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Royal v. Commissioner of Social Security

United States District Court, M.D. Florida, Jacksonville Division

September 23, 2019

Emily Jane Bohannon Royal, Plaintiff,
Commissioner of Social Security, Defendant.


          Patricia D. Barksdale, United States Magistrate Judge

          Emily Jane Bohannon Royal brings this action under 42 U.S.C. §§ 405(g) and 1383(c)(3) to review a final decision of the Commissioner of Social Security denying her applications for benefits. Doc. 1. Under review is a decision by an Administrative Law Judge (“ALJ”) dated August 24, 2017. Tr. 15–30. Summaries of the law and the administrative record are in the ALJ’s decision, Tr. 15–30, and the parties’ briefs, Docs. 17, 18, and not fully repeated here.

         A court reviews the Commissioner’s factual findings for substantial evidence. 42 U.S.C. § 405(g). “[W]hatever the meaning of ‘substantial’ in other contexts, the threshold for such evidentiary sufficiency is not high.” Biestek v. Berryhill, 139 S.Ct. 1148, 1154 (2019). “It means-and means only-such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.” Id. (internal quotation marks and quoted authority omitted). A court may not decide facts anew, reweigh evidence, make credibility determinations, or substitute its judgment for the Commissioner’s judgment. Moore v. Barnhart, 405 F.3d 1208, 1211 (11th Cir. 2005). If substantial evidence supports an ALJ’s decision, a court must affirm even if other evidence preponderates against the factual findings. Martin v. Sullivan, 894 F.2d 1520, 1529 (11th Cir. 1990). “This restrictive standard of review applies only to findings of fact, ” and “no similar presumption of validity attaches to the [Commissioner’s] conclusions of law[.]” Brown v. Sullivan, 921 F.2d 1233, 1236 (11th Cir. 1991) (quoted authority omitted).

         Royal argues the ALJ erred in assessing opinions of Raymond Pomm, M.D., and Advanced Registered Nurse Practitioner (“ARNP”) Daphne Hayes, treatment providers at River Regions Human Services, Inc. (“River Regions”). Doc. 17 at 16–21.

         The Social Security Administration (“SSA”) evaluates every medical opinion it receives. 20 C.F.R. §§ 404.1527(c), 416.927(c) (2012).[1] A “medical opinion” is a statement from an “acceptable medical source” that reflects judgment about the nature and severity of a claimant’s impairment. Id. §§ 404.1527(a)(2), 416.927(a)(2) (2012). An “acceptable medical source” is a licensed physician, licensed or certified psychologist, licensed optometrist, licensed podiatrist, and qualified speech-language pathologist. Id. §§ 404.1513(a), 416.913(a) (2013). An ALJ must state with particularity the weight given to each medical opinion and the reasons for the weight. Winschel v. Comm’r of Soc. Sec., 631 F.3d 1176, 1179 (11th Cir. 2011).

         To determine the severity of an impairment and how it affects a claimant’s ability to work, the SSA may use evidence from sources that are not acceptable medical sources. 20 C.F.R. §§ 404.1513(d), 416.913(d) (2012). Other sources include nurse practitioners. Id. §§ 404.1513(d)(1), 416.913(d)(1) (2013). “Since there is a requirement to consider all relevant evidence … the case record should reflect the consideration of opinions from medical sources who are not ‘acceptable medical sources[.’]” Social Security Ruling 06-03p, 2006 WL 2263437 (Aug. 9, 2006).[2] “[T]he adjudicator generally should explain the weight given to opinions from these ‘other sources, ’ or otherwise ensure that the discussion of the evidence in the determination or decision allows a claimant or subsequent reviewer to follow the adjudicator’s reasoning, when such opinions may have an effect on the outcome of the case.” Id.

         On March 21, 2017, ARNP Hayes completed and signed a “Mental Capacity Assessment” form. Tr. 635–37. She checked boxes indicating Royal has marked limitations[3] in twelve areas (including limitations in the categories of “Understanding & Memory, ” “Sustained Concentration & Persistence, ” “Social Interaction, ” and “Adaptation”). Tr. 365–37. She checked boxes indicating Royal has extreme limitations[4] in three areas (including limitations in the categories of “Sustained Concentration & Persistence” and “Adaptation”). Tr. 365–37. She checked a box indicating Royal likely would have four or more absences in an average month. Tr. 636. The record includes another copy of this form. Tr. 666–68. It is identical to the first form, except it also includes a signature for Dr. Pomm. Tr. 668.

         In his decision, the ALJ gave “no weight” to the mental capacity assessments by ARNP Hayes and Dr. Pomm, explaining:

The 2017 mental capacity assessments completed by ARNP Daphne Hayes and a treating psychiatrist, Dr. Pomm, are given no weight as they are clearly unsupported by the totality of these medical records and statements made by the claimant to other medical providers that her depression is under control. Her presentations in front of her other medical providers do not demonstrate the kind of marked and extreme limitations that are suggested in these mental health opinions. Indeed, it does not appear that she was even seen by this psychiatrist on a regular basis and she did not recognize his name when asked at the hearing on this matter. Most of the office visits that are documented were handled by Daphne Hayes, ARNP. The records show that ARNP Hayes usually spent 15 to 20 minutes with the claimant, which is indicative of medication management and not any psychotherapy. The claimant’s limitation to occasional to frequent contact with others [in the residual functional capacity (“RFC”) assessment)] address her allegations of problems being around others that she claimed at the hearing and there are no other mental impairments noted or supported by this record.

Tr. 24 (internal citation omitted).

         The ALJ did not have to give ARNP Hayes’s opinion deference because she is not an “acceptable medical source.” 20 C.F.R. §§ 404.1513(a), 416.913(a) (2013). Instead, he only had to consider her opinion and generally explain the weight given to it or otherwise ensure that his discussion would allow Royal or a reviewer to follow his reasoning. See SSR 06-03p, 2006 WL 2263437. The ALJ did so. Tr. 24.

         Substantial evidence supports the ALJ’s findings regarding ARNP Hayes’s opinion. The record shows only four visits with ARNP Hayes, all of which were labeled “medication management” visits and none of which lasted longer than 35 minutes. Tr. 645, 647, 650, 653.[5] As summarized in the ALJ’s decision, the record is replete with notations contemporaneous with ARNP Hayes’s treatment of Royal showing a lack of mental health symptoms consistent with the marked and extreme limitations in ARNP Hayes’s opinion. See, e.g. Tr. 463–64, 480–81, 484–85, 488, 492–93, 496, 500–01, 504–05, 512, 516, 521, 529–30, 533, 537–38, 540–42, 545–46, 549–50, 553– 54, 556–56, 561–62 (treatment notes from ARNP Faith Snyder showing Royal was “[a]lert and oriented x3” and had grossly normal mental status exams, as well as normal affect and judgment despite complaints of anxiety and depression that occasionally improved and occasionally worsened); Tr. 606–07 (“Brief Behavioral Health Status Exam” from River Regions with indecipherable signature showing normal mental status exam, including appropriate dress, realistic insight, good judgment, rational thought processes, normal speech, and normal mood and affect); Tr. 610 (“Assessment Rating Report” from counselor Amy Ros at River Regions rating depression and anxiety as “moderate” problems, a “less than slight problem” with interpersonal relations, and no problem with functioning in activities of daily living); Tr. 653 (medication management note from ARNP Hayes providing a normal mental status exam, including regular speech, euthymic mood, thought content within normal limits, adequate judgment and insight despite reports of family discord and back pain); Tr. 654 (treatment note from Ros rating depression as “slight to moderate” problem and anxiety as “moderate” problem and noting “no problem” with activities of daily living); Tr. 661–62 (treatment note from Ros finding “General Functioning/Social Adjustment” and “Daily Living Skills/Self-Care” to be “acceptable/within normal limits” and indicating a normal mental status exam except for a saddened affect and a dysphoric and anxious mood); Tr. 647 (treatment note from ARNP Hayes showing normal mental status exam except for anxious affect).

         Royal contends the ALJ erred in finding ARNP Hayes saw Royal briefly and only for medication management because the record shows Royal’s treatment plan included hourly sessions once a month for six months with ARNP Hayes and Royal testified she was, at the time, seeing ARNP Hayes for therapy an hour every two months. Doc. 17 at 17 (citing Tr. 66, 450). The question is not, however, whether evidence could have supported a finding that Royal saw ARNP Hayes for hourly therapy sessions; it is whether substantial evidence supports the ALJ’s finding that Royal saw ARNP Hayes only for relatively brief medication management sessions. See Martin, 894 F.2d at 829. As explained, it does. To the extent Royal complains about the ALJ’s failure to credit her testimony that she was seeing ARNP Hayes for an hour every two months for therapy, the ALJ found Royal’s testimony “not entirely consistent with the medical evidence and other evidence in this record, ” Tr. 20, and Royal has not challenged that finding.

         Royal also contends the ALJ erred in finding ARNP Hayes’s opinions unsupported by the totality of the medical records because treatment providers and the state agency reviewing physician diagnosed Royal with depression and anxiety and because observations in notes from treatment providers are consistent with and support ARNP Hayes’s opinion. Doc. 17 at 19–21. Royal points to portions of treatment records from ARNP Hayes; Parveen Khanna, M.D.; Sriramulu Aprameya, M.D.; William Hunt, M.D.; ARNP Faith ...

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