Opinion ID: 152890
Heading Depth: 3
Heading Rank: 1

Heading: Good Reason Requirement

Text: -7- No. 09-4071 Coldiron v. Comm’r of Soc. Sec. The ALJ must give “good reasons” for not according controlling weight to a treating physician’s opinion. Wilson v. Comm’r of Soc. Sec., 378 F.3d 541, 544 (6th Cir. 2004). “An ALJ must give the opinion of a treating source controlling weight if he finds the opinion ‘well-supported by medically acceptable clinical and laboratory diagnostic techniques’ and ‘not inconsistent with the other substantial evidence in [the] case record.’” Id. (quoting 20 C.F.R. § 404.1527(d)(2)). Evidence in the record must support the relative weight that the adjudicator accords to the treating source’s medical opinion and the reasons for that weight “must be sufficiently specific.” SSR 96-2p, 1996 WL 374188, at  (S.S.A. July 2, 1996). Dr. Murtaugh, a cardiologist, treated Coldiron several times over the course of a year and ultimately diagnosed him with right heart failure and sleep apnea. In the RFC he submitted to the ALJ, Dr. Murtaugh described Coldiron’s ability to sit as limited, found him capable of standing and walking ten minutes without interruption for a total of only twenty minutes in an entire eight-hour workday, and precluded him from lifting, carrying, climbing, balancing, stooping, crouching, kneeling, and crawling. Dr. Murtaugh clarified that Coldiron’s obesity—and no other medical impairment—accounted for these limitations. Although Coldiron persuasively argues that some of the ALJ’s proffered reasons for not according Dr. Murtuagh’s opinion controlling weight do not comply with the good reason requirement, the ALJ appropriately labeled Dr. Murtaugh’s RFC “too inconsistent and unclear to be helpful.” Specifically, he noted two of Dr. Murtaugh’s conclusions—that Coldiron could stand -8- No. 09-4071 Coldiron v. Comm’r of Soc. Sec. and walk ten minutes without interruption and that he could walk for a total of only twenty minutes in an entire eight-hour day—lacked internal consistency. The ALJ further explained that no time limitations accompanied Dr. Murtaugh’s restriction on Coldiron’s ability to sit. See Gaskin v. Comm’r of Soc. Sec., 280 F. App’x 472, 476 (6th Cir. 2008) (finding that an ALJ properly rebuffed the portion of an opinion that he characterized as vague). Thus, the ALJ’ s proffered reasons for not crediting Dr. Murtaugh’s opinion satisfy the good reason requirement. Moreover, even if the ALJ’s asserted reasons for rejecting Dr. Murtaugh’s RFC failed to adequately comply with the good reason requirement, we find such error harmless. In Wilson, we acknowledged the good reason requirement does not require conformity at all times. 378 F.3d at 547. Violation of the rule constitutes harmless error if the ALJ has met the goals of the procedural requirement—to ensure adequacy of review and to permit the claimant to understand the disposition of his case—even though he failed to comply with the regulation’s terms. Id. An ALJ may accomplish the goals of this procedural requirement by indirectly attacking the supportability of the treating physician’s opinion or its consistency with other evidence in the record. See Nelson v. Comm’r of Soc. Sec., 195 F. App’x 462, 470–72 (6th Cir. 2006); Hall v. Comm’r of Soc. Sec., 148 F. App’x 456, 464–65 (6th Cir. 2005). Notably, courts look to the ALJ’s decision itself, and not other evidence in the record, for this support. We find that the ALJ’s evaluation of the other physicians’ opinions of record and Coldiron’s credibility undermined both the supportability and the consistency of Dr. Murtaugh’s opinion. The -9- No. 09-4071 Coldiron v. Comm’r of Soc. Sec. ALJ stated that, although Dr. Murtaugh—a cardiologist—treated Coldiron for heart failure, the limitations in his RFC opinion “appear to be based primarily on obesity,” not his heart condition, and that “overall, the limitations that Dr. Murtaugh gives are too . . . unclear to be helpful.” By making this statement, the ALJ attacked the supportability of Dr. Murtaugh’s findings. Indeed, medical signs and laboratory findings do not substantiate Dr. Murtaugh’s conclusory opinions. See 20 C.F.R. § 404.1527(d)(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.”). A review of his medical records confirms that Dr. Murtaugh never tested the limitations his report attributed to Coldiron’s obesity; rather, objective medical evidence supports only Dr. Murtaugh’s findings related to Coldiron’s heart condition. See Buxton v. Halter, 246 F.3d 762, 773 (6th Cir. 2001) (“[T]he ALJ is not bound by conclusory statements of doctors, particularly where they are unsupported by detailed objective criteria and documentation.” (internal quotation marks and citation omitted)). The ALJ also indirectly attacked the consistency of Dr. Muraugh’s opinion with other record evidence. Dr. Murtaugh suggested that Coldiron could not lift or carry any weight at all; the ALJ, however, explained that both state agency physicians found that Coldiron lacked a “diminished capacity for lifting/carrying.” Although Dr. Murtaugh believed that Coldiron could stand and walk for only twenty minutes in an eight-hour workday, both state agency physicians reported that Coldiron could stand for six hours out of eight. Further, while Dr. Murtaugh found Coldiron’s ability to sit limited, both state agency physicians opined that Coldiron could sit for six hours of eight -10- No. 09-4071 Coldiron v. Comm’r of Soc. Sec. hours, and Dr. Evans opined that Coldiron could sit continuously for one hour at a time. Finally, while Dr. Murtaugh foreclosed climbing, balancing, stooping, crouching, kneeling, and crawling, the ALJ noted that Coldiron participated in physical therapy on a regular basis and that Coldiron reported that “the exercises helped and he had more mobility.” The ALJ also noted that Coldiron “had an outline for a home exercise program and planned to continue with the pool and treadmill at the YMCA.” The ALJ’s discussion of other record evidence shows that Dr. Murtaugh’s opinion lacks the support and consistency required to compel controlling weight. We thus conclude that the ALJ “met the goal of § 1527(d)(2)—the provision of the procedural safeguard of reasons” even if he did not “compl[y] with the terms of the regulation.” Wilson, 378 F.3d at 547. 2. Substantial Evidence Supports the ALJ’s Controlling Weight Decisions Coldiron also contends that, because each of his treating and examining physicians rendered RFCs that found him incapable of performing sedentary work, substantial evidence does not support the ALJ’s failure to accord those opinions controlling weight, as required by the treating physician rule. Coldiron’s argument misconstrues the rule. The treating physician rule states that, although “the opinions of treating physicians are given substantial, if not controlling, deference,” those opinions do not bind an ALJ. Warner, 375 F.3d at 390. Rather, an ALJ must give a treating physician’s opinion controlling weight only if the opinion -11- No. 09-4071 Coldiron v. Comm’r of Soc. Sec. relies on objective medical findings, Harris v. Heckler, 756 F.2d 431, 435 (6th Cir. 1985), and substantial evidence does not contradict it, Hardaway v. Sec’y of Health and Human Servs., 823 F.2d 922, 927 (6th Cir. 1987). If the ALJ finds the treating physician’s opinion fails to meet these two conditions, he may discredit that opinion, so long as he communicates a reasoned basis for doing so. Shelman v. Heckler, 821 F.2d 316, 321 (6th Cir. 1987). Coldiron’s argument misinterprets the treating physician rule in two ways. First, the rule does not instruct an ALJ to compare the consistency of treating and examining physicians’ opinions to each other. Instead, the rule instructs an ALJ to compare the consistency of a physician’s opinion to the record as a whole. 20 C.F.R. §§ 404.1527(d)(2); see also Hephner v. Matthews, 574 F.2d 359, 362 (6th Cir. 1978) (disability determination must be made on the basis of the record as a whole). When deciding if a physician’s opinion is consistent with the record, the ALJ may consider evidence such as the claimant’s credibility, whether or not the findings are supported by objective medical evidence, as well as the opinions of every other physician of record. See SSR 96-5p, 1996 WL 374183, at  (S.S.A. July 2, 1996); SSR 96-8p, 1996 WL 374184, at  (S.S.A. July 2, 1996); Hickey-Haynes v. Barnhart, 116 F. App’x 718, 726 (6th Cir. 2004) (An ALJ may “consider all of the medical and nonmedical evidence.” (quotation marks and citation omitted)). Coldiron asks us to focus entirely on the opinions of these physicians while ignoring the remainder of the record. Regulations and our precedent direct otherwise. -12- No. 09-4071 Coldiron v. Comm’r of Soc. Sec. Second, Coldiron’s argument that we give the shared opinions of Drs. Evans, Bailey, and Murtaugh controlling weight extends the treating physician rule to examining physicians as well. Generally, a treating physician’s opinion deserves controlling weight because “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). Dr. Evans, a specialist in occupational health, and Dr. Bailey, a consultative examiner for the Social Security Administration, each examined Coldiron only once. As the district court properly held, Drs. Evans and Bailey do not, for purposes of the regulation, constitute treating physicians. See 20 C.F.R. § 404.1502 (defining a treating source as a physician or other medical source who has had an ongoing relationship with the claimant); Walters v. Comm’r of Soc. Sec., 127 F.3d 525, 529–30 (6th Cir. 1997) (stating that “the opinions of treating physicians are accorded greater weight than those of physicians who examine claimants only once”). Thus, the treating physician rule did not oblige the ALJ to grant the opinions of Dr. Evans and Dr. Bailey controlling weight. Atterberry v. Sec’y of Health & Human Servs., 871 F.2d 567, 572 (6th Cir. 1989). As for treating physician Murtaugh’s opinion, internal inconsistencies, conflicts with other record evidence, and lack of objective medical data provide substantial evidentiary support for the ALJ’s decision not to accord it controlling weight. -13- No. 09-4071 Coldiron v. Comm’r of Soc. Sec. C. The ALJ’s ultimate RFC determination took obesity into account and finds substantial evidentiary support 1. Obesity Coldiron attacks the ALJ’s ultimate RFC determination, alleging that the ALJ did not comply with the procedure outlined in SSR 02-1p for discussing how obesity affects a claimant’s ability to work. We find this claim meritless. Social Security Ruling 02-1p explains the Administration’s policy on the evaluation of obesity. Although the Administration no longer qualifies obesity as a “listed impairment,” the ruling “remind[s] adjudicators to consider its effects when evaluating disability.” SSR 02-1p, 2000 WL 628049, at  (S.S.A.). SSR 02-1p states: An assessment should also be made of the effect obesity has upon the individual’s ability to perform routine movement and necessary physical activity within the work environment. Individuals with obesity may have problems with the ability to sustain a function over time . . . [O]ur RFC assessments must consider an individuals’ maximum remaining ability to do sustained work activities in an ordinary work setting ona [sic] regular and continuing basis. A “regular and continuing basis” means 8 hours a day, for 5 days a week, or an equivalent work schedule. Id. at . Contrary to Coldiron’s argument, the Sixth Circuit declared it “a mischaracterization to suggest that Social Security Ruling 02-1p offers any particular procedural mode of analysis for obese -14- No. 09-4071 Coldiron v. Comm’r of Soc. Sec. disability claimants.” Bledsoe v. Barnhart, 165 F. App’x 408, 412 (6th Cir. 2006). Instead, SSR 021p provides that “obesity, in combination with other impairments, ‘may’ increase the severity of the other limitations.” Id. at 412. The record here shows that the ALJ sufficiently accounted for the effect that obesity has on Coldiron’s ability to do sedentary work. The ALJ discussed obesity multiple times throughout his findings of fact, determining that Coldiron “appeared to be limited primarily by obesity and deconditioning,” and finding that, at 5'11 and 403 pounds, Coldiron qualified as morbidly obese. He also concluded that Coldiron’s obesity constituted a “severe impairment” and acknowledged that obesity contributed to Coldiron’s other medical conditions. He noted, for instance, that Coldiron’s weight exacerbated his mild restrictive lung defect, dyspnea, obstructive sleep apnea, and the musculoskeletal symptoms related to Coldiron’s knees and back. Further, when assigning Coldiron an RFC, the ALJ considered RFCs from physicians who explicitly accounted for Coldiron’s obesity. State agency physician Dr. Klyop noted Coldiron’s “extreme range of obesity” in opining that he could perform light work. State agency physician Dr. Norris noted that Coldiron’s morbid obesity exacerbated his other conditions. Dr. Bailey discussed Coldiron’s morbid obesity throughout her findings and Dr. Evans recorded Coldiron’s weight at 335 pounds. Dr. Zancan, who performed Coldiron’s shoulder surgery, also noted Coldiron’s obesity. Every medical opinion that the ALJ evaluated acknowledged Coldiron’s obesity. Thus, by utilizing the opinions of these physicians in fashioning Coldiron’s RFC, the ALJ incorporated the effect that -15- No. 09-4071 Coldiron v. Comm’r of Soc. Sec. obesity has on the claimant’s ability to work into the RFC he constructed. See Bledsoe, 165 F. App’x at 412 (noting that an ALJ does not need to make specific mention of obesity if he credits an expert’s report that considers obesity); Skarbek v. Barnhart, 390 F.3d 500, 504 (7th Cir. 2004) (stating “although the ALJ did not explicitly consider [claimant’s] obesity, it was factored indirectly into the ALJ’s decision as part of the doctors’ opinions.”). Given the ALJ’s discussion of Coldiron’s obesity throughout his findings of fact and the ALJ’s use of RFCs from physicians who explicitly considered Coldiron’s obesity, we find that the ALJ adequately accounted for the effect that obesity has on Coldiron’s ability to perform sedentary work.