Document ID: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-almd-2_04-cv-00700/USCOURTS-almd-2_04-cv-00700-0/pdf.json

Parties Involved:
Jo Anne B. Barnhart
Defendant
Debra L. Latimer
Plaintiff

Document Text:

1IN THE DISTRICT COURT OF THE UNITED STATES

FOR THE MIDDLE DISTRICT OF ALABAMA

NORTHERN DIVISION

DEBRA L. LATIMER )

)

Plaintiff, )

)

v. ) CIVIL ACTION NO. 1:04CV700-M

) [WO]

JO ANNE B. BARNHART, )

Commissioner of Social Security )

)

Defendant. )

MEMORANDUM OPINION AND ORDER

Claimant Debra L. Latimer [“Latimer”] has filed this action seeking review of a final

decision by the Commissioner (Doc. # 1) pursuant to 42 U.S.C. §§ 405(g) and 1383(c). (Doc.

# 1, p. 1). Upon review of the record and the briefs submitted by the parties, the court

concludes that the Commissioner’s decision is supported by substantial evidence and is

hereby affirmed.

I. PROCEDURAL BACKGROUND AND FACTS

Latimer, who was 38 years old when she first applied for disability insurance and

supplemental income benefits in March 1996, alleged an onset date of 22 December 1995

(R. 89 ). Latimer alleges that she has been unable to work since then, primarily as a result

of mental illness, namely depression and panic disorder, which she classified simply as

“nerves” on her disability report. (R. 97). She is a high-school graduate, is certified as a

nursing and physical therapy assistant, and has received training as an EKG technician. (R.

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1

Judge Walker determined that Judge Dugan failed to address the opinions or records of Latimer’s treating

physicians or provide any explanation for his disregard. (R. 330). In addition, the ALJ had not assessed the severity of

Latimer’s well-documented impairments. (R. 333). Judge Walker also denied Latimer’s request for remand to allow

the ALJ to consider a physical capacities evaluation completed by her treating physician only after the ALJ had issued

his decision in April 1998. (R. 337). Key to Judge Walker’s denial was the fact that the physician had not related his

assessment back to a date prior to the ALJ’s decision. (R. 337, citing Caulder v. Bowen, 791 F.2d 872, 87-78 (11th Cir.

1986)). 

2While Judge Dugan’s decision regarding Latimer’s 1996 application was wending its way through the appeals

process, she filed another application for benefits, this time alleging an onset date of 1 May 1998. (R. 530). That

application was also denied initially and upon reconsideration. (R. 509; 519-522). After an evidentiary hearing before

2

101). She has previously worked as a “Wire Harness Assembler . . ., Circuit Board

Assembler . . ., Nursing Assistant . . ., and Cashier . . ..” (R. 314). 

In her own words, Latimer contends that she is no longer capable of maintaining

employment because her depression and panic disorder prevent her from being able to sleep

and concentrate (R. 51). She does not understand what people say (R. 381). She gets

“hysterical” and is “afraid of people.” (R. 51). She does not “get along with people very

good [sic].” (R. 51). Although she has not been physically violent, she is prone to lash out

verbally at those around her (R. 53). As she testified, “I want to be in my own little world

at home with the blinds closed with my little dog . . ..” (R. 385).

A simplified version of the complex procedural history of this case follows: Latimer’s

petition was denied initially (R. 68), upon reconsideration (R. 75), and after an evidentiary

hearing before an Administrative Law Judge [“ALJ”], D. Kevin Dugan (R. 17-29). The

Appeals Council denied Latimer’s request for review of the ALJ’s decision (R. 5), and

Latimer appealed to this court. Judge Susan Russ Walker reversed the Commissioner’s

decision and remanded the case for a rehearing. (R. 321-339).1 Latimer now asks this court

to review the opinion issued as the result of the rehearing. (R. 297-319).2 

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a different ALJ, Steven L. Carnes, Latimer received a fully favorable decision in November 2001. (R. 418). Judge

Carnes also presided over the rehearing. 

3

In Graham v. Apfel, 129 F. 3d at 1422, the Court of Appeals stated that:

Substantial evidence is described as more than a scintilla, and

means such relevant evidence as a reasonable mind might accept

as adequate to support a conclusion. See Richardson v. Perales,

402 U.S. 389, 401, 91 S.Ct. 1420, 1427, 28 L.Ed.2d 842 (1971).

3

II. STANDARD OF REVIEW

The district court’s review of the Commissioner's decision is a limited one.

Reviewing courts “may not decide the facts anew, reweigh the evidence, or substitute [their]

judgment for that of the [Commissioner].” Miles v. Chater, 84 F. 3d 1397, 1400 (11th Cir.

1996) (citing Bloodsworth v. Heckler, 703 F.2d 1233, 1239 (11th Cir. 1983)). The court

must affirm the Commissioner’s decision “if it is supported by substantial evidence and the

correct legal standards were applied,” Kelley v. Apfel, 185 F.3d 1211 (11th Cir. 1999) (citing

Graham v. Apfel, 129 F. 3d 1420, 1422 (11th Cir. 1997)).3 This is true despite the fact that

“[s]ubstantial evidence may even exist contrary to the findings of the ALJ.” Barron v.

Sullivan, 924 F.2d 227, 230 (11th Cir. 1991). “There is no presumption, however, that the

Commissioner followed the appropriate legal standards in deciding a claim for benefits or

that the legal conclusions reached were valid.” Miles, 84 F. 3d at 1400 (citations omitted).

III. DISCUSSION

A. Standard for Determining Disability

An individual who files an application for Social Security disability benefits must

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prove that he is disabled. See 20 C.F.R. § 416.912 (2004). The Act defines “disability”

as the “inability 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.” 42 U.S.C. § 423(d)(1)(A) (2004). 

The Social Security regulations provide a five-step sequential evaluation process

for determining if a claimant has proven that he is disabled. See 20 C.F.R. § 416.920. 

The ALJ must evaluate the claimant’s case using this sequential evaluation process, 

Ambers v. Heckler, 736 F.2d 1467, 1469 (11th Cir. 1984); Williams v. Barnhart, 186 F.

Supp. 2d 1192, 1195 (M.D. Ala. 2002). The steps are as follows:

a. If the claimant is working or engaging in substantial gainful activity, he is not

disabled. However, if the claimant is not working or engaging in substantial

gainful activity, the Court must consider whether the claimant has a severe

impairment.

b. If the claimant does not have a severe impairment, he is not disabled. A severe

impairment is defined as a condition that precludes one from performing basic

work-related activities. If the claimant has a severe impairment, the Court must

then consider whether the impairment has lasted or is expected to last for more

than twelve (12) months.

c. If a claimant’s impairment has lasted or is expected to last for a continuous

period of twelve (12) months or more and it is either included on or equivalent

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5

to an item in a list of severe impairments, as found in Appendix I of the

regulations, the claimant is disabled. If neither of the above conditions, when

considered in association with the continuity requisite of twelve (12) months,

is deemed true, the ALJ must go on to step 4 of the evaluation sequence. 

d. If it is determined that the claimant can return to previous employment,

considering his residual functional capacity [“RFC”] and the physical and

mental demands of the work that he has done in the past, the claimant will not

be considered disabled. If it is determined that the claimant cannot return to

previous employment, the SSA must continue to step 5 in the sequential

evaluation process.

e. If, upon considering the claimant’s RFC, age, education, and past work

experience, the SSA determines that the impairments determined do not

preclude the claimant from performing a significant number of jobs that are

available in the national economy, the claimant will not be considered disabled

within the meaning of the Social Security Act. Therefore, she/he will not be

entitled to benefits pursuant to 42 U.S.C. §§ 401 et seq. and/or 42 U.S.C. §

1381. If, however, it is determined that there are not a significant number of

jobs the claimant can perform available in the national economy and the

impairment meets the duration requirement, the claimant will be considered

disabled.

See §§ 20 C.F.R. 404.1520(a)-(f), 416.920(a)-(f). 

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B. Application of the Standard

On rehearing, Administrative Law Judge Carnes ultimately determined that Latimer

was not under a disability prior to 1 May 1998, thus affirming the original conclusion in this

case. It is not necessary to discuss all of Judge Carnes’ findings, however, because Latimer

appeals the decision on fairly narrow grounds, namely: (1) his decision not to assign

controlling weight to a letter her treating physician wrote on her behalf three days after the

rehearing; (2) his apparent failure to take into consideration certain records from treatment

Latimer received during a brief hospital stay, including the opinion of the psychiatrist

overseeing her care; and (3) his decision to assign great weight to the non-examining medical

expert who testified at the rehearing. 

1. The Law Regarding a Treating Physician’s Opinion

A treating physician’s opinion is entitled to controlling weight if it “is well-supported

by medically acceptable clinical and laboratory diagnostic techniques and is not inconsistent

with the other substantial evidence in [the] case record . . ..” 20 C.F.R.§§ 404.1527(d)(2)(I);

416.927(d). When the ALJ determines that the treating physician’s opinion is not entitled

to controlling weight, he or she must take the following factors into consideration when

deciding what weight to give the opinion: 

(1) length of treatment relationship and frequency of examination; 

(2) nature and extent of the treatment relationship; 

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4

The more a medical source presents relevant evidence to support an opinion,

particularly medical signs and laboratory findings, the more weight we will give

that opinion. The better an explanation a source provides for an opinion, the more

weight we will give that opinion. Furthermore, because nonexamining sources have

no examining or treating relationship with you, the weight we will give their

opinions will depend on the degree to which they provide supporting explanations

for their opinions. We will evaluate the degree to which these opinions consider

all of the pertinent evidence in your claim, including opinions of treating and other

examining sources. 

20 C.F.R. § 404.1527(d)(3).

7

(3) the supportability of the opinion given;4

(4) the consistency of the opinion; 

(5) whether the treating physician is a specialist in a relevant area; and 

(6) any other factors the claimant raises that “tend to support or contradict the

opinion.” 

§§ 404.1527(d)(2)-(6); 416.927 (d)(2)-(6). 

At the very least, in the Eleventh Circuit, treating physicians’ opinions are accorded

“substantial or considerable weight unless good cause is shown to the contrary.” Phillips v.

Barnhart, 357 F.3d 1232, 1240 (11th Cir. 2004) (quoting Lewis v. Callahan, 125 F.3d 1436,

1440 (11th Cir. 1997)). Good cause exists when, for example, “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.” Id. at 1241. The ALJ must state his or her reasons for the weight given the

opinion. § 404.1527(d)(2); 416.927(d)(2).

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5Unless otherwise stated, the facts and conclusions discussed relate to the time period at issue in Latimer’s

initial application, to wit, 22 December 1995 through 30 April 1998. Lopez’ letter of 12 January 2004 suggests he had

met with her several times during that period, but he does not provide any specific dates and does not explicitly state

whether he met directly with her. (R. 364-65). Her records indicate an in-person examination by Lopez on 8 April, 8

July and 7 October 1996. (R. 171-73). 

6Other than noting her mood and appearance at the time of the session, the notes, for the most part, simply relay

information provided by Latimer herself. (R. 171-82; 665-733). This type of information is of limited value to an

objective records reviewer charged with evaluating a person’s ability to work, particularly when the person’s credibility

is in question. Good examples of the kind of information that frequently proves more useful can be found in notes from

the clinical director of ECMH, who made the following observation in August 1998:

Despite client’s compliance with keeping appointments and her reported med.

compliance, she has made little, if any, progress in treatment consistently [sic]

reporting some new complaint or problem, and finding excuses for not making

progress. Judging from the number of referrals from attorneys that are charted, she

just seems intent on getting disability!

8

2. Latimer’s Alleged Treating Physicians’ Opinions

Latimer raises arguments regarding only the opinions of Dr. Fernando Lopez

[“Lopez”] and Dr. Timothy L. Reid [“Reid”] (Doc. # 20, pp. 1-13). The court limits its

discussion accordingly except where otherwise warranted. 

a. Lopez’ Opinion

Latimer first visited East Central Mental Health and Mental Retardation, Inc.

[“ECMH”], where Lopez works as a psychiatrist, in March 1996. (R. 732). Although

Latimer testified that Lopez was her treating physician (R. 380), and Judge Carnes did not

dispute this fact, her medical records do not make clear whether Lopez met with Latimer

more than three times during the relevant time period.5 (R. 171-82; 665-733). The notes

from those examinations provide little insight into Latimer’s condition (R. 171-73), as do

the notes of other ECMH therapists.6 (R. 171-82; 665-733). 

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(R. 670). In April 1999, the director again observed:

It should be noted that client did not return to this agency until eight (8) days before

their [sic] 4-22-99 request for information was obtained from DDU. New treatment

plan, therefore, has not been developed. The 4-14-99 progress note, however,

indicates there is not likely to be a change in diagnosis. It seems quite evident that

this client is continuing and persistent in her attempt to get disability, instead of

seeking training and/or employment!

(R. 667).

7While he may have personally examined Latimer at that time, the report is written in such a way that suggests

otherwise. 

8

Restatements of Latimer’s subjective statements have been excised. 

9

SENSORIUM AND COGNITIVE FUNCTIONING: Ms.

Latimer was alert and oriented in 3 spheres. She was unable to

perform serial 7 subtractions from 100. She was able to perform

serial 4 additions from 1. M[s]. Latimer correctly calculated 3

out of three single-digit multiplication problems and 1 out of two

9

Lopez did conduct a thorough consultative exam.7 (R. 178-82). As with the therapy

notes, however, the five-page report provides limited objective information or insight into

Lopez’ own thoughts about Latimer’s condition. (R. 178-82). He did note the following,

however: 

MENTAL STATUS: Ms. Latimer is a mildly obese Caucasian

female with adequate development. She casually dressed in

blue jeans, pink t-shirt, and boots. Her grooming was adequate.

Throughouttheexamination,Ms.Latimercontinuallypacedtheroomwringingherhands. Hercharacteristicsofspeechwere

unremarkable as was speed and quantity. Her stream of thought and association appeared

logical. . . . Throughout the examination, her affect was dysphoric with a large amount of

anxiety noted. Her affect did not appear to be appropriate to the content of thought and

conversation. Her relationship with the examiner was poor. Her mood was reported to be

depressed. Symptoms of depression include sleep disturbance (Initial Insomnia), loss of

energy, anhedonia, crying spells, and psychomotor retardation. Suicidal and homicidal

ideations were denied.8

(R. 181)

After describing Latimer’s responses to a number of clinical tests,9

 Lopez noted: “Her

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simple word problems. When asked the similarity between an

orange and a banana, she responded, “they’re not.” When asked

the similarity between a dog and a lion, she responded, “both are

animals.” When asked to interpret the proverb about glass

houses, she responded, “If you plan to hurt somebody, don’t do

it. Sweep off your own doorstep first.” When asked to interpret

the proverb about spilled milk, she responded, “I don’t know.”

When asked what she would do with an envelope that she found

in the street what [sic] was sealed, addressed, and stamped, she

replied, “mail it.” When asked what she would do if she saw

thick smoke coming from the window of a neighbor’s home, she

replied, “call to see if there was a fire.” She was unable to give

details of current news items. She correctly identified the current

president. She incorrectly identified the preceding president.

She identified five large cities to be, “Orlando, Atlanta, Troy,

Daytona, and Miami.” She identified five famous people to be,

“Billy Ray Cyrus, Linda Lovelace, Bob Hope, Bing Crosby, and

George Jones.” She indicated that there are 52 weeks in a year.

She recited 4 digits forward and 3 in reverse. She recognized

three objects and recalled 0 out of three after a five minute

interval. She was able to give a detailed description of her trip

to the examination today. She could describe what she had eaten

in the last 24 hours. She was able to give dates of birth of

significant people in her life. She knew the age at which she left

school. She was able to give dates of previous employment. 

10

level of intellectual functioning appears to be in the average to low average range. She has

adequate insight into her current situation. . .. Ms. Latimer’s judgment appears adequate at

this time. She will need assistance with any awarded funds.” (R. 182). 

On 12 January 2004, three days after the rehearing at issue, Lopez wrote a letter on

Latimer’s behalf. (R. 364-65). That letter, which is central to Latimer’s claims on appeal,

stated that Latimer “has been totally disabled due to her two mental disorders since at least

March 1996.” (R. 364). Lopez then referred to the residual functional assessment he

completed in June 1998, in which he “stated that she would have moderately severe

limitations in responding appropriately to supervision, to co-workers, and to customary work

pressures”, and asserted, “When I initially evaluated Ms. Latimer in March 1996, her

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11

condition was much worse than in June 1998.” (R. 364). The remainder of his letter follows,

in relevant part:

During my treatment of her between March 1996 and June 1998,

she responded to treatment and medications and displayed some

improvements and some exacerbations, but generally her mental

condition during this period was worse than or approximately

the same as I related in my June 1998 functional assessment.

Ms. Latimer’s mental limitations have been so severe from at

least March 1996 to the present time that she has not been able

to be employed on a competitive basis. 

Ms. Latimer has been attended by myself and other psychiatrists

and psychologists, and she has sought treatment regularly for

examinations and medication refills over the last seven years. 

In reviewing her records, I notice that Dr. Marcelo Anayas

[“Anayas”] stated in September 1997 that it was his opinion that

Ms. Latimer’s mental limitations would prevent her from

maintaining employment. I agree with Dr. Anayas’ opinion.

Ms. Latimer’s ability to establish or maintain effective or

favorable relationships with people is considerably impaired and

her symptoms prevent competitive employment. My treatment

and evaluations of Ms. Latimer confirm that her ability to

establish or maintain relationships with people is severely

impaired due to his [sic] two mental disorders[,] and her

symptoms caused by these mental disorders would prevent her

from being able to perform any work in a competitive work

environment. 

Ms. Latimer has been able to maintain a considerably impaired

life since March 1996 by performing minimal activities and not

being around crowds or unknown people. 

Please find enclosed a copy of my Residual Functional Capacity

statement dated June 15, 1998 as to her mental abilities. His

[sic] mental restrictions have been at this level since March

1996. 

In summary, it is my professional opinion that Ms. Latimer has

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10

“Schizophrenia is a disorder that lasts for at least 6 months and includes at least 1 month of active-phase

symptoms (i.e., two [or more] of the following: delusions, hallucinations, disorganized speech, grossly disorganized or

catatonic behavior, negative symptoms).” AM. PSYCH IATRIC ASS’N.,DIAG NO STIC AND STATISTICAL MANUAL OF MENTAL

DISORDERS at 298 (4th Ed., text rev., 2004) [“DSM-IV”]. 

11Judge Carnes gave no weight whatsoever to Anayas’ opinion. (R. 312). In support of this, he stated, “Dr.

Anayas [sic] diagnosis of schizophrenia and opinion that the claimant has ‘mental limitations’ that prevent employment

is so brief and conclusory that it lacks persuasive weight; it is unsubstantiated by any clinical or laboratory findings and

it is not accompanied by objective medical evidence.” (R. 312). Although Latimer mentions the schizophrenia diagnosis

12

been and remains restricted and unable to function at a

productive level of work for gainful competitive employment on

a sustained basis. She has probably been totally disabled and

unable to perform substantial gainful employment due to her

Dysthymic disorder and Panic disorder with Agoraphobia since

at least March 1996. 

(R. 364-65).

Latimer argues that Judge Carnes should have given Lopez’ opinion, specifically the

letter he wrote in 2004, controlling weight. Judge Carnes gave the conclusions in the letter

only “little weight,” however, for the following reasons: 

(1) the letter itself does not appear consistent and, thus, reliable; 

(2) Lopez’ conclusory opinions regarding Latimer’s ability to work are not

entitled to controlling weight as a matter of law; and 

(3) his opinions are not supported by his own notes. 

Judge Carnes first points out that Lopez’ agreement with Anayas’ opinion is

contradictory. (R. 312). Dr. Anayas’ opinion regarding Latimer’s ability to work was based

on a diagnosis of schizophrenia.

10 (R. 197). Lopez never diagnosed Latimer with

schizophrenia, though. His letter refers only to his diagnoses of “Dysthymic disorder and

Panic disorder with Agoraphobia”. (R. 365).11 Thus, it can be reasonably inferred that Lopez

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(Doc. # 20, p. 9), she raises no arguments with respect to Judge Carnes’ decision not to accord Anayas’ diagnosis or

opinion any weight. Notably, Anayas makes no reference to Schizophrenia or any other mental conditions in his final

assessment. (R. 289). 

12Latimer attempts to undermine Judge Carnes’ understanding by noting that Lopez never stated that he was

opining with “certainty.” (Doc. # 20, p. 9). Latimer consequently concedes that Lopez’ initial opinion was less than

firm. Furthermore, her argument ignores the linguistic reality that an assertion predicated on “probably” is less

unequivocal than the same assertion without the qualifier.

13

would have not agreed with Anayas’ diagnosis, which is clearly stated on the very same page

of his opinion regarding Latimer’s ability to work. (R. 197). The fact that Lopez nonetheless

agrees with Anayas’ conclusion certainly raises the inference that Lopez’ letter is

incongruous. While reasonable minds may differ in this respect, the inference is also

reasonable. 

Judges Carnes addressed a second internal contradiction. (R. 313). Noting that

Lopez’, toward the end of his letter, qualifies “been totally disabled” with “probably,” Judge

Carnes concludes, “Between the beginning of the letter and the end, Dr. Lopez changes from

stating a certainty that the claimant is disabled to stating a probability.” (R. 313). Again,

although different interpretations are possible, a fair reading of the letter could reasonably

lead one to conclude that Lopez’ initial certitude was passing.12

 

As further support for discounting Lopez’ opinion, Judge Carnes correctly notes that

a treating physician’s opinion on the ultimate issue of disability is not entitled to controlling

weight. Watkins v. Schweiker, 667 F.2d 954, 958 n.1 (11th Cir. 1982) (“That determination

is made solely by the Secretary based on medical findings.”); see also 20 C.F.R. §

404.1527(e) (“A statement by a medical source that you are ‘disabled’ or ‘unable to work’

does not mean that we will determine that you are disabled.”). Yet much of the strength of

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13Latimer argues that this is not a contradiction because “[a]lthough the mere existence of symptom-free periods

may negate a finding of disability when a physical ailment is alleged, symptom-free intervals do not necessarily compel

such a finding when a mental disorder is the basis of a claim.” (Doc. # 20, p. 10, citing Poulin v. Bowen, 817 F.2d 865,

875 (D.C. Cir. 1987). The court does not disagree, but in addressing the weight of Lopez’ opinion, Judge Carnes was

merely pointing out the obvious contradiction between Lopez’ statement that Latimer was severely impaired between

1996 through 1998 and his notes suggesting otherwise. He was not resting his ultimate decision on the fact that Lopez’

notes indicated periods of improvement. Moreover, Latimer’s argument on this point is based largely on a diagnosis of

schizophrenia. (Doc. # 20, p. 9). Anayas, not Lopez, diagnosed Latimer with schizophrenia, and Latimer has not

challenged Judge Carnes’ decision to discount Anayas’ diagnosis altogether.

14Importantly, Judge Walker determined that Lopez’ June 1998 assessment did not relate back to the relevant

time period. (R. 336-37). Supra note 1. 

15Latimer attempts to expose a contradiction in Judge Carnes’ opinion by noting that he relied on Lopez’ 2001

assessment when deciding that Latimer had been under a disability since 1 May 1998. (Doc. # 20, p. 10). While Judge

Carnes did note the 2001 assessment in his previous opinion, he did not discuss what weight he accorded Lopez’ opinion,

and he based his decision on the entire record. (R. 424, 427). One could thus easily argue that Judge Carnes ruled in

favor of Latimer despite Lopez’ 2001 assessment, which would mean he assigned less than controlling weight to Lopez’

opinion then as well, consistent with his present decision. Regardless, Carnes merely pointed out contradictions. He

did not suggest that Lopez’ 2001 assessment was correct. 

14

Lopez’ letter springs directly from his conclusions regarding Latimer’s disability status.

Latimer does not argue this point. 

Finally, Judge Carnes noted that Lopez’ treatment notes contradict his opinion. As

Latimer concedes, Lopez’ notes indicated that her condition had improved from 1996 to

1998.13 (Doc. # 20, p. 9). Moreover, his 2004 opinion that Latimer’s condition was severe

from 1996 to the date of the letter conflicts somewhat with his 1998 assessment, which listed

moderately severe impairments at worst.14 (R. 295-96). 

Both assessments conflict to an even greater extent with his 2001 opinion, which

noted only two moderately severe impairments (ability to relate to other people and ability

to respond to customary work pressures), four moderate impairments, five mild impairments,

and no impairment with respect to her ability to “understand, carry out, and remember

instructions.”15 (R. 895-96). Although Judge Carnes did not mention it in this context,

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15

Lopez’ 1996 assessment quoted earlier in this opinion does not remotely suggest the level

of severity that Lopez assigned to Latimer’s condition in his letter.

Upon review of the entire record, the court concludes that Judge Carnes’ decision to

accord Lopez’ 2004 opinion only little weight is supported by substantial evidence.

Moreover, Judge Carnes methodically and thoughtfully demonstrated good cause. 

b. Reid’s Opinion

Latimer saw Reid on 17 and 21 October 1997 during a brief hospital stay. (R. 599-

606). She checked herself into the emergency room of Memorial Hospital West Volusia in

Florida. (R. 606). Judge Carnes’ opinion neither mentions Reid nor discusses specifically

the weight given to his diagnoses. (R. 300-19). Latimer argued that this oversight

constitutes legal error. (Doc. # 20, p. 13 ). The court disagrees.

The regulations regarding disability determinations define “treating source” as

follows: 

[Y]our own physician, psychologist or other acceptable medical

source who provides you, or has provided you, with medical

treatment or evaluation and who has, or has had, an ongoing

treatment relationship with you. Generally, we will consider

that you have an ongoing treatment relationship with an

acceptable medical source when the medical evidence

establishes that you see, or have seen, the source with a

frequency consistent with accepted medical practice for the type

of treatment and/or evaluation required for your medical

condition(s). We may consider an acceptable medical source

who has treated or evaluated you only a few times or only after

long intervals (e.g., twice a year) to be your treating source if the

nature and frequency of the treatment or evaluation is typical for

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16Judge Carnes discussed the records from Latimer’s hospitalization, including Reid’s assessments and

diagnoses. But, he did not mention Reid’s initial Global Assessment of Functioning [“GAF”] of 35. (R. 304). Nor did

he note that two weeks prior to her visits with Reid, “one of [Latimer’s] mental health providers [at ACT] estimated her

[GAF] at 50.” (Doc. # 20, p. 12; R. 224). Latimer finds these oversights material. (Doc. # 20, pp. 12-13). 

 Judge Carnes is not required to mention every finding on every page of Latimer’s records, and his failure to

cite a specific finding “does not indicate that such evidence was not considered.” McCray v. Massanari, 175 F. Supp.

2d 1329, 1336 (M.D. Ala. 2001) (quoting Black v. Apfel, 143 F.3d 383, 386 (8th Cir. 1998). Notably, Judge Carnes did

refer to Reid’s discharge GAF of 45. (R. 304). 

A GAF score, moreover, offers only limited guidance for the purpose of making a disability determination. A

patient with a GAF of between 41 and 50 evidences either “serious symptoms . . . OR any serious impairment in social,

occupational, or school functioning . . .” (emphasis in original). DSM -VI, at 32 (“The GAF rating is within a particular

decile if either the symptom severity or the level of functioning falls within the range.” (emphasis in original)). Thus,

someone experiencing “suicidal ideations,” which is considered a serious symptom for GAF purposes, would qualify

for a GAF score of between 41 and 50 regardless of the person’s social impairments. Consequently, a score without an

explanation of the basis therefor, is virtually useless to a reviewer. 

The GAF suffers yet another flaw. “In most instances, ratings on the GAF Scale should be for the current

period (i.e., the level of functioning at the time of the evaluation) because ratings of current functioning will generally

reflect the need for treatment or care.” DSM-VI, at 33. Latimer’s examiners did not indicate whether the scores

extended beyond the current period. (R. 224, 600, 602). The assessments were made within a two-week period of

obvious difficulty for Latimer. But Latimer has failed to persuade the court that the scores are indicative of her ability

to function in a work setting before or beyond that time. See, Walker v. Apfel, No. Civ.A. 98-1201, 2000 WL 724167,

at *7 (S.D. Ala. May 16, 2000). Therefore, they are not deserving of special significance, and Judge Carnes did not err

by not mentioning two of the three scores. 

16

your condition(s). 

(20 C.F.R. §§ 404.1502, 416.902). 

Latimer’s relationship with Reid was insufficient to consider Reid a treating source.

Two examinations within five days of each other amounts to nothing more than a one-time

treatment, which is not consistent with “accepted medical practice” for treating psychological

problems that, as Latimer’s records reflect, tend to be long-term. Judge Carnes was,

therefore, under no obligation to refer to Reid specifically, to assign any presumptive weight

to his opinions or reveal what weight was actually given.16 See McSwain v. Bowen, 814 F.2d

617, 619 (11th Cir. 1987) (stating that one-time examiners were not treating physicians);

Vazquez v. Sec’y of Health and Human Svcs., 45 F.3d 424 (1st Cir. 1995) (declining to treat

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17

a claimant’s physician as a treating source when the claimant had seen the physician only

twice). 

Judge Carnes’ discussion of records relating to Latimer’s hospitalization at West

Memorial demonstrates that he considered all of the records, and his decision to leave out a

reference to Reid or the weight assigned to Reid’s opinion was legally proper and is

supported by substantial evidence. 

3. Testimony of the Medical Expert at the Rehearing

At the rehearing, Judge Carnes called Dr. Doug McKeown [“McKeown”] to testify

regarding Latimer’s mental residual functional capacity. At the time of his testimony,

McKeown had reviewed all of Latimer’s medical records but had not examined her. (Doc.

# 20, p. 13). Judge Carnes nonetheless gave “great weight to [McKeown’s] . . . testimony

and opinion regarding the claimant’s mental impairment and mental functional capacities.”

(R. 310). Latimer argues that McKeown’s opinion was entitled only to “little weight”

because it was “contradicted by the two examining psychiatrists,” referring to Lopez and

Reid. (Doc. # 20, p. 14). 

As a general matter, a nonexamining medical expert’s opinion cannot alone form the

basis for an administrative decision. See, e.g., Broughton v. Heckler, 776 F.2d 960, 962

(11th Cir. 1985). Furthermore, such an opinion is entitled only to little weight when it

conflicts with the opinion of an examining medical source whose opinion has not been

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17Latimer cites only Swindle v. Sullivan, 914 F.2d 222, 226 n.3 (11th Cir. 1990), which dealt primarily with

the ALJ’s credibility determination. Id. at 223-24. In the cited footnote, the Eleventh Circuit stated, “Because Dr.

Hibbett did not examine Ms. Swindle, his opinion is entitled to little weight and taken alone does not constitute

substantial evidence to support an administrative decision.” Id. at 226 n.3 (quoting Broughton, 776 at 962). Out of

context, the quoted statement conflates the principles espoused by the Broughton court and suggests that a nonexamining

medical source’s opinion is never entitled to anything more than little weight. That is not an accurate summary of

Broughton’s holding, however, and implicit in the Swindle court’s footnote is the recognition that the nonexamining

physician’s opinion was contrary to the medical evidence in the record. In the same footnote, the court stated that the

nonexamining physician had failed to consider many of the claimant’s symptoms of pain as reflected in the record. Id.

Thus, the nonexamining expert’s opinion was not supported by substantial evidence. This understanding resolves the

apparent conflict separating the Swindle court’s statement of law and the holding in more recent cases. See Crawford

v. Comm’r of Soc. Sec., 363 F.3d 1155, 1158-60 (11th Cir. 2004) (finding that substantial evidence supported the ALJ’s

RFC determination, which was based upon the opinion of a nonexamining physician after discounting the opinion of all

of the claimant’s treating physicians); Edwards v. Sullivan, 937 F.2d 580, 584-85 (11th Cir. 1991) (see infra note 19).

18Edwards is virtually on point with respect to the issue before the court. The court noted that the nonexamining

expert “provided an interpretation of [the claimant’s] condition vis-a-vis the limitations those conditions placed on

Edwards’ abilities. Because this information was not contained in either [examining physicians’] reports, we cannot say

that [the nonexamining report] contradicted their findings. Consequently, the ALJ did not err in relying on her report.”

Edwards, 937 F.2d at 585. 

18

properly discounted. Id.17 Conversely, an ALJ is entitled to give greater weight to the

opinion of a nonexamining medical expert when the opinion is supported by substantial

evidence and the opinion of the examining source has been properly discounted. See

Crawford, 363 F.3d at 1158-60 (see supra note 18); Edwards, 937 F.2d at 584-85.18 

The court has already held that the ALJ properly discounted Lopez’ opinion. No other

examining physician offered an opinion with respect to Latimer’s functional limitations.

Therefore, if McKeown’s testimony is supported by substantial evidence, the ALJ did not

err by according it great weight.

A close review of the full record leads the court to conclude that McKeown’s reasoned

testimony, as well as Judge Carnes’ decision to accord it great weight, is supported by

substantial evidence. In fact, McKeown provided an interpretation of the record itself,

paying particular attention to the consultative report provided by Latimer’s treating

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19Latimer contends that McKeown’s testimony is not to be trusted because he was unable to recall the specifics

of Anayas’ opinion. (Doc. # 20, p. 14). After reviewing Anayas’ records again, however, McKeown’s opinion did not

change because nothing in the record supported Anayas’ diagnosis of schizophrenia, on which Anayas’ opinion had been

based. (R. 398). 

19

physician, Lopez. He based his testimony on the pertinent diagnoses as well as the

observations recorded by Latimer’s therapists, which, as a whole, support McKeown’s

conclusions. Importantly, Latimer does not challenge the substance of McKeown’s

testimony or Judge Carnes’ determination of her RFC.19 

IV. CONCLUSION

Therefore, for the reasons discussed herein, it is hereby

ORDERED that the final decision of the Commissioner be and is AFFIRMED.

Done this 29th day of April, 2005.

/s/ Vanzetta Penn McPherson

VANZETTA PENN MCPHERSON

UNITED STATES MAGISTRATE JUDGE 

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