MEMORANDUM OPINION AND ORDER

DAVID A. BAKER, Magistrate Judge.

This cause came on for consideration without oral argument on review of the Commissioner's administrative decision finding Plaintiff was no longer disabled as of June 30, 2012. For the reasons set forth herein, the decision of the Commissioner is REVERSED and the matter is REMANDED for additional proceedings.

Procedural History

Plaintiff protectively filed an application for a period of disability, disability insurance benefits (Title II) on October 4, 2005, and was found disabled beginning August 1, 2004 (R. 66, 143-47). Pursuant to a statutorily required continuing disability review, the Commissioner determined that Plaintiff's disability had ceased as of April 6, 2012, and her period of disability terminated June 30, 2012 (R. 67). On November 15, 2012, the Commissioner's disability hearing officer affirmed the cessation of Plaintiff's disability benefits (R. 68, 77-81, 87-99). Plaintiff requested and received a hearing before an administrative law judge ("the ALJ"). On February 21, 2014, the ALJ issued an unfavorable decision, finding Plaintiff to be no longer disabled as of June 30, 2012 (R. 20-34). The Appeals Council declined to grant review (R. 1-3), making the ALJ's decision the final decision of the Commissioner. Plaintiff timely filed her Complaint (Doc. 1), the parties consented to the jurisdiction of the undersigned magistrate judge, and the matter is fully briefed and ripe for review pursuant to 42 U.S.C. §405(g).

Nature of Claimed Disability

On December 6, 2005, the date of the original decision finding Plaintiff disabled, Plaintiff had the medically determinable impairments of ulcerative colitis and aplastic anemia; and these impairments were found to meet the requirements of Section 5.06 of the Listings (20 CFR Part 404, Subpart P, Appendix 1) (R. 22). Plaintiff claims to be continuously disabled due to ulcerative colitis, hypothyroidism, and anxiety (R. 163).

Summary of Evidence Before the ALJ

Plaintiff was thirty seven years old on the date of the ALJ's decision (R. 34, 143), with two years of college (R. 45) and past relevant work as a fast food lead worker, dietary assistant, file room clerk, certified nursing assistant, and day care worker (R. 62, 197).

In the interest of privacy and brevity, the medical evidence relating to the pertinent time period is summarized here only to the extent necessary to address Plaintiff's objections. In addition to the medical records and opinions of her healthcare providers, the record includes the testimony of Plaintiff and a Vocational Expert; written forms and reports completed by Plaintiff and her sister; and opinions from non-examining state agency consultants.

As explained by the ALJ, to determine if a claimant continues to be disabled, the ALJ follows an eight step sequential assessment (R. 20-21):

(R. 20-21).

Here, the ALJ determined that, through June 30, 2012, the claimant did not engage in substantial gainful activity (R. 22). Next, the ALJ found that the medical evidence established that "as of June 30, 2012, the claimant continued to have the severe medically determinable impairment of ulcerative colitis/pancolitis. However, the condition reportedly now is under control." Id. The ALJ found that since June 30, 2012, the claimant has not had an impairment or combination of impairments which met or medically equaled the severity of an impairment listed in 20 CFR Part 404, Subpart P, Appendix 1 (R. 24). The ALJ determined that "medical improvement occurred as of June 30, 2012," and that medical improvement is related to the ability to work "because as of June 30, 2012, the claimant's CPD [comparison point decision] impairments no longer met or medically equaled the same listings that were met at the time of the CPD." (R. 24).

The ALJ determined that Plaintiff continued to have a severe impairment or combination of impairments (R. 24) and, as of June 30, 2012, had the following residual functional capacity ("RFC"):

(R. 25). Although the ALJ found Plaintiff to be unable to perform her past relevant work (R. 32), she was deemed to be able to perform a significant number of jobs in the national economy, and was therefore no longer disabled as of June 30, 2012 (R. 33-34).

Standard of Review

The scope of this Court's review is limited to determining whether the ALJ applied the correct legal standards, McRoberts v. Bowen, 841 F.2d 1077, 1080 (11th Cir. 1988), and whether the findings are supported by substantial evidence, Richardson v. Perales, 402 U.S. 389, 390 (1971). The Commissioner's findings of fact are conclusive if supported by substantial evidence. 42 U.S.C. § 405(g). Substantial evidence is more than a scintilla — i.e., the evidence must do more than merely create a suspicion of the existence of a fact, and must include such relevant evidence as a reasonable person would accept as adequate to support the conclusion. Foote v. Chater, 67 F.3d 1553, 1560 (11th Cir. 1995).

Where the Commissioner's decision is supported by substantial evidence, the district court will affirm, even if the reviewer would have reached a contrary result as finder of fact, and even if the reviewer finds that the evidence preponderates against the Commissioner's decision. Edwards v. Sullivan, 937 F.2d 580, 584 n.3 (11th Cir. 1991); Barnes v. Sullivan, 932 F.2d 1356, 1358 (11th Cir. 1991). The district court must view the evidence as a whole, taking into account evidence favorable as well as unfavorable to the decision. Foote, 67 F.3d at 1560; accord, Lowery v. Sullivan, 979 F.2d 835, 837 (11th Cir. 1992) (court must scrutinize the entire record to determine reasonableness of factual findings).

Issues and Analysis

Plaintiff argues that the ALJ erred by failing to include in the RFC the limitations found by Plaintiff's treating physicians (Nasir Hasan, M.D., Stephen Fitzgerald, M.D., and Scott Seminer, M.D.), and by discounting their opinions and giving greater weight to the opinions of non-examining state agency physicians and psychologists. Upon close review, the Court agrees that remand for further consideration is warranted.

Evaluating Medical Evidence

The Eleventh Circuit has held that whenever a physician offers a statement reflecting judgments about the nature and severity of a claimant's impairments, including symptoms, diagnosis, and prognosis, what the claimant can still do despite his or her impairments, and the claimant's physical and mental restrictions, the statement is an opinion requiring the ALJ to state with particularity the weight given to it and the reasons therefor. Winschel v. Comm'r, Soc. Sec. Admin., 631 F.3d 1176, 1178-79 (11th Cir. 2011) (citing 20 CRF §§ 404.1527(a)(2), 416.927(a)(2); Sharfarz v. Bowen, 825 F.2d 278, 279 (11th Cir. 1987).) When evaluating a physician's opinion, an ALJ considers numerous factors, including whether the physician examined the claimant, whether the physician treated the claimant, the evidence the physician presents to support his or her opinion, whether the physician's opinion is consistent with the record as a whole, and the physician's specialty. See 20 C.F.R. §§ 404.1527(c), 416.927(c).

Substantial weight must be given to the opinion, diagnosis and medical evidence of a treating physician unless there is good cause to do otherwise. See Lewis v. Callahan, 125 F.3d 1436 (11th Cir. 1997); Edwards v. Sullivan, 937 F.2d 580, 583 (11th Cir. 1991); 20 C.F.R. § 404.1527(d). Good cause for disregarding an opinion can exist when: (1) the opinion is not bolstered by the evidence; (2) the evidence supports a contrary finding; or (3) the opinion is conclusory or is inconsistent with the source's own treatment notes. Lewis, 125 F.3d at 1440. By contrast, a consultative examiner's opinion is not entitled to the deference normally given a treating source. See 20 C.F.R. § 404.1527(c)(2); Crawford v. Comm'r, Soc. Sec. Admin., 363 F.3d 1155, 1161 (11th Cir. 2004) (noting a one-time examiner's opinion is not entitled to great weight). Nonetheless, all opinions, including those of non-treating state agency or other program examiners or consultants, are to be considered and evaluated by the ALJ. See 20 C.F.R. §§ 404.1527, 416.927, and Winschel.

Applied here, Plaintiff"s long time internist and her two gastroenterologists all provided opinions as to her limitations, and all concluded that Plaintiff was disabled. The ALJ did not credit any of these opinions.

The ALJ reviewed and summarized pertinent treatment notes of Dr. Hasan, Plaintiff's internist (R. 29-30). On February 12, 2012, Dr. Hasan opined Plaintiff was not capable of full-time sustained work activity in that she "has easy fatigability due to a combination of physical (ulcerative colitis, anemia) and mental (depression/anxiety) factors" (R. 298). The ALJ acknowledged this opinion, but gave it "limited weight," focusing solely on the assessment of Plaintiff's mental status:

(R. 31).

Stephen Fitzgerald, M.D., was one of Plaintiff's gastroenterologists. The ALJ summarized Plaintiff's treatment with Dr. Fitzgerald, noting, among other things:

(R. 28).

On the May 24, 2012 visit, just a month before the date the ALJ determined that Plaintiff ceased her disability, Dr. Fitzgerald noted Plaintiff's weight and appetite were "fair at best" and Plaintiff was having five bowel movements a day, with some bleeding (R. 452). In June 2012, Dr. Fitzgerald noted the claimant was taking Remicade treatments, high-dose Asacol, and low-dose prednisone, and was doing well with less pain and less bleeding (R. 448). By September 2012, the ulcerative colitis was described as being under good control (R. 371).

The ALJ acknowledged Dr. Fitzgerald's formal opinions:

(R. 28).

Plaintiff also saw Dr. Fitzgerald's colleague, gastroenterologist Scott Z. Seminer, M.D. (Doc. 28). Dr. Seminer saw Plaintiff in August 2013, noting that he had followed her for years for her ulcerative colitis, but had not seen her in about three or four years (R. 446). On this visit, it was noted that Plaintiff was doing "well at this time" on Remicade and Asacol (R. 447). By separate letter, Dr. Seminer confirmed that he had treated Plaintiff for at least 10 years and Plaintiff "has had multiple difficulties over that period of time, but over the last few years, she has been stabilized with the use of Remicade 500 mg IV every two months and Asacol 800 mg three times daily." (R. 445). It was noted that Plaintiff would require lifetime treatment and observation to maintain her in her present state and Dr. Seminer opined that Plaintiff "is clearly disabled from this disease." Id.

In November 2013, Dr. Seminer provided an opinion similar to Dr. Fitzgerald's but he did not estimate how long Plaintiff could sit, stand or walk during a workday (R. 29, 478-80). Dr. Seminer opined that Plaintiff would need five to six unscheduled restroom breaks of 30 to 60 minutes and ready access to a restroom with the need to lie down for 30 to 60 minutes at unpredictable intervals (R. 29, 478-480). He felt Plaintiff was incapable of low stress work and would miss at least four days per month and be off task at least 25 percent of the time (R. 29, 481).

The ALJ reviewed the opinions of the treating gastroenterologists and noted:

(R. 31).

Plaintiff objects to the discounting of her providers' opinions as being unsupported by good cause and thus not supported by substantial evidence. Plaintiff also contends that the evaluation of these opinions was not in accordance with proper legal standards in that the ALJ did not address "all parts" of her doctors' opinions. While the Court does not hold that an ALJ must always explicitly reference all aspects of an opinion, the Court agrees that the ALJ's findings with respect to these opinions are insufficient here.

The articulated basis for discounting the opinions of the treating gastroenterologists is the ALJ's determination that Plaintiff's condition had significantly improved. As noted earlier in the decision:

(R. 31 emphasis added).

According to the rationale put forth by the ALJ as the sole reason for discounting the entirety of the specialists' opinions, the finding of significant improvement while on medications is "inconsistent" with an opinion that the Plaintiff is nonetheless significantly limited by her disease. The Court sees no such inconsistency. While the medical records do support improvement, the very existence of the "exceptions" acknowledged by the ALJ belies a finding that the disease is "controlled" to the extent that the ALJ need not address the specific limitations set forth by the treating specialists. The Court finds the rationale offered here to be too perfunctory for appropriate review.

It is undisputed that prior to her improvement Plaintiff was disabled by her condition. Even after her condition improved, none of her physicians noted Plaintiff to be cured or even in sustained remission. The uncontroverted evidence, as her specialist noted, is that this impairment is lifelong, fraught with "difficulties," and must be actively managed. As observed by her doctors and as Plaintiff testified to at her hearing,1 the nature of her impairment is such that she does not know and cannot predict when a disabling flare up will occur. Indeed, Plaintiff had such a flare up just one month prior to the date the ALJ determined she was no longer disabled, and testified to several others (R. 48-9, 55, 58-60). Despite unanimous acknowledgment of the unpredictability of this disease and the need for frequent and unscheduled restroom breaks during a flare up, the RFC formulated by the ALJ does not include any accommodation for this. Moreover, the medical records show that during such flare ups, Plaintiff loses weight, becomes anemic and experiences debilitating fatigue. Indeed, despite unanimous findings of fatigability by all of Plaintiff's long time treating physicians, the ALJ does not address that limitation at all, and makes no accommodation for it in the RFC. The sparse rationale provided by the ALJ here is not sufficient to support a wholesale rejection of any and all of the limitations placed by treating doctors. Under the circumstances here, the ALJ's failure to address the specific limitations by long time treating specialists warrants remand. See, e.g., Zobel v. Colvin, No. 1:14-CV-45-MP-GRJ, 2015 WL 5468455, at *10 (N.D. Fla. Aug. 3, 2015), report and recommendation adopted, No. 1:14-CV-00045-MP-GRJ, 2015 WL 5470197 (N.D. Fla. Sept. 17, 2015) ("The ALJ also does not adequately explain why Dr. Sninsky's functional assessment regarding Plaintiff's need for bathroom breaks — which is uncontradicted by either Dr. Axline or Dr. Zelaya-should be rejected. Remand is necessary so that the ALJ can properly account for the relevant factors and adequately explain the basis for evaluating the treating physician's functional assessment.").

To be clear, the Court is not finding that anything short of a cure means that this condition is always disabling. Nor is the Court finding that the opinions are necessarily entitled to great or, indeed, any weight. It is for the ALJ to make and support that finding in the first instance. The Court holds only that this finding is not sufficient under the appropriate legal standard. On remand, the ALJ should make more particularized findings explaining the basis for the weight to be given the treating provider's opinions regarding limitations and accounting for the relevant factors.

Conclusion

The Court finds that the decision of the Commissioner is not supported by substantial evidence and was not made in accordance with proper legal standards. As such, the decision is REVERSED and the matter REMANDED to the Commissioner, under sentence four of 42 U.S.C. §405(g), with instructions to properly address the treatment records and the opinions of Plaintiff's providers and reassess Plaintiff's residual functional capacity, based on all of the evidence of record; then, if need be, conduct such further proceedings as are necessary to issue a new decision based on substantial evidence and proper legal standards. The Clerk is directed to enter judgment for the Plaintiff accordingly, terminate all matters and close the file.

DONE and ORDERED.