JOEL C. HOPPE, Magistrate Judge.
Plaintiff Felicia Faye Throckmorton asks this Court to review the Acting Commissioner of Social Security's ("Commissioner") final decision denying her applications for disability insurance benefits ("DIB") and supplemental security income ("SSI") under Titles II and XVI of the Social Security Act (the "Act"), 42 U.S.C. §§ 401-434, 1381-1383f. The case is before me by referral under 28 U.S.C. § 636(b)(1)(B). ECF No. 12. Having considered the administrative record, the parties' briefs, and the applicable law, I find that the decision is not supported by substantial evidence. Accordingly, I recommend that the decision be reversed and the case be remanded under the fourth sentence of 42 U.S.C. § 405(g) to give the Commissioner another opportunity to explain her findings and conclusions.
The Social Security Act authorizes this Court to review the Commissioner's final decision that a person is not entitled to disability benefits. 42 U.S.C. §§ 405(g), 1383(c)(3); see also Hines v. Barnhart, 453 F.3d 559, 561 (4th Cir. 2006). The Court's role, however, is limited—it may not "reweigh conflicting evidence, make credibility determinations, or substitute [its] judgment" for that of agency officials. Hancock v. Astrue, 667 F.3d 470, 472 (4th Cir. 2012). Instead, a court reviewing the merits of the Commissioner's final decision asks only whether the Administrative Law Judge ("ALJ") applied the correct legal standards and whether substantial evidence supports the ALJ's factual findings. Meyer v. Astrue, 662 F.3d 700, 704 (4th Cir. 2011); see Riley v. Apfel, 88 F.Supp.2d 572, 576 (W.D. Va. 2000) (citing Melkonyan v. Sullivan, 501 U.S. 89, 98-100 (1991)).
"Substantial evidence" means "such relevant evidence as a reasonable mind might accept as adequate to support a conclusion." Richardson v. Perales, 402 U.S. 389, 401 (1971). It is "more than a mere scintilla" of evidence, id., but not necessarily "a large or considerable amount of evidence," Pierce v. Underwood, 487 U.S. 552, 565 (1988). Substantial evidence review takes into account the entire record, and not just the evidence cited by the ALJ. See Universal Camera Corp. v. NLRB, 340 U.S. 474, 487-89 (1951); Gordon v. Schweiker, 725 F.2d 231, 236 (4th Cir. 1984). Ultimately, this Court must affirm the ALJ's factual findings if "conflicting evidence allows reasonable minds to differ as to whether a claimant is disabled." Johnson v. Barnhart, 434 F.3d 650, 653 (4th Cir. 2005) (per curiam) (quoting Craig v. Chater, 76 F.3d 585, 594 (4th Cir. 1996)). However, "[a] factual finding by the ALJ is not binding if it was reached by means of an improper standard or misapplication of the law." Coffman v. Bowen, 829 F.2d 514, 517 (4th Cir. 1987).
A person is "disabled" if he or she is unable to engage in "any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months." 42 U.S.C. §§ 423(d)(1)(A), 1382c(a)(3)(A); accord 20 C.F.R. §§ 404.1505(a), 416.905(a). Social Security ALJs follow a five-step process to determine whether an applicant is disabled. The ALJ asks, in sequence, whether the applicant (1) is working; (2) has a severe impairment; (3) has an impairment that meets or equals an impairment listed in the Act's regulations; (4) can return to his or her past relevant work based on his or her residual functional capacity; and, if not (5) whether he or she can perform other work. See Heckler v. Campbell, 461 U.S. 458, 460-62 (1983); 20 C.F.R. §§ 404.1520(a)(4), 416.920(a)(4). The applicant bears the burden of proof at steps one through four. Hancock, 667 F.3d at 472. At step five, the burden shifts to the agency to prove that the applicant is not disabled. See id.
This case involves Throckmorton's fourth attempt since March 2003 to obtain disability benefits. See Administrative Record ("R.") 10, ECF No. 9-1. Throckmorton filed the underlying applications on August 27, 2012, alleging that she is disabled because of anxiety attacks and depression, migraine headaches, emphysema, bilateral carpal tunnel syndrome, two herniated discs in her back, and toxoplasmosis. R. 78, 88. She says that she has been disabled since May 18, 2012, which is one day after ALJ Charles Boyer issued a written decision denying her third application for benefits. R. 10, 63-73, 78, 88. The Commissioner rejected Throckmorton's current claims initially in November 2012 and on reconsideration in August 2013. R. 98-99, 134-35. On February 5, 2015, Throckmorton appeared with counsel for an administrative hearing before ALJ Brian Kilbane. R. 39-58. Throckmorton and a vocational expert ("VE") both testified at the hearing. R. 42-53, 53-57.
ALJ Kilbane issued an unfavorable decision on February 20, 2015. R. 10-31. He first found that Throckmorton had not worked since May 18, 2012, and that she met the Act's insured status requirements through June 30, 2014.
The ALJ next evaluated Throckmorton's residual functional capacity ("RFC") based on all of her medical impairments.
Throckmorton's brief contains several arguments that either challenge specific aspects of ALJ Kilbane's RFC determination, see Pl.'s Br. 4-7, 11, or more broadly object to his evaluation of the medical and other relevant evidence in the record, see id. at 8-11, 12-15. Her main objection to the RFC determination—and by extension ALJ Kilbane's reliance on the VE's testimony in response to a hypothetical question propounding the same RFC—is that the ALJ did not explain how the restriction to "simple, unskilled work" accommodated his step-three finding that Throckmorton had "moderate difficulties" maintaining concentration, persistence, or pace.
A claimant's RFC represents her "maximum remaining ability to do sustained work activities in an ordinary work setting on a regular and continuing basis"
Throckmorton's medical records from the relevant time show that she had been diagnosed with chronic anxiety and depression and had been prescribed several medications (e.g., Celexa, Cymbalta, Lexapro, Paxil, Xanax, Zoloft) for those conditions. See generally R. 379-413, 431-502. Throckmorton's primary care provider, Johanna Thomas, M.D., typically managed these medications. Throckmorton went to Dr. Thomas's clinic for routine follow-up appointments about once a month between July 2012 and January 2015. See id. On most visits, providers observed that Throckmorton was alert, oriented, cooperative, and exhibited normal memory function. R. 380, 383, 386, 395, 398, 401, 404, 410, 454, 457, 460, 469, 482, 488, 492. They very rarely observed that Throckmorton exhibited a "flat affect," R. 432, or appeared "sad" and "depressed," R. 436, 440. Treatment notes reflect that Throckmorton's chronic anxiety and/or depressive disorder often fluctuated between "controlled" and "not controlled" throughout the relevant period. R. 380, 395, 407, 432, 437, 447, 450, 454, 466, 473, 479, 482, 495, 501. Dr. Thomas or her colleagues occasionally increased or changed Throckmorton's medications. R. 392-93, 398, 406-07, 431-33, 455, 460, 465-67, 483-84, 494-96. On three occasions, Throckmorton told providers that she could not get certain prescriptions, or pursue mental-health counseling, because she did not have health insurance and could not afford to pay out of pocket. R. 449-50 (Aug. 2014), 446 (Sept. 2014), 432 (Jan. 2015).
On August 13, 2013, Throckmorton had a consultative psychological examination with Christopher Cousins, Ph.D. R. 415-23. She reported "one prior in-patient psychiatric hospitalization" for a week or two "sometime in her 20s," but she could not recall exactly why she was hospitalized. R. 418-19. Throckmorton said that she had attended outpatient counseling in the past, but she could not produce any psychiatric records for Dr. Cousins to review. R. 419. Dr. Cousins noted that the available medical records "indicate[d] a history of anxiety and depression," and that Throckmorton was currently taking Xanax and Cymbalta for those conditions. Id. Throckmorton reported feeling sad "all the time" and said there is "no activity she enjoys doing or likes to do." R. 420. She spent most days lying on the couch watching television. R. 419. Throckmorton said that she could prepare her own "microwave meals, cereal, and snacks," but that her father and a friend handled the shopping. R. 420. If she did go shopping, she would only go out on Friday night to avoid the crowds of people that triggered her "frequent" panic attacks. R. 422. Throckmorton also noted that chronic physical pain prevented her from performing "instrumental activities of daily living," such as doing laundry and cleaning her home. R. 421.
Dr. Cousins observed that Throckmorton was cooperative and answered his questions without "evidence of suspiciousness, hostility, or evasiveness," but that her affect and mood were "restricted" and "depressed," and that she "became tearful on a few occasions during the evaluation." R. 415-16. On examination, he noted that Throckmorton was "oriented to person, time, and place," R. 421, and "was able to articulate an understanding of the purpose of the evaluation," R. 416. Her memory function seemed to be a mixed bag: her recent memory appeared "to be good," while her remote memory appeared "to be fair-to-good" and her immediate memory appeared "to be fair at best." R. 421. Throckmorton's abstract thinking ability, judgment, and common-sense reasoning ability all "appear[ed] to be fair." Id. Her thought content and processes remained "logical, coherent, and organized" throughout the evaluation. R. 420. "However, [she] would sometimes be tangential with her responses," which required Dr. Cousins "to redirect her to the question asked." R. 416. Throckmorton's eye-contact was "broken" and she exhibited "[s]ome psychomotor retardation" during the evaluation. Id.
Dr. Cousins diagnosed Throckmorton with major depressive disorder, recurrent, moderate-to-severe without psychotic features and panic disorder without agoraphobia. R. 422. He opined that, "[b]ased on her performance on the mental status evaluation," Throckmorton appeared capable of performing "simple and repetitive tasks," but "would not be able to perform detailed and complex tasks." Id. Dr. Cousins did not see anything in Throckmorton's intellectual functioning to suggest she would need special instructions or additional supervision on the job. Id. "Due to her depression and anxiety symptoms," however, she "would likely have difficulty maintaining regular attendance in the workplace, performing work activities on a consistent basis, and completing a normal work day or work week without interruption." Id. Dr. Cousins opined that Throckmorton "appear[ed] capable of accepting instructions from a supervisor," but that her panic attacks would likely cause "difficulty" when interacting with coworkers and the public. R. 423. He also said she "would have difficulty coping with the typical stresses encountered in competitive work." Id.
On August 29, 2013, Andrew Bockner, M.D., reviewed Throckmorton's records submitted to the state agency through that date. R. 117-32. He opined that her diagnosed panic disorder without agoraphobia and major depressive disorder were "severe" medically determinable impairments that caused "moderate" difficulties in social functioning, "moderate" difficulties maintaining concentration, persistence, or pace, and "mild" limitations in activities of daily living.
But Dr. Bockner also opined that Throckmorton was "moderately limited" in many other work-related areas, including her ability to: "maintain attention and concentration for extended periods"; "work in coordination with or in proximity to others without being distracted by them"; "interact appropriately with the general public"; "get along with coworkers or peers without distracting them or exhibiting behavioral extremes"; "respond appropriately to changes in the work setting"; and "complete a normal workday and workweek without interruptions from psychologically based symptoms and to perform at a consistent pace without an unreasonable number and length of rest periods." R. 111-13, 129-30. Like Dr. Cousins, Dr. Bockner attributed these limitations to Throckmorton's performance on her mental status evaluation, as well as to her history of depression, anxiety, and reported panic attacks. R. 111-13, 128-30; see also R. 109-10, 113, 126, 130 (Dr. Bockner noting that the specific limitations Dr. Cousins identified were "generally consistent w[ith] the other evidence" and were not "more restrictive" than Dr. Bockner's own findings). Ultimately, Dr. Bockner concluded that Throckmorton could "perform competitive work doing simple repetitive tasks" as long as she had at most "limited contact with the general public." R. 113, 130; see also R. 112-13, 129-30 (Dr. Bockner stating that Throckmorton "can do SRW that is not in a public venue" and "cannot work in public"). He did not explicitly indicate whether Throckmorton's "moderately limited" abilities "to maintain attention and concentration for extended periods" and "to perform at a consistent pace without an unreasonable number and length of rest periods" would nonetheless allow her to perform "simple repetitive tasks" on a sustained basis. See R. 112-13, 129-30.
Throckmorton filled out an Adult Function Report in October 2012, and again in May 2013. R. 268-75, 310-17. She reported that she could dress herself, microwave frozen meals, and feed her dog, but that chronic physical pain, emphysema, anxiety, and depression prevented her from performing most other activities of daily living. See R. 269-75, 310-16. She usually did two loads of laundry per month and could do "a little" cleaning around her mobile home on the days her friends did not stop by to help. See R. 269-71. Throckmorton left her house only when necessary to go to doctors' appointments and the grocery store and pharmacy, usually two or three times per month. See R. 271-72, 313, 314. She used to enjoy reading books, but now struggled to stay focused and remember what she read. R. 272. In October 2012, Throckmorton estimated that she could concentrate on "someone talking or [the] TV" for fifteen minutes and said that she could follow written instructions only if she read them "many times." R. 273. By May 2013, Throckmorton estimated that she could pay attention for five minutes before her "mind is wandering" and she could follow directions only "if explained a few times" because she was "very forgetful." R. 315. Throckmorton also wrote notes to remind herself to shower regularly and to take her medications every day. R. 270, 312.
At the administrative hearing in February 2015, Throckmorton testified that she felt depressed all the time and that her doctor recently told her to stop taking Xanax for her anxiety attacks because the drug should not be combined with one of her pain medications. R. 47, 48; see R. 460. She spent most of her time watching television and still struggled to concentrate or pay attention for extended periods. R. 51. Throckmorton did not do any laundry or yard work, and her father would come to her house "two [or] three dozen times a day" to "do whatever needed to be done." R. 51-52.
ALJ Kilbane discussed Throckmorton's mental impairments throughout his written decision. At step two, he found that Throckmorton's major depressive disorder and panic disorder without agoraphobia were "severe" medically determinable impairments because they caused "more than minimal limitations" in her ability to perform basic mental work activities. R. 13; see 20 C.F.R. §§ 404.1521(b), 416.921(b) (2014). At step three, ALJ Kilbane found that Throckmorton had "mild" limitations performing daily activities, "moderate difficulties" with social functioning, and "moderate difficulties" maintaining concentration, persistence, or pace. R. 15. He explained his finding as to Throckmorton's difficulties maintaining concentration, persistence, or pace by noting that her own statements to the agency
R. 15 (citing R. 268-75, 310-17). Elsewhere in his decision, the ALJ explained that Throckmorton's statements describing her psychological symptoms were "not entirely credible," R. 17, because she had "not sought outpatient mental health treatment and ha[d] no history of psychiatric hospitalizations"; her primary-care provider prescribed medication for anxiety and depression; her anxiety and depressive disorder were noted to be "controlled" on several occasions throughout the relevant period; she "never sought emergency room or urgent care treatment for exacerbation of symptoms"; her mental-status "examination findings were mostly normal and she never appeared in distress"; and, although her "activities of daily living may be slightly limited," they were "not indicative of [a] disabling mental health impairment," see R. 21.
ALJ Kilbane also summarized the medical-source evidence of Throckmorton's mental impairments and related functional limitations in assessing her RFC. See R. 19-21, 24-25. His written decision included a fairly thorough and mostly accurate discussion of Dr. Thomas's clinic notes, Dr. Cousins's opinions and report from the consultative evaluation, and Dr. Bockner's subsequent opinions and mental RFC assessment. See R. 19-21, 24-25. For example, the ALJ's discussion of Dr. Thomas's progress notes tended to highlight the visits where Throckmorton's chronic anxiety and/or depressive disorder were noted to be "controlled" on her current medications, see R. 20-21 (citing R. 395, 437, 479, 501), without explicitly acknowledging there were many times throughout the relevant period when providers considered those conditions "not controlled" by medications, see, e.g., R. 380, 407, 432, 447, 450, 454, 482, 495. Similarly, the ALJ limited his discussion of Throckmorton's performance on the August 2013 mental-status exam to Dr. Cousins's findings that "she was alert and oriented, and had fair immediate memory," R. 20, without acknowledging Dr. Cousins's abnormal findings, such as that Throckmorton exhibited "[s]ome psychomotor retardation" and gave "tangential" responses, which required Dr. Cousins "to redirect her to the question asked," R. 420.
ALJ Kilbane explained that Dr. Cousins had opined that Throckmorton "appeared capable of performing simple and repetitive tasks without special instructions or additional supervision," but that "she would likely have difficulty" maintaining regular attendance in the workplace, performing activities on a consistent basis, completing a normal workday or workweek without interruption, coping with the typical stresses encountered in competitive work, and interacting with coworkers and the public. R. 25. He gave Dr. Cousins's opinion "little weight" because it seemed to be an "overestimate of [Throckmorton's] limitations, based only on a snapshot of her functioning." Id. The ALJ also found that Dr. Cousins's opinion was "inconsistent with" Throckmorton's "conservative treatment history" and her reported daily activities. Id.
ALJ Kilbane noted that Dr. Luck, the state-agency psychologist who initially reviewed Throckmorton's records available in November 2012, opined that her anxiety and depression were non-severe impairments because they caused "only mild" restrictions in her activities of daily living, social functioning, and ability to maintain concentration, persistence, or pace. R. 24; see R. 78-87, 88-97 (Exs. B2A, B3A). He also explained that in August 2013, Dr. Bockner opined that Throckmorton's severe "mental health impairments (major depressive disorder and panic disorder without agoraphobia) caused mild restriction" in her activities of daily living, "moderate difficulties" in social functioning, and "moderate difficulties in maintaining concentration, persistence, or pace," but that she was "capable of performing competitive work doing simple, repetitive tasks with limited contact with the general public." R. 24; see R. 100-16, 117-32 (Exs. B6A, B7A). ALJ Kilbane did not mention Dr. Bockner's more detailed opinions that Throckmorton was "moderately limited" in her ability to perform or sustain specific mental activities—including those related to concentration, persistence, and pace—in a competitive workplace. R. 24; see R. 112-13, 129-30.
ALJ Kilbane then assigned a collective weight to all of the state-agency reviewers' medical opinions: "The opinions of the State Agency assessments are given partial weight, particularly the assessment at Exhibits B6A and B7A in their finding of severe mental impairment." R. 25. He explained that "[t]heir opinions [were] generally consistent with [Throckmorton's] history of conservative treatment and limited clinical findings during the period at issue" and were further "consistent with" her reported daily activities from the same time. Id. (citing R. 268-75). ALJ Kilbane also noted that his RFC determination included environmental restrictions to accommodate Throckmorton's severe respiratory impairments, R. 24, which were not identified in any of the state-agency reviewers' opinions. Ultimately, ALJ Kilbane found that, "[d]espite her mental impairments," Throckmorton retained "the ability to perform simple, unskilled work on a sustained basis in a competitive work environment with no more than occasional interaction with coworkers in the [sic] general public." R. 16.
Throckmorton's objection to the ALJ's findings as to concentration, persistence, or pace invokes the Fourth Circuit's decision in Mascio, which, among other things, clarified the ALJ's duty to explain how a finding at step three that a claimant's "moderate limitation in concentration, persistence, or pace" either does or "does not translate into a limitation in [the claimant's] residual functional capacity." 780 F.3d at 638. In that case, the ALJ found that Mascio had "moderate" limitations maintaining concentration, persistence, or pace, but his subsequent RFC determination merely limited her to "unskilled work." Id. And, although the ALJ's hypothetical question to the VE "said nothing about Mascio's mental limitations," he ultimately relied on the VE's testimony identifying certain "unskilled, light work jobs" in concluding at step five that Mascio was not disabled. Id. at 637-38 ("The ALJ's hypothetical, together with the [VE's] unsolicited addition of `unskilled work,' matched the ALJ's finding regarding Mascio's residual functional capacity."). The Fourth Circuit reversed the Commissioner's decision and remanded the case for the ALJ to explain why Mascio's "moderate" limitations maintaining concentration, persistence, or pace did not translate into a limitation in her RFC—i.e., her maximum remaining ability to sustain work-related activities on a regular and continuing basis. See id. In doing so, the panel explained "that an ALJ does not account `for a claimant's limitations in concentration, persistence, and pace by restricting the [RFC and] hypothetical question to simple, routine tasks or unskilled work,'" because "the ability to perform simple tasks differs from the ability to stay on task."
Much like in Mascio, the ALJ in this case found at step three that Throckmorton had "moderate difficulties" maintaining concentration, persistence, or pace, but in assessing her RFC, he found that she retained "the ability to perform simple, unskilled work on a sustained basis in a competitive work environment with no more than occasional interaction with coworkers in the [sic] general public." R. 15, 16. He then relied on the VE's response to a hypothetical question propounding the same RFC in concluding at step five that Throckmorton was not disabled because she could perform certain "unskilled" light occupations. R. 26; see R. 54. But ALJ Kilbane never explained why he concluded that Throckmorton could perform "simple, unskilled work on a sustained basis in a competitive work environment," R. 16, even though she had "moderate difficulties" maintaining concentration, persistence or pace, R. 15. As in Mascio, that omission warrants reversal and remand for further explanation. 780 F.3d at 637-38.
The Commissioner responds that the ALJ's mental RFC determination is supported by substantial evidence because, although both Dr. Cousins and Dr. Bockner said Throckmorton "had difficulty staying on task" and had "moderate limitation[s] in [her] ability to complete a normal workday and workweek without interruptions from psychologically based symptoms and to perform at a consistent pace without an unreasonable number and length of rest periods," the ALJ correctly noted that "Dr. Bockner ultimately opined that [Throckmorton] could perform simple, repetitive tasks with limited contact with the general public." Def.'s Br. 6. She also notes that the ALJ explained he gave Dr. Cousins's opinion little weight because he found it to be inconsistent with Throckmorton's "conservative treatment history" and reported daily activities. See id. at 6-7. As the Fourth Circuit has stated, there will be cases where a restriction to "simple, unskilled work" reasonably accommodates a claimant's "moderate" difficulties or limitations maintaining concentration, persistence, or pace—especially where there is credible medical evidence that the claimant can "show sustained attention to perform simple repetitive tasks" or is "mentally capable of independently performing basic, routine tasks on a sustained basis." Sizemore v. Berryhill, ___ F.3d ___, 2017 WL 6374237, at *6 (4th Cir. Dec. 1, 2017) (rejecting a Mascio-type challenge where the ALJ cited such evidence in "finding that, despite Sizemore's overall moderate difficulties with concentration, persistence, or pace, he would nonetheless be able to stay on task while performing `simple one, two-step tasks,' as long as he was `working in low stress non-production jobs with no public contact'"). But in such a circumstance, the ALJ must explain, citing relevant evidence from the record, how limiting the claimant to simple, unskilled work adequately accounts for her actual mental impairments. See Mascio, 780 F.3d at 637-38; cf. Claiborne v. Comm'r, No. SAG-14-1918, 2015 WL 2062184, at *4 (D. Md. May 1, 2015) (stating that the ALJ's findings at step three should represent a well-reasoned consideration of the evidence and "are not simply an opportunity to give the claimant the benefit of the doubt at one step while taking it away at the next step"). Here, ALJ Kilbane concluded that Throckmorton could do "simple, unskilled work on a sustained basis in a competitive work environment," R. 16 (emphasis added), but he did not cite or otherwise describe the evidence that he believed supported this particular conclusion, Mascio, 780 F.3d at 636-37. Cf. Monroe, 826 F.3d at 189 (explaining that it is not enough for the ALJ to "cite[] evidence that he appeared to believe tended to discredit" the claimant's testimony if he still "failed to `build an accurate and logical bridge from the evidence to his conclusion' that [her] testimony was not credible" (quoting Clifford, 227 F.3d at 872)).
ALJ Kilbane compounded this error when weighing Dr. Cousins's and Dr. Bockner's medical opinions. See Pl.'s Br. 5-7 & n. 2. An ALJ must explain the weight given to all medical opinions, Radford, 734 F.3d at 295-96, and his "decision `must be sufficiently specific to make clear to any subsequent reviewers the weight [he] gave' to the opinion and `the reasons for that weight,'" Harder v. Comm'r of Soc. Sec., No. 6:12cv69, 2014 WL 534020, at *4 (W.D. Va. Feb. 10, 2014) (quoting SSR 96-2p, 1996 WL 374188, at *5 (July 2, 1996)). ALJ Kilbane's written decision does not meet this minimum standard, and there are two reasons why that deficiency requires reversal and warrants remand for further explanation.
First, Dr. Bockner's ultimate opinion, see Def.'s Br. 6, that Throckmorton "would be able to perform competitive work doing simple repetitive tasks with limited contact with the general public," R. 113, 130, is generally consistent with Dr. Cousins's opinion that Throckmorton "appears capable of performing simple and repetitive tasks," but "would likely have difficulty interacting with co-workers and the public," R. 423. See also R. 113, 130 (Dr. Bockner noting that Dr. Cousins's opinions were not "more restrictive" than his own findings). Both doctors said their opinions were based on Dr. Cousins's findings and observations during Throckmorton's August 2013 consultative psychological examination. See R. 126, 128-30, 422. The ALJ gave "little weight" to Dr. Cousins's opinion because it seemed "to be an overestimate of the severity of [Throckmorton's] limitations, based only on a snapshot of her functioning," and was "inconsistent with" her "conservative treatment history" and reported daily activities. R. 25. Yet, the ALJ also appeared to credit Dr. Bockner's opinion identifying the same limitations because he found that opinion to be "consistent with" Throckmorton's daily activities, conservative treatment, and the "limited clinical findings during the period at issue." R. 24; see R. 16, 25. He did not explain or otherwise attempt to clarify this discrepancy.
Second, ALJ Kilbane did not mention Dr. Bockner's specific opinions that Throckmorton was "moderately limited" in her abilities "to maintain attention and concentration for extended periods" and "to perform at a consistent pace without an unreasonable number and length of rest periods."
For the foregoing reasons, I respectfully recommend that the presiding District Judge
Failure to file timely written objections to these proposed findings and recommendations within 14 days could waive appellate review. At the conclusion of the 14 day period, the Clerk is directed to transmit the record in this matter to the Honorable Jackson L. Kiser, Senior United States District Judge.
The Clerk shall send certified copies of this Report and Recommendation to all counsel of record.
