United States District Court, N.D. Alabama, Southern Division
MADELINE HUGHES HAIKALA UNITED STATES DISTRICT JUDGE.
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. The Court now supplements its initial
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.
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.
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.
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).
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.
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 ...