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") and/or Supplemental Security Income ("SSI").
Plaintiff filed for DIB and SSI alleging a disability onset date of December 27, 2007. PageID 355-67. Plaintiff claims disability as a result of a number of alleged impairments including, inter alia, hearing loss, anxiety, and depression. PageID 77.
After initial denial of her applications, Plaintiff received a hearing before ALJ Samuel Rodner on March 3, 2013, and a subsequent hearing before ALJ Vincent Misenti on July 30, 2013. PageID 95-161. ALJ Misenti issued a written decision on August 26, 2013 finding Plaintiff not disabled. PageID 74-85. Specifically, his findings were as follows:
PageID 76-84. It is the ALJ's findings which are at issue in this appeal.
Thereafter, the Appeals Council denied Plaintiff's request for review, making the ALJ's non-disability finding the final administrative decision of the Commissioner. PageID 43-46. Plaintiff then filed this timely appeal. Cook v. Comm'r of Soc. Sec., 480 F.3d 432, 435 (6th Cir. 2007) (noting that, "[u]nder the Federal Rules of Appellate Procedure, [claimant] had 60 days from the Appeals Council's notice of denial in which to file his appeal").
The ALJ set forth a detailed recitation of the underlying medical evidence in this case. PageID 77-84. Plaintiff, in her Statement of Errors, summarizes the relevant medical evidence. Doc. 8 at PageID 1099-1101. The Commissioner's memorandum in opposition defers to the ALJ's recitation of the evidence. Doc. 9 at PageID 1116. Except as otherwise stated in this Report and Recommendation, the undersigned incorporates the statement of facts set forth by both Plaintiff and the ALJ. 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 disability under the Social Security Act's definition. Key v. Comm'r of Soc. Sec., 109 F.3d 270, 274 (6th Cir. 1997).
"[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). In descending order, these medical source opinions are: (1) treaters; (3) examiners; and (3) record reviewers. Id.
A treater's opinion must be given "controlling weight" if "well-supported by medically acceptable clinical and laboratory diagnostic techniques and . . . not inconsistent with the other substantial evidence in [the] case record." LaRiccia v. Comm'r of Soc. Sec., 549 F. App'x 377, 384 (6th Cir. 2013). Treaters are entitled to greater deference because they "are likely to be . . . most able to provide a detailed, longitudinal picture of [a claimant's] 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). Even if a treater's opinion is not entitled to controlling weight, "the ALJ must still determine how much weight is appropriate by considering a number of factors, including the length of the 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." Blakley v. Comm'r of Soc. Sec., 581 F.3d 399, 406 (6th Cir. 2009); see also 20 C.F.R. § 404.1527(c).
After treaters, "[n]ext in the hierarchy are examining physicians and psychologists, who often see and examine claimants only once." Snell, 2013 WL 372032, at *9.
Record reviewers are afforded the least deference. These "non-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)). Unless the opinion of the treating source is entitled to controlling weight, an ALJ must "evaluate all medical opinions" with regard to the factors set forth in 20 C.F.R. § 404.1527(c). Walton v. Comm'r of Soc. Sec., No. 97-2030, 1999 WL 506979, at *2 (6th Cir. June 7, 1999).
In this case, there were no opinions from treating physicians, psychiatrists, or psychologists. With regard to medical source opinions concerning Plaintiff's mental impairments, the ALJ instead gave "great weight" to an unidentified record-reviewer's "psychological assessment" because "[t]he treatment records through July 2013 support that the claimant is not more than moderately impaired." PageID 83. Initially, the undersigned notes that the record contains separate opinions from two record reviewing medical sources; namely, an opinion from David Dietz, Ph.D. dated September 6, 2011; and an opinion from Kristen Haskins, Psy.D. dated February 15, 2012. PageID 170-71, 180-81, 192-94, 205-07. Presumably, the ALJ credited Dr. Dietz's opinion, though such presumption is not entirely clear from the ALJ's decision considering he failed to not only identify the medical source given great weight, but also failed to cite the opinion within the record. PageID 83.
Notwithstanding the ALJ's failure in this regard, the undersigned finds error with the ALJ's analysis — regardless of which record-reviewer he credited — for a number of reasons. First, the ALJ's analysis is perfunctory, conclusory, and provides no meaningful explanation of the weight given. Hollon v. Comm'r of Soc. Sec., 142 F.Supp.3d 577, 584 (S.D. Ohio 2015) (holding that "[s]imply restating a non-treating source's opinion and offering a conclusory assessment, without further discussion, fails to satisfy the requirement that the ALJ provide meaningful explanation of the weight given to all the medical opinion evidence"). Although the ALJ found the opinion supported by treatment records, he failed to identify such records and further failed explain why they provide support.
Second, the conclusory statement posited by the ALJ in weighing this opinion is inconsistent with findings set forth elsewhere in his decision. PageID 83. Notably, in weighing the record reviewers' opinions, the ALJ found that treatment notes through July 2013 support a conclusion that Plaintiff "is not more than moderately limited." Id. However, contrary to such statement, the ALJ previously gave weight to a statement that Plaintiff "had marked ability to complete work tasks at a consistent pace and perform at production levels[.]" Id. "Moderate" functional limitations are "non-disabling," see Sims v. Comm'r of Soc. Sec., 406 F. App'x 977, 980 (6th Cir. 2011), whereas "marked" and "extreme" limitations are suggestive of disability. See 20 C.F.R. Pt. 404, Subpt. P, App. 1 § 12.00(C), et seq. See Holland v. Comm'r of Soc. Sec., No. 3:14-CV-246, 2015 WL 6891032, at *4 (S.D. Ohio July 6, 2015). Such an inconsistent and conclusory assessment deprives this Court of the opportunity to meaningfully review the ALJ's decision. Cf. Wilson v. Comm'r of Soc. Sec., 378 F.3d 541, 544 (6th Cir. 2004).
Third, as set forth infra, the undersigned also finds that, based upon a careful review of the ALJ's analysis concerning Heather's opinion, the ALJ's conclusion — that Plaintiff is no more than moderately limited — is unsupported by substantial evidence. Based on all of the foregoing, the ALJ erred in failing to meaningfully analyze the opinions of record-reviewers Deitz and Haskins.
In addition to "medical source opinions," opinions from "other sources" can be used to establish the severity of a claimant's impairment and establish how impairments affect a claimant's ability to work. 20 C.F.R. § 404.1513(d). "Other sources" include medical sources such as nurse practitioners that do not qualify as "acceptable medical sources" under the regulations. Id. Although "other medical sources" who have treated a claimant are not entitled to controlling weight like a treating physician or psychologist are, "other sources" may be entitled to more weight than "acceptable medical sources" under the unique circumstances of a given case. SSR 06-03p, 2006 WL 2329939, at *5 (Aug. 9, 2006). In fact, the opinions of "other sources," such as nurse practitioners, may even be given more weight than a treating physician if the "other sources" have seen the claimant more frequently than the "acceptable sources" and have provided better explanations for their opinions. Id.
ALJs weigh the opinions of "other sources" using the factors set forth in 20 C.F.R. § 404.1527(c), i.e., "how long the source has known the individual, how frequently the source has seen the individual, how consistent the opinion of the source is with other evidence, how well the source explains the opinion, and whether the source has a specialty or area of expertise related to the individual's impairment." Williamson v. Comm'r of Soc. Sec., No. 1:14-cv-731, 2016 WL 255033, at *8 (S.D. Ohio Jan. 20, 2016); see also 20 C.F.R. § 404.1527(c). ALJs should "explain the weight given" such opinions, "or otherwise ensure that the discussion of the evidence in the determination or decision allows a claimant or subsequent reviewer to follow the [ALJ's] reasoning, when such opinions may have an effect on the outcome of the case." Williamson, at *8.
Here, beginning in August 2011, Plaintiff received mental health treatment from Heather, an advance practice nurse specializing in adult psychiatry. PageID 761; see also doc. 9 at PageID 1118. Months later, on April 23, 2012, Heather opined that Plaintiff handled stress "poorly" and could perform "in a simple work setting" on a part-time basis only (and thus was incapable of full-time employment and thus disabled).
In his decision, the ALJ — while giving "some weight" to Heather's assessment that Plaintiff was limited in her ability to "complete work tasks at a consistent pace and perform at production levels" — rejected the conclusion that Plaintiff was only capable of part-time work and that she could only maintain attention and concentration for short periods of time. PageID 82-83. With regard to Heather's opinion concerning part-time work, the ALJ found such opinion was "not supported by [Heather's] findings or the other mental health treatment records in evidence[,]" specifically:
PageID 82-83. In rejecting Heather's opinion concerning Plaintiff's ability to maintain attention and concentration for only brief periods of time, the ALJ pointed to Plaintiff's ability to drive, as well as her daily activities. Id. Plaintiff argues that these reasons are insufficient to undermine Heather's opinion. The undersigned agrees.
First, with regard to Plaintiff's medication usage, a careful review of the record demonstrates that — as a result of the combination of all of Plaintiff's impairments (i.e., her poor eyesight and mental health impairments) — Plaintiff had extreme difficulty sorting and monitoring her weekly medications. See PageID 1048-97. In fact, Plaintiff required weekly assistance from mental health providers in this regard. See PageID 1054; see also PageID 1066 (noting Plaintiff's report that her "difficulty with vision is much of the reason why she cannot organize her medication on her own"); PageID 1080 (noting that Plaintiff's "anxiety/impulsiveness which impact[s] her problem sol[ving] ability" contributes to her need for assistance in monitoring her medications). In fact, on at least one occasion, Plaintiff was unable to identify medication in her weekly planner. See PageID 1064 (noting that Plaintiff reported having "one big blue pill in her planner and she [was] unsure which medication it is" and that she needed someone to "watch [her] because sometimes [she] put 2 pills in when it should be one"). Further, numerous records document Plaintiff's inability "to demonstrate the importance of filing her weekly med[ication] planner on her own." PageID 1050-54, 1060, 1072-74, 1078-80, 1086. Accordingly, although there are notes that Plaintiff's medications assist with her symptoms, in light of the fact she is unable to manage and sort her medications independently, the records in this regard do not undermine Heather's opinion that Plaintiff could only perform part-time work.
With regard to statements made by Plaintiff regarding "day care work for `mama Turk,'" the record does not detail what this work involved. The Court's review of Plaintiff's treatment records reveal that she was living "with a local family" where she received "free rent in exchange for taking care of one of their family members." PageID 801-09. Absent further information about the nature of this "work" — and whether it was performed on a regular and continued basis, see SSR 96-8p, 1996 WL 374184, at *1 — the undersigned concludes that it fails to provide substantial evidence undermining Heather's opinion regarding Plaintiff's ability to perform only part-time work. In fact, the treatment note itself reflects Plaintiff's statement that "she is not ready to try to work." PageID 801.
The undersigned also fails to see how Plaintiff's desire to win her Social Security disability case, purchase a newer car, and begin dating undermines Heather's opinion that she cannot maintain more than part-time employment. Certainly most, if not all, Social Security claimants desire to win their disability cases, particularly those in dire financial situations like Plaintiff — who was without a home, food, or transportation for periods of time. Cf. Fajardo v. Astrue, No. CV 08-01615 AJW, 2010 WL 273168, at *4 (C.D. Cal. Jan. 14, 2010) (stating that "[e]very disability claimant presumably is motivated by the desire to win benefits" and that such reason is insufficient, in and of itself, to hold against a Social Security disability claimant). Plaintiff's financial difficulties are well documented in the record, as well as her need for a newer car. See, e.g., PageID 799 (noting that Plaintiff did not "want to stay homeless" and needed to work with her case manager "to get into [a] homeless shelter"); PageID 1048 (noting Plaintiff's "loss of her vehicle ([and] repairs [were] unaffordable) and [her] decision . . . to have [her] car go to salvage"); PageID 1-56 (noting that Plaintiff "had to sell her car for scrap" after "it quit running," and that "she is depressed without a vehicle"); PageID 1077 (noting Plaintiff's need for transportation "to/from appointments"); PageID 1096 (noting Plaintiff's report that "she has been out of food since Friday" and ate only "cake icing and stale crackers"). With regard to her desire to date, records note that she tended to socially isolate and, therefore, beginning dating relationships appears to be a treatment goal as opposed to a testament to her ability to interact with others. See PageID 1048. Accordingly, none of these reasons provide substantial evidence upon which the ALJ could rely upon in reducing the weight given to Heather's opinion.
With regard to Plaintiff's stable appearance at certain therapy/treatment sessions, such statement fails to consider the nature of mental health impairments, i.e., that the symptoms of such impairments wax and wane from day-to-day. Cf. Neikirk v. Comm'r of Soc. Sec., 3:13-cv-269, 2014 WL 7176625, at *5 (S.D. Ohio Sep. 25, 2014). To that end, the Court notes other record evidence supporting Plaintiff's claim of disabling mental limitations. See PageID 1045-46, 1050, 1052, 1062.
Insofar as the ALJ rejected Heather's opinion that Plaintiff had a "marked limitation" in her ability to maintain attention and concentration, the undersigned finds that Plaintiff's ability to drive, as well as her restricted and limited daily activities — i.e., walking one block to a store on a weekly basis, using public transportation for the purpose of attending her medical appointments, or cleaning her home infrequently, PageID 122-26 — do not undermine Heather's opinion. This is not a case where a claimant engages in a wide range of activities. Cf. Warner v. Comm'r of Soc. Sec., 375 F.3d 387, 392 (6th Cir. 2004). Further, Plaintiff's limitations in maintaining attention and concentration are supported by her treatment records, noted supra, including evidence showing Plaintiff's inability to focus on monitoring her weekly medications. PageID 1050-54, 1060, 1072-74, 1078-80, 1086.
Finally, the ALJ did not discuss the factors favoring Heather's opinion;, namely, the frequency and length of his treatment of Plaintiff and his specialty in adult psychiatry. See SSR 06-03p, 2006 WL 2329939 at *4 (Aug. 9, 2006) (explaining that 20 C.F.R. § 404.1527 factors apply to "other source" opinions). While the ALJ need not give a formulaic recitation of the factors discussed in the Social Security regulations, cf. Francis v. Comm'r of Soc. Sec., 414 F. App'x 802, 805 (6th Cir. 2011), the ALJ must "ensure that the discussion of the evidence in the determination or decision allows a claimant or subsequent reviewer to follow the [ALJ's] reasoning." SSR 06-03p, at *6.
Accordingly, based on the foregoing, the undersigned finds the ALJ's rejection of Heather's opinion is unsupported by substantial evidence.
When the ALJ's non-disability determination is 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).
Here, proof of disability is not overwhelming. Upon remand, the ALJ should appropriately assess all evidence of record (including opinions from other sources); determine Plaintiff's RFC based upon the substantial evidence of record; and, after utilizing a vocational expert or medical advisor if appropriate, determine Plaintiff's disability status anew.
