PHILIP P. SIMON, District Judge.
Ricky A. Johnson is a 57-year-old man who left school in the eighth grade and has worked as a construction laborer and a factory machine operator. [AR at 183, 176, 197.]
Johnson had a hearing before a Social Security administrative law judge on July 9, 2015, at which Johnson appeared and gave testimony. [AR at 36-72.] The ALJ issued a written decision denying Johnson's claim for benefits on July 23, 2015. [AR 20-35.] The ALJ found that Johnson has severe impairments of degenerative disc disease of the lumbar and cervical spines, status post lumbar fusion and cervical fusion, arthritis of the left acromioclavicular joint, depression and anxiety. [AR at 22.] The ALJ concluded that Johnson's severe impairments do not conclusively establish disability by meeting or medically equaling the severity of the listed impairments in 20 CFR Part 404, Subpart P, Appendix 1. [Id. at 23.] The ALJ also found that Johnson possessed the residual functional capacity to perform light work with limitations, that he was capable of performing jobs that exist in significant numbers in the national economy, and that Johnson is not disabled. [AR at 25, 34, 35.] The Social Security Administration's Appeals Council denied Johnson's request for further review. [AR at 1.] This case is Johnson's appeal from the denial of disability insurance benefits.
Johnson asks me to reverse the ALJ's decision or remand the case for further proceedings by the Social Security Administration. My review of the ALJ's decision is deferential. I must affirm it if it is supported by substantial evidence, meaning "`such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.'" McKinzey v. Astrue, 641 F.3d 884, 889 (7
Johnson's first challenge to the ALJ's decision is that his treatment of various medical opinion evidence was faulty. Medical opinions are considered by the ALJ in formulating a claimant's residual functional capacity. RFC is the disability term for the description of what a claimant is able to do despite functional limitations from medical impairments, and represents the Commissioner's determination of the individual's "capacity to perform work-related physical and mental activities." POMS DI 24510.001(A)(1).
In this case, the ALJ found that Johnson had the RFC:
[AR at 25.]
Under §404.1567(b):
By its silence on certain capabilities, the ALJ's RFC suggests no limits on Johnson's ability to sit, walk or stand, and an ability to frequently lift or carry 10 pounds, and to lift up to 20 pounds. In rendering this RFC opinion, the ALJ gave great weight to (that is, agreed with and adopted) the conclusions of state agency medical consultant Dr. J. Sands, who completed an RFC assessment on June 17, 2013. [AR at 31-32, 78-80.] The ALJ offers no explanation for favoring Dr. Sands' opinion over that of other doctors with differing opinions about Johnson's capabilities.
The ALJ had the benefit of a number of medical opinions in arriving at his RFC assessment. One of Johnson's treating physicians is Dr. Julian Ungar-Sargon, a neurologist and specialist in pain management. Dr. Ungar-Sargon provided a Medical Source Statement in which he offered his opinions about Johnson's work-related limitations. Dr. Ungar-Sargon concluded that Johnson could only rarely lift or carry up to 10 pounds, and could never lift or carry more, based on severe carpal tunnel syndrome as shown on EMG. [AR at 996.] Due to chronic lumbar spine issues shown on EMG, Dr. Ungar-Sargon opined that Johnson could sit 2 hours at a time and a total of 3 hours in an 8-hour work day, and that Johnson could stand or walk for an hour at a time and a total of 2 hours in an 8-hour work day. [AR at 997.] Dr. Ungar—Sargon said that Johnson could rarely reach overhead and otherwise could never reach, handle, finger, feel, push or pull, and that he could only rarely operate foot controls. [AR at 998, 999.]
"A treating physician's opinion on the nature and severity of a medical condition is entitled to controlling weight if it is well supported by medical findings and is consistent with other evidence in the record." Gerstner v. Berryhill, 879 F.3d 257, 261 (7
Here the ALJ's explanation for the lesser weight given Dr. Ungar-Sargon's assessment includes the fact that his treatment relationship with Johnson was only 3 months long. [AR at 32.] Nonetheless, Dr. Ungar-Sargon was the only treater from whom the ALJ had this kind of RFC assessment opinion, and the ALJ had expressly discounted two other medical opinions on the ground that they were not from doctors who had treated Johnson. [AR at 29, 31.] In his discussion of the weight of Dr. Ungar-Sargon's opinion, the ALJ does not expressly acknowledge that the doctor is a specialist (neurology and pain management), which tends to increase the weight to be given his conclusions. 20 C.F.R. §416.927(c)(5) ("We generally give more weight to the opinion of a specialist about medical issues related to his or her area of specialty than to the opinion of a source who is not a specialist.")
Based on his knowledge of Johnson's history, test results and current condition, Dr. Ungar-Sargon was willing to opine "within a reasonable degree of medical probability as to past limitations" that Johnson's functional limitations were present as of November 27, 2012. [AR at 1002.] The ALJ is critical of Dr. Ungar-Sargon's lack of "firsthand knowledge of the claimant's functional abilities dating back to the alleged onset date." [AR at 32.] As Johnson points out, however:
Martinez v. Massanari, 242 F.Supp.2d 372, 377 (S.D.N.Y. 2003) (internal citations omitted). The Seventh Circuit has held: "There can be no doubt that medical evidence from a time subsequent to a certain period is relevant to a determination of a claimant's condition during that period." Halvorsen v. Heckler, 743 F.2d 1221, 1225 (7
The ALJ's justification for discounting Dr. Ungar-Sargon's opinion concludes with his assertion that "the overall evidence, including Dr. Ungar-Sargon's own treatment records, does not support such restrictive limitations." [AR at 32.] The sweeping allusion to the "overall evidence" is not further explained, and no contrary evidence is identified or cited. As to the doctor's own records, the ALJ points to tests ordered by Dr. Ungar-Sargon, suggesting that although the results "showed some abnormalities, they were only moderately abnormal." [Id.] The ALJ cannot persuasively pitch his own (unexplained) interpretation of "moderately abnormal" test results against those of a medical specialist who cited test results in giving opinions about a patient's limitations. ALJs must "rely on expert opinions instead of determining the significance of particular medical findings themselves." Moon v. Colvin, 763 F.3d 718, 722 (7
I conclude that the ALJ failed to provide the necessary "good reasons" for discounting Dr. Ungar-Sargon's opinions about Johnson's functional capacities. Brown, 845 F.3d at 252. The ALJ's proffered explanation does not demonstrate that Dr. Ungar-Sargon's assessments were not "well supported by medical findings" or were "inconsistent with other substantial evidence in the record." Id.
Johnson also challenges the ALJ's discounting of the opinion of consultative examiner Dr. Gregory French. Dr. French's opinion was that Johnson had no limitations sitting, walking or standing, as the ALJ found. Dr. French's opinion was also that Johnson could only lift or carry less than 10 pounds, which the ALJ disagreed with. Now Johnson faults the ALJ for disagreeing with that aspect of Dr. French's assessment. Dr. French is one of the physicians whom the ALJ discounted because he was merely "an examining source as opposed to a treating source." [AR at 29.] The vacuity of this reasoning is demonstrated by the fact that the ALJ discounted the only treating medical source, but gave great weight to a medical source who did not treat OR examine Johnson, but only reviewed the file (Dr. Sands).
Again the ALJ refers to the "overall evidence," this time citing Johnson's successful recovery from lumbar surgery and "some improvement" after his second neck surgery. [AR at 29.] What those circumstances have to do with the ability to lift and carry is unclear. Dr. French had himself found Johnson's bilateral upper extremity fine motor abilities diminished as well as the strength of Johnson's hands. [AR at 353.] To say that the "overall evidence does not support such a restrictive limitation regarding lifting and carrying" is to overlook entirely the contrary opinion of the one treating physician in the file, Dr. Ungar-Sargon, and the medical evidence (test results) supporting it. [Id.] Other medical evidence is also consistent with Dr. French's conclusion about Johnson's ability to lift and carry. Johnson's primary care physician, Dr. Hoff, noted in March 2013 that Johnson suffered from paresthesias of the fourth and fifth fingers on both hands. [AR at 356.] And the ALJ himself notes "the presence of some hand numbness" even after the final spinal surgery. [AR at 29, 326.] For these reasons, the ALJ's weighing of Dr. French's opinion is not well supported by the explanation he offers.
The ALJ found Johnson to have severe impairments of depression and anxiety. [AR at 22.] In determining RFC limitations relative to these conditions, the ALJ had before him the opinions of two psychologists who examined Johnson in June 2015, Anthony Conger, Ph.D. and Judith Dygdon, Ph.D. [AR Exh. 15F.] The evaluation performed by Dr. Conger and Dr. Dygdon was undertaken at the request of Johnson's attorney for purposes of his disability application. [AR at 1034.] It involved the doctors' review of Johnson's medical records, an interview with Johnson, and the administration of a battery of tests of behavioral, cognitive and personality functioning. [AR at 1033.] Dr. Conger and Dr. Dygdon produced a detailed 16-page report [AR at 1033-1048], and completed the Social Security Administration's form "Psychiatric Review Technique," in which they presented their opinion that Johnson's impairments met Listings 12.04 (for depressive, bipolar and related disorders) and 12.06 (for anxiety and obsessive-compulsive disorders). [AR at 1050.] For each category of functional limitation known as the "B" criteria, Dr. Conger and Dr. Dygdon found Johnson to have higher degree of limitation than the ALJ ultimately concluded. [AR at 1053.] The ALJ gave "little weight" to the findings of Dr. Conger and Dr. Dygdon. [AR at 31.]
Johnson challenges the ALJ's reasons for discounting Dr. Conger and Dr. Dygdon's conclusions. The ALJ cites the fact that they were not a "treating source" but only an "examining source" who saw Johnson on one occasion. [AR at 31.] Again, this reliance on the hierarchy of opinion evidence rings false when the ALJ gave the greatest weight to the state agency consultant, Dr. Sands, who neither treated nor examined Johnson. Without further explanation, the ALJ dismisses Dr. Conger and Dr. Dygdon's report on the grounds that "the findings in their own exam" and "the totality of the evidence" do not support their opinions. [AR at 31.] These conclusory justifications that fail to identify and explain the contradictory evidence are an inadequate basis for the ALJ's discounting the doctors' conclusions. Finally, the ALJ refers to Johnson's relative lack of mental health treatment. [AR at 31.] But he did so without "considering possible reasons (the claimant) . . . may not comply with treatment or seek treatment consistent with the degree of his or her complaints," as required by Social Security Ruling 16-3p. See also Beardsley v. Colvin, 758 F.3d 834, 840 (7
The Commissioner's support of the ALJ's decision provides no argument for the sufficiency of the ALJ's treatment of these various medical opinions. [AR 15 at 3-5.] Instead, the brief merely recaps what the ALJ said about each opinion, without responding to Johnson's arguments or offering any discussion of why the ALJ's analysis was adequate. [Id.] I clearly don't find the sufficiency of the ALJ's handling of the medical source opinions to be self-evident, as the Commissioner's response suggests. Instead, I conclude that a lack of substantial evidence and explanation for the weight given to each of the four opinions requires a remand for further consideration of those opinions and their impact on the RFC assessment.
Next Johnson argues that the ALJ's reasons for not fully accepting Johnson's statements about his symptoms are "legally insufficient and unsupported by the record." [[DE 15 at 19.] Finding Johnson's statements "not fully credible," the ALJ cited "medical records that show only improvement of his symptoms after his surgeries and that his chronic neck and back pain is well-controlled and stable with medication." [AR at 33.] Because the case is being remanded on the grounds previously discussed for further consideration of Johnson's RFC, the Commissioner will have a new opportunity to evaluate the credibility of Johnson's claims about his symptoms.
Furthermore, the reevaluation can take into account the additional medical evidence submitted at the Appeals Council level that was too late to be considered by the ALJ. [AR at 272, 2.] This evidence, not included in the record before me, is described as the report from an EMG done on October 19, 2015 plus additional records from treating physician Dr. Ungar-Sargon that Johnson contends support his subjective complaints. [Id.] This evidence may be pertinent to a reconsideration of the ALJ's conclusion that Johnson's statements about the intensity, persistence and limiting effects of his symptoms were not entirely credible because the "totality of the evidence" did not fully support them. [AR at 26.]
Next Johnson challenges the ALJ's analysis of his COPD and hypothyroidism, which the ALJ identified as non-severe impairments. [DE 15 at 20; AR at 23.] It is true that in making an RFC assessment, the Commissioner is required to consider the combined effect of all impairments, both severe and non-severe. Social Security Ruling 96-8p; Yurt v. Colvin, 758 F.3d 850, 860 (7
The argument is made without citations to evidence of record. The plaintiff offers no support for his suggestion that "potential environmental limitations" were warranted due to Johnson's COPD or that additional psychosocial limitations needed to be considered based on nothing more than Johnson's brief testimony linking agitation and tears to hyperthyroidism. [DE 15 at 21.] This "perfunctory and undeveloped argument . . . unsupported by pertinent authority" is entirely unpersuasive, even if considered on its merits rather than deemed waived. Crespo v. Colvin, 824 F.3d 667, 674 (7
The same is true of Johnson's argument that the ALJ "did not properly address whether Mr. Johnson had limitations that prevented him from sustaining a 40-hour workweek." [DE 15 at 22.] Johnson merely generally asserts that "the weight of the evidence" suggested a need for a "sustainability" analysis, but cites no evidence in support of this contention, which I therefore reject as perfunctory and undeveloped.
Finally, Johnson contends that when the ALJ considered Johnson's ability to perform work, the ALJ did not correctly identify the applicable "rule" or "grid" in the medical-vocational guidelines. [DE 15 at 22.] The ALJ concluded that Johnson's limitations impeded his ability to "perform all or substantially all of the requirements of" the category of "light work," but nonetheless determined based on the testimony of the vocational expert that Johnson is "capable of making a successful adjustment to other work that exists in significant numbers in the national economy." [AR at 34, 35.]
Johnson now suggests that the ALJ should have given additional consideration to whether his "exertional capacity is so reduced from the regulatory definition that it supports a finding that there remains little more than the occupational base for the lower rule." [DE 15 at 23.] If this had resulted in an analysis of available "sedentary work" of which Johnson is capable, he would have been found disabled. [Id. at 24.] This argument fundamentally depends on the assessment of Johnson's RFC. Because that determination will be revisited on remand, I need not proceed further with a ruling on the issue now raised.
An ALJ must build a logical bridge from the evidence to his conclusion. Brown v. Colvin, 845 F.3d at 251; Ghiselli v. Colvin, 837 F.3d 771, 778 (7
The final decision of the Commissioner of Social Security denying plaintiff Ricky A. Johnson's application for Social Security Disability benefits is REVERSED AND REMANDED for further proceedings consistent with this opinion.
The Clerk shall enter judgment in favor of plaintiff and against defendant.