Opinion
Case No.: 3:22cv01503/ZCB
2023-03-06
Terrill Ann MAJOR, Plaintiff, v. Kilolo KIJAKAZI, Acting Commissioner of Social Security, Defendant.
Terrill Ann Major, Pensacola, FL, Pro Se. Megan Cleary DePonte, Social Security Administration, Atlanta, GA, Peter Gunnar Fisher, Northern District of Florida, Tallahassee, FL, for Defendant.
Terrill Ann Major, Pensacola, FL, Pro Se. Megan Cleary DePonte, Social Security Administration, Atlanta, GA, Peter Gunnar Fisher, Northern District of Florida, Tallahassee, FL, for Defendant. ORDER Zachary C. Bolitho, United States Magistrate Judge
This is a Social Security appeal under 42 U.S.C. § 405(g). Plaintiff, Terrill Ann Major, proceeding pro se, seeks judicial review of the Commissioner's final decision denying her claim for a period of disability and disability insurance benefits. Because the Commissioner's decision is supported by substantial evidence, it is affirmed.
I. Background
Plaintiff first applied for a period of disability and disability insurance benefits on October 17, 2019. (Tr. 42, 517-18). Plaintiff's initial application for benefits alleged an onset date of November 16, 2007. (Tr. 42, 517-18). Her date last insured was December 31, 2012. (Tr. 42). The Social Security Administration initially denied her claim on January 17, 2020, and again on reconsideration on April 17, 2020. (Tr. 42, 461-62). Plaintiff requested a hearing before an Administrative Law Judge (ALJ). That hearing was held telephonically on November 6, 2020. (Tr. 42, 491). On November 27, 2020, the ALJ issued a written decision finding Plaintiff not disabled. (Tr. 42-56). The Appeals Council denied Plaintiff's request for review. (Tr. 32-38). The ALJ's decision now stands as the final decision of the Commissioner. Plaintiff has timely requested judicial review under 42 U.S.C. § 405(g).
Citations to the administrative record filed by the Commissioner are designated as "Tr." The page numbers cited herein are those found on the bottom right corner of each page of the transcript, rather than the page numbers that were assigned by the Court's electronic docketing system.
II. The Legal Framework
"Disability" is defined 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 12 months." 42 U.S.C. § 423(d)(1)(A). The Social Security Administration has established a five-step sequential process to determine whether a claimant is disabled. Phillips v. Barnhart, 357 F.3d 1232, 1237 (11th Cir. 2004); 20 C.F.R. § 404.1520(a)(4).
First, the Commissioner must determine whether the claimant is engaged in substantial gainful activity. 20 C.F.R. § 404.1520(a)(4)(i). If so, the Commissioner will find that the claimant is not disabled. 20 C.F.R. § 404.1520(b). Second, if the claimant is not engaged in substantial gainful activity, then the Commissioner will determine the severity of the claimant's impairments or combination of impairments. 20 C.F.R. § 404.1520(a)(4)(ii). To be disabled, a claimant must have a "severe impairment," which is an impairment that "significantly limits [a claimant's] physical or mental ability to do basic work activities." 20 C.F.R. § 404.1520(c).
Third, the Commissioner evaluates whether the claimant's severe impairment meets or equals an impairment listed in Appendix 1 to subpart P of Part 404 of the regulations (the "Listing"). 20 C.F.R. § 404.1520(a)(4)(iii). Fourth, the Commissioner determines whether the claimant's residual functional capacity can meet the physical and mental demands of past relevant work. 20 C.F.R. § 404.1520(a)(4)(iv). Fifth and finally, the Commissioner determines whether the claimant's residual functioning capacity, age, education, and past work experience prevent the performance of any other work in the national economy. 20 C.F.R. § 404.1520(a)(4)(v).
The claimant bears the burden of proof at the first four steps. Goode v. Comm'r of Soc. Sec., 966 F.3d 1277, 1278 (11th Cir. 2020). If the claimant establishes the first four steps, then the burden shifts to the Commissioner at step five to show the existence of other jobs in the national economy that the claimant can perform. Buckwalter v. Acting Comm'r of Soc. Sec., 5 F.4th 1315, 1321 (11th Cir. 2021). If the Commissioner carries this burden, then the claimant must prove that she cannot perform the work identified by the Commissioner. Goode, 966 F.3d at 1279.
III. The ALJ's Decision
The ALJ found at step one that Plaintiff had not engaged in substantial gainful activity from her alleged onset date through December 31, 2012, her date last insured. (Tr. 44, Finding 2). At step two, the ALJ found that Plaintiff suffered from the following medically determinable impairments: diabetes mellitus, hypothyroidism, obesity, status post gastric bypass surgery, status post fracture of wrist and distal end of radius. (Tr. 44-45, Finding 3). The ALJ noted that Plaintiff had claimed other impairments, including spinal injury, various mental impairments, digestive issues, and Hashimoto's disease. (Id.). But, the ALJ found that based on the information in the record, those impairments were not medically determinable for the period prior to the date last insured. (Id.).
Regarding the medically determinable impairments, the ALJ concluded they were non-severe because Plaintiff failed to show that they significantly limited her ability to perform basic work activities during the relevant time period. (Tr. 45, Finding 4). The ALJ, therefore, found that Plaintiff was not under a disability from the alleged onset date through the date last insured. (Tr. 55-56, Finding 5). In reaching his conclusion, the ALJ stressed that he was tasked with finding whether Plaintiff was disabled as of December 31, 2012, (the date last insured) and not whether Plaintiff had become disabled since that date. (Tr. 46). On that point, the ALJ explained that much of the information presented by Plaintiff applied to her current medical condition as opposed to her condition as of the date last insured. (Id.). The ALJ also pointed out that Plaintiff alleged that her symptoms had worsened over the years, which demonstrated to the ALJ that Plaintiff's current condition was not the same as her condition on the date last insured. (Tr. 47). And the ALJ's review of Plaintiff's medical records prior to the date last insured did not support Plaintiff's claim that she was disabled as of December 31, 2012. (Tr. 50-51). The ALJ explained that the record established that prior to the date last insured, Plaintiff regularly traveled internationally and engaged in normal life activities without significant limitations. (Tr. 49-51). The ALJ found that the medical issues Plaintiff experienced during the relevant time period were treated conservatively, and there "was no evidence that the claimant's long-term impairments were worsening or combining in limiting effect to establish severity." (Id.).
IV. Standard of Review
This Court's review of the Commissioner's final decision is limited to determining whether there is substantial evidence to support the Commissioner's findings and whether the correct legal standards were applied. Wilson v. Barnhart, 284 F.3d 1219, 1221 (11th Cir. 2002). Thus, it is not this Court's role to "decide the facts anew, reweigh the evidence, or substitute [its] judgment for that of the [Commissioner]." Simon v. Comm'r, Soc. Sec. Admin., 7 F.4th 1094, 1104 (11th Cir. 2021) (cleaned up). Indeed, the Social Security Act provides that "[t]he findings of the [Commissioner] as to any fact, if supported by substantial evidence, shall be conclusive." 42 U.S.C § 405(g) (cleaned up).
The substantial evidence standard is "not high" and is "deferential" to the ALJ's decision. Biestek v. Berryhill, — U.S. —, 139 S. Ct. 1148, 1154, 1156, 203 L.Ed.2d 504 (2019). It requires "more than a mere scintilla, but less than a preponderance." Dyer v. Barnhart, 395 F.3d 1206, 1210 (11th Cir. 2005) (per curiam) (internal quotations omitted). Put another way, it requires only "such relevant evidence as a reasonable mind might accept as adequate to support a conclusion." Biestek, 139 S.Ct. at 1154 (internal quotation omitted). And, "[i]f the Commissioner's decision is supported by substantial evidence, we must affirm, even if the proof preponderates against it." Phillips, 357 F.3d at 1240 n.8 (internal quotations omitted).
V. Discussion
Plaintiff claims that the ALJ erred by finding that she was "not under a disabling condition at the time of her alleged onset date[,] November 17, 2007 and last day insured, December 31, 2012." (Doc. 13 at 4). The focus of Plaintiff's appeal is the ALJ's determination that she did not have a medically determinable mental health impairment prior to the date last insured, as opposed to the ALJ's determination that her medically determinable physical impairments were non-severe. (See id. at 13) (stating "Claimant is also choosing to concentrate on her symptoms that are mental disorders, that exacerbate her physical conditions, rather than what she stated in her record testimony"). Plaintiff argues that she suffers from mental health disorders, primarily Post-traumatic Stress Disorder (PTSD) and Battered Person Syndrome. She claims that she was suffering from those conditions prior to the date last insured, and the ALJ erred by failing to find that those conditions rendered her disabled.
Plaintiff specifically argues that the ALJ failed to: (1) "apply the rules of evidence carefully and consistently"; (2) "give 'proper weight' to the [Plaintiff's] 'treating doctors' "; (3) "give proper consideration of the [Plaintiff's] 'well supported' medical opinions and 'consistent' medical diagnosis, from her numerous expert treating physicians over a span of twenty[-]five years"; and (4) acknowledge "symptoms of stress, anxiety and trauma [Plaintiff] was enduring at her AOD and through her last date insured." (Id. at 4-7). Defendant has responded by arguing that the ALJ's decision was supported by substantial evidence, which is all this Court needs to determine at the end of the day. (Doc. 15 at 4). For the reasons below, the Court agrees with Defendant that substantial evidence supports the ALJ's decision.
Plaintiff has included what she declares "Case Issues" 5, 6, and 7, which appear to be summaries of Plaintiff's alleged history of abuse, trauma, and anxiety, rather than specific contentions concerning the ALJ's findings. (See Doc. 13 at 7-9). Thus, the Court will consider issues 1-4 to be the issues Plaintiff raises for this Court's review.
A. The ALJ did not fail to "apply the rules of evidence carefully and consistently."
In support of Plaintiff's argument that the ALJ erroneously found her not to be disabled, Plaintiff first argues that the ALJ "did not apply the rules of evidence carefully and consistently." (Doc. 13 at 4-5). It is not entirely clear what Plaintiff means by this assignment of error, but to the extent she is claiming the ALJ incorrectly applied the Federal Rules of Evidence at the administrative hearing, her claim lacks merit. That is so because the Federal Rules of Evidence do not apply in Social Security administrative hearings. See Goode, 966 F.3d at 1283 (recognizing that the Federal Rules of Evidence do not apply in Social Security administrative hearings); see also 42 U.S.C. § 405(b)(1) (stating that "[e]vidence may be received at any hearing before the Commissioner of Social Security even though inadmissible under rules of evidence applicable to court procedure"). Because the Federal Rules of Evidence did not apply at the hearing, the ALJ could not have erred by failing to apply them "carefully and consistently."
B. The ALJ properly considered the opinions of Plaintiff's treating medical providers.
Plaintiff next argues the ALJ did not appropriately consider the opinions of her treating medical providers. Although her brief is somewhat hard to follow, Plaintiff appears to be claiming that the ALJ erred by not crediting the opinions of medical providers who opined that she suffered from a mental health condition during the relevant time period. (Doc. 13 at 10-11). As explained below, the ALJ sufficiently considered and discussed the medical opinion evidence in the record.
For benefits claims filed after March 27, 2017, the Social Security regulations state that the ALJ "will not defer or give any specific evidentiary weight, including controlling weight, to any medical opinion(s)." 20 C.F.R. § 404.1520c(a). This regulatory change "eliminated the treating-physician rule" that was previously applied in Social Security cases. Harner v. Soc. Sec. Admin., Comm'r, 38 F.4th 892, 897 (11th Cir. 2022). Thus, the "new regulatory scheme no longer requires the ALJ to either assign more weight to medical opinions from a claimant's treating source or explain why good cause exists to disregard the treating source's opinion." Matos v. Comm'r of Soc. Sec., No. 21-11764, 2022 WL 97144, at *4 (11th Cir. Jan 10, 2022).
Plaintiff filed her initial application on October 17, 2019. (Tr. 42, 517-18).
For claims after March 27, 2017, an ALJ is required to consider the following factors when determining the weight to give a medical opinion, "the supportability of the medical opinion, its consistency with other record evidence, the physician's relationship with the claimant, the physician's specialty, and other relevant information, such as the physician's familiarity with the other record evidence and with a making a claim for disability." Harner, 38 F.4th at 897. Of those factors, the Eleventh Circuit has said that the most important are the supportability of the medical opinion and its consistency with other evidence in the record. See Walker v. Soc. Sec. Admin., Comm'r, No. 21-12732, 2022 WL 1022730, at *2 (11th Cir. Apr. 5, 2022) (recognizing supportability and consistency as the most important factors); see also Matos, 2022 WL 97144, at *4 (stating that the ALJ "may, but is not required to, explain how she considered factors other than supportability and consistency"). Supportability refers to the principle that "[t]he more relevant the objective medical evidence and supporting explanations presented by a medical source are to support his or her medical opinion(s) or prior administrative finding(s), the more persuasive the medical opinions or prior administrative medical finding(s) will be." 20 C.F.R. § 416.920c(c)(1). And consistency refers to the principle that "[t]he more consistent a medical opinion(s) or prior administrative finding(s) is with the evidence from other medical sources and nonmedical sources in the claim, the more persuasive the medical opinion(s) or prior administrative medical finding(s) will be." 20 C.F.R. § 416.920c(c)(2).
Looking to the record in this case, the ALJ conducted a sufficient supportability and consistency evaluation of the medical opinions submitted by Plaintiff. For example, one medical provider whose opinion Plaintiff alleges was not given proper weight was Dr. Ehrmann. But, the ALJ discussed Dr. Ehrmann's opinion in detail. (Tr. 53-54). The ALJ explained that Plaintiff did not see Dr. Ehrmann until 2020—well after the date last insured. And the ALJ stated that Dr. Ehrmann's "medical history was based largely on Plaintiff's statements rather than careful review of all of her medical records." (Tr. 53). As for Dr. Ehrmann's conclusion that Plaintiff "met the diagnostic criteria for PTSD, MDD, and anxiety" for the preceding "40 years," the ALJ explained that the conclusion was "inconsistent" with Plaintiff's medical records from 2007 to 2012. (Tr. 53). The medical records from that time reflected "no signs or symptoms" to support Dr. Ehrmann's conclusion, and the ALJ noted that "Dr. Ehrmann was not treating the claimant 40 years ago, in 2007, 2012, or even 2018." (Tr. 53). The ALJ also stated that Dr. Ehrmann based his conclusion largely on a letter provided by Plaintiff as well as a "single interview" with Plaintiff. (Tr. 54). Thus, the ALJ concluded that Dr. Ehrmann's opinion was "too general and uncorroborated by the objective record to be persuasive." (Id.). The ALJ similarly concluded that the opinion of Nurse Practitioner Scott Durance—who Plaintiff saw in 2020—was unpersuasive because it was unsupported by the record and was based on Plaintiff's characterizations as opposed to a review and analysis of the historic medical record. (Tr. 53).
The ALJ also sufficiently explained why he found the medical source statements from Dr. Lloyd Sloan and Dr. Carrie Gray to be unpersuasive regarding Plaintiff's condition prior to the date last insured. (Tr. 54-55). The ALJ pointed out that neither Dr. Sloan nor Dr. Gray were familiar with Plaintiff prior to 2019-2020, and their statements were not based on reviews of the entire medical record. (Id.). As the ALJ explained, Dr. Sloan's statement was "too recent, too poorly supported, and too internally inconsistent to warrant any persuasiveness." (Tr. 54). The same was said about Dr. Gray's opinion. (Tr. 55).
In sum, the ALJ's determination that the medical source opinions offered by Plaintiff were unpersuasive was not improper because the ALJ considered and discussed the appropriate factors. See, e.g., Glasby v. Soc. Sec. Admin., Comm'r, No. 21-12093, 2022 WL 1214015 (11th Cir. Apr. 25, 2022) (finding substantial evidence supported the ALJ's finding that the claimant's treating physician's opinion was not persuasive under 20 C.F.R. § 404.1520c); Matos, 2022 WL 97144, at *7 (affirming the ALJ's finding that claimant's doctor's opinion was unpersuasive because it was inconsistent with the record as a whole). Moreover, the ALJ's determination that Plaintiff failed to show she had a medically determinable mental health impairment during the relevant time period finds sufficient support in the medical records. Various medical records from 2009-2012 show that Plaintiff was not diagnosed with any mental health disorders. Notes from various physician visits throughout the relevant time period state that Plaintiff had normal psychiatric and/or psychological exams. (See, e.g., Tr. 1078) ("No psychiatric diagnosis or condition on axis I"); (Tr. 1041) ("No psychological symptoms." "A mental status exam was normal."); (Tr. 1033) ("No psychiatric diagnosis or condition on Axis I"); (Tr. 1027) ("A mental status exam was normal."); (Tr. 1026) ("No psychological symptoms."); (Tr. 960) ("Behavior demonstrated no abnormalities."); (Tr. 935) ("No depression."); (Tr. 921) ("Mood was euthymic"); (Tr. 1161) ("No psychiatric diagnosis or condition on axis I"). Because the "ALJ articulate[d] specific reasons for failing to give" the Plaintiff's medical source statements controlling weight and those reasons are "supported by substantial evidence," this Court finds no basis for reversing the ALJ's decision. Moore v. Barnhart, 405 F.3d 1208, 1212-13 (11th Cir. 2005).
Plaintiff admits as much, although she attributes the lack of a diagnosis to the abusive environment she was living in during the relevant time period. (Doc. 13 at 13) (stating "Claimant admits she did not receive proper diagnosis due to the situation of her environment").
Much of the information provided by Plaintiff in this case relates to medical care provided well after the date of last insured. Such information is only relevant to the extent that it speaks to the nature and severity of Plaintiff's condition prior to the date last insured. See White v. Berryhill, 704 F. App'x 774, 779 (10th Cir. 2017) (stating that "evidence documenting a claimant's condition after her date last insured may be considered if it relates to the insured period"). And it is not persuasive where the post-date insured medical opinion is inconsistent with the pre-date insured medical record. See Mason v. Comm'r of Soc. Sec., 430 F. App'x 830, 832 (11th Cir. 2011) (explaining that a "physician's post-insured-date opinion that the claimant suffered a disabling condition prior to the insured date" is not persuasive unless "that opinion was consistent with pre-insured-date medical evidence"). Although Plaintiff may have been diagnosed with trauma-related mental health conditions after the date last insured, substantial evidence supports the ALJ's conclusion that Plaintiff failed to meet her burden of proving that she suffered from the same mental health conditions and that those conditions significantly impacted her ability to do basic work activities on and before December 31, 2012—the date last insured. (Tr. 42).
C. The ALJ sufficiently considered Plaintiff's medical evidence.
Plaintiff next argues the "ALJ did not give proper consideration of the [Plaintiff's] 'well supported' medical opinions and 'consistent' medical diagnosis." (Doc. 13 at 5). Plaintiff appears to assert that because she was primarily treated in "Military Health Care facilities" she refrained from disclosing her "mental health issues" to any of her doctors out of fear. (Id.). Plaintiff includes references to what appear to be new exhibits that were not part of the record below, such as articles about domestic abuse in the military, an alleged witness statement about Plaintiff's abuse, and an "ApologyLetterfromAbuser" (sic). (Id.). Later in her brief, Plaintiff states that her treating nurses and physicians were unable to "capture all that is pertinent as [Plaintiff's] records don't show years of abuse, because she could not report her abuse without hurting her spouses' career and family." (Id. at 14-15).
As mentioned above, it is Plaintiff's burden to come forward with evidence establishing her disability during the relevant time period. See Mason, 430 F. App'x at 831 (recognizing that it is the claimants' burden to "show that they were disabled on or before their last-insured date"). Plaintiff's statement that she was not honest with her treatment providers because of her abusive relationship is insufficient to show that prior to the date last insured she suffered from a medically determinable mental impairment that was severe in nature and rendered her disabled. In support of his decision, the ALJ analyzed Plaintiff medical records (year-by-year) for the relevant time period and summarized what they showed. (Tr. 48-51). The ALJ also reviewed Plaintiff's postdate last insured records—also year-by-year—which ultimately provided "additional support for the non-severity of the pre-[date last insured] impairments." (Tr. 51-53). Thus, Plaintiff's contention that the ALJ failed to consider relevant, entire timeframes of her medical records, is unfounded. The ALJ sufficiently considered of Plaintiff's relevant medical history and explained how the medical history did not establish Plaintiff suffered from a severe impairment that rendered her disabled. The ALJ's finding was supported by substantial evidence.
D. The ALJ's acknowledgment of Plaintiff's alleged symptoms of stress, anxiety, and trauma.
Finally, Plaintiff contends "the ALJ missed symptoms of stress, anxiety and trauma [Plaintiff] was enduring at her AOD through her date last insured." (Doc. 13 at 6). Plaintiff continues by asserting her medical records "were not properly evaluated by ALJ (sic) and paid state Agencies Opinions." (Id.). Plaintiff argues the state physicians "did not have all the evidence to review and recognize trauma and abuse victims; PTSD symptoms, . . . cognitive dissonance . . . and numbing out to avoid and deny mental health issues due to the stigma." (Id.). Plaintiff contends the state physicians considered only "limited documentation" and excluded "essential case history." (Id.). Plaintiff states "[s]he was not aware of a mental health diagnosis" at the time she filed her social security benefits application and that she "didn't realize she would be able to provide evidence of her mental health conditions." (Id. at 7). Plaintiff states that due to her "severe[ ] traumatiz[ation,]" she was "unable to recognize . . . that she suffered from mental health issues." (Id.).
Plaintiff does not state exactly what "essential case history" the ALJ excluded or failed to consider. And Plaintiff admits to not disclosing her mental health symptoms to her treating physicians prior to the date last insured. Contrary to Plaintiff's assertion, the ALJ explicitly acknowledged Plaintiff's experience and history of trauma. (See Tr. 46-47) ("[Plaintiff] alleges forty years of spousal abuse . . . panic attacks dating to 1979, anxiety, agoraphobia, acrophobia, claustrophobia, and vertigo . . . MDD and PTSD . . . . [t]hese mental symptoms 'broke' her and 'crippled her ability to drive or performance daily tasks required . . . . [t]he undersigned also considered the question of alleged spousal abuse, dating to 2003, and frankly far earlier."). The ALJ also acknowledged that while Plaintiff may be experiencing these symptoms, the ALJ "cannot summarily accept that the claimant's current symptoms, functioning, and response to treatment are an accurate window into her pre-DLI experience . . . . the burden is on the claimant to establish this in medically meaningful terms using the evidence." (Tr. 46-47). Further, the ALJ highlighted that Plaintiff has not alleged "that all pre-DLI impairments have been at their 2020 level of limiting effect since her alleged onset date. [Plaintiff] alleges progressively worsening symptoms over the years." (Tr. 47). The ALJ determined the Plaintiff simply had not met her burden to establish the nexus between the domestic abuse she describes and a "particularized anatomical, physiological, or psychological abnormality, which can be shown by medically acceptable clinical and laboratory diagnostic techniques." (Tr. 47); see 20 C.F.R. 404.1521. The ALJ primarily relied on the "much more voluminous record as a whole, and the sound analyses from the State agency sources who have a known familiarity with the standards applied by the Administration" than the number of sources who merely state "that the claimant's history of abuse caused her current impairments." (Tr. 47-48). As the ALJ highlighted, the medical evidence suggests Plaintiff's "impairments were not severe prior to the DLI, worsened afterward, and [ ] other new impairments have emerged." (Tr. 48). Therefore, Plaintiff's argument that the ALJ did not consider her mental health symptoms and history of experiencing traumatic events is incorrect. The ALJ sufficiently considered the entirety of Plaintiff's medical record and reached a decision that was supported by substantial evidence.
VI. Conclusion
Accordingly, it is ORDERED that:
1. The Commissioner's decision is AFFIRMED, this action is DISMISSED, and a final judgment is ENTERED pursuant to sentence four of 42 U.S.C. § 405(g); and
2. The Clerk of Court is directed to close the case file.
SO ORDERED, this 6th day of March 2023.