DENISE J. CASPER, District Judge.
Plaintiff Maria Mendes ("Mendes") filed claims for Social Security disability insurance benefits ("SSDI") and supplemental security income ("SSI"). R. 11.
Mendes's alleged onset of disability was January 1, 2004, when she was 20 years old. R. 13, 17. She previously worked as a cashier and at a sandwich shop. R. 29-30, 225, 230. Mendes filed applications for SSDI and SSI, alleging she was unable to work due to her bipolar disorder. R. 13, 30.
Mendes filed applications for SSDI and SSI on July 27, 2011. R. 11. The Social Security Administration ("SSA") initially denied Mendes's claims on October 26, 2011, R. 11, 47-60, and again upon reconsideration on January 13, 2012, R. 11, 61-76. Mendes requested a hearing before an ALJ, R. 94-99, which was held on December 17, 2012. R. 11. In a written decision dated December 28, 2012, the ALJ determined Mendes was not disabled within the definitions of the Social Security Act and denied her claims. R. 18. On March 26, 2014, the Appeals Council ("AC") denied a request to review Mendes's claim, rendering the ALJ's decision the Commissioner's final decision. R. 1-3.
A claimant's entitlement to SSDI and SSI turns on whether she has a "disability," defined as an "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 has lasted or can be expected to last for a continuous period of not less than 12 months." 42 U.S.C. §§ 416(i), 423(d)(1)(A); 20 C.F.R. § 404.1505. The inability must be severe, rendering the claimant unable to do any of her previous work or any other substantial gainful activity which exists in the national economy. 42 U.S.C. § 423(d)(2); 20 C.F.R. § 404.1505.
The Commissioner follows a five-step process to determine whether an individual has a disability. 20 C.F.R. § 416.920. All five steps are applied to every applicant; the determination may be concluded at any step along the process.
The Court may affirm, modify or reverse a Commissioner's decision upon review of the pleadings and the record. 42 U.S.C. § 405(g). This review is limited, however, "to determining whether the ALJ used the proper legal standards and found facts upon the proper quantum of evidence."
The Court must accept the factual findings of the Commissioner as conclusive "if supported by substantial evidence." 42 U.S.C. § 405(g). Substantial evidence exists where "a reasonable mind, reviewing the evidence in the record as a whole, could accept it as adequate to support [the Commissioner's] conclusion."
In November 2004, Mendes saw Karen Fink ("Fink"), a licensed independent clinical social worker ("LICSW"). R. 480. Mendes told Fink that she had been hospitalized two months prior, had received medication and wanted to be back on medication after she stopped taking it a few days after her discharge.
That same month, Mendes saw Fink a second time. R. 471-72. She reported that she had started her medication and felt it was helping her. R. 472. Mendes reflected on an abusive relationship with a partner who had introduced her to drugs.
In November 2004, Mendes also saw Dr. Anna Fitzgerald ("Dr. Fitzgerald"), who knew Mendes from several previous admissions after her first manic episode. R. 474. During those admissions, she had been agitated, irritable and delusional with grandiose and paranoid themes.
In February 2005, Dr. Fitzgerald found that Mendes did not seem to have any psychosis. R. 467. Mendes' GAF remained at 60. R. 469. Eight months later, Mendes stated that she had stopped taking medication because it was hard to make her appointments. R. 460. Dr. Fitzgerald found her whispering while talking in a "potentially psychotic" manner and concluded Mendes was "apparently suffering a relapse." R. 460, 462. Mendes's GAF was 45. R. 462.
In December 2005, Mendes confirmed that she was having a stressful time at school and that she was suffering from social withdrawal, increased depression and paranoia. R. 456. Two weeks later, Mendes was feeling better. R. 450. Dr. Fitzgerald concluded that her bipolar disorder was "beginning to remit but still with some odd affect and possible milder thought disorder." R. 451. Mendes did "not appear entirely ready to return to school" but was "nonetheless . . . improving."
In January 2006, Mendes planned to return to school and was cautioned by Dr. Fitzgerald and Austin Lawrence, LICSW to take only two courses. R. 440, 442. In April 2006, Mendes stated she felt better but had recent sleep issues. R. 435. Two months later, Mendes's mood was stable and was largely without perceptual abnormalities although she heard voices sometimes. R. 431. Mendes told Dr. Fitzgerald she was worried she would start using cocaine again because of her old friends, even though she had no interest in doing so.
In August 2006, Dr. Fitzgerald found Mendes well. R. 426. Mendes was working at a sandwich shop and intended to restart college.
In March 2007, Mendes reported doing "well." R. 413. In September 2007, Dr. Fitzgerald mentioned Mendes's bright attire and mood. R. 403. Mendes showed no manic or depressed symptoms but was self-confident and "clearly pleased with her recent stability."
In December 2007, Mendes told Dr. Fitzgerald she felt great and was enjoying her courses. R. 398. Although she occasionally heard "a voice" when tired, Mendes denied feeling depression, mania or any sleep, appetite or energy changes.
In February 2008, Dr. Fitzgerald reported that Mendes was "functioning well." R. 394. Mendes sometimes heard voices but was able to "shrug them off."
In August 2008, Mendes was grieving her father's death. R. 382. She was feeling anxious and hearing more voices, but was functioning fine with no safety concerns.
In February 2009, Dr. Fitzgerald reported that Mendes was "[e]uthymic and friendly." R. 373. Mendes was proud to be taking psychology classes at school.
In April 2010, Dr. Fitzgerald reported that Mendes came to the appointment with her boyfriend. R. 355. Both felt she was doing well, but Dr. Fitzgerald noted that Mendes seemed a bit less ebullient and more anxious than usual.
In January 2011, Mendes was having trouble sleeping and more anxious and irritable. R. 503. In March 2011, Dr. Fitzgerald wrote that Mendes had left conflicting messages for her. R. 339. One message mentioned that she was very depressed and wanted something like Prozac.
In August 2011, Dr. Fitzgerald wrote that "[t]hings are going well." R. 331. Mendes was looking forward to her wedding and she was going back to school with only three courses to go.
In November 2011, Mendes had married, the couple was "happy" and she was doing well. R. 490. Mendes expressed an interest in working and had worked at a supermarket before, but she was worried she would get too tired.
In April 2012, Dr. Fitzgerald wrote that Mendes "[c]ontinues to worry and feel guilty sometimes in . . . [an] OCD and guilty delusional manner." R. 569. Church sometimes made her feel worse and she occasionally heard voices while attending.
In July 2012, Mendes and her husband reported that she was doing well. R. 564. Dr. Fitzgerald observed that despite some anxiety with her family, Mendes was "relatively euthymic," with no mania or psychosis.
In August 2012, Mendes told Dr. Fitzgerald that her mother-in-law had invited her to live with them but that she was unsure whether to accept. R. 560. With only two courses left, she expressed a desire to return to school.
In October 2012, Mendes reported she was tired of living with her family but also having issues with her husband. R. 572. Church remained helpful yet stressful.
In August 2011, Mendes submitted an adult function report to the SSA. R. 238, 245. She reported taking a while to dress and bathe. R. 239. She did not eat as much due to her medication.
On October 24, 2011, Dr. James Carpenter reviewed Mendes's records on initial review. R. 50, 56. He concluded that she did not have severe mental impairment because she was planning on getting married and going back to school and Dr. Fitzgerald reported that her bipolar disorder was in complete remission. R. 50, 56.
On January 12, 2012, Dr. Carol Montgomery reviewed Mendes's records for reconsideration. R. 65. She concluded that Mendes did not have severe mental impairment because there was no worsening of mental health symptoms and her disorder remained in full remission.
At the December 17, 2012 administrative hearing, the ALJ heard testimony from Mendes and vocational expert ("VE") Faith Johnson. R. 23-46. Mendes testified she was currently on welfare. R. 29. She last worked at a sandwich shop. R. 29-30. She graduated high school and had been working toward a college degree for ten years. R. 27-28. At the time of the hearing, she had stopped attending school and she testified that her grades had been poor. R. 41-42.
As to her bipolar disorder, she reported experiencing both depressed and manic states. R. 31. When depressed, she has crying spells every day that last a few minutes.
Mendes testified that she has trouble concentrating and has a poor memory. R. 34-35. Although capable of reading, she noted that she dislikes reading books because she gets confused and loses focus. R. 35. Mendes also reported hearing voices, either her mother's or her friends' voices. R. 36. The more active she was, the more voices she heard. R. 36. She testified that she would like to go to church every day as she had before, but she now limits it to once or twice a week. R. 38-39. When she went to church more often, she was hearing more voices. R. 38-39. She also had trouble sleeping regularly. R. 36-37.
Mendes noted that she does not cook because she has trouble focusing, often leading to burnt food. R. 39. She also reported that she does not clean or vacuum because she feels like she does not know how. R. 40. She does her own laundry, "little by little." R. 40. When manic, she tends to want to go shopping for groceries, but she shops quickly. R. 41.
The VE testified that for a hypothetical individual between age 20 and 29 with a high school education, no past relevant work experience, no exertional impairments, but who is frequently unable to understand, remember or carry out complex or detailed instructions, that person "would only be able to do unskilled work." R. 45. Assuming that Mendes's testimony was completely credible, the VE did not know of any jobs that Mendes could perform on a fulltime basis.
Following the five-step process, 20 C.F.R. § 416.920, at step one, the ALJ found Mendes was not engaged in substantial gainful activity and had not been since January 1, 2004, the date of the alleged onset of her disability. R. 13. At step two, the ALJ found, for the purposes of his decision, that her bipolar disorder was "severe."
Mendes seeks reversal of the ALJ's decision, or alternatively, remand for further proceedings. D. 28 at 1.
Mendes's first two arguments concern Dr. Fitzgerald. Mendes alleges that the ALJ committed legal error (1) by affording little, rather than controlling, weight to Dr. Fitzgerald's opinion that her "illness prevents her from working full time and is disabling," D. 29 at 8 (citing R. 566), and (2) by failing to provide good reasons for doing so.
Generally, an ALJ gives controlling weight to a treating physician's opinion only if that opinion is (1) "well-supported by medically acceptable clinical and laboratory diagnostic techniques" and (2) consistent with "other substantial evidence in [the claimant's] record." 20 C.F.R. § 404.1527(c)(2). An ALJ is not obligated to accept a treating physician's conclusions.
When a treating physician's opinion is not controlling, an ALJ considers six factors to determine the proper weight for that opinion: "(1) the length of the treatment relationship and the frequency of examination; (2) the nature and extent of the treatment relationship; (3) the relevant evidence in support of the medical opinion; (4) the consistency of the medical opinions reflected in the record as a whole; (5) whether the medical provider is a specialist in the area in which he renders his opinion; and (6) other factors which tend to support or contradict the opinion."
There is, however, "no requirement that an administrative law judge slavishly discuss" each factor in his decision.
Ultimately, whether the claimant is disabled is reserved for the Commissioner to determine. 20 C.F.R. §§ 404.1527(d), 416.927(d). As a result, the "opinion of a treating physician that a claimant is unable to work is entitled to no deference at all (as it is not a medical opinion)."
Here, the ALJ did not err in not giving controlling weight to Dr. Fitzgerald's opinions and did not fail to provide good reasons for doing so. First, Dr. Fitzgerald's comment that Mendes's "illness prevents her from working full time and is disabling" is not entitled to deference because it is not a medical opinion. R. 566;
After Mendes's first manic episode in 2004, Dr. Fitzgerald found that by late 2005, Mendes was improving and her bipolar disorder had begun to go into remission. R. 451. By mid-2006, Mendes was working at a sandwich shop and planning to restart college. R. 426. At the end of 2006, Mendes had completed two college courses and felt good about them. R. 418. A year later, in 2007, Mendes was pleased with her progress and Dr. Fitzgerald concluded that her disorder was in full remission. R. 403, 406.
For the next three years, Mendes continued to do well, even as she coped with the death of her father and another relative. R. 377, 382. She continued her college classes, R. 369, found a new supportive boyfriend who later became her fiancé, R. 343, and thought about looking for work, R. 348. By 2011, Mendes had married, R. 490, she had changed churches and was three classes away from getting her college degree. R. 331. In 2012, Mendes continued to be stable and twice expressed an interest in working at least part-time. R. 564, 572. Since 2007 and throughout this entire time, Mendes's bipolar disorder remained in remission and she received GAF scores ranging from 55 to 65, reflecting mild to moderate symptoms. See, e.g., R. 379, 361, 567. Both non-examining psychologists who reviewed Mendes's records up to January 2012 concluded that Mendes's mental impairment was not severe. R. 50, 56, 65.
Mendes faults the ALJ for relying on her GAF scores, arguing that doctors no longer use GAF scores as a diagnostic tool for a patient's functioning. D. 29 at 12. Mendes is correct that the American Psychiatric Association has stopped using the GAF score. D. 31 at 15 (citing
Here, the ALJ did not rely on GAF scores in isolation nor did he compare GAF scores from different doctors. Instead, the ALJ declined to give controlling weight to Dr. Fitzgerald's opinion that Mendes could not work because the ALJ noted the "inconsisten[cies]" between that opinion and Dr. Fitzgerald's own treatment notes, including but not limited to the GAF scores. R. 17. Specifically, the ALJ concluded that Dr. Fitzgerald's opinion was "inconsistent with the record, which show[ed] stable symptoms with medication and normal activities of daily living."
Mendes bears the burden to prove that her mental impairment meets the condition for one of the "listed" impairments in the Social Security regulations.
Mendes argues that the ALJ's conclusion was not supported by substantial evidence because the ALJ "selected isolated pieces of evidence" to support his determination. D. 32 at 9. For example, Mendes points out that the ALJ ignored her testimony at the hearing that she sometimes lacks motivation to cook and has crying spells every day. D. 29 at 11-12; D. 32 at 8.
The evidence as a whole supports the ALJ's decision. This is particularly so because "[c]onflicts in the evidence are for the ALJ to resolve, not for doctors or the courts."
More importantly, the standard is not whether the record could justify a different conclusion. The law is clear that "even if the administrative record could support multiple conclusions, a court must uphold the Commissioner's findings `if a reasonable mind, reviewing the evidence in the record as a whole, could accept it as adequate to support his conclusion.'"
The ALJ cited several different examples in Mendes's life to support his finding that Mendes showed only "mild restriction" for activities of daily living and "mild difficulties" in social functioning. R. 14. Mendes was able to go outside, take the bus, attend church and shop.
Although Mendes did testify that she had issues focusing while cooking and that she had daily crying spells, the ALJ found that Mendes's statements concerning the intensity, persistence and limiting effects of her symptoms were "not entirely credible." R. 16. Credibility determinations by an ALJ, "who observed the claimant, evaluated h[er] demeanor, and considered how that testimony fit in with the rest of the evidence, [are] entitled to deference, especially when supported by specific findings."
For the above reasons, the Commissioner's motion to affirm, D. 30, is ALLOWED and Mendes's motion to reverse or remand, D. 28, is DENIED. The Court ALLOWS nunc pro tunc Mendes's motion for an extension of time, D. 19.
