KAREN L. LITKOVITZ, Magistrate Judge.
Plaintiff brings this action pursuant to 42 U.S.C. § 405(g) and§ 1383(c)(3) for judicial review of the final decision of the Commissioner of Social Security (Commissioner) denying plaintiff's application for supplemental security income (SSI). This matter is before the Court on plaintiff's Statement of Errors (Doc. 13) and the Commissioner's response in opposition (Doc. 18).
Plaintiff protectively filed her application for SSI in December 2011, alleging disability since June 15, 2011, due to chronic obstructive pulmonary disease (COPD), asthma, anxiety and bipolar disorder. (Tr. 252). Plaintiff's application was denied initially and upon reconsideration. Plaintiff, through counsel, requested and was granted a de novo hearing before administrative law judge (ALJ) Larry A Temin. Plaintiff and a vocational expert (VE) appeared and testified at the ALJ hearing. On July 23, 2014, the ALJ issued a decision denying plaintiff's SSI application. Plaintiff's request for review by the Appeals Council was denied, making the decision of the ALJ the final administrative decision of the Commissioner.
To qualify for disability benefits, a claimant must suffer from a medically determinable physical or mental impairment that can be expected to result in death or that has lasted or can be expected to last for a continuous period of not less than 12 months. 42 U.S.C. § 1382c(a)(3)(A). The impairment must render the claimant unable to engage in the work previously performed or in any other substantial gainful employment that exists in the national economy. 42 U.S.C. § 1382c(a)(3)(B).
Regulations promulgated by the Commissioner establish a five-step sequential evaluation process for disability determinations:
Rabbers v. Comm'r of Soc. Sec., 582 F.3d 647, 652 (6th Cir. 2009) (citing 20 C.F.R. §§ 416.920(a)(4)(i)-(v), 416.920(b)-(g)). The claimant has the burden of proof at the first four steps of the sequential evaluation process. Id.; Wilson v. Comm'r of Soc. Sec., 378 F.3d 541, 548 (6th Cir. 2004). Once the claimant establishes a prima facie case by showing an inability to perform the relevant previous employment, the burden shifts to the Commissioner to show that the claimant can perform other substantial gainful employment and that such employment exists in the national economy. Rabbers, 582 F.3d at 652; Harmon v. Apfel, 168 F.3d 289, 291 (6th Cir. 1999).
The ALJ applied the sequential evaluation process and made the following findings of fact and conclusions of law:
(Tr. 71-88).
Judicial review of the Commissioner's determination is limited in scope by 42 U.S.C. §405(g) and involves a twofold inquiry: (I) whether the findings of the ALJ are supported by substantial evidence, and (2) whether the ALJ applied the correct legal standards. See Blakley v. Comm'r of Soc. Sec., 581 F.3d 399, 406 (6th Cir. 2009); see also Bowen v. Comm'r of Soc. Sec., 478 F.3d 742, 745-46 (6th Cir. 2007).
The Commissioner's findings must stand 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 (1971) (citing Consolidated Edison Co. v. N.L.R.B., 305 U.S. 197, 229 (1938)). Substantial evidence consists of "more than a scintilla of evidence but less than a preponderance...." Rogers v. Comm'r of Soc. Sec., 486 F.3d 234, 241 (6th Cir. 2007). In deciding whether the Commissioner's findings are supported by substantial evidence, the Court considers the record as a whole. Hephner v. Mathews, 574 F.2d 359 (6th Cir. 1978).
The Court must also determine whether the ALJ applied the correct legal standards in the disability determination. Even if substantial evidence supports the ALJ's conclusion that the plaintiff is not disabled, "a decision of the Commissioner will not be upheld where the SSA fails to follow its own regulations and where that error prejudices a claimant on the merits or deprives the claimant of a substantial right." Rabbers, 582 F.3d at 651 (quoting Bowen, 478 F.3d at 746). See also Wilson, 378 F.3d at 545-46 (reversal required even though ALJ's decision was otherwise supported by substantial evidence where ALJ failed to give good reasons for not giving weight to treating physician's opinion, thereby violating the agency's own regulations).
In her Statement of Errors, plaintiff argues that the ALJ erred by: (1) improperly weighing the opinion of her treating physician, Dr. Oluwole Onadeko, M.D., which the ALJ gave only "some weight;" (2) failing to analyze whether plaintiff's breathing impairment equaled Listing 3.02; and (3) failing to properly weigh the opinion of the psychological consultative examiner, Dr. Kevin L. Corbus, Psy.D., which the ALJ gave only "some weight." (Doc. 13).
Plaintiff alleges that the ALJ erred at Step Three of the sequential evaluation process by failing to discuss "equaling [of the Listing] in any capacity." (Doc. 13 at 17, citing Tr. 72). Plaintiff alleges that substantial evidence supports a finding that her respiratory impairment equals Listing 3.02, 20 C.F.R. Pt. 404, Subpt. P, App. 1. (Doc. 13 at 17). To satisfy Listing 3.02 for COPD, the claimant must suffer from "[c]hronic obstructive pulmonary disease, due to any cause, with the FEV
In response, the Commissioner argues that plaintiff has not satisfied her burden to show that her impairments medically equaled Listing 3.02. (Doc. 18 at 4-7). The Commissioner contends that the ALJ discussed the opinion of the medical expert, Dr. Mark Farber, M.D., who reviewed the medical record and completed medical interrogatories; the ALJ properly found that pulmonary function results showing FEV
The ALJ is required to "consider all evidence in [the claimant's] case record" in making the disability determination and to "consider the medical severity of [the claimant's] impairments" at step three of the sequential evaluation process. Forrest v. Comm'r of Soc. Sec., 591 F. App'x 359, 365 (6th Cir. 2014) (citing 20 C.F.R. §§ 404.1520(a)(3), 404.1520(a)(4)(iii); Bowie v. Commissioner of Social Sec., 539 F.3d 395, 400 (6th Cir. 2008)). Contrary to plaintiff's allegation, the ALJ considered the severity of plaintiff's respiratory impairment at step three of the sequential evaluation process and evaluated whether her impairment met or equaled Listing 3.02. (Tr. 72-74). The ALJ found that plaintiff did not have an impairment or combination of impairments that met or medically equaled the severity of a listed impairment. (Tr. 72). In making this finding, the ALJ thoroughly considered the findings of the medical expert, Dr. Farber, who reviewed the medical evidence of record, answered interrogatories, and opined that plaintiff's COPD did not meet or equal Listing 3.02. (Id., citing Tr. 652-81). The ALJ noted that Dr. Farber found that plaintiff's COPD did not meet Listing 3.02 and that Dr. Farber reported "the record contains FEV
Plaintiff has not shown that the ALJ's finding was erroneous and that her impairments met or equaled in severity Listing 3.02A during the time period in issue as is her burden. See Forrest, 591 F. App'x at 366 (even if the ALJ's reasoning failed to support his step-three findings, the error was harmless because the plaintiff did not show his impairments met or equaled a listed impairment). Plaintiff alleges that the ALJ failed to consider her additional severe impairments of myocardial infarction and obesity "which could impact her breathing." (Doc. 13 at 17) (emphasis added). However, the ALJ did consider whether plaintiff's obesity impacted her functioning pursuant to Social Security Ruling 02-1p
Plaintiff's second assignment of error should be overruled.
Plaintiff alleges as her first assignment of error that the ALJ erred in weighing the opinion of her treating pulmonologist, Dr. Onadeko. It is well-established that the findings and opinions of treating physicians are entitled to substantial weight. "In general, the opinions of treating physicians are accorded greater weight than those of physicians who examine claimants only once." Walters v. Comm'r of Soc. Sec., 127 F.3d 525, 530-31 (6th Cir. 1997). See also Harris v. Heckler, 756 F.2d 431, 435 (6th Cir. 1985) ("The medical opinions and diagnoses of treating physicians are generally accorded substantial deference, and if the opinions are uncontradicted, complete deference."). "The treating physician doctrine is based on the assumption that a medical professional who has dealt with a claimant and his maladies over a long period of time will have a deeper insight into the medical condition of the claimant than will a person who has examined a claimant but once, or who has only seen the claimant's medical records." Barker v. Shalala, 40 F.3d 789, 794 (6th Cir. 1994).
"Treating-source opinions must be given `controlling weight' if two conditions are met: (1) the opinion `is well-supported by medically acceptable clinical and laboratory diagnostic techniques'; and (2) the opinion `is not inconsistent with the other substantial evidence in [the] case record.'" Gayheart v. Comm'r of Soc. Sec., 710 F.3d 365, 376 (6th Cir. 2013) (citing 20 C.F.R. § 404.1527(c)(2)). See also Cole v. Astrue, 661 F.3d 931, 937 (6th Cir. 2011). If the ALJ declines to give a treating source's opinion controlling weight, the ALJ must balance the factors set forth in 20 C.F.R. § 416.927(c)(2)-(6) in determining what weight to give the opinion. See Gayheart, 710 F.3d at 376; Wilson, 378 F.3d at 544. These factors include the length, nature and extent of the treatment relationship and the frequency of examination. 20 C.F.R. § 416.927(c)(2)(i)(ii); Wilson, 378 F.3d at 544. In addition, the ALJ must consider the medical specialty of the source, how well-supported by evidence the opinion is, how consistent the opinion is with the record as a whole, and other factors which tend to support or contradict the opinion. 20 C.F.R. § 416.927(c)(3)-(6); Gayheart, 710 F.3d at 376; Wilson, 378 F.3d at 544.
"Importantly, the Commissioner imposes on its decision makers a clear duty to `always give good reasons in [the] notice of determination or decision for the weight [given a] treating source's opinion.'" Cole, 661 F.3d at 937 (citation omitted). See also 20 C.F.R. § 416.927(c)(2). See also Wilson, 378 F.3d at 544 (ALJ must give "good reasons" for the ultimate weight afforded the treating physician opinion). Those 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." Cole, 661 F.3d at 937 (citing SSR 96-2p). This procedural requirement "ensures that the ALJ applies the treating physician rule and permits meaningful review of the ALJ's application of the rule." Gayheart, 710 F.3d at 376 (quoting Wilson, 378 F.3d at 544).
Generally, an opinion from a medical source who has examined a claimant is given more weight than that of a source who has not performed an examination. Id. (citing 20 C.F.R. §§ 404.1502 and 404.1527(c)(1)). Opinions from nontreating and nonexamining sources are weighed based on the examining relationship, specialization, consistency, and supportability as well as other factors "which tend to support or contradict the opinion." 20 C.F.R. § 416.927(c)(6). However, "the opinions of State agency medical and psychological consultants and other program physicians and psychologists can be given weight only insofar as they are supported by evidence in the case record[.]" SSR 96-6p, 1996 WL 374180 at *2.
Dr. Onadeko first saw plaintiff in the emergency room on January 28, 2013, where she was admitted for an altered mental state and heroin overdose and treated for a non-ST segment elevation myocardial infarction and acute respiratory failure. (Tr. 480-540; Tr. 590). Dr. Onadeko saw plaintiff three times after her discharge between February 26, 2013 and September 25, 2013, before he issued a medical assessment on November 11, 2013. (Id.; Tr. 569-88). Dr. Onadeko completed a Pulmonary Residual Functional Capacity Questionnaire on that date. (Tr. 589-95). Dr. Onadeko diagnosed plaintiff with acute respiratory failure, hypoxemia, hypercapnia, tobacco use disorder, BiPAP (biphasic positive airway pressure) dependence, and severe COPD.
The ALJ declined to give Dr. Onadeko's opinion "controlling weight." (Tr. 86). The ALJ found that the opinion (1) was not well supported by medically-acceptable clinical and laboratory diagnostic techniques, and (2) was not consistent with other substantial evidence in the case record. (Id.). Instead, the ALJ gave Dr. Onadeko's opinion "some weight." (Id.). Plaintiff acknowledges that the ALJ balanced the regulatory factors set forth in 20 C.F.R. § 416.920(c)(2)-(6) by noting that the ALJ gave the following reasons for discounting Dr. Onadeko's opinion: (1) the opinion was not well-supported by medically acceptable clinical and laboratory diagnostic techniques; (2) the opinion was not consistent with the other substantial evidence in the case record; (3) the values yielded by pulmonary testing were not at listing level; (4) the record did not document the need for supplemental oxygen; (5) Dr. Onadeko did not provide support for the sitting/standing/walking limitations he assessed; (6) the limitations Dr. Onadeko assessed were inconsistent with plaintiff's testimony; (7) the limitations assessed were not consistent with plaintiff's activities of daily living; and (8) Dr. Onadeko had seen plaintiff only three times since their initial hospital encounter. (Doc. 13 at 9). Plaintiff argues that none of these reasons provided by the ALJ for discounting Dr. Onadeko's opinion are supported by the evidence. (Id. at 10-17).
Plaintiff's argument is not well-taken. To the contrary, the record demonstrates that substantial evidence supports the ALJ's analysis of the regulatory factors under 20 C.F.R. § 416.927(c)(2)-(6) and his decision to afford Dr. Onadeko's opinion only "some weight." The ALJ reasonably found that Dr. Onadeko's opinion of debilitating limitations was not well-supported by the evidence in the record and was not consistent with other substantial evidence in the case record. The ALJ relied on evidence that showed plaintiff continued to smoke, despite being on oxygen and despite repeatedly being advised to quit; she was non-compliant with treatment, which affected the reliability of her pulmonary function test results; and her condition improved with treatment. (See Tr. 334, 350, 390, 417, 558-59, 637, 743, 754, 767-72). The ALJ also reasonably considered that plaintiff's pulmonary function study results were not at listing level in discounting Dr. Onadeko's more extreme restrictions. As explained above, although plaintiff tested below Listing level on occasion, the medical records showing FEV
The ALJ further reasonably found that Dr. Onadeko did not provide objective support for the standing, walking, or sitting limitations he assessed.
In addition, substantial evidence supports the ALJ's finding that the restrictions Dr. Onadeko assessed were inconsistent with plaintiff's testimony that she can lift up to 25 pounds and with her daily activities. (Tr. 86). The ALJ relied on testimony and evidence that plaintiff spent four to five hours during the day on the computer, made her own meals, washed her own dishes, did her own laundry, tended to her self-care, vacuumed a little, and reportedly rode a bicycle to her friend's house in February 2012. (Id., citing Tr. 382-88). The ALJ reasonably found this evidence of plaintiff's ability to perform "a somewhat normal level of daily activity" and to engage in physical activities that involved lifting and bending to be inconsistent with the debilitating limitations assessed by Dr. Onadeko. (Tr. 84). See 20 C.F.R. § 416.929(c)(3)(i) (authorizing an ALJ to consider daily activities when evaluating symptoms); Warner v. Comm'r of Soc. Sec., 375 F.3d 387, 392 (6th Cir. 2004) (permitting an ALJ to consider daily activities such as housework in evaluating complaints of disabling pain). Plaintiff argues that additional testimony she provided concerning her symptoms, her functioning, and restrictions on her daily activities "place the evidence cited by the ALJ into context" and show that her activities of daily living are not inconsistent with Dr. Onadeko's opinion. (Doc. 13 at 15). However, the ALJ discounted plaintiff's credibility and testimony as to her debilitating symptoms for reasons he thoroughly discussed in his written decision (Tr. 74-87), and plaintiff has not challenged the ALJ's credibility finding on appeal. (Doc. 13). The ALJ's finding that plaintiff's activities of daily living were inconsistent with the level of limitation found by Dr. Onadeko is well-supported by the evidence the ALJ credited, and the ALJ did not err in this regard.
The ALJ also took into consideration Dr. Onadeko's area of specialization and his treatment relationship with plaintiff in accordance with 20 C.F.R. § 416.927(c)(2), (5). The ALJ acknowledged that Dr. Onadeko is a treating source and a pulmonary specialist; however, the ALJ noted that Dr. Onadeko had seen plaintiff a total of only three times after his initial encounter with her following her emergency room admission for a drug overdose. (Tr. 86). Plaintiff argues this is "not insignificant treatment" and that the amount of contact Dr. Onadeko had with plaintiff puts him in "an optimal position" to render an opinion on plaintiff's functional limitations, or at least in "a much better position" than the examining and reviewing physicians of record. (Doc. 13 at 16). While the opinions of treating physicians are generally accorded greater weight than one-time examining or non-examining physicians' opinions, Walters, 127 F.3d at 529-530, the ALJ is not required to credit a treating physician's opinion based solely on the nature of the treatment relationship; instead, the ALJ must balance several factors in determining whether to defer to the treating physician's opinion. See 20 C.F.R. § 416.927(c)(2)-(6). The ALJ fulfilled his duty here by considering Dr. Onadeko's status as a treating physician and his area of specialization, while also acknowledging the Dr. Onadeko had seen plaintiff only a handful of times and balancing the remaining factors outlined in§ 416.927(c)(2)-(6). Moreover, under the particular circumstances of this case, the ALJ was not required to give the opinion of Dr. Onakedo more weight than the opinion of the medical expert, Dr. Farber, based on the treating physician's area of specialization given that Dr. Farber likewise specialized in the area of pulmonary disease. (Tr. 86). Cf. 20 C.F.R. § 416.927(c)(5) ("We generally give more weight to the opinion of a specialist about medical issues related to his or her area of specialty than to the opinion of a source who is not a specialist."). Plaintiff has shown no error in this regard.
Finally, plaintiff challenges the ALJ's reliance on Dr. Farber's opinion that the record did not document a need for supplemental oxygen as a basis for discounting Dr. Onadeko's opinion. (See Tr. 86, citing Tr. 668- Dr. Farber noted on Dr. Onadeko's report: "no documentation for [oxygen] requirement but even if she requires, still can perform sedentary work"). Plaintiff characterizes Dr. Farber's opinion as "confusing" in light of plaintiff's severe COPD, various test results, and Dr. Farber's indication in his RFC assessment that plaintiff may require a workplace accommodation for an oxygen tank (Tr. 654). (Doc. 13 at 12-13). However, the Court need not address whether the ALJ's reliance on this aspect of Dr. Farber's opinion was justified. Even if Dr. Farber's finding that plaintiff did not require supplemental oxygen is not supported by the evidence, the remaining reasons the ALJ gave for discounting Dr. Onadeko's opinion provide substantial support for the ALJ's decision.
Thus, the ALJ thoroughly evaluated the medical and other evidence of record and gave "good reasons" that are substantially supported by the record for discounting Dr. Onadeko's opinion. Instead of crediting Dr. Onadeko's assessment, the ALJ gave "significant weight" to the opinion of the medical expert, Dr. Farber, a physician with a specialization in pulmonary disorders. (Tr. 84). The ALJ found that Dr. Farber had an opportunity to review a majority of the medical evidence of record and that his opinions were well-supported by the explanations he provided and the objective evidence he cited. (Tr. 84-85). As discussed earlier, Dr. Farber reviewed the medical evidence of record and answered medical interrogatories on April 28, 2014. (Tr. 652-81). Dr. Farber opined that plaintiff's COPD did not meet Listing 3.02.
The ALJ was entitled to rely on Dr. Farber's assessment for the reasons the ALJ stated. See Atterberry v. Sec'y of Health & Human Servs., 871 F.2d 567, 570 (6th Cir. 1989) (medical expert testimony consistent with the evidence of record can constitute substantial evidence to support the Commissioner's decision). The ALJ considered the degree to which Dr. Farber provided supporting explanations for his opinions and the degree to which his opinion considered all of the pertinent evidence in the record, including the opinions of treating and other examining sources, as required under the governing regulations. See 20 C.F.R. § 416.927(c)(3) (a non-treating source's opinion is weighed based on how well-supported by evidence the opinion is). The ALJ's decision to afford Dr. Farber's significant weight" is supported by substantial evidence.
Thus, for the reasons discussed above, the ALJ did not err in evaluating the medical opinion evidence related to plaintiff's physical impairments. The ALJ's decision to give Dr. Onadeko's opinion "some weight" and to rely instead on the opinions of the medical expert, Dr. Farber, is substantially supported by the record. Plaintiff's first assignment of error should be overruled.
Plaintiff alleges that the ALJ erred by assigning only "some weight" to the report of the consultative examining psychologist, Dr. Kevin L. Corbus, Psy.D. (Doc. 13 at 18-19). Plaintiff alleges that the ALJ's reasons for giving reduced weight to Dr. Corbus' report are not supported by the record. The Commissioner argues in response that the ALJ's reasons are substantially supported by the record. (Doc. 18 at 17-20)
Dr. Corbus evaluated plaintiff at the request of the state agency in April 2012. (Tr. 401-06). Plaintiff reported to Dr. Corbus that she maintained good relationships with family but did not socialize with anyone. (Tr. 401-02). She reported that she had a history of extensive mental health treatment but was not currently participating in such treatment. (Tr. 402). She reported she had been prescribed anxiety medication but could not afford it at the time of the evaluation. (Tr. 402). She had never been hospitalized for psychiatric issues. (Id.). At the time of the evaluation, plaintiff had been working at Burger King for 3 years and currently worked 15-25 hours every two weeks but felt she could not work more hours due to anxiety and COPD. (Tr. 403). Plaintiff reported that she had never been fired and had no history of interpersonal problems with supervisors, coworkers or customers. (Tr. 403). She reported "some history" of difficulty maintaining an adequate pace at past jobs. (Id.). Plaintiff described her daily routine as waking and going to bed at variable times, watching TV, sleeping, and helping around the house by doing the dishes and vacuuming "a little at a time because of the COPD." (Id.). Dr. Corbus reported that plaintiff's grooming and hygiene were adequate, she was cooperative and volunteered information and details readily, and she maintained good eye contact. (Id.). He observed that plaintiff was extremely shaky and tearful and constantly tapped her feet during the evaluation. (Id.). Flow of conversation and thought were normal except that plaintiff's rate of speech was "slowed." (Id.). Her mood appeared anxious with congruent affect. (Tr. 404). She reported symptoms of mania and two to three manic phases each week lasting from a couple of hours to a couple of days. (Id.). Plaintiff reported being currently depressed with symptoms of low self-esteem, concerns about the future, sadness, tearfulness, lack of energy, and poor appetite. (Id.). She demonstrated symptoms of anxiety during the examination as she was shaky and fidgety, and she reported having panic attacks 4 to 5 times each week during which she is unable to catch her breath and does not want to be around anyone. Her mental content was normal. She was oriented in all spheres. Her cognitive functioning was in the average range. Her attention and concentration were poor, her ability to abstract was fair, and she demonstrated some difficulties with memory during the evaluation. (Id.). She could understand and follow directions during the evaluation and her performance on memory/recall tasks was average. (Id.).
Dr. Corbus diagnosed plaintiff with mood disorder NOS, anxiety disorder NOS, and cocaine dependence (in sustained full remission). (Tr. 405). He assigned her a GAF score of 50.
The ALJ discounted Dr. Corbus' assessment on three grounds. First, the ALJ found the assessment was based heavily upon plaintiff's self-reports, which the ALJ found were "less than fully credible." (Tr. 79). Second, the ALJ discounted the assessment based on plaintiff's lack of significant mental health treatment, which the ALJ found indicated her mental health symptoms were not as debilitating as she presented to Dr. Corbus. (Id.). Third, the ALJ discounted the assessment based on the "consistent normal psychiatric findings on other examinations," which the ALJ found likewise cast doubt on the debilitating nature of the symptoms presented by plaintiff. (Id.). Plaintiff acknowledges that the ALJ discounted Dr. Corbus' assessment on these grounds but alleges the ALJ's reasons are not supported. (Doc. 13 at 18-19). The Court disagrees and finds that the ALJ properly weighed Dr. Corbus' opinion and gave valid reasons for declining to credit his assessment.
First, the ALJ properly considered the extent to which Dr. Corbus' opinion was supported by the objective and clinical evidence, as opposed to plaintiff's subjective allegations alone. See 20 C.F.R. § 416.927(c)(3) ("The more a medical source presents relevant evidence to support an opinion, particularly medical signs and laboratory findings, the more weight we will give that opinion.") Objective evidence in the psychiatric/psychological context includes "medical signs," 20 C.F.R. § 416.912(b)(1), which are defined as "psychological abnormalities which can be observed, apart from your statements (symptoms). . . . Psychiatric signs are medically demonstrable phenomena that indicate specific psychological abnormalities, e.g., abnormalities of behavior, mood, thought, memory, orientation, development, or perception. They must also be shown by observable facts that can be medically described and evaluated." 20 C.F.R. § 416.928(b). Here, it appears that Dr. Corbus relied heavily on plaintiff's subjective allegations in rendering his assessment. For instance, in assessing plaintiff's ability to understand, remember and carry out instructions, Dr. Corbus found that plaintiff was able to follow instructions in the evaluation and that her performance on memory/recall tasks was average. (Tr. 405). However, he appears to have relied on plaintiff's self-report that she will not fully complete tasks at times because she will need to remove herself from anxiety-producing situations. (Id.). In assessing plaintiff's ability to maintain attention, concentration, persistence and pace to perform simple and multi-step tasks, Dr. Corbus relied on plaintiff's reports that she had a history of difficulty in maintaining adequate pace at past jobs, even though she was currently working, and that her depression and anxiety "will [] cause her to be inconsistent at work, and have poor pace and persistence." (Tr. 406). In addition, Dr. Corbus noted that plaintiff had no history of interpersonal difficulties in a work setting, she was likely to respond appropriately to coworkers in a work setting, and she did not have a significant history of violent or aggressive outbursts; however, he noted plaintiff's subjective report that she will sometimes be short-tempered and verbally aggressive when she is anxious. (Id.). Finally, Dr. Corbus appears to have relied exclusively on plaintiff's self-reported difficulty in responding appropriately to work pressure when assessing her ability in this area. (Id.). Dr. Corbus assessed plaintiff's abilities and limitations in this area of functioning as follows:
(Id.) (emphasis added). Thus, the ALJ reasonably determined that Dr. Corbus relied heavily on plaintiff's self-reported symptoms rather than objective evidence in reaching his conclusions as to her mental functional limitations. (Tr. 79). In light of the ALJ's finding that plaintiff was not fully credible, which plaintiff has not challenged, the ALJ was justified in discounting Dr. Corbus' opinion on the ground he relied largely on plaintiff's self-reported symptoms.
Second, the ALJ reasonably discounted Dr. Corbus' assessment in light of plaintiff's history of a lack of significant mental health treatment. (Id.). Plaintiff simply notes in response to this finding that she did not have health insurance until recently and that she had begun mental health treatment in March 2014, long after abnormal psychiatric findings were first noted on her examinations and approximately two years after Dr. Corbus issued his assessment. (Doc. 13 at 19, citing Tr. 101-02, 627-51). However, plaintiff has not pointed to any evidence in the record to show that her lack of insurance precluded her from obtaining mental health treatment throughout the period of alleged disability. In fact, the ALJ noted that the evidence showed that plaintiff had obtained a medical card around October 15, 2012 (Tr. 458-59) and that she admitted smoking one-half to three packs of cigarettes per day during the applicable period with her family members often paying for her cigarettes. (Tr. 84). The ALJ reasonably concluded based on this evidence that plaintiff could have afforded some treatment or medication. See Moore v. Commissioner of Social Sec., 573 F. App'x 540, 542-43 (6th Cir. 2014) (ALJ reasonably concluded that plaintiff's failure to pursue treatment greatly eroded her credibility where she testified she could not afford treatment but she continued to purchase up to three packs of cigarettes a day and the evidence showed she had obtained medical insurance long before the alleged onset date) (citing Blacha v. Sec'y of Health & Human Servs., 927 F.2d 228, 231 (6th Cir. 1990) ("concluding that the claimant's failure to seek treatment undercut his complaints of disabling symptoms"). The ALJ therefore was entitled to discount Dr. Corbus' assessment of debilitating mental functional limitations based on plaintiff's failure to pursue treatment during the alleged period of disability.
Finally, plaintiff alleges that the record does not support the ALJ's decision to discount Dr. Corbus' assessment on the ground there were consistently normal psychiatric findings on examination. (Doc. 13 at 19; see Tr. 79). Plaintiff contends the ALJ's finding is unsupported because there were four dates on which abnormal mental status findings were made: Dr. Corbus' April 2012 assessment (Tr. 401-06), and four treatment sessions at St. Aloysius on March 4, 2014 (Tr. 647), March 24, 2014 (Tr. 628), and May 20, 2014 (Tr. 713-15). (Doc. 13 at 19). Plaintiff alleges that Dr. Corbus observed numerous abnormalities, and on some or all of the above dates her treating providers noted that she appeared nervous, restless, fidgety, anxious and mistrustful; her affect and facial expressions were blunted; her mood and affect were anxious, depressed and constricted; she had a mild impairment of attention and concentration; and her insight and judgment were limited to fair. (Id.). However, as the Commissioner notes, the record also documents normal mental status findings made during the course of many more medical appointments. (Doc. 18 at 20). The ALJ noted in his written decision that several examination reports noted that plaintiff was alert and oriented x3 and had a normal mood and affect. (Tr. 77, citing Tr. 335- plaintiff alert and oriented x3, normal affect reported in June 2011 emergency room report; Tr. 349-50- normal mood and affect report in September 2011 emergency room report; Tr. 390-98- plaintiff alert and oriented x3, normal mood and affect and behavior reported in January 2012 emergency room report; Tr. 435-52- normal mood and affect and behavior reported in October 2012 emergency room report; Tr. 458-59- normal mood and affect, behavior, judgment, and thought content reported in October 2012 emergency room report; Tr. 621-22, plaintiff was alert and oriented x3, affect, conversation and mood were normal, and no abnormal thinking was noted in September 2013 emergency room report). Given that these normal mental status findings were made during several emergency room visits that spanned more than two years, the ALJ's decision to give reduced weight to Dr. Corbus' assessment in light of consistently normal psychiatric findings is substantially supported.
The ALJ provided valid reasons which are substantially supported by the evidence for giving only "some weight" to Dr. Corbus' assessment of plaintiff's mental functional limitations. The ALJ reasonably discounted Dr. Corbus' assessment on the grounds it was based in large part on plaintiff's subjective reports and was inconsistent with plaintiff's lack of mental health treatment history and with the consistent reports of normal psychiatric findings found in other examination reports throughout the record. Cf. Sims v. Comm'r of Soc. Sec., 406 F. App'x 977, 979-80 (6th Cir. 2011) (finding the ALJ appropriately discounted treating physician's opinion which was "based largely on plaintiff's subjective complaints and was not supported by other medical evidence in the record"). Accordingly, plaintiff's third assignment of error should be overruled.
The decision of the Commissioner be
Pursuant to Fed. R. Civ. P. 72(b),
SSR 96-9p, 1996 WL 374185, at *3 (July 02, 1996)
