MARK W. BENNETT, District Judge.
This matter is before me pursuant to Karisha Eddington's application for Disability Insurance benefits under Title XVI of the Act, 42 U.S.C. § 401 et seq. Eddington seeks judicial review of a final decision of the Commissioner of Social Security (the Commissioner) denying her application for benefits. Eddington argues that the administrative record (AR) does not contain substantial evidence to support the Commissioner's decision that she was not disabled during the relevant period of time.
Eddington was 22 years old on her alleged onset date. (At the time of the ALJ's decision, she was 26 years old.) Eddington completed high school, where she took some special education classes, and attended some college. She is not married and has no children. She has a spare work history, including stints in fast food restaurants and as a hotel maid. Eddington has mostly lived at home, with one or both of her parents. However, she has also, at times, lived with her boyfriend.
Eddington filed her application for disability benefits on October 2, 2008. Eddington alleged she became disabled on September 12, 2004. The Social Security Administration denied Eddington's application initially and upon reconsideration. Eddington appeared for a hearing before Administrative Law Judge (ALJ) Robert Labrum in 2010. ALJ Labrum issued a decision denying benefits on October 19, 2010. Eddington requested review and, on June 8, 2012, the Appeals Council remanded Eddington's claim for a supplemental hearing. Eddington appeared for a second hearing before ALJ Thomas M. Donahue on October 16, 2012. On January 31, 2013, the ALJ again denied Eddington's claim. Eddington appealed the ALJ's decision, but the Appeals Council denied review. Eddington timely filed the present case on March 31, 2014.
On October 21, 2014, Judge O'Brien held a hearing on Eddington's complaint. Unfortunately, Judge O'Brien passed away before issuing a ruling and this case was reassigned to me. I have reviewed the record, along with the audio recording of the hearing, and now enter the following.
A disability is defined as the inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or that has lasted or can be expected to last for a continuous period of not less than twelve months. 42 U.S.C. §§ 423(d)(1)(A), 1382c(a)(3)(A); 20 C.F.R. § 416.905. A claimant has a disability when the claimant is "not only unable to do his previous work but cannot, considering his age, education, and work experience, engage in any other kind of substantial gainful work which exists . . . in significant numbers either in the region where such individual lives or in several regions of the country." 42 U.S.C. §§ 423(d)(2)(A), 1382c(a)(3)(B).
To determine whether a claimant has a disability within the meaning of the Social Security Act, the Commissioner follows a five-step sequential evaluation process outlined in the regulations. 20 C.F.R. § 416.920; see Kirby v. Astrue, 500 F.3d 705, 707 (8th Cir. 2007). First, the Commissioner will consider a claimant's work activity. If the claimant is engaged in substantial gainful activity, then the claimant is not disabled. 20 C.F.R. § 416.920(a)(4)(i).
Second, if the claimant is not engaged in substantial gainful activity, the Commissioner looks to see "whether the claimant has a severe impairment that significantly limits the claimant's physical or mental ability to perform basic work activities." Dixon v. Barnhart, 353 F.3d 602, 605 (8th Cir. 2003). "An impairment is not severe if it amounts only to a slight abnormality that would not significantly limit the claimant's physical or mental ability to do basic work activities." Kirby, 500 F.3d at 707; see 20 C.F.R. §§ 416.920(c), 416.921(a).
The ability to do basic work activities is defined as "the abilities and aptitudes necessary to do most jobs." 20 C.F.R. § 416.921(b). These abilities and aptitudes include (1) physical functions such as walking, standing, sitting, lifting, pushing, pulling, reaching, carrying, or handling; (2) capacities for seeing, hearing, and speaking; (3) understanding, carrying out, and remembering simple instructions; (4) use of judgment; (5) responding appropriately to supervision, co-workers, and usual work situations; and (6) dealing with changes in a routine work setting. Id. § 416.921(b)(1)-(6); see Bowen v. Yuckert, 482 U.S. 137, 141, 107 S.Ct. 2287, 2291 (1987). "The sequential evaluation process may be terminated at step two only when the claimant's impairment or combination of impairments would have no more than a minimal impact on her ability to work." Page v. Astrue, 484 F.3d 1040, 1043 (8th Cir. 2007) (internal quotation marks omitted).
Third, if the claimant has a severe impairment, then the Commissioner will consider the medical severity of the impairment. If the impairment meets or equals one of the presumptively disabling impairments listed in the regulations, then the claimant is considered disabled, regardless of age, education, or work experience. 20 C.F.R. §§ 416.920(a)(4)(iii), 416.920(d); see Kelley v. Callahan, 133 F.3d 583, 588 (8th Cir. 1998).
Fourth, if the claimant's impairment is severe, but does not meet or equal one of the presumptively disabling impairments, then the Commissioner will assess the claimant's residual functional capacity (RFC) to determine the claimant's "ability to meet the physical, mental, sensory, and other requirements" of the claimant's past relevant work. 20 C.F.R. §§ 416.920(a)(4)(iv), 416.945(a)(4). "RFC is a medical question defined wholly in terms of the claimant's physical ability to perform exertional tasks or, in other words, what the claimant can still do despite his or her physical or mental limitations." Lewis v. Barnhart, 353 F.3d 642, 646 (8th Cir. 2003) (internal quotation marks omitted); see 20 C.F.R. § 416.945(a)(1). The claimant is responsible for providing evidence the Commissioner will use to make a finding as to the claimant's RFC, but the Commissioner is responsible for developing the claimant's "complete medical history, including arranging for a consultative examination(s) if necessary, and making every reasonable effort to help [the claimant] get medical reports from [the claimant's] own medical sources." 20 C.F.R. § 416.945(a)(3). The Commissioner also will consider certain non-medical evidence and other evidence listed in the regulations. See id. If a claimant retains the RFC to perform past relevant work, then the claimant is not disabled. Id. § 416.920(a)(4)(iv).
Fifth, if the claimant's RFC as determined in Step Four will not allow the claimant to perform past relevant work, then the burden shifts to the Commissioner to show that there is other work that the claimant can do, given the claimant's RFC as determined at Step Four, and his or her age, education, and work experience. See Bladow v. Apfel, 205 F.3d 356, 358-59 n.5 (8th Cir. 2000). The Commissioner must show not only that the claimant's RFC will allow the claimant to make an adjustment to other work, but also that the other work exists in significant numbers in the national economy. Eichelberger v. Barnhart, 390 F.3d 584, 591 (8th Cir. 2004); 20 C.F.R. § 416.920(a)(4)(v). If the claimant can make an adjustment to other work that exists in significant numbers in the national economy, then the Commissioner will find the claimant is not disabled. If the claimant cannot make an adjustment to other work, then the Commissioner will find that the claimant is disabled. 20 C.F.R. § 416.920(a)(4)(v). At Step Five, even though the burden of production shifts to the Commissioner, the burden of persuasion to prove disability remains on the claimant. Stormo v. Barnhart, 377 F.3d 801, 806 (8th Cir. 2004).
In this case, the ALJ applied the appropriate methodology and found:
AR 11-24.
The Commissioner's decision must be affirmed "if it is supported by substantial evidence on the record as a whole." Pelkey v. Barnhart, 433 F.3d 575, 577 (8th Cir. 2006); see 42 U.S.C. § 405(g) ("The findings of the Commissioner of Social Security as to any fact, if supported by substantial evidence, shall be conclusive. . . ."). "Substantial evidence is less than a preponderance, but enough that a reasonable mind might accept as adequate to support a conclusion." Lewis, 353 F.3d at 645. The Eighth Circuit explains the standard as "something less than the weight of the evidence and [that] allows for the possibility of drawing two inconsistent conclusions, thus it embodies a zone of choice within which the [Commissioner] may decide to grant or deny benefits without being subject to reversal on appeal." Culbertson v. Shalala, 30 F.3d 934, 939 (8th Cir. 1994).
In determining whether the Commissioner's decision meets this standard, the court considers "all of the evidence that was before the ALJ, but it [does] not re-weigh the evidence." Vester v. Barnhart, 416 F.3d 886, 889 (8th Cir. 2005). The court considers both evidence which supports the Commissioner's decision and evidence that detracts from it. Kluesner v. Astrue, 607 F.3d 533, 536 (8th Cir. 2010). The court must "search the record for evidence contradicting the [Commissioner's] decision and give that evidence appropriate weight when determining whether the overall evidence in support is substantial." Baldwin v. Barnhart, 349 F.3d 549, 555 (8th Cir. 2003) (citing Cline v. Sullivan, 939 F.2d 560, 564 (8th Cir. 1991)).
In evaluating the evidence in an appeal of a denial of benefits, the court must apply a balancing test to assess any contradictory evidence. Sobania v. Sec'y of Health & Human Servs., 879 F.2d 441, 444 (8th Cir. 1989). The court, however, does not "reweigh the evidence presented to the ALJ," Baldwin, 349 F.3d at 555 (citing Bates v. Chater, 54 F.3d 529, 532 (8th Cir. 1995)), or "review the factual record de novo." Roe v. Chater, 92 F.3d 672, 675 (8th Cir. 1996) (citing Naber v. Shalala, 22 F.3d 186, 188 (8th Cir. 1994)). Instead, if, after reviewing the evidence, the court finds it "possible to draw two inconsistent positions from the evidence and one of those positions represents the Commissioner's findings, [the court] must affirm the [Commissioner's] denial of benefits." Kluesner, 607 F.3d at 536 (quoting Finch v. Astrue, 547 F.3d 933, 935 (8th Cir. 2008)). This is true even in cases where the court "might have weighed the evidence differently." Culbertson, 30 F.3d at 939 (quoting Browning v. Sullivan, 958 F.2d 817, 822 (8th Cir. 1992)). The court may not reverse the Commissioner's decision "merely because substantial evidence would have supported an opposite decision." Baker v. Heckler, 730 F.2d 1147, 1150 (8th Cir. 1984); see Goff v. Barnhart, 421 F.3d 785, 789 (8th Cir. 2005) ("[A]n administrative decision is not subject to reversal simply because some evidence may support the opposite conclusion.").
Eddington contends the ALJ's decision is flawed for two reasons:
(docket no. 11)
As discussed above, at Step Two, the ALJ must consider whether a medically determinable impairment is "severe." 20 C.F.R. § 404.1520(a)(4)(ii). A severe impairment is one which "significantly limits [the claimant's] physical or mental ability to do basic work activities." 20 C.F.R. § 404.1520(c). Basic work activities include physical functions such as walking, standing, sitting, lifting, pushing, pulling, reaching, carrying or handling; capacities for seeing, hearing and speaking; understanding, carrying out and remembering simple instructions; use of judgment; responding appropriately to supervision, co-workers and usual work situations; and dealing with changes in a routine work setting. 20 C.F.R. § 404.1521(b). If the impairment would have no more than a minimal effect on the claimant's ability to work, it is not severe. Page, 484 F.3d at 1043. If the claimant has a severe impairment, then the Commissioner will consider the medical severity of the impairment. If the impairment meets or equals one of the presumptively disabling impairments listed in the regulations, then the claimant is considered disabled, regardless of age, education, or work experience. 20 C.F.R. §§ 416.920(a)(4)(iii), 416.920(d); see Kelley, 133 F.3d at 588. If the claimant's impairment is severe, but it does not meet or equal one of the presumptively disabling impairments, then the Commissioner will assess the claimant's RFC to determine the claimant's "ability to meet the physical, mental, sensory, and other requirements" of the claimant's past relevant work. 20 C.F.R. §§ 416.920(a)(4)(iv), 416.945(a)(4). The claimant's RFC is "what [the claimant] can still do" despite his or her "physical or mental limitations." 20 C.F.R. § 404.1545(a)(1). "The ALJ must determine a claimant's RFC based on all of the relevant evidence." Fredrickson v. Barnhart, 359 F.3d 972, 976 (8th Cir. 2004). The claimant's RFC "is a medical question," Lauer v. Apfel, 245 F.3d 700, 704 (8th Cir. 2001), and must be supported by "some medical evidence." Dykes v. Apfel, 223 F.3d 865, 867 (8th Cir. 2000) (per curiam). The medical evidence should address the claimant's "ability to function in the workplace." Lewis, 353 F.3d at 646. The RFC determination is not based exclusively on the medical evidence, or on any one physician's opinion, but on the record as a whole. Cox v. Astrue, 495 F.3d 614, 619 (8th Cir. 2007). While the RFC assessment draws from medical sources, it is ultimately an administrative determination reserved to the Commissioner. Id.
"An ALJ must not substitute his opinions for those of the physician." Finch, 547 F.3d at 938 (quoting Ness v. Sullivan, 904 F.2d 432, 435 (8th Cir. 1990)). Rather, "it is the ALJ's responsibility to determine [the] claimant's RFC based on all the relevant evidence, including medical records, observations of treating physicians and others, and claimant's own description of her limitations." Jones v. Astrue, 619 F.3d 963, 971 (8th Cir. 2010) (citing Page, 484 F.3d at 1043). "It is the ALJ's function to resolve conflicts among the opinions of various treating and examining physicians. The ALJ may reject the conclusions of any medical expert, whether hired by the claimant or the government if they are inconsistent with the record as a whole." Pearsall v. Massanari, 274 F.3d 1211, 1219 (8th Cir. 2001). "An ALJ's failure to consider or discuss a treating physician's opinion that a claimant is disabled is error when the record contains no contradictory medical opinion." Hogan v. Apfel, 239 F.3d 958, 961 (8th Cir. 2001) (citing Black v. Apfel, 143 F.3d 383, 386 (8th Cir. 1998)). The ALJ is not required to mechanically list and reject every possible limitation. McCoy v. Astrue, 648 F.3d 605, 615 (8th Cir. 2011). Furthermore, "[a]n ALJ's failure to cite specific evidence does not indicate that such evidence was not considered." Wildman v. Astrue, 596 F.3d 959, 966 (8th Cir. 2010) (quoting Black v. Apfel, 143 F.3d 383, 386 (8th Cir. 1998)).
Medical opinions can come from a treating source, an examining source, or a non-treating, non-examining source (typically a state agency medical consultant who issues an opinion based on a review of medical records). Medical opinions from treating physicians are entitled to substantial weight. Singh v. Apfel, 222 F.3d 448, 452 (8th Cir. 2000). A treating physician's opinion "does not automatically control or obviate the need to evaluate the record as [a] whole." Leckenby v. Astrue, 487 F.3d 626, 632 (8th Cir. 2007). Nonetheless, if the ALJ finds that a treating physician's medical opinion as to the nature and severity of the claimant's impairment is "well-supported by medically acceptable clinical and laboratory diagnostic techniques and is not inconsistent with the other substantial evidence in [the claimant's] record, [the ALJ] will give it controlling weight." 20 C.F.R. § 416.927(c)(2). "When an ALJ discounts a treating physician's opinion, he should give good reasons for doing so." Brown v. Astrue, 611 F.3d 941, 951-52 (8th Cir. 2010). Note, however, that a treating physician's conclusion that an applicant is "disabled" or "unable to work" addresses an issue that is reserved for the Commissioner and, therefore, is not a "medical opinion" that must be given controlling weight. Ellis v. Barnhart, 392 F.3d 988, 994 (8th Cir.2005).
At the other end of the medical-opinion spectrum are opinions from non-treating, non-examining sources: "The opinions of non-treating practitioners who have attempted to evaluate the claimant without examination do not normally constitute substantial evidence on the record as a whole." Shontos v. Barnhart, 328 F.3d 418, 427 (8th Cir. 2003). This does not mean, however, that such opinions are to be disregarded. Indeed, "an ALJ may credit other medical evaluations over that of the treating physician when such other assessments are supported by better or more thorough medical evidence." Prosch v. Apfel, 201 F.3d 1010, 1014 (8th Cir. 2000) (internal quotations and citations omitted). Unless a treating source's opinion is given controlling weight, the ALJ "must explain in the decision the weight given to the opinions of a State agency medical or psychological consultant." 20 C.F.R. § 416.927(e)(2)(ii).
In the middle of the spectrum are opinions from consultative examiners who are not treating sources, but who examined the claimant for purposes of forming a medical opinion. Normally, the opinion of a one-time consultative examiner will not constitute substantial evidence, especially when contradicted by a treating physician's opinion. Cantrell v. Apfel, 231 F.3d 1104, 1107 (8th Cir. 2000).
Ultimately, it is the ALJ's duty to assess all medical opinions and determine the weight to be given these opinions. See Finch, 547 F.3d at 936 ("The ALJ is charged with the responsibility of resolving conflicts among medical opinions."); Estes v. Barnhart, 275 F.3d 722, 725 (8th Cir. 2002) ("[i]t is the ALJ's function to resolve conflicts among `the various treating and examining physicians.'") (citing Bentley v. Shalala, 52 F.3d 784, 785-87 (8th Cir. 1995)).
The medical record in this case is sparse and largely limited to evaluations conducted for the purpose of disability determination. Although the record makes mention of various records that pre-date the application period, the first relevant medical evidence contained in the record is an evaluation performed by Dr. Melanie Bonnstetter, Psy. D. The Commissioner referred Eddington to Dr. Bonnstetter for a mental evaluation, which was conducted on December 5, 2008. At that time, Eddington was 22 years old. Eddington reported to Dr. Bonnstetter that she did have a primary care provider and her exclusive medication was a birth control shot. AR 458. Dr. Bonnstetter reviewed the medical records, interviewed Eddington and her parents, and performed various tests. Of significance, Eddington admitted to Dr. Bonnstetter that she had two or three jobs from which she had been fired because "she gets bored or doesn't feel that things are fair and as a result becomes argumentative or agitated." AR 455. Dr. Bonnstetter found that "patient's personality functioning is more directly impeding her ability to work than problems with ADHD and/or intellectual capacity. It is this examiner's opinion that the patient has learned how to ensure her wants/needs are met by her parents to the point that she is not properly motivated to seek or maintain employment." AR 460. Regarding her ADHD, Eddington reported to Dr. Bonnstetter that she had discontinued taking her medication because she didn't want to be dependent on pills. AR 457. Dr. Bonnstetter tested Eddington's IQ and gave her a full IQ score of 88, which means that Eddington had an IQ in the low average range of intellectual functioning. AR 460. Dr. Bonnstetter assigned her a GAF score of 55, but noted that Eddington was not taking any medication which could potentially improve her condition.
Myrna Tashner, Ed.D., another agency expert, examined the record and provided a functional capacity assessment on December 26, 2008. Tashner stated that Eddington's functional capacity did not meet or exceed the listings. AR 464. In coming to that conclusion, Tashner cited the fact that Eddington was not currently treating for any ongoing medical or mental issues and that she could take care of herself on a daily basis. AR 464.
Sometime in 2010, Eddington fell and injured her shoulder. Her local health care provider referred her to the University of Iowa Hospital. AR 516. She appeared at the University of Iowa Hospital for an evaluation on July 1, 2010. The University of Iowa Hospital did not find any acute issue with the shoulder, and recommended conservative treatment with pain medication. AR 502. Also in 2010, Eddington presented at the Community Health Center in Fort Dodge for a variety of routine medical issues, including ear pain and gastrointestinal issues. AR 509-515. In only one instance does it appear depression was noted by the doctor. AR 511.
On January 10, 2010, Eddington saw Teresa Anderson, MS, a counselor in Fort Dodge, Iowa.
On April 5, 2011, Dan Rogers, Ph.D. evaluated Eddington following a referral from the Commissioner. Apparently the medical records available to Rogers was the note from Teresa Anderson, described above. Accordingly, Rogers relied primarily on the in-person evaluation. Rogers noted that, "[a]lthough [Eddington] used the word `depressed' to describe her usual mood she actually described boredom, lack of spending money, and concern for her parents, but she did not describe lengthy periods of sadness or other symptoms of depression. . . She also did not describe symptoms of borderline personality." AR 529. Rogers assigned Eddington a GAF score of 65 and concluded that, "[t]here are no apparent signs of serious mental disorder for [Eddington]." AR 530.
On May 24, 2011, Eddington sought a disability evaluation at Trimark Family Practice in Fort Dodge, Iowa. AR 497. Dr. Michael Stitt concluded the claimant's major problem appeared to be anger management or adult oppositional disorder of some sort. AR 498. Dr. Stitt stated that, "[t]here is no[t] much on the physical exam to indicate problems with the shoulder knee or feet." Id.
On July 22, 2011, Dennis Weis, M.D., performed a record review for the agency, as did Jennifer Ryan, Ph.D., on July 25, 2011. AR 536-537. Neither found significant limitations or any reason to reverse the previous agency findings that Eddington is not disabled. Id.
Eddington presented at the Community Health Center in Fort Dodge for several more normal health checks in 2011 and 2012, including for a rash (AR 541), a sinus infection (AR 543-544), and bronchitis (AR 566). On October 14, 2011, Eddington injured her toes. An x-ray revealed no serious damage and the attending doctor directed Eddington to take over-the-counter pain medication. AR 571-572. On June 20, 2012, Eddington sought treatment for elbow pain after playing video games. The attending doctor prescribed her pain medication. AR 560-562. On September 12, 2012, Eddington sought treatment for rib pain and was prescribed pain medication. AR 555-556.
Eddington saw counselor Teresa Anderson, again, on July 19, 2012. AR 552. Eddington told Anderson that she was experiencing increased symptoms of depression and anxiety. Eddington noted that she stopped taking her depression medication and asked to be re-started on it. AR 551. Anderson diagnosed Eddington with panic disorder without agoraphobia, major depressive disorder, relationship issues, and chronic, intermittent, pain. AR 553. Anderson assigned Eddington a GAF score of 51-55 and referred her for a psychiatric evaluation. Id.
Pursuant to the referral from counselor Anderson, Eddington appeared at the Berryhill Center for Mental Health in Fort Dodge, Iowa, on August 9, 2012. Dr. Maria Lozano Celis examined Eddington. Dr. Celis noted that Eddington had previously been evaluated at Berryhill in 2008. AR 547. Dr. Celis noted that, during that previous disability evaluation, Dr. Melanie Porter had diagnosed Eddington with ADHD, depression, and personality disorder. Id. Dr. Celis diagnosed recurrent, moderate, depressive disorder, childhood onset ADHD, possible personality disorder, and assigned Eddington a GAF score of 50. AR 549. Dr. Celis recommended that Eddington restart the depression medication Pristiq and attend a follow-up therapy session. AR 549.
On October 10, 2012, Dr. E. Christiansen, Ph.D., conducted a psychological evaluation of Eddington. Based on his examination of Eddington, along with a review of the medical records, Dr. Christiansen diagnosed Eddington with Dysthymia with episodes of major depression, anxiety disorder, ADHD, mixed personality disorder, and assigned Eddington a GAF score of 50. AR 579-580. Regarding her ability to work, Dr. Christiansen concluded:
AR 580.
The ALJ evaluated Eddington's RFC and found as follows:
AR 13.
AR 14.
The ALJ then discussed each medical record individually. The ALJ summarized the opinion of Dr. Bonnstetter, as follows:
AR 16-17. Regarding Dr. Christiansen, the ALJ stated:
AR 19. The ALJ weighed the various medical opinions and concluded:
AR 19-20.
Eddington's first argument is that the ALJ erred in giving little weight to the opinions of Dr. Bonnstetter and Dr. Christiansen in concluding that her severe impairments did not meet a listing criteria and that she had the residual functional capacity to return to work. In making that argument, Eddington alleges that: 1) the opinions and work-related limitations from Dr. Bonnstetter and Dr. Christiansen are materially different from the ALJ's mental residual RFC assessment; 2) the ALJ failed to evaluate the opinions of Dr. Bonnstetter at all; 3) the ALJ's decision is internally inconsistent regarding Eddington's ability to maintain attention and concentration; and 4) the opinions from Dr. Christiansen and Dr. Bonnstetter are consistent with the record as a whole while the ALJ's findings are not supported by substantial evidence in the record as a whole.
The second of those claims is clearly without merit. As quoted immediately above, the ALJ devoted several paragraphs of his opinion to discussing and weighing the records provided by Dr. Bonnstetter. Accordingly, I will only discuss Eddington's other three points. At the outset of my analysis, I repeat the observation of the ALJ that this case presents a unique situation in that the medical record is almost completely devoid of treatment notes, especially related to the severe impairments. Rather, the administrative record is comprised almost entirely of various evaluations conducted specifically for the purpose of Eddington's pending disability claim. Thus, this case is far removed from the `normal' RFC case, where the arguments primarily relate to whether the medical source conclusions, and the ALJ's RFC finding, are supported by the treatment notes.
Eddington's first point is that the ALJ's RFC determination is materially different from the opinions of Dr. Bonnstetter and Dr. Christiansen. However, this argument is paradoxical, because Dr. Bonnstetter and Dr. Christiansen's opinions are materially different from each other. Dr. Christiansen is, without a doubt, the least conservative in diagnosing Eddington, offering the conclusion that Eddington is completely disabled. Meanwhile, the overarching conclusion of Dr. Bonnstetter's evaluation is that, although Eddington has low-average intelligence, "the patient's personality functioning is more directly impeding her ability to work than problems with ADHD or intellectual capacity. . . . [T]he patient has learned how to ensure her wants/needs are met by her parents to the point that she is not properly motivated to seek or maintain employment." AR 460. Dr. Bonnstetter went on to say that, "[Eddington] is able to pick up on social cues and respond to them appropriately when and if she chooses. . . ." Id.
In weighing Eddington's mental impairments, the ALJ found that she had moderate difficulties in social functioning and moderate difficulties with regard to concentration, persistence, and pace. AR 12. Those limitations seem to be somewhat more than what Dr. Bonnstetter observed, but somewhat less than what Dr. Christiansen observed. It is true that the ALJ's RFC is not a direct reflection of either medical opinion. But, there is no requirement under the law that the ALJ must adopt the report of one particular doctor, especially when, as is the present case, neither doctor was Eddington's treating source. Rather, as pointed out by the Commissioner, "the ALJ does not base his residual functional capacity determination on any one physician's opinion, even a treating physician's opinion, but he bases it on the record as a whole. Cox v. Astrue, 495 F.3d 614, 619 (8th Cir. 2007)." (docket no. 12, p. 7) The fact that the ALJ's RFC is different from either Dr. Bonnstetter or Dr. Christiansen's assessment does not mean that it is not supported by substantial evidence in the record.
The next point raised by Eddington is that the ALJ made contradictory findings regarding her ability to maintain concentration. Specifically, Eddington argues that the ALJ cannot, on one hand, recognize that Eddington has the severe impairment of ADHD, while, on the other hand, finding Eddington had normal concentration, because ADHD necessarily impairs attention and concentration.
There are a number of problems with this argument. There is a legally significant difference between the initial finding of a severe impairment and the RFC finding regarding the extent said impairment impacts the claimant. The mere fact that the claimant is diagnosed with what constitutes a severe impairment does not mean that impairment will render the claimant disabled. The country is full of individuals who have what could be severe impairments, such as asthma, obesity, or diabetes, but have never even considered seeking benefits because their symptoms are not limiting. Thus, the mere fact that the ALJ recognized that Eddington has the severe impairment of ADHD, but did not find that the ADHD caused a marked limitation is not, in and of itself, an error. Rather, the proper function of the ALJ in crafting an RFC is to determine whether the claimant has the ability to function in spite of her impairments. That is exactly what the ALJ did in this case.
Additionally, there is a factual inconsistency in Eddington's argument. As set out in her brief, Eddington argues that, "according to the ALJ, the claimant had intact attention and concentration. (TR 19)." (docket no. 11, p. 13) The citation provided by Eddington for that contention is page 19 of the ALJ's order. On page 19 of his order, the ALJ does state that the claimant has "intact attention and concentration." AR 19. However, that statement is in reference to a previous medical opinion in the record. It is not the ALJ's conclusion. Rather, as was noted above, the ALJ concluded that Eddington had moderate limitations with regard to attention and concentration. Thus, there is no inconsistency in the ALJ's order. He noted a severe impairment of ADHD and found that the ADHD had a moderate impact on Eddington's concentration and attention.
Eddington's final point is the catch all argument that the ALJ's medical assessment and RFC are not supported by substantial evidence. Eddington specifically attacks the ALJ's decision to give little weight to the opinion of Dr. Christiansen. Eddington argues that the ALJ should have found her to have poor judgment and impulse control in crafting the RFC. The Plaintiff argues that if the ALJ had properly credited Dr. Christiansen's opinion, the RFC would have included those additional limitations.
The simple fact that Dr. Christiansen provides an opinion contrary to the RFC does not mean the RFC is invalid. My role is not to reweigh the evidence, but to determine if the ALJ's conclusion is supported by substantial evidence. In this case, it is. First, Dr. Christiansen is merely a consulting physician. Even though Dr. Christiansen examined Eddington, Dr. Christiansen is not entitled to the deferential weight provided to a long term provider. This is especially true when it appears that the provider is an outlier whose opinion was sought simply for the purposes of bolstering a disability claim. There simply is no legal rationale which would compel the ALJ to give Dr. Christiansen controlling weight in spite of the contrary opinions from the other medical sources.
Second, the ALJ meticulously cites the medical record in support of his RFC finding. As was stated above, several times, the ALJ's RFC relied, in part, on the opinion of Dr. Bonnstetter, who found that `motivation' and `personality' where Eddington's biggest issues. AR 20. The ALJ noted that Dr. Celis found "claimant's memory, attention, and concentration were . . . intact and within normal limits." AR 18. The ALJ also cited to Dr. Rogers who stated that, although Eddington considered herself depressed, "she actually described boredom. . ." AR 17. The ALJ cites the fact that Dr. Rogers found no serious mental limitations and assigned Eddington the relatively healthy GAF score of 65. Similarly, the ALJ stated that, although counselor Anderson diagnosed Eddington with a variety of issues, Anderson cited `grief' as a major component of Eddington's sadness and assigned her a GAF score of 55-60. AR 17. Finally, as will be discussed more below, the ALJ cited Eddington's inconsistent treatment and lack of medication to support his RFC. Based on the foregoing, it is clear that the medical component of the ALJ's RFC is supported by substantial evidence.
"The credibility of a claimant's subjective testimony is primarily for the ALJ to decide, not the courts." Pearsall v. Massanari, 274 F.3d 1211, 1218 (8th Cir. 2001).
To determine a claimant's credibility, the ALJ must consider:
Polaski v. Heckler, 739 F.2d 1320, 1322 (8th Cir. 1984). "`Acts which are inconsistent with a claimant's assertion of disability reflect negatively upon that claimant's credibility.'" Heino v. Astrue, 578 F.3d 873, 881 (8th Cir. 2009) (quoting Johnson v. Apfel, 240 F.3d 1145, 1148 (8th Cir. 2001)). However, the Eighth Circuit Court of Appeals has repeatedly stated that "the ability to do activities such as light housework and visiting with friends provides little or no support for the finding that a claimant can perform full-time competitive work." Hogg v. Shalala, 45 F.3d 276, 278-79 (8th Cir. 1995) (citing Harris v. Sec'y of Dep't of Health and Human Servs., 959 F.2d 723, 726 (8th Cir. 1992)). A claimant need not prove she is bedridden or completely helpless to be found disabled. Reed v. Barnhart, 399 F.3d 917, 923 (8th Cir. 2005). Yet, the Eighth Circuit Court of Appeals has also held that "cooking, vacuuming, washing dishes, doing laundry, shopping, driving, and walking, are inconsistent with subjective complaints of disabling pain." Medhaug v. Astrue, 578 F.3d 805, 817 (8th Cir. 2009).
With respect to determining whether activities of daily living are inconsistent with subjective complaints of disability, the ALJ must consider the "quality of the daily activities and the ability to sustain activities, interest, and relate to others over a period of time and the frequency, appropriateness, and independence of the activities." Wagner v. Astrue, 499 F.3d 842, 852 (8th Cir. 2007) (citing Leckenby v. Astrue, 487 F.3d 626, 634 (8th Cir. 2007)). "Other relevant factors include the claimant's relevant work history, and the absence of objective medical evidence to support the complaints." Mouser v. Astrue, 545 F.3d 634, 638 (8th Cir. 2008) (quoting Wheeler v. Apfel, 224 F.3d 891, 895 (8th Cir. 2000)). An ALJ may not discount a claimant's subjective complaints solely because they are unsupported by objective medical evidence, Halverson v. Astrue, 600 F.3d 922, 931-32 (8th Cir. 2010), but such evidence is one factor that the ALJ may consider. Ford v. Astrue, 518 F.3d 979, 982 (8th Cir. 2008). The ALJ need not explicitly discuss each factor as long as the ALJ acknowledges and considers the factors before discounting the claimant's subjective complaints. Goff, 421 F.3d at 791. "An ALJ who rejects [subjective] complaints must make an express credibility determination explaining the reasons for discrediting the complaints." Singh v. Apfel, 222 F.3d 448, 452 (8th Cir. 2000).
When an ALJ explicitly discredits the claimant's testimony and gives good reason for doing so, the court should normally defer to the ALJ's credibility determination. Gregg v. Barnhart, 354 F.3d 710, 714 (8th Cir. 2003). It is not my role to re-weigh the evidence. See 42 U.S.C. § 405(g); see also Young v. Apfel, 221 F.3d 1065, 1068 (8th Cir. 2000) ("[I]f, after reviewing the record, [the Court] find[s] that it is possible to draw two inconsistent positions from the evidence and one of those positions represents the [Commissioner's] findings, [the Court] must affirm the decision of the Commissioner.") (citations and quotations omitted). However, in reviewing the ALJ's credibility determination, I must consider the evidence that both supports and detracts from the ALJ's decision. Perks v. Astrue, 687 F.3d 1086, 1091 (8th Cir. 2012) (citing Ellis v. Barnhart, 392 F.3d 988, 993 (8th Cir. 2005)). It is not appropriate to reverse the ALJ's decision simply because some evidence would support a different conclusion. Perks, 687 F.3d at 1091. An ALJ is not required to discuss every piece of evidence that was submitted, and an ALJ's failure to cite specific evidence does not indicate that such evidence was not considered. Black v. Apfel, 143 F.3d 383, 386 (8th Cir. 1998). I must defer to the ALJ's determination regarding the credibility of testimony as long as it is supported by good reasons and substantial evidence. Id. (citing Pelkey v. Barnhart, 433 F.3d 575, 578 (8th Cir. 2006)).
At her hearing before the ALJ, and throughout the course of the disability application process, Eddington maintained that, because of her depressive disorder, low intelligence, and her ADHD, she is unable to return to work. AR 67-69. The ALJ found that Eddington's statements concerning the intensity, persistence, and limiting effects of her symptoms from her mental impairments were not entirely credible. After referencing the Polaski factors and examining some of the medical and opinion evidence, the ALJ found as follows:
AR 20. The ALJ found inconsistencies in the record, stating:
AR 21. The ALJ also noted Eddington's ability to maintain an independent lifestyle, stating:
AR 21.
Eddington argues the ALJ failed to properly consider her subjective allegations. In doing so, she makes two main points. She argues that the ALJ failed to articulate his reasons for discounting her subjective allegations, and she argues the ALJ improperly discounted the third party reports from her family. The Commissioner, obviously, disagrees and argues that the ALJ's ruling is supported by substantial evidence.
Based on my review of the record, I conclude that, for the most part, the ALJ gave detailed reasons for discounting Eddington's subjective complaints and limitations. The ALJ gave at least three separate reasons why Eddington's subjective allegations are not supported by the record.
The Eighth Circuit Court of Appeals has stated that the claimant's ability to perform basic life functions can be a factor considered by the ALJ in determining if the claimant's allegations are credible. See Baker v. Barnhart, 457 F.3d 882, 893 (8th Cir. 2006) (the Eighth Circuit Court of Appeals considered the fact that the claimant was capable of full self-care, drove a car every day, shopped, and ran a number of errands as one factor in determining if claimant's allegations were credible). However, a "limited ability to complete light housework and short errands does not mean [a claimant] has `the ability to perform the requisite physical acts day in and day out, in the sometimes competitive and stressful conditions in which real people work in the real world.'" Tilley v. Astrue, 580 F.3d 675, 682 (8th Cir. 2009) citing McCoy v. Schweiker, 683 F.2d 1138, 1147 (8th Cir. 1982) (en banc) abrogated on other grounds by Higgins v. Apfel, 222 F.3d 504, 505 (8th Cir. 2000). In this case, the ALJ properly considered, and cited, Eddington's ability to perform basic life tasks as one factor in determining if her allegations were credible.
The ALJ also noted Eddington's failure to regularly treat for her various medical issues. As can be seen in the review of the medical records set out above, there is no possible, factual dispute that Eddington failed to seek regular medical treatment. Over the five years' worth of medical records presently before me, Eddington never sought regular, and continuing, medical care for her allegedly disabling symptoms. Eddington only saw her counselor two times over the course of four years. The ALJ properly relied on Eddington's lack of treatment in his credibility assessment.
Finally, as was discussed in some detail in the previous section, the ALJ stated that the medical record did not support Eddington's allegations. With the exception of Dr. Christiansen, none of the providers appearing in the record opined that Eddington had disabling/severe symptoms. The medical record is replete with references to Eddington having low normal to normal cognitive function and, at most, moderate issues with attention, pace, and social functioning. As was discussed above, some providers, such as Dr. Rogers and Dr. Bonnstetter, specifically opined that many of Eddington's issues were related to personality, motivation, and boredom, rather than the severe impairments of record. It is not my job to reweigh the evidence. Rather, the question is whether the ALJ gave good reasons for his opinion and whether the opinion is supported by substantial evidence. In this case, the ALJ gave at least three clear reasons, which are supported by citations to the record, that tend to show that the claimant's subjective allegations were not credible. Accordingly, the ALJ's finding is supported by substantial evidence.
Eddington also argues that the ALJ should have given greater weight to the third party reports provided by her family. The ALJ gave little weight to the reports provided by Eddington's mother, sister, and boyfriend, stating:
AR 22. Although the statements of Eddington's family generally support her subjective allegations, the ALJ was entitled to discount that corroborating testimony for the same reason he used to discredit Eddington's. Eddington has alternately lived with her mother and her boyfriend, and is often tasked with taking care of her mother. Clearly, they all have an interest in a disability finding. See Black v. Apfel, 143 F.3d 383, 387 (8th Cir. 2006) (ALJ's failure to give specific reasons for disregarding testimony of the claimant's husband was inconsequential, as the same reasons the ALJ gave to discredit claimant could serve as basis for discrediting the husband). The ALJ provided detailed reasons for his credibility findings, and those findings are substantially supported by the medical evidence. Accordingly, I must deny Eddington's argument.
After a thorough review of the entire record and in accordance with the standard of review I must follow, I conclude that the ALJ's determination that Eddington was not disabled within the meaning of the Act is supported by substantial evidence in the record. Accordingly, the decision of the ALJ is
