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Anxiety, Depression Insufficient for SSI Disability Claim

Zabala v. Astrue, Case No. 08-0928 (C.A. 2, Feb. 11, 2010)

Petitioner Gloria Zabala appeals from an order of the United States District Court for the Southern District of New York (William H. Pauley III, J.) rejecting her petition to set aside the decision of the Commissioner of Social Security denying her claim for Supplemental Security Income (“SSI”) based on disability. We affirm.

Petitioner worked as a self-employed jewelry salesperson for six or seven years until 1992. She also worked as a “marathon assistant” from October to December 1997. Beginning in April 1998, she sought treatment at the emergency room of St. Barnabas Hospital, complaining of sleeplessness, hearing voices, and nervousness. The psychiatrist who examined Petitioner reported that she was fully oriented and had an appropriate affect, but was anxious. He also reported that her insight and judgment were fair, and that no psychotic symptoms were elicited. The diagnosis was adjustment/anxiety disorder. Petitioner was referred to Fordham-Tremont Community Mental Health Center (“FTMH”).

Dr. Maria Sandos of FTMH treated Petitioner from June 1998 to January 1999. At her initial examination, Sandos observed that Petitioner was fully oriented, alert, positive, and adequately groomed. Her memory, impulse control, insight, and social judgment were fair. Sandos noted that Petitioner was preoccupied with her son’s arrest, and that she complained of hallucinatory voices. Sandos’s diagnosis was “major depression, moderate, dysthimia.” Sandos also concluded that Petitioner’s Global Assessment of Functioning (“GAF”) was 65. After attending therapy sessions through 1998, Petitioner reported that she felt “somewhat better” with medication, although her anxiety and depression persisted.

In September 1998, Petitioner was examined by a consulting physician, who determined that Petitioner had no physical difficulties or limitations, although she appeared anxious. In December 1998, she was examined by a consulting psychiatrist, who determined that her mood was depressed, but her judgment was fair, she possessed emotional insight, and she had no psychotic symptoms or suicidal or homicidal ideation. He diagnosed Petitioner with “[m]ajor depression, recurrent, moderate in intensity, without psychotic features.” He opined that she could manage her own funds and had a fair to limited ability to understand, carry out, and remember instructions in a work setting. Also in December 1998, a state agency physician produced a report based on Petitioner’s medical record. The state physician indicated that she could lift weights up to fifty pounds and could sit, stand, or walk for periods of six hours. The state physician noted that she had deficiencies in concentration and one or two episodes of decompensation (i.e., temporary increases in symptoms) in a work-like setting. He therefore opined that Petitioner had moderate limitations in activities of daily living and social functioning, marked limitations in her ability to understand, remember, and carry out complex instructions, but no limitations in understanding, remembering, and carrying out simple instructions or making simple work-related decisions.
 

 

Jurisdiction: U.S. Court of Appeals, Second Circuit
Related Categories: Health Care , Insurance
 
Circuit Court Judge(s)
Pierre Leval
Barrington Parker
Rosemary Pooler

 
Appellant Lawyer(s) Appellant Law Firm(s)
Cara Campbell Seton Hall University School of Law Center for Social Justice
Jon Romberg Seton Hall University School of Law Center for Social Justice

 
Appellee Lawyer(s) Appellee Law Firm(s)
John E. Gura, Jr. US Attorney's Office
David S. Jones US Attorney's Office

 

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19 under review would be the "closed period" from january 1, 1998 to january 3, 2001, after which, 5 1999); schaal v. apfel, 134 f.3d 496, 504-05 (2d cir. 1998); johnson v. bowen, 817 f.2d 983, 7 also concluded that petitioner's global assessment of functioning ("gaf") was 65. after1 08-0928-cv 8 concluded that the alj's decision was supported by substantial evidence and granted judgment 18 proceedings"). petitioner has not pointed to any evidence that she was coerced or deceived into psychological, social, and occupational functioning. a gaf in the range of 61 to 70 indicates 17 petitioner worked as a self-employed jewelry salesperson for six or seven years until 11 doctor's 2002 report would have changed the alj's determination that petitioner was not 7 the alj found that petitioner's mental condition did not limit her ability to perform 10 after a session in january 1999, at which sandos observed that her mood was less 16 guidelines may only be used to evaluate exertional limitations. 19 stipulating to the closed period. see id. 416.1540(c)(1). absent such a showing, the attorney's 5 16 background 4 state physician noted that she had deficiencies in concentration and one or two episodes of 6 more severe condition, they are less relevant to the period under review (which ended on january 11 leval, circuit judge: 19 medical evidence. four of these alleged errors merit discussion: the alj's decision to close the zabala v. astrue 8 in light of this evidence, the alj determined that although petitioner's "residual 5 and that the medicine she was prescribed had no side effects. 19 denied by the commissioner of social security based on a finding that she was not disabled, 20 incomplete and unsigned was factually incorrect. the alj accordingly failed to satisfy the 4 10 and hearing voices. otherwise, from february 2001 through july 2001, she appeared 8 15 income ("ssi") based on disability. we affirm. 8 evidence, the alj's determination that petitioner could perform her previous unskilled work was 5 the evidence using the five-step evaluation guidelines found in 20 c.f.r. 416.920. 13 salesperson. 14 "major depression, recurrent, moderate, without psychotic features." petitioner had one more 15 physician is entitled to a degree of deference. scublinsky treated petitioner, and the alj's 10 in september 1998, petitioner was examined by a consulting physician, who determined 08-0928-cv 4 see section 301.677-010, united states dep't of labor, dictionary of occupational titles (4th 1 blacknall v. heckler, 721 f.2d 1179, 1181 (9th cir. 1983)). however, the "mere existence of a 8 attending therapy sessions through 1998, petitioner reported that she felt "somewhat better" with the 2001 report was "good," while the prognosis in the 2002 report is "fair." as this difference 1 alj's conclusion at step four that petitioner could return to her former work; and the alj's use 11 basic mental demands of unskilled work because of her mental impairment," and she would be "[s]ome mild symptoms (e.g., depressed mood and mild insomnia) or some difficulty in social, 17 light of social security administration ("ssa") records indicating that she had earned $9,605 in 2 marathon assistant was not supported by substantial evidence. the reports of petitioner's5 10 michael j. astrue, in his official capacity as commissioner of social security, 12 11 depressed and that she had no complaints of anxiety, petitioner did not appear for her next seven 13 excluded report is unnecessary. 14 p, app. 2, in determining whether there was work in the national economy that petitioner could 9 per child per week by the city. the alj, noting that ssa records indicated that she earned 6 in october, november, and december 2000, petitioner reported that she was "stressed 2 nonexertional impairment does not automatically . . . preclude reliance on the guidelines." id. at zabala v. astrue 14 psychotic [features]." he further reported that her gaf was 55. he noted that her primary zabala v. astrue 3 to be gainfully employed" unjustified by his diagnosis of dysthymic disorder and a gaf of 60, 12 "review the administrative record de novo to determine whether there is substantial evidence 18 permitted by his exertional limitations," the alj is required to consult with a vocational expert. 11 11 that petitioner had no physical difficulties or limitations, although she appeared anxious. in 15 session, in june 1999, at which she reported feeling better on medication, and then did not return 19 "depressive disorder nos [not otherwise specified]." she went to ftmh in june 2000 and was likelihood that consideration of these differences could have led to a different determination. 2 stated that the period under review was the closed period from august 18, 1998, the claimed 4 include a substantive assessment whether petitioner was able to return to previous work). 21 reported that she was fully oriented and had an appropriate affect, but was anxious. he also 14 psychotic symptoms or suicidal or homicidal ideation. he diagnosed petitioner with "[m]ajor 5 so narrows a claimant's possible range of work as to deprive him of a meaningful employment 2 produced a report based on petitioner's medical record. the state physician indicated that she 5 sandos noted that petitioner was preoccupied with her son's arrest, and that she complained of 13 supporting the commissioner's decision and whether the commissioner applied the correct legal 8 petitioner's ability to work. 16 could manage her own funds and had a fair to limited ability to understand, carry out, and 10 [t]here is no basis in the record to support a finding that the claimant is not able to perform the 2 cara campbell, julie gendel (jon romberg, on occupational, or school functioning (e.g., occasional truancy, or theft within the household), but 5 appellant. 08-0928-cv 12 petitioner next argues that the alj's refusal to consider the june 2002 scublinsky report, 9 medication, although her anxiety and depression persisted. 6 and recommendation that the commissioner's denial of benefits be affirmed. petitioner objected 2 questionnaire by scublinsky. the alj found eshkenazi's conclusion that petitioner was "unable 15 depression, recurrent, moderate in intensity, without psychotic features." he opined that she 7 legal standard could lead to only one conclusion." schaal, 134 f.3d at 504. "[w]here 20 appeals from the decision of the united states district court for the southern district of new 15 involved taking four children to school, picking them up, and watching them for two to three 2 wrote "unable to assess." 5 judge pauley assigned the matter to magistrate judge ronald l. ellis, who submitted a report 3 the brief), seton hall university school of law 7 from august 18, 1998 to january 3, 2001. at step two, the alj determined that her mental 6 $800 per month was also consistent with babysitting four hours per weekday (about eighty 11 conclusion 3 treating psychiatrists and most of her consulting doctors during the review period indicate that 14 2003, petitioner stated that she worked as a babysitter for "a few months" in 2001, which 14 at step four, the alj reviewed the evidence to determine whether petitioner was disabled 12 able to return to her former unskilled work as a marathon assistant and a self-employed jewelry 5 and that her condition improved with medication. none of the clinicians who examined her zabala v. astrue 10 alj found, for the period at issue, no evidence that she was limited in her ability to maintain 12 in july 2001, at the request of petitioner's counsel, dr. scublinsky completed a 8 dr. scublinsky's 2001 report, and dr. sculbinsky's 2002 report, which the alj overlooked, was 12 alj issued an opinion finding that petitioner was not disabled. the social security appeals 15 petitioner's counsel's concession and amendment of the period under review were within 08-0928-cv 18 she complained of headaches and dizziness. a psychiatric consultation resulted in a diagnosis of 11 respondent-appellee. 4 the period after examining her ssa earnings records for 2001 and 2002. the alj then reviewed 19 perform "exist in significant numbers in the national economy." accordingly, the alj 11 physician's opinion where there was no substantial evidence to refute the treating physician's 13 the end of may 1999, and was examined by a different psychiatrist, who diagnosed her with disturbance, feelings of worthlessness, and somatization. additionally, the prognosis given in 5 eshkenazi also opined that she was, "at present, . . . unable to be gainfully employed." also in 7 gloria zabala, 4 i. closing the review period 11 psychologically stable and did not complain of hearing voices. 5 docket no. 08-0928-cv 13 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - x 9 while severe, was not a disability per se under 20 c.f.r. part 404, subpart p, appendix 1. the zabala v. astrue 12 in her ability to maintain concentration, and that she had not displayed repeated episodes of 4 new york seeking review of the commissioner's decision pursuant to 42 u.s.c. 405(g). 17 give scublinsky's opinions controlling weight or to provide good reasons for discounting them. 10 southern district of new york, for appellee. 18 wages in 2001. after an off-the-record discussion, petitioner's attorney stated that the period 18 (1938))). petitioner asserts various errors in the alj's development of the record and analysis of 11 iv. the step five determination zabala v. astrue relates only to forward looking "prognoses" and not to petitioner's condition in the relevant occupational, or school functioning (e.g., no friends, unable to keep a job)." dsm-iv, at 34. 08-0928-cv 4 (argued: may 26, 2009 decided: february 11, 2010) 8 on the brief), new york, new york, for lev l. zabala v. astrue zabala v. astrue 9 december 2000 and mid-january 2001, petitioner reported that she suffered from sleeplessness 9 she did. accordingly, the alj did not err by limiting review to the closed period from august generally functioning pretty well, has some meaningful interpersonal relationships." american 16 to ftmh for approximately one year. 3 could lift weights up to fifty pounds and could sit, stand, or walk for periods of six hours. the 3 excluded evidence, at least where the unconsidered evidence is significantly more favorable to or school functioning (e.g., few friends, conflicts with peers or co-workers)." dsm-iv, at 34. 12 december 1998, she was examined by a consulting psychiatrist, who determined that her mood 10 $9,600 in 2001, inquired further into this arrangement, but petitioner did not alter her testimony. 1 14 decision of the commissioner of social security denying her claim for supplemental security 12 for the foregoing reasons, we affirm the judgment of the district court. 3 603. a nonexertional impairment "significantly limit[s]" a claimant's range of work when it 21 york (william h. pauley iii, j.) which rejected her petition to set aside the commissioner's 9 on the pleadings in favor of the commissioner. 16 poor memory, feelings of worthlessness, social withdrawal, and decreased energy. in a section of 17 petitioner's return to treatment began with an emergency room visit in may 2000, where 14 so-called treating physician rule, according to which the report of a claimant's "treating" 2 the decision of the commissioner. it does not appear that her employment as a marathon assistant was full-time work.5 18 see 20 c.f.r. 404.1527(d)(2); see also halloran v. barnhart, 362 f.3d 28, 32 (2d cir. 2004). 13 decompensation. 5 beginning in january 2001. the alj refused to consider dr. scublinsky's june 2002 4 at ftmh within the next month, petitioner reported that she had no delusions or hallucinations, 9 there is no need to require agency reconsideration." johnson, 817 f.2d at 986; see also havas v. 17 before: leval, pooler, and parker, circuit judges. 6 june 2002, dr. scublinsky prepared another questionnaire, reporting the same diagnosis and 1 community mental health center ("ftmh"). 2 dr. maria sandos of ftmh treated petitioner from june 1998 to january 1999. at her 9 responding to supervision. thus, her nonexertional limitations did not result in an additional loss 15 continued to step five, which places the burden on the commissioner to show that the claimant 19 medication. the alj described the main findings of scublinsky's july 2001 questionnaire, 7 hours per month) at $10 per hour. in light of petitioner's testimony and her counsel's 6 at step one, the alj found that petitioner had not engaged in substantial gainful activity 6 period from august 18, 1998 to january 3, 2001, because the alj had a duty to further develop 10 need not "reconcile explicitly every conflicting shred of medical testimony"). 1 the questionnaire regarding petitioner's ability to perform work-related functions, scublinsky 9 dassin, acting united states attorney for the 12 scheduled appointments and ftmh closed her case file in april 1999. she returned to ftmh at 08-0928-cv 9 functional capacity is diminished by her non-exertional limitations imposed by her depression[,] 23 the diagnosis was adjustment/anxiety disorder. petitioner was referred to fordham-tremont 08-0928-cv 3 at school and watching them for several hours at home were consistent with a babysitting job. 9 largely identical to it. because the report that the alj overlooked was not significantly more 8 unskilled work, including carrying out simple instructions, dealing with work changes, and 14 claimant was totally disabled, were significantly more favorable to the claimant than the reports 7 3, 2001) than the 2001 report because they refer to a more remote period. the alj considered4 9 v. 22 ruling. the court of appeals (leval, j.) affirms, finding that the denial of benefits was based on 16 his authority. see 20 c.f.r. 416.1510(a)(3)-(4) (a claimant's representative may "[m]ake 2 beginning in january 2001. the activities she described picking up and dropping off children 10 3 scublinsky saw her again and raised his assessment of her gaf to 55. after two more sessions3 3 17 if a claimant has nonexertional limitations that "significantly limit the range of work 11 in reviewing a district court's decision upholding a decision of the commissioner, we 3 determination at step five. 12 petitioner gloria zabala appeals from an order of the united states district court for the 8 stable and indicated that her medication was helpful. in two sessions with scublinsky, in mid- 6 opportunity." id. at 605-06. 18 1992. she also worked as a "marathon assistant" from october to december 1997. beginning in 9 petitioner's pursuit of ssi benefits began when she filed an application on september 10, 1 in her second opinion, the alj again found that petitioner was not disabled. the alj 6 john e. gura, jr., assistant united states attorney 20 noting that he diagnosed major depression with a gaf of 55, but could not assess her ability to 7 the complete, signed questionnaire was in the record. 34 (4th ed. rev. 2000). 16 essentially duplicative of evidence considered by the alj. the 2002 scublinsky report is largely 08-0928-cv 14 standard." machadio v. apfel, 276 f.3d 103, 108 (2d cir. 2002); see also richardson v. perales, 12 and went off the record. when the hearing went back on the record, counsel requested to amend 11 law judge ("alj") robin j. arzt in september 1999, for a review of the determination. the 23 substantial evidence. although the administrative law judge improperly declined to consider a 10 1998. after her application was denied, she appeared with an attorney before administrative period, which was 18 months earlier, it is not more helpful to her case. we see no reasonable 2 anxiety disorder and determined her gaf to be 45. eight days later, on june 20, 2000,2 zabala v. astrue zabala v. astrue 5 ed. rev. 1991), 1991 wl 672652 (g.p.o.). the amount that she earned $9,600, an average of 18 dr. scublinsky found a gaf of 55, in line with the gaf found by the other treating and 16 consideration of his opinions was therefore subject to the rule. the alj was required either to 20 counsel acknowledged, she was "engaging in sga [substantial gainful activity]." the principal difference between the two scublinsky reports is that the later report spoke4 1 reports that he was "unable to assess" petitioner's work-related functioning. cf. halloran, 362 psychiatric association, diagnostic and statistical manual of mental disorders ("dsm-iv"), at 10 discussion 24 report by a treating psychiatrist, the report was substantially duplicative so that consideration of 15 petitioner further contends that the alj's determination that petitioner's impairment did 20 review period in january 2001; the alj's refusal to consider the 2002 scublinsky report; the 20 consistent with other reports in the record. most significantly, dr. scublinsky stated in both 6 questionnaire because the alj believed that it was incomplete and unsigned. in fact, however, 12 18 was "not disabled" because she could perform unskilled work and because jobs that she could 9 3 zabala filed this petition in the united states district court for the southern district of 4 and he determined that the conclusion was "inappropriate" in view of her babysitting work 3 onset date of her condition, to january 3, 2001, noting that petitioner and her attorney amended 14 that petitioner performed substantial gainful activity beginning on january 3, 2001. described her symptoms as including recurrent panic attacks, suicidal ideation, persistent 6 indicated that she had anything more than moderate limitations in her work-related functioning, 16 hours per day. the alj questioned this description of the duration of her babysitting work in zabala v. astrue 20 determined that she was not eligible for benefits by virtue of her august 18, 1998 application. 13 council, however, reversed and remanded. during the second hearing before alj artzt, in july 15 5 petitioner first argues that it was error for the alj to limit the review period to the closed 4 causes an "additional loss of work capacity beyond a negligible one or, in other words, one that 10 18, 1998 to january 3, 2001. 16 1998 indicated that she had only mild symptoms with a gaf of 65, and that by january 1999, her 7 marked limitations in her ability to understand, remember, and carry out complex instructions, 12 disabled during the closed period. accordingly, remand for consideration of the improperly 9 simple work-related decisions. 08-0928-cv 8 petitioner-appellant, 14 despite concluding that petitioner was not eligible for benefits at step four, the alj zabala v. astrue 1 any event, the record supports the conclusion that petitioner was employed as a babysitter 08-0928-cv zabala v. astrue 11 the alj expressed doubt that petitioner could earn $9,600 babysitting for only a few months, 14 20 conduct is imputed to petitioner. see link v. wabash r.r. co., 370 u.s. 626, 633-34 (1962). in 20 of sleeplessness, hearing voices, and nervousness. the psychiatrist who examined petitioner 16 5 moreover, to the extent that any of the indicators in the 2002 report might be deemed to reflect a 10 of work capacity, and the alj's use of the medical-vocational guidelines was permissible. 5 decompensation (i.e., temporary increases in symptoms) in a work-like setting. he therefore in slightly more precise terminology in describing zabala's symptoms. sculbinsky's 2002 report irrational fears, and irritability, while his 2001 report said that she suffered from mood 15 symptoms were depression, anxiety, and auditory hallucinations, but that she also suffered from 1 the appeals council denied petitioner's request for review, leaving the alj's second opinion as 1 treating physician rule. 3 august term, 2008 4 she was depressive, without psychotic features other than occasional self-reported hallucination, 1 the report would not have affected the disability determination. 3 initial examination, sandos observed that petitioner was fully oriented, alert, positive, and 4 adequately groomed. her memory, impulse control, insight, and social judgment were fair. 4 center for social justice, newark, new jersey, for 17 guidelines of appendix 2 of 20 c.f.r. part 404, subpart p, the alj determined that petitioner 8 but no limitations in understanding, remembering, and carrying out simple instructions or making 19 the reason the alj provided for discounting scublinsky's june 2002 report that the report was 15 perform. she asserts that her limitations were nonexertional and the medical-vocational 18 in treatment in 1999 and 2000, but when she was evaluated, she was determined to be stable on 08-0928-cv 10 favorable to petitioner, we find no reasonable likelihood that her consideration of the same 7 2 15 13 southern district of new york (william h. pauley iii, j.) rejecting her petition to set aside the 16 relevant evidence as a reasonable mind might accept as adequate to support a conclusion." 1 not prevent her from performing her previous work as a self-employed jewelry salesperson or a 19 consulting doctors. in both reports, dr. scublinsky listed the same diagnoses, which are also 15 402 u.s. 389, 401 (1971) ("[substantial evidence is] more than a mere scintilla. it means such 11 ii. the 2002 scublinsky report 17 (internal quotation marks omitted) (quoting consol. edison co. v. nlrb, 305 u.s. 197, 229 08-0928-cv a gaf in the range of 41 to 50 indicates "[s]erious symptoms (e.g., suicidal ideation,2 8 amendment of the review period, the alj was not required to develop the record any more than severe obsessional rituals, frequent shoplifting) or any serious impairment in social, 08-0928-cv 4 claim for benefits. eshkanazi diagnosed a disthymic disorder and indicated that her gaf was 60. 13 premised on the alj's mistake of fact regarding the report's completeness, was a violation of the 4 the claimant than the evidence considered. see, e.g., snell v. apfel, 177 f.3d 128, 134 (2d cir. 13 the period under review to the closed period from january 1, 1998 to january 3, 2001, conceding 16 has the residual functional capacity to perform other jobs. applying the medical-vocational 13 11 social functioning or attend to the activities of daily living, that she was only moderately limited 12 conclusion that the claimant could not return to his prior employment). 22 reported that her insight and judgment were fair, and that no psychotic symptoms were elicited. 2 of the medical-vocational guidelines, rather than testimony of a vocational expert, to make her 9 well supported. see fiorello v. heckler, 725 f.2d 174, 176 (2d cir. 1983) (noting that an alj 20 examined by dr. albert scublinsky, who continued to treat her through 2002. at her intake, dr. 10 bowen, 804 f.2d 783, 786 (2d cir. 1986) (declining to remand for consideration of a treating 18 petitioner, whose application for supplemental security income based on disability was 7 and most reported less severe limitations. although there was some conflicting medical 1 united states court of appeals 13 questionnaire and reported a diagnosis of "major depressive [disorder], severe, recurrent, [with] 1 scublinsky diagnosed petitioner with major depression with psychotic features and general circumstantial speech, occasional panic attacks) or moderate difficulty in social, occupational, 19 april 1998, she sought treatment at the emergency room of st. barnabas hospital, complaining 2 for the second circuit 08-0928-cv 12 finally, petitioner argues that the alj erred by failing to consult a vocational expert and 7 and the district court reviewed the report and recommendation de novo. the district court 17 condition had improved with treatment. the alj also found that petitioner had significant gaps 17 identical to a july 2001 report by the same doctor, which the alj did consider. in both reports, 13 relying instead on the commissioner's medical-vocational guidelines, 20 c.f.r. pt. 404, subpt. 7 gaf as he did in the july 2001 questionnaire, and again indicating that he was unable to assess 3 in june 2002, petitioner was examined by dr. azariah eshkenazi in connection with her 8 condition was a "severe impairment." at step three, the alj decided that petitioner's condition, 6 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -x 19 bapp v. bowen, 802 f.2d 601, 605 (2d cir. 1986) (internal quotation marks omitted) (quoting 13 was depressed, but her judgment was fair, she possessed emotional insight, and she had no 3 expressly referencing the treating physician rule where the alj noted that the report did not zabala v. astrue 17 statements about facts and law . . . [and m]ake any request or give any notice about the 6 986-87 (2d cir. 1987). remand is unnecessary, however, "[w]here application of the correct 2 such an error ordinarily requires remand to the alj for consideration of the improperly 6 hallucinatory voices. sandos's diagnosis was "major depression, moderate, dysthimia." sandos 15 that were considered. snell, 177 f.3d at 130, 134. here, in contrast, the excluded evidence is 13 in snell, we remanded because the unconsidered physician reports, asserting that the 08-0928-cv 8 application of the correct legal principles to the record could lead [only to the same] conclusion, 2 f.3d at 32 (affirming the decision of an alj which discounted a treating physician report without 8 2001, she worked as a babysitter for "a few months" and that she was paid between $75 and $90 gaf rates overall psychological functioning on a scale of 0-100 that takes into account1 7 the record regarding her 2001 activities. at the hearing, petitioner testified that, beginning in 1 remember instructions in a work setting. also in december 1998, a state agency physician 7 out" from having taken custody of her daughter's children, but she appeared psychiatrically 1 work. however, the alj discounted the june 2002 evaluation by eshkenazi and the june 2002 14 iii. the step four determination zabala v. astrue a gaf in the range of 51 to 60 indicates "[m]oderate symptoms (e.g., flat affect and3 6 14 7 (david s. jones, assistant united states attorney, 15 during the relevant period. the alj noted that petitioner's first evaluations at ftmh in june 6 opined that petitioner had moderate limitations in activities of daily living and social functioning,


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