F I L E D
United States Court of Appeals
Tenth Circuit
UNITED STATES CO URT O F APPEALS
August 8, 2007
FO R TH E TENTH CIRCUIT Elisabeth A. Shumaker
Clerk of Court
D IA N A G. K ER WIN ,
Plaintiff-Appellant,
v. No. 06-6343
(D.C. No. CIV-05-1202-M )
M ICH AEL J. ASTRU E, * (W .D. Okla.)
Commissioner of Social Security
Administration,
Defendant-Appellee.
OR D ER AND JUDGM ENT **
Before H E N RY and A ND ER SO N, Circuit Judges, and BROR BY, Senior Circuit
Judge.
Plaintiff Diana G. Kerwin appeals from the district court’s order affirming
the Commissioner’s denial of her application for disability benefits. “W e review
the C ommissioner’s decision to determine w hether the factual findings are
*
Pursuant to Fed. R. App. P. 43(c)(2), M ichael J. Astrue is substituted for
Jo Anne B. Barnhart as appellee in this appeal.
**
After examining the briefs and appellate record, this panel has determined
unanimously to grant the parties’ request for a decision on the briefs without oral
argument. See Fed. R. App. P. 34(f); 10th Cir. R. 34.1(G). The case is therefore
ordered submitted without oral argument. This order and judgment is not binding
precedent, except under the doctrines of law of the case, res judicata, and
collateral estoppel. It may be cited, however, for its persuasive value consistent
with Fed. R. App. P. 32.1 and 10th Cir. R. 32.1.
supported by substantial evidence and whether the correct legal standards were
applied.” Angel v. Barnhart, 329 F.3d 1208, 1209 (10th Cir. 2003). M s. Kerw in
argues the Commissioner provided an improper discussion and evaluation of
consulting physicians’ findings and opinions concerning her mental and physical
limitations. W e reverse and remand for further proceedings because the correct
legal standards were not applied.
Background
M s. Kerwin asserts disability beginning on September 30, 2002, due to
multiple mental and physical impairments. The A dministrative Law Judge (ALJ)
found that M s. Kerwin’s ability to work was not affected by her mental
impairments of anxiety and depression, but was affected by the severe physical
impairments of chronic obstructive pulmonary disease, degenerative disc disease,
hypothyroidism, and hypertension. In spite of these physical limitations, the ALJ
concluded M s. Kerwin had the residual functional capacity (RFC) to perform light
work and that she w as capable of returning to her previous relevant work as a
fast-food manager, file clerk, cashier, receptionist, dry-cleaner clerk, and
newspaper carrier.
The ALJ therefore denied benefits at step four of the five-step sequential
evaluation process. See 20 C.F.R. § 404.1520. His decision became the final
decision of the Commissioner when the A ppeals Council denied M s. Kerwin’s
request for review. The district court affirmed the Commissioner’s decision.
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Discussion
M s. Kerwin contends that the ALJ improperly rejected the opinions of M ax
M . Edgar, Ph.D, a psychologist who conducted a consultative mental examination,
and Aaron Cates, M .D., an internist who performed a consultative physical
examination. As a result, she contends, the ALJ formulated an incomplete RFC
assessment.
M ental im pairm ents
After examining M s. Kerwin at the Commissioner’s request, Dr. Edgar
provided a detailed evaluation of his impressions of M s. Kerw in and her
responses to his inquiries. He described M s. Kerwin’s demeanor and affect as
suggestive of psychomotor retardation and severe depression. His diagnosis was
that M s. Kerwin likely had a bipolar or schizoaffective disorder with severe major
depression and some audio and visual hallucinations, an underlying personality
disorder with possible learning difficulties, and possibly had post-traumatic stress
disorder with panic related to childhood abuse, and extreme levels of
psychosocial stressors. Dr. Edgar estimated M s. Kerwin’s Global Assessment of
Functioning score at 30-40, opining that she “does not appear w ell enough to
handle any kind of gainful employment” and “would need help in managing any
funds.” Aplt. App. at 251. 1
1
A global assessment of functioning (GAF) score “is a subjective
(continued...)
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Later, non-examining agency consultants conducted a mental RFC
assessment based only on medical records and completed a psychiatric review
technique (PRT) form. 2 The PRT noted a contrast between M s. Kerw in’s
behavior at the examination performed by consultative internist Dr. Cates, when
“[s]he was able to hear and understand conversation well,” and her “description
of hallucinations” during Dr. Edgar’s examination. Id. at 276. Although it noted
that M s. Kerwin regularly takes Paxil prescribed by her treating physician for
depression, the PRT observed that “[w]hile she complains of depression, anxiety
and depression, she has never received mental health treatment.” Id. The
consultants found it telling that M s. Kerwin was “able to fix sandwiches and visit
with her family.” Id.
The consultants concluded that M s. Kerwin’s m ental functional capacity
was not significantly limited, except for marked limitations in her ability to
1
(...continued)
determination based on a scale of 1 to 100 of the clinician’s judgment of the
individual’s overall level of functioning.” Salazar v. Barnhart, 468 F.3d 615, 624
n.4 (10th Cir. 2006) (quotation omitted). “A GAF of 31-40 is extremely low, and
indicates some impairment in reality testing or communication or major
impairment in reality testing or communication or major impairment in reality
testing or communication or major impairment in several areas, such as work or
school, family relations, judgment, thinking, or mood.” Id. (quotation and
alterations omitted).
2
The forms were completed initially by Sally Varghese, M .D. (a
psychiatrist) on October 18, 2002, and were reviewed by M argaret M cKinney
Ph.D. (a psychologist) on December 17, 2002.
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understand and carry out short and simple instructions. According to the
consultants, M s. Kerwin was “able to perform simple tasks with routine
supervision” and “relate to coworkers and supervisors for work[-]related matters.”
Id. at 262. In direct opposition to Dr. Edgar’s opinion, they stated that
M s. Kerw in had “independ[e]nt living skills” and “nothing suggest[ed] she could
not do other work.” Id. at 263.
The A LJ conducted a hearing, at which M s. Kerw in and a vocational expert
testified. The ALJ then issued his decision. In evaluating the evidence, the ALJ
emphasized the notations in the medical record that M s. Kerwin tended to
overstate her symptoms. He repeated the consultants’ statement that she “has no
history of mental health treatment,” but mentioned that she took medication for
depression. Id. at 14. In addition, he cited to the treatment record of an
emergency room visit on October 18, 2000 (for foot pain of unexplained origin)
which lacked indications of “mood swings, anxiety, depression, tension or
memory changes.” Id. at 15. Also of significance to the ALJ was that, in the year
2000, M s. Kerwin was able to be a caregiver for her grandchildren during the
daytime and for her ill father at night. All of these observations factored into the
ALJ’s determination that M s. Kerwin’s “complaints at the mental[-]status
consultative exam were exaggerated, possibly in an attempt to generate evidence
for her appeal.” Id. at 14.
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In the end, the ALJ implicitly rejected Dr. Edgar’s report. W ithout
mentioning Dr. Edgar’s GAF assessment and related opinions on M s. Kerw in’s
functional mental capacity, the ALJ found “only a moderate restriction of
activities of daily living, moderate difficulties in maintaining social functioning,
moderate difficulties in maintaining concentration, persistence or pace, and no
episodes of decompensation.” Id. at 15. According to the ALJ, “[h]er limitations
appear[ed] to be related to her physical condition, not due to a mental
impairment.” Id. at 14.
On appeal, M s. Kerwin argues that the ALJ committed legal error by failing
to acknowledge and consider several significant aspects of Dr. Edgar’s
psychological evaluation: the GAF assessment, diagnosis of possible underlying
personality disorder, description of M s. Kerwin’s affect, levels of psychosocial
stressors, and conclusion that M s. Kerwin was incapable of any type of
em ploym ent or even handling any benefit payments. To address this issue, we
refer to basic precepts of social-security law.
“[A]n ALJ is required to consider all of the claimant’s medically
determinable impairments, singly and in combination; the statute and regulations
require nothing less” and a failure to do so “is reversible error.” Salazar v.
Barnhart, 468 F.3d 615, 621 (10th Cir. 2006). An ALJ “may not ignore evidence
that does not support his decision, especially when that evidence is significantly
probative.” Briggs ex rel. Briggs v. M assanari, 248 F.3d 1235, 1239 (10th Cir.
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2001) (quotation omitted); see also Clifton v. Chater, 79 F.3d 1007, 1010
(10th Cir. 1996) (“[I]n addition to discussing the evidence supporting his
decision, the ALJ also must discuss . . . significantly probative evidence he
rejects.”).
Specifically applicable to M s. Kerwin’s case are our previous statements
that “psychological opinion may rest . . . on observed signs and symptoms,”
Robinson v. Barnhart, 366 F.3d 1078, 1083 (10th Cir. 2004), and that an ALJ may
not substitute his own judgment for that of a medical professional, see Winfrey v.
Chater, 92 F.3d 1017, 1022 (10th Cir. 1996). M oreover, an examining
physician’s opinion is normally entitled to more weight than a non-examining
physician’s opinion. See Robinson, 366 F.3d at 1084 (“The opinion of an
examining physician is generally entitled to less weight than that of a treating
physician, and the opinion of an agency physician who has never seen the
claimant is entitled to the least weight of all.”) (citing 20 C.F.R. § 404.1527(d)
and SSR 96-6p, 1996 W L 374180, at *2). Under these standards, the A LJ’s
determination is legally flawed. The ALJ essentially adopted most of the
non-examining consultants’ opinions without discussing the contrary opinions of
Dr. Edgar, the examining consultant. This situation is not fully remedied by the
ALJ’s determination that M s. Kerwin’s statements to Dr. Edgar were not credible,
based on indications in the medical record that M s. Kerwin may exaggerate her
physical symptoms, put forth less than maximal effort during testing, or provide
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conflicting information. W e must remand this matter for further consideration of
the medical evidence on M s. Kerwin’s mental impairments, using the proper legal
standards.
On remand, the ALJ may decide that the record regarding mental
impairments is insufficient and needs to be developed with additional evidence.
See Robinson, 366 F.3d at 1084; see also 20 C.F.R. § 404.1512(e)(1) (“W e will
seek additional evidence or clarification from your medical source when the
report from your medical source contains a conflict or ambiguity that must be
resolved, the report does not contain all the necessary information, or does not
appear to be based on medically acceptable clinical and laboratory diagnostic
techniques.”). In any event, the ALJ must discuss the probative aspects of
Dr. Edgar’s report and, if he again rejects its conclusions, give legally adequate
reasons for doing so.
Physical Im pairm ents
M s. Kerwin argues that the ALJ incorrectly evaluated the report of
Dr. Cates’ consultative internist examination, particularly with regard to
limitations in her use of her right wrist and hand and lack of a safe and steady
gait. Dr. Cates’ report described his examination findings, including his opinion
that M s. Kerwin lacked a safe or stable gait without the use of a cane and had
range-of-motion limitations in her back, neck, hip, knee, ankle, and shoulder,
though some of “[t]his may be partially the patient’s playing up her limitations.”
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Aplt. App. at 238. As for her hands and wrists, M s. Kerwin had limited flexion
and hyperextension of all fingers on her right hand, reduced grip strength, and an
inability to manipulate objects or grasp tools with her right hand, but no
right-hand atrophy. Also, he noted that M s. Kerwin had great difficulty stepping
off a curb outside and problems walking in the examination room. Dr. Cates’
conclusion was that M s. Kerwin “has multiple medical problems and does appear
to be significantly limited in her ability to function normally on a daily basis.”
Id. at 240.
The ALJ’s physical-impairment evaluation was similar to his
mental impairment analysis. The A LJ focused on indications of M s. Kerw in’s
inconsistent symptoms, shifting descriptions of activities, and exaggerated pain
behaviors w ithout mentioning the specific hand-and-wrist limitations or gait
problems found by Dr. Cates. Other than his thoughts on M s. Kerw in’s
credibility, the ALJ did not “provide specific, legitimate reasons for rejecting
[Dr. C ates’ opinion],” as required by the agency’s regulations. Doyal v. Barnhart
331 F.3d 758, 764 (10th Cir. 2003). In reaching the RFC determination that
M s. Kerwin was capable of performing light work, the ALJ did not include any
handling, fingering, or walking limitations.
An ALJ is not entitled to pick and choose through a medical opinion, taking
only the parts that are favorable to a finding of nondisability. Robinson, 366 F.3d
at 1083. Although “an ALJ is not required to discuss every piece of evidence,” he
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must discuss the uncontroverted evidence he chooses not to rely upon, as well as
significantly probative evidence he rejects.” Clifton, 79 F.3d at 1009-10. And
the absence of a explanation is of significance in M s. Kerwin’s case: all of her
former relevant jobs involve frequent handling or fingering. See Dictionary of
Occupational Titles §§ 185.137.010 (manager, fast-food services); 206.387-034
(file clerk); 211.462-014 (cashier-checker); 237.367-038 (receptionist); 290.477-
014 (retail-sales clerk); 292.457-010 (newspaper carrier). Further, light-work
positions require that an individual be able to stand or walk up to six hours in an
eight-hour day. See SSR 83-10, 1983 W L 31251, *6 (1983).
On the issue of physical impairments, we remand for further consideration
of Dr. Cates’ report and, if necessary, development of additional evidence
concerning M s. Kerwin’s hand and gait limitations. 3
Conclusion
The judgment of the district court is REVERSED, and this case is
REM ANDED to the district court with directions to REM AND to the
Commissioner for further proceedings.
Entered for the Court
Robert H. Henry
Circuit Judge
3
M s. Kerwin also claims that the ALJ’s determination of her RFC is not
supported by substantial evidence. Because this issue is interwoven with the
ALJ’s evaluation of Dr. Cates’ report, we do not specifically address this
argument.
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Kerwin v. Barnhart
Combined Opinion