Opinion ID: 854868
Heading Depth: 4
Heading Rank: 2

Heading: Reports of consultative doctors

Text: Gayheart was separately examined by two psychologists, Drs. Flexman and Chiappone, at the request of the Bureau of Disability Determination. Dr. Flexman saw Gayheart in February 2006. He diagnosed Gayheart with panic disorder without agoraphobia and a personality disorder (not otherwise specified). Dr. Flexman assigned Gayheart a GAF score of 55, indicating moderate symptoms or moderate difficulty in social or occupational functioning. See American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, Text Revision 34 (4th ed. 2000). Gayheart’s attitude was found to be depressed, his affect negative, and his eye contact poor during 30 percent of the evaluation, but his tone of voice was pleasant. His “response style” was “suboptimal,” causing Dr. Flexman to judge the reliability of the responses to be poor, suggesting “moderate malingering.” Dr. Flexman concluded that Gayheart was moderately impaired in his ability to interact appropriately with the public and coworkers, and in his ability to respond appropriately to work pressures and changes in a work setting. All other limitations, such as concentration, sustaining attention, following simple instructions, and interacting with supervisors, were noted as slight. Dr. Chiappone examined Gayheart in June 2008. He diagnosed Gayheart with a pain disorder due both to psychological factors and to Gayheart’s general medical condition (depression), with panic disorder without agoraphobia, and with borderline intellectual functioning. Dr. Chiappone assigned Gayheart a GAF score of 45 based upon the latter’s symptoms, but noted a functional level of 51 because Gayheart could “do some basic tasks on a limited basis in the confines of home.” Gayheart appeared to be depressed, anxious, and nervous, and “[h]e did not appear to be malingering.” Dr. Chiappone noticed a tremor and that Gayheart had his head in his hands a lot. Gayheart said during the evaluation that he suffered anxiety attacks weekly that were “very severe and feel like a heart attack.” Dr. Chiappone opined that Gayheart was moderately impaired in his ability to remember one- and two-step job instructions and was “at least moderately impaired in No. 12-3553 Gayheart v Commissioner of Social Security Page 10 his ability to maintain concentration and attention.” Likewise, the doctor noted moderate impairment in Gayheart’s ability to persist with a task or to tolerate stress. He also noted marked impairment in Gayheart’s ability to relate to coworkers, supervisors, and the public, to respond to usual work situations and changes in a routine work setting, and to understand, remember, and carry out complex instructions. The Bureau of Disability Determination also requested that Dr. David Demuth review the medical evidence in the case. Dr. Demuth performed this review not long after Dr. Flexman’s February 2006 examination. He reported that Gayheart exhibited no generalized persistent anxiety, depressive syndrome, or substance-abuse disorder, and that Gayheart required no restrictions on daily living activities. Gayheart was not found to be significantly limited in his ability to understand, remember, and carry out detailed instructions, to work in coordination with or proximity to others without being distracted, to respond to changes in the work setting, or to travel in unfamiliar places or use public transportation. Moderate restrictions were noted in social functioning.