MARCIA S. KRIEGER, Chief District Judge.
Mr. Williams sought disability benefits under Title II of the Act
A second hearing was conducted in April 2012 by the same ALJ. He again determined that Mr. Williams was not disabled. The Appeals Council declined review of the decision, making it the final decision of the Commissioner. Mr. Williams timely appealed to this Court, which exercises jurisdiction pursuant to 42 U.S.C. § 405(g).
When he filed his disability claim, Mr. Williams was 46 years old, had a college degree and had worked as a customer service representative, telephone solicitor, stock clerk, cleaner, protective signal operator, order clerk, sandwich maker, and caterer helper. He sought disability benefits because he could not work due to his mental illness.
Between 2005 and 2012, Mr. Williams was diagnosed as suffering from and treated for bipolar affective disorder, major depressive disorder, post-traumatic stress disorder, anxiety disorder, and a panic disorder. At various times, he was prescribed a variety of different medications including Seroquel, Zoloft, Trileptol, Alprazolam, and Xanax.
His subjective symptoms included anxiety, panic attacks, racing thoughts, auditory hallucinations, insomnia, paranoia, and difficulty with comprehension and concentration. In particular, he stated that he experienced panic, high anxiety, paranoia, feelings of doom, and terror, particularly around crowds. He also described being sensitive to noise and unable to tolerate environments that are too fast or too loud. In such environments, he stated that his system becomes overloaded, his brain "overheats," his thoughts race and he experiences adrenaline rushes which affect his ability to get along with others.
Between 2005 and 2009, Mr. Williams was treated by psychotherapist Faith Donaldson, who focused upon his problems of self-confidence, anger, difficulties with interpersonal relationships, and sensory integration issues. In January 2011, Ms. Donaldson completed a "medical source statement of ability to do work-related activities (mental)" in which she expressed two opinions — a conclusory opinion that she could not see Mr. Williams as "being able to hold down a job of any kind," and a differentiated opinion assessing his functional limitations. She opined that Mr. Williams had:
Beginning in 2006, Mr. Williams began treatment with Dr. Howard Weiss, M.D, a psychiatrist. Dr. Weiss offered two opinions. The first was written on his business letterhead and simply stated that Mr. Williams was under his care for mood instability and he was "unable to attain and maintain gainful employment due to severe depression." The second was issued in February 2011, when Dr. Weiss completed a "medical source statement of ability to do work-related activities (mental)." He agreed with many areas of limitation noted by Ms. Donaldson and added several more. He opined that Mr. Williams had:
Beginning in 2010, Mr. Williams received treatment from various mental health professionals through the Jefferson Center for Mental Health. Professionals at the Jefferson Center, Dr. Barry Frieder, M.D., Dr. Thomas Kinney, Psy.D, Dr. John Martens, M.D., and Malgorzata Gawron, APRN, all offered medical opinions. Dr. Frieder expressed an opinion in his 2010 treatment notes that Mr. Williams's "level of irritability precludes his holding work long enough to sustain himself." Dr. Kinney completed a "medical source statement of ability to do work-related activities (mental)," in 2011 that reflects the same areas of limitation as those recognized by Ms. Donaldson and Dr. Weiss:
In early 2011, Dr. John Martens, M.D., and Malgorzata Gawron, APRN, jointly completed a "medical source statement of ability to do work-related activities (mental)," in which they opined that Mr. Williams suffered from bi-polar disorder and had:
The record also contains opinions of consultants, but these were submitted in 2009 and never supplemented.
Consulting psychologist Brett Valette, Ph.D., examined and evaluated Mr. Williams at the request of the state agency in August 2009. Dr. Valette reviewed only records by Ms. Donaldson prior to examination. Dr. Valette diagnosed Mr. Williams as suffering from posttraumatic stress disorder (PTSD), bipolar II disorder, generalized anxiety disorder, and panic disorder, and assigned him a global assessment of functioning (GAF) score of 55-60, indicative of moderate symptoms
MaryAnn Wharry, Psy.D, a state consulting psychologist, also reviewed Mr. Williams's medical records in 2009. She considered records of treatment by Ms. Donaldson, Dr. Weiss and the assessment of Dr. Valette. Dr. Wharry opined Mr. Williams suffered from a bipolar II Disorder, PTSD, and Generalized Anxiety and Panic disorders. She also opined that the records demonstrated "mild" restriction of activities of daily living, but "moderate" difficulties in maintaining social functioning. She noted that a Mental Residual Functional Capacity Assessment was necessary. In her report, she opined that Mr. Williams had only two limitations:
She summarized that as of 2009, Mr. Williams was able to do "work of limited complexity, but which requires accuracy and attention to detail; can respond appropriately to supervision and coworkers but must have minimal to no interaction with the general public.
The Decision reflects the standard 5-step analytical process. At issue are the ALJ's analysis and findings at Steps 3 and 4.
At Step 3, the ALJ found that the severe impairments identified at Step 2 — "depressive disorder versus bipolar disorder; anxiety disorder; panic disorder; and posttraumatic stress disorder"
At Step 4, the ALJ first determined that Mr. Williams's description of his symptoms was not credible. Then, the ALJ rejected the functional assessment opinions of all treating providers as "unpersuasive" because they were premised, at least in part, upon Mr. Williams's description of his symptoms. In addition, the ALJ rejected the opinions of Dr. John Martens, M.D., Malgorzata Gawron, APRN, and Ms. Donaldson as "not acceptable." The opinions of Ms. Donaldson and Ms. Gawron were rejected because they were not acceptable medical sources. Dr. Martens's opinion was rejected because he was not a "treating source."
Ultimately, in reliance upon Dr. Wharry's 2009 record review opinion, which he found consistent with Dr. Valette's 2009 consulting examination opinion and "other objective medical evidence," the ALJ determined that Mr. Williams was: 1) unable to perform rapid production-rate physical work, such as rapid assembly-line work, work requiring hyper-vigilance, work involving safety operations, or work involving responsibility for the safety of others; and 2) that he should have no direct exposure in the workplace to alcohol, marijuana, illegal drugs, or the prescription drug Xanax. Subject to these limitations, the ALJ found that Mr. Williams could perform semi-skilled work, with workplace noise at a moderate level, with frequent interaction with coworkers and the public. Based on this RFC determination, the ALJ found that Mr. Williams could perform his past relevant work as a customer service representative, telephone solicitor, stock clerk, cleaner, order clerk, and sandwich maker, and therefore was not disabled.
Mr. Williams challenges the Decision in several respects: 1) at Step 3, he argues that the ALJ failed to properly evaluate Mr. Williams's mental impairments in accordance with the Listings; 2) at Step 4, he argues that the ALJ erred in evaluating the medical evidence in determining Mr. Williams's RFC; and 3) also at Step 4, he argues that the RFC finding is not supported by substantial evidence because the ALJ failed to properly evaluate Mr. Williams's credibility.
This Court is not free to reweigh the evidence nor substitute its judgment for that of the Commissioner. Rather, the Court carefully reviews the record and the Decision to determine "whether the correct legal standards were applied and whether the decision is supported by substantial evidence." Maes v. Astrue, 522 F.3d 1093, 1096 (10th Cir. 2008); see Madrid v. Barnhart, 447 F.3d 788, 790 (10th Cir. 2006); Hackett v. Barnhart, 395 F.3d 1168, 1172 (10th Cir. 2005). If the Decision fails to reflect application of the correct legal standard, it must be reversed. Washington v. Shalala, 37 F.3d 1437, 1439-40 (10th Cir. 1994). Similarly, if a factual finding is not supported by substantial evidence, it must be reversed. Substantial evidence is such relevant evidence as a reasonable mind might accept as adequate to support a conclusion. Haddock v. Apfel, 196 F.3d 1084, 1088 (10th Cir. 1999) (quoting Richardson v. Perales, 402 U.S. 389, 401 (1971)).
The Court begins with Mr. Williams' challenge at Step 3. Mr. Williams contends that the ALJ filed to "evaluate properly Mr. Williams' mental impairments." In his brief, he offers 13 pages of entries drawn from his medical treatment records from 2006-2012, which he contends generally would demonstrate satisfaction of the Listing requirements at 12.04 or 12.06. However, there is no specific argument that explains how the medical records show that Mr. Williams's impairment meets or equals the Listings. Alternatively, Mr. Williams argues that the ALJ should have employed a medical expert to opine as to whether the combination of Mr. Williams's severe impairments would equal a Listing. The Commissioner responds in conclusory fashion that "substantial evidence" supports the ALJ's findings.
The arguments of both parties miss the mark. A claimant bears the burden of establishing that an impairment matches a Listing. Bernal v. Bowen, 851 F.2d 297, 300 (10th Cir 1988). Mr. Williams's chronology of medical treatment records is not helpful in this regard because the Court is not free to assess the medical records to make factual findings.
The Commissioner's argument is also unhelpful. Saying that the finding is supported by substantial evidence doesn't address whether the ALJ applied the correct legal standard or sufficiently articulated consideration of appropriate factors and evidence. At Step 3, an ALJ must discuss uncontroverted evidence not relied upon as well as significant probative evidence that is rejected. Clifton v. Chater, 79 F.3d 1007 (10th Cir 1996). Failure to do this deprives this Court of the ability to engage in meaningful review. An inadequacy of articulation, however, does not necessarily require reversal if there are "confirmed or unchallenged findings made elsewhere in the ALJ's decision" that confirm the step three determination. Fischer-Ross v. Barnhart, 431 F.3d 729 (10th Cir 2005).
The Court finds that the Decision's articulation at Step 3 is deficient. The Decision does not identify any uncontroverted evidence or significant probative evidence that was rejected. The only medical evidence considered in determining whether the "Paragraph B and C criteria" of Listings 12.04 and 12.06 were satisfied is Dr. Wharry's 2009 record review opinion. Consistent with Fischer-Ross, the Court will consider whether the requisite articulation is apparent elsewhere in the Decision.
However, even if a fuller explanation of the evidence appears elsewhere, the Step 3 findings are not supported by substantial evidence. This is because the time period for consideration of Mr. Williams's impairments begins in April 2009 and extends through April 2012, but the evidence upon which the ALJ relies is limited to Dr. Wharry's opinion in 2009. There is no consideration of evidence of Mr. Williams's condition in 2010, 2011, or 2012. As a consequence, the Step 3 findings are not supported by substantial evidence, requiring reversal.
With regard to the ALJ's Step 4 RFC determination, Mr. Williams frames two intertwined objections. He contends that the ALJ failed to apply the correct legal standard in assessing medical evidence and in formulation of his RFC. In particular, he argues that the ALJ improperly substituted his credibility assessment for the proper legal standards. The Commissioner does not address the question of legal error, responding only that the credibility determination and the resulting RFC was supported by substantial evidence.
The Court pauses here to note the significance of the issue that Mr. Williams raises. The heart of his challenge is that rather than evaluating medical opinions based on established legal standards, the ALJ first decided whether Mr. Williams was believable and then let that perception drive the outcome of the matter. This is a serious and significant challenge, one that the Commissioner never directly addresses despite the Court bringing it to counsels' attention and providing the opportunity for supplemental briefing.
This is a serious and significant matter
It is also serious and significant, because there is no recognition by the Commissioner of the problem. The Commissioner's repeated response to challenges of legal or procedural error is that the decision/finding is supported by "substantial evidence." This reflects a fundamental confusion between factual findings and legal conclusions. The "substantial evidence" standard is a measurement of the proof necessary to support factual findings; it does act as a substitute for proper application of the law. In essence, the Commissioner is saying that if the outcome is acceptable, then it does not matter what process or law is used to produce it, a proposition this Court fundamentally rejects.
Finally, this issue is serious and significant because it describes a problem that occurs all too frequently. In this Court's experience with hundreds of Social Security Appeals, the "credibility assessment of the claimant" (as compared to the credibility of the claimant's
In this Decision, the ALJ rejected the medical opinions of all treating and examining medical sources for a singular reason — they were "unpersuasive." By this, the ALJ meant that he did not believe Mr. Williams's description of his symptoms, and therefore he rejected all opinions by treating sources that consonant with that description because they necessarily were based on Mr. Williams's own incredible complaints. The ALJ explained:
In addition to finding their opinions "unpersuasive," the ALJ rejected the opinion of Dr. John Martens, M.D., because the ALJ could find no treatment records evidencing his treatment and rejected the opinion of Malgorzata Gawron, APRN, because she was not an accepted medical source.
In determination of disability claims, the existence and the extent of an impairment is determined by considering evidence of "Signs" and "Symptoms." 20 CFR § 404.1508. "Signs" are objective medically recognized facts that can be described, evaluated, and documented using acceptable clinical, diagnostic or laboratory techniques. 20 CFR § 404.1528(b). Medical facts are reported in tests, treatment notes, and serve as the basis of medical opinions as to diagnosis, prognosis and functional capability and limitation. For example, results of a blood test may indicate diabetes or clinical observation may show signs muscle strain.
In the psychiatric/psychological context there may be no laboratory or test result that measure mental disease. Thus, with regard to psychological or mental impairments, medical signs are demonstrable phenomena indicating psychological abnormalities, e.g., abnormalities of behavior, mood, thought, memory, orientation, development or perception. 20 CFR § 404.1528(b). Observations of medical signs by clinicians constitute medical data, and to the extent that an opinion with regard to psychological or mental impairments rests on clinically-observed signs and reported symptoms, the opinion are treated as any other medical opinion. 20 C.F.R. Subpart P, App 1 § 12.00(B); Robinson v. Barnhart, 366 F.3d 1078, 1083 (10th Cir. 2004); Washington v. Shalala, 37 F.3d 1437, 1441 (10th Cir. 1994).
"Symptoms," in contrast, are observations or descriptions made by a claimant with regard to an impairment or how the impairment affects him or her. 20 CFR Part 404, Subpart P, Appendix 1, § 12.00(B); 20 CFR § 404.1528(a). By definition, symptoms are subjective and most often cannot be measured or tested. They often include pain, fatigue, weakness, nervousness and the like.
Not surprisingly, "signs" and "symptoms" are evaluated using different frameworks. A medical provider's evaluation of facts and opinions with regard to diagnosis, prognosis, and functional capability is given a great deal of deference.
As noted, a claimant's credibility cannot be considered in assessing medical evidence. A claimant's credibility is pertinent only as to statements about his or her symptoms, and then only to assess the intensity, persistence and functional limitations of such symptoms. 20 CFR § 404.1529 and 416.929. The credibility determination is not a free-form judgment of whether the claimant is truthful in general, but instead requires a structured consideration of the relationship between the objective medical facts and the subjective symptoms:
SSR 96-7p.
There is no basis for the ALJ to make an assessment of subjective symptoms (or the credibility of the claimant's statements) before concluding that a medically determinable impairment that could cause the symptoms exists. This requires the ALJ to first evaluate the medical evidence to determine what impairments exist.
Limitation in the role of credibility assessment is applicable to mental impairments and to physical impairments that are hard to document with objective medical evidence. In Valdez v. Barnhart, 63 Fed. Appx. 838 (10th Cir. 2003) (unpublished), the Tenth Circuit considered facts similar to those presented here. The ALJ rejected opinions of treating physicians with regard to the claimant's mental impairments based on an assessment of the credibility of the claimant's symptom description. The Court reversed the Commissioner's decision to deny benefits, finding that that the ALJ erred in applying the correct legal standard. The Court observed:
62 Fed. Appx. at 842; see also Sisco v. United States Dep't of Health & Human Servs., 10 F.3d 739, 744 (10th Cir 1993) (chronic fatigue syndrome); McGoffin v. Barnhart, 288 F.2d 1248, 1252 (10th Cir. 2002) (mental impairment); Thomas v. Barnhart, 147 Fed. Appx. 755, 759-60 (10th Cir 2005) (mental impairment); Ryan v. Commissioner of Social Security, 528 F.3d 1194 (9th Cir 2008) (mental impairment); Sanchez v. Astrue No. 08-cv-560-REB (D. Colo. 12/20/2009); Trichak v. Colvin, No. 13-cv-374-WYD (D. Colo. 7/14/2014).
Here, the ALJ erred in application of several legal standards. He improperly considered credibility of the claimant's statements in assessing the opinions of treating sources: Ms. Donaldson, Drs. Weiss, Frieder, Kinney, and Martens and Ms. Gawron, APRN. In addition, he failed to utilize the appropriate legal test to evaluate the credibility of Mr. Williams's statements about his subjective symptoms and to limit application of such credibility determinations as required by law.
In addition, although the ALJ was correct that Ms. Donaldson, as a psychotherapist (but not a psychologist) and Ms. Gawron, as a nurse, are not treated as accepted medical sources, (20 CFR 404.1513(a)), he erred in rejecting their opinions on that basis. He was required to evaluate their opinions in accordance with the factors contained in 20 CFR § 404.1527, which he did not do.
The ALJ erred as a matter of law in his rejection of Dr. Marten's opinion on the grounds that "he is not a treating source." The record reflects that Ms. Gawron and Dr. Marten signed a "medical source statement of ability to do work-related activities (mental)" in early 2011 and it is undisputed that both were employed by the Jefferson Center for Mental Health who treated Mr. Williams. But if the ALJ had doubts about Dr. Marten's role in Mr. Williams's treatment, he could have requested additional information or treated it as a non-accepted medical source. Absent a showing that Dr. Marten knew nothing about Mr. Williams, the ALJ should not have rejected the opinion.
Assuming, for purposes of argument, that there was no error in application of appropriate legal standards, the RFC is still not supported by substantial evidence for two reasons. As noted, the ALJ gave no weight to the functional capacity opinion of any treating provider based on his credibility assessment of the claimant. He gave significant weight, however, to Dr. Wharry's 2009 opinion that Mr. Williams could perform semi-skilled work, which he found to be consistent with Dr. Valette's opinion and with "other objective medical evidence of record."
Unfortunately, Dr. Wharry's opinion and Dr. Valette's opinion suffer from the same flaw that the ALJ ascribes to the opinions of the treating sources — that is, they are based on Mr. Williams's statements as to his subjective symptoms. With regard to Dr. Wharry, her opinion is derived in its entirety from Mr. Williams's medical records as of 2009, which are necessarily infected by perceptions of his treating professionals based on his recitation of his symptoms. Dr. Valette's opinion is also a product of (and indeed recites) Mr. Williams's description of his symptoms. Thus, using the ALJ's logic, because all treatment and assessment depends on Mr. Williams's description of his symptoms, no medical opinion constitutes substantial evidence upon which an RFC can be based. The Court recognizes that this extends the logic employed by the ALJ to the absurd, but in doing so hopes to emphasize why credibility assessments have no place in evaluation of medical opinions.
In addition, as noted with regard to the error at Step 3, the only evidence that the ALJ considers relative to Mr. Williams's functional capacity is dated to 2009. Both Dr. Wharry's and Dr. Valette's opinions were rendered in 2009. Neither was updated, nor did the ALJ obtain more current medical information in accordance with the Remand Order. The only reference to Mr. Williams's functional capabilities during the time period 2010 through 2012 is a conclusory statement that Dr. Wharry's opinion is consistent with "other objective medical evidence of record." This reference is too general for this Court to review. Furthermore, in light of the ALJ's rejection of all other medical evidence, it is hard to imagine to what objective evidence the ALJ is referring.
For the foregoing reasons, the Court
