United States District Court, D. Kansas
MEMORANDUM AND ORDER
JOHN W. LUNGSTRUM, District Judge.
Plaintiff seeks review of a decision of the Commissioner of Social Security (hereinafter Commissioner) denying Social Security Disability (SSD) benefits and Supplemental Security Income (SSI) benefits under sections 216(i), 223, 1602, and 1614(a)(3)(A) of the Social Security Act. 42 U.S.C. §§ 416(i), 423, 1381a, and 1382c(a)(3)(A) (hereinafter the Act). Finding error in the Commissioner's evaluation of the medical opinions, the court ORDERS that the decision shall be REVERSED and that judgment shall be entered pursuant to the fourth sentence of 42 U.S.C. § 405(g) REMANDING the case for further proceedings consistent with this opinion.
Plaintiff applied for SSD and SSI, alleging disability beginning April 10, 2010. (R. 24, 164-65, 171-74). Plaintiff exhausted proceedings before the Commissioner, and now seeks judicial review of the final decision denying benefits. He alleges the Administrative Law Judge (ALJ) erred in evaluating the record medical opinions, and erroneously concluded at step four of the sequential evaluation process that Plaintiff is able to perform his past relevant work as a pipe cutter.
The court's review is guided by the Act. Wall v. Astrue, 561 F.3d 1048, 1052 (10th Cir. 2009). Section 405(g) of the Act provides that in judicial review "[t]he findings of the Commissioner as to any fact, if supported by substantial evidence, shall be conclusive." 42 U.S.C. § 405(g). The court must determine whether the ALJ's factual findings are supported by substantial evidence in the record and whether he applied the correct legal standard. Lax v. Astrue, 489 F.3d 1080, 1084 (10th Cir. 2007); accord, White v. Barnhart, 287 F.3d 903, 905 (10th Cir. 2001). Substantial evidence is more than a scintilla, but it is less than a preponderance; it 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); see also, Wall, 561 F.3d at 1052; Gossett v. Bowen, 862 F.2d 802, 804 (10th Cir. 1988).
The court may "neither reweigh the evidence nor substitute [its] judgment for that of the agency." Bowman v. Astrue, 511 F.3d 1270, 1272 (10th Cir. 2008) (quoting Casias v. Sec'y of Health & Human Servs., 933 F.2d 799, 800 (10th Cir. 1991)); accord, Hackett v. Barnhart, 395 F.3d 1168, 1172 (10th Cir. 2005). Nonetheless, the determination whether substantial evidence supports the Commissioner's decision is not simply a quantitative exercise, for evidence is not substantial if it is overwhelmed by other evidence or if it constitutes mere conclusion. Gossett, 862 F.2d at 804-05; Ray v. Bowen, 865 F.2d 222, 224 (10th Cir. 1989).
The Commissioner uses the familiar five-step sequential process to evaluate a claim for disability. 20 C.F.R. §§ 404.1520, 416.920; Wilson v. Astrue, 602 F.3d 1136, 1139 (10th Cir. 2010) (citing Williams v. Bowen, 844 F.2d 748, 750 (10th Cir. 1988)). "If a determination can be made at any of the steps that a claimant is or is not disabled, evaluation under a subsequent step is not necessary." Wilson, 602 F.3d at 1139 (quoting Lax, 489 F.3d at 1084). In the first three steps, the Commissioner determines whether claimant has engaged in substantial gainful activity since the alleged onset, whether he has a severe impairment(s), and whether the severity of his impairment(s) meets or equals the severity of any impairment in the Listing of Impairments (20 C.F.R., Pt. 404, Subpt. P, App. 1). Williams, 844 F.2d at 750-51. After evaluating step three, the Commissioner assesses claimant's residual functional capacity (RFC). 20 C.F.R. §§ 404.1520(e), 416.920(e). This assessment is used at both step four and step five of the process. Id.
The Commissioner next evaluates steps four and five of the sequential process- determining at step four whether, in light of the RFC assessed, claimant can perform his past relevant work; and at step five whether, when also considering the vocational factors of age, education, and work experience, claimant is able to perform other work in the economy. Wilson, 602 F.3d at 1139 (quoting Lax, 489 F.3d at 1084). In steps one through four the burden is on Plaintiff to prove a disability that prevents performance of past relevant work. Blea v. Barnhart, 466 F.3d 903, 907 (10th Cir. 2006); accord, Dikeman v. Halter, 245 F.3d 1182, 1184 (10th Cir. 2001); Williams, 844 F.2d at 751 n.2. At step five, the burden shifts to the Commissioner to show jobs in the economy within the RFC assessed. Id .; Haddock v. Apfel, 196 F.3d 1084, 1088 (10th Cir. 1999).
The court finds that remand is necessary because the ALJ erred in evaluating the medical opinions. Because a proper evaluation of the medical opinions will require a new RFC assessment, potentially affecting the ALJ's step four finding, it would be premature at this time to evaluate the alleged errors at step four of the sequential evaluation process. Plaintiff may address this issue to the Commissioner on remand.
II. Evaluation of the Medical Opinions
Plaintiff claims the ALJ erred in according "substantial weight" to the opinions of the state agency non-examining source physicians and psychologist, Dr. Siemsen, Dr. Blum, and Dr. Reed, because the opinions of such medical sources are entitled to the least weight, and when unaccompanied by thorough written reports or persuasive testimony they are not substantial evidence. He argues that because these medical opinions were provided without the benefit of consideration of over a year's worth of treatment records and of the opinions of Plaintiff's treating psychiatrist, Dr. Patriarca, these opinions are suspect. And, he argues that the ALJ's finding that these opinions were consistent with the medical evidence or the longitudinal record is an insufficient basis to accord greater weight to them than to the opinions of treating and non-treating sources. Plaintiff argues that the ALJ erred in discounting Dr. Patriarca's opinion because it was based on a one-time visit, and because Dr. Patriarca apparently relied heavily and without question on Plaintiff's subjective report of symptoms. He argues that the ALJ did not provide legitimate reasons to discount the opinion. Finally, Plaintiff argues that the reasons given to discount the examination report of Dr. Schwartz are erroneous and insufficient.
The Commissioner argues that the ALJ gave good reasons for the weight accorded to the medical opinions. She argues that it is not error to consider opinion forms provided by state agency physicians and psychologists, because the regulations require that they are entitled to consideration, and Plaintiff's argument focuses excessively on the single factor of a treating or examining relationship. She notes Social Security Ruling (SSR) 96-6p's admonition that the opinions of state agency physicians and psychologists may be entitled to greater weight than opinions of treating or non-treating sources "[i]n appropriate circumstances." (Comm'r Br. 8-9) (quoting SSR 96-6p). She argues that the ALJ did not rely on the state agency opinions exclusively to support his RFC assessment, and points to record evidence which, in her view, is consistent with those opinions. The Commissioner also argues that the ALJ gave good reasons for discounting the opinions of Dr. Schwartz and Dr. Patriarca, noting that the ALJ agreed with Dr. Blum regarding Dr. Schwartz's opinion, and arguing that Dr. Patriarca's marked limitations in mental abilities is at odds with the other record evidence.
A. Standard for Evaluating Medical Opinions
"Medical opinions are statements from physicians and psychologists or other acceptable medical sources that reflect judgments about the nature and severity of [a claimant's] impairment(s) including [claimant's] symptoms, diagnosis and prognosis." 20 C.F.R. §§ 404.1527(a)(2), 416.927(a)(2). Such opinions may not be ignored and, unless a treating source opinion is given controlling weight, all medical opinions will be evaluated by the Commissioner in accordance with factors contained in the regulations. Id . §§ 404.1527(c), 416.927(c); SSR 96-5p, West's Soc. Sec. Reporting Serv., Rulings 123-24 (Supp. 2014). A physician or psychologist who has treated a patient frequently over an extended period of time is expected to have greater insight into the patient's medical condition, and his opinion is generally entitled to "particular weight." Doyal v. Barnhart, 331 F.3d 758, 762 (10th Cir. 2003). But, "the opinion of an examining physician [(a nontreating source)] who only saw the claimant once is not entitled to the sort of deferential treatment accorded to a treating physician's opinion." Id. at 763 (citing Reid v. Chater, 71 F.3d 372, 374 (10th Cir. 1995)). However, opinions of non-treating sources are generally given more weight than the opinions of non-examining sources who have merely ...