NANCY A. VECCHIARELLI, Magistrate Judge.
Plaintiff, Ronnett M. Langlois ("Plaintiff"), challenges the final decision of Defendant, Carolyn W. Colvin, Acting Commissioner of Social Security ("Commissioner"), denying her application for Supplemental Security Income ("SSI") under Titles II and XVI of the Social Security Act,
On April 13, 2012, Plaintiff filed her application for SSI, alleging a disability onset date of April 25, 2002. (Transcript ("Tr.") 25.) The claims were denied initially and upon reconsideration, and Plaintiff requested a hearing before an administrative law judge ("ALJ"). (Id.) On March 11, 2014, an ALJ held Plaintiff's hearing. (Id.) Plaintiff participated in the hearing, was represented by counsel, and testified. (Id.) A vocational expert ("VE") also participated and testified. (Id.) On March 27, 2014, the ALJ found Plaintiff not disabled. (Tr. 38.) On June 22, 2015, the Appeals Council declined to review the ALJ's decision, and the ALJ's decision became the Commissioner's final decision. (Tr. 1.)
On August 21, 2015, Plaintiff filed her complaint to challenge the Commissioner's final decision. (Doc. No. 1.) The parties have completed briefing in this case. (Doc. Nos. 15, 17, 18.)
Plaintiff asserts the following assignments of error: (1) the ALJ erred in evaluating the opinions of Plaintiff's treating physicians and psychiatrists; and (2) the ALJ erred by ascribing great weight to the opinions of State Agency reviewing psychologist. (Doc. Nos. 15 & 18.)
Plaintiff was born in December 1978 and was twenty-three (23) years old on her alleged disability onset date. (Tr. 37.) She has no past relevant work, has at least a high school education, and was able to communicate in English. (Id.)
Plaintiff's treating psychiatrist, Vishwas Mashalkar, M.D., completed three Mental Functional Capacity Assessment forms bearing the markings of Ohio Job & Family Services.
There is no indication when the forms were completed, though the first form indicates that Plaintiff was last seen by Dr. Mashalkar on January 4, 2012. (Tr. 661.) Dr. Mashalkar checked boxes indicating that Plaintiff was not significantly limited in her ability to carry out very short and simple instructions, but was markedly limited in the following areas: the ability to carry out detailed instructions; the ability to maintain attention and concentration for extended periods; the ability to sustain an ordinary work routine without special supervision; the ability to work in coordination with or proximity to others without being distracted by them; and the ability to complete a normal workday and workweek without interruptions from psychologically based symptoms and to perform at a consistent pace without an unreasonable number and length of rest periods. (Id.) Dr. Mashalkar found Plaintiff moderately limited in the 14 remaining areas. (Id.) He concluded that Plaintiff was unemployable and that the above limitations were expected to last 12 months. (Id.)
The second form indicates that Plaintiff was last seen by Dr. Mashalkar on June 6 — the year is illegible. (Tr. 662.) Dr. Mashalkar checked boxes indicating that Plaintiff was not significantly limited in her ability to be aware of normal hazards and take appropriate precautions, but was markedly limited in the following areas: the ability to work in coordination with or proximity to others without being distracted by them; the ability to make simple work-related decisions; the ability to complete a normal workday and workweek without interruptions from psychologically based symptoms and to perform at a consistent pace without an unreasonable number and length of rest periods; the ability to accept instructions and respond appropriately to criticism from supervisors; the ability to get along with coworkers or peers without distracting them or exhibiting behavioral extremes; and, the ability to maintain socially appropriate behavior and to adhere to basic standards of neatness and cleanliness. (Id.) Dr. Mashalkar found Plaintiff moderately limited in 11 other areas and failed to complete two areas. (Id.) He concluded that Plaintiff was unemployable and that the above limitations were expected to last between 30 days to 9 months. (Id.)
The third form indicates that Plaintiff was last seen by Dr. Mashalkar on December 9, 2012. (Tr. 663.) Dr. Mashalkar checked boxes indicating that Plaintiff was not significantly limited in her ability to accept instructions and respond appropriately to criticism from supervisors — a marked limitation in the previous form. (Id.) Plaintiff was then deemed markedly limited in thirteen areas (including 8 new areas), and moderately limited in only 6 areas. (Id.) He concluded that Plaintiff was unemployable and that the above limitations were expected to last between 30 days to 9 months. (Id.) None of the forms contain any explanation as to why Plaintiff is as limited as stated, nor do they contain a diagnosis setting forth Plaintiff's mental impairments.
On May 29, 2012, Pamela Hackl, D.O., completed a questionnaire for the Rehabilitation Services Commission.
At the March 11, 2014, hearing, Plaintiff testified as follows:
The ALJ posed the following hypothetical question to the VE:
(Tr. 77-78.)
The VE responded in the affirmative, identifying the following as examples of jobs that such an individual could perform: assembler, Dictionary of Occupational Titles ("DOT") 739.687-030 (4,000 jobs in the region, 160,000 nationally); packager, DOT 753.687-038 (2,000 jobs in the region, 80,000 nationally); and inspector, DOT 559.687-074 (2,000 jobs in the region, 80,000 nationally). (Tr. 78.)
The ALJ posed a second hypothetical asking the ALJ to assume a person of claimant's age and education with no past relevant work who could perform unskilled, sedentary work and was limited to simple, entry-level tasks. (Tr. 78-79.) The VE testified that such a person could perform the above identified inspector position in reduced numbers (1,000 in the region, 40,000 nationally), and some of the assembly jobs (1,000 in the region, 40,000 nationally). (Tr. 79.) In addition, the hypothetical person could perform the job of a hand trimmer, DOT 734.687-094 (500 jobs in the region, 20,000 nationally). (Tr. 79.)
In a third hypothetical, the ALJ inquired what jobs would remain if he combined the mental RFC from the first hypothetical with the sedentary work from the second hypothetical. (Tr. 80.) The VE testified that such an individual could perform all the jobs cited in response to the second hypothetical. (Tr. 80.)
Using the ALJ's third hypothetical, Plaintiff's counsel inquired as to the impact of a limitation to no more than 5 pounds of lifting and a need to shift positions every 15 minutes. (Tr. 81.) The VE testified that those additional limitations would reduce the numbers of the previously identified jobs by approximately 50 percent. (Tr. 81-82.)
A claimant is entitled to receive benefits under the Social Security Act when she establishes disability within the meaning of the Act.
The Commissioner reaches a determination as to whether a claimant is disabled by way of a five-stage process.
The ALJ made the following findings of fact and conclusions of law:
(Tr. 28-38.)
Judicial review of the Commissioner's decision is limited to determining whether the Commissioner's decision is supported by substantial evidence and was made pursuant to proper legal standards.
The Commissioner's conclusions must be affirmed absent a determination that the ALJ failed to apply the correct legal standards or made findings of fact unsupported by substantial evidence in the record.
In her first assignment of error, Plaintiff asserts that the ALJ failed to adequately address the opinions of her treating physicians, specifically those of Dr. Hackl and Dr. Mashalkar. (Doc. No. 15 at pp. 13-18.)
"An ALJ must give the opinion of a treating source controlling weight if he finds the opinion `well-supported by medically acceptable clinical and laboratory diagnostic techniques' and `not inconsistent with the other substantial evidence in the case record.'" Wilson v. Comm'r of Soc. Sec., 378 F.3d 541, 544 (6th Cir. 2004) (quoting 20 C.F.R. § 404.1527(d)(2)) (internal quotes omitted). If an ALJ decides to give a treating source's opinion less than controlling weight, he must give "good reasons" for doing so that are sufficiently specific to make clear to any subsequent reviewers the weight given to the treating physician's opinion and the reasons for that weight. See Wilson, 378 F.3d at 544 (quoting S.S.R. 96-2p, 1996 WL 374188, at *5 (S.S.A.)). This "clear elaboration requirement" is "imposed explicitly by the regulations," Bowie v. Comm'r of Soc. Sec., 539 F.3d 395, 400 (6th Cir. 2008), and its purpose is to "let claimants understand the disposition of their cases" and to allow for "meaningful review" of the ALJ's decision, Wilson, 378 F.3d at 544 (internal quotation marks omitted). Where an ALJ fails to explain his reasons for assigning a treating physician's opinion less than controlling weight, the error is not harmless and the appropriate remedy is remand. Id.
"The medical opinions and diagnoses of treating physicians are generally accorded substantial deference, and if the opinions are uncontradicted, complete deference." Howard v. Comm'r of Soc. Sec., 276 F.3d 235, 240 (6th Cir. 2002), citing Harris v. Heckler, 756 F.2d 431, 435 (6th Cir. 1985). Furthermore, it is well-established that administrative law judges may not make medical judgments. See Meece v. Barnhart, 192 Fed. App'x 456, 465 (6th Cir. 2006) ("But judges, including administrative law judges of the Social Security Administration, must be careful not to succumb to the temptation to play doctor.") (quoting Schmidt v. Sullivan, 914 F.2d 117, 118 (7th Cir. 1990)). Although an ALJ may not substitute his or her opinions for that of a physician, "an ALJ does not improperly assume the role of a medical expert by assessing the medical and non-medical evidence before rendering a residual functional capacity finding." Poe v. Comm'r of Soc. Sec., 342 F. App'x 149, 157 (6th Cir. 2009); see also
With respect to Dr. Hackl, the ALJ addressed her opinion as follows:
(Tr. 34-35.)
Plaintiff challenges the ALJ's characterization of Dr. Hackl's opinion as essentially an opinion that she is disabled or unable to work. (Doc. No. 15 at p. 14.) The Court disagrees, and finds the ALJ's treatment of Dr. Hackl's opinion as an opinion on an issue reserved for the Commissioner a reasonable interpretation in light of the evidence. While Dr. Hackl's opinion is rather thorough in its description of Plaintiff's diagnoses (Tr. 412) and in its description of Plaintiff's medications (Tr. 413), it is, by contrast, glaringly devoid of any description of Plaintiff's functional limitations or a description of the symptoms that support any limitations. (Tr. 411-13.) Tellingly, Plaintiff fails to identify a single, specific limitation assessed by Dr. Hackl that she believes should have been included in the RFC. The closest approximation to a functionality assessment is Dr. Hackl's statement that Plaintiff "is presently not mentally able to handle a work environment as her mood is not stable or controlled . . ." (Tr. 413.)
Plaintiff contends that it is not clear that Dr. Hackl's opinion falls into the category of opinions reserved to the Commissioner, because Dr. Hackl "focused on [Plaintiff's] ability to handle the mental demands of work." (Id.) This is a distinction without a difference. Regardless of whether a physician opines that a claimant cannot work due to mental limitations, physical limitations, or a combination of both, such an opinion — absent an explanation — is, at its core, an opinion that the claimant cannot work and, therefore, is disabled. An opinion that a claimant cannot work is not a "medical opinion." It is well established that a treating physician's opinion is only entitled to special attention and deference when it constitutes is a "medical opinion" as that term is defined by the regulations. Turner v. Comm'r of Soc. Sec., 381 F. App'x 488, 492-93 (6
Here, Dr. Hackl opined Plaintiff would have difficulty working due to mental impairments, but assessed no further functional limitations. The ALJ correctly observed that Dr. Hackl's opinion was not a medical opinion, and thus, not entitled to deference. Moreover, the ALJ expressly noted that Dr. Hackl was not a mental health specialist. (Tr. 35.) Pursuant to 20 C.F.R. § 416.927(c)(5), "specialization," is one of six factors that an ALJ should consider when evaluating opinion evidence. Further, there is no requirement that an ALJ engage in an explicit discussion of each factor. See Francis v. Comm'r of Soc. Sec., 414 F. App'x 802, 805 (6th Cir. 2011) ("Although the regulations instruct an ALJ to consider these factors, they expressly require only that the ALJ's decision include `good reasons . . . for the weight . . . give[n] [to the] treating source's opinion" — not an exhaustive factor-by-factor analysis.") (quoting 20 C.F.R. § 404.1527(d)(2)) (alterations in original). Accordingly, the ALJ provided good reasons for her decision to discount Dr. Hackl's opinion and her analysis comports with the treating source rule.
Turning to Dr. Mashalkar's January 2012 assessment, the ALJ explained the weight ascribed to his opinion as follows:
(Tr. 35.)
The ALJ specifically mentions Dr. Mashalkars' treatment notes from July 13, 2012 as contradicting his earlier January 2012 assessment. (Tr. 35.) On July 13, 2012, Dr. Mashalkar noted that Plaintiff "[s]till does not want to work," "[has] not worked for several years," that he had suggested she "can start working part time," that she had been told not to combine Xanax with Vicodin, and that he informed Plaintiff he "CANNOT attest to an indefinite period of disability for her." (Tr. 650, Exh. B6F at 9.) Plaintiff was also ascribed a Global Assessment of Functioning ("GAF") score of 65.
Furthermore, the ALJ found the "check the box" form utilized by Dr. Mashalkar provides no real explanation for the limitations assessed or the evidence relied upon in forming the opinion. (Tr. 35.) The ALJ's determination is not unreasonable, as "Supportability" is one of the factors specifically set forth in the regulations, which states that "[t]he more a medical source presents relevant evidence to support an opinion, particularly medical signs and laboratory findings, the more weight we will give that opinion. The better an explanation a source provides for an opinion, the more weight we will give that opinion." 20 C.F.R. § 416.927(C). Numerous courts have agreed that the use of checklist or check-the-box forms, where no explanation is provided for the limitations assessed, are unsupported and, therefore, need not be accepted even when completed by a treating source. See, e.g.,
Plaintiff also argues that the ALJ erred by not specifically addressing Dr. Mashalkar's two other assessments, which were contained on identical checklist forms. (Doc. No. 15 at pp. 15-18.) The Commissioner concedes the ALJ did not specifically address these opinions, but states that if there was any error, it was harmless because the ALJ was not required to repeat the same analysis twice as the latter two assessments suffered from the same shortcomings as the first. (Doc. No. 17 at pp. 11-13.) In her reply, Plaintiff counters that Dr. Mashalkar's other two assessments contain additional marked limitations that were not included in the first, and that Plaintiff was seen at least six more times by Dr. Mashalkar between the January 2012 assessment and the December 2012 assessment. (Doc. No. 18 at p. 2.)
Plaintiff's argument is unconvincing, as neither the inclusion of greater limitations nor the additional treatment visits overcome the shortcomings the ALJ identified in relation to the January 2012 assessment. The two other assessments, like the January 2012 assessment, are at odds with Dr. Mashalkar's July 13, 2012 treatment note. Moreover, the other two assessments are identical to the January 2012 assessment in that they are checklist forms completely devoid of any explanation for the severity of assessed limitations. "No principle of administrative law or common sense requires us to remand a case in quest of a perfect opinion unless there is reason to believe that the remand might lead to a different result." Shkabari v. Gonzales, 427 F.3d 324, 328 (6
The Court finds Plaintiff's first assignment of error to be without merit.
In Plaintiff's second assignment of error, she argues that "in light of the [ALJ's] failure to provide good reasons for the weight given to treating psychiatrist opinion," the ALJ erred inappropriately ascribed great weight to the opinions of State Agency reviewing psychologists. (Doc. No. 15 at pp. 18-20.) The Court, as explained above, has found that the ALJ did indeed set forth sufficient reasons for rejecting the opinions of Dr. Hackl and Dr. Mashalkar. Furthermore, the reasons given by the ALJ for ascribing those opinions little weight were not based on their conflict with the State Agency opinions.
To the extent Plaintiff is suggesting that an ALJ errs by ascribing great weight to a State Agency doctor's opinion where a conflicting treating source opinion has been properly rejected, Plaintiff cites no law to support such a position. Moreover, State Agency opinions can constitute substantial evidence upon which an ALJ may base her decision. "State agency medical and psychological consultants and other program physicians, psychologists, and other medical specialists are highly qualified physicians, psychologists, and other medical specialists who are also experts in Social Security disability evaluation."
Plaintiff's second assignment of error is without merit.
For the foregoing reasons, the Commissioner's final decision is AFFIRMED.