998 F.

2d 1012

NOTICE: Fourth Circuit I.O.P. 36.6 states that citation of

unpublished dispositions is disfavored except for establishing
res judicata, estoppel, or the law of the case and requires
service of copies of cited unpublished dispositions of the Fourth
Circuit.
Frances C. WOOTEN, Plaintiff-Appellant,
v.
Donna E. SHALALA, Secretary of Health and Human
Services,
Defendant-Appellee.
No. 92-1636.

United States Court of Appeals,

Fourth Circuit.
Argued: June 7, 1993.
Decided: July 16, 1993.

Appeal from the United States District Court for the District of South
Carolina, at Columbia. Charles W. Gambrell, Magistrate Judge. (CA-911415-3-OAH)
D. Michael Kelly, Suggs & Kelly, Columbia, South Carolina, for
Appellant.
Ronald Lamar Paxton, Assistant Regional Counsel, Department of Healtg
and Human Services, Atlanta, Georgia, for Appellee.
Stuart E. Gerson, Assistant Attorney General, John S. Simmons, United
States Attorney, Bruce R. Granger, Chief Counsel, Region IV, Mack A.
Davis, Deputy Chief Counsel for Social Security Litigation and Programs,
Mary Ann Sloan, Principal Regional Counsel, Social Security Disability
Litigation, Haila Naomi Kleinman, Supervisory Assistant Regional
Counsel, Department of Health and Human Services, Atlanta, Georgia, for
Appellee.
D.S.C.

AFFIRMED.
Before MURNAGHAN, HAMILTON, and LUTTIG, Circuit Judges.
PER CURIAM:

OPINION
1

Frances Wooten sought supplemental security income and disability insurance

benefits under Titles II and XVI of the Social Security Act, 42 U.S.C. 401433, 1381-1383c, alleging disability due to narcolepsy and chronic depression.
The Administrative Law Judge, after conducting a hearing on Wooten's claims,
concluded that Wooten was disabled within the meaning of the Act since
August 11, 1988; consequently, he determined that she was eligible for
supplemental security income beginning on that date. However, he did not find
that Wooten was disabled at any time on or before December 31, 1987, the date
she last met the earnings requirement for disability insurance benefits, and
therefore concluded that she did not qualify for benefits under Title XVI. The
Secretary of Health and Human Services adopted the ALJ's decision, and
Wooten appealed to the district court for the District of South Carolina. The
district court concluded that substantial evidence supported the Secretary's
findings and further that her decision was proper in light of the relevant law.
Wooten has appealed the district court's affirmance of the Secretary's decision.

Wooten, a fifty-eight year old female, graduated from high school in 1958 and
completed secretarial training at a vocational school in 1970. Thereafter, she
worked as a secretary to the sales manager of Stone Manufacturing Company
from October 1976 to May 1980.

From February 1981 to February 17, 1982, she was employed fulltime as a
record keeper for a furniture store. She has not been employed full-time since
February 1982, although she occasionally worked temporary jobs through a
placement agency from 1983 through 1985.

At her hearing before the ALJ, Wooten testified that she became unable to
work on February 17, 1982, because her health was poor and she felt
chronically nervous and depressed. She was seen for a general physical
examination by Dr. William S. Bradham, a specialist in internal medicine, on
July 1, 1982. At that time, she reported recurrent nausea and vomiting, pain in
her left side, irritability, lack of confidence and energy, anxiety, and other
subjective symptoms. All physical findings were within normal limits.

Dr. Bradham concluded that Wooten suffered from chronic depression, and
prescribed mild dosages of Ascendin and Ritalin (antidepressants). He testified
that he had no knowledge of ever diagnosing Wooten as narcoleptic and that he
did not refer her to a psychiatrist. Although he did not examine her between July
1, 1982 and August 1988, Dr. Bradham continued to prescribe mild dosages of
anti-depressant medication for Wooten.

On August 11, 1988, Wooten underwent a consultative psychological

examination by Dr. Mark Sloan, who noted severe anxiety, agitated behavior,
and weeping demeanor. At that time, Dr. Sloan concluded that Wooten suffered
from severe anxiety and depression with resultant impairment of judgment and
inability to deal with work stresses, function independently, relate predictably
in social situations, or behave in an emotionally stable manner.

Dr. Sloan's findings were supported by those of Dr. J.H. DeWitt, a psychiatrist
who performed a post-hearing consultative examination on July 7, 1989.
According to Dr. DeWitt, Wooten had a normal IQ but demonstrated depressed
mood and generalized anxiety with a panic disorder, which, in his opinion, had
resulted in poor or no ability to maintain attention and concentration, deal with
work stresses, interact with supervisors or the general public, function
independently, or demonstrate reliability.

Wooten filed applications with the Department of Health and Human Services,
Social Security Administration (SSA) for supplemental security income and
disability insurance benefits on June 17, 1988, and July 12, 1988, respectively,
alleging disability commencing on February 17, 1982, due to narcolepsy and
chronic depression. In support of her applications, she relied on: (1) Dr
Bradham's diagnosis in 1982, (2) a one-line letter dated June 15, 1988, from Dr.
Bradham, who had not seen her since July 12, 1982, stating that "Wooten is
totally and permanently disabled because of a chronic depressive reaction," (3)
the fact that she was taking anti-depressants, and (4) her own account of her
illness.

The SSA denied Wooten's applications initially and again upon reconsideration
on the grounds that Wooten could perform "other work." Wooten duly filed a
request for hearing on March 9, 1989. The hearing was held before an
Administrative Law Judge in Columbia, South Carolina, on May 25, 1989, at
which time Wooten was represented by counsel. At issue at her hearing was
whether she was disabled within the meaning of the Act, and if so, when her
disability commenced and how long it continued.

10

After the hearing, the ALJ determined that Wooten was not entitled to a period

10

After the hearing, the ALJ determined that Wooten was not entitled to a period
of disability or disability insurance benefits because she was not disabled as
defined by the Act on or before December 31, 1987, the date Wooten last met
the insured status requirements for entitlement. See 42 U.S.C. 423(c)(1); 20
C.F.R. 404.131 (requiring insured status in order to receive a period of
disability or disability insurance benefits).

11

As for Wooten's supplemental security income claim, the ALJ found that, as of
August 11, 1988, Wooten had severe depressive neurosis, generalized anxiety,
and panic disorder which were of the level of severity necessary to meet the
requirements ofs 12.04 and 12.06 of the governing regulations. 20 C.F.R. Part
404, Subpart P, App. 1. Therefore, he determined that, as of August 11, 1988,
Wooten was disabled for the purpose of eligibility for supplemental security
income.

12

The ALJ reached his decision after making several findings of fact. He found,
based on the medical evidence and her appearance at the hearing, that Wooten
suffered from severe mental impairments since August 11, 1988. However, he
ruled that, prior to August 11, 1988, Wooten's only impairment was a history of
mild depression in 1982 which was controlled by anti-depressant medications
and which did not require mental health counseling or other psychiatric
treatment. In addition, he found that Wooten's allegations that she suffered from
disabling pain, depression, and other subjective symptoms prior to August 11,
1988, were not supported by the overall evidence in the record, including her
description of daily activities prior to that date and the absence of any
emergency room treatment, hospitalization, or even visits to a physician,
psychiatrist, or other medical professional in the entire period between July 1,
1982, and August 11, 1988.

13

In light of all the evidence in the record, the ALJ concluded that Wooten did
not suffer from a "severe" impairment (i.e., an impairment which significantly
limited her ability to perform basic workrelated functions, 20 C.F.R.
404.1521) prior to August 11, 1988. The Appeals Council denied Wooten's
request for review of the ALJ's decision, finding that the evidence did not show
mental illness on or before December 31, 1987. The Secretary thereafter
adopted the ALJ's decision.

14

Wooten next brought suit in the United States District Court for the District of
South Carolina, Columbia Division, challenging the Secretary's decision. With
the consent of both parties, the case was referred to a magistrate judge. The
magistrate judge found that the Secretary's decision was supported by
substantial evidence and, in fact, that there was no evidence of record about

Wooten's condition prior to December 31, 1987, other than Dr. Bradham's
report of July 1, 1982 and Wooten's self-account.
15

In affirming the Secretary's holding, the magistrate judge rejected Wooten's

characterization of Dr. Bradham as her"treating physician," because Dr.
Bradham did not continuously observe Wooten over a prolonged period of
time. He also dismissed Wooten's contention that she should not be penalized
for failing to seek medical treatment which she allegedly could not afford on
the grounds that Wooten had access to various mental health clinics and
hospitals funded by the state and that her financial status was not relevant to the
determination of the onset date of her condition.

16

We find that the lower court correctly concluded that substantial evidence
supported the Secretary's finding that Wooten did not prove that she suffered,
on or prior to December 31, 1987, a "severe disability" as defined by the Social
Security Act and thus she was not entitled to disability insurance benefits or a
period of disability. Substantial evidence shall, of course, be conclusive on
factual issues. Laws v. Celebrezze, 368 F.2d 640, 642 (4th Cir. 1966); accord
Richardson v. Perales, 402 U.S. 389, 401 (1971); see also Hays v. Sullivan, 907
F.2d 1453, 1456 (4th Cir. 1990). However, a factual finding "is not binding if it
was reached by means of an improper standard or misapplication of the law."
Coffman v. Bowen, 829 F.2d 514, 517 (4th Cir. 1987). Therefore, we must
consider whether the Secretary applied the correct legal standards in reaching
her factual findings in the instant case.

17

The Secretary concluded that it must be assumed that Wooten's depression

responded to the mild dosages of anti-depressant medication prescribed by Dr.
Bradham since Wooten sought no additional medical treatment. Relying on our
decision in Lovejoy v. Heckler, 790 F.2d 1114 (4th Cir. 1986), Wooten argues
that the Secretary improperly penalized her for failing to receive ongoing
medical treatment which she could not afford.

18

In Lovejoy, we held that it was improper to consider a disability claimant's

failure to seek treatment in determining whether her impairment was severe
when the failure was justified by lack of funds. Lovejoy, 790 F.2d at 11161117. Lovejoy testified at her hearing that she had very little income and lacked
the funds to seek medical help or medication for her ailments. Id. at 1117.

19

Lovejoy 's holding, however, does not support Wooten's position for several
reasons. First, free mental health treatment was available to Wooten. Second,
unlike Lovejoy, the question presented here is when the claimant's disability

arose, not merely whether she suffers a disability at present. Finally, it is not
clear from the record that Wooten could not afford medical treatment. In fact,
she continued to purchase medication throughout the 1982-1988 period and
failed to meet with Dr. Bradham after her initial visit despite his instruction that
she return for a follow-up appointment. Such circumstances support the
Secretary's conclusion that Wooten did not seek other medical treatment
because the anti-depressants were controlling her depressive symptoms to the
extent that they did not interfere with her ability to perform basic work
activities.
20

Wooten also challenges the Secretary's decision on the grounds that Dr.
Bradham was her treating physician and thus his opinion of disability should
have been given great weight. Specifically, she believes that the Secretary
should have deferred to Dr. Bradham's statement in a one-line letter dated June
15, 1988 and addressed to "To Whom It May Concern" stating that "Wooten is
totally and permanently disabled because of a chronic depressive reaction."

21

In the Fourth Circuit, the opinion of a treating physician must be afforded great
weight by the Secretary and "may be disregarded only if there is persuasive
contradictory evidence." Coffman, 829 F.2d at 517 (applying the attending
physician's rule). Although the Secretary is not bound by the opinion of a
treating physician, she still must grant it sufficient deference as "it reflects an
expert judgment based upon a continuing observation of the patient's condition
over a prolonged period of time." Vitek v. Finch, 438 F.2d 1157, 1160 (4th Cir.
1971); see also Mitchell v. Schweiker, 699 F.2d 185, 187 (4th Cir. 1983).

22

Nevertheless, Dr. Bradham's opinion did not merit great weight because he was
not Wooten's "treating physician" under the circumstances here. Although he
did continue to prescribe antidepressant medication for Wooten, Dr. Bradham
did not see her at all during the six-year period between July 1982 and August
1988. Thus, the magistrate judge properly concluded that Dr. Bradham's June
15, 1988 letter "cannot have been based on continuous observation of the
plaintiff over a prolonged period of time;" and therefore, the letter should not
have been accorded great weight under the attending physician doctrine.*

23

We therefore conclude that the Secretary's denial of Wooten's claim for

disability insurance benefits based on the finding that Wooten failed to
establish that she was disabled on or before December 31, 1987, the date she
last met the insured status requirements, is supported by substantial evidence
and by the law. Accordingly, the judgment is

24

AFFIRMED.

24

AFFIRMED.

*In addition, even if we accorded Dr. Bradham's letter great weight, it is

unclear what result the letter supports. Couched in the present tense, the June
15, 1988 note did not mention pre-January 1, 1988 circumstances. Therefore,
the letter does not appear to satisfy Wooten's burden of proof.