United States District Court, W.D. Kentucky, Bowling Green Division
MEMORANDUM OPINION AND ORDER
King, Magistrate Judge United States District Court.
matter is before the Court on Plaintiff's Complaint
seeking judicial review, pursuant to 42 U.S.C. § 405(g),
of the final decision of the Commissioner denying his claim
for Social Security disability benefits. The fact and law
summaries of Plaintiff and Defendant are at Docket # 15 and
Docket # 18, respectively, and the case is ripe for
determination. The parties have consented to the jurisdiction
of the undersigned Magistrate Judge to determine this case,
with any appeal lying before the Sixth Circuit Court of
Appeals. (Docket # 13).
a former combat veteran, applied for disability benefits
through the Veterans Administration (VA). The VA adjudicated
him to be 50-percent disabled due to service-connected post-
traumatic stress disorder (PTSD) and, effective November 19,
2010, increased his disability rating to 100 percent.
(Administrative Record (AR), pp. 416 and 951). In May 2013,
apparently as part of an ongoing VA review of his disability
status, Plaintiff was examined by clinical psychologist John
Lacy, Ph.D. Dr. Lacy completed the PTSD Questionnaire.
(AR, pp. 875-86).
C.F.R. § 404.1527(c) requires that “[r]egardless
of its source [e.g., the VA], we [i.e., the Social Security
Administration] will evaluate every medical opinion we
receive.” The Administrative Law Judge's
(ALJ's) mental residual functional capacity (RFC) finding
did not accord with applicable legal standards because the
ALJ's decision did not “evaluate” (or even
mention) Dr. Lacy's assessment.
the Court will REMAND this matter to the Commissioner for a
new decision evaluating Dr. Lacy's findings and opinions.
considering Plaintiff's third argument, the Court
considered Dr. Lacy's assessment.
presents three arguments. (Docket # 15, p. 2). First,
“the ALJ erred in finding [Plaintiff] to have no severe
physical impairment, especially with regard to the right knee
and lumbar spine.” (Id.). Second, “the
ALJ failed to consider Listing 12.02 regarding
[Plaintiff's] neurocognitive impairment.”
(Id.). Third, “the ALJ failed to properly
consider the evidence underlying the VA's determination
that the claimant is 100% service-connected disabled due to
Court will consider Plaintiff's third argument first.
While Plaintiff did not specifically mention Dr. Lacy by
name, the Court will exercise its discretion to consider Dr.
Lacy's findings and opinions contained in his completion
of the PTSD Questionnaire. (AR, pp. 875-86).
erred in not evaluating the weight given to Dr. Lacy's
is a veteran of the Gulf War Era, who served in the Army and
was deployed to Iraq on four occasions from May 2002 through
November 2009. (AR, p. 416). Plaintiff was hit on multiple
occasions by improvised explosive devices (IEDs) while in his
vehicle and witnessed the deaths of two particularly close
friends. One died in an explosion right beside Plaintiff and
the other was hit, removed from the vehicle (dead or dying),
and left on the roadside to be airlifted out (AR, pp. 44-52;
718-19; 952; 982). Plaintiff experiences flashbacks and panic
attacks, gets triggered by flashing lights, loud noises, and
gas/diesel odors, acts hypervigilant in vehicles, plays an
MP3 player at low volume with headphones when in a vehicle or
in public to counteract intrusive recollections, and suffers
insomnia and reluctance to sleep due to intrusive nightmares.
(Id.). Upon return from service, Plaintiff initially
self-medicated with alcohol (as much as a pint of whiskey and
a 12-pack per day), but he reports having stopped or
considerably reduced his consumption. (AR, p. 39).
Plaintiff's wife and two children initially separated
from him until he was willing to work on his PTSD issues.
(AR, p. 884). Plaintiff is currently enrolled in the PTSD
clinical teams (PCT) program, attends biweekly telemental
health sessions, and engages in individual therapy through
the VA Mental Health Clinic (MHC). (AR, p. 880).
to Dr. Lacy, Plaintiff's symptoms include: depressed
mood; anxiety; suspiciousness; panic attacks more than once a
week; impairment of short- and long-term memory; impaired
judgment; disturbances of motivation and mood; difficulty in
establishing and maintaining effective work and social
relationships; difficulty in adapting to stressful
circumstances, including work or a work like setting; and
suicidal ideation. (AR, pp. 882-83).
Lacy's PTSD Questionnaire tracks Criteria A through F of
the Diagnostic and Statistical Manual of Mental Disorders,
Fourth Edition. (DSM-4). According to Dr. Lacy,
Plaintiff's A through F Criteria are as follows (AR, pp.
Veteran has been exposed to a traumatic event where both of
the following were present:
• The Veteran experienced, witnessed or was confronted
with an event that involved actual or threatened death or
serious injury, or a threat to the physical integrity of self
• The Veteran's response involved intense fear,