ROBERT S. BALLOU, Magistrate Judge.
Plaintiff, John A. Hutton ("Hutton"), challenges the Social Security Commissioner's ("Commissioner") decision denying his application for supplemental security income ("SSI") benefits under the Social Security Act ("Act"). 42 U.S.C. §§ 1381-1383f. Specifically, Hutton alleges that the Administrative Law Judge ("ALJ") erred by improperly evaluating and weighing the consultative examiners' opinions and that the case should be remanded to the Commissioner to consider additional evidence submitted to the Appeals Council. I agree that the ALJ did not provide a sufficient explanation for the weight given to the consultative examiners' opinions. As such, I
This court limits its review to a determination of whether substantial evidence supports the Commissioner's conclusion that Hutton failed to demonstrate that he was disabled.
Hutton protectively filed for SSI on December 17, 2010, claiming that his disability began on January 10, 2010. R. 193-201. The Commissioner denied his application at the initial and reconsideration levels of administrative review. R. 72-87, 88-102. On February 14, 2013, ALJ Benjamin R. McMillion held a hearing to consider Hutton's disability claim. R. 39-71. Hutton was represented by an attorney at the hearing, which included testimony from Hutton and vocational expert Ashley Wells.
On March 27, 2013, the ALJ entered his decision analyzing Hutton's claim under the familiar five-step process
R. 26. The ALJ determined that Hutton could return to his past relevant work as a milker, and that Hutton also could work at jobs that exist in significant numbers in the national economy such as a textile manufacturing laborer/production worker, machine feeder/dryer attendant, and packager. R. 32-34. Thus, the ALJ concluded that he was not disabled. R. 34. On April 25, 2014, the Appeals Council denied Hutton's request for review (R. 1-6), and this appeal followed.
Hutton does not challenge the conclusion that he can engage in medium work with certain limitations. Rather, Hutton asserts that the ALJ and Appeals Council improperly reviewed his mental health evidence as it relates to his ability to interact with other people. Hutton first contends that the ALJ inaccurately evaluated and weighed the opinions of licensed clinical psychologists Angelia Berry, Psy.D. and Pamela S. Tessnear, Ph.D., both of whom performed consultative examinations. Hutton also asserts that the additional evidence from Dr. Tessnear and vocational expert John Newman submitted to the Appeals Council warrant remand. I find that the ALJ inadequately explained the basis for the weight assigned to the opinions of the consultative examiners, and thus, I cannot determine whether substantial evidence supports the ALJ's decision.
The ALJ assigned "great weight" to the consultative opinion of the functional limitations and abilities determined by Dr. Berry, but only "little weight" to the opinions of Dr. Tessnear. Hutton's primary issue on appeal is that the ALJ improperly discounted Dr. Tessnear's assessment of Hutton's ability to interact with other people, specifically coworkers and supervisors. Hutton argues that the opinions from both consultative examinations were relatively similar-except for how they described Hutton's ability to interact with other people; thus, the opinions of Dr. Tessnear should have received the same consideration to that of Dr. Berry.
Dr. Berry examined Hutton on March 28, 2011 and diagnosed him with bipolar disorder, anxiety disorder, cannabis dependence, intermittent explosive disorder, borderline intellectual functioning, and personality disorder. R. 343-49. She further described that she could not rule out that Hutton had schizoaffective and learning disorders.
Dr. Tessnear examined Hutton two years later on March 12, 2013 at the request of his attorney. R. 466-75. Dr. Tessnear diagnosed Hutton with mood disorder, anxiety disorder, personality disorder, and a history of polysubstance abuse. R. 474. Hutton had a GAF score of 50 at the time of the examination and functional limitations quite similar to those of Dr. Berry. R. 474-75. Regarding Hutton's ability to interact with other people, Dr. Tessnear wrote,
R. 475. The ALJ only gave Dr. Tessnear's conclusions and GAF assessment "little weight," citing them as inconsistent with her own clinical findings. R. 31-32. Specifically, the ALJ highlighted Hutton's ability to complete intake forms without assistance, his intact memory, his logical stream of thought, and his daily activities. R. 32. The ALJ also contends that her conclusions "fail[] to correlate functionally with other clinical findings in the record." R. 32.
When making an RFC assessment, the ALJ must assess every medical opinion received into evidence. 20 CFR § 404.1527(c). Under 20 CFR §§ 404.1527(c)(1) and 404.1527(c)(2), the opinion of a consultative examining source receives greater weight than a non-examining source. Similarly, the opinion of a treating source receives greater weight than that of a consultative examining source. Medical specialists who have examined a claimant generally are accorded more weight than a general medical examiner as well.
Dr. Berry's opinion, which was accorded great weight, appears similar both in observation and functional limitations to Dr. Tessnear's opinion accorded little weight. Drs. Berry and Tessnear diagnosed Hutton with anxiety disorder and personality disorder, along with each finding a slew of other mental disorders. R. 348, 474. Both Drs. Berry and Tessnear noted multiple psychiatric hospitalizations,
The functional assessments of both doctors also were comparable. Dr. Berry recommended limiting Hutton's work to simple directions and simple work-related decisions, noted "significant deficits interacting appropriately with others due to symptoms of anger and anxiety" and a mild impairment in his ability to cope with daily stressors, and articulated concern that all of the impairments could worsen during manic episodes. R. 348. Dr. Tessnear recommended limiting Hutton's work to simple instructions for periods of two hours, but further expressed caution about his poor judgment, lack of reliability, and "poor control of angry impulses" that prevents him from working with the public and strains relationships with coworkers. R. 475. Both doctors' recommended functional limitations are alike, with the exception that Dr. Tessnear separately addresses Hutton's interactions with the public and coworkers and suggests possibly more severe limitations. Although Dr. Berry discussed Hutton's interactions with others more generally, the court cannot discern why her discussion should be taken as only addressing the general public and not include coworkers and supervisors.
The ALJ stated he gave Dr. Tessnear's opinion little weight because it was inconsistent with her own clinical findings, highlighting Hutton's ability to complete intake forms without assistance, his intact memory, his logical stream of thought, and daily activities. R. 32. However, these same findings were made in Dr. Berry's examination that was accorded great weight. R. 343 ("Mr. Hutton was unaccompanied to the appointment and completed intake paperwork independently."), 346 ("Short and long-term memory was grossly intact."), 346 ("Thought content was logical and coherent."). Drs. Berry and Tessnear generally reviewed the same self-reported daily activities as well.
The record contains only two mental health records during the relevant period. On January 31, 2013, Hutton reported to Mount Rogers where he was diagnosed with mood disorder, personality disorder, cannabis abuse in remission, cocaine abuse in remission, and opioid abuse in remission. R. 462-64. He received treatment for outbursts of anger, severe anxiety around crowds of people, and interpersonal difficulties. R. 463. On February 28, 2013, Hutton did not attend his appointment at Mount Rogers (R. 465), which the ALJ interpreted as "suggest[ing] the claimant was doing fine." R. 29.
The ALJ did not address any of the evidence in the record before the relevant period of Hutton's mental health treatment. A review of that evidence shows that Hutton was hospitalized at the Southwestern Virginia Mental Health Institute ("Southwestern") in December 2005 and January 2006. R. 297-341. Suicidal ideations led to Hutton's hospitalization from December 19 through 22, 2005. R. 307. He was diagnosed at that time with major depression, benzodiazepine dependence, and cannabis abuse, and received GAF scores ranging from 30 to 50. R. 299-329. The record noted prior hospitalizations both at Southwestern and Saint Albans Hospital. R. 307, 325. On January 3, 2006, Hutton was hospitalized at Southwestern under to a Temporary Detention Order. He was diagnosed with adjustment disorder with depressed mood and a personality disorder. R. 330-39. Hutton explained during this hospitalization "that he often impulsively thinks of killing himself when he gets angry." R. 337. Hutton was discharged the next day after the magistrate dismissed the detention order and the staff found no evidence of depression. R. 337.
The state agency psychologists' who reviewed Hutton's mental health records recommended limitations similar to both Dr. Berry's and Dr. Tessnear's opinions. On April 19, 2011, Linda Dougherty, Ph.D. determined Hutton faced marked limitations in his ability to work in coordination with or in proximity to others without being distracted by them. R. 82. Dr. Dougherty explained that "Claimant has a long history of being unable to get along with others, reportedly, as a result of excessive anger." R. 83. She further found that Hutton had moderate limitations in his ability (1) to interact appropriately with the general public, (2) to accept instructions and respond appropriately to criticism from supervisors, and (3) to get along with coworkers or peers without distracting them or exhibiting behavioral extremes. R. 83.
In a report dated September 14, 2011, state agency psychologist Stephanie Fearer, Ph.D. assessed Hutton as having moderate limitations (1) working in coordination or proximity to others without being distracted by them, (2) interacting appropriately with the general public, (3) accepting instructions and responding appropriately to criticism from supervisors, and (4) getting along with coworkers or peers without distracting them or exhibiting behavioral extremes. R. 98-99. Dr. Fearer explained that "Claimant has a long history of being unable to get along with others, reportedly as a result of excessive anger. CE examiner notes cl[aimant] is likely to experience significant deficits interacting appropriately with others due to symptoms of anger and anxiety." R. 99. Dr. Fearer summarized at the end of her opinion that "while his impairments cause moderate limitations in his ability to remember and carry out detailed instructions, maintain sustained concentration for extended periods, interact well with others, and adapt to the workplace, he is capable of performing simple routine work in an environment requiring limited contact with the public." R. 100. Although the state agency psychologists' recommend limitations and comments run parallel to those of Dr. Tessnear, the ALJ accorded their opinions great weight-compared to Dr. Tessnear's little weight-because their opinions were consistent with the record describing Hutton's long-term conditions, treatment history, and limitations. R. 32.
The crux of the problem in this case is the limited to nonexistent reasoning from the ALJ as to why he assigned such limited weight to the opinions of Dr. Tessnear despite assigning great weight to similar medical opinions. Dr. Tessnear, Dr. Berry, and the two state agency psychologists reached similar conclusions regarding Hutton's impairments and determined that he faced significant limitations in his interactions with others. All four medical opinions addressed Hutton's challenges managing relationships in the workplace. The ALJ appears to have discounted the state agency psychologists' findings of Hutton's moderate limitations interacting with supervisors and coworkers, and assumed without any basis that Dr. Berry's finding of Hutton's "significant deficits interacting appropriately with others" did not include coworkers or supervisors. Given that every medical opinion mentioned Hutton's challenges with workplace relationships, the ALJ needed to offer an explanation to justify his exclusion of this limitation in general, and particularly in Dr. Tessnear's opinion.
The Commissioner invites the court to infer that Dr. Berry's opinion that Hutton experiences "significant deficits interacting appropriately with others" equates to occasional interaction with the general public; such an inference does not permit the court to review why Dr. Tessnear's opinion was not accepted on the whole and does not appear to have any support in Dr. Berry's opinion. Although the court reviews the ALJ's decision under the substantial evidence standard, the ALJ still must provide a sufficient explanation of the conclusions reached to allow the court to conduct a meaningful review on appeal. Substantial evidence does not support the ALJ's finding that Dr. Tessnear's conclusions did not align with other clinical findings, particularly where Dr. Berry, the state agency psychologists, and the treatment record note that Hutton has limitations dealing with supervisors and coworkers. If the ALJ disagrees with Dr. Tessnear's particular conclusion about Hutton's ability to work with the general public, supervisors, or coworkers, then he must provide an explanation that allows meaningful review.
The court cannot determine why the ALJ chose not to include a limitation about interacting with coworkers and supervisors in Hutton's RFC. Dr. Fearer found that Hutton should have limited interaction with the public. Both Dr. Fearer and Dr. Dougherty found that Hutton had moderate limitations in his interactions with coworkers and supervisors. Dr. Berry concluded that Hutton "experience[d] significant deficits interacting appropriately with others." The ALJ simply provided no explanation why, despite several opinions explaining Hutton's difficulty interacting with supervisors and coworkers, the RFC provided no corresponding limitation. The ALJ's explanation for discounting Dr. Tessnear's opinion, and how the medical opinions influenced the RFC, does not allow for meaningful review and thus requires remand.
Hutton contends that his claim should be remanded for further administrative consideration based upon additional evidence submitted to the Appeals Council. Hutton provided the March 23, 2013 addendum from Dr. Tessnear clarifying her opinion and the September 9, 2013 questionnaire from vocational expert John Newman that concludes Hutton is precluded from employment. R. 296, 481-82. The Appeals Council accepted the additional evidence and considered it with the rest of the record, but "found that this information does not provide a basis for changing the Administrative Law Judge's decision." R. 2. I find that this evidence does not warrant remand.
Dr. Tessnear completed the addendum based on her March 12, 2013 consultative examination of Hutton. R. 481. She dated the addendum on March 23, 2013, only days prior to the ALJ's decision. Dr. Tessnear determined that Hutton experienced moderate limitations in his ability to get along with coworkers and peers, marked limitations in his ability to interact appropriately with the general public, and marked limitations in his ability to respond appropriately to criticism from supervisors. R. 481. Dr. Tessnear further determined that Hutton faced marked limitations in making decisions and using good judgment without special supervision, and moderate limitations in performing activities within a schedule, maintaining regular attendance, and being punctual. R. 481. She related these limitations to the date of Hutton's application for SSI benefits. R. 481.
Mr. Newcomb completed his opinion as a vocational expert on September 9, 2013. The opinion consisted of a checkbox question asking whether Hutton could work based on Dr. Tessnear's March 12, 2013 evaluation and March 23, 2013 supplemental addendum. R. 296. Mr. Newcomb determined Hutton could not work, and offered the following explanation: "According to Dr. Tessnear, Mr. Hutton's inability to respond appropriately to supervision and his inability to make judgments incommensurate with unskilled work will either separately or collectively preclude competitive employment." R. 296.
The regulations permit a claimant to submit "new and material evidence" to the Appeals Council. Evidence is new if it is not duplicative or cumulative; it is material if there is a reasonable possibility it would have changed the outcome of the Commissioner's decision.
This Court must "review the record as a whole, including the new evidence, in order to determine whether substantial evidence supports the [Commissioner's] findings."
In this case, the Appeals Council's consideration of the additional evidence and denial of further review met its obligations under the agency's regulations. Hutton has the burden of demonstrating that a remand is appropriate given any new and material evidence.
Dr. Tessnear's and Mr. Newcomb's opinions are not material and thus would not have changed the ALJ's decision. The ALJ gave Dr. Tessnear's opinion little weight; although this court finds that the ALJ should have provided a more thorough explanation as to why he disregarded her opinion, Dr. Tessnear's addendum does not add information unavailable in her prior reviewed opinion or speak to the reasons for why the ALJ discredited her opinion. Dr. Tessnear's addendum is only a checkbox questionnaire based on her report submitted to the ALJ. Courts in the Fourth Circuit have recognized the limited probative value of such checkbox opinion forms.
Even if Dr. Tessnear's and Mr. Newcomb's opinions offered new material information, courts are reticent to remand on the basis of clarifying opinions submitted to the Appeals Council.
The records submitted to the Appeals Council contribute no new evidentiary value to the record. As such, the evidence is not material and remand is not warranted on this basis alone.
For the foregoing reasons, it is
The Clerk is directed to transmit the record in this case to Glen E. Conrad, Chief United States District Judge, and to provide copies of this Report and Recommendation to counsel of record. Both sides are reminded that pursuant to Rule 72(b), they are entitled to note any objections to this Report and Recommendation within fourteen (14) days hereof. Any adjudication of fact or conclusion of law rendered herein by me that is not specifically objected to within the period prescribed by law may become conclusive upon the parties. Failure to file specific objections pursuant to 28 U.S.C. § 636(b)(1)(C) as to factual recitations or findings as well as to the conclusion reached by me may be construed by any reviewing court as a waiver of such objection.
