Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-alnd-6_14-cv-01370/USCOURTS-alnd-6_14-cv-01370-0/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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UNITED STATES DISTRICT COURT

FOR THE NORTHERN DISTRICT OF ALABAMA

JASPER DIVISION

TRACY MOTES,

Plaintiff,

v.

CAROLYN W. COLVIN,

Commissioner of the

Social Security Administration,

Defendant.

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}

}

}

}

}

}

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Case No.: 6:14-CV-01370-MHH

MEMORANDUM OPINION 

Pursuant to 42 U.S.C. § 405(g), plaintiff Tracy Motes seeks judicial review 

of a final adverse decision of the Commissioner of Social Security. The 

Commissioner denied Ms. Motes’s claims for a period of disability and disability 

insurance benefits. After careful review, the Court affirms the Commissioner’s 

decision.

I. PROCEDURAL HISTORY

Ms. Motes applied for a period of disability and disability insurance benefits

on October 20, 2011. (Doc. 7-6, p. 18). Ms. Motes alleges that her disability 

began on April 30, 2007. (Doc. 7-3, p. 19). The Commissioner initially denied 

Ms. Motes’s claims on January 25, 2012, and Ms. Motes requested a hearing 

FILED

 2015 Sep-29 PM 02:36

U.S. DISTRICT COURT

N.D. OF ALABAMA

Case 6:14-cv-01370-MHH Document 12 Filed 09/29/15 Page 1 of 23
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before an Administrative Law Judge (ALJ). (Id.). The ALJ issued an unfavorable 

decision on September 23, 2013. (Id., p. 29). On May 12, 2014, the Appeals 

Council declined Ms. Motes’s request for review, (id., p. 2), making the 

Commissioner’s decision final and a proper candidate for this Court’s judicial 

review. See 42 U.S.C. § 405(g).

II. STANDARD OF REVIEW

The scope of review in this matter is limited. “When, as in this case, the 

ALJ denies benefits and the Appeals Council denies review,” the Court “review[s] 

the ALJ’s ‘factual findings with deference’” and her “‘legal conclusions with close 

scrutiny.’” Riggs v. Comm’r of Soc. Sec., 522 Fed. Appx. 509, 510-11 (11th Cir. 

2013) (quoting Doughty v. Apfel, 245 F.3d 1274, 1278 (11th Cir. 2001)).

The Court must determine whether there is substantial evidence in the record 

to support the ALJ’s findings. “Substantial evidence is more than a scintilla and is 

such relevant evidence as a reasonable person would accept as adequate to support 

a conclusion.” Crawford v. Comm’r of Soc. Sec., 363 F.3d 1155, 1158 (11th Cir. 

2004). In making this evaluation, the Court may not “decide the facts anew, 

reweigh the evidence,” or substitute its judgment for that of the ALJ. Winschel v. 

Comm’r of Soc. Sec. Admin., 631 F.3d 1176, 1178 (11th Cir. 2011) (internal 

quotations and citation omitted). If the ALJ’s decision is supported by substantial 

evidence, the Court “must affirm even if the evidence preponderates against the 

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Commissioner’s findings.” Costigan v. Comm’r, Soc. Sec. Admin., 603 Fed. Appx. 

783, 786 (11th Cir. 2015) (citing Crawford, 363 F.3d at 1158).

With respect to the ALJ’s legal conclusions, the Court must determine 

whether the ALJ applied the correct legal standards. If the Court finds an error in 

the ALJ’s application of the law, or if the Court finds that the ALJ failed to provide 

sufficient reasoning to demonstrate that the ALJ conducted a proper legal analysis, 

then the Court must reverse the ALJ’s decision. Cornelius v. Sullivan, 936 F.2d 

1143, 1145-46 (11th Cir. 1991).

III. SUMMARY OF THE ALJ’S DECISION

To determine whether a claimant has proven she is disabled, an ALJ follows 

a five-step sequential evaluation process. The ALJ evaluates:

(1) whether the claimant is currently engaged in substantial gainful 

activity; (2) whether the claimant has a severe impairment or 

combination of impairments; (3) whether the impairment meets or 

equals the severity of the specified impairments in the Listing of 

Impairments; (4) based on a residual functional capacity (“RFC”) 

assessment, whether the claimant can perform any of his or her past 

relevant work despite the impairment; and (5) whether there are 

significant numbers of jobs in the national economy that the claimant

can perform given the claimant’s RFC, age, education, and work 

experience.

Winschel, 631 F.3d at 1178.

In this case, the ALJ found that Ms. Motes has not engaged in substantial 

gainful activity since April 30, 2007, the alleged onset date. (Doc. 7-3, p. 21). The 

ALJ determined that Ms. Motes suffers from the following severe impairments: 

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fibromyalgia, anxiety disorder, depression, and obesity. (Id.) Nevertheless, the 

ALJ concluded that Ms. Motes does not have an impairment or combination of 

impairments that meets or medically equals the severity of any of the listed 

impairments in 20 C.F.R. Part 404, Subpart P, Appendix 1. (Id., pp. 21–22). Next, 

the ALJ determined that Ms. Motes has the RFC:

to perform light work as defined in 20 CFR 404.1567, except the 

claimant can lift and carry twenty pounds occasionally and ten pounds 

frequently; can sit for six hours in an eight-hour day; can stand and 

walk for six hours in an eight-hour day; can never climb ladders, 

ropes, or scaffolds, but can occasionally climb ramps and stairs; can 

occasionally balance, stoop, crouch, kneel, and crawl; should avoid all 

exposure to workplace hazards such as dangerous machinery and 

unprotected heights; and can perform simple, routine, and repetitive 

tasks; can maintain attention and concentration for two-hour [sic] at a 

time; will work best in relative isolation, but may have occasional 

interaction with co-workers; can perform jobs that do not require 

interacting with the general public as part of the job duties; and will

miss up to two days of work per month.

(Id., pp. 22–23). Based on this RFC, the ALJ concluded that Ms. Motes is not able 

to perform her past relevant work as a payroll clerk and fast food worker. (Id., p.

27). Relying on testimony from a vocational expert, the ALJ found that jobs exist

in the national economy that Ms. Motes can perform, including assembler, hand 

packager,

1

and quality control inspector. (Id., p. 28). Accordingly, the ALJ 

 

1

In her decision, the ALJ determined that Ms. Motes’s “past relevant work exceeds[s] [her] 

residual functional capacity.” (Doc. 7-3, p. 27). However, during the hearing, the ALJ noted 

that Ms. Motes worked as a hand packager from 1999-2006. (Id., p. 49). Based on the 

vocational expert’s testimony, the ALJ determined that Ms. Motes could perform this past work. 

(Id., pp. 51, 28). If the ALJ erred in finding that Ms. Motes could work as a hand packager, the 

Case 6:14-cv-01370-MHH Document 12 Filed 09/29/15 Page 4 of 23
5

determined that Ms. Motes is not disabled as defined in the Social Security Act. 

(Id.).

IV. SUMMARY OF MEDICAL EVIDENCE

The administrative record contains a small collection of medical records 

from treating physicians. A handful of medical records from the Guin Clinic 

ranging from May 2001 through July 2006 are unremarkable with the exception of 

a record from July 2003 which reflects that Ms. Motes was taking Prozac. (Doc. 7-

8, p. 5). There is a gap in Ms. Motes’s medical records from 2006 until 2010.

From early 2010 through June 2011, Ms. Motes visited Lamar Medical 

Clinic. Dr. R. Wayne Stevens, a general practitioner and treating physician, treated 

Ms. Motes on multiple occasions. (Doc. 7-3, p. 24). A September 2010 treatment 

note from Dr. Stevens states, “Patient suffers from fibromyalgia, depression and 

chronic intractable non-malignant pain. Patient currently takes Prozac 40 mg daily 

. . . Depression, stable.” (Doc. 7-8, p. 28). Medical records from Dr. Stevens from 

July, August, and October 2010 state that Ms. Motes was suffering from 

depression, and she routinely took 40 mg of Prozac daily. (Doc. 7-8, pp. 26, 29-

32). Dr. Stevens’s October 2010 medical record for Ms. Motes contains a 

diagnosis of “anxiety” and a prescription for Klonopin. (Doc. 7-8, p. 24). A 

subsequent nurse’s note on a record from November 2010 contains the following

 

error is harmless because the ALJ found that other jobs exist in the national economy that Ms. 

Motes could perform.

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6

remark: “Paxil is not helping.” (Doc. 7-8, p. 21). Dr. Stevens’s notes from the 

same visit contain the following pertinent information: “Anxiety disorder;” “I 

placed her on some Paxil for anxiety, and that isn’t helping her much, she says;” 

and “d/c the Paxil [] Will just place her on Klonopin.” (Doc. 7-8, p. 22). Records

from Ms. Motes’s January and April 2011 visits to the Lamar Clinic reflect that 

Ms. Motes was prescribed Xanax when she visited the clinic for “med refills.” 

(Doc. 7-8, pp. 17, 19).

The record indicates that in 2011, Ms. Motes began seeing Dr. Kimberly

Balasky, a general practitioner at Guin Medical Clinic. According to a note from 

June 2011, Ms. Motes was taking 20 mg of Prozac and 1 mg of Xanax. (Doc. 7-8, 

p. 38). Ms. Motes saw Dr. Balasky again in October 2011. The notes from those 

two visits are cursory. (Id.). 

The Commissioner sent Ms. Motes to see Dr. Bryan Thomas for a mental 

examination in December 2011. (Doc. 7-8, p. 39). Dr. Thomas’s notes indicate 

that Ms. Motes attended school through the 12th grade.2 At the time of her visit, 

Ms. Motes was taking 60 mg of Prozac once per day and 2 mg of Zanax twice each 

day. (Doc. 7-8, p. 40). Dr. Thomas wrote that Ms. Motes’s “current health issues 

include fibromyalgia, anxiety, depression.” (Doc. 7-8, p. 40). Regarding Ms. 

Motes’s daily activities, Dr. Thomas recorded that Ms. Motes “doesn’t like to be 

 

2

 Ms. Motes failed seventh grade and tenth grade. (Doc. 7-8, p. 40).

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around a lot of people gets nervous” and “doesn’t like to talk on the phone.” (Doc. 

7-8, p. 40). Dr. Thomas also reported with respect to Ms. Motes’s psychiatric 

history that Ms. Motes “had outpatient treatment from Dr. Sheehan approximately 

6-7 years ago because of anxiety and depression but stopped because of lack of 

insurance.” (Doc. 7-8, p. 40). Ms. Motes reported that the treatment did not help. 

(Id. at 41). 

Dr. Thomas noted that Ms. Motes’s “[a]ffect is depressed and she cries 

frequently.” (Doc. 7-8, p. 41). Ms. Motes reported the following mental health 

symptoms to Dr. Thomas: 

sleep impairment, anhedonia, feelings of guilty, feelings of 

worthlessness, impaired energy level, impaired concentration, 

appetite/weight problems, thoughts of death but denies plan/intent for 

suicide. Depression has been ongoing since 16 years old but at 

present level since 2007 when her husband was injured at work and 

again worsened in December 2009 when she found her sister dead 

from over-dose. She doesn’t know why she is depressed. 

Claimant reports symptoms of post traumatic stress including: finding 

her sister dead from suicide, with the claimant responding with 

intense fear, helplessness of horror, with the claimant re-experiencing 

the event in a distressing way over the last month. She also reports 

trauma related to her husband nearly d[y]ing at work and being told 

that he likely would not live. 

She reports the following related to her sister’s death: In the past 

month the following have occurred

-avoided thinking about or talking about the event

-avoided activities, places or people that remind claimant of the 

event

-become much less interested in hobbies or social activities

-felt detached or estranged from others

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In the past month the following have occurred

-especially irritable

-felt nervous or constantly on guard

-easily startled

In the past month these problems have significantly interfered with 

work or social activities or causes [sic] significant distress.

(Doc. 7-8, p. 41). 

Objective assessments that Dr. Thomas performed produced the following 

findings: poor concentration; poor verbal abstraction, poor judgment concerning 

basic verbal problems; remote and recent memory adequate; poor immediate 

memory. (Doc. 7-8, p. 41). Dr. Thomas provided the following diagnosis for Ms. 

Motes: major depression, post-traumatic stress disorder, “ability to perform 

routine repetitive tasks appears fair but persistence is likely poor,” “ability to 

interact with coworkers appears questionable,” “ability to sustain attention appears 

poor,” and “ability to handle funds if so assigned appears adequate.” (Doc. 7-8, p. 

41). Dr. Thomas added: “Prognosis for improvement over the next 12 months 

appears questionable/poor without treatment.” (Doc. 7-8, p. 42). 

The Commissioner sent Ms. Motes to see Dr. Boyde J. Harrison in January 

2012 for a “medical examination.” (Doc. 7-8, p. 56). At the time of her visit, Ms. 

Motes reported that she was taking 2mg of Xanax twice daily and 60mg of Prozac 

per day. (Doc. 7-8, p. 58). Dr. Harrison noted a family history of depression and 

PTSD. (Doc. 7-8, p. 57). Dr. Harrison’s evaluation focused on Ms. Motes’s 

Case 6:14-cv-01370-MHH Document 12 Filed 09/29/15 Page 8 of 23
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physical symptoms. He examined her vital signs, her vision, her hearing, and her 

chest, abdomen, musculoskeletal, and neurological symptoms. (Doc. 7-8, pp. 58-

59). With respect to his neurological examination, Dr. Harrison noted that “the 

traditional trigger points associated with fibromyalgia were not endorsed.” (Doc. 

7-8, p. 59). Dr. Harrison opined: “(1) Patient has mild depression (2) Patient 

likely has substance dependence which increases her depression, decreases her 

motivation (3) Myalgia secondary to inactivity. . . . In my opinion, the patient 

should be treated for iatrogenic substance dependence and encouraged to exercise, 

encouraged to remain in the work place.” (Doc. 7-8, p. 59).

Dr. Balasky completed three assessments of Ms. Motes and one declaration 

for purposes of Ms. Motes’s application for Social Security benefits. The first

assessment, labeled “Medical Opinion re: Ability to do Work-Related Activities 

(Mental)” is dated September 13, 2012. (Doc. 7-8, pp. 78-79). That document 

asks: “please give us your opinion based on your examination of how your 

patient’s mental/emotional capabilities are affected by the impairment(s).” (Doc. 

7-8, p. 78) (emphasis in original). In that assessment, Dr. Balasky stated that she 

anticipated that Ms. Motes’s impairments would cause her to be absent from work 

“more than four days per month.” (Doc. 7-8, p. 78).

The second assessment entitled “Statement of Treating Physician” is dated 

October 8, 2012. (Doc. 7-8, pp. 72-77). Dr. Balasky made a diagnosis of “chronic 

Case 6:14-cv-01370-MHH Document 12 Filed 09/29/15 Page 9 of 23
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joint and muscle pain, depression, [and] fatigue,” and listed Ms. Motes’s prognosis 

as “fair.” (Id., p. 72). Dr. Balasky opined that the symptoms would “rarely” 

preclude the requisite level of attention for performing simple work tasks and that 

in the work environment “moderate stress” would be acceptable. (Id., p. 73). Dr. 

Balasky also indicated that Ms. Motes was capable of sitting for two hours and 

standing for forty-five minutes at a time; that she could sit for a total of six hours 

and stand or walk for two hours during an eight-hour workday; and that Ms. 

Motes’s impairments would cause her to miss two days of work per month. (Id., 

pp. 74–76). In her assessment of Ms. Motes’s mental abilities, Dr. Balasky 

characterized Ms. Motes as being “unlimited or very good” in twenty categories, 

“limited but satisfactory” in two categories, and “seriously limited but not 

precluded” in three categories. (Id., p. 78–79). In that report, Dr. Balasky 

indicated that Ms. Motes’s impairments would cause her to have good and bad 

days and to miss work “[a]bout two days per month.” (Doc. 7-8, p. 56). 

The final assessment titled “Physician Assessment of Fibromyalgia” is dated 

October 23, 2012. (Doc. 7-8, pp. 70-71). In it, Dr. Balasky checked boxes 

indicating that Ms. Motes presented with signs of “fatigue,” “depression,” and 

“chronic fatigue syndrome.” (Doc. 7-8, p. 70). Dr. Balsky opined that these 

symptoms could be attributed to Ms. Motes’s fibromyalgia and that all other 

possible conditions had been excluded. (Id., p. 71).

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In the declaration that she executed on December 4, 2012, Dr. Balasky stated 

that she offered the declaration “to clarify [] comments that [she] made in response 

to two questionnaires about [Ms. Motes].” (Doc. 7-8, p. 80). She explained:

It has come to my attention that my responses to these questionnaires 

might appear to be inconsistent, and now that they have been brought 

to my attention, I hope to clear up any potential misunderstandings. 

Ms. Motes’s primary disabling condition is her depression. She 

reports some symptoms of physical pain, but those physical symptoms 

are most often secondary to her flare ups in her depression. However, 

her depression does not completely account for all of her physical 

symptoms, which is why I have given her a separate diagnosis of 

fibromyalgia. When I completed the separate questionnaires . . . I was 

attempting to separate the limiting effects of her depression from the 

limiting effects of her depression [sic]. In other words, I would expect 

that her fibromyalgia would cause her to be absent from work about 

two days per month, and her depression would cause her to be absent 

from work more than four days per month. 

I also have been asked to explain why I indicated that Ms. Motes 

would be absent ‘more than four days per month’ due to her 

depression, but that I marked that she would have ‘unlimited or very 

good’ abilities in most areas on the questionnaire. That is the nature 

of depression. Many patients with depression will be able to function 

nearly normally on most days. Often they will find the effort to 

maintain function at a normal level to be very taxing, but they manage 

to cope with their symptoms in order to do what they need to do. 

However, when their symptoms flare up, they may find themselves 

unable to function at a level that is necessary to adequately perform 

their jobs. They may find themselves unable to keep their minds 

focused on the task at hand. Their symptoms may have outward signs 

that can be distracting to others. They may often perform at a much 

slower pace than normal, which may cause problems with tardiness 

and lapses in productivity. Even if they manage to arrive at their 

place of work on days when their symptoms flare up, often patients 

with depression will be unable to sustain their coping efforts long 

enough to complete the work day. My comments on the ‘Medical 

Opinion Re: Ability to Do Work-Related Activities (Mental)’ 

Case 6:14-cv-01370-MHH Document 12 Filed 09/29/15 Page 11 of 23
12

questionnaire for Ms. Motes were intended to reflect the nature of her 

depression flares. On most days, she may struggle in some areas to 

cope, but she will be able to ‘soldier on’ so to speak. However, I 

expect that she would have flare ups in her depression more than four 

days per month, and on those days, she would not be able to keep her 

mind on her job well enough to attend work that day.

(Doc. 7-8, pp. 80-81). 

V. ANALYSIS

Ms. Motes argues that she is entitled to relief from the ALJ’s decision 

because the ALJ failed to properly weigh the opinions of Dr. Balasky and Dr. 

Thomas. Well-settled standards guide the Court in evaluating Ms. Motes’s 

arguments.

An ALJ “must state with particularity the weight given to different medical 

opinions and the reasons therefor.” Phillips v. Barnhart, 357 F. 3d 1232, 1240–41 

(11th Cir. 2004). In the absence of sufficient particularity, the Court “cannot 

determine whether substantial evidence supports the ALJ’s decision.” Denomme v. 

Comm’r, Soc. Sec., 518 Fed. Appx. 875, 877 (11th Cir. 2013) (citing Winschel, 631 

F.3d at 1179). An ALJ must give the opinion of a treating physician “substantial 

or considerable weight unless ‘good cause’ is shown to the contrary.” Phillips v.

357 F.3d at 1240-41. Typically, an examining physician’s opinion receives more 

weight than that of a non-examining physician. See Gray v. Comm’r of Soc. Sec., 

550 Fed Appx. 850 (11th Cir. 2013). “However, in evaluating a physician’s 

opinions, ‘the [ALJ] may reject any medical opinion,’ including that of a treating 

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or consulting physician, ‘if the evidence supports such a contrary 

finding.’” Aderholt v. Astrue, 2012 WL 2499164, at *2 (N.D. Ala. June 26, 2012) 

(quoting Syrock v. Heckler, 764 F. 2d 834, 835 (11th Cir.1985)). An ALJ may 

give less weight to the opinion of a treating physician if the ALJ articulates good 

cause for doing so. Examples of good cause include instances “when the: (1) 

treating physician’s opinion was not bolstered by the evidence; (2) evidence 

supported a contrary finding; or (3) treating physician’s opinion was conclusory or 

inconsistent with the doctor’s own medical records.” Winschel, 631 F. 3d at 1179. 

An ALJ owes no deference to the opinion of a one-time examining 

physician. Eyre v. Comm’r, Soc. Sec. Admin., 586 Fed. Appx. 521 (11th Cir. 2014) 

(citing McSwain v. Bowen, 814 F.2d 617, 619 (11th Cir.1987)). And an ALJ “may 

reject the opinion of any physician when the evidence supports a contrary 

conclusion.” McCloud v. Barnhart, 166 Fed. Appx. 410, 418-19 (11th Cir. 2006). 

With these standards in mind, the Court considers Ms. Motes’s arguments. 

A. Dr. Balasky 

Of the psychologists and physicians whose opinions the ALJ discussed, only 

Dr. Balasky arguably rises to the level of a treating physician. The ALJ gave Dr. 

Balasky’s opinion “only some weight.” (Doc. 7-3, p. 25). 

The Court is not convinced that Dr. Balasky qualifies as a treating physician. 

“A treating source (i.e., a treating physician) is a claimant’s own physician, 

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psychologist, or other acceptable medical source who provides you, or has 

provided you, with medical treatment and who has, or has had an ongoing 

treatment relationship with you.” Nyberg v. Comm’r of Soc. Sec., 179 Fed. Appx 

589, 591 n. 3 (11th Cir. 2006) (internal quotations omitted). The assumption 

underlying the weight accorded to the opinions of treating physicians is that “these 

sources are likely to be the medical professionals most able to provide a detailed, 

longitudinal picture of your medical impairment(s) . . . .” C.F.R. § 404.1527(d)(2).

The administrative record indicates that Ms. Motes had only two visits with 

Dr. Balasky, one in June 2011 and one in October 2011. (Doc. 7-8, p. 38). The 

one page of notes that documents both visits contains almost no information about 

Dr. Balasky’s examination of Ms. Motes. (Id.). The “Statement of Treating 

Physician” form that Dr. Balasky completed in the fall of 2012 asked Dr. Balasky 

to indicate “Nature, frequency, and length of contact.” (Doc. 7-8, p. 72). Dr. 

Balasky replied, “general medical care since”—Dr. Balasky did not complete the 

sentence. (Id.). 

On this record, Dr. Balasky’s opinions are not due the deference that an ALJ 

must accord to a treating physician. See Chaney-Everett v. Astrue, 839 F. Supp. 2d 

1291, 1303 (S.D. Fla. 2012) (finding that a physician who saw a claimant only 

twice “did not have an ongoing treatment relationship” with the claimant and 

therefore did not qualify as a “treating source”); Casher v. Halter, 2001 WL 

Case 6:14-cv-01370-MHH Document 12 Filed 09/29/15 Page 14 of 23
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294921 at *12 (S.D. Ala. Mar. 29, 2001) (because claimant only saw a physician 

twice, it was questionable whether he was a treating physician under the 

regulations). Dr. Balasky falls somewhere between a treating physician and a onetime examining physician.3

The ALJ determined that Dr. Balasky’s opinion that Ms. Motes’s would 

have depression flare-ups more than four days a month was “inconsistent with the 

record as a whole,” particularly Dr. Steven’s treating notes that span several years. 

(Doc. 7-3, p. 25; Doc. 7-8, pp. 16–34). The ALJ also noted that “many of [Dr. 

Balasky’s] opinions regarding [Ms. Motes’s] abilities were contradictory to each 

other.” (Doc. 7-3, p. 25). For example, the ALJ found that Dr. Balasky’s

conclusion that Ms. Motes was limited to a less than sedentary range of work was 

belied by her findings that Ms. Motes could endure moderate stress and had mental 

abilities described as “unlimited or very good” in over three quarters of the abilities 

evaluated. (Id.). In no category was Ms. Motes rated as either “unable to meet 

competitive standards” or “no useful ability to function”. (Doc. 7-8, pp. 78–79). 

The ALJ also noted that Dr. Balasky’s conclusion that Ms. Motes “would ‘rarely’

have pain that would preclude the level of attention and concentration needed to 

perform simple work tasks” was inconsistent with her determination that the 

 

3 Ms. Motes’s testimony from the hearing before the ALJ suggests that Ms. Motes sees Dr. 

Balasky more frequently than the physician’s documents in the administrative record suggest, 

but Ms. Motes offered no concrete information about the nature or frequency of her visits with 

Dr. Balasky. (See Doc. 7-3, pp. 41-42). 

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plaintiff was likely to miss four or more days of work per month. (Doc. 7-3, p. 

25).4

In reaching these conclusions, the ALJ confused Dr. Balasky’s opinions 

regarding Ms. Motes’s physical impairments with Dr. Balasky’s opinions 

regarding Ms. Motes’s mental impairments. Ms. Motes submitted a declaration 

from Dr. Balasky to address some of the confusion that the ALJ had expressed. 

In her declaration, Dr. Balasky explained that “Ms. Motes’s primary 

disabling condition is her depression. However, her depression does not 

completely account for all her physical symptoms, which is why I have given her a 

separate diagnosis of fibromyalgia.” (Doc. 7-8, p. 80). Dr. Balasky commented 

that in her assessments, she attempted to separate the effects of these conditions, 

but that, in sum, she “would expect that [Ms. Motes’s] fibromyalgia would cause 

her to be absent from work about two days per month, and her depression would 

cause her to be absent from work more than four days per month.” (Id., p. 81). To 

reconcile the apparent inconsistency in her assessment of Ms. Motes’s mental 

abilities, Dr. Balasky explained “[m]any patients with depression will be able to 

function nearly normally on most days. . . . However, when their symptoms flare 

 

4

 The distinction between absence from work for two days versus four days is significant 

because the vocational expert testified that if Ms. Motes were to miss more than two days of 

work per month, “[t]hat would preclude performance of all work, especially at the unskilled 

level.” (Doc. 7-3, pp. 54-55). 

Case 6:14-cv-01370-MHH Document 12 Filed 09/29/15 Page 16 of 23
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up, they may find themselves unable to function at a level that is necessary to 

adequately perform their jobs.” (Id.). 

The ALJ found that, notwithstanding her clarification, Dr. Balasky’s opinion 

was inconsistent both internally and with the medical evidence as a whole. The 

ALJ provided two reasons for finding Dr. Balasky’s opinion inconsistent. The 

ALJ determined that Dr. Balasky’s findings were at odds with the more substantial 

treatment provided by Dr. Stevens, and the ALJ reasoned that if Dr. Balasky’s 

clarification was accurate, then Dr. Balasky would have referred Ms. Motes for 

psychiatric care to treat the primary disabling impairment. (Doc. 7-3, p. 25). 

These rationales have intuitive appeal, but they do not provide a sufficient basis for 

the ALJ’s treatment of Dr. Balasky’s opinion.

The Court struggles to find inconsistency between Dr. Stevens’s treatment 

records and Dr. Balasky’s treatment records. Dr. Stevens consistently treated Ms. 

Motes for depression and anxiety, adjusting her medications over time to try to 

find the most effective treatment. (Doc. 7-8, pp. 17-32). In one record, Dr. 

Stevens described Ms. Motes’s depression as stable (Doc. 7-8, p. 28); but another

record states “Paxil is not helping” (Doc. 7-8, p. 21). Dr. Stevens’s records contain 

no details about Ms. Motes’s depression or her anxiety. Nowhere does Dr. Stevens 

express an opinion about the frequency of Ms. Motes’s depression flare-ups, nor 

does he indicate how often Ms. Motes would be forced by her impairments to miss 

Case 6:14-cv-01370-MHH Document 12 Filed 09/29/15 Page 17 of 23
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work. The brevity of Dr. Stevens’s notes does not dictate the conclusion that Dr. 

Stevens’s findings and Dr. Balasky’s findings are at odds. Indeed, virtually all of 

Ms. Motes’s medical records are bare-boned.

In addition, Dr. Balasky’s apparent failure to refer Ms. Motes for treatment 

from a mental health specialist is inadequate justification for according Dr. 

Balasky’s opinion only some weight. “[L]ack of evidence alone is not sufficient to 

support a finding that an impairment did not exist at a disabling level of severity.” 

Spellman v. Shalala, 1 F.3d 357, 363 (11th Cir. 1993). Uncontroverted evidence in 

the record demonstrates that Ms. Motes could not have afforded such treatment. 

(Doc. 7-3, p. 42). Indeed, the record shows that Ms. Motes received outpatient 

psychiatric treatment in 2004 or 2005 for anxiety and depression, but she stopped 

attending the therapy sessions because of lack of insurance. (Doc. 7-8, p. 40). It is 

undisputed that Ms. Motes had no insurance when she applied for Social Security 

benefits. An ALJ’s reliance on a claimant’s failure to obtain treatment is error 

when the claimant has a legitimate excuse such as poverty. Dawkins v. Bowen, 

848 F.2d 1211, 1212 (11th Cir. 1988) (holding “that a claimants inability to afford 

a prescribed medical treatment excuses noncompliance”). Thus, such a rationale 

cannot afford a substantial basis for giving limited weight to Dr. Balasky’s 

opinion.

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In the final analysis, though the Court rejects the rationale that the ALJ 

offered for her finding, the Court concludes that the ALJ did not err in giving Dr. 

Balasky’s opinion “only some weight,” because on the record before the Court, Dr. 

Balasky is not a treating physician, so her opinion is not entitled to deference. 

Because the only two (half-page) treatment notes from Dr. Balasky in the 

administrative record precede by more than one year the written assessments of 

Ms. Motes that Dr. Balasky prepared for purposes of Ms. Motes’s benefits claim,

the Court cannot conclude from the record that Dr. Balasky is in a position to 

provide a detailed, longitudinal picture of Ms. Motes’s medical impairments of 

depression and anxiety. Therefore, Dr. Balasky’s opinion is entitled to some 

weight. 

B. Dr. Thomas

Dr. Thomas performed a consultative examination on December 22, 2011. 

After conducting a mental status evaluation and reviewing Ms. Motes’s selfreported symptoms, Dr. Thomas diagnosed Ms. Motes’s with “major depression 

vs. depression not otherwise specified” and “post traumatic stress disorder.” (Doc. 

7-8, p. 41). Dr. Thomas opined that Ms. Motes’s work skills were “likely poor” as 

was her “[p]rognosis for improvement.” (Doc. 7-8, pp. 41-42). The ALJ 

determined that Dr. Thomas’s opinion was entitled to no weight because “it is so 

inconsistent with the objective medical evidence as a whole.” (Doc. 7-3, p. 26). 

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Significantly, of all of the medical sources in the record, Dr. Thomas is the 

only psychologist who personally evaluated Ms. Motes. The ALJ gave Dr. 

Thomas’s opinion no weight because of inconsistencies between Dr. Thomas’s

findings and the record as a whole. The ALJ noted: 

[t]he claimant reported to Dr. Thomas symptoms of sleep impairment, 

anhedonia, feelings of guilt, feelings of worthlessness, impaired 

energy level, impaired concentration, appetite/weight problems, and 

thoughts of suicide with no plan. However, the claimant has never 

reported any of these symptoms in the past, in particular, to Dr. 

Stevens who treated the claimant for multiple years. 

(Doc. 7-3, p. 26). Ms. Motes’s takes issue with the ALJ’s reliance on the silence in 

the treatment history that Dr. Stevens provided with respect to Ms. Motes’s 

psychological symptoms. Such silence, though, “is equally susceptible to either 

inference, therefore, no inference should be taken.” Lamb v. Bowen, 847 F. 2d 

698, 703 (11th Cir. 1988). And Dr. Stevens is a medical doctor, not a psychologist 

or a psychiatrist. Still, one would expect Dr. Stevens and Dr. Balasky to note in 

Ms. Motes’s medical records suicidal reports from Ms. Motes. Neither did. 

The ALJ found additional support for her decision to reject Dr. Thomas’s 

opinion in the report of Dr. Harrison, a one-time examining physician who 

conducted a medical examination of Ms. Motes. In addition to his findings 

regarding Ms. Motes’s physical symptoms, Dr. Harrison noted that Ms. Motes 

suffered from “mild depression” and “likely substance dependence which increases 

her depression, [and] decreases her motivation.” (Doc. 7-8, p. 59). Dr. Harrison 

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opined that Ms. Motes should be treated “for substance dependence and 

encouraged to exercise, [and] encouraged to remain in the workplace.” (Id.). 

Although Dr. Harrison was a medical examiner tasked with evaluating Ms. 

Motes’s physical symptoms, he stands in the same posture as Dr. Stevens and Dr. 

Balasky with respect to his diagnosis of depression. The record supports Dr. 

Harrison’s impression of “likely substance dependence.” 

The ALJ was sufficiently clear in her reasons for rejecting the opinion of Dr. 

Thomas. Although the undersigned would not go so far as to say that Dr. 

Thomas’s opinion should be accorded no weight, the record as a whole suggests 

that Ms. Motes may have exaggerated some of her symptoms when she visited Dr. 

Thomas. 

C. Other Opinions Supporting the ALJ’s Decision

In addition to Dr. Harrison’s opinion, the ALJ considered the opinion of Dr. 

Robert Hughes, M.D., a non-examining medical expert who prepared a state 

agency physical assessment. (Doc. 7-8, pp. 60-63). The ALJ accorded Dr. 

Hughes’s opinion “some weight because evidence received at the hearing level 

shows that [Ms. Motes] is more limited than determined by [Dr. Hughes].” (Doc. 

7-3, p. 26). Dr. Melissa Jackson, Ph.D. and Dr. David Hill, Ph.D. are nonexamining psychologists who performed state agency medical assessments. (Doc. 

7-8, pp. 43-54, 64-68). Drs. Jackson and Hill concluded that Ms. Motes is not 

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disabled. (Doc. 7-8, pp. 43-54, 64-68). The ALJ accorded the opinions of these 

medical experts “great weight because they are consistent with the objective 

medical evidence.” (Doc. 7-3, p. 27). 

V. CONCLUSION

The Court strongly suspects that the administrative record in this case does 

not tell the whole story, but the Court must limit its review to the record. The 

Court is mindful too that Ms. Motes bears the burden of proving that she is 

disabled. Hubbard v. Comm’r of Soc. Sec., --- Fed. Appx. ---, 2015 WL 4508768, 

at * 5 (11th Cir. 2015) (citing Moore v. Barnhart, 405 F.3d 1208, 1211 (11th Cir. 

2005)). Were she able to establish a more extensive relationship with Dr. Balasky, 

the Court might reach a different conclusion. The record leaves little doubt that 

Ms. Motes has struggled with depression for years, and Dr. Thomas’s report 

indicates that Ms. Motes’s depression has legitimate roots in a number of 

challenging experiences. The record also demonstrates that beyond routine 

medication refills for Prozac and Xanax (and a number of other prescription 

medications), Ms. Motes has received little treatment. On the record before it, the 

Court concludes that substantial evidence supports the ALJ’s conclusion, even if 

the evidence and the reasonable inferences from that evidence preponderate against 

the Commissioner’s conclusion. Accordingly, the Court affirms the 

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Commissioner’s decision. The Court will enter a separate final judgment 

consistent with this memorandum opinion.

DONE and ORDERED this September 29, 2015.

 _________________________________

 MADELINE HUGHES HAIKALA

 UNITED STATES DISTRICT JUDGE

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