United States District Court, D. Massachusetts
MEMORANDUM AND ORDER ON PLAINTIFF'S MOTION FOR
JUDGMENT ON THE PLEADINGS AND DEFENDANT'S MOTION TO
AFFIRM THE DECISION OF THE COMMISSIONER
DENNIS SAYLOR IV UNITED STATES DISTRICT JUDGE.
an appeal of the final decision of the Commissioner of the
Social Security Administration (“SSA”) denying an
application for social security disability insurance
(“SSDI”) and supplemental security income
(“SSI”) benefits. Plaintiff Thomas Ezekiel Ford,
IV, alleges disability based on post-traumatic stress
disorder, depression, anxiety, and obesity. The
Administrative Law Judge determined that Ford retained a
sufficient residual functional capacity to perform work
existing in the national economy, and thus was not disabled
under the Social Security Act, 42 U.S.C. §§ 416(i)
has moved for judgment on the pleadings seeking an order
reversing the ALJ's decision. He contends that the ALJ
(1) failed to give proper weight to certain medical opinion
evidence; (2) made an improper credibility determination that
is not supported by substantial evidence; and (3) failed to
properly account for his moderate mental limitations when
presenting a hypothetical question concerning residual
functional capacity (“RFC”) to the vocational
expert. Defendant has cross-moved for an order affirming the
reasons set forth below, plaintiff's motion for judgment
on the pleadings will be denied, and defendant's motion
to affirm the ALJ's decision will be granted.
Educational and Occupational History
Ezekiel Ford, IV, was born on February 23, 1974, and was 37
years old at the alleged onset of his disability. (A.R. 46;
see A.R. 49). He received a bachelor's degree in
sociology and comparative international development from
Johns Hopkins University and a master's degree in
political science from American University in Cairo, Egypt.
November 2009 to March 2011, Ford worked for the United
States Agency for International Development as a General
Development Officer. (A.R. 250, 271, 458). While he was
embedded with the U.S. military in Afghanistan, Ford endured
several life-threatening events, including witnessing enemy
explosives cause the death of one soldier and another
soldier's loss of three limbs. (A.R. 458). Ford then
requested a transfer to a different base in Afghanistan
because of job-related stress. (Id.).
his return to the United States in April 2011, Ford worked as
a curriculum development and pre-deployment trainer for
International Development Systems (“IDS”), a
defense contractor based in Alexandria, Virginia. (A.R.
271-73). Ford left that job in June 2011, and then worked as
a consulting expert until December 2012. (A.R. 65, 271). He
has not worked since. (Id.).
November 2012-November 2013
contends that he suffers from PTSD, depression, anxiety, and
obesity. On November 19, 2012, Ford saw Mark Gorman, Ph.D.,
for an initial mental-health consultation at the Weight
Center at Massachusetts General Hospital (“MGH”).
(A.R. 367). According to the doctor's report, Ford's
mental status examination (“MSE”) was normal
except for diminished concentration, some guilt, and reports
of sleep problems. (A.R. 371). Ford reported that his
stressors were his “work/travel schedule” and
“caretaking for parents.” (A.R. 368). He reported
that his current job at IDS required relocation every two to
four weeks, so he had avoided making close, personal
connections with his co-workers. (A.R. 370).
Gorman assessed a Global Assessment of Functioning
(“GAF”) score of 71-80 and diagnosed a major
depressive disorder in remission and emotionally-triggered
eating in remission. (A.R. 372). He also found that Ford
demonstrated active symptoms of post-traumatic stress
disorder, such as avoidance and numbing; insomnia, diminished
concentration; and hypervigilance. (A.R. 370). However, Dr.
Gorman opined that Ford did not meet the full diagnostic
criteria of PTSD, because he was no longer experiencing
flashbacks or intrusive memories. (A.R. 372). Dr. Gorman
supported a referral for psychotherapy if Ford was
saw Elizabeth Goetter, Ph.D., at MGH for a psychiatric intake
on December 19, 2012. (A.R. 348). Ford described the multiple
traumatic experiences he faced as a civilian aid worker in
Afghanistan. (Id.). Ford's chief complaint was
“sleep issues.” (Id.). Dr. Goetter noted
that Ford experienced emotional and physical reactivity to
trauma cues, such as anxiety, tachycardia, and flushing.
(Id.). He reported increased irritability,
hypervigilance, and diminished interest in socializing.
(Id.). He stated that his mood had been “fine
. . . more stable, less angry, ” but reported
depressive episodes in the past, most recently in March
through August 2012, that included decreased energy, loss of
focus, and passive suicidal ideation. (A.R. 348-49). His MSE
was within normal limits, apart from a blunted emotional
affect. (A.R. 351-52). Dr. Goetter diagnosed major depressive
disorder, recurrent and in remission, generalized anxiety
disorder, and PTSD, assessing a GAF of 55. (A.R.
352). She opined that his psychiatric symptoms
were likely exacerbated by numerous psychosocial stressors,
including job dissatisfaction, limited social support, his
parents' failing health, and his own medical concerns.
returned to MGH and saw Heather Kapson, Ph.D. on October 2,
2013. (A.R. 343). Dr. Kapson noted that Ford's primary
complaint was that his role as his “parents'
primary caregiver over the last 2 years” had been
triggering, and living with them had prevented him
“from working and from engaging in life with [his]
spouse, ” who lived in Baltimore. (Id.). Ford
again recounted the difficulties of his time in Afghanistan,
and noted that his “tour ended by him visiting his
parents and not returning when he saw their health
significantly declining.” (Id.). Dr. Kapson
noted that Ford still met the symptoms for PTSD, but his
symptoms, as reported by him, had decreased as compared with
his first one-and-a-half years after his return from
Afghanistan. (Id.). His PTSD Checklist score, or PCL
score, had improved significantly from his intake in December
2012. (Id.; A.R. 352). Dr. Kapson assessed a GAF score
of 55. (A.R. 345). She also diagnosed major depressive
disorder, recurrent and mild; generalized anxiety disorder;
and adjustment disorder. (Id.). She also noted
economic, occupational, and social support problems.
October 30, 2013, Ford met with Ann R. Stewart, MSW, LICSW,
to follow up on his psychosocial needs. He informed her that
his mother had passed away on October 11, 2013. (A.R. 391).
On November 12, 2013, Ford again saw Dr. Kapson and notified
her of his recent decision to move to Baltimore to be with
his husband. (A.R. 385). Dr. Kapson noted that he
“appeared visibly relieved, ” and expressed
“looking forward to being in one place where he can
establish roots, refocus on his career, and build a life with
his husband.” (Id.). Ford reported that he
generally felt more stable, but continued to struggle with
sleep disturbances, fatigue, motivation, and difficulty with
change overall. (Id.). Ford's MSE was normal,
his PCL score further improved to 31, and his GAF score was
60. (A.R. 385-86).
State Agency Consultant Disability Determination - Dr.
November 13, 2013, Ford underwent a consultative psychiatric
evaluation with Olga Rossello, M.D., for his SSDI
application. (A.R. 397). Ford recounted his experiences in
Afghanistan and reported sleeping problems, an “up and
down” mood, irritability, and concentration problems.
(Id.). He reported that he stopped working because
it exacerbated his problems and caused him to be on edge and
lose his patience. (A.R. 398). Dr. Rossello noted that his
MSE was normal and that he presented a cooperative attitude,
a reactive affect, good remote memory, and fair insight and
judgment. (Id.). Ford reported that his typical day
includes “watch[ing] news, science, history stuff,
” and that he could cook, clean, and shop
independently. (A.R. at 398). He stated that his hobbies were
“cars [and] working out” and that he enjoyed
reading books about fishing and, for example, works by
William Faulkner. (Id.). He explained that when he
goes to the market or mall, “he is comfortable with
crowds if he gets in and out, ” and socially he
“get[s] along with others . . . okay.”
(Id.). Dr. Rosello assessed a GAF score of
and diagnosed PTSD. (A.R. at 399). She noted that his
capability appeared fair and that his condition could be
improved by treatment. (Id.).
November 25, 2013, Dr. Diana Walcutt, Ph.D., a state agency
psychological consultant, completed a Disability
Determination Explanation form after reviewing Ford's
medical records and Dr. Rosello's evaluation. (A.R.
84-85, 88). Dr. Walcutt summarized and cited to Ford's
treatment notes, and noted that Ford “suffers from
extreme PTSD symptoms, violent mood swings [and]
insomnia.” (A.R. 86-88). She diagnosed severe anxiety
disorder and severe affective disorders that resulted in 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 repeated episodes of decompensation of
extended duration. (A.R. 87-88). She further determined that
despite Ford's insomnia and moderate difficulty with
sustained concentration, he was able to understand and follow
simple and complex instructions, and he could read, shop, and
prepare meals. (A.R. 91). Dr. Walcutt found that Ford
experienced mild to moderate limitations in areas dealing
with continuity of performance and social interactions. (A.R.
92). Ultimately, Dr. Walcutt determined that because Ford had
“the ability to interact and relate with others
socially, ” could “adequately negotiate in the
general community, ” and retained “the capacity
to perform simple tasks from a mental health perspective,
” he was not disabled. (A.R. 93).
April 2014-November 2014
relocating to Maryland, Ford began treatment on April 9,
2014, with Julie Eastin, Ph.D. (A.R. 420-25). Ford reported
feeling “helpless, ” “trapped, ”
withdrawn from people, and unable to be proactive. (A.R.
420). He said he felt some anger and had scared himself after
punching a wall during an argument in January 2014.
(Id.). He denied any thoughts of suicide, but
expressed that he “accomplished the goals [he] wanted
to, and now there[']s no reason left to stay here.”
(A.R. 423-24). He reported a stressful past few months
because of his partner's “neediness” and
feeling as though “he is a psychologist more than a
husband.” (A.R. 421). He noted that he used to enjoy
music, reading, and writing, and that his recent efforts to
write again had been difficult because of his lack of
concentration. (A.R. 422). Dr. Easton noted that his MSE was
normal. (A.R. 423). She assessed a PCL score of 70 and
diagnosed PTSD. (A.R. 424).
first saw Heather Chase, LCSW, on May 14, 2014. (A.R. 413).
She noted that his MSE presented a neutral affect and low
mood, but was otherwise normal. (A.R. 413). Ford reported
difficulty concentrating, intrusive thoughts, guilt,
insomnia, grief and loss, and relational challenges.
(Id.). He described thoughts of “not being
here anymore, ” but denied any suicidal ideations.
(Id.). Ford next met with Chase on May 29, 2014, and
appeared “slightly dysphoric” and “tired,
” and became “tearful” in response to
Chase's discussion about coping skills. (A.R. 412). At
his next session on June 5, 2014, Ford presented with a
neutral affect at first, but overall displayed a dysphoric
mood and affect. (A.R. 415). Chase performed no MSE.
(Id.). Ford stated that he recently experienced
panic when expressing his needs to his husband and described
the grounding coping technique he used in response to that
panic. (Id.). At his fourth session with Chase on
June 12, 2014, she noted no significant changes to Ford's
presentation. (A.R. 417). She discussed more
distress-tolerance skills with Ford. (Id.). There
are no treatment notes in the record from Chase after the
June 12 appointment, but a behavioral health summary
indicates Ford saw her 19 more times through November 25,
2014. (A.R. 478).
State Agency Consultant Disability Determination, Dr.
24, 2014, Jeannie Nunez, Psy.D., a state agency psychological
consultant, reconsidered Ford's disability determination
by reviewing Dr. Walcutt's DDE and Ford's updated
medical records. (A.R. 126-38). Dr. Nunez reaffirmed Dr.
Walcutt's conclusion. (A.R. 137-38).
August 2014-January 2015 and Medical
August 8, 2014, Ford saw Dr. Douglas Gartrell, M.D., and
reported panic symptoms, poor sleep, feeling unsafe when
someone is behind him, some depression, anhedonia, and poor
appetite, energy, concentration, memory, and motivation.
(A.R. 505). He reported flashbacks and being triggered by
sound because of his work trauma. (Id.). Dr.
Gartrell noted that his MSE reflected good hygiene; a
cooperative attitude; clear speech; good eye contact; normal
behavior; a constricted, sad, and anxious affect; a dysphoric
and anxious mood; an organized thought process with thought
content within normal limits; good insight and judgment; and
no suicidal risk. (A.R. 507-08). Dr. Gartrell diagnosed
depressive disorder and PTSD, assessed a GAF score of 60, and
prescribed mirtazapine and Xanax. (A.R. 508-09). At an August
29, 2014 follow-up, Ford reported depression
(“7/10”), sleeping a lot, anxiety, and isolation.
(A.R. 495). Ford's MSE remained mostly unchanged, except
for the addition of an irritable mood. (Id.).
September 17, 2014, Chase wrote a letter to Ford's
representative discussing her work with him since May 2014.
(A.R. 432). She opined that Ford's current symptoms of
anxiety and depression were “significant barriers to
his ability to work, ” and thus qualified him as
disabled. (Id.). She stated that Ford was working to
gradually increase his exposure to crowds and social
settings, but found it “unlikely that [Ford] would be
able to tolerate the continued social interaction that comes
with a full-time job” and that his challenges with
focus and concentration would render him unable to perform
work reliably. (Id.). To support her opinion that
Ford's “challenges with sleep and fatigue”
would make it “difficult for [him] to attend a job on