Opinion ID: 3004583
Heading Depth: 3
Heading Rank: 2

Heading: Dr. Kachmann’s Opinion

Text: Minnick also argues that the ALJ improperly discounted the opinion of treating physician Dr. Kachmann in assessing the RFC. Dr. Kachmann treated Minnick twice. The first time, he opined that Minnick should exercise, read up on his condition, and be weaned off narcotic medication. He also diagnosed centralized cerebral pain and fibromyalgia. The second time two months later, he opined that Minnick could not do any bending or twisting, was unable to be reeducated 16 No. 13-3626 for work, and was “clearly disabled.” Dr. Kachmann then diagnosed severe fibromyalgia and migraines. The ALJ found the opinions inconsistent. The ALJ also found that Dr. Kachmann’s opinions regarding hiring practices were outside the scope of his expertise and that his opinions regarding Minnick’s ability to bend and twist were unsupported by the record. For these reasons, the ALJ gave Dr. Kachmann’s opinion only limited weight. Under 20 C.F.R. § 404.1527(c)(1), an ALJ should “give more weight to the opinion of a source who has examined [the claimant] than to the opinion of a source who has not examined [the claimant]” because of his greater familiarity with the claimant’s conditions and circumstances. Section 404.1527(c)(2) further provides “[i]f [the ALJ] find[s] that a treating source’s opinion on the issue(s) of the nature and severity of [the claimant’s] impairment(s) is well-supported by medically acceptable clinical and laboratory diagnostic techniques and is not inconsistent with the other substantial evidence in [the claimant’s] case record, [the ALJ] will give it controlling weight.” 20 C.F.R. § 404.1527(c)(2). In discounting Dr. Kachmann’s opinion that Minnick could not bend or twist, the ALJ stated the limitation to occasional stooping in the RFC was better supported by the record as a whole. The ALJ failed to explain why Dr. Kachmann’s opinion that Minnick could not bend or twist was not supported by the record, particular as to twisting. This was error. See Roddy, 705 F.3d at 636–37 (finding ALJ should have, but did not, explain why treating physician’s opinion about severity of claimant’s pain was inconsistent with record evidence indicating pain); see also Murphy v. Astrue, 496 F.3d 630, 634 (7th Cir. 2007) (finding No. 13-3626 17 ALJ erred in failing to explain disregard of pertinent record evidence). First, it is unclear from the ALJ’s opinion how the ability to occasionally stoop would mean Minnick could also twist. Second, the record contains a number of other doctors’ opinions suggestive of Minnick’s inability to bend or twist. For example, Dr. Karl and Dr. Onamusi, both treating physicians, noted Minnick had a diminished range of motion in the lumbar spine. Further, the only doctor to recommend stooping was Dr. Sands, a non-treating physician. His recommendation was a check-box style review of Minnick’s records, meaning Dr. Sands was not obligated to, and indeed did not, provide any reasons for his conclusion. The ALJ also discounted Dr. Kachmann’s opinion due to internal inconsistencies. Internal inconsistencies may provide good cause to deny controlling weight to a treating physician’s opinion, but the reasoning for the denial must be adequately articulated. Roddy, 705 F.3d at 636–37. Though the ALJ found inconsistencies in Dr. Kachmann’s reports, we do not see any conflict between his two opinions. It is not unreasonable to believe that Dr. Kachmann felt exercise could be helpful to Minnick, but later found that he is unable to bend or twist. For example, Minnick’s decreased usage of narcotics is noted in the record between his August and October visits with Dr. Kachmann; the reduced painkiller use could indicate that Minnick was in more pain in the October meeting than in the August one, diminishing his ability to tolerate certain movements. The ALJ also took issue with Dr. Kachmann’s recommendation that Minnick read a few books on his condition compared to his later statement that Minnick could not be reeducated for work. An inability to be reeducated for work is 18 No. 13-3626 not necessarily incompatible with the ability to educate oneself on one’s own condition. The ALJ has a duty to fully develop the record before drawing any conclusions and must adequately articulate her analysis so that we can follow her reasoning. Murphy, 496 F.3d at 634. Without explaining how or why Dr. Kachmann’s bending and twisting opinion was not supported by the record, we are unable to properly review the ALJ’s opinion determination. Similarly, the ALJ did not adequately articulate why Dr. Kachmann’s statements were internally inconsistent. In light of these errors, the ALJ must reevaluate whether Dr. Kachmann’s findings are entitled to controlling weight.