TERRY F. MOORER, Magistrate Judge.
Following administrative denial of her application for Supplemental Security Income benefits under Title XVI of the Social Security Act, Jennifer Parten ("Parten" or "Plaintiff") received a requested hearing before an administrative law judge ("ALJ") who rendered an unfavorable decision. When the Appeals Council rejected review, the ALJ's decision became the final decision of the Commissioner of Social Security ("Commissioner"). See Chester v. Bowen, 792 F.2d 129, 131 (11th Cir. 1986). Judicial review proceeds pursuant to 42 U.S.C. § 405(g), 42 U.S.C. § 1383(c)(3), and 28 U.S.C. § 636(c), and for reasons herein explained, the Court concludes the Commissioner's decision denying disability insurance benefits and supplemental security income benefits should be reversed and remanded.
Parten requests judicial review of the Commissioner of Social Security Administration's decision denying her application for disability insurance benefits. United States district courts may conduct limited review of such decisions to determine whether they comply with applicable law and are supported by substantial evidence. 42 U.S.C. § 405. The court may affirm, reverse and remand with instructions, or reverse and render a judgment. Id.
Judicial review of the Commissioner's decision to deny benefits is narrowly circumscribed. The court reviews a social security case solely to determine whether the Commissioner's decision is supported by substantial evidence and based upon proper legal standards. Winschel v. Comm'r of Soc. Sec., 631 F.3d 1176, 1178 (11th Cir. 2011). The court "may not decide the facts anew, reweigh the evidence, or substitute [its] judgment for that of the Commissioner," but rather "must defer to the Commissioner's decision if it is supported by substantial evidence." Miles v. Chater, 84 F.3d 1397, 1400 (11th Cir. 1997) (quoting Bloodsworth v. Heckler, 703 F.2d 1233, 1239 (11th Cir. 1983)); see also Winschel, 631 F.3d at 1178 (stating the court should not re-weigh the evidence). This court must find the Commissioner's decision conclusive "if it is supported by substantial evidence and the correct legal standards were applied." Kelley v. Apfel, 185 F.3d 1211, 1213 (11th Cir. 1999); see also Kosloff v. Comm'r of Soc. Sec., 581 Fed. Appx. 811, 811 (11th Cir. 2015) (citing Kelley).
Substantial evidence is more than a scintilla — i.e., the evidence must do more than merely create a suspicion of the existence of a fact, and must include such relevant evidence as a reasonable person would accept as adequate to support the conclusion. Winschel, 631 F.3d at 1178 (quoting Crawford v. Comm'r of Soc. Sec., 363 F.3d 1155, 1158 (11th Cir. 2004)); Lewis v. Callahan, 125 F.3d 1436, 1440 (citing Richardson v. Perales, 402 U.S. 389, 401, 91 S.Ct. 1420, 1427, 28 L.Ed.2d 842 (1971)). If the Commissioner's decision is supported by substantial evidence, the district court will affirm, even if the court would have reached a contrary result as finder of fact, and even if the court finds that the evidence preponderates against the Commissioner's decision. Edwards v. Sullivan, 937 F.2d 580, 584 n.3 (11th Cir. 1991); see also Henry v. Comm'r of Soc. Sec., 802 F.3d 1264, 1267 (11th Cir. 2015) ("even if the evidence preponderates against the Commissioner's findings, we must affirm if the decision reached is supported by substantial evidence.") (citation omitted). The district court must view the record as a whole, taking into account evidence favorable as well as unfavorable to the decision. Foote v. Chater, 67 F.3d 1553, 1560 (11th Cir. 1995) (citing Chester v. Bowen, 792 F.2d 129, 131 (11th Cir. 1986)).
The district court will reverse a Commissioner's decision on plenary review if the decision applies incorrect law, or if the decision fails to provide the district court with sufficient reasoning to determine that the Commissioner properly applied the law. Keeton v. Department of Health and Human Services, 21 F.3d 1064, 1066 (11th Cir. 1994) (internal citations omitted). There is no presumption that the Secretary's conclusions of law are valid. Id.; Brown v. Sullivan, 921 F.2d 1233, 1236 (11th Cir. 1991).
The Social Security Act's Supplemental Security Income ("SSI") is a general public assistance measure providing an additional resource to the aged, blind, and disabled to assure that their income does not fall below the poverty line.
42 U.S.C. §§ 423(d)(1)(A), 1382c(a)(3)(A). A "physical or mental impairment" is one resulting from anatomical, physiological, or psychological abnormalities which are demonstrable by medically acceptable clinical and laboratory diagnostic techniques. 42 U.S.C. §§ 423(d)(3), 1382c(a)(3)(D).
The Commissioner utilizes a five-step, burden-shifting analysis to determine when claimants are disabled. 20 C.F.R. §§ 404.1520, 416.920; Phillips v. Barnhart, 357 F.3d 1232, 1237 (11th Cir. 2004); O'Neal v. Comm'r of Soc. Sec., 614 Fed. Appx. 456, 2015 U.S. App. LEXIS 9640, 2015 WL 3605682 (11th Cir. June 10, 2015). The ALJ determines:
Winschel, 631 F.3d at 1178; Doughty v. Apfel, 245 F.3d 1274, 1278 (11th Cir. 2001). When a claimant is found disabled — or not — at an early step, the remaining steps are not considered. McDaniel v. Bowen, 800 F.2d 1026, 1030 (11th Cir. 1986). This procedure is a fair and just way for determining disability applications in conformity with the Social Security Act. See Bowen v. Yuckert, 482 U.S. 137, 153, 107 S.Ct. 2287, 2297, 96 L.Ed.2d 119 (1987) (citing Heckler v. Campbell, 461 U.S. 458, 461, 103 S.Ct. 1952, 1954, 76 L.Ed.2d 66 (1983)) (The use of the sequential evaluation process "contribute[s] to the uniformity and efficiency of disability determinations").
The burden of proof rests on the claimant through Step 4. See Ostborg v. Comm'r of Soc. Sec., 610 Fed. Appx. 907, 915 (11th Cir. 2015); Phillips, 357 F.3d at 1237-39. A prima facie case of qualifying disability exists when a claimant carries the Step 1 through Step 4 burden. Only at the fifth step does the burden shift to the Commissioner, who must then show there are a significant number of jobs in the national economy the claimant can perform. Id.
To perform the fourth and fifth steps, the ALJ must determine the claimant's Residual Functioning Capacity ("RFC"). 20 C.F.R. § 404.1520(a)(4). RFC is what the claimant is still able to do despite the impairments, is based on all relevant medical and other evidence, and can contain both exertional and nonexertional limitations. Phillips, 357 F.3d at 1242-43. At the fifth step, the ALJ considers the claimant's RFC, age, education, and work experience to determine if there are jobs available in the national economy the claimant can perform. Id. at 1239. In order to do this, the ALJ can either use the Medical Vocational Guidelines
The grids allow the ALJ to consider factors such as age, confinement to sedentary or light work, inability to speak English, educational deficiencies, and lack of job experience. Each of these factors can independently limit the number of jobs realistically available to an individual. Id. at 1240. Combinations of these factors yield a statutorily-required finding of "Disabled" or "Not Disabled." Id. Otherwise, the ALJ may use a vocational expert. Id. A vocational expert is an expert on the kinds of jobs an individual can perform based on her capacity and impairments. Id. In order for a vocational expert's testimony to constitute substantial evidence, the ALJ must pose a hypothetical question which comprises all of the claimant's impairments. Jones v. Apfel, 190 F.3d 1224, 1229 (11th Cir. 1999) (citing McSwain v. Bowen, 814 F.2d 617, 619-20 (11th Cir. 1987)).
On March 18, 2011, Parten filed an application for SSI alleging disability beginning on June 1, 2008. (Tr. 148-155).
Employing the five step process, the ALJ found that Parten has not engaged in substantial gainful activity since the March 18, 2011 application date (Step 1); has severe impairments — both physical and mental (Step 2)
At Step Four, the ALJ found Parten had the RFC to perform medium work with a number of exceptions. The ALJ articulated the following exceptions:
(Tr. 48).
As a result of these limitations, the ALJ determined Parten could not perform past relevant work. (Tr. 50). Therefore, the ALJ moved to Step Five to determine whether Parten could perform other jobs in the national economy and determined there are jobs that exist in significant numbers in the national economy that Parten could perform. (Tr. 51). The ALJ utilized the Medical-Vocational Rules and Vocational Expert (VE) testimony regarding jobs in existing in the national economy which Parten could perform. The ALJ provided several hypotheticals to the VE and utilized some VE provided several examples of jobs which Parten could perform such as cleaner, kitchen helper, and store laborer. (Tr. 51). Consequently, the ALJ found Parten has not been disabled since the alleged onset date. (Tr. 52).
Parten identifies three issues on appeal:
Pl. Br. at p. 1.
The Commissioner re-words the issue as follows:
Def. Br. at p. 1. Regardless of the wording, the Commissioner does address the issues raised by Plaintiff in the brief.
Parten alleges the ALJ rejected her treating physician's opinion and the consulting examining physician and instead only accepts the opinions a non-treating/non-examining consultant. The regulations give preference to the opinion of the treating physicians. 20 C.F.R. § 404.1527(d)(1)-(2); Winschel, 631 F.3d at 1179 ("Absent good cause, an ALJ is to give the medical opinions of treating physicians "substantial or considerable weight.") (internal citations and quotations omitted). However, "the ALJ has the discretion to weigh objective medical evidence and may choose to reject the opinion of a treating physician while accepting the opinion of a consulting physician ... [but] if he follows that course of action, he must show `good cause' for his decision." Gholston v. Barnhart, 347 F.Supp.2d 1108, 1114 (M.D. Ala. 2003); see also Phillips, 357 F.3d at 1240 (quoting Lewis, 125 F.3d at 1440) (The opinion of a treating physician "must be given substantial or considerable weight unless `good cause' is shown to the contrary."). "Good cause exists `when the: (1) treating physician's opinion was not bolstered by the evidence; (2) evidence supported a contrary finding; or (3) treating physician's opinion was conclusory or inconsistent with the doctor's own medical records.'" Winschel, 631 F.3d at 1179 (quoting Phillips, 357 F.3d at 1241). In other words, the Eleventh Circuit has found good cause for discounting a treating physician's report when the report "is not accompanied by objective medical evidence or is wholly conclusory." Crawford v. Commissioner of Social Security, 363 F.3d 1155, 1159 (11th Cir. 2004) (quoting Edwards v. Sullivan, 937 F.2d 580, 583-84 (11th Cir.1991)). Additionally, there is good cause where the treating physicians' opinions are "inconsistent with their own medical records[.]" Roth v. Astrue, 249 Fed. Appx. 167, 168 (11th Cir. 2007) (citing Lewis, 125 F.3d at 1440). However, the ALJ must clearly articulate his reasons for disregarding the opinion of a treating physician. Winschel, 631 F.3d at 1179. Thus, "[w]hen the ALJ articulates specific reasons for not giving the treating physician's opinion controlling weight, and those reasons are supported by substantial evidence, there is no reversible error." Schuhardt v. Astrue, 303 Fed. Appx. 757, 759 (11th Cir. 2008) (citing Moore v. Barnhart, 405 F.3d 1208, 1212 (11th Cir. 2005)).
In the case at hand, the ALJ rejected not only Parten's treating psychologist (Dr. Sterling Taylor, Ph.D.), but also the opinion of Dr. Donald Blanton — a consultative examining psychologist who performed an examination at the request of the Commissioner. The only opinion the ALJ gave any credit was a non-examining consultant — Dr. M. Hope Jackson. While not an error outright, it does raise some skepticism when the ALJ relied solely upon the only psychologist who did not actually examine the claimant. Thus, the Court turns to the "good cause" analysis. As noted above, good cause exists in one of three instances. The Court reviewed the entire medical record and even reviewing in the light most favorable to the ALJ's determination, the Court still cannot reach the conclusion that the ALJ adequately articulately valid reasons for rejecting the treating physician and consulting examiners' opinions. In short, substantial evidence does not support the ALJ's reasons for not giving the treating physician's opinion controlling weight.
Specifically, the records indicate a long history of significant mental health issues. Schizoaffective bipolar disorder, obsessive compulsive disorder, and panic disorder have been documented from at least 2008. Parten had several suicide attempts, suicidal thoughts, instances of self-inflicted pain/mutilation, auditory hallucinations, and panic attacks. The ALJ acknowledges all of these, but still rejects the opinions of the psychologists who treated and/or examined her. The ALJ rejects the opinions when he states the following:
ALJ opinion (Tr. 50). The Court will address these two different reasons for rejection.
With regard to the ALJ's second paragraph articulating the rationale for rejection. The Court finds this line of reasoning to be as speculative in the current case. While the Court acknowledges that this line of reasoning is certainly a potential reality in the world of disability claims, the substantial evidence here cannot support the application in the case at hand. First, the ALJ not only rejected the treating physician, but also the consulting psychologist actually requested by the Commissioner. A consulting psychologist who is performing an examination on behalf of the agency does not have loyalty to the patient. Rather, they are performing a service at the request of the Commissioner of Social Security. Parten was referred to Dr. Blanton by the Social Security Commissioner — she did not seek him out. Dr. Blanton had no ongoing doctor-patient relationship and therefore no need to avoid tension or please the patient. In addition, though Dr. Taylor was a treating physician, the evidence shows that, due to lack of insurance and financial resources, Parten had difficulties maintaining a regular treatment schedule. Though the Commissioner asserts this means Dr. Taylor's opinion is unreliable, it also conversely indicates Dr. Taylor likely does not have the same doctor-patient pressures speculatively discussed and relied upon by the ALJ.
The Commissioner asserts the lack of recent treatment also means Dr. Taylor was not a treating psychologist. Social Security regulations define treating source as follows:
20 C.F.R § 416.902 (emphasis added). The Commissioner's argues that Dr. Taylor is not a treating source because Dr. Taylor's significant treatment occurred in 2008. However, the definition itself notes that a past treating relationship constitutes a treating source. The historical value may simply be considered in the weight given to an opinion without recent treatment. It does not merit outright rejection. Further, the ALJ did not state the reason for the rejection of Dr. Taylor's opinion was because of the gap in treatment. Rather, the ALJ stated he rejected the opinion because the medical evidence did not support the conclusions he reached.
The opinion the ALJ relied upon was by the nonexamining consultant Dr. Jackson. However, the ALJ states "[t]here is no indication in the record that claimant has any difficulty interacting socially and no indication that the claimant would have problems interacting with supervisors." Yet, even Dr. Jackson found Parten has: (1) moderate difficulties in maintaining social functioning, (2) moderate difficulties in maintaining concentration, persistence, or pace, (3) moderately limited ability to understand and remember detailed instructions and to carry out detailed instructions, (4) moderately limited ability to interact appropriately with the general public and accept instructions and respond appropriately to criticism from supervisors, and (5) moderately limited ability to respond to changes in the work setting. (Tr. 399, 403-404). Finally, Dr. Jackson concludes with "contact with the general public should be infrequent. Supervision and feedback should be non-confrontational in nature. Changes in work routine should be minimal." (Tr. 405). Though the ALJ addresses these in his RFC, this specifically contradicts his findings when rejecting Dr. Taylor and Dr. Blanton. In one place the ALJ acknowledges the social/supervisory challenges, yet when rejecting Dr. Taylor and Dr. Blanton's opinions, the ALJ states there no indication in the record that Parten has difficult with social interaction and interaction with supervisors. In short, the ALJ's opinion is contradictory.
The ALJ commits error when he substitutes his own uninformed medical evaluations for those of a claimant's treating physicians. Wind v. Barnhart, 133 Fed. Appx. 684, 691 (11th Cir. 2005); Graham v. Bowen, 786 F.2d 1113, 1115 (11th Cir. 1986).
The Court also finds error in that the Commissioner's opinion is not supported by substantial evidence as the ALJ failed to address the issue of whether Plaintiff could afford to seek treatment. Parten clearly discusses her lack of financial resources and insurance. (Tr. 71, 409). Specifically, at the hearing, Parten stated she did not have insurance and her parents paid for everything. (Tr. 71). Initially her mother paid for her treatment, but then her dad stopped the financial support because he felt the money was too much. Id. It is well established in this Circuit that poverty can excuse non-compliance with taking medication and even the failure to seek treatment. See, e.g. Ellison v. Barnhart, 355 F.3d 1272, 1275 (11th Cir. 2003) ("when an ALJ relies on noncompliance as the sole ground for the denial of disability benefits, and the record contains evidence showing that the claimant is financially unable to comply with prescribed treatment, the ALJ is required to determine whether the claimant was able to afford the prescribed treatment."); Dawkins v. Bowen, 848 F.2d 1211, 1213 (11th Cir. 1988) ("To a poor person, a medicine that he cannot afford to buy does not exist.").
Though this case is somewhat distinguishable in that the ALJ did not base his opinion solely on noncompliance, it is an issue the Court finds the ALJ should have discussed especially as he was based his credibility finding on the fact Parten was not fully compliant with her bipolar medication. See ALJ opinion (Tr. 49) ("In addition, the claimant testified that she stopped taking her medication on her own, and she told the consultative examiner that she takes her medication every now and then. This is strong indication that the claimant's alleged bipolar disorder is not [as] severe as alleged and that the claimant is not compliant with treatment."). The ALJ makes no reference in his opinion to Parten's lack of financial resources which was raised both in the hearing and in Dr. Blanton's report. Tr. 71, 409. Therefore, "the ALJ may not draw an adverse inference from a claimant's lack of medical treatment without first considering the claimant's explanation for his failure to seek treatment." Brown v. Comm'r of Soc. Sec., 425 Fed. Appx. 813, 817 (citing Social Security Regulation 96-7 at 7, 1996 WL 374186, 1996 SSR LEXIS 4).
Therefore, this failure to address financial resources and ability to seek treatment also constitutes legal error which merits remand.
Finally, the ALJ notes Parten's activities and uses them to discredit her. As the Court has already determined the case merits remand on this issue, the court shall pretermit lengthy discussion on the matter. However, the ALJ did not discuss that persons who suffer from chronic mental health issues have good days and bad days. Those with chronic mental health impairments "may commonly have [their lives] structured in such a way as to minimize [] stress and reduce [] symptoms and signs. In such a case, [the claimant] may be much more impaired for work than [their] symptoms and signs would indicate." 20 C.F.R. Pt. 404, Subpt. P, App. 1, § 12.00(E).
Pursuant to the findings and conclusions detailed in this Memorandum Opinion, the Court concludes substantial evidence did not support the ALJ's rejection of Dr. Taylor and Dr. Blanton's opinions and also in not addressing Plaintiff's poverty status when finding her complaints not credible. Accordingly, this case will be reversed and remanded to the Commissioner for further proceedings consistent with this opinion. A separate order will be entered.
