MARCIA S. KRIEGER, Chief District Judge.
The Court has jurisdiction over an appeal from a final decision of the Commissioner under 42 U.S.C. § 405(g).
The Court briefly summarizes the pertinent facts and procedure here, and elaborates as necessary in its analysis.
At the time of her application for disability benefits in 2012, Ms. Bowe was 40 years old. She had two years of college education and lived with her 12-year old son and her mother. She had previously worked as a bridal consultant, and also had experience as an executive assistant, a Human Resources manager, and a manager of an auto parts store, among other things. She claimed a disability onset date of 2011,
Ms. Bowe testified at the hearing that, due to these various maladies, she could concentrate on a given task for 30 minutes to an hour, that she could lift 5-10 lbs., could walk "about a block," could stand for 20-40 minutes and sit for the same period before needing to change positions. She testified that she experienced disabling migraines approximately 3 times per month, each lasting for a full day. She has irregular anxiety attacks that she attributes to stress and which require her to spend time alone to recover from. She did not cook, beyond preparing frozen foods for herself. She went grocery shopping six times per month, but did so in the morning or evening to avoid crowds. She reported that this was effectively the only time she left the house, and that she spent 97% of her time in her room. She socialized only with her mother, her 12-year old son, and a friend, all of whom live in the same house with her.
However, in a March 2013 Functional Report, Ms. Bowe reported that she "tr[ies] to get outside everyday at least for some air and sun," that she will drive up to 10 miles, that she goes grocery shopping "a couple of times a week," stated that she handles stress "very well — I become completely calm, deal with it, and move on" (although she also stated that she "internalizes it" which is "why I'm sick"), and that she can handle changes in routine because "I can always handle anything, I have been through just about everything you can imagine."
Treating providers offered several opinions:
• Dr. Lutt, a rheumatologist, opined that Ms. Bowe should avoid stressful situations, repetitive motion activities, and jobs that require her to remain in one position for more than an hour. Dr. Lutt also stated that Ms. Bowe would require an understanding and flexible employer that could accommodate some absenteeism due to fibromyalgia flare-ups, doctor appointments, and unscheduled breaks to change positions.
• Dr. Zacharias, a neurologist, opined that Ms. Bowe averages three disabling headaches per week, each lasting an entire day. She also opined that any employer would have to accommodate absenteeism on that frequency due to such headaches. Dr. Zacharias further opined that Ms. Bowe would need unscheduled breaks, would have to avoid stressful situations, avoid environmental extremes of heat and cold, avoid bright or flashing lights or sustained computer work.
• Dr. Dowdy, Ms. Bowe's family practitioner, opined that she was unable to do any physical work and must spend the majority of her time resting in bed. Dr. Dowdy stated that Ms. Bowe has migraine headaches for at least 10 days per month which last up to 3 days, and that she is unable to drive due to seizures. Dr. Dowdy opined that any employer would have to be flexible to accommodate absenteeism and unscheduled breaks, that Ms. Bowe would have to avoid computer work, bright or florescent lights, odors, fumes, or heat. Dr. Dowdy also opined that Ms. Bowe should avoid walking, should not stand or sit for more than 30 minutes, and should not interact with people.
• Ms. DuMond, a social worker,
The record also reflects the following opinions of consulting experts:
• Dr. Lipson, an examining psychologist, opined that Ms. Bowe had, in general, a mild impairment in her ability to maintain productive employment. He rated her as markedly impaired in the activities of remembering complex instructions and maintaining persistence on complex tasks; as moderately impaired in interacting with the public and supervisors, in responding to criticism and adapting to changes in routine, in maintaining pace on complex tasks, in remembering simple instructions, and in maintaining persistence on simple tasks; and as mildly impaired in maintaining pace on simple tasks, on maintaining concentration on complex tasks, and on interacting with supervisors. He opined that she had no impairments in comprehending simple instructions, attending to simple repetitive tasks, and sustaining concentration on simple tasks. He also noted that Ms. Bowe would have moderate impairments in her ability to keep to a schedule, maintain attendance, be punctual, adapt to the work environment, and complete a normal work day without special or additional supervision.
• Dr. Glasco, a psychiatrist, opined that Ms. Bowe can perform work not involving significant complexity or judgment, but should not work with the general public.
• Dr. Kutz, an examining psychologist, opined that Ms. Bowe's attention, concentration, persistence and pace, and social adaptation are all mild to moderately impaired.
• Dr. Kreiger, opined that Ms. Bowe could perform light exertion work, and should avoid exposure to machinery and heights.
Ms. Bowe's claim was considered at a hearing before an Administrative Law Judge ("ALJ") in 2014. At that hearing, Ms. Bowe and her housemate both testified. The ALJ also took evidence from a vocational expert ("VE"). The VE testified that Ms. Bowe's past work experience generally had an SVP level of 6-8 and a light-to-sedentary exertional level. The ALJ inquired whether a person with Ms. Bowe's education, with the ability to lift 20 lbs. occasionally and 10 lbs. frequently, to stand and walk or sit for 6 hours, able to balance, and unable to perform work that required intense concentration, could perform any of her past work. The VE responded that nearly all of Ms. Bowe's past work would be performable with such limitations. The ALJ then inquired whether the same scenario, plus the additional limitation that she is only able to understand and carry out simple instructions and perform simple tasks, would change that result. The VE responded that, with the additional limitation, Ms. Bowe would not be able to perform any of her past relevant work, but could perform the jobs of office helper or photocopy machine operator. In response to questions from Ms. Bowe's counsel, the VE testified that both jobs would be unavailable in each of the following additional circumstances: (i) if the person performing it was limited to standing or sitting for only 20 minutes at a time; (ii) if the person had seizures or migraine headaches that were exacerbated by bright or flashing lights; (iii) if the person suffered from short-term memory deficits requiring regular reminders every 5-10 minutes; (iv) if the person suffered from an anxiety disorder from working around others that would require her to take 15-30 minute breaks two to three times per week; (v) if the person's fibromyalgia or arthritis required that they leave work unexpectedly two times per month to go home and rest; and (vi) if the person would need to leave work for an entire day twice a month because of migraines.
The ALJ issued a Decision in October 2014. Employing the standard five step analysis, the ALJ found at Step 2, that Ms. Bowe had severe impairments in the form of a thyroid disorder, asthma, fibromyalgia, migraine headaches, a mood disorder not otherwise specified, an affective disorder, and PTSD.
At Step 3, the ALJ found that she has mild restrictions in the activities of daily living, mild-to-moderate difficulties in social functioning, and mild-to-moderate difficulties with regard to concentration, persistence, and pace, as reflected in the consultative opinion of Dr. Kutz. This combination of impairments did not rise to the level sufficient to meet a Listing.
At Step 4, the ALJ determined that Ms. Bowe has the residual functional capacity to lift 20 lbs. occasionally/10 lbs. frequently, to stand and/or walk and to six for up to six hours per day, and to walk on uneven terrain. She could not climb ladders or be exposed to extreme cold, moving machinery, or unprotected heights. She could not perform assembly line work or any work requiring intense and sustained concentration (such as that demanded of a lifeguard or air traffic controller). In determining this RFC, the ALJ rejected
Based on the testimony of the VE and the ALJ's findings, the ALJ further found that Ms. Bowe could perform all of the jobs within her past relevant work, with the exception of department manager.
Finally, reaching Step 5 as an alternative to his findings at Step 4, based on the testimony of the VE, the ALJ found that Ms. Bowe has the residual functional capacity to perform jobs in the national and regional economy that require only the ability to understand and carry out simple instructions and perform simple tasks, particularly the jobs of office helper, and photocopy machine operator. The ALJ rejected Ms. Bowe's testimony as to greater limitations for the reasons set forth above. Accordingly, the ALJ denied Ms. Bowe's claim.
Ms. Bowe requested that the Appeals Council review the ALJ's determination, but the Appeals Council declined. The ALJ's decision thus became the decision of the Commissioner. Ms. Bowe then timely filed the instant appeal.
Ms. Bowe raises three
Although the Court's review is de novo, the Court must uphold the Commissioner's decision if it is free from legal error and the Commissioner's factual findings are supported by substantial evidence. See Fischer-Ross v. Barnhart, 431 F.3d 729, 731 (10th Cir. 2005). Substantial evidence is evidence a reasonable person would accept to support a conclusion, requiring "more than a scintilla, but less than a preponderance." Lax v. Astrue, 489 F.3d 1080, 1084 (10th Cir. 2007). The Court may not reweigh the evidence, but it looks to the entire record to determine if substantial evidence exists to support the Commissioner's decision. Wall, 561 F.3d at 1052. If the ALJ failed to apply the correct legal standard, the decision must be reversed, regardless of whether there was substantial evidence to support factual findings. Thompson v. Sullivan, 987 F.2d 1482, 1487 (10th Cir. 1993).
Ordinarily, a treating physician's opinion must be given controlling weight if it is well supported by medically acceptable clinical and laboratory diagnostic techniques and is consistent with the other substantial evidence in the record. Pisciotta v. Astrue, 500 F.3d 1074, 1077 (10th Cir. 2007), 20 C.F.R. § 404.1527(c)(2). As explained in Watkins v. Barnhart, 350 F.3d 1297, 1299 (10th Cir. 2003):
If both prongs of this test are met, the treating physician's opinion is given controlling weight over all contrary opinions. To give a treating provider's opinion less than controlling weight, the ALJ must give specific and legitimate reasons. Drapeau v. Massanri, 255 F.3d 1211 (10th Cir 2001); Langley v. Barnhart, 373 F.3d 1116, 1119 (10th Cir. 2004).
If a treating physician's opinion is not afforded controlling weight, the ALJ must then proceed to weigh the opinions of
Although Ms. Bowe's arguments in this regard are vague and generalized,
The ALJ's opinion addresses the medical providers' opinions in a somewhat elliptical and disjointed way. The ALJ begins by extensively summarizing the
The ALJ then proceeds to summarize Ms. Bowe's treatment records relating to mental health treatment, and concludes with another paragraph that again seems to be a functional capacity finding regarding her mental impairments: "Considering the claimant's psychological impairments she should not perform any work requiring intense, sustained concentration . . . The evidence as a whole does not support a finding that the claimant is unable to work due to her psychological impairments." Id. at 23-24. Once again, it is unclear how the ALJ reached this finding.
Only then does the ALJ address medical opinions with regard to Ms. Bowe's
Docket # 14-2 at 24-25.
This is the total discussion with regard to whether the opinions of the treating physicians should be given controlling weight. It is flawed for several reasons. First, it is not clear that the ALJ performed the full analysis required by Watkins: the Court can locate nothing in the ALJ's opinion that addresses the first step of the inquiry: whether each of Ms. Bowe's treating providers' opinions were or were not supported by medically-acceptable clinical or diagnostic procedures.
Second, to the extent the ALJ refused to give controlling weight to the treating source opinion because he found them to be inconsistent with substantial evidence in the record, the finding is too cursory. It fails to identify the contents of the opinions by treating providers at all, and fails to identify how the contents of such opinions are inconsistent with other evidence in the record.
Third, each opinion must be weighed individually, and reasons for it not receiving controlling weight must be specifically articulated. 20 C.F.R. § 404.1527(c)(2). As Watkins makes clear, the ALJ must explain his reasoning with "sufficient[ ] specific[ity] to make clear to any subsequent reviewers the weight the adjudicator gave to the treating source's medical opinion and the reasons for that weight." 373 F.3d at 1119. Even assuming that the ALJ's "relative weight" analysis has some applicability to his evaluation of the treating providers' opinions at the "controlling weight" stage, the Court is not sanguine that the ALJ has adequately explained the reasons he gave for crediting the consultative providers' opinions. The ALJ often addresses the consultative providers' opinions categorically (rather than individually), and often offers only conclusory reasons for crediting them: e.g. "the above medical source opinions are more consistent with the longitundial record"; "these medical sources presented more relevant supporting medical evidence, and provided more satisfactory supporting explanations, for the opinions given." The ALJ does not explain why he believes that one opinion is "more consistent with the longitudinal record" than another, or which consultative providers offered "more relevant supporting evidence" than the treating providers. As a result, the Court is left with only conclusions, not reasoning, to evaluate. Although it is permissible for an ALJ to find that conflicting opinions by consultative examiners are "substantial evidence" in the record sufficient to render a treating provider's opinion "inconsistent," the ALJ must make specific findings explaining why he concluded that the consultative examiner's opinion is more consistent with the actual facts in the record, or why the treating provider's opinion is not. See e.g. Veino v. Barnhart, 312 F.3d 578, 588 (2d Cir. 2002) (ALJ could reject controlling weight to treating provider's opinion based on consultative examiner's contrary opinion, because consultative examiner "conducted tests to support his conclusions," whereas treating provider "fail[ed] to provide any objective medical evidence to support his findings"). The ALJ here failed to do so.
Accordingly, the Court finds that the erred in failing to demonstrate application of the correct legal standard regarding the treating providers' opinions. Because the Decision must be reversed and remanded due to legal error, it is not necessary to address the remainder of Ms. Bowe's contentions.
For the reasons set forth above and based on the full administrative record