Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-2_09-cv-01687/USCOURTS-azd-2_09-cv-01687-0/pdf.json

Nature of Suit Code: 863
Nature of Suit: Social Security - DIWC/DIWW (405(g))
Cause of Action: 42:405 Review of HHS Decision (DIWC)

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WO

IN THE UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF ARIZONA

Jill Ann Mons, 

Plaintiff, 

vs.

Michael J. Astrue, Commissioner of Social

Security, 

Defendant. 

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No. CV-09-01687-PHX-NVW

ORDER

Plaintiff Jill Ann Mons seeks review, pursuant to 42 U.S.C. § 405(g), of the

administrative denial of her application for social security disability insurance benefits

and supplemental security income. Because the ALJ’s decision was based on legal error,

the Commissioner’s decision will be vacated and remanded for further administrative

proceedings.

I. Background

A. Factual Evidence

Ms. Mons was born August 19, 1970. (Tr. 132.) She graduated high school and

has a bachelor’s degree in social work from Northern Arizona University. (Tr. 36, 38.)

Her work history includes positions as a receptionist, waitress/hostess, and case aide to a

non-profit organization. (Tr. 200.) Ms. Mons suffers from bipolar disorder, depression,

panic disorder, and alcohol and marijuana dependence. She has been prescribed

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Depakote, a mood stabilizer, and Effexor, an anti-depressant, to treat her condition. (Tr.

142.) Ms. Mons claims that the effects of her anxiety attacks, bipolar disorder and

depression leave her unable to handle the stress of a job or concentrate on her job duties. 

(Tr. 137.) It is undisputed that Ms. Mons has not engaged in significant gainful

employment since May 15, 2005, when she left her job as a waitress. (Tr. 37.) Ms. Mons

stated that she lived alone, and that her daily activities consisted of cleaning her home,

preparing simple meals, doing laundry, watering plants, shopping for groceries, watching

television, attending church, walking to doctor’s appointments, and spending time with

her family. (Tr. 44-46, 190-195.) 

Prior to her alleged disability onset date of May 15, 2005, Ms. Mons was

hospitalized four times and sought treatment variously for paranoid delusions and

hallucinations (Tr. 356, 358), manic episodes with psychosis (Tr. 344-55), anxiety and

depression related to bipolar disorder and alcohol dependence (Tr. 441-49), and substance

abuse of alcohol and marijuana. (Tr. 300-320.) After her alleged disability onset date,

Ms. Mons sought treatment at Helping Associates in June 2005 for her bipolar disorder;

she continued to receive ongoing counseling there through 2006 and 2007. (Tr. 370.) On

September 20, 2007, Ms. Mons was hospitalized for fourteen days and treated for a manic

episode. (Tr. 540-50.) Upon her release on October 8, 2007, Ms. Mons was admitted to a

treatment center, Southwest Behavioral Health Services (Tr. 621), from which she

voluntarily discharged herself on October 20, 2007. (Tr. 630.) Ms. Mons continued

receiving counseling at Helping Associates for the remainder of 2007, 2008, and into

2009. (Tr. 678.)

B. Procedural History

On December 15, 2006, Ms. Mons filed a Title II application for disability

insurance benefits and a Title XVI application for supplemental security income. Ms.

Mons alleged disability from bipolar disorder, panic disorder, and alcohol and marijuana

dependence in early remission, with an onset date of May 15, 2005. Ms. Mons is insured

through December 31, 2010, and must establish disability on or before that date to be

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entitled to benefits.

The SSA denied Ms. Mons’s application initially on April 18, 2007, and again

upon reconsideration on August 22, 2007. Ms. Mons had a hearing before an ALJ on

April16, 2008, which was attended by Ms. Mons, her attorney Eric Slepian, and

vocational expert Ruth Van Fleet. The ALJ issued an unfavorable decision on June 17,

2008. Ms. Mons filed a request for review of the ALJ’s decision on August 15, 2008. On

June 15, 2009, the SSA Appeals Council denied her request and the ALJ’s decision

became the final decision of the Social Security Commissioner. Pursuant to 42 U.S.C.

§405(g), Ms. Mons sought judicial review of the ALJ’s decision in this Court on August

14, 2009.

II. Standard of Review

The Court will uphold the Commissioner’s final decision if it is supported by

substantial evidence and not based on legal error. See 42 U.S.C. § 405(g) (“findings of

the Commissioner of Social Security as to any fact, if supported by substantial evidence,

shall be conclusive”); Smolen v. Chater, 80 F.3d 1273, 1279 (9th Cir. 1996). The

substantial evidence standard requires the evidence to “be more than a mere scintilla but

not necessarily a preponderance.” Tomassetti v. Astrue, 533 F.3d 1035, 1038 (9th Cir.

2008) (citations omitted). The Court must consider the “entire record as a whole and may

not affirm simply by isolating a ‘specific quantum of supporting evidence.’” Orn v.

Astrue, 495 F.3d 625, 630 (9th Cir. 2007) (citations omitted).

The Court will also review only the issues raised by the party challenging the

ALJ’s decision. See Lewis v. Apfel, 235 F.3d 503, 517 n.13 (9th Cir. 2001). The ALJ’s

decision will be upheld where the “evidence is susceptible to more than one rational

interpretation” and the ALJ’s decision is supported by one such rational interpretation. 

Orn, 495 F.3d at 630. The court will not reverse for harmless error, which exists “when it

is clear from the record that ‘the ALJ's error was inconsequential to the ultimate

nondisability determination.’” Tomassetti, 533 F.3d at 1038.

III. Analysis

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Social Security regulations define disability as “the inability to do any substantial

gainful activity by reason of any medically determinable physical or mental impairment

which can be expected to last for a continuous period of not less than 12 months.” 20

C.F.R. § 404.1505(a). To determine whether a claimant is disabled, the ALJ conducts a

five-step analysis as outlined in 20 C.F.R § 404.1520(a)(4).

At step one, the ALJ found that Ms. Mons was not engaged in substantial gainful

activity. (Tr. 22.) At step two, the ALJ found that Ms. Mons had the following severe

impairments: bipolar disorder, panic disorder, and alcohol and marijuana dependence in

early remission (not material). (Id.) At step three, the ALJ found that Ms. Mons did not

have an impairment or combination of impairments that met or medically equaled one of

the listed impairments in 20 C.F.R. Part 404, Subpart P, Appendix 1 (20 C.F.R. §

404.1520(d), 404.1525, 404.1526, 416.920(d), 416.925 and 416.926). Ms. Mons does not

allege error with respect to the ALJ’s findings in steps one, two and three.

At the fourth step, the ALJ assessed Ms. Mons’s residual functional capacity and

her ability to perform past relevant work. The ALJ found that while Ms. Mons was

unable to perform any past relevant work (Tr. 28), she was able to perform a full range of

work at all exertional levels, and short and simple tasks. He found she had moderate

mental limitations in her ability to carry out detailed instructions, perform activities

within a schedule, maintain regular attendance, be punctual within customary tolerance,

interact appropriately with the general public, maintain socially appropriate behavior, and

adhere to basic standards of neatness and cleanliness. (Tr. 24.) At the fifth step, the ALJ

considered Ms. Mons’s age, education, work experience, and residual functional capacity;

he found that she was not disabled as there were significant numbers of jobs in the

national economy that she could perform, such as janitor, assembler, and car washer. (Tr.

28.) Ms. Mons alleges error in the ALJ’s determination of her credibility, consideration

of Carol Mons’s third party report, failure to ask the testifying vocational expert about

conflicts between her testimony and the Dictionary of Occupational Titles, and weighing

of the medical opinion evidence.

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A. The ALJ Properly Evaluated Ms. Mons’s Credibility.

The ALJ engages in a two-step analysis when evaluating a claimant’s testimony as

to subjective pain or other symptoms. See Vasquez v. Astrue, 572 F.3d 586, 591 (9th Cir.

2009). The ALJ must first determine that “the claimant has presented objective medical

evidence of an underlying impairment which could reasonably be expected to produce the

pain or other symptoms alleged” and that the claimant is not malingering. Id. If the ALJ

finds the claimant’s testimony is not credible, he must provide specific, clear and

convincing reasons for so finding. Id. Further, if the ALJ’s “credibility finding is

supported by substantial evidence in the record, [the reviewing court] may not engage in

second-guessing.” Thomas v. Barnhart, 278 F.3d 947, 958-59 (9th Cir. 2002). 

When evaluating the intensity and persistence of a claimant’s symptoms, the ALJ

considers a broad range of factors in addition to the claimant’s own statements regarding

the limitations caused by her symptoms. These factors include the claimant’s daily

activities, effectiveness of any medication or treatment in controlling the symptoms,

objective medical evidence of the symptoms, and statements by treating and non-treating

sources about how a claimant’s symptoms affect her ability to work. See 20 C.F. R.

§404.1529(c). With respect to daily activities, a claimant is not required to be “utterly

incapacitated” to be found disabled. See Fair v. Bowen, 885 F.2d 597, 603 (9th Cir.

1989). However, if a claimant is

able to perform household chores and other activities that involve many of the

same physical tasks as a particular type of job, it would not be farfetched for an

ALJ to conclude that [a claimant’s] pain does not prevent [the claimant] from

working...a specific finding as to this fact may be sufficient to discredit an

allegation of disabling excess pain. (Id.)

Further, “[w]hile subjective pain testimony cannot be rejected on the sole ground that it is

not fully corroborated by objective medical evidence, the medical evidence is still a

relevant factor in determining the severity of the claimant’s pain and its disabling

effects.” Rollins v. Massanari, 261 F.3d 853, 857 (9th Cir. 2001).

1. Ms. Mons’s hearing testimony

At the hearing, Ms. Mons stated that she left her most recent job because she was

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“stressed out,” was “lashing out at [her] customers and [her coworkers],” and “wasn’t

getting along with most of the people [she] worked with.” (Tr. 37.) She reported that her

manic episodes interfered with her previous receptionist job and ultimately caused her

dismissal from that position. (Id.) Ms. Mons stated that she could not work because she

was having problems with her hygiene, was depressed, and needed to take naps most

days. (Tr. 44.) She claimed to have the following symptoms of depression: negativity,

being overwhelmed, irritability, weight gain, sleeping, isolation, and difficulty with

memory and concentration. (Tr. 50-51.) She described her representative daily activities

as getting up, having coffee and cigarettes, walking to doctor’s appointments, spending

time with her parents, napping, eating, watching television, going grocery shopping, and

doing laundry. (Tr. 44-45.) Ms. Mons noted that there have been times when she

neglects chores and does not leave the house. (Tr. 51.) She also detailed her history of

marijuana and alcohol use and dependence. (Tr. 37-44.)

2. The ALJ’s credibility findings

The ALJ considered the evidence and found that while Ms. Mons had produced

objective medical evidence of an impairment which could reasonably produce her alleged

symptoms, her “statements concerning the intensity, persistence and limiting effects of

[her] symptoms are not credible to the extent they are inconsistent with the residual

functional capacity assessment for the reasons explained below.” (Tr. 25.) The ALJ went

on to give specific reasons based on the evidence in record for discounting Ms. Mons’s

credibility. First, he found that Ms. Mons’s statements were inconsistent with much of

the objective medical evidence presented. The ALJ credited progress notes from Ms.

Mons’s treatment at Helping Associates indicating that she had been “compliant with

medication and appeared stable over a significant period of time.” (Id.) The ALJ noted

that after her discharge from Southwest Behavioral Health Services for voluntary alcohol

detoxification, Ms. Mons “continued on psychiatric medications as prescribed” and was

“free of withdrawal symptoms and alert and oriented...with good grooming and

hygiene...[h]er insight and judgment were intact.” (Id.) The ALJ also credited

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psychiatric progress notes throughout 2006 which reported Ms. Mons’s mood and

symptoms as “stable,” “doing well,” “decreased anxiety,” “no symptoms of psychosis,”

unremarkable appearance, good hygiene, eye contact, insight judgment, concentration,

affect, perception, and memory. (Tr. 25-26.)

The ALJ then considered objective medical evidence stemming from Ms. Mons’s

consultative evaluation with psychologist Dr. Geary, in which Dr. Geary reported Ms.

Mons’s “cognition was grossly intact,” she was “independent in all activities,” she

“appeared depressed although her mood seemed stable[,] and there was no evidence of

mood swings or acute bipolar symptoms.” (Tr. 26.) Dr. Geary also found that Ms. Mons

was moderately limited in certain areas, including her capacity to “carry out detailed and

complex job instructions, maintain regular attendance, complete a normal work week

without interruption from psychological symptoms, persistently deal with the public, and

adhere to basic standards of neatness and cleanliness.” (Id.) Although Ms. Mons had

reported some stress, anxiety, and specific phobias, Dr. Geary believed Ms. Mons’s

symptoms would improve if she refrained from using drugs and alcohol. (Id.)

Further, the ALJ noted that Ms. Mons’s prognosis after inpatient treatment for

bipolar disorder and mania was “fair, [depending] on ‘compliance with her current

treatment plan and social support.’” (Tr. 26.) He also noted that during her

hospitalization, Ms. Mons was “placed ‘back on’” certain of her medications. (Id.) 

Progress notes chronicling Ms. Mons’s treatment through the end of 2007 and into 2008

stated Ms. Mons “had periods of sadness,” but that her appearance, eye contact, and

cooperation were good, her speech normal, affect appropriate, and insight fair; she was

also oriented to person, place, time, and circumstances, compliant with medication, and

“appeared to be responsive and functioning within normal limits.” (Id.) Nonetheless,

nurse practitioner Judy Johnson gave her opinion in a medical assessment that Ms. Mons

was disabled and had a restrictive mental residual functional capacity (id.), and therapist

Denise Carr gave the opinion that Ms. Mons was disabled by her bipolar disorder and had

restrictive mental limitations. (Tr. 26.) The ALJ stated that he did not give controlling

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weight to either Ms. Johnson or Ms. Carr’s conclusions as they were inconsistent with the

progress notes and because neither Ms. Johnson nor Ms. Carr was a qualified

psychologist or psychiatrist. (Tr. 26-27.)

After considering the objective medical evidence, the ALJ went on to weigh other

factors in his credibility determination. He noted that Ms. Mons had “acknowledged

longstanding difficulties with alcohol and marijuana...[and] acknowledged alcohol use the

week prior to the hearing, and in or around December 2007.” (Tr. 27.) The ALJ also

noted that he found Ms. Mons to be “circumspect about her drinking and the use of

marijuana.” (Id.) The ALJ also credited evidence that treatment was generally successful

in controlling Ms. Mons’s symptoms, weighing against the credibility of her testimony

regarding the “severity and functional consequences of her symptoms.” (Id.) Finally, the

ALJ factored in evidence regarding Ms. Mons’s functioning in her daily activities in his

credibility assessment and found that Ms. Mons’s “self-described daily activities are not

that limited to the extent one would expect, given the complaints of disabling symptoms

and limitations.” (Id.)

 The ALJ thus did not rely solely on the fact that Ms. Mons’s reported daily

activities were inconsistent with her disability, nor did he justify his credibility

determination on the lack of full and objective medical corroboration for Ms. Mons’s

symptoms alone. Rather, his determination was based on an overall assessment of several

factors collectively. See Thomas, 278 F.3d at 958-59 (noting ALJ may consider several

different factors when weighing claimant’s credibility). Because the ALJ provided

specific, clear, and convincing reasons for discounting Ms. Mons’s statements regarding

the severity and impact of her symptoms, including objective medical reports, the extent

of and independence in daily activities, her drug and alcohol use and circumspection at

the hearing with regard thereto, and the effectiveness of treatment in controlling her

symptoms, there was no error in the ALJ’s credibility determination. 

B. The ALJ Properly Weighed Carol Mons’s Third Party Report.

On January 24, 2007, Carol Mons, Ms. Mons’s mother, completed a third party

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function report detailing her observations regarding her daughter’s daily life activities and

the limiting impact of Ms. Mons’s impairment. (Tr. 180-87.) Ms. Mons alleges that the

ALJ erred by rejecting, without reason, Carol Mons’s third party report. Under 20 C.F.R

§ 404.1513(e)(2), “observations by nonmedical sources about how impairments affect a

claimant’s ability to work” will be considered in assessing a disability claim. See Smolen,

80 F.3d at 1288. Friends and family “in a position to observe a claimant’s symptoms and

daily activities are competent to testify as to [the claimant’s] condition.” Dodrill v.

Shalala, 12 F.3d 915, 918-19 (9th Cir. 1993). An ALJ must “give reasons that are

germane to each witness” in order to discount the testimony of a lay witness. Id. at 919.

Contrary to Ms. Mons’s allegations, the ALJ did not reject Carol Mons’s report or

improperly discount her testimony. Rather, the ALJ discussed Carol Mons’s report and

noted several of her observations made therein: that her daughter usually spent one day a

week at her home, shopped, went to church on a regular basis, watched television,

prepared simple meals, did light household chores and laundry, went out daily, used

public transportation, drove a car, walked, rode a bicycle, and handled her finances. (Tr.

25.) Further, the ALJ noted Carol Mons’s statements in the report that her daughter spent

time with others, had no difficulty getting along with others, took notes for reminders,

was able to follow instructions, but did not do well with changes in routine or stress. (Id.) 

Rather than finding that the ALJ implicitly rejected Carol Mons’s report by denying Ms.

Mons’s disability claim, it can be inferred that the ALJ credited her report by finding that

Ms. Mons’s “medically determinable impairments could reasonably be expected to

produce the alleged symptoms” (id.) and that Ms. Mons’s daily activities belied a claim of

severe functional impairment. (Tr. 27.)

The ALJ went on to find that “the claimant’s statements concerning the intensity,

persistence and limiting effects of these symptoms are not credible to the extent they are

inconsistent with the residual functional capacity assessment....” (Id.) The testimony

rejected here by the ALJ concerned statements made by Ms. Mons herself regarding the

severity of her symptoms; the ALJ does not reject Carol Mons’s testimony. The

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statements made by Carol Mons were consistent with the ALJ’s findings that while Ms.

Mons’s impairment caused anxiety and stress that limited her in some ways, she was still

able to complete many daily life activities.

Even if it could be inferred that the ALJ discounted portions of Carol Mons’s

report regarding the intensity of Ms. Mons’s symptoms, the ALJ gave sufficient reasons

for disbelieving the purported intensity of Ms. Mons’s limitations. The ALJ explained

that he found the claim that Ms. Mons could not engage in any substantial gainful activity

as a result of her bipolar disorder and panic disorder lacking credibility, given the extent

to which she could carry on daily life activities. (Tr. 27.) This statement is a sufficiently

germane reason to discount Carol Mons’s report as well, since her report detailed the

extent of her daughter’s daily activities. See Lewis, 236 F.3d at 512 (finding ALJ’s

observation that claimant’s daily activities were inconsistent with family reports

regarding severity of claimant’s symptoms sufficiently germane to reject family testimony

even though ALJ “did not clearly link his determination to those reasons”). The ALJ thus

properly weighed Carol Mons’s third party report.

C. The ALJ’s Failure to Ask Testifying Vocational Expert, Ms. Ruth Van

Fleet, Whether Her Testimony Conflicted with the Dictionary of

Occupational Titles was Harmless Error Since There Was No Conflict.

Ms. Mons alleges that the ALJ failed to identify and resolve conflicts between the

Dictionary of Occupational Titles (“DOT”) and the occupational evidence provided by

Ms. Ruth Van Fleet. Under SSR 00-4p, an ALJ may not “rely on the testimony of a

vocational expert regarding the requirements of a particular job without first inquiring

whether the expert’s testimony conflicts with the [DOT].” Massachi v. Astrue, 486 F.3d

1149 (9th Cir. 2007). However, failing to inquire whether a vocational expert’s testimony

conflicted with the DOT is merely harmless error if there was no actual conflict. Id. at

1154, n.19.

At Ms. Mons’s hearing, the ALJ asked Ms. Van Fleet to assume an individual of

Ms. Mons’s age, education, and work background, and assume that this individual was

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The four categories of moderate limitation are ability to: carry out detailed instructions;

perform activities with a schedule, maintain regular attendance and be punctual within

customary tolerances; interact appropriately with the general public or to maintain socially

appropriate behavior; and to adhere to basic standards of neatness and cleanliness. (Tr. 52).

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moderately limited in four mental health categories.1

 (Tr. 52.) Ms. Van Fleet testified

that an individual so limited would not be able to perform Ms. Mons’s past work. 

However, she noted that there existed jobs in the national economy which such an

individual could perform, such as “janitor,” “something in production assembly,” and

“car vehicle washer.” (Tr. 53-54.) Ms. Van Fleet provided the DOT numbers for these

three positions upon Ms. Mons’s attorney’s request, but the ALJ did not ask Ms. Van

Fleet whether her testimony conflicted with the DOT.

Ms. Mons has raised no conflict between Ms. Van Fleet’s testimony and the DOT. 

She does not identify any inconsistency between requirements for the positions Ms. Van

Fleet identified and the requirements for these positions listed in the DOT. Rather, Ms.

Mons’s complaint here seems to be more accurately characterized as disputing the ALJ’s

acceptance of some medical source opinions over others. Since there was no conflict

between Ms. Van Fleet’s testimony and the DOT, the ALJ’s failure to ask Ms. Van Fleet

whether her testimony was consistent with the DOT was inconsequential to his ultimate

determination that Ms. Mons was not disabled. Accordingly, this error was harmless. 

See Robbins v. Soc. Sec. Admin., 466 F.3d 880, 885 (9th Cir. 2006).

D. The ALJ Failed to Properly Weigh the Medical Opinion Evidence.

 Ms. Mons alleges that the ALJ did not properly weigh the various medical source

opinions in the record. When presented with conflicting medical opinions, the ALJ must

make credibility determinations and resolve any conflicts. See Benton v. Barnhart, 331

F.3d 1030, 1040 (9th Cir. 2003). Medical opinions in the record can be from “acceptable

medical sources,” such as licensed physicians, licensed psychologists, or certified

psychologists, or “other sources,” such as nurse practitioners or therapists. See 20 C.F.R.

§404.1513. The Ninth Circuit also distinguishes between treating physicians, examining

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physicians, and non-examining physicians. See Lester v. Chater, 81 F.3d 821, 830 (9th

Cir. 1995). Generally, the opinion of a treating physician is entitled to greater weight

than the opinion of a non-treating physician, and the opinion of an examining physician is

entitled to greater weight than the opinion of a non-examining physician. Id.

As explained in SSR 06-03p, “only ‘acceptable medical sources’ can be considered

treating sources...whose opinions may be entitled to controlling weight.” 2006 WL

2329939, at *2. “Other sources” can give evidence of the severity of a claimant’s

impairment and how her impairment affects her ability to function, id., and their opinions

as to how an impairment affects a claimant’s ability to work should be considered by an

ALJ as part of the record as a whole. See Nguyen v. Chater, 100 F.3d 1462, 1467 (9th

Cir. 1996). The weight given to the “other source” opinions should be evaluated using

factors such as the length, nature, and extent of the treatment relationship, the frequency

of examination, relevant evidence supporting the opinion, the consistency of the opinion

with the whole record, the source’s medical specialization, and other factors. See SSR

03-06, at *4.

An ALJ is entitled to give more weight to the opinions of acceptable medical

sources than to the opinions of other sources. See Gomez v. Chater, 74 F.3d 967, 970-71

(9th Cir. 1996). However, an ALJ may also “give more weight to the opinion of a

medical source who is not an acceptable medical source if he or she has seen the

individual more often than the treating source and has provided better supporting

evidence and a better explanation for his or her opinion.” SSR 03-06, at *5. 

Accordingly, an ALJ must give specific, germane reasons, supported by the record, for

rejecting an “other source” opinion. See Lewis, 236 F.3d at 511.

1. Ms. Denice Carr and Ms. Judy Johnson

Ms. Denice Carr is a therapist and an “other source” who treated Ms. Mons at

Helping Associates. The record contains her treatment progress notes and a medical

source statement she completed giving her opinion regarding Ms. Mons’s ability to do

work-related activities. In her treatment progress notes, Ms. Carr repeatedly assessed Ms.

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Mons as having fair insight, good appearance, eye contact, speech, cooperation, attention

and concentration, normal speech, appropriate mood and affect, and being oriented to

person, place, time, and circumstances. (Tr. 584, 586, 594.) On one occasion, she

assessed Ms. Mons’s mood as sad and depressed, and her insight as poor (Tr. 596); her

impression and prognosis from that session noted that Ms. Mons “appeared responsive”

and continued “to be sad on an almost daily basis.” (Id.) Ms. Carr noted during another

session that Ms. Mons “appeared responsive” and continued having “anxiety symptoms

as related to past events.” (Tr. 585.) At other sessions, Ms. Carr stated her

“impression/prognosis” that Ms. Mons “appeared responsive and functioning” within

normal limits. (Tr. 587, 595.)

In her medical source statement, Ms. Carr gave the opinion that Ms. Mons had

restrictive mental limitations in most categories and was disabled due to bipolar disorder. 

She noted that Ms. Mons had poor coping skills, could be easily distracted, feared change,

and became nervous easily. (Tr. 288-92.) Although she assessed Ms. Mons as markedly

limited in many areas, Ms. Carr noted that when Ms. Mons was on medication, she could

remember short and simple instructions, maintain concentration, sustain an ordinary

routine, and have good social interactions. (Id.)

Ms. Judy Johnson is a nurse practitioner and “other source” who completed a

medical assessment of Ms. Mons’s ability to perform work related activities. In her

assessment, Ms. Johnson noted her opinion that Ms. Mons was disabled and had a

restrictive mental residual functional capacity. (Tr. 603-04.) While her opinion may have

been based on ongoing treatment of Ms. Mons, in the assessment itself Ms. Johnson

simply circled the rating terms of Ms. Mons’s functionality in various areas. She did not

elaborate or provide more evidence as to how or why she reached these conclusions. (Id.)

Contrary to Ms. Mons’s complaint, the ALJ did state and consider the opinions of

Ms. Carr and Ms. Johnson in his decision. (Tr. 26, 27.) Ultimately, though, the ALJ

chose not to give these opinions controlling weight because neither Ms. Carr nor Ms.

Johnson was a “qualified psychologist or psychiatrist” and their assessment opinions were

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“not consistent with the progress notes” detailing Ms. Mons’s condition. (Tr. 26.) The

ALJ cited substantial evidence in the record, including the inconsistency of Ms. Carr and

Ms. Johnson’s assessments with Dr. Geary and Dr. Tangeman’s assessments, Ms. Carr’s

progress notes, and Ms. Mons’s daily activities, as well as Ms. Carr and Ms. Johnson’s

“other source” status, for discounting their opinions. These reasons are sufficiently

specific and germane to justify the ALJ’s decision to not give controlling weight to Ms.

Carr and Ms. Johnson’s opinions. Although Ms. Carr and Ms. Johnson treated Ms. Mons

and had a longer relationship with her than either Dr. Geary or Dr. Tangeman, a rational

interpretation of the evidence as a whole supports the ALJ’s ultimate determination to

accord controlling evidentiary weight to Dr. Geary and Dr. Tangeman’s opinions.

2. Dr. Brent Geary and Dr. Paul Tangeman

As a licensed psychologist, Dr. Brent Geary is an “acceptable medical source.” 

Dr. Geary examined and evaluated Ms. Mons in March 2007, and submitted a detailed

report explaining his medical opinions regarding Ms. Mons’s residual functional capacity. 

(Tr. 455-65.) He diagnosed Ms. Mons with bipolar I disorder, panic disorder, and alcohol

and marijuana abuse in remission. (Tr. 458.) He explained the results of tests he

administered to measure Ms. Mons’s short-term recall, judgment, and ability to perform

calculations. (Tr. 456.) Dr. Geary also stated his opinion that Ms. Mons was moderately

limited in

her capacity to carry out detailed and complex job instructions, maintain regular

attendance, complete a normal work week without interruption from psychological

symptoms, persistently deal with the public, and adhere to basic standards of

neatness and cleanliness. (Tr. 459.)

He noted that his prognosis was “guarded” but would likely “improve substantially” if

Ms. Mons “maintain[ed] abstinence from alcohol and other drugs.” (Id.) The ALJ gave

Dr. Geary’s opinion controlling weight, finding it to be “well supported by objective

findings” and “not inconsistent with the other substantial evidence.” (Tr. 26.) 

Dr. Paul Tangeman is a state agency psychologist who reviewed Ms. Mons’s

record and issued a mental residual functional capacity assessment did not treat or

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examine her. (Tr. 467-84.) In his assessment, Dr. Tangeman found Ms. Mons was not

significantly limited in most areas; he also found that she was capable of performing short

and simple tasks. (Tr. 467-68.) Dr. Tangeman stated that Ms. Mons was moderately

limited in her ability to carry out detailed instructions, perform activities within a

schedule, maintain regular attendance, be punctual within customary tolerances, interact

appropriately with the general public, maintain socially appropriate behavior, and adhere

to basic standards of neatness and cleanliness. (Id.) He elaborated that Ms. Mons

displayed “adequate residual ability to sustain basic work tasks that are not fast paced or

socially demanding” and “appear[ed] stable over a significant period of time.” (Tr. 469.) 

He further noted that Ms. Mons appeared depressed and had some anxiety and specific

phobias, but “she was independent in all daily activities,” and there was “no evidence of

mood swings or acute bipolar symptoms.” (Id.) He also stated his opinion that the

medial source statement “provided by an unqualified psychological source is not

consistent with the progress notes.” (Id.) The ALJ accorded evidentiary weight to Dr.

Tangeman’s assessment because as the state agency reviewing physician he had

“expertise in the evaluation of medical issues in disability claims under the [Social

Security Act].” (Tr. 27.)

The ALJ’s decision to assign controlling weight to Dr. Geary and Tangeman’s

opinions was supported by substantial evidence in the record. The ALJ credited their

expertise and status as licensed psychologists and “acceptable medical sources” under the

regulations; he also found their opinions to be more consistent with the progress notes

regarding Ms. Mons’s condition and the extent of her daily activities reported by both Ms.

Mons and her mother than the other medical source opinions. Accordingly, there was no

error in the ALJ’s weighing of these medical opinions.

3. Dr. Marc Walter

Dr. Marc Walter, a licensed psychologist and “acceptable medical source,”

evaluated Ms. Mons on April 22, 2008. (Tr. 653.) His assessment of Ms. Mons’s ability

to perform work-related activities was submitted into evidence as a post-hearing

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development. (Tr. 642.) Dr. Walter interviewed Ms. Mons and stated that in the

interview, Ms. Mons “describe[d] many psychotic symptoms as well as high levels of

depression, anxiety, paranoid ideation, emotional hypersensitivity, and physical problems

as well as obsessions.” (Tr. 647.) Dr. Walter also administered an MMPI test, which

“generated an extremely elevated scale.” (Id.) He noted that it was his “impression that

to some degree [Ms. Mons’s] profile is a ‘cry for help.’” (Id.) Dr. Walter diagnosed Ms.

Mons with bipolar I disorder, anxiety disorder, and probable obsessive compulsive

disorder, and found that she had periodic severe manic episodes in spite of her treatment. 

He found she had “marked restriction” in activities of daily living, maintaining social

functioning, concentration, persistence, and pace, and that she had “repeated episodes of

decompensation, each of extended duration.” (Id.)

The ALJ did not make any reference to Dr. Walter’s opinion in his decision. Dr.

Walter’s opinion constituted relevant medical evidence and should have been considered. 

Failure to consider all of the relevant medical source opinion evidence is clear error. 20

C.F.R. §404.1527(d) (“Regardless of its source, we will evaluate every medical opinion

we receive.”); see also Smolen, 80 F.3d at 1286 (finding error where ALJ’s decision did

not discuss relevant medical source opinions). As consideration of additional medical

source opinion evidence could have impacted the ultimate disability determination, this

error is not harmless. See Tomassetti, 533 F.3d at 1038. Accordingly, the ALJ’s decision

will be vacated and remanded for further proceedings. 

Nothing in this order suggests that Dr. Walter’s opinion need be credited as against

the extensive contrary evidence surveyed by the ALJ. However, it must be considered. 

Indeed, it may have been considered already, but the silence of the record on whether it

was considered requires remand to assure that it is.

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IT IS ORDERED that the Clerk enter judgment vacating the final decision of the

Commissioner of Social Security and remanding this case to the Commissioner for further

proceedings as directed in this order. The Clerk shall terminate this action.

DATED this 22nd day of October, 2010.

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