# Polsgrove v. Saul

> District Court, W.D. Missouri · February 14, 2022

URL: https://www.frixlaw.com/law-library/cases/10242269

## Case

- **Court:** District Court, W.D. Missouri
- **Decided:** February 14, 2022
- **Opinion:** 100trialcourt
- **Cited by:** 0 later opinions in the Frix Law Library

## Citator (automated)

- No negative treatment found by the automated citator. That is not the same as a confirmation that the case is good law; read the citing cases.
- Full citator and citing cases: https://www.frixlaw.com/law-library/cases/10242269

## How later opinions describe it (automated extraction)

- finding that assessments consisting “of nothing more than vague, conclusory statements—checked boxes, circled answers, and brief fill-in-the-blank responses” that “cite no medical evidence and provide little to no elaboration . . . possess “little evidentiary value”

## Opinion text

IN THE UNITED STATES DISTRICT COURT
WESTERN DISTRICT OF MISSOURI
ST. JOSEPH DIVISION

BRANDON LEE POLSGROVE,

Plaintiff,

v. No. 21-06063-SJ-NKL-SSA

KILOLO KIJAKAZI
Acting Commissioner of Social Security,

Defendant.
ORDER
Plaintiff Brandon Lee Polsgrove seeks review of the denial by the Acting Commissioner
of his application for Social Security Disability Insurance and Supplemental Security Income
under Title II and Title XVI of the Social Security Act, 42 U.S.C. § 401 et seq. For the reasons
set forth below, the Court affirms the administrative decision.
I. FACTUAL BACKGROUND
Polsgrove, born on July 6, 1974, was 42 years old on the alleged disability-onset date. Tr.
31. He has a high school education. Id. His past relevant employment was as a mail carrier,
industrial cleaner, and firefighter. Tr. 30.
Although Polsgrove alleged disability beginning June 2017, the earliest medical evidence
identified in the record is from November 2018. Doc. 633; see also Doc. 15, p. 2. At that time,
Polsgrove had an initial psychiatric visit with Merlin Brown, M.D. Doc. 633. Overall, Polsgrove’s
appearance was anxious. Id. He reported fearful thoughts, a depressed mood, difficulty
concentrating, difficulty falling and staying asleep, diminished interest or pleasure, excessive
worry, fatigue, racing thoughts and restlessness. Id. He reported that functioning was extremely
difficult, and that he had tried multiple medications, but they had not been effective. Tr. 633.
On January 13, 2019, Polsgrove was admitted to a hospital on an emergency basis for acute
renal failure, sepsis, acute liver failure, acute pancreatitis, alcoholism, and shock. Tr. 346, 361.
Polsgrove, who was at risk of dying (see Tr. 346), remained in the hospital from 1/13/2019 to
1/29/2019. Tr. 337-538.
Nonetheless, the very next month, Polsgrove denied participating in, and expressly denied

interest in participating in, group treatment or treatment facilities for alcoholism. Tr. 548-49. Still,
he abstained from alcohol for a period of time. Tr. 554.
In June 2019, at least, Polsgrove relapsed in his alcoholism. Tr. 573. He reported that his
anxiety and depression were high and that he was having difficulty accepting the possibility that
he would have to take disability. Id.
In November 2019, Polsgrove saw therapist Joseph Kline, LCSW, for evaluation and
management of his mental health, following a referral from his primary care provider (“PCP”),
Ashley Lance, APRN. Tr. 640. Polsgrove reported depression and anxiety, and correspondingly
appeared anxious and depressed, sitting in a tense posture. Tr. 644. His activity was accelerated

and his speech was rapid, pressured and “overproductive.” Id. He appeared to have thought
processes that were circumstantial, but also flights of ideas. Id. He reported visual and auditory
hallucinations in the past months, but not at present. Id. He appeared to have impairment of
attention/concentration and memory. Diagnoses were noted as post-traumatic stress disorder,
major depressive disorder that was both recurrent and severe, and severe alcohol-use disorder. Tr.
648.
Polsgrove, referred by his PCP, also saw Sreenadha Davuluri, M.D., for neurological
evaluations for memory loss and tremors on December 11, 2019. Tr. 754. Dr. Davuluri noted that
Polsgrove was experiencing memory impairment, essential tremors, and polyneuropathy, most
likely related to his prior alcohol use. Tr. 758. Dr. Davaluri saw Polsgrove again in January and
May 2020 for follow-up regarding the memory loss. Tr. 750. Polsgrove had had some drinks in
the interim. Id. An MRI of Polsgrove’s brain was unremarkable. Id. The doctor prescribed
medication for the memory loss. Id. In the May visit, the doctor noted that Polsgrove was “stable”
and that he would see Polsgrove only on an as-needed basis.

On January 13, 2020, following a recommendation from therapist Kline, Donald Hinton,
M.D., a psychiatrist, conducted an initial psychiatric evaluation of Polsgrove. Tr. 656. Dr. Hinton
noted that Seroquel had “been helpful for his mood and insomnia” and changed some of
Polsgrove’s medication and dosages. Tr. 657, 660. Dr. Hinton saw Polsgrove again on January
28, 2020. Polsgrove reported that he was not drinking and he felt better on medication. Tr. 661.
Dr. Hinton’s notes from his continued visits with Polsgrove on March 23, 2020, May 8, 2020, June
11, 2020, and July 8, 2020 indicate that, despite frequent reports of anxiety, Polsgrove’s mental
health issues generally had improved. Tr. 668, 675, 682, and 689.
In a medical source statement dated December 9, 2020, which was submitted to the

Appeals Council, Dr. Hinton wrote that Polsgrove had been unable to work since 2019, although
Dr. Hinton had been seeing Polsgrove since only January 2020. Tr. 10. Dr. Hinton reported
Polsgrove’s diagnosis as “severe PTSD and major depression” with a history of alcohol use
currently in remission. Id. Most of the information in the statement was provided in the form of
checked boxes. Tr. 7-11.
At the Commissioner’s request, Polsgrove underwent a physical consultative examination
with Andre Mitchell, M.D., on June 29, 2019. Dr. Mitchell noted a history of acute hepatorenal
failure with significant abdominal pain on Tizanidine. Tr. 580. Neurological exam demonstrated
weakness of the right and left proximal and distal arms, and weakness in the right and left proximal
and distal legs. Tr. 583-84. Polsgrove lacked full range of motion in his extremities. Tr. 584.
Also at the request of the Commissioner, Polsgrove underwent a consultative psychological
evaluation on June 29, 2019 with Christie Nelson, Psy.D. On clinical examination, Dr. Nelson
indicated that Polsgrove’s “presentation was bizarre.” Tr. 594. He made guttural noises that were

startling in volume and intensity, and his eye contact vacillated between intense and sparse. Dr.
Nelson expressly considered whether Polsgrove was “[m]alingering,” noting that his “atypical
presentation would outwardly suggest the exaggeration of impairment for the purposes of
secondary gain (i.e., disability benefits),” but she noted that Polsgrove’s “symptoms of confusion,
memory impairment, and mood instability are also legitimate byproducts of hepatorenal failure.”
Tr. 595. Dr. Nelson also noted that Plaintiff was “a poor historian throughout the clinical contact”
and that the information in her report “should be interpreted with caution.” Tr. 592.1

II. PROCEDURAL BACKGROUND
Polsgrove filed a Title II application for a period of disability and disability insurance
benefits and a Title XVI application for supplemental security income on January 15, 2019,
alleging disability beginning June 1, 2017.
After Polsgrove’s claims for SSDI and SSI were denied at the State Agency level,
Polsgrove requested an administrative hearing. Following the hearing (Tr. 72-85), the
Administrative Law Judge (ALJ) denied Polsgrove’s claim on October 26, 2020. Tr. 17-36. The
ALJ determined at step four of the Commissioner’s sequential evaluation process that Polsgrove

was incapable of his past work as a firefighter, mail carrier, or industrial cleaner, but at step five,

1 Polsgrove also suffered from back pain that he attributed to a fall he took when working as a
firefighter. That pain is not, however, at issue on this appeal.
concluded that Polsgrove could perform work as a router, retail price marker, and collator operator,
and that Polsgrove therefore was not entitled to disability benefits. Tr. 30-31.
Polsgrove requested a review of the hearing decision by the Appeals Council and submitted
additional opinion evidence from his treating psychiatrist, Dr. Hinton. Tr. 7-11. By letter dated
April 8, 2021, the Appeals Council declined to review the decision. Tr. 1-6.

Polsgrove has exhausted his administrative remedies.
III. 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). “Substantial evidence is

less than a preponderance, but is enough so that a reasonable mind would find it adequate to
support the ALJ’s conclusion.” Singh v. Apfel, 222 F.3d 448, 451 (8th Cir. 2000). The Court must
consider both “evidence that detracts from the Commissioner’s decision as well as evidence that
supports it.” Id. (quotation marks and citation omitted). However, “as 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).
IV. DISCUSSION
A. Whether the Commissioner Failed to Adequately Evaluate Medical Opinion
Evidence in Formulating the RFC with Regard to Mental Impairments
Polsgrove argues that the ALJ erred in finding that Polsgrove was capable of a limited
range of simple, routine, and repetitive work. In reaching this conclusion, the ALJ found the
opinion of consulting psychological Dr. Nelson “unpersuasive” and instead found the opinion of
the non-examining and non-treating consultant Dr. Skolnick persuasive. The ALJ explained his
decision to discount Dr. Nelson’s opinion by pointing to indications that Polsgrove lives
independently, prepares meals, drives, goes out alone, shops, does household chores, and manages
his money; that he has had limited mental health treatment; and that when he takes his medication
and is sober, his depression and anxiety improve.

i. Whether the ALJ Selectively Cited Polsgrove’s Medical Records
Polsgrove argues first that the portions of the record to which the ALJ cites were
misconstrued or taken out of context. However, the pages the ALJ cites include the following
notes:
• January 28, 2020: “The patient reports that he is feeling better on the medicine. He
says, ‘I’m not as anxious and not as angry.’ . . . His mood is ‘calmer’ and brighter.

He denies feeling sad, hopeless or depressed. He denies having any current
thoughts of harming himself or anyone else. No side effects. No signs of mania or
psychosis. He is compliant with his meds. He is not drinking.” Tr. 661.
• March 23, 2020: “He denies feeling sad, hopeless or depressed. He denies having
any current thoughts of harming himself or anyone else. No signs of mania or
psychosis. He denies drinking any [a]lcohol.” Tr. 668.
• May 8, 2020: “He feels better. His mood is good. We reviewed all of his meds.
No side effects. He denies feeling sad, hopeless or depressed. He denies having
any current thoughts of harming himself or anyone else. No signs of mania or
psychosis. Sleeping okay.” Tr. 675.

The only complaints Polsgrove noted in these visits had to do with being unable to sleep
(Tr. 661, 668) and, in the March visit, anxiety (668). Indeed, except for intermittent reports of
anxiety, Polsgrove’s positive response to his medication continued. See Tr. 682 (June 11, 2020:
“The patient reports that he is doing all right and ‘hanging in there.’ He feels his meds are helping.
No side effects. He feels that his meds help his [sic] ‘to not get as upset as I used to.’ His mood
is good. He still struggles with a little Anxiety. He denies drinking any Alcohol. He denies feeling
sad, hopeless or depressed. He denies having any current thoughts of harming himself or anyone
else. No signs of mania or psychosis.”); Tr. 689 (July 8, 2020: “He feels anxious frequently. His
mood is okay overall. He denies feeling sad, hopeless or depressed. He denies having any current
thoughts of harming himself or anyone else. No signs of mania or psychosis. We reviewed all of

his current meds. No side effects. We discussed a trial of Hydroxyzine pm to address his Anxiety
symptoms and he agrees.”).
One of the records that Plaintiff cites in complaining about the ALJ’s selective citation was
from Polsgrove’s “initial psychiatric assessment” in January 2020 and predated the
aforementioned records. Tr. 656. Plaintiff also cites the June and July 2020 notes that indicate
anxiety but also overall “good” or “okay” mood. Tr. 682. As discussed above, the few reports of
anxiety are outweighed by the subsequent or contemporaneous records that plainly show
improvement with medication. See Bernard v. Colvin, 774 F.3d 482, 488 (8th Cir. 2014)
(“Impairments that are controllable or amenable to treatment do not support a finding of total
disability.” (quotation marks and citation omitted)). Finally, while Polsgrove indicated that he had
had passive thoughts of death, as reflected above, he expressly denied thoughts of self-harm on
each of those visits. Thus, the ALJ’s citations to the record are supported by substantial evidence
in the record.

ii. Whether the ALJ Erred in Discounting the Opinion of Dr. Nelson
Polsgrove also argues that, if the Commissioner had properly weighed the findings of
Plaintiff’s examining medical source Dr. Nelson, he would have determined that Plaintiff did not
have the residual functional capacity to perform work.
Dr. Nelson found that Polsgrove “has limited ability for sustained concentration an
persistence in simple and repetitive tasks”; “appears incapable of retaining information and

effectively carrying out instructions that are multi-step and moderate without the use of memory
aids”; “has impaired social skills and limited ability to interact with others routinely and adapt to
his environment”; “experiences significant mood instability which negatively impacts social skills
and daily living”; “appears to lack a sound ability to reason and make work-related decisions”; and
“appears to have struggles with concentration, persistence, or pace”; and that his functioning was
likely to decline with increased stress. Tr. 596. She considered whether Polsgrove was
“[m]alingering,” noting that his “atypical presentation would outwardly suggest the exaggeration
of impairment for the purposes of secondary gain (i.e., disability benefits),” but concluded that
Polsgrove’s “symptoms of confusion, memory impairment, and mood instability are also
legitimate byproducts of hepatorenal failure.” Tr. 595.

The ALJ found Dr. Nelson’s opinion “unpersuasive,” concluding that it was inconsistent
with the record:
[T]he claimant’s presentation at follow up exams since his January 2019
hospitalization did not indicate any altered mental status or bizarre presentation,
and an examination four days prior to Dr. Nelson’s evaluation did not indicate any
strange behavior or limited cognition. Similarly, the claimant did not have
difficulty interacting at his medical consultative evaluation that occurred the same
day and no bizarre behavior was noted. Further, the claimant’s function report
suggests that he is able to do more than his presentation at Dr. Nelson’s evaluation
suggests.
Tr. 29.
Polsgrove does not dispute that no medical reports since the January 2019 hospitalization
reflect the kind of “bizarre behavior” that Polsgrove purportedly exhibited when Dr. Nelson
evaluated him. Dr. Nelson herself also noted that Plaintiff was “a poor historian throughout the
clinical contact” and that the information in her report “should be interpreted with caution.” Tr.
592.
Polsgrove also does not contest that Dr. Nelson’s findings were not consistent with
Polsgrove’s activities of daily living. For example, Polsgrove reported that he typically cooks,
cleans the house, grocery shops for one or two hours every two weeks, watches some television,
talks with and visits family, and attempts “to fix anything around [his] home that [he] can.” Tr.
283 and 285. He also fishes, does yardwork, and housework “sometimes,” although “[n]ot well if
it[’]s physically demanding.” Tr. 286. He also drives and is capable of going out alone. Tr. 285.
These activities are not consistent with Dr. Nelson’s conclusions that Polsgrove “has limited ability
for sustained concentration and persistence in simple and repetitive tasks”; “appears incapable of
retaining information and effectively carrying out instructions that are multi-step and moderate
without the use of memory aids”; “has impaired social skills and limited ability to interact with
others routinely and adapt to his environment”; “experiences significant mood instability which
negatively impacts social skills and daily living”; and “appears to have struggles with
concentration, persistence, or pace . . . .” Tr. 596. Dr. Nelson’s findings concerning Polsgrove’s
mood are also inconsistent with Dr. Hinton’s subsequent medical notes from 2020 that showed
significant improvement with medication. See Tr. 661, 668, 675, 682, 689. Thus, the ALJ’s
decision to discount the opinion of Dr. Nelson was supported by substantial evidence in the record.

iii. Whether the ALJ Erred in Discounting the
Opinion of Treating Medical Source Dr. Hinton
Polsgrove also argues that, if the Commissioner had properly weighed the findings of
Plaintiff’s treating medical source Dr. Hinton, he would have determined that Plaintiff did not have
the residual functional capacity to perform work. After the ALJ’s October 2020 decision,
Polsgrove submitted a medical source statement from Dr. Hinton, his treating psychiatrist, to the
Appeals Council.2 The entire document is in checkbox form, with the exception of the following
statement: “Pt. has been seen since 1-13-20. [U]nable to work since 2019. Diagnosis is severe
PTSD & major depression. h/o Alcohol use prior to Jan 2020. No Alcohol use since 1-15-20. (in
remission)[.]” Tr. 10. Dr. Hinton’s checkmarks indicate that Polsgrove had “extreme” limitations
in ability to understand, remember, and carry out detailed instructions, ability to maintain attention
and concentration for extended periods, ability to perform activities within a schedule, maintain
regular attendance, and be punctual within customary tolerances, ability to work in coordination
with or proximity to others without being distracted by them, ability to complete a normal workday

and workweek without interruptions from psychologically based symptoms and to perform at a
consistent pace without an unreasonable number and length of rest periods, ability to get along
with coworkers or peers without distracting them or exhibiting behavioral extremes, and ability to

2 The Appeals Council reviewed the additional evidence, but found that Plaintiff had not shown a
reasonable probability that it would change the outcome of the decision. Tr. 1-2. When the
Appeals Council denies review of an ALJ’s decision after reviewing new evidence, the Court’s
role is not to scrutinize the Appeals’ Council’s decision, but to determine whether the record as a
whole, including the new evidence, supports the ALJ’s decision. McDade v. Astrue, 720 F.3d 994,
1000 (8th Cir. 2013).
set realistic goals or plans independently of others; and “marked” limitations in ability to remember
locations and work-like procedures, ability to sustain an ordinary routine without special
supervision, ability to make simple work-related decisions, ability to accept instructions and
respond appropriately to criticism from supervisors, and ability to travel in unfamiliar places or
use public transportation. Tr. 7-11.

Checkbox forms by themselves carry little evidentiary weight. Thomas v. Berryhill, 881
F.3d 672, 675 (8th Cir. 2018) (finding that assessments consisting “of nothing more than vague,
conclusory statements—checked boxes, circled answers, and brief fill-in-the-blank responses” that
“cite no medical evidence and provide little to no elaboration . . . possess “little evidentiary value”).
Dr. Hinton’s “extreme” and “marked” findings are not supported by, and indeed, stand in contrast
with, his own treatment records, which note that Polsgrove was “feeling better on . . . medicine”
and documented only occasional reports of anxiety and trouble sleeping. Tr. 661; see also Tr. 668,
675, 682, 689. See e.g., Kraus v. Saul, 988 F.3d 1019, 1025 (8th Cir. 2021) (“Substantial evidence
supports the ALJ’s decision to give ‘little weight’ to Dr. Duffy’s opinion. . . . Dr. Duffy checked

boxes indicating Kraus could not work, but gave no explanation and proffered no evidence for his
conclusion. Further, his treatment notes do not support his conclusion, noting continued
improvement in her memory, concentration, sleep, mood, and physical health.”). Dr. Hinton
multiple times concluded that Polsgrove did not even require a full mental status examination. Tr.
668, 675, 682, 689.
* * *
For the reasons discussed above, the Court finds that Polsgrove has not identified any
portion of the ALJ’s RFC with respect to Polsgrove’s mental capabilities that was not supported
by substantial evidence in the record.
B. Whether the Commissioner Failed to Consider the Combined Effect of
Polsgrove’s Impairments, Including His Gastrointestinal Disorder,
Polyneuropathy, and Hand Tremors, in Formulating the RFC
Polsgrove argues that the ALJ did not properly consider the combined effect of Polsgrove’s
physical impairments, particularly his gastrointestinal system disorder, polyneuropathy, and hand
tremors, in formulating the RFC.
The ALJ “must consider limitations and restrictions imposed by all of an individual’s
impairments, even those that are not ‘severe.’ While a ‘not severe’ impairment(s) standing alone
may not significantly limit an individual’s ability to do basic work activities, it may--when
considered with limitations or restrictions due to other impairment--be critical to the outcome of
the claim.” SSR 96-8p; see also 20 C.F.R. § 404.1545(a)(2) (“We will consider all of your
medically determinable impairments of which we are aware, including your medically
determinable impairments that are not ‘severe,’ . . . when we assess your residual functional
capacity.”).

i. Whether the ALJ Erred in Finding that Polsgrove’s
Gastrointestinal Problems Were Not Severe
Polsgrove suggests that the ALJ erred in not finding the gastrointestinal disorder severe
despite the conclusion of reviewing consultant Dr. Debroy that the disorder was Polsgrove’s
primary severe impairment (Tr. 94) and the ALJ’s conclusion that Dr. Debroy’s opinion was
persuasive (Tr. 29). However, Dr. Debroy’s notes discuss the gastrointestinal issues in connection
with Polsgrove’s January 2019 hospitalization. Tr. 99-10, 119-20. The very next month,
Polsgrove reported that he was “doing well” and his physical exam was unremarkable. Tr. 120.
Thus, substantial evidence supports the ALJ’s decision to find that Polsgrove’s gastrointestinal
disorder was not severe.
Moreover, Polsgrove has not suggested how treating the disorder as more severe would
have affected Polsgrove’s RFC. See Burgess v. Berryhill, No. 4:17 CV 2316 ACL, 2018 WL
4457308, at *6 (E.D. Mo. Sept. 17, 2018) (“Even if the ALJ should have noted Burgess’ diagnoses
. . . as severe, his failure to do so would not be sufficient cause for remand because it is the
functional limitations imposed by a severe impairment that are dispositive, not the fact of

diagnosis.” (citing Collins ex rel. Williams v. Barnhart, 335 F.3d 726, 730-31 (8th Cir. 2003)
(“Thus, the dispositive question remains whether [claimant]’s functioning in various areas is
markedly impaired, not what one doctor or another labels his disorder.”))).
ii. Whether Polsgrove’s Neuropathy Warrants Remand
Polsgrove also argues that the Commissioner’s decision disregards his neuropathy.

Polsgrove had complained that, “sometimes,” when he sits in a chair, his “feet turn purple,” and
“there’s times where it feels like a needle is just poking me in the bottom of my foot all over.” Tr.
79. Examining physician Dr. Mitchell noted demonstrated weakness of the right and left proximal
and distal arms and weakness in the right and left proximal and distal legs. Tr. 583-84. Dr.
Mitchell also noted that Polsgrove’s range of motion was not full in all extremities. Tr. 584.
The ALJ found Dr Mitchell’s opinions consistent with the record. Tr. 29. Nonetheless, he
found Polsgrove’s hand tremors and polyneuropathy non-severe, noting that “the polyneuropathy
and hand tremors are treated with medication and during the claimant’s most recent physical
examinations, he denied feeling any numbness or tingling in his feet and he did not report[] any
significant problems with his hands.” Id. The ALJ also cited Polsgrove’s activities of daily living.

Id.
Dr. Mitchell’s report is dated June 29, 2019. Polsgrove’s subsequent medical records
indicated that he was not experiencing numbness or tingling. Tr. 703 (July 2020); Tr. 710 (May
2020); Tr. (January 2020). Further, Polsgrove’s reported activities of daily living—which include
driving alone, performing housework and yardwork, repairing things, fishing, and hunting—
suggest that the polyneuropathy and hand tremors did not limit Polsgrove’s manual capabilities.
Substantial evidence in the record thus supports the ALJ’s decision to not find the polyneuropathy
and hand tremors severe, and to not include additional limitations in the RFC to account for them.

V. CONCLUSION
For the reasons discussed above, the Court AFFIRMS the administrative decision.
s/ Nanette K. Laughrey
NANETTE K. LAUGHREY
United States District Judge

Dated: February 14, 2022
Jefferson City, Missouri

---

Source: Frix Law Library, https://www.frixlaw.com/law-library/cases/10242269. Public record. Not legal advice.