United States District Court, E.D. Missouri, Northern Division
BRIAN G. WALLS, Plaintiff,
NANCY A. BERRYHILL, Acting Commissioner of Social Security, Defendant.
D. NOCE UNITED STATES MAGISTRATE JUDGE
action is before this court for judicial review of the final
decision of the Commissioner of Social Security finding that
plaintiff Brian G. Walls is not disabled and, thus, not
entitled to either disability insurance benefits
(“DIB”) under Title II of the Social Security
Act, 42 U.S.C. §§ 401 et seq, or Supplemental
Security Income (“SSI”) under Title XVI, 42
U.S.C. §§ 1381-1385. The parties have consented to
the exercise of plenary authority by the undersigned United
States Magistrate judge pursuant to 28 U.S.C. § 636(c).
For the reasons set forth below, the decision of the
Commissioner is affirmed.
was born on February 23, 1970. (Tr. 189, 196). He
protectively filed his applications for DIB and SSI on
October 10, 2012, eventually amending his disability onset
date to the same date. (Tr. 214-15). Plaintiff claimed that
the following conditions limited his ability to work:
depression, bipolar disorder, attention deficit disorder,
lupus, and anxiety. (Tr. 219). Plaintiff's application
was denied on January 9, 2013, and he requested a hearing
before an administrative law judge (“ALJ”). (Tr.
11, 111-15, 118-19). A hearing was held in October 2014,
where plaintiff and a vocational expert (“VE”)
testified. (Tr. 33-92). By decision dated November 7, 2014,
the ALJ found that plaintiff was not disabled under the
Social Security Act. (Tr. 11-23). The ALJ determined that
plaintiff retained the residual functional capacity
(“RFC”) to perform jobs available in significant
numbers in the national economy. Id. On January 14,
2016, the Appeals Council of the Social Security
Administration denied plaintiff's request for review of
the ALJ's decision. (Tr. 1-3). Consequently, the
ALJ's decision stands as the final decision of the
argues that the ALJ's decision is not supported by
substantial evidence. Specifically, he asserts that the ALJ
erred in not giving his treating physician's opinion
controlling weight, failed to fully develop the record, and
failed to perform a proper credibility analysis of
plaintiff's testimony. Plaintiff asks that the ALJ's
decision be reversed or that the case be remanded for a new
Medical Record and Evidentiary Hearing
court adopts plaintiff's unopposed statement of facts
(ECF No. 18), as well as defendant's unopposed statement
of facts. (ECF No. 23). These facts, taken together, present
a fair and accurate summary of the medical record and
testimony at the evidentiary hearing. The court will discuss
specific facts as they are relevant to the parties'
found that plaintiff had not engaged in substantial gainful
activity since his alleged onset date. (Tr. 13). She also
found that plaintiff suffered from the severe impairments of
degenerative disc disease of the cervical spine, lumbago,
discoid lupus, recurrent bilateral carpal tunnel syndrome,
bipolar disorder, and attention deficit disorder.
Id. However, the ALJ concluded that none of these
impairments, individually or in combination, met or equaled
an impairment listed in the Commissioner's regulations.
(Tr. 14-15). With respect to plaintiff's mental
impairment, the ALJ found that the “paragraph B”
and “paragraph C” criteria were not met, because
plaintiff had no restrictions in activities of daily living;
only mild difficulties in social functioning; moderate
difficulties with regard to concentration, persistence, or
pace; and no extended episodes of decompensation.
determined that plaintiff's impairments left him with the
RFC to “perform light work as defined in 20 C.F.R.
404.1567(b) and 416.967(b), ” except that he can only
occasionally lift and carry up to 20 pounds, can frequently
lift and carry up to 10 pounds, can only stand or walk six
hours in an eight-hour workday, and can sit six hours in an
eight-hour workday. (Tr. 15). He cannot crawl or climb on
ropes, ladders, or scaffolds, and he must avoid concentrated
exposure to extreme cold, vibration, and work hazards like
heavy machinery. Id. The ALJ also found that he must
avoid ultraviolet light exposure, though fluorescent lights
are permissible. Id. Finally the ALJ found that
plaintiff can handle and finger bilaterally on a frequent
basis. Id. The ALJ found that plaintiff had
diagnoses for his impairments, but that plaintiff's
statements concerning the intensity, persistence, and
limiting effects of the symptoms were “not entirely
credible.” (Tr. 16-17).
reasoned that the objective medical evidence did not
substantiate plaintiff's allegations. (Tr. 17).
Specifically, the ALJ observed that the record was
“devoid of any evidence showing a significant degree of
nerve compression, muscle atrophy, paravertebral muscle
spasm, sensory or motor loss, reflex abnormality, abnormal
coordination, or consistent gait disturbance.”
Id. The ALJ noted that plaintiff's physical
examinations produced normal or mild findings, his
impairments required no hospitalization, and his sole visit
to the emergency room was to refill a prescription, not
because the severity of his pain required such a visit. (Tr.
16-17, 650) (with the doctor stating, “really suspect
this is tramadol withdraw[a]l . . . fairly classic
presentation. Will give 10 tablets of tramadol to get him
through”). The ALJ also considered plaintiff's
activities of daily living to be inconsistent with his
allegations of debilitating carpal tunnel syndrome. (Tr. 18).
He texts messages, uses a computer keyboard, does not drop
objects, and is able to manipulate a cigarette out of its
package and light it. Id. Ultimately, the ALJ
decided that plaintiff may be experiencing some degree of
pain, but that his physical impairments are addressed in the
limitations of his RFC. Id.
plaintiff's mental impairments, the ALJ emphasized
plaintiff's normal mental status examinations; normal
appearance, behavior, affect, mood, thought, judgment, and
insight; and documented good response to treatment. (Tr. 19).
He also noted a number of inconsistent statements in the
record that erode plaintiff's credibility. Id.
For example, plaintiff reported to the ALJ that he did not
play video games, yet he reported to mental health care
providers that he played video games on a frequent basis.
(Tr. 57, 736, 740, 745).
terms of the medical opinions in the record, the ALJ
explained that he gave “little weight” to
plaintiff's treating physician, Mark Tucker, DO, because
his opinion was inconsistent with his own medical records.
(Tr. 20). For example, when plaintiff told Dr. Tucker he hurt
his back while shoveling, Dr. Tucker showed him correct
lifting techniques to avoid injuries while shoveling. (Tr.
697). As the ALJ noted, “[s]uch counsel is inconsistent
with the functional limitations opined in the medical source
statement.” (Tr. 20).
also gave the opinions of psychiatrists David E. Goldman, DO,
and Lyle A. Clark, MD “little weight” because
they were not supported by the medical evidence. Id.
at 20-21. She noted in particular that their Global
Assessment of Functioning (“GAF”)
scores of 45 and 36, respectively, which indicate
very serious psychological symptoms, were of limited
probative value because they were assigned during an initial
evaluation. Id. She noted that GAF scores are
generally considered “snapshots” of a
plaintiff's abilities at the time of examination, and do
not reflect his day-to-day capabilities or how treatment may
control symptoms. Id.
gave partial weight to the opinion of an examining prison
doctor who assigned plaintiff a GAF score of 60, because it
indicated the claimant was experiencing moderate
psychological symptoms, which ...