GAF Scores must be properly considered by the ALJ

A recent case from the Eastern District of Tennessee resulted in a remand on a number of important issues. The first issue discussed in this post concerns GAF scores:

The ALJ rejected the Global Assessment of Functioning (“GAF”) scores. The ALJ reasoned that GAF scores “are not based on standardized norms and admittedly provide only a snapshot impression of an individual’s psychological status. . . .” (Tr. 16). The ALJ further stated that “detailed observations and descriptions in a provider’s notes are a vastly superior reflection of an individual’s true functional abilities than a shorthand GAF score. . . .” (Id.). As Plaintiff notes however, the ALJ does not cite to any observations and descriptions from treating providers to contradict the assigned GAF scores. Plaintiff argues the ALJ rejected the numerous GAF scores in the record that would support a finding of severe social and occupational impairment (Tr. 16). A review of the record shows that from the time of Plaintiff’s alleged onset date through the date of the hearing in this matter, treating psychologists and psychiatrists at the VA, almost without exception, rated Plaintiff’s GAF at 50 and on one occasion 45. (See, e.g., Tr. 763, 780, 783, 790, 1044 and 1068). In light of the multiple GAF scores in this range, I conclude a fuller explanation of the reason for their rejection is required. I note that the GAF scale shows 41 to 50 as serious symptoms but the range of 51 to 60 reflects moderate symptoms. There may be reasons why the ALJ concluded the scores  did not reflect serious symptoms but the articulation of those reasons is for the ALJ and not this court.

Reynolds v. Colvin, 2014 U.S. Dist. Lexis 8450 (E.D.Tenn. Jan. 3, 2014)


Recent Decision Re: Credibility

In Hobson v. SSA, 2013 U.S. Dist. LEXIS 62901 (M.D.Tenn. May 2, 2013), the Magistrate Judge for the District Court recommended reversal and remand of a decision denying the plaintiff’s claim for disability benefits in large part because of the ALJ’s credibility determination.  The Magistrate Judge began the legal analysis by noting  the following important rule of law:

There is no question that a claimant’s subjective complaints can support a finding of disability — irrespective of the credibility of that claimant’s statements before the agency — if they are grounded in an objectively established, underlying medical condition and are borne out by the medical and other evidence of record. Id.; see, e.g., Walters v. Comm’r of Soc. Sec., 127 F.3d 525, 531 (6th Cir. 1997); SSR 96-7p, 1996 SSR LEXIS 4 at *3, 1996 WL 374186, at *1, 5 (describing the scope of the analysis as including “the objective medical evidence, the individual’s own statements about symptoms, statements and other information provided by treating or examining physicians or psychologists and other persons about the symptoms and how they affect the individual, and any other relevant evidence in the case record[;]” “a finding that an individual’s statements are not credible, or not wholly credible, is not in itself sufficient to establish that the individual is not disabled.”).

The ALJ found that the claimant was “able to assist his children with their homework; to care for his own personal needs; to prepare simple meals; to shop; to manage funds/pay bills; to concentrate; to understand the spoken word; to get along with authority figures and to handle stress and/or changes in routine. This evidences that the claimant is able to function.”  The ALJ further found that medical treatment improved the claimant’s condition and that the objective medical testing was “unremarkable.”  As a result, the ALJ took issue with the claimant’s credibility.

The District Court noted that although the objective medical testing was unremarkable,

There is clearly an underlying medical condition giving rise to plaintiff’s subjective report of pain: migraine headaches likely caused or exacerbated by plaintiff’s cranial osteoma.”  The Court reasoned that the claimant’s treating physicians “did not in any way articulate that they doubted plaintiff’s report of migraine symptoms. Rather, the neurologists and primary care physicians at the VA continued to prescribe a combination of medications for his migraines, with adjustments made at intervals in an attempt to relieve his symptoms without resorting to narcotic pain medication, before finally adverting to narcotic therapy in 2009, with good results. . . . In fact, during the period at issue, there does not appear to be any legitimately conflicting evidence on the issue of pain in the record, a point which the Sixth Circuit has deemed significant. King v. Heckler, 742 F.2d 968 (6th Cir. 1984). Lastly, while not in any way binding on the SSA, it is certainly noteworthy that the VA awarded plaintiff benefits based on its determination of his unemployability, owing to the combined effect of his migraines, seizures, and asthma (of which plaintiff’s migraines were the most significant factor in the VA disability calculus).

The Court noted that while an ALJ’s credibility findings are due “significant deference”, in this case, the ALJ did not ask the plaintiff any questions during the short 15 minute hearing.  Moreover,

The ALJ failed entirely to discuss the alleged medication side effects mentioned above, including to what extent those side effects occurred during the period at issue here, prior to the introduction of narcotic pain medication; plaintiff had earlier reported drowsiness and weakness as side effects of amitriptyline. In short, the ALJ’s credibility determination is not supported by substantial evidence, and is not deserving of deference under these circumstances.

The Court concluded the decision as follows:  “In sum, the decision of the SSA is not supported by substantial evidence, and the undersigned therefore concludes that reversal and remand to the agency are in order in this case.”

Exceptions to Mariaz

Generally, it is harmless error if an ALJ fails to find an impairment severe as long as the ALJ finds at least one other severe impairment and proceeds with the remaining steps of the sequential evaluation process. Mariaz v. Sec. of Health and Human Services, 837 F.2d 240 (6th Cir. 1987).  The general rule, though, should not apply if the ALJ failed to consider the limitations caused by an impairment in determining residual functional capacity.  The following non-exhaustive list of cases address the situations when Mariaz does not apply:

  • Griffin, 2012 U.S. Dist. Lexis 28214
  • Steele v. Astrue, 2013 U.S. Dist. Lexis 11717
  • Childs, 2013 U.S. Dist. Lexis 9021
  • Sparck, 2012 U.S.Dist. Lexis 129852

If you have been denied disability benefits, feel free to contact Patrick Cruise for a free consultation. 

Chronic Pain

Clint Cooper, a staff writer for the Chattanooga Times Free Press, published a very good article on Chronic Pain in today’s paper.  If your chronic pain keeps you from working, feel free to contact Patrick Cruise at The Hamilton Firm for a free consultation. You may be entitled to disability benefits.

Failure to seek Mental Health Treatment

“It is a questionable practice to chastise one with a mental impairment for the exercise of poor judgment in seeking rehabilitation.”  Blankenship v. Bowen, 874 F.2d 1116 (6th Cir. 1989).

Inability to Afford Medical Treatment

SSR 82-59 addresses this issue in detail. In any case involving an allegation that the claimant is unable to afford medical treatment, SSR 82-59 should be carefully reviewed. See also: Slaughter v. Astrue, 857 F.Supp.2d 631 (S.D. Tex. 2012)

Compassionate Allowances

There are now 200 conditions on the compassionate allowances list.  Click here to see the current list

Additional information on compassionate allowances can be found in POMS DI 23022, et al