Opinion ID: 3048416
Heading Depth: 1
Heading Rank: 3

Heading: mcmahon’s appeal

Text: McMahon’s argument that the ALJ failed to follow the proper legal standards lacks merit. The ALJ followed the five-step process and, at steps one through three, found that McMahon had not engaged in substantial gainful activity since June 1, 1992, had several severe mental impairments, including her alcohol dependence, and that these impairments met Listings 12.04, 12.06, 12.08 and 10 Case: 14-10597 Date Filed: 09/24/2014 Page: 11 of 17 12.09. Because McMahon met the Listings, there was no need for the ALJ to determine McMahon’s RFC and proceed to steps four and five. Contrary to McMahon’s assertions, the fact that the ALJ found that she met the Listing criteria does not render her immediately entitled to disability benefits because this determination included consideration of her alcohol abuse disorder. See 20 C.F.R. § 404.1535(a). Similarly, the ALJ’s determination that McMahon had the “severe impairments” of depression, anxiety, dependent personality traits, and alcohol dependence does not mean the ALJ necessarily found that the nonalcohol impairments were independently severe. See id. § 404.1520(a)(4)(ii), (c) (explaining that at step two the ALJ considers whether the claimant has an impairment or combination of impairments that is severe). Because there was medical evidence of McMahon’s alcoholism, after the ALJ found that she met the Listings with her alcohol dependence and therefore was disabled, the ALJ was required to determine whether McMahon’s alcohol dependence was a contributing factor material to that disability determination. See 42 U.S.C. § 423(d)(2)(C); 20 C.F.R. § 404.1535(b). Thus, the ALJ correctly went on to determine whether McMahon would be disabled without alcohol use by going back to step two. See 20 C.F.R. § 404.1535(b). Finally, because the ALJ determined that McMahon did not satisfy the severe impairment requirement at step two without alcohol use, the 11 Case: 14-10597 Date Filed: 09/24/2014 Page: 12 of 17 ALJ properly stopped her analysis there and did not proceed on to steps three through five. See id. § 404.1520(c); McDaniel, 800 F.3d at 1032.
The ALJ also properly evaluated the medical opinion evidence in the record in concluding that McMahon’s impairments were not severe. See Sharfarz v. Bowen, 825 F.2d 278, 280-81 (11th Cir. 1987) (explaining that the ALJ is required to indicate and explain the weight assigned to different medical opinions). The ALJ specifically addressed the weight given to each doctor’s medical opinion. Although McMahon contends the ALJ did not give proper weight to her mental health counselor’s 1997 letters and the nurses’ progress notes from McMahon’s 2001 inpatient treatment for alcohol dependence, these documents do not constitute “medical opinions” because they are not statements from physicians or psychologists that reflect judgment about the nature and severity of McMahon’s impairments. See 20 C.F.R. § 404.1527(a)(2).4 Thus, the ALJ was not required to assign and explain the weight given to that evidence. See id.; see also Sharfarz, 825 F.2d at 280-81. Further, while the ALJ must address medical opinions explicitly, the ALJ is not required to address every piece of evidence in the record. 4 In 1995, while in nursing school, McMahon was forced to withdraw from classes due to her drinking problem and, in order to remain in the nursing program, agreed to, among other things, seek counseling. Between 1996 and 1997, Donna Roberts, a licensed mental health counselor and registered nurse, counseled McMahon and also wrote two letters to McMahon’s university. 12 Case: 14-10597 Date Filed: 09/24/2014 Page: 13 of 17 See Dyer v. Barnhart, 395 F.3d 1206, 1211 (11th Cir. 2005) (stating that “there is no rigid requirement that the ALJ specifically refer to every piece of evidence in his decision”); see also Cowart v. Schweiker, 662 F.2d 731, 735 (11th Cir. 1981) (noting that the ALJ should sufficiently explain the weight given to “obviously probative” evidence). As McMahon concedes, the letters and progress notes were not from an “acceptable medical source” for determining whether McMahon had a medically determinable impairment. See 20 C.F.R. § 404.1513(a), (d). The ALJ may still consider evidence from nurses and therapists in determining the severity (rather than the existence) of medically determinable impairments. Id. § 404.1513(d). Here, however, neither the mental health counselor’s letters nor the nurses’ progress notes addressed the severity of McMahon’s other mental impairments, that is, the degree to which those other mental impairments limited her ability to do basic work activities. See id. § 404.1521(a) & (b) (explaining that an impairment is non-severe “if it does not significantly limit [the claimant’s] physical or mental ability to do basic work activities”). The mental health counselor’s letters did not describe any significant limitations on McMahon’s mental ability to do basic work activities, except to say that McMahon found nursing school stressful, that “stress made it difficult for [McMahon] to continue to concentrate on her class work” and that McMahon had 13 Case: 14-10597 Date Filed: 09/24/2014 Page: 14 of 17 “PMS related depression.” The mental health counselor, however, also requested that McMahon’s university permit her to remain a student in good standing and later expressed surprise when McMahon was dismissed from the program. Moreover, the mental health counselor indicated that, although McMahon had failed a drug test, missed a counseling session, and admitted to drinking, McMahon had since put her recovery program back in place and understood her alcoholism. Thus, the mental health counselor’s letters support, rather than undermine, the ALJ’s finding that McMahon’s alcoholism was a contributing material factor to her disability, and, if McMahon stopped using alcohol, her other mental impairments would not cause more than minimal impact on her ability to perform basic work activities during the relevant periods. Likewise, the progress notes for McMahon’s 2001 treatment for alcohol dependence do not contain any evidence of significant limitations caused by McMahon’s other mental impairments. These progress notes indicated, inter alia, that McMahon was sober, sleeping well, and working at a mortgage company and, importantly, that her alcohol dependence was in early remission and her major depression recurrent was in full remission. In short, this evidence supported the ALJ’s finding that, when McMahon was not using alcohol, McMahon’s other mental impairments were not severe.
14 Case: 14-10597 Date Filed: 09/24/2014 Page: 15 of 17 McMahon argues that the ALJ did not properly evaluate her subjective complaints. We disagree. When a claimant attempts to establish disability through her own testimony about her subjective symptoms, a three-part “pain standard” applies. Wilson v. Barnhart, 284 F.3d 1219, 1225 (11th Cir. 2002). The pain standard requires: “(1) evidence of an underlying medical condition; and (2) either (a) objective medical evidence confirming the severity of the alleged pain; or (b) that the objectively determined medical condition can reasonably be expected to give rise to the claimed pain.” Id. If the ALJ determined that the claimant has a medically determinable impairment that could reasonably be expected to produce the pain or other symptoms, then the ALJ evaluates the extent to which the intensity and persistence of those symptoms limit her ability to work. 20 C.F.R. § 404.1529(b). At this stage, the ALJ considers the claimant’s history, the medical signs and laboratory findings, the claimant’s statements, statements by treating and nontreating physicians, and other evidence of how the pain affects the claimant’s daily activities and ability to work. Id. § 404.1529(a). A claimant’s testimony supported by medical evidence that satisfies the pain standard is sufficient to support a finding of disability. Foote v. Chater, 67 F.3d 1553, 1561 (11th Cir. 1995). If the ALJ decides not to credit a claimant’s testimony about her symptoms, the ALJ “must articulate explicit and adequate 15 Case: 14-10597 Date Filed: 09/24/2014 Page: 16 of 17 reasons for doing so. Failure to articulate the reasons for discrediting subjective pain testimony requires . . . that the testimony be accepted as true.” Id. at 1561-62. Here, the ALJ properly applied the pain standard, found that McMahon had medically determinable impairments (apart from her alcohol dependence) that could reasonably be expected to produce the alleged symptoms (primarily panic attacks and an inability to concentrate), but did not credit McMahon’s statements about the intensity and persistence of those symptoms. Further, the ALJ articulated specific reasons for discrediting McMahon’s statements regarding the intensity, persistence, and limiting effects of her symptoms, explaining that: (1) McMahon provided minimal evidence regarding her disability; (2) up until September 30, 1997, the record showed that McMahon had problems, but those problems were all related to her alcoholism; (3) McMahon not only attended college during this time period, but also graduated from college; and (4) there was no evidence to corroborate McMahon’s alleged panic attacks. The ALJ properly discredited McMahon’s subjective symptom testimony, and that credibility finding is supported by substantial evidence.5 D. Severity of Other Mental Impairments Without Alcohol 5 McMahon also complains that the ALJ did not consider her husband’s 2009 questionnaire. The ALJ was not required to explicitly address this piece of evidence in her decision, especially given that it was duplicative of McMahon’s testimony, which the ALJ found not credible. 16 Case: 14-10597 Date Filed: 09/24/2014 Page: 17 of 17 Finally, substantial evidence supports the ALJ’s determination that McMahon’s remaining mental impairments would have resulted in only mild limitations in the functional areas of activities of daily living, social functioning, and concentration, persistence, and pace, as well as no episodes of decompensation. The record showed that McMahon had intact mental functioning and improvement during periods when she was not drinking alcohol. During these times, she also successfully worked and went to school. Thus, the record contains relevant evidence that a reasonable person would accept as adequate to support a finding that McMahon’s other mental impairments would not have a more than minimal impact on her ability to perform basic work activities if she stopped using alcohol. See Moore, 405 F.3d at 1211.