UNITED STATES DISTRICT COURT FOR THE DISTRICT OF NEW HAMPSHIRE
Brenda L . Corson
v. Civil N o . 12-cv-371-PB Opinion N o . 2013 DNH 144 U.S. Social Security Administration, Commissioner
MEMORANDUM AND ORDER
Brenda Corson seeks judicial review of a ruling by the
Commissioner denying her application for disability insurance
benefits (“DIB”) because she failed to prove that she was
disabled at any point prior to September 3 0 , 1998, the last date
that she was eligible for DIB. Corson claims that the
Administrative Law Judge (“ALJ”) failed to properly credit
evidence from a treating medical source and failed to properly
consider lay evidence. She additionally argues that the ALJ’s
residual functional capacity (“RFC”) assessment is not supported
by substantial evidence because it failed to account for all of
Corson’s functional limitations. For the reasons set forth
below, I deny Corson’s request and affirm the decision of the
Commissioner. I. BACKGROUND1
A. Procedural History
Corson originally applied for DIB on August 5 , 2002,
alleging a disability onset date of July 2 2 , 1994. After the
Commissioner denied her application on August 2 7 , 2002, ALJ Ruth
Kleinfeld held a hearing on September 1 8 , 2003. Corson,
represented by an attorney, testified along with her daughter-
in-law. On April 3 0 , 2004, the ALJ issued a decision finding
that Corson was not disabled between the alleged onset date of
her disability and September 3 0 , 1998, her date last insured
(“DLI”). 2 After the Appeals Council denied Corson’s request for
review, this court issued a remand order, finding that the ALJ’s
decision was not supported by substantial evidence. Endorsed
Order, Corson v . Soc. Sec. Admin., Comm’r, N o . 04-cv-357 (D.N.H.
June 2 9 , 2005). The Appeals Council then vacated the earlier
decision and remanded the case.
The ALJ held a second hearing on September 7 , 2006. Corson
was absent, but her attorney appeared, as well as a medical
1 The background information is taken from the parties’ Joint Statement of Material Facts (Doc. N o . 1 3 ) . Citations to the Administrative Transcript are indicated by “Tr.” 2 In order to be eligible for DIB under the Social Security Act, Corson must demonstrate that she was disabled on or prior to her date last insured. See 42 U.S.C. § 423(c) .
2 expert and vocational expert. On February 2 5 , 2008, the ALJ
issued a second decision finding that Corson was not entitled to
benefits. This court then remanded the case a second time on a
motion by the Commissioner, and the Appeals Council subsequently
vacated the earlier decision and remanded the case. 3
On June 8 , 2010, ALJ Edward Hoban held a hearing at which
Corson, represented by an attorney, testified. Corson’s friend
Cynthia Vandermark also testified, as did medical expert D r .
Gerald Koocher and vocational expert Christine Spaulding. On
September 2 4 , 2010, the ALJ issued a decision finding Corson not
disabled at any time between her alleged onset date and her DLI.
On July 1 2 , 2012, the Appeals Council declined to assume
jurisdiction, making the ALJ’s decision the Commissioner’s final
decision and therefore subject to judicial review.
B. Medical History
Corson was forty-four years old on her alleged onset date
and forty-nine years old on her DLI. She has a high school
education and past relevant work as a housekeeper and laundry
worker. Although Corson originally claimed physical
3 The Commissioner moved for a limited remand to reevaluate whether Corson’s prior position as a file clerk constituted past relevant work. The court granted the motion subject to a broader scope, noting that the ALJ could revisit any issue he or she deemed appropriate. Endorsed Order, Corson v . Astrue, Comm’r of Soc. Sec., N o . 08-cv-441 (D.N.H. June 1 8 , 2009). 3 incapacitation along with her mental ailments, her arguments
here rest solely upon her alleged pre-DLI mental impairments.4
1. Treatment Summary, 1996-2005
On August 1 9 , 1996, Corson arrived without an appointment
at Community Medical Associates of Concord (“CMAC”), where she
had previously been treated for a back injury. She was crying
and stated that she was tired, not feeling well, and having
trouble with her husband. T r . at 191. Corson described herself
as “dirty and unkempt,” but the examining doctor, D r . Benson,
disagreed with her self-assessment, noting that she was “hardly
so.” D r . Benson diagnosed Corson as depressed and started her
on antidepressant medication, and on a visit later that month he
prescribed two additional medications to treat anxiety and
depression. Id.
On August 2 7 , 1996, Corson returned to CMAC and was treated
by Linda Douville, a nurse practitioner. Corson complained that
she felt tearful all the time, unlike herself, bored with her
life, and feared people snooping outside of her home. She also
reported continuing marital problems. In September, D r . Benson 4 Corson originally alleged back pain as a basis for disability, but now only challenges the ALJ’s assessment of her mental impairments. I thus need not address Corson’s physical work capacity. See Brun v . Shalala, N o . 93-320-B, 1994 WL 504305, at *1 n.3 (D.N.H. July 2 9 , 1994) (citing Alan Corp. v . Int’l Surplus Lines, Inc., 22 F.3d 339, 343 n.4 (1st Cir. 1994)).
4 advised Corson to remain on the same medications and to seek
counseling. Later in the month, Corson told Douville that she
had stopped taking two of her prescribed medications due to
headaches, but continued taking the third in order to sleep.
She stated that she was feeling better about her relationship
with her husband, whose physical and verbal abuse were allegedly
at the root of many of her problems. Id. at 192.
On October 9, 1996, Corson discussed her marital problems
with D r . Benson and reported that her husband did not want her
to work. Id. at 193. Later that month, Corson told Douville
that she was in better spirits and was contemplating working
part-time over the holidays, which Douville encouraged. On
November 2 1 , 1996, Douville reported that Corson’s depression
had resolved and encouraged Corson to get a driver’s license and
seek employment. Id. at 194.
On February 3 , 1997, Corson again reported trouble eating,
sleeping, and difficulties with her husband, and D r . Benson
restarted her on a second medication for depression. By mid-
month, Corson reported that she felt better but still tearful,
and D r . Benson restarted her on the third medication. Corson
reported being happier that March and continued taking her
medication. In September 1998 Corson told Douville that she was
“doing fine” and was back working. Id. at 200. 5 On February 1 0 , 1999, Corson told Douville that she was
stressed because her husband did not want her to work outside of
the home. Corson requested a replacement for two of her
medications due to headaches and she started a different
antidepressant. That March, Corson told Douville that she had
significant relief from anxiety while on her new medication, and
in September she told Douville that she felt more social.
Corson reported doing well on her new medication through late
2001. Id. at 200-01, 2 0 4 , 206.
In early 2002, medical authorities were first alerted to
potential problems beyond the scope of Corson’s previously
diagnosed chronic anxiety and depression. On February 6, 2002,
Douville documented a phone call from Corson’s son expressing
concern for Corson’s mental state. He specifically described
two episodes: one in which Corson saw “midgets” looking in the
window, the other in which she thought she had been shot. Id.
at 208.
On July 9, 2002, Corson first told Douville that she had
been having paranoid episodes manifesting in auditory
hallucinations, fear of the dark, and the fear that someone was
hurting her. Id. at 210. Douville reports that “she has had
these symptoms for a very long time, but has been afraid to tell
6 anybody about it.” Douville referred Corson to Concord
Psychiatry Associates (“CPA”) and increased her dose of
antidepressants.
On July 3 1 , 2002, Corson saw Joyce Blood, Ph.D., a nurse
practitioner at CPA.5 Id. at 225. Corson told Blood that she
constantly felt like crying, was afraid of the dark and afraid
to take a shower, and had auditory hallucinations and fears that
people were staring at her. Corson noted that she felt anxious,
stressed, and depressed, and reported excessive hand washing.
Blood observed that Corson behaved normally and had clear
thought processes, displaying average intelligence with a
depressed and anxious mood. Blood provisionally diagnosed6
Corson with a psychotic disorder, paranoid type, and ruled out
bipolar and obsessive-compulsive disorders. Id. at 226.
In a medical source statement dated March 2 6 , 2003, Blood
5 The Joint Statement of Material Facts refers to Blood as “Dr. Blood” because she has a Ph.D. Doc. N o . 1 3 . Acknowledging her doctorate in nursing, T r . at 5 6 7 , I refer to her as Blood because she is not a medical doctor, nor a licensed physician or psychologist for the purpose of diagnosing patients. See 20 C.F.R. § 404.1513(a). 6 A “provisional diagnosis” is used in circumstances of diagnostic uncertainty, when “there is a strong presumption that the full criteria will ultimately be met for a disorder but not enough information is available to make a firm diagnosis.” Am. Psychiatric Ass’n, Diagnostic and Statistical Manual of Mental Disorders 23 (5th ed. 2013).
7 opined on Corson’s mental ability to accomplish work-related
activities. Id. at 251. Blood found that Corson had marked
restrictions in her ability to understand and remember short,
simple instructions and moderate restrictions in her ability to
carry them out. She noted that Corson had marked restrictions
in her ability to understand, remember, and carry out detailed
instructions; moderate restrictions in her ability to make work-
related decisions and to interact appropriately with supervisors
and co-workers; and marked restrictions in her ability to
interact appropriately with the public and to respond to
changing pressures and work conditions. Blood opined that these
limitations were due to Corson’s high levels of anxiety and
agoraphobia. Id. at 252.
On September 3 , 2003, Blood gave an opinion on Corson’s
mental impairments for a Social Security prehearing mental
impairment questionnaire. Blood claimed that her opinion
applied both presently and prior to September 3 0 , 1998, Corson’s
DLI. Id. at 257. Noting that she saw Corson on a quarterly to
monthly basis, Blood reported a delusional disorder with a host
of signs and symptoms, including hallucinations, paranoia, and
anxiety.7 Blood noted that Corson’s anxiety decreased while she
7 The list of signs and symptoms that Blood found included: poor memory; appetite, sleep, and mood disturbance; emotional 8 was on psychotropic medications, and that she currently took an
antidepressant and medication for schizophrenia. Blood found
that Corson’s symptoms were likely to recur, and that she would
likely be absent from work more than three times per month due
to her mental impairments. Id. at 259. According to Blood,
almost all of Corson’s mental abilities were found to be either
“seriously limited” or “unable to function.” Blood opined that
Corson had no limitations on her ability to do daily tasks, but
marked difficulties in maintaining social functioning, frequent
difficulties with concentration, and repeated episodes of
decompensation in work-like settings. Id. at 261. She also
stated that if Corson were awarded benefits she could manage
them in her own best interest.
During the first half of 2005, Blood saw Corson roughly
once a month to discuss Corson’s depression and anxiety, both of
which were exacerbated by her husband’s recent death. At that
point, Corson was on five different medications for depression,
insomnia, and schizophrenia. On July 1 4 , 2005, D r . Thomas
Meehan, a doctor at CPA, reviewed Corson’s records at Blood’s
liability; hallucinations; recurrent panic attacks; psychomotor agitation; paranoia; difficulty concentrating; oddities of thought, perception, speech, or behavior; perceptual disturbances; social withdrawal; blunt, flat, or inappropriate affect; illogical thinking; obsessions; persistent irrational fears; and generalized persistent anxiety. T r . at 257. 9 request. D r . Meehan acknowledged that Corson presented
psychotic symptoms in 2002 when Blood began treatment and had
been ill for about two years before that, but that otherwise
Corson’s “past history was indicative of generalized anxiety and
possibly earlier depression,” with “no history of earlier onset
psychosis.” Id. at 393. In his written report, D r . Meehan
affirmed Blood’s diagnoses of psychotic disorder, NOS and major
depression, noting that he “would probably add Generalized
Anxiety Disorder.”
2. State Agency and Medical Expert Assessments
On August 2 7 , 2002, state agency psychologist Michael
Snyder, Psy.D., opined that the record contained insufficient
evidence to determine whether Corson had a psychosis-related
mental impairment prior to her DLI. On October 2 9 , 2007,
medical expert Gerald Koocher, Ph.D., opined that Corson
appeared to have psychosis with moderate impairments from 2002-
2005, but that there was no documentation to support a level of
severity beyond moderate, and that her condition seemed to have
improved with medication. T r . at 426. D r . Koocher further
stated that the record contained insufficient evidence to
determine whether Corson had a psychosis-related mental
impairment prior to her DLI.
10 C. Hearing Testimony
1. September 1 8 , 2003 Hearing
After initially testifying that she had not worked since
1992 because her husband forbade her from working due to her
anxiety, Corson testified that she had in fact worked for
several months in 1998 making turkey pies, but had left because
she did not like the job. Id. at 61-62. She stated that she
had been hospitalized for a nervous breakdown as a teenager.
Describing her mental impairments, Corson noted that during the
1990s she was afraid to take showers and feared people were
looking into her home. She testified that she frequently
hallucinated and heard voices. She did not tell Douville or
other medical authorities about her hallucinations because “she
was very scared to tell her.” Corson testified that she had
told her husband about the hallucinations, but he then told her
“it’s in your mind,” and that she did not know what she was
talking about. Id. at 7 0 . Medication did not help with the
hallucinations.
Corson’s daughter-in-law, Teresa Corson, also testified
that she first noticed Corson’s problems in 1994 or 1995, when
Corson would say she saw aliens or was afraid of people watching
her. Teresa Corson noted that the family spoke about getting
Corson help, but that she refused such offers. Teresa Corson 11 testified that several times Corson had to be driven from their
home in Cape Cod to New Hampshire in the middle of the night due
to her anxiety and concerns about aliens or neighbors watching
her. Id. at 8 4 . Teresa Corson testified that Corson would go
two or three months without problems, then in the next several
months would mention five different paranoid incidents. Id. at
85.
3. June 8 , 2010 Hearing
Corson again testified that she quit her job making turkey
pies because she did not like i t , and that she also quit a
dishwashing job during the alleged disability period because she
could not get along with her brother-in-law as a co-worker. Id.
at 631. Corson stated that she stopped working in 1992 due to
back pain and physical burnout, as well as stress. She alleged
that in 1992 she thought that she was seeing people and things
that were not there. She told her son, husband, and friend
about her hallucinations, but did not tell any doctors. Corson
testified that in 1998, her friend Tracy McAllister had to help
her shower because of her fears. When questioned, Corson could
not remember an incident from 1994 where her brother- and
sister-in-law convinced her to go to the hospital after she
alleged to have been shot by a motorcycle gang.
12 Corson’s friend Cynthia Vandermark testified to working
with Corson from 1989 to 1992, noting that Corson had always
been “up and down emotionally” and complained about stress.
Vandermark further testified that Corson had always been nervous
in public, was afraid that people were watching her, kept her
door bolted and blinds and curtains closed, and had difficulty
being alone. Id. at 647-50.
Dr. Koocher, a psychologist, testified as a non-examining
medical expert that evidence indicated that Corson had a history
of mental illness, including anxiety, depression, and some
symptoms suggestive of a schizophrenic or psychotic disorder,
but none to the extent required by the listings. See 20 C.F.R.
p t . 4 0 4 , subpt. P, app. 1 ; T r . at 653-65. D r . Koocher opined
that statements made by Corson’s family and friends demonstrated
problems before her D L I , but did not provide sufficient
information to determine the severity of her impairments. Tr.
at 654-55. Although treatment for anxiety and depression were
part of Corson’s routine medical care before her D L I , the 2002
phone call to Douville was the first mention in the medical
record of “something that sound[ed] like a psychotic symptom.”
Dr. Koocher opined that there was “no sign of hallucinations or
delusions reported in the medical record before the date last
insured.” Id. at 657. According to D r . Koocher, Corson’s daily 13 living, social functioning, and concentration would have been
mild to moderately limited as of the D L I , with no evidence of
episodes of decompensation of extended duration. D r . Koocher
also opined that Corson would be able to perform simple work and
function socially, and that the statements from Corson’s family
and other lay testimony evidencing problems with paranoia were
“episodic” rather than constant. Id. at 660. D r . Koocher
testified that at the time of her D L I , Corson would have been
moderately impaired in her ability to interact with the public,
respond to work pressures, and attend work punctually and
regularly. D r . Koocher opined that Corson’s depression and
anxiety might have interfered with her ability to complete a
normal workweek, but not on a regular basis, and that as of her
DLI Corson could tolerate occasional interaction with the public
and coworkers.
The June 8 hearing also included testimony from Christine
Spaulding, a vocational expert. The ALJ asked questions
concerning a hypothetical individual capable of doing light
work, limited to simple, repetitive tasks with occasional
interaction with coworkers, the public, and supervisors.
Spaulding testified that such a person could not do any of
Corson’s past relevant work, but would be able to perform work
as a cleaner, laundry worker, or cafeteria attendant. Id. at 14 667-68. She further testified that these jobs could be done by
someone who was unable to perform stressful, fast-paced
production work. The ALJ agreed that if Corson had the
limitations as described in Blood’s assessment, she would be
incapable of substantial gainful employment. Id. at 669.
D. Witness Statements
The record also includes sworn statements by Corson’s
friends and relatives. On June 1 0 , 2003, Corson’s brother-in-
law, John Corson, stated that in June 1994 Corson arrived at his
house saying she had been shot in the neck by a motorcycle gang.
She rejected his offer of water, saying it had been poisoned,
and would not stay at the hospital when he took her there. John
Corson also stated that claimant drew her curtains at home so
people could not spy on her, and that her problems had existed
for many years. Id. at 174. These statements were echoed in
another sworn statement by Lorraine Corson, the claimant’s
sister-in-law.
On September 6, 2003, Tracy McAllister, the claimant’s
friend, stated that she met the claimant at work in 1983, and
first noticed a change in 1988, when Corson began thinking that
people were spying on her. McAllister stated that in 1990
Corson mentioned seeing aliens, and believed that her sister-in-
law spread feces around her bathroom and went through her 15 things. McAllister helped Corson find a part-time job at a
plumbing company, but Corson had not liked it and quit abruptly.
She stated that Corson was verbally abusive towards her during a
1995 visit and threw things across the room, and that they did
not see each other again until November 2002, when they began
occasionally visiting each other. Id. at 172.
E. ALJ’s Decision
In applying the five-step sequential process required for
evaluating DIB claims, 20 C.F.R. § 404.1520(a)(4)(i-v), the ALJ
found that Corson last met the insured status requirement on
September 3 0 , 1998. He then found that Corson had not engaged
in substantial gainful activity during the period between her
alleged disability onset date and DLI.
At steps two and three, the ALJ found that Corson had
severe impairments for low back pain, depression, and anxiety,
but that none of her impairments met the listing requirements.
In detail, the ALJ described Corson’s visits to her primary care
provider between August 1996, when she first presented
complaints of depression, and 1999, her DLI. The ALJ next
considered medical expert D r . Koocher’s opinion, noting that the
expert viewed the entire medical record and found that prior to
2002, the medical record only supported diagnoses of depression
and anxiety. T r . at 447. The ALJ then considered post-DLI 16 evidence, including Corson’s son’s phone call to Douville,
Corson’s treatment by Blood for paranoid episodes, and Blood’s
retrospective opinion finding the presence of a delusional
disorder prior to Corson’s DLI. He noted that Blood “may not be
an acceptable medical source.” Id.
After considering this evidence, the ALJ found D r .
Koocher’s testimony consistent with clinical records from CMAC
and the record as a whole. He agreed with D r . Koocher’s
findings of severe impairments for depression and anxiety. He
said, however, that he “cannot find, based upon the evidence now
in file, that the claimant had the medically determinable
impairment of a psychotic/delusional disorder . . . as alleged
during the period in question.” To reinforce his decision, the
ALJ noted that Corson did not report symptoms of psychosis to
her primary care provider and was not described as experiencing
such symptoms at any time prior to 2002. He then considered the
record’s lay evidence, giving it “very limited weight” after
noting that the testimony from Corson’s brother- and sister-in-
law only described isolated observations from one event that
occurred prior to the alleged disability onset date. The ALJ
next considered other lay evidence, and reinforced his
assessment by noting that D r . Koocher considered the lay
opinions before finding that Corson had not suffered from an 17 impairment prior to her DLI.
After finding that Corson did not have an impairment that
met or medically equaled one of the listings, the ALJ next found
that through her D L I , Corson had the RFC to perform light work
involving simple, repetitive, unskilled tasks with occasional
interaction with others in a low-stress, non-production setting.
In drawing this conclusion, the ALJ explained that Corson’s
testimony was not fully credible concerning the “intensity,
persistence and limiting effects” of her symptoms, though she
attempted to provide information to the best of her abilities.
He noted that while testifying, Corson had difficulty recalling
specific pertinent instances, and that she had quit the two jobs
she worked during the eligibility period because she did not
like them or had difficulties getting along with her brother-in-
law – not because she was unable to perform the work.
In explaining why he did not factor hallucinations and
paranoia into the RFC, the ALJ stated that the medical evidence
in the record did not establish the presence of these symptoms
at any time prior to the DLI. The ALJ noted that concerns about
such symptoms were raised by a family member in 2002, and next
turned to Blood’s retrospective diagnosis, which he avowed to
have “carefully considered.” Id. at 451. In affording Blood’s
opinion only limited weight, the ALJ reasoned that Blood 18 provided no clinical observations to support her assertion. He
also noted that the opinion is inconsistent with other
substantial evidence, including that from Corson’s primary care
provider and Corson’s self-reporting from the time period in
question.
The ALJ next addressed lay testimony, finding that none of
it supported a conclusion that Corson suffered from limitations
beyond the previously found anxiety and depression. The ALJ
noted that the testimony from Corson’s brother- and daughter-in-
law describe only “very isolated events,” and acknowledged that
“at times [Corson] was ‘perfectly fine.’” He found that the
testimony from McAllister, Corson’s friend, did not specifically
pertain to the eligibility period and that the evidence “does
not establish any ongoing inability to maintain appropriate
social interactions.” He also addressed Vandermark’s testimony,
noting that it only established nervousness and that Corson
maintained social interaction throughout the eligibility period.
Id.
The ALJ gave significant weight to medical evidence from
Corson’s primary care provider during the eligibility period,
reasoning that “it is the only evidence produced
contemporaneously with the time the claimant alleges she was
disabled.” Id. He noted the absence of any documented signs of 19 paranoia or delusions, and also considered Corson’s self-
reporting of her illnesses, as found in the treatment records as
the “best evidence” from this time period. The ALJ also gave
considerable weight to the “documented timing” of when
delusional symptoms were first reported in 2002, the evidence
that Corson first entered into psychiatric treatment in 2002,
and “the well-supported opinion of D r . Koocher.” Id. at 452.
The ALJ found that Corson was unable to perform any of her
past relevant work, but that jobs existed in significant numbers
in the national economy that Corson could perform. Thus, the
ALJ found that Corson was not disabled at any point from her
alleged disability onset date through her DLI. Id. at 453.
II. STANDARD OF REVIEW
Under 42 U.S.C. § 405(g), I am authorized to review the
pleadings submitted by the parties and the administrative record
and enter a judgment affirming, modifying, or reversing the
“final decision” of the Commissioner. My review “is limited to
determining whether the ALJ used the proper legal standards and
found facts [based] upon the proper quantum of evidence.” Ward
v . Comm’r of Soc. Sec., 211 F.3d 6 5 2 , 655 (1st Cir. 2000).
Findings of fact made by the ALJ are accorded deference as
long as they are supported by substantial evidence. Id. 20 Substantial evidence to support factual findings exists “‘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) (per curiam) (quoting Rodriguez v . Sec’y of
Health & Human Servs., 647 F.2d 2 1 8 , 222 (1st Cir. 1981)). If
the substantial evidence standard is met, factual findings are
conclusive even if the record “arguably could support a
different conclusion.” Id. at 770. Findings are not
conclusive, however, if they are derived by “ignoring evidence,
misapplying the law, or judging matters entrusted to experts.”
Nguyen v . Chater, 172 F.3d 3 1 , 35 (1st Cir. 1999) (per curiam).
The ALJ is responsible for determining issues of
credibility and for drawing inferences from evidence in the
record. Irlanda Ortiz, 955 F.2d at 769. It is the role of the
ALJ, not the court, to resolve conflicts in the evidence. Id.
To determine whether an applicant is disabled, the ALJ
follows a five-step sequential analysis. 20 C.F.R. § 404.1520.
In the context of a claim for social security benefits,
disability is defined as “the inability to do any substantial
gainful activity by reason of any medically determinable
physical or mental impairment” expected to result in death or to
last for a continuous period of not less than twelve months. 20 21 C.F.R. § 404.1505(a). The applicant bears the burden, through
the first four steps, of proving that his impairments exist and
preclude him from working. Freeman v . Barnhart, 274 F.3d 606,
608 (1st Cir. 2001). At the fifth step, the ALJ determines if
employment exists in significant numbers in the national economy
that the claimant can do despite his or her impairments. The
ALJ must produce substantial evidence to support that finding.
Seavey v . Barnhart, 276 F.3d 1 , 5 (1st Cir. 2001).
III. ANALYSIS
Corson presents several related arguments in support of her
challenge to the ALJ’s decision. She first argues that the ALJ
failed to properly credit Blood’s retrospective opinion as a
treating source in finding no severe impairment for her alleged
delusional disorder. Corson also maintains that in failing to
find a delusional disorder at step two of his analysis, the ALJ
failed to properly credit lay witness testimony establishing the
existence of psychotic symptoms prior to Corson’s DLI.
Relatedly, Corson argues that the ALJ’s failure to properly
credit Blood’s opinion resulted in an erroneous RFC unsupported
by the existing substantial evidence. Had he properly credited
Blood’s opinion, argues Corson, the ALJ would have found that
Corson was disabled prior to her DLI. Corson does not dispute 22 the ALJ’s findings concerning her back pain, anxiety, and
depression, instead centering her argument upon the ALJ’s
allegedly inadequate consideration of her psychotic/delusional
disorder prior to her DLI. I conclude that the ALJ gave proper
consideration to Blood’s testimony and that of the lay witnesses
and affirm the ALJ’s decision as supported by substantial
evidence.
A. Weight of Medical Opinions
In arguing her case, Corson accurately cites regulations
describing the additional weight generally given to examining
sources, the factors an ALJ must apply to any medical opinion
not given controlling weight, and the requirement that an ALJ
give “good reasons” for rejecting a medical opinion. See 20
C.F.R. § 404.1527(c)(1-6), ( d ) . As the ALJ noted, however,
Blood is not an “acceptable medical source” qualified to give a
medical opinion.8 See id. §§ 404.1513(a)(1-2), .1527(a)(2).
Acceptable medical sources include licensed physicians or
8 Finding that Blood is not an acceptable medical source does not end my inquiry. Although objective medical evidence is necessary to establish the existence of a disabling impairment, it is unnecessary to establish the disability onset date. Moriarty v . Astrue, 2008 DNH 1 5 8 , 1 4 ; SSR 83-20, 1983 WL 31249, at *3 (1983). Although he declined to confirm Blood’s retrospective diagnosis of an impairment existing prior to Corson’s D L I , D r . Meehan affirmed her diagnosis of psychotic disorder, NOS as of 2005. T r . at 393.
23 licensed or certified psychologists, but do not include nurse
practitioners, who are considered “other sources.” Id. §
404.1513(a)(1-2), ( d ) . Despite her doctoral degree, Blood is
neither a physician nor a licensed or certified psychologist.
Her curriculum vitae includes a Ph.D. in nursing and state
certifications as a nurse practitioner in the field of
psychiatric/mental health and as a registered nurse. T r . at
567-69. Because she is not an acceptable medical source, Blood
is also not a “treating source” entitled to the preferential
treatment requested by Corson.9 See 20 C.F.R. § 404.1502.
To be sure, the ALJ is still required to consider Blood’s
opinion as part of “all of the relevant evidence.” See
Alcantara v . Astrue, 257 F. App’x 333, 335 (1st Cir. 2007)
(citing 20 C.F.R. § 416.920(a), ( c ) ) . Opinions from “other”
medical sources can provide information about the severity and
functional effects of an established impairment, 20 C.F.R. §
404.1513(d), particularly when the source has a treatment
9 The Social Security Administration clarifies why the regulations differentiate between “acceptable medical sources” and “other sources.” SSR 06-3P, 2006 WL 2329939, at *2 (Aug. 9, 2006). First, only “acceptable medical sources can establish the existence of a medically determinable impairment. Id. (citing 20 C.F.R. § 404.1513(a)). Second, only acceptable medical sources can give medical opinions. Id. (citing 20 C.F.R. § 404.1527(a)(2)). Third, only acceptable medical sources can be “treating sources.” Id. (citing 20 C.F.R. §§ 404.1502, .1527(d)). 24 relationship with the plaintiff. Agrusso v . Astrue, 2013 DNH
006, 22-23. An ALJ cannot simply ignore the body of evidence
opposed to his view. Dunn v . Apfel, N o . CIV. 98-591-B, 1999 WL
1327399, at *8 (D.N.H. Dec. 1 0 , 1999). There is no error,
however, where the ALJ clearly considered a source’s opinion
and, after evaluating the record including other acceptable
medical sources supporting the opposite conclusion, he or she
decided to discount the source’s opinion. See Russell v .
Barnhart, 2004 DNH 009, 24-25. The weight given to other source
opinions varies depending on an assessment of multiple factors,
including the source’s relationship with the claimant, its
consistency with other evidence, the amount of evidence used to
support its opinion, its explanation of the opinion, and its
knowledge of a specialty area or expertise. Couitt v . Astrue,
2012 DNH 066, 14 (citing SSR 06-03p, 2006 WL 2329939, at *4-5
(Aug. 9, 2006)).
The ALJ clearly considered Blood’s treating relationship
with Corson, but also noted her opinion’s retrospective
application. Blood first examined Corson several years after
Corson’s DLI and was privy to no medical evidence documenting
the existence of a delusional impairment prior to Corson’s DLI.
Before discounting a retrospective opinion, an ALJ “must
consider whether it substantiates a disability that existed 25 during the eligible period or is corroborated by contemporaneous
evidence.” Sibley v . Astrue, 2013 DNH 0 2 2 , 19 (citing Marcotte
v . Callahan, 992 F. Supp. 485, 491 (D.N.H. 1997)). Here, the
ALJ correctly noted that the record contains no medical evidence
of this impairment prior to 2002, despite the fact that
throughout the eligible period Corson was frequently treated for
other mental issues by her primary care providers. Moreover,
the ALJ sought out further testimony of a medical expert to
assess whether the record substantiated a disability existing
prior to Corson’s D L I , and squarely discussed Corson’s
contemporaneous lay evidence in finding that substantial
evidence supports a finding of no disability.
An ALJ is also required to examine “other source” testimony
for its consistency with the record as a whole. The ALJ clearly
considered and gave significant weight to the treatment records
existing prior to Corson’s DLI and, as explained below, afforded
limited weight to the lay testimony provided by Corson. He also
examined other post-DLI evidence in the record to assess its
potential retrospective applicability. In doing s o , he
permissibly found that the evidence does not substantiate a pre-
DLI disability and is not sufficiently corroborated by
contemporaneous evidence.
26 Not only did the ALJ find Blood’s testimony inconsistent
with the pre-DLI medical records and Corson’s own explanations
of her ailments, he also found it to be inconsistent with
opinions from acceptable medical sources. The ALJ credited D r .
Koocher, the medical expert, noting that he considered the
entire record, including all lay testimony. An ALJ is permitted
to give significant weight to testimony from non-examining
medical experts. See Gray v . Heckler, 760 F.2d 369, 373 (1st
Cir. 1985) (per curiam); Lizotte v . Sec’y of Health & Human
Servs., 654 F.2d 1 2 7 , 130 (1st Cir. 1981); Rodriguez, 647 F.2d
at 223-24. This court has found such reliance to be
particularly appropriate when, as here, the expert has viewed
all of the claimant’s medical records and where, as here, the
record contains no other RFC assessment prepared by an
acceptable medical source. See Menezes v . Apfel, 2000 DNH 1 0 7 ,
40. Moreover, “the fact that a medical opinion is from an
‘acceptable medical source’ is a factor that may justify giving
that opinion greater weight than an opinion from a medical
source who is not an ‘acceptable medical source.’” Hines v .
Astrue, N o . 11-cv-262, 2012 WL 2752192, at *10 (D.N.H. Jul. 9,
2012). Blood’s testimony is also inconsistent with an
assessment by the state agency psychologist and with the
findings of D r . Meehan, who upon Blood’s request examined 27 Corson’s records and found “no history of earlier onset
psychosis.” T r . at 393. Although not dispositive, no
acceptable medical source found evidence of a delusional
impairment prior to the DLI.
In deciding the weight to allocate to an “other source”
opinion, an ALJ should also examine the amount of evidence and
adequacy of explanation used to support the opinion. Here, the
ALJ found that Blood provided no clinical observations to
support her opinion. Further, Blood did not explain her
retroactive opinion, which consisted of (1) a statement in 2003,
with no further explanation, that her diagnosis applied prior to
Corson’s DLI; and (2) a second statement in 2006, again with no
explanation, reiterating her pre-DLI application. The complete
absence of medical evidence establishing an impairment during
the eligible period makes Blood’s unexplained statements that
much less credible.
Finally, an ALJ should also consider whether the source has
any specialty or expertise in the area concerned. As a
psychiatric nurse practitioner specializing in mental health,
Blood undoubtedly has attained some level of related specialized
experience. The ALJ accounted for Blood’s specialty by
carefully considering her evidence as he would that of a
treating source, rather than summarily dismissing i t . 28 Viewing each factor, it is clear that the ALJ afforded
Blood’s opinion both careful consideration and adequate weight.
Moreover, the ALJ described the substantial evidence in the
record opposing Blood’s cursory retrospective diagnosis, and why
substantial evidence favored a finding of no disability. Here,
the ALJ recognized that Blood may not be an acceptable medical
source, but then “acknowledged (and complied with) his
obligation to provide an explanation for his decision to give
her opinions only limited weight.” See Rakip v . Astrue, N o . 11-
cv-323, 2012 WL 1884678, at *4 (D.N.H. May 2 3 , 2012). I thus
find no error in the ALJ’s weighing of medical opinions.
I emphasize that the record also contains substantial
evidence supporting Corson’s allegations of disabling mental
impairments. Given the stigma often associated with mental
illness, I am particularly sensitive to the evidence concerning
Corson’s fear and reticence to broach the issue of a delusional
disorder with her doctors. It is the role of the ALJ, however,
and not of this court, to weigh and resolve conflicts in the
evidence. See Rodriguez, 647 F.2d at 222 (citing Richardson v .
Perales, 402 U.S. 389, 399 (1971)). The record here arguably
could justify a different conclusion, Lizotte, 654 F.2d at 129-
3 1 , but the ALJ’s decisions in assessing the medical opinions
were supported by substantial evidence. There was no error. 29 B. Consideration of Lay Evidence
Acknowledging that relevant evidence from “other sources”
also includes evidence from non-medical lay sources, 20 C.F.R. §
404.1513(d), I find that the ALJ adequately considered the lay
testimony presented by Corson’s friends and relatives. In his
decision, the ALJ addressed the lay evidence, discrediting some
testimony as describing an isolated incident from before the
alleged onset date, other testimony as failing to establish any
ongoing inability to maintain appropriate social interactions,
and still other testimony as indicating nervousness but no
overwhelming disability. In summarizing the lay testimony, he
found that “[n]one of these statements support a conclusion that
[Corson] was suffering from additional limitations than have
been found herein.” T r . at 451. The ALJ’s decision to give
little weight to the lay evidence is rooted in medical expert
testimony that Corson’s impairments are episodic. The lay
evidence fails to overcome the paucity of medical evidence
supporting a finding of a delusional impairment prior to
Corson’s DLI.
C. RFC Finding
Corson also argues that the ALJ’s RFC finding was not
supported by substantial evidence. Specifically, she argues
that Blood’s opinion should be credited as supporting a much 30 more restricted RFC. This argument is unavailing for the
reasons discussed above. The ALJ gave adequate weight to
Blood’s opinion. An “other” medical source’s opinion can be
given significant weight in limited circumstances, such as when
the other source has seen the claimant more frequently, has
provided better supporting evidence, and has better explained
his or her opinion. SSR 06-3P, 2006 WL 2329939, at *3-5 (Aug.
9, 2006). That is not the case here, however, where the “other
source” did not treat Corson before her D L I , provided little to
no supporting evidence tying Corson’s current impairment to the
eligibility period, and failed to explain why her opinion
deserved retrospective application. Because the ALJ properly
weighed Blood’s “other source” opinion and explained in detail
the extent to which he discredited Corson’s own testimony, he
was justified in omitting her alleged delusional impairments
from both the RFC and his questions to the vocational expert.10
10 Corson also argues that the ALJ failed to include a functional limitation relating to her ability to maintain regular work attendance that was acknowledged by both D r . Koocher and Blood. The record shows no such agreement between D r . Koocher and Blood. Rather, as the Commissioner notes, D r . Koocher testified that Corson’s ability to attend work regularly would only be moderately impaired, and that her depression and anxiety would not interfere with her ability to complete a normal workweek. Tr. at 663-64. D r . Koocher’s testimony is thus in line with the ALJ’s findings. Id. at 451-53.
31 IV. CONCLUSION
In his decision, the ALJ addressed the opposing evidence
and chose to credit the only acceptable medical sources and the
only medical evidence in the record relating to the period prior
to the D L I , giving little weight to both Blood’s “other source”
opinion and the lay evidence. He properly relied upon
substantial evidence in the record to arrive at his decision.
For the foregoing reasons, I grant the Commissioner’s
motion to affirm (Doc. N o . 11) and deny Corson’s motion to
reverse (Doc. N o . 9 ) . The clerk is directed to enter judgment
accordingly and close the case.
SO ORDERED.
/s/Paul Barbadoro Paul Barbadoro United States District Judge
November 1 , 2013
cc: Raymond J. Kelly, Esq. T . David Plourde, Esq.