United States District Court, D. Rhode Island
J. McConnell, Jr. United States District Judge
Houle applied for disability insurance benefits and
supplemental security income, claiming disability as of May
1, 2013. Her claims were denied initially and on
reconsideration. She appealed and requested a hearing. The
Administrative Law Judge found that based on her residual
function capacity ("RFC"), Ms. Houle was capable of
successfully adjusting to other work and therefore was not
disabled. Ms. Houle appeals to this Court claiming that the
ALJ improperly weighed the opinions of the treating
therapists and failed to evaluate properly Ms. Houle's
Houle is a 48-year-old mother of three young children, who
completed the ninth grade and lives with her mother. Over the
years, she has been employed as a cashier at a gas station
and an attendant at a dom.it shop, both jobs described as
light and unskilled in nature. She left her gas station job
because she birthed a child prematurely, and she left her
donut shop job due to her anxiety. She has not worked since
May of 2013 and claims to be unable to work because she has
difficulties getting along with others.
Houle has had long-standing mental health impairments. The
ALJ found that she has dysthymic (depression) disorder,
attention deficit hyperactivity disorder, borderline
intellectual functioning, and general anxiety disorder. She
found each of these was a severe impairment and caused more
than a slight restriction in Ms, Houle's ability to
perform basic work-related activities. The ALJ found that
these impairments did not meet or did not medically equal the
criteria of listing conditions. The ALJ concluded that Ms.
Houle had a RFC to perform "a full range of work at all
exertion levels, but with some nonexertional
limitations." While she is unable to perform past
relevant work as a cashier, the ALJ found that based on the
testing of the vocational expert that Ms. Houle could
successfully adjust to other work, including occupations such
as a cleaner, inspector, production laborer, and machine
tender - all jobs that would limit her need to interact with
the public. Based on these findings, the ALJ found that Ms.
Houle was not disabled.
Court's review of facts determined by the Commissioner is
limited to whether the Commissioner's findings are
"supported by substantial evidence." 42 U.S.C.
§ 405(g). The Court "must uphold the
[Commissioner's] findings ... if a reasonable mind,
reviewing the evidence in the record as a whole, could accept
it as adequate to support his conclusion." Irlanda
Ortiz v. Sec'y of Health & Human Servs., 955
F.2d 765, 769 (1st Cir. 1991) (internal quotation marks
omitted) (quoting Rodriguez v. Sec'y of Health &
Human Servs., 647 F.2d 218, 222 (1st Cir. 1981)). Thus,
the Court "must affirm the [Commissioner's final
decision], even if the record could arguably justify a
different conclusion, so long as it is supported by
substantial evidence." Rodriguez Pagan v. Sec'y
of Health & Human Servs., 819 F.2d 1, 3 (1st Cir.
1987) (per curiam). Substantial evidence is "more than a
mere scintilla. It means such relevant evidence as a
reasonable mind might accept as adequate to support a
conclusion." Richardson v. Perales, 402 U.S.
389, 401 (1971) (internal quotation marks omitted) (quoting
Consolidated fidison Co. v. NLRB, 305 U.S. 197, 229
Houle claims the ALJ erred in establishing her RFC because
the ALJ made a decision on the RFC without the aid of a
medical opinion, the two treating therapist's opinions
were inappropriately dismissed, and the ALJ inappropriately
relied on GAF scores.
Ms. Houle claims that the ALJ improperly weighed the opinion
evidence. Ms. Houle is correct that an ALJ lacks the
expertise to make an RFC assessment without an opinion from a
physician. Rivera-Torres v. Sec'y of Health &
Human Servs., 837 F.2d 4, 7 (1st Cir. 1988) (per curiam)
(citing Berrios v. Sec'y of Health & Human
Servs., 796 F.2d 574, 576 (1st Cir. 1986)) ("[T]he
ALJ, a lay factfinder, lacks sufficient expertise to conclude
claimant has [certain functional abilities]. Rather, an
explanation of claimant's functional capacity from a
doctor is needed."). However, the ALJ here did not make
the RFC assessment without the aid of medical opinion. The
ALJ's RFC finding is substantively consistent with the
opinions of two consulting psychologists, Dr. John Warren and
Dr. Jeffery Hughes. Both medical doctors found that Ms. Houle
was not disabled. Dr. Warren found that Ms. Houle was able to
understand/remember simple instructions, but unable to do so
for moderately to highly complex/detailed instructions; able
to sustain the mental demands associated with carrying out
simple tasks over the course of a routine workday/workweek
with acceptable attention, persistence, and pace tolerances,
but unable to do so for moderately to highly complex/detailed
tasks requiring sustained attention! and able to sustain the
basic demands associated with relating adequately with
supervisors/co-workers, but unable to interact appropriately
with the general public. Dr. Hughes independently came to the
same conclusion that Ms. Houle was not disabled. These
medical opinions are consistent with the ALJ's RFC
Ms. Houle claims that the ALJ did not afford the appropriate
weight to the opinions from her two treating therapists.
Neither therapist is an "acceptable medical source"
under agency regulations, and therefore neither therapist is
entitled to the controlling weight afforded to a
claimant's treating sources. 20 C.F.R. §§
404.1513(a), 416.913(a) (stating that acceptable medical
sources include licensed physicians and licensed or certified
psychologists). Although not entitled to controlling weight,
their opinions, for other purposes, may be considered,
including showing the severity of the individual's
impairment and how it affects the ability to function.
The ALJ could not simply ignore [the therapist's]
opinion. Although acceptable medical sources are the
primary sources of evidence about the severity of impairment
and its effect on work abilities, they are not the sole
permissible sources of such evidence. 20 C.F.R. §§
416.913(d); 416.929(c)(3). [The therapist] was a medical
source capable of providing evidence about the severity
and effects of impairment, as well as a general source of
evidence. 20 C.F.R. §§ 416.902, 416.912(b),
416.913(d), 416.945(a). The ALJ was required to weigh all of
the evidence. 20 C.F.R. §§ 416.920(a)(3), 416.920a
(a) & (c); 416.927(c).
Alcantara v. Astrue, 257 F.App'x 333, 334-35
(1st Cir. 2007) (per curiam).
exactly what the ALJ did here. She stated that she considered
all opinion evidence and reviewed extensively the report and
findings of the two therapists. The ALJ found an inherent
conflict between the therapists' assessments because one
of the therapists gave Ms. Houle a GAF score of 55 while the
other gave her a 60. After her extensive review of all of the
evidence, the ALJ found a RFC that was consistent with the
two state agency consultants, Drs. Warren and Hughes. This
Court cannot say that substantial evidence did not support
the ALJ's findings.
Ms. Houle claims that the ALJ failed to evaluate properly Ms.
Houle's sxibjective complaints, alleging that the
ALJ's findings concerning Ms. Houle's credibility
were cursory and conclusory and lacked the required specific
findings. The ALJ was required to determine the extent to
which Ms. Houle's subjective complaints of symptoms and
resulting limitations could be credited. See 20
C.F.R. §§ 404.1545(a), 416.945(a); Avery v.
Sec'y of Health & Human Servs.,797 F.2d 19, 29
(1st Cir. 1986). Here, the ALJ considered Ms. Houle's
activities of daily living, including her ability to care for
herself and her children, the fact that she did not seek
treatment for her allegedly disabling mental impairments for
the majority of her adult life, her failure to consistently
comply with prescribed counseling and medication, and normal
mental status evaluations noted by psychiatrist Dr. David E.
Kroessler. Contrary to Ms. Houle's arguments, the
ALJ's assessment of the credibility ...