TIMOTHY S. BLACK, District Judge.
This is a Social Security disability benefits appeal. At issue is whether the administrative law judge ("ALJ") erred in finding the Plaintiff "not disabled" and therefore not entitled to supplemental security income ("SSI") and disability insurance benefits ("DIB"). (See Administrative Transcript ("Tr.") (Tr. 11-21) (ALJ's decision)).
Plaintiff filed for DIB and SSI on February 26, 2010, alleging disability beginning December 1, 2009, due to a combination of mental impairments. (Tr. 11, 184, 188, 226). Her applications were denied initially and upon reconsideration. (Tr. 87-90). Following a hearing, the ALJ issued a decision on August 28, 2012, concluding that Plaintiff was not disabled and retained the RFC to perform a full range of exertional work with certain non-exertional limitations. (Tr. 8-21)
The Appeals Council denied Plaintiff's request for review, making the ALJ's decision the final decision of the Commissioner. (Tr. 1-3). The Court has jurisdiction pursuant to 42. U.S.C. §§ 405(g) and 1383(c).
Plaintiff is 41 years old. (Tr. 19). She quit school in the tenth grade because she got pregnant and could not cope. (Tr. 411).
The ALJ's "Findings," which represent the rationale of her decision, were as follows:
(Tr. 11-21).
In sum, the ALJ concluded that Plaintiff was not under a disability as defined by the Social Security Regulations, and was therefore not entitled to SSI or DIB. (Tr. 21).
On appeal, Plaintiff argues that: (1) the ALJ failed to properly evaluate medical listing 12.05(c); (2) the ALJ incorrectly found substance abuse to be a material contributing factor; and (3) the ALJ failed to properly evaluate the opinions of the medical expert and the consultative examining psychologist. The Court will address each error in turn.
The Court's inquiry on appeal is to determine whether the ALJ's non-disability finding is supported by substantial evidence. 42 U.S.C. § 405(g). Substantial evidence is "such relevant evidence as a reasonable mind might accept as adequate to support a conclusion." Richardson v. Perales, 402 U.S. 389, 401 (1971). In performing this review, the Court considers the record as a whole. Hephner v. Mathews, 574 F.2d 359, 362 (6th Cir. 1978). If substantial evidence supports the ALJ's denial of benefits, that finding must be affirmed, even if substantial evidence also exists in the record upon which the ALJ could have found plaintiff disabled. As the Sixth Circuit has explained:
Felisky v. Bowen, 35 F.3d 1027, 1035 (6th Cir. 1994).
The claimant bears the ultimate burden to prove by sufficient evidence that she is entitled to disability benefits. 20 C.F.R. § 404.1512(a). That is, she must present sufficient evidence to show that, during the relevant time period, she suffered an impairment, or combination of impairments, expected to last at least twelve months, that left her unable to perform any job in the national economy. 42 U.S.C. § 423(d)(1)(A).
The record reflects that:
Plaintiff is divorced and at the time her application was filed had three dependent children (Tr. 188-189), with one child reaching majority since that time. Plaintiff reported that she lived with her boyfriend and two small children, and she spent her days cleaning the house and caring for the kids and her cat. (Tr. 209-210). Plaintiff reported that she is able to drive, manage her own personal hygiene and self-care, do laundry, and cook for her family. (Tr. 210-212). On her forms, Plaintiff wrote that her spelling was not good, but her responses were all spelled correctly. (Tr. 214-216).
On March 25, 2007, Plaintiff was taken to the emergency room due to reported threats of suicide. (Tr. 333). She was unconscious upon presentation to the ER, and later reported using drugs to self-medicate. (Tr. 340). Plaintiff indicated that she had been on a cocaine binge for several weeks. (Id.) The toxicology screening was positive for cocaine. (Tr. 335). She was discharged with a diagnoses of crack addiction and depression. (Tr. 338).
On April 4, 2007, Plaintiff presented to the hospital with complaints of a drug overdose and the toxicology screening was positive for cocaine. (Tr. 306, 309).
On January 5, 2010, Plaintiff presented to the ER with complaints of depression and suicidal ideation. (Tr. 333). Plaintiff admitted to crack cocaine use and the toxicology was positive for cocaine. (Tr. 335). She was diagnosed with depression and crack addiction and referred for outpatient detox and rehab. (Tr. 338).
The January 13, 2010 adult diagnostic assessment, notes a recent six day crack cocaine binge, and that she had abandoned her one and four year old children by leaving them with her boyfriend's family. (Tr. 357-367). Plaintiff admitted to suicidal ideation as well as prior physical and sexual abuse from her ex-husband. (Id.)
The February 12, 2010 mental health notes indicate prior childhood sexual abuse from age 9 to age 12 or 13. (Tr. 369-371). Plaintiff reported that she just sits and cries some days, that she gets hives from anxiety, and has mood swings and sleep problems due to racing thoughts. (Id.) Plaintiff was diagnosed with PTSD, cocaine dependence, cannabis dependence, and alcohol dependence. (Id.)
The February 23, 2010 initial psychiatric evaluation notes that Plaintiff was feeling sad, helpless, and hopeless, had mood swings, was irritable, easily agitated, had severe insomnia, racing thoughts, a history of impulsivity, unstable functioning, poor coping skills, and anxiety attacks. (Tr. 352). Plaintiff was diagnosed with bipolar disorder, cocaine dependence, cannabis dependence, and alcohol abuse. (Tr. 355).
The March 17, 2010, mental health transfer/discharge summary indicates diagnoses of bipolar disorder, PTSD, cocaine dependence, cannabis dependence, and alcohol dependence. (Tr. 438).
The March 19, 2010, mental health records indicate increased agitation, explosiveness, and poor sleep. (Tr. 376).
On March 25, 2010, Plaintiff presented by EMS to the hospital after having a relapse with crack and alcohol. (Tr. 380). Plaintiff indicated that she had been clean and sober for three months until the day she presented to the hospital. (Id.) The toxicology report was positive for cocaine. (Tr. 389).
From April 7, 2010 through April 12, 2010, Plaintiff was admitted to the Atrium Medical Center psychiatric unit for suicidal ideation. (Tr. 395-410). Prior to admission, Plaintiff had been cutting her wrists in a suicide attempt. (Tr. 396). Despite Plaintiff's statement that she had used crack the previous night, the toxicology was negative for drugs of abuse. (Tr. 408). Plaintiff was diagnosed with bipolar disorder and polysubstance abuse, and was assigned a GAF score of 25.
The April 16, 2010, mental health records indicate no substance abuse relapses, but continued anger problems and severe anxiety. (Tr. 467-468).
On April 30, 2010, Dr. Chiappone examined Plaintiff as part of a psychological consultative examination. (Tr. 411-417). Dr. Chiappone noted that Plaintiff was cooperative, independent, and understood the purpose of the evaluation. (Tr. 413). Plaintiff had goal directed comments, tight associations, and logical and relevant speech. (Id.) Plaintiff thought she "could make basic decisions regarding her future," and "conduct her own living arrangements." (Tr. 414). Her intellect was judged as "being in the borderline range." (Id.) Plaintiff reported daily use of crack cocaine over the past year until January 2010. (Tr. 412). Plaintiff complained of problems sleeping, with appetite fluctuation, decreased interests, daily crying, suicidal ideation, and feeling hopeless, helpless, and worthless. (Tr. 413). Plaintiff reported having panic attacks several times per day and flashbacks several times per week. (Id.) Dr. Chiappone noted that Plaintiff did not appear to exaggerate or minimize her complaints, that the history reported by Plaintiff appeared accurate, and that she did not appear to be malingering. (Tr. 379-380).
Dr. Chiappone administered IQ testing which yielded results of verbal 68, performance 63, and full scale 63.
Dr. Chiappone diagnosed Plaintiff with polysubstance dependence in remission, panic disorder without agoraphobia, depressive disorder, PTSD, and borderline intellectual functioning. Dr. Chiappone assigned a GAF of 45,
In May 2010, a state agency non-examining psychologist, Patricia Semmelman, Ph.D, reviewed some of the medical records and completed two assessment forms. (Tr. 418-435). Dr. Semmelman noted moderate mental limitations in a number of areas, including her ability to complete a normal workday or workweek, and a marked impairment in one area. (Tr. 432-35).
The May 3, 2010 mental health records indicate diminished cognitive functioning. (Tr. 473).
The May 7, 2010 mental health records indicate a somewhat brighter mood and some decrease in irritability, but continue to note that Plaintiff remains agitated and restless at night. (Tr. 463).
The May 10, 2010 mental health records indicate Plaintiff was anxious, her face was red, her jaw was clenched, and that she shook during the appointment. (Tr. 474). The records also indicate Plaintiff's complaints of increased anxiety and accompanying physical symptoms, as well as reports of feeling like her head was a "subway." (Id).
The May 25, 2010 and June 22, 2010 mental health records indicate Plaintiff was feeling better on her current medications, that she was compliant with treatment, and that she had not had any substance abuse lapses. (Tr. 458-461).
The July 13, 2010 mental health records indicate complaints of increased anxiety. (Tr. 486).
The July 16, 2010 mental health records document complaints of severe anxiety and that she was shaky upon presentation. (Tr. 456-457).
The July 29, 2010 mental health records indicate baseline mood with restricted affect and diminished thought process. (Tr. 487).
The September 17, 2010 mental health records indicate that Plaintiff was stable. (Tr. 530-531). December 9, 2010 mental health records indicate a little brighter mood and her compliance with treatment. (Tr. 532-533).
In December 2010, Robelyn Marlow, Ph.D., reviewed Plaintiff's records. (Tr. 491). Dr. Marlow affirmed Dr. Semmelman's assessment, including her belief that Plaintiff's mental impairments did not meet or equal any Listings, and that Plaintiff had no more than moderate limitations. (Tr. 491).
At the hearing, Dr. Herschel Goren testified as the medical expert. Dr. Goren stated that he did not disagree with Dr. Chiappone's assessment that Plaintiff had Borderline Intellectual Functioning, but that he thought she met Listing 12.05(C) because of her low IQ score and her depression. (Tr. 47-49). Dr. Goren thought Plaintiff's substance abuse was material to her disability prior to April 30, 2010, but was immaterial thereafter, and her abuse of crack, alcohol, and marijuana did not have an effect on her IQ scores. (Tr. 48-50). Dr. Goren thought that Plaintiff's usage of marijuana and alcohol preceding her hospitalization in January 2011 did not make her substance abuse material in 2011. (Tr. 51-52). Dr. Goren thought Plaintiff's impairments met Listing 12.04 due to her GAF score of 45. (Tr. 52-53).
On January 19, 2011, Plaintiff presented to Kettering Medical Center (Tr. 493-507) on referral by her mental health therapist due to self-mutilating and worsening depressive symptoms (Tr. 497). Plaintiff complained of frequent crying and mood swings, poor sleep and appetite, and racing thoughts. (Id.) Plaintiff indicated that she cuts herself because it makes her feel "real" as well as reporting thoughts of dying and intense urges to cut herself and thoughts of overdosing. (Tr. 497, 504).
From January 19, 2011 through January 24, 2011, Plaintiff was admitted to the psychiatric ward at Fort Hamilton Hospital. (Tr. 508-519). Plaintiff reported her last daily use of cocaine was in April 2010. (Tr. 509). Plaintiff was diagnosed with PTSD, mood disorder, history of polysubstance abuse, personality disorder, and assigned a GAF score of 20-25 on admission and a GAF score of 45-50 on discharge. (Tr. 508).
The March 4, 2011 mental health records indicate poor coping skills, no substance abuse relapses, and overall making progress with treatment. (Tr. 543-544).
The March 21, 2011 mental health adult diagnostic assessment notes symptoms of depression, anxiety, mood swings and a history of blackouts, as well as Plaintiff's report of sobriety since April 2010. (Tr. 545). Plaintiff was diagnosed with bipolar disorder, dissociative reactive disorder, PTSD, cocaine and cannabis dependence in remission, and she was assigned a GAF score of 48. (Tr. 552).
The April 1, 2011 mental health records document Plaintiff's complaints of feeling worse on Zyprexa, poor coping skills, and crying spells. (Tr. 562-563).
The June 1, 2011 mental health transfer/discharge summary indicates no change since March 21, 2011. (Tr. 564). The summary diagnoses Plaintiff with bipolar disorder, dissociative reactive disorder, and PTSD, and assigns a GAF score of 48. (Id.)
The August 1, 2011 mental health transfer/discharge summary indicates that Plaintiff completed AOD treatment and was in outpatient and aftercare for crack addiction. (Tr. 523). The records indicate that Plaintiff had maintained sobriety from crack since March 25, 2010, that she struggles with chronic anxiety, and that she has a few periods of stability interspersed with time in inpatient hospital care. (Tr. 524). The records further indicate that she has a very low threshold for stress and has few coping skills, that anxiety interferes with her ability to go out in public causing her to stay home almost all of the time, and that she has nightmares a couple of times per month. (Id.)
The October 11, 2011 mental health records indicate Plaintiff remains free of substance abuse. (Tr. 521).
The December 13, 2011 mental health records indicate Plaintiff is stable, compliant with treatment, and free of substance abuse. (Tr. 575-576).
The February 6, 2012 mental health adult diagnostic assessment indicates sobriety from crack since March 25, 2010, struggles with chronic high levels of anxiety, a very low threshold for stress, and few coping skills. (Tr. 578). Plaintiff was diagnosed with bipolar disorder, dissociative reactive disorder, PTSD, cocaine dependence in remission, cannabis dependence in remission, and alcohol dependence in remission and she was assigned a GAF score of 50. (Tr. 580).
First, Plaintiff maintains that the ALJ failed to properly evaluate Listing 12.05. The ALJ found that Plaintiff did not meet Listing 12.05, because the record did not document an IQ of 60-70 and a physical or other mental impairment imposing additional and significant work related limitations.
Listing 12.05 requires a claimant to show "significantly subaverage intellectual functioning with deficits in adaptive functioning initially manifested during the developmental period, i.e., the evidence demonstrates or supports onset of the impairment before age 22." 20 C.F.R. Part 404, Subpt. P, App. 1 at § 12.05. Subparagraph C of this listing requires "[a] valid verbal, performance, or full scale IQ of 60 through 70 and a physical or other mental impairment imposing an additional and significant work-related limitation of function[.]" Id. at § 12.05C. To meeting Listing 12.05(C), an individual's impairment must satisfy both the diagnostic description of mental retardation in the introductory paragraph and the requirements set forth in subparagraph C. Id. at § 12.00A.
Although Plaintiff reported that she quit school in tenth grade, she stated that she did so mainly because she got pregnant and could not cope. (Tr. 411). Plaintiff's records show that IQ testing in 1984 (when she was 11) revealed a verbal IQ of 90 and a Performance IQ of 95. Plaintiff was said to "function within the average range of intellectual ability." (Tr. 628-629). IQ testing three years later (when Plaintiff was 14), revealed an average IQ score of 86, which is considered an indication of low average intelligence. (Tr. 626). Individual Education Plans ("IEP") for 1986-1987, 1987-1988 show that Plaintiff was in all regular classes, but was given additional tutoring. (Tr. 619, 623). An IEP was recommended for Plaintiff because her family vacationed in Florida for three months each winter, and even though she attended school in Florida during that time, "the yearly trips to Florida with her family may be an obstacle for her. Amy needs time to readjust to her academic program...when she returns from Florida. The change in schools and in teachers would create an adjustment problem for any student." (Tr. 629, 631). Accordingly, Plaintiff failed to evidence adaptive deficits prior to age 22.
Dr. Chiappone, the consultative psychological examiner, performed an IQ test on April 30, 2010. Plaintiff's full scale IQ score was 63, but this was a low estimate, and based on her functional level, she was diagnosed with borderline intellectual functioning. (Tr. 415-416). After examination, Dr. Chiappone opined that Plaintiff "could make basic decisions regarding her future," and "conduct her own living arrangements." (Tr. 414). Daniels v. Comm'r of Soc. Sec., 70 Fed. App'x 868, 872 (6th Cir. 2003) ("The ALJ acknowledged Plaintiff's WAIS-R performance I.Q. of 67, but he determined that she nevertheless was not mentally retarded, pointing out Dr. Berg's observation that she clinically appeared to function at a level exceeding her test score."). In fact, Dr. Chiappone assigned a functional GAF score of 55, because Plaintiff only had moderate functional limitations and was "capable of basic tasks." (Tr. 415-16).
Plaintiff argues that the ALJ should have adopted Dr. Goren's opinion. Dr. Goren opined that Plaintiff met Listing 12.05, because of her low IQ score plus her depression. (Tr. 48-49). In reaching his opinion, Dr. Goren narrowly focused his analysis on Plaintiff's IQ score. (Id.) The ALJ rejected Dr. Goren's analysis because a low IQ score is only one component of mental retardation.
Accordingly, the ALJ properly found that Plaintiff's impairments did not meet Listing 12.05, because Plaintiff failed to evidence both adaptive deficits prior to age 22 and an additional and significant work-related limitation.
Next, Plaintiff argues that the ALJ incorrectly found that substance abuse was a material contributing factor to meeting Listing 12.04 and 12.09.
Pursuant to the Contract with America Advancement Act of 1996, disability benefits cannot be awarded to an individual where drug addiction or alcoholism is a material contributing factor to the finding of disability. Bartley v. Barnhart, 117 F. App'x 993, 998 (6th Cir. 2004). The regulations state in part:
20 C.F.R. § 416.935(b)(1)-(2). If the claimant's remaining limitations no not render the claimant disabled, then the claimant's drug or alcohol problem will be deemed a contributing factor material to his/her disability. 20 C.F.R. § 416.935(b)(2)(i). "To make a materiality determination, an ALJ may `look at a claimant's periods of sobriety and compare those periods to times when the claimant was abusing substances.'" Mulkey v. Comm'r of Soc. Sec., No. 1:10-cv-466, 2011 U.S. Dist. LEXIS 111386, at *1 (W.D. Mich. Sept. 29, 2011)). The claimant bears the ultimate burden of proving his substance abuse is not a contributing factor material to his disability. Underwood v. Comm'r of Soc. Sec., No. 4:08cv2540, 2010 U.S. Dist. LEXIS 5085, at *6 (N.D. Ohio Jan. 22, 2010).
The ALJ found that Plaintiff met Listing 12.04
Dr. Goren testified that Plaintiff's drug and alcohol abuse was material to her disability prior to April 2010, because the only mental health treatment prior to that date was due to her alcohol, marijuana, and crack usage. (Tr. 48). After this date, Plaintiff reported that she was no longer using crack, so Dr. Goren opined that her substance abuse was no longer material to her impairments. (Tr. 48-52). However, while Plaintiff states that she last used crack in April 2010, she had used alcohol and marijuana prior to her January 2011 hospitalization. (Tr. 508-509). Accordingly, substantial evidence supports the ALJ's determination that Plaintiff's substance abuse was materially involved in her disability prior to January 2011, because it resulted in her hospitalization. (Tr. 14-15). Once Plaintiff got her substance abuse under control after her January 24, 2011 discharge, her GAF scores started improving and she no longer sought impatient or emergency room treatment, and began reporting that she was stable. (Tr. 19).
While Dr. Goren stated that the January 2011 hospitalization did not affect his belief that Plaintiff's substance abuse was immaterial to her disability after April 2010, he did not explain his reasoning. (Tr. 52). Dr. Goren merely declared the two were not related. The ALJ is not bound by conclusory medical opinions. White v. Comm'r of Soc. Sec., 572 F.3d 272, 286 (6th Cir. 2009) ("Conclusory statements from physicians are properly discounted by ALJs."). Here, Dr. Goren's pronouncements about when substance abuse was no longer material were not based on the evidence and were not properly explained, so they were given little weight. Buxton v. Halter, 246 F.3d 762, 773 (6th Cir. 2001) ("[T]he ALJ is not bound by conclusory statements of doctors, particularly where they are unsupported by detailed objective criteria and documentation.").
The ALJ noted that Plaintiff claimed she last used marijuana in March 2011. (Tr. 18). Therefore, it was more reasonable to conclude that "her disability due to drug and alcohol abuse ended January 24, 2011, when she was last admitted for drug treatment and rehabilitation." (Id.) The ALJ based this, in part, on the fact that "there has been no further hospital treatment for substance abuse issues" after that date. (Tr. 16). This was a reasonable basis upon which the ALJ could form his opinion about when substance abuse was no longer material, and it is supported by the record.
Accordingly, the ALJ's finding that Plaintiff's substance abuse was a material contributing factor to meeting Listing 12.04 and 12.09 is supported by substantial evidence.
Finally, Plaintiff claims that the ALJ failed to properly evaluate the opinions of the medical expert and the consultative examining psychologist.
Dr. Chiappone's opinion that Plaintiff had marked limitations in concentration and attention were undermined by his own observations. Specifically, Dr. Chiappone noted that when he administered the IQ tests, Plaintiff "was able to understand and follow direction," but her persistence was limited and she gave up easily, which resulted in a "slight low estimate" of her abilities. (Tr. 19, 412). As the ALJ explained, this undermined Dr. Chiappone's opinion that Plaintiff's limitations in concentration and attention were marked. (Tr. 19). Moreover, Dr. Chiappone opined that Plaintiff "could make basic decisions regarding her future" and "conduct her own living arrangements" which contradicts his finding of marked restriction in concentration and attention. (Tr. 414).
Dr. Semmelman also discussed Plaintiff's consultative examination with Dr. Chiappone in great detail. (Tr. 434-435). While Dr. Chiappone thought Plaintiff would have marked impairments in concentration, Dr. Semmelman found that "concentration and attention is no worse than moderately impaired." (Tr. 434). In support, she pointed to Plaintiff's wide variety of daily activities and the fact that treatment notes "do not show her to be distractible." (Id.) Dr. Semmelman went on to note that Dr. Chiappone remarked that Plaintiff "did not put forth her best effort" that she "gave up easily and her [activities of daily living] shows she has the capacity to sustain concentration and attention for routine tasks." (Id.) Dr. Semmelman concluded that Plaintiff "appears capable of understanding and following routine oral and written directions in a predictable environment with no more than superficial social demands. She would likely perform best in a setting which is not fast paced or of high demand." (Tr. 435).
The ALJ also discounted Dr. Goren's testimony because it was not consistent with the evidence as a whole. 20 C.F.R. § 404.1527(c)(4), 416.927(c)(4) ("Consistency. Generally, the more consistent an opinion is with the record as a whole, the more weight we will give to that opinion"). See, e.g., supra Section II.B, explaining that Dr. Goren's analysis about Listing 12.05 was not supported by substantial evidence.
Accordingly, the ALJ properly evaluated the opinions of Drs. Chiappone and Goren.
For the foregoing reasons, Plaintiff's assignments of error are unavailing. The ALJ's decision is supported by substantial evidence and is affirmed.