UNITED STATES DISTRICT COURT 

EASTERN DISTRICT OF MICHIGAN 

SOUTHERN DIVISION 

DEBRA A. BETHKE, 

 

 Plaintiff, Civil Action No. 14-13694 

 Honorable David M. Lawson 

v. Magistrate Judge David R. Grand 

 

COMMISSIONER OF 

SOCIAL SECURITY, 

 

 Defendant. 

_________________________/ 

REPORT AND RECOMMENDATION 

ON CROSS-MOTIONS FOR SUMMARY JUDGMENT [16, 19] 

 Plaintiff Debra Bethke (“Bethke”) commenced this action pursuant to 42 U.S.C. § 405(g), 

challenging a final decision of defendant Commissioner of Social Security (“Commissioner”) 

denying her applications for Disability Insurance Benefits (“DIB”) and Supplemental Security 

Income (“SSI”) under the Social Security Act (the “Act”). Both parties filed motions for 

summary judgment, which have been referred to this Court for a Report and Recommendation 

pursuant to 28 U.S.C. § 636(b)(1)(B). 

I. RECOMMENDATION 

 For the reasons set forth below, the Court finds that substantial evidence supports the 

Administrative Law Judge’s (“ALJ”) conclusion that Bethke is not disabled under the Act. 

Accordingly, the Court recommends that the Commissioner’s motion for summary judgment 

[19] be GRANTED, Bethke’s motion for summary judgment [16] be DENIED and, pursuant to 

sentence four of 42 U.S.C. § 405(g), the Commissioner’s decision be AFFIRMED. 

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II. REPORT 

A. Procedural History 

 On June 8, 2012, Bethke filed the instant application for DIB, alleging an amended 

disability onset date of January 1, 2011. (Tr. 55-56, 230). On June 12, 2012, she filed the instant 

application for SSI, alleging the same disability onset date. (Tr. 64-65). Both claims were 

initially denied on August 17, 2012. (Tr. 63, 72). Thereafter, Bethke filed a timely request for an 

administrative hearing, which was held on April 15, 2013, before ALJ JoErin O’Leary. (Tr. 33-

53). Bethke, who was represented by attorney John Wildeboer, testified at the hearing, as did 

vocational expert Michelle Ross. (Id.). In a written decision dated May 31, 2013, the ALJ 

determined that Bethke is not disabled. (Tr. 19-28). On July 30, 2014, the Appeals Council 

denied review. (Tr. 1-4). Bethke filed for judicial review of the final decision on September 24, 

2014. (Doc. #1). 

B. Framework for Disability Determinations 

 Under the Act, DIB and SSI are available only for those who have a “disability.” See 

Colvin v. Barnhart, 475 F.3d 727, 730 (6th Cir. 2007). The Act defines “disability” in relevant 

part 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), 1382c(a)(3)(A). 

 The Commissioner’s regulations provide that a disability is to be determined through the 

application of a five-step sequential analysis: 

Step One: If the claimant is currently engaged in substantial gainful 

activity, benefits are denied without further analysis. 

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Step Two: If the claimant does not have a severe impairment or 

combination of impairments that “significantly limits . . . physical or 

mental ability to do basic work activities,” benefits are denied without 

further analysis. 

Step Three: If the claimant is not performing substantial gainful activity, 

has a severe impairment that is expected to last for at least twelve months, 

and the severe impairment meets or equals one of the impairments listed in 

the regulations, the claimant is conclusively presumed to be disabled 

regardless of age, education, or work experience. 

Step Four: If the claimant is able to perform his or her past relevant work, 

benefits are denied without further analysis. 

Step Five: Even if claimant is unable to perform his or her past relevant 

work, if other work exists in the national economy that plaintiff can 

perform, in view of his or her age, education, and work experience, 

benefits are denied. 

Schueuneman v. Comm’r of Soc. Sec., No. 11-10593, 2011 U.S. Dist. LEXIS 150240, at *21 

(E.D. Mich. Dec. 6, 2011) (citing 20 C.F.R. §§ 404.1520, 416.920); see also Heston v. Comm’r 

of Soc. Sec., 245 F.3d 528, 534 (6th Cir. 2001). “The burden of proof is on the claimant 

throughout the first four steps . . . [i]f the analysis [then] reaches the fifth step without a finding 

that claimant is not disabled, the burden transfers to the [defendant].” Preslar v. Sec’y of Health 

& Human Servs., 14 F.3d 1107, 1110 (6th Cir. 1994). 

C. Background 

 1. Disability and Function Reports 

 In a disability report from June 20, 2012, Bethke stated that she suffers from anxiety, 

depression, and bipolar disorder. (Tr. 160). Bethke reported that she stopped working on January 

1, 2005, as a result of these conditions. (Id.). She indicated that several doctors had treated her 

for the above mental impairments. (Tr. 164-65). At the time of the report, Bethke was taking 

multiple medications, including Abilify (for bipolar disorder), Ambien (for sleep disorder), 

Ativan (for anxiety), Lamictal (for depression and anti-seizure), Prozac (for depression), and 

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Vistaril (for depression). (Tr. 163). Her updated disability report from August 31, 2012, noted 

that she was experiencing more anxiety attacks since her last report. (Tr. 214). And Bethke 

reported that she was hospitalized at the McLaren Bay Regional Medical center on August 18, 

2012, after experiencing a seizure. (Tr. 215). 

 In a function report dated July 15, 2012, Bethke stated that she lives in a house with her 

“friends.” (Tr. 190). When asked how her conditions limit her ability to work, Bethke responded 

that, “[m]y anxiety causes me not to be able to walk and talk. My depression causes me to cry 

non-stop and think about suicide any way possible. I also have very bad mood swings and that 

results in anxiety or depression.” (Id.). When asked to describe her daily activities, Bethke 

indicated that, “on a good day I wake up and take my meds, do some laundry and dishes. On a 

bad day I am unable to do anything.” (Tr. 191). Bethke reported that she can no longer “[b]e in 

public alone” and that her mental conditions impair her ability to sleep. (Id.). She indicated that 

she needs to be reminded to bathe and take care of her personal hygiene. (Id.). She also noted 

that someone in her household provides her with daily medications so that she does not commit 

suicide. (Tr. 192). 

 Bethke stated that she is able to prepare breakfast cereal, sandwiches, and microwave 

foods, but has stopped cooking because she is unable to follow written directions. (Id.). 

Regarding household chores, Bethke reported that she does the laundry and cleans the house on a 

monthly basis for an entire day. (Tr. 192). She goes outside on a weekly basis and is able to ride 

in a car. (Tr. 193). She shops for food once a month. (Id.). She indicated that she no longer 

drives because her license has been suspended and she suffers from anxiety attacks. (Id.). With 

respect to managing her finances, Bethke noted that she can no longer pay bills, count change, 

handle a savings account, or use a checkbook and money orders. (Tr. 193-94). 

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 Under hobbies and interests, Bethke listed watching television and reading. (Tr. 194). 

For social activities, Bethke reported that she visits her parents on a weekly basis. (Id.). She 

stated that she needs someone to accompany her on her visits. (Id.). She does not have problems 

getting along with family, friends, neighbors, or others. (Tr. 195). When asked to describe the 

activities she could perform before the onset of her conditions that she can no longer perform, 

Bethke indicated that she “used to enjoy sports [and] gardening.” (Id.). 

 When asked to identify functions impacted by her conditions, Bethke checked seeing, 

memory, completing tasks, concentration, understanding, following instructions and getting 

along with others. (Tr. 195). She can walk for two blocks before she needs to stop to rest for 10 

minutes. (Id.). Bethke noted that she is not able to follow written instructions and that she 

“skip[s] things and then get[s] depressed.” (Id.). She also has problems following spoken 

instructions due to lack of concentration, which ultimately results in anxiety attacks and 

depression. (Id.). She stated that she does not handle stress well on account of anxiety attacks; 

she does not handle changes in routine well; and she cannot be around large groups of people. 

(Tr. 196). She listed her medications, with accompanying side effects, as follows: Prozac 

(tiredness), Abilify (weight gain), Lamictal (forgetfulness), Ativan (tiredness), Ambien (unable 

to wake up in the morning), Uisteril (dry sinuses), and Oxybutynin (dry mouth and eyes).1

 (Tr. 

197). 

2. Bethke’s Testimony 

At the time of the April 15, 2013 hearing before the ALJ, Bethke was living with her 

boyfriend, his dad, and his brother. (Tr. 37). She testified that she does not perform any 

household chores on account of her anxiety. (Id.). The only time she leaves the house is when 

 

1

 Bethke’s friend, George Watson, drafted a third-party function report dated July 13, 2012. (Tr. 

179-86). His report is largely consistent with Bethke’s statements.

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she attends therapist and psychiatrist appointments. (Id.). Bethke reported that she does not go 

shopping, or engage in social activities outside of her home because of the frequency (3-4 times 

per week) and duration (each one lasts for approximately 2-3 hours) of her anxiety attacks. (Tr. 

38). Bethke noted that, in order to calm herself, “I have to lay down and it has to be quiet and 

dark and I have to have three to four blankets on top of me.” (Id.). She stated that she had been 

fired from her prior employment as a healthcare worker because her anxiety attacks caused her to 

miss an inordinate amount of workdays. (Tr. 39). She also could not perform her job duties, 

such as cleaning or cooking for her clients. (Tr. 40). 

With respect to medications, Bethke testified that she takes Lamictal (anti-seizure), 

Triptol, Klonopins, Abilify, Resoril, and Pristiq. (Id.). Her medications often cause drowsiness 

throughout the day and dizziness in the morning. (Id.). As for daily activities, Bethke generally 

watches television and reads. (Tr. 41). She reported that her attention span is so short that she 

can only read for 10 minutes at a time and she frequently changes the channels on her television 

due to lack of concentration. (Id.). Bethke indicated that she was hospitalized in August 2012 

after suffering a seizure, though she has not suffered from any repeated episodes. (Id.). She also 

suffers from migraine headaches 2-3 times per week that cause her to vomit. (Tr. 42). Bethke 

treats her migraines with Fioricet and often lays down under blankets to shield her eyes from 

light. (Id.). 

Bethke acknowledged that she had past convictions for heroin delivery in 2011 and two 

counts of “driving under the influence.” (Tr. 43). She also admitted to past marijuana use, but 

denied using marijuana the night she experienced the seizure in August 2012. (Id.). Bethke 

testified that she began monthly treatments with a nurse practitioner in September 2012 and that 

she currently visits the practitioner once every three months. (Tr. 44-45). She stated that she 

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currently suffers from suicidal ideations and was hospitalized after a suicide attempt in 2008. (Tr. 

45-46). 

At the hearing, Bethke presented with her right arm in a sling to immobilize her shoulder. 

(Tr. 47). She indicated that she was scheduled to undergo an MRI the week after the hearing. 

(Id.). In the meantime, Bethke’s nurse practitioner prescribed her Ibuprofen 800 to minimize her 

pain. (Tr. 48). 

3. Medical Evidence

The Court has thoroughly reviewed the record, and will discuss the relevant medical 

evidence within the analysis portion of this Report and Recommendation. 

 4. Vocational Expert’s Testimony 

 Michelle Ross testified as an independent vocational expert (“VE”). (Tr. 48-52). She 

initially identified Bethke’s past work as a home attendant (semi-skilled, light as performed; 

semi-skilled, medium as generally performed) and cleaner (unskilled, light). (Tr. 49). The ALJ 

then asked the VE several hypotheticals, which were progressively more restrictive. (Tr. 59-61). 

The ALJ first asked the VE to imagine a claimant of Bethke’s age, education, and work 

experience, who has no exertional limitations, but otherwise: 

should not perform any overhead reaching; they should not climb ladders 

or scaffolds; they should not work around unprotected heights or 

dangerous, moving, mechanical parts; and they would be limited to 

simple, routine, and repetitive tasks not performed at a production rate 

pace; they would be limited to simple work-related decisions; they should 

not be required to work with the general public; and they would be limited 

to tolerating relatively few changes in a . . . work routine setting. 

 

(Tr. 50). The VE testified that the hypothetical individual would be unable to perform Bethke’s 

past relevant work, but could perform (at the unskilled medium level) the positions of packager 

(7,200 jobs statewide), machine feeder (15,500 statewide), and (at the unskilled light level) the 

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position of light assembler (14,000 jobs statewide). (Tr. 51). The ALJ then inquired as to the 

availability of work if the hypothetical individual would not be able to maintain regular 

attendance and would be absent from work for more than four days per month. (Id.). The VE 

responded that there would be no work that such a hypothetical claimant could perform, and 

confirmed that her testimony comported with the Dictionary of Occupational Titles (“DOT”). 

(Id.). 

 On cross-examination, Bethke’s attorney asked the VE to envision a claimant with the 

same restrictions as those imposed in the ALJ’s first hypothetical, except with moderate 

limitations in simple job instructions requiring redirection and reinstruction by a supervisor at 

least twice a day regarding simple job instructions. (Tr. 52). The VE testified that such an 

individual would be precluded from working because they would be “off their target too much of 

the time.” (Id.). 

D. The ALJ’s Findings 

Following the five-step sequential analysis, the ALJ found that Bethke is not disabled 

under the Act. At Step One, the ALJ found that Bethke had not engaged in substantial gainful 

activity from the amended alleged onset date of January 1, 2011. (Tr. 21). At Step Two, the ALJ 

found that Bethke has the severe impairments of seizure disorder, migraine headaches, anxiety 

disorder, affective disorder, personality disorder, and substance abuse in sustained remission. 

(Id.). At Step Three, the ALJ found that Bethke’s impairments, whether considered alone or in 

combination, do not meet or medically equal a listed impairment. (Tr. 21-23). The ALJ then 

assessed Bethke’s residual functional capacity (“RFC”), concluding that she is capable of 

performing a full range of work at all exertional levels with the following nonexertional 

limitations: no overhead reaching; no climbing of ladders or scaffolds; no exposure to 

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unprotected heights or dangerous moving mechanical parts; she can perform simple, routine, 

repetitive tasks with no production-rate paced work; she is limited to simple work-related 

decisions with few changes in routine work setting and no contact with the general public. (Tr. 

23). 

At Step Four, the ALJ determined that Bethke is unable to perform any past relevant 

work. (Tr. 26). At Step Five, based in part on the VE’s testimony, the ALJ concluded that 

Bethke is capable of performing a significant number of jobs that exist in the national economy. 

(Tr. 27). As a result, the ALJ concluded that Bethke is not disabled under the Act. (Tr. 27-28). 

E. Standard of Review 

 The District Court has jurisdiction to review the Commissioner’s final administrative 

decision pursuant to 42 U.S.C. § 405(g). Judicial review under this statute is limited in that the 

Court “must affirm the Commissioner’s conclusions absent a determination that the 

Commissioner has failed to apply the correct legal standard or has made findings of fact 

unsupported by substantial evidence in the record.” Longworth v. Comm’r of Soc. Sec., 402 F.3d 

591, 595 (6th Cir. 2005) (internal citations omitted); Rabbers v. Comm’r of Soc. Sec., 582 F.3d 

647, 654 (6th Cir. 2009) (“[I]f an agency has failed to adhere to its own procedures, we will not 

remand for further administrative proceedings unless the claimant has been prejudiced on the 

merits or deprived of substantial rights because of the agency’s procedural lapses.”) (internal 

quotations omitted). Substantial evidence is “more than a scintilla of evidence but less than a 

preponderance; it is such relevant evidence as a reasonable mind might accept as adequate to 

support a conclusion.” Rogers v. Comm’r of Soc. Sec., 486 F.3d 234, 241 (6th Cir. 2007) 

(internal quotations omitted). In deciding whether substantial evidence supports the ALJ’s 

decision, the Court does “not try the case de novo, resolve conflicts in evidence or decide 

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questions of credibility.” Bass v. McMahon, 499 F.3d 506, 509 (6th Cir. 2007); Rogers, 486 

F.3d at 247 (“It is of course for the ALJ, and not the reviewing court, to evaluate the credibility 

of witnesses, including that of the claimant.”). 

 When reviewing the Commissioner’s factual findings for substantial evidence, the Court 

is limited to an examination of the record and must consider the record as a whole. Bass, 499 

F.3d at 512-13; Wyatt v. Sec’y of Health & Human Servs., 974 F.2d 680, 683 (6th Cir. 1992). 

The Court “may look to any evidence in the record, regardless of whether it has been cited by the 

Appeals Council,” or in this case, the ALJ. Heston, 245 F.3d at 535; Bethke v. Sec’y of Health & 

Human Servs., 884 F.2d 241, 245 (6th Cir. 1989). There is no requirement, however, that either 

the ALJ or this Court discuss every piece of evidence in the administrative record. Kornecky v. 

Comm’r of Soc. Sec., 167 F. App’x 496, 508 (6th Cir. 2006) (stating that “an ALJ can consider 

all evidence without directly addressing in his written decision every piece of evidence submitted 

by a party.”) (internal quotations omitted). If the Commissioner’s decision is supported by 

substantial evidence, “it must be affirmed even if the reviewing court would decide the matter 

differently and even if substantial evidence also supports the opposite conclusion.” Cutlip v. 

Sec’y of Health & Human Servs., 25 F.3d 284, 286 (6th Cir. 1994) (internal citations omitted). 

F. Analysis 

Bethke argues that the ALJ erred by: (1) failing to give controlling weight to the opinions 

of her treating nurse practitioner and treating psychologist; (2) affording “great weight” to the 

opinion of the state agency psychiatrist; (3) formulating an RFC assessment that did not 

incorporate any limitations on account of Bethke’s migraine headaches; and (4) improperly 

discounting Bethke’s subjective account of her migraine symptoms. (Doc. #16 at 6-24). Each 

of these arguments will be addressed in turn. 

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1. Medical Source Opinions 

Bethke maintains that the ALJ erred when she declined to give controlling weight to the 

opinions of her treating nurse practitioner, Kay McLaren, NP, and her treating psychologist, 

Deanna Hodgsen, M.A. (Id. at 6-17). She also contends that the ALJ erred by giving “great 

weight” to the opinion of the state agency consultant, Robert Newhouse, M.D. (Id. at 17-20). 

These arguments lacks merit. 

Social Security regulations require ALJs to give treating source opinions controlling 

weight if they are “well-supported by medically acceptable clinical and laboratory diagnostic 

techniques and [are] not inconsistent with the other substantial evidence in [the] case record.” 

Blakley v. Comm’r of Soc. Sec., 581 F.3d 399, 406 (6th Cir. 2009) (internal quotations omitted). 

While treating source opinions are entitled to controlling weight under these circumstances, it is 

“error to give an opinion controlling weight simply because it is the opinion of a treating source” 

– such weight is only appropriate if the opinion is well-supported and consistent with the record 

as a whole. Social Security Ruling 96-2p, 1996 SSR LEXIS 9, at *5 (Jul. 2, 1996); see also 

Warner v. Comm’r of Soc. Sec., 375 F.3d 387, 390 (6th Cir. 2004) (stating that “[t]reating 

physicians’ opinions are only given such deference when supported by objective medical 

evidence.”). 

If the ALJ declines to give a treating source’s opinion controlling weight, he must 

document how much weight he gives it, “considering a number of factors, including the length of 

the treatment relationship and the frequency of examination, the nature and extent of the 

treatment relationship, supportability of the opinion, consistency of the opinion with the record 

as a whole, and any specialization of the treating physician.” Blakley, 581 F.3d at 406 (citing 

Wilson v. Comm’r of Soc. Sec., 378 F.3d 541, 544 (6th Cir. 2004)); see also 20 C.F.R. §§ 

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404.1527(c)(2), 416.927(c)(2) (requiring the ALJ to provide “good reasons” for the weight the 

given to treating source opinions); Francis v. Comm’r of Soc. Sec., 414 F. App’x 802, 804 (6th 

Cir. 2011) (providing good reasons does not entail “an exhaustive factor-by-factor analysis.”). 

Bethke’s treating nurse practitioner, Kay McLaren, completed a medical source statement 

dated February 20, 2013. (Tr. 411-13). McLaren opined that Bethke has moderate limitations in 

following work rules, using her judgment, functioning independently, and maintaining attention 

and concentration. (Tr. 411). McLaren found that Bethke demonstrated marked limitations in 

dealing with the public, interacting with supervisors, and dealing with work stresses. (Id.). 

Regarding Bethke’s ability to make job performance adjustments, McLaren indicated that Bethke 

has moderate limitations in executing complex, detailed, and simple job instructions. (Tr. 411-

12). She also exhibited marked limitations in her ability to behave in an emotionally stable 

manner, and moderate limitations in relating predictably in social situations and demonstrating 

reliability. (Tr. 412). With respect to functional limitations, McLaren indicated that Bethke has 

moderate difficulties in maintaining social functioning, marked difficulties in maintaining 

concentration, persistence, and pace, and a history of “one or two” extended episodes of 

decompensation. (Tr. 413). 

In her written decision, the ALJ considered this medical opinion and properly accorded it 

little weight. (Tr. 25-26). To begin with, the ALJ correctly decided that McLaren’s opinion was 

not entitled to controlling weight because, as a nurse practitioner, she is not an “acceptable 

medical source.” See 20 C.F.R. §§404.1513(a), 416.913(a). Since only “acceptable medical 

sources” can give “medical opinions” within the meaning of the applicable regulations, 

McLaren’s opinion would not necessarily be entitled to controlling weight pursuant to the 

treating source rule even if it had been well-supported by medically acceptable clinical and 

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laboratory diagnostic techniques and was not inconsistent with the other substantial evidence in 

the record. See 20 C.F.R. §§404.1527(a)(2), 416.927(a)(2). 

Moreover, the ALJ appropriately discounted McLaren’s opinion in light of the length 

(four months) and frequency (once a month) of the treatment relationship at the time McLaren 

proffered her opinion. (Tr. 44-45, 35). In a similar vein, the ALJ acted well within her discretion 

when she determined that the extensive limitations imposed by McLaren were not consistent 

with the “limited course of treatment” that she provided to Bethke. See Francis, 414 App’x at 

806 (ALJ reasonably rejected treating source opinion where “limited treatment [w]as 

inconsistent” with his medical diagnosis). McLaren’s earlier treatment notes also appear to 

contradict the severity of the limitations she recommended in her February 20, 2013 medical 

source statement. For instance, in a December 10, 2012 treatment note, McLaren observed that 

Bethke was alert and oriented. In fact, Bethke herself reported that her depression and the 

severity of her panic attacks had diminished. (Tr. 358). In another treatment note dated January 

7, 2013, McLaren further stated that Bethke’s racing thoughts had decreased with medication; 

her moods were less labile; and she did not exhibit evidence of psychosis. (Tr. 360). 

Consequently, the ALJ did not err by affording limited weight to McLaren’s opinion. 

The ALJ also correctly decided that Hodgsen’s September 6, 2012 psychosocial 

assessment, in which she assigned Bethke a Global Assessment Functioning Score2

 of 40, was 

not entitled to controlling weight because, as a limited license psychologist, she is not an 

 

2

 “The GAF scale is a method of considering psychological, social, and occupational function on 

a hypothetical continuum of mental health. The GAF scale ranges from 0 to 100, with serious 

impairment in functioning at a score of 50 or below. Scores between 51 and 60 represent 

moderate symptoms or a moderate difficulty in social, occupational, or school functioning, 

whereas scores between 41 and 50 represent serious symptoms or serious impairment in these 

areas.” Norris v. Comm’r of Soc. Sec., 461 F. App’x 433, 436 n.1 (6th Cir. 2012) (citations 

omitted).

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“acceptable medical source.” See 20 C.F.R. §§404.1513(a), 416.913(a); see also McCommons v. 

Comm’r of Soc. Sec., No. 10-14992, 2012 U.S. Dist. LEXIS 77291, at *39 (E.D. Mich. Mar. 13, 

2012) (stating that opinion of limited license psychological therapists “are not entitled to 

controlling weight.”). 

Furthermore, even if Hodgsen were an acceptable medical source, the ALJ appropriately 

discounted the GAF Score in question. (Tr. 26). In Administrative Message 13066 (“AM13066”), dated July 22, 2013, the Social Security Administration established the following 

guidelines for reviewing GAF scores: 

[A] GAF needs supporting evidence to be given much weight. By itself, 

the GAF cannot be used to “raise” or “lower” someone’s level of function. 

The GAF is only a snapshot opinion about the level of functioning. It is 

one opinion that we consider with all the evidence about a person’s 

functioning. Unless the clinician clearly explains the reasons behind his or 

her GAF rating, and the period to which the rating applies, it does not 

provide a reliable longitudinal picture of the claimant’s mental functioning 

for a disability analysis. 

“Global Assessment of Functioning (GAF) Evidence in Disability Adjudication,” Social Security 

Administrative Message AM-13066, ¶ E; available at pp. 18-24 of the New York State Bar 

Association’s seminar materials for “Moving Towards Civil Gideon,” 

http://www.nysba.org/WorkArea/DownloadAsset.aspx?id=51489 (visited Jan. 11, 2015). Here, 

Hodgsen summarily assigned Bethke a GAF score of 40 without explaining the basis for this 

rating or whether it applied during a specified period in Bethke’s clinical history. (Tr. 387). This 

GAF score is also belied by other evidence in the record demonstrating that Bethke’s mental 

functioning varied between mildly impaired and stable and that she consistently exhibited 

appropriate appearance; orientation as to time, person, and place; lucid and coherent thought 

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content; organized thinking; and normal sensorium.3

 (Tr. 391-408). For the same reasons, the 

GAF score alone cannot support a closed period of disability from the amended disability onset 

date until September 6, 2012, the date that Hodgsen performed the psychological assessment.4

See AM-13066, supra. Therefore, the ALJ’s decision to give limited weight to Hodgsen’s 

psychosocial assessment is supported by substantial evidence in the record. 

 Finally, the Court finds that the ALJ did not err when she accorded “great weight” to Dr. 

Newhouse’s opinion that Bethke would function optimally “in small familiar groups” and that 

she “retains the ability to do simple tasks on [a] sustained basis.” (Tr. 62, 71). Social Security 

regulations provide that, “[i]n appropriate circumstances, opinions from State agency medical . . . 

consultants . . . may be entitled to greater weight than the opinions of treating or examining 

sources.” Soc. Sec. Rul. 96-6p, 1996 SSR LEXIS 3 at *6-7 (Jul. 2, 1996). “Once the ALJ 

determine[s] not to accord” controlling weight to a treating source opinion, the ALJ need only 

 

3

 A treatment note dated December 21, 2012 indicates that Bethke reported a suicide attempt a 

month and a half earlier. (Tr. 405). However, her therapy appointment the following week 

shows normal mental status ratings and only mildly impaired functioning. (Tr. 406). 

4

 The ALJ wrote that the GAF score “does not account for [Bethke’s] recent improvement as 

noted by unremarkable mental status and minimal impairment,” but that “it shows the previous 

condition of [Bethke].” (Tr. 26, citing Tr. 400-08). Bethke argues that because “the ALJ 

Decision found that the GAF assessment of 40 ‘shows’ [her] ‘previous condition’ as of 

September 6, 2012, the ALJ Decision was required to determine whether the period of time [she] 

was properly assessed with a GAF of 40 was for 12 consecutive calendar months or more prior 

to the perceived ‘period of improvement.’” (Doc. #16 at 16). This argument lacks merit as it 

ignores the ALJ’s assertion that a GAF score is simply an assessment of “how a patient is doing 

on one particular day.” (Tr. 26) (emphasis added). Although the ALJ did note Bethke’s “recent 

improvement,” there is no way to construe the ALJ as having concluded that the GAF score 

established disability for any prior period of time, even one day. Indeed, the ALJ found Bethke 

had only “moderate” impairments in terms of social functioning and concentration, persistence 

and pace. (Tr. 22-23). And, the ALJ found that “there is no objective evidence of a history of 

inability to function outside a highly supportive living arrangement...” (Tr. 23). Finally, as the 

Commissioner notes, the record is replete with evidence between March 2011 and August 2012 

of Bethke being alert and appropriately oriented at her doctor’s visits, and having “normal” 

mental status exams. (Tr. 320, 324, 334-39, 368, 418). 

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provide “‘good reasons’ for giving greater weight to the opinions of agency sources.” Helm v. 

Comm’r of Soc. Sec., 405 F. App’x 997, 1002 (6th Cir. 2011) (quoting 20 C.F.R. § 

404.1527(d)(2)). 

 In this case, a review of the ALJ’s decision indicates that she acted in conformance with 

the above standard when she determined that Dr. Newhouse’s opinion was entitled to “great 

weight” because: (1) his mental RFC assessment was consistent with the objective medical 

evidence in the record; and (2) he is a “highly qualified psychologist” and an expert “in the 

evaluation of medical issues in disability claims under the Act.” (Tr. 26). In particular, the ALJ 

properly found that Dr. Newhouse’s RFC was consistent with treatment notes showing 

“relatively unremarkable mental status in treatment sessions that noted stable to mildly impaired 

function through February 2013.” (Tr. 25; see Tr. 391-408). 

 The Court further notes that, contrary to Bethke’s contention, there is “no categorical 

requirement that the non-treating source’s opinion be based on a ‘complete’ or ‘more detailed 

and comprehensive’ case record” than a treating source’s opinion. Helm, 405 F. App’x at 1002. 

Nor does Bethke highlight anything in the record that would justify imposing a particular set of 

limitations beyond those recommended by Dr. Newhouse. As a result, the Court perceives no 

error in the ALJ’s treatment of Dr. Newhouse’s mental RFC assessment. 

2. RFC Assessment and Credibility Determination 

Bethke argues that the ALJ’s RFC assessment is incomplete because it fails to account 

for limitations stemming from her migraine headaches. More specifically, she assigns error to 

the fact that “[t]here is no provision in the RFC for any days of missed work, unscheduled 

breaks, or periods of time when she would be off task as a result of symptoms from migraine 

headaches.” (Doc. # 16 at 21). A review of the record shows that the ALJ committed no error 

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with respect to this issue. 

In support of her contention, Bethke highlights no clinical evidence or medical opinions 

that would warrant imposing any RFC limitations resulting from her alleged migraine condition. 

On the contrary, the record shows that Bethke reported to nurse practitioner Heather Prior on 

August 14, 2012, that she suffered from migraines one to two times per week “for years” and 

that conservative treatment with Motrin, Ibuprofen and rest typically alleviated her symptoms. 

(Tr. 365). At a doctor’s appointment on November 9, 2012, Bethke “denie[d] headaches” 

altogether. (Tr. 349-50). After Prior prescribed Fioricet to treat future headaches (Tr. 368), 

Bethke reported in February 2013 that her migraines “improved greatly.” (Tr. 370). And Bethke 

stated that limiting her caffeine intake–she acknowledged drinking one liter of soda per day–had 

“helped” her migraine headaches. (Id.). 

In her decision, the ALJ sufficiently discussed the medical evidence related to Bethke’s 

migraine condition in conformance with Soc. Sec. Rul. 96-8p to support her RFC.5

 The record 

includes a letter from Bethke’s attorney in which he notes that Bethke went to the emergency 

room on August 14, 2012, for a “one-time event” – a seizure, and that “she had a migraine at the 

time of this and wonders if that might have triggered the seizure.” (Tr. 364). In his Step Three 

 

5

 “Although a function-by-function analysis is desirable, S.S.R. 96–8p does not require ALJs to 

produce such a detailed statement in writing. . . . [T]he ALJ need only articulate how the 

evidence in the record supports the RFC determination, discuss the claimant’s ability to perform 

sustained work-related activities, and explain the resolution of any inconsistencies in the record.” 

Delgado v. Comm’r of Soc. Sec., 30 F. App’x 542, at 547-548 (6th Cir. 2002) (citations and 

quotation marks omitted); see also, e.g., Knox v. Astrue, 327 F. App’x 652, 657–58 (7th Cir. 

2009) (“Although the ‘RFC assessment is a function-by-function assessment,’ S.S.R. 96–8p, the 

expression of a claimant’s RFC need not be articulated function-by-function; a narrative 

discussion of a claimant’s symptoms and medical source opinions is sufficient.”); Tobey v. 

Comm’r of Soc. Sec., No. 11-15069, 2013 WL 1010727, at *11 (E.D. Mich. Feb. 22, 2013), 

adopted by 2013 WL 1016736 (E.D. Mich. Mar. 14, 2013) (finding that the”[t]he ALJ . . . 

sufficiently articulated his residual functional capacity finding under S.S.R. 96–8p” because he 

“discussed the medical and other evidence on the disputed issues and his narrative discussion 

adequately explained the basis of plaintiff s RFC”). 

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analysis the ALJ found that Bethke’s “migraine headaches fail to meet or medically equal Listing 

11.00 (Neurological) . . . because the evidence fails to show any neurological deficits.” (Tr. 22). 

The ALJ referenced Bethke’s hearing testimony where she complained of “headaches 2-3 times 

a week with the need to lie down in a dark room,” (Tr. 24), but ultimately found that testimony 

was belied by the clinical and other evidence in the record. (Tr. 25). For instance, referencing 

the August 2012 emergency room visit, the ALJ noted that “[i]n terms of [Bethke’s] seizure 

disorder and migraine headaches, she sought emergency treatment for a seizure [due to an] 

overdose of medication and using marijuana...[which she took] basically to get high.’” (Tr. 24, 

quoting Tr. 445). The ALJ noted that “[n]eurologically and psychiatrically, she was alert, 

responsive, and responding to questions appropriately.” (Tr. 24, quoting Tr. 445). The ALJ 

referenced a neurologist’s note that “no particular workup was done at that time...[but that 

Bethke] did notice that she had a headache all day long that particular day.’” (Tr. 24-25, quoting 

Tr. 349). The ALJ went on to cite a brain MRI from that same time period which showed mostly 

“unremarkable findings.” (Tr. 25, citing Tr. 440-41). In short, Bethke’s assertion that the ALJ 

“failed to discuss any of the medical records relating to [her] migraine headaches,” (Doc. #16 at 

20), lacks merit, and the ALJ was able to “consider all evidence without directly addressing in 

[her] written decision every piece of evidence submitted by [Bethke].” Kornecky, 167 F. App’x 

at 508 (quoting Loral, 200 F.3d at 453). 

Similarly, Bethke’s argument that the ALJ mistakenly rejected her subjective accounts of 

migraine symptoms is unavailing. The Sixth Circuit has held that determinations of credibility 

related to subjective complaints of pain rest with the ALJ because “the ALJ’s opportunity to 

observe the demeanor of the claimant ‘is invaluable, and should not be discarded lightly.’” Kirk 

v. Sec’y of Health & Human Servs., 667 F.2d 524, 538 (6th Cir. 1981) (quoting Beavers v. Sec’y 

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of Health, Ed. & Welfare, 577 F.2d 383, 387 (6th Cir. 1978)). Thus, an ALJ’s credibility 

determination will not be disturbed “absent compelling reason.” Smith v. Halter, 307 F.3d 377, 

379 (6th Cir. 2001). The ALJ is not required to simply accept the testimony of a claimant if it 

conflicts with medical reports and other evidence in the record. See Walters v. Comm’r of Soc. 

Sec., 127 F.3d 525, 531 (6th Cir. 1997). Rather, when a complaint of pain is in issue, after the 

ALJ finds a medical condition that could reasonably be expected to produce the claimant’s 

alleged symptoms, he must consider “the entire case record, including the objective medical 

evidence, the individual’s own statements about symptoms, statements and other information 

provided by treating or examining physicians . . . and any other relevant evidence in the case 

record” to determine if the claimant’s claims regarding the level of his pain are credible. Soc. 

Sec. Rul. 96-7p, 1996 SSR LEXIS 4, at *2 (Jul. 2, 1996); see also 20 C.F.R. §416.929. 

In this case, after finding that Bethke suffers from the severe impairment of migraine 

headaches (Tr. 21), the ALJ concluded that she still retains the residual functional capacity to 

perform a full range of work at all exertional levels. (Tr. 23). In reaching this conclusion, the 

ALJ specifically referenced Bethke’s testimony about the frequency and severity of her headache 

symptoms. (Tr. 24). Indeed, she also examined a November 2012 treatment note from Dr. AlQasmi, in which Bethke reported that she was suffering from a headache on the same day that 

she was later hospitalized for a seizure. (Tr. 25; see Tr. 349). Nonetheless, while the ALJ found 

that Bethke’s condition could reasonably be expected to produce the alleged symptoms, the ALJ 

also found that her statements about the intensity, persistence and limiting effects of those 

symptoms were not entirely credible to the extent they conflicted with the RFC assessment. (Tr. 

24-25). In reaching this conclusion, the ALJ specifically considered Bethke’s activities of daily 

living, prior statements and reports contained in the record, and the objective medical evidence. 

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(Id.). 

As stated above regarding the objective medical evidence, the ALJ noted that Bethke’s 

brain MRI “was largely unremarkable” and that her treatment history “has been routine and 

conservative . . .” (Tr. 25; see Tr. 440-41). By February 2013, Bethke herself reported that her 

migraines had “greatly improved” after receiving a prescription for Fioricet and limiting her 

caffeine intake. (Tr. 370). Such objective evidence is a “useful indicator” for an ALJ to use 

when evaluating the credibility of a claimant’s symptoms. See 20 C.F.R. §416.929(c)(2) 

(“Objective medical evidence of this type is a useful indicator to assist us in making reasonable 

conclusions about the intensity and persistence of your symptoms and the effect those symptoms, 

such as pain, may have on your ability to work.”). 

In addition, while assessing the credibility of Bethke’s allegations, the ALJ noted that, 

despite her allegations of disabling symptoms, she performs occasional household chores and is 

able to independently take care of her personal needs. (Tr. 25). The record reflects that she is 

able to attend alcohol support groups once every two months and keep up with her doctors’ 

appointments. (Tr. 25, 37). Bethke reported that she goes out to the store and visits her family on 

a weekly basis. (Tr. 25, 37-38). She also acknowledged having sufficient concentration to read, 

watch television, and shop. (Id.). Thus, it was entirely appropriate for the ALJ to consider the 

fact that Bethke’s ability to perform daily activities is less limited than one would expect, given 

her allegations of disabling symptoms. See Walters, 127 F.3d at 532 (an ALJ may consider 

household and social activities in evaluating the credibility of the claimant’s allegations of 

disabling symptoms). 

Finally, the ALJ noted inconsistencies between Bethke’s testimony that she could not 

leave her home and evidence in the record of several criminal convictions. One of these 

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convictions – for drug delivery – occurred during the alleged disability period, which, as the ALJ 

noted, exhibited at least some level of social interaction beyond Bethke’s self-reported 

limitations. (Tr. 25, 43). Again, the inconsistencies between these statements were appropriate 

considerations in evaluating Bethke’s credibility. See Hairston v. Comm’r of Soc. Sec., No. 14-

13218, 2015 U.S. Dist. LEXIS 101715, at *19 (E.D. Mich. Aug. 3, 2015) (factors relevant to 

credibility include “the consistency of the claimant’s statements, both internally and with other 

information in the record”). 

In sum, the ALJ recognized the duty imposed upon her by the regulations and 

appropriately considered Bethke’s activities of daily living, prior statements and reports, and the 

objective medical evidence. Accordingly, the ALJ’s credibility determination is supported by 

substantial evidence and should not be disturbed. 

III. CONCLUSION 

 For the foregoing reasons, the Court RECOMMENDS that the Commissioner’s motion 

for summary judgment [19] be GRANTED, Bethke’s motion for summary judgment [16] be 

DENIED, and the Commissioner’s decision be AFFIRMED. 

Dated: January 22, 2016 s/David R. Grand 

Ann Arbor, Michigan DAVID R. GRAND 

 United States Magistrate Judge 

NOTICE TO THE PARTIES REGARDING OBJECTIONS 

 The parties to this action may object to and seek review of this Report and 

Recommendation, but are required to act within fourteen (14) days of service of a copy hereof as 

provided for in 28 U.S.C. § 636(b)(1) and Fed. R. Civ. P. 72(b)(2). Failure to file specific 

objections constitutes a waiver of any further right of appeal. Thomas v. Arn, 474 U.S. 140 

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(1985); Howard v. Sec’y of Health & Human Servs., 932 F.2d 505, 508 (6th Cir.1991); United 

States v. Walters, 638 F.2d 947, 949–50 (6th Cir.1981). The filing of objections which raise 

some issues, but fail to raise others with specificity, will not preserve all the objections a party 

might have to this Report and Recommendation. Willis v. Sec’y of Health & Human Servs., 931 

F.2d 390, 401 (6th Cir.1991); Smith v. Detroit Fed’n of Teachers Local 231, 829 F.2d 1370, 

1373 (6th Cir.1987). Pursuant to E.D. Mich. LR 72.1(d)(2), a copy of any objections is to be 

served upon this magistrate judge. 

CERTIFICATE OF SERVICE

 The undersigned certifies that the foregoing document was served upon counsel of record 

and any unrepresented parties via the Court’s ECF System to their respective email or First Class 

U.S. mail addresses disclosed on the Notice of Electronic Filing on January 22, 2016. 

 s/Eddrey O. Butts 

 EDDREY O. BUTTS 

 Case Manager

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