JOHN W. LUNGSTRUM, District Judge.
Plaintiff seeks review of a decision of the Acting Commissioner of Social Security (hereinafter Commissioner) denying Disability Insurance benefits (DIB) under sections 216(i) and 223 of the Social Security Act. 42 U.S.C. §§ 416(i) and 423 (hereinafter the Act). Finding no error, the court ORDERS that judgment shall be entered pursuant to the fourth sentence of 42 U.S.C. § 405(g) AFFIRMING the Commissioner's decision.
Plaintiff applied for DIB, alleging disability beginning December 10, 2007. (R. 498, 137). The Commissioner denied benefits, and Plaintiff sought judicial review. (R. 715-29). In a Memorandum and Order dated September 24, 2013, the district court found that the Commissioner's decision was not supported by substantial evidence and remanded for further consideration.
On remand, further proceedings were had, another hearing was held on March 25, 2014, and the Administrative Law Judge (ALJ) issued a decision dated April 11, 2014 in which he found Plaintiff is not disabled. (R. 498-514). That decision became the final decision of the Commissioner after remand, and on August 8, 2014 Plaintiff again sought judicial review. (Doc. 1). Plaintiff claims the ALJ improperly evaluated the opinion evidence, erred in his credibility determination, improperly assessed residual functional capacity (RFC), and erred in relying upon the vocational expert (VE) testimony.
The court's review is guided by the Act.
The court may "neither reweigh the evidence nor substitute [its] judgment for that of the agency."
The Commissioner uses the familiar five-step sequential process to evaluate a claim for disability. 20 C.F.R. §§ 404.1520, 416.920;
The Commissioner next evaluates steps four and five of the sequential process— determining at step four whether, in light of the RFC assessed, claimant can perform his past relevant work; and at step five whether, when also considering the vocational factors of age, education, and work experience, claimant is able to perform other work in the economy.
The court finds no error as alleged by Plaintiff, and considers each allegation in the order presented in Plaintiff's Brief.
Plaintiff claims the ALJ erred in evaluating the opinions of Plaintiff's treating psychiatrist, Dr. Hachinsky; erred in failing to mention opinion statements contained in the treatment notes of another treating physician, Dr. Kessler; and erroneously failed to mention the findings of Plaintiff's current therapist or discuss the significance of GAF
"Medical opinions are statements from physicians and psychologists or other acceptable medical sources
"If [the Commissioner] find[s] that a treating source's opinion on the issue(s) of the nature and severity of [the claimant's] impairment(s) [(1)] is well-supported by medically acceptable clinical and laboratory diagnostic techniques and [(2)] is not inconsistent with the other substantial evidence in [claimant's] case record, [the Commissioner] will give it controlling weight." 20 C.F.R. § 404.1527(c)(2); see also, SSR 96-2p, West's Soc. Sec. Reporting Serv., Rulings 111-15 (Supp. 2015) ("Giving Controlling Weight to Treating Source Medical Opinions").
The Tenth Circuit has explained the nature of the inquiry regarding a treating source's medical opinion.
If the treating source opinion is not given controlling weight, the inquiry does not end.
After considering the factors, the ALJ must give reasons in the decision for the weight he gives the opinion.
Recognizing the reality that an increasing number of claimants have their medical care provided by health care providers such as nurse practitioners, physician's assistants, social workers, and therapists, who are not "acceptable medical sources," the Commissioner promulgated SSR 06-3p. West's Soc. Sec. Reporting Serv., Rulings 327-34 (Supp. 2015). In that ruling, the Commissioner noted:
SSR 06-3p explains that such opinions will be evaluated using the regulatory factors for evaluating medical opinions;
The ALJ's evaluation of the medical opinions encompassed about four pages of his decision. (R. 507-11). In that span, he evaluated and accorded weight to the medical opinions of five state agency non-examining sources (Drs. Coleman, Siemsen, Fantz, Warrander, and Stern) and of Plaintiff's treating physician, Dr. Hachinsky, and evaluated and accorded weight to the reports of three non-treating sources who examined Plaintiff at the request of the agency (Drs. Koeneman, McCullough, and Neufeld).
Plaintiff argues that the ALJ erred in weighing Dr. Hachinsky's opinion and that
Dr. Hachinsky's treating source opinion should have been accorded greater weight, but he does not argue that the weight accorded to the other medical sources' opinions was erroneous. Rather, he argues that the ALJ should have weighed certain statements in Dr. Kessler's treatment notes, should have discussed the significance of GAF scores assigned by Dr. Koeneman, Dr. Hachinsky, and Plaintiff's therapist, and should have discussed the findings of "plaintiff's current therapist." (Pl. Br. 45) (without identification).
The court finds that the record evidence as cited and explained by the ALJ supports the weight he accorded to each of the opinions of Drs. Coleman, Siemsen, Fantz, Warrander, Koeneman, McCullough, Stern, and Neufeld, and it will not further address those findings except as necessary to address Plaintiff's specific arguments.
Plaintiff's assertion of error in the failure of the ALJ to "discuss the significance of any of the GAF scores assigned to plaintiff" (Pl. Br. 45), is without merit. In two footnotes in her brief, the Commissioner argues that a GAF score can be entirely unrelated to a claimant's functioning, and cites to unpublished decisions of the Tenth Circuit to support her argument that an ALJ does not err in failing to discuss GAF scores. (Comm'r Br. 5, 6, nn.3, 4).
As the Commissioner's Brief implies, in August 2000 the Commissioner revised the Mental Impairment Listings, and explained the decision not to discuss the GAF scale in subparagraph 12.00D (Documentation) of those listings. Revised Medical Criteria for Evaluating Mental Disorders and Traumatic Brain Injury, 65 Fed. Reg. 50,746, 50,764-65 (August 21, 2000). In the explanation, the Commissioner noted that two commenters recommended discussing the GAF scale in Subparagraph 12.00D.
An ALJ is not required to discuss every piece of evidence. But, he must discuss the uncontroverted evidence he chooses not to rely upon, and any significantly probative evidence he decides to reject.
Plaintiff's allegation of error in the failure to mention the findings of his therapist is equally unavailing. Plaintiff does not identify his therapist, or (other than referring to a GAF score of 45) point to any functional limitations which were suggested by the therapist. Plaintiff's Brief cites to a treatment note (R. 1151) apparently completed by his therapist which contains a GAF assessment of "45," and the court has thereby identified Exhibit 46F as the treatment notes of Plaintiff's therapist, which are signed by Kristy N. Cramer, MA, LPC. The court is unable to discover any opinion in those notes (beyond the GAF score discussed above) which can be construed as an opinion which is clearly contrary to the ALJ's RFC assessment. Plaintiff has shown no opinion presented by his therapist which should have been considered by the ALJ.
Plaintiff complains that the ALJ did not mention Dr. Kessler's statements that Plaintiff was "hindered" by his pain and his pain medication, and that Plaintiff was weak, on narcotic medications that made him tired, and could not work or even complete activities of daily living. (Pl. Br. 45 & n.12) (citing R. 1110, 1141). In a footnote to her Brief, the Commissioner suggests that Dr. Kessler's statements are not medical opinions, and argues that the treatment notes relied upon by Plaintiff merely contain his subjective symptoms or Dr. Kessler's examination findings, and that Plaintiff does not explain "how those symptoms or findings are inconsistent with sedentary work." (Comm'r Br. 4, n.2) (citing R. 1110,1141). In his Reply Brief, Plaintiff argues that contrary to the Commissioner's Brief, Dr. Kessler stated in the "Plan" section of his treatment notes that "plaintiff `cannot work as he cannot even complete adl.'" (Reply 3) (quoting R. 1142).
As Plaintiff suggests, in a treatment note dated October 24, 2012, Dr. Kessler reported "New symptom(s)" including that Plaintiff is "hindered seecondary [sic] to pain and the pain meds which cause drowsiness." (R. 1110). Plaintiff also relied upon a treatment note dated June 3, 2013. (R. 1141-42). At the end of that treatment note, Dr. Kessler provided his "Plan" in which, for 7 lines of text, he explained that he was going to continue several medications in certain dosages, strengths, methods, and periods. (R. 1142). At the end of that "Plan," the treatment note states: "patient cannot work as he cannot even complete adl [presumably `activities of daily living']. he [sic] is weak and on narcotics for the pain and it makes him tired, and constipated."
The court finds no error in the ALJ's failure to evaluate these statements as medical opinions or to explain the weight accorded to them. First, the decision makes clear that the ALJ considered Dr. Kessler's treatment notes, because he summarized evidence from those treatment notes and cited to those notes in his decision. (R. 501) (noting a recent diagnosis of hypogonadism, and citing Ex. 44F); (R. 504-05) (noting treatment for back and neck pain and citing Ex. 37F); (R. 505) (noting a history of coronary artery disease and citing Exs. 37F, 44F, and 45F). As the Commissioner noted, Dr. Kessler's statement that Plaintiff was "hindered" by pain and his pain medications (R. 1110), was merely a repeat of Plaintiff's report of his symptoms, and makes no mention of any quantified or quantifiable limitation resulting from those symptoms. Dr. Kessler's note that Plaintiff is weak and that his narcotic pain medications make him tired and constipated (R. 1142) is similarly flawed. These statements simply do not reflect a medical opinion which must be evaluated by the ALJ. Plaintiff can show no prejudice resulting from a failure to specifically mention or evaluate them.
Dr. Kessler's statement — "patient cannot work as he cannot even complete adl," could certainly be viewed as a medical opinion, but Plaintiff has not shown that it is the medical opinion of Dr. Kessler, or even if it is, that the ALJ should have noticed it, much less should have discussed it. As the Tenth Circuit has explained the court cannot insist on technical perfection in the ALJ's evaluation of the medical evidence.
The ALJ devoted more than a page in his decision to discussion and consideration of Dr. Hachinsky's opinions. (R. 507, 508-09). He summarized Dr. Hachinsky's letter dated April 8, 2007 (R. 507), and he summarized and accorded weight to the medical source statements provided by Dr. Hachinsky and dated August 30, 2010. (R. 508-09). The ALJ noted that in its remand order, the district court had instructed the Commissioner to recontact Dr. Hachinsky for clarification of the inconsistencies in his opinions, and he explained that he had recontacted Dr. Hachinsky, but that Dr. Hachinsky had not responded. (R. 508). He accorded "no weight" to Dr. Hachinsky's opinions because Dr. Hachinsky stated his opinions were supported by Plaintiff's subjective reports, and because the opinions were "internally inconsistent, inconsistent with each other, [and] inconsistent with the record as a whole." (R. 508).
Apparently alluding to the requirement that an ALJ must determine whether a treating source opinion is worthy of controlling weight, Plaintiff argues that the "ALJ never made a specific determination as to whether the opinions of Dr. Hachinsky were `well-supported by medically acceptable clinical and laboratory diagnostic techniques' per SSR 96-2p." (Pl. Br. 47). While it is true that the ALJ did not state whether Dr. Hachinsky's opinions are supported by such techniques, he did state that the opinions are inconsistent with the other substantial evidence in the record. (R. 508). The Tenth Circuit has held that if an "opinion is deficient in
Plaintiff also argues that it was error to discount Dr. Hachinsky's opinion because it was based on Plaintiff's subjective allegations. (Pl. Br. 47). He argues that there is no indication Dr. Hachinsky believed Plaintiff was exaggerating, and that psychiatrists must base their opinions upon their patients' reports and their interactions with and observations of their patients. (Reply 2) (citing
"In choosing to reject the treating physician's assessment, an ALJ may not make speculative inferences from medical reports."
Plaintiff argues that Dr. Hachinsky's two medical source statements "are actually generally consistent" (Pl. Br. 48), that merely finding the opinions inconsistent is insufficient, and that other record evidence was also consistent with Dr. Hachinsky's opinions. (Pl. Br. 49). And, in his Reply Brief, Plaintiff argues that the ALJ should have reviewed the other reports to see if they outweigh Dr. Hachinsky's report, not the other way around. (Reply 3) (citing
The fact that there are also consistent findings between Dr. Hachinsky's statements does not negate the ALJ's finding of inconsistencies. Plaintiff does not, and cannot, argue that there are no inconsistencies between the two statements—which, as the ALJ noted, are dated the same day. To the extent that Plaintiff points out consistencies between the statements, and with other record evidence, he does not argue that the ALJ's findings are wrong or are not supported by record evidence. Plaintiff must demonstrate the error in the ALJ's rationale or finding; the mere fact that there is evidence which might support a contrary finding will not establish error in the ALJ's determination. "The possibility of drawing two inconsistent conclusions from the evidence does not prevent an administrative agency's findings from being supported by substantial evidence. [The court] may not displace the agency's choice between two fairly conflicting views, even though the court would justifiably have made a different choice had the matter been before it de novo."
To the extent Plaintiff argues that the ALJ did not review the other medical opinions to see if they outweigh Dr. Hachinsky's report, the court finds no basis for that argument. As noted above, the ALJ evaluated the medical opinions of nine doctors, including Dr. Hachinsky, and explained his findings in his decision. He accorded "some weight," "partial weight," and "substantial weight" to the opinions of eight of those doctors, and "no weight" to Dr. Hachinsky's opinion. And, he stated his reasons for doing so. It is abundantly clear that the ALJ reviewed those medical opinions and determined that they outweigh Dr. Hachinsky's report.
Plaintiff also argues that the "ALJ did not discuss the weight he assigned the opinions of Dr. Hachinsky in his letter of April 8, 2010." (Pl. Br. 45). The Commissioner responds that "it would have been preferable for the ALJ to have addressed this letter" (Comm'r Br. 8), but she argues that the letter does not provide functional limitations, and that the ALJ's thorough analysis of the record makes it clear that he afforded little weight to the opinions, if any, expressed in the letter, and why. (Comm'r Br. 8-9). In his Reply Brief, Plaintiff argues that there are "express limitations in Dr. Hachinsky's letter, such as his statement that plaintiff's [sic] anxiety caused him to become homebound for a long period of time, he was unable to drive even as a passenger [sic] in a car, he needed structure and routine with no variables to contend with and, importantly, his symptoms prevented him from maintaining steady employment." (Reply 1-2) (citing R. 444-45).
The court notes that in his decision, the ALJ specifically addressed Dr. Hachinsky's letter:
(R. 508). This is a fair summary of the substance of Dr. Hachinsky's letter, and Plaintiff does not argue otherwise. Moreover, contrary to Plaintiff's argument, the letter simply does not contain any functional limitations opined by Dr. Hachinsky. As but one example of that fact, the letter states: "He currently
The closest thing to an opinion in Dr. Hachinsky's letter is his statement that "I am very concerned about [Plaintiff's] ability to maintain steady employment at the present time
Plaintiff claims the ALJ erred in making his credibility determination. He asserts that the record is "replete with evidence of plaintiff's [sic] severe anxiety disorder and its disabling effect." (Pl. Br. 50). He argues that the ALJ discussed little of that evidence in his credibility analysis, and that the evidence he did discuss does not support his conclusions.
The framework for a proper credibility analysis is set out in
The court's review of an ALJ's credibility determination is deferential. Credibility determinations are generally treated as binding on review.
Early in his RFC assessment, the ALJ explained the standard for evaluating credibility, summarized Plaintiff's allegations regarding disability, and noted that he found Plaintiff's allegations of symptoms not credible "for the reasons explained in this decision." (R. 503-04). Next, he summarized the medical evidence and evaluated the medical opinions. (R. 504-11). Finally, he explained six reasons for discounting the credibility of Plaintiff's allegations. (R. 511-12). He found (1) that Plaintiff's activities of daily living are inconsistent with his allegations of disability: (2) that his mental health treatment has been routine, infrequent, and conservative; (3) that Plaintiff testified his mental health medication helps; (4) that Plaintiff has not been compliant with his treating providers recommendations; (5) that the record documents improvement when Plaintiff complies with treatment recommendations; and (6) that Plaintiff has worked during the time he alleged disability. (R. 511-12).
As the Commissioner argues, the ALJ determined Plaintiff's allegations of symptoms resulting from his impairments are not entirely credible, and provided reasons in support of his determination. The court finds that those reasons are supported by record evidence.
Plaintiff first argues that the ALJ erred in finding that Plaintiff's activities of daily living are inconsistent with his allegations of disability. He argues this is so because the ALJ recognized that Plaintiff reported in his 2013 function report he needed assistance with his personal care, but the ALJ found this report was inconsistent with Plaintiff's hearing testimony despite that "both plaintiff [sic] and his wife testified he needed assistance." (Pl. Br. 52). The ALJ's finding that Plaintiff's activities of daily living are inconsistent with his allegations of disability was based on more than this one factor. Moreover, the ALJ's analysis of this factor is supported by the record evidence. After citing record evidence that Plaintiff can provide his own personal care (in addition to record evidence that Plaintiff prepares meals, helps his children get ready for school, drives a limited amount, shops, does some laundry, manages his finances, washes dishes, and performs minimal household chores), the ALJ explained:
(R. 511). This explanation is supported by the record evidence. Plaintiff testified that he drives more than once a week, and when pressed, he testified he drives "[m]aybe four times" a week. (R. 602). He also testified that he uses a computer. (R. 613-14).
With regard to personal care, in his April 2013 function report, Plaintiff reported that he is unable to perform daily tasks such as dressing and grooming and that he can "move from bed to couch" "with assistance." (R. 942). In the section of the function report specifically titled "Personal Care," Plaintiff stated, "All activities are very limited," and that "wife must assist" with dressing, bathing, care for hair, and shaving. (R. 943). He stated that he can feed himself and that in using the toilet his wife will "assist to bathroom." (R. 943).
Plaintiff's hearing testimony with regard to personal care is reproduced here:
(R. 620-21).
Plaintiff's hearing testimony was that bending is a problem, and that his wife helps him overcome that problem by helping him put on shoes and socks when he goes someplace requiring tie shoes, and that she got him a "sponge thing" for use in the shower or bath. On the other hand, his function report states that he can move from bed to couch only "with assistance," that all personal care activities are very limited, and that all except feeding himself require assistance. The ALJ did not err in finding inconsistency between Plaintiff's hearing testimony and his 2013 function report, or in concluding that "claimant's wide range of activities of daily living leads the undersigned to find the claimant's allegedly disabling impairments are not as significant as alleged." (R. 511).
Plaintiff's claim that the "ALJ did not discuss or consider type, dosage, effectiveness and side effects of plaintiff's [sic] medication" (Pl. Br. 52), is also incorrect. The ALJ clearly considered and discussed this factor because he noted in the decision that Plaintiff's hypertension is controlled with medication (R. 501, 506), that Plaintiff reported "memory problems and difficulty concentrating secondary to his medications" (R. 504), that Ms. Blazevic testified that Plaintiff's mental medication helps (R. 504, 512), and that Plaintiff reported "his medication was helping him sleep." (R. 506). Moreover, the ALJ specifically noted that the standard for evaluating credibility required him to consider "the type, dosage, effectiveness, and side effects of any medication." (R. 511).
Plaintiff claims the ALJ erred in finding that his mental health treatment has been routine, infrequent, and conservative because Plaintiff "saw Dr. Hachinsky on eight occasions over a two and a half year period" (Pl. Br. 53), and "recently found a therapist nearby, which the ALJ neglected to acknowledge." (Pl. Br. 54). Contrary to Plaintiff's claim, the ALJ specifically acknowledged the testimony of both Plaintiff and his wife that he had been seeing a therapist monthly for the four or five months immediately before the hearing. (R. 504, 511). Moreover, the ALJ cited the therapist's treatment notes when summarizing Plaintiff's mental health treatment. (R. 506) (citing Ex. 46F). While it is true that Plaintiff saw Dr. Hachinsky eight times over a two and a half year period, it is also true, as the ALJ specifically noted, that Plaintiff had not seen a psychiatrist since he last saw Dr. Hachinsky "in August 2010, more than three years ago." (R. 511). The ALJ did not err in finding that Plaintiff's mental health treatment has been routine, infrequent, and conservative.
Plaintiff's assertion that there is also record evidence which could support a finding that Plaintiff's allegations are credible is merely an invitation to the court to reweigh the evidence and substitute its judgment for that of the ALJ. That is a course which the court is forbidden to take.
Finally, Plaintiff cannot show error in the ALJ's failure to accord specific weight to the lay opinion of Plaintiff's wife, either as his wife, or as a medical professional. In the Tenth Circuit, an ALJ is not required to make specific, written findings regarding third party credibility when the written decision reflects that the ALJ considered the statements.
Here, as in
Plaintiff claims, in part, that the ALJ erred in his RFC assessment because he erred in weighing the medical source opinions and provided an inadequate credibility analysis. As discussed above, the court found no error in these matters, and they did not result in error in the ALJ's RFC assessment.
Plaintiff also claims however, that the ALJ erred in finding Plaintiff can occasionally bend, and in failing to explain how Plaintiff "would be expected to arrive at his workplace" even though the ALJ determined Plaintiff should not drive in his work. (Pl. Br. 55-56). The Commissioner argues that the representative jobs provided by the vocational expert and accepted by the ALJ do not require stooping in any case, and that although "the ALJ reasonably concluded that Plaintiff should not drive as a profession, the record simply does not support Plaintiff's argument that he cannot drive at all." (Comm'r Br. 14-15). The court finds no error in these claims.
The ALJ did not find that Plaintiff can occasionally bend, as Plaintiff's claim of error alleges. Rather, he found that Plaintiff can occasionally stoop. (R. 503). However, Plaintiff appears to recognize this because his specific argument was that "[a]n individual must be able to bend (stoop) occasionally in order to perform substantially all the requirements of most sedentary jobs." (Pl. Br. 55) (citing SSR 85-15 (without pinpoint citation)).
SSR 85-15 defines "stoop" as "to bend the spine alone," as opposed to bending both the spine and legs (crouching), or bending the legs alone (kneeling). 1985 WL 56857 at *2. That ruling provides that "[i]f a person can stoop occasionally (from very little up to one-third of the time) in order to lift objects, the sedentary and light occupational base is virtually intact."
As far as the testimony of Plaintiff and his wife are concerned, the ALJ found Plaintiff's allegations only partially credible, and the court finds no error in that finding. With regard to Dr. McCullough's opinion, Plaintiff does not acknowledge all of Dr. McCullough's opinion. Dr. McCullough opined both that Plaintiff's "lumbar spine was limited to 45 degrees of flexion," and that his cervical spine is limited to "20 degrees forward flexion." (R. 1030)
As for Plaintiff's argument that the ALJ failed to "explain how plaintiff [sic] would be expected to arrive at his workplace" (Pl. Br 55-56), Plaintiff cites no authority for the proposition that an ALJ must explain how a claimant is able to get to work, or that a claimant must be able to drive or be able to be driven to work. The Act requires that the agency demonstrate that work the claimant is able to perform is available in the economy. Plaintiff may "arrive at his workplace" however he wishes. Moreover, and perhaps more to the point, as the Commissioner points out "the record simply does not support Plaintiff's argument that he cannot drive at all," and Dr. Neufeld, to whose opinions the ALJ accorded "partial weight," "opined that . . . `the claimant's responses indicated that he would be capable of getting to and from a job in this regard.'" (Comm'r Br. 13-14) (quoting R. 1134). Plaintiff has shown no error in the ALJ's RFC assessment.
Plaintiff claims the ALJ's reliance on the testimony of the vocational expert was erroneous because the hypothetical question did not include all of Plaintiff's limitations. However, as the Commissioner points out, none of the limitations suggested earlier in Plaintiff's Brief are borne out by the record. Moreover, the hypothetical question included all of the limitations the ALJ found were supported by the record evidence. Thererfore, it was not error for the ALJ to rely on the vocational expert's testimony in that regard.
Plaintiff also argues that the vocational expert "testified some employers of the jobs she identified as available . . . would require that workers pass a drug screen and someone taking narcotic pain medication, even if prescribed, would not be able to pass such a test." (Pl. Br. 56).
As Plaintiff suggests, the vocational expert testified that some employers in the jobs she identified would require a drug screen, and would not allow exceptions for someone taking narcotic pain medication. However, the vocational expert's testimony was much more nuanced than Plaintiff reports. When asked if a hypothetical individual using an opiate medication such as Oxycontin or Percocet would be able to pass a drug screen, she testified:
(R. 639-40). At that point, Plaintiff's counsel ended her questioning of the vocational expert and stated: "I don't have anything further, Your Honor." (R. 640).
Thus, the thrust of the testimony was that some employers who require drug screening will allow exceptions for prescribed narcotic medications and some will not, and it is more likely exceptions will be made where the employee is not driving or operating machinery. Here, the ALJ specifically determined that Plaintiff should have a job not requiring driving (R. 503), and the representative jobs at issue, printed circuit board inspector, and lens inserter do not require operating machinery. Therefore, these are jobs in which a greater number of employers will allow exceptions. The vocational expert testified that there are a significant number of such jobs available for a hypothetical individual such as Plaintiff.
Plaintiff has shown no error in the decision at issue.
"Treating source:" an "acceptable medical source" who has provided the claimant with medical treatment or evaluation in an ongoing treatment relationship. 20 C.F.R. §§ 404.1502, 416.902.
"Nontreating source:" an "acceptable medical source" who has examined the claimant, but never had a treatment relationship.
"Nonexamining source:" an "acceptable medical source" who has not examined the claimant, but provides a medical opinion.