DAVID C. NORTON, District Judge.
This matter is before the court on Magistrate Judge Mary Gordon Baker's Report and Recommendation ("R&R") that the court reverse Acting Commissioner of Social Security Andrew Saul's (the "Commissioner") decision denying claimant Tammy Putnam's ("Putnam") application for disability insurance benefits ("DIB") under the Social Security Act (the "Act"). The Commissioner filed objections to the R&R. For the reasons set forth below, the court reviews the action
Unless otherwise noted, the following background is drawn from the R&R.
Putnam filed an application for DIB on December 24, 2014, alleging an onset disability date of September 30, 2013. The Social Security Administration ("the Agency") denied Putnam's application both initially and on reconsideration. Putnam requested a hearing before an administrative law judge ("ALJ"), and ALJ Colin Fritz presided over a hearing held on August 2, 2017. In a decision issued on January 5, 2018, the ALJ determined that Putnam was not disabled within the meaning of the Act. Putnam requested Appeals Council review of the ALJ's decision on February 28, 2018. This decision became the final decision of the Commissioner when the Appeals Council denied further review on November 8, 2018.
On December 20, 2018, Putnam filed this action seeking review of the ALJ's decision. ECF No. 1. Magistrate Judge Baker issued an R&R on October 10, 2019, recommending that this court reverse the ALJ's decision and remand the matter back to the Commissioner. ECF No.15. The Commissioner filed an objection to the R&R on October 24, 2018, ECF No. 16, and supplemented his objection on October 28, 2018, ECF No. 18. Putnam responded on November 7, 2019, ECF No. 19. The matter is now ripe for review.
Because the parties are familiar with Putnam's medical history, the court dispenses with a lengthy recitation thereof and instead briefly recounts those facts material to its review of the Commissioner's objections to the R&R. Prior to her alleged disability onset date, Putnam worked for Clemson University as a utility database administrator. Putnam took an extended leave from work in September of 2013 due to issues with her spine and neck. When she expended the time allotted to her for medical leave, Putnam stopped work entirely. Over the next few years, Putnam struggled with medical issues related to her neck, back, and shoulder, as well as with anxiety and depression. During that time, Putnam was diagnosed with, among others, lumbar degenerative disc disease, shoulder impingement, headaches, neuralgia, arthropathy, cervical radiculitis, and obesity.
The Social Security Act defines "disability" as the "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 12 months." 42 U.S.C. § 423(d)(1)(A); 20 C.F.R. § 404.1505. The Social Security regulations establish a five-step sequential evaluation process to determine whether a claimant is disabled.
To determine whether Putnam was disabled from her alleged onset date of September 30, 2013 until August 2, 2017, the date of Putnam's hearing, the ALJ employed the statutorily required five-step evaluation process. At step one, the ALJ found that Putnam did not engage in substantial gainful employment during the period between her alleged onset date and her date of last insured. Tr. 37. At step two, the ALJ determined that Putnam suffered from the severe impairments of status-post cervical fusion, lumbar degenerative disc disease, left shoulder impingement, headaches, and obesity. Tr. 37-38. At step three, the ALJ found that Putnam's impairments or combination thereof did not meet or medically equal one of the impairments listed in the Agency's Listing of Impairments. Tr. 38-39. Before reaching the fourth step, the ALJ determined that Putnam retained the residual functional capacity ("RFC") to "perform light work as defined in 20 CFR [§] 404.1567(b)," noting that "over the course of an 8-hour workday, in 2-hour increments with normal and acceptable work breaks," Putnam can
Tr. 39-40. The ALJ found, at the fourth step, that Putnam was unable to perform her past relevant work as an administrative assistant or billing supervisor. Tr. 44. However, at step five, the ALJ determined that, based on her RFC, Putnam can perform jobs that exist in significant numbers in the national economy. Tr. 44-46. Therefore, the ALJ concluded that Putnam was not disabled under the meaning of the Act during the period at issue. Tr. 46.
This court is charged with conducting a
Judicial review of the Commissioner's final decision regarding disability benefits "is limited to determining whether the findings of the [Commissioner] are supported by substantial evidence and whether the correct law was applied."
Although the district court's role is limited, "it does not follow . . . that the findings of the administrative agency are to be mechanically accepted. The statutorily granted review contemplates more than an uncritical rubber stamping of the administrative action."
Before turning to the substantive issues of this action, the court must resolve the unique procedural predicament this matter presents. Putnam's action seeking review of the final decision of the Commissioner, first presented to Magistrate Judge Baker, alleged two errors by the ALJ that she claimed warranted reversal. First, Putnam argued that the ALJ erred in relying on testimony from the Vocational Expert ("VE") that was inconsistent with information in the Dictionary of Titles ("DOT") without sufficiently explaining the discrepancy. Second, Putnam argued that the ALJ failed to properly evaluate the opinion evidence of her physicians. Considering the former allegation of error, the R&R noted the well-settled Fourth Circuit precedent that "an ALJ has not fully developed the record if it contains an unresolved conflict between the VE's testimony and the DOT." ECF No. 15 at 8 (citing
The Magistrate Judge filed the R&R on October 10, 2019. On October 24, 2019, the Fourth Circuit resolved the split among the district courts when it issued its opinion in
On October 28, 2019, the Commissioner filed a supplement to his objection, arguing that
28 U.S.C. § 636 outlines the procedure as it relates to a district court's review of a Magistrate Judge's R&R:
28 U.S.C. § 636. "While [§ 636] does not require the judge to review an issue
Here, justice demands a
In her second allegation of error, Putnam argues that the ALJ improperly evaluated the medical opinions her treating primary care physician, Dr. Miller, and a consultative examiner, Dr. Rogers. Putnam contends that the ALJ erred in the process of evaluating the opinions as well as in his finding that the opinions did not warrant great weight. In response, the Commissioner argues that the ALJ's assignments of weight to Putnam's physicians' opinions were based upon the correct legal standard and supported by substantial evidence. Because the ALJ's assignment of little weight to Dr. Miller's opinion is not supported by substantial evidence, his evaluation of the medical opinion evidence constitutes error and warrants reversal.
Medical opinions are "statements from acceptable medical sources that reflect judgments about the nature and severity of [] impairment(s), including [] symptoms, diagnosis and prognosis, what [a claimant] can still do despite impairment(s), and [] physical or mental restrictions." 20 C.F.R. § 404.1527(a)(1).
Under the "treating physician rule," the opinion of a claimant's treating physician is generally entitled to significant weight in the determination of disability.
Dr. Miller articulated several medical findings in his opinion, each of which is either partially or wholly contrary to the ALJ's determination of Putnam's RFC. Dr. Miller opined that (1) Putnam cannot lift more than ten pounds; (2) Putnam cannot squat, stoop, or climb; (3) Putnam cannot sit for more than an hour without rest; (4) Putnam cannot walk more than 100 yards without back pain; and (5) Putnam's limitations and symptoms prevent her from returning to work activity.
There is no dispute that Dr. Miller is Putnam's primary physician such that his opinion triggers the treating physician rule's deferential evaluation standard. Indeed, the ALJ noted that Dr. Miller is Putnam's "primary care provider" who has treated her for "8-10 years." Tr. 41. Nevertheless, the ALJ departed from the treating physician rule and afforded Dr. Miller's medical opinion little weight
As one of the bases for according little weight to Dr. Miller's opinion, the ALJ explained that the opinion lacks a "function-by-function" analysis. The court is perplexed by this ground because it is both based upon an incorrect legal standard and, even if the "function-by-function" standard were applicable here, unsupported by the substantial evidence.
The Social Security Rulings emphasize that an ALJ's:
SSR 96-8p, 1996 WL 374184, at *1. The Fourth Circuit has held that "remand may be appropriate . . . where an ALJ fails to assess a claimant's capacity to perform relevant functions[]."
The ALJ's notion that a treating physician's opinion is entitled to less weight because it fails to articulate a function-by-function analysis lacks any legal or logical support. SSR 96-8 imposes a requirement upon the ALJ; the ALJ's attempt to impose SSR 96-8 upon a treating physician is deeply troubling. There is no requirement in the regulations or elsewhere that a physician must justify his medical findings or his diagnoses to an ALJ through the articulation of a function-by-function analysis. In his briefs, the Commissioner cites to no law that might suggest that an ALJ may evaluate a treating physician's opinion on this ground, and the court is confident that no such law exists. An ALJ may not mandate the methods by which a physician reaches his or her medical opinions. Therefore, the court finds that a physician's failure to articulate a function-by-function justification of his opinion is not a proper ground for an ALJ to discredit that physician's opinion.
Perhaps even more baffling, although not required by any law, Dr. Miller's opinion does in fact include a function-by-function analysis. Paragraph (b) of 20 CFR 404.1545 lists out applicable functions that an ALJ must include in her analysis of a claimant's RFC, including "sitting, standing, walking, lifting, carrying, pushing, pulling, or other physical functions (including manipulative or postural functions, such as reaching, handling, stooping or crouching)." Although Dr. Miller's ultimate opinion— that Putnam's limitations prevent her from working—is conclusive, his opinion includes a function-by-function analysis justifying that conclusion. Dr. Miller notes Putnam's limitations with respect to her ability to lift more than ten pounds, squat, stoop, climb, sit for extended periods of time, and walk extended distances. These are the very functions contemplated by paragraph (b) of 20 CFR 404.1545. Therefore, the court finds that the ALJ's evaluation of Dr. Miller's opinion was based on an improper standard of law and contrary to the substantial evidence.
Second, the ALJ afforded little weight to the opinion of Dr. Miller because it "renders a conclusion that is reserved solely to the Commissioner." Tr. 43. The regulations provide that "[o]pinions on some issues . . . are not medical opinions . . . but are, instead, opinions on issues reserved to the Commissioner because they are administrative findings that are dispositive of a case," such as "a statement by a medical source that [a claimant is] `disabled' or `unable to work'." 20 C.F.R. § 404.1527.
To be sure, the regulations make clear that the issue of Putnam's ability to work requires an administrative finding reserved solely to the Commissioner. Dr. Miller did opine that Putnam is not capable of returning to work activities based on her impairments. Tr. 728. This opinion fits squarely within the type of conclusory opinion that 20 C.F.R. § 404.1527 reserves to the Commissioner and allows an ALJ to disregard. However, § 404.1527 does not give the ALJ any grounds for discrediting Dr. Miller's medical opinions related to Putnam's functional capacity. The ALJ's ability to discredit a treating physician's conclusory administrative opinion does not give him grounds to discredit that physician's non-administrative, medical findings. 20 C.F.R. § 404.1527 does not provide the ALJ with a proper ground to discredit opinions of Dr. Miller, other than his opinion that Putnam is unable to work due to her limitations. His failure to give controlling weight to Dr. Miller's other medical findings remains without legal justification.
Finally, the ALJ assigned Dr. Miller's opinion little weight because "the severity of the limitations are [sic] not supported by the longitudinal medical record." Tr. 43. Specifically, the ALJ pointed to perceived inconsistencies within the medical record to determine that Dr. Miller's opinion was not credible. An ALJ may depart from the treating physician rule and accord a treating physician's opinion little weight only in the face of "persuasive contradictory evidence."
"An ALJ has the obligation to consider all relevant medical evidence and cannot simply cherrypick facts that support a finding of nondisability while ignoring evidence that points to a disability finding."
The ALJ pointed to several pieces of the record as inconsistent with Dr. Miller's opinion: (1) an improvement in Putnam's symptoms after a March 2014 cervical discectomy; Tr. 436-437; (2) a note that degenerative deficits in her spine did not merit surgery in March of 2015, Tr. 645-47; (3) notes of normal leg-raising and strength tests, Tr. 735; and (4) instances in Putnam's physician's notes that refer to normal conditions or symptom improvements, Tr. 642, 645. None of these isolated pieces of evidence persuasively contradict the medical opinions of Dr. Miller. Just as numerous in the record, and often within the same reports on which the ALJ relied, is evidence of failed strength tests, diagnoses of severe conditions, MRIs indicating spinal diseases, failures of conservative treatment measures, reports of debilitating pain, and recommendations of surgery, among other evidence that weighs in favor of a finding of disability.
As the law makes clear, an ALJ cannot dredge up a physician's notations of positive aspects of a patient's health as a basis for rejecting his or her conclusions. Surely, the ALJ is not in a position to conclude that Putnam can lift a certain amount of weight based on, for example, the fact that her condition didn't warrant surgery in March of 2015. A medical provider is in a substantially better position to consider and interpret the comprehensive medical record, including consideration of the "inconsistencies" noted by the ALJ, and render a medical conclusion. Just as an ALJ may not point to one healthy tissue of a claimant's lung and conclude that a physician's diagnosis of black lung is unsupported, he may not point to a healthy body function as evidence that a treating physician's opinion is incorrect. The treating physician rule is founded upon the recognition that a treating physician can more effectively analyze the medical record and render a medical opinion than an ALJ. Therefore, the court finds that the ALJ's evaluation of Dr. Miller's opinion is based on an improper standard of law and against the substantial evidence.
Finally, the ALJ noted that Dr. Miller's opinions are recorded in "an attorney-drafted questionnaire." Tr. 43. This is not a proper consideration in evaluating the opinion of a treating physician.
"The purpose for which medical reports are obtained does not provide a legitimate basis for rejecting them. The Ninth Circuit has found that "[a]n examining doctor's findings are entitled to no less weight when the examination is procured by the claimant than when it is obtained by the Commissioner."
Because the court finds the ALJ's mistreatment of the Dr. Miller's opinion a sufficient basis to remand the case to the Commissioner, the Court declines to specifically address Putnam's additional allegation of error by the ALJ. However, upon remand, the Commissioner should take into consideration Putnam's remaining allegation of error and analyze the opinion of Dr. Rogers according to the framework provided in 20 C.F.R. § 404.1527(c).
For the foregoing reasons the court