GRAMES v. COMMISSIONER OF SOCIAL SECURITY (2019)

ORDER

Margaret Ann Grames, a Michigan resident proceeding through counsel, appeals a district court judgment affirming the Social Security Commissioner's decision denying her applications for disability insurance benefits (“DIB”) and supplemental security income benefits (“SSI”). The parties have waived oral argument, and this panel unanimously agrees that oral argument is not needed. See Fed. R. App. P. 34(a).

In 2014, Grames applied for DIB and SSI, alleging a disability onset date of July 19, 2013. The Commissioner denied Grames' applications, and Grames sought review before an administrative law judge (“ALJ”). Following a hearing at which a vocational expert (“VE”) testified, the ALJ denied Grames' applications for benefits. In relevant part, the ALJ found that Grames' severe impairments of degenerative disc disease, obesity, major depression, personality disorder, and anxiety disorder did not meet or medically equal a listed impairment, that Grames had the residual functional capacity (“RFC”) to perform light work with specific restrictions, and that Grames could perform her past work as a cashier and retail clerk. The Appeals Council denied Grames' request for review. Grames sought judicial review, and the district court affirmed the Commissioner's decision.

On appeal, Grames argues that the ALJ erred in evaluating both the medical opinion evidence and her own testimony regarding her psychological limitations.

We review a district court's decision in a social security case de novo. Ealy v. Comm'r of Soc. Sec., 594 F.3d 504, 512 (6th Cir. 2010) (citing Jordan v. Comm'r of Soc. Sec., 548 F.3d 417, 422 (6th Cir. 2008)). This review “is limited to determining whether the Commissioner's decision ‘is supported by substantial evidence and was made pursuant to proper legal standards.’ ” Id. (quoting Rogers v. Comm'r of Soc. Sec., 486 F.3d 234, 241 (6th Cir. 2007)). “Substantial evidence is less than a preponderance but more than a scintilla; it refers to relevant evidence that a reasonable mind might accept as adequate to support a conclusion.” Gentry v. Comm'r of Soc. Sec., 741 F.3d 708, 722 (6th Cir. 2014) (citing Rogers, 486 F.3d at 241). “If the Commissioner's decision is based upon substantial evidence, we must affirm, even if substantial evidence exists in the record supporting a different conclusion.” Ealy, 594 F.3d at 512 (citing Lindsley v. Comm'r of Soc. Sec., 560 F.3d 601, 604 (6th Cir. 2009)).

I. Treating Physician Dr. Dale D'Mello

Grames first argues that the ALJ erred both by giving little weight to the opinions of Dr. D'Mello and by failing to give good reasons for according little weight to his opinions. Under the “treating physician rule,” the opinion of a treating physician must be afforded controlling weight if it is “well-supported by medically acceptable clinical and laboratory diagnostic techniques and is not inconsistent with the other substantial evidence in [the] case record.” 20 C.F.R. § 404.1527(c)(2); Smith v. Comm'r of Soc. Sec., 482 F.3d 873, 877 (6th Cir. 2007). An ALJ must “always give good reasons” for the weight that he assigns to a treating source's opinion. 20 C.F.R. § 404.1527(c)(2); Gayheart v. Comm'r of Soc. Sec., 710 F.3d 365, 376 (6th Cir. 2013). Those reasons must be “supported by the evidence in the case record, and must be sufficiently specific to make clear to any subsequent reviewers the weight the adjudicator gave to the treating source's medical opinion and the reasons for that weight.” Gayheart, 710 F.3d at 376 (quoting SSR 96-2p, 1996 WL 374188, at *5 (July 2, 1996)).

Dr. D'Mello, a psychiatrist who treated Grames from February 2014 through December 2015 and examined her approximately every eight weeks, offered his opinions on Grames' medical limitations in two separate documents. First, in a March 15, 2015 Mental Impairment Questionnaire, he reported Grames' Global Assessment of Functioning (“GAF”) score as “45,” indicated that she experienced episodes of decompensation or deterioration in a work or work-like setting, and stated that she was “[u]nable to work.” He opined that Grames was moderately limited in her ability to understand and remember work-related instructions and procedures and that she was moderately-to-markedly limited in her ability to concentrate and maintain work activities, interact socially, and adapt to work conditions. Dr. D'Mello estimated that Grames would have to be absent from work more than three times per month due to her psychiatric impairments.

Second, in an April 25, 2016 letter, Dr. D'Mello opined that Grames' symptoms “markedly limited ․ her ability to perform activities within a schedule, travel to unfamiliar places and use public transportation.” He reiterated that Grames experienced episodes of decompensation in a work or work-like setting, and he therefore opined that she would be absent from her job more than three times per month and was “incapable of working.” Dr. D'Mello reiterated that the opinions expressed in his March 2015 questionnaire were still valid.

To the extent that the ALJ refused to give controlling weight to Dr. D'Mello's opinion that Grames was “unable to work,” that decision was proper, because the ultimate question of whether an individual is disabled or unable to work is to be decided by the Commissioner. 20 C.F.R. § 404.1527(d)(1); White v. Comm'r of Soc. Sec., 572 F.3d 272, 286 (6th Cir. 2009). However, the ALJ's decision to reject Dr. D'Mello's opinions about Grames' specific limitations is not supported by substantial evidence. First, the ALJ found that Dr. D'Mello failed to explain why Grames decompensates or needs to be off work more than three times per month. However, in his April 2016 letter, Dr. D'Mello explained that being in a work or work-like setting causes Grames to decompensate and that the instances of decompensation “cause[ ] her to withdraw and experience an[ ] exacerbation of symptoms.” Dr. D'Mello listed those specific symptoms in his letter. He explained that the exacerbation of symptoms and the need for treatment would likely cause Grames to miss work more than three times per month.

The ALJ also found that Dr. D'Mello's opinions concerning the severity of Grames' condition were not supported by the objective medical evidence. To support his finding, the ALJ cited portions of Dr. D'Mello's records stating that Grames “was pleasant and polite, ․ neatly and casually attired,” and oriented, and that she “showed no memory, knowledge, concentration, or intellectual deficits.” The ALJ also found that Dr. D'Mello's treatment notes showed that Grames' condition improved from April 2015 through December 2015. But, the ALJ simply cherry-picked certain observations and medical findings while ignoring other serious symptoms that Dr. D'Mello and other practitioners noted throughout the relevant time-period. An ALJ's decision cannot be upheld where she “selectively considered the evidence in denying benefits.” Howard v. Barnhart, 376 F.3d 551, 554 (6th Cir. 2004); see Miller v. Comm'r of Soc. Sec., 811 F.3d 825, 838 (6th Cir. 2016); Glenn v. Comm'r of Soc. Sec., 763 F.3d 494, 498 (6th Cir. 2014).

Here, at the same appointments that Dr. D'Mello observed no impairments in Grames' judgment, intellect, and concentration, he also noted that Grames reported experiencing flashbacks, daily panic attacks, nightmares, low energy, difficulty falling asleep, dissociative spells, ruminative thoughts, and dysphoria. Therapist Deborah Larimer documented these symptoms, too. Dr. D'Mello apparently believed these complaints to be credible, because he prescribed numerous medications to treat them. He also repeatedly noted psychomotor agitation and psychomotor retardation. Finally, despite Dr. D'Mello's failure to personally observe any concentration difficulties, Grames did report such problems several times. These findings were not accounted for by the ALJ.

The ALJ's finding that Grames' condition improved in April 2015 also ignores an important part of her story. Grames' April 2015 appointment with Dr. D'Mello was only her second visit with him following a three-day inpatient stay in a mental health facility in late February and early March 2015. Indeed, Dr. D'Mello assigned Grames a GAF score of 60 during her April 24, 2015, visit—an improvement from the GAF score of 45 that she received while hospitalized, but a score that still signaled the existence of “[m]oderate symptoms (e.g., flat affect and circumstantial speech, occasional panic attacks), or moderate difficulty in social, occupational, or school functioning (e.g., few friends, conflicts with peers or co-workers).” Kornecky v. Comm'r of Soc. Sec., 167 F. App'x 496, 503 (6th Cir. 2006) (per curiam) (alteration in original) (quoting Am. Psychiatric Ass'n, Diagnostic and Statistical Manual of Mental Disorders 34 (4th ed. 1994)). A GAF score, although not determinative, “may assist an ALJ in assessing a claimant's mental RFC.” Miller, 811 F.3d at 835 (citing Kennedy v. Astrue, 247 F. App'x 761, 766 (6th Cir. 2007)). That is the case here. Grames' GAF scores track her symptoms: they decreased when Grames' symptoms worsened, and they increased when her symptoms improved. The GAF score assigned in April 2015 provides context for the improvement of Grames's symptoms: although her symptoms improved that month, they did so only to a certain extent, and Grames' GAF score never exceeded a “60” during her treatment relationship with Dr. D'Mello.

The ALJ's focus on Grames' improvement in 2015 also ignores medical evidence documenting her condition after that period. In February 2016, a licensed professional counselor with Life Skills Psychological Services noted that Grames' symptoms and her ability to function had regressed. One month later, Grames reported to Dr. Rachel Plum, the psychiatrist who took over her care in March 2016, that she had multiple panic attacks every day and that she frequently did not leave her house or her room as a result. She continued to experience panic attacks, alternating periods of sleeplessness and hypersomnia, and other anxiety symptoms through May 2016.

Finally, before concluding that Dr. D'Mello's opinions were entitled to “little weight,” the ALJ failed to consider numerous factors set forth in 20 C.F.R. § 404.1527(c), including the “[l]ength of the treatment relationship and the frequency of examination,” the “[n]ature and extent of the treatment relationship,” the “[s]upportability” of the physician's opinions, and the physician's specialization. 20 C.F.R. § 404.1527(c); see Wilson v. Comm'r of Soc. Sec., 378 F.3d 541, 544 (6th Cir. 2004). Under such circumstances, remand is warranted. See Hensley v. Astrue, 573 F.3d 263, 267 (6th Cir. 2009).

II. Treating Physician Dr. Plum

Grames also argues that the ALJ erred by rejecting the opinion of Dr. Plum. This claim is meritless, because Dr. Plum offered no opinion about Grames' RFC, and stated that she could not do so because she had examined Grames only twice.

III. Examining Psychologist Dr. Mark Garner

Next, Grames challenges the ALJ's decision to give “great weight” to the opinions of Dr. Garner, a psychologist who did not examine her and who reviewed only a portion of her medical records. Indeed, Dr. Garner conducted his review on February 4, 2015, before Grames was hospitalized for an exacerbation of psychiatric symptoms and before Dr. D'Mello opined about Grames' specific work limitations in light of her psychological condition. The record before the ALJ included over a year of additional medical records that Dr. Garner had not reviewed. Under these circumstances, the ALJ did not follow the Social Security Administration's own procedural rules when she gave more weight to the opinions of Dr. Garner than to those of Dr. D'Mello. See Blakley v. Comm'r of Soc. Sec., 581 F.3d 399, 409 (6th Cir. 2009); SSR 96-6p, 1996 WL 374180, at *2-3 (July 2, 1996).

IV. Grames' Testimony

Finally, Grames argues that the ALJ considered only “the normal mental status findings and symptoms” noted in her medical record when concluding that those records conflicted with her testimony about the severity and limiting effects of her symptoms. When assessing a claimant's subjective statements, “the ALJ must [first] determine whether a claimant has a medically determinable physical or mental impairment that can reasonably be expected to produce the symptoms alleged.” Calvin v. Comm'r of Soc. Sec., 437 F. App'x 370, 371 (6th Cir. 2011); SSR 16-3p, 2017 WL 5180304, at *3 (Oct. 25, 2017). The ALJ answered this question affirmatively. Next, the ALJ must consider the objective medical evidence and the claimant's reported daily activities, as well as several other factors, to evaluate the intensity, persistence, and functional limitations of the claimant's symptoms. See Curler v. Comm'r of Soc. Sec., 561 F. App'x 464, 474 (6th Cir. 2014); 20 C.F.R. § 404.1529(c)(1)-(3); SSR 16-3p, 2017 WL 5180304, at *4, *7-8 (Oct. 25, 2017). At this step, the ALJ found that “[t]he medical evidence of record does not support that Ms. Grames' mental functioning is as limited as she alleges.” To support this conclusion, the ALJ cited reports in Grames' medical records that she dressed appropriately, was oriented, had no concentration difficulties or difficulty sleeping, and “had unremarkable psychomotor status.”

Substantial evidence does not support the ALJ's conclusion. The medical records support Grames' contention that her panic attacks began in mid-2013, after her son stabbed her husband in her presence. The record includes descriptions of Grames' panic attacks that are consistent with her testimony. In late 2013, she described “a ‘meltdown’ ” during which she blanked out and started crying uncontrollably and an episode of shaking and hyperventilating while shopping. In February 2014, Dr. D'Mello noted that Grames' panic attacks included “spells of breathlessness, perioral tingling, dizziness, and tremulousness” and that Grames described “apparent dissociative spells [and] transient absences with amnesia.” At times Grames reported multiple panic attacks per day, while at other times, they were less frequent. The most recent medical records, from May 2016, showed that Grames was having multiple panic attacks per day, her mood was “all over the place,” the medication prescribed by Dr. Plum was not working as well as previous medications, and Grames “frequently d[id] not leave her house or her room” because of the panic attacks.

Other specific findings made by the ALJ are also contradicted by the record. The ALJ found that Grames had no trouble sleeping, but Grames repeatedly complained to her physicians of difficulties falling and staying asleep. The ALJ stated that Grames' medical records showed that she had no problems with memory or concentration, but, again, Grames routinely told her mental healthcare providers that she had difficulties in these areas, and Larimer noted in December 2013 that Grames had “some difficulty with times and dates during intake.” Dr. D'Mello also routinely noted psychomotor agitation or retardation, and a separate care provider noted in December 2014 that Grames' “[p]sychomotor status was lethargic and [her] motor status was slowed.” The ALJ's failure to even acknowledge these findings when assessing Grames' testimony was improper.

Accordingly, we VACATE the district court's judgment and REMAND the case to the district court with directions that it be returned to the Commissioner for further proceedings to reconsider or more fully explain (1) the lack of weight given to Dr. D'Mello's opinions (2) the lack of weight given to Grames' testimony and (3) the extensive weight given to Dr. Garner's opinions in light of the additional evidence suggesting that Grames' condition had worsened since Dr. Garner's review.