DAVID A. RUIZ, Magistrate Judge.
Plaintiff, Bobby Carter (hereinafter "Plaintiff"), challenges the final decision of Defendant Nancy A. Berryhill, Acting Commissioner of Social Security (hereinafter "Commissioner"), denying his application for Supplemental Security Income ("SSI") under Title XVI of the Social Security Act, 42 U.S.C. § 1381 et seq. ("Act"). This court has jurisdiction pursuant to 42 U.S.C. § 405(g). This case is before the undersigned United States Magistrate Judge pursuant to an automatic referral under Local Rule 72.2(b) for a Report and Recommendation. For the reasons set forth below, the Magistrate Judge recommends that the Commissioner's final decision be AFFIRMED.
On September 20, 2013, Plaintiff filed his applications for SSI, alleging a disability onset date of September 5, 2013. (Transcript ("Tr.") 149-154). The application was denied initially and upon reconsideration, and Plaintiff requested a hearing before an Administrative Law Judge ("ALJ"). (Tr. 100-111). Plaintiff participated in the hearing on July 7, 2015, was represented by counsel, and testified. (Tr. 37-63). A vocational expert ("VE") also participated and testified. Id. On July 29, 2015, the ALJ found Plaintiff not disabled. (Tr. 25). On June 23, 2016, the Appeals Council declined to review the ALJ's decision, and the ALJ's decision became the Commissioner's final decision. (Tr. 1-3). On July 21, 2016, Plaintiff filed a complaint challenging the Commissioner's final decision. (R. 1). The parties have completed briefing in this case. (R. 12 & 14).
Plaintiff asserts the following assignments of error: (1) the ALJ failed to properly apply the treating physician rule; and (2) the ALJ erred by rejecting the psychological evaluations of the State Agency doctors. (R. 12).
Plaintiff was born in August of 1981 and was 32-years-old on the alleged disability onset date. (Tr. 23). He had a limited education and was able to communicate in English. (Tr. 23). He has no past relevant work. Id.
On April 5, 2011, Plaintiff was seen at Connections.
On November 11, 2012, Plaintiff presented to the ER indicating that he had an alcohol problem. (Tr. 389). Plaintiff reported drinking 3-4 bottles of liquor every day. Id.
On May 13, 2013 and May 17, 2013, Plaintiff was seen in an emergency department where he was diagnosed with an anxiety attack, prescribed Lorazepam and Paroxentine, and released the same day or the following day. (Tr. 362-363, 367-369, 371-372).
On May 9, 2014, Plaintiff was seen by Lynn M. Pattimakiel, M.D., after last being seen by her on January 25, 2012.
(Tr. 961). On physical examination, Plaintiff had a low effect, was in no acute distress, was alert and oriented, well-groomed, there was prominence/tenderness over the right zygomatic process, had no edema, and normal gait. (Tr. 963). Dr. Pattimakiel diagnosed anxiety, depression, low back pain, and hypertension. (Tr. 963-964). She noted Plaintiff had recently been restarted on Paxil and the treatment plan included a consult with a psychiatrist. (Tr. 964).
On October 14, 2014, Plaintiff went to the ER and complained of hearing voices, depression, not sleeping at night, and trouble getting along with others. (Tr. 908). He had recently been released from county jail, and had a history of domestic violence. Id. On mental status exam, Plaintiff was adequately groomed; his behavior was withdrawn, agitated, guarded; he was oriented x 3; his speech was clear, normal rate and flow, and slow; his thought process was logical; association was tight; no abnormal processes noted, "no derailment or disorganized thoughts of psychotic nature, no spontaneous speech of delusional nature, expressed feelings of agitation, expressed ideas of reference, expressed paranoid ideation, positive auditory hallucination, positive visual hallucination," judgment and insight were fair; his memory was good with recent and remote recall; attention span and concentration were sustained; his language was appropriate; his fund of knowledge "okay;" his mood depressed, guilty, irritable, anxious, and sad; and his mood was incongruent. (Tr. 912). He was assigned a Global Assessment of Functioning ("GAF") score ranging from 41-50.
On October 20, 2014, Plaintiff was seen by Anela Jyoti, M.D., who noted that Plaintiff had "no consistent prior outpatient psychiatric history except for his trial on psychotropic meds while incarcerated." (Tr. 915). Plaintiff reported been feeling depressed for many years, since his father passed away. Id. On mental status examination, Plaintiff was well-groomed, his behavior cooperative, he was oriented x 3, his speech was clear, he had logical thought process with tight association but did express paranoid ideation, his insight and judgment were fair, recent and remote memory were adequate, attention span and concentration were sustained, his language was appropriate, his fund of knowledge was "okay," his affect was constricted, and his mood was irritable, anxious, angry, frustrated, and sad. (Tr. 19).
On February 20, 2015, Plaintiff was seen by Gabriela Feier, M.D. (Tr. 949-951). Plaintiff's subjective complaints included feeling depressed, isolated, and anxious. (Tr. 949). He indicated he had difficulty remembering things and not getting along well with others. Id. He was living with his girlfriend, stated he was currently sober, enjoyed fishing and playing basketball, and had good support from his sister and mother. Id. On objective mental status examination, Dr. Feier noted the following: Plaintiff was adequately groomed; his behavior was cooperative; he was oriented x 3; his speech was spontaneous with normal rate and flow; his thought process logical and organized; his thought content and perception showed no evidence of paranoia, delusions, or perceptual disturbance; his mood was depressed/anxious; his affect constricted; and his judgment and insight were fair. (Tr. 950). With respect to memory. Dr. Feier noted that Plaintiff reported difficulties. Id. Plaintiff was diagnosed with mood disorder not otherwise specified ("NOS") and post-traumatic stress disorder ("PTSD"). Id.
On June 9, 2011, J. Joseph Konieczny, Ph.D., performed a psychological evaluation of Plaintiff at the request of the State Agency. (Tr. 292-296). Plaintiff arrived to his evaluation with his girlfriend and her son using public transportation. (Tr. 292). He had never married, but had four children from two relationships. Id. He was irritable throughout the evaluation, responded to all questions asked, and was occasionally vague in his presentation. Id. Plaintiff reported dropping out of high school during the tenth grade, and repeating two grades. Id. Plaintiff had previously been convicted of carrying a concealed weapon and drug charges. (Tr. 293). He reported heavy past use of alcohol and continuing regular consumption. Id. On mental status examination, Dr. Konieczny observed that Plaintiff "showed no difficulties in movement or walking, but did verbalize complaints of back pain and pain in his right knee," and "show[ed] some indications of undue impulsivity which appeared to reflect his irritability." Id. Plaintiff reported significant difficulties in controlling his temper and also reported episodes of mood swings, and his "level of motivation and participation throughout the evaluation seemed questionable and reflective of his presentation." Id. Plaintiff spoke reasonably well and was quite capable of expressing himself in a clear and coherent manner; maintained appropriate eye contact; was oriented x 3; had marked deficits in his general fund of information; was unable to perform serial threes; had no deficits in logical abstract reasoning; and had poor insight and judgment. (Tr. 294). With respect to activities of daily living, Plaintiff reported waking up at 9 a.m., dressing only if he is going out of the house, watching television and "just sitting out," performing household chores; and occasionally going fishing. Id. He reported minimal involvement with outside social activities and having no friends. Id. He can perform simple cooking tasks, but his girlfriend does the majority of the cooking. Id. Dr. Konieczny diagnosed depressive disorder NOS, personality disorder NOS, possible alcohol abuse or dependence, and assessed a GAF score ranging from 44-52.
On November 20, 2013, David House, Ph.D., performed a psychological evaluation of Plaintiff at the request of the State Agency. (Tr. 748-755). Dr. House indicated that Plaintiff's long and short-term memory was reduced and it was "unlikely" he could carry out instructions, and that his concentration was reduced also rendering it "unlikely" that Plaintiff could follow multistep instructions. (Tr. 754). When asked to describe Plaintiff's abilities to respond appropriately to supervision and cope with co-workers in a work setting, Dr. House referenced Plaintiff's self-described social isolation, but did not believe Plaintiff satisfied the diagnostic criteria for a schizoid personality. (Tr. 755). Dr. House opined Plaintiff's coping skills and emotional resources were highly reduced, resulting in Plaintiff being dysfunctional and disruptive in a work environment. Id. Dr. House diagnosed mood disorder, PTSD, personality disorder, and assigned a GAF score of 42. Id.
On December 4, 2013, State Agency physician Leslie Rudy, Ph.D., reviewed the medical records and completed a mental RFC assessment. (Tr. 75-77). She found that Plaintiff was not significantly limited in his ability to do the following: remember locations and work-like procedures; understand, remember, and carry out very short and simple instructions; perform activities within a schedule, maintain attendance, and be punctual within customary tolerances; sustain an ordinary routine without special supervision; work in coordination with or in close proximity to others; ask simple questions or request assistance; maintain socially appropriate behavior; be aware of normal hazards; or, use public transportation. (Tr. 75-76). He was moderately limited in his ability to do the following: understand, remember, and carry out detailed instructions; maintain attention and concentration for extended periods; make simple work-related decisions; complete a normal workday or workweek without interruption from psychologically based symptoms and perform at a consistent pace; interact appropriately with the general public; accept instructions and respond appropriately to criticism from supervisors; get along with co-workers without distracting them or exhibiting behavioral extremes; and responding appropriately to changes in the work setting. Id. Her opinion was based on Plaintiff's "task completion and participation at [the] CE [consultative examination]," which showed that he could understand 1-4 step tasks, could concentrate sufficiently to complete simple 1-2 step tasks, and that his relationships demonstrate the ability to interact on an occasional, superficial basis. Id.
On February 22, 2014, State Agency physician Carl Tischler, Ph.D., reviewed the medical records and completed a mental RFC assessment. (Tr. 91-93). His findings mirrored those of Dr. Rudy. Id. Noting inconsistent statements by Plaintiff during the consultative exams of Drs. House and Konieczny, Dr. Tischler found Plaintiff only partially credible. He ascribed great weight to the body of Dr. House's report, but noted that Dr. Konieczny's statements were made two years earlier. (Tr. 90).
On May 9, 2014, the same day Plaintiff was seen by Dr. Pattimakiel after a more than two year hiatus, Dr. Pattimakiel completed a check-the-box medical source statement concerning Plaintiff's mental capacity.
At the July 7, 2015 hearing, Plaintiff testified as follows:
The ALJ posed the following hypothetical question to the VE:
(Tr. 57-58).
The VE testified that such an individual could perform a number of jobs and identified the following as examples: kitchen helper, Dictionary of Occupational Titles ("DICOT") 318.687-010, medium, unskilled, with an SVP of 2 (3,500 jobs locally, 20,000 in Ohio, 500,000 nationally); cleaner II, DICOT 919.687-014, medium, unskilled, with an SVP of 2 (2,000 jobs locally, 12,000 in Ohio, 300,000 nationally); laundry worker II, DICOT 361.685-018, medium, unskilled, with an SVP of 2 (1,500 jobs locally, 8,000 in Ohio, 200,000 nationally). (Tr. 58).
The ALJ posed a second hypothetical question to the VE: "Now for the second hypothetical, I would like you to consider the same person, this person is limited to sedentary." (Tr. 59). The VE responded by identifying the following jobs as examples that the hypothetical person could perform: final assembler, DICOT 713.687-018, sedentary, unskilled, with an SVP of 2 (1,500 jobs locally, 6,000 in Ohio, 100,000 nationally); lens inserter, DICOT 713.687-026, sedentary, unskilled, with an SVP of 2 (1,200 jobs locally, 6,000 in Ohio, 100,000 nationally); and table worker/sorter, DICOT 739.687-182, sedentary, unskilled, with an SVP of 2 (1,200 jobs locally, 5,000 in Ohio, 100,000 nationally). (Tr. 59-60). The VE stated his testimony was consistent with the DICOT. (Tr. 59, 60).
The ALJ posed a third and fourth hypothetical to the VE asking him to consider an individual who would be off-task 20 percent of the time and an individual who will be absent twice a month on an ongoing basis. (Tr. 60). The VE responded that either scenario would render the hypothetical individual unemployable. (Tr. 60-61).
In response to a question posed by Plaintiff's counsel, the VE testified that an individual who was limited to 1 to 2 step instructions and had to be redirected on an occasional basis day in and day out was unemployable. (Tr. 61) Similarly, a person who would be disruptive to supervisors and co-workers twice a day and who would not accept supervision was also unemployable. (Tr. 62).
A claimant is entitled to receive benefits under the Social Security Act when he establishes disability within the meaning of the Act. 20 C.F.R. § 404.1505 & 416.905; Kirk v. Sec'y of Health & Human Servs., 667 F.2d 524 (6th Cir. 1981). A claimant is considered disabled when he cannot perform "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." 20 C.F.R. §§ 404.1505(a) and 416.905(a); 404.1509 and 416.909(a).
The Commissioner reaches a determination as to whether a claimant is disabled by way of a five-stage process. 20 C.F.R. § 404.1520(a)(4); Abbott v. Sullivan, 905 F.2d 918, 923 (6
The ALJ made the following findings of fact and conclusions of law:
(Tr. 18-24).
Judicial review of the Commissioner's decision is limited to determining whether it is supported by substantial evidence and was made pursuant to proper legal standards. Ealy v. Comm'r of Soc. Sec., 594 F.3d 504, 512 (6th Cir. 2010). Review must be based on the record as a whole. Heston v. Comm'r of Soc. Sec., 245 F.3d 528, 535 (6th Cir. 2001). The court may look into any evidence in the record to determine if the ALJ's decision is supported by substantial evidence, regardless of whether it has actually been cited by the ALJ. (Id.) However, the court does not review the evidence de novo, make credibility determinations, or weigh the evidence. Brainard v. Sec'y of Health & Human Servs., 889 F.2d 679, 681 (6
The Commissioner's conclusions must be affirmed absent a determination that the ALJ failed to apply the correct legal standards or made findings of fact unsupported by substantial evidence in the record. White v. Comm'r of Soc. Sec., 572 F.3d 272, 281 (6
In the first assignment of error, Plaintiff asserts the ALJ erred by assigning little weight to the May 9, 2014 opinion of Dr. Pattimakiel, whom he characterizes as a treating source. (R. 12, PageID# 1141-1144). The Commissioner challenges Plaintiff's assertion that Dr. Pattimakiel was a treating source as defined by the regulations, arguing that she only saw Plaintiff on two occasions several years apart at the time of the May 9, 2014 opinion. (R. 14, PageID# 1160-1161). Under Social Security regulations, a "treating source" is defined as follows:
20 C.F.R. § 416.927(a)(2).
First, it is significant that the ALJ himself did not specify that he considered Dr. Pattimakiel a treating source, but referred to her opinion as merely a "medical source statement." (Tr. 23). Plaintiff points to no evidence suggesting this finding was unreasonable. Moreover, the court agrees with the Commissioner that two documented visits by Plaintiff do not establish the kind of longitudinal relationship that underpins the deference accorded to treating physician's opinions. See 20 C.F.R. § 416.927(c)(2) ("we give more weight to medical opinions from your treating sources, since these sources are likely to be the medical professionals most able to provide a detailed, longitudinal picture of your medical impairment(s)") (emphasis added). In Daniels v. Comm'r of Soc. Sec., 152 Fed. App'x 485 (6th Cir. 2005), the Sixth Circuit found as follows:
Daniels, 152 Fed. App'x at 489-91 (footnotes omitted) (emphasis added). The pertinent issue is whether there was an on-going relationship to qualify as a treating physician, and "two or three visits often will not suffice for an ongoing treatment relationship[,]" with some possible exceptions depending on the circumstances and nature of the person's underlying medical condition. Kornecky v. Comm'r of Soc. Sec., 167 Fed. App'x 496, 507 (6
An infrequent treatment history is arguably even more significant when it comes to psychiatric care. See e.g., Smith v. Astrue, No. 4:11-cv-0863, 2012 WL 946852 at *6 (N.D. Ohio Mar. 20, 2012) (White, M.J.) ("Two psychiatric visits only one month apart were insufficient to establish a treating relationship, as it is not a frequency consistent with the longitudinal nature of psychiatric treatment"); accord East v. Comm'r of Soc. Sec. Admin., No. 1:13-CV-1479, 2014 WL 3828433 at *11 (N.D. Ohio Aug. 4, 2014) (McHargh, M.J.). Plaintiff's two visits to Dr. Pattimakiel, more than two years apart, is even less suggestive of a treating relationship than some of the above cited cases. Further, it is not entirely clear from the record that Dr. Pattimakiel ever treated Plaintiff for his mental health issues, referring him for a psychiatric consult instead and focusing primarily on his physical issues. (Tr. 346-349, 961-964). Due to the sparse and sporadic evidence of treatment by Dr. Pattimakiel contained in the record, the ALJ was not required to consider her opinion as coming from a treating source.
The opinion of a non-treating but examining source is not subject to the rigors of the treating physician rule. Other courts have determined that "the regulation requiring an ALJ to provide `good reasons' for the weight given a treating physician's opinion does not apply to an ALJ's failure to explain his favoring of one non-treating source's opinion over another." Williams v. Colvin, 2015 WL 5165458 at *5 (N.D. Ohio, Sept. 2, 2015) (citing Kornecky v. Comm'r of Soc. Sec., 167 Fed. App'x 496 (6th Cir. 2006); accord Chandler v. Comm'r of Soc. Sec., 2014 WL 2988433 at *8 (S.D. Ohio, July 1, 2014) ("the ALJ is not required to give `good reasons' for rejecting a nontreating source's opinions in the same way as must be done for a treating source"). While a claimant may disagree with the ALJ's explanation as to why little weight was assigned to a non-treating medical source, such a disagreement with the ALJ's rationale does not provide a basis for remand. See, e.g., Steed v. Colvin, 2016 WL 4479485 (N.D. Ohio Aug. 25, 2016) (McHargh, M.J.).
The ALJ offered the following assessment of Dr. Pattimakiel's May 2014 opinion:
(Tr. 23).
Plaintiff's brief takes issue with this explanation, claiming that the there was "no basis" for the conclusion that Dr. Pattimakiel was simply reiterating Plaintiff's subjective complaints. (R. 12, PageID# 1141). The court finds this argument lacks merit, given the decision directly quotes from Dr. Pattimakiel's notes that she "filled out [the] psychiatric evaluation by obtaining direct responses from patient." (Tr. 963, Exh. 26F at p. 3). The ALJ interpreted this statement as an indication that the May 2014 assessment did not reflect Dr. Pattimakiel's own opinions or observations, but rather those of the Plaintiff. The court finds no fault with this entirely reasonable interpretation of the record. In fact, while this court does not conduct a de novo review or reweigh the evidence, it would be hard-pressed to ascribe any other interpretation to the above notation after reviewing the record and the pertinent medical source statement form. (Tr. 784-85, 961-64).
Therefore, the court finds the first assignment of error meritless.
In the second assignment of error, Plaintiff asserts the ALJ erred by failing to explain why he discredited the opinions of consultative examiners Drs. House and Konieczny. (R. 12, PageID# 1144-1146).
An ALJ, when arriving at the RFC assessment, "must always consider and address medical source opinions [and] [i]f the RFC assessment conflicts with an opinion from a medical source, the adjudicator must explain why the opinion was not adopted." SSR 96-8p, 1996 WL 374184 at *7 (July 2, 1996); see also Puckett v. Colvin, 2014 WL 1584166 at *9 (N.D. Ohio April 21, 2014) (Vecchiarelli, M.J.) (explaining that, although the ALJ was not required to evaluate opinions of consultative examiners with the same standard of deference as would apply to an opinion of a treating source, he was required to "acknowledge that [the examiners'] opinions contradicted his RFC finding and explain why he did not include their limitations in his determination of Plaintiff's RFC").
First, Plaintiff suggests that "[w]hen evaluating the opinion of an examining or consulting physician, the ALJ must apply the same level of scrutiny as used to assess the opinion of treating physicians." (R. 12, PageID# 1144). Plaintiff's assertion is incorrect, and his citation to Gayheart v. Comm'r of Soc. Sec., 710 F.3d 365, 379 (6
Here, the ALJ addressed the opinions of Drs. Konieczny and House as follows:
(Tr. 23).
Reading the decision as a whole, the ALJ sufficiently explained why he was giving little weight to the consultative examiners. Admittedly, the explanation could have been more thorough, but the explanation requirement is not as rigorous as the "good reasons" requirement of the treating physician rule. See, e.g., Moscorelli v. Colvin, No. 1:15cv1509, 2016 WL 4486851 at **3-4 (N.D. Ohio Aug. 26, 2016) (Lioi, J.) (observing that a "thin" explanation that would not constitute a `good reason' for discounting a treating source's opinion may, nevertheless, satisfy the explanation requirement for a non-treating source). First, the ALJ explained that the opinions were not well supported objectively and were inconsistent with the record as a whole. Second, the ALJ plainly found the opinions of Drs. Rudy and Tischler more persuasive, and consistent with the evidence. Typically, more weight is given to the opinion of an examining versus non-examining source. See 20 C.F.R. § 416.927(c)(1). With respect to State Agency physicians, ALJs "are not required to adopt any prior administrative medical findings, but they must consider this evidence . . . because our Federal or State agency medical or psychological consultants are highly qualified and experts in Social Security disability evaluation." See 20 C.F.R. § 416.913a(b)(1). Nevertheless, "it is not a per se error of law, as [claimant] suggests, for the ALJ to credit a nonexamining source over a nontreating source." Norris v. Comm'r of Soc. Sec., 461 Fed. App'x 433, 439 (6th Cir. 2012); accord Moscorelli, 2016 WL 4486851 at *3.
Further, a recent decision from the Southern District of Ohio, with nearly identical facts, is instructive, wherein the claimant had no treating psychologist or psychiatrist and obtained her medication from her primary care physician. See Lowther v. Comm'r of Soc. Sec., No. 2:15-cv-3010, 2016 WL 7111604 at *7 (S.D. Ohio, Dec. 7, 2016), adopted by 2017 WL 25551 (Jan. 2, 2017). The Lowther decision reasoned that "[b]ecause there was no medical source with a longitudinal picture of Plaintiff's mental health, each psychological medical source opinion necessarily was based on a limited amount of evidence." Lowther, 2016 WL 7111604 at *7. "Considering all of this," the court reasoned, "the ALJ's decision to place more weight on the conclusions" of a non-examining State Agency psychologist, who reviewed the record, than those of two consultative examining psychologists "was within the permissible `zone of choice' afforded to an ALJ." Id. (citations omitted).
This court agrees with the sound reasoning of the Lowther decision, and finds that the ALJ did not err by assigning greater weight to the non-examining opinions of Drs. Rudy and Tischler, who had the benefit of reviewing the majority of the medical record—including the opinions of the consultative examiners. The ALJ adequately explained why he assigned less weight to Drs. Konieczny and House. The second assignment of error, therefore, is without merit.
For the foregoing reasons, it is recommended that the Commissioner's final decision be AFFIRMED.