Kearns v. Colvin , 633 F. App'x 678 ( 2015 )

FILED
United States Court of Appeals
UNITED STATES COURT OF APPEALS Tenth Circuit
FOR THE TENTH CIRCUIT December 10, 2015
_________________________________
Elisabeth A. Shumaker
Clerk of Court
TERESA KEARNS,
Plaintiff - Appellant,
v. No. 15-6078
(D.C. No. 5:14-CV-00394-M)
CAROLYN W. COLVIN, Acting (W.D. Okla.)
Commissioner of Social Security
Administration,
Defendant - Appellee.
_________________________________
ORDER AND JUDGMENT*
_________________________________
Before LUCERO, GORSUCH, and McHUGH, Circuit Judges.
_________________________________
The Commissioner of the Social Security Administration denied Teresa
Kearns’s application for disability insurance benefits (DIB). The district court
affirmed the denial, and Ms. Kearns appeals. Exercising jurisdiction under 28 U.S.C.
§ 1291 and 42 U.S.C. § 405(g), we affirm.
*
After examining the briefs and appellate record, this panel has determined
unanimously to honor the parties’ request for a decision on the briefs without oral
argument. See Fed. R. App. P. 34(f); 10th Cir. R. 34.1(G). The case is therefore
submitted without oral argument. This order and judgment is not binding precedent,
except under the doctrines of law of the case, res judicata, and collateral estoppel. It
may be cited, however, for its persuasive value consistent with Fed. R. App. P. 32.1
and 10th Cir. R. 32.1.
I. Background
When she was thirty-eight years old, Ms. Kearns applied for DIB based on
post-traumatic stress disorder (PTSD), bipolar disorder, severe anxiety and
depression, and panic attacks. The Commissioner denied her application for benefits,
both on initial consideration and reconsideration. Ms. Kearns then appeared at a
hearing before an administrative law judge (ALJ) in September 2012, where she was
represented by counsel. Ms. Kearns testified, as did a vocational expert (VE). The
ALJ concluded that Ms. Kearns was not disabled during the relevant time period.
In reaching this conclusion, the ALJ applied the familiar five-step sequential
evaluation process used to assess social security claims, see 20 C.F.R.
§ 404.1520(a)(4):
 At step one, the ALJ determined Ms. Kearns had not engaged in substantial
gainful activity from her alleged onset date (August 2, 2010) through her
date last insured (June 30, 2012).
 At step two, the ALJ determined Ms. Kearns had several severe
impairments: status post ankle fracture, obesity, bipolar I disorder, PTSD,
and borderline personality.
 At step three, the ALJ considered Ms. Kearns’s back and ankle pain,
obesity, and mental impairments and determined she did not have an
impairment (or combination of impairments) that met or was medically
equal to an impairment listed in 20 C.F.R. Part 404, Subpart P, Appendix 1,
so as to be per se disabling.
 At step four, the ALJ determined Ms. Kearns had the residual functional
capacity (RFC) to perform a limited range of light work:
[T]he claimant was able to occasionally stoop, kneel, and crouch. The
claimant is able to interact appropriately on a superficial work basis
with coworkers and supervisors, but cannot interact with the general
public. The claimant was able to understand, remember, and follow
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simple routine instructions and had concentration capability necessary
to perform unskilled work with the specific vocational profile level of
two.
Aplt. App., Vol. I at 40. The ALJ also found that Ms. Kearns was not able
to perform her past relevant work as a home healthcare aide, personal-care
attendant, cashier/checker, teacher aide, habilitation specialist, or cook
helper.
 At step five, the ALJ considered Ms. Kearns’s age (then forty years old),
high school education, work experience, and RFC and found that she could
perform jobs that existed in significant numbers in the national economy—
including the jobs of night cleaner, packing-line worker, and
small-products assembler. Therefore, Ms. Kearns was not disabled within
the meaning of the Social Security Act and was not entitled to benefits.
The Appeals Council denied Ms. Kearns’s request for review, and the district
court affirmed, adopting the magistrate judge’s report and recommendation.
Ms. Kearns now brings this timely appeal.
II. Discussion
Ms. Kearns asserts the ALJ erred in four ways: (1) the RFC and the
hypothetical question posed to the VE were inadequate because they did not account
for work-related mental limitations, and besides the jobs suggested by the VE involve
detailed work and thus do not fit the hypothetical question; (2) the ALJ did not
discuss the low Global Assessment of Functioning (GAF) scores that Ms. Kearns was
assigned throughout her treatment or the weight he gave those scores; (3) the ALJ
gave significant weight to an agency doctor’s opinion that had become stale, without
analyzing it in the context of the entire evidence; and (4) the ALJ’s credibility
analysis was flawed.
3
As explained below, Ms. Kearns failed to preserve the first and fourth issues
for appeal. For the second and third issues, our task is limited to determining
whether substantial evidence supports the agency’s factual findings and whether the
agency applied the correct legal standards. Barnett v. Apfel, 231 F.3d 687, 689
(10th Cir. 2000). “Substantial evidence is such relevant evidence as a reasonable
mind might accept as adequate to support a conclusion.” Id. (internal quotation
marks omitted). We cannot “reweigh the evidence” or “substitute our judgment for
that of the agency.” Id. (internal quotation marks omitted).
A. Mental Limitations and Unskilled Work
We begin with Ms. Kearns’s argument that the RFC and the hypothetical
question posed to the VE were deficient because a limitation to “unskilled work”
does not account for her work-related mental limitations—namely, her bipolar I
disorder, PTSD, and borderline personality, which were identified as severe
impairments at step two. Ms. Kearns conflates the RFC’s reference to her ability to
“follow simple routine instructions” with the limitation to “unskilled work,” Aplt.
App., Vol. I at 40, and inaccurately characterizes the RFC as a limitation to “simple
work,” e.g., Aplt. Principal Br. at 6, 9. Nevertheless, we understand her point to be
that an ALJ cannot speak solely in terms of skill level in his RFC and hypothetical
question to the VE because “if [the claimant’s] mental impairments are affecting her,
it will not matter how much skill is required in her specific job—her mental
impairments will prevent any work,” id. at 7.
4
We agree with the Commissioner that Ms. Kearns waived this argument
because it was absent from her initial brief to the district court and first surfaced in
her objections to the magistrate judge’s report and recommendation. “In this circuit,
theories raised for the first time in objections to the magistrate judge’s report are
deemed waived.” United States v. Garfinkle, 261 F.3d 1030, 1031 (10th Cir. 2001).1
Of course, an argument that was never raised before the district court is also waived.
Wilburn v. Mid-South Health Dev., Inc., 343 F.3d 1274, 1280 (10th Cir. 2003). This
is the case with Ms. Kearns’s newly presented argument that the jobs suggested by
the VE do not fit the hypothetical question because they involve detailed work.
1
Ms. Kearns attempts to avert waiver through two alternative contentions,
neither of which has merit. See Aplt. Reply Br. at 1–3. First, she asserts this issue
was encompassed within her argument to the district court that the RFC did not
contain sufficiently specific terms. See Aplt. App., Vol. III at 591–92. But there,
Ms. Kearns critiqued the ALJ’s use of the word “superficial” in describing her
“ability to interact appropriately on a superficial work basis with coworkers and
supervisors”—an entirely separate issue from an ALJ’s ability or inability to
adequately address a claimant’s mental impairments through a limitation to unskilled
work. Second, Ms. Kearns argues it was temporally impossible to present this issue
in the initial brief to the district court because her position stems from our
unpublished opinion in Jaramillo v. Colvin, 576 F. App’x 870 (10th Cir. 2014),
which was released shortly after she filed that initial brief. But the citations in her
appellate briefs date back to 1996, demonstrating that Jaramillo was not the first
word on this issue. E.g., Chapo v. Astrue, 682 F.3d 1285 (10th Cir. 2012); Wayland
v. Chater, 76 F.3d 394 (10th Cir. 1996) (unpublished table decision). The same is
true for Ms. Kearns’s parallel argument that the hypothetical question posed to the
VE was deficient, an issue we also discussed in Chapo, 682 F.3d at 1290 & n.3. And
Ms. Kearns again cites decades-old cases in support of her position. E.g., Evans v.
Chater, 55 F.3d 530 (10th Cir. 1995); Hargis v. Sullivan, 945 F.2d 1482 (10th Cir.
1991).
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B. GAF Scores
We turn next to Ms. Kearns’s argument that the ALJ did not discuss or weigh
certain low GAF scores in his RFC assessment, and that these scores are at odds with
the final determination on Ms. Kearns’s ability to work:
 a score of 50 during outpatient treatment at Mental Health Services of
Southern Oklahoma on April 6, 2011, Aplt. App., Vol. III at 507;
 a score of 25 upon admission to Carl Albert Mental Health Center on
April 12, 2012, and a past score of 45 noted on the admission form, id. at
554; and
 a score of 30 upon admission to Griffin Memorial Hospital on June 5, 2012,
id. at 568.
Ms. Kearns does not mention two other GAF scores she received: (1) a score of
75-80 during a consultative examination by psychiatrist Adonis Al-Botros, M.D., on
January 31, 2011, see id., Vol. II at 376, which is recounted in the ALJ’s analysis,
see id., Vol. I at 41; and (2) a score of 52 upon release from Griffin Memorial
Hospital on July 24, 2012 (up from 30 at intake), see id., Vol. III at 571.
Our analysis necessarily begins with a brief explanation of GAF scores and
what they signify. “The GAF is a 100-point scale divided into ten numerical ranges,
which permits clinicians to assign a single ranged score to a person’s psychological,
social, and occupational functioning.” Keyes-Zachary v. Astrue, 695 F.3d 1156, 1162
n.1 (10th Cir. 2012). Its purpose is to allow clinicians to plan treatment, measure its
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impact, and predict the outcome. Am. Psychiatric Ass’n, Diagnostic & Statistical
Manual of Mental Disorders 32 (4th ed. Text Revision 2000).2
It is true that the ALJ did not expressly recite or reconcile Ms. Kearns’s lower
GAF scores, but that omission does not constitute error or take away from the
substantial evidence supporting the ALJ’s decision. While “[t]he record must
demonstrate that the ALJ considered all of the evidence, . . . an ALJ is not required to
discuss every piece of evidence.” Mays v. Colvin, 739 F.3d 569, 576 (10th Cir. 2014)
(internal quotation marks omitted). An ALJ’s failure to conduct a comparative
analysis and weigh conflicting GAF evidence does not mandate reversal.
Keyes-Zachary, 695 F.3d at 1164. “While a GAF score may be of considerable help
to the ALJ in formulating the RFC, it is not essential to the RFC’s accuracy.”
Howard v. Comm’r of Soc. Sec., 276 F.3d 235, 241 (6th Cir. 2002).
In any event, it is obvious the ALJ considered the medical records that
contained the GAF scores. At step four, he provided details on Ms. Kearns’s
outpatient treatment at Mental Health Services of Southern Oklahoma in 2011, as
well as her inpatient care at Carl Albert and at Griffin Memorial Hospital in 2012—
details that paraphrased those treatment records. See Aplt. App., Vol. I at 41–42.
The GAF scores were only one component of those records, and the ALJ’s discussion
2
In the most recent edition of the manual, the American Psychiatric
Association dropped the GAF scale “for several reasons, including its conceptual
lack of clarity (i.e., including symptoms, suicide risk, and disabilities in its
descriptors) and questionable psychometrics in routine practice.” Am. Psychiatric
Ass’n, Diagnostic & Statistical Manual of Mental Disorders 16 (5th ed. 2013).
7
of the records accurately described the overarching evidence of Ms. Kearns’s
improved mental state when she was compliant with her prescribed medications, her
stable condition upon release from treatment, and the “positive future projection” for
her mental health, id. at 42. Substantial evidence supports the ALJ’s decision, and
his failure to specifically discuss all of the GAF scores was not fatal.
C. Agency Doctor’s Opinion
Ms. Kearns also faults the ALJ for giving significant weight to the “stale”
opinion of an agency doctor without analyzing it in the context of the entire medical
evidence, which shows a decline in mental health in 2012. We deduce that she
critiques the ALJ’s reliance on the Psychiatric Review Technique (PRT) and Mental
Residual Functional Capacity Assessment (MRFCA) performed by Joan Holloway,
Ph.D., a non-examining state-agency psychologist.3
Here too we discern no error. The ALJ followed the mandate in
Keyes-Zachary: “It is the ALJ’s duty to give consideration to all the medical
opinions in the record. He must also discuss the weight he assigns to such opinions.”
3
In Section I of the MRFCA (“Summary Conclusions”), Dr. Holloway
checked boxes indicating that Ms. Kearns was “[m]arkedly [l]imited” in “[t]he ability
to understand and remember detailed instructions,” “[t]he ability to carry out detailed
instructions,” and “[t]he ability to interact appropriately with the general public.”
Aplt. App., Vol. II at 392–93. She found no significant limitations in the remaining
categories. In Section III (“Functional Capacity Assessment”), Dr. Holloway
explained that Ms. Kearns “can perform simple tasks with routine supervision,” “can
relate to supervisors and peers on a superficial work basis,” “cannot relate to the
general public,” and “can adapt to a work situation.” Id. at 394. A second
non-examining state-agency psychologist, Sharon Taber, Ph.D., affirmed the findings
and assessments in the MRFCA, as well as the PRT, on reconsideration.
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695 F.3d at 1161 (citing 20 C.F.R. §§ 404.1527(c), (e)(2)(ii), 416.927(c), (e)(2)(ii)).
In addition to the opinion by Dr. Holloway, which was affirmed by Dr. Taber on
reconsideration, the ALJ considered:
 a March 23, 2011, case analysis by a state-agency physician, Janet G.
Rodgers, M.D., finding no evidence of severe physical impairments, which
was affirmed in an August 15, 2011, case analysis by a second state-agency
physician, Luther Woodcock, M.D. (which the ALJ gave “strong weight
and consideration”), Aplt. App., Vol. I at 44;
 three unidentified checklist forms dated July 13, 2010, November 5, 2010,
and February 17, 2011, which were completed in connection with an
application for social services from the Seminole Nation of Oklahoma
(which the ALJ gave “minimal weight or consideration”), id. at 44–45;
 an April 14, 2011, letter from Don Bruce Chesler, M.D., which Ms. Kearns
procured to defend against felony-assault charges for striking a police
officer (which the ALJ gave “minimal weight or consideration”), id. at 45;
and
 a September 13, 2010, “third party adult function report” completed by
Ms. Kearns’s father, which the ALJ deemed to be of questionable accuracy
and “simply not consistent with the preponderance of the opinions and
observations by medical doctors in this case,” id.
The ALJ’s discussion of this opinion evidence was preceded by a thorough
recitation of the medical evidence, including records documenting panic attacks in
2010; the examination by Dr. Al-Botros on January 31, 2011; regular visits to Public
Indian Health Clinics in 2011; outpatient care with Mental Health Services of
Southern Oklahoma in 2011; emergency treatment and inpatient care at Carl Albert in
April and May 2012; and inpatient care at Griffin Memorial Hospital in June and July
2012. See id. at 40–43.
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Not only did the ALJ examine the medical opinions in the context of
Ms. Kearns’s medical history, he also devoted extensive attention to the 2012
incidents—when Ms. Kearns was admitted to Carl Albert after taking too many pills
within a short period and to Griffin Memorial Hospital following an overdose. In
particular, he outlined the progress she made during treatment. When Ms. Kearns
left Carl Albert, for instance, she “was stabilized on medications with reported
improvement”; she had “attended and interacted well in her group sessions”; she
“was alert and oriented with intact memory, normal concentration, and intact
judgment” upon discharge; “she was sleeping well with good appetite [and]
compliant upon her medications without any side effects”; and “she was utilizing
effective coping skills.” Id. at 42. Similarly, at Griffin Memorial Hospital, she
“stabilized and improved upon her modified medications” and was “discharged as
stable” with a mental health treatment plan. Id.
The ALJ carefully considered all of the medical evidence in formulating an
RFC that addressed Ms. Kearns’s mental impairments. Just because his assessment
was similar to the medical opinions of Drs. Holloway and Taber does not mean that it
was based solely on stale evidence. Substantial evidence supports the ALJ’s
decision.
D. Credibility Analysis
The final argument is that the ALJ did not perform a proper credibility analysis
in rejecting Ms. Kearns’s subjective complaints of pain and limitation because he
used boilerplate language and did not analyze the objective medical evidence. We do
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not reach the merits of this argument because it was not properly preserved for
appeal.
To preserve an issue for appellate review, a party must object to the magistrate
judge’s report and recommendation in a way “that is sufficiently specific to focus the
district court’s attention on the factual and legal issues that are truly in dispute.”
United States v. 2121 E. 30th St., 73 F.3d 1057, 1060 (10th Cir. 1996). Although
Ms. Kearns complained about the ALJ’s credibility analysis in her opening brief to
the district court, she did not make a specific objection to the magistrate judge’s
subsequent finding that the ALJ’s credibility determination was “well supported by
the record,” Aplt. App., Vol. III at 615. Indeed, she ignored this issue entirely. She
therefore waived appellate review of this determination under this court’s firm
waiver rule. See Port City Props. v. Union Pac. R.R. Co., 518 F.3d 1186, 1190 n.1
(10th Cir. 2008) (deeming issue waived where appellant failed to raise it in his
objection to the magistrate judge’s report and recommendation).
III. Conclusion
The judgment of the district court is affirmed.
Entered for the Court
Carolyn B. McHugh
Circuit Judge
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