Thomas v. Barnhart

F I L E D
United States Court of Appeals
Tenth Circuit
UNITED STATES COURT OF APPEALS
September 2, 2005
FOR THE TENTH CIRCUIT
PATRICK FISHER
Clerk
MARGARET J. THOMAS,
Plaintiff-Appellant,
v. No. 04-7141
(D.C. No. CIV-03-594-P)
JO ANNE B. BARNHART, (E.D. Okla.)
Commissioner of Social Security
Administration,
Defendant-Appellee.
ORDER AND JUDGMENT *
Before HENRY, ANDERSON , and TYMKOVICH , Circuit Judges.
After examining the briefs and appellate record, this panel has determined
unanimously to grant 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
ordered 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This order and judgment is not binding precedent, except under the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. The court
generally disfavors the citation of orders and judgments; nevertheless, an order
and judgment may be cited under the terms and conditions of 10th Cir. R. 36.3.
Margaret J. Thomas appeals from the district court’s order affirming the
Commissioner’s decision that she is not entitled to Supplemental Security Income
(SSI) benefits. We have jurisdiction under 42 U.S.C. § 405(g) and 28 U.S.C.
§ 1291. Because we conclude that the administrative law judge (ALJ) in this case
did not apply the correct legal standards in making her decision, we reverse and
remand for further proceedings.
I.
Mrs. Thomas, who was 41 years old in 2003, has never performed work that
meets a level considered to be substantial gainful activity under the Social
Security Act. She has a high school education and completed a one-year vo-tech
business course, but did not qualify for a certification. Her only job has been as a
toy assembler at a sheltered workshop. Mrs. Thomas alleges that she suffers from
arthritis, carpal tunnel syndrome, brain injury, obesity, and depression that
prevent her from engaging in substantial gainful employment. Her fourth
application for SSI benefits was denied initially and on reconsideration.
Following a hearing, the ALJ determined that Mrs. Thomas is not disabled at step
five of the five-step sequential evaluation process. See Williams v. Bowen, 844
F.2d 748, 750-52 (10th Cir. 1988). The ALJ found no medical support for
Mrs. Thomas’s claims of arthritis, carpal tunnel syndrome, or brain injury, and
she does not challenge those rulings. As to the claims of disabling obesity and
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depression, the ALJ concluded that Mrs. Thomas has the severe impairment of
morbid obesity but that her mental impairments cause only “mild functional
limitations in the areas of . . . daily living and concentration, persistence, and
pace.” Aplt. App. Ex. 4 at 25. The ALJ concluded that, despite her obesity,
Mrs. Thomas retains the residual functional capacity (RFC) to perform sedentary
work, limited to never climbing, stooping, kneeling, crouching, or crawling and
only occasional pushing and pulling. See id. After consulting a vocational expert
(VE), the ALJ concluded that Mrs. Thomas is able to perform several sedentary
jobs and is, therefore, not disabled as defined in the Social Security Act. The
Appeals Council denied review, thus the ALJ’s decision became the final decision
of the Commissioner. Mrs. Thomas filed a complaint in the district court, and the
district court affirmed the Commissioner’s decision. Mrs. Thomas appeals,
contending that the ALJ failed to consider the effect of her non-exertional
limitations and to recognize all of her severe mental impairments.
II.
Our standard of review in social security cases is well-settled.
“We review the [Commissioner’s] decision to determine
whether it is supported by substantial evidence and whether the
[Commissioner] applied the correct legal standards.” Washington v.
Shalala, 37 F.3d 1437, 1439 (10th Cir. 1994). We must examine the
record closely to determine whether substantial evidence supports the
[Commissioner’s] determination. Id. 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, 91
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S. Ct. 1420, 1427, 28 L. Ed.2d 842 (1971)(quotation omitted). In
addition to a lack of substantial evidence, the [Commissioner’s]
failure to apply the correct legal standards, or to show us that she has
done so, are also grounds for reversal. Washington, 37 F.3d at 1439.
Winfrey v. Chater , 92 F.3d 1017, 1019 (10th Cir. 1996). “In evaluating the
appeal, we neither reweigh the evidence nor substitute our judgment for that of
the agency.” Casias v. Sec’y of Health & Human Servs. , 933 F.2d 799, 800 (10th
Cir. 1991).
We bear in mind, however, that, because the Commissioner’s decision in
this case was made at step five of the sequential process, it was the
Commissioner’s burden to prove that Mrs. Thomas can perform work at a level
lower than her past relevant work. See Thompson v. Sullivan, 987 F.2d 1482,
1491 (10th Cir. 1993). We also note that an ALJ’s decision must be evaluated
based solely on the reasons stated in that decision. See Burlington Truck Lines,
Inc. v. United States, 371 U.S. 156, 168-69 (1962).
III.
A. Application of Social Security Ruling 96-9p. Mrs. Thomas first
argues that the ALJ’s opinion is internally inconsistent because, although the ALJ
found that Mrs. Thomas may “never climb, stoop, kneel, crouch, and crawl,” the
ALJ also stated that she could “perform more than the full range of sedentary
work.” Aplt. App. Ex. 4 at 25 (emphasis added). Mrs. Thomas asserts that the
ALJ failed to follow Social Security Ruling 96-9p, which notes that most
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unskilled sedentary occupations require an ability to stoop. Under that ruling,
“[a] complete inability to stoop it would significantly erode the unskilled
sedentary occupational base and a finding that the individual is disabled would
usually apply.” SSR 96-9p, 1996 WL 374185, *8.
Although we agree that the ALJ’s decision is ambiguous, we note that in
her formal findings, the ALJ did, in fact, find that Mrs. Thomas’s “exertional
limitations do not allow her to perform the full range of work,” Aplt. App. Ex. 4
at 32. Accordingly, the ALJ consulted a VE to give an opinion regarding what
specific sedentary jobs Mrs. Thomas could perform in the national economy given
her physical limitations. Id. at 31. In the hypothetical given to the VE, the ALJ
stated that Mrs. Thomas was limited in “some pushing and pulling” and could
“never climb, stoop, kneel, crouch, or crawl.” Id. at 66. The VE opined that
Mrs. Thomas could still perform at least three different jobs with those
limitations. Id. at 66-67.
Ruling 96-9p states that “a finding that an individual has the ability to do
less than a full range of sedentary work does not necessarily equate with a
decision of ‘disabled’,” SSR 96-9p, 1996 WL 374185, *1; thus the ALJ may
consult with a VE for consideration of what jobs a claimant with a particular
limitation can perform, see id. at *8. The VE’s testimony that Mrs. Thomas could
still perform certain unskilled sedentary jobs despite her limitations constitutes
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substantial evidence upon which the ALJ could rely for her decision, and the fact
that the ALJ consulted a VE demonstrates that the ALJ properly applied Ruling
96-9p even though she did not mention the ruling in her written decision.
B. Severe mental impairments. Mrs. Thomas next asserts that the ALJ
erred in determining that she has no severe mental impairments.
“When there is evidence of a mental impairment that allegedly
prevents a claimant from working, the [Commissioner] must follow
the procedure for evaluating mental impairments set forth in 20
C.F.R. § 404.1520a and the Listing of Impairments and document the
procedure accordingly.” Cruse v. United States Dep’t of Health &
Human Servs., 49 F.3d 614, 617 (10th Cir. 1995). Documentation is
made by completing a PRT form, which the ALJ must attach to his
written decision. “[T]he record must contain substantial competent
evidence to support the conclusions reached on the PRT form[, and]
if the ALJ prepares the form himself, he must ‘discuss in his opinion
the evidence he considered in reaching the conclusions expressed on
the form.’” Id. at 617-18 (quoting Washington, 37 F.3d at 1442).
Winfrey , 92 F.3d at 1024. The ALJ noted the required procedure and included in
the administrative record a PRT prepared by a non-examining, agency-hired
consulting psychologist. An impairment is “not severe” when the “‘medical
evidence establishes only a slight abnormality or a combination of slight
abnormalities which would have no more than a minimal effect on an individual’s
ability to work.’” Bowen v. Yuckert , 482 U.S. 137, 154 n.12 (1987) (quoting SSR
85-28, 1985 WL 56856). Mrs. Thomas contends that the ALJ did not fully
consider the opinions of her treating and consulting physicians when determining
whether she has a severe mental impairment.
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The medical record shows that Dr. Sturch, Mrs. Thomas’s treating
physician, diagnosed and treated her for depression and “thought disorders.” Aplt.
App. Ex. 4 at 164-70. It also shows that, although she responded well to
antidepressant medication, Mrs. Thomas stated that she could not afford the
medication and took it only when Dr. Sturch gave her samples. See id. ; and see
id. at 155 (note by non-examining consulting psychologist acknowledging that
Dr. Sturch gave Mrs. Thomas samples of medication “when he has them” and that
Mrs. Thomas has “lowered concentration and memory which appears to be from
the depression. With ongoing medications, it is felt she would fare much
better.”).
At the Commissioner’s request, Mrs. Thomas was examined by consulting
psychiatrist Dr. Mynatt. Dr. Mynatt conducted psychological tests for intellectual
functioning during which Mrs. Thomas was unable to recall items a few minutes
after hearing them and was unable to count backwards, subtract double-digit
numbers, or perform simple multiplication and division tasks. Dr. Mynatt
diagnosed “[m]ajor depressive disorder” with “particular difficulties with memory
and concentration, which are likely symptoms of depression,” and opined that her
condition “is not expected to improve significantly within the next 12 months.”
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Aplt. App. Ex. 4 at 142. Dr. Mynatt assigned Mrs. Thomas an LOF 1
score of 58,
indicating that she has moderate difficulties in performing in a social or
occupational setting. See Langley v. Barnhart , 373 F.3d 1116, 1122 n.3 (10th Cir.
2004).
The ALJ ignored the LOF score and totally rejected Dr. Mynatt’s opinion,
stating, “the conclusion was based solely on the subjective findings during the
evaluation. Given the lack of objective findings, the [ALJ] simply cannot credit
the claimant’s allegations.” Aplt. App. Ex. 4 at 24. The ALJ instead relied on the
non-examining consulting psychologist’s PRT assessment, based only on medical
records, that Mrs. Thomas’s mental impairment is “not severe” and that her
difficulties in maintaining concentration, persistence, or pace were only “mild.”
See id. at 27, 143, 153. We conclude that the ALJ did not properly evaluate
Dr. Mynatt’s opinion.
The practice of psychology is necessarily dependent, at least in part, on a
patient’s subjective statements. A psychological opinion need not be based on
solely objective “tests”; those findings “may rest either on observed signs and
1
“LOF” is an abbreviation for a level of functioning or global assessment of
functioning score, and is also sometimes called a GAF score. “The GAF is a
subjective determination based on a scale of 100 to 1 of the clinician's judgment
of the individual’s overall level of functioning. A GAF score of 51-60 indicates
moderate symptoms, such as a flat affect, or moderate difficulty in social or
occupational functioning.” Langley, 373 F.3d at 1122 n.3 (citation and quotation
marks omitted).
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symptoms or on psychological tests.” Robinson v. Barnhart , 366 F.3d 1078, 1083
(10th Cir. 2004) (citing 20 C.F.R. Subpart P, App. 1 § 12.00(B)); Langley , 373
F.3d at 1122 (same). The ALJ’s approach of rejecting Dr. Mynatt’s opinion
because he based it, in part, on Mrs. Thomas’s responses to his psychological
tests involving memory and concentration impermissibly put the ALJ in the
position of judging a medical professional on the assessment of medical data. See
Winfrey , 92 F.3d at 1022. The ALJ cannot reject Dr. Mynatt’s opinion solely for
the reason that it was based on Mrs. Thomas’s responses because such rejection
impermissibly substitutes her judgment for that of Dr. Mynatt. See id. We note,
however, that Dr. Mynatt did not state whether Mrs. Thomas’s LOF score actually
affected her ability to function in an occupational setting or affected only her
social functions. If the ALJ believes that the medical record regarding
Mrs. Thomas’s mental impairments is insufficient and needs to be further
developed, the ALJ must do so. See Robinson, 366 F.3d at 1084 (“If evidence
from the claimant’s treating doctor is inadequate to determine if the claimant is
disabled, an ALJ is required to recontact a medical source, including a treating
physician, to determine if additional needed information is readily available.”); 20
C.F.R.
§ 416.912(e)(1) (“We will seek additional evidence or clarification from your
medical source when the report from your medical source contains a conflict or
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ambiguity that must be resolved, the report does not contain all the necessary
information, or does not appear to be based on medically acceptable clinical and
laboratory diagnostic techniques.”).
Further, a consulting, examining physician’s testimony is normally
supposed to be given more weight than a consulting, non-examining physician’s
opinion. See Robinson , 366 F.3d at 1084 (“The opinion of an examining
physician is generally entitled to less weight than that of a treating physician, and
the opinion of an agency physician who has never seen the claimant is entitled to
the least weight of all.”) (citing 20 C.F.R. § 416.927(1), (2) and SSR 96-6p, 1996
WL 374180, at *2). On remand, if there is still a conflict between non-examining
and examining consultant’s opinions, the ALJ must give adequate reasons if she
again rejects the latter in favor of the former. See id.Finally, we address the Commissioner’s contention that the ALJ’s findings
must be upheld based on her view that Dr. Sturch’s notes “show that Appellant’s
depression was controlled with medication and that she was doing well.” Aplee.
Br. at 25. A review of the medical record shows that depression and thought
disorders were a continuing problem during the period that Dr. Sturch treated
Mrs. Thomas, and he tried several kinds of medication. Despite acknowledging
that Mrs. Thomas was diagnosed and prescribed medication for depression, the
ALJ failed to comment on the important evidence that treatment was inconsistent
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because of Mrs. Thomas’s apparent inability to afford the medications. In
arriving at a disability decision, the ALJ “must discuss the uncontroverted
evidence [she] chooses not to rely upon, as well as significantly probative
evidence [she] rejects.” Clifton v. Chater , 79 F.3d 1007, 1010 (10th Cir. 1996).
Whether a person is being consistently treated with available medication is
important probative information. As the Fifth Circuit has stated, “the medicine or
treatment an indigent person cannot afford is no more a cure for his condition
than if it had never been discovered. . . . To a poor person, a medicine that he
cannot afford to buy does not exist.” Lovelace v. Bowen , 813 F.2d 55, 59 (5th
Cir. 1987) (footnotes omitted).
Because the VE opined that individuals could not perform the unskilled,
sedentary jobs he listed if “problems with their short-term memory” caused them
to “have a hard time remembering instructions” or if an individual “had problems
with her ability to concentrate and focus on the task at hand such that the
individual would have errors in their job,” Aplt. App. Ex. 4 at 68, we conclude
that the ALJ’s errors require remand for further development and discussion of
the medical record regarding Mrs. Thomas’s mental impairments and/or further
consideration and weighing of the medical evidence using the proper legal
standards. See Hargis v. Sullivan , 945 F.2d 1482, 1492 (10th Cir. 1991)
(“Testimony elicited by hypothetical questions that do not relate with precision all
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of a claimant’s impairments cannot constitute substantial evidence to support the
[Commissioner’s] decision.” (bracket and quotation marks omitted)).
The judgment of the district court is REVERSED, and the case is
REMANDED to the district court with instructions to remand to the
Commissioner for further proceedings.
Entered for the Court
Stephen H. Anderson
Circuit Judge
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