MARY M. ROWLAND, Magistrate Judge.
Plaintiff Thelmarae Wieringa filed this action seeking reversal of the final decision of the Commissioner of Social Security denying her application for Disability Insurance Benefits under Title II of the Social Security Act (Act). 42 U.S.C. §§ 405(g), 423 et seq. The parties have consented to the jurisdiction of the United States Magistrate Judge, pursuant to 28 U.S.C. § 636(c), and Plaintiff has filed a request to reverse the ALJ's decision and remand for additional proceedings. For the reasons stated below, the case is remanded for further proceedings consistent with this Opinion.
To recover Disability Insurance Benefits (DIB), a claimant must establish that he or she is disabled within the meaning of the Act. York v. Massanari, 155 F.Supp.2d 973, 977 (N.D. Ill. 2001).
20 C.F.R. §§ 404.1509, 404.1520; see Clifford v. Apfel, 227 F.3d 863, 868 (7th Cir. 2000). "An affirmative answer leads either to the next step, or, on Steps 3 and 5, to a finding that the claimant is disabled. A negative answer at any point, other than Step 3, ends the inquiry and leads to a determination that a claimant is not disabled." Zalewski v. Heckler, 760 F.2d 160, 162 n.2 (7th Cir. 1985). "The burden of proof is on the claimant through step four; only at step five does the burden shift to the Commissioner." Clifford, 227 F.3d at 868.
Plaintiff applied for DIB on September 15, 2009, alleging that she became disabled on February 6, 2009, because of sleep apnea, diabetes, chronic back pain, depression, COPD, thyroid disease, restless leg syndrome, and sinusitis. (R. at 24, 112). The application was denied initially and on reconsideration, after which Plaintiff filed a timely request for a hearing. (Id. at 24, 106-23). On December 20, 2011, Plaintiff, represented by counsel, testified at a hearing before an Administrative Law Judge (ALJ). (Id. at 24, 53-105). The ALJ also heard testimony from Grace Gianforte, a vocational expert (VE). (Id. at 24, 53-105, 166).
The ALJ denied Plaintiff's request for benefits on January 27, 2012. (R. at 24-36). Applying the five-step sequential evaluation process, the ALJ found, at step one, that Plaintiff has not engaged in substantial gainful activity from February 6, 2009, her alleged onset date, through March 31, 2011, her date last insured (DLI).
The ALJ then assessed Plaintiff's residual functional capacity (RFC)
(R. at 28). At step four, the ALJ determined that through her date last insured, Plaintiff was unable to perform any past relevant work. (Id. at 34). Based on Plaintiff's RFC, age, education, and the VE's testimony, the ALJ determined at step five that through her date last insured, there were jobs that existed in significant numbers in the national economy that Plaintiff could have performed, including clerical stock checker, attendant, and counter attendant. (Id. at 35). Accordingly, the ALJ concluded that Plaintiff was not suffering from a disability, as defined by the Act, at any time from February 6, 2009, the alleged onset date, through March 31, 2011, the date last insured. (Id.).
The Appeals Council denied Plaintiff's request for review on October 26, 2012. (R. at 8-11). Plaintiff now seeks judicial review of the ALJ's decision, which stands as the final decision of the Commissioner. Villano v. Astrue, 556 F.3d 558, 561-62 (7th Cir. 2009).
Judicial review of the Commissioner's final decision is authorized by § 405(g) of the SSA. In reviewing this decision, the Court may not engage in its own analysis of whether the plaintiff is severely impaired as defined by the Social Security Regulations. Young v. Barnhart, 362 F.3d 995, 1001 (7th Cir. 2004). Nor may it "reweigh evidence, resolve conflicts in the record, decide questions of credibility, or, in general, substitute [its] own judgment for that of the Commissioner." Id. The Court's task is "limited to determining whether the ALJ's factual findings are supported by substantial evidence." Id. (citing § 405(g)). Evidence is considered substantial "if a reasonable person would accept it as adequate to support a conclusion." Indoranto v. Barnhart, 374 F.3d 470, 473 (7th Cir. 2004); see Moore v. Colvin, 743 F.3d 1118, 1120-21 (7th Cir. 2014) ("We will uphold the ALJ's decision if it is supported by substantial evidence, that is, such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.") (citation omitted). "Substantial evidence must be more than a scintilla but may be less than a preponderance." Skinner v. Astrue, 478 F.3d 836, 841 (7th Cir. 2007). "In addition to relying on substantial evidence, the ALJ must also explain his analysis of the evidence with enough detail and clarity to permit meaningful appellate review." Briscoe ex rel. Taylor v. Barnhart, 425 F.3d 345, 351 (7th Cir. 2005).
Although this Court accords great deference to the ALJ's determination, it "must do more than merely rubber stamp the ALJ's decision." Scott v. Barnhart, 297 F.3d 589, 593 (7th Cir. 2002) (citation omitted). "This deferential standard of review is weighted in favor of upholding the ALJ's decision, but it does not mean that we scour the record for supportive evidence or rack our brains for reasons to uphold the ALJ's decision. Rather, the ALJ must identify the relevant evidence and build a "logical bridge" between that evidence and the ultimate determination." Moon v. Colvin, 763 F.3d 718, 721 (7th Cir. 2014). The Court must critically review the ALJ's decision to ensure that the ALJ has built an "accurate and logical bridge from the evidence to his conclusion." Young, 362 F.3d at 1002. Where the Commissioner's decision "lacks evidentiary support or is so poorly articulated as to prevent meaningful review, the case must be remanded." Steele v. Barnhart, 290 F.3d 936, 940 (7th Cir. 2002).
Plaintiff has suffered from depression and anxiety on and off since 2003, when she was placed on a series of antidepressants. (R. at 913). Her Zoloft medication worked fine until 2005, and then became ineffective.
On December 18, 2009, Mark Conard, Ph.D., performed a mental status consultative examination on behalf of the Commissioner. (R. at 544-45). Plaintiff reported a history of depression and anxiety attacks, which were first diagnosed in 2002. (Id. at 544). She denied current suicidal ideations. (Id.). Dr Conard found Plaintiff to be alert, attentive, and cooperative. (Id.). Her mood was calm, with an appropriate affect. (Id.). Her thought process was organized and oriented to person, place and time, and her immediate and remote memory fair. (Id.). Plaintiff struggled to complete serial 7s and simple calculations. (Id. at 544-45). Dr. Conard diagnosed major depressive disorder, recurrent, moderate, and assigned a Global Assessment of Functioning (GAF) score of 66.
On February 4, 2010, S. Hill, Ph.D., a nonexamining DDS doctor, reviewed the file and completed a Psychiatric Review Technique (PRT) form. (R. at 570-83). Based primarily on Dr. Conard's report, Dr. Hill concluded that Plaintiff has mild difficulties in maintaining concentration, persistence or pace. (Id. at 573, 580, 582). On August 24, 2010, Towfig Argmand, M.D., another nonexamining DDS doctor, affirmed Dr. Hill's conclusions. (Id. at 598-600).
On September 15, 2010, Sushma Ragnavendra, M.D., diagnosed depression and prescribed fluoxetine 20mg.
On June 14, 2011, Plaintiff began treating with Porter-Starke Services. (R. at 903). She presented with anxiety, expansive mood, and disjointed speech patterns. (Id.). She reported recurrent depressive symptoms, most notably anger and irritability, and occasional panic attacks. (Id.). Plaintiff admitted to occasional passive suicidal thoughts but denied current ideations. (Id.). She reported short term memory problems, difficulty concentrating, and frequent confusion. (Id. at 903, 906). She noted that Dr. Ragnavendra had recently increased her Prozac dosage after it became ineffective in controlling her symptoms. (Id. at 903). On a mental status examination, Plaintiff's mood was stressed and elevated. (Id. at 904). Samir Gupta, M.D., diagnosed depressive disorder NOS, provisionally diagnosed bipolar disorder, assessed Clinical Global Impression severity at 5,
On June 30, 2011, Plaintiff complained of depression, anxiety, lack of motivation, and lack of energy. (R. at 913). She stated that Prozac no longer controls her symptoms. (Id.). On examination, she had appropriate affect and mood, intact memory, average intelligence, and preserved judgment and insight. (Id. at 914). Daniel Kim, M.D., diagnosed major depression, recurrent, and dysthymic disorder, with a guarded prognosis, and assigned a GAF score of 50-55.
On July 6, 2011, Plaintiff presented as tired, depressed, very distressed, desperate, and hostile. (R. at 907-08, 910). She reported recurrent panic attacks and confusion. (Id. at 908). On August 17, 2011, Plaintiff reported increased irritability and passive thoughts of self-harm. (Id. at 910). She denied current suicidal ideations, but admitted to punching walls in her home out of uncontrolled anger. (Id.). She reported difficulty with memory and concentration. (Id.). On August 19, 2011, Dr. Gupta referred Plaintiff to outpatient therapy because of her limited financial resources. (Id. at 912).
The ALJ determined that Plaintiff has sleep apnea, diabetes mellitus, asthma, and degenerative disc disease of the lumbar spine. (R. at 26). The ALJ also concluded that Plaintiff's "medically determinable mental impairment of depression did not cause more than minimal limitation in [Plaintiff's] ability to perform basic mental work activities and was therefore nonsevere." (Id. at 26-27). After examining the medical evidence and giving partial credibility to some of Plaintiff's subjective complaints, the ALJ found that Plaintiff has the RFC to perform a limited range of light work.
"The RFC is an assessment of what work-related activities the claimant can perform despite her limitations." Young, 362 F.3d at 1000; see 20 C.F.R. § 404.1545(a)(1) ("Your residual functional capacity is the most you can still do despite your limitations."); Social Security Ruling (SSR)
After carefully examining the record, the Court concludes that the ALJ failed to fully consider the effects of Plaintiff's mental illness on her ability to work. The ALJ adopted the PRT completed by the DDS doctor in February 2010 and "limited [Plaintiff] to understanding, remembering and carrying out detailed instructions versus complex." (R. at 33). Under the circumstances, the ALJ's decision to merely limit Plaintiff to carrying our detailed versus complex instructions is not supported by substantial evidence.
First, the ALJ erred by handpicking which evidence to evaluate while disregarding other critical evidence. Scrogham v. Colvin, 765 F.3d 685, 696-99 (7th Cir. 2014); Myles v. Astrue, 582 F.3d 672, 678 (7th Cir. 2009). From September 2010 through July 2011, Plaintiff's treating physicians diagnosed major depression, dysthymic disorder, anxiety, and panic disorder. (R. at 824, 905, 914). Major depressive disorder is characterized by "decreased physical, social, and role functioning." DSM-IV at 371. Some people with major depressive disorder "have isolated episodes . . ., whereas others have clusters of episodes, and still others have increasing frequent episodes as they grow older." Id. at 372.
The Commissioner contends that Plaintiff failed to demonstrate any additional mental functional limitations beyond those identified in the PRT. (Resp. 5). On the contrary, Plaintiff consistently complained of feeling depressed, hopeless, unmotivated, lethargic, uncontrollably angry, irritable, and confused. (R. at 862, 903, 910, 913). She reported recurrent panic attacks and passive suicidal thoughts. (Id.). Plaintiff's treating physicians observed anxiety, expansive, stressed and elevated mood, disjointed speech patterns, depression, desperation, and hostility. (Id. at 903, 904, 907-08, 910). They prescribed anti-depressant and antianxiety medications, and the dosages were increased after they became ineffective. (Id. at 266-67, 849, 903, 914, 915). Plaintiff's GAF was assessed at 54 and 50-55. (Id. at 905, 914). Her physicians recommended weekly counseling and psychotherapy. (Id. at 266, 862, 905-06, 912, 915). The ALJ cannot discuss only those portions of the record that support her opinion. See Myles, 582 F.3d at 678 ("An ALJ may not selectively consider medical reports, especially those of treating physicians, but must consider all relevant evidence. It is not enough for the ALJ to address mere portions of a doctor's report.") (citations omitted); Murphy v. Astrue, 496 F.3d 630, 634 (7th Cir. 2007) ("An ALJ cannot disregard medical evidence simply because it is at odds with the ALJ's own unqualified opinion."). Instead, the ALJ must consider all relevant evidence, and may not choose to disregard certain evidence or discuss only the evidence that favors his or her decision. See Herron v. Shalala, 19 F.3d 329, 334 (7th Cir. 1994).
The Commissioner contends that since all of the Parker-Starke Services treatment notes postdate Plaintiff's date last insured,
Second, the ALJ erroneously concluded that Plaintiff's treatment notes were "generally normal." (R. at 33). On the contrary, in March 2011, after Plaintiff had been taking Prozac for six months, Dr. Ragnavendra referred Plaintiff to mental health counseling, three times weekly, and increased Plaintiff's Prozac dosage. (Id. at 266-67, 849, 862, 903). On June 14, 2011, Plaintiff presented with anxiety symptoms, an expansive, stressed and elevated mood, and disjointed speech patterns, and Dr. Grupta recommended weekly individual therapy. (Id. at 903-006). On June 30, 2011, Dr. Kim diagnosed major depression, recurrent, and dysthymic disorder, gave a guarded prognosis,
The ALJ erroneously concluded that because Plaintiff's GAF score "only reflects a specific moment in time and is highly depending on [Plaintiff's] current situation, it provides no indication of [Plaintiff's] overall level of functioning over an extended period." (R. at 33). While the American Psychiatric Association no longer uses the GAF metric, see Williams v. Colvin, 757 F.3d 610, 613 (7th Cir. 2014), at the time of Plaintiff's psychological evaluations, clinicians still used GAF scores to indicate a "clinician's judgment of the individual's overall level of functioning." DSM-IV at 32. Here, Plaintiff's GAF score of 50-54 indicates moderate to serious symptoms, including suicidal ideations and serious impairment in social and occupational functioning. DSM-IV at 34. It's true that GAF scores are not dispositive of Plaintiff's disability. See Denton v. Astrue, 596 F.3d 419, 425 (7th Cir. 2010) (explaining that the GAF score does not necessarily reflect doctor's opinion of functional capacity because the score measures severity of both symptoms and functional level). Nevertheless, Plaintiff's GAF scores are evidence suggesting a far lower level of functioning than the ALJ assigned. Yurt v. Colvin, 758 F.3d 850, 859-60 (7th Cir. 2014) (Although the ALJ was not required to give any weight to individual GAF scores, "the problem here is not the failure to individually weigh the low GAF scores but a larger general tendency to ignore or discount evidence favorable to Yurt's claim, which included GAF scores from multiple physicians suggesting a far lower level of functioning than that captured by the ALJ's hypothetical and mental RFC."). And, as discussed above, the ALJ was obligated to consider this post-DLI evidence, especially since the GAF scores postdated the DLI by less than three months. Cf. Eichstadt v. Astrue, 534 F.3d 663, 666 (7th Cir. 2008) (post-DLI evidence indicating that claimant was currently disabled provided little if any evidence that she was disabled 15 years prior).
The treating psychiatrists' diagnoses were validated by other medical opinions. Dr. Ragnavendra, Plaintiff's general practitioner diagnosed depression, prescribed Prozac, and referred her for counseling. (R. at 266-67, 849, 862). Dr. Ungar, Plaintiff's neurologist, diagnosed panic and anxiety disorder.
Finally, the ALJ's reliance on the State agency consultants' evaluation is not supported by substantial evidence. The ALJ gave "significant weight to the opinions of the State agency physician's Psychiatric Review Technique as it is consistent with the evidence." (R. at 34). But the State agency consultant issued his evaluation without having reviewed significant medical evidence. For example, none of Plaintiff's psychiatric treatments at Porter-Starke Services were in the file when Dr. Hill performed his mental disability evaluation. Nor did Dr. Hill have Dr. Ungar's diagnosis of panic and anxiety disorder when he completed the PRT form.
In sum, the ALJ failed to "build an accurate and logical bridge from the evidence to [his] conclusion." Steele, 290 F.3d at 941 (internal quotation omitted). This prevents the court from assessing the validity of the ALJ's findings and providing meaningful judicial review. See Scott, 297 F.3d at 595. For the reasons set forth herein, the ALJ's decision is not supported by substantial evidence. On remand, the ALJ shall seek appropriate expert medical advice to determine what effects Plaintiff's mental illnesses have on her ability to work. The ALJ shall then reassess Plaintiff's RFC by "evaluating all limitations that arise from medically determinable impairments, even those that are not severe." Villano, 556 F.3d at 563. "In making a proper RFC determination, the ALJ must consider all of the relevant evidence in the record, even limitations that are not severe, and may not dismiss a line of evidence contrary to the ruling." Murphy v. Colvin, 759 F.3d 811, 817 (7th Cir. 2014) (citation omitted); see Goins v. Colvin, 764 F.3d 677, 681 (7th Cir. 2014) ("We keep telling the Social Security Administration's administrative law judges that they have to consider an applicant's medical problems in combination.") (collecting cases). The RFC shall be "expressed in terms of work-related functions" and include a narrative discussion describing how the evidence supports each conclusion, citing specific medical facts and nonmedical evidence. SSR 968p.
Because the Court is remanding on the mental impairment issue, the Court chooses not to address Plaintiff's other arguments. Nevertheless, on remand, after fully considering the effect of Plaintiff's mental illness on her ability to work, the ALJ shall reassess the weight to be given to Dr. Ungar's opinion. If the ALJ finds "good reasons" for not giving Dr. Ungar's opinion controlling weight, see Campbell v. Astrue, 627 F.3d 299, 306 (7th Cir. 2010), the ALJ shall explicitly "consider the length, nature, and extent of the treating relationship, frequency of examination, the physician's specialty, they types of tests performed, and the consistency and supportability of the physician's opinion," Moss v. Astrue, 555 F.3d 556, 561 (7th Cir. 2009), in determining the weight to give Dr. Ungar's opinion. The ALJ shall then reevaluate Plaintiff's physical and mental impairments and RFC, considering all of the evidence of record, including Plaintiff's testimony, and shall explain the basis of her findings in accordance with applicable regulations and rulings. Finally, with the assistance of a VE, the ALJ shall determine whether there were jobs that existed in significant numbers that Plaintiff could have performed through the date last insured.
For the reasons stated above, Plaintiff's request to reverse the ALJ's decision and remand for additional proceedings is
