Guetzloff v. Kijakazi

IN THE UNITED STATES DISTRICT COURT

FOR THE WESTERN DISTRICT OF MISSOURI

CENTRAL DIVISION

)

MARTHA L. GUETZLOFF, )

)

Plaintiff, )

) Case No. 2:20-cv-04177-NKL

v. )

)

KILOLO KIJAKAZI, )

Acting Commissioner of Social Security, )

Defendants. )

)

)

ORDER

Plaintiff Martha Guetzloff seeks review of the denial by the Commissioner of the Social

Security Administration (the “Commissioner”) of her application for supplemental security

income (“SSI”) under 42 U.S.C §§ 1381–1385. Ms. Guetzloff argues reversal is required both

because the ALJ improperly evaluated the intensity, persistence, and limiting effects of her

symptoms and because the ALJ improperly weighed the medical opinion evidence when

evaluating her residual functional capacity (“RFC”). As discussed in more detail below, the

ALJ’s decision is AFFIRMED.

I. Background

On September 25, 2018, Ms. Guetzloff protectively filed her SSI application, claiming an

alleged onset date of September 25, 2018.1 See Tr. 10. The claim was initially denied, and Ms.

Guetzloff requested a hearing before an administrative law judge. On July 25, 2019,

1 Ms. Guetzloff initially claimed an onset date of July 1, 2005. However, the onset date was

subsequently amended to September 25, 2018. See Tr. 10.

Administrative Law Judge Vicky Ruth (the “ALJ”) held a video hearing on Ms. Guetzloff’s

claims, after which she ultimately concluded that Ms. Guetzloff was not disabled. Tr. 25.

Applying the five-step process defined in 20 C.F.R. § 404.1520(a), the ALJ concluded that

Ms. Guetzloff had several severe impairments: post-traumatic stress disorder (“PTSD”); major

depressive disorder; bipolar disorder; obesity; diabetes mellitus; fibromyalgia; and spinal

stenosis. See Tr. 13. However, none of these impairments—individually or cumulatively—were

found to meet or equal the severity of one of the listed impairments in 20 C.F.R. Part 404,

Subpart P, Appendix 1. Id. The ALJ then found Ms. Guetzloff had the RFC to perform light

work with several additional limitations. Specifically, Ms. Guetzloff could never climb ladders,

ropes, or scaffolds. Tr. 16. She could only occasionally balance, stoop, kneel, crouch, crawl,

and climb ramps or stairs. Tr. 16. The ALJ further found that Ms. Guetzloff should avoid

concentrated exposure to excessive vibration and workplace hazards, but could perform simple

routine tasks with no fast-paced production work. Tr. 16. Ms. Guetzloff could have no

interaction with the public, and only occasional interaction with coworkers and supervisors. Tr.

16.

The ALJ then determined that, considering Ms. Guetzloff’s age, education, work experience,

and RFC, she could perform work that existed in significant numbers in the national economy.

Tr. 24. Based upon the testimony of a vocational expert, the ALJ specifically concluded that Ms.

Guetzloff could work as a Router, Mail Clerk, or Laundry Worker. Tr. 25. Because Ms.

Guetzloff could perform work that was available in significant numbers in the national economy,

she was deemed not disabled. Tr. 25.

Ms. Guetzloff appealed the ALJ’s decision to the Appeals Council on July 14, 2020, which

ultimately affirmed the ALJ’s decision. Accordingly, the ALJ’s decision is a final decision of

the Commissioner and is ripe for judicial review.

II. Legal Standard

The Court must affirm the Commissioner’s denial of social security benefits so long as “there

was no legal error” and “the findings of fact are supported by substantial evidence on the record

as a whole.” Brown v. Colvin, 825 F.3d 936, 939 (8th Cir. 2016) (internal citation omitted).

“‘Substantial evidence is less than a preponderance but enough that a reasonable mind would

find it adequate to support the ALJ’s conclusion.’” Milam v. Colvin, 794 F.3d 978, 983 (8th Cir.

2015) (quoting Jones v. Astrue, 619 F.3d 963, 968 (8th Cir. 2010)). The Court must consider

evidence that both supports and detracts from the ALJ’s decision. Id. “[A]s long as substantial

evidence in the record supports the Commissioner’s decision, [the Court] may not reverse it

because substantial evidence [also] exists in the record that would have supported a contrary

outcome, or because [the Court] would have decided the case differently.” Andrews v. Colvin,

791 F.3d 923, 928 (8th Cir. 2015) (quotation marks and citation omitted). The Court must “defer

heavily to the findings and conclusions of the Social Security Administration.” Michel v. Colvin,

640 F. App’x 585, 592 (8th Cir. 2016) (quotation marks and citations omitted).

III. Discussion

Ms. Guetzloff claims that the ALJ erred in evaluating her RFC. Specifically, Ms.

Guetzloff argues that the ALJ improperly discounted her testimony regarding the intensity,

persistence, and limiting effects of her symptoms (her “subjective complaints”). She also argues

that the ALJ inappropriately relied on the medical opinion evidence from State Agency

psychological consultant Dr. Robert Cottone and improperly discounted opinions from one of

Ms. Guetzloff’s mental health providers, Nurse Practitioner (“NP”) Vivian Kamara.2 The Court

will address each argument in turn.

A. RFC Generally

A claimant’s RFC is “what [she] can do” despite her “physical or mental limitations.” 20

C.F.R. § 404.1545(a). “When determining whether a claimant can engage in substantial

employment, an ALJ must consider the combination of the claimant’s mental and physical

impairments.” Lauer v. Apfel, 245 F.3d 700, 703 (8th Cir. 2001) (citation omitted). “The ALJ

must assess a claimant’s RFC based on all relevant, credible evidence in the record, ‘including

the medical records, observations of treating physicians and others, and an individual’s own

description of his limitations.’” Tucker v. Barnhart, 363 F.3d 781, 783 (8th Cir. 2004) (quoting

McKinney v. Apfel, 228 F.3d at 860, 863 (8th Cir. 2000)); see also Myers v. Colvin, 721 F.3d

521, 526 (8th Cir. 2013).

“To determine a claimant’s RFC, the ALJ must move, analytically, from ascertaining the

true extent of the claimant’s impairments to determining the kind of work the claimant can still

do despite her impairments.” Morton v. Saul, No. 2:19-CV-92, 2021 WL 307552, at *4 (E.D.

Mo. Jan. 29, 2021) (citing Anderson v. Shalala, 51 F.3d. 777, 779 (8th Cir. 1995)). “Although it

is the ALJ’s responsibility to determine the claimant's RFC, the burden is on the claimant to

establish his or her RFC.” Buford v. Colvin, 824 F.3d 793, 796 (8th Cir. 2016) (internal citations

2 While Ms. Guetzloff mentions the ALJ’s decision to discount psychologist Dr. Ann Pollock’s

opinion that Ms. Guetzloff’s “combination of mental and physical issues prevents her from

working at this time,” Tr. 23, 392, she does not argue that this decision was invalid. For the

avoidance of doubt, the ALJ was within her power to find such an opinion unpersuasive, given

that it infringes on issues reserved to the Commissioner. See 30 C.F.R. § 416.920b(c)(3); see

also Krogmeier v. Barnhart, 294 F.3d 1019, 1023 (8th Cir. 2002) (“[T]reating physicians’

opinions are not medical opinions that should be credited when they simply state that a claimant

cannot be gainfully employed, because they are merely “opinions on the application of the

statute, a task assigned solely to the discretion of the [Commissioner]).” (citation omitted).

omitted). “[S]ome medical evidence must support the determination of the claimant's RFC, and

the ALJ should obtain medical evidence that addresses the claimant's ability to function in the

workplace.” Lauer, 245 F.3d at 704 (internal citations omitted). Thus, an ALJ is “required to

consider at least some supporting evidence from a professional.” Id.; see also Vossen v. Astrue,

612 F.3d 1011, 1016 (8th Cir. 2010) (“The ALJ bears the primary responsibility for determining

a claimant's RFC and because RFC is a medical question, some medical evidence must support

the determination of the claimant's RFC.”).

B. Whether the ALJ Erred in Evaluating the Intensity, Persistence, and

Limiting Effect of Ms. Guetzloff’s Symptoms.

Ms. Guetzloff argues the ALJ improperly discounted her subjective complaints regarding

the intensity, persistence, and limiting effects of her psychological symptoms. When an ALJ

evaluates subjective complaints, the ALJ “must consider objective medical evidence, the

claimant’s work history, and other evidence relating to (1) the claimant’s daily activities; (2) the

duration, frequency, and intensity of the pain; (3) precipitating and aggravating factors; (4) the

dosage, effectiveness, and side effects of medication; and (5) the claimant’s functional

restrictions.” Schwandt v. Berryhill, 926 F.3d 1004, 1012 (8th Cir. 2019) (citing Polaski v.

Heckler, 739 F.2d 1320, 1322 (8th Cir. 1984), and 20 C.F.R. § 404.1529(c)). However, the ALJ

is not required to discuss each of these factors. Id. (citation omitted).3 Further, the “ALJ may

decline to credit a claimant’s subjective complaints ‘if the evidence as a whole is inconsistent

3 Ms. Guetzloff appears to point to general deficiencies in the ALJ’s opinion writing technique,

specifically taking aim at the general and conclusory language at times deployed. While

additional detail and explanation from the ALJ would certainly have been welcome, the Court

cannot conclude that this was reversible error. The ALJ's analysis here provides “an adequate

basis for meaningful judicial review” and is supported by substantial evidence. See Mills, 2015

WL 5785691at *8 (quoting Cichocki v. Astrue, 729 F.3d 172, 177 (2nd Cir. 2013) (holding that

the ALJ’s failure to explicitly engage in a function-by-function RFC analysis does not require

remand where the “ALJ’s analysis . . . affords an adequate basis for meaningful judicial review,

applies the proper legal standards, and is supported by substantial evidence”)).

with the claimant’s testimony.’” Julin v. Colvin, 826 F.3d 1082, 1086 (8th Cir. 2016) (citation

omitted); see also Gwathney v. Chater, 104 F.3d 1043, 1045 (8th Cir. 1997) (“The ALJ may

discount subjective complaints of physical and mental health problems that are inconsistent with

medical reports, daily activities, and other such evidence.”) (citation omitted).

On appeal, this Court does not reweigh the evidence before the ALJ. Guilliams v.

Barnhart, 393 F.3d 798, 801 (8th Cir. 2005) (citation omitted). Additionally, the Court must

“defer to the ALJ’s determinations regarding” a claimant’s subjective complaints, “so long as

they are supported by good reasons and substantial evidence.” Id. (citation omitted). Ultimately,

determinations about a claimant’s subjective complaints “are in the province of the ALJ,” and a

reviewing court “will not substitute its opinion for the ALJ's, who is in a better position to gauge

[subjective complaints] and resolve conflicts in evidence.” Nash v. Comm’r, Soc. Sec. Admin.,

907 F.3d 1086, 1090 (8th Cir. 2018) (citations omitted).

As relevant to this appeal, Ms. Guetzloff argues she is unable to work due to several

psychological symptoms. She claims that, despite medication, she is depressed, and accordingly

does not want to get out of bed and frequently becomes angry and irritable. Tr. 17, 45. Ms.

Guetzloff also reported “high stress,” anxiety, occasional visual hallucinations, and a history of

trauma. Tr. 20. Ms. Guetzloff also has been diagnosed with bipolar disorder, post-traumatic

stress order, generalized anxiety disorder, major depressive disorder, and obsessive-compulsive

disorder. Tr. 17, 20. At times, she struggles to leave the house. Tr. 17, 46. Ms. Guetzloff

claims that she has between three to four bad days a week, or about fifteen to sixteen a month.

Tr. 17, 45–46.

The ALJ discounted Ms. Guetzloff’s subjective complaints because Ms. Guetzloff

received a conservative course of treatment, she did not require hospitalizations after the alleged

onset date, and because the evidence of Ms. Guetzloff’s daily activities did not support the

severity of her claimed impairments. Tr. 21. Ms. Guetzloff specifically takes aim at the ALJ’s

evaluation of her daily activities.

First, the ALJ found Ms. Guetzloff’s subjective complaints incompatible with the record

because she originally stopped working because she had a baby, indicating that she “took on a

number of tasks involved in caring for an infant, including feeding the infant, bathing the infant,

changing the infant, doing laundry, cleaning, and entertaining the infant – these activities

actually reflect she was likely performing work related functions on a full-time basis[.]” Tr. 21.

While that may be true, that was in 1999. Id. It is unclear—because the ALJ did not explain—

why Ms. Guetzloff’s daily activities from more than 19 years before her alleged onset date would

be relevant. See Zinselmeier v. Kijakazi, No. 4:20 CV 255, 2021 WL 3616763, at *5 (E.D. Mo.

Aug. 16, 2021) (“Because an ALJ must determine a claimant’s abilities as they exist at the time

of the hearing, she cannot rely on remote evidence to determine a claimant’s abilities.”) (citing

Frankl v. Shalala, 47 F.3d 935, 939 (8th Cir. 1995)). The ALJ never discussed how Ms.

Guetzloff’s current relationship with her children—now all adults (Tr. 40)—reflect on her

subjective complaints. Indeed, the record suggests that Ms. Guetzloff had to stop parenting and

leave one of her children in the custody of her father because of other mental health concerns.

Tr. 43. Accordingly, this portion of the ALJ’s analysis is not supported by substantial evidence.

See Richardson v. Perales, 402 U.S. 389, 401 (1971) (“[Substantial evidence] means such

relevant evidence as a reasonable mind might accept as adequate to support a conclusion.”).

However, this error was harmless. An error is harmless when the claimant fails to

“provide some indication that the ALJ would have decided differently if the error had not

occurred.” Byes v. Astrue, 687 F.3d 913, 917 (8th Cir. 2012). While the ALJ inappropriately

found that Ms. Guetzloff’s pre-2018 daily activities conflicted with her current description of her

symptoms, there is still substantial evidence supporting the ALJ’s decision to discount Ms.

Guetzloff’s subjective complaints. Buford v. Colvin, 824 F.3d 793, 795 (8th Cir. 2016) (noting a

court “will not reverse simply because some evidence supports a” different conclusion).

To begin, the ALJ found that the fact that Ms. Guetzloff was capable of planning and

executing a move from Tennessee to Missouri contradicts her testimony regarding the severity of

her symptoms. Tr. 21. Ms. Guetzloff counters that the record does not establish how she moved

and whether she had help. Ms. Guetzloff did not enter evidence suggesting—and does not now

concretely argue—that there was anything about the move that should displace the ALJ’s

finding. The record, as a whole, shows that Ms. Guetzloff was able to move to Missouri and

establish a life once she arrived. Ms. Guetzloff obtained a Missouri phone number, made

friends, and established a serious relationship with a romantic partner. Tr. 15, 21, 399, 457–58,

474, 482. Given the record, the Court cannot conclude that the ALJ erred in finding that the

activities involved in moving from Tennessee to Missouri contradicted Ms. Guetzloff’s

subjective complaints, especially relating to her ability to interact with others and function

socially. Richardson, 402 U.S. at 401 (holding that substantial evidence “means such relevant

evidence as a reasonable mind might accept as adequate to support a conclusion.”); Bland v.

Bowen, 861 F.2d 533, 535 (8th Cir. 1988) (“In reviewing a denial of social security benefits we

are limited to assessing whether there is substantial evidence in the record as a whole to support

the Secretary's decision.”) (citation omitted).

The record also shows that Ms. Guetzloff took a trip to Tennessee alone to attend the

graduation of one of her children. See e.g., Tr. 40, 476. Ms. Guetzloff testified—and indicated

to her therapist—that she enjoyed the time with her family and the graduation itself went well.

Tr. 476. True, Ms. Guetzloff testified that she experienced anxiety on the trip to Tennessee, but

Ms. Guetzloff relied on coping skills she learned in therapy to manage her anxiety. Tr. 40–41. It

is also true that Ms. Guetzloff had to be driven back to Missouri from Tennessee. However,

While Ms. Guetzloff was in Tennessee, her abusive ex-husband passed away. Tr. 40–41. Both

her treatment notes and Ms. Guetzloff’s own testimony make clear that this provoked an

emotional response and affected Ms. Guetzloff deeply. Tr. 40–41, 476, 508. That said, before

her ex-husband’s death, Ms. Guetzloff’s medical records suggest that her “mood ha[d] been

better.” Tr. 508. Ms. Guetzloff also ran out of her psychiatric medication while on this trip. Tr.

508. Taken together, there is enough evidence to permit the ALJ to conclude that the level of

functioning evinced by Ms. Guetzloff’s trip to Tennessee contradicts her subjective complaints.

Richardson, 402 U.S. at 401; Bland, 861 F.2d at 535.

The ALJ further discounted Ms. Guetzloff’s subjective complaints given her lack of work

history. An ALJ may properly discount a claimant’s subjective complaints when, among other

reasons, the record indicates lack of motivation to work as evidenced by sporadic work history or

relatively low earnings. See Bernard v. Colvin, 774 F.3d 482, 489 (8th Cir.2014) (ALJ

appropriately considered claimant’s sporadic work history in discrediting his subjective

complaints); Fredrickson v. Barnhart, 359 F.3d 972, 976 (8th Cir.2004) (ALJ properly

considered claimant’s sporadic work history and relatively low earnings record as evidence of

potential lack of motivation to work). This is true when, like here, the limited work history

occurs prior to a claimant’s onset date. See Mills v. Colvin, No. 5:15-CV-06003, 2015 WL

5785691, at *6 (W.D. Mo. Oct. 2, 2015) (discounting claimant’s subjective complaints when

claimant had limited work history) (citations omitted).

The ALJ also concluded after a “longitudinal review of the claimant’s treatment history”

that “she has received conservative treatment for her . . . mental health during the relevant

period.” Tr. 21. The ALJ also found that Ms. Guetzloff was on a relatively conservative course

of treatment and lacked any recent hospitalizations and based on this she determined that Ms.

Guetzloff’s symptoms were less severe than she complained. Gray v. Apfel, 192 F.3d 799, 803–

04 (8th Cir. 1999) (finding ALJ properly discredited claimant's subjective complaints of pain

based on discrepancy between complaints and medical evidence, inconsistent statements, lack of

pain medications, and extensive daily activities). The record also reflects that Ms. Guetzloff was

responding well to treatment. See e.g., Tr. 406 (“[Ms. Guetzloff] reports that her depression and

anxiety [are] getting better. She reports [she has] been feeling better these days and has some

motivation to do things. She reports that her mood is good today, but she at times continues to

feel anxious. She reports that taking her medications helps with her anxiety and depression.”);

Tr. 408(“[Ms. Guetzloff] reports that her worries [are] still there but taking her medications is

helping.”); Tr. 507 (“[Ms. Guetzloff] reports that taking her [medications] helps with her anxiety

and depression.”), Tr. 508 (“[Ms. Guetzloff] said the medication is helping when she takes it, but

she ran out of her medication while in Tennessee.”), Tr. 513 (“[Ms. Guetzloff] reports that taking

her medications helps some.”); Guilliams, 393 F.3d at 801 (“Evidence of effective medication

resulting in relief, for example, may diminish the credibility of a claimant’s complaints.”)(citing

Rose v. Apfel, 181 F.3d 943, 944 (8th Cir. 1999)).

Given the additional evidence, the Court cannot conclude the ALJ committed reversible

error in evaluating the severity or persistence of Ms. Guetzloff’s subjective complaints. Cline v.

Colvin, 771 F.3d 1098, 1102 (8th Cir. 2014) (“As long as substantial evidence in the record

supports the Commissioner’s decision, [a reviewing court] may not reverse it because substantial

evidence exists in the record that would have supported a contrary outcome, or because [the

court] would have decided the case differently.”) (citation omitted). While Ms. Guetzloff

experienced serious psychological symptoms, symptoms alone do not automatically render a

person disabled. C.f. McGinnis v. Chater, 74 F.3d 873, 874 (8th Cir. 1996) (“[T]he appropriate

question [is] not whether [a claimant] suffers any pain but instead whether the pain [is] so

disabling as to prevent her from performing any type of work.”). There must be severe

functional loss establishing an inability to engage in substantial gainful activity. Buckner v.

Astrue, 646 F.3d 549, 557 (8th Cir. 2011).

Substantial evidence in the record as a whole supports the ALJ’s decision to discount the

severity of Ms. Guetzloff’s symptoms. Ms. Guetzloff was able to plan and execute a move from

Tennessee to Missouri, she was able to establish a life once she arrived, including a serious

relationship with a romantic partner, she was able to travel to Tennessee and enjoy time with her

family, and, perhaps more importantly, the record indicates that Ms. Guetzloff’s symptoms were

beginning to improve. Because any error in evaluating Ms. Guetzloff’s subjective complaints

was harmless, Ms. Guetzloff’s appeal on this basis is DENIED.

C. Whether the ALJ Erred in her Evaluation of the Medical Evidence

Ms. Guetzloff faults the ALJ for crediting the opinions of State Agency psychological

consultant Dr. Robert Cottone and discounting the opinions of NP Vivian Kamara, who treated

Ms. Guetzloff. Ms. Guetzloff does not challenge the legal framework the ALJ used to analyze

the experts’ opinions; instead, she seems to argue that substantial evidence does not support the

ALJ’s conclusion.

An ALJ’s analysis of medical opinion evidence is governed by 20 C.F.R. § 404.1520c(a).

For claims filed on or after March 27, 2017—like Ms. Guetzloff’s—the agency will not defer or

give any specific evidentiary weight, including controlling weight, to any medical opinion. See

Id. The 2017 amendments to the Commissioner’s regulations remove the “perceived hierarchy

of medical sources, deference to specific medical opinions, and [the practice of] assigning

‘weight’ to a medical opinion.” Brian O v. Comm'r of Soc. Sec., No. 1:19-CV-983, 2020 WL

3077009, at *4 (N.D.N.Y. June 10, 2020) (quoting 20 C.F.R. § 404.1520c(a), (b)) (alteration

omitted). That said, “the ALJ must still ‘articulate how he or she considered the medical

opinions’ and ‘how persuasive he or she finds all of the medical opinions.’” Id. Under the new

regulations, the agency will evaluate the persuasiveness of medical opinions considering five

specific factors, the most important of which are the supportability and consistency of the

opinion. 20 C.F.R. § 404.1520c(b)(2); see also Morton v. Saul, No. 2:19-CV-92, 2021 WL

307552, at *7 (E.D. Mo. Jan. 29, 2021).

The Commissioner’s regulations explain that, under the supportability factor, “the more

relevant the objective medical evidence and supporting explanations presented by a medical

source are to support his or her medical opinion(s) . . . the more persuasive the medical opinions .

. . will be. 20 C.F.R. § 404.1520c(c)(1) (2017). In other words, an opinion is more persuasive if

it presents more relevant objective medical evidence and explanatory rationale in support of the

opinion.” Morton, 2021 WL 307552, at *7. With respect to consistency, “the more consistent a

medical opinion[] . . . is with the evidence from other medical sources and nonmedical sources in

the claim, the more persuasive the medical opinion[] . . .will be.” 20 C.F.R. § 404.1520c(c)(2)

(2017). “Stated more simply, an opinion is more persuasive if it is more consistent with the

overall evidence as whole.” Morton, 2021 WL 307552, at *7.

Dr. Robert Cottone

In January 2015, State Agency medical consultant Dr. Robert Cottone, a mental health

professional, reviewed Ms. Guetzloff’s medical records and formed opinions regarding her

mental impairments and their impact on her ability to do work. Tr. 74–82. Dr. Cottone did not

treat or personally evaluate Ms. Guetzloff. From his review, Dr. Cottone determined that Ms.

Guetzloff’s psychological conditions caused mild to moderate limits to her functioning,

including difficulty interacting with supervisors and co-workers, maintaining concentration for

extended periods, and carrying out detailed instructions, but found her able to “understand,

remember, and carry out short and simple instructions[,]” “adapt to most changes in the

workplace[,]” and “make simple work-related decisions.” Tr. 82.

The ALJ found Dr. Cottone’s review persuasive, and specifically credited several of his

opinions. Although she offered no detailed explanation, the ALJ generally found that each

opinion was consistent with the evidence in the record and well supported by Dr. Cottone’s

narrative discussion. Tr. 22.

The ALJ first relied on Dr. Cottone’s opinion that Ms. Guetzloff suffers from severe

affective disorder, severe trauma or stressor related disorder and non-severe substance abuse

disorder. Tr. 22. The ALJ further credited Dr. Cottone’s opinion that Ms. Guetzloff has “mild

limitation to understanding, remembering, or applying information, moderate limitation to

interacting with others, moderate limitation to concentration, persistence or pace, and mild

limitation to adapting or managing” and that Ms. Guetzloff “retained the ability to understand,

remember, and carry out simple instructions; to adopt to most changes in the workplace; to make

simple work related decisions[.]” Tr. 22.

Ms. Guetzloff appears to argue that Dr. Cottone’s opinion was not supportable because:

(1) Dr. Cottone never personally examined or treated Ms. Guetzloff, (2) he reached the opinion

before Ms. Guetzloff began receiving psychiatric care and counseling—and therefore without the

benefit of records from those visits, and (3) the opinion itself is contradicted by the evidence. As

an initial matter, there is no per se rule preventing an ALJ from finding the opinion of a non-

examining state agency consultant more persuasive than that of a treating healthcare provider.

See 20 C.F.R. § 404.1520c(a); Fatuma A. v. Saul, No. 19-CV-3160, 2021 WL 616522, at *9 (D.

Minn. Jan. 26, 2021), report and recommendation adopted, No. 19-CV-3160, 2021 WL 615414

(D. Minn. Feb. 17, 2021). Nor does a medical consultant’s opinion need to be discarded simply

because his opinion was reached without the benefit of a claimant’s full medical record. See

McCoy v. Saul, No. 4:19-CV-00704, 2020 WL 3412234, at *9 (W.D. Mo. June 22, 2020)

(holding that ALJ did not err in finding medical consultant’s opinion persuasive even though that

opinion was reached before more than 300 pages of additional medical evidence had been

adduced). “[A]n ALJ may embrace a state agency psychological consultant’s opinion even if it

was made before the record was fully developed.” Kuikka v. Berryhill, No. 17-cv-374, 2018 WL

1342482, at *10 (D. Minn. Mar. 15, 2018) (citation omitted). At bottom, the ALJ alone is

responsible for calculating the RFC. Perks v. Astrue, 687 F.3d 1086, 1092 (8th Cir. 2012)

(“Even though the RFC assessment draws from medical sources for support, it is ultimately an

administrative determination reserved to the Commissioner.”). As such, an ALJ can rely on the

“opinion of a state agency medical consultant who did not have access to all the records, so long

as the ALJ conducts an independent review of the evidence and takes into account portions of the

record the consultant had not considered.” Kuikka, 2018 WL 1342482, at *10.

Here, the ALJ clearly considered the medical evidence submitted after Dr. Cottone

performed his analysis. See Tr. 20–21 (ALJ discussing treatment notes from Compass Health

Network describing visits between February 2019 through July 2019). Indeed, the ALJ discusses

various complaints made by Ms. Guetzloff during this period, as well as how her symptoms

progressed and responded to treatment. Id. After discussing this evidence, the ALJ found that

Ms. Guetzloff has a “moderate limitation to interacting with others and to concentration,

persistence or pace” and explicitly adopted restrictions in her RFC to account for that limitation.

Id. at 21. This discussion is enough to demonstrate the ALJ was aware of, and weighed, Ms.

Guetzloff’s additional medical evidence. See generally Fatuma A., 2021 WL 616522 at *9

(holding the ALJ did not err when relying on the opinion of a state agency consultant who did

not have access to the full record because the ALJ analyzed the record as a whole, including the

additional records, when crafting the RFC).

The remainder of Ms. Guetzloff’s arguments related to Dr. Cottone, such as that he

misinterpreted the evidence of Ms. Guetzloff’s daily activities and its impact on her level of

impairment, invite the Court to reweigh the facts before the ALJ and come to a different

conclusion. However, the Court may not do so. Guilliams, 393 F.3d at 801 (“We do not re-

weigh the evidence presented to the ALJ[.]”) (citation omitted). Both Dr. Cottone and the ALJ

analyzed Ms. Guetzloff’s medical records and drew conclusions regarding Ms. Guetzloff’s

ability to function in the workplace. Those conclusions are supported by substantial evidence.

See e.g., Tr. 390–92 (psychological evaluation from Dr. Ann Pollock). The Court’s inquiry ends

there. Ms. Guetzloff claims that the evidence of her daily activities considered by Dr. Cottone

should “indicate significant impairment[,]” Doc. 18, at 26, but so long as the ALJ’s conclusion is

supported by substantial evidence, the Court cannot reweigh the facts. Kirby v. Astrue, 500 F.3d

705, 709 (8th Cir. 2007) (“It is the function of the ALJ to weigh conflicting evidence and to

resolve disagreements among physicians.”) (citation omitted); Woolf v. Shalala, 3 F.3d 1210,

1213 (8th Cir. 1993) (“Although these pieces of evidence, if accepted as credible, might have

proved sufficient to support a finding of disability, we are not allowed to substitute our opinion

for that of the ALJ, who enjoys a closer position to the testimony in support of an application)

(citation omitted); Michel, 640 F. App’x at 592 (holding that the Court must “defer heavily to the

findings and conclusions of the Social Security Administration”) (quotation marks and citations

omitted). As such, Ms. Guetzloff’s appeal on this point is DENIED.

Nurse Practitioner Vivian Kamara

Ms. Guetzloff also faults the ALJ for discounting the medical opinion of Vivian Kamara,

a nurse practitioner at Compass Health Network (“Compass”). NP Kamara began treating Ms.

Guetzloff on April 4, 2019, and met with her three additional times, on April 18, 2019, June 13,

2019, and July 26, 2019. See Tr. 396–414, 504–510, 513–516. Ms. Guetzloff also saw a

therapist, Kerry Earthsoul, at Compass beginning in March 2019. See e.g., Tr. 483.

On July 19, 2019, NP Kamara completed a treating source statement, indicating that Ms.

Guetzloff had Category III (10% limitation in an eight-hour workday) to Category IV (20%

limitation in an eight-hour workday) limitations, including impairments to her ability to perform

simple work activity, maintain concentration, attend work regularly, interact with others, respond

to changes, and be aware of normal hazards. See Tr. 23–24; 427–430. NP Kamara further

concluded that Ms. Guetzloff would miss two or more days of work each month due to her

psychological limitations, and that even a minimal increase in mental demands or changes in

environment would cause Plaintiff to decompensate. Tr. at 429. These findings were reported

on a checkbox form, with only minimal narrative discussion. Where the opinions were

supported, NP Kamara pointed to her own mental status examinations, interactions with Ms.

Guetzloff, and well as “diagnosis and assessment.” Tr. at 427–430. The ALJ found these

opinions to be unpersuasive, given they were “basically unsupported” and inconsistent with the

medical evidence in the record. Tr. 24. Ms. Guetzloff argues that it was enough that NP Kamara

based her conclusions on “[Ms. Guetzloff’s] mental status exam and interaction with client.

Based on diagnosis and assessment.” Tr. 427–429.

To begin, it was permissible for the ALJ to discount NP Kamara’s opinions. Ms.

Guetzloff indirectly tries, several times, to suggest that NP Kamara’s opinions are entitled to

more weight than the opinions from other, non-treating medical professionals. See Doc. 18, 28–

31 (Ms. Guetzloff’s Brief in Support of Complaint). The Commissioner’s new regulations

directly foreclose her efforts.

While Ms. Guetzloff is correct that treating physicians can rely on their own experience

working with a claimant, it does not follow that an ALJ must accept an unsupported and

unexplained citation to a treating physician’s experience, “diagnosis[,] and assessment.” See

Doc. 18 at 29; see also Tr. 427–29. Here, NP Kamara’s blanket citation to her assessment of Ms.

Guetzloff is even less reliable because it is not clear which assessments NP Kamara purports to

rely on. The record suggests that NP Kamara herself only met with Ms. Guetzloff four times

(April 4, 2019; April 18, 2019; June 13, 2019; and July 26, 2019). Tr. 485–520. Meanwhile,

Ms. Guetzloff met with her therapist, also at Compass, more frequently.

And substantial evidence supports the ALJ’s decision to find NP Kamara’s opinions

inconsistent with the record as a whole. As Ms. Guetzloff points out, she reported feelings of

anxiety, irritability, low concentration, anger, and sadness; and explained that she felt these

things “most of the time.” See Tr. 409. She also disclosed her abusive relationship, nightmares,

and flashbacks. Tr. 413. But, Ms. Guetzloff was attending regular therapy and was prescribed

medication to manage these symptoms. See e.g., Tr. 460–461, 467–80. And, according to the

treatment notes, Ms. Guetzloff was responding well to that treatment. Tr. 406, 467–70, 474, 513

(medical records explaining improvements to nightmares, hallucinations, anxiety, social

relationships, and social activity). While Ms. Guetzloff at times reported increased anxiety and

depression, during therapy she was alert, pleasant, cooperative, and engaged. Tr. 402, 413, 509,

515.

While the record certainly shows that Ms. Guetzloff worked through difficult topics—

including trauma from her past abusive relationships—in therapy, and that she was forced to

confront challenging life events that occurred after the onset period, such as the death of her

abuser, the record reflects that the tools provided by her therapist, as well as medication

prescribed by NP Kamara, were generally helpful in controlling symptoms. See Tr. 41, 467–70,

474, 513. While Ms. Guetzloff did report instances of worsening symptoms, NP Kamara herself

wrote that Ms. Guetzloff’s “Depressed Anxious Affect” was “appropriate to content[,]” Tr. 515,

and her therapist also regularly noted that Ms. Guetzloff had good hygiene, made good eye

contact, and that her thought processes were linear and goal directed. Tr. 402, 413, 509–10, 515.

Other providers made similar, mild findings. See Tr. 380, 392, 422, 438.

Just because the ALJ did not find NP Kamara’s opinion related to the severity of Ms.

Guetzloff’s impairments persuasive does not mean that the ALJ rejected the pages of medical

records stemming from Ms. Guetzloff’s treatment at Compass, including by NP Kamara.

Indeed, the ALJ’s opinion clearly reflects a careful consideration of this evidence. However, the

ALJ concluded—and substantial evidence supports the conclusion—that NP Kamara’s opinions

conflict with the underlying medical evidence. This evidence includes reports from other health

care providers who examined Ms. Guetzloff, such as Dr. Pollock, who reported “[Ms.

Guetzloff’s] attention and concentration abilities appeared intact. She can learn, understand, and

recall information. She can manage finances independently.” Tr. 392.4 The Court will not re-

weigh the facts presented to the ALJ nor disturb the conclusions drawn by the ALJ—even if the

record would support a different one—so long as the ALJ’s conclusion is supported by

substantial evidence. Guilliams, 393 F.3d at 801; Michel, 640 F. App'x at 592. Accordingly,

Ms. Guetzloff’s appeal on this basis is DENIED.

IV. CONCLUSION

Because the ALJ did not commit reversible error in the calculation of Ms. Guetzloff’s

RFC—either in her assessment of Ms. Guetzloff’s subjective complaints or in her evaluation of

the relevant medical evidence—and the ALJ’s decision is supported by substantial evidence, the

ALJ’s decision is AFFIRMED

s/ Nanette K. Laughrey

NANETTE K. LAUGHREY

United States District Judge

Dated: 11/5/2021

Jefferson City, Missouri

4 Although the ALJ ultimately rejected Dr. Pollock’s conclusion that Ms. Guetzloff is unable to work, Dr.

Pollock’s evaluation of Ms. Guetzloff is still relevant medical evidence.