Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-almd-2_11-cv-00752/USCOURTS-almd-2_11-cv-00752-0/pdf.json

Nature of Suit Code: 864
Nature of Suit: Social Security - SSID Title XVI
Cause of Action: 42:405 Review of HHS Decision (SSID)

---

IN THE DISTRICT COURT OF THE UNITED STATES

FOR THE MIDDLE DISTRICT OF ALABAMA

NORTHERN DIVISION

ANNETTE STEWART WATKINS )

)

Plaintiff, )

)

v. ) CIVIL ACTION NO. 2:11-cv-752-TFM

) (WO)

MICHAEL ASTRUE, )

Commissioner of Social Security, )

)

Defendant. )

MEMORANDUM OPINION and ORDER

I. Introduction

Plaintiff Annette Stewart Watkins (“Watkins”) applied for disability insurance

benefits pursuant to Title II of the Social Security Act, 42 U.S.C. §§ 401 et seq., and

supplemental security income benefits pursuant to Title XVI, 42 U.S.C. § 1381 et seq.,

alleging that she is unable to work because of a disability. Her application was denied at the

initial administrative level. The plaintiff then requested and received a hearing before an

Administrative Law Judge (“ALJ”). Following the hearing, the ALJ concluded that the

plaintiff was not under a “disability” as defined in the Social Security Act. The ALJ,

therefore, denied the plaintiff’s claim for benefits. The Appeals Council rejected a

subsequent request for review. Consequently, the ALJ’s decision became the final decision

of the Commissioner of Social Security (Commissioner).1

 See Chester v. Bowen, 792 F.2d

1

 Pursuant to the Social Security Independence and Program Improvements Act of 1994, Pub.L. No.

103-296, 108 Stat. 1464, the functions of the Secretary of Health and Human Services with respect to Social

Security matters were transferred to the Commissioner of Social Security.

Case 2:11-cv-00752-TFM Document 14 Filed 04/26/12 Page 1 of 15
129, 131 (11th Cir. 1986). Pursuant to 28 U.S.C. § 636(c), the parties have consented to

entry of final judgment by the United States Magistrate Judge. The case is now before the

court for review pursuant to 42 U.S.C. §§ 405 (g) and 1631(c)(3). Based on the court's

review of the record in this case and the parties’ briefs, the court concludes that the

Commissioner’s decision should be affirmed.

II. Standard of Review

Under 42 U.S.C. § 423(d)(1)(A), a person is entitled to disability benefits when the

person is unable 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 . . . 

 To make this determination,2

 the Commissioner employs a five-step, sequential 

evaluation process. See 20 C.F.R. §§ 404.1520, 416.920.

(1) Is the person presently unemployed?

(2) Is the person’s impairment severe?

(3) Does the person's impairment meet or equal one of the specific

impairments set forth in 20 C.F.R. Pt. 404, Subpt. P, App. 1?

(4) Is the person unable to perform his or her former occupation?

(5) Is the person unable to perform any other work within the economy?

An affirmative answer to any of the above questions leads either to the next

question, or, on steps three and five, to a finding of disability. A negative

2

 A “physical or mental impairment” is one resulting from anatomical, physiological, or

psychological abnormalities which are demonstrable by medically acceptable clinical and laboratory

diagnostic techniques.

2

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answer to any question, other than step three, leads to a determination of “not

disabled.”

McDaniel v. Bowen, 800 F.2d 1026, 1030 (11th Cir. 1986).3

The standard of review of the Commissioner’s decision is a limited one. This court

must find the Commissioner’s decision conclusive if it is supported by substantial evidence.

42 U.S.C. § 405(g); Graham v. Apfel, 129 F.3d 1420, 1422 (11th Cir. 1997). “Substantial

evidence is more than a scintilla, but less than a preponderance. It is such relevant evidence

as a reasonable person would accept as adequate to support a conclusion.” Richardson v.

Perales, 402 U.S. 389, 401 (1971). A reviewing court may not look only to those parts of

the record which supports the decision of the ALJ but instead must view the record in its

entirety and take account of evidence which detracts from the evidence relied on by the ALJ. 

Hillsman v. Bowen, 804 F.2d 1179 (11th Cir. 1986). 

[The court must] . . . scrutinize the record in its entirety to determine the

reasonableness of the [Commissioner’s] . . . factual findings . . . No similar

presumption of validity attaches to the [Commissioner’s] . . . legal

conclusions, including determination of the proper standards to be applied in

evaluating claims.

Walker v. Bowen, 826 F.2d 996, 999 (11th Cir. 1987).

III. The Issues

A. Introduction. Watkins was 40 years old at the time of the hearing and has a high

school equivalency diploma. (R. 28, 32, 47.) Watkins has prior work experience as a

3

 McDaniel v. Bowen, 800 F.2d 1026 (11th Cir. 1986) is a supplemental security income case (SSI). 

The same sequence applies to disability insurance benefits. Cases arising under Title II are appropriately

cited as authority in Title XVI cases. See e.g. Ware v. Schweiker, 651 F.2d 408 (5th Cir. 1981) (Unit A).

3

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laborer and assistant plant control operator, a car porter, waitress, and construction worker. 

(R. 33-36, 50-51.) Watkins alleges that she became disabled on August 14, 2007, from rapid

cycling bipolar depression, neck and back pain, arthritis, and breathing problems. (R. 38,

40, 42-43.) After the hearing, the ALJ found that Watkins suffers from severe impairments

of degenerative disc disease of the cervical and lumbosacral spine, osteoarthritis of the

hands, bipolar disorder, osteoarthritis, and headache disorder. (R. 13.) The ALJ found that

Watkins is unable to perform her past relevant work, but that she retains the residual

functional capacity to perform light work with limitations. (R. 18.) Specifically, the ALJ

found:

[Watkins] can lift and/or carry 20 pounds occasionally and 10 pounds

frequently; stand and/or walk for 6 hours in an 8-hour workday; sit for 6 hours

out of 8 hours; frequently balance and kneel; occasionally stoop, crouch, crawl

and climb ramps and stairs; never climb ladders, ropes or scaffolds; frequently

handle bilaterally; and frequently finger bilaterally. The claimant is limited

to work that requires no more than occasional exposure to extreme cold and

avoids all exposure to unprotected heights and dangerous machinery. She will

have one to two unplanned absences per month for medical reasons. The

claimant is limited to work involving no more than simple, routine tasks and

non-transactional interaction with the public. She is able to sustain

concentration and attention for 2 hour[] periods with customary breaks. 

Workplace changes must be gradual and infrequent, and the claimant requires

a well-spaced work environment.

(R. 18.) 

Testimony from a vocational expert led the ALJ to conclude that a significant number

of jobs exist in the national economy that Watkins could perform, including work as a table

worker, document scanner, and general clerk. (R. 22.) Accordingly, the ALJ concluded that

Watkins is not disabled. (Id.)

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B. The Plaintiff’s Claims. Watkins presents the following issues for review:

(1) The Commissioner’s decision should be reversed, because the

ALJ failed to discuss Ms. Watkins’ severe headache disorder.

(2) The Commissioner’s decision should be reversed, because the

ALJ failed to give proper weight to the opinion of Dr. Meghani,

Ms. Watkins’ treating physician.

(Doc. No. 11, p. 6.)

IV. Discussion

A. The Headache Disorder. Watkins asserts that the ALJ failed to consider how

her headache disorder impacts her ability to work. During the hearing before the ALJ,

Watkins’ attorney stated that Watkins “suffers some headaches as well as numbness

throughout portions of her extremities” due to suffering from degenerative disc disease of

both the cervical and lumbar spine and arthritis. (R. 31.) The record indicates that, although

Watkins testified about back pain, she did not provide any testimony indicating that she

suffers from headaches. Nonetheless, in his analysis, the ALJ found that Watkins testified

that she suffers from headaches. (R. 18.) Thus, the court will discuss whether the ALJ

applied the proper standard when considering whether Watkins headaches affect her residual

functional capacity to perform work. 

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“Subjective pain testimony supported by objective medical evidence of a condition

that can reasonably be expected to produce the symptoms of which the plaintiff complains

is itself sufficient to sustain a finding of disability.” Hale v. Bowen, 831 F.2d 1007 (11th Cir.

1987). The Eleventh Circuit has established a three-part test that applies when a claimant

attempts to establish disability through his own testimony of pain or other subjective

symptoms. Landry v. Heckler, 782 F.2d 1551, 1553 (11th Cir. 1986); see also Holt v.

Sullivan, 921 F.2d 1221, 1223 (11th Cir. 1991). This standard requires evidence of an

underlying medical condition and either (1) objective medical evidence that confirms the

severity of the alleged pain arising from that condition or (2) an objectively determined

medical condition of such severity that it can reasonably be expected to give rise to the

alleged pain. Landry, 782 F. 2d at 1553. In this circuit, the law is clear. The Commissioner

must consider a claimant’s subjective testimony of pain if he finds evidence of an underlying

medical condition and the objectively determined medical condition is of a severity that can

reasonably be expected to give rise to the alleged pain. Mason v. Bowen, 791 F.2d 1460,

1462 (11th Cir. 1986); Landry, 782 F.2d at 1553. Thus, if the Commissioner fails to

articulate reasons for refusing to credit a claimant's subjective pain testimony, the

Commissioner has accepted the testimony as true as a matter of law. This standard requires

that the articulated reasons must be supported by substantial reasons. If there is no such

support then the testimony must be accepted as true. Hale, 831 F.2d at 1012.

The ALJ considered Watkins’ testimony and discussed the medical evidence. The

ALJ acknowledged that Watkins “had complaints of headaches, yet the evidence does not

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reflect these were of the severity as alleged.” (R. 20.) Where an ALJ decides not to credit

a claimant’s testimony, the ALJ must articulate specific and adequate reasons for doing so,

or the record must be obvious as to the credibility finding. Foote v. Chater, 67 F.3d 1553,

1561-62 (11th Cir. 1995); Jones v. Dept. of Health & Human Servs., 941 F.2d 1529, 1532

(11th Cir. 1991) (articulated reasons must be based on substantial evidence). If proof of

disability is based on subjective evidence and a credibility determination is, therefore, critical

to the decision, “‘the ALJ must either explicitly discredit such testimony or the implication

must be so clear as to amount to a specific credibility finding.’” Foote, 67 F.3d at 1562,

quoting Tieniber, 720 F.2d at 1255 (although no explicit finding as to credibility is required,

the implication must be obvious to the reviewing court). The ALJ has discretion to discredit

a plaintiff’s subjective complaints as long as he provides “explicit and adequate reasons for

his decision.” Holt, 921 F.2d at 1223. Relying on the treatment records, objective evidence,

and Watkins’ own testimony, the ALJ concluded that her allegations regarding her headache

pain were not credible to the extent alleged and discounted that testimony. After a careful

review of the ALJ’s analysis, the court concludes that the ALJ properly discounted the

plaintiff’s testimony and substantial evidence supports the ALJ’s credibility determination.

The medical records support the ALJ’s conclusion that, while Watkins’ headaches

could reasonably be expected to produce pain, her headache impairment is not so severe as

to give rise to disabling pain. In December 2006, Watkins sought treatment for her

headaches from Dr. Muhammad W. Ali, a neurologist. (R. 231.) During the initial visit,

Watkins complained of suffering from a pounding headache at the base of her neck two to

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three times a week and that her pain was a ten on a scale of zero to ten. (Id.) Dr. Ali’s

impression was that Watkins suffers from discogenic syndrome/HNP lumbar, parasthesia

numbness, cervicobrachial syndrome (diffuse), and headache. (R. 232.) Dr. Ali prescribed

Maxalt MLT and Depakote for the treatment of headaches, as well as Lortab, Provigil,

Celebrex, and Lexapro. (R. 233.) Watkins continued to receive treatment for her headaches

and back and neck condition, including physical therapy, massage therapy, epidural steroid

injections, and medication on a monthly basis. (R. 222-227.) During this time, the severity

of her headache pain gradually subsided. (Id.) For example, on May 29, 2007, Watkins

returned to Dr. Ali complaining of a pounding headache near the base of her neck

accompanied by photophobia and phonophobia two to three times a week. (R. 223.) She

reported that her pain was between three and four on a ten-point scale. (Id.) Dr. Ali

administered physical therapy to Watkins’ lumbar, cervical, and upper thoracic regions and

noted a good prognosis. (R. 224.) During a follow-up visit on July 9, 2007, Dr. Ali

recommended that Watkins continue taking her current medication, including Maxalt MLT,

Valproic Acid, and Lortab. (R. 222.)

One week before the August 14, 2007 date of onset, Watkins returned to Dr. Ali’s

office complaining of lower back and neck pain, as well as a pounding headache at the base

of her neck accompanied by photophobia and phonophobia. (R. 220.) She reported that her

headaches occurred two to three times a week and her pain was a seven on a scale of zero to

ten. (Id.) Dr. Ali assessed that Watkins suffered from a “flare up of old condition,” 

performed physical therapy on her spine, and assessed a good prognosis. (R. 221.)

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During a consultative examination by Dr. James O. Colley, a general surgeon at MDSI

Physician Services, on May 20, 2008, Watkins reported a history of suffering from posterior,

severe headaches about once a week, associated with nausea, photophobia, and phonophobia. 

(R. 242.) Although Dr. Colley diagnosed Watkins as suffering from several conditions,

including degenerative disc disease, osteoarthritis, and obstructive sleep apnea, the

consultative physician did not list Watkins’ headaches as one of her chief complaints or as

a diagnosed impairment. (R. 241-248.) 

 On September 28, 2009, Watkins sought treatment from Dr. G. Alan Young, an

internist, at the Enterprise Medical Clinic for her complaints of arthritis, lung problems, and

mitral valve prolapse. (R. 205.) She reported a past medical history of headaches, that she

receives pain management treatment from a clinic in Jasper, Alabama, and that she currently

takes Depakote, Xanax, Lexapro, and Adderall. (R. 205-207.) Thus, the medical records

demonstrate that the only treatment Watkins’ sought for her headaches during the relevant

time period is pain management, which included a prescription for Depakote, at a local clinic. 

After a careful review of the record, the court concludes that the ALJ’s reasons for

discrediting Watkins’ testimony were both clearly articulated and supported by substantial

evidence. To the extent that Watkins is arguing that the ALJ should have accepted her

testimony regarding her pain, as the court explained, the ALJ had good cause to discount her

testimony. This court must accept the factual findings of the Commissioner if they are

supported by substantial evidence and based upon the proper legal standards. Bridges v.

Bowen, 815 F.2d 622 (11th Cir. 1987). 

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B. Rejection of Treating Physician’s Opinion. Watkins argues that the ALJ

improperly rejected her treating psychiatrist’s opinion about the severity of her limitations. 

In essence, the plaintiff argues that if the ALJ accepted Dr. Shakir Meghani’s assessment

about her mental impairments, she would be disabled. In October 2009, Dr. Meghani

completed a psychiatric evaluation form describing Watkins’ mental limitations. (R. 302-

305.) According to Dr. Meghani, Watkins had marked limitations in eighteen areas dealing

with her ability to function in a work environment and her mental impairments would be

expected to last more than twelve months. (Id.)

 The law is well-settled; the opinion of a claimant’s treating physician must be

accorded substantial weight unless good cause exists for not doing so. Jones v. Bowen, 810

F.2d 1001, 1005 (11th Cir. 1986); Broughton v. Heckler, 776 F.2d 960, 961 (11th Cir. 1985). 

The Commissioner, as reflected in his regulations, also demonstrates a similar preference for

the opinion of treating physicians.

Generally, we give more weight to opinions from your treating sources, since

these sources are likely to be the medical professionals most able to provide

a detailed, longitudinal picture of your medical impairment(s) and may bring

a unique perspective to the medical evidence that cannot be obtained from the

objective medical findings alone or from reports of individual examinations,

such as consultive examinations or brief hospitalizations.

Lewis v. Callahan, 125 F.3d 1436, 1440 (11th Cir. 1997) (citing 20 CFR § 404.1527 (d)(2)). 

The ALJ’s failure to give considerable weight to the treating physician’s opinion is reversible

error. Broughton, 776 F.2d at 961-2; Wiggins v. Schweiker, 679 F.2d 1387 (11th Cir. 1982). 

However, there are limited circumstances when the ALJ can disregard the treating

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physician’s opinion. The requisite “good cause” for discounting a treating physician’s

opinion may exist where the opinion is not supported by the evidence, or where the evidence

supports a contrary finding. See Schnorr v. Bowen, 816 F.2d 578, 582 (11th Cir. 1987). 

Good cause may also exist where a doctor’s opinions are merely conclusory; inconsistent

with the doctor’s medical records; or unsupported by objective medical evidence. See Jones

v. Dep’t. of Health & Human Servs., 941 F.2d 1529, 1532-33 (11th Cir. 1991); Edwards v.

Sullivan, 937 F.2d 580, 584-85 (11th Cir. 1991); Johns v. Bowen, 821 F.2d 551, 555 (11th

Cir. 1987). The weight afforded to a physician’s conclusory statements depends upon the

extent to which they are supported by clinical or laboratory findings and are consistent with

other evidence of the claimant’s impairment. Wheeler v. Heckler, 784 F.2d 1073, 1075 (11th

Cir. 1986). The ALJ “may reject the opinion of any physician when the evidence supports

a contrary conclusion.” Bloodsworth v. Heckler, 703 F.2d 1233, 1240 (11th Cir. 1983). The

ALJ must articulate the weight given to a treating physician’s opinion and must articulate any

reasons for discounting the opinion. Schnorr, 816 F.2d at 581. 

After reviewing all the medical records, the ALJ rejected the opinion of Dr. Meghani

because his treatment records do not support his assessment that Watkins suffers from

marked mental limitations. (R. 20.) 

As for the opinion evidence, Dr. Meghani described the claimant as

having marked impairments in the Mental Residual Functional Capacity;

however, on August 27, 2009, the treatment records of Dr. Meghani indicated

the claimant’s behavior was normal, she was fully alert, her attention span was

good, her thought process was good and direct, her memory (recent) was good,

her impulse control was good as well as her judgment/insight, consequently,

the mental residual functional capacity form that Dr. Meghani completed does

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not merit significant weight.

The Residual Functional Capacity in Exhibit 7-F and the Psychiatric

Review Technique Form in Exhibit 5-F are consistent with the credible

medical evidence and merit significant weight.

The medical expert testified the claimant’s “B” criteria impairments

were mild in daily activity, mild in social functioning and mild in

concentration, persistence and pace with no episodes of decompensation. This

testimony is generally consistent with the credible medical evidence of record

and merits substantial weight.

(R. 20-21.)

The ALJ’s determination is supported by substantial evidence. On May 22, 2008, Dr.

Walter Jacobs, a consultative psychologist, conducted an examination of Watkins. (R. 235.) 

Dr. Jacobs noted Watkins’ history of mental illness, including a three-week hospitalization

for an episode of bipolar depression at Hillcrest Hospital eight years earlier. (Id.) He also

noted that Watkins had not received any mental health care since September 2007. (Id.) 

During the evaluation, Watkins reported that she had “been in bed for three days,” her

appetite was poor, her energy was variable, and she felt the need to cry. (R. 236.) Dr.

Jacobs’ diagnostic impression was bipolar disorder, mixed. (R. 237.) Dr. Jacobs concluded

that, with proper treatment, Watkins should have a reasonably good prognosis. (Id.) 

In addition, the medical records demonstrate that Watkins’ mental condition steadily

improved upon seeking treatment from Dr. Meghani, a psychiatrist. During an initial

psychiatric evaluation on October 27, 2008, Dr. Meghani found that Watkins suffered from

a depressed mood, poor attention, and fair insight and diagnosed her as suffering from rapid

cycling bi-polar disorder and attention deficit hyperactivity disorder. (R. 298.) On

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December 29, 2008, Dr. Meghani noted that Watkins’ affect was labile, her impulse control

was fair, and her psycho motor activity was hyperactive. (R. 293.) He also determined that

her progress toward treatment goals was fair and changed her medication to Adderall. (Id.) 

Upon conducting an evaluation on February 23, 2009, Dr. Meghani found that Watkins had

a good attention span and impulse control, appropriate affect, and average judgment or

insight, and that her progress toward treatment goals was good. (R. 292.) Dr. Meghani also

noted Watkins’ current medications were Xanax, Lexapro, and Adderrall. (Id.) When

Watkins returned for a follow-up appointment on May 25, 2009, she reported that she was

“doing ok” and denied having any problems or complaints. (R. 291.) Dr. Meghani found

that Watkins’ attention span, impulse control, and memory were good, her thought process

was goal directed, her affect was appropriate, and her judgment or insight were average. (Id.) 

Dr. Meghani concluded that Watkins was making good progress toward her treatment goals

and advised her to continue her current medications. (Id.) This court therefore concludes

that the ALJ’s discounting of Dr. Meghani’s opinion that Watkins is markedly impaired in

all areas of mental functioning on the basis that the treating physician’s opinion is

inconsistent with his own medical records is supported by substantial evidence. 

The ALJ’s rejection of Dr. Meghani’s conclusory opinion is also supported by the

testimony of Dr. Doug McKeown, a medical expert. During the hearing, Dr. McKeown

testified concerning the conflict between Dr. Meghani’s assessment that Watkins suffers

from marked mental limitations and the other mental health records. Dr. McKeown stated:

. . . Current medications indicated are Adderall, basically a

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psychostimulant; Xanax, an anxiolytic medication; Depakote, the mood

stabilizer; and Lexapro, an SSRI antidepressant. The ongoing mental status

notes from Dr. [Meghani] indicate in all cases when she’s seen that she’s doing

well, adjusting well to the medication, and Dr. [Meghani] considered her to

have a good prognosis. A bipolar with ADHD symptoms were the primary

diagnostic considerations. 

There is a RFC from Dr. [Meghani] at 11F that basically indicates the

Claimant is markedly impaired in all areas. This is inconsistent with progress

notes he provides, which indicate basically minimum symptomatology. And

I would have to consider that to be an overstatement of the symptoms, and

particularly since there’s been no necessary treatment required other than

basically medication management. The evaluation for the Department would

be under 12.04 for bipolar disorders. The B criteria would indicate mild

impairments of activities in daily living, social functioning; and concentration,

persistence, and pace with no episodes of decompensation in work or worklike settings dating back to 2007.

From an RFC perspective, based on the available progress notes from

Dr. [Meghani], there really would be no impairments above a moderate level,

with the moderate level perhaps with regard to completing complex task and

varied task. Otherwise essentially there would be no more than mild

impairments in all other areas. 

(R. 47-48.)

Thus, the ALJ further resolved any conflict between Dr. Meghani’s opinion that

Watkins suffers from marked impairments and the other medical records by consulting a

medical expert. “Because the ALJ articulated good cause for discounting the treating

physician’s opinion, the ALJ did not err in giving more weight to the consulting, examining

physician’s opinion.” Kelly v. Commissioner of Social Sec., 401 Fed. Appx. 403, 408 (11th

Cir. 2010). This court therefore finds that the ALJ’s discounting of Dr. Meghani’s opinion

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that Watkins is markedly impaired is supported by substantial evidence.4

 V. Conclusion

The court has carefully and independently reviewed the record and concludes that

substantial evidence supports the ALJ’s conclusion that plaintiff is not disabled. Thus, the

court concludes that the decision of the Commissioner is supported by substantial evidence

and is due to be affirmed.

A separate order will be entered.

DONE this 26th day of April, 2012.

/s/ Terry F. Moorer

TERRY F. MOORER

UNITED STATES MAGISTRATE JUDGE

4

 In her brief, Watkins argues that the ALJ failed to consider her treating physician’s diagnosis of

ADHD. Watkins, however, does not point to any limitations related to ADHD which were not accounted for

in the ALJ’s finding concerning her residual functional capacity to perform work. Furthermore, in his

summary of the medical records, the ALJ discussed Dr. Meghani’s diagnosis of ADHD. (R. 16.) During the

hearing before the ALJ, the medical expert testified that Watkins suffers from bipolar depression with ADHD

symptoms. (R. 47.) Dr. McKeown’s testimony is supported by substantial medical evidence in the record. 

(R. 235, 293.) As previously discussed, the ALJ considered the extent which Watkins’ bipolar depression

and other mental conditions have on her ability to perform work. Thus, Watkins is entitled to no relief with

respect to this contention. 

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