Opinion ID: 808708
Heading Depth: 3
Heading Rank: 2

Heading: Dr. Reddy’s consultative-examination report

Text: Ms. Keyes-Zachary also mentions a physical-consultative-examination report prepared by Dr. Sri K. Reddy. The report itself expresses few conclusions about her physical capacities, but Dr. Reddy’s accompanying physical-medical-source statement opined that Ms. Keyes-Zachary could sit, stand, or walk for eight hours at a time and for eight hours in an eight-hour workday and otherwise found only modest limitations. The ALJ discussed this record but did not expressly weigh it. His RFC, however, is generally consistent with Dr. Reddy’s findings. There is no reason to believe that a further analysis or weighing of this opinion could advance Ms. Keyes-Zachary’s claim of disability. The alleged error is harmless. 3. Therapist Blasdel’s mental-health assessment Next is a mental-health assessment performed by therapist Bob Blasdel. Mr. Blasdel is neither a physician nor a psychologist; his credentials are stated as “MS, LADC, LMFT.” Id. at 823. The ALJ did discuss his report in two paragraphs, but did not provide any analysis from which it can be determined what weight he gave to it. Although Mr. Blasdel is not an “acceptable medical source” such as a medical doctor or a licensed psychologist, see 20 C.F.R. § 404.1513(a), the ALJ was still required to explain the amount of weight he gave to the opinions he expressed: -8- [T]he adjudicator generally should explain the weight given to opinions from these “other sources,” or otherwise ensure that the discussion of the evidence in the determination or decision allows a claimant or subsequent reviewer to follow the adjudicator’s reasoning, when such opinions may have an effect on the outcome of the case. SSR 06-03p, 2006 WL 2329939, at  (Aug. 9, 2006). Most of Mr. Blasdel’s report is a narrative summary of statements by Ms. Keyes-Zachary. These portions of the report do not express any opinions concerning her “symptoms, diagnosis and prognosis, what [she] can still do despite the impairment(s), [or her] physical and mental restrictions.” Id. at . The ALJ was not required to assign a weight to Mr. Blasdel’s narrative of statements relayed to him by Ms. Keyes-Zachary. There are, however, a few statements scattered throughout the report that might be considered “opinions” in the broad sense described by SSR 06-03p. Mr. Blasdel noted, for example, that Ms. Keyes-Zachary’s “intellectual level is estimated to be within the borderline average range” and that her “cognitive abilities are essentially intact.” Aplt. App., Vol. 5 at 818. He stated that her “clinical presentation includes moderately severe depression with an element of increased anxiety” and he estimated her readiness for change as “fair.” Id. He opined that “it is very much possible that she has some learning/processing deficits,” id. at 822, and noted “[p]otential negative factors” that might affect her therapy including “a multitude of psychiatric issues” and “very poor coping skills,” id. at 823. He also made some passing common-sense observations, noting that Ms. Keyes-Zachary’s -9- “aggressive behavior could be considered quite risky,” id. at 819, and that “[s]he could probably benefit from additional positive social interaction,” id. at 821. None of these observations, however, offers an assessment of the effect of Ms. KeyesZachary’s mental limitations on her ability to work. The file includes much more directly relevant evidence on these issues from acceptable medical sources. The ALJ’s failure to assign a specific weight to Mr. Blasdel’s observations therefore did not represent harmful error. Of more concern was Mr. Blasdel’s assignment to Ms. Keyes-Zachary of a current GAF score of 46, and a highest GAF score in the previous year of 50. The vocational expert (VE) testified that scores in this range would eliminate all jobs because a person with these GAF scores cannot maintain a job. This low GAF score is inconsistent with other GAF evidence in the record, and the ALJ did not explain how he weighed the conflicting GAF evidence. But this lack of comparative analysis and weighing does not require reversal. In the case of a nonacceptable medical source like Mr. Blasdel, the ALJ’s decision is sufficient if it permits us to “follow the adjudicator’s reasoning.” SSR 06-03p, 2006 WL 2329939, at . Particularly given the VE’s testimony on the GAF-score issue, it is obvious that the ALJ gave little or no weight to Mr. Blasdel’s GAF opinion. Simply put, had he assigned great weight to the low GAF score, he would not have developed the mental RFC for Ms. Keyes-Zachary that he did. - 10 - We further note that Ms. Keyes-Zachary fails to show that the ALJ erred by rejecting or assigning only modest weight to Mr. Blasdel’s low GAF score in light of the other GAF evidence in the record. Dr. Gordon’s report, assigning Ms. Keyes-Zachary a GAF score of 65, was prepared by an “acceptable medical source” and hence qualified as a medical opinion, while the GAF score of 45, assessed by a counselor, was not. See 20 C.F.R. §§ 404.1513(a), 416.913(a). This alone justifies reliance on Dr. Gordon’s higher GAF score. See SSR 06–03p, 2006 WL 2329939, at  (“The fact that a medical opinion is from an acceptable medical source is a factor that may justify giving that opinion greater weight than an opinion from a medical source who is not an acceptable medical source because . . . acceptable medical sources are the most qualified health care professionals.” (internal quotation marks omitted)). In sum, we discern no harmful error here. 4. Dr. Crall’s disability examination Stephanie C. Crall, Ph.D., conducted a disability examination of Ms. Keyes-Zachary on December 19, 2008. The ALJ mentioned her evaluation, noting that Dr. Crall had found Ms. Keyes-Zachary to be suffering from “major depressive disorder, moderate, chronic and anxiety disorder.” Id., Vol. 3 at 474. He did not state what weight he assigned to the opinion. Dr. Crall’s most specific opinion concerning Ms. Keyes-Zachary’s mental RFC was as follows: - 11 - In the opinion of this evaluator, her ability to engage in work-related mental activities, such as sustaining attention, understanding, and remembering and to persist at such activities was likely adequate for simple and some complex tasks. Functional limitations appeared more likely due to physical rather than mental impairments. Id., Vol. 5 at 838. These specific limitations that Dr. Crall assigned to Ms. Keyes-Zachary were not inconsistent with the limitations the ALJ placed in her RFC. See id., Vol. 3 at 469 (limiting Ms. Keyes-Zachary to “simple, repetitive and routine tasks” and slightly limiting her “contact with the general public, co-workers and supervisors”). Any error in failing to specify the weight given to the opinion was harmless. 5. The Mental-Status Form Finally, Ms. Keyes-Zachary points to a mental-status form completed on March 30, 2009, diagnosing her with major depression (recurrent moderately) and generalized anxiety. It is unclear who completed this one-page form, which is signed only with a sideways “S.” Ms. Keyes-Zachary asserts without discussion that it was prepared by an unspecified treating physician. Although the person who completed the form attributed a number of mental limitations to Ms. Keyes-Zachary, the only specific work-related limitation is not inconsistent with the ALJ’s RFC. The form states that she can “remember, comprehend and carry out (simple) (complex) instructions on an independent basis.” Aplt. App., Vol. 5 at 908. We discern no harmful error in the ALJ’s failure to specify the weight he accorded to this opinion. - 12 - B. ALJ’s alleged failure to consider medical evidence The ALJ found that Ms. Keyes-Zachary’s medical evidence contained “few objective findings that would substantiate the level of pain that she alleges,” and that the record also failed “to demonstrate the presence of any pathological clinical signs, significant medical findings, or any neurological abnormalities that would establish the existence of a pattern of pain of such severity as to prevent her from engaging in any work on a sustained basis.” Id., Vol. 3 at 474. Ms. Keyes-Zachary contends that in reaching these conclusions, the ALJ mischaracterized or inadequately considered certain medical evidence.3 The regulations require the ALJ to “consider all evidence in [the] case record when [he] make[s] a determination or decision whether [claimant is] disabled.” 20 C.F.R. § 404.1520(a)(3). He may not “pick and choose among medical reports, using portions of evidence favorable to his position while ignoring other evidence.” Hardman v. Barnhart, 362 F.3d 676, 681 (10th Cir. 2004). Ms. Keyes-Zachary notes that Dr. Gary R. Lee, a physical consultative examiner (“CE”) who saw her in November 2004, determined that she had “decreased, painful ROM [range of motion] with tenderness of the spine.” Although Dr. Lee did make such findings, this decreased or painful range of motion was 3 Because of the heading under which this argument appears in Ms. KeyesZachary’s brief, we view the argument as an assertion that the ALJ’s findings concerning the state of the medical record are unsupported by substantial evidence, rather than as part of a more general attack on his conclusions concerning Ms. KeyesZachary’s credibility, which are the subject of her second issue, discussed infra. - 13 - consistent with the ALJ’s conclusion that she is able to do a limited range of light work. Dr. Lee noted that she could extend her back 20◦ out of an expected 25 and could flex it 70◦ out of an expected 90; that she could laterally flex her back 20◦ on both left and right out of an expected 25; that she could extend her neck by 30◦ out of an expected 60, and flex her neck by 40◦ out of an expected 50; and that she had a right extension value for her elbow of negative 5◦, while the expected value was 0. Otherwise, all his ROM findings were normal. Ms. Keyes-Zachary next cites examination results from Dr. Sri K. Reddy, the CE who examined her in September 2006. These results do not support her attack on the ALJ’s findings. Dr. Reddy found that she had “functional” ROM in various joints, but also noted that she had tenderness in the spine and knees and some reduced sensation in her feet. Id. She appears to believe that these exam results support her argument about significantly limiting pain. (We note that Ms. KeyesZachary simultaneously attacks Dr. Reddy for failing to measure and report ROMs specifically and instead simply concluding that they were “functional”; she does not, however, cite any authority requiring a consultative examiner to report specific ROM values.) But despite his findings concerning tenderness and reduced sensation, Dr. Reddy opined that Ms. Keyes-Zachary could sit, stand, and walk for up to eight hours at a time in an eight-hour day, and could frequently lift up to 25 pounds and frequently carry 20 pounds. - 14 - Neither Dr. Lee’s nor Dr. Reddy’s examination undermines the ALJ’s conclusions concerning the severity of Ms. Keyes-Zachary’s physical impairments. To the extent that she raises additional issues involving the ALJ’s evaluation of the medical evidence, her arguments lack merit or are insufficiently developed for our review. In sum, we reject Ms. Keyes-Zachary’s contention that the ALJ’s opinion does not adequately evaluate and discuss the medical-source evidence. Where, as here, we can follow the adjudicator’s reasoning in conducting our review, and can determine that correct legal standards have been applied, merely technical omissions in the ALJ’s reasoning do not dictate reversal. In conducting our review, we should, indeed must, exercise common sense. The more comprehensive the ALJ’s explanation, the easier our task; but we cannot insist on technical perfection.