JAMES R. KLINDT, District Judge.
Carl Hobbs ("Plaintiff") is appealing the Commissioner of the Social Security Administration's final decision denying his claim for disability insurance benefits ("DIB"). His alleged inability to work is based upon damaged nerves in his back, right wrist fusion, carpal tunnel syndrome, a rotator cuff tear, stomach problems, eye problems, trouble sleeping, weight problems, hearing problems, and memory loss. Transcript of Administrative Proceedings (Doc. No. 13; "Tr." or "administrative transcript"), filed November 19, 2013, at 182. On September 8, 2010, Plaintiff filed an application for DIB, Tr. at 153-54, alleging an onset disability date of October 18, 2008,
On December 22, 2011, a hearing was held before an Administrative Law Judge ("ALJ"), during which Plaintiff and a vocational expert ("VE") testified. Tr. at 28-54. Plaintiff was represented by an attorney at the hearing. Tr. at 12, 28, 35. The ALJ issued an unfavorable Decision on February 24, 2012, finding Plaintiff not disabled from October 18, 2008, through December 31, 2010, Plaintiff's date last insured. Tr. at 12-21. On June 8, 2013, the Appeals Council denied Plaintiff's request for review, Tr. at 1-4, thereby making the ALJ's Decision the final decision of the Commissioner. Plaintiff then commenced this action on July 3, 2013 under 42 U.S.C. § 405(g), by filing a Complaint (Doc. No. 1), seeking judicial review of the Commissioner's final decision.
Plaintiff raises one issue on appeal: whether the ALJ "erred by not placing the appropriate weight on the opinions of [Plaintiff's] treating psychiatrist. Pl.'s Mem. at 5 (capitalization and emphasis omitted). On March 11, 2014, Defendant filed a memorandum addressing the issue raised by Plaintiff.
When determining whether an individual is disabled,
Here, the ALJ followed the five-step sequential inquiry.
The ALJ determined Plaintiff has the following RFC:
Tr. at 16 (emphasis omitted). At step four, the ALJ found Plaintiff "was unable to perform any past relevant work" as an automobile mechanic, fork lift driver, and refrigeration technician. Tr. at 19 (emphasis omitted). At step five, after considering Plaintiff's age (forty-one (41) on the alleged disability onset date), education ("at least a high school education"), work experience, and RFC, the ALJ determined that "there were jobs that existed in significant numbers in the national economy that [Plaintiff] could have performed [through the date last insured.]" Tr. at 19 (citations omitted). Those jobs included "[h]ospital [p]roduct [a]ssembler," "[w]ire [a]ssembler," and "[e]lectrical [p]roduct [a]ssembler[.]" Tr. at 20. The ALJ concluded Plaintiff "was not under a disability . . . at any time from October 18, 2008, the alleged onset date, through December 31, 2010, the date last insured." Tr. at 20 (emphasis and citation omitted).
This Court reviews the Commissioner's final decision as to disability pursuant to 42 U.S.C. §§ 405(g) and 1383(c)(3). Although no deference is given to the ALJ's conclusions of law, findings of fact "are conclusive if . . . supported by `substantial evidence' . . . ."
Although Plaintiff's alleged disability stems mostly from physical problems, Plaintiff on appeal mainly focuses on the ALJ's findings relating to his mental condition. Plaintiff contends the ALJ erred in discounting the opinion of treating psychiatrist Chirag Desai, M.D. Pl.'s Mem. at 5-7.
The Regulations instruct ALJs how to appropriately weigh a treating psychiatrist's
If an ALJ concludes the opinion of a treating psychiatrist should be given less than substantial or considerable weight, he or she must clearly articulate reasons showing "good cause" for discounting it.
Dr. Desai began treating Plaintiff at Shands Jacksonville for depression in December 2010, Tr. at 658-60, and Dr. Desai indicated Plaintiff had seen a psychiatrist since 2007, Tr. at 645. The administrative transcript also documents that Plaintiff saw a psychiatrist at Shands Jacksonville as early as 2007. Tr. at 646-47. Dr. Desai saw Plaintiff a total of four times. Tr. at 658-66. Plaintiff's first visit to Dr. Desai was on December 27, 2010. Tr. at 658-60. Plaintiff reported his mood as a three out of ten, angry feelings "all the time," little to no energy or motivation, constant passive suicidal ideation, frequent panic attacks, and occasional nighttime visual hallucinations of seeing snakes. Tr. at 658. Plaintiff felt his current medicine regimen could be improved, and Dr. Desai agreed. Tr. at 658-59. Dr. Desai added a brief trial of Seroquel XR 150 mg to assist with Plaintiff's anger and other factors. Tr. at 659. Dr. Desai also referred Plaintiff to individual therapy. Tr. at 659.
Plaintiff followed up with Dr. Desai on March 24, 2011. Tr. at 661-62. Though Plaintiff's mood increased to a four to five out of ten, Plaintiff indicated the Seroquel XR was not fully effective. Tr. at 661. Additionally, Plaintiff no longer reported suicidal ideation, and Dr. Desai stated Plaintiff's anxiety symptoms "appear[ed] to be somewhat better." Tr. at 661. Plaintiff continued to report variability with sleep, appetite, and energy level. Tr. at 661. At the end of Plaintiff's visit, Dr. Desai decided to increase Plaintiff's Seroquel XR regimen from 150 mg to 300 mg and recommended Plaintiff continue individual therapy. Tr. at 661.
Plaintiff's third visit was on June 9, 2011. Tr. at 663-64. Plaintiff arrived timely, having just come from a session with his individual therapist. Tr. at 663. Plaintiff reported to Dr. Desai that his mood was "somewhat `better,'" a five out of ten, but Plaintiff continued reporting some issues of depression, anxiety, and occasional auditory hallucinations. Tr. at 663. Plaintiff believed Seroquel was somewhat helpful, but still felt there was room for improvement. Tr. at 663. Dr. Desai decided to discontinue Seroquel and instead prescribe Plaintiff Abilify at 5 mg. Tr. at 663. Dr. Desai indicated he would "likely continue further dose titration [of Abilify] for clinical efficacy." Tr. at 663. Plaintiff was also to continue individual therapy sessions. Tr. at 663.
Plaintiff's last visit with Dr. Desai that is documented in the administrative transcript was on September 9, 2011. Tr. at 665-66. At this time, Plaintiff was taking 7.5 mg of Abilify, which Plaintiff was "quite pleased with." Tr. at 665. Plaintiff felt Abilify was "helping substantially with his irritability as well as anxiety symptoms." Tr. at 665. Plaintiff was also no longer having any problems with sleep, appetite, or energy level. Tr. at 665. Dr. Desai indicated Plaintiff "respond[ed] very well to supportive psychotherapy." Tr. at 665. Plaintiff reported no visual hallucinations and occasional auditory hallucinations of a door knocking. Tr. at 665. Dr. Desai recommended Plaintiff continue on his current medicine regimen and follow-up with Dr. Desai in one to two months. Tr. at 665.
On November 1, 2011, Dr. Desai completed a Medical Assessment of Ability to do Work Related Activities (Mental) ("Medical Assessment") in which he opined Plaintiff had moderate to marked limitations in making occupational adjustments, which was supported by "clinical interviews over the past year." Tr. at 643-44. Plaintiff also had moderate to marked limitations making personal/social adjustments, as well as marked limitations in making performance adjustments, due to "severe depression [and] anxiety which adversely impact [Plaintiff's] ability to pay attention or concentrate for extended periods of time." Tr. at 644. Dr. Desai indicated he expected Plaintiff to miss work four to seven days per month due to his condition. Tr. at 645.
The ALJ accurately summarized Dr. Desai's findings in the Medical Assessment of Ability to do Work Related Activities (Mental), Tr. at 18, and then stated:
Tr. at 18 (citations omitted).
Plaintiff argues the reasons articulated by the ALJ for discounting Dr. Desai's opinion are insufficient and are not supported by substantial evidence in the record.
The undersigned finds the ALJ did not sufficiently articulate the reasons for discounting Dr. Desai's opinion, and/or the reasons stated are not supported by substantial evidence in the record. Indeed, in discounting Dr. Desai's opinion, the ALJ either erroneously relied on old notes of other physicians, while attributing them to Dr. Desai, or inaccurately summarized the content of Dr. Desai's notes. A more detailed discussion follows.
The ALJ's first reason for discounting Dr. Desai's opinion in the Medical Assessment is because Dr. Desai's opinion is "inconsistent with his own treatment records (from 4 visits) in which he noted that [Plaintiff] improved with medication and was somewhat non-compliant with recommended treatment as he did not make an effort to attend the chronic pain group therapy sessions." Tr. at 18. By specifically highlighting Plaintiff's past noncompliance in
The ALJ may have mistakenly considered other doctors' notes at Shands Jacksonville, while attributing the notes to Dr. Desai, in finding Plaintiff was noncompliant. Dr. Satyen Madkaiker met with Plaintiff on October 30, 2007, at Shands Jacksonville and scheduled Plaintiff for therapy sessions with Mr. Ed Paat. Tr. at 646-47. On April 16, 2008, Dr. Steven Cuffe, also at Shands Jacksonville, indicated Plaintiff was not attending his therapy sessions. Tr. at 649. Plaintiff was discharged, Tr. at 650, but returned back to Shands Jacksonville to visit with Dr. Eduardo Sanchez on February 2, 2009. Tr. at 652-53. Instead of being noncompliant, Dr. Sanchez noted on November 9, 2009, that Plaintiff was "doing well with the present therapeutic regimen." Tr. at 655. Plaintiff's last visit with Dr. Sanchez was on May 7, 2010. Tr. at 657. So, regardless of whether the ALJ was erroneously attributing these doctors' notes to Dr. Desai in finding Plaintiff noncompliant with therapy, these notes do not support the noncompliance finding.
The ALJ stated as a second reason for discounting Dr. Desai that "Dr. Desai discharged [Plaintiff] back to his primary care physician's care as he had remained stable and due to non-compliance with recommended treatment." Tr. at 18. Again, Dr. Desai did not indicate Plaintiff was noncompliant, and he did not discharge Plaintiff to his primary care physician. Dr. Desai recommended that Plaintiff follow-up with him in one to two months after Plaintiff's last appointment on September 9, 2011. Tr. at 665. Dr. Desai neither discharged Plaintiff nor mentioned Plaintiff remaining "stable." Tr. at 643-45, 658-66. It is possible that the ALJ confused Dr. Desai's treatment notes with other earlier medical records from Shands Jacksonville. For example, Dr. Cuffe indicated Plaintiff was not attending therapy sessions and eventually discharged Plaintiff in 2008. Tr. at 649-50. In contrast, Dr. Desai treated Plaintiff in 2010 and 2011. Tr. at 658-66. As such, substantial evidence does not support this reason for discounting Dr. Desai's opinion.
Third, the ALJ discounted Dr. Desai's opinion in the Medical Assessment in part because "this opinions [sic] is beyond the claimant's last date insured." Tr. at 18. However, Dr. Desai began treating Plaintiff on December 27, 2010, Tr. at 658, which falls during the relevant time period, before Plaintiff's date last insured, December 31, 2010, Tr. at 12. While Dr. Desai's Medical Assessment was completed after Plaintiff's date last insured, Tr. at 645, opinions rendered retrospectively may still be relevant to an ALJ's determination. "[A]s a simple matter of logic, even if medical evidence (such as the post-date last insured opinions of Dr. [Desai]) did not exist at the date last insured, that fact standing alone does not mean that such evidence lacks probative value as to a plaintiff's pre-date last insured impairments."
A retrospective diagnosis may be considered if it is validated by evidence within the relevant time period.
Defendant contends the ALJ's opinion is supported by substantial evidence, and Defendant provides a number of reasons (that the ALJ failed to provide) why the administrative transcript allegedly supports the ALJ's election to reject Dr. Desai's opinion. Def.'s Mem. at 5-12. Although there may be reasons to properly discredit Dr. Desai's opinion, the ALJ has failed to sufficiently articulate those reasons, and Defendant may not correct this error. Defendant's reasons, regardless of whether they are supported by substantial evidence, cannot bolster or replace the ALJ's reasons or lack thereof. Defendant's analysis cannot serve as
For the reasons stated above, the undersigned finds the rationale stated by the ALJ for discounting Dr. Desai's opinion insufficient and/or not supported by substantial evidence in the record. Judicial review is frustrated because the ALJ erred in either erroneously relying on other doctors' old notes while attributing them to Dr. Desai, or inaccurately summarizing Dr. Desai's notes. Additionally, the ALJ erred in not considering Dr. Desai's opinion merely because it was written after Plaintiff's date last insured. Accordingly, it is
1. The Clerk of Court is directed to enter judgment pursuant to sentence four of 42 U.S.C. § 405(g)
2. The Clerk is further directed to close the file.
3. In the event benefits are awarded on remand, Plaintiff's counsel shall ensure that any § 406(b) fee application be filed within the parameters set forth by the Order entered in Case No. 6:12-mc-124-Orl-22 (In Re: Procedures for Applying for Attorney's Fees Under 42 U.S.C. §§ 406(b)).