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 Disability Insurance benefits (DIB) 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 administrative law judge's (ALJ) evaluation of the medical opinions, the court ORDERS that the Commissioner's 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.
Plaintiff applied for DIB and SSI, alleging disability beginning December 18, 2000. (R. 12, 179-82). He exhausted proceedings before the Commissioner, and now seeks judicial review of the final decision denying benefits. Plaintiff alleges the ALJ erred in his residual functional capacity (RFC) assessment by improperly applying Dr. Hough's medical opinion and by erring in the relative weighing of Dr. Hough's and Dr. Blum's opinions.
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 RFC. 20 C.F.R. §§ 404.1520(e), 416.920(e). This assessment is used at both step four and step five of the sequential evaluation 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 that there are jobs in the economy which are 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 failed to adequately explain his evaluation of the medical opinions.
II. Evaluation of the Medical Opinions
Plaintiff points out that the ALJ accorded significant weight to Dr. Hough's non-treating source opinion-that it is unlikely Plaintiff would be able to relate adequately to supervisors because of his paranoia. (Pl. Br. 8) (citing R. 21). He notes that the ALJ assessed a limitation to no more than occasional contact with the public and with coworkers, but assessed no limitation relating to supervisors. Id . (citing R. 18). He argues that the limitation the ALJ assessed is contrary to Dr. Hough's opinion to which the ALJ accorded significant weight, and that this constitutes error because the ALJ explained neither how this ambiguity or material inconsistency was considered and resolved nor why Dr. Hough's opinion in this regard was not adopted. He also argues that the ALJ erred in according greater weight to Dr. Blum's non-examining source opinion because Dr. Hough's opinion was supported by Dr. Barnett's non-treating source opinion. (Pl. Br. 14).
The Commissioner argues that the ALJ reasonably considered the regulatory factors for weighing medical opinions "with respect to Dr. Hough, Dr. Barnett, and Dr. Blum, and found that on balance, Dr. Blum's opinion was entitled to the greatest weight." (Comm'r Br. 5) (citing R. 19-22). She points to record evidence supporting the ALJ's determination to accord significant weight to Dr. Blum's opinion, and argues that "the ALJ reasonably gave [Dr. Hough's] opinion less weight after weighing it against Dr. Hough's own findings and the other evidence of record." Id. at 7. The Commissioner acknowledges that "the ALJ also gave some aspects of Dr. Hough's opinion greater weight, i.e., with respect to Plaintiff being capable of remembering and understanding simple instructions, [with respect to] his limited ability to maintain appropriate social interactions, as well as [with respect to] some limitations regarding persistence and pace." Id. at 8. But, she argues that although the decision indicates that the ALJ meant to accord significant weight to Dr. Hough's opinion regarding simple instructions and limited social interaction, it also indicates that he did not mean to accord significant weight to Dr. Hough's limitation regarding supervisors. Id. at 9. She acknowledges Dr. Barnett's opinion providing a diagnosis of cognitive disorder and a full scale IQ score of 52, but argues that it was reasonable for the ALJ to defer to Dr. Blum's opinion "regarding Dr. Barnett's testing, particularly when Dr. Blum gave several sound reasons to support his conclusions (which the ALJ then noted in his decision)." (Comm'r Br. 10).
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 [the 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 in accordance with factors contained in the regulations. Id . §§ 404.1527(c), 416.927(c) (effective March 26, 2012); Soc. Sec. Ruling (SSR) 96-5p, West's Soc. Sec. Reporting Serv., Rulings 123-24 (Supp. 2014). Those factors are: (1) length of treatment relationship and frequency of examination; (2) the nature and extent of the treatment relationship, including the treatment provided and the kind of examination or testing performed; (3) the degree to ...