UNITED STATES DISTRICT COURT                             
                DISTRICT OF MINNESOTA                                


Kristopher T. T.,                      Case No. 23-cv-359 (TNL)           

     Plaintiff,                                                      

v.                                           ORDER                        

Martin J. O’Malley,                                                       
Commissioner of Social Security                                           
Administration,1                                                          

     Defendant.                                                      


Edward A. Wicklund, Olinsky Law Group, 250 South Clinton Street, Suite 210, 
Syracuse, NY 13202; and Jyotsna Asha Sharma, Disability Partners, PLLC, 2579 
Hamline Avenue North, Suite C, Roseville, MN 55113 (for Plaintiff); and   

Ana H. Voss, Assistant United States Attorney, 300 South Fourth Street, Suite 600, 
Minneapolis, MN 55415; and James Potter and James D. Sides, Special Assistant United 
States Attorneys, Social Security Administration, 6401 Security Boulevard, Baltimore, 
MD 21235 (for Defendant).                                                 


                   I. INTRODUCTION                                   
Plaintiff  Kristopher  T.  T.  brings  the  present  case,  contesting  Defendant 
Commissioner  of  Social  Security’s denial  of  his applications  for  disability  insurance 
benefits (“DIB”) under Title II of the Social Security Act, 

 et seq., and 
supplemental security income (“SSI”) under Title XVI of the same, 

 et 
seq.  The parties have consented to a final judgment from the undersigned United States 

1 Martin J. O’Malley was sworn into office as the Commissioner of the Social Security Administration on December 
20, 2023.  Commissioner, Soc. Sec. Admin., https://www.ssa.gov/agency/commissioner/ (last accessed Mar. 26, 
2024).  The Court has substituted O’Malley for former Acting Commissioner Kilolo Kijakazi.  See Fed. R. Civ. P. 
25(d) (public officer’s successor “automatically substituted as a party”). 
Magistrate Judge in accordance with 

(c), Fed. R. Civ. P. 73, and D. Minn. 
LR 72.1(c).                                                               

Pursuant to the Supplemental Rules for Social Security Actions Under 

(g) (“Supplemental Rules”), Plaintiff’s challenge to the Commissioner’s decision 
“is presented for decision” by the Court on “the parties’ briefs.”2  Fed. R. Civ. P. Supp. 
Soc. Sec. R. 5.  Rather than file a brief as provided in Rule 6 of the Supplemental Rules, 
Plaintiff filed a Motion for Summary Judgment and supporting memorandum, consistent 
with the procedure employed prior to the Supplemental Rules.  See generally ECF Nos. 

19, 20.  Consistent with Rule 7 of the Supplemental Rules, the Commissioner has filed a 
brief, requesting that the decision of the administrative law judge (“ALJ”) be affirmed.  
See generally ECF No. 22.                                                 
Being  duly  advised  of  all  the  files,  records,  and  proceedings  herein,  IT  IS 
HEREBY ORDERED that Plaintiff’s motion is denied, the Commissioner’s request for 

relief is granted, and the ALJ’s decision is affirmed.                    
               II. PROCEDURAL HISTORY                                
Plaintiff  applied  for  DIB  and  SSI  asserting  that  he  has  been  disabled  since 
November 2019 due to, among other things, depression, intermittent explosive disorder, 
anxiety disorder, obsessive compulsive disorder, and psychosis.  Tr. 18, 83-84, 101-102.  

Plaintiff’s applications were denied initially and again upon reconsideration.  Tr. 18, 99, 
117, 119-20, 123, 133, 144, 146.  Plaintiff appealed the reconsideration of his DIB and 


2 The Supplemental Rules went into effect on December 1, 2022.  See, e.g., D. Minn. LR 7.2 Dec. 2022 advisory 
comm. note.                                                               
SSI determinations by requesting a hearing before an administrative law judge (“ALJ”).  
Tr. 18, 177-78.  The ALJ held a hearing in February 2022, and issued an unfavorable 

decision.  See generally Tr. 18-37, 50-81.  Thereafter, Plaintiff requested review from the 
Appeals Council, which was denied.  Tr. 1-4.                              
Plaintiff then filed the instant action, challenging the ALJ’s decision.  Compl., 
ECF No. 1.  This matter is now ready for a determination on the briefs.  See Fed. R. Civ. 
P. Supp. Soc. Sec. R. 5.                                                  

                 III. MEDICAL RECORDS                                
Plaintiff has a history of multiple psychiatric diagnoses, including intermittent 
explosive disorder, depression, anxiety, psychosis, and hallucinations.  See, e.g., Tr. 448-
50, 481-82, 497-99; see also Tr. 801-60.  He also has a history of substance abuse.  See, 
e.g., Tr. 448-50, 481-82, 497-99.  Plaintiff was previously hospitalized in connection with 
his mental impairments and last discharged in 2016.  Tr. 482; see also Tr. 861-74.  He 

also has a history of suicide attempts prior to that hospitalization.  Tr. 482.  In addition, 
Plaintiff has tried numerous medications to treat his mental impairments.  See, e.g., Tr. 
482, 768-69; see also Tr. 481.  Plaintiff resides in subsidized housing in connection with 
a mental-health program and has a case manager.  Tr. 482; see generally Tr. 560-656. 
A. 2018                                                              

In mid-December 2018, Plaintiff met with Brian Johns, M.D., for a psychiatric 
follow-up appointment.3  Tr. 481.  Dr. Johns noted that Plaintiff “developed psychosis 
after ingesting large quantities of an experimental drug” he obtained overseas.  Tr. 481.  

3 Plaintiff’s care was transitioned to Dr. Johns after his previous provider left the facility.  See Tr. 801. 
Plaintiff reported that he experienced auditory hallucinations “occasionally when he does 
not sleep or is stressed.”  Tr. 481.  He found Haldol4 to be helpful in addressing the 

hallucinations and reported that “he only needs Haldol approximately once or twice a 
month.”  Tr. 481.  Dr. Johns noted that Plaintiff’s hallucinations had been “far worse in 
the past.”  Tr. 481.  Plaintiff also reported that he self-medicated with marijuana and 
cannabinoid oil.  Tr. 481.  Dr. Johns and Plaintiff “discussed the risk of these compounds 
worsening psychosis.”  Tr. 481.  Plaintiff’s primary complaint was his depression and he 
was interested an increased dose of pramipexole,5 which he had found to be “very helpful 

for [his] mood.”  Tr. 481.                                                
Dr. Johns observed that Plaintiff was oriented and casually dressed with good 
hygiene and eye contact.  Tr. 483.  His mood was “[n]ot super dysphoric but definitely 
dysthymic” and his affect was calm. Tr. 483.  Plaintiff’s speech and thought processes 
were normal, and he denied currently experiencing auditory or visual hallucinations.  Tr. 

483.    Plaintiff’s  memory  was  grossly  intact  without  formal  testing  and  his  fund  of 
knowledge was adequate.  Tr. 483.  Dr. Johns described Plaintiff’s insight as poor to fair 
and his judgment as fair.  Tr. 483.                                       




4 Haldol is a brand name for haloperidol, a medication “used to treat psychotic disorders (conditions that cause 
difficulty telling the difference between things or ideas that are real and things or ideas that are not real).”  
Haloperidol, MedlinePlus, Nat’l Lib. of Med., https://medlineplus.gov/druginfo/meds/a682180.html (last accessed 
Mar. 26, 2024).                                                           
5 Among other things, pramipexole can be used to treat conditions that cause “difficulties with movement” and 
“works by acting in place of dopamine.”  Pramipexole, MedlinePlus, Nat’l Lib. of Med., https://medlineplus.gov/ 
druginfo/meds/a697029.html (last accessed Mar. 26, 2024).  Mirapex is a brand name for pramipexole.  

 
Dr.  Johns  made  several  changes  to  Plaintiff’s  medications.    He  prescribed 
Effexor,6  increased  the  dose  of  pramipexole,  increased  the  dose  of  gabapentin,7 
discontinued clonazepam,8 and prescribed Xanax.9  Tr. 483.  Dr. Johns also prescribed a 

mood light and noted that he previously encouraged Plaintiff to start therapy.  Tr. 483.  
Plaintiff was directed to return in two to three months.  Tr. 484.        
B. 2019                                                              
In mid-February 2019, Plaintiff returned for a follow-up appointment with Dr. 
Johns.    Tr.  477,  756.    Plaintiff  reported that  he  was  “no  longer  using  psychoactive 

substances, such as THC,” just “CBD oil, which he feels helps with anxiety.”  Tr. 477; 
accord Tr. 756.  Dr. Johns “review[ed] coping techniques to remain sober” and Plaintiff 
understood his “risk of relapse is high.”  Tr. 477; accord Tr. 756.  Plaintiff’s auditory 
hallucinations  had  “largely  resolved  since  [his]  last  visit  two  months  ago  and  his 
cessation of THC.”  Tr. 477; accord Tr. 756.  Plaintiff reported that he took “Haldol 

occasionally when he feels the need to ensure he will sleep or if worried about psychosis 
returning due to triggers,” “taking it once a month presently.”  Tr. 477; accord Tr. 756.  



6 Effexor is a brand name for venlafaxine, a medication “used to treat depression.”  Venlafaxine, MedlinePlus, Nat’l 
Lib. of Med., https://medlineplus.gov/druginfo/meds/a694020.html (last accessed Mar. 26, 2024). 
7 Among other things, gabapentin can be used to treat certain types of “seizures by decreasing abnormal excitement 
in the brain.”  Gabapentin, MedlinePlus, Nat’l Lib. of Med., https://medlineplus.gov/druginfo/meds/a694007.html 
(last accessed Mar. 26, 2024).                                            
8 Clonazepam can be “used to relieve panic attacks (sudden, unexpected attacks of extreme fear and worry about 
these attacks)” and is in a class of medications called benzodiazepines.”  Clonazepam, MedlinePlus, Nat’l Lib. of 
Med., https://medlineplus.gov/druginfo/meds/a682279.html (last accessed Mar. 26, 2024).  “It works by decreasing 
abnormal electrical activity in the brain.”  

  Klonopin is a brand name for clonazepam.  

 
9 Xanax is a brand name for alprazolam, a medication “used to treat anxiety disorders and panic disorder (sudden, 
unexpected attacks of extreme fear and worry about these attacks).”  Alprazolam, MedlinePlus, Nat’l Lib. of Med., 
https://medlineplus.gov/druginfo/meds/a684001.html (last accessed Mar. 26, 2024).  “Alprazolam is in a class of 
medications called benzodiazepines” and “works by decreasing abnormal excitement in the brain.”  

 
Dr. Johns encouraged him “to maintain sobriety in order to ensure success of his mental 
health symptoms.”  Tr. 477; accord Tr. 756.                               

Plaintiff  also  felt  that  his  mood  was  “relatively  stable”  and  “denie[d]  overt 
depressive symptoms,” which he “attribute[d] . . . to having structured things to do with 
his time.”  Tr. 477; accord Tr. 756.  Plaintiff felt the increased dose of pramipexole was 
helpful and did not feel a need to increase any of his antidepressant medications.  Tr. 477, 
756.  Plaintiff had been unable to obtain Xanax for insurance reasons and continued 
taking clonazepam three times a day for his anxiety.  Tr. 477, 756.  Plaintiff reported 

feeling sedated and Dr. Johns encouraged him not to take this medication so frequently.  
Tr. 477, 756.  Plaintiff was, however, “reluctant to make any changes regarding this 
regimen.”  Tr. 477; accord Tr. 756.                                       
Plaintiff had also spent two weeks caring for his adult disabled brother while their 
mother was away and recovering from an illness.  Tr. 478, 756.  “This went well.”  Tr. 

478; accord Tr. 756.                                                      
Dr. Johns made similar findings when conducting a mental status examination of 
Plaintiff.  See Tr. 479-80, 758.  Plaintiff’s mood was described as “[t]oo busy to notice.”  
Tr.  480;  accord  Tr.  758.    Dr.  Johns  formally  discontinued  Xanax  and  restarted 
clonazepam, but otherwise maintained Plaintiff’s medications at their current levels.  Tr. 

480, 759.  Plaintiff was directed to return in three to four months.  Tr. 481, 759. 
Plaintiff next saw Dr. Johns in mid-August.  Tr. 474, 750.  He reported that he 
continued  to  experience  auditory  hallucinations  twice  per  month,  for  which  he  used 
Haldol, but they were “overall improved since cessation of THC.”  Tr. 474; accord Tr. 
750.    While  Plaintiff  continued  to  benefit  from  pramipexole,  he  reported  having  a 
“relatively low” mood and wanted to try an increase in Effexor.  Tr. 474; accord Tr. 750.  

Plaintiff also reported that he had started working for a pizza restaurant “a few months 
ago.”  Tr. 474; accord Tr. 750.                                           
Compared to prior mental status examinations, Plaintiff’s mood was noted to be 
“bored” and his affect described as “restricted.”  Tr. 476; accord Tr. 752.  Plaintiff was 
described as having “moderate hygiene and eye contact.”  Tr. 476; accord Tr. 752.  
Plaintiff’s thought content included “some mild” auditory hallucinations.  Tr. 476; accord 

Tr.  752.    Dr.  Johns  noted  that  Plaintiff’s  “[s]ubstance  use  remains  relatively  well 
controlled for him.”  Tr. 476; accord Tr. 752.  Among other things, Dr. Johns increased 
Plaintiff’s Effexor dose and directed him to return in three to four months.  Tr. 476, 754. 
Towards  the  middle  of  November,  Plaintiff’s  mother  contacted  a  crisis  line, 
concerned over a text message she had received from Plaintiff stating that he would not 

“be around for more than a month or so.”  Tr. 525; see also Tr. 597.  Plaintiff’s mother 
reported that it was possible he was using a controlled substance.  Tr. 525.  Plaintiff’s 
mother additionally noted that Plaintiff had lost his job at the pizza restaurant and had 
stated “the voices are quiet right now and that is how I want to go out.”  Tr. 525.  Mental-
health professionals attempted to reach Plaintiff at his residence and were unsuccessful.  

Tr. 525.                                                                  
When  Plaintiff  saw  Dr.  Johns  again  approximately  two  months  later  in  mid-
November, he was “struggling emotionally.”  Tr. 471; accord Tr. 746.  Plaintiff had lost 
two jobs in the last several months following personality conflicts with coworkers.  Tr. 
471, 746.  He was terminated from one position after an outburst and the second position 
after he “threatened to potentially harm [a coworker] in a letter to his manager.”  Tr. 471; 

accord  Tr.  746.    Plaintiff  “note[d]  some  conflicts  historically  with  people  who  are 
‘jerks.’”  Tr. 471; accord Tr. 746.                                       
Plaintiff’s mood did not improve with the increased Effexor dose and he wanted to 
try  an  additional  increase.    Tr.  471,  746.    Plaintiff  also  wanted  to  try  increasing 
pramipexole again.  Tr. 471, 746.  Dr. Johns noted that Plaintiff was not currently seeing 
his therapist.  Tr. 471, 746.  Plaintiff’s mental status examination remained the same.  Tr. 

473, 748.  Dr. Johns increased the doses of both Effexor and pramipexole and directed 
Plaintiff to return in two months.  Tr. 473, 748-49.                      
C. 2020                                                              
When Plaintiff was next seen by Dr. Johns in mid-January 2020, he reported that 
his mood had improved with the increased Effexor and pramipexole doses.  Tr. 468, 742.  

He also had not used Haldol recently.  Tr. 469, 742.  Plaintiff did, however, report “some 
increase in impulsive behaviors and spent some money on a sale for cannabinoids.”  Tr. 
468; accord Tr. 742.  Plaintiff was also “playing games on his telephone” and “wak[ing] 
up in the middle of the night to engage in this.”  Tr. 468; accord Tr. 742.  Plaintiff told 
Dr. Johns that he “has not been looking for work and currently feels overwhelmed with 

just basic living arrangements.”  Tr. 468; accord Tr. 742.  Plaintiff continued to work 
with his case manager.  Tr. 469, 742.                                     
During  this  visit,  Dr.  Johns  observed  that  Plaintiff  had  “poor  hygiene  and 
moderate eye contact.”  Tr. 470; accord Tr. 742.  Plaintiff’s affect remained restricted, 
but his mood was “better.”  Tr. 470; accord Tr. 744.  Plaintiff had mild psychomotor 
retardation.  Tr. 470, 744.  Dr. Johns also continued to note the presence of “some mild, 

occasional”  auditory  hallucinations.    Tr.  470;  accord  Tr.  744.    Dr.  Johns  continued 
Plaintiff’s medications as prescribed and directed him to return in three to four months.  
Tr. 470-71, 745.                                                          
In March, Plaintiff was assessed for continued receipt of services through the 
mental-health program.  See Tr. 460-68, 732-41.  As part of this assessment, Plaintiff 
reported that his depression makes it “[v]ery difficult for him to do his work, take care of 

things at home, or get along with other people.”  Tr. 464; accord Tr. 736.  Plaintiff’s 
mood was dysthymic and his affect was flat.  Tr. 466, 738.  His eye contact, speech, 
attention, concentration, thought processes, and memory were normal.  Tr. 466, 738.  
Plaintiff’s judgment and insight were both noted to be impaired.  Tr. 466, 738.  Plaintiff 
was diagnosed with major depressive disorder, generalized anxiety disorder, psychosis, 

and polysubstance abuse.  Tr. 467, 740.  Plaintiff was found eligible to continue to 
receive services through the mental-health program.  Tr. 468, 741.        
Plaintiff’s next visit with Dr. Johns occurred in mid-April and “was conducted via 
telehealth due to the COVID-19 pandemic.”  Tr. 457; accord Tr. 728.  Plaintiff’s “life 
remain[ed] largely unchanged.”  Tr. 457; accord Tr. 728.  He continued to benefit from 

the increased Effexor and pramipexole doses, which he found “helpful for maintaining 
his euthymic mood.”  Tr. 457; accord Tr. 728.  Plaintiff did not feel a need to change his 
medications  and  felt  that  “his  brain  [was]  healing  after  several  years  of  psychotic 
symptoms due to drug overdose.”  Tr. 457 (quotation omitted); accord Tr. 728.  Plaintiff 
reported that he had not needed Haldol for the past year and had not “had hallucinations 
for longer than that.”  Tr. 457 (quotation omitted); accord Tr. 728.  Plaintiff thought it 

might “be time to start looking for another job.”  Tr. 457; accord Tr. 728.  While Plaintiff 
still had a case manager, he had “little contact with them aside from moral support.”  Tr. 
457 (quotation omitted); accord Tr. 728.                                  
Plaintiff’s affect continued to be restricted and his mood was “okay.”  Tr. 459.  Dr. 
Johns noted that his auditory hallucinations had resolved.  Tr. 459.  Plaintiff was directed 
to continue with his medications as prescribed and return in three to four months.  Tr. 

459.                                                                      
Plaintiff had another telehealth appointment with Dr. Johns in early July.  Tr. 454, 
724.  Plaintiff reported feeling “more anxious than usual,” but was uncertain as to why.  
Tr. 454; accord Tr. 724.  Plaintiff had also recently ordered a substance online from 
overseas that he had taken in the past and found helpful, but believed a neighbor may 

have stolen the package.  Tr. 454, 724.  Dr. Johns asked Plaintiff why he did not just 
make an appointment to increase his clonazepam dose, and Plaintiff responded that he did 
not “think that would be an option.”  Tr. 454; accord Tr. 724.  Dr. Johns advised Plaintiff 
“not to take substance[s] in addition to prescribed medications or he would risk losing 
those as well.”  Tr. 454; accord Tr. 724.                                 

Plaintiff  additionally  reported  spending  time  playing  games  on  his  phone  and 
“spending money on his game” as well as “over $100 on medications from the internet.”  
Tr. 454; accord Tr. 724.  Plaintiff thought the pramipexole might be contributing to his 
spending, but he did not want to adjust the dose due to the mood benefits.  Tr. 454, 724.  
Plaintiff had also been talking with a therapist weekly, which he found helpful, and was 
going to “discuss his impulse control issues further with the therapist.”  Tr. 454; accord 

Tr. 724.  Plaintiff did not feel that gabapentin was helping his anxiety and wanted to 
discontinue it in favor of an increased dose of clonazepam.  Tr. 454, 724.  Plaintiff had 
not “taken Haldol in months” as he had not had hallucinations.  Tr. 454; accord Tr. 724. 
Plaintiff  discovered  that  a  prior  application  for  disability  benefits  had  been 
rejected over a year ago and his case manager had put him in touch with an attorney.  Tr. 
454, 724.  Plaintiff also had a job interview with a fast-food restaurant.  Tr. 454, 724.  

Plaintiff’s affect continued to be restricted and his mood was “a little bit furious.”  
Tr. 456; accord Tr. 726.  Dr. Johns noted that Plaintiff’s insight and judgment were both 
limited  to  fair.    Tr.  456,  726.    Dr.  Johns  discontinued  gabapentin,  increased  the 
clonazepam dose, and directed Plaintiff to return in three months.  Tr. 456, 726. 
At his next appointment in early October, Plaintiff reported some fatigue from the 

increased clonazepam, but felt he had adjusted to it and did not always take it three times 
a day if he was not feeling anxious.  Tr. 451, 720.  Plaintiff continued to struggle with 
sleep due to gaming on his phone.  Tr. 451, 720.  He continued to remain free of auditory 
hallucinations.  Tr. 451, 720.  Plaintiff did not “follow-through with a job at [the fast-
food restaurant] because he doesn’t have an ID and SS card so has been working with his 

case manager to get those.”  Tr. 451; accord Tr. 720.  Plaintiff was considering applying 
for other jobs or becoming a PCA for his brother.  Tr. 451, 720.  Plaintiff was also 
making better food choices and had not purchased “designer drugs online.”  Tr. 452; 
accord Tr. 720.  Additionally, Plaintiff had reapplied for disability benefits with the 
assistance of an attorney.  Tr. 451, 720.  Plaintiff’s mental status examination remained 
largely the same with his mood being described as “not great, not awful.”  Tr. 453; see 

Tr. 451; accord Tr. 720, 722.  Dr. Johns continued Plaintiff’s medications at their current 
levels and directed Plaintiff to follow up in two to three months.  Tr. 453, 723. 
Towards the end of December, Plaintiff contacted a crisis line due to auditory 
hallucinations.  Tr.  520-23.    During  the  first  call,  Plaintiff  reported  “concerns  about 
hearing voices over the past few days and . . . [that] he may not be able to see his family 
over the holidays.”  Tr. 523.  Plaintiff reported that it had been “a long time” since he had 

heard voices.  Tr. 523.  Plaintiff was not currently taking his medication.  Tr. 523.  
During a follow-up call two days later, Plaintiff reported that he had taken some old 
Haldol  and  felt  better.    Tr.  520,  521.    It  was  noted that  Plaintiff  had  an  upcoming 
appointment with Dr. Johns in two weeks.  Tr. 521.  Plaintiff was described as “brief, 
superficial, guarded, and minimizing his symptoms.”  Tr. 521.  His thought processes 

were “rambling” and his insight and judgment were fair.  Tr. 521.         
D. 2021                                                              
Plaintiff had a telehealth appointment with Dr. Johns in early January 2021.  Tr. 
530.  Plaintiff’s chief complaints were hallucinations, depression, and anxiety. Tr. 530.  
Plaintiff described his mood as “kinda a roller coaster.”  Tr. 530.  Plaintiff told Dr. Johns 

that,  before  Christmas,  he  experienced  auditory  hallucinations  “at  7/10.”    Tr.  530.  
Plaintiff reported that it had “been 2 years since the last episode.”  Tr. 530.  Plaintiff 
believed the hallucinations were possibly caused by “not eating and sleeping.”  Tr. 530.  
Plaintiff also reported “taking kratom for pain,” which “may have contributed.”10  Tr. 
530.  Plaintiff noted that he “took Haldol and started eating regularly as well.”  Tr. 530.  

Dr. Johns noted that both Plaintiff’s therapist and caseworker were currently on vacation.  
Tr. 530.  Plaintiff was interested in increasing his dose of Wellbutrin.11  Tr. 530. 
Plaintiff’s mental status examination was similar to previous examinations with 
his mood being described as “up and down.”  Tr. 532.  Dr. Johns increased the Wellbutrin 
dose and directed Plaintiff to return in three months.  Tr. 532-33.       
Plaintiff had another telehealth appointment with Dr. Johns in mid-February.  Tr. 

542, 716.  Plaintiff did not notice a difference with the increased dose of Wellbutrin and 
his mood continued to be up and down.  Tr. 542, 716.  Plaintiff had not had any auditory 
hallucinations since the prior visit.  Tr. 542, 716.  Dr. Johns noted that Plaintiff had 
“stopped playing his online phone game and deleted it,” which “was a huge step for 
[Plaintiff], as he was very addicted to it and has been going through ‘withdrawals.’”  Tr. 

542; accord Tr. 716.  Dr. Johns again increased Plaintiff’s Wellbutrin dose and directed 
him to return in three months.  Tr. 545, 719.                             
In  early  May,  Plaintiff  presented  to  the  emergency  room  for  auditory 
hallucinations.  Tr. 660.  Plaintiff reported that the voices had “drastically increased as of 
late” and had “also caused issues with keeping up on taking his medications.”  Tr. 660.  

Plaintiff reported that he considered taking “all of his clonazepam” to try to silence them.  

10 Kratom “commonly refers to an herbal substance that can produce opioid- and stimulant-like effects.”  Kratom, 
Nat’l Inst. on Drug Abuse, https://nida.nih.gov/research-topics/kratom (last accessed Mar. 26, 2024).  “Kratom and 
kratom-based products are currently legal.”  

                          
11 Wellbutrin is a brand name for bupropion, a medication used to treat depression and seasonal affective disorder.  
Bupropion, MedlinePlus, Nat’l Lib. of Med., https://medlineplus.gov/druginfo/meds/a695033.html (last accessed 
Mar. 26, 2024).                                                           
Tr. 660.  Plaintiff additionally reported that alcohol use made the voices worse and, “a 
couple weeks ago he drank 750ml of vodka,” which caused the voices to get worse.  Tr. 

662; see Tr. 762 (“did drink to black out a couple of times with hard alcohol”).  This was 
a “significant increase” from his usual consumption.  Tr. 662.  Plaintiff also reported 
increased anxiety, which he described as “pent up energy,” and said  he was “doing 
pushups in the ED lobby.”  Tr. 662.  Plaintiff had been unable to connect with his case 
manager or therapist due to a broken cell phone.  Tr. 662-63; see Tr. 673. 
Plaintiff  was  noted  to  have  a  “flat  affect”  and  “depressed  mood.”    Tr.  668.  

Plaintiff remained overnight and was discharged the following day.  Tr. 669, 671-72.  
Plaintiff improved with medication and was “feeling much better” with a decrease in his 
auditory hallucinations at the time of discharge.  Tr. 672.               
In mid-May, Plaintiff had another telehealth appointment with Dr. Johns.  Tr. 762.  
Plaintiff  discussed  his  recent  episode,  noting  that  he  had  been  having  auditory 

hallucinations on a daily basis in the month leading up to his emergency room visit.  Tr. 
762.  Plaintiff reported that the voices did not “want him to take medications.”  Tr. 762.  
Plaintiff told Dr. Johns that he received Abilify12 at the hospital, has continued taking it, 
and found it to be helpful with his mood.  Tr. 762.  Plaintiff reported that he felt “very 
depressed” prior to the auditory hallucinations.  Tr. 762.  Plaintiff’s sleep was also poor at 

the time of the hallucinations, but had since improved.  Tr. 762.         


12 Abilify is a brand name for aripiprazole, a medication that can be used to treat schizophrenia, among other things, 
and in conjunction with other medications “to treat depression when symptoms cannot be controlled by the 
antidepressant alone.”  Aripiprazole, MedlinePlus, Nat’l Lib. of Med., https://medlineplus.gov/druginfo/meds/ 
a603012.html (last accessed Mar. 26, 2024).                               
Plaintiff  was  interested  in  trying  to  increase  Effexor.    Tr.  762.    He  had  also 
stopped taking pramipexole “due to the [auditory hallucinations].”  Tr. 762.  Plaintiff was 

concerned about continuing with this medication as, when he restarted it, “he became 
obsessed with video games again.”  Tr. 762.  Plaintiff had also stopped taking Wellbutrin, 
but was interested in restarting this medication.  Tr. 762.               
Dr. Johns noted that Plaintiff’s memory was impaired and his attention decreased.  
Tr. 764.  Plaintiff’s mood was also low and he had high anxiety.  Tr. 764.  Dr. Johns 
increased  Plaintiff’s  Effexor  dose,  restarted  Wellbutrin,  and  formally  discontinued 

pramipexole.  Tr. 764.                                                    
In mid-June, Plaintiff began treating with Joseph A. Hanson, D.O., via telehealth.  
Tr. 688, 712; see Tr. 545, 719 (noting care transfer).  Plaintiff told Dr. Hanson that his 
“psychotic episode” lasted approximately three weeks and “[t]he triggering events were 
sleep deprivation and stress in his life.”  Tr. 688; accord Tr. 712.  Plaintiff reported that 

“he was having visual hallucinations that look like characters of people that were close to 
him and they were saying negative things about him.”  Tr. 688; accord Tr. 712.  Plaintiff 
stated he was given Abilify in the hospital and, after continuing with this medication, he 
“noticed a total resolution of his psychotic symptoms” over the course of several days.  
Tr. 688; accord Tr. 712.  Plaintiff had “been stable for over 2 weeks now,” was “sleeping 

well,” and had “a good appetite.”  Tr. 688; accord Tr. 712.               
Dr. Hanson noted that Plaintiff was alert and oriented, had good concentration, 
and normal thought processes.  Tr. 689, 713.  Plaintiff’s affect was appropriate and his 
mood was euthymic.  Tr. 689, 713.  Plaintiff also had good insight and judgment.  Tr. 
689, 713.  Dr. Hanson prescribed Abilify, continued Plaintiff’s other medications, and 
directed him to follow up in one month.  Tr. 690, 714.                    

When he followed up with Dr. Hanson a month later, Plaintiff reported that “he 
now only hears murmur in the voice” and cannot make out what the voice is saying.  Tr. 
685; accord Tr. 709.  Plaintiff reported being compliant with his medications and denied 
any side effects.  Tr. 685, 709.  Plaintiff wanted “to make more time to read now that he 
is feeling better.”  Tr. 685; accord Tr. 709.  “On good days,” Plaintiff was “productive 
and [able to] get himself to do yoga or some form of exercise to create structure in his 

day.”  Tr. 685; accord Tr. 709.  He was also sleeping regularly and had a good appetite.  
Tr.  685,  709.    Unlike  the  previous  visit,  Dr.  Hanson  described  Plaintiff’s  mood  as 
depressed, his insight poor, and his judgment fair.  Tr. 686, 710.  Dr. Hanson increased 
Plaintiff’s Effexor dose and continued his other medications at existing levels.  Tr. 687, 
711.  Plaintiff was to follow up in three months.  Tr. 687, 711.          

Plaintiff met with Dr. Johns via telehealth in mid-October.  Tr. 766.  Dr. Johns 
noted that Plaintiff was continuing to see Dr. Hanson.  Tr. 766.  Plaintiff reported that, 
following his episode of psychosis, he “had been feeling good through the summer until 
recently.”  Tr. 766.  Plaintiff noted some weight gain with Abilify.  Tr. 766.  Plaintiff also 
experienced mild auditory hallucinations occasionally and his mood remained low with 

fleeting suicidal ideation despite the increase in medication.  Tr. 766.  Plaintiff was 
interested in trying ketamine injections and transcranial magnetic stimulation (“TMS”)13 
as possible treatment options.  Tr. 766.                                  

Dr. Johns’ examination findings remained unchanged.  See Tr. 770-71.  Dr. Johns 
noted that Plaintiff “has a long history of depression” and was currently experiencing 
“severe, treatment resistant depression.”  Tr. 771.  Dr. Johns noted that Plaintiff had 
“failed numerous antidepressants” and “treated with psychotherapy without resolution of 
depression.”  Tr. 771.  Dr. Johns continued Plaintiff’s existing medications, prescribed a 
course of ketamine injections for three weeks, and authorized TMS.  Tr. 771. 

During  the  next  telehealth  appointment  with  Dr.  Hanson  in  early  November, 
Plaintiff reported feeling more depressed lately, which he attributed to the change in 
seasons.  Tr. 706.  Plaintiff had “a sad light” and said “he will be trying to use it more.”  
Tr. 706.  Plaintiff had also undergone “a few courses of IV ketamine infusions,” which he 
felt helped his mood, but “he still endorse[d] significant feelings of depression.”  Tr. 706.  

Plaintiff’s appetite and sleep were “fair.”  Tr. 706.  Plaintiff denied experiencing any 
hallucinations.  Tr. 706.                                                 
Plaintiff’s mental status examination was overall a bit better this time.  Although 
his mood remained depressed, his insight and judgment were good.  Tr. 708.  Dr. Hanson 
increased Plaintiff’s Abilify dose and continued his remaining medications.  Tr. 708.  

Plaintiff was directed to follow up in three months.  Tr. 708.            


13 “TMS uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression.”  
Transcranial Magnetic Stimulation (TMS) – Treatment for Depression, U.S. Dep’t of Veterans Affairs, 
https://www.va.gov/montana-health-care/programs/transcranial-magnetic-stimulation-tms-treatment-for-depression/ 
(last accessed Mar. 26, 2024).                                            
Plaintiff had another telehealth appointment with Dr. Hanson the following month.  
Tr. 703.  Both his mood and hallucinations were better.  Tr. 703.  Plaintiff reported that 

“his auditory hallucinations have decreased and at one point he was not hearing any.”  Tr. 
703; see Tr. 703 (“jokingly states that he thought the voices were finished”).  Plaintiff 
described his depression as “slightly improved.”  Tr. 703.  Plaintiff had some concerns 
about weight gain, and indicated that he would try to get outdoors more and stay active.  
Tr. 704.  Dr. Hanson noted that Plaintiff’s mood was euthymic.  Tr. 704.  Plaintiff’s 
medications were continued at their current levels and he was again directed to follow up 

in three months.  Compare Tr. 705 with Tr. 708.                           
A few days later, Plaintiff also had a telehealth appointment with Dr. Johns.  Tr. 
773.  Plaintiff felt that his mood was improving with the ketamine injections, but “[h]e 
continues to play online games incessantly.”  Tr. 773.  Plaintiff continued to spend time 
helping  his  brother  and  was  “paid  to  be  his  brother’s  PCA.”    Tr.  773.    Plaintiff 

experienced additional weight gain with an increased dose of Abilify, but the medication 
continued to be helpful in managing his auditory hallucinations.  Tr. 773. 
Compared to prior findings, Dr. Johns noted that Plaintiff’s memory was intact,  
but  his  attention  was  decreased.    Tr.  774.    Plaintiff’s  mood  and  anxiety  were  both 
improving.  Tr. 774.  Dr. Johns reviewed Plaintiff’s history of psychosis with him at 

length  and  concluded  that  Plaintiff  met  the  criteria  for  schizoaffective  disorder, 
depressive type.  Tr. 773, 774.  Dr. Johns added Topamax14 to Plaintiff’s medication 


14 Topamax is a brand name for topiramate, a medication often used for the treatment of certain seizures, but “also 
sometimes used for the management of alcohol dependence and for the treatment of binge eating disorder.”  
regimen to address the weight gain, but otherwise did not make changes to Plaintiff’s 
treatment plan.  Tr. 774; see Tr. 777-98 (continued ketamine therapy).    

E. Scott Kamilar                                                     
From at least November 2018 through December 2021, Plaintiff appears to have 
regularly attended therapy with Scott Kamilar.  See Tr. 509-13, 536, 679-80, 700; cf. Tr. 
857  (treatment  note  from  January  2017  stating  Plaintiff  sees  Kamilar  “for  regular 
counseling and has been seeing him for many years”).  As the ALJ noted, Kamilar’s 
“notes are handwritten and difficult to read.”  Tr. 31.  Generally speaking, they appear to 

contain a few short notes from each visit, often less than a sentence or two in length. 
                 IV. OPINION EVIDENCE                                
A. Dr. Johns                                                         
In March 2021, Dr. Johns completed a mental capacity assessment.15  See Tr. 551-
53.  The form asked Dr. Johns to rate Plaintiff’s degree of limitation in understanding, 

remembering, or applying information; concentration, persistence, or maintaining pace; 
adapting  or managing  oneself; and  interacting  with  others.    Tr.  551-53.    After  each 
section, the form asked for the medical/clinical findings supporting the assessment.  Tr. 
551-53.                                                                   
As for understanding, remembering or applying information, Dr. Johns opined that 

Plaintiff had moderate limitation in his ability to follow one or two-step oral instructions 
to carry out a task and in his ability to recognize a mistake, correct it, or identify and 

Topiramate, MedlinePlus, Nat’l Lib. of Med., https://medlineplus.gov/druginfo/meds/a697012.html (last accessed 
Mar. 26, 2024).                                                           
15 Dr. Johns also completed a physical assessment.  Tr. 549-50.  Only Plaintiff’s mental impairments are at issue 
here.                                                                     
solve problems.  Tr. 551.  Plaintiff had marked limitation in his ability to sequence multi-
step activities.  Tr. 551.  Plaintiff had extreme limitation in his ability to use reason and 

judgment to make work-related decisions.  Tr. 551.  Dr. Johns did not complete the 
medical/clinical findings section here.                                   
With  respect  to  concentrating,  persisting,  or  maintaining  pace,  Plaintiff  had 
moderate limitation in his abilities to initiate and perform a known task and to work at an 
appropriate and consistent pace/complete tasks in a timely manner.  Tr. 552.  Plaintiff had 
marked limitation in his abilities to ignore or avoid distractions while working and to 

work closely to or with others without interrupting or distracting them.  Tr. 552.  Plaintiff 
had  extreme  limitation  in  his  abilities  to  sustain  an  ordinary  routine  with  regular 
attendance at work and to work a full day without needing more than customary rest 
periods.  Tr. 552.  Dr. Johns also did not complete the medical/clinical findings section 
here.                                                                     

As for adapting and managing oneself, Plaintiff had moderate limitation in his 
ability to make plans independent of others.  Tr. 552.  Plaintiff had marked limitation in 
his abilities to adapt to change; distinguish between acceptable and unacceptable work 
performance; set realistic goals; and be aware of normal hazards and take appropriate 
precautions.    Tr.  552.    Plaintiff  had  extreme  limitation  in  his  abilities  to  manage 

psychologically based symptoms and to maintain appropriate personal hygiene and attire.  
Tr. 552.  Here, Dr. Johns explained that Plaintiff had a history of “psychosis and poor 
insight and judgement, as well as personality conflicts with others.”  Tr. 552.  Dr. Johns 
noted that Plaintiff “has ongoing depression, anxiety, poor focus, concentration, attention 
and memory.”  Tr. 552.  Dr. Johns also noted that Plaintiff has limited daily activities.  
Tr. 552.                                                                  

With respect to interacting with others, Plaintiff had moderate limitation in his 
abilities to cooperate with others and ask for help when needed.  Tr. 553.  Plaintiff had 
marked limitation in his abilities to understand and respond to social cues and to respond 
to requests, suggestions, criticism, correction, and challenges.  Tr. 553.  Plaintiff had 
extreme limitation in his abilities to handle conflict with others and to keep interactions 
free from excessive irritability, sensitivity, argumentativeness, or suspiciousness.  Tr. 

553.  As for the medical/clinical findings, Dr. Johns wrote: “See above.”  Tr. 553. 
Dr.  Johns  additionally  noted  that  Plaintiff  had  a  history  of  obtaining  legal 
substances  online  from  overseas,  “resulting  in  psychosis  and  likely  permanent 
impartment.”  Tr. 553.                                                    
B. State Agency Psychological Consultants                            

Both initially and on reconsideration, the state agency psychological consultants 
found that Plaintiff had no understanding or memory limitations, but did have some 
limitation in the areas of concentration and persistence, social interaction, and adaptation.  
See  Tr.  94-97,  112-15, 131-32,  142-43.    The  state  agency  psychological  consultants 
opined that, based on Plaintiff’s psychological symptoms, inattention, personality issues, 

and limited coping skills, Plaintiff would be able to “concentrate, persist and keep pace 
for detailed tasks with brief, superficial interaction with others” and “would do best with 
low workplace changes, pressures and responsibilities.”  Tr. 95, 97; accord Tr. 113, 115, 
131,  132,  142,  143;  see  also  Tr.  96  (“brief,  superficial  interaction  with  public  and 
others”);  accord  Tr.  114,  132,  143.    At  both  stages,  the  state  agency  psychological 
consultants  noted  that  Plaintiff  reported  his  symptoms  were  stable  with  ongoing 

treatment.  Tr. 97, 132, 115, 143.                                        
On reconsideration, the state agency psychological consultant noted the following 
with respect to Dr. Johns’ opinion:                                       
     [This  opinion]  is  now  dated  and  is  not  fully  persuasive, 
     supported, or consistent.  [Plaintiff] has reported difficulties 
     holding  jobs  due  [to]  interpersonal  conflicts  at  work.   
     However,  he  has  been  generally  cooperative  at  visits  and 
     appears able to sustain attention/concentration adequately for  
     activities of interest such as video games and yoga.  [Plaintiff] 
     was  evaluated  overnight  in  the  [emergency  room  in  April 
     2021] . . . for worsening [auditory hallucinations], which he   
     attributed to life stressors and sleep deprivation.  He endorsed 
     [suicidal  ideation]  with  an  intention  to  [overdose]  on   
     prescribed  medication.    [His]  condition  improved  with     
     treatment  and  he  declined  admission.    [Plaintiff]  has    
     subsequently established care with another psychiatrist and     
     his  [mental-health]  conditions  are  generally  described  as 
     stable  on  his  current  medications.    Overall,  [Dr.  Johns’ 
     opinion]  is  overly  restrictive  with  regard  to  [Plaintiff’s] 
     limitations  in  social  functioning,  stress  tolerance,  and  
     concentration/persistence/pace.    [Plaintiff]  has  no  recent 
     psychiatric  hospitalizations  and  has  denied  recent  [suicidal 
     ideation/homicidal ideation].  [Plaintiff] has denied a history 
     of  [chemical  dependency]  treatment.    While  motivation     
     appears  to  be  limited,  he  has  reported  at  recent  visits 
     compliance with prescribed medications.                         

Tr. 129; accord Tr. 140.                                                  
                V. HEARING TESTIMONY                                 
At the hearing, Plaintiff testified that he currently lived on his own in an apartment 
and had lived by himself for almost ten years.  Tr. 55.  Plaintiff received rental assistance 
and participated in other assistance programs. Tr. 55-56.  Plaintiff testified that his case 
manager generally assisted him with completing the necessary forms as he would become 
overwhelmed by the process.  Tr. 69-70.                                   

When  asked  how  his  psychological  impairments  affected  his  ability  to  work, 
Plaintiff testified that his symptoms were unpredictable and severe enough to “render[ 
him]  unable  to  work  completely.”    Tr.  60.    Plaintiff  still  experienced  auditory 
hallucinations occasionally, describing them as “just a sentence or two every day or two” 
and typically when he was trying to fall asleep.  Tr. 71.  Plaintiff testified that he was 
currently  on  several  medications  and  recalled  that  his  last  hospitalization  was  in 

approximately April 2021.  Tr. 63.  Plaintiff testified that he tried ketamine therapy for 
approximately three months, with his last injection occurring approximately three weeks 
prior, but stopped because they were not helping.  Tr. 64.  Plaintiff also testified that he 
had been terminated from previous employment due to an inability to get along with 
others.  Tr. 68.                                                          

Additionally, Plaintiff testified that he has been working as a PCA for his brother 
since 2021.    Tr.  57.    Plaintiff  worked  approximately  20 hours  per  month  providing 
services for his brother, stepping in when his mother was not able to be home.  Tr. 57-58.  
Plaintiff testified that his responsibilities primarily involved keeping an eye on his brother 
to prevent “him from doing things he shouldn’t be doing.”  Tr. 59.  Plaintiff testified that 

he did not believe his psychological impairments significantly impacted his ability to care 
for his brother and, if he thought that were the case on a given day, he would let his 
mother know.  Tr. 65-66.  Plaintiff acknowledged, however, that at one point he was a 
co-guardian for his brother, but his mother made the decision to “revoke[] it.”  Tr. 70.   
                   VI. ALJ’S DECISION                                
The ALJ found that Plaintiff had the severe impairments of intermittent explosive 

disorder;  dysthymia;  major  depressive  disorder;  generalized  anxiety  disorder; 
schizoaffective disorder, depressive type; and alcohol and polysubstance use disorders.  
Tr. 21.  The ALJ concluded that these impairments did not individually or in combination 
meet or equal a listed impairment in 20 C.F.R. pt. 404, subpt. P, app. 1.  Tr. 21-22.  As to 
Plaintiff’s residual functional capacity, the ALJ concluded that Plaintiff had the residual 
functional  capacity  to  perform  work  at  all  exertional  levels  with  the following  non-

exertional limitations:                                                   
     he can perform simple, routine, and repetitive tasks, but not at 
     a  production  rate  pace  (so,  for example,  no  assembly  line 
     work);  can  respond  appropriately  to  occasional  interaction 
     with supervisors and co-workers, but should have no team or     
     tandem  work  with  co-workers  and  no  interaction  with  the 
     general  public;  and  can  tolerate  few  changes  in  the  work 
     setting, defined as routine job duties that remain static and are 
     performed in a stable, predictable work environment.            

Tr. 25.  In reaching this residual-functional-capacity determination, the ALJ found Dr. 
Johns’ opinion to be unpersuasive.  See Tr. 33-34.                        
Based  on  Plaintiff’s  age,  education,  work  experience,  and  residual  functional 
capacity as well as the testimony of a vocational expert, the ALJ found that Plaintiff was 
capable  of  performing  the  representative  jobs  of  kitchen  helper,  routing  clerk,  and 
document preparer.  Tr. 36.  Accordingly, the ALJ concluded that Plaintiff was not under 
a disability.  Tr. 36-37.                                                 
                     VII. ANALYSIS                                   
This Court’s “task is to determine whether the ALJ’s decision complies with the 

relevant  legal  standards  and  is  supported  by  substantial  evidence  in  the  record  as  a 
whole.”  Lucus v. Saul, 

 (8th Cir. 2020) (quotation omitted); accord 
Kraus v. Saul, 

 (8th Cir. 2021); see also Biestek v. Berryhill, 

 (2019).  “Legal error may be an error of procedure, the use of erroneous 
legal  standards,  or  an  incorrect  application  of  the  law.”    Lucus,  

 
(quotation omitted).                                                      

“Under  the  substantial-evidence  standard,  a  court  looks  to  an  existing 
administrative record and asks whether it contains sufficient evidence to support the 
agency’s factual determinations.”  Biestek, 

 (quotation omitted).  “[T]he 
threshold  for  such evidentiary  sufficiency  is  not  high.”    

    “It  means—and  means 
only—such relevant evidence as a reasonable mind might accept as adequate to support a 

conclusion.”  

 (quotation omitted); see, e.g., Chismarich v. Berryhill, 

 (8th Cir. 2018) (defining “substantial evidence as less than a preponderance but 
enough  that  a  reasonable  mind  would  find  it  adequate  to  support  the  conclusion” 
(quotation omitted)).                                                     
This standard requires the Court to “consider both evidence that detracts from the 

[ALJ’s] decision and evidence that supports it.”  Boettcher v. Astrue, 

 
(8th Cir. 2011); see Grindley v. Kijakazi, 

 (8th Cir. 2021).  The ALJ’s 
decision “will not [be] reverse[d] simply because some evidence supports a conclusion 
other than that reached by the ALJ.”  Boettcher, 

; accord Grindley, 

; Perks v. Astrue, 

 (8th Cir. 2012).  “The court must 
affirm the [ALJ’s] decision if it is supported by substantial evidence on the record as a 

whole.”  Chaney v. Colvin, 

 (8th Cir. 2016) (quotation omitted).  Thus, 
“[i]f, after reviewing the record, the court finds it is possible to draw two inconsistent 
positions from the evidence and one of those positions represents the ALJ’s findings, the 
court must affirm the ALJ’s decision.”  Perks, 

 (quotation omitted); 
accord Chaney, 

.                                           
Disability benefits are available to individuals who are determined to be under a 

disability.  

(a)(1), 1381a; accord 

, 416.901.  An 
individual is considered to be disabled if he is unable “to engage in any substantial 
gainful activity by reason of any medically determinable physical or mental impairment 
which can be expected to result in death or which has lasted or can be expected to last for 
a continuous period of not less than 12 months.”  

(d)(1)(A); accord 42 

U.S.C. § 1382c(a)(3)(A); see also 

(a), 416.905(a).  This standard is 
met when a severe physical or mental impairment, or impairments, renders the individual 
unable to do his previous work or “any other kind of substantial gainful work which 
exists in the national economy” when taking into account his age, education, and work 
experience.  

(d)(2)(A); accord 42 U.S.C. § 1382c(a)(3)(B); see also 

(a), 416.905(a).                                        
Disability is determined according to a five-step, sequential evaluation process.  

(a)(4), 416.920(a)(4).                               
     To determine disability, the ALJ follows the familiar five-step 
     process, considering whether: (1) the claimant was employed;    
     (2) []he was severely impaired; (3) h[is] impairment was, or    
     was  comparable  to,  a  listed  impairment;  (4)  []he  could  
     perform past relevant work; and if not, (5) whether []he could  
     perform any other kind of work.                                 

Halverson v. Astrue, 

 (8th Cir. 2010).  In general, the burden of proving 
the existence of disability lies with the claimant.  

(a), 416.912(a). 
Plaintiff asserts that the ALJ erred in determining his residual functional capacity 
by not properly considering Dr. Johns’ opinion.                           
A. Residual Functional Capacity                                      
A claimant’s “residual functional capacity is the most [he] can do despite [his] 
limitations.”  

(a)(1), 416.945(a)(1) (same); see McCoy v. Astrue, 

 (8th Cir. 2011) (“A claimant’s [residual functional capacity] represents 
the most he can do despite the combined effects of all of his credible limitations and must 
be based on all credible evidence.”); see also, e.g., Schmitt v. Kijakazi, 

 (8th Cir. 2022).  “Because a claimant’s [residual functional capacity] is a medical 
question, an ALJ’s assessment of it must be supported by some medical evidence of the 
claimant’s ability to function in the workplace.”  Perks, 

 (quotation 
omitted); accord Schmitt, 

.                               
At the same time, the residual-functional-capacity determination “is a decision 
reserved to the agency such that it is neither delegated to medical professionals nor 
determined exclusively based on the contents of medical records.”  Norper v. Saul, 

  (8th  Cir.  2020);  see  Perks,  

;  see  also  

(c),  416.946(c).    “An  ALJ  determines  a  claimant’s  [residual  functional 
capacity] based on all the relevant evidence, including the medical records, observations 

of treating physicians and others, and an individual’s own description of [his or her] 
limitations.”  Combs v. Berryhill, 

 (8th Cir. 2017) (quotation omitted); 
accord Schmitt, 

; Norper, 

.  As such, there is no 
requirement that a residual-functional-capacity determination “be supported by a specific 
medical opinion.”  Schmitt, 

 (quotation omitted).   Nor is an ALJ “limited 
to considering medical evidence exclusively.”  

 (quotation omitted).  Accordingly, 

“[e]ven though the [residual-functional-capacity] assessment draws from medical sources 
for  support,  it  is  ultimately  an  administrative  determination  reserved  to  the 
Commissioner.”  Perks, 

 (quotation omitted); accord Schmitt, 

; see 

(c), 416.946(c).  Plaintiff bears the burden to establish 
his residual functional capacity.  Mabry v. Colvin, 

 (8th Cir. 2016). 

B. Evaluation of Opinion Evidence                                    
The evaluation of opinion evidence is governed by the criteria set forth in 

.1520c and 416.920c.  Although the opinion of a treating provider, Dr. 
Johns’ opinion is not entitled to special deference.  Bowers v. Kijakazi, 

 
(8th Cir. 2022); see 

.1520c(a) (“We will not defer or give any specific 

evidentiary  weight,  including  controlling  weight,  to  any  medical  opinion(s)  or  prior 
administrative  medical  finding(s),  including  those  from  your  medical  sources.”), 
416.920c(a) (same).                                                       
  Instead, ALJs evaluate the persuasiveness of medical opinions by   
  considering (1) whether they are supported by objective medical    
  evidence,  (2)  whether  they  are  consistent  with  other  medical 
  sources, (3) the relationship that the source has with the claimant, 
  (4) the source’s specialization, and (5) any other relevant factors. 

Bowers, 

; accord Austin v. Kijakazi, 

 (8th Cir. 2022); see 
generally 

.1520c(c), 416.920c(c) (listing factors).      
“The first two factors—supportability and consistency—are the most important.”  
Bowers, 

; accord Austin, 

; see 

.1520c(a), 
(b)(2),  416.920c(a),  (b)(2).    With  respect  to  supportability,  “[t]he  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.”  

.1520c(c)(1); 

.920c(c)(1) (same).  
As for consistency, “[t]he more consistent a medical opinion(s) . . . is with the evidence 
from other medical sources and nonmedical sources in the claim, the more persuasive the 
medical opinion(s) . . . will be.”  

.1520c(c)(2); 

.920c(c)(2) 
(same).  The regulations provide that the ALJ “will explain how [he or she] considered 
the supportability and consistency factors for a medical source’s opinions in [the] . . . 
decision.”  

.1520c(b)(2); 

.920c(b)(2) (same); see, e.g., 
Bonnett v. Kijakazi, 

, 20 (8th Cir. 2021) (per curiam) (“ALJ must explain 

how both supportability and consistency factors are considered”).         
C. Consideration of Dr. Johns’ Opinion                               
When evaluating the opinion evidence, the ALJ found that Dr. Johns’ opinion was 
not persuasive.  See Tr. 33-34.  The ALJ noted that, although             
     this opinion was based on regular examination of [Plaintiff] in 
     the course of treatment, . . . [Plaintiff’s] visits were at 3- to 4-
     month intervals or longer and the conclusions about marked      
     and extreme limitations in most areas of mental functioning     
     are not supported by the whole body of evidence regarding       
     the claim period, including the current psychiatric treatment   
     records.                                                        

Tr. 34.  The ALJ also recited the comments of the state agency psychological consultant 
on reconsideration and stated that “[t]he medical evidence of record received into the 
record since the reconsideration review shows a stable condition since that time, and 
remains fully consistent with their analysis of the inconsistencies between the opinion of 
Dr. Johns and the medical evidence of record regarding [Plaintiff’s] functioning during 
the present claim period.”  Tr. 34.                                       
Plaintiff does not assert that the ALJ failed to follow the applicable regulations.  
Instead, Plaintiff asserts that the ALJ’s “reasoning is grossly inadequate.”  Pl. Mem. in 
Supp. at 11, ECF No. 20.  Plaintiff asserts that the record reflects he regularly sought 
treatment for his mental impairments and the finding that these impairments were stable 
ignores evidence to the contrary.  According to Plaintiff, “there is ample evidence in this 
case that [his] numerous mental[-]health diagnoses cause him very serious limitations 
such that he could not function in any full-time work setting.”  Pl. Mem. in Supp. at 11. 
Plaintiff asserts that “Dr. Johns has been [his] treating psychiatrist for many years” 
and his “opinion is well-supported by his treatment notes and consistent with the record.”  
Pl. Mem. in Supp. at 9.  He additionally asserts that he “has an excellent and continuous 
record of treatment” with his case manager, therapist, and Dr. Johns during the relevant 
period and “[t]he ALJ’s claim that Dr. Johns has a sporadic/irregular treating history with 
[him] is false.”  Pl. Mem. in Supp. at 12.  Plaintiff likewise asserts that “it is unreasonable 
to allow the ALJ to use frequency of treatment with Dr. Johns—particularly as here, 

during the COVID-19 Pandemic—as a basis for discounting Dr. Johns[’] opinion, while 
accepting the opinion of sources who have never examined Plaintiff.”  Pl. Mem. in Supp. 
at  12.    Plaintiff  also  asserts  that  the  ALJ  improperly  relied  on  the  state  agency 
psychological  consult’s  characterization  of  Dr.  Johns’  opinion  as  “dated”  on 
reconsideration when the opinion was issued just six months earlier.  Pl. Mem. in Supp. 
at 13.                                                                    

First,  contrary  to  Plaintiff’s  assertion,  the  ALJ  did  not  find  that  he  had  “a 
sporadic/irregular treating history” with Dr. Johns.  Pl. Mem. in Supp. at 12.  Indeed, the 
ALJ noted that Dr. Johns’ opinion was “based on regular examination of [Plaintiff] in the 
course of treatment.”  Tr. 33.  The ALJ then permissibly took into account the frequency 
with which Plaintiff saw Dr. Johns, accurately noting that these appointments were often 

three to four months apart, compared to the marked and extreme limitations set forth in 
Dr. Johns’ opinion.  Plaintiff points to a decision from the Northern District of Iowa 
wherein  the  district  court  disagreed  with  an  ALJ’s  characterization  of  psychiatric 
treatment occurring “anywhere from four weeks to four months” apart as “relatively 
infrequent.”  Sidney v. Kijakazi, 

, 1093-94 (N.D. Ia. 2022).  But, 

whether it is possible to view the frequency of Plaintiff’s appointments differently is not 
the relevant question.  See Nash, 907 F.3d at 1089; see also Sidney, 630 F. Supp. 3d at 
1093.                                                                     
Second, again contrary to Plaintiff’s assertion, the ALJ did not find Dr. Johns’ 
opinion to be unpersuasive because a state agency psychological consultant found it to be 

“dated.”  Pl. Mem. in Supp. at 13.  A careful reading of the ALJ’s decision reflects that 
the ALJ was summarizing the comments of the state agency psychological consultant on 
reconsideration, which included the consultant’s opinion that Dr. Johns’ “opinion was 
now outdated.”  Tr. 34.  The salient part of the ALJ’s analysis comes, however, after this 
summary, wherein the ALJ explains that “[t]he medical evidence received into the record 
since the reconsideration review shows a stable condition since that time, and remains 

fully consistent with their analysis of the inconsistencies between the opinion of Dr. 
Johns and the medical evidence of record regarding [Plaintiff’s] functioning during the 
present claim period.”  Tr. 34.  Thus, the ALJ did not find Dr. Johns’ opinion to be 
unpersuasive because of the age of the opinion, but because the marked and extreme 
limitations contained in the opinion were inconsistent with other medical evidence in the 

record, including the more recent psychiatric treatment records.          
Fundamentally,  Plaintiff  asserts  that  his  medication  regimen  “has  been 
unsuccessful in treating his symptoms” and the record reflects that he “has repeatedly 
tried  and  failed  to  hold  low-level  jobs  because  he  inevitably  gets  into  verbal 
confrontations with coworkers and mangers.”  Pl. Mem. in Supp. at 10.  Plaintiff asserts 

that the ALJ did “not cite to the record” when concluding that Plaintiff was generally 
stable on his medications as of 2021 and “[a] lack of suicidal or homicidal ideation is not 
a reasonable basis for denying disability.”  Pl. Mem. in Supp. at 14.  Plaintiff asserts that 
Dr. Johns’ decision to pursue TMS and ketamine therapy to address the symptoms of his 
mental impairments reflects that these conditions were far from stable.   

Here  too,  Plaintiff’s  assertion  that  the  ALJ  “omit[ted]  evidence  refuting  the 
assertion of stability” is incorrect.  Pl. Mem. in Supp. at 14.  When discussing the medical 
evidence,  the  ALJ  discussed  how  there  were  times  when  Plaintiff  experienced 
“breakthrough psychotic symptoms.”  Tr. 28; see, e.g., Tr. 28 (“breakthrough symptoms 
about  twice  a  month”),  30  (“had  been  having  auditory  hallucinations”).    The  ALJ 
contextualized these episodes, pointing out that they tended to occur when Plaintiff was 

using  non-prescribed  substances  and  not  sleeping  and  eating  regularly.    Plaintiff’s 
psychotic episodes resolved with medication and he reported improvements in his mood 
with medication adjustments.  See Hensley v. Colvin, 

 (8th Cir. 
2016) (“If an impairment can be controlled by treatment or medication, it cannot be 
considered disabling.”).                                                  

Nor was it outside the zone of choice for the ALJ to find that Plaintiff’s condition 
overall remained stable since his April 2021 episode.  In mid-June 2021, Dr. Hanson 
noted that Plaintiff had been stable for over two weeks.  The following month, Plaintiff 
reported feeling better despite occasionally hearing a “murmur.”  Tr. 685; accord Tr. 709.  
Plaintiff told Dr. Johns a few months later that he “had been feeling good” up until 

recently  with  the  change  in  seasons  and  experienced  mild  auditory  hallucinations 
occasionally.    Tr.  766.    And  while  Plaintiff  reported  feeling  more  depressed  in 
November, he told both Dr. Hanson and Dr. Johns that he was doing better in December.  
Thus,  the  more  recent  psychiatric  records  reflect  that  Plaintiff’s  symptoms  and 
functioning improved with medication.                                     

Similarly,  while  Plaintiff  emphasizes  that  he  was  diagnosed  with  “treatment 
resistant depression,” Pl. Mem. in Supp. at 10, 14, the fact that Plaintiff continued to have 
medically documented impairments during this time “does not perforce result in a finding 
of disability,” Stormo v. Barnhart, 

 (8th Cir. 2004).  Even if this 
characterization of Plaintiff’s depression combined with Dr. Johns’ notation that Plaintiff 
had “failed numerous antidepressants” and the treatment decision to pursue TMS and 

ketamine therapy could support an alternative conclusion, this alone does not warrant 
reversal.  Fentress v. Berryhill, 

 (8th Cir. 2017) (“[W]e will not 
reverse simply because some evidence supports a conclusion other than that reached by 
the  Commissioner.”).    Moreover,  the  ALJ  considered  other  evidence  in  the  record 
indicating  Plaintiff  overall  exhibited  greater  functioning  than  reflected  in  Dr.  Johns’ 

opinion.    Among  other  things,  the  ALJ  noted  that  Plaintiff  lived  on  his  own  in  an 
apartment  and  was  working  at  least  part  time  as  a  PCA  for  his  brother.    “Despite 
[Plaintiff’s] dissatisfaction with how the ALJ weighed the evidence, it is not this Court’s 
role to reweigh that evidence.”  Schmitt, 

.               
Lastly, although the ALJ did not find Dr. Johns’ opinion to be persuasive, the ALJ 

did include limitations in the residual functional capacity related to Plaintiff’s mental 
impairments, including difficulties getting along with others.  The ALJ limited Plaintiff to 
“simple, routine, and repetitive tasks” to “address the complaints of difficulty with focus 
and periods of diminished attention and concentration in mental status examinations.”  
Tr. 27.  The ALJ included limitations regarding pace (no “production rate pace”) and 
variability (“few changes in the work setting, defined as routine job duties that remain 

static  and  are  performed  in  a  stable,  predictable  work  environment”)  to  “address 
moderate difficulties with adapting and managing the self.”  Tr. 25, 27.  The ALJ also 
limited Plaintiff’s “interaction with others” to address the difficulties he experienced in 
previous employment situations while also taking into account that he was able to interact 
with others in other settings, including with his brother, case manager, and treatment 
providers.  Tr. 27.                                                       

In sum, there is substantial evidence in the record as a whole to support the ALJ’s 
conclusion that Dr. Johns’ opinion was unpersuasive.                      
                      VIII. ORDER                                    
Based  upon  the  record,  memoranda,  and  the  proceedings  herein,  and  for  the 
reasons stated above, IT IS HEREBY ORDERED that:                          

1.  Plaintiff’s Motion for Summary Judgment, ECF No. 19, is DENIED.  

2.  The Commissioner’s request for relief, ECF No. 22, is GRANTED.   

3.  The ALJ’s decision is AFFIRMED.                                  


LET JUDGMENT BE ENTERED ACCORDINGLY.                                      


Dated:  March    26    , 2024           s/ Tony N. Leung                  
                              Tony N. Leung                          
                              United States Magistrate Judge         
                              District of Minnesota                  

                              Kristopher T. T. v. O’Malley           
                              Case No. 23-cv-359 (TNL)               

            UNITED STATES DISTRICT COURT                             
                DISTRICT OF MINNESOTA                                


Kristopher T. T.,                      Case No. 23-cv-359 (TNL)           

     Plaintiff,                                                      

v.                                           ORDER                        

Martin J. O’Malley,                                                       
Commissioner of Social Security                                           
Administration,1                                                          

     Defendant.                                                      


Edward A. Wicklund, Olinsky Law Group, 250 South Clinton Street, Suite 210, 
Syracuse, NY 13202; and Jyotsna Asha Sharma, Disability Partners, PLLC, 2579 
Hamline Avenue North, Suite C, Roseville, MN 55113 (for Plaintiff); and   

Ana H. Voss, Assistant United States Attorney, 300 South Fourth Street, Suite 600, 
Minneapolis, MN 55415; and James Potter and James D. Sides, Special Assistant United 
States Attorneys, Social Security Administration, 6401 Security Boulevard, Baltimore, 
MD 21235 (for Defendant).                                                 


                   I. INTRODUCTION                                   
Plaintiff  Kristopher  T.  T.  brings  the  present  case,  contesting  Defendant 
Commissioner  of  Social  Security’s denial  of  his applications  for  disability  insurance 
benefits (“DIB”) under Title II of the Social Security Act, 

 et seq., and 
supplemental security income (“SSI”) under Title XVI of the same, 

 et 
seq.  The parties have consented to a final judgment from the undersigned United States 

1 Martin J. O’Malley was sworn into office as the Commissioner of the Social Security Administration on December 
20, 2023.  Commissioner, Soc. Sec. Admin., https://www.ssa.gov/agency/commissioner/ (last accessed Mar. 26, 
2024).  The Court has substituted O’Malley for former Acting Commissioner Kilolo Kijakazi.  See Fed. R. Civ. P. 
25(d) (public officer’s successor “automatically substituted as a party”). 
Magistrate Judge in accordance with 

(c), Fed. R. Civ. P. 73, and D. Minn. 
LR 72.1(c).                                                               

Pursuant to the Supplemental Rules for Social Security Actions Under 

(g) (“Supplemental Rules”), Plaintiff’s challenge to the Commissioner’s decision 
“is presented for decision” by the Court on “the parties’ briefs.”2  Fed. R. Civ. P. Supp. 
Soc. Sec. R. 5.  Rather than file a brief as provided in Rule 6 of the Supplemental Rules, 
Plaintiff filed a Motion for Summary Judgment and supporting memorandum, consistent 
with the procedure employed prior to the Supplemental Rules.  See generally ECF Nos. 

19, 20.  Consistent with Rule 7 of the Supplemental Rules, the Commissioner has filed a 
brief, requesting that the decision of the administrative law judge (“ALJ”) be affirmed.  
See generally ECF No. 22.                                                 
Being  duly  advised  of  all  the  files,  records,  and  proceedings  herein,  IT  IS 
HEREBY ORDERED that Plaintiff’s motion is denied, the Commissioner’s request for 

relief is granted, and the ALJ’s decision is affirmed.                    
               II. PROCEDURAL HISTORY                                
Plaintiff  applied  for  DIB  and  SSI  asserting  that  he  has  been  disabled  since 
November 2019 due to, among other things, depression, intermittent explosive disorder, 
anxiety disorder, obsessive compulsive disorder, and psychosis.  Tr. 18, 83-84, 101-102.  

Plaintiff’s applications were denied initially and again upon reconsideration.  Tr. 18, 99, 
117, 119-20, 123, 133, 144, 146.  Plaintiff appealed the reconsideration of his DIB and 


2 The Supplemental Rules went into effect on December 1, 2022.  See, e.g., D. Minn. LR 7.2 Dec. 2022 advisory 
comm. note.                                                               
SSI determinations by requesting a hearing before an administrative law judge (“ALJ”).  
Tr. 18, 177-78.  The ALJ held a hearing in February 2022, and issued an unfavorable 

decision.  See generally Tr. 18-37, 50-81.  Thereafter, Plaintiff requested review from the 
Appeals Council, which was denied.  Tr. 1-4.                              
Plaintiff then filed the instant action, challenging the ALJ’s decision.  Compl., 
ECF No. 1.  This matter is now ready for a determination on the briefs.  See Fed. R. Civ. 
P. Supp. Soc. Sec. R. 5.                                                  

                 III. MEDICAL RECORDS                                
Plaintiff has a history of multiple psychiatric diagnoses, including intermittent 
explosive disorder, depression, anxiety, psychosis, and hallucinations.  See, e.g., Tr. 448-
50, 481-82, 497-99; see also Tr. 801-60.  He also has a history of substance abuse.  See, 
e.g., Tr. 448-50, 481-82, 497-99.  Plaintiff was previously hospitalized in connection with 
his mental impairments and last discharged in 2016.  Tr. 482; see also Tr. 861-74.  He 

also has a history of suicide attempts prior to that hospitalization.  Tr. 482.  In addition, 
Plaintiff has tried numerous medications to treat his mental impairments.  See, e.g., Tr. 
482, 768-69; see also Tr. 481.  Plaintiff resides in subsidized housing in connection with 
a mental-health program and has a case manager.  Tr. 482; see generally Tr. 560-656. 
A. 2018                                                              

In mid-December 2018, Plaintiff met with Brian Johns, M.D., for a psychiatric 
follow-up appointment.3  Tr. 481.  Dr. Johns noted that Plaintiff “developed psychosis 
after ingesting large quantities of an experimental drug” he obtained overseas.  Tr. 481.  

3 Plaintiff’s care was transitioned to Dr. Johns after his previous provider left the facility.  See Tr. 801. 
Plaintiff reported that he experienced auditory hallucinations “occasionally when he does 
not sleep or is stressed.”  Tr. 481.  He found Haldol4 to be helpful in addressing the 

hallucinations and reported that “he only needs Haldol approximately once or twice a 
month.”  Tr. 481.  Dr. Johns noted that Plaintiff’s hallucinations had been “far worse in 
the past.”  Tr. 481.  Plaintiff also reported that he self-medicated with marijuana and 
cannabinoid oil.  Tr. 481.  Dr. Johns and Plaintiff “discussed the risk of these compounds 
worsening psychosis.”  Tr. 481.  Plaintiff’s primary complaint was his depression and he 
was interested an increased dose of pramipexole,5 which he had found to be “very helpful 

for [his] mood.”  Tr. 481.                                                
Dr. Johns observed that Plaintiff was oriented and casually dressed with good 
hygiene and eye contact.  Tr. 483.  His mood was “[n]ot super dysphoric but definitely 
dysthymic” and his affect was calm. Tr. 483.  Plaintiff’s speech and thought processes 
were normal, and he denied currently experiencing auditory or visual hallucinations.  Tr. 

483.    Plaintiff’s  memory  was  grossly  intact  without  formal  testing  and  his  fund  of 
knowledge was adequate.  Tr. 483.  Dr. Johns described Plaintiff’s insight as poor to fair 
and his judgment as fair.  Tr. 483.                                       




4 Haldol is a brand name for haloperidol, a medication “used to treat psychotic disorders (conditions that cause 
difficulty telling the difference between things or ideas that are real and things or ideas that are not real).”  
Haloperidol, MedlinePlus, Nat’l Lib. of Med., https://medlineplus.gov/druginfo/meds/a682180.html (last accessed 
Mar. 26, 2024).                                                           
5 Among other things, pramipexole can be used to treat conditions that cause “difficulties with movement” and 
“works by acting in place of dopamine.”  Pramipexole, MedlinePlus, Nat’l Lib. of Med., https://medlineplus.gov/ 
druginfo/meds/a697029.html (last accessed Mar. 26, 2024).  Mirapex is a brand name for pramipexole.  

 
Dr.  Johns  made  several  changes  to  Plaintiff’s  medications.    He  prescribed 
Effexor,6  increased  the  dose  of  pramipexole,  increased  the  dose  of  gabapentin,7 
discontinued clonazepam,8 and prescribed Xanax.9  Tr. 483.  Dr. Johns also prescribed a 

mood light and noted that he previously encouraged Plaintiff to start therapy.  Tr. 483.  
Plaintiff was directed to return in two to three months.  Tr. 484.        
B. 2019                                                              
In mid-February 2019, Plaintiff returned for a follow-up appointment with Dr. 
Johns.    Tr.  477,  756.    Plaintiff  reported that  he  was  “no  longer  using  psychoactive 

substances, such as THC,” just “CBD oil, which he feels helps with anxiety.”  Tr. 477; 
accord Tr. 756.  Dr. Johns “review[ed] coping techniques to remain sober” and Plaintiff 
understood his “risk of relapse is high.”  Tr. 477; accord Tr. 756.  Plaintiff’s auditory 
hallucinations  had  “largely  resolved  since  [his]  last  visit  two  months  ago  and  his 
cessation of THC.”  Tr. 477; accord Tr. 756.  Plaintiff reported that he took “Haldol 

occasionally when he feels the need to ensure he will sleep or if worried about psychosis 
returning due to triggers,” “taking it once a month presently.”  Tr. 477; accord Tr. 756.  



6 Effexor is a brand name for venlafaxine, a medication “used to treat depression.”  Venlafaxine, MedlinePlus, Nat’l 
Lib. of Med., https://medlineplus.gov/druginfo/meds/a694020.html (last accessed Mar. 26, 2024). 
7 Among other things, gabapentin can be used to treat certain types of “seizures by decreasing abnormal excitement 
in the brain.”  Gabapentin, MedlinePlus, Nat’l Lib. of Med., https://medlineplus.gov/druginfo/meds/a694007.html 
(last accessed Mar. 26, 2024).                                            
8 Clonazepam can be “used to relieve panic attacks (sudden, unexpected attacks of extreme fear and worry about 
these attacks)” and is in a class of medications called benzodiazepines.”  Clonazepam, MedlinePlus, Nat’l Lib. of 
Med., https://medlineplus.gov/druginfo/meds/a682279.html (last accessed Mar. 26, 2024).  “It works by decreasing 
abnormal electrical activity in the brain.”  

  Klonopin is a brand name for clonazepam.  

 
9 Xanax is a brand name for alprazolam, a medication “used to treat anxiety disorders and panic disorder (sudden, 
unexpected attacks of extreme fear and worry about these attacks).”  Alprazolam, MedlinePlus, Nat’l Lib. of Med., 
https://medlineplus.gov/druginfo/meds/a684001.html (last accessed Mar. 26, 2024).  “Alprazolam is in a class of 
medications called benzodiazepines” and “works by decreasing abnormal excitement in the brain.”  

 
Dr. Johns encouraged him “to maintain sobriety in order to ensure success of his mental 
health symptoms.”  Tr. 477; accord Tr. 756.                               

Plaintiff  also  felt  that  his  mood  was  “relatively  stable”  and  “denie[d]  overt 
depressive symptoms,” which he “attribute[d] . . . to having structured things to do with 
his time.”  Tr. 477; accord Tr. 756.  Plaintiff felt the increased dose of pramipexole was 
helpful and did not feel a need to increase any of his antidepressant medications.  Tr. 477, 
756.  Plaintiff had been unable to obtain Xanax for insurance reasons and continued 
taking clonazepam three times a day for his anxiety.  Tr. 477, 756.  Plaintiff reported 

feeling sedated and Dr. Johns encouraged him not to take this medication so frequently.  
Tr. 477, 756.  Plaintiff was, however, “reluctant to make any changes regarding this 
regimen.”  Tr. 477; accord Tr. 756.                                       
Plaintiff had also spent two weeks caring for his adult disabled brother while their 
mother was away and recovering from an illness.  Tr. 478, 756.  “This went well.”  Tr. 

478; accord Tr. 756.                                                      
Dr. Johns made similar findings when conducting a mental status examination of 
Plaintiff.  See Tr. 479-80, 758.  Plaintiff’s mood was described as “[t]oo busy to notice.”  
Tr.  480;  accord  Tr.  758.    Dr.  Johns  formally  discontinued  Xanax  and  restarted 
clonazepam, but otherwise maintained Plaintiff’s medications at their current levels.  Tr. 

480, 759.  Plaintiff was directed to return in three to four months.  Tr. 481, 759. 
Plaintiff next saw Dr. Johns in mid-August.  Tr. 474, 750.  He reported that he 
continued  to  experience  auditory  hallucinations  twice  per  month,  for  which  he  used 
Haldol, but they were “overall improved since cessation of THC.”  Tr. 474; accord Tr. 
750.    While  Plaintiff  continued  to  benefit  from  pramipexole,  he  reported  having  a 
“relatively low” mood and wanted to try an increase in Effexor.  Tr. 474; accord Tr. 750.  

Plaintiff also reported that he had started working for a pizza restaurant “a few months 
ago.”  Tr. 474; accord Tr. 750.                                           
Compared to prior mental status examinations, Plaintiff’s mood was noted to be 
“bored” and his affect described as “restricted.”  Tr. 476; accord Tr. 752.  Plaintiff was 
described as having “moderate hygiene and eye contact.”  Tr. 476; accord Tr. 752.  
Plaintiff’s thought content included “some mild” auditory hallucinations.  Tr. 476; accord 

Tr.  752.    Dr.  Johns  noted  that  Plaintiff’s  “[s]ubstance  use  remains  relatively  well 
controlled for him.”  Tr. 476; accord Tr. 752.  Among other things, Dr. Johns increased 
Plaintiff’s Effexor dose and directed him to return in three to four months.  Tr. 476, 754. 
Towards  the  middle  of  November,  Plaintiff’s  mother  contacted  a  crisis  line, 
concerned over a text message she had received from Plaintiff stating that he would not 

“be around for more than a month or so.”  Tr. 525; see also Tr. 597.  Plaintiff’s mother 
reported that it was possible he was using a controlled substance.  Tr. 525.  Plaintiff’s 
mother additionally noted that Plaintiff had lost his job at the pizza restaurant and had 
stated “the voices are quiet right now and that is how I want to go out.”  Tr. 525.  Mental-
health professionals attempted to reach Plaintiff at his residence and were unsuccessful.  

Tr. 525.                                                                  
When  Plaintiff  saw  Dr.  Johns  again  approximately  two  months  later  in  mid-
November, he was “struggling emotionally.”  Tr. 471; accord Tr. 746.  Plaintiff had lost 
two jobs in the last several months following personality conflicts with coworkers.  Tr. 
471, 746.  He was terminated from one position after an outburst and the second position 
after he “threatened to potentially harm [a coworker] in a letter to his manager.”  Tr. 471; 

accord  Tr.  746.    Plaintiff  “note[d]  some  conflicts  historically  with  people  who  are 
‘jerks.’”  Tr. 471; accord Tr. 746.                                       
Plaintiff’s mood did not improve with the increased Effexor dose and he wanted to 
try  an  additional  increase.    Tr.  471,  746.    Plaintiff  also  wanted  to  try  increasing 
pramipexole again.  Tr. 471, 746.  Dr. Johns noted that Plaintiff was not currently seeing 
his therapist.  Tr. 471, 746.  Plaintiff’s mental status examination remained the same.  Tr. 

473, 748.  Dr. Johns increased the doses of both Effexor and pramipexole and directed 
Plaintiff to return in two months.  Tr. 473, 748-49.                      
C. 2020                                                              
When Plaintiff was next seen by Dr. Johns in mid-January 2020, he reported that 
his mood had improved with the increased Effexor and pramipexole doses.  Tr. 468, 742.  

He also had not used Haldol recently.  Tr. 469, 742.  Plaintiff did, however, report “some 
increase in impulsive behaviors and spent some money on a sale for cannabinoids.”  Tr. 
468; accord Tr. 742.  Plaintiff was also “playing games on his telephone” and “wak[ing] 
up in the middle of the night to engage in this.”  Tr. 468; accord Tr. 742.  Plaintiff told 
Dr. Johns that he “has not been looking for work and currently feels overwhelmed with 

just basic living arrangements.”  Tr. 468; accord Tr. 742.  Plaintiff continued to work 
with his case manager.  Tr. 469, 742.                                     
During  this  visit,  Dr.  Johns  observed  that  Plaintiff  had  “poor  hygiene  and 
moderate eye contact.”  Tr. 470; accord Tr. 742.  Plaintiff’s affect remained restricted, 
but his mood was “better.”  Tr. 470; accord Tr. 744.  Plaintiff had mild psychomotor 
retardation.  Tr. 470, 744.  Dr. Johns also continued to note the presence of “some mild, 

occasional”  auditory  hallucinations.    Tr.  470;  accord  Tr.  744.    Dr.  Johns  continued 
Plaintiff’s medications as prescribed and directed him to return in three to four months.  
Tr. 470-71, 745.                                                          
In March, Plaintiff was assessed for continued receipt of services through the 
mental-health program.  See Tr. 460-68, 732-41.  As part of this assessment, Plaintiff 
reported that his depression makes it “[v]ery difficult for him to do his work, take care of 

things at home, or get along with other people.”  Tr. 464; accord Tr. 736.  Plaintiff’s 
mood was dysthymic and his affect was flat.  Tr. 466, 738.  His eye contact, speech, 
attention, concentration, thought processes, and memory were normal.  Tr. 466, 738.  
Plaintiff’s judgment and insight were both noted to be impaired.  Tr. 466, 738.  Plaintiff 
was diagnosed with major depressive disorder, generalized anxiety disorder, psychosis, 

and polysubstance abuse.  Tr. 467, 740.  Plaintiff was found eligible to continue to 
receive services through the mental-health program.  Tr. 468, 741.        
Plaintiff’s next visit with Dr. Johns occurred in mid-April and “was conducted via 
telehealth due to the COVID-19 pandemic.”  Tr. 457; accord Tr. 728.  Plaintiff’s “life 
remain[ed] largely unchanged.”  Tr. 457; accord Tr. 728.  He continued to benefit from 

the increased Effexor and pramipexole doses, which he found “helpful for maintaining 
his euthymic mood.”  Tr. 457; accord Tr. 728.  Plaintiff did not feel a need to change his 
medications  and  felt  that  “his  brain  [was]  healing  after  several  years  of  psychotic 
symptoms due to drug overdose.”  Tr. 457 (quotation omitted); accord Tr. 728.  Plaintiff 
reported that he had not needed Haldol for the past year and had not “had hallucinations 
for longer than that.”  Tr. 457 (quotation omitted); accord Tr. 728.  Plaintiff thought it 

might “be time to start looking for another job.”  Tr. 457; accord Tr. 728.  While Plaintiff 
still had a case manager, he had “little contact with them aside from moral support.”  Tr. 
457 (quotation omitted); accord Tr. 728.                                  
Plaintiff’s affect continued to be restricted and his mood was “okay.”  Tr. 459.  Dr. 
Johns noted that his auditory hallucinations had resolved.  Tr. 459.  Plaintiff was directed 
to continue with his medications as prescribed and return in three to four months.  Tr. 

459.                                                                      
Plaintiff had another telehealth appointment with Dr. Johns in early July.  Tr. 454, 
724.  Plaintiff reported feeling “more anxious than usual,” but was uncertain as to why.  
Tr. 454; accord Tr. 724.  Plaintiff had also recently ordered a substance online from 
overseas that he had taken in the past and found helpful, but believed a neighbor may 

have stolen the package.  Tr. 454, 724.  Dr. Johns asked Plaintiff why he did not just 
make an appointment to increase his clonazepam dose, and Plaintiff responded that he did 
not “think that would be an option.”  Tr. 454; accord Tr. 724.  Dr. Johns advised Plaintiff 
“not to take substance[s] in addition to prescribed medications or he would risk losing 
those as well.”  Tr. 454; accord Tr. 724.                                 

Plaintiff  additionally  reported  spending  time  playing  games  on  his  phone  and 
“spending money on his game” as well as “over $100 on medications from the internet.”  
Tr. 454; accord Tr. 724.  Plaintiff thought the pramipexole might be contributing to his 
spending, but he did not want to adjust the dose due to the mood benefits.  Tr. 454, 724.  
Plaintiff had also been talking with a therapist weekly, which he found helpful, and was 
going to “discuss his impulse control issues further with the therapist.”  Tr. 454; accord 

Tr. 724.  Plaintiff did not feel that gabapentin was helping his anxiety and wanted to 
discontinue it in favor of an increased dose of clonazepam.  Tr. 454, 724.  Plaintiff had 
not “taken Haldol in months” as he had not had hallucinations.  Tr. 454; accord Tr. 724. 
Plaintiff  discovered  that  a  prior  application  for  disability  benefits  had  been 
rejected over a year ago and his case manager had put him in touch with an attorney.  Tr. 
454, 724.  Plaintiff also had a job interview with a fast-food restaurant.  Tr. 454, 724.  

Plaintiff’s affect continued to be restricted and his mood was “a little bit furious.”  
Tr. 456; accord Tr. 726.  Dr. Johns noted that Plaintiff’s insight and judgment were both 
limited  to  fair.    Tr.  456,  726.    Dr.  Johns  discontinued  gabapentin,  increased  the 
clonazepam dose, and directed Plaintiff to return in three months.  Tr. 456, 726. 
At his next appointment in early October, Plaintiff reported some fatigue from the 

increased clonazepam, but felt he had adjusted to it and did not always take it three times 
a day if he was not feeling anxious.  Tr. 451, 720.  Plaintiff continued to struggle with 
sleep due to gaming on his phone.  Tr. 451, 720.  He continued to remain free of auditory 
hallucinations.  Tr. 451, 720.  Plaintiff did not “follow-through with a job at [the fast-
food restaurant] because he doesn’t have an ID and SS card so has been working with his 

case manager to get those.”  Tr. 451; accord Tr. 720.  Plaintiff was considering applying 
for other jobs or becoming a PCA for his brother.  Tr. 451, 720.  Plaintiff was also 
making better food choices and had not purchased “designer drugs online.”  Tr. 452; 
accord Tr. 720.  Additionally, Plaintiff had reapplied for disability benefits with the 
assistance of an attorney.  Tr. 451, 720.  Plaintiff’s mental status examination remained 
largely the same with his mood being described as “not great, not awful.”  Tr. 453; see 

Tr. 451; accord Tr. 720, 722.  Dr. Johns continued Plaintiff’s medications at their current 
levels and directed Plaintiff to follow up in two to three months.  Tr. 453, 723. 
Towards the end of December, Plaintiff contacted a crisis line due to auditory 
hallucinations.  Tr.  520-23.    During  the  first  call,  Plaintiff  reported  “concerns  about 
hearing voices over the past few days and . . . [that] he may not be able to see his family 
over the holidays.”  Tr. 523.  Plaintiff reported that it had been “a long time” since he had 

heard voices.  Tr. 523.  Plaintiff was not currently taking his medication.  Tr. 523.  
During a follow-up call two days later, Plaintiff reported that he had taken some old 
Haldol  and  felt  better.    Tr.  520,  521.    It  was  noted that  Plaintiff  had  an  upcoming 
appointment with Dr. Johns in two weeks.  Tr. 521.  Plaintiff was described as “brief, 
superficial, guarded, and minimizing his symptoms.”  Tr. 521.  His thought processes 

were “rambling” and his insight and judgment were fair.  Tr. 521.         
D. 2021                                                              
Plaintiff had a telehealth appointment with Dr. Johns in early January 2021.  Tr. 
530.  Plaintiff’s chief complaints were hallucinations, depression, and anxiety. Tr. 530.  
Plaintiff described his mood as “kinda a roller coaster.”  Tr. 530.  Plaintiff told Dr. Johns 

that,  before  Christmas,  he  experienced  auditory  hallucinations  “at  7/10.”    Tr.  530.  
Plaintiff reported that it had “been 2 years since the last episode.”  Tr. 530.  Plaintiff 
believed the hallucinations were possibly caused by “not eating and sleeping.”  Tr. 530.  
Plaintiff also reported “taking kratom for pain,” which “may have contributed.”10  Tr. 
530.  Plaintiff noted that he “took Haldol and started eating regularly as well.”  Tr. 530.  

Dr. Johns noted that both Plaintiff’s therapist and caseworker were currently on vacation.  
Tr. 530.  Plaintiff was interested in increasing his dose of Wellbutrin.11  Tr. 530. 
Plaintiff’s mental status examination was similar to previous examinations with 
his mood being described as “up and down.”  Tr. 532.  Dr. Johns increased the Wellbutrin 
dose and directed Plaintiff to return in three months.  Tr. 532-33.       
Plaintiff had another telehealth appointment with Dr. Johns in mid-February.  Tr. 

542, 716.  Plaintiff did not notice a difference with the increased dose of Wellbutrin and 
his mood continued to be up and down.  Tr. 542, 716.  Plaintiff had not had any auditory 
hallucinations since the prior visit.  Tr. 542, 716.  Dr. Johns noted that Plaintiff had 
“stopped playing his online phone game and deleted it,” which “was a huge step for 
[Plaintiff], as he was very addicted to it and has been going through ‘withdrawals.’”  Tr. 

542; accord Tr. 716.  Dr. Johns again increased Plaintiff’s Wellbutrin dose and directed 
him to return in three months.  Tr. 545, 719.                             
In  early  May,  Plaintiff  presented  to  the  emergency  room  for  auditory 
hallucinations.  Tr. 660.  Plaintiff reported that the voices had “drastically increased as of 
late” and had “also caused issues with keeping up on taking his medications.”  Tr. 660.  

Plaintiff reported that he considered taking “all of his clonazepam” to try to silence them.  

10 Kratom “commonly refers to an herbal substance that can produce opioid- and stimulant-like effects.”  Kratom, 
Nat’l Inst. on Drug Abuse, https://nida.nih.gov/research-topics/kratom (last accessed Mar. 26, 2024).  “Kratom and 
kratom-based products are currently legal.”  

                          
11 Wellbutrin is a brand name for bupropion, a medication used to treat depression and seasonal affective disorder.  
Bupropion, MedlinePlus, Nat’l Lib. of Med., https://medlineplus.gov/druginfo/meds/a695033.html (last accessed 
Mar. 26, 2024).                                                           
Tr. 660.  Plaintiff additionally reported that alcohol use made the voices worse and, “a 
couple weeks ago he drank 750ml of vodka,” which caused the voices to get worse.  Tr. 

662; see Tr. 762 (“did drink to black out a couple of times with hard alcohol”).  This was 
a “significant increase” from his usual consumption.  Tr. 662.  Plaintiff also reported 
increased anxiety, which he described as “pent up energy,” and said  he was “doing 
pushups in the ED lobby.”  Tr. 662.  Plaintiff had been unable to connect with his case 
manager or therapist due to a broken cell phone.  Tr. 662-63; see Tr. 673. 
Plaintiff  was  noted  to  have  a  “flat  affect”  and  “depressed  mood.”    Tr.  668.  

Plaintiff remained overnight and was discharged the following day.  Tr. 669, 671-72.  
Plaintiff improved with medication and was “feeling much better” with a decrease in his 
auditory hallucinations at the time of discharge.  Tr. 672.               
In mid-May, Plaintiff had another telehealth appointment with Dr. Johns.  Tr. 762.  
Plaintiff  discussed  his  recent  episode,  noting  that  he  had  been  having  auditory 

hallucinations on a daily basis in the month leading up to his emergency room visit.  Tr. 
762.  Plaintiff reported that the voices did not “want him to take medications.”  Tr. 762.  
Plaintiff told Dr. Johns that he received Abilify12 at the hospital, has continued taking it, 
and found it to be helpful with his mood.  Tr. 762.  Plaintiff reported that he felt “very 
depressed” prior to the auditory hallucinations.  Tr. 762.  Plaintiff’s sleep was also poor at 

the time of the hallucinations, but had since improved.  Tr. 762.         


12 Abilify is a brand name for aripiprazole, a medication that can be used to treat schizophrenia, among other things, 
and in conjunction with other medications “to treat depression when symptoms cannot be controlled by the 
antidepressant alone.”  Aripiprazole, MedlinePlus, Nat’l Lib. of Med., https://medlineplus.gov/druginfo/meds/ 
a603012.html (last accessed Mar. 26, 2024).                               
Plaintiff  was  interested  in  trying  to  increase  Effexor.    Tr.  762.    He  had  also 
stopped taking pramipexole “due to the [auditory hallucinations].”  Tr. 762.  Plaintiff was 

concerned about continuing with this medication as, when he restarted it, “he became 
obsessed with video games again.”  Tr. 762.  Plaintiff had also stopped taking Wellbutrin, 
but was interested in restarting this medication.  Tr. 762.               
Dr. Johns noted that Plaintiff’s memory was impaired and his attention decreased.  
Tr. 764.  Plaintiff’s mood was also low and he had high anxiety.  Tr. 764.  Dr. Johns 
increased  Plaintiff’s  Effexor  dose,  restarted  Wellbutrin,  and  formally  discontinued 

pramipexole.  Tr. 764.                                                    
In mid-June, Plaintiff began treating with Joseph A. Hanson, D.O., via telehealth.  
Tr. 688, 712; see Tr. 545, 719 (noting care transfer).  Plaintiff told Dr. Hanson that his 
“psychotic episode” lasted approximately three weeks and “[t]he triggering events were 
sleep deprivation and stress in his life.”  Tr. 688; accord Tr. 712.  Plaintiff reported that 

“he was having visual hallucinations that look like characters of people that were close to 
him and they were saying negative things about him.”  Tr. 688; accord Tr. 712.  Plaintiff 
stated he was given Abilify in the hospital and, after continuing with this medication, he 
“noticed a total resolution of his psychotic symptoms” over the course of several days.  
Tr. 688; accord Tr. 712.  Plaintiff had “been stable for over 2 weeks now,” was “sleeping 

well,” and had “a good appetite.”  Tr. 688; accord Tr. 712.               
Dr. Hanson noted that Plaintiff was alert and oriented, had good concentration, 
and normal thought processes.  Tr. 689, 713.  Plaintiff’s affect was appropriate and his 
mood was euthymic.  Tr. 689, 713.  Plaintiff also had good insight and judgment.  Tr. 
689, 713.  Dr. Hanson prescribed Abilify, continued Plaintiff’s other medications, and 
directed him to follow up in one month.  Tr. 690, 714.                    

When he followed up with Dr. Hanson a month later, Plaintiff reported that “he 
now only hears murmur in the voice” and cannot make out what the voice is saying.  Tr. 
685; accord Tr. 709.  Plaintiff reported being compliant with his medications and denied 
any side effects.  Tr. 685, 709.  Plaintiff wanted “to make more time to read now that he 
is feeling better.”  Tr. 685; accord Tr. 709.  “On good days,” Plaintiff was “productive 
and [able to] get himself to do yoga or some form of exercise to create structure in his 

day.”  Tr. 685; accord Tr. 709.  He was also sleeping regularly and had a good appetite.  
Tr.  685,  709.    Unlike  the  previous  visit,  Dr.  Hanson  described  Plaintiff’s  mood  as 
depressed, his insight poor, and his judgment fair.  Tr. 686, 710.  Dr. Hanson increased 
Plaintiff’s Effexor dose and continued his other medications at existing levels.  Tr. 687, 
711.  Plaintiff was to follow up in three months.  Tr. 687, 711.          

Plaintiff met with Dr. Johns via telehealth in mid-October.  Tr. 766.  Dr. Johns 
noted that Plaintiff was continuing to see Dr. Hanson.  Tr. 766.  Plaintiff reported that, 
following his episode of psychosis, he “had been feeling good through the summer until 
recently.”  Tr. 766.  Plaintiff noted some weight gain with Abilify.  Tr. 766.  Plaintiff also 
experienced mild auditory hallucinations occasionally and his mood remained low with 

fleeting suicidal ideation despite the increase in medication.  Tr. 766.  Plaintiff was 
interested in trying ketamine injections and transcranial magnetic stimulation (“TMS”)13 
as possible treatment options.  Tr. 766.                                  

Dr. Johns’ examination findings remained unchanged.  See Tr. 770-71.  Dr. Johns 
noted that Plaintiff “has a long history of depression” and was currently experiencing 
“severe, treatment resistant depression.”  Tr. 771.  Dr. Johns noted that Plaintiff had 
“failed numerous antidepressants” and “treated with psychotherapy without resolution of 
depression.”  Tr. 771.  Dr. Johns continued Plaintiff’s existing medications, prescribed a 
course of ketamine injections for three weeks, and authorized TMS.  Tr. 771. 

During  the  next  telehealth  appointment  with  Dr.  Hanson  in  early  November, 
Plaintiff reported feeling more depressed lately, which he attributed to the change in 
seasons.  Tr. 706.  Plaintiff had “a sad light” and said “he will be trying to use it more.”  
Tr. 706.  Plaintiff had also undergone “a few courses of IV ketamine infusions,” which he 
felt helped his mood, but “he still endorse[d] significant feelings of depression.”  Tr. 706.  

Plaintiff’s appetite and sleep were “fair.”  Tr. 706.  Plaintiff denied experiencing any 
hallucinations.  Tr. 706.                                                 
Plaintiff’s mental status examination was overall a bit better this time.  Although 
his mood remained depressed, his insight and judgment were good.  Tr. 708.  Dr. Hanson 
increased Plaintiff’s Abilify dose and continued his remaining medications.  Tr. 708.  

Plaintiff was directed to follow up in three months.  Tr. 708.            


13 “TMS uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression.”  
Transcranial Magnetic Stimulation (TMS) – Treatment for Depression, U.S. Dep’t of Veterans Affairs, 
https://www.va.gov/montana-health-care/programs/transcranial-magnetic-stimulation-tms-treatment-for-depression/ 
(last accessed Mar. 26, 2024).                                            
Plaintiff had another telehealth appointment with Dr. Hanson the following month.  
Tr. 703.  Both his mood and hallucinations were better.  Tr. 703.  Plaintiff reported that 

“his auditory hallucinations have decreased and at one point he was not hearing any.”  Tr. 
703; see Tr. 703 (“jokingly states that he thought the voices were finished”).  Plaintiff 
described his depression as “slightly improved.”  Tr. 703.  Plaintiff had some concerns 
about weight gain, and indicated that he would try to get outdoors more and stay active.  
Tr. 704.  Dr. Hanson noted that Plaintiff’s mood was euthymic.  Tr. 704.  Plaintiff’s 
medications were continued at their current levels and he was again directed to follow up 

in three months.  Compare Tr. 705 with Tr. 708.                           
A few days later, Plaintiff also had a telehealth appointment with Dr. Johns.  Tr. 
773.  Plaintiff felt that his mood was improving with the ketamine injections, but “[h]e 
continues to play online games incessantly.”  Tr. 773.  Plaintiff continued to spend time 
helping  his  brother  and  was  “paid  to  be  his  brother’s  PCA.”    Tr.  773.    Plaintiff 

experienced additional weight gain with an increased dose of Abilify, but the medication 
continued to be helpful in managing his auditory hallucinations.  Tr. 773. 
Compared to prior findings, Dr. Johns noted that Plaintiff’s memory was intact,  
but  his  attention  was  decreased.    Tr.  774.    Plaintiff’s  mood  and  anxiety  were  both 
improving.  Tr. 774.  Dr. Johns reviewed Plaintiff’s history of psychosis with him at 

length  and  concluded  that  Plaintiff  met  the  criteria  for  schizoaffective  disorder, 
depressive type.  Tr. 773, 774.  Dr. Johns added Topamax14 to Plaintiff’s medication 


14 Topamax is a brand name for topiramate, a medication often used for the treatment of certain seizures, but “also 
sometimes used for the management of alcohol dependence and for the treatment of binge eating disorder.”  
regimen to address the weight gain, but otherwise did not make changes to Plaintiff’s 
treatment plan.  Tr. 774; see Tr. 777-98 (continued ketamine therapy).    

E. Scott Kamilar                                                     
From at least November 2018 through December 2021, Plaintiff appears to have 
regularly attended therapy with Scott Kamilar.  See Tr. 509-13, 536, 679-80, 700; cf. Tr. 
857  (treatment  note  from  January  2017  stating  Plaintiff  sees  Kamilar  “for  regular 
counseling and has been seeing him for many years”).  As the ALJ noted, Kamilar’s 
“notes are handwritten and difficult to read.”  Tr. 31.  Generally speaking, they appear to 

contain a few short notes from each visit, often less than a sentence or two in length. 
                 IV. OPINION EVIDENCE                                
A. Dr. Johns                                                         
In March 2021, Dr. Johns completed a mental capacity assessment.15  See Tr. 551-
53.  The form asked Dr. Johns to rate Plaintiff’s degree of limitation in understanding, 

remembering, or applying information; concentration, persistence, or maintaining pace; 
adapting  or managing  oneself; and  interacting  with  others.    Tr.  551-53.    After  each 
section, the form asked for the medical/clinical findings supporting the assessment.  Tr. 
551-53.                                                                   
As for understanding, remembering or applying information, Dr. Johns opined that 

Plaintiff had moderate limitation in his ability to follow one or two-step oral instructions 
to carry out a task and in his ability to recognize a mistake, correct it, or identify and 

Topiramate, MedlinePlus, Nat’l Lib. of Med., https://medlineplus.gov/druginfo/meds/a697012.html (last accessed 
Mar. 26, 2024).                                                           
15 Dr. Johns also completed a physical assessment.  Tr. 549-50.  Only Plaintiff’s mental impairments are at issue 
here.                                                                     
solve problems.  Tr. 551.  Plaintiff had marked limitation in his ability to sequence multi-
step activities.  Tr. 551.  Plaintiff had extreme limitation in his ability to use reason and 

judgment to make work-related decisions.  Tr. 551.  Dr. Johns did not complete the 
medical/clinical findings section here.                                   
With  respect  to  concentrating,  persisting,  or  maintaining  pace,  Plaintiff  had 
moderate limitation in his abilities to initiate and perform a known task and to work at an 
appropriate and consistent pace/complete tasks in a timely manner.  Tr. 552.  Plaintiff had 
marked limitation in his abilities to ignore or avoid distractions while working and to 

work closely to or with others without interrupting or distracting them.  Tr. 552.  Plaintiff 
had  extreme  limitation  in  his  abilities  to  sustain  an  ordinary  routine  with  regular 
attendance at work and to work a full day without needing more than customary rest 
periods.  Tr. 552.  Dr. Johns also did not complete the medical/clinical findings section 
here.                                                                     

As for adapting and managing oneself, Plaintiff had moderate limitation in his 
ability to make plans independent of others.  Tr. 552.  Plaintiff had marked limitation in 
his abilities to adapt to change; distinguish between acceptable and unacceptable work 
performance; set realistic goals; and be aware of normal hazards and take appropriate 
precautions.    Tr.  552.    Plaintiff  had  extreme  limitation  in  his  abilities  to  manage 

psychologically based symptoms and to maintain appropriate personal hygiene and attire.  
Tr. 552.  Here, Dr. Johns explained that Plaintiff had a history of “psychosis and poor 
insight and judgement, as well as personality conflicts with others.”  Tr. 552.  Dr. Johns 
noted that Plaintiff “has ongoing depression, anxiety, poor focus, concentration, attention 
and memory.”  Tr. 552.  Dr. Johns also noted that Plaintiff has limited daily activities.  
Tr. 552.                                                                  

With respect to interacting with others, Plaintiff had moderate limitation in his 
abilities to cooperate with others and ask for help when needed.  Tr. 553.  Plaintiff had 
marked limitation in his abilities to understand and respond to social cues and to respond 
to requests, suggestions, criticism, correction, and challenges.  Tr. 553.  Plaintiff had 
extreme limitation in his abilities to handle conflict with others and to keep interactions 
free from excessive irritability, sensitivity, argumentativeness, or suspiciousness.  Tr. 

553.  As for the medical/clinical findings, Dr. Johns wrote: “See above.”  Tr. 553. 
Dr.  Johns  additionally  noted  that  Plaintiff  had  a  history  of  obtaining  legal 
substances  online  from  overseas,  “resulting  in  psychosis  and  likely  permanent 
impartment.”  Tr. 553.                                                    
B. State Agency Psychological Consultants                            

Both initially and on reconsideration, the state agency psychological consultants 
found that Plaintiff had no understanding or memory limitations, but did have some 
limitation in the areas of concentration and persistence, social interaction, and adaptation.  
See  Tr.  94-97,  112-15, 131-32,  142-43.    The  state  agency  psychological  consultants 
opined that, based on Plaintiff’s psychological symptoms, inattention, personality issues, 

and limited coping skills, Plaintiff would be able to “concentrate, persist and keep pace 
for detailed tasks with brief, superficial interaction with others” and “would do best with 
low workplace changes, pressures and responsibilities.”  Tr. 95, 97; accord Tr. 113, 115, 
131,  132,  142,  143;  see  also  Tr.  96  (“brief,  superficial  interaction  with  public  and 
others”);  accord  Tr.  114,  132,  143.    At  both  stages,  the  state  agency  psychological 
consultants  noted  that  Plaintiff  reported  his  symptoms  were  stable  with  ongoing 

treatment.  Tr. 97, 132, 115, 143.                                        
On reconsideration, the state agency psychological consultant noted the following 
with respect to Dr. Johns’ opinion:                                       
     [This  opinion]  is  now  dated  and  is  not  fully  persuasive, 
     supported, or consistent.  [Plaintiff] has reported difficulties 
     holding  jobs  due  [to]  interpersonal  conflicts  at  work.   
     However,  he  has  been  generally  cooperative  at  visits  and 
     appears able to sustain attention/concentration adequately for  
     activities of interest such as video games and yoga.  [Plaintiff] 
     was  evaluated  overnight  in  the  [emergency  room  in  April 
     2021] . . . for worsening [auditory hallucinations], which he   
     attributed to life stressors and sleep deprivation.  He endorsed 
     [suicidal  ideation]  with  an  intention  to  [overdose]  on   
     prescribed  medication.    [His]  condition  improved  with     
     treatment  and  he  declined  admission.    [Plaintiff]  has    
     subsequently established care with another psychiatrist and     
     his  [mental-health]  conditions  are  generally  described  as 
     stable  on  his  current  medications.    Overall,  [Dr.  Johns’ 
     opinion]  is  overly  restrictive  with  regard  to  [Plaintiff’s] 
     limitations  in  social  functioning,  stress  tolerance,  and  
     concentration/persistence/pace.    [Plaintiff]  has  no  recent 
     psychiatric  hospitalizations  and  has  denied  recent  [suicidal 
     ideation/homicidal ideation].  [Plaintiff] has denied a history 
     of  [chemical  dependency]  treatment.    While  motivation     
     appears  to  be  limited,  he  has  reported  at  recent  visits 
     compliance with prescribed medications.                         

Tr. 129; accord Tr. 140.                                                  
                V. HEARING TESTIMONY                                 
At the hearing, Plaintiff testified that he currently lived on his own in an apartment 
and had lived by himself for almost ten years.  Tr. 55.  Plaintiff received rental assistance 
and participated in other assistance programs. Tr. 55-56.  Plaintiff testified that his case 
manager generally assisted him with completing the necessary forms as he would become 
overwhelmed by the process.  Tr. 69-70.                                   

When  asked  how  his  psychological  impairments  affected  his  ability  to  work, 
Plaintiff testified that his symptoms were unpredictable and severe enough to “render[ 
him]  unable  to  work  completely.”    Tr.  60.    Plaintiff  still  experienced  auditory 
hallucinations occasionally, describing them as “just a sentence or two every day or two” 
and typically when he was trying to fall asleep.  Tr. 71.  Plaintiff testified that he was 
currently  on  several  medications  and  recalled  that  his  last  hospitalization  was  in 

approximately April 2021.  Tr. 63.  Plaintiff testified that he tried ketamine therapy for 
approximately three months, with his last injection occurring approximately three weeks 
prior, but stopped because they were not helping.  Tr. 64.  Plaintiff also testified that he 
had been terminated from previous employment due to an inability to get along with 
others.  Tr. 68.                                                          

Additionally, Plaintiff testified that he has been working as a PCA for his brother 
since 2021.    Tr.  57.    Plaintiff  worked  approximately  20 hours  per  month  providing 
services for his brother, stepping in when his mother was not able to be home.  Tr. 57-58.  
Plaintiff testified that his responsibilities primarily involved keeping an eye on his brother 
to prevent “him from doing things he shouldn’t be doing.”  Tr. 59.  Plaintiff testified that 

he did not believe his psychological impairments significantly impacted his ability to care 
for his brother and, if he thought that were the case on a given day, he would let his 
mother know.  Tr. 65-66.  Plaintiff acknowledged, however, that at one point he was a 
co-guardian for his brother, but his mother made the decision to “revoke[] it.”  Tr. 70.   
                   VI. ALJ’S DECISION                                
The ALJ found that Plaintiff had the severe impairments of intermittent explosive 

disorder;  dysthymia;  major  depressive  disorder;  generalized  anxiety  disorder; 
schizoaffective disorder, depressive type; and alcohol and polysubstance use disorders.  
Tr. 21.  The ALJ concluded that these impairments did not individually or in combination 
meet or equal a listed impairment in 20 C.F.R. pt. 404, subpt. P, app. 1.  Tr. 21-22.  As to 
Plaintiff’s residual functional capacity, the ALJ concluded that Plaintiff had the residual 
functional  capacity  to  perform  work  at  all  exertional  levels  with  the following  non-

exertional limitations:                                                   
     he can perform simple, routine, and repetitive tasks, but not at 
     a  production  rate  pace  (so,  for example,  no  assembly  line 
     work);  can  respond  appropriately  to  occasional  interaction 
     with supervisors and co-workers, but should have no team or     
     tandem  work  with  co-workers  and  no  interaction  with  the 
     general  public;  and  can  tolerate  few  changes  in  the  work 
     setting, defined as routine job duties that remain static and are 
     performed in a stable, predictable work environment.            

Tr. 25.  In reaching this residual-functional-capacity determination, the ALJ found Dr. 
Johns’ opinion to be unpersuasive.  See Tr. 33-34.                        
Based  on  Plaintiff’s  age,  education,  work  experience,  and  residual  functional 
capacity as well as the testimony of a vocational expert, the ALJ found that Plaintiff was 
capable  of  performing  the  representative  jobs  of  kitchen  helper,  routing  clerk,  and 
document preparer.  Tr. 36.  Accordingly, the ALJ concluded that Plaintiff was not under 
a disability.  Tr. 36-37.                                                 
                     VII. ANALYSIS                                   
This Court’s “task is to determine whether the ALJ’s decision complies with the 

relevant  legal  standards  and  is  supported  by  substantial  evidence  in  the  record  as  a 
whole.”  Lucus v. Saul, 

 (8th Cir. 2020) (quotation omitted); accord 
Kraus v. Saul, 

 (8th Cir. 2021); see also Biestek v. Berryhill, 

 (2019).  “Legal error may be an error of procedure, the use of erroneous 
legal  standards,  or  an  incorrect  application  of  the  law.”    Lucus,  

 
(quotation omitted).                                                      

“Under  the  substantial-evidence  standard,  a  court  looks  to  an  existing 
administrative record and asks whether it contains sufficient evidence to support the 
agency’s factual determinations.”  Biestek, 

 (quotation omitted).  “[T]he 
threshold  for  such evidentiary  sufficiency  is  not  high.”    

    “It  means—and  means 
only—such relevant evidence as a reasonable mind might accept as adequate to support a 

conclusion.”  

 (quotation omitted); see, e.g., Chismarich v. Berryhill, 

 (8th Cir. 2018) (defining “substantial evidence as less than a preponderance but 
enough  that  a  reasonable  mind  would  find  it  adequate  to  support  the  conclusion” 
(quotation omitted)).                                                     
This standard requires the Court to “consider both evidence that detracts from the 

[ALJ’s] decision and evidence that supports it.”  Boettcher v. Astrue, 

 
(8th Cir. 2011); see Grindley v. Kijakazi, 

 (8th Cir. 2021).  The ALJ’s 
decision “will not [be] reverse[d] simply because some evidence supports a conclusion 
other than that reached by the ALJ.”  Boettcher, 

; accord Grindley, 

; Perks v. Astrue, 

 (8th Cir. 2012).  “The court must 
affirm the [ALJ’s] decision if it is supported by substantial evidence on the record as a 

whole.”  Chaney v. Colvin, 

 (8th Cir. 2016) (quotation omitted).  Thus, 
“[i]f, after reviewing the record, the court finds it is possible to draw two inconsistent 
positions from the evidence and one of those positions represents the ALJ’s findings, the 
court must affirm the ALJ’s decision.”  Perks, 

 (quotation omitted); 
accord Chaney, 

.                                           
Disability benefits are available to individuals who are determined to be under a 

disability.  

(a)(1), 1381a; accord 

, 416.901.  An 
individual is considered to be disabled if he is unable “to engage in any substantial 
gainful activity by reason of any medically determinable physical or mental impairment 
which can be expected to result in death or which has lasted or can be expected to last for 
a continuous period of not less than 12 months.”  

(d)(1)(A); accord 42 

U.S.C. § 1382c(a)(3)(A); see also 

(a), 416.905(a).  This standard is 
met when a severe physical or mental impairment, or impairments, renders the individual 
unable to do his previous work or “any other kind of substantial gainful work which 
exists in the national economy” when taking into account his age, education, and work 
experience.  

(d)(2)(A); accord 42 U.S.C. § 1382c(a)(3)(B); see also 

(a), 416.905(a).                                        
Disability is determined according to a five-step, sequential evaluation process.  

(a)(4), 416.920(a)(4).                               
     To determine disability, the ALJ follows the familiar five-step 
     process, considering whether: (1) the claimant was employed;    
     (2) []he was severely impaired; (3) h[is] impairment was, or    
     was  comparable  to,  a  listed  impairment;  (4)  []he  could  
     perform past relevant work; and if not, (5) whether []he could  
     perform any other kind of work.                                 

Halverson v. Astrue, 

 (8th Cir. 2010).  In general, the burden of proving 
the existence of disability lies with the claimant.  

(a), 416.912(a). 
Plaintiff asserts that the ALJ erred in determining his residual functional capacity 
by not properly considering Dr. Johns’ opinion.                           
A. Residual Functional Capacity                                      
A claimant’s “residual functional capacity is the most [he] can do despite [his] 
limitations.”  

(a)(1), 416.945(a)(1) (same); see McCoy v. Astrue, 

 (8th Cir. 2011) (“A claimant’s [residual functional capacity] represents 
the most he can do despite the combined effects of all of his credible limitations and must 
be based on all credible evidence.”); see also, e.g., Schmitt v. Kijakazi, 

 (8th Cir. 2022).  “Because a claimant’s [residual functional capacity] is a medical 
question, an ALJ’s assessment of it must be supported by some medical evidence of the 
claimant’s ability to function in the workplace.”  Perks, 

 (quotation 
omitted); accord Schmitt, 

.                               
At the same time, the residual-functional-capacity determination “is a decision 
reserved to the agency such that it is neither delegated to medical professionals nor 
determined exclusively based on the contents of medical records.”  Norper v. Saul, 

  (8th  Cir.  2020);  see  Perks,  

;  see  also  

(c),  416.946(c).    “An  ALJ  determines  a  claimant’s  [residual  functional 
capacity] based on all the relevant evidence, including the medical records, observations 

of treating physicians and others, and an individual’s own description of [his or her] 
limitations.”  Combs v. Berryhill, 

 (8th Cir. 2017) (quotation omitted); 
accord Schmitt, 

; Norper, 

.  As such, there is no 
requirement that a residual-functional-capacity determination “be supported by a specific 
medical opinion.”  Schmitt, 

 (quotation omitted).   Nor is an ALJ “limited 
to considering medical evidence exclusively.”  

 (quotation omitted).  Accordingly, 

“[e]ven though the [residual-functional-capacity] assessment draws from medical sources 
for  support,  it  is  ultimately  an  administrative  determination  reserved  to  the 
Commissioner.”  Perks, 

 (quotation omitted); accord Schmitt, 

; see 

(c), 416.946(c).  Plaintiff bears the burden to establish 
his residual functional capacity.  Mabry v. Colvin, 

 (8th Cir. 2016). 

B. Evaluation of Opinion Evidence                                    
The evaluation of opinion evidence is governed by the criteria set forth in 

.1520c and 416.920c.  Although the opinion of a treating provider, Dr. 
Johns’ opinion is not entitled to special deference.  Bowers v. Kijakazi, 

 
(8th Cir. 2022); see 

.1520c(a) (“We will not defer or give any specific 

evidentiary  weight,  including  controlling  weight,  to  any  medical  opinion(s)  or  prior 
administrative  medical  finding(s),  including  those  from  your  medical  sources.”), 
416.920c(a) (same).                                                       
  Instead, ALJs evaluate the persuasiveness of medical opinions by   
  considering (1) whether they are supported by objective medical    
  evidence,  (2)  whether  they  are  consistent  with  other  medical 
  sources, (3) the relationship that the source has with the claimant, 
  (4) the source’s specialization, and (5) any other relevant factors. 

Bowers, 

; accord Austin v. Kijakazi, 

 (8th Cir. 2022); see 
generally 

.1520c(c), 416.920c(c) (listing factors).      
“The first two factors—supportability and consistency—are the most important.”  
Bowers, 

; accord Austin, 

; see 

.1520c(a), 
(b)(2),  416.920c(a),  (b)(2).    With  respect  to  supportability,  “[t]he  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.”  

.1520c(c)(1); 

.920c(c)(1) (same).  
As for consistency, “[t]he more consistent a medical opinion(s) . . . is with the evidence 
from other medical sources and nonmedical sources in the claim, the more persuasive the 
medical opinion(s) . . . will be.”  

.1520c(c)(2); 

.920c(c)(2) 
(same).  The regulations provide that the ALJ “will explain how [he or she] considered 
the supportability and consistency factors for a medical source’s opinions in [the] . . . 
decision.”  

.1520c(b)(2); 

.920c(b)(2) (same); see, e.g., 
Bonnett v. Kijakazi, 

, 20 (8th Cir. 2021) (per curiam) (“ALJ must explain 

how both supportability and consistency factors are considered”).         
C. Consideration of Dr. Johns’ Opinion                               
When evaluating the opinion evidence, the ALJ found that Dr. Johns’ opinion was 
not persuasive.  See Tr. 33-34.  The ALJ noted that, although             
     this opinion was based on regular examination of [Plaintiff] in 
     the course of treatment, . . . [Plaintiff’s] visits were at 3- to 4-
     month intervals or longer and the conclusions about marked      
     and extreme limitations in most areas of mental functioning     
     are not supported by the whole body of evidence regarding       
     the claim period, including the current psychiatric treatment   
     records.                                                        

Tr. 34.  The ALJ also recited the comments of the state agency psychological consultant 
on reconsideration and stated that “[t]he medical evidence of record received into the 
record since the reconsideration review shows a stable condition since that time, and 
remains fully consistent with their analysis of the inconsistencies between the opinion of 
Dr. Johns and the medical evidence of record regarding [Plaintiff’s] functioning during 
the present claim period.”  Tr. 34.                                       
Plaintiff does not assert that the ALJ failed to follow the applicable regulations.  
Instead, Plaintiff asserts that the ALJ’s “reasoning is grossly inadequate.”  Pl. Mem. in 
Supp. at 11, ECF No. 20.  Plaintiff asserts that the record reflects he regularly sought 
treatment for his mental impairments and the finding that these impairments were stable 
ignores evidence to the contrary.  According to Plaintiff, “there is ample evidence in this 
case that [his] numerous mental[-]health diagnoses cause him very serious limitations 
such that he could not function in any full-time work setting.”  Pl. Mem. in Supp. at 11. 
Plaintiff asserts that “Dr. Johns has been [his] treating psychiatrist for many years” 
and his “opinion is well-supported by his treatment notes and consistent with the record.”  
Pl. Mem. in Supp. at 9.  He additionally asserts that he “has an excellent and continuous 
record of treatment” with his case manager, therapist, and Dr. Johns during the relevant 
period and “[t]he ALJ’s claim that Dr. Johns has a sporadic/irregular treating history with 
[him] is false.”  Pl. Mem. in Supp. at 12.  Plaintiff likewise asserts that “it is unreasonable 
to allow the ALJ to use frequency of treatment with Dr. Johns—particularly as here, 

during the COVID-19 Pandemic—as a basis for discounting Dr. Johns[’] opinion, while 
accepting the opinion of sources who have never examined Plaintiff.”  Pl. Mem. in Supp. 
at  12.    Plaintiff  also  asserts  that  the  ALJ  improperly  relied  on  the  state  agency 
psychological  consult’s  characterization  of  Dr.  Johns’  opinion  as  “dated”  on 
reconsideration when the opinion was issued just six months earlier.  Pl. Mem. in Supp. 
at 13.                                                                    

First,  contrary  to  Plaintiff’s  assertion,  the  ALJ  did  not  find  that  he  had  “a 
sporadic/irregular treating history” with Dr. Johns.  Pl. Mem. in Supp. at 12.  Indeed, the 
ALJ noted that Dr. Johns’ opinion was “based on regular examination of [Plaintiff] in the 
course of treatment.”  Tr. 33.  The ALJ then permissibly took into account the frequency 
with which Plaintiff saw Dr. Johns, accurately noting that these appointments were often 

three to four months apart, compared to the marked and extreme limitations set forth in 
Dr. Johns’ opinion.  Plaintiff points to a decision from the Northern District of Iowa 
wherein  the  district  court  disagreed  with  an  ALJ’s  characterization  of  psychiatric 
treatment occurring “anywhere from four weeks to four months” apart as “relatively 
infrequent.”  Sidney v. Kijakazi, 

, 1093-94 (N.D. Ia. 2022).  But, 

whether it is possible to view the frequency of Plaintiff’s appointments differently is not 
the relevant question.  See Nash, 907 F.3d at 1089; see also Sidney, 630 F. Supp. 3d at 
1093.                                                                     
Second, again contrary to Plaintiff’s assertion, the ALJ did not find Dr. Johns’ 
opinion to be unpersuasive because a state agency psychological consultant found it to be 

“dated.”  Pl. Mem. in Supp. at 13.  A careful reading of the ALJ’s decision reflects that 
the ALJ was summarizing the comments of the state agency psychological consultant on 
reconsideration, which included the consultant’s opinion that Dr. Johns’ “opinion was 
now outdated.”  Tr. 34.  The salient part of the ALJ’s analysis comes, however, after this 
summary, wherein the ALJ explains that “[t]he medical evidence received into the record 
since the reconsideration review shows a stable condition since that time, and remains 

fully consistent with their analysis of the inconsistencies between the opinion of Dr. 
Johns and the medical evidence of record regarding [Plaintiff’s] functioning during the 
present claim period.”  Tr. 34.  Thus, the ALJ did not find Dr. Johns’ opinion to be 
unpersuasive because of the age of the opinion, but because the marked and extreme 
limitations contained in the opinion were inconsistent with other medical evidence in the 

record, including the more recent psychiatric treatment records.          
Fundamentally,  Plaintiff  asserts  that  his  medication  regimen  “has  been 
unsuccessful in treating his symptoms” and the record reflects that he “has repeatedly 
tried  and  failed  to  hold  low-level  jobs  because  he  inevitably  gets  into  verbal 
confrontations with coworkers and mangers.”  Pl. Mem. in Supp. at 10.  Plaintiff asserts 

that the ALJ did “not cite to the record” when concluding that Plaintiff was generally 
stable on his medications as of 2021 and “[a] lack of suicidal or homicidal ideation is not 
a reasonable basis for denying disability.”  Pl. Mem. in Supp. at 14.  Plaintiff asserts that 
Dr. Johns’ decision to pursue TMS and ketamine therapy to address the symptoms of his 
mental impairments reflects that these conditions were far from stable.   

Here  too,  Plaintiff’s  assertion  that  the  ALJ  “omit[ted]  evidence  refuting  the 
assertion of stability” is incorrect.  Pl. Mem. in Supp. at 14.  When discussing the medical 
evidence,  the  ALJ  discussed  how  there  were  times  when  Plaintiff  experienced 
“breakthrough psychotic symptoms.”  Tr. 28; see, e.g., Tr. 28 (“breakthrough symptoms 
about  twice  a  month”),  30  (“had  been  having  auditory  hallucinations”).    The  ALJ 
contextualized these episodes, pointing out that they tended to occur when Plaintiff was 

using  non-prescribed  substances  and  not  sleeping  and  eating  regularly.    Plaintiff’s 
psychotic episodes resolved with medication and he reported improvements in his mood 
with medication adjustments.  See Hensley v. Colvin, 

 (8th Cir. 
2016) (“If an impairment can be controlled by treatment or medication, it cannot be 
considered disabling.”).                                                  

Nor was it outside the zone of choice for the ALJ to find that Plaintiff’s condition 
overall remained stable since his April 2021 episode.  In mid-June 2021, Dr. Hanson 
noted that Plaintiff had been stable for over two weeks.  The following month, Plaintiff 
reported feeling better despite occasionally hearing a “murmur.”  Tr. 685; accord Tr. 709.  
Plaintiff told Dr. Johns a few months later that he “had been feeling good” up until 

recently  with  the  change  in  seasons  and  experienced  mild  auditory  hallucinations 
occasionally.    Tr.  766.    And  while  Plaintiff  reported  feeling  more  depressed  in 
November, he told both Dr. Hanson and Dr. Johns that he was doing better in December.  
Thus,  the  more  recent  psychiatric  records  reflect  that  Plaintiff’s  symptoms  and 
functioning improved with medication.                                     

Similarly,  while  Plaintiff  emphasizes  that  he  was  diagnosed  with  “treatment 
resistant depression,” Pl. Mem. in Supp. at 10, 14, the fact that Plaintiff continued to have 
medically documented impairments during this time “does not perforce result in a finding 
of disability,” Stormo v. Barnhart, 

 (8th Cir. 2004).  Even if this 
characterization of Plaintiff’s depression combined with Dr. Johns’ notation that Plaintiff 
had “failed numerous antidepressants” and the treatment decision to pursue TMS and 

ketamine therapy could support an alternative conclusion, this alone does not warrant 
reversal.  Fentress v. Berryhill, 

 (8th Cir. 2017) (“[W]e will not 
reverse simply because some evidence supports a conclusion other than that reached by 
the  Commissioner.”).    Moreover,  the  ALJ  considered  other  evidence  in  the  record 
indicating  Plaintiff  overall  exhibited  greater  functioning  than  reflected  in  Dr.  Johns’ 

opinion.    Among  other  things,  the  ALJ  noted  that  Plaintiff  lived  on  his  own  in  an 
apartment  and  was  working  at  least  part  time  as  a  PCA  for  his  brother.    “Despite 
[Plaintiff’s] dissatisfaction with how the ALJ weighed the evidence, it is not this Court’s 
role to reweigh that evidence.”  Schmitt, 

.               
Lastly, although the ALJ did not find Dr. Johns’ opinion to be persuasive, the ALJ 

did include limitations in the residual functional capacity related to Plaintiff’s mental 
impairments, including difficulties getting along with others.  The ALJ limited Plaintiff to 
“simple, routine, and repetitive tasks” to “address the complaints of difficulty with focus 
and periods of diminished attention and concentration in mental status examinations.”  
Tr. 27.  The ALJ included limitations regarding pace (no “production rate pace”) and 
variability (“few changes in the work setting, defined as routine job duties that remain 

static  and  are  performed  in  a  stable,  predictable  work  environment”)  to  “address 
moderate difficulties with adapting and managing the self.”  Tr. 25, 27.  The ALJ also 
limited Plaintiff’s “interaction with others” to address the difficulties he experienced in 
previous employment situations while also taking into account that he was able to interact 
with others in other settings, including with his brother, case manager, and treatment 
providers.  Tr. 27.                                                       

In sum, there is substantial evidence in the record as a whole to support the ALJ’s 
conclusion that Dr. Johns’ opinion was unpersuasive.                      
                      VIII. ORDER                                    
Based  upon  the  record,  memoranda,  and  the  proceedings  herein,  and  for  the 
reasons stated above, IT IS HEREBY ORDERED that:                          

1.  Plaintiff’s Motion for Summary Judgment, ECF No. 19, is DENIED.  

2.  The Commissioner’s request for relief, ECF No. 22, is GRANTED.   

3.  The ALJ’s decision is AFFIRMED.                                  


LET JUDGMENT BE ENTERED ACCORDINGLY.                                      


Dated:  March    26    , 2024           s/ Tony N. Leung                  
                              Tony N. Leung                          
                              United States Magistrate Judge         
                              District of Minnesota                  

                              Kristopher T. T. v. O’Malley           
                              Case No. 23-cv-359 (TNL)