was moderately limited in her abilities to: maintain attention and concentration for extended periods; complete a normal workday and workweek without interruptions from psychologically based symptoms and to perform at a consistent pace without an unreasonable number and length of rest periods; accept instructions and respond appropriately to criticism from supervisors; and set realistic goals or make plans independently of others. (T. 350-51). Dr. Harris said Plaintiff would "have periodic difficulty handling criticism" and she would "need help with effective planning." (T. 352).
On May 21, 2008, Plaintiff was treated at Fish Memorial Hospital for chest pain and anxiety. (T. 395). On June 11, 2008, she complained of experiencing "intermittent anxiety attacks" once a month with her "anxiety pills not working." (Tr. 375, 378). Dr. James Hayes determined that she was anxious and suffering from a panic attack. (T. 375).
On June 23, 2008, Plaintiff returned to Family Psychiatric Service where she was diagnosed with bipolar disorder and anxiety disorder, not otherwise specified ("NOS"). (T. 555). On July 17, 2008, State agency review physician Timothy Foster, Ph.D., completed a psychiatric review technique form and diagnosed Plaintiff with intermittent explosiveness disorder. (T. 405-18). Dr. Foster opined that Plaintiff had mild difficulties in maintaining concentration, persistence, or pace. (T. 415).
On September 20, 2008, Plaintiff was treated at Fish Memorial Hospital and diagnosed with acute asthma exacerbation. (T. 523). On October 15, 2008, Dr. Amy Kelley diagnosed Plaintiff with acute anxiety. (T. 511-12).
On February 4, 2009, Plaintiff complained of feeling depressed with thoughts of suicide while being treated at Family Psychiatric Service. (T. 554). She was diagnosed with bipolar disorder and anxiety disorder, NOS. (
On February 12, 2009, Plaintiff was diagnosed with anxiety while at Fish Memorial Hospital. (T. 494). On September 23, 2009, mental health counselor Norma Blackman, M.S., wrote a narrative report to Plaintiff's former representative. (T. 424). Ms. Blackman reported that she had seen Plaintiff four times since August 13, 2009 and Plaintiff was considered at risk for Post-Partum Depression "because she has a history of depression." (
On November 13, 2009, Plaintiff was treated by Trevor Deraney, PAC who diagnosed her with anxiety. (Tr. 472). On December 12, 2009, she complained of headaches occurring three to four times a week. (T. 460). Dr. Stanley Stockhammer diagnosed Plaintiff with anxiety and headaches. (
On January 14, 2010, Adly Thebaud, M.D., of Family Psychiatry Service completed a mental RFC assessment form on Plaintiff. (T. 456-58.). Dr. Thebaud diagnosed her with bipolar disorder and anxiety disorder. (T. 456). Dr. Thebaud opined that Plaintiff had extreme limitations in her abilities to: complete a normal workday and workweek without interruptions from psychologically based symptoms; and get along with coworkers or peers without distracting them or exhibiting behavioral extremes. (T. 457). Dr. Thebaud said Plaintiff had marked limitations in her abilities to: remember locations and work-like procedures; understand and remember detailed instructions; carry out detailed instructions; maintain attention and concentration for extended periods; perform activities within a schedule, maintain regular attendance, and be punctual within customary tolerances; sustain an ordinary routine without special supervision; work in coordination with or in proximity to others without being distracted by them; perform at a consistent place with a standard number of length of rest periods; interact appropriately with the general public; accept instructions and respond appropriately to criticism from supervisors; maintain socially appropriate behavior and adhere to basic standards of neatness and cleanliness; respond appropriately to changes in the work setting; and set realistic goals or make plans independently of others. (T. 456-58).
Dr. Thebaud opined that Plaintiff was moderately limited in her abilities to: understand and remember very short and simple instructions; carry out very short and simple instructions; make simple work-related decisions; ask simple questions or request assistance; and travel in unfamiliar places or use public transportation. (T. 456-58). Dr. Thebaud concluded that Plaintiff would be absent from more than 4 days of work per month. (T 457). Dr. Thebaud noted that Plaintiff's anxiety, depression, easy distraction, lack of concentration, and difficulty staying focused supported his medical opinion. (T. 458).
On January 14, 2010, Plaintiff reported feeling increased social anxiety, stress, depression, and anxiety while being treated at Family Psychiatric Service. (T. 475). She was diagnosed with bipolar disorder and anxiety disorder, NOS. (
On January 27, 2010, Plaintiff was treated at Deland Hospital for chronic back pain. (T. 481). On February 5, 2010, while at Deland Hospital, she was diagnosed with acute exacerbation of chronic back pain. (T. 482).
When determining whether an individual is disabled, the ALJ must follow the five-step sequential evaluation process established by the Commissioner and set forth in 20 C.F.R. §§ 404.1520(a)(4) and 416.920(a)(4). Specifically, the ALJ must determine whether the claimant (1) is currently employed; (2) has a severe impairment; (3) has an impairment or combination of impairments that meets or medically equals an impairment listed at 20 C.F.R. Part 404, Subpart P, Appendix 1; (4) can perform past relevant work; and (5) retains the ability to perform any work in the national economy.
The ALJ determined at step one that Plaintiff had not engaged in substantial gainful activity since her August 1, 2006 alleged onset date. (Tr. 24). At step two, the ALJ found Plaintiff suffered from the following severe impairments: affective mood disorder and asthma. (
The scope of this Court's review is limited to determining whether the ALJ applied the correct legal standards and whether the ALJ's findings are supported by substantial evidence.
When the Commissioner's decision is supported by substantial evidence the district court will affirm even if the reviewer would have reached a contrary result as finder of fact, and even if the reviewer finds that the preponderance of the evidence is against the Commissioner's decision.
Plaintiff argues that the ALJ failed to obtain a consultative intelligence examination and thus, failed to properly develop the record in this case. (Doc. 26 at 9). Plaintiff contends that the ALJ should have obtained a consultative intelligence examination because she applied for disability benefits in part due to "limited comprehension" and the highest grade she completed was the eighth grade. (
In the Eleventh Circuit the ALJ has a basic duty to develop a full record.
The Eleventh Circuit has held that the ALJ "is not required to order a consultative examination as long as the record contains sufficient evidence for the administrative law judge to make an informed decision."
There is no credible evidence to support Plaintiff's claim that she is so severely impaired by limited concentration that it affects her functioning and ability to perform basic work activities. The ALJ's conclusion that Plaintiff was able to carry out daily functions without significant limitation, despite her limited education, is supported by substantial evidence. In reaching his decision, the ALJ relied in part on the opinion of consultative examiner, Dr. Graham, who found no evidence of "tangential or circumstantial thinking" or problems with memory or concentration. (Tr. 26) (citing Tr. 348). Dr. Graham did not find any intellectual disabilities. (
(Tr. 369). Plaintiff's medical records largely consist of emergency room reports, none of which note limited comprehension.
Plaintiff has not (a) demonstrated that she is so severely impaired by limited concentration that it affects her functioning and ability to perform basic work activities, (b) sought the opportunity to supplement her medical record, or (c) identified "any missing records or evidentiary gaps which might preclude the ALJ's decision."
Plaintiff argues that the ALJ failed to properly credit the testimony of her treating physician, Dr. Thebaud. (Doc. 26). Weighing the opinions and findings of treating physicians is an integral part of steps four and five of the sequential evaluation process. The Eleventh Circuit recently clarified the standard the Commissioner is required to utilize when considering medical opinion evidence. In
Absent good cause, the opinions of treating physicians must be accorded substantial or considerable weight.
When a treating physician's opinion does not warrant controlling weight, the ALJ must still consider the following factors in deciding how much weight to give the opinion: "(1) the length of the treatment relationship and the frequency of examination; (2) the nature and extent of the treatment relationship; (3) the medical evidence supporting the opinion; (4) consistency with the record as a whole; (5) specialization in the medical issues at issue; (6) other factors which tend to support or contradict the opinion."
The ALJ's finding that Dr. Thebaud's medical opinion is inconsistent with his treatment record and unsupported by the record as a whole is based on substantial evidence. Dr. Thebaud's mental capacity assessment is the only medical source opinion that categorizes Plaintiff's condition as extreme. He opined that she was extremely limited in the following areas: the ability to complete a normal workday without interruptions from psychologically based symptoms; the ability to complete a normal workweek without interruptions from psychologically based symptoms; and the ability to get along with coworkers or peers without distracting them or exhibiting behavioral extremes. (Tr. 457).
Dr. Thebaud noted that Plaintiff was markedly limited in the following areas: the ability to remember locations and work-like procedures; the ability to understand and remember detailed instructions; the ability to carry out detailed instructions; the ability to maintain attention and concentration for extended periods; the ability to perform activities within a schedule, maintain regular attendance, and be punctual within customary tolerances; the ability to sustain an ordinary routine without special supervision; the ability to work in coordination with or in proximity to others without being distracted by them; the ability to perform at a consistent pace with a standard number and length of rest periods; the ability to interact appropriately with the general public; the ability to accept instructions and respond appropriately to criticism from supervisors; the ability to maintain socially appropriate behavior and to adhere to basic standards of neatness and cleanliness; ability to respond appropriately to changes in the work setting; and the ability to set realistic goals or make plans independently of others. (Tr. 456-458).
Despite painting this grim picture of Plaintiff's condition, Dr. Thebaud (on at least two occasions) opined that Plaintiff had good remote and short-term memory, as well as appropriate insight and judgment. (Tr. 342, 555);
In her brief, Plaintiff argues that the ALJ erred in ascribing "little weight" to Dr. Thebaud's opinions because they were consistent with the other medical diagnoses in the record. (Doc. 26). Plaintiff's argument is fatally flawed. Simply listing diagnoses does not give the Court any insight into the severity of Plaintiff's limitations or her ability to perform substantial gainful activity. The ALJ is not concerned with a claimant's diagnosis; the relevant inquiry is the degree to which a claimant's condition limits her ability to engage in substantial gainful activity.
The ALJ's conclusion that Dr. Thebaud's medical opinion is inconsistent with his treatment record and unsupported by the record as a whole is based on substantial evidence. Accordingly, I respectfully recommend that the district court reject Plaintiff's argument and affirm the Commissioner's decision in this regard.
Plaintiff argues that the ALJ failed to "reconcile the RFC determination with the opinion of State agency review physician Dr. Harris." (Doc. 26). The ALJ afforded "some weight" to the opinions of non-examining state agency consultants — a group which included Dr. Harris. (T. 28-29). The ALJ was under no obligation to give Dr. Harris' opinion (or the opinion of any other state agency consultant) a certain amount of weight.
Plaintiff argues that the ALJ erred in finding that her subjective complaints were not credible. (Doc. 26 at 17). Plaintiff's subjective complaints, by themselves, are insufficient to establish a disability.
Here, the ALJ found Plaintiff's medically determinable impairments could reasonably be expected to cause some of her alleged symptoms; but, after a thorough review of the evidence, the ALJ held that Plaintiff's claims concerning the severity of her symptoms were inconsistent with the medical evidence in the record. (Tr. 28). On one hand, Plaintiff testified that because of her impairment, she needed assistance caring for her children and doing laundry. (Tr. 56-57). On the other hand, she informed the social security case worker that she had the ability to take care of all of her child's needs and even helps her mom take care of the animals. (Tr. 369). She also told the social worker she could manage her own finances (
Plaintiff takes issue with the ALJ's acknowledgement that "the record reflects significant gaps in [Plaintiff's] history of treatment" and that there have been periods of time when Plaintiff did not take any medications for her symptoms. (Doc. 26 at 18-19). The ALJ did not "criticize" Plaintiff for her inability to afford prescribed medication, as Plaintiff argues. The ALJ simply observed that the record evidence established that Plaintiff's symptoms improved when she took her medications as prescribed. (Tr. 28). Plaintiff's medication compliance is part of her medical history, which the ALJ was permitted to consider along with the rest of the record evidence in developing Plaintiff's RFC. See20 C.F.R. §§404.1529(c)(3)(iv), 416.929(c)(3)(iv); SSR 96-7P, 1996 WL 374186 (1996). I am not persuaded by Plaintiff's argument and recommend that the district court reject it.
Lastly, Plaintiff argues that "the ALJ's errors in developing the record, determining Plaintiff's RFC, and determining Plaintiff's credibility" necessarily means that the hypothetical presented to the Vocational Expert was incomplete. (Doc. 26 at 20-22). Specifically, Plaintiff maintains that the VE hypothetical was incomplete because it did not include the limitations assessed by Dr. Thebaud and Dr. Harris' specific opinion that Plaintiff would need assistance with effective planning. (Id. at 21). As discussed in sections IV.B.1 and 2 of this report and recommendations, the ALJ's decision to attribute little weight to Dr. Thebaud's opinion and some weight to Dr. Harris' opinion was based on substantial evidence. Therefore, I respectfully recommend that Plaintiff's argument based upon his previously dispelled contentions be rejected and that the district court affirm the Commissioner's decision.
Upon consideration of the foregoing, I respectfully recommend that: