Opinion ID: 170126
Heading Depth: 3
Heading Rank: 1

Heading: ALJ’s Step Two and Step Three Evaluation

Text: At step two, the decision found in Mr. Petree’s favor that he had “an impairment or a combination of impairments considered ‘severe.’” Aplt. App., Vol. 2 at 24. At step three, the ALJ determined that Mr. Petree’s bipolar disorder -9- did not meet or equal the severity of an affective disorder at § 12.04 of the Listed Impairments. In particular, the ALJ found that Mr. Petree had not proven that he met the requirements of subsection B of § 12.04. Under that subsection, the ALJ was required to determine whether Mr. Petree’s disorder resulted in at least two of the following: 1. Marked restriction of activities of daily living [(ADLs)]; or 2. Marked difficulties in maintaining social functioning; or 3. Marked difficulties in maintaining concentration, persistence, or pace; or 4. Repeated episodes of decompensation, each of extended duration[.] Mr. Petree argues that the ALJ erred in determining that at least two of these requirements were not met. 3 The ALJ first found that Mr. Petree had at most a moderate and not a marked restriction of ADLs. According to subsection C of § 12.00, “[a]ctivities of daily living include adaptive activities such as cleaning, shopping, cooking, taking public transportation, paying bills, maintaining a residence, caring 3 We only consider the first three of the four domains. In his reply brief, Mr. Petree agrees that the record does not support a claim that he experienced repeated episodes of decompensation, each of an extended duration, and he withdraws that argument. Aplt. Reply Br. at 6. -10- appropriately for your grooming and hygiene, using telephones and directories, and using a post office.” A “marked” limitation means more than moderate but less than extreme. A marked limitation may arise when several activities or functions are impaired, or even when only one is impaired, as long as the degree of limitation is such as to interfere seriously with [a claimant’s] ability to function independently, appropriately, effectively, and on a sustained basis. Listed Impairments, § 12.00, subs. C. We agree with the magistrate judge that there is substantial evidence to support the ALJ’s finding that there was no more than a moderate restriction of ADLs. There is much evidence in the record describing Mr. Petree’s ability to groom himself, prepare meals, undertake various hobbies, and perform other ADLs, including evidence from Mr. Petree himself. The medical source opinions from medical consultants of the State agency also concluded only a moderate restriction was present. Mr. Petree argues that the ability to perform ADLs does not, by itself, prove that he is not disabled. See Thompson v. Sullivan, 987 F.2d 1482, 1490 (10th Cir. 1993) (“The sporadic performance of household tasks or work does not establish that a person is capable of engaging in substantial gainful activity.”) (quotation omitted). This is true, but irrelevant. At this step, we are concerned only with whether the evidence showing his ability to perform ADLs provides substantial evidence for the ALJ’s finding that he was no more than moderately restricted in his ability to perform ADLs. It clearly does. -11- Similarly, we hold that there is substantial evidence to support the ALJ’s finding that Mr. Petree had no more than moderate difficulties in maintaining both social functioning and concentration, persistence, or pace. The magistrate judge’s analysis is cogent and persuasive when considering the sufficiency of the ALJ’s findings regarding these requirements. We therefore affirm the ALJ’s findings on these issues for the reasons set forth in the district court’s March 28, 2007, opinion and order. While it is clear that there is evidence in the record, especially Mr. Petree’s own testimony as to his limitations, that would support a finding of a more marked restriction, the ALJ is not required to discuss every piece of evidence, Clifton, 79 F.3d at 1009-10, and even if two inconsistent conclusions could be properly drawn from the evidence, this would not prevent a finding of substantial evidence, Lax, 489 F.3d at 1084. Mr. Petree also argues that he had a medically diagnosed anxiety disorder and that the ALJ erred in (1) not determining whether it constituted a severe medical impairment at step two of the sequential evaluation, and (2) not determining whether, if severe, the mental impairment caused by his anxiety disorder was equivalent to a listed impairment. Any error that occurred was harmless. 4 Since subsection B of the anxiety related disorder section of the Listed Impairments–§ 12.06–is the same as subsection B of § 12.04, which was 4 We do note that there are no records dated after the alleged onset of disability that show that Mr. Petree was still having anxiety attacks. -12- considered, the ALJ could not have found that Mr. Petree’s mental disorder met or equaled the severity of § 12.06. See Fischer-Ross v. Barnhart, 431 F.3d 729, 733-34 (10th Cir. 2005) (holding that reversal is not required “where the ALJ’s factually substantiated findings at steps four and five of the evaluation process alleviate any concern that [but for the error] a claimant might have been adjudged disabled at step three”). B. ALJ’s Evaluation of Treating Physician Opinion Mr. Petree next argues that the ALJ failed to properly evaluate a treating physician’s medical opinion and that the ALJ’s RFC determination was inconsistent with that opinion. Specifically, Mr. Petree claims that the ALJ ignored the fact that Dr. Luc’s September 23, 2002, mental status form stated that Mr. Petree could “carry out simple instructions.” Aplt. App., Vol. 2 at 141. Mr. Petree argues that the RFC finding that, among other limitations, Mr. Petree was “able to understand, remember, and carry out simple one-step instructions and some more detailed instructions,” was inconsistent with Dr. Luc’s opinion as to the severity of his limitations. Id. at 24. He also argues that the ALJ failed to determine whether Dr. Luc’s opinion should be given controlling weight and, if not, state what weight the opinion was being given. It is true that [w]hen evaluating the opinion of a treating physician, the ALJ must follow a sequential analysis. In the first step of this analysis, he should consider whether the opinion is well supported by medically -13- acceptable clinical and laboratory diagnostic techniques and is consistent with the other substantial evidence in the record. If the answer to both these questions is “yes,” he must give the opinion controlling weight. But even if he determines that the treating physician’s opinion is not entitled to controlling weight, the ALJ must then consider whether the opinion should be rejected altogether or assigned some lesser weight. Pisciotta v. Astrue, 500 F.3d 1074, 1077 (10th Cir. 2007) (citations omitted). This precept provides no support for Mr. Petree’s argument, however, because the opinion in question is an opinion as to Mr. Petree’s mental status fourteen months before Mr. Petree claims he became disabled. As set forth in detail above, the administrative record includes later medical records from Dr. Luc, completed after he completed his mental status form, showing Mr. Petree’s condition greatly improving, with the final records from Dr. Luc showing that Mr. Petree was reporting no symptoms from his disorders. Dr. Luc tendered no opinion on Mr. Petree’s limitations as of the date that Mr. Petree claimed that he became disabled, because he had stopped treating Mr. Petree almost a year before. Finally, the most recent consultative medical opinion in the record, from which the ALJ apparently took the limitation language in question, was prepared after Mr. Petree had ceased his treatment at GLMHC and F&CS. The RFC Assessment form in question was prepared by an agency medical consultant on February 18, 2003. It stated that Mr. Petree’s ability to carry out very short and simple instructions was not significantly limited and that his ability to understand, remember and carry out detailed instructions was moderately limited. The -14- assessment was that Mr. Petree “[c]an perform simple [and] some more complex tasks.” Id. at 183. Consequently, we hold that the ALJ’s RFC finding that Mr. Petree was “able to understand, remember, and carry out simple one-step instructions and some more detailed instructions,” id. at 24, was supported by substantial evidence. C. ALJ’s Evaluation of Credibility In his third point on appeal, Mr. Petree claims that the ALJ erred in finding that his testimony was “not totally credible when considered in the light of all of the evidence of record.” Id. at 22. The ALJ found that Mr. Petree’s testimony regarding his inability to do any work was not entirely consistent with his work history showing that he worked from 1993 through 2002 despite the presence of a mental impairment, and that he continued to search for another job after being fired from his last one in May 2002. The ALJ also found that Mr. Petree’s ability to provide for his own ADL’s and the fact that he at times independently cared for his child was not entirely consistent with his claim that he could not perform even simple work. We affirm the ALJ’s determination as to this point of error for the reasons set forth in the district court’s opinion and order of March 28, 2007. D. ALJ’s Evaluation At Step Four In his final point on appeal, Mr. Petree argues that the ALJ’s step four determination that Mr. Petree could perform his past relevant work was not -15- supported by substantial evidence because it ignored two statements made by the VE at the hearing. The first of these statements was made in response to the following question Mr. Petree’s attorney asked the VE following the VE’s testimony that Mr. Petree could perform his past relevant work. The attorney asked: “What affect would the [Global Assessment of Functioning] score 43 have on the jobs that you listed before?” Id. at 301. The VE answered: “Well, a person with a GAF of 43 couldn’t function in the workplace.” Id. Mr. Petree argues that since he had been tested at one point with a GAF of 43, this testimony shows he was disabled. We disagree. First, a GAF score is not a one-time measure of a person’s level of functioning that can be expected to remain constant. This fact is clearly evident from Mr. Petree’s own case. For example, a record from 1993 shows that Mr. Petree was assigned a GAF score of 20-30 at that time. Id. at 210. But the same record also shows that he had received a GAF score of 60-70 within the past year. Id. A record from December 2001 shows a GAF score of 55-60. Later, a comprehensive assessment performed by GLMHC on August 2, 2002, rated Mr. Petree’s GAF score as 43, but noted that his highest GAF score within the -16- past year was 50. F&CS’s records from January 2, 2003 contain this exact same scoring. 5 Second, Mr. Petree’s argument fails to acknowledge the fact that the latest GAF score in the record is from the second day of 2003, almost eleven months prior to the alleged onset date of disability and the record shows that Mr. Petree’s GAF scores have fluctuated historically. Finally, a low GAF score does not alone determine disability, but is instead a piece of evidence to be considered with the rest of the record. See Howard v. Comm’r of Soc. Sec., 276 F.3d 235, 241 (6th Cir. 2002) (“While a GAF score may be of considerable help to the ALJ in formulating the RFC, it is not essential to the RFC’s accuracy.”); Lee v. Barnhart, 117 F. App’x 674, 678 (10th Cir. 2004) (unpublished) (“Standing alone, a low GAF score does not necessarily evidence an impairment seriously interfering with a claimant’s ability to work.”). The second statement by the VE that Mr. Petree alleges shows his disability was made during the following exchange at the hearing after Mr. Petree’s attorney had referenced a number of limitations faced by Mr. Petree including moderate limitation maintaining concentration, persistence and pace. 5 A GAF rating between 41 and 50 indicates “[s]erious symptoms (e.g., suicidal ideation . . .) OR any serious impairment in social, occupational, or school functioning (e.g., . . . unable to keep a job);” whereas a GAF rating between 51 and 60 indicates moderate symptoms or impairments in these categories. American Psychiatric Assoc., Diagnostic and Statistical Manual of Mental Disorders at 34 (Text Rev. 4th ed. 2000) (emphasis omitted). -17- Attorney: “I’d like to know how these additional limitations would affect the jobs that you listed under hypothetical number one.” VE: “I think they were pretty much the same as the Judge had given me. It would limit him to simple, repetitive unskilled work but that didn’t involve working around the public.” Attorney: “Okay, what about the restrictions to daily living and social functioning and concentration, persistence and pace though?” VE: “Well, it would still be moderate. So I don’t know that it has.” Attorney: “Would the combination of the three together have any affect on his ability to maintain work?” VE: “Well, maybe the difficulties of maintaining concentration, persistence and pace might cause him to lose jobs.” Aplt. App., Vol. II at 299-300. Mr. Petree essentially argues that in this exchange the VE reversed his previous determination that Mr. Petree could perform his past relevant work. We think that such an argument accords this exchange too much weight. A single unclear statement that “maybe the difficulties of maintaining concentration, persistence and pace might cause him to lose jobs,” id. at 300 (emphasis added), following the VE’s unambiguous testimony that Mr. Petree could perform his past relevant work, and two other statements that the moderate difficulties in maintaining concentration, persistence and pace would not have any -18- affect on that testimony, is not enough for us to say that the ALJ’s step four determination was not supported by substantial evidence.