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Jones v. Berryhill

United States District Court, S.D. Alabama, Northern Division

January 24, 2018

JASMINE JONES, Plaintiff,
v.
NANCY A. BERRYHILL, Acting Commissioner of Social Security, [1]Defendant.

          MEMORANDUM OPINION AND ORDER

          P. BRADLEY MURRAY UNITED STATES MAGISTRATE JUDGE

         Plaintiff Jasmine Jones brings this action, pursuant to 42 U.S.C. §§ 405(g) and 1383(c)(3), seeking judicial review of a final decision of the Commissioner of Social Security (“the Commissioner”) denying her claim for Supplemental Security Income (“SSI”), based on disability. The parties have consented to the exercise of jurisdiction by the Magistrate Judge, pursuant to 28 U.S.C. § 636(c), for all proceedings in this Court. (Doc. 30 (“In accordance with the provisions of 28 U.S.C. 636(c) and Fed.R.Civ.P. 73, the parties in this case consent to have a United States Magistrate Judge conduct any and all proceedings in this case, … order the entry of a final judgment, and conduct all post-judgment proceedings.”)). See also Doc. 31. Upon consideration of the administrative record, Jones's brief, the Commissioner's brief, and all other documents of record, it is determined that the Commissioner's decision denying benefits should be affirmed.[2]

         I. PROCEDURAL HISTORY

         Sylvia Jones, Jasmine Jones's custodial grandmother, filed an application for SSI on her behalf, based on disability, under Title XVI of the Social Security Act (“the Act”), 42 U.S.C. §§ 1381-1383d, on April 26, 2010, alleging disability beginning on May 31, 2006. (Tr. 273-76). She was awarded benefits on June 4, 2010. (Tr. 138-39, 1043-58). When Jones turned 18, her eligibility for SSI benefits was re-determined under the rules for disability in adults, and on February 16, 2012, it was determined that she was no longer disabled as of February 1, 2012. (Tr. 150). On March 14, 2012, Jones filed a request for reconsideration, which was denied on June 5, 2013. (Tr. 155, 184-87). On June 13, 2013, she requested a hearing by an Administrative Law Judge (ALJ). (Tr. 190). After hearings were held on June 11, 2014, and October 22, 2014, the ALJ issued an unfavorable decision finding that Jones was not under a disability from the date the application was filed through the date of the decision, March 23, 2015. (Tr. 73-107, 59-72, 18-58). Jones appealed the ALJ's decision to the Appeals Council, which denied her request for review of the ALJ's decision on June 29, 2016. (Tr. 520-28, 1-8).

         After exhausting her administrative remedies, Jones sought judicial review in this Court, pursuant to 42 U.S.C. §§ 405(g) and 1383(c). (Doc. 1). The Commissioner filed an answer and the social security transcript on November 22, 2016, and a supplemental transcript on January 18, 2017. (Docs. 10, 11, 17). On February 17, 2017, Jones filed a brief in support of her claim. (Doc. 22). The Commissioner filed her brief on May 16, 2017. (Doc. 29). The parties waived oral argument. (Docs. 34, 35). The case is now ripe for decision.

         II. CLAIMS ON APPEAL

         Jones alleges that the ALJ's decision to deny her benefits is in error for the following three reasons:

1. The ALJ was impermissibly biased against Jones because he seemingly prejudged his decision based on the fact that Jones has not worked, attempted to find work, or sought assistance from a vocational rehabilitation service;
2. The ALJ erred in his assessment of the weight to be afforded the opinion of Jones's treating neurologist, the opinion of her treating psychologist, and the opinion of the psychological consultative examiner; and
3. The ALJ erred in finding that Jones did not have any severe impairments. (Doc. 22 at p. 2).

         III. BACKGROUND FACTS

         Jones was born on August 25, 1993 and was 21 years old at the time the ALJ issued his opinion denying her benefits. (Tr. 352). Jones alleged disability due to mental issues, behavior problems, seizures, and breathing problems. (Tr. 335). She graduated with a standard diploma on May 23, 2011, and she passed the Alabama High School Graduation Exam on her sixth attempt. (Tr. 453-54). Records from Wilcox Central High School reflect that, at the end of her senior year, she had earned 27 credits, had a weighted GPA of 1.917, a numeric weighted cumulative average of 72.484, and was ranked 141 out of 154 in her class. (Tr. 453). She has never worked. (Tr. 216, 233). Jones engages in limited daily activities; such as, sleeping, watching television, eating, and occasional light chores around the house. (Tr. 334, 336, 342, 346). She can dress and generally care for herself, but she needs reminders to bathe and change clothes. (335-336, 345-46). She is limited in preparing food and must be supervised because of her seizures. (Tr. 336, 346). She can count change, but has never paid bills, handled a savings account, or used a checkbook. (Tr. 337, 347). She cannot drive. (Id.). After conducting two hearings, the ALJ made a determination that Jones's disability ended on February 1, 2012, and she had not become disabled again between that date and the date of his decision. (Tr. 21).

         IV. ALJ'S DECISION

         The ALJ made the following relevant findings in his March 23, 2015 decision:

2. Since February 1, 2012, the claimant has had the following severe combination of impairments: obesity with noncompliance; seizure disorder with significant evidence of noncompliance and relatively well controlled with medication; allergic rhinitis, refractive error and keratoconjunctivitis in both eyes; anemia; history of stuttering; history of oppositional-defiant disorder, impulse control disorder; mild major depression; depression with bipolar mood swings; anti-social personality disorder; questionable intermittent explosive disorder; questionable mild receptive language delay secondary to possible malingering; questionable borderline intellectual functioning; and questionable unspecified type schizophrenia, unspecified state 3. [sic] (20 CFR 416.920(c)).


The undersigned carefully reviewed the medical and other evidence of record. As indicated above, the undersigned found that, individually, none of the claimant's impairments cause greater than slight limitation in her capacity for work activity. Therefore, individually, they are nonsevere. However, although the undersigned found that they may be severe in combination, this conclusion is based in part on Agency guidance and overwhelming but suspect medical evidence.
As Agency guidance directs, the undersigned's conclusion that the claimant's impairments are nonsevere, is not the final step in the analysis. The undersigned must also assess the cumulative effect of the claimant's nonsevere impairments. If the combination of the claimant's impairments causes greater than slight limitation in the claimant's capacity for work activity, then the undersigned must proceed with the sequential analysis and determine how said combination, limits the claimant's capacity for mental and/or physical work activities. If the undersigned concludes that said combination does not cause greater than slight limitation, then the undersigned may complete the decision at the related step in the sequential analysis. However, this conclusion must be unequivocal. If the undersigned cannot rule out the possibility that said combination causes greater than slight limitation in the claimant's capacity for work activity then the undersigned must complete the remaining steps in the sequential analysis (SSR 85-28).
Quite candidly, the undersigned does not believe that the claimant's impairments collectively cause limitation in her capacity for mental or physical work activity. Based on the claimant's credibility as it relates to her allegations, as well as the credibility of those around her, the record strongly suggests that the claimant is determined to obtain disability compensation, regardless of her ability to perform work activity. However, while the undersigned's opinion is significant, the record is littered with medical source opinions indicating limitation, and even some reports indicating disability.
While the undersigned disagrees with such opinions -- and wholly rejects any opinion that suggests that the claimant is disabled -- the totality of the evidence prevents the undersigned from unequivocally ruling out the possibility of limitation. Accordingly, the undersigned found that there was at least enough colorable evidence to report the limitations highlighted below. Nevertheless, any suggestion of greater limitation is grossly inconsistent with and not supported by the totality of the medical or objective evidence of record. As an aside, as suggested above, subjective reports provided by the claimant, her mother and her grandmother, unfortunately warranted and received very little weight. As suggested above, there is clear evidence that pursuit of disability compensation was a collective goal.
This is the claimant's fourth application. Two administrative law judges denied applications in 2006 and 2008, respectively (Exhibits C1 and 2A). The first was not appealed. The Appeals Council denied her appeal of the second decision in June 2010 (Exhibit C6A). The claimant and her family would not be deterred. They, the claimant was a child, submitted a third application on April 2010, prior to receiving the Appeals Council decision. In fact, they submitted the application prior to an Individualized Education Program (IEP) report (Exhibits C4F). Not surprisingly, the IEP report does not support the previous applications or the application submitted a month before its completion.
As part of the IEP process, the claimant reported seizure activity without indication of any severe limitations secondary to seizure activity. Most glaring, the claimant reported “no other reported medical problems” (Exhibit C4F, page 3) (emphasis added). As the two previous decisions show, the claimant's reports of medical problems for education purposes is grossly inconsistent with her report of medical problems for disability compensation. This gross inconsistency is enough standing alone to detract wholly from the claimant's allegations. However, there is more evidence to share.
The author also noted that the claimant did not get along with her mother who was also receiving disability compensation (Id.). The claimant reported that she needed to improve in the area of getting along with others such as teachers and peers; however, there was no indication of any severe deficit in this area. The claimant's English teacher reported that the claimant “stays on task and completes all of her assignments” (Id.) (emphasis added). The teacher also felt that the claimant could do better to interact with others. However, her Math teacher reported that the claimant gets along “very well” with her peers (Id.) (emphasis added). Despite the suggestion that she improve her interactive skills, there was certainly no objective evidence to indicate that she did not or was markedly (or even moderately) unable to interact with others. Neither teacher had anything negative to say about their interactions with the claimant. Although the Math teacher had the most concern regarding her subject knowledge, the claimant successfully completed her Math exit examination. At the time of that portion of the IEP, she had failed all other exams. Digressing briefly, the undersigned rejects the notion that she passed that test first, yet suffered from mild mental retardation. Additional evidence below confirms that conclusion.
The IEP also reported the claimant's 11th grade course grades. The claimant completed Plant Biotechnology with a B. She achieved a C in English II, and BusTech Applications. Unfortunately, she obtained a D in Botany, Geometry, and Physical Science. Lastly, and most disturbing, she achieved an F in U.S. History II (Id. at 1). These scores are indicative of her functioning on many levels, none of which supports a conclusion that the claimant is disabled.
The undersigned notes that it [sic] highly unlikely that an individual functioning within the mentally retarded or borderline ranges of intellectual functioning would be placed in such classes; and although her grades were not overly impressive conversely, based on the subject matter and her reported limitations they were not overly unimpressive. Over the year, the claimant scored a 91, 88, 90, and 83 in Plant Biotechnology; yet, in U.S. History II, she scored a 50, 76, 63, and 45 (Id.). While some possibly unknown factor was at play, intelligence and cognitive ability did not cause the discrepancy. The remaining grades and relevant subject matter do not provide support for any report of marked deficiency in either area.
The claimant did continue to receive special education assistance in a general education setting. However, her 12th grade classes did not offer any respite from classes that demanded more from her than expected of someone function in the aforementioned ranges. Per the IEP, she was to enroll in the following classes: English 12, Physics, Pre-Calculus, Government/ Economics, Choir, Family Wellness, and AHSGE Basics (Id. at 3) (emphasis added). The claimant's planned classes are grossly inconsistent with borderline intellectual functioning and certainly grossly inconsistent with mild mental retardation. The undersigned notes that not only does service in the Choir suggest greater mental functioning than suggested; it also shows that the claimant did not suffer any moderate or marked limitation in her capacity for interaction with others such as choir mates. The team also assessed the claimant's future in terms of her diploma and the type of work activity she might enjoy. The team reported the following, in relevant part:
her strengths in reading and a desire to care for and help others, a preference for working with people leading toward Jasmine's transitional goals for adult life, the IEP Team has selected the Regular Diploma Option for her... (Id. at 3) (emphasis added).
The evidence shows that the application for disability the claimant and her family submitted to the State agency a month before the IEP was completed was based purely on pursuit of compensation and not on the presence of any disabling impairment. This conclusion is not only based on the IEP which includes the claimant's subjective reports, but also two judges concluded she was not disabled prior to the IEP and the Appeals Council agreed a few months after the IEP. The undersigned finds that any conflicting reports or opinion, including the State agency's conclusion that she was disabled at that time, are without merit and questionable at best. Each instance of a contrary position is tainted by the claimant's clear goal and the undersigned finds all allegations lacked merit.
The claimant's grandmother did report that, during high school, the claimant was struck in the head. However, her attempt to show that there was some intervening factor that caused her to depreciate in the cognitive functioning is also without merit. As noted above, the family began pursuing benefits as far back as 2004, long before the claimant started high school. Her later reports and the subsequent tests are not persuasive and warranted little weight.
Others involved in this process have questioned the claimant's motives as well. For example, despite her uneven reports of seizure activity, every time she visited an emergency room related to seizure activity, laboratory testing indicated that the claimant was not taking her medication as directed. More recently, in 2014, the claimant and her grandmother visited her neurologist. The doctor was puzzled after neither could tell him when she experienced her last seizure or how often she was experiencing seizures. Although, the undersigned allowed for limitations secondary to this condition, because of the breadth of the medical evidence, the undersigned strongly believes that the claimant is noncompliant with medications. The record relevant to the period before the undersigned is void of a single documented report of seizure activity provided by anyone outside of the claimant's family. Upon virtually every visit to her doctor or an emergency room, the claimant was fully functioning without signs of depreciation or residuals.
Although the bulk of the medical evidence is discussed below, a few brief comments from consultants are warranted here. The IEP discussed above, contains little to no mention of the claimant's reported stutter. The undersigned notes that her treatment records contain little mention of a stutter as well. Nonetheless, the State agency sent the claimant out for a consultative speech evaluation. The consultant reported the following, in relevant part:
[a]ccording to Jasmine, she is here today because she stutters.
Jasmine stated “I stutter 24-7.” However, during the course of the 90-minute evaluation this examiner did not observe a single stuttering event under any speaking situation . . . (Exhibit C22F, page 2) (no emphasis added).
The undersigned must stress that the consultant and not the undersigned highlighted the information in bold above. She did not stop there. She added:
In general, language skills were judged to NOT impair communication skills during activities of daily living. . . Test results are felt to be lower than Jasmine's true ability due to possible malingering. . . (Id. at 4) (no emphasis added).
Once again, the consultant added the caps and bold letters. Ultimately, the consultant assessed: mild receptive language delay and expressive language delay secondary to possible malingering (Id.) (emphasis added).
The consultant's opinion warranted and received great weight. As noted, it is consistent with the lack of limitation reflected in the IEP. It is also consistent with multiple visits with doctors and other such professionals, which do not indicate any notable limitation in her capacity for speech. However, although the consultant somewhat tempered her opinion with the use of the word "possible" her use of highlights make clear that she felt the claimant was malingering.
In fact, the record contains treatment notes and multiple opinions from her mental healthcare provider, Richard Reynolds, Ph.D. He has been involved in her mental healthcare since approximately 2010. His opinions all suggest that the claimant is disabled. In one report, he opined, without relevant medical evidence, that the claimant's impairments meet the requirements of listings 12.03 and 12.04 (Exhibit C36F). On September 13, 2012, he reported that the claimant suffered marked-to-extreme limitation in her capacity to respond to customary work pressures. He reported she suffered marked limitation in her ability for the following as well: responding appropriately to supervision, coworkers, the public, and change in routine (Exhibit C28F). However, recent treatment notes are grossly inconsistent with his opinions. The notes reveal the following interaction, in relevant part, on May 8, 2014:
Pt. presents with weight gain. Continued report of chronic boredom. Pt. continues to say I'm depressed because I have nothing to do... Writer urged daily exercise, both as life activity to address boredom and to address weight gain. Discussed need to seek activities out of home, such as volunteering at the library to address boredom... (Exhibit C34F, page 2) (emphasis added).
This report does not support the notion that the claimant suffers marked limitation in the areas report [sic] and certainly no extreme limitation. Apart from possibly janitorial work, most voluntary work at a library would require at least some semiskilled activity and certainly some ability to respond appropriately to others, including the public. In fact, the undersigned is puzzled as to how treatment personnel thought she could do volunteer work in a library, yet failed to recommend that she try to work with vocational rehabilitation and/or seek unskilled work activity. As suggested above, the record continues to indicate that the claimant and those around her are set on the disability compensation course and even her ability to engage in at least some work activity is apparently not an obstacle. It should also be noted that clearly, despite all of purported mental deficits, the claimant clearly suffered no mental limitation in her capacity to lose weight. Once unsupported opinions are taken out of the equation, the notes strongly support the undersigned's conclusions.
As noted above, the undersigned is convinced that the claimant does not suffer a severe impairment. The undersigned believes that even collectively, the claimant's impairments do not cause greater than slight limitation. Nonetheless, the undersigned cannot unequivocally conclude that said combination does not cause limitation. Accordingly, in an abundance of caution, the undersigned considered all evidence, including medical source opinions discussed below and found there is colorable although suspect evidence to find the limitations set out below.
However, the undersigned also emphatically notes that any suggestion of greater limitation is grossly inconsistent with the totality of the evidence as set out here and below.
4. Since February 1, 2012, the claimant did not have an impairment or combination of impairments that meets or medically equals the severity of one of the listed impairments in 20 CFR Part 404, Subpart P, Appendix 1(20 CFR 416.920(d), 416.925 and 416.926).


The undersigned Administrative Law Judge has considered listings 11.02 for convulsive epilepsy, 11.03 for nonconvulsive epilepsy, 12.02 for organic mental disorders, 12.03 for schizophrenic, paranoid and other psychotic disorders, 12.04 for affective disorders, 12.05 for mental retardation, and 12.08 for personality disorders.
As to listings 11.02 and 11.03, the record shows the claimant to have generalized seizure disorder. Description of seizures indicates they are both convulsive and nonconvulsive. Emergency room records seem to show they are mostly nonconvulsive with no shaking, jerking or loss of bowel or urine (Exhibit C17F). Whether convulsive or nonconvulsive, it is unclear from the treatment record her seizures' frequency. However, the undersigned notes that a treating neurologist Walid W. Freij, M.D., has completed a medical source statement, dated June 24, 2014 (Exhibit C37F). Therein, he indicated that the claimant has convulsive seizures more than once a month and nonconvulsive seizures about once a week and that she had good compliance with treatment. The undersigned gives little weight to this opinion. First, there is no evidence that Dr. Freij has witnessed seizure activity in his office. He has only seen the claimant for routine visits every six months. His opinion is based solely upon the reports of the claimant and her family members. Second, the doctor 's progress notes do not contain specific information regarding the number of convulsive seizures and the number of nonconvulsive seizures during the six-month periods between doctor visits. In fact, in progress notes dated May 12, 2013 --the month prior to completing his medical source statement-- Dr. Freij noted that, based upon the responses of the claimant and her grandmother, he could not tell how many seizures she was experiencing (Exhibit C38F) (emphasis added). Moreover, while the doctor reports compliance with treatment, the medical record shows the claimant to have a significant history of medication noncompliance; low levels of Dilantin (Phenytoin) in her system during the adjudicative period; and untimely refills of anti-seizure medications, as shown in pharmacy records, which suggest missed doses (Exhibits C30E, C43E, C3F, C17F, C18F, C25F). For these reasons, the undersigned finds that the claimant does not meet or medically equal the listings for epilepsy.
The undersigned has considered listing 12.05C for intellectual disability. This listing requires the claimant to have significantly subaverage general intellectual functioning with deficits in adaptive functioning initially manifested during the developmental period; i.e., the evidence demonstrates or supports onset of the impairment before age 22, with valid verbal, performance or full scale IQ of 60 through 70 and a physical or other mental impairment imposing an additional and significant work-related limitation of function.
Attorney Coplin suggested at the disability hearing that the claimant has an intellectual disability based upon a diagnosis of mild mental retardation. He also contends that she has valid IQ scores between 60-70 (Exhibit C31 E). The undersigned disagrees. The record does not contain valid IQ scores between 60 and 70. The claimant was administered the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) on March 15, 2011 (Exhibit C6F). She obtained a Verbal Comprehension composite score of 81, Perceptual Reasoning composite score of 73, Working Memory composite score of 71, Processing Speed composite score of 86, and a Full Scale IQ of 74. Her Full Scale IQ score falls in the borderline range of intellectual functioning. It is also consistent with her Full Scale (FS) IQ score in 2006 (Exhibit C20F, page 13). The undersigned does note that Richard Reynolds, Ph.D., at Behavioral Health of Selma diagnosed mild mental retardation in July 2012 and September 2013 (Exhibit C29F, page 2). However, his diagnosis is inconsistent with the above scores and with his previous diagnosis of Borderline Intellectual Functioning (Exhibits C29F, page 7). His diagnosis of MMR is also inconsistent with claimant's academic achievement (Exhibit 29E). High school records show that the claimant was in the general education classroom. She took typical high school subjects, such as Economics, English, Geometry, Botany, U.S. History, and Algebra. She received limited special education services in the 12th grade, which provided remediation in reading and math. This was to prepare her for taking the Alabama High School Graduation Exam (AHSGE). She passed the AHSGE in the spring of 2011. She graduated high school on May 23, 2011 with a standard diploma (Exhibit C29E, page 1).
Linda Duke, Ph.D., completed a form entitled, “Psychiatric Review Technique (PRT), ” dated February 15, 2012 (Exhibit C14F). Therein, she evaluated the claimant under 12.02 for organic mental disorder (borderline intellectual functioning) and 12.08 for personality disorder. Under the “Paragraph B” criteria of the listings, she indicated that the claimant has mild restriction of activities of daily living; moderate difficulties in maintaining social functioning, moderate difficulties in maintaining concentration, persistence or pace, and one or two episodes of decompensation, each of extended duration. She further stated that the evidence does not establish the presence of the “C” criteria.
Donald E. Hinton, Ph.D., completed [sic] form entitled, “Psychiatric Review Technique (PRT), ” dated April 30, 2012 (Exhibit C20F). Therein, he evaluated the claimant under 12.02 for organ[ic] mental disorder, 12.04 for affective disorder, and 12.08 for personality disorder. Under the “Paragraph B” criteria of the listings, he indicated that the claimant has mild 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, each of extended duration. He further stated that the evidence does not establish the presence of the “C” criteria.
The undersigned Administrative Law Judge gives significant weight to Dr. Duke's and Dr. Hinton's PRT's. These mental health professionals generally agree that the claimant's mental impairments do not meet or medically equal listing severity. They reviewed the evidence of record and provided specific findings for their opinions.
As noted, Richard Reynolds, Ph.D., completed a medical source statement, dated June 18, 2014 (Exhibit C36F). Therein, he indicated that the claimant meets the qualifications for listings 12.03 and 12.04. Dr. Reynolds is a treating psychologist. However, the undersigned gives little weight to his opinion. First, Dr. Reynolds does not state with specificity how these listings are met under paragraphs A, B or C. Second, from review of his progress notes, Dr. Reynolds appears to have based his opinion primarily upon the subjective reports of the claimant and her family members on June 17, 2014 (Exhibit C40F, page 10). Third, Dr. Reynolds' opinion is inconsistent with mental health treatment during the adjudicative period. The claimant has required no psychiatric hospitalizations. She has attended outpatient family counseling on a monthly basis and taken low doses of psychotropic medications. Fourth, on October 7, 2014, Dr. Reynolds noted that the claimant was generally stable on medication with two or three “bad days” per week with anger outbursts and paranoid ideation and that the claimant has been compliant with medication (Exhibit C40F, page 2). Yet, other evidence shows noncompliance. According to Dr. Reynolds' records, the claimant should have been taking Lexapro (Escitalopram) and Zyprexa (Olanzapine) during the adjudicative period. Pharmacy records show untimely refills of these medications (Exhibits C30F, C43F). The undersigned notes that, while claimant's grandmother controls her SSI payments (See Testimony), it does not appear that she made sure that claimant gets her medication regularly. This puts into question whether claimant's family members truly see her as mentally disabled. Fifth, Dr. Reynolds' opinion is inconsistent with those of Drs. Duke and Hinton.
The severity of the claimant's mental impairments, considered singly and in combination, do not meet or medically equal the criteria of listings 12.02, 12.03, 12.04, and 12.08. In making this finding, the undersigned has considered whether the “paragraph B” criteria are satisfied. To satisfy the “paragraph B” criteria, the mental impairments must result in at least two of the following: marked restriction of activities of daily living; marked difficulties in maintaining social functioning; marked difficulties in maintaining concentration, persistence, or pace; or repeated episodes of decompensation, each of extended duration. A marked limitation means more than moderate but less than extreme. Repeated episodes of decompensation, each of extended duration, means three episodes within 1 year, or an average of once every 4 months, each lasting for at least 2 weeks.
In activities of daily living, the claimant has mild restriction. The claimant is mentally able to initiate, sustain, and complete activities such as attending to her personal care, preparing meals, shopping, and managing finances, independent of direction or supervision. While the claimant's impairments may interfere with complex activities, the claimant's performance of a simple routine is appropriate, effective and sustainable.
In social functioning, the claimant has moderate difficulties. The claimant can communicate clearly, demonstrate cooperative behaviors, initiate and sustain social contacts and participate in group activities. However, the claimant reported that she has difficulty interacting with others, including authority figures. Medical evaluations, discussed below and above, contain indication of at least some difficulty consistent with the claimant's reports. Nonetheless, the evidence does not suggest greater than moderate limitation in this domain.
With regard to concentration, persistence or pace, the claimant has moderate difficulties. The claimant can sustain the focused attention and concentration necessary to permit the timely and appropriate completion of tasks commonly found in routine and repetitive, not detailed or complex, work settings.
As for episodes of decompensation, the claimant has experienced no episodes of decompensation, which have been of extended duration. There is no evidence of psychiatric hospitalization or serious loss of adaptive functioning during the adjudicative period.
Because the claimant's mental impairments do not cause at least two “marked” limitations or one “marked” limitation and “repeated” episodes of decompensation, each of extended duration, the “paragraph B” criteria ...

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