Opinion ID: 2979448
Heading Depth: 2
Heading Rank: 1

Heading: Deference Owed Treating Physician

Text: First, plaintiff contends the Commissioner’s decision is flawed because the ALJ improperly discounted the opinion of her treating physician. In June 2006, plaintiff was seen by Gary Spencer, M.D., a family physician who had treated her before her accident, for a check-up and consultation. On physical examination, Dr. Spencer noted tenderness in the lower lumbar and left knee areas, and pain down both legs secondary to plaintiff’s back surgeries. In Dr. Spencer’s opinion, plaintiff could not stand for more than one or two hours and could not work a full eight-hour shift due to back and leg pain. Plaintiff contends that under the Commissioner’s own regulations, particularly 20 C.F.R. § 404.1527, the opinion of Dr. Spencer, as a treating physician, is entitled either to controlling weight or at least great deference. See Rogers v. Comm’r of Soc. Sec., 486 F.3d 234, 242-43 (6th Cir. 2007) (treating physician’s opinion is controlling if well-supported by medical evidence and not inconsistent with other substantial evidence; otherwise, the opinion is presumptively entitled to great deference, the weight to be determined by the ALJ based on consideration of numerous factors); cf. -3- No. 09-5773 Sims v. Comm’r of Soc. Sec. Bass, 499 F.3d at 511 (ALJ is not bound by physician’s conclusory opinion that claimant is unable to work). If a treating physician’s opinion is not accorded controlling weight, the ALJ is required to explain how the opinion was weighed and why. 20 C.F.R. § 404.1527(d); Bass, 499 F.3d at 511. Plaintiff contends the ALJ did not give Dr. Spencer’s opinion substantial deference and violated the applicable regulation by failing to adequately explain why. We disagree. Like the district court, we hold that the ALJ committed no error in her evaluation of Dr. Spencer’s opinion. The ALJ was fully cognizant of and explicitly observed her duty to give careful consideration to Dr. Spencer’s opinion. She explained her refusal to grant Dr. Spencer’s opinion controlling weight as follows: Dr. Spencer’s opinion is not supported by objective medical findings or findings on examination, but rather based on what the claimant has subjectively told him, which is not fully credited. Objective testing (MRI’s, x-rays, EMG/NCS) are either mild, normal or negative. At the time he offered this opinion, Dr. Spencer had not treated the claimant since well before her injury (about 18 months prior). Her treating specialists did not impose such limitations, and they are in a better position to evaluate her limitations/residuals. Dr. Spencer has since treated the claimant on a routine basis, [prescribing] medication refills every three to four months, but there is no change in her condition which would warrant the limitations he assessed. Moreover, the claimant did return to work in December 2005, but could not tolerate the prolonged standing/walking, bending and lifting associated with that job. She has consistently stated that prolonged standing and walking exacerbates her pain. She testified she is able to do light chores around the house, as long as she can sit and take the weight off her back/buttocks. Accordingly, Dr. Spencer’s opinion is not persuasive and cannot be afforded “controlling weight.” A.R. 20, ALJ Decision p. 9. The ALJ thus considered several appropriate factors in evaluating Dr. Spencer’s opinion, including: (1) the frequency of examination and length of his treatment relationship with plaintiff; (2) the nature and extent of their relationship; (3) the lack of medical evidence supporting his opinion; (4) the inconsistency of his opinion with objective testing results; -4- No. 09-5773 Sims v. Comm’r of Soc. Sec. and (5) the fact that Dr. Spencer is not a specialist. See 20 C.F.R. § 404.1527(d); Bass, 499 F.3d at 511-12. The ALJ correctly noted that Dr. Spencer’s conclusory opinion about plaintiff’s ability to work was based largely on plaintiff’s subjective complaints and was not supported by other medical evidence in the record. See 20 C.F.R. § 404.1527(b) (medical opinions are to be evaluated in the context of the record as a whole).1 In September 2005, plaintiff’s medical records were reviewed by John Gedmark, M.D., who completed a physical residual functional capacity assessment. The ALJ noted that Dr. Gedmark identified exertional limitations resulting from plaintiff’s physical impairments that would limit her to light work, as of December 2005. This opinion was consistent with that of rehabilitation specialist Barton W. Huddleston, M.D., who, in October 2005, after testing for and finding no neuropathic abnormalities in plaintiff’s lower back and left leg, believed that she was showing improvement and would be able to return to part-time work after five to six weeks of continued conditioning, with eventual return to full-time work within six to eight weeks of her initial return to work. In addition, Dr. Spencer’s opinion was arguably at odds with the mental residual capacity assessment completed by Alex Guerrero, M.D., in November 2005. While Dr. Guerrero recognized that plaintiff suffered from anxiety and pain disorder, the only functional limitations he identified 1 Moreover, Dr. Spencer’s implied opinion that plaintiff was unable to work is tantamount to a disability opinion, a matter reserved to the Commissioner for determination. Such an opinion by a treating physician is not entitled to “any special significance.” 20 C.F.R. § 404.1527(e). See also Warner v. Comm’r of Soc. Sec., 375 F.3d 387, 390 (6th Cir. 2004) (recognizing the determination of disability to be the prerogative of the Commissioner, not the treating physician). -5- No. 09-5773 Sims v. Comm’r of Soc. Sec. were non-disabling: “mild” limitation in activities of daily living; and “moderate” limitation in social functioning and in maintaining concentration, persistence and pace. Dr. Guerrero noted that these impairments limited plaintiff’s ability to work, but she retained the ability: (1) to understand, remember, and carry out simple instructions and chores; (2) to relate adequately with co-workers and supervisors for task completion; and (3) to adapt to the changes in non-complex and “not too stressful” work situations. We are thus satisfied that the ALJ gave adequate deference to Dr. Spencer’s opinion by finding that plaintiff had impairments that precluded her past work and significantly limited the types of other jobs that she could perform. See Bass, 499 F.3d at 512; Warner, 375 F.3d at 391-92. To the extent the ALJ discounted Dr. Spencer’s implied opinion that plaintiff was unable to perform any work, however, we concur in the district court’s determination that the ALJ’s analysis is sound and supported by substantial evidence.