WALTER H. RICE, JUDGE
Plaintiff has brought this action pursuant to 42 U.S.C. § 405(g) to review a decision
In reviewing the Commissioner's decision, the Magistrate Judge's task is to determine if that decision is supported by "substantial evidence." 42 U.S.C. § 405(g). Under 28 U.S.C. § 636(b)(1)(C), this Court, upon objections being made to the Magistrate Judge's Report and Recommendations, is required to make a de novo review of those recommendations of the report to which objection is made. This de novo review, in turn, requires this Court to re-examine all the relevant evidence, previously reviewed by the Magistrate Judge, to determine whether the findings "are supported by substantial evidence." Valley v. Comm'r of Soc. Sec., 427 F.3d 388, 390 (6th Cir. 2005). This Court's sole function is to determine whether the record as a whole contains substantial evidence to support the Commissioner's decision. The Commissioner's findings must be affirmed if they are supported by "such relevant evidence as a reasonable mind might accept as adequate to support a conclusion." Richardson v. Perales, 402 U.S. 389, 401, 91 S.Ct. 1420, 28 L.Ed.2d 842 (1971) (quoting Consol. Edison Co. v. N.L.R.B., 305 U.S. 197, 229, 59 S.Ct. 206, 83 L.Ed. 126 (1938)). "Substantial evidence means more than a mere scintilla, but only so much as would be required to prevent a directed verdict."
In determining "whether there is substantial evidence in the record ... we review the evidence in the record taken as a whole." Wilcox v. Sullivan, 917 F.2d 272, 276-77 (6th Cir. 1990) (citing Allen v. Califano, 613 F.2d 139, 145 (6th Cir. 1980)). However, the Court "may not try the case de novo[;] nor resolve conflicts in evidence[;] nor decide questions of credibility." Jordan v. Comm'r of Soc. Sec., 548 F.3d 417,
In addition to the foregoing, in ruling as aforesaid, this Court makes the following, non-exclusive, observations:
1. The decisions of the Administrative Law Judge ("ALJ") to assign great weight to the opinions of two agency consulting physicians, Drs. Gary Hinzman and Diane Manos, and to assign little weight to the opinion of Plaintiff's treating physician, Dr. Rajindra Bhat, Doc. # 6, PAGEID # 71-72, were not supported by substantial evidence. The ALJ was required to follow a two-step process in assigning weight to Dr. Bhat's opinion.
Blakley v. Comm'r of Soc. Sec., 581 F.3d 399, 406-07 (6th Cir. 2009) (quoting 20 C.F.R. § 404.1527(c)(2); Soc. Sec. Ruling 96-2p, 1996 WL 374188, at *5). The ALJ, in his cursory discussion of Dr. Bhat's opinion, Doc. #6, PAGEID #71-72, failed to satisfy the requirements of either step. As noted in the Report and Recommendations, the ALJ:
Doc. # 12, PAGEID #648 (citations omitted). Further, even if the ALJ had conducted a proper controlling weight analysis, he was still required to consider several factors in determining the proper weight to assign Dr. Baht's opinion, "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." Blakley, 581 F.3d at 406. Other than finding that "[t]he claimant's `plantar fasciitis' is not well documented in the record," and stating, with no citation to evidence of record, that "Dr. Bhat's records do not suggest
The ALJ's analysis of the opinions of Drs. Hinzman and Manos was similarly inadequate, as he merely recited their conclusion that Plaintiff was "capable of medium work activity with postural limitations given her left ankle condition and diabetes," Doc. # 6, PAGEID # 71 (citing Doc. # 6, PAGEID # 106-16, 118-29), and stated that he gave "these opinions great weight and adopted some of the postural restrictions." Id. The ALJ's brief analysis contained no evaluation of their opinions or discussion of how those opinions were consistent with evidence of record; nor did it contain any analysis of the supporting explanations included by Drs. Hinzman and Manos in their opinions. See 20 C.F.R. § 404,1527(c)(3) ("because nonexamining sources have no examining or treating relationship with you, the weight we will give their opinions will depend on the degree to which they provide supporting explanations for their opinions"). As the Report and Recommendations correctly states, the ALJ's cursory analysis "evidences application of `greater scrutiny' to the opinions given by treating sources, a practice deemed error by the Sixth Circuit." Doc. # 12, PAGEID # 651 (citing Gayheart v. Comm'r of Soc. Sec., 710 F.3d 365, 380 (6th Cir. 2013)).
In sum, the ALJ's failure to weigh the opinions of the treating and consulting physicians using the appropriate factors meant that her finding that Plaintiff was not disabled was unsupported by substantial evidence, and must be reversed.
2. Plaintiff, in her objections, argues that "the overwhelming medical evidence supports the opinion of Dr. Bhat, and the opinions of the State agency reviewers are not substantial evidence to support a rejection." Doc. #13, PAGEID #665-66. Thus, she claims, "the decision of the ALJ should be reversed and benefits should be awarded." Id. However, "[a] judicial award of benefits is proper only where the proof of disability is overwhelming or where the proof of disability is strong and evidence to the contrary is
WHEREFORE, based upon the aforesaid, this Court adopts the Report and Recommendations of the United States Magistrate Judge, Doc. #12, in their entirety. Plaintiff's Objections to said judicial filing, Doc. #13, are overruled. Judgment will be ordered entered in favor of Plaintiff and against the Defendant Commissioner, reversing the decision of the Defendant Commissioner that Plaintiff was not disabled and, therefore, not entitled to benefits under the Social Security Act, and remanding to the Commissioner, pursuant to the fourth sentence of 42 U.S.C. § 405(g), for further proceedings consistent with the Report and Recommendations.
The captioned cause is hereby ordered terminated upon the docket records of the United States District Court for the Southern District of Ohio, Western Division, at Dayton.
Michael J. Newman, United States Magistrate Judge
This is a Social Security disability benefits appeal. At issue is whether the Administrative Law Judge ("ALP) 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 October 15, 2005. PageID 185-88, 203-13. Plaintiff claims disability as a result of a number of alleged impairments including residuals of a 1988 right ankle fracture, diabetes mellitus, and depression. PagelD 68.
After initial denials of her applications, Plaintiff received a hearing before ALJ Gregory G. Kenyon on January 31, 2014. PagelD 80-104. The ALJ issued a written decision on March 27, 2014 finding Plaintiff not disabled. PageID 64-75. Specifically, the ALJ's findings were as follows:
PageID 66-74.
Thereafter, the Appeals Council denied Plaintiffs request for review, making the ALJ's non-disability finding the final administrative decision of the Commissioner. PageID 46-49. 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 63-73. Plaintiff and the Commissioner both summarize the record evidence in their respective filings. Doc. 7 at PageID 600-05; doe. 10 at PageID 619-22. Accordingly, except as otherwise noted, the undersigned incorporates the ALJ's recitation of the evidence as well as the parties' summaries of the evidentiary record.
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, 91 S.Ct. 1420, 28 L.Ed.2d 842 (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
In her Statement of Errors, Plaintiff argues that the ALJ erred in: (1) relying on the opinions of record-reviewers Gary Hinman, M.D. and Diane Manos, M.D. to the exclusion of treating physician Rajindra Bhat, M.D.; and (2) finding her not fully credible. Doc. 7 at PagelD 606-12. The undersigned finds the ALJ committed reversible error in weighing Dr. Bhat's opinion, and thus, does not reach Plaintiff's second assignment 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 well-supported 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 Fed.Appx. 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) (citation 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 the treating physician's 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
Dr. Bhat treated Plaintiff for various physical impairments beginning in 2005. See PagelD 399, 401. On November 9, 2010, he listed Plaintiff's medical conditions as including chronic right ankle pain, plantar fasciitis, diabetes, hypertension, gastroesophageal reflux disease ("GERD"), and obesity. PagelD 441. Dr. Bhat also opined that Plaintiff can walk/stand for thirty minutes at a time (up to two hours out of an eight hour workday); can frequently lift/carry up to five pounds and occasionally lift/carry up to ten pounds; is markedly limited in her ability to push/pull and perform repetitive foot movements; and is moderately limited in her ability to bend. PageID 442. Such limitations translate into a restriction to sedentary work activity. See PageID 71, 103; 20 C.F.R. § 404.1567(a); Social Security Ruling ("SSR") 83-10, 1983 WL 31251, at *5 (Jan. 1, 1983) (stating that, at the "sedentary level of exertion, periods of standing or walking should generally total no more than about 2 hours of an 8-hour workday, and sitting should generally total approximately 6 hours"). Although typically an individual who can perform sedentary work is deemed "not disabled," given Plaintiff's age and other relevant vocational factors, it is arguable that a sedentary work finding would deem Plaintiff disabled under the Medical-Vocational Guidelines ("Grid").
The ALJ gave Dr. Bhat's opinion "little weight," stating:
PageID 71-72. The undersigned agrees with Plaintiff that the ALJ erred in analyzing,
Initially, the undersigned notes that the ALJ failed to mention the "controlling weight" concept and made no specific finding — and provided no analysis — as to whether Dr. Bhat's opinion is "well supported by medically acceptable clinical and laboratory diagnostic techniques and ...not inconsistent with other substantial evidence in the case record[,]" i.e., the factors for determining whether a treating physician's opinion is entitled to controlling weight. See 20 C.F.R. § 404.1527(c)(2). The ALJ's silence in this regard omits reference to the number of objective and/or clinical findings tending to support Dr. Bhat's opinion, such as: tenderness and reduced range of motion on exam, PageID 375; an abnormal gait, PagelD 354; multiple x-rays indicating joint space narrowing at the ankle mortise associated with sclerosis and soft-tissue swelling, PagelD 408, 556; decreased sensation in her feet, right ankle swelling, and decreased range of motion, PagelD 480, 486, 518, 528; and increased lumbar lordosis. PagelD 573. The ALJ's failure to conduct a controlling weight analysis — and, further, to address the foregoing objective and/or clinical evidence in rejecting Dr. Bhat's opinion — deprives the Court of the opportunity to meaningfully review 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) (stating that the lack of explanation regarding the "controlling weight [analysis] hinders a meaningful review of whether the ALJ properly applied the treatingphysician rule that is at the heart of this regulation"). 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).
Even assuming, arguendo, that the ALJ properly conducted a controlling weight analysis — which the undersigned concludes he did not — the ALJ failed to provide good reasons for the ultimate weight given to Dr. Bhat's opinion. For example, the ALJ tried to discredit Dr. Bhat's opinion concerning Plaintiff's physical limitations by pointing out that her "diabetes is uncontrolled because she is not compliant with diet, exercise, or medications." PagelD 72. Under the Social Security regulations, a claimant must follow treatment recommendations in order to be awarded benefits, unless the claimant can demonstrate a "good reason" for non-compliance. 20 C.F.R. § 404.1530(a)-(b).
Here, the ALJ failed to consider whether Plaintiff's non-compliance with treatment was due to a "good reason." This failure might have been harmless had the record contained no evidence supporting a plausible reason for non-compliance. The record contains such evidence, however. For instance, evidence of record shows that, at one point, Plaintiff ran out of medication and could not afford to buy more. Pagel.") 395; see also SSR 82-59, 1982 WL 31384, at *1 (Jan. 1, 1982) (stating that an inability to afford treatment can be an acceptable reason for failing to comply with treatment). In addition, mental health treatment records note that Plaintiff was overwhelmed with her diabetes care, and was caring for her brother who was gravely ill with Stage IV cancer. PagelD 536. Additionally, the record reveals that Plaintiff suffers from depression, a mental health disorder the ALJ found to be a "severe impairment" in Plaintiff's case. See PagelD 66. As stated by the Sixth Circuit, the failure to seek or comply with treatment recommendations can simply be a symptom of mental health disorders. White v. Comm'r of Soc. Sec., 572 F.3d 272, 283 (6th Cir. 2009). With regard to Plaintiff's purported failure to
Based upon the foregoing, the undersigned concludes that the ALJ's cursory treatment of the non-compliance issue fails to demonstrate consideration of any reason for Plaintiff's purported non-compliance with treatment, Absent further explanation by the ALJ, the undersigned concludes that Plaintiff's purported failure to comply with treatment does not provide a "good reason" for rejecting Dr. Bhat's opinion.
The undersigned also finds the ALJ's assessment of Dr. Bhat's opinion fails to consider the significant factors under 20 C.F.R. § 404.1527(c) favoring the assessment of deferential weight. 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)). Here, the ALJ fails to mention Dr. Bhat's long-term treatment relationship with Plaintiff — over five years at the time he provided his opinion — and how he could, therefore, provide a meaningful, "detailed, longitudinal picture of [Plaintiff's] medical impairment[,]" as contemplated by the regulations. See 20 C.F.R. § 404.1527(c)(2); PagelD 399-401. The ALJ also failed to acknowledge the consistency between Dr. Bhat's opinion and the opinion of podiatrist Tanisha Richmond, D.P.M. — i.e., the only other medical source to have treated or personally examined Plaintiff.
Finally, the ALJ's conclusory analysis of the "great weight" given to the record reviewers exacerbates these aforementioned errors. Drs. Hinman and Manos both provided opinions in which they concluded Plaintiff is capable of medium work activity with postural limitations related to her left ankle condition and diabetes. PagelD 71, 111-12, 123-25. The entirety of the ALJ's analysis of the record reviewers' opinions is as follows:
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).
In this case, the evidence of disability is not overwhelming. There are conflicting medical opinions regarding the severity of Plaintiff's impairments. See supra. Therefore, a remand for further proceedings is proper. On remand, the ALJ should: (1) conduct an appropriate review of all evidence of record; (2) assess Plaintiff's credibility; and (3) determine Plaintiff's disability status anew.