MEMORANDUM AND ORDER DENYING PLAINTIFF'S MOTION FOR SUMMARY JUDGMENT AND GRANTING DEFENDANT'S CROSS MOTION FOR SUMMARY JUDGMENT

FRANCES H. STACY, Magistrate Judge.

Before the Magistrate Judge1 in this social security appeal is Plaintiff's Motion for Summary Judgment (Document No. 14), Defendant's Cross Motion for Summary Judgment (Document No. 15), and Defendant's Response to Plaintiff's Motion for Summary Judgment (Document No. 16). After considering the cross motions for summary judgment, the administrative record, and the applicable law, the Magistrate Judge ORDERS, for the reasons set forth below, that Defendant's Cross Motion for Summary Judgment (Document No. 15) is GRANTED, Plaintiff's Motion for Summary Judgment (Document No. 14) is DENIED, and the decision of the Commissioner is AFFIRMED.

I. Introduction

Plaintiff, Samantha Guzik ("Guzik" or "Plaintiff") brings this action pursuant to the Social Security Act ("Act"), 42 U.S.C. 405(g), seeking judicial review of a final decision of the Commissioner of Social Security Administration ("Commissioner") denying her application for disability insurance benefits and supplemental security income. Guzik argues that the Administrative Law Judge ("ALJ") failed to consider all the evidence when rendering a decision on Guzik's claim. Guzik argues that the ALJ did not fully address Guzik's mental health impairments. Further, the ALJ failed to give proper weight to available medical records from the Department of Veteran's Affairs. Guzik seeks an order reversing the ALJ's decision, and awarding benefits, or in the alternative, remanding her claim for further consideration. The Commissioner responds that there is substantial evidence in the record to support the ALJ's decision that Guzik was not disabled, that the decision comports with applicable law, and that the decision should, therefore, be affirmed.

II. Administrative Proceedings

On July 15, 2014, Guzik filed for social security disability insurance benefits and supplemental security income claiming she has been disabled since December 27, 2007, due to psychophysiological insomnia, severe depression, and anxiety disorder. (74-94, 221-230). The Social Security Administration denied her applications at the initial and reconsideration stages. (74-124). On February 26, 2015, Guzik requested a hearing before an ALJ. (138-139). The Social Security Administration granted her request, and the ALJ held a hearing on June 1, 2016. (185-212, Tr. 43-73). On July 26, 2016, the ALJ issued his decision finding Guzik was not disabled. (25-37). Guzik sought review by the Appeals Council of the ALJ's adverse decision. (314). The Appeals Council will grant a request to review an ALJ's decision if any of the following circumstances are present: (1) it appears that the ALJ abused her discretion; (2) the ALJ made an error of law in reaching her conclusion; (3) substantial evidence does not support the ALJ's actions, findings, or conclusions; (4) a broad policy issue may affect the public interest or (5) there is new and material evidence and the decision is contrary to the weight of all the record evidence. After considering Guzik's contentions in light of the applicable regulations and evidence, the Appeals Council, on November 23, 2016, concluded that there was no basis upon which to grant Guzik's request for review. (6-11). The ALJ's findings and decision thus became final.

After requesting an extension of time to file a civil action with the Social Security Administration, Guzik timely filed civil action no. 4:17-cv-01065, Samantha Guzik v. Nancy A. Berryhill Acting Commissioner of the Social Security Administration in the United States District Court for the Southern District of Texas requesting review of the ALJ's decision. (Document No. 1). Guzik has filed a Motion for Summary Judgment (Document No. 14). Likewise, the Commissioner has filed a Cross Motion for Summary Judgment (Document No. 15) and a Response to Plaintiff's Motion for Summary Judgment (Document No. 16). This appeal is now ripe for ruling.

The evidence is set forth in the transcript, pages 1 through 533. (Document No. 7). There is no dispute as to the facts contained therein.

III. Standard for Review of Agency Decision

The court, in its review of a denial of disability benefits, is only "to [determine] (1) whether substantial evidence supports the Commissioner's decision, and (2) whether the Commissioner's decision comports with relevant legal standards." Jones v. Apfel, 174 F.3d 692, 693 (5th Cir. 1999). Indeed, Title 42, Section 405(g) limits judicial review of the Commissioner's decision as follows: "[t]he findings of the Commissioner of Social Security as to any fact, if supported by substantial evidence, shall be conclusive." 42 U.S.C. § 405(g). The Act specifically grants the district court the power to enter judgment, upon the pleadings, and transcript, "affirming, modifying, or reversing the decision of the Commissioner of Social Security with or without remanding the case for a rehearing" when not supported by substantial evidence. Id. While it is incumbent upon the court to examine the record in its entirety to decide whether the decision is supportable, Simmons v. Harris, 602 F.2d 1233, 1236 (5th Cir. 1979), the court may not "reweigh the evidence in the record nor try the issues de novo, nor substitute its judgment" for that of the Commissioner even if the evidence preponderates against the Commissioner's decision. Chaparo v. Bowen, 815 F.2d 1008, 1009 (5th Cir. 1987); see also Jones at 693; Cook v. Heckler, 750 F.2d 391, 392 (5th Cir. 1985). Conflicts in the evidence are for the Commissioner to resolve. Anthony v. Sullivan, 954 F.2d 289, 295 (5th Cir. 1992).

The United States Supreme Court has defined "substantial evidence," as used in the Act, to be "such relevant evidence as a reasonable mind might accept as adequate to support a conclusion." Richardson v. Perales, 402 U.S. 389, 401 (1971) (quoting Consolidated Edison Co. v. N.L.R.B., 305 U.S. 197, 229 (1938)). Substantial evidence is "more than a scintilla and less than a preponderance." Spellman v. Shalala, 1 F.3d 357, 360 (5th Cir. 1993). The evidence must create more than "a suspicion of the existence of the fact to be established, but no `substantial evidence' will be found only where there is a `conspicuous absence of credible choices' or `no contrary medical evidence.'" Hames v. Heckler, 707 F.2d 162, 164 (5th Cir. 1983) (quoting Hemphill v. Weinberger, 483 F.2d 1127 (5th Cir. 1973)).

IV. Burden of Proof

An individual claiming entitlement to disability insurance benefits under the Act has the burden of proving her disability. Johnson v. Bowen, 864 F.2d 340, 344 (5th Cir. 1988). The Act defines disability 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 which 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). The impairment must be proven through medically accepted clinical and laboratory diagnostic techniques. Id. § 423(d)(3). The impairment must be so severe as to limit the claimant in the following manner:

Id. § 423(d)(2)(A). The mere presence of an impairment is not enough to establish that one is suffering from a disability. Rather, a claimant is disabled only if she is "incapable of engaging in any substantial gainful activity." Anthony v. Sullivan, 954 F.2d 289, 293 (5th Cir. 1992) (quoting Milan v. Bowen, 782 F.2d 1284 (5th Cir. 1986)).

The Commissioner applies a five-step sequential process to determine disability status:

Id., 954 F.2d at 293; see also Leggett v. Chater, 67 F.3d 558, 563 n.2 (5th Cir. 1995); Wren v. Sullivan, 925 F.2d 123, 125 (5th Cir. 1991). Under this formula, the claimant bears the burden of proof on the first four steps of the analysis to establish that a disability exists. If successful, the burden shifts to the Commissioner, at step five, to show that the claimant can perform other work. McQueen v. Apfel, 168 F.3d 152, 154 (5th Cir. 1999). Once the Commissioner demonstrates that other jobs are available, the burden shifts, again, to the claimant to rebut this finding. Selders v. Sullivan, 914 F.2d 614, 618 (5th Cir. 1990). If, at any step in the process, the Commissioner determines that the claimant is or is not disabled, the evaluation ends. Leggett, 67 F.3d at 563.

In the instant action, the ALJ determined, in her July 26, 2014, decision that Guzik was not disabled at step five. (25-37). In particular, the ALJ determined that Guzik had not engaged in substantial gainful activity since December 27, 2007, the alleged onset date, and that she met the insured status requirements of the Act through December 31, 2019 (step one); that Guzik's diagnoses of affective disorder, anxiety disorder, and borderline personality disorder were severe impairments (step two); that Guzik did not have an impairment or combination of impairments that met or medically equaled one of the listed impairments in Appendix 1 of the regulations (step three); that Guzik had the RFC to perform a full range of work at all exertional levels but with the following nonexertional limitations: "She can perform simple, routine, repetitive tasks, with occasional changes in a routine work setting; she can occasionally interact with co-workers and the general public." (31).

The ALJ further found that Guzik was unable to perform any past relevant work (step four); and that based on Guzik's RFC, age, education, work experience, and the testimony of a vocational expert, that Guzik could perform work as an industrial cleaner sweeper, packager, and label coder, and that Guzik was not disabled within the meaning of the Act (step five). (35-36). As a result, the Court must determine whether substantial evidence supports the ALJ's step five finding.

In determining whether substantial evidence supports the ALJ's decision, the court weighs four factors: (1) the objective medical facts; (2) the diagnosis and expert opinions of treating, examining and consultative physicians on subsidiary questions of fact; (3) subjective evidence as testified to by the plaintiff and corroborated by family and neighbors; and (4) the plaintiff's educational background, work history, and present age. Wren, 925 F.2d at 126.

V. Discussion

The objective medical evidence shows that Guzik has been treated for anxiety, depression anger, insomnia, and severe attention and concentration problems.1 The record consists of medical records including correspondence of Bill Abright, PhD, LCSW dated July 23, 2007 and an October 31, 2007 Diagnostic Polysomnography Report.2 The records show that Dr. Abright met with Guzik for several counseling sessions between July 23, 2007 and October 31, 2007.3 Dr. Abright evaluated Guzik for depression, anxiety, and fatigue including excessive daytime sleepiness.4 In a July 23, 2007 letter to his medical staff, Dr. Abright expressed concern about Guzik's high level of depression and generalized anxiety, and stated, ". . . Based on my clinical judgment, I would definitely give Ms. Davis5 a provisional diagnosis of Major Depressive Disorder with anxiety symptoms that is often expressed as anger and extreme frustration." Further, the Multiple Sleep Latency Test administered on October 31, 2007, at the Georgetown Sleep Center showed a score of nineteen out of twenty-four points indicating excessive daytime sleepiness. Guzik was taking Zoloft, an anti-anxiety medication, and Ambien, a prescription sleep aide, at the time of the test.6

The record further reflects that between December 2013 and the end of May 2014, Guzik received primary care treatment at the One Health Ohio Community and Medical and Dental Center ("One Health Ohio")7. The treatment notes are narrative and summarize the office visits. During Guzik's initial visit on December 27, 2013, a "Patient Plan" was generated by Marian Mattern, MSN, CNP, and in addition to being treated for flu-like symptoms, Guzik was given dietary counseling, physical activity counseling, tobacco cessation counseling, and was referred to mental health counseling due to a diagnosis of mood disorder.8 It was also noted that Guzik takes 25 milligrams ("mg") of Zoloft daily.9

In a visit to One Health Ohio on January 6, 2014, Guzik presented with symptoms associated with fatigue.10 Guzik was administered a Patient Health Questionnaire (PHQ-9) and was assessed with an initial diagnosis of Major Depressive Disorder based upon the screening total.11 The psychiatric evaluation during the same visit was summarized by Dr. Dwinnells as follows:

Guzik was diagnosed with depression. M. Dwinnells increased Guzik's daily dosage of Zoloft to 50 mg, and she was referred for further mental health counseling.12 Guzik's Zoloft prescription was increased again to 100 mg during a visit with Marrian Mattern, MSN, CNP on March 19, 2014, for insomnia.13 During a May 20, 2014 office visit, Guzik complained of depression, diminished interest or pleasure, difficulty sleeping, and depressed mood.14 Guzik's prescription for Zoloft was renewed at the same dosage of 100 mg per day.15 During Guzik's final visit at One Health Ohio a week later on May 27, 2014, Guzik was diagnosed with chlamydia and administered an oral antibiotic.16 In a letter dated August 15, 2014, One Health Ohio indicated they attempted to contact Guzik several times regarding appointments, but she never returned for any visits with this provider.17

During June 2014, the record reveals that Guzik began receiving mental health counseling at Coleman Behavioral Health ("Coleman").18 The record reflects that Guzik had an initial Access Diagnostic Assessment on June 3, 2014 with Dr. Marsha Schott, and a follow-up counseling session on July 2, 2014, with Dr. Jamie Hain.19 The session notes are narrative in nature and contain primarily subjective reports by Guzik.20 In the initial session at Coleman, Guzik reported that she was attempting to obtain social security disability and veteran's disability.21 Guzik reported that she served in the Army from 2006-2007 but was dishonorably discharged due to habitual lateness.22 Guzik further reported that she had difficulty sleeping most nights and went forty-eight hours without sleep in the past, interfering with her ability to get out of bed in the morning to go to work.23 Guzik denied suicidal intentions but admitted there were times when "I think about killing people" from anger.24 Guzik also admitted that she was arrested during 2007 for animal cruelty and that she beat her own dog out of rage.25 Overall, Guzik concluded that she felt fearful because it was becoming more difficult for her to control her anger. She also reported auditory hallucinations in which should could hear God speaking to her and that she felt her life was "insane".26

Providers noted that Guzik was not taking medication due to pregnancy, and had no history of substance abuse or prior psychiatric hospitalizations.27 Dr. Schott also noted that Guzik's seven-month-old daughter had died due to an unknown cause.28 The following is a summary of Guzik's DSM diagnoses as of June 3, 2014 made by the providers at Coleman and Guzik's Global Assessment Functioning score as of that date:

According to the record, Guzik received no further treatment at Coleman. Guzik was evaluated for a disability determination by unit physician Jennifer Haaga, Psy.D. on December 18, 2014.29 Dr. Haaga completed a mental residual functional capacity assessment of Guzik during a consultative visit.30 Dr. Haaga's evaluation consisted of a face-to-face clinical interview with Guzik wherein they discussed: Guzik's personal history, educational history, community problems, substance abuse history, health history and medications, mental health history, work history, and Guzik's activities of daily living.31

Dr. Haaga summarized the results of Guzik's mental status examination as follows32:

As for Guzik's level of functioning, Dr. Haaga wrote33:

Dr. Haaga's DSM-5 Diagnoses and final prognosis were34:

For Dr. Haaga's overall Functional Assessment she opined36:

Overall, Dr. Haaga opined that anger and anxiety will occasionally interfere with Guzik's functionality, but that she has an adequate support system in place through family to help influence how she may cope with these issues in a work setting. Further, Dr. Haaga opined that Guzik is capable of comprehending and completing both simple and routine tasks despite limitations that may arise should the demands or stresses of a job become too great.37 If Guzik engaged in treatment, Dr. Haaga predicted that her psychiatric symptoms would likely subside. Ultimately, Guzik's claim for social security disability was denied.38

The record further reflects that commencing January 2015, Guzik began receiving extensive primary and mental health care through the Department of Veteran's Affairs ("VA").39 Guzik received primary care treatment, psychotherapy and medications for treatment of mental issues from various doctors between February 2015 and the beginning of May 2016 at VA clinics.40 The available notes are narrative in nature.

In an initial visit to the Cleveland VA Medical Center ("Cleveland VAMC") on February 20, 2015, Guzik was assigned a Mental Health Coordinator, and an outpatient Mental Health Treatment Plan was established to treat depression, anger, and irritability.41 The goal of the treatment plan was to "reduce depressive symptoms of anger, irritability, loss of interest and motivation, and low energy."42 Guzik received a risk assessment as a victim of abuse.43 In an interpretative summary, it was noted that Guzik was on time for her appointment, brought her six-week-old infant along, and that she interacted with him in a "loving and appropriate way."44 Further, Guzik was perceived to be polite, cooperative, and alert by treating medical personnel.45

Guzik returned to the Cleveland VAMC for a scheduled individual supportive therapy session with Julie Ainslie ("Ainslie") on February 24, 2015.46 It was noted that Guzik planned to move to Texas to re-unite with her ex-husband, and that she sent him $3,000 so he could find them a place to live, but did not hear from her ex-husband after sending him the money.47 Guzik indicated that she has an issue with knowing who to trust and that if she were to get back with her ex, she would get over her depression because she would be more motivated to shower and cook for someone other than herself.48 Ainslie supported Guzik's insights while providing empathy and active listening.49 Ainslie also brought it to Guzik's attention that she was capable of being assertive and even aggressive (as self-reported by Guzik) in other situations, and that Guzik could improve upon these situations with continued therapy.50

On April 3, 2015, Guzik had an individual psychotherapy session with Ainslie.51 Guzik brought along her six-year-old son.52 Guzik was casually dressed and displayed adequate hygiene and grooming.53 Guzik's attitude was polite and cooperative but her mood was depressed, anxious, and angry.54 During the session, Guzik's thought process was coherent and logical with no flight of ideas or loose associations, and she posed a low risk of harm to herself or others.55 Guzik reported that she felt worse and was still having difficulties motivating herself to clean or shower.56 Guzik also expressed that she was yelling at her children often and out of concern that she might harm her infant child, so she left the infant with a trusted friend for the week.57 Ainslie, however, noted that Guzik interacted warmly and appropriately with her son during the session.58 Ainslie further discussed that Guzik was likely experiencing depression and that Guzik should contact Children's Services to ask for help related to her children. Ainslie also advised Guzik that if the conditions of her mental health status and messy home did not improve, Ainslie would be required to call Children's Services.59 Guzik was calm towards the end of the session and agreed to schedule another therapy session for the following week.60

Guzik appeared for her next individual psychotherapy session with Ainslie on April 10, 2015.61 Guzik presented with her six-year-old and her three-year-old children.62 Again, Guzik was appropriately dressed and groomed, and appeared polite and cooperative.63 Guzik explained to Ainslie that she cleaned up part of her home, and that her infant son had returned to her care.64 Ainslie noted that she interacted appropriately with her present children during the session.65 Ainslie also provided active listening and validation, and informed Guzik that she had achieved some positive things since her last session.66 Guzik agreed to return for another therapy session in two weeks and was calm at the end of the session.67

Guzik had a primary care visit with Sharon Phillips ("Phillips"), a nurse specialist, on April 15, 2015.68 Guzik was dressed casually and appropriately, and her attitude was pleasant yet somewhat tense.69 Guzik smiled and initiated appropriate conversation with Phillips.70 Guzik presented with symptoms suggestive of bi-polar disorder, including: moderate anxiety, mood swings, hypersexual behavior, excessive spending, extremes in moods, anger, depression, irritability, excessive talking, and racing thoughts.71 Phillips noted that the mood extremes may be related to the birth of Guzik's infant during January 2015, and Guzik was prescribed Divalproex, a mood stabilizer.72 Phillips instructed Guzik to monitor her response to the new pharmacology regimen, and to return in one month for a follow-up appointment.73

On April 20, 2015, Guzik saw psychologist Dr. Emily Breighner for completion of a V.A. Disability Benefits Questionnaire ("DBQ") for a Psychiatric Mental Disorder Compensation and Pension examination.74 Guzik was on time for her scheduled exam and brought her infant son and three-year old son with her.75 Guzik's self-presentation was dramatic with loud, rapid speech.76 Her insight and judgement were fair at present, and she presented with emotional lability and immaturity.77 Further, Guzik endorsed thoughts of suicide without plan, and indicated her children were protective factors preventing her from taking suicidal action.78

In addition to reviewing all of Guzik's available Veteran's Affairs medical records and her military separation documents,79 Dr. Breighner administered the Beck Depression Inventory — Second Edition.80 Guzik scored a forty-one (41) out of sixty-three (63), and score above twenty-nine (29) indicates severe depression.81 Guzik was diagnosed with Unspecified Bipolar Related Disorder, PTSD related to death of daughter during 2010, and Borderline Personality Disorder were listed on the DBQ.82 Based on the test results, Dr. Breighner further indicated that Guzik would experience occupational and social impairment with deficiencies in most areas, including work, school, family relations, judgment, thinking and/or mood.83 In explaining Guzik's occupational and social impairments, Breighner wrote:

Dr. Breighner further opined that Guzik lacked family and social support since her closest family members lived in Florida,85 and that she had difficulty forming and maintaining relationships with others.86 Further, after reviewing her military and occupational history, Breighner further found that Guzik had a history of chronic interpersonal conflicts and difficulty coping with stress in occupational settings, which included being fired from multiple jobs and discharged from the army after serving less than two years.87

Dr. Breighner's overall conclusion was that Ms. Guzik had a significant psychiatric disability.88 Based on evidence obtained during the clinical interview, psychological testing, and medical records, the level of severity for Guzik's service related disability was established at seventy (70) percent by Dr. Breighner.

The following day, April 21, 2015, Guzik returned to the Cleveland VAMC for a post-partum appointment scheduled four months after the birth of her infant son.89 Guzik noted little residual pain in her back from the epidural, and stated she was not sexually active at the time.90 Guzik was prescribed oral contraceptives but expressed she was poorly compliant, and requested to be put back on the Nuva Ring to prevent pregnancy.91 The postpartum check was overall unremarkable and Guzik expressed no issues related to her mood whatsoever.92

On April 28, 2015, Guzik saw Ainslie for another individual psychotherapy session.93 Guzik's hair appeared styled and she was wearing makeup and clothing which were remarkably nicer than previous visits.94 Guzik's mood was anxious and excited, but not depressed.95 Guzik stated to Ainslie that she made a new female friend through church and would be traveling to California on a trip with her. This friend was also living with Guzik to assist her with caring for her home and children.96 Ainslie provided Guzik with active listening, and they explored Guzik's past concerning trusting and making friends too quickly.97

Two days later, on April 30, 2018, a nurse called Guzik to follow-up regarding her responses to the dosage of Divalproex prescribed to Guzik.98 Guzik stated she was feeling okay at that time, and did not voice any suicidal or homicidal ideations.99 Guzik was pleasant and she spoke in a coherent, normal tone.100 Further, Guzik agreed to schedule an appointment for June 2015 to have her blood drawn related to the medication.101

Guzik appeared for three psychotherapy sessions with Ainslie on May 12, 2015, May 26, 2015, and June 9, 2015.102 Guzik again was accompanied by some of her children during two out of the three visits, and her mood ranged from depressed and anxious to possibly hypomanic.103 Guzik showed adequate hygiene and grooming during all three visits.104 The common discussion amongst all three sessions related to Guzik's continual eagerness to trust strangers too quickly.105

Ainslie provided active listening with empathy during the sessions but outlined for Guzik all of the times she had been taken advantage of since she began therapy with Ainslie including: providing money to her ex-husband followed by his disappearance, allowing a female stranger (who was also allegedly a minor) to move into her home, Guzik's trip to California which resulted in a physical altercation with that same female, and Guzik speaking to a strange man online and her plans to meet the man in person in Michigan.106 Overall, Ainslie expressed caution, worry, and indicated to Guzik how to identify when she was being too trusting, and how to handle these situations by being direct and using communication.107

Guzik had her final appointments on June 19, 2015 and June 30, 2015 at the Cleveland VAMC prior to relocating to Florida to be closer to family.108 During a medication reconciliation on June 19, 2015, Guzik stated she was feeling "good," but that she only took her prescribed bipolar medication for two weeks because it gave her stomach aches.109 Guzik complained of anxiety and requested that she be prescribed Hydroxyzine for anxiety because it helped her in the past.110 Phillips noted that Guzik's mood was stable, she was less aggressive towards her children, and she reported feeling calmer.111 Guzik admitted to using cannabis but was nonspecific regarding the amount of same.

During her final therapy session at Cleveland VAMC with Ainslie on June 30, 2015, Guzik reported that her mood was better than it had been for quite a while, and that she was awarded 100% veteran's disability.112 Ainslie observed that Guzik was feeling more secure and grateful since being awarded at 100%, and she felt less need to attach herself to others.113 Ainslie believed Guzik was finally thinking more long term and was able to plan ahead rather than focus on one day at a time.114 Guzik expressed gratitude for being awarded veteran's disability and agreed to continue working towards treatment goals.115

The record shows that several months lapsed while Guzik moved to Florida and prior to her receiving any further medical treatment. On August 12, 2015, Guzik met with Robert Campbell, a social worker at the Leesburg VA clinic. Guzik requested assistance related to housing.116 Guzik expressed that she desired to live with her grandmother, however, was unable to do so because her grandmother lived in a fifty-five (55) and older restricted community.117 Campbell provided Guzik with contact information for a realtor in Leesburg who was known to assist veterans looking for housing.118 In a follow-up call during October 1, 2015, Guzik informed Campbell that she was able to secure housing for her and her three children.119

On September 28, 2015, Guzik returned to the Leesburg VA Clinic to have an initial primary care consultation.120 Guzik was evaluated for chronic management of pain, and reported pain on her back and tingling after having several epidurals.121 Further, Guzik expressed that she has constant abdominal pain accompanied by slow digestion.122 Guzik's mental history was noted, however, but the only present complaint related to her prior mental diagnoses was that she experienced increased stress related to moving into a new home in Florida.123 Generally, Guzik appeared "well nourished, well developed, and in no acute distress."124

The record further shows that Guzik had a Mental Health Initial Evaluation with Rosemarie Cropper, D.O., staff psychiatrist at the Leesburg VA Clinic, on November 10, 2015.125 Dr. Cropper reviewed Guzik's mental treatment history and diagnoses during a clinical interview, in addition to reviewing Guzik's history in the military.126 The available notes are narrative.

During her mental status exam, the records show Guzik was depressed, angry, irritable, an anxious.127 The following are a portion of Dr. Cropper's observations during the exam:

The following are Dr. Cropper's diagnoses128:

The following is the treatment plan129 compiled by Dr. Cropper:

Guzik agreed to this plan and medication regimen suggested by Dr. Cropper.130 In a subsequent Suicide Risk Assessment on November 16, 2015, performed by Dr. Cropper, Guzik was found to be a low risk for suicide.131 On December 4, 2015, Guzik had a Social Work Psychological Assessment performed by Campbell.132 Guzik provided reports of her presenting symptoms, military history, medical history, and mental health history.133 These reports were largely consistent with reports made to other prior treating physicians, however, Guzik revealed that she struggled with promiscuity dating back to her teens.134

In a follow-up visit on January 26, 2016, with Dr. Cropper, it was noted that Guzik was confirmed to be pregnant and ceased taking all medications.135 Guzik indicated that she was feeling better since she found roommates to help her pay rent and assist her with childcare.136 Guzik described herself as emotional, but within the normal limits of what is expected during pregnancy.137 She denied being depressed or anxious.138 Guzik also admitted continuing to use marijuana at times during pregnancy, but ceased smoking cigarettes.139

The final available medical record dated May 20, 2016, is a Medical Source Statement of Ability to Do Work Related-Activity sent from Dr. Cropper to Chris Bell, a non-attorney disability consultant representing Guzik at the time the request was made.140 Dr. Cropper's medical findings where that, "[Guzik] has a long history of impulsive behaviors. She has difficulty getting her children to school consistently because of periods of depression. Currently unable to be on medications since she's pregnant."141 Dr. Cropper further indicated that Guzik could satisfactorily perform the following work-related activities142:

Dr. Cropper also indicated that Guzik could perform the following work-related activities satisfactorily some of the time143:

Here, substantial evidence supports the ALJ's finding that Guzik's diagnoses of affective disorder (mood disorder), anxiety disorder, and borderline personality disorder were severe impairments at step two, and that such impairments at step three, individually or in combination, did not meet or equal a listed impairment. The ALJ addressed listings 12.02, 12.03, 12.04, and 12.06 and concluded that Guzik did not meet or equal the listings. With respect to these listings, the ALJ considered medical records and hearing testimony. Substantial evidence supports this determination.

As for listings 12.02, 12.03, 12.04 and 12.06, the ALJ wrote:

Substantial evidence supports the ALJ's determination that Guzik did not meet or equal listings for 12.02, 12.03, 12.04, or 12.06.

RFC is what an individual can still do despite her limitations. It reflects the individual's maximum remaining ability to do sustained work activity in an ordinary work setting on a regular and continuing basis. SSR 96-8p, 1996 WL 374184, at *2 (SSA July 2, 1996). The responsibility for determining a claimant's RFC is with the ALJ. see Villa v. Sullivan, 895 F.2d 1019, 1023-24 (5th Cir. 1990). The ALJ is not required to incorporate limitations in the RFC that she did not find to be supported by the record. See Muse v. Sullivan, 925 F.2d 785, 790 (5th Cir. 1991). Here, the ALJ carefully considered all of the medical evidence in formulating an RFC that addressed Guzik's mental impairments. The ALJ's RFC determination is consistent with Dr. Haaga's and Dr. Cropper's opinions and the record as a whole. The ALJ, based on the totality of the evidence, concluded that Guzik could perform a full range of work at all exertional levels but with the following nonexertional limitations: She can perform simple, routine, repetitive tasks, with occasional changes in a routine work setting; and she can occasionally interact with coworkers and the general public. The ALJ gave specific reasons in support of this determination. The objective medical evidence weighs in favor of the ALJ's decision.

B. Diagnosis and Expert Opinion

The second element considered is the diagnosis and expert opinions of treating and examining physicians on subsidiary questions of fact. The law is clear that "a treating physician's opinion on the nature and severity of a patient's impairment will be given controlling weight if it is well-supported by medically acceptable clinical and laboratory diagnostic techniques and is not inconsistent with . . . other substantial evidence." Newton, 209 F.3d at 455. The ALJ may give little or no weight to a treating source's opinion, however, if good cause is shown. Id. at 455-56. The Fifth Circuit in Newton described good cause as where the treating physician's evidence is conclusory, is unsupported by medically acceptable clinical, laboratory, or diagnostic techniques, or in otherwise unsupported by the evidence. Id. at 456. "[A]bsent reliable medical evidence from a treating or examining physician controverting the claimant's treating specialist, an ALJ may reject the opinion of the treating physician only if the ALJ performs a detailed analysis of the treating physician's views under the criteria set forth in 20 C.F.R. § 404.1527(d)(2)." Id. at 453.

The six factors that must be considered by the ALJ before giving less than controlling weight to the opinion of a treating source are: (1) the length of treatment relationship; (2) frequency of examination; (3) nature and extent of the treatment relationship; (4) the support of the source's opinion afforded by the medical evidence of record; (5) the consistency of the opinion with the record as a whole; and (6) the specialization of the source. 20 C.F.R. § 404.1527(d)(2); Newton, 209 F.3d at 456. An ALJ does not have to consider the six factors "where there is competing first-hand medical evidence and the ALJ finds as a factual matter that one doctor's opinion is more well-founded than another," and were the ALJ weighs the treating physician's opinion on disability against the medical opinion of other physicians who have treated or examined the claimant and have specific medical bases for a contrary opinion." Id. at 458; Alejandro v. Barnhart, 291 F.Supp.2d 497, 507-11 (S.D.Tex. 2003). Further, regardless of the opinions and diagnoses of medical sources, "the ALJ has sole responsibility for determining a claimant's disability status." Martinez, 64 F.3d at 176. "The ALJ's decision must stand or fall with the reasons set forth in the ALL's decision, as adopted by the Appeals Council." Id. at 455; see also Cole v. Barnhart, 288 F.3d 149, 151 (5th Cir. 2002) ("It is well-established that we may only affirm the Commissioner's decision on the grounds which he stated for doing so."). However, perfection in administrative proceedings is not required. See Mays v. Bowen, 837 F.2d 1362, 1364 (5th Cir. 1988). Additionally, in weighing evidence, a VA determination does not bind the Commissioner; it is merely evidence for the ALJ's consideration. See Garcia v. Berryhill, 880 F.3d 700, 705 (5th Cir. 2018). The weight assigned to a disability determination will vary depending upon the particular circumstances of the case. Id.

According to Guzik, the ALJ erred in failing to consider all of the psychiatric treating records from Dr. Haaga, Dr. Cropper, providers at One Health Ohio, Cleveland VAMC, and the Leesburg VA Clinic. Guzik argues the ALJ ignored certain "findings" of Dr. Haaga, which primarily consist of subjective reports from Guzik including but not limited to: the loss of Guzik's daughter during infancy, a history of reported victimization during basic training and witnessing domestic violence in her childhood home, a lack of socialization skills and affiliations with organizations, a history of struggling academically in school and disciplinary problems.

Guzik further argues that the ALJ erred in failing to give weight to the Department of Veteran Affairs' findings of disability for Guzik at 70% for Guzik's military service related disabilities and ignored the conditions she received from VA providers. Guzik argues the ALJ failed to consider all the evidence. The Commissioner responds that ALJ properly weighed the medical opinions and performed an analysis of the opinion evidence. According to the Commissioner, the ALJ can consider the evidence in the record without directly addressing such evidence in the decision, and that it is appropriate for an ALJ not to afford weight to an unsupported portion of a doctor's medical opinion.

With respect to the opinions and diagnoses of treating physicians and medical sources, the ALJ wrote:

Here, the thoroughness of the ALJ's decision shows that she carefully considered the medical records and testimony, and that her determination reflects those findings accurately. The ALJ summarized the evidence and set forth specific reasons concerning the weight given to the opinions of the medical sources. The ALJ explained her rationale for discounting Guzik's mental limitations in Dr. Cropper's, Dr. Breighner's and the VA's respective reports. As for Guzik's arguments concerning several psychological reports, the law is clear that good cause exists for an ALJ to provide little weight to a treating physician's questionnaire opinion due to its brevity and conclusory nature, lack of explanatory notes or supporting objective tests and examinations. See Foster v. Astrue, 410 Fed. Appx. 831, 833 (5th Cir. 2011) ([T]he `questionnaire' format typifies `brief or conclusory' testimony . . . [W]e agree with the magistrate judge's conclusion that `due to its brevity and conclusory nature, lack of explanatory notes, or supporting objective tests and examinations, [the] treating physician's] opinion is given little weight.'"); Nguyen v. Colvin, No. 4:13-CV-2957, 2015 WL 222328, at *9 (S.D.Tex. Jan 14, 2015). The ALJ's decision also highlights Dr. Haaga's report and how it was compiled based upon objective and subjective evidence, and was consistent with the ALJ's residual functional capacity statement. Conflicts of evidence are for the Commissioner, not the courts, to resolve. Byrd v. Comm'r of Soc. Sec., 368 Fed. Appx. 542, 543 (5th Cir. 2010). The ALJ gave detailed reasons in assigning weight to the medical source opinions including observations at the hearing, the progress notes detailing Guzik's treatment, and consultative examination reports. Given the proper discounting of the opinions of the VA, Dr. Cropper, and Dr. Breighner concerning Guzik's mental limitations, and the medical opinions which do support the ALJ's residual functional capacity determination, upon this record, the Court concludes that the diagnosis and expert opinion factor also supports the ALJ's decision.

C. Subjective Evidence of Mental Disorder

The next element to be weighed is the subjective evidence of pain or mental impairment, including the claimant's testimony and corroboration by family and friends. The proper standard for evaluating mental impairment is codified in the Social Security Disability Benefits Reform Act of 1984, 42 U.S.C. § 423. The statute provides that allegations of mental impairment do not constitute conclusive evidence of disability. There must be objective medical evidence showing the existence of a physical or mental impairment which could reasonably be expected to cause disability. Statements made by the individual or his physician as to the severity of the plaintiff's impairment must be reasonably consistent with the objective medical evidence on the record. 42 U.S.C. § 423. The evaluation of evidence concerning subjective symptoms is a task particularly within the province of the ALJ, who has had the opportunity to observe the claimant. Hames, 707 F.2d at 166.

Here, Guzik testified about her health and its impact on her daily activities. She offered no testimony or corroboration from her family or friends with respect to her complaints about her condition. Guzik testified that she was twenty-seven years old and had previously been married. (Tr. 46-47). She lives at home with occasional guests, is unemployed, and cares for her three children, ages seven (7), four (4), and one (1).144 The record further reflects that Guzik was pregnant with an additional child at the time of the hearing.145 Guzik testified that she stayed at home most of the time, but was able to drive her son to school in the mornings and occasionally took her children to the park.146 Otherwise, her younger children remained at home with Guzik sleeping in bed with her, playing on a tablet, or watching movies.147 Guzik remarked that she was able to feed her son when he requested to have something to eat.148 Overall, she is able to care for her children alone with periodic visits from her mother.149

With respect to her educational background and occupational history, Guzik completed the 11th grade and obtained a GED.150 Guzik served in the Army for less than two years working in a supply warehouse.151 Guzik was discharged from the Army and subsequently employed by DIRECTTV in sales, AT&T in technical support, and Arby's as a cashier. She has also delivered newspapers, drove a taxi, and held seasonal jobs.152 Guzik testified that she had many different jobs because she cannot keep one steady job for several reasons.153 Guzik claims that she has a hard time reading, comprehending, and remaining focused at work.154 One of the biggest reasons Guzik cannot hold down a job is that she claims to suffer from issues with severe anger and dealing with management.155 Guzik testified that she becomes so anxious and angry while working that she needs to retreat to the bathroom to cry and vent frequently.156 This would result in discipline from management for taking too many breaks.157 Guzik claims to have difficulties getting along with others, supervisors, and adjusting to change in work settings.158

Guzik also testified that she suffers from bad anxiety, and this contributes to aggressive behaviors. Guzik explained during the hearing before the ALJ that her diagnosis of intermittent explosive disorder makes it very difficult for her to control her anger eruptions.159 She testified that she will exhibit aggressive behaviors towards her children, and once yelled at her son so loudly he wet himself.160 Guzik testified that she occasionally contemplates harming herself and others when she experiences angry outbursts.161 Guzik described to this state of mind as "kill mode." Guzik further testified that she has vivid dreams about hurting others.162 Additionally, Guzik claimed to experience panic attacks at least seven times a month, lasting anywhere between thirty-minutes to an hour.163

Guzik stated that she cannot work due to depression, which she compared to a weight sitting on top of her.164 Guzik claims that she periodically suffers from deep depression, and when this occurs she is unable to get out of bed for work.165 Guzik testified that she would be physically confined to her bed for weeks because of the depression.166 Guzik also testified that she goes through depression every month, and would miss at least a week of work.167

Guzik testified that she is depressed, she does not take care of her children or her personal hygiene. Guzik cannot get out of bed to shower, clean, or care for her children because of depression.168 Guzik testified that if her children want to eat while she is depressed, the kids will have to bring her peanut butter, jelly, and bread, and she will make them sandwiches in bed.169 Guzik state that once she was in such a deep depression that her children had to go live with their father because she was unable to care for them or clean her home.170 On top of depression, Guzik stated that she suffers from insomnia and will sleep for hours during the day, which also prevents her from properly caring for her kids and getting her son to school timely.171

Guzik further testified that she was also diagnosed with PTSD related to the death of her infant daughter during 2010.172 Guzik discovered her daughter dead in her crib.173 This had such a traumatic impact, Guzik frequently checks on her children while they are sleeping to ensure they are still alive.174 Guzik testified there are times when she will believe her children are dead.175 Guzik testified that when pregnant is unable to take any medications to treat her symptoms of anxiety, anger, PTSD, or depression.176 Guzik testified she was awarded disability at 100% from the VA because her mental impairments are believed to be related to her service in the Army.177

The undersigned finds that there is nothing in the record to suggest that the ALJ made improper credibility findings, or that she weighed the testimony improperly. Accordingly, this factor also supports the ALJ's decision.

D. Education, Work History, and Age

The final element to be weighed is the claimant's educational background, work history and present age. A claimant will be determined to be under disability only if the claimant's physical or mental impairments are of such severity that she is not only unable to do her previous work, but cannot, considering his age, education and work experience, engage in any other kind of substantial gainful work which exists in the national economy. 42 U.S.C. § 423(d)(2)(A).

The record shows that the ALJ questioned Suzanna Roche, a vocational expert ("VE"), at the hearing. "A vocational expert is called to testify because of his familiarity with job requirements and working conditions. `The value of a vocational expert is that he is familiar with the specific requirements of a particular occupation, including working conditions and the attributes and skills needed.'" Vaughan v. Shalala, 58 F.3d 129, 131 (5th Cir. 1995) (quoting Fields v. Bowen, 805 F.2d 1168, 1170 (5th Cir. 1986)). It is well settled that a vocational expert's testimony, based on a properly phrased hypothetical question, constitutes substantial evidence. Bowling v. Shalala, 36 F.3d 431, 436 (5th Cir. 1994). A hypothetical question is sufficient when it incorporates the impairments which the ALJ has recognized to be supported by the whole record. Beyond the hypothetical question posed by the ALJ, the ALJ must give the claimant the "opportunity to correct deficiencies in the ALJ's hypothetical questions (including additional disabilities not recognized by the ALJ's findings and disabilities recognized but omitted from the question)." Bowling, 36 F.3d at 436.

The ALJ posed comprehensive hypothetical questions to the VE (Tr. 69-71), and Guzik's counsel questioned the VE. (Tr. 71-72). A hypothetical question is sufficient when it incorporates the impairments which the ALJ has recognized to be supported by the whole record. Upon this record, there is an accurate and logical bridge from the evidence to the ALJ's conclusion that Guzik was not disabled. Based on the testimony of the vocational expert and the medical records, substantial evidence supports the ALJ's finding that Guzik could perform work as a newspaper deliverer, industrial sweeper, cleaner, a hand packager, and a label coder. The Court concludes that the ALJ's reliance on the vocational testimony was proper, and that the vocational expert's testimony, along with the medical evidence, constitutes substantial evidence to support the ALJ's conclusion that Guzik was not disabled within the meaning of the Act and therefore was not entitled to benefits. Further, it is clear from the record that the proper legal standards were used to evaluate the evidence presented. Accordingly, this factor also weighs in favor of the ALJ's decision.

V. Conclusion

Considering the record as a whole, the Court is of the opinion that the ALJ and the Commissioner properly used the guidelines propounded by the Social Security Administration, which direct a finding that Guzik was not disabled within the meaning of the Act, that substantial evidence supports the ALL's decision, and that the Commissioner's decision should be affirmed. As such, it is

ORDERED Plaintiff's Motion for Summary Judgment (Document No. 14), is DENIED, Defendant's Cross Motion for Summary Judgment (Document No. 15) is GRANTED, and the decision of the Commissioner of Social Security is AFFIRMED.