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Stiffey v. Colvin

United States District Court, W.D. Pennsylvania

March 17, 2017

LORI A. STIFFEY, Plaintiff,
v.
CAROLYN W. COLVIN, Acting Commissioner of Social Security, Defendant.

          MEMORANDUM OPINION

          Lisa Pupo Lenihan United States Magistrate Judge

         I. Introduction

         This case is before the Court on appeal from a final decision by the Defendant, the Acting Commissioner of Social Security (“the Commissioner”), denying the claim of Plaintiff Lori A. Stiffey (“Stiffey”) for social security disability income (“SSDI”) and supplemental security income (“SSI”) under Title II and Title XVI, respectively, of the Social Security Act (“SSA”). Stiffey filed her Complaint seeking judicial review pursuant to 42 U.S.C. § 405(g), (ECF No. 3), and the parties have submitted cross-motions for summary judgment with briefs in support.[1](ECF Nos. 12, 13, 18, 19). The Commissioner's motion seeks affirmance and Stiffey's motion seeks remand. In accordance with the provisions of 28 U.S.C. § 636(c)(1), the parties have voluntarily consented to have a United States Magistrate Judge conduct proceedings in this case, including the entry of a final judgment. For the following reasons, the Court will grant the Commissioner's motion, deny Stiffey's motion, and affirm the denial of benefits.

         II. Statement of the Case

         A. Procedural History.

         On September 7, 2012, Stiffey protectively filed an application for SSDI, and on September 10, 2012, she protectively filed an application for SSI. (ECF 13 at 3); R. 25.[2]Although she initially alleged that her disability began on November 19, 2006, she amended her onset date to May 20, 2010 at the hearing held on June 26, 2014. R. 72. Stiffey remained insured through December 31, 2012. Stiffey's claims were initially denied and she filed a timely request for a hearing, which was held before Administrative Law Judge (“ALJ”) Brian W. Wood on June 26, 2014. R. 45. Stiffey was represented by counsel and testified at the hearing, as did an independent vocational expert (“VE”), Karen Crowell. R. 45. By Decision dated September 5, 2014, the ALJ determined that Stiffey was not disabled under the SSA, and therefore, was not entitled to SSDI or SSI benefits. R. 25-40.

         Stiffey timely filed for review by the Appeals Council of the ALJ's determination that she was not disabled under the Act. The Appeals Council denied review on July 29, 2015. R. 1. Thus, the ALJ's Decision became the Commissioner's final decision for purposes of this Court's review. Having exhausted her administrative remedies, Stiffey filed the instant action seeking judicial review of the final decision of the Commissioner of Social Security denying her SSI and SSDI applications. With leave granted December 21, 2015, (ECF 2), Stiffey proceeds in forma pauperis.

         B. General Background

         Stiffey has a high school education, R. 25, 40, 50, and attended online college studying business organization for four years, but did not obtain her bachelor's degree because she did not pay the matriculation fee. R. 50, 51. She was 41 years old on the amended date of her alleged onset of disability, May 10, 2010, R. 49, 72, placing her in the age category of younger person under the regulations. 20 C.F.R. §§ 404.1563(c), 416.963(c). She lives at home with her husband and with her daughter, who attends college. R. 49. Stiffey previously worked as a school bus driver; as a teacher/counselor for a youth emergency shelter, which involved her watching the children, teaching them skills, taking them on outings, and doing paperwork; and on a paper route. R. 51, 52.

         C. Medical Record

         1. Physical Health Treatment Records

         Stiffey underwent back surgery in 2006 and 2008 after being diagnosed with herniated nucleus pulposus. R. 353, 354. Surgery was to relieve low back pain that radiated into her right buttock and thigh as steroids and narcotics had only provided moderate pain relief. R. 352, 486. She also has degenerative disc disease, R. 353, 356, that ultimately may require a fusion procedure as indicated by her physician in February of 2008. R. 352-353.

         Stiffey sought emergency room treatment for her low back pain in January of 2009, R. 269, and was prescribed analgesics, vicodin and a muscle relaxer. R. 268. At the beginning of February of 2010, a lumbar spine MRI revealed a mild degree of spinal stenosis in the L4-5 level with a bulging disk, recurrent moderate L5/S1 disk protrusion, and degenerative disk disease. R. 295. She was referred to physical therapy. R. 298. She appeared for a physical therapy evaluation on February 23, 2010, R. 297, at which she reported pain at its worse as high as 8 or 9 on a 10 point scale and difficulty sitting or standing for prolonged periods of time. R. 297, 298. The evaluation noted a decreased lumbar range of motion, decreased trunk strength, low back pain with radiculopathy, and gait abnormality. Stiffey only attended the single session of physical therapy. (ECF No. 13 at 6). May 24, 2010 treatment notes from her primary care physician, Dr. Jeffrey Reyer, DO, also indicated that she experienced chronic low back pain. R. 359. On June 16, 2010, Stiffey was treated in the emergency room for pain related to her gall bladder, regarding which she indicated that she was to have it removed but had not done so because of the prior back surgeries. R. 272. Dr. Reyer's treatment notes from November 22, 2010 indicate no back pain. R. 361. On December 22, 2010, Stiffey was treated at an urgent care center by Dr. Laila Avelta for low back pain radiating down her left leg. R. 569-570. Dr. Avelta indicated left sciatica and prescribed steroids, vicodin, toradol and muscle relaxers. R. 570. As indicated in Dr. Reyer's treatment notes from January 17, 2011 and May 4, 2011, she did not present with back pain, R. 369, 373, but he noted in his treatment notes from visits for other issues in May 2011 and August 2011, that her issue with chronic low back pain continued, R. 377, 385, and also noted some relief with Robaxin. R. 357.

         Stiffey was treated at the hospital on March 13, 2012, as a result of a fall, displayed pain on physical exam, and was diagnosed with low back pain, but denied any pain radiating down her legs, shortness of breath or chest pain. R. 304. An x-ray revealed moderate degenerative narrowing of the L5-S1 interspace but no spondylosis. R. 305. MRI on June 12, 2012 showed a minor annular bulge and mild to moderate facet arthrosis with mild bilateral recess narrowing at ¶ 4-5 and moderate L5-S1 disk space narrowing and desiccation with chronic endplate reactive changes, and moderate degenerative disk disease with no recurrent disk protrusion or nerve impingement. R. 306

         Stiffey had her thyroid removed in 2005 due to cancer, and must take synthroid (levothyroxine) as a result, but is not fully compliant with taking her medication. R 302-303. She has a two pack a day history as a smoker, but indicated in 2012 and at the hearing that she was trying to decrease and attempt to quit smoking, and also indicated that she smoked a half of a pack a day. R. 69, 397, 606. The records reflect Stiffey treated at the urgent care on January 27, 2010 for chest pain on breathing, and was prescribed steroids and vicodin. R. 572-573. Then in February 2010, Stiffey experienced shortness of breath and chest pain, had diagnostic imaging that was unremarkable, and again was prescribed steroids and vicodin. R. 296. On December 22, 2010, Stiffey treated at the urgent care for cough and chest pain and was prescribed steroids and vicodin. R. 570-571. Stiffey had a cardiac stress test on November 2, 2012 to evaluate her chest pain, R. 511, which revealed no evidence of ischemia, but which was stopped before completion due to Stiffey's shortness of breath. R. 511. Pulmonary function tests were performed March 8, 2013, revealing moderate airflow obstruction with mild restrictive defect and decreased diffusion lung capacity, which was suggestive of emphysema with smoking history and which also could be related to her body habitus (obesity) versus interstitial lung disease. R. 586. Her respiratory findings were normal in the beginning of 2014. R. 558.

         Dr. Singh. Plaintiff began treating with Dr. Daljit “Davis” Singh, MD, on January 24, 2014, regarding her low back and leg pain and intermittent diarrhea. R. 557. He reviewed her history and medications noting that she complained of back pain, headache, diarrhea, anxiety and depression, was then taking synthroid, baclofen, and acetaminophen/hydrocodone, and was treating with a psychologist for anxiety and depression and also taking Abilify, Klonopin, and Wellbutrin for her mental health. R. 557. Dr. Singh continued the prescription of acetaminophen/hydrocodone and muscle relaxer for her back pain. R. 558.

         2. Mental Health Treatment Records

         Stiffey treated for her mental health at the Family Counseling Center of Armstrong County (“FCC”) from June 24, 2010, through January 16, 2014. R. 429, 601. Several therapists and physicians, including Kelly M. Rock, CRNP (“Nurse Rock”), counselor Gayle Richardson, M.A., Kimberly Altmeyer, LCSW, Dr. Mahendra Patil, M.D., and Dr. Mary Galonski, M.D., participated in her mental health care at FCC, which included several medical management appointments and counseling. Nurse Rock in particular treated Stiffey on numerous occasions at the FCC during that time period. Based on Stiffey's initial visit in 2010, Nurse Rock noted Stiffey's affect was constricted and fatigued; she was anxious, irritable and depressed; her short term memory was impaired; she expressed suicidal ideation in thoughts; and she maintained attention and had logical thought process. R. 430-431. Nurse Rock assessed Stiffey to have major depression, agoraphobia with panic disorder, and generalized anxiety, and prescribed her Celexa. R. 431. Her GAF[3] score in June of 2010 was 60. R. 431. Treatment notes from Kimberly Altmeyer from October 11, 2010, R. 434, indicate Stiffey's major depression, agoraphobia with panic disorder, and generalized anxiety continued, her GAF was then assessed at 58, R. 434, and Stiffey had not been compliant with therapy. R. 435. Dr. Patil assessed her on November 23, 2010 at the FCC, R. 439, with euthymic mood and appropriate affect, intact memory, logical thought process and assessed her GAF as 65. R. 437. Dr. Patil also noted that as Stiffey had been compliant with her medication for the past couple of weeks, she had noticed mood leveling and overall felt 60% better. R. 436.

         Nurse Rock's February 24, 2011 notes indicate that Stiffey reported she had not taken her synthroid for a month or more because of the $3.00 co-pay, had dropped out of therapy, and had not gone to MD appointments that she should because of lack of money for gas. R. 440. Stiffey also indicated she had a supportive friend who she helped deliver newspapers. R. 440. At that appointment, Stiffey indicated she had intermittent suicide ideation, was very tearful, rated her depression from 6-8 on a ten point scale, and had broken sleep due to health problems and pain. R. 440. Nurse Rock indicated that Stiffey's affect was constricted, her mood was depressed, but that her memory was intact, she was cooperative, maintained attention, and she had logical thought processes. R. 441. Nurse Rock saw Stiffey on March 17, 2011, and noted that Stiffey had low energy, was tearful, experienced poor sleep and had intermittent suicide ideation. R. 444-445. Nurse Rock next saw Stiffey on April 21, 2011, and Stiffey reported that her depression was well controlled and that she was taking medication consistently. R. 446. On July 28, 2011, Nurse Rock noted that Stiffey reported having good days and bad days, and rated her depression as an 8 and her anxiety as a 5-6 on a ten point scale. R. 450. Nurse Rock observed that Stiffey's mood was depressed, but her affect was appropriate, her memory was intact, her attention was maintained, and she was planning on spending time away in Indiana to reduce stress. R. 450, 451. Her medication was changed from Celexa to Effexor XR. R. 452. On August 18, 2011, Nurse Rock's notes indicate that Stiffey had a relationship with an individual in Indiana and was planning to be in Indiana for three months to “clear her head and ‘relax, '” R. 454, 456; she had issues with sleep, anxiety, crowds; and she denied suicide ideation but indicated a passive death wish when completely stressed. R. 454.

         On March 1, 2012, Nurse Rock indicated that Stiffey had returned from Indiana in November of 2011 after being away for 3 months, had been off all of her psychiatric medications for 4-6 weeks at the time of her appointment, and her symptoms had returned including mood lability. R. 460. Stiffey reported that when she is off of her medications she has intermittent visual hallucinations consisting of intermittently seeing shadows and flashing lights. R. 460. Stiffey was assessed a GAF score of 55. R. 462. On April 24, 2012, Gayle Richardson, M.A., assessed Stiffey with a GAF of 55. On May 17, 2012, Nurse Rock noted Stiffey's GAF was 57, R. 469, noted that Stiffey had not been consistent with taking her synthroid and noted that she had self-reduced her Effexor to half the dose because she felt tired and “zoned out” from the medication, but that Effexor had resulted in her feeling less depressed, less often. R. 467. The treatment notes also reflected that Stiffey's concentration and attention were poor at that time, R. 467, but that Stiffey indicated she does better when she keeps herself busy. R. 467. On August 22, 2012, she was assessed with a GAF of 58. R. 471. On October 25, 2012, Nurse Rock noted that Stiffey indicated that she had started Abilify and that her “visual hallucinations” had “eased off, ” her mood and paranoia had somewhat improved, and her depression was not as bad. R. 474. Stiffey was still experiencing irritability, R. 474, felt a bit more tired, continued to have problems with concentration, attention and focus, had good days and bad days, R. 474, and occupied her time with Facebook and arts and crafts. R. 474. The treatment notes for this appointment also indicated a diagnosis of bipolar disorder. R. 474. Nurse Rock's treatment notes from October 25, 2012, indicate a GAF of 57, R. 639, constricted affect, distracted attention, visual hallucinations, but logical thought process and no suicide ideation. R. 638. Treatment notes from November 20, 2012, indicated ongoing issues with depression and anxiety, racing thoughts and excessive worry. R. 651. They also reflect that Stiffey enjoys crafts, cooking, walking and computer games. R. 650. Treatment notes from November 29, 2012, indicate that Stiffey had 3-4 good days a week when she did not have anxiety associated with going places and doing things, but on bad days she felt depressed, irritable and edgy. She had a lot of “anticipatory anxiety” and a passive death wish, but no panic attacks or suicide ideation. R. 632. Stiffey was taking her medication, R. 633, and Abilify helped to drastically reduce her visual hallucinations. R. 632. Her GAF then was assessed as a 58. R. 634.

         In January 31, 2013, Stiffey denied suicide ideation, but expressed a passive death wish. R. 627. She indicated that since taking Abilify her visual hallucinations were very rare. R. 627. She was prescribed Neurontin for anxiety. R. 621. Her GAF at that time was assessed as a 56. R. 629. On April 4, 2013, her GAF was assessed as a 55, R. 623, her Effexor was increased, R. 624, and her Neurontin was discontinued as she reported no effect from the medication. R. 624. She denied suicide ideation at that time, but felt overwhelmed and was “scattered and disorganized.” R. 621. Gayle Richardson, MA, assessed Stiffey with a GAF of 56 in March of 2013 and notes indicate continuing issues with panic, anxiety and depression. R. 649. Her GAF on June 6, 2013, as indicated by Nurse Rock, was a 59. R. 618. Her affect was appropriate and her thought process was logical. R. 617. Stiffey was planning at that time to host graduation party and baby shower. R. 616. Her anxiety was better overall, R. 616, but her inattention and concentration remained unchanged. R. 616. She experienced anxiety triggered by crowds, R. 616, and had experienced the previous visual hallucinations. R. 617. Again, in July of 2013, Gayle Richardson, MA, indicated Stiffey's continuing issues with panic, anxiety and depression and then assessed her with a GAF of 57. R. 645. On August 15, 2013, Nurse Rock indicated Stiffey's GAF was assessed as a 56. R. 613. Stiffey's affect was appropriate and her thought processes were logical. R. 612-613. She noted improved depression and anxiety and decrease in visual hallucinations, and denied suicide ideation. R-613. 612. She indicated that she enjoyed cooking and crafts but concentration and focus remained a problem R. 611. Gayle Richardson, M.A., assessed Stiffey with a GAF of 57 on October 9, 2013. R. 642. On November 14, 2013, Stiffey reported to Nurse Rock that she does not like to go into stores, large groups make her uncomfortable, and she had suicide ideation. R. 606-607. Her affect was constricted, her attention was gained and distracted, but her visual hallucinations were rare and her thought process was logical. R. 606-607. Stiffey indicated she did not take her Effexor as prescribed because it made her tired, R. 606, and her Effexor prescription was decreased. R. 609.

         On January 16, 2014, Nurse Rock noted that Stiffey had quit on her own taking the Effexor because it made her tired. R. 601. She was then prescribed Wellbutrin, R. 604, which also could help Stiffey with her efforts to stop smoking. R. 604. Stiffey's affect was constricted, but her attention was maintained and her thought process was logical. R. 602. She did not express suicide ideation, her visual hallucinations were rare, but she expressed having trouble finishing projects and experiencing panic in public, was avoiding large crowds and expressed a passive death wish. R. 601-602. Her GAF was assessed at 57 at that time. R. 603.

         3. Opinion Evidence

         The record includes opinion evidence from treating, examining consultative and non-examining consultative sources.

         a. Treating & Examining Source Opinions

         Dr. Singh. Related to her back pain and on the basis of Stiffey's one visit on January 24, 2014 treating with Dr. Singh, R. 557, Dr. Singh completed a “Residual Functional Capacity Questionnaire” dated May 31, 2014, which consisted of twelve separate questions. R. 662-663. Dr. Singh provided on the checklist form that: Stiffey had low back pain, that her “symptoms associated with [her] impairments” were “constantly” “severe enough to interfere with the attention & concentration required to perform simple work-related tasks, ” that the side effects of her medications were “tired/dizziness/sleepy;” and hat her prognosis was fair to poor. R. 662. He further indicated that she could walk less than one block without rest or significant pain; that she could sit for 15 minutes at one time, could walk for 10 minutes at one time, and could sit for 5 hours out of an 8 hour day; that she needed a job that permitted shifting positions at will, and needed to take an indefinite number of unscheduled fifteen minute breaks during the workday; that she would be absent from work as a result of her impairments more than four times a month; that she could occasionally lift 10 pounds or less, but never 20 pounds or more; and that she had no limitations in repetitive reaching, handling or fingering. R. 662-663. Dr. Singh did not, however, indicate any answer to question 8(c) regarding the number of hours Stiffey could stand/walk in an 8 hour workday nor to question twelve posing the question: “[i]s your patient physically capable of working an 8 hour day, 5 days a week employment on a sustained basis.” R. 663. Dr. Singh also did not provide any written evaluation with the checklist form. R. 662-663. Ultimately, the ALJ accorded “little weight” to Dr. Singh's checklist opinion. R. 36.

         Dr. Malik. State Agency Consultative Examiner, Dr. Mohammad Malik, M.D., examined Stiffey on January 16, 2013, and completed a consultative evaluation with report based on his own physical examination of her, noting Stiffey was able to get off the exam table without difficulty. R. 523. In considering her range of motion in numerous areas and detailing same on a range of motion chart, R. 527-528, his examination revealed only a slightly decreased flexion of the lumbar spine. R. 521, 528. He also determined that Stiffey had equal reflexes in the knees and ankles and equal muscle strength in her quadriceps and in her hamstrings. R. 523. Ultimately, Dr. Malik opined that Stiffey could occasionally both lift and carry up to twenty lbs., that she could stand and walk up to four hours in an eight hour workday, that she could sit four hours in a work day, that her pushing and pulling was not limited, R. 525, that she could only occasionally engage in posturals (bending, kneeling, stooping, crouching, balancing, and climbing), R. 526, and that she could not be exposed to heights and moving machinery. R. 526. The ALJ gave Dr. Malik's opinion great weight, R. 37, but also determined that Stiffey's ability to sit for a longer period was “slightly more limited due to pain with prolonged sitting.” R. 37.

         Nurse Rock. Stiffey was seen repeatedly by Nurse Rock for mental health issues and medication management at the FCC, beginning in June 24, 2010 through January, 2014. Nurse Rock completed three mental capacity assessments, which were dated September 20, 2012, R. 495, December 26, 2013, R. 553 and February 27, 2014, R. 657, and which were all check the box forms without further report and on which Nurse Rock declined to describe the medical/clinical findings that support her assessment, though requested. R. 495-497, 553-555, 657-659. The September 20, 2012 assessment indicated a marked[4] limitation in the ability to understand and remember detailed instruction; carrying out detailed instructions; maintaining attention and concentration for extended periods; and completing a normal workweek without interruption due to psychologically based symptoms. R. 495-496. It indicated a moderate limitation: in the ability to perform activities within a schedule, maintain attendance, and be punctual within customary tolerances; the ability to work in coordination with or in proximity to others without distraction; the ability to compete a normal workday without interruptions from psychologically based symptoms; the ability to perform at a consistent pace; the ability to accept instructions and respond appropriately to criticism from supervisors; the ability to get along with coworkers without distracting them or exhibiting behavioral extremes; the ability to respond appropriately to changes in work setting the ability to travel to unfamiliar places or use public transportation; and the ability to set realistic goals or make plans independent of others. The form also provided that Stiffey likely would miss work two times a month. R. 496.

         The December 26, 2013 assessment was similar to the September 20, 2012 assessment, but then indicated a marked as opposed to moderate limitation: in the ability to perform activities within a schedule, maintain regular attendance, and be punctual within customary tolerances; in the ability to work in coordination with or in proximity to others without being distracted by them; the ability to complete a normal workaday without interruptions from psychologically based symptoms; the ability to perform at a consistent pace with a standard number and length of rest periods; and the ability to set realistic goals or make plans independently of others. R. 553-554. It indicated a moderate as opposed to slight limitation in the ability to interact appropriately with the general public, maintain socially appropriate behavior and adhere to basic standards of neatness and cleanliness. R. 554. It indicated a slight as opposed to moderate limitation in the ability to accept instruction and respond appropriately to criticism from supervisors. R. 554. Where the December 26, 2013 form requested how many absences Stiffey likely would have in a month, Nurse Rock indicated “unknown.” R. 554.

         Finally, the February 27, 2014 assessment was similar to the December 26, 2013 assessment, but indicated an extreme as opposed to marked limitation: in the ability to carry out detailed instructions and to maintain attention and concentration for extended periods; in the ability to perform activities within a schedule, maintain regular attendance, and be punctual within customary tolerances; in the ability to work in coordination with or in proximity to others without being distracted by them; in the ability to complete a normal workday without interruptions from psychologically based symptoms, to complete a normal workweek without interruptions from psychologically based symptoms, and to set realistic goals or make plans independently of others; a marked as opposed to moderate limitation in: the ability to sustain an ordinary routine without special supervision and to travel in unfamiliar places or use public transportation R. 657-659. It indicated a moderate as opposed to slight limitation in the ability to accept instructions and respond appropriately to criticism from supervisor. R. 658. It also indicated a slight as opposed to marked limitation in the ability to understand and remember detailed instruction. R. 657. The form provides that Nurse Rock anticipated Stiffey likely would miss work “4” times a month. R. 658. The ALJ gave little weight to Nurse Rock's check the box opinions. R. 37.

         Dr. Charles Kennedy, PhD. Dr. Kennedy completed a mental consultative examination of Stiffey on November 8, 2012. R. 498. Dr. Kennedy diagnosed Stiffey with panic disorder with agoraphobia, and major depressive disorder. R. 503. Dr. Kennedy's notes in support of his opinion indicated that Stiffey arrived on time with fair appearance and hygiene, R. 498, responded appropriately to his request, was well-mannered and displayed fair self-sufficiency. R. 498-499. Dr. Kennedy observed that Stiffey maintained good eye contact, her psychomotor activity and speech was normal, her affect was appropriate with limited range of expression, her emotional expression was appropriate to thought content and situation, she put forth good effort to answer questions, she sustained attention throughout the entire process of his exam, her stream of thought was goal-directed, and her abstract thinking was good. R. 501. Stiffey did not reveal any delusions or perceptual disturbances. R. 501. She also expressed that she has a passive death wish, lacks motivation, sleeps excessively, has trouble concentrating, and isolates herself. R. 499. Dr. Kennedy assessed that Stiffey had marked restrictions in interacting appropriately with the public, and moderate restrictions interacting appropriately with a supervisor and co-workers, responding appropriately to work pressures in a usual work setting and to changes in a routine work setting, and in understanding, remembering and carrying out detailed instructions. R. 506. Dr. Kennedy assessed Stiffey with a GAF of 55 and indicated a “fair” prognosis. R. 503. The ALJ gave significant weight to Dr. Kennedy's opinion. R. 37.

         GAF Scores. As indicated supra, (p. 6 at n.3), GAF scores are considered medical opinion evidence by the Social Security Administration. Stiffey points out in her brief that her GAF scores as assessed by her treatment providers remained at 65 throughout 2011, R. 444, 452; (ECF 13 at 7), which connotes mild difficulty in functioning at that time. Her GAF scores from her treatment providers at the FCC ranged from 55 to 58 in 2012. Similarly, in 2013, her treatment providers at the FCC assessed her with GAF scores from 55 to 59. Finally, in 2014, she was assessed with a GAF score of 57 at the FCC. Dr. Kennedy, the consultative examiner assessed Stiffey's GAF score to be 55 on November 8, 2012. R. 503. Thus, Stiffey's GAF scores from 2011 connoted mild difficulty in social, occupational or school functioning, and her GAF scores from 2012 through 2014 connoted moderate difficulty. The ALJ gave great weight to the GAF scores assessed throughout Stiffey's treatment record. R. 38.

         b. Non-Examining Source Opinions

         Dr. Nghia Van Tran, MD. The state agency non-examining medical consultant, Dr. Van Tran completed a physical RFC assessment on March 27, 2013. R. 115-117, 129-131. Dr. Van Tran indicated that Stiffey would be limited to unskilled work and that she had the maximum sustained work capability for light work with additional restrictions, R. 133, that she occasionally could lift 20 lbs. and frequently could lift 10 lbs., that she could stand and/or walk with normal breaks for about 6 hours in an 8 hour workday, that she could sit about 6 hours in an 8 hour workday, that her push/pull was unlimited except for the lifting and carrying weight restrictions, that she could occasionally engage in posturals, and that she must avoid even moderate exposure to extreme cold and heat, wetness, humidity, fumes, odors, gases, and poor ventilation. R. 115-116. Dr. Van Tran's assessed ...


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