Opinion ID: 4421217
Heading Depth: 3
Heading Rank: 1

Heading: Hess’s Social Security Application and

Text: the ALJ’s Opinion In August 2013, Hess applied for social security disability benefits. After a hearing, the ALJ denied his claims. Her decision was based on her conclusion that Hess was not disabled within the meaning of the applicable regulations. In reaching that conclusion, she followed the five-step disability analysis just outlined. The ALJ’s reasoning and the findings she made are central to this case. Consequently, we describe the relevant portions of her opinion in detail. As to step one, however, it is sufficient to simply note that the ALJ determined Hess was not engaged in substantial gainful activity. At step two, the ALJ found that Hess had multiple “severe impairments[.]” (App. at 30.) Specifically, she said that Hess suffered from: major depressive disorder single episode-mild, depressive disorder not otherwise specified, bipolar disorder, posttraumatic stress disorder, history of conduct disorder and impulse control disorder, personality disorder not otherwise specified with antisocial tendencies, osteoarthritis and degenerative joint disease of the right ankle, cervical degenerative disc 9 disease, chronic pain disorder and history of opioid abuse and dependence. (App. at 30-31 (citations omitted).)3 At step three, the ALJ found that Hess’s mental impairments did not meet the standards for a “listed impairment[.]” (App. at 31.) In making that finding, she rated Hess in the four areas of mental functional limitation.4 As to “concentration, persistence or pace” – the area of functional limitation at issue here – she concluded that Hess had “moderate difficulties.” (App. at 32.) She reasoned that, although a state psychological consultant had rated Hess as having “not … more than mild limitation in this area of functioning,” that opinion was inconsistent with the record, including that Hess had been “diagnosed with mental health impairments, was in mental health treatment, and was prescribed mental health medications.” (App. at 32, 37.) The ALJ clarified, however, that she did not consider Hess’s “moderate”-level difficulties in “concentration, persistence, or pace” to be so serious that he could not perform simple tasks. In her words: 3 Only the impairments that affect Hess’s mental capabilities are at issue now. 4 As earlier noted, those are “[a]ctivities of daily living; social functioning; concentration, persistence, or pace; and episodes of decompensation.” 20 C.F.R. §§ 404.1520a(c)(3), 416.920a(c)(3). 10 [Hess’s] self-reported activities of daily living, such as doing laundry, taking care of his personal needs, shopping, working, and paying bills (when he has money), … are consistent with an individual who is able to perform simple, routine tasks. Furthermore, progress notes from treating and examining sources generally indicate no serious problems in this area of functioning, reporting that [Hess] could perform simple calculations, was fully oriented, and had intact remote/recent memory. (App. at 32 (citations omitted).) The “self-reported activities of daily living,” as referenced by the ALJ, were described more fully as follows: [Hess] reported he could care for his own personal needs and grooming, do laundry (although he needs help carrying the basket), clean, use public transportation, attend appointments, work part time, and go shopping in stores. [Hess] also pays bills (when he has money), counts change, and uses money orders. [Hess] testified that he works three days a week for five to six hours as a dishwasher, and he keeps track of the pantry items, checking for empty boxes and out of date food items. (App. at 32 (citations omitted).) 11 At step four, the ALJ performed an RFC assessment.5 She decided that Hess was “limited to jobs requiring understanding, remembering, and carrying out only simple instructions and making only simple work-related decisions[.]” (App. at 33-34.) In selecting that limitation, the ALJ engaged in a detailed examination of the record, from which she concluded that Hess’s mental difficulties were such that he was capable of performing simple tasks. The ALJ first noted that Hess’s self-reported symptoms could “reasonably be expected” to flow from his “medically determinable impairments[.]” (App. at 34.) Those symptoms included “trouble with concentration and completing tasks[,] …. trouble with written and verbal instructions[,] … [inability to] handle stress very well[,] …. racing thoughts, a lot of scrambled thoughts, and trouble sleeping.” (App. at 34 (citations omitted).) The ALJ found, however, that his “statements concerning the intensity, persistence and limiting effects of these symptoms [were] not entirely consistent with the medical evidence and other evidence in the record[.]” (App. at 34-35.) To support that finding, and to evaluate Hess’s capabilities more generally, the ALJ analyzed each source of relevant evidence. Specifically, she looked to mental status examinations and reports, opinion evidence, Hess’s Global Assessment of Functioning (“GAF”) scores, his mental health 5 More precisely, as earlier noted (supra n.2), the ALJ viewed the RFC assessment as an intermediate step between steps three and four. As also noted, however, we will treat the RFC assessment as an element of step four. 12 treatment history, his activities of daily living, and a report by one of Hess’s longtime friends. Regarding the evidence from mental status examinations and reports, the ALJ recognized that Hess had “numerous mental health diagnoses” and was “intermittently engaged in formal mental health treatment, including therapy and psychotropic medications.” (App. at 35 (citations omitted).) Nevertheless, she decided that the evidence showed that Hess was not seriously limited and he was capable of functioning effectively. For example, an October 2013 mental status examination revealed that Hess “was not currently taking any psychotropic medications”; “had fair hygiene and grooming, good eye contact, a pleasant and friendly attitude, a cooperative attitude, goal directed thought processes, no delusions or paranoia, appropriate affect, neutral mood, full orientation, adequate recent/remote memory, and adequate impulse control”; and “could perform simple mathematical calculations.” (App. at 36 (citation omitted).) Likewise, a February 2014 mental status examination showed that Hess had “appropriate dress and grooming, cooperative attitude, good eye contact, normal speech, goal directed thought processing, full orientation, and no suicidal and homicidal ideations.” (App. at 36 (citation omitted).) Furthermore, an August 2015 mental status examination demonstrated “neat and clean hygiene and grooming, a cooperative attitude, normal speech, full orientation, and normal memory.” (App. at 36 (citations omitted).) Additionally, the ALJ noted that records from a period of close observation that Hess had in 2014 did “not contain any references to psychologically based problems[.]” (App. at 36.) 13 The ALJ acknowledged that a March 2015 mental status examination “allude[d] to an inability to work,” as well as “a depressed mood and poor insight/judgment[.]” (App. at 36, 38.) But she assigned “[a]ny report of an inability to work … little weight” because it was inconsistent with the record, the examination itself contained “no function by function opinion on th[at] issue,” and Hess’s inability to work was self-reported. (App. at 38.) Moreover, the examination was not all negative. It revealed “fair hygiene, fair eye contact, a cooperative attitude, normal speech, a calm affect, full orientation, and goal directed thought processing.” (App. at 36.) Moving on to the opinion evidence, the ALJ similarly found that it showed Hess’s mental difficulties left him capable of engaging in simple work. For example, she explained that Dr. Schwartz, a psychologist, opined that Hess “had ‘mild’ limitations in his ability to understand and remember simple instructions[,]” had “‘moderate’ limitations in his ability to carry out simple instructions[,]” “could perform simple, unskilled work with additional restrictions in social and adaptive functioning[,]” and had “‘marked’ limitations in his ability to respond appropriately to usual work pressures or changes in a routine work setting.” (App. at 36-37 (citation omitted).) The ALJ assigned most of that opinion “great weight[,]” but she gave “little weight” to the conclusion that Hess had “marked” limitations because it was inconsistent with the record generally and with a mental status examination Dr. Schwartz himself had performed, and because it was “based predominantly upon [Hess’s] subjective complaints[.]” (App. at 37.) 14 The ALJ also examined the opinion of a “treating mental health provider[,]” who said that Hess “could perform simple unskilled work but had ‘marked’ limitations in … his ability consistently to concentrate, persist, and keep pace in a routine work setting.” (App. at 37 (citation omitted).) The ALJ again rejected the “marked” rating as inconsistent with the record. In doing so, she noted that Hess “was able to work part-time as a dishwasher and tolerate [a period of structured supervision] without any reports of behavioral issues or problems completing tasks.” (App. at 37.) She further highlighted the mental status examinations – which “regularly and routinely described [Hess] as cooperative and calm, having normal speech, full orientation, and logical thought processes” – and observed that the record did “not contain frequent references to fatigue, anhedonia, or staying in bed all day.” (App. at 37.)6 As to Hess’s GAF scores, the ALJ also deemed them not to be indicative of significant mental health difficulties. She acknowledged that Hess received “scores ranging from serious symptoms to moderate symptoms.” (App. at 36 (citations omitted).) But, she gave the GAF scores reflecting more serious symptoms “little weight” because they were “not consistent with the underlying mental status examinations[,]” Hess’s “own reported daily activities[,]” and “the record as [a] whole that did not reveal frequent or regular serious symptoms.” (App. at 37-38 (citations omitted).) Additionally, the ALJ explained that Hess’s “most recent 6 The ALJ additionally considered the state psychological consultant’s opinion referenced in our discussion of step three above, to which, as noted there, she gave little weight. 15 scores … indicat[ed] that [Hess] was experiencing moderate work-related mental health symptoms.” (App. at 36 (citations omitted).) She assigned the GAF scores reflecting less serious symptoms “great weight” because they were “more consistent with the record” and more accurately captured Hess’s “overall functioning.” (App. at 38 (citations omitted).) In doing so, the ALJ again cited the mental status examinations, which “revealed few serious symptoms,” the fact that Hess was “able to work part time as a dishwasher,” and records from close observation that “did not reveal any serious behavioral issues[.]” (App. at 38.) Regarding Hess’s mental health treatment history, the ALJ reasoned that it neither supported the claimed severity level of Hess’s symptoms nor suggested that he was unable to perform simple tasks. She said that Hess was “not always compliant with treatment … and ha[d] been discharged from treatment due to non-compliance”; “experienced short hospitalizations” in 2013 and 2015 “due in part to narcotics misuse and heroin addiction”; and “was not fully engaged in substance abuse treatment until” 2015. (App. at 36.) She noted, though, that Hess was then in a treatment program that began in August 2015, had been compliant with that treatment, and his symptoms had improved. Turning to Hess’s daily activities, the ALJ likewise found that those activities were not suggestive of symptoms as serious as Hess claimed, and that they instead demonstrated an ability to engage in simple work. As part of the RFC analysis, the ALJ reiterated what she had earlier said at step three concerning Hess’s daily activities; namely, that Hess “takes care of his own personal needs and grooming, does laundry[,] … cleans, uses public transportation, attends 16 appointments, works part time, … goes shopping in stores[,] …. pays bills (when he has money), counts change, … uses money orders[,] …. [w]orks three days a week for five to six hours as a dishwasher, and … keeps track of the pantry items checking for empty boxes and out of date food items.” (App. at 36-37 (citations omitted).) Finally, the ALJ reviewed a report by a longtime friend of Hess’s stating that Hess “could cook daily, play computer games, pay bills, follow instructions good, pay attention for a long time, go shopping in stores, use public transportation, and take care of his own personal needs and grooming.” (App. at 38 (citation omitted).) The ALJ assigned that report “partial weight insofar as it [was] consistent with the record as a whole[.]” (App. at 38.) The ALJ ultimately concluded that she had discerned “appropriate limitations” to account for Hess’s “mental impairments” and that those “impairments and the restrictions caused by them would not prevent him from performing sedentary, unskilled work as defined … in the [RFC].” (App. at 38-39.) She said that her RFC determination was based on her findings as to Hess’s functional limitations (e.g., as to “concentration, persistence, or pace”) and “all the evidence with consideration of the limitations and restrictions imposed by the combined effects of all [of Hess’s] medically determinable impairments[.]” (App. at 34.) She particularly cited the mental status examinations, “the objective medical evidence … [Hess’s] non-compliance [with treatment], the opinion evidence, and [Hess’s] activities of daily living.” (App. at 38.) 17 At step five,7 the ALJ found that there were “jobs … in significant numbers in the national economy that [Hess could] perform” and, thus, she concluded that Hess was not disabled. (App. at 39.) She based that conclusion on answers to hypothetical questions she posed to a vocational expert about whether there were jobs “in the national economy for an individual with [Hess’s] age, education, work experience, and [RFC].” (App. at 40.) [App. at 40, 43-45.]