REPORT AND RECOMMENDATION

MARTIN C. CARLSON, Magistrate Judge.

I. Introduction and Litigation History

In considering Allan B. Newton's ("Newton") Social Security disability application we most assuredly do not write upon a blank slate. Quite the contrary, through a series of prior administrative rulings, the question of Newton's entitlement to disability benefits prior to February of 2010 has been resolved. Likewise, in the last ruling by the ALJ, the ALJ found that Newton was entitled to benefits beginning March 24, 2013, but "was not under a disability within the meaning of the Social Security Act at any time through March 31, 2012." (Tr. 825.) Therefore, all that remains before the Court is a judgment regarding whether Newton met the requirements for disability during the only relevant time period that has yet to be adjudicated, February 20, 2010 to March 31, 2012. (Tr. 816.)2

As to this closed period of alleged disability, it is undisputed that Newton has long suffered from a severe form of mental illness, a schizoaffective disorder. In this appeal we are presented with the following question: Does substantial evidence support the ALJ's decision to afford little weight to the opinion of Newton's treating physician, Dr. Shah, who found that Newton "is permanently and totally disabled" (Tr. 785), when the ALJ's only explanation for this rejection was that Newton's "mental status examinations were within normal limits and do not support Dr. Shahs' opinion," (Tr. 822), and that justification advanced by the ALJ is contradicted by Dr. Shah's treatment notes, which consistently documented profound impairments for Newton, including persistent auditory hallucinations? Because we find that Dr. Shah's treatment records, which repeatedly describe Newton's on-going hallucinations, cannot be fairly characterized as mental status examinations that were within normal limits, for the reasons set forth below it is recommended that this case be remanded for further proceedings.

II. Factual Background

Allan Newton initially filed protectively under Title II of the Social Security Act for a period of disability and disability insurance benefits on April 8, 2010, and also filed protectively under Title XVI of the Social Security Act for supplemental security income on April 26, 2010. (Tr. 814.) The ALJ later determined that the relevant time period for this claim was from February 20, 2010 to March 31, 2012, Newton's date last insured, a closed period of claimed disability which is not disputed by the parties in this appeal. (Tr. 816.) In this application Newton alleged mental illness as the reason he was limited in his ability to work, (Tr. 187), and it is undisputed that Newton suffered from a schizoaffective disorder during this time, a form of mental illness which the ALJ conceded was a severe impairment in this case. (Tr. 818.)

With Newton's disability claim framed in this fashion, the central issue with respect to this closed period claim is the disabling effect of Newton's schizoaffective disorder. On this score a significant body of evidence, including treating source opinions and records, indicated that Newton struggled with severe mental illness. Due to his schizoaffective disorder Newton has been hospitalized ten times and has required continuous outpatient psychiatric treatment. (Doc. 14 p. 3.) From what can be gleaned from the record, Newton has been treated by Dr. Shah for his schizoaffective disorder since the year 2008, and Dr. Shah has consistently reported in her treatment notes that Newton hears voices and has experienced auditory hallucinations. (Tr. 472-475; 477; 478-479; 481-483; 485-487; 89-490; 494-495; 497-500; 775; 779-781; 785, 1182.) Dr. Shah has also reported instances in which Newton also experienced visual hallucinations, and described seeing shadowy figures. (Tr. 742, 473, 477, 486, 489, 497, 511.) These treatment notes also document episodes of suicidal ideation by Newton. (Tr. 453, 497, 506, 511.) Further, the treatment records reflect that his treating mental health professionals have assigned Global Assessment of Functioning, or GAF scores for Newton which range between 48 and 60. (Tr. 447, 463, 479 and 775.) These are clinically significant findings since:

Markoch v. Colvin, No. 3:14-CV-00780, 2015 WL 2374260, at *10 (M.D. Pa. May 18, 2015). Moreover, under the GAF score system:

Jones v. Colvin, No. 1:16-CV-1535, 2017 WL 4277289, at *2 (M.D. Pa. Sept. 25, 2017), report and recommendation adopted sub nom. Jones v. Berryhill, No. 1:16-CV-1535, 2017 WL 4314572 (M.D. Pa. Sept. 27, 2017).

Thus, the GAF scores assigned to Newton by this treating source characterized his degree of impairment as ranging between moderate and severe. Consistent with these clinical findings, on June 22, 2011, Dr. Shah issued a statement to the Pennsylvania Department of Revenue stating that Newton "is permanently and totally disabled" within the meaning of the Social Security Act. (Tr. 785.)

Dr. Shah's treating source opinion drew additional support and credence from a consultative psychological examination conducted by Dr. Charles Lajeunesse on March 15, 2013. (Tr. 1556-63.) Following this consultative examination, Dr. Lajeunesse issued a report which found that Newton had marked mental and social limitations and a GAF score of 50, a score which was emblematic of severe-to-moderate mental impairment. (Tr. 1559.)

It was against the backdrop of this medical and mental health record that the ALJ issued an opinion denying Newton's claim for this closed period of disability benefits on May 24, 2016. (Tr. 809-26.) Although the ALJ found that Newton qualified for disability benefits after March 2013, the ALJ found that Newton was not entitled to benefits as a result of any disabling mental health conditions between February 2010 and March 2012. The ALJ's May 24, 2016 decision found that Newton suffered from the following five severe impairments that affected his ability to work: (1) schizoaffective disorder, (2) coronary artery disease, (3) obesity, (4) left rotator cuff tear, and (5) history of substance abuse. (Tr. 818.) The ALJ further found that Newton did not meet any listings under 20 C.F.R. Part 404, Subpart P, Appendix 1 and did not suffer from a disability at any time during the relevant period of this appeal. (Tr. 818; 825.) The ALJ then determined that Newton has the residual functional capacity (RFC) to perform light work, but Newton could not perform overhead work, crawling, kneeling, or climbing of ladders or scaffolds. (Tr. 819.) The ALJ also limited Newton "to simple, routine, repetitive work generally described as unskilled" where Newton will "have no interaction with the public and occasional interaction with co-workers and supervisors." (Tr. 819.)

In the course of reaching this conclusion, the ALJ gave "little weight" to Dr. Shah's treating source opinion that Newton's mental health condition was permanently and totally disabling. (Tr. 822.) Despite Dr. Shah's specialization in the psychological field and history of treating Newton, the ALJ rejected Dr. Shah's opinion. (Tr. 822.) The ALJ's treatment of this treating source opinion was cursory and the only explanation offered by the ALJ for rejection of this treating source opinion was that Newton's "mental status examinations were within normal limits and do not support Dr. Shahs' opinion." (Tr. 822.) The ALJ's decision did not reconcile this assertion that Newton's "mental status examinations were within normal limits," (Id.), with Newton's thoroughly documented treating source history of auditory hallucinations, visual hallucinations, suicidal thoughts, or GAF scores which confirmed severe to moderate mental impairments. Nor did the ALJ reconcile this decision to afford little weight to this treating source opinion with the corroborating support of Dr. Lajeunesse's March 15, 2013 consultative examination report which found that Newton had marked mental and social limitations and a GAF score of 50, a score which was emblematic of severe-to-moderate mental impairment. (Tr. 1559.) Instead, curiously, the ALJ gave Dr. Lajeunesse's opinion "moderate" weight, while completely discounting the report's conclusion that Newton had marked limitations in social interactions, based solely upon a notation that Newton's eye contact and behavior were normal. (Tr. 823.)

This appeal followed. (Doc. 1.) On appeal, Newton presents the following five issues: (1) the ALJ erred by rejecting the testimony of the Commissioner's medical expert, Dr. Freemont, opining that Newton's mental impairment met a listing, (2) The ALJ erroneously rejected the medical opinion of treating psychiatrist Dr. Shah, (3) the ALJ erred failing to credit Dr. Lajeunesse's opinion, (4) the hypothetical presented to the VE did not contain all of Newton's credibly established limitations, and (5) the ALJ did not properly consider Newton's knee impairment in the RFC assessment. (Doc. 14 p. 4.) This case is fully briefed and is, therefore, ripe for resolution.

For the reasons set forth below, we find that the administrative record, read as a whole, does not support the ALJ's finding that Newton's "mental status examinations were within normal limits." (Tr. 822.) Quite the contrary, Newton's treatment history disclosed auditory hallucinations, visual hallucinations, suicidal thoughts, and GAF scores which confirmed severe to moderate mental impairments. Since none of these clinical findings can be reconciled with the ALJ's assertion that Newton's "mental status examinations were within normal limits," (Tr. 822), it is recommended that this case be remanded for further consideration of the medical evidence.

III. Discussion

A. Substantial Evidence Standard of Review

Resolution of the instant social security appeal involves an informed consideration of the respective roles of two adjudicators—the ALJ and this court. At the outset, it is the responsibility of the ALJ in the first instance to determine whether a claimant has met the statutory prerequisites for entitlement to benefits. To receive benefits under the Social Security Act by reason of disability, a claimant must demonstrate an inability to "engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than twelve months." 42 U.S.C. §423(d)(1)(A); 42 U.S.C. §1382c(a)(3)(A); see also 20 C.F.R. §§404.1505(a), 416.905(a). To satisfy this requirement, a claimant must have a severe physical or mental impairment that makes it impossible to do his or her previous work or any other substantial gainful activity that exists in the national economy. 42 U.S.C. §423(d)(2)(A); 42 U.S.C. §1382c(a)(3)(B); 20 C.F.R. §§404.1505(a), 416.905(a).

In making this determination at the administrative level, the ALJ follows a five-step sequential evaluation process. 20 C.F.R. §§404.1520(a), 416.920(a). Under this process, the ALJ must sequentially determine: (1) whether the claimant is engaged in substantial gainful activity; (2) whether the claimant has a severe impairment; (3) whether the claimant's impairment meets or equals a listed impairment; (4) whether the claimant is able to do his or her past relevant work; and (5) whether the claimant is able to do any other work, considering his or her age, education, work experience and residual functional capacity ("RFC"). 20 C.F.R. §§404.1520(a)(4), 416.920(a)(4).

Between steps three and four, the ALJ must also assess a claimant's RFC. RFC is defined as "that which an individual is still able to do despite the limitations caused by his or her impairment(s)." Burnett v. Comm'r of Soc. Sec., 220 F.3d 112, 121 (3d Cir. 2000) (citations omitted); see also 20 C.F.R. §§404.1520(e), 404.1545(a)(1), 416.920(e), 416.945(a)(1). In making this assessment, the ALJ considers all of the claimant's medically determinable impairments, including any non-severe impairments identified by the ALJ at step two of his or her analysis. 20 C.F.R. §§404.1545(a)(2), 416.945(a)(2).

There is an undeniable medical aspect to an RFC determination, since that determination entails an assessment of what work the claimant can do given the physical limitations that he experiences. Yet, when considering the role and necessity of medical opinion evidence in making this determination, courts have followed several different paths. Some courts emphasize the importance of medical opinion support for an RFC determination and have suggested that "[r]arely can a decision be made regarding a claimant's residual functional capacity without an assessment from a physician regarding the functional abilities of the claimant." Biller v. Acting Comm'r of Soc. Sec., 962 F.Supp.2d 761, 778-79 (W.D. Pa. 2013) (quoting Gormont v. Astrue, Civ. No. 11-2145, 2013 WL 791455 at *7 (M.D. Pa. Mar. 4, 2013)). In other instances, it has been held that: "There is no legal requirement that a physician have made the particular findings that an ALJ adopts in the course of determining an RFC." Titterington v. Barnhart, 174 F. App'x 6, 11 (3d Cir. 2006). Further, courts have held in cases where there is no evidence of any credible medical opinion supporting a claimant's allegations of disability that "the proposition that an ALJ must always base his RFC on a medical opinion from a physician is misguided." Cummings v. Colvin, 129 F.Supp.3d 209, 214-15 (W.D. Pa. 2015).

These seemingly discordant legal propositions can be reconciled by evaluation of the factual context of these decisions. Those cases which emphasize the importance of medical opinion support for an RFC assessment typically arise in a factual setting where a factually-supported and well-reasoned medical source opinion regarding limitations that would support a disability claim is rejected by an ALJ based upon a lay assessment of other evidence by the ALJ. In contrast, when an ALJ fashions an RFC determination on a sparse factual record or in the absence of any competent medical opinion evidence, courts have adopted a more pragmatic view and have sustained the ALJ's exercise of independent judgment based upon all of the facts and evidence. See Titterington v. Barnhart, 174 F. App'x 6, 11 (3d Cir. 2006); Cummings v. Colvin, 129 F.Supp.3d 209, 214-15 (W.D. Pa. 2015). In either event, once the ALJ has made this determination, our review of the ALJ's assessment of the plaintiff's RF C is deferential, and that RFC assessment will not be set aside if it is supported by substantial evidence. Burns v. Barnhart, 312 F.3d 113, 129 (3d Cir. 2002).

At steps one through four, the claimant bears the initial burden of demonstrating the existence of a medically determinable impairment that prevents him or her from engaging in any of his or her past relevant work. 42 U.S.C. §423(d)(5); 42 U.S.C. §1382c(a)(3)(H)(i)(incorporating 42 U.S.C. §423(d)(5) by reference); 20 C.F.R. §§404.1512, 416.912; Mason v. Shalala, 994 F.2d 1058, 1064 (3d Cir. 1993).

Once the claimant has met this burden, it shifts to the Commissioner at step five to show that jobs exist in significant number in the national economy that the claimant could perform that are consistent with the claimant's age, education, work experience and RFC. 20 C.F.R. §§404.1512(f), 416.912(f); Mason, 994 F.2d at 1064.

Once the ALJ has made a disability determination, it is then the responsibility of this court to independently review that finding. In undertaking this task, this court applies a specific, well-settled and carefully articulated standard of review. In an action under 42 U.S.C. § 405(g) to review the decision of the Commissioner of Social Security denying Plaintiff's claim for disability benefits, Congress has specifically provided that the "findings of the Commissioner of Social Security as to any fact, if supported by substantial evidence, shall be conclusive[.]" 42 U.S.C. § 405(g); 42 U.S.C. §1383(c)(3). Thus, when reviewing the Commissioner's final decision denying a claimant's application for benefits, this court's review is limited to the question of whether the findings of the final decision-maker are supported by substantial evidence in the record. See 42 U.S.C. §405(g); 42 U.S.C. §1383(c)(3); Johnson v. Comm'r of Soc. Sec., 529 F.3d 198, 200 (3d Cir. 2008); Ficca v. Astrue, 901 F.Supp.2d 533, 536 (M.D. Pa. 2012). Substantial evidence "does not mean a large or considerable amount of evidence, but rather such relevant evidence as a reasonable mind might accept as adequate to support a conclusion." Pierce v. Underwood, 487 U.S. 552, 565 (1988). Substantial evidence is less than a preponderance of the evidence but more than a mere scintilla. Richardson v. Perales, 402 U.S. 389, 401 (1971). A single piece of evidence is not substantial evidence if the ALJ ignores countervailing evidence or fails to resolve a conflict created by the evidence. Mason v. Shalala, 994 F.2d 1058, 1064 (3d Cir. 1993).

But in an adequately developed factual record, substantial evidence may be "something less than the weight of the evidence, and the possibility of drawing two inconsistent conclusions from the evidence does not prevent [the ALJ's decision] from being supported by substantial evidence." Consolo v. Fed. Maritime Comm'n, 383 U.S. 607, 620 (1966). "In determining if the Commissioner's decision is supported by substantial evidence the court must scrutinize the record as a whole." Leslie v. Barnhart, 304 F.Supp.2d 623, 627 (M.D. Pa. 2003). The question before this court, therefore, is not whether a plaintiff is disabled, but whether the Commissioner's finding that he is not disabled is supported by substantial evidence and was reached based upon a correct application of the relevant law. See Arnold v. Colvin, No. 3:12-CV-02417, 2014 WL 940205, at *1 (M.D. Pa. Mar. 11, 2014) ("[I]t has been held that an ALJ's errors of law denote a lack of substantial evidence.") (alterations omitted); Burton v. Schweiker, 512 F.Supp. 913, 914 (W.D. Pa. 1981) ("The Secretary's determination as to the status of a claim requires the correct application of the law to the facts."); see also Wright v. Sullivan, 900 F.2d 675, 678 (3d Cir. 1990) (noting that the scope of review on legal matters is plenary); Ficca, 901 F.Supp.2d at 536 ("[T]he court has plenary review of all legal issues. . . .").

The ALJ's disability determination must also meet certain basic substantive requisites. Most significant among these legal benchmarks is a requirement that the ALJ adequately explain the legal and factual basis for this disability determination. Thus, in order to facilitate review of the decision under the substantial evidence standard, the ALJ's decision must be accompanied by "a clear and satisfactory explication of the basis on which it rests." Cotter v. Harris, 642 F.2d 700, 704 (3d Cir. 1981). Conflicts in the evidence must be resolved and the ALJ must indicate which evidence was accepted, which evidence was rejected, and the reasons for rejecting certain evidence. Id. at 706-707. In addition, "[t]he ALJ must indicate in his decision which evidence he has rejected and which he is relying on as the basis for his finding." Schaudeck v. Comm'r of Soc. Sec., 181 F.3d 429, 433 (3d Cir. 1999). Moreover, in conducting this review we are cautioned that "an ALJ's findings based on the credibility of the applicant are to be accorded great weight and deference, particularly since an ALJ is charged with the duty of observing a witness's demeanor and credibility." Frazier v. Apfel, No. 99-715, 2000 WL 288246, *9 (E.D. Pa. March 7, 2000) (quoting Walters v. Commissioner of Social Sec., 127 F.3d 525, 531 (6th Cir. 1997)); see also Casias v. Secretary of Health & Human Servs., 933 F.2d 799, 801 (10th Cir. 1991) ("We defer to the ALJ as trier of fact, the individual optimally positioned to observe and assess witness credibility."). Furthermore, in determining if the ALJ's decision is supported by substantial evidence the court may not parse the record but rather must scrutinize the record as a whole. Smith v. Califano, 637 F.2d 968, 970 (3d Cir. 1981).

B. Legal Standards Governing Assessment of Medical Treatment and Opinion Evidence

The Commissioner's regulations also set standards for the evaluation of medical evidence, and define medical opinions as "statements from physicians and psychologists or other acceptable medical sources that reflect judgments about the nature and severity of [a claimant's] impairment(s), including [a claimant's] symptoms, diagnosis and prognosis, what [a claimant] can still do despite impairments(s), and [a claimant's] physical or mental restrictions." 20 C.F.R. §§404.1527(a)(2); 416.927(a)(2) (effective Aug. 24, 2012, through Mar. 26, 2017).3 Regardless of its source, the ALJ is required to evaluate every medical opinion received. 20 C.F.R. §§404.1527(c); 416.927(c).

In deciding what weight to accord to competing medical opinions and evidence, the ALJ is guided by factors outlined in 20 C.F.R. §§404.1527(c) and 416.927(c). "The regulations provide progressively more rigorous tests for weighing opinions as the ties between the source of the opinion and the individual become weaker." SSR 96-6p, 1996 WL 374180 at *2. Treating sources have the closest ties to the claimant, and therefore their opinions generally are entitled to more weight. See 20 C.F.R. §§404.1527(c)(2); 416.927(c)(2) ("Generally, we give more weight to opinions from your treating sources . . ."); 20 C.F.R. §404.1502 (effective June 13, 2011, through Mar. 26, 2017) (defining "treating source"). Under some circumstances, the medical opinion of a treating source may even be entitled to controlling weight. 20 C.F.R. §§ 404.1527(c)(2); 416.927(c)(2); see also SSR 96-2p, 1996 WL 374188 (explaining that controlling weight may be given to a treating source's medical opinion only where it is well-supported by medically acceptable clinical and laboratory diagnostic techniques, and it is not inconsistent with the other substantial evidence in the case record).

Where no medical source opinion is entitled to controlling weight, the Commissioner's regulations direct the ALJ to consider the following factors, where applicable, in deciding the weight given to any non-controlling medical opinions: length of the treatment relationship and frequency of examination; nature and extent of the treatment relationship; the extent to which the source presented relevant evidence to support his or her medical opinion, and the extent to which the basis for the source's conclusions were explained; the extent to which the source's opinion is consistent with the record as a whole; whether the source is a specialist; and, any other factors brought to the ALJ's attention. 20 C.F.R. §§404.1527(c); 416.927(c).

At the initial level of administrative review, state agency medical and psychological consultants may act as adjudicators. See SSR 96-5p, 1996 WL 374183 at *4. As such, they do not express opinions; they make findings of fact that become part of the determination. Id. At the ALJ and Appeals Council levels of the administrative review process, however, findings by nonexamining state agency medical and psychological consultants should be evaluated as medical opinion evidence. 20 C.F.R. §§404.1527(e); 416.927(e) (effective Aug. 24, 2012, through Mar. 26, 2017). As such, ALJs must consider these opinions as expert opinion evidence by nonexamining physicians and must address these opinions in their decisions. SSR 96-5p, 1996 WL 374183 at *6. Opinions by state agency consultants can be given weight "only insofar as they are supported by evidence in the case record." SSR 96-6p, 1996 WL 374180 at *2. In appropriate circumstances, opinions from nonexamining state agency medical consultants may be entitled to greater weight than the opinions of treating or examining sources. Id. at *3.

Furthermore, as discussed above, it is beyond dispute that, in a social security disability case, the ALJ's decision must be accompanied by "a clear and satisfactory explication of the basis on which it rests." Cotter, 642 F.2d at 704. This principle applies with particular force to the opinions and treating records of various medical sources. As to these medical opinions and records: "Where a conflict in the evidence exists, the ALJ may choose whom to credit but `cannot reject evidence for no reason or the wrong reason.'" Plummer v. Apfel, 186 F.3d 422, 429 (3d Cir. 1999) (quoting Mason, 994 F.2d at 1066)); see also Morales v. Apfel, 225 F.3d 310, 317 (3d Cir. 2000).

Oftentimes, as in this case, an ALJ must evaluate medical opinions and records tendered by both treating and non-treating sources. Judicial review of this aspect of ALJ decision-making is guided by several settled legal tenets. First, when presented with a disputed factual record, it is well-established that "[t]he ALJ — not treating or examining physicians or State agency consultants — must make the ultimate disability and RFC determinations." Chandler v. Comm'r of Soc. Sec., 667 F.3d 356, 361 (3d Cir. 2011). Thus, "[w]here . . . the opinion of a treating physician conflicts with that of a non-treating, non-examining physician, the ALJ may choose whom to credit but `cannot reject evidence for no reason or for the wrong reason.'" Morales v. Apfel, 225 F.3d 310, 317 (3d Cir. 2000) (quoting Plummer, 186 F.3d at 429)). Therefore, provided that the decision is accompanied by an adequate, articulated rationale, it is the province and the duty of the ALJ to choose which medical opinions and evidence deserve greater weight.

In making this assessment of medical evidence:

Durden v. Colvin, 191 F.Supp.3d 429, 455 (M.D. Pa. 2016).

It is against these legal guideposts that we assess the ALJ's decision in the instant case.

C. The ALJ's Decision Does Not Provide Adequate Rationale for Discounting Treating Psychiatrist Dr. Shah's Opinion.

As we have observed, the regulations call for the consideration of all medical opinions; however, case law construing those regulations state a clear preference for the informed opinions of doctors who have actually treated or examined a claimant. Further, while the ALJ can choose upon which opinions to rely upon in making a decision, an ALJ's decision must be accompanied by "a clear and satisfactory explication of the basis on which it rests." Cotter v. Harris, 642 F.2d 700, 704 (3d Cir. 1981). Guided by these legal tenets, we recommend that this case be remanded since the ALJ's rationale for rejecting treating psychiatrist Dr. Shah's opinion that Newton was disabled is not adequately explained or supported on the administrative record in this case.

On this score, the ALJ states in his decision that he "gives little weight to the unsubstantiated opinion of Dr. Shah, dated June 22, 2011 that [Newton] is permanently and totally disabled (Exhibit B22F/1). As set forth above, [Newton's] mental status examinations were within normal limits and do not support Dr. Shah's opinion." (Tr. 822.) The Court finds that this is an insufficient explanation for rejecting this treating source opinion for multiple reasons.

First, the factual record simply does not support the ALJ's finding that Newton's mental status examinations were within normal limits. Quite the contrary, Dr. Shah, who treated Newton for his mental health problems over the course of years, consistently reported that Newton was hearing voices in her treatment notes. (Tr. 472-475; 477; 478-479; 481-483; 485-487; 489-490; 494-495; 497-500; 775; 779-781; 785, 1182.) Further, Dr. Shah also reported instances in which Newton experienced visual hallucinations, and described seeing shadowy figures. (Tr. 742, 473, 477, 486, 489, 497, 511.) These treatment notes also documented episodes of suicidal ideation by Newton. (Tr. 453, 497, 506, 511.) Further, the treatment records reflected that treating mental health professionals have assigned Global Assessment of Functioning, or GAF, scores for Newton which ranged between 48 and 60, GAF scores which were consistent with severe-to-moderate emotional impairment. (Tr. 447, 463, 479 and 775.)

Recognizing that Dr. Shah was Newton's treating psychiatrist, and that her treatment records revealed this cascading array of significant mental health symptoms, as well as the physician's statement finding that Newton was "permanently and totally disabled," the ALJ's decision to discount her opinion required more than the factually inaccurate one sentence explanation given by the ALJ. (Tr. 785; 822.) Newton's condition, as described in these treating notes, is not a "mental status" that the Court can accept as normal, and the ALJ erred in concluding that these were normal clinical findings. (Tr. 822.) In short, to sustain the ALJ's decision there needs to be substantial evidence to which the ALJ points that supports the choice to discount the opinion of a treating doctor/specialist. In this case we can find no such support relied upon by the ALJ. Therefore we conclude that the ALJ needs to further explain why Newton's auditory hallucinations, limited insight, and limited judgment, as noted by Dr. Shah, do not support Dr. Shah's opinion that Newton is disabled.

The need for further consideration of this medical evidence is further underscored by the fact that cases have frequently found that auditory hallucinations like those reportedly experienced by Newton constitute evidence of disabling impairments. See Bass v. Colvin, No. 3:14CV109, 2015 WL 1299266, at *1 (N.D. Ohio Mar. 23, 2015). Thus, far from demonstrating mental status examinations within normal limits, these treatment notes appear to document a potentially disabling impairment. Indeed, on this issue there is also an internal inconsistency in the ALJ's decision that warrants further consideration on remand since the ALJ's decision seems to discount these hallucinations while at the same time acknowledging the existence of these profound mental health symptoms. In his decision, the ALJ first notes that Newton's mental status examination by Dr. Shah "was normal except for the auditory hallucinations and limited insight and judgment." (Tr. 820)(emphasis added). Later in the ALJ's decision, however, the ALJ omits the material fact that Dr. Shah documented a history of hallucinations on Newton's part and discounts Dr. Shah's opinion that Newton is disabled because Newton's "mental status examinations were within normal limits." (Tr. 822.) Thus, the ALJ first acknowledged that Newton's mental status is not completely normal in one part of his decision, but later in this decision found that Newton's mental status was essentially normal when the ALJ rejected Dr. Shah's treating source opinion. This apparent inconsistency requires further consideration on remand.

In addition, we find another inconsistency in the ALJ's opinion concerning the weight the ALJ gave Dr. Lajeunesse's opinions regarding Newton's mental capabilities. As noted earlier, in stark contrast to Dr. Shah's treating source opinion which was given little weight, the ALJ gave Dr. Lajeunesse's opinions "moderate weight." (Tr. 823.) This presents an inconsistency in the ALJ's analysis because Dr. Lajeunesse's opinion that Newton had marked impairments, and Dr. Lajeunesse's opinion that Newton's GAF score was 50 were entirely consistent with Dr. Shah's opinion that Newton was disabled. Nonetheless, despite the fact that both opinions from the treating and examining medical sources seem to largely corroborate Newton's disability claim, the opinions are given differing weights, and both opinions' ultimate conclusions were discounted by the ALJ. Thus, the ALJ did not reconcile the differing weight given to these two largely consistent opinions or sufficiently explain why these medical opinions failed to support Newton's disability claim.4

Finally, having rejected the treating and examining source opinions for reasons we find to be insufficient, the ALJ decision did not point to any medical opinions that clearly contradicted Dr. Shah's opinion about Newton's disability status or that supported the ALJ's finding that Newton could work despite his severe mental impairments. The marked absence of any medical opinion evidence supporting these key conclusions made by the ALJ gives the impression that the ALJ may have impermissibly substituted his own interpretation of objective medical evidence for that of Dr. Shah's assessment, as corroborated by Dr. Lajeunesse. See Van Horn v. Schweiker, 717 F.2d 871, 874 (3d Cir. 1983); see Gunder v. Astrue, 2012 WL 511936, *15 (M.D.Pa. 2012). If the medical findings and lab results within the record can be interpreted as evidence of Newton's mental status being "normal", then the ALJ needs to provide a more fulsome explanation regarding how the evidence supports this finding.

In sum, taking all of these considerations into account, the Court concludes that the ALJ's decision to give little weight to Dr. Shah's opinion that Newton is disabled is not sufficiently supported by, or explained in the record. Therefore, the Court recommends that this case be remanded so that the ALJ can better explain his reasoning in his decision and further consider the evidence before him. Because the Court has found a clear basis for remand, we need not address Newton's remaining arguments. To the extent that any other error occurred, it may be remedied on remand. Finally, nothing in this Report and Recommendation should be deemed as expressing a judgment on what the ultimate outcome of any reassessment of this evidence should be. Rather, the task should remain the duty and province of the ALJ on remand.

IV. Recommendation

Accordingly, because we find that the ALJ's decision is not supported by substantial evidence, IT IS RECOMMENDED that Newton's request for a new administrative hearing should be GRANTED, the final decision of the Commissioner denying these claims should be vacated, and this case should be remanded to the Commissioner to conduct a new administrative hearing pursuant to sentence four of 42 U.S.C. §405(g) and 42 U.S.C. §1383(c)(3). IT IS FURTHER RECOMMENDED that final judgment should be entered in favor of Newton and against the Commissioner of Social Security.

The parties are further placed on notice that pursuant to Local Rule 72.3:

Failure to file timely Objections to the foregoing Report and Recommendation may constitute a waiver of any appellate rights.