Stevenson v. Berryhill

          MEMORANDUM OPINION

          MADELINE HUGHES HAIKALA UNITED STATES DISTRICT JUDGE.

         After reviewing the parties' briefs and the administrative record in this case, the Court gave the parties an opportunity to address the ALJ's failure to discuss or give weight to Mr. Stevenson's GAF evidence which includes multiple GAF scores at or below 45. (Doc. 11, pp. 13-14). The Commissioner filed a brief. (Doc. 12). Mr. Stevenson did not.^[1] The Court now supplements its initial opinion.

         GAF stands for “Global Assessment of Functioning.” For years, the American Psychiatric Association used the “GAF Scale” to measure an individual's “overall functioning” in light of the individual's mental impairments. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), p. 32, American Psychiatric Association (4th ed. text revision, 2000). More recently, the American Psychiatric Association replaced the GAF scale with a different global functioning measure - “the WHO Disability Assessment Schedule (WHODAS)....” Diagnostic and Statistical Manual of Mental Disorders (DSM-5), p. 16, American Psychiatric Association (5th ed. 2013). Mr. Stevenson's medical records contain only GAF scores; there are no WHODAS scores in his medical records.

         The Eleventh Circuit Court of Appeals has indicated that GAF scores may have a bearing on an ALJ's assessment of a claimant's ability to function with mental impairments. McCloud v. Barnhart, 166 Fed.Appx. 410 (11th Cir. 2006).In McCloud, the Eleventh Circuit found that the ALJ erroneously assessed part of the GAF evidence in the administrative record and ignored other relevant GAF evidence. The Court of Appeals stated:

We group Issues 3-6 together because we conclude that the ALJ erred when dealing with these issues and that the errors warrant remand. First, the parties agree that the ALJ erred when he labeled McCloud's 1998 GAF score as reflective of moderate symptoms. In fact, a GAF score of 41-50 indicates severe impairments. American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders 34 (4th ed.1994). We are unable to determine from the record what weight the ALJ placed on the GAF score of 45; therefore, we reject the Commissioner's argument that any error was harmless. With the knowledge that a GAF score of 45 reflects severe impairments, the ALJ should determine what, if any, weight to place on the score. In addition to this error, the ALJ failed to consider McCloud's GAF score of 48 from June 2000, which occurred just days before she filed for SSI benefits, when determining whether she was disabled. On remand, the ALJ must also consider what, if any, weight to accord McCloud's June 2000 GAF score.

McCloud, 166 Fed.Appx. at 418. Thus, the Eleventh Circuit held that an ALJ should consider relevant GAF scores, and when an individual has a GAF score that “reflects severe impairments, the ALJ should determine what, if any, weight to place on the score.” McCloud, 166 Fed.Appx. at 418.

         Mr. Stevenson alleges that his disability began on September 23, 2012. (Doc. 7-6, p. 2). Mr. Stevenson suffers from the severe impairment of paranoid schizophrenia. (Doc. 7-3, p. 17). Mr. Stevenson applied for a period of disability and supplemental security income on February 24, 2015, (Doc. 7-4, p. 29), and the ALJ held an administrative hearing on March 1, 2017. (Doc. 7-3, p. 55). A number of Mr. Stevenson's medical records from the period between December 29, 2014, and July 6, 2016, contain GAF scores. With one exception, all of the scores are below 50. (See Doc. 7-8, pp. 53, 58, 61) (admitted to Hill Crest Behavioral Health Service on Dec. 29, 2014 with GAF score of 40; discharged on Feb. 12, 2015 with GAF score of 50); (Doc. 7-8, p. 65) (Feb. 13, 2015 outpatient record from Western Mental Health Center reporting GAF score of 45); (Doc. 7-8, p. 61) (Mar. 16, 2015 psychiatric assessment at Western Mental Health Center, reporting GAF score of 40); (Doc. 7-9, pp. 6-7) (July 14, 2015 outpatient treatment record from Western Mental Health Center, reporting GAF score of 45); (Doc. 7-9, pp. 14-15) (July 6, 2016 outpatient treatment record from Western Mental Health Center, reporting GAF score of 45, with highest GAF score over preceding 12 months of 45 and lowest of 40). Mr. Stevenson also was assessed with a GAF score of 40 in 2012 while he was hospitalized at UAB. (Doc. 7-8, p 36). Although the score falls outside of the relevant time period, the score indicates the longitudinal aspect of Mr. Stevenson's consistent GAF scores.^[2]

         The GAF rating scale in Mr. Stevenson's records indicates that a score in the 50-41 range indicates “Moderately Severe Symptoms & Impairments.” (Doc.7-9, p. 15). An individual whose GAF score falls in this range:

[has] [s]ome suicidal ideation, no clear plan, some risk for self harm OR [is] sometimes verbally aggressive, intimidating or demanding OR [is] sometimes circumstantial, tangential, illogical, perseverative, hard to understand, severe obsessive thoughts/compulsive rituals OR sometimes fails to maintain grooming and hygiene, sometimes needs prompts OR [has] any serious impairment in social, occupational, or school functioning (e.g., some problems at work/school: conflicts, fails to complete tasks, late, absenteeism). [Has] [f]ew friends, sometimes has interpersonal conflicts.

(Doc. 7-9, p. 15). The GAF rating scale in Mr. Stevenson's records indicates that a score in the 40-31 range indicates “Severe Symptoms & Impairments.” (Doc. 7-9, p. 15). An individual whose GAF score falls in this range:

[is] [o]ften preoccupied with suicidal ideation or self harm, [has] no intent to act, has plan to prevent self harm, OR often verbally aggressive, may sometimes become physically aggressive without injury OR often circumstantial, tangential, illogical, perseverative, or incoherent OR often fails to maintain grooming and hygiene, often needs grooming prompts OR [has a] major impairment in several areas, such as work or school, family, judgment, thinking, or mood (e.g., avoids friends, neglects family, [is] unable to work, [if a] child, frequently beats up younger children, [is] defiant at home, [is] failing at school.

(Doc. 7-9, p. 15). The scale states that an evaluator assigning a GAF score should “[c]onsider psychological, social, and occupational functioning on a hypothetical continuum of mental health-illness.” (Doc. 7-9, p. 15). The ALJ did not mention Mr. Stevenson's GAF scores in her decision. (Doc. 12, p. 1).

         The Commissioner acknowledges that a GAF score “reflects an examiner's opinion regarding a patient's symptoms or possible difficulty in social, occupational, or school functioning at the time of the examination, ” but the Commissioner argues that “a GAF score may simply be an examiner's impression of the patient's alleged symptoms on one day with little or no bearing on the patient's functioning, particularly her ability to work.” (Doc. 12, p. 2). The argument is internally inconsistent and inconsistent with the GAF scale. It is true that a GAF score reflects an examiner's observations of a patient on a particular day, but the score is based on the examiner's assessment of the patient's ability to function psychologically, socially, and occupationally. The assessment of a patient's ability to function socially, psychologically, and especially occupationally bears on the patient's ability to work. Here, virtually every day that an examiner rated Mr. Stevenson over an 18-month period, the examiner assigned a GAF score of 45 or below; there is only one score above 45 during the 18-month period. The ALJ did not mention these consistently low GAF scores, and she did not assign a weight to the scores.

         The Commissioner argues that the Eleventh Circuit Court of Appeals remanded for further proceedings in McCloud only because the ALJ in that case confused the meaning of a GAF score of 45. (Doc. 12, p. 5). That was one of the flaws that the Eleventh Circuit identified in the ALJ's analysis, but as discussed above, the Eleventh Circuit also made clear that the ALJ erred by failing to mention ...