UNITED STATES DISTRICT COURT FOR THE DISTRICT OF NEW HAMPSHIRE

Brenda L . Corson

v. Civil N o . 12-cv-371-PB Opinion N o .

U.S. Social Security Administration, Commissioner

MEMORANDUM AND ORDER

Brenda Corson seeks judicial review of a ruling by the

Commissioner denying her application for disability insurance

benefits (“DIB”) because she failed to prove that she was

disabled at any point prior to September 3 0 , 1998, the last date

that she was eligible for DIB. Corson claims that the

Administrative Law Judge (“ALJ”) failed to properly credit

evidence from a treating medical source and failed to properly

consider lay evidence. She additionally argues that the ALJ’s

residual functional capacity (“RFC”) assessment is not supported

by substantial evidence because it failed to account for all of

Corson’s functional limitations. For the reasons set forth

below, I deny Corson’s request and affirm the decision of the

Commissioner. I. BACKGROUND1

A. Procedural History

Corson originally applied for DIB on August 5 , 2002,

alleging a disability onset date of July 2 2 , 1994. After the

Commissioner denied her application on August 2 7 , 2002, ALJ Ruth

Kleinfeld held a hearing on September 1 8 , 2003. Corson,

represented by an attorney, testified along with her daughter-

in-law. On April 3 0 , 2004, the ALJ issued a decision finding

that Corson was not disabled between the alleged onset date of

her disability and September 3 0 , 1998, her date last insured

(“DLI”). 2 After the Appeals Council denied Corson’s request for

review, this court issued a remand order, finding that the ALJ’s

decision was not supported by substantial evidence. Endorsed

Order, Corson v . Soc. Sec. Admin., Comm’r, N o . 04-cv-357 (D.N.H.

June 2 9 , 2005). The Appeals Council then vacated the earlier

decision and remanded the case.

The ALJ held a second hearing on September 7 , 2006. Corson

was absent, but her attorney appeared, as well as a medical

1 The background information is taken from the parties’ Joint Statement of Material Facts (Doc. N o . 1 3 ) . Citations to the Administrative Transcript are indicated by “Tr.” 2 In order to be eligible for DIB under the Social Security Act, Corson must demonstrate that she was disabled on or prior to her date last insured. See

(c) .

2 expert and vocational expert. On February 2 5 , 2008, the ALJ

issued a second decision finding that Corson was not entitled to

benefits. This court then remanded the case a second time on a

motion by the Commissioner, and the Appeals Council subsequently

vacated the earlier decision and remanded the case. 3

On June 8 , 2010, ALJ Edward Hoban held a hearing at which

Corson, represented by an attorney, testified. Corson’s friend

Cynthia Vandermark also testified, as did medical expert D r .

Gerald Koocher and vocational expert Christine Spaulding. On

September 2 4 , 2010, the ALJ issued a decision finding Corson not

disabled at any time between her alleged onset date and her DLI.

On July 1 2 , 2012, the Appeals Council declined to assume

jurisdiction, making the ALJ’s decision the Commissioner’s final

decision and therefore subject to judicial review.

B. Medical History

Corson was forty-four years old on her alleged onset date

and forty-nine years old on her DLI. She has a high school

education and past relevant work as a housekeeper and laundry

worker. Although Corson originally claimed physical

3 The Commissioner moved for a limited remand to reevaluate whether Corson’s prior position as a file clerk constituted past relevant work. The court granted the motion subject to a broader scope, noting that the ALJ could revisit any issue he or she deemed appropriate. Endorsed Order, Corson v . Astrue, Comm’r of Soc. Sec., N o . 08-cv-441 (D.N.H. June 1 8 , 2009). 3 incapacitation along with her mental ailments, her arguments

here rest solely upon her alleged pre-DLI mental impairments.4

1. Treatment Summary, 1996-2005

On August 1 9 , 1996, Corson arrived without an appointment

at Community Medical Associates of Concord (“CMAC”), where she

had previously been treated for a back injury. She was crying

and stated that she was tired, not feeling well, and having

trouble with her husband. T r . at 191. Corson described herself

as “dirty and unkempt,” but the examining doctor, D r . Benson,

disagreed with her self-assessment, noting that she was “hardly

so.” D r . Benson diagnosed Corson as depressed and started her

on antidepressant medication, and on a visit later that month he

prescribed two additional medications to treat anxiety and

depression.

On August 2 7 , 1996, Corson returned to CMAC and was treated

by Linda Douville, a nurse practitioner. Corson complained that

she felt tearful all the time, unlike herself, bored with her

life, and feared people snooping outside of her home. She also

reported continuing marital problems. In September, D r . Benson 4 Corson originally alleged back pain as a basis for disability, but now only challenges the ALJ’s assessment of her mental impairments. I thus need not address Corson’s physical work capacity. See Brun v . Shalala, N o . 93-320-B,

, at *1 n.3 (D.N.H. July 2 9 , 1994) (citing Alan Corp. v . Int’l Surplus Lines, Inc.,

, 343 n.4 (1st Cir. 1994)).

4 advised Corson to remain on the same medications and to seek

counseling. Later in the month, Corson told Douville that she

had stopped taking two of her prescribed medications due to

headaches, but continued taking the third in order to sleep.

She stated that she was feeling better about her relationship

with her husband, whose physical and verbal abuse were allegedly

at the root of many of her problems. Id. at 192.

On October 9, 1996, Corson discussed her marital problems

with D r . Benson and reported that her husband did not want her

to work. Id. at 193. Later that month, Corson told Douville

that she was in better spirits and was contemplating working

part-time over the holidays, which Douville encouraged. On

November 2 1 , 1996, Douville reported that Corson’s depression

had resolved and encouraged Corson to get a driver’s license and

seek employment. Id. at 194.

On February 3 , 1997, Corson again reported trouble eating,

sleeping, and difficulties with her husband, and D r . Benson

restarted her on a second medication for depression. By mid-

month, Corson reported that she felt better but still tearful,

and D r . Benson restarted her on the third medication. Corson

reported being happier that March and continued taking her

medication. In September 1998 Corson told Douville that she was

“doing fine” and was back working. Id. at 200. 5 On February 1 0 , 1999, Corson told Douville that she was

stressed because her husband did not want her to work outside of

the home. Corson requested a replacement for two of her

medications due to headaches and she started a different

antidepressant. That March, Corson told Douville that she had

significant relief from anxiety while on her new medication, and

in September she told Douville that she felt more social.

Corson reported doing well on her new medication through late

2001. Id. at 200-01, 2 0 4 , 206.

In early 2002, medical authorities were first alerted to

potential problems beyond the scope of Corson’s previously

diagnosed chronic anxiety and depression. On February 6, 2002,

Douville documented a phone call from Corson’s son expressing

concern for Corson’s mental state. He specifically described

two episodes: one in which Corson saw “midgets” looking in the

window, the other in which she thought she had been shot. Id.

at 208.

On July 9, 2002, Corson first told Douville that she had

been having paranoid episodes manifesting in auditory

hallucinations, fear of the dark, and the fear that someone was

hurting her. Id. at 210. Douville reports that “she has had

these symptoms for a very long time, but has been afraid to tell

6 anybody about it.” Douville referred Corson to Concord

Psychiatry Associates (“CPA”) and increased her dose of

antidepressants.

On July 3 1 , 2002, Corson saw Joyce Blood, Ph.D., a nurse

practitioner at CPA.5 Id. at 225. Corson told Blood that she

constantly felt like crying, was afraid of the dark and afraid

to take a shower, and had auditory hallucinations and fears that

people were staring at her. Corson noted that she felt anxious,

stressed, and depressed, and reported excessive hand washing.

Blood observed that Corson behaved normally and had clear

thought processes, displaying average intelligence with a

depressed and anxious mood. Blood provisionally diagnosed6

Corson with a psychotic disorder, paranoid type, and ruled out

bipolar and obsessive-compulsive disorders. Id. at 226.

In a medical source statement dated March 2 6 , 2003, Blood

5 The Joint Statement of Material Facts refers to Blood as “Dr. Blood” because she has a Ph.D. Doc. N o . 1 3 . Acknowledging her doctorate in nursing, T r . at 5 6 7 , I refer to her as Blood because she is not a medical doctor, nor a licensed physician or psychologist for the purpose of diagnosing patients. See

(a). 6 A “provisional diagnosis” is used in circumstances of diagnostic uncertainty, when “there is a strong presumption that the full criteria will ultimately be met for a disorder but not enough information is available to make a firm diagnosis.” Am. Psychiatric Ass’n, Diagnostic and Statistical Manual of Mental Disorders 23 (5th ed. 2013).

7 opined on Corson’s mental ability to accomplish work-related

activities.

. Blood found that Corson had marked

restrictions in her ability to understand and remember short,

simple instructions and moderate restrictions in her ability to

carry them out. She noted that Corson had marked restrictions

in her ability to understand, remember, and carry out detailed

instructions; moderate restrictions in her ability to make work-

related decisions and to interact appropriately with supervisors

and co-workers; and marked restrictions in her ability to

interact appropriately with the public and to respond to

changing pressures and work conditions. Blood opined that these

limitations were due to Corson’s high levels of anxiety and

agoraphobia.

.

On September 3 , 2003, Blood gave an opinion on Corson’s

mental impairments for a Social Security prehearing mental

impairment questionnaire. Blood claimed that her opinion

applied both presently and prior to September 3 0 , 1998, Corson’s

DLI.

. Noting that she saw Corson on a quarterly to

monthly basis, Blood reported a delusional disorder with a host

of signs and symptoms, including hallucinations, paranoia, and

anxiety.7 Blood noted that Corson’s anxiety decreased while she

7 The list of signs and symptoms that Blood found included: poor memory; appetite, sleep, and mood disturbance; emotional 8 was on psychotropic medications, and that she currently took an

antidepressant and medication for schizophrenia. Blood found

that Corson’s symptoms were likely to recur, and that she would

likely be absent from work more than three times per month due

to her mental impairments.

. According to Blood,

almost all of Corson’s mental abilities were found to be either

“seriously limited” or “unable to function.” Blood opined that

Corson had no limitations on her ability to do daily tasks, but

marked difficulties in maintaining social functioning, frequent

difficulties with concentration, and repeated episodes of

decompensation in work-like settings.

. She also

stated that if Corson were awarded benefits she could manage

them in her own best interest.

During the first half of 2005, Blood saw Corson roughly

once a month to discuss Corson’s depression and anxiety, both of

which were exacerbated by her husband’s recent death. At that

point, Corson was on five different medications for depression,

insomnia, and schizophrenia. On July 1 4 , 2005, D r . Thomas

Meehan, a doctor at CPA, reviewed Corson’s records at Blood’s

liability; hallucinations; recurrent panic attacks; psychomotor agitation; paranoia; difficulty concentrating; oddities of thought, perception, speech, or behavior; perceptual disturbances; social withdrawal; blunt, flat, or inappropriate affect; illogical thinking; obsessions; persistent irrational fears; and generalized persistent anxiety. T r . at 257. 9 request. D r . Meehan acknowledged that Corson presented

psychotic symptoms in 2002 when Blood began treatment and had

been ill for about two years before that, but that otherwise

Corson’s “past history was indicative of generalized anxiety and

possibly earlier depression,” with “no history of earlier onset

psychosis.” Id. at 393. In his written report, D r . Meehan

affirmed Blood’s diagnoses of psychotic disorder, NOS and major

depression, noting that he “would probably add Generalized

Anxiety Disorder.”

2. State Agency and Medical Expert Assessments

On August 2 7 , 2002, state agency psychologist Michael

Snyder, Psy.D., opined that the record contained insufficient

evidence to determine whether Corson had a psychosis-related

mental impairment prior to her DLI. On October 2 9 , 2007,

medical expert Gerald Koocher, Ph.D., opined that Corson

appeared to have psychosis with moderate impairments from 2002-

2005, but that there was no documentation to support a level of

severity beyond moderate, and that her condition seemed to have

improved with medication. T r . at 426. D r . Koocher further

stated that the record contained insufficient evidence to

determine whether Corson had a psychosis-related mental

impairment prior to her DLI.

10 C. Hearing Testimony

1. September 1 8 , 2003 Hearing

After initially testifying that she had not worked since

1992 because her husband forbade her from working due to her

anxiety, Corson testified that she had in fact worked for

several months in 1998 making turkey pies, but had left because

she did not like the job. Id. at 61-62. She stated that she

had been hospitalized for a nervous breakdown as a teenager.

Describing her mental impairments, Corson noted that during the

1990s she was afraid to take showers and feared people were

looking into her home. She testified that she frequently

hallucinated and heard voices. She did not tell Douville or

other medical authorities about her hallucinations because “she

was very scared to tell her.” Corson testified that she had

told her husband about the hallucinations, but he then told her

“it’s in your mind,” and that she did not know what she was

talking about. Id. at 7 0 . Medication did not help with the

hallucinations.

Corson’s daughter-in-law, Teresa Corson, also testified

that she first noticed Corson’s problems in 1994 or 1995, when

Corson would say she saw aliens or was afraid of people watching

her. Teresa Corson noted that the family spoke about getting

Corson help, but that she refused such offers. Teresa Corson 11 testified that several times Corson had to be driven from their

home in Cape Cod to New Hampshire in the middle of the night due

to her anxiety and concerns about aliens or neighbors watching

her. Id. at 8 4 . Teresa Corson testified that Corson would go

two or three months without problems, then in the next several

months would mention five different paranoid incidents. Id. at

85.

3. June 8 , 2010 Hearing

Corson again testified that she quit her job making turkey

pies because she did not like i t , and that she also quit a

dishwashing job during the alleged disability period because she

could not get along with her brother-in-law as a co-worker. Id.

at 631. Corson stated that she stopped working in 1992 due to

back pain and physical burnout, as well as stress. She alleged

that in 1992 she thought that she was seeing people and things

that were not there. She told her son, husband, and friend

about her hallucinations, but did not tell any doctors. Corson

testified that in 1998, her friend Tracy McAllister had to help

her shower because of her fears. When questioned, Corson could

not remember an incident from 1994 where her brother- and

sister-in-law convinced her to go to the hospital after she

alleged to have been shot by a motorcycle gang.

12 Corson’s friend Cynthia Vandermark testified to working

with Corson from 1989 to 1992, noting that Corson had always

been “up and down emotionally” and complained about stress.

Vandermark further testified that Corson had always been nervous

in public, was afraid that people were watching her, kept her

door bolted and blinds and curtains closed, and had difficulty

being alone. Id. at 647-50.

Dr. Koocher, a psychologist, testified as a non-examining

medical expert that evidence indicated that Corson had a history

of mental illness, including anxiety, depression, and some

symptoms suggestive of a schizophrenic or psychotic disorder,

but none to the extent required by the listings. See 20 C.F.R.

p t . 4 0 4 , subpt. P, app. 1 ; T r . at 653-65. D r . Koocher opined

that statements made by Corson’s family and friends demonstrated

problems before her D L I , but did not provide sufficient

information to determine the severity of her impairments. Tr.

at 654-55. Although treatment for anxiety and depression were

part of Corson’s routine medical care before her D L I , the 2002

phone call to Douville was the first mention in the medical

record of “something that sound[ed] like a psychotic symptom.”

Dr. Koocher opined that there was “no sign of hallucinations or

delusions reported in the medical record before the date last

insured.” Id. at 657. According to D r . Koocher, Corson’s daily 13 living, social functioning, and concentration would have been

mild to moderately limited as of the D L I , with no evidence of

episodes of decompensation of extended duration. D r . Koocher

also opined that Corson would be able to perform simple work and

function socially, and that the statements from Corson’s family

and other lay testimony evidencing problems with paranoia were

“episodic” rather than constant. Id. at 660. D r . Koocher

testified that at the time of her D L I , Corson would have been

moderately impaired in her ability to interact with the public,

respond to work pressures, and attend work punctually and

regularly. D r . Koocher opined that Corson’s depression and

anxiety might have interfered with her ability to complete a

normal workweek, but not on a regular basis, and that as of her

DLI Corson could tolerate occasional interaction with the public

and coworkers.

The June 8 hearing also included testimony from Christine

Spaulding, a vocational expert. The ALJ asked questions

concerning a hypothetical individual capable of doing light

work, limited to simple, repetitive tasks with occasional

interaction with coworkers, the public, and supervisors.

Spaulding testified that such a person could not do any of

Corson’s past relevant work, but would be able to perform work

as a cleaner, laundry worker, or cafeteria attendant. Id. at 14 667-68. She further testified that these jobs could be done by

someone who was unable to perform stressful, fast-paced

production work. The ALJ agreed that if Corson had the

limitations as described in Blood’s assessment, she would be

incapable of substantial gainful employment. Id. at 669.

D. Witness Statements

The record also includes sworn statements by Corson’s

friends and relatives. On June 1 0 , 2003, Corson’s brother-in-

law, John Corson, stated that in June 1994 Corson arrived at his

house saying she had been shot in the neck by a motorcycle gang.

She rejected his offer of water, saying it had been poisoned,

and would not stay at the hospital when he took her there. John

Corson also stated that claimant drew her curtains at home so

people could not spy on her, and that her problems had existed

for many years. Id. at 174. These statements were echoed in

another sworn statement by Lorraine Corson, the claimant’s

sister-in-law.

On September 6, 2003, Tracy McAllister, the claimant’s

friend, stated that she met the claimant at work in 1983, and

first noticed a change in 1988, when Corson began thinking that

people were spying on her. McAllister stated that in 1990

Corson mentioned seeing aliens, and believed that her sister-in-

law spread feces around her bathroom and went through her 15 things. McAllister helped Corson find a part-time job at a

plumbing company, but Corson had not liked it and quit abruptly.

She stated that Corson was verbally abusive towards her during a

1995 visit and threw things across the room, and that they did

not see each other again until November 2002, when they began

occasionally visiting each other. Id. at 172.

E. ALJ’s Decision

In applying the five-step sequential process required for

evaluating DIB claims,

(a)(4)(i-v), the ALJ

found that Corson last met the insured status requirement on

September 3 0 , 1998. He then found that Corson had not engaged

in substantial gainful activity during the period between her

alleged disability onset date and DLI.

At steps two and three, the ALJ found that Corson had

severe impairments for low back pain, depression, and anxiety,

but that none of her impairments met the listing requirements.

In detail, the ALJ described Corson’s visits to her primary care

provider between August 1996, when she first presented

complaints of depression, and 1999, her DLI. The ALJ next

considered medical expert D r . Koocher’s opinion, noting that the

expert viewed the entire medical record and found that prior to

2002, the medical record only supported diagnoses of depression

and anxiety. T r . at 447. The ALJ then considered post-DLI 16 evidence, including Corson’s son’s phone call to Douville,

Corson’s treatment by Blood for paranoid episodes, and Blood’s

retrospective opinion finding the presence of a delusional

disorder prior to Corson’s DLI. He noted that Blood “may not be

an acceptable medical source.”

After considering this evidence, the ALJ found D r .

Koocher’s testimony consistent with clinical records from CMAC

and the record as a whole. He agreed with D r . Koocher’s

findings of severe impairments for depression and anxiety. He

said, however, that he “cannot find, based upon the evidence now

in file, that the claimant had the medically determinable

impairment of a psychotic/delusional disorder . . . as alleged

during the period in question.” To reinforce his decision, the

ALJ noted that Corson did not report symptoms of psychosis to

her primary care provider and was not described as experiencing

such symptoms at any time prior to 2002. He then considered the

record’s lay evidence, giving it “very limited weight” after

noting that the testimony from Corson’s brother- and sister-in-

law only described isolated observations from one event that

occurred prior to the alleged disability onset date. The ALJ

next considered other lay evidence, and reinforced his

assessment by noting that D r . Koocher considered the lay

opinions before finding that Corson had not suffered from an 17 impairment prior to her DLI.

After finding that Corson did not have an impairment that

met or medically equaled one of the listings, the ALJ next found

that through her D L I , Corson had the RFC to perform light work

involving simple, repetitive, unskilled tasks with occasional

interaction with others in a low-stress, non-production setting.

In drawing this conclusion, the ALJ explained that Corson’s

testimony was not fully credible concerning the “intensity,

persistence and limiting effects” of her symptoms, though she

attempted to provide information to the best of her abilities.

He noted that while testifying, Corson had difficulty recalling

specific pertinent instances, and that she had quit the two jobs

she worked during the eligibility period because she did not

like them or had difficulties getting along with her brother-in-

law – not because she was unable to perform the work.

In explaining why he did not factor hallucinations and

paranoia into the RFC, the ALJ stated that the medical evidence

in the record did not establish the presence of these symptoms

at any time prior to the DLI. The ALJ noted that concerns about

such symptoms were raised by a family member in 2002, and next

turned to Blood’s retrospective diagnosis, which he avowed to

have “carefully considered.” Id. at 451. In affording Blood’s

opinion only limited weight, the ALJ reasoned that Blood 18 provided no clinical observations to support her assertion. He

also noted that the opinion is inconsistent with other

substantial evidence, including that from Corson’s primary care

provider and Corson’s self-reporting from the time period in

question.

The ALJ next addressed lay testimony, finding that none of

it supported a conclusion that Corson suffered from limitations

beyond the previously found anxiety and depression. The ALJ

noted that the testimony from Corson’s brother- and daughter-in-

law describe only “very isolated events,” and acknowledged that

“at times [Corson] was ‘perfectly fine.’” He found that the

testimony from McAllister, Corson’s friend, did not specifically

pertain to the eligibility period and that the evidence “does

not establish any ongoing inability to maintain appropriate

social interactions.” He also addressed Vandermark’s testimony,

noting that it only established nervousness and that Corson

maintained social interaction throughout the eligibility period.

Id.

The ALJ gave significant weight to medical evidence from

Corson’s primary care provider during the eligibility period,

reasoning that “it is the only evidence produced

contemporaneously with the time the claimant alleges she was

disabled.” Id. He noted the absence of any documented signs of 19 paranoia or delusions, and also considered Corson’s self-

reporting of her illnesses, as found in the treatment records as

the “best evidence” from this time period. The ALJ also gave

considerable weight to the “documented timing” of when

delusional symptoms were first reported in 2002, the evidence

that Corson first entered into psychiatric treatment in 2002,

and “the well-supported opinion of D r . Koocher.” Id. at 452.

The ALJ found that Corson was unable to perform any of her

past relevant work, but that jobs existed in significant numbers

in the national economy that Corson could perform. Thus, the

ALJ found that Corson was not disabled at any point from her

alleged disability onset date through her DLI. Id. at 453.

II. STANDARD OF REVIEW

Under

(g), I am authorized to review the

pleadings submitted by the parties and the administrative record

and enter a judgment affirming, modifying, or reversing the

“final decision” of the Commissioner. My review “is limited to

determining whether the ALJ used the proper legal standards and

found facts [based] upon the proper quantum of evidence.” Ward

v . Comm’r of Soc. Sec.,

5 2 , 655 (1st Cir. 2000).

Findings of fact made by the ALJ are accorded deference as

long as they are supported by substantial evidence.

20 Substantial evidence to support factual findings exists “‘if a

reasonable mind, reviewing the evidence in the record as a

whole, could accept it as adequate to support his conclusion.’”

Irlanda Ortiz v . Sec’y of Health & Human Servs.,

(1st Cir. 1991) (per curiam) (quoting Rodriguez v . Sec’y of

Health & Human Servs.,

1 8 , 222 (1st Cir. 1981)). If

the substantial evidence standard is met, factual findings are

conclusive even if the record “arguably could support a

different conclusion.” Id. at 770. Findings are not

conclusive, however, if they are derived by “ignoring evidence,

misapplying the law, or judging matters entrusted to experts.”

Nguyen v . Chater,

1 , 35 (1st Cir. 1999) (per curiam).

The ALJ is responsible for determining issues of

credibility and for drawing inferences from evidence in the

record. Irlanda Ortiz,

. It is the role of the

ALJ, not the court, to resolve conflicts in the evidence.

To determine whether an applicant is disabled, the ALJ

follows a five-step sequential analysis.

.

In the context of a claim for social security benefits,

disability is defined as “the inability to do any substantial

gainful activity by reason of any medically determinable

physical or mental impairment” expected to result in death or to

last for a continuous period of not less than twelve months. 20

(a). The applicant bears the burden, through

the first four steps, of proving that his impairments exist and

preclude him from working. Freeman v . Barnhart,

(1st Cir. 2001). At the fifth step, the ALJ determines if

employment exists in significant numbers in the national economy

that the claimant can do despite his or her impairments. The

ALJ must produce substantial evidence to support that finding.

Seavey v . Barnhart,

, 5 (1st Cir. 2001).

III. ANALYSIS

Corson presents several related arguments in support of her

challenge to the ALJ’s decision. She first argues that the ALJ

failed to properly credit Blood’s retrospective opinion as a

treating source in finding no severe impairment for her alleged

delusional disorder. Corson also maintains that in failing to

find a delusional disorder at step two of his analysis, the ALJ

failed to properly credit lay witness testimony establishing the

existence of psychotic symptoms prior to Corson’s DLI.

Relatedly, Corson argues that the ALJ’s failure to properly

credit Blood’s opinion resulted in an erroneous RFC unsupported

by the existing substantial evidence. Had he properly credited

Blood’s opinion, argues Corson, the ALJ would have found that

Corson was disabled prior to her DLI. Corson does not dispute 22 the ALJ’s findings concerning her back pain, anxiety, and

depression, instead centering her argument upon the ALJ’s

allegedly inadequate consideration of her psychotic/delusional

disorder prior to her DLI. I conclude that the ALJ gave proper

consideration to Blood’s testimony and that of the lay witnesses

and affirm the ALJ’s decision as supported by substantial

evidence.

A. Weight of Medical Opinions

In arguing her case, Corson accurately cites regulations

describing the additional weight generally given to examining

sources, the factors an ALJ must apply to any medical opinion

not given controlling weight, and the requirement that an ALJ

give “good reasons” for rejecting a medical opinion. See

(c)(1-6), ( d ) . As the ALJ noted, however,

Blood is not an “acceptable medical source” qualified to give a

medical opinion.8 See

§§ 404.1513(a)(1-2), .1527(a)(2).

Acceptable medical sources include licensed physicians or

8 Finding that Blood is not an acceptable medical source does not end my inquiry. Although objective medical evidence is necessary to establish the existence of a disabling impairment, it is unnecessary to establish the disability onset date. Moriarty v . Astrue,

5 8 , 1 4 ; SSR 83-20,

, at *3 (1983). Although he declined to confirm Blood’s retrospective diagnosis of an impairment existing prior to Corson’s D L I , D r . Meehan affirmed her diagnosis of psychotic disorder, NOS as of 2005. T r . at 393.

23 licensed or certified psychologists, but do not include nurse

practitioners, who are considered “other sources.”

§

404.1513(a)(1-2), ( d ) . Despite her doctoral degree, Blood is

neither a physician nor a licensed or certified psychologist.

Her curriculum vitae includes a Ph.D. in nursing and state

certifications as a nurse practitioner in the field of

psychiatric/mental health and as a registered nurse. T r . at

567-69. Because she is not an acceptable medical source, Blood

is also not a “treating source” entitled to the preferential

treatment requested by Corson.9 See

.

To be sure, the ALJ is still required to consider Blood’s

opinion as part of “all of the relevant evidence.” See

Alcantara v . Astrue,

(1st Cir. 2007)

(citing

(a), ( c ) ) . Opinions from “other”

medical sources can provide information about the severity and

functional effects of an established impairment,

(d), particularly when the source has a treatment

9 The Social Security Administration clarifies why the regulations differentiate between “acceptable medical sources” and “other sources.” SSR 06-3P,

, at *2 (Aug. 9, 2006). First, only “acceptable medical sources can establish the existence of a medically determinable impairment.

(citing

(a)). Second, only acceptable medical sources can give medical opinions.

(citing

(a)(2)). Third, only acceptable medical sources can be “treating sources.”

(citing

, .1527(d)). 24 relationship with the plaintiff. Agrusso v . Astrue,

, 22-23. An ALJ cannot simply ignore the body of evidence

opposed to his view. Dunn v . Apfel, N o . CIV. 98-591-B,

, at *8 (D.N.H. Dec. 1 0 , 1999). There is no error,

however, where the ALJ clearly considered a source’s opinion

and, after evaluating the record including other acceptable

medical sources supporting the opposite conclusion, he or she

decided to discount the source’s opinion. See Russell v .

Barnhart,

. The weight given to other source

opinions varies depending on an assessment of multiple factors,

including the source’s relationship with the claimant, its

consistency with other evidence, the amount of evidence used to

support its opinion, its explanation of the opinion, and its

knowledge of a specialty area or expertise. Couitt v . Astrue,

(citing SSR 06-03p,

, at *4-5

(Aug. 9, 2006)).

The ALJ clearly considered Blood’s treating relationship

with Corson, but also noted her opinion’s retrospective

application. Blood first examined Corson several years after

Corson’s DLI and was privy to no medical evidence documenting

the existence of a delusional impairment prior to Corson’s DLI.

Before discounting a retrospective opinion, an ALJ “must

consider whether it substantiates a disability that existed 25 during the eligible period or is corroborated by contemporaneous

evidence.” Sibley v . Astrue,

2 2 , 19 (citing Marcotte

v . Callahan,

(D.N.H. 1997)). Here, the

ALJ correctly noted that the record contains no medical evidence

of this impairment prior to 2002, despite the fact that

throughout the eligible period Corson was frequently treated for

other mental issues by her primary care providers. Moreover,

the ALJ sought out further testimony of a medical expert to

assess whether the record substantiated a disability existing

prior to Corson’s D L I , and squarely discussed Corson’s

contemporaneous lay evidence in finding that substantial

evidence supports a finding of no disability.

An ALJ is also required to examine “other source” testimony

for its consistency with the record as a whole. The ALJ clearly

considered and gave significant weight to the treatment records

existing prior to Corson’s DLI and, as explained below, afforded

limited weight to the lay testimony provided by Corson. He also

examined other post-DLI evidence in the record to assess its

potential retrospective applicability. In doing s o , he

permissibly found that the evidence does not substantiate a pre-

DLI disability and is not sufficiently corroborated by

contemporaneous evidence.

26 Not only did the ALJ find Blood’s testimony inconsistent

with the pre-DLI medical records and Corson’s own explanations

of her ailments, he also found it to be inconsistent with

opinions from acceptable medical sources. The ALJ credited D r .

Koocher, the medical expert, noting that he considered the

entire record, including all lay testimony. An ALJ is permitted

to give significant weight to testimony from non-examining

medical experts. See Gray v . Heckler,

(1st

Cir. 1985) (per curiam); Lizotte v . Sec’y of Health & Human

Servs.,

2 7 , 130 (1st Cir. 1981); Rodriguez, 647 F.2d

at 223-24. This court has found such reliance to be

particularly appropriate when, as here, the expert has viewed

all of the claimant’s medical records and where, as here, the

record contains no other RFC assessment prepared by an

acceptable medical source. See Menezes v . Apfel,

0 7 ,

40. Moreover, “the fact that a medical opinion is from an

‘acceptable medical source’ is a factor that may justify giving

that opinion greater weight than an opinion from a medical

source who is not an ‘acceptable medical source.’” Hines v .

Astrue, N o . 11-cv-262,

, at *10 (D.N.H. Jul. 9,

2012). Blood’s testimony is also inconsistent with an

assessment by the state agency psychologist and with the

findings of D r . Meehan, who upon Blood’s request examined 27 Corson’s records and found “no history of earlier onset

psychosis.” T r . at 393. Although not dispositive, no

acceptable medical source found evidence of a delusional

impairment prior to the DLI.

In deciding the weight to allocate to an “other source”

opinion, an ALJ should also examine the amount of evidence and

adequacy of explanation used to support the opinion. Here, the

ALJ found that Blood provided no clinical observations to

support her opinion. Further, Blood did not explain her

retroactive opinion, which consisted of (1) a statement in 2003,

with no further explanation, that her diagnosis applied prior to

Corson’s DLI; and (2) a second statement in 2006, again with no

explanation, reiterating her pre-DLI application. The complete

absence of medical evidence establishing an impairment during

the eligible period makes Blood’s unexplained statements that

much less credible.

Finally, an ALJ should also consider whether the source has

any specialty or expertise in the area concerned. As a

psychiatric nurse practitioner specializing in mental health,

Blood undoubtedly has attained some level of related specialized

experience. The ALJ accounted for Blood’s specialty by

carefully considering her evidence as he would that of a

treating source, rather than summarily dismissing i t . 28 Viewing each factor, it is clear that the ALJ afforded

Blood’s opinion both careful consideration and adequate weight.

Moreover, the ALJ described the substantial evidence in the

record opposing Blood’s cursory retrospective diagnosis, and why

substantial evidence favored a finding of no disability. Here,

the ALJ recognized that Blood may not be an acceptable medical

source, but then “acknowledged (and complied with) his

obligation to provide an explanation for his decision to give

her opinions only limited weight.” See Rakip v . Astrue, N o . 11-

cv-323,

, at *4 (D.N.H. May 2 3 , 2012). I thus

find no error in the ALJ’s weighing of medical opinions.

I emphasize that the record also contains substantial

evidence supporting Corson’s allegations of disabling mental

impairments. Given the stigma often associated with mental

illness, I am particularly sensitive to the evidence concerning

Corson’s fear and reticence to broach the issue of a delusional

disorder with her doctors. It is the role of the ALJ, however,

and not of this court, to weigh and resolve conflicts in the

evidence. See Rodriguez, 647 F.2d at 222 (citing Richardson v .

Perales,

(1971)). The record here arguably

could justify a different conclusion, Lizotte,

-

3 1 , but the ALJ’s decisions in assessing the medical opinions

were supported by substantial evidence. There was no error. 29 B. Consideration of Lay Evidence

Acknowledging that relevant evidence from “other sources”

also includes evidence from non-medical lay sources,

(d), I find that the ALJ adequately considered the lay

testimony presented by Corson’s friends and relatives. In his

decision, the ALJ addressed the lay evidence, discrediting some

testimony as describing an isolated incident from before the

alleged onset date, other testimony as failing to establish any

ongoing inability to maintain appropriate social interactions,

and still other testimony as indicating nervousness but no

overwhelming disability. In summarizing the lay testimony, he

found that “[n]one of these statements support a conclusion that

[Corson] was suffering from additional limitations than have

been found herein.” T r . at 451. The ALJ’s decision to give

little weight to the lay evidence is rooted in medical expert

testimony that Corson’s impairments are episodic. The lay

evidence fails to overcome the paucity of medical evidence

supporting a finding of a delusional impairment prior to

Corson’s DLI.

C. RFC Finding

Corson also argues that the ALJ’s RFC finding was not

supported by substantial evidence. Specifically, she argues

that Blood’s opinion should be credited as supporting a much 30 more restricted RFC. This argument is unavailing for the

reasons discussed above. The ALJ gave adequate weight to

Blood’s opinion. An “other” medical source’s opinion can be

given significant weight in limited circumstances, such as when

the other source has seen the claimant more frequently, has

provided better supporting evidence, and has better explained

his or her opinion. SSR 06-3P,

, at *3-5 (Aug.

9, 2006). That is not the case here, however, where the “other

source” did not treat Corson before her D L I , provided little to

no supporting evidence tying Corson’s current impairment to the

eligibility period, and failed to explain why her opinion

deserved retrospective application. Because the ALJ properly

weighed Blood’s “other source” opinion and explained in detail

the extent to which he discredited Corson’s own testimony, he

was justified in omitting her alleged delusional impairments

from both the RFC and his questions to the vocational expert.10

10 Corson also argues that the ALJ failed to include a functional limitation relating to her ability to maintain regular work attendance that was acknowledged by both D r . Koocher and Blood. The record shows no such agreement between D r . Koocher and Blood. Rather, as the Commissioner notes, D r . Koocher testified that Corson’s ability to attend work regularly would only be moderately impaired, and that her depression and anxiety would not interfere with her ability to complete a normal workweek. Tr. at 663-64. D r . Koocher’s testimony is thus in line with the ALJ’s findings. Id. at 451-53.

31 IV. CONCLUSION

In his decision, the ALJ addressed the opposing evidence

and chose to credit the only acceptable medical sources and the

only medical evidence in the record relating to the period prior

to the D L I , giving little weight to both Blood’s “other source”

opinion and the lay evidence. He properly relied upon

substantial evidence in the record to arrive at his decision.

For the foregoing reasons, I grant the Commissioner’s

motion to affirm (Doc. N o . 11) and deny Corson’s motion to

reverse (Doc. N o . 9 ) . The clerk is directed to enter judgment

accordingly and close the case.

SO ORDERED.

/s/Paul Barbadoro Paul Barbadoro United States District Judge

November 1 , 2013

cc: Raymond J. Kelly, Esq. T . David Plourde, Esq.

32