MICHAEL J. NEWMAN, Magistrate Judge.
This is a Social Security disability benefits appeal. At issue is whether the Administrative Law Judge ("ALJ") erred in finding Plaintiff not "disabled" and therefore unentitled to Disability Insurance Benefits ("DIB"), Supplemental Security Income ("SSI"), and/or Disabled Widow's Benefits ("DWB").
Plaintiff filed for DIB, SSI, and DWB alleging a disability onset date of January 30, 2006. Tr. 1302. She suffers from a number of impairments including, inter alia, osteoarthritis of the knees and shoulders, coronary artery disease, degenerative disc disease of the cervical and lumbar spines, and obesity. Tr. 1305.
After initial denials of her applications, Plaintiff received a hearing before ALJ James R. Norris, who issued a written decision finding Plaintiff not disabled on April 29, 2009. Tr. 19-35. The Appeals Council denied Plaintiff's request for review, and she appealed the ALJ's decision to this Court. Tr. 9-12. Judge Rice reversed the ALJ's non-disability finding, and remanded the case to the Commissioner under the Fourth Sentence of 42 U.S.C. § 405(g) for further proceedings. Tr. 1302, 1348.
Plaintiff thereafter received a hearing before ALJ Irma J. Flottman. Tr. 1784-1820. ALJ Flottman issued a written decision on August 19, 2014, again finding Plaintiff not disabled. Tr. 1302-16. Specifically, her findings were as follows:
Tr.1305-16.
Plaintiff did not seek Appeals Council review of this second ALJ decision. See 20 C.F.R. § 404.984(d) (in a case remanded by a Federal Court, "[i]f no exceptions are filed and the Appeals Council does not assume jurisdiction of [the] case, the decision of the [ALJ] becomes the final decision of the Commissioner after remand"). Plaintiff now challenges on appeal whether or not ALJ Flottman's August 2014 decision, adverse to her, is supported by substantial evidence.
The ALJ set forth a detailed recitation of the underlying medical evidence in this case. Tr. 1305-15. Plaintiff and the Commissioner both summarize the record evidence in their respective filings. Doc. 9 at PageID 31-38; doc. 10 at PageID 51-52. Accordingly, except as otherwise noted in this Report and Recommendation, the undersigned incorporates the ALJ's recitation of evidence as well as the summaries provided by the parties. Where applicable, the Court will identify the medical evidence relevant to this decision.
The Court's inquiry on a Social Security appeal is to determine (1) whether the ALJ's non-disability finding is supported by substantial evidence, and (2) whether the ALJ employed the correct legal criteria. 42 U.S.C. § 405(g); Bowen v. Comm'r of Soc. Sec., 478 F.3d 742, 745-46 (6th Cir. 2007). In performing this review, the Court must consider the record as a whole. Hephner v. Mathews, 574 F.2d 359, 362 (6th Cir. 1978).
Substantial evidence is "such relevant evidence as a reasonable mind might accept as adequate to support a conclusion." Richardson v. Perales, 402 U.S. 389, 401 (1971). When substantial evidence supports the ALJ's denial of benefits, that finding must be affirmed, even if substantial evidence also exists in the record upon which the ALJ could have found Plaintiff disabled. Buxton v. Halter, 246 F.3d 762, 772 (6th Cir. 2001). Thus, the ALJ has a "`zone of choice' within which he [or she] can act without the fear of court interference." Id. at 773.
The second judicial inquiry — reviewing the correctness of the ALJ's legal analysis — may result in reversal even if the ALJ's decision is supported by substantial evidence in the record. Rabbers v. Comm'r of Soc. Sec., 582 F.3d 647, 651 (6th Cir. 2009). "[A] decision of the Commissioner will not be upheld where the [Social Security Administration] fails to follow its own regulations and where that error prejudices a claimant on the merits or deprives the claimant of a substantial right." Bowen, 478 F.3d at 746.
To be eligible for disability benefits, a claimant must be under a "disability" as defined by the Social Security Act. 42 U.S.C. § 423(d)(1)(A). Narrowed to its statutory meaning, a "disability" includes physical and/or mental impairments that are both "medically determinable" and severe enough to prevent a claimant from (1) performing his or her past job and (2) engaging in "substantial gainful activity" that is available in the regional or national economies. Id.
Administrative regulations require a five-step sequential evaluation for disability determinations. 20 C.F.R. § 404.1520(a)(4). Although a dispositive finding at any step ends the ALJ's review, see Colvin, 475 F.3d at 730, the complete sequential review poses five questions:
20 C.F.R. § 404.1520(a)(4); see also Miller v. Comm'r of Soc. Sec., 181 F.Supp.2d 816, 818 (S.D. Ohio 2001). A claimant bears the ultimate burden of establishing that he or she is disabled under the Social Security Act's definition. Key v. Comm'r of Soc. Sec., 109 F.3d 270, 274 (6th Cir. 1997).
In her Statement of Errors, Plaintiff argues that ALJ Flottman erred in: (1) evaluating the medical source opinion evidence, including opinions from Plaintiff's treating cardiologist Deovrat Singh, M.D. and medical expert ("ME") William Houser, M.D.; (2) determining her RFC; and (3) assessing her credibility. Doc. 9 at PageID 38-47. Finding remand warranted based upon the ALJ's assessment of the medical opinion evidence, the undersigned makes no finding with regard to Plaintiff's remaining assignments of error.
"[T]he Commissioner's regulations establish a hierarchy of acceptable medical source opinions[.]" Snell v. Comm'r of Soc. Sec., No. 3:12-cv-119, 2013 WL 372032, at *9 (S.D. Ohio Jan. 30, 2013). Treating physicians and psychologists top the hierarchy. Id. "Next in the hierarchy are examining physicians and psychologists, who often see and examine claimants only once." Id. "[N]on-examining physicians' opinions are on the lowest rung of the hierarchy of medical source opinions." Id. "The regulations provide progressively more rigorous tests for weighing opinions as the ties between the source of the opinion and the individual [claimant] become weaker." Id. (citing SSR 96-6p, 1996 WL 374180, at *2 (July 2, 1996)).
"An ALJ is required to give controlling weight to `a treating source's opinion on the issue(s) of the nature and severity of [the claimant's] impairment(s)' if the opinion `is wellsupported by medically acceptable clinical and laboratory diagnostic techniques and is not inconsistent with the other substantial evidence in [the] case record.'" LaRiccia v. Comm'r of Soc. Sec., 549 F. App'x 377, 385 (6th Cir. 2013) (citation omitted) (alterations in original). This requirement is known as the "treating physician" rule. Blakley v. Comm'r of Soc. Sec., 581 F.3d 399, 406 (6th Cir. 2009) (citations omitted). Greater deference is given to treating source opinions "since these sources are likely to be the medical professionals most able to provide a detailed, longitudinal picture of your medical impairment(s) and may bring a unique perspective to the medical evidence that cannot be obtained from the objective medical findings alone or from reports of individual examinations[.]" 20 C.F.R. § 404.1527(c)(2); see also Blakley, 581 F.3d at 406. Thus, an ALJ must give controlling weight to a treating source if the ALJ finds that opinion well-supported by medically acceptable evidence and not inconsistent with other substantial evidence in the record. Wilson v. Comm'r of Soc. Sec., 378 F.3d 541, 544 (6th Cir. 2004).
Closely associated with the treating physician rule is the "good reasons rule," which "require[s] the ALJ to always give good reasons in [the] notice of determination or decision for the weight given to the claimant's treating source's opinion." Blakley, 581 F.3d at 406-07. "Those good reasons must be `supported by the evidence in the case record, and 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. Thus, when the ALJ declines to give controlling weight to a treating physician's assessment, "the ALJ must still determine how much weight is appropriate by considering a number of factors, including the length of treatment relationship and the frequency of examination, the nature and extent of the treatment relationship, supportability of the opinion, consistency of the opinion with the record as a whole, and any specialization of the treating physician." Id. at 406; see also 20 C.F.R. § 404.1527(c).
After treating Plaintiff's cardiac condition for over 15 years, Tr. 1801, Dr. Singh opined in December 2012 that Plaintiff "would not be able to hold a physically demanding job due to her [c]ardiac condition. . . . I believe that any additional amount of stress bestowed upon this patient would aggravate her current problems." Tr. 1560. In September 2013, Dr. Singh opined that Plaintiff could lift up to 5 pounds for 5 to 10 minutes; stand/walk for 1 hour in a workday; sit for up to 5 hours in a workday; and is "unable to maintain gainful employment"
Tr. 1314.
The undersigned agrees with Plaintiff that the ALJ erred in analyzing, and ultimately discounting, Dr. Singh's opinions. Initially, the undersigned notes that ALJ Flottman failed to mention the "controlling weight" concept and never specifically declined to afford Dr. Singh's opinions "controlling weight." See id. Because of the ALJ's failure in this regard, the Court cannot determine whether he undertook the "two-step inquiry" required when analyzing treating source opinions. See supra note 5; see also Gayheart v. Comm'r of Soc. Sec., 710 F.3d 365, 376-78 (6th Cir. 2013). The lack of explanation regarding the "controlling weight [analysis] hinders a meaningful review of whether the ALJ properly applied the treating-physician rule that is at the heart of this regulation." Gayheart, 710 F.3d at 377 (referencing 20 C.F.R. § 404.1527(c)(2)). Such failure amounts to reversible error. See Aytch v. Comm'r of Soc. Sec., No. 3:13-cv-135, 2014 WL 4080075, at *5 (S.D. Ohio Aug. 19, 2014) (citation omitted).
Further, the undersigned finds ALJ Flottman's assessment fails to consider significant evidence, as required by 20 C.F.R. § 404.1527(c)(2). Blakley, 581 F.3d at 406 (stating that when the ALJ declines to give controlling weight to a treating physician's assessment, "the ALJ must still determine how much weight is appropriate by considering a number of factors" set forth in 20 C.F.R. § 404.1527(c)). The ALJ failed to acknowledge Dr. Singh's specialization as a cardiologist and the supportability of his opinions, i.e., the narrative explanations within the 2013 opinion and the 86 pages of treatment notes containing objective findings. Tr. 1560-1649; 20 C.F.R. §§ 404.1527(c)(3), (5). Notably, in discounting Dr. Singh's opinions, the ALJ did not consider his long-term treatment relationship with Plaintiff — over 16 years at the time Dr. Singh provided the 2013 opinion — and how he could, therefore, provide a meaningful, "detailed, longitudinal picture of [Plaintiff's] medical impairment[,]" as contemplated by the regulations. 20 C.F.R. § 404.1527(c)(2); Tr. 1314.
Finally, to the extent ALJ Flottman relied on an apparent inconsistency between treater Singh's opinion and the ME's opinion, a mere disagreement between a treating physician and a reviewing physician is an insufficient basis upon which the ALJ can rely to give a treater less than controlling weight. As the Sixth Circuit has held:
Gayheart, 710 F.3d at 377; see also Pickett v. Astrue, No. 3:10-cv-177, 2011 WL 1626559, at *5 (S.D. Ohio Apr. 28, 2011) (citation omitted)
Based upon the foregoing, the undersigned finds that ALJ Flottman failed to properly assess and give good reasons, supported by substantial evidence, for discounting the opinions of Plaintiff's long-term treating cardiologist. See Blakley, 581 F.3d at 409-10 (holding that "the Commissioner must follow his own procedural regulations in crediting medical opinions"). Accordingly, the ALJ's non-disability finding must be reversed.
The undersigned also finds that the ALJ failed to properly analyze and give good reasons for relying on the ME's opinion. In assessing that opinion, ALJ Flottman merely summarized his conclusion — that Plaintiff is "capable of engaging in less than a full range of light exertional level work activities" — and assigned the opinion "great weight" based upon the conclusory assessment that the ME "is well qualified by reason of training and experience in reviewing an objective record and formulating an opinion as to medical severity"; "had access to the entire record and had the opportunity to observe the claimant through the course of the proceedings"; "[h]is analysis is consistent with and supported by objective clinical and laboratory findings found in the record"; "he has knowledge of the Social Security Administration program and had access to all of the medical evidence on record"; and "his opinion is also based on a greater longitudinal perspective of [Plaintiff's] condition." Tr. 1313.
Nowhere does ALJ Flottman provide a specific analysis of any of the required factors set forth in 20 C.F.R. § 404.1527(e)(2)(ii) or point to any evidence within the record that he purportedly found consistent with the ME's opinion. Simply restating the ME's opinion and offering a conclusory assessment fails to satisfy the requirement that the ALJ provide meaningful explanation of the weight given to all the medical opinion evidence. See 20 C.F.R. § 404.1527(c); see also Madewell v. Comm'r of Soc. Sec., No. 3:13-cv-318, 2015 WL 163468, at *5 (S.D. Ohio Jan. 13, 2015) Report and Recommendation adopted 2015 WL 1468303 (S.D. Ohio Mar. 26, 2015) (finding error when the ALJ assigned the ME's opinion "great weight" due to, inter alia, its consistency with unspecified objective medical evidence and the ME's familiarity with the Social Security disability program).
Accordingly, the undersigned concludes that the ALJ erred in assessing the ME's opinion, and sustains Plaintiff's assignment of error in this regard.
When the ALJ's non-disability determination is found unsupported by substantial evidence, the Court must determine whether to remand the matter for rehearing or to award benefits. Generally, benefits may be awarded immediately "if all essential factual issues have been resolved and the record adequately establishes a plaintiff's entitlement to benefits." Faucher v. Sec'y of Health & Human Servs., 17 F.3d 171, 176 (6th Cir. 1994); see also Abbott v. Sullivan, 905 F.2d 918, 927 (6th Cir. 1990). The Court may only award benefits where proof of disability is strong and opposing evidence is lacking in substance, so that remand would merely involve the presentation of cumulative evidence, or where proof of disability is overwhelming. Faucher, 17 F.3d at 176; see also Felisky v. Bowen, 35 F.3d 1027, 1041 (6th Cir. 1994); Mowery v. Heckler, 771 F.2d 966, 973 (6th Cir. 1985).
In this instance, the undersigned is reluctant to remand in light of the two administrative hearings Plaintiff has already received; because it would further delay this case, filed over ten years ago; and because of the strength of Dr. Singh's opinion. However, there is no vocational expert ("VE") testimony in the record concerning whether Plaintiff would be able to perform her past relevant work or a significant number of other jobs in the national economy if limited as opined by Dr. Singh. See Tr. 1814-20. Accordingly, the undersigned concludes that remand for further proceedings is necessary so the ALJ can reasonably and meaningfully weigh all opinion evidence in accordance with the regulations, assess Plaintiff's credibility, and determine Plaintiff's RFC and disability status anew.
Pursuant to Fed. R. Civ. P. 72(b), any party may serve and file specific, written objections to the proposed findings and recommendations within
