PROPOSED FINDINGS AND RECOMMENDED DISPOSITION

GREGORY J. FOURATT, Magistrate Judge.

THIS MATTER is before the Court upon Plaintiff Jaime Vining's "Motion to Reverse or Remand Administrative Agency Decision, with Supporting Memorandum" ("Motion") [ECF No. 23]. Having meticulously reviewed the entire record and being otherwise fully advised, the undersigned finds that the Administrative Law Judge ("ALJ") erred in rejecting certain important medical opinions of Plaintiff's treating physicians without proper explanation. A straightforward application of the well-known "treating physician rule" demonstrates that the ALJ's decision falls short of the justification the Tenth Circuit requires before an ALJ can reject material opinions from a treating physician. For the following reasons, the undersigned recommends that Plaintiff's Motion be GRANTED and the case REMANDED for further proceedings consistent with this recommended disposition.

I. FACTUAL AND PROCEDURAL BACKGROUND

Plaintiff filed an application for disability insurance benefits and supplemental security income on May 8, 2013, alleging disability beginning on March 1, 2012. Administrative R. ("AR") 16, ECF No. 17. Both claims were initially denied on September 24, 2013, and upon reconsideration on March 14, 2014. Plaintiff then filed a written request for hearing on March 26, 2014. A hearing was held on January 15, 2015 in Albuquerque, New Mexico before ALJ Ann Farris. At the hearing, the ALJ heard testimony from Plaintiff, as well as Mary Diane Weber, an impartial vocational expert. AR 16.

On February 25, 2015, the ALJ issued a decision, finding Plaintiff was not disabled under the Social Security Act, from March 1, 2012, through the date of the decision. AR at 32. Plaintiff filed a request for review by the Appeals Council on March 17, 2015, see AR 14-16, which was denied on April 23, 2015. AR 8-12. Therefore, the ALJ's decision became the final decision of the Commissioner.

II. STANDARD OF REVIEW

Pursuant to 42 U.S.C. § 405(g), a court may review a final decision of the Commissioner only to determine whether the decision is supported by substantial evidence and whether the correct legal standards were applied. See 42 U.S.C. § 405(g) (2015); see also Maes v. Astrue, 522 F.3d 1093, 1096 (10th Cir. 2008) (citing Hamilton v. Sec'y of Health & Human Servs., 961 F.2d 1495, 1497-98 (10th Cir. 1992)). If substantial evidence supports the ALJ's findings and the correct legal standards were applied, the Commissioner's decision stands, and the plaintiff is not entitled to relief. See Langley v. Barnhart, 373 F.3d 1116, 1118 (10th Cir. 2004); see also Hamlin v. Barnhart, 365 F.3d 1208, 1214 (10th Cir. 2004). "In reviewing the ALJ's decision, `we neither reweigh the evidence nor substitute our judgment for that of the agency.'" See Bowman v. Astrue, 511 F.3d 1270, 1272 (10th Cir. 2008) (quoting Casias v. Sec'y of Health & Human Servs., 933 F.2d 799, 800 (10th Cir. 1991)); see also Hamlin, 365 F.3d at 1214 ("[B]ecause our review is based on the record taken as a whole, [the Court] will meticulously examine the record in order to determine if the evidence supporting the agency's decision is substantial ...").

Substantial evidence is "such relevant evidence as a reasonable mind might accept as adequate to support a conclusion." Doyal v. Barnhart, 331 F.3d 758, 760 (10th Cir. 2003) (quoting Fowler v. Bowen, 876 F.2d 1451, 1453 (10th Cir. 1989)). "A decision is not based on substantial evidence if it is overwhelmed by other evidence in the record or if there is a mere scintilla of evidence supporting it." Langley, 373 F.3d at 1118 (quoting Bernal v. Bowen, 851 F.2d 297, 299 (10th Cir. 1988)). "The record must demonstrate that the ALJ considered all of the evidence, but an ALJ is not required to discuss every piece of evidence." Clifton v. Chater, 79 F.3d 1007, 1009-10 (10th Cir. 1996) (citation omitted). "Rather, in addition to discussing the evidence supporting his decision, the ALJ also must discuss the uncontroverted evidence he chooses not to rely upon, as well as significantly probative evidence he rejects." Id. at 1010. "The possibility of drawing two inconsistent conclusions from the evidence does not prevent an administrative agency's findings from being supported by substantial evidence." Lax v. Astrue, 489 F.3d 1080, 1084 (10th Cir. 2007) (quoting Zoltanski v. F.A.A., 372 F.3d 1195, 1200 (10th Cir. 2004)).

III. SUMMARY OF ARGUMENTS

Plaintiff argues that the ALJ committed reversible legal error for the following reasons: (i) the ALJ did not give any weight to the opinions of Plaintiff's treating physicians nor adequately explained why; (ii) the ALJ did not give any weight to the opinions of Plaintiff's treating therapist nor adequately explained why; (iii) the ALJ erred in using the Medical Vocational Guidelines to deny Plaintiff benefits; (iv) the ALJ erred in failing to find that Plaintiff's migraine headaches constituted a severe impairment; and (v) the ALJ erred in failing to consider the effect that Plaintiff's absences, caused by her migraine headaches and fibromyalgia, would have on her occupational base. See Pl.'s Mot. 1-23, ECF No. 23. Defendant contends the ALJ evaluated the record as a whole, including the medical source opinions and Plaintiff's complaints, and determined Plaintiff could perform a restricted range of light work. See Def.'s Br. in Resp. to Pl.'s Mot. to Reverse and Remand the Agency's Administrative Decision 8-19, ECF No. 27.

IV. APPLICABLE LAW AND SEQUENTIAL EVALUATION PROCESS

A. Legal Standard

For purposes of Social Security disability insurance benefits, the term "disability" means "inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months." 42 U.S.C. § 423(d)(1)(A) (2015). To determine if an individual is disabled, the Social Security Administration utilizes a five-step sequential evaluation process, 20 C.F.R. § 404.1520 (2015), with each step being followed in order. Id. § 404.1520(4). If it is determined that the individual is or is not disabled at a step of the evaluation process, the evaluation will not go on to the next step. Id.

The claimant bears the burden of establishing a prima facie case of disability at steps one through four. Williams v. Bowen, 844 F.2d 748, 750-52 (10th Cir. 1988).

Grogan v. Barnhart, 399 F.3d 1257, 1261 (10th Cir. 2005) (quoting Williams, 844 F.2d at 750-52). At step five, "the burden shifts to the Commissioner to show the claimant retains sufficient residual functional capacity (RFC) to perform work in the national economy, given his age, education, and work experience." Id. (quoting Williams, 844 F.2d at 751).

B. ALJ Decision

On February 25, 2015, the ALJ issued a decision denying Plaintiff's application for benefits. In doing so, the ALJ conducted the five-step sequential evaluation process. AR 20-32. At step one, the ALJ found that Plaintiff had not engaged in substantial gainful activity since March 1, 2012, the date of her alleged disability onset. At step two, the ALJ determined Plaintiff had the following severe impairments: affective disorders, personality disorders, and fibromyalgia. The ALJ found these impairments "cause[d] more than minimal limitation in [Plaintiff's] ability to perform basic work activities and are therefore severe." AR 25.

At step three, the ALJ concluded that Plaintiff did not have an impairment or combination of impairments that met or medically equaled the severity of a listed impairment in 20 CFR Part 404, Subpart P, Appendix 1.1 AR 18-19.2 In reaching this conclusion, the ALJ reviewed the medical evidence and considered the opinions of the State agency medical consultants. First, the ALJ noted there is no listing for fibromyalgia in the Social Security Code. Moving to Plaintiff's mental impairments, the ALJ noted that Plaintiff experiences "no restriction in her activities of daily living." AR 19. The ALJ based this on Plaintiff's adult function report, which indicates Plaintiff is able to handle significant familial responsibilities, including maintaining the family home, managing family finances, cooking, driving her children to school, and attending the children's sporting activities. AR 19.

The ALJ also noted that Plaintiff experiences only "moderate difficulties" in social functioning, including irritability with family members, altercations with non-family members, and increased paranoia. AR 19. Therefore, the ALJ determined that Plaintiff's mental impairments did not satisfy the paragraph B criteria for Listings 12.04 (affective disorders), 12.06 (anxiety-related disorders), and 12.08 (personality disorders) because her mental impairments had not caused the requisite number of marked limitations and/or episodes of decompensation.3 AR 20. The ALJ found: "[T]he claimant has experienced no episodes of decompensation that have been of extended duration. There is no evidence the claimant has been hospitalized for psychiatric treatment for an extended period of time." AR 20. Based on the evidence, the ALJ determined the paragraph C criteria were also not satisfied.4 The ALJ found that there was no evidence to suggest the Plaintiff would be unable to function outside of her home. AR 20.

Before step four, the ALJ determined Plaintiff had the following residual functional capacity (RFC):

AR 21. In support of this RFC assessment, the ALJ found that Plaintiff's "medically determinable impairments might be expected to cause some of the alleged symptoms; however, the [Plaintiff's] statements concerning the intensity, persistence, and limiting effects of these symptoms are not entirely credible ..." AR 28. In reaching this determination, the ALJ gave significant weight to Dr. Raul Young-Rodriguez, M.D., who examined Plaintiff at the request of the State agency and opined that "there was no clinical medical evidence to support a limitation of physical activity." AR 30. Additionally, the ALJ considered opinions from Plaintiff's counselor, primary care physician, and psychiatrist; she gave slight consideration to the opinions of Plaintiff's counselor, but did not give controlling weight either to the opinions of her primary care physician or to her psychiatrist. AR 29-30. The ALJ also considered Plaintiff's lack of hospitalizations, her own descriptions of her daily activities, and Global Assessment of Functioning scores given by various doctors that indicated the presence of only moderate symptoms. AR 30.

At the fifth and final step, the ALJ noted that Plaintiff was born on March 16, 1980, and was therefore 31 years old as of the alleged disability onset date, which is considered to be a "younger individual" pursuant to 20 C.F.R. §§ 404.1563 and 416.963. AR 31. The ALJ further noted that Plaintiff has at least a high school education, is able to communicate in English, and stated that "[t]ransferability of job skills is not material to the determination of disability because using the Medical-Vocation Rules as a framework supports a finding that the [Plaintiff] is `not disabled,' whether or not [she] has transferable job skills." AR 31. The ALJ determined Plaintiff would not be able to perform any past work because "[her] past relevant work all required more contact with co-workers and supervisors than her current residual functional capacity would allow." AR 31. Therefore, the ALJ asked the vocational expert "whether jobs exist in the national economy for an individual with the [Plaintiff's] age, education, work experience, and residual functional capacity." AR 32. The vocational expert testified that such an individual would be capable of working in the following jobs: flat work tier (DOT5 361.587-101), merchandise marker (DOT 209.587-034), and warehouse checker (DOT 222.687-010). Subsequently, the ALJ concluded that Plaintiff "is capable of making a successful adjustment to other work that exists in significant numbers in the national economy" and therefore she was not disabled under the meaning of the Act from March 1, 2012 through the date of the decision. AR 32.

V. DISCUSSION

The undersigned finds that the ALJ erred in rejecting, without adequate explanation, certain medical opinions of Dr. Higi, Plaintiff's treating primary care physician, and Dr. Nguyen, Plaintiff's treating psychiatrist.

A. The Treating Physician Rule

"Under the regulations, the agency rulings, and our case law, an ALJ must `give good reasons in [the] notice of determination or decision' for the weight assigned to a treating physician's opinion." Watkins v. Barnhart, 350 F.3d 1297, 1300 (10th Cir. 2003) (quoting 20 C.F.R. § 404.1527(d)(2)). The notice of determination or decision "must be sufficiently specific 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." Id. (quoting SSR 96-2p, 1996 WL 374188, at *5). When evaluating a treating source medical opinion as to the nature or severity of an individual's impairments, an ALJ should "[g]enerally, ... give more weight to opinions from [claimant's] treating sources." 20 C.F.R. § 404.1527(d)(2). "The treating physician's opinion is given particular weight because of his unique perspective to the medical evidence that cannot be obtained from the objective medical findings alone or from reports of individual examinations, such as consultative examinations or brief hospitalizations." Hamlin v. Barnhart, 365 F.3d 1208, 1215 (10th Cir. 2004) (citing Doyal v. Barnhart, 331 F.3d 758, 762 (10th Cir. 2003)).

In reviewing the opinions of a treating physician, an ALJ must proceed sequentially. Watkins, 350 F.3d at 1300. First, an ALJ must consider whether the medical opinion is "well-supported by medically acceptable clinical and laboratory diagnostic techniques." Id. (quoting SSR 96-2p, 1996 WL 374188, at *2). If the ALJ finds that the medical opinion is well-supported by such techniques, he or she must then confirm it is consistent with other substantial evidence in the record. Id. "[I]f the opinion is deficient in either of these respects, then it is not entitled to controlling weight." Id.

The Tenth Circuit has explained that resolving whether a medical opinion is entitled to controlling weight does not conclude the analysis:

Watkins, 350 F.3d at 1300 (quoting SSR 96-2p, 1996 WL 374188, at *4). The factors set forth in § 1527 and 416.927 are:

Id. at 1301 (citing Drapeau v. Massanari, 255 F.3d 1211, 1213 (10th Cir. 2001)). Not every factor is applicable in every case, nor should all six factors be seen as absolutely necessary. What is absolutely necessary, though, is that the ALJ give good reasons — reasons that are "sufficiently specific to [be] clear to any subsequent reviewers" — for whatever the weight that she ultimately assigns to the opinions. Langley, 373 F.3d at 1119 (10th Cir. 2004). If an ALJ rejects the medical opinion in its entirety, he or she must provide "specific, legitimate reasons" for doing so. See Miller v. Chater, 99 F.3d 972, 976 (10th Cir. 1996) (quoting Frey v. Bowen, 816 F.2d 508, 513 (10th Cir. 1987)).

1. Dr. Marcus Higi, M.D.

Dr. Higi served as Plaintiff's primary care physician for more than three years, during which time she was treated by him or his staff on at least 17 occasions. See AR 21, 553-55. Plaintiff first established care with Dr. Higi in April 2011. AR 435. Dr. Higi diagnosed Plaintiff with chronic fibromyalgia syndrome in January 2012. AR 411. In a "Fibromyalgia Questionnaire" completed June 26, 2013, Dr. Higi listed four diagnoses in total: (1) fibromyalgia, (2) migraines-intractable, (3) borderline personality disorder, and (4) depression. AR 444-46. He assessed Plaintiff's pain as widespread in accordance with the criteria for fibromyalgia6, and noted that this pain has persisted for at least three months. Dr. Higi listed the following additional symptoms that could be reasonably expected to result from the aforementioned diagnoses, including: nausea, vomiting, muscle pain and weakness, irregular bowels, agitation, and insomnia. Dr. Higi opined that Plaintiff would be unable to sustain an eight hour work day, or forty (40) hours per week in a seated position. He also opined that as a result of Plaintiff's impairments, she would have frequent absences from work, such as one day a week or multiple days in a month. AR 444-46.

To develop his medical opinion, Dr. Higi indicated he relied upon clinical interviews, objective clinical observations, chart reviews, and objective testing. He agreed his opinion was consistent with his treatment notes. AR 444-46.

In July 2014, Dr. Higi provided an updated medical opinion regarding Plaintiff's ability to do work-related activities. AR 522. He identified Plaintiff's symptoms as: profound daily pain, diffuse muscle pain, and severe migraines. As a result, he opined that Plaintiff could stand and walk less than two hours out of an eight hour workday; she could sit for less than two hours out of an eight hour workday; she was limited to lifting and carrying items below ten pounds; she needed to lie down at unpredictable times; and she was unable to complete prolonged computer work due to migraines. AR 522.

Regarding Dr. Higi's opinions, the ALJ stated merely that:

AR 29. The ALJ treated all of Dr. Higi's opinions as a single conglomeration rather than analyzing them individually. And importantly, the ALJ's decision is silent on what if any weight she actually assigned to any of Dr. Higi's opinions.

The ALJ did, however, assign "significant" weight to a non-treating doctor, Dr. Paul Young-Rodriguez, M.D. AR 30. At the request of the state agency, Dr. Young-Rodriguez examined Plaintiff on — one occasion only — for fibromyalgia, borderline personality disorder, depression, anxiety, migraines, chronic fatigue, and chronic pain. AR 505-08. Dr. Young-Rodriguez found "[t]here is no clinical medical evidence noted today to support a limitation of physical activity." AR 508.

When analyzed in tandem, it is clear that the ALJ's RFC determination is consistent with the results of Dr. Young-Rodriguez's one-time evaluation of Plaintiff. Thus, it appears the ALJ adopted Dr. Young-Rodriguez's opinions to the extent they differed at all with those made by Dr. Higi. While it is for the ALJ and not the Court to decide what weight to give conflicting evidence, an ALJ is required to explain with sufficient detail and specificity when she is giving other than controlling weight to the opinions of a treating physician.

The undersigned finds that the reasons the ALJ cited are not legally sufficient to support the ALJ's treatment of Dr. Higi's opinion. Although the ALJ's findings may be enough to satisfy the first phase of the treating physician rule (requiring a finding as to whether the doctor's opinion is supported by medical evidence and/or is consistent with the record), they plainly do not satisfy the second phase. If an ALJ finds a treating physician's opinion is not entitled to controlling weight, the opinion should not be rejected outright. The second phase of the treating physician rule requires the ALJ to give those medical opinions some deference. Furthermore, in deciding how much weight to assign the "non-controlling" opinion of a treating physician, an ALJ must assess those opinions in the context of at least some of the six Watkins factors. If, at that point, the ALJ decides to reject the treating physician's opinion in its entirety, he or she must provide specific, legitimate reasons for doing so.

In this case, with the exception of relying on Dr. Young-Rodriguez's opinions, the ALJ did not elaborate on which portions of Dr. Higi's opinions were not well supported by the medical evidence. Furthermore, she offered no discernible explanation for her decision not to assign controlling weight to Dr. Higi's opinions, other than that "[t]he file does not contain evidence to support the level of severity that Dr. Higi assigns to the claimant's impairments." AR 29. At most, the ALJ's reasons correspond to the third and fourth Watkins factors: (3) the degree to which the physician's opinion is supported by relevant evidence; and (4) consistency between the opinion and the record as a whole. See Watkins, 350 F.3d at 1301. However, without the required specific and detailed findings, it is not possible for this Court or the presiding judge or the Tenth Circuit to determine precisely what the ALJ considered in arriving at her determination that Dr. Higi's opinions were not entitled to controlling weight.

To emphasize: the ALJ did not comply with the second part of the treating physician rule analysis, which requires the ALJ to specify what lesser weight, if any, should be assigned to Dr. Higi's medical opinions. The ALJ's decision appears to be silent on that finding. The Court is unable to conclude which of the Watkins factors, if any, the ALJ considered in arriving at her conclusion to dispose of Dr. Higi's opinions with one boilerplate paragraph. Because the ALJ failed to explain or identify what the claimed inconsistencies were between Dr. Higi's opinions and the other substantial evidence in the record (aside from the contradictory opinions of Dr. Young-Rodriguez), her reasons for essentially rejecting Dr. Higi's opinions are not sufficiently specific to enable this Court to meaningfully review her findings.

Apart from the ALJ's failure to explain what weight (short of controlling) she gave to Dr. Higi's opinions, there are at least two other specific areas where the Court is left with insufficient information essential to its review. First, in his July 22, 2014 "Medical Opinion Re: Ability to Do Work-Related Activities," Dr. Higi identified a series of postural limitations that would be caused by the diffuse pain, profound daily fatigue, and migraines associated with Plaintiff's physical impairments. AR 522. He specifically opined that those impairments would foreclose Plaintiff from standing and walking more than two hours in an eight-hour workday and from sitting more than two hours in the same workday. AR 522. He also opined that Plaintiff would need the freedom to shift at will between sitting and standing/walking. AR 522. He further opined that Plaintiff would need to lie down at unpredictable times during an eight-hour workday. AR 522. And he opined that Plaintiff would be "unable to do prolonged computer work due to migraines." AR 522. Yet so far as the Court can tell, the ALJ ignored and implicitly rejected each of those opinions and left her rejections of them wholly unexplained. The law permits an ALJ to give such opinions of a treating physician less than controlling weight, and even to reject them entirely, but the law requires an ALJ to adequately and specifically explain herself when doing so. The ALJ here came up well short of meeting this requirement.

A second example of the ALJ's legal error in applying the treating physician rule pertained to the opinions of Dr. Higi and Plaintiff's treating psychiatrist, Dr. Nguyen, with respect to how much work they anticipated Plaintiff would miss due to her severe impairments. In his June 26, 2013 Fibromyalgia Questionnaire, Dr. Higi opined that the symptoms associated with Plaintiff's fibromyalgia "would result in frequent absences from work, such as one day a week or multiple days in a month." AR 444-46. More than a year later, in his July 22, 2014 Medical Opinion Re: Ability to Do Work-Related Activities, Dr. Higi opined that the symptoms of and treatment for Plaintiff's fibromyalgia would cause her to miss work more than three times per month. AR 522. For his part, Dr. Nguyen opined in his June 11, 2014 Mental Impairment Questionnaire that Plaintiff's conditions would cause her to miss work "about three times per month." AR 511-12. Four months later, in his October 6, 2014 Mental Impairment Questionnaire, Dr. Nguyen upgraded Plaintiff's mental condition and revised his opinion of how much work Plaintiff would miss down to "about twice a month." AR 711-13.

These are medical opinions from two of Plaintiff's treating physicians. And these opinions relate to a material aspect of whether Plaintiff could be employed in a full-time capacity. Indeed, when asked by the Plaintiff's attorney how being absent from work two or more days per month would affect the hypothetical person's occupational base, the vocational expert testified:

AR 55-59. Yet, the ALJ did not specifically address these opinions and the reason(s) she was rejecting them. She appears to have simply lumped these opinions in with the rest of the medical opinions of Drs. Higi and Nguyen and swept them away with the same generalized, conclusory, boilerplate paragraphs. The law requires the ALJ to do well more than that. It is not the proper role of this Court to speculate or hypothesize as to why the ALJ rejected without specific explanation certain material aspects of the treating doctors' opinions, nor to fill yawning gaps in the ALJ's analysis. It may well be that the ALJ cures these deficiencies on remand and then reaches the same overall conclusion of non-disability. But at least in that event, this Court and all other reviewing courts will be able to perform their judicial function under the appropriate standard of review.7

CONCLUSION

For the reasons stated above, the undersigned FINDS that the Commissioner's decision should be remanded for further proceedings, including proper consideration of Plaintiff's two treating physicians, Dr. Higi and Dr. Nguyen. Though it may be possible to assemble support for the ALJ's conclusion from parts of the record cited in the ALJ's decision, that is not the role of this Court.

IT IS THEREFORE RECOMMENDED that Plaintiff's Motion be GRANTED and the case be REMANDED to the Commissioner for further proceedings consistent with this recommended disposition.8

IT IS SO RECOMMENDED.

THE PARTIES ARE FURTHER NOTIFIED THAT WITHIN 14 DAYS OF SERVICE of a copy of these Proposed Findings and Recommended Disposition they may file written objections with the Clerk of the District Court pursuant to 28 U.S.C. § 636(b)(1)(c). Any request for an extension must be filed in writing no later than seven days from the date of this filing. A party must file any objections with the Clerk of the District Court within the fourteen-day period if that party wants to have appellate review of the proposed findings and recommended disposition. If no objections are filed, no appellate review will be allowed.