KATHERINE P. NELSON, Magistrate Judge.
Social Security Claimant/Plaintiff Andrew Cooke has brought this action under 42 U.S.C. § 405(g) seeking judicial review of a final decision of the Defendant Commissioner of Social Security ("the Commissioner") denying his protective application for disability insurance benefits ("DIB") under Title II of the Social Security Act, 42 U.S.C. § 401, et seq. By the consent of the parties (see Doc. 25), the Court has designated the undersigned Magistrate Judge to conduct all proceedings and order the entry of judgment in this civil action, in accordance with 28 U.S.C. § 636(c), Federal Rule of Civil Procedure 73, and S.D. Ala. GenLR 73. (See Doc. 28).
Upon consideration of the parties' briefs (Docs. 14, 15, 21, 23) and the administrative record (Doc. 13) (hereinafter cited as "(R. [page number(s)])"),
Cooke protectively filed an applications for DIB with the Social Security Administration ("SSA") on August 18, 2011, alleging disability beginning December 26, 2008.
"In Social Security appeals, [the Court] must determine whether the Commissioner's decision is "`supported by substantial evidence and based on proper legal standards. Substantial evidence is more than a scintilla and is such relevant evidence as a reasonable person would accept as adequate to support a conclusion.'"" Winschel v. Comm'r of Soc. Sec., 631 F.3d 1176, 1178 (11th Cir. 2011) (quoting Crawford v. Comm'r of Soc. Sec., 363 F.3d 1155, 1158 (11th Cir. 2004) (per curiam) (internal citation omitted) (quoting Lewis v. Callahan, 125 F.3d 1436, 1439 (11th Cir. 1997))). However, the Court "`may not decide the facts anew, reweigh the evidence, or substitute our judgment for that of the [Commissioner].'" Winschel, 631 F.3d at 1178 (quoting Phillips v. Barnhart, 357 F.3d 1232, 1240 n.8 (11th Cir. 2004) (alteration in original) (quoting Bloodsworth v. Heckler, 703 F.2d 1233, 1239 (11th Cir. 1983))). "`Even if the evidence preponderates against the [Commissioner]'s factual findings, we must affirm if the decision reached is supported by substantial evidence.'" Ingram, 496 F.3d at 1260 (quoting Martin v. Sullivan, 894 F.2d 1520, 1529 (11th Cir. 1990)).
"Yet, within this narrowly circumscribed role, [courts] do not act as automatons. [The court] must scrutinize the record as a whole to determine if the decision reached is reasonable and supported by substantial evidence[.]" Bloodsworth, 703 F.2d at 1239 (citations and quotation omitted). "In determining whether substantial evidence exists, [a court] must...tak[e] into account evidence favorable as well as unfavorable to the [Commissioner's] decision." Chester v. Bowen, 792 F.2d 129, 131 (11th Cir. 1986). Moreover, "[t]here is no presumption...that the Commissioner followed the appropriate legal standards in deciding a claim for benefits or that the legal conclusions reached were valid. Instead, [the court] conduct[s] `an exacting examination' of these factors." Miles v. Chater, 84 F.3d 1397, 1400 (11th Cir. 1996) (per curiam) (citing Martin v. Sullivan, 894 F.2d 1520, 1529 (11th Cir. 1990)) (internal citation omitted). In sum, courts "review the Commissioner's factual findings with deference and the Commissioner's legal conclusions with close scrutiny." Doughty v. Apfel, 245 F.3d 1274, 1278 (11th Cir. 2001). See also Moore v. Barnhart, 405 F.3d 1208, 1211 (11th Cir. 2005) (per curiam) ("In Social Security appeals, we review de novo the legal principles upon which the Commissioner's decision is based. Chester v. Bowen, 792 F.2d 129, 131 (11th Cir. 1986). However, we review the resulting decision only to determine whether it is supported by substantial evidence. Crawford v. Comm'r of Soc. Sec., 363 F.3d 1155, 1158-59 (11th Cir. 2004)."). "`The [Commissioner]'s failure to apply the correct law or to provide the reviewing court with sufficient reasoning for determining that the proper legal analysis has been conducted mandates reversal.'" Ingram, 496 F.3d at 1260 (quoting Cornelius v. Sullivan, 936 F.2d 1143, 1145-46 (11th Cir. 1991)).
Thornton v. Comm'r, Soc. Sec. Admin., 597 F. App'x 604, 609 (11th Cir. Feb. 11, 2015) (per curiam) (unpublished).
Winschel, 631 F.3d at 1178 (citing 20 C.F.R. §§ 404.1520(a)(4)(i)-(v), 416.920(a)(4)(i)-(v); Phillips, 357 F.3d at 1237-39).
"These regulations place a very heavy burden on the claimant to demonstrate both a qualifying disability and an inability to perform past relevant work." Moore, 405 F.3d at 1211 (citing Spencer v. Heckler, 765 F.2d 1090, 1093 (11th Cir. 1985)). "In determining whether the claimant has satisfied this initial burden, the examiner must consider four factors: (1) objective medical facts or clinical findings; (2) the diagnoses of examining physicians; (3) evidence of pain; and (4) the claimant's age, education, and work history." Jones v. Bowen, 810 F.2d 1001, 1005 (11th Cir. 1986) (per curiam) (citing Tieniber v. Heckler, 720 F.2d 1251, 1253 (11th Cir. 1983) (per curiam)). "These factors must be considered both singly and in combination. Presence or absence of a single factor is not, in itself, conclusive." Bloodsworth, 703 F.2d at 1240 (citations omitted).
If, in Steps One through Four of the five-step evaluation, a claimant proves that he or she has a qualifying disability and cannot do his or her past relevant work, it then becomes the Commissioner's burden, at Step Five, to prove that the claimant is capable—given his or her age, education, and work history—of engaging in another kind of substantial gainful employment that exists in the national economy. Jones v. Apfel, 190 F.3d 1224, 1228 (11th Cir. 1999); Sryock v. Heckler, 764 F.2d 834, 836 (11th Cir. 1985). Finally, but importantly, although the "claimant bears the burden of demonstrating the inability to return to [his or] her past relevant work, the Commissioner of Social Security has an obligation to develop a full and fair record." Shnorr v. Bowen, 816 F.2d 578, 581 (11th Cir. 1987). "This is an onerous task, as the ALJ must scrupulously and conscientiously probe into, inquire of, and explore for all relevant facts. In determining whether a claimant is disabled, the ALJ must consider the evidence as a whole." Henry v. Comm'r of Soc. Sec., 802 F.3d 1264, 1267 (11th Cir. 2015) (per curiam) (citation and quotation omitted).
"When no new evidence is presented to the Appeals Council and it denies review, then the administrative law judge's decision is necessarily reviewed as the final decision of the Commissioner, but when a claimant properly presents new evidence to the Appeals Council, a reviewing court must consider whether that new evidence renders the denial of benefits erroneous." Ingram, 496 F.3d at 1262.
(Doc. 15 at 1).
Cooke alleges disability beginning December 26, 2008, which is the date he was admitted to a hospital due to suffering a "possible" seizure while engaged in his former job of driving a school bus. (R. 41). The ALJ found from the record evidence that Cooke showed "no more seizure activity" after that one reported episode. Cooke does not challenge this finding on appeal, nor does he challenge any of the ALJ's findings regarding his physical impairments, only his mental impairments.
After conducting an examination of Cooke on November 19, 2012, Dr. Goff diagnosed him with "adjustment disorder with depressed mood," "moderate to severe reading disorder," "disorder of written expression," and "borderline intellectual functioning." (R. 429). Dr. Goff also commented that Cooke's "cognitive deficits are problematic and represent interfering factors in regard to vocational activity" and that "[h]is depression at this point represents a severe impairment." (R. 429). Additionally, Dr. Goff completed a Medical Source Opinion Form (Mental), dated November 21, 2012, opining that Cooke had "extreme" limitations in his ability to respond to customary work pressures and to maintain attention, concentration, or pace for periods of at least two hours in a routine work setting, and "marked" limitations in his ability to deal with change in a routine work setting.
At Step One, the ALJ determined that Cooke had "not engaged in substantial gainful activity since December 26, 2008, the alleged onset date." (R. 37). At Step Two, the ALJ determined that Cooke had the following severe impairments: mild coronary artery disease, and one possible seizure episode on December 26, 2008, without subsequent seizure activity. (R. 37). The ALJ noted at Step Two that Dr. Goff had suggested "mental impairments of adjustment disorder with some depressed mood; possible disorder of written expression; and possible borderline intellectual functioning." (R. 38). However, the ALJ expressed skepticism of the severity of Dr. Goff's assessment, concluding that, while Cooke "might suffer some mental impairment[,]" "per the totality of the evidence, his mental impairments appear to be slight abnormalities that — if they exist at all — cause little, if any, limitation in [Cooke's] ability to perform mental work activity" and "are therefore nonsevere." (R. 38). At Step Three, the ALJ found that Cooke did not have an impairment or combination of impairments that meets or equals the severity of the specified impairments in the Listing of Impairments. (R. 40).
Phillips, 357 F.3d at 1238-39 (footnote omitted).
The ALJ determined that Cooke had the RFC "to perform the full range of medium work as defined in 20 CFR 404.1567(c)."
Cooke asserts that substantial evidence does not support the ALJ's decision to give no weight to Dr. Goff's opinions. "`Medical opinions are statements from physicians and psychologists or other acceptable medical sources that reflect judgments about the nature and severity of [the claimant's] impairment(s), including [the claimant's] symptoms, diagnosis and prognosis, what [the claimant] can still do despite impairment(s), and [the claimant's] physical or mental restrictions.'" Winschel, 631 F.3d at 1178-79 (quoting 20 C.F.R. §§ 404.1527(a)(2), 416.927(a)(2)). "There are three tiers of medical opinion sources: (1) treating physicians; (2) nontreating, examining physicians; and (3) nontreating, nonexamining physicians." Himes v. Comm'r of Soc. Sec., 585 F. App'x 758, 762 (11th Cir. Sept. 26, 2014) (per curiam) (unpublished) (citing 20 C.F.R. §§ 404.1527(c)(1)-(2), 416.927(c)(1)-(2)). "In assessing medical opinions, the ALJ must consider a number of factors in determining how much weight to give to each medical opinion, including (1) whether the physician has examined the claimant; (2) the length, nature, and extent of a treating physician's relationship with the claimant; (3) the medical evidence and explanation supporting the physician's opinion; (4) how consistent the physician's opinion is with the record as a whole; and (5) the physician's specialization. These factors apply to both examining and non-examining physicians." Eyre v. Comm'r, Soc. Sec. Admin., 586 F. App'x 521, 523 (11th Cir. Sept. 30, 2014) (per curiam) (unpublished) (internal citations and quotation marks omitted) (citing 20 C.F.R. §§ 404.1527(c) & (e), 416.927(c) & (e)). "[T]he ALJ must state with particularity the weight given to different medical opinions and the reasons therefor." Winschel, 631 F.3d at 1179 (citing Sharfarz v. Bowen, 825 F.2d 278, 279 (11th Cir. 1987) (per curiam)). However, the ALJ "may reject the opinion of any physician when the evidence supports a contrary conclusion." Bloodsworth, 703 F.2d at 1240. Accord, e.g., Anderson v. Comm'r of Soc. Sec., 427 F. App'x 761, 763 (11th Cir. 2011) (per curiam) (unpublished).
There is no denying that the ALJ expressed some suspicion of Dr. Goff's opinion because he assessed Cooke "at the behest of [Cooke]'s representative..." (R. 38. See also R. 46 ("Nonetheless, and somewhat incredulously, the claimant's representative directed him to a third party consultative psychological evaluation[ by Dr. Goff].")). Cooke selectively quotes in support a Ninth Circuit decision, Reddick v. Chater, for the proposition that "the mere fact that a medical report is provided at the request of counsel or, more broadly, the purpose for which an opinion is provided, is not a legitimate basis for evaluating the reliability of the report." 157 F.3d 715, 726 (9th Cir. 1998). See also Lester v. Chater, 81 F.3d 821, 832 (9th Cir. 1995) ("The purpose for which medical reports are obtained does not provide a legitimate basis for rejecting them. An 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 ... The Secretary may not assume that doctors routinely lie in order to help their patients collect disability benefits." (quotation marks omitted)); Moss v. Astrue, 555 F.3d 556, 560-61 (7th Cir. 2009) (per curiam).
However, the very next sentence in Reddick states that "[e]vidence of the circumstances under which the report was obtained and its consistency with other records, reports, or findings could ... form a legitimate basis for evaluating the reliability of the report." 157 F.3d at 726. Reddick thus held that, "
The ALJ did not reject Dr. Goff's assessment solely because it was obtained at the behest of Cooke's representative. The ALJ clearly considered other circumstances under which the report was obtained, Reddick, 157 F.3d at 726, noting that Dr. Goff's examination occurred "shortly before the [administrative ]hearing"
The ALJ determined that "the medical and objective evidence of record strongly contradicts Dr. Goff's opinion" and "contains little evidence of depression let alone indication that the claimant is `very depressed' ..." (R. 38). However, Dr. Goff's Medical Source Opinion Form (R. 430-431) was accompanied by five-page evaluation report detailing the objective evidence Dr. Goff considered in formulating his opinions. (R. 425-429). This report, which is itself medical evidence, stated that Dr. Goff had interviewed Cooke about his history and had considered a number of Cooke's medical, school, and other records. The report also provided scores and results from a number of psychological tests that Dr. Goff administered (the Wechsler Adult Intelligence Scale, which produced an IQ score of 73 for Cooke; the Reitan-Indiana Aphasia Screening Test; informal clock drawing tasks; the Wide Range Achievement Test, fourth edition; and the Personality Assessment Inventory). The report set forth specific diagnoses of mental impairments: "adjustment disorder with depressed mood," "moderate to severe reading disorder," "disorder of written expression," and "borderline intellectual functioning." (R. 429) Finally, the report noted that Dr. Goff had administered Cooke the Victoria Symptom Validity Test, "a test for dissimulation of cognitive deficits," which gave "no indications for malingering or dissimulation concerning the cognitive aspects of the examination." (R. 427).
Here, then, the ALJ was presented with a medical opinion regarding Cooke's mental impairments, given by an examining mental health specialist,
The medical evidence of record noted by the ALJ as "strongly contradicting" Dr. Goff's opinion regarding Cooke's mental impairments consists of cursory statements made by other physicians in the course of primarily assessing physical impairments, seemingly made in passing and based on little more than the physicians' observations of Cooke's demeanor at the time. Two of these physicians, a general practitioner and a cardiologist, cannot reasonably be considered mental health specialists.
Indeed, the ALJ appears to have been more swayed by Cooke's failure to report medical symptoms to his health care providers, repeatedly citing to portions of the record where he believes Cooke should have mentioned them but did not.
Though disability claimants frequently accuse ALJs of "succumb[ing] to the temptation to play doctor and make their own independent medical findings" whenever they reject medical opinions favoring claimants' assertions of disability,
The ALJ also discounted Dr. Goff's opinions based on his conclusion that they were not consistent with Cooke's ability to engage in certain activities. For instance, the ALJ determined that Cooke's "maintain[ing] a commercial driver's license," his having "recently renewed that license," and his past work as a school bus driver, furniture assembler, and collection and repossession agent were "not consistent with borderline intellectual functioning, or a reading disorder." (R. 38, 47 ("He also did collections and repossession of furniture again which would require the ability to read and write reports.")). The ALJ further determined that Cooke's self-reported daily activities,
The Seventh Circuit Court of Appeals addressed a strikingly similar situation where, "[w]ithout expressly relying on any medical evidence or authority, the ALJ determined that [the claimant]'s efforts at engaging in a small machine repair/resale business were incompatible with a diagnosis of major depression and [the treating psychiatrist's] conclusions regarding [the claimant]'s functional abilities." Rohan, 98 F.3d at 970. The Seventh Circuit held that the ALJ had erred in doing so, stating:
Id. at 970-71. Accord Blakes ex rel. Wolfe v. Barnhart, 331 F.3d 565, 570 (7th Cir. 2003) ("[T]he ALJ seems to have succumbed to the temptation to play doctor when she concluded that a good prognosis for speech and language difficulties was inconsistent with a diagnosis of mental retardation because no expert offered evidence to that effect here. See Rohan v. Chater, 98 F.3d 966, 970-71 (7th Cir. 1996) (
In sum, "there is no medical testimony to rebut Dr. [Goff]'s opinion, nor is there overwhelmingly compelling non-medical evidence to the contrary ... in the absence of competing medical opinions." Rivera v. Sullivan, 923 F.2d 964, 969 (2d Cir. 1991). Even factoring in the "circumstances under which the report was obtained[,]" Reddick,157 F.3d at 726 — namely, the mere fact that it was obtained three weeks prior to Cooke's hearing before the ALJ and was not the result of a physician referral — the ALJ's decision to reject Dr. Goff's opinions is not supported by substantial evidence. While the ALJ was entitled to cast some suspicion on such an eleventh-hour diagnosis, the ALJ was not entitled to disregard it absent substantial contrary evidence. To the extent the ALJ believed Dr. Goff's assessment was inconsistent with Cooke's overall history, he had other tools at his disposal to resolve the inconsistency, including ordering a consultative examination. See 20 C.F.R. § 404.1520b(c); Holladay v. Bowen, 848 F.2d 1206, 1209 (11th Cir. 1988) ("[B]ecause of the Secretary's duty to develop the medical record fully and fairly, this court has held that it is reversible error for an ALJ not to order a consultative examination
Accordingly, the Court
Though styled as a separate claim of error, Claim 2 is merely an extension of Claim 1, being based on the premise that, because the ALJ improperly rejected Dr. Goff's opinion, "that opinion must be accepted as true." (Doc. 15 at 7). Cooke appears to invite the Court to itself apply Social Security Ruling 85-15 and, after considering Dr. Goff's opinions in conjunction with other evidence in the administrative record, remand with instructions that Cooke be found disabled.
Cooke cites no authority for his proposition that Dr. Goff's opinions must be accepted as true. As the Commissioner correctly notes (see Doc. 21 at 10 n.2), at most, there is authority in this Circuit indicating that when the Commissioner "has ignored or failed properly to refute a
In accordance with the foregoing analysis, it is
Under Federal Rule of Civil Procedure 54(d)(2)(B), the Court hereby grants Cooke's counsel an extension of time in which to file a petition for authorization of attorney's fees under 42 U.S.C. § 406(b) until thirty days after receipt of a notice of award of benefits from the Social Security Administration. See Bergen v. Comm'r of Soc. Sec., 454 F.3d 1273, 1277 (11th Cir. 2006) (per curiam) ("Fed. R. Civ. P. 54(d)(2) applies to a § 406(b) attorney's fee claim."); Blitch v. Astrue, 261 F. App'x 241, 242 n.1 (11th Cir. 2008) (per curiam) (unpublished) ("In Bergen v. Comm'r of Soc. Sec., 454 F.3d 1273 (11th Cir. 2006), we suggested the best practice for avoiding confusion about the integration of Fed. R. Civ. P. 54(d)(2)(B) into the procedural framework of a fee award under 42 U.S.C. § 406 is for a plaintiff to request and the district court to include in the remand judgment a statement that attorneys fees may be applied for within a specified time after the determination of the plaintiff's past due benefits by the Commission. 454 F.3d at 1278 n.2.").
Final judgment shall issue separately in accordance with this Order and Federal Rule of Civil Procedure 58.