CHARLES S. COODY, Magistrate Judge.
On May 6, 2011, Plaintiff Eric Daniels protectively filed a Title II application for a period of disability and disability benefits and a Title XVI application for supplemental security income, alleging he became disabled on March 1, 2011. (R. 19, 134-44, 169). The applications were denied initially and on reconsideration (R. 71-84, 87-88). Daniels then requested a hearing by an administrative law judge (ALJ). Following a hearing held on January 16, 2013 (R. 45-70), ALJ Michael D. Anderson issued a decision denying the claim on April 25, 2013. (R. 19-40). The Appeals Council denied Daniels's subsequent request for review (R. 1-6). The ALJ's decision consequently became the final decision of the Commissioner of Social Security ("Commissioner").
Under 42 U.S.C. § 423(d)(1)(A) a person is entitled to disability benefits when the person is unable to
To make this determination
McDaniel v. Bowen, 800 F.2d 1026, 1030 (11th Cir. 1986).
The standard of review of the Commissioner's decision is a limited one. This court must find the Commissioner's decision conclusive if it is supported by substantial evidence. Graham v. Apfel, 129 F.3d 1420, 1422 (11th Cir. 1997); 42 U.S.C. § 405(g). "Substantial evidence is more than a scintilla, but less than a preponderance. It is such relevant evidence as a reasonable person would accept as adequate to support a conclusion." Richardson v. Perales, 402 U.S. 389, 401 (1971). A reviewing court may not look only to those parts of the record which supports the decision of the ALJ, but instead must view the record in its entirety and take account of evidence which detracts from the evidence relied on by the ALJ. Hillsman v. Bowen, 804 F.2d 1179 (11th Cir. 1986).
Walker v. Bowen, 826 F.2d 996, 999 (11th Cir. 1987).
The ALJ found that Daniels has the following severe impairments: Major Depression, Post Traumatic Stress Disorder, and a history of Alcohol, Cocaine, and Cannabis abuse and dependence. (R. 22). The ALJ concluded that these impairments, including the substance abuse disorders, meet or medically equal the listings found in section 12.09 (substance addiction disorders) and 12.04 (affective disorders) of 20 CFR Part 404, Subpart P, Appendix 1. (R. 22-23). The ALJ determined that, in the absence of substance abuse, Daniels's remaining limitations would be severe but would not meet or medically equal any of the listed impairments in 20 CFR Part 404, Subpart P, Appendix 1. (R. 23-24). Further, the ALJ determined that, "[i]f the claimant stopped the substance use, and with medication compliance and treatment, the claimant would have the residual functional capacity to perform medium work as defined in 20 CFR 404.1567(c) and 416.967(c)," with certain limitations. (R. 25). The ALJ determined that, if he stopped substance use, Daniels would not be able to perform his past relevant work (R. 38), but that he would be able to perform other jobs that exist in significant numbers in the national economy. (R. 39). The ALJ concluded that Daniels was not disabled within the meaning of the Social Security Act because his substance abuse disorder is a contributing factor material to the determination of disability and he would not be disabled if he stopped the substance abuse.
Daniels presents the following issues for review:
1. Whether the ALJ committed reversible error by improperly rejecting the opinion of Daniels's treating psychiatrist; and
2. Whether the ALJ erred by ignoring portions of the opinion of a consulting physician.
(Doc. 12 pp. 5, 13).
A disability claimant bears the initial burden of demonstrating an inability to return to his past work. Lucas v. Sullivan, 918 F.2d 1567 (11 th Cir. 1990). In determining whether the claimant has satisfied this burden, the Commissioner is guided by four factors: (1) objective medical facts or clinical findings, (2) diagnoses of examining physicians, (3) subjective evidence of pain and disability, e.g., the testimony of the claimant and his family or friends, and (4) the claimant's age, education, and work history. Tieniber v. Heckler, 720 F.2d 1251 (11th Cir. 1983). The ALJ must conscientiously probe into, inquire of and explore all relevant facts to elicit both favorable and unfavorable facts for review. Cowart v. Schweiker, 662 F.2d 731, 735-36 (11th Cir. 1981). The ALJ must also state, with sufficient specificity, the reasons for his decision referencing the plaintiff's impairments.
42 U.S.C. § 405(b)(1).
An individual is not considered "disabled" for purposes of social security disability insurance or supplemental security income if alcoholism or drug addiction is "a contributing factor material to the Commissioner's determination that the individual is disabled." 2 U.S.C. § 423(d)(2)(C); 42 U.S.C. § 1382c(a)(3)(J). Therefore, when the ALJ finds that a claimant is disabled and there is medical evidence of drug addiction or alcoholism, the ALJ must determine whether the drug addiction or alcoholism is a contributing factor material to the determination of disability. 20 C.F.R. §§ 416.935(a); 404.1535(a). The key factor in determining whether alcoholism is a contributing factor material to the determination of a disability (the "materiality determination") is whether the claimant would still be found disabled if he stopped using drugs or alcohol. 20 C.F.R. §§ 416.935(b)(1); 404.1535(b)(1). The ALJ makes this determination by first evaluating which of the claimant's physical and mental limitations would remain if the claimant stopped using drugs or alcohol. 20 C.F.R. §§ 416.935(b); 404.1535(b). The ALJ then must determine whether any or all of the remaining limitations would be disabling; if the remaining limitations are not disabling, then the ALJ must find that the claimant's drug addiction or alcoholism is a contributing factor material to the determination of disability. 20 C.F.R. §§ 416.935(b); 404.1535(b). However, if the ALJ determines that the remaining limitations would be disabling, the ALJ must conclude that the claimant is "disabled independent of [his] . . . alcoholism and . . . [his] . . . alcoholism is not a contributing factor material to the determination of disability." 20 C.F.R. §§ 416.935(b); 404.1535(b).
As noted in the ALJ's opinion, Daniels has an extensive history of treatment for depression, post-traumatic stress disorder, and substance abuse. In February 2012, during a time when he had relapsed and was not compliant with his mental health treatment (R. 1039-40, 1046, 1058), one of Daniels's treating physicians, Dr. Margaret Bok, opined that he was unable to work a full time job due to major depression, PTSD, and polysubstance abuse, though he had been "sober since June" with "sobriety off and on." (R. 888). On January 24, 2013, during another period when Daniels had relapsed and was not compliant with his mental health treatment, Dr. Bok completed a mental residual functional capacity assessment form in which she opined that, as a result of his "current psychiatric/psychological impairment[s]," Daniels had marked limitations in the following functional abilities: ability to relate to other people; ability to maintain concentration, pace and attention for extended periods of at least 2 hours; ability to sustain a routine without special supervision; ability to perform activities within a schedule, maintain regular attendance, and be punctual; understand, carry out and remember instructions; respond appropriately to supervision; respond appropriately to co-workers; respond to customary work pressures; respond appropriately to changes in the work setting; use good judgment on the job; perform complex, repetitive, or varied tasks, and behave in an emotionally stable manner. (R. 1024-25). In support of her opinion, Dr. Bok cited Daniels's history of quitting jobs or being fired and noted that he "cannot cope with stress." (R. 1025). She opined that drug and alcohol abuse were material factors regarding Daniels's mental condition, that Daniels had sustained no permanent damage as a result of drug and alcohol abuse, and that, if drug and alcohol use were to stop, there would be no change in Daniels's functional limitations. (R. 1025).
In his opinion, the ALJ stated that he "agree[d] with Dr. Bok's opinion that the claimaint's drug and alcohol use is a material factor regarding his mental condition. However [the ALJ did] not agree with her opinion that the claimant's level of functioning would not improve in the absence of substance abuse." (R. 35).
Daniels argues that the ALJ erred in rejecting Dr. Bok's opinion that the marked limitations reflected in her residual functional capacity assessment would persist in the absence of substance abuse. Daniels contends that, because Dr. Bok is his treating physician, her February 2012 opinion about his ability to work and her January 2013 opinion regarding his residual functional capacity in the absence of substance abuse are entitled to great weight unless good cause is shown to the contrary. It is true that the medical opinion of a treating physician is entitled to substantial or controlling weight unless the ALJ articulates good cause for rejecting that opinion. See 20 C.F.R. §§ 404.1527(c)(2), 416.927(c)(2); Lewis v. Callahan, 125 F.3d 1436, 1440 (11th Cir. 1997). However, a treating physician's opinions on legal issues that are reserved to the Commissioner are not considered medical opinions and are not entitled to any special weight. 20 C.F.R. §§ 404.1527(d), 416.927(d). Issues reserved to the Commissioner include opinions that the claimant is "disabled" or "unable to work" and opinions regarding the claimant's residual functional capacity. 20 C.F.R. §§ 404.1527(d), 416.927(d). Thus, Dr. Bok's opinion regarding Daniels's ability to work and his residual functional capacity in the absence of substance abuse is not a "medical opinion" and is not entitled to any special weight.
Although the Commissioner is the final authority for determining a claimant's residual functional capacity and whether the claimant can work, the Commissioner is required to consider "all of the medical findings and evidence that support a medical source's statement" that a claimant is unable to work, as well as all medical source opinions regarding the claimant's residual functional capacity. 20 C.F.R. §§ 404.1527(d), 416.927(d). The ALJ did so in this case, as is reflected in the ALJ's thorough discussion of the extensive evidence in this case, including Dr. Bok's opinions.
The ALJ noted that Dr. Bok's February 2012 opinion that Daniels had permanent conditions that prevented him from being able to work at full-time job was entitled to "little weight regarding Daniels's ability to work during periods of sobriety" because that opinion was inconsistent with Dr. Bok's own records, including the fact that Dr. Bok consistently assigned Daniels a Global Assessment Score (GAF) of 55, which is reflective of moderate symptoms and moderate functional limitations. (R. 34). The court notes that, in her February 2012 opinion, Dr. Bok specifically stated that one of the permanent medical conditions that prevented Daniels from being able to work was "polysubstance abuse" "sober since June — sobriety off and on." (R. 888). Thus, Dr. Bok's February 2012 opinion is not a statement of Daniels's ability to work in the absence of substance abuse, and there is no error in the ALJ's conclusion that the opinion was due "little weight regarding the claimant's ability to work during periods of sobriety." (R. 34) (emphasis added). In fact, the ALJ's opinion is in complete agreement with Dr. Bok's February 2012 opinion that Daniels is disabled when all of his impairments, including substance abuse, are considered. (R. 22-24; R. 888). See 20 C.F.R. §§ 416.935(b)(1); 404.1535(b)(1) (providing that the key factor in determining whether alcoholism is a contributing factor material to the determination of a disability is whether the claimant would still be found disabled if he stopped using drugs or alcohol).
The ALJ provided the following specific reason for rejecting Dr. Bok's January 2013 opinion regarding Daniel's residual functional capacity in the absence of substance abuse:
(R. 34-35).
As noted by the ALJ and confirmed by Dr. Bok's treatment notes, the record does contain evidence that Daniels's level of functioning improved with sobriety. For example, as noted by the ALJ (R. 28), on June 9, 2010, Daniels reported that he had been free of alcohol and illicit drugs and that his depression medicine helped him with motivation. (R. 315). Although he had recently relapsed to substance abuse and quit his post-secondary education program, on June 9, 2010 he was interested in obtaining a letter from his doctor that would allow him to return to school. (R. 315, 317). The ALJ noted that mental health treatment notes from August 2011 through February 2012, a period in which Daniels maintained sobriety, indicated that Daniels experienced improvement in his condition. (R. 28, 34). In August 2011, Daniels moved in with his father, reported that he was doing well, was keeping himself busy by cutting grass and doing yard work and other odd jobs, and planned to make money by cutting hair. (R. 814). Further, as the ALJ noted (R. 33-34, 37), two consultative examinations were performed while Daniels had been sober for substantial periods of time, and these examinations reflected much more moderate limitations than those assigned by Dr. Bok, whose January 2013 residual functional capacity assessment was completed during a period when Daniels had relapsed and was not compliant with his mental health treatment. In fact, as the ALJ noted, prior to January 2013, Dr. Bok had last seen Daniels in February 2012, and, in January 2013, Daniels had been drinking daily, used marijuana and cocaine, and had not taken any mental health medications in over two months. (R. 1044, 1047, 1051, 1058-59). Notations in Dr. Bok's own records consistently assigned Daniels GAF scores of 55 during periods of sobriety, which were consistent with moderate functional limitations and inconsistent with Dr. Bok's residual functional capacity assessment.
The court has independently reviewed the record and finds that it contains substantial support for the ALJ's conclusions regarding Daniels's residual functional capacity and improved functioning in the absence of substance abuse. This record documents a recurrent cycle in which Daniels's functioning improves with mental health treatment compliance and sobriety. However, when Daniels is noncompliant with his mental health treatment and relapses into substance abuse, he experiences increased symptoms of depression and PTSD, as well as significant impairment in functioning. This cycle is detailed in the margin.
Accordingly, the ALJ applied the correct legal standard by independently assessing Daniels's ability to work and his residual functional capacity in the absence of substance abuse. 20 C.F.R. §§ 416.935; 416.927(d); 404.1535; 404.1527(d). Substantial evidence supports the ALJ's conclusion regarding Daniels's residual functional capacity in the absence of substance abuse. Therefore, the court finds no error in the ALJ's rejection of Dr. Bok's opinions regarding Daniels's ability to work and his residual functional capacity in the absence of substance abuse.
Dr. Daniel C. Clark, Ph.D., performed a consultative examination on September 19, 2011 (862-67). On September 10, 2012, at a time when Daniels reported that he had been sober for one year, Dr. Clark performed another consultative examination and evaluation (including administering the WAIS-IV IQ test) and completed a medical source statement of mental ability to do work-related activities. The ALJ adopted Dr. Clark's September 2012 assessment as the claimant's mental residual functional capacity. (R. 34).
On September 30, 2011, and October 5, 2011, Dr. Robert Estock, M.D., completed a mental residual functional capacity assessment and psychological review technique based on the medical records available at that time, including Dr. Clark's September 2011 consultative evaluation. (R. 868-884). Although the ALJ did not adopt Dr. Estock's 2011 assessments, the ALJ noted that his "findings agree substantially with those of the State Agency medical consultant [Dr. Estock] who also determined that the claimant was not disabled in the absence of substance abuse." (R. 37).
Daniels argues that the ALJ erred as a matter of law by failing to specifically adopt two limitations in Dr. Estock's mental residual functional capacity assessment: a limitation that Daniels "would be expected to miss 1-2 days of work per month due to symptoms of depression," and a limitation that Daniels "would work best with supportive nonconfrontational supervision." (R. 870). The ALJ did not adopt Dr. Estock's residual functional capacity assessment. The ALJ was not obligated to adopt or defer to Dr. Estock's assessment because the residual functional capacity assessment is a legal determination that is reserved to the Commissioner. 20 C.F.R. §§ 404.1527(d), 416.927(d). As explained in Part IV.B. of this memorandum opinion, the ALJ's detailed opinion confirms that the ALJ did independently consider all the evidence and make a determination as to Daniels's residual functional capacity.
For the reasons as stated, the court concludes that the decision of the Commissioner should be affirmed. See Landry v. Heckler, 782 F.2d 1551, 1551-52 (11th Cir. 1986) ("Because the factual findings made by the [ALJ] . . . are supported by substantial evidence in the record and because these findings do not entitle [the claimant] to disability benefits under the appropriate legal standard, we affirm.").
The Court will enter a separate final judgment.
