Opinion ID: 715825
Heading Depth: 4
Heading Rank: 2

Heading: Opinions of Treating Physician and Specialist

Text: 52 Because treating physicians are employed to cure and thus have a greater opportunity to know and observe the patient as an individual, their opinions are given greater weight than the opinions of other physicians. Rodriguez v. Bowen, 876 F.2d 759, 761-62 (9th Cir.1989); Sprague v. Bowen, 812 F.2d 1226, 1230 (9th Cir.1987). Therefore, an ALJ may not reject treating physicians' opinions unless he makes findings setting forth specific, legitimate reasons for doing so that are based on substantial evidence in the record. Magallanes v. Bowen, 881 F.2d 747, 751 (9th Cir.1989) (quoting Winans v. Bowen, 853 F.2d 643, 647 (9th Cir.1987)). In addition, if the treating physicians' opinions are uncontroverted, those reasons must be clear and convincing. Rodriguez, 876 F.2d at 761-62. Similarly, the opinions of a specialist about medical issues related to his or her area of specialization are given more weight than the opinions of a nonspecialist. See 20 C.F.R. § 404.1527(d)(5). See also Bunnell v. Sullivan, 912 F.2d 1149, 1153 (9th Cir.1990), aff'd on reh'g, 947 F.2d 341 (9th Cir.1991) (en banc). 53 Smolen produced the opinions of four physicians--Drs. Smolen, Hoeflich, Bowen, and Morich--in support of her application for benefits. Here, we need only consider the ALJ's rejection of the opinions of two of those physicians--Dr. Hoeflich and Dr. Smolen. Dr. Hoeflich was Smolen's treating physician. Dr. Smolen was a specialist in the area of medicine that was most relevant to assessing Smolen's condition--physiatry; both Dr. Morich and Dr. Pesado, one of the ALJ's experts, stated that a physiatrist would be the most appropriate specialist to evaluate Smolen's condition and her residual functional capacity during the years in question. Dr. Smolen was the only physiatrist to give an opinion in this case. Therefore, both Dr. Hoeflich's and Dr. Smolen's opinions were entitled to greater weight than the opinions of Dr. Maxwell--a nontreating, nonexamining internist called by the ALJ. Rodriguez, 876 F.2d at 761-62 (opinions of treating physician given greater weight than nontreating physician); Bunnell, 912 F.2d at 1153 (opinions of specialist given greater weight than nonspecialist). See also Pitzer v. Sullivan, 908 F.2d 502 (9th Cir.1990) (conclusion of nonexamining physician entitled to less weight than conclusion of examining physician). 54 The opinions of both physicians were also uncontroverted. The ALJ appears to have treated Dr. Smolen's and Dr. Hoeflich's opinions as controverted by the testimony of Dr. Maxwell, especially regarding the cause of Smolen's fatigue and its effect on her ability to function. However, this treatment was erroneous. Dr. Smolen and Dr. Hoeflich opined that Smolen's fatigue could reasonably have resulted from Smolen's childhood radiation treatment and chemotherapy and that the fatigue and related conditions would have made it impossible for her to have sustained even sedentary work on a full-time basis beginning before November 1, 1982, and continuing thereafter. As previously noted, Dr. Maxwell, while ruling out mild anemia by itself  in an otherwise well  person as a cause of disabling fatigue, also testified that a perfectly good hypothesis is that everything Smolen went through related to her childhood cancer--including horrendous illness, two major surgeries, chemotherapy and x-ray therapy--impaired her ability to function. That testimony was consistent with Dr. Smolen's and Dr. Hoeflich's opinions. 55 In addition, the three physicians agreed that it was reasonable to infer from available lab reports that Smolen had anemia beginning before November 1, 1982, and continuing ever since. And, Dr. Smolen and Dr. Maxwell agreed that Smolen suffered from at least mild bone marrow suppression, which could possibly have caused her to be susceptible to viral infections. 56 Accordingly, the opinions of Drs. Smolen and Hoeflich were uncontroverted opinions entitled to great weight. Moreover, because Dr. Hoeflich's opinions were the uncontroverted opinions of a treating physician, the ALJ could reject those opinions only on the basis of specific, clear and convincing reasons, supported by substantial evidence. See supra p. 1285. With those principles in mind, we now examine the ALJ's rejection of Dr. Hoeflich's and Dr. Smolen's opinions. 57 In denying Smolen's application for disabled child's benefits, the ALJ discussed only the opinions Dr. Smolen and Dr. Hoeflich offered in response to four questions Smolen's counsel posed to them; he did not discuss the opinions Dr. Smolen and Dr. Hoeflich offered in other letters. By disregarding those opinions and making contrary findings, he effectively rejected them. His failure to offer reasons for doing so was legal error. 58 The ALJ also rejected the opinions he did discuss. Those opinions were offered in response to a letter in which Smolen's counsel summarized relevant evidence in the record and applicable legal standards and asked four questions. Dr. Hoeflich and Dr. Smolen both answered yes to each question and Dr. Smolen added explanations for his answers. The ALJ stated that those opinions were not entitled to much weight and ultimately rejected them entirely by making contrary findings. The ALJ offered the same reasons for rejecting both physicians opinions. 59 The first reason the ALJ gave for rejecting Dr. Smolen's and Dr. Hoeflich's responses was that they were based on a somewhat biased and incomplete summary of the evidence and therefore were themselves somewhat biased and incomplete. However, the summary prepared by counsel generally reflected the evidence in the record accurately. The summary was neither materially incomplete nor improperly inclusive. 60 Regarding incompleteness, the ALJ stated generally that the summary omitted facts from which contrary inferences could have been drawn. But he failed to explain what those inferences would have been and in what way they would have been contrary to the opinions the physicians offered. Upon review of the omitted facts about which the ALJ was concerned, it appears that each of those facts was either implicit in other facts set out in the summary of evidence or was immaterial to the questions or physicians' responses. We address each of these omitted facts. 61 First, the ALJ pointed out that the summary did not mention that Smolen graduated from high school in 1980. However, the summary did state that Smolen attended community college, which implies she graduated from high school. The ALJ also noted that the summary omitted that Smolen completed a course and was certified as a CNA [Certified Nurses' Aide]. However, the summary stated that Smolen worked two jobs as a CNA, which implies that she completed a course and was certified as a CNA. 62 Second, the ALJ stated that the summary omitted that Smolen graduated 170th out of 238 in her high school class. However, the summary gave complete information about Smolen's activities during the relevant period-including her attendance at community college starting in the Fall of 1982, her grade point average and attendance record in college, and detailed information regarding her work history from May 1982 through 1987. Nothing suggests that knowledge of Smolen's high school class rank would have changed the opinions Dr. Smolen and Dr. Hoeflich offered, especially given that the rank was low. 63 Third, the ALJ noted that the summary omitted the fact that Smolen had not been tested for anemia between 1982 and 1987 and possibly wrongly implied that she had been tested during that period, but that the records had been destroyed. However, the only information material to the questions asked was that there were no records showing Smolen's hemoglobin levels between 1968 and 1987; the summary accurately stated that fact. The reason for the gap in the records was immaterial. 64 Finally, the ALJ noted that the summary omitted the fact that there was a 16-year gap in Smolen's medical records 10 and included only selected medical records. Regarding the 16-year gap, the ALJ's main concern was that there were no medical records during that period documenting Smolen's complaints of disabling fatigue or her anemia. However, the physicians' responses did not address whether Smolen had in fact experienced the fatigue she alleged; if they had, a lack of medical records documenting complaints of fatigue might have been relevant. Moreover, the questions directed to the physicians regarding anemia were specifically premised on the gap in records documenting hemoglobin levels. Regarding the inclusion of only selected medical records, the ALJ failed to point to anything in the omitted records that might have led to different responses to any of the four questions and our examination of the records has disclosed nothing. 65 Other than omitted facts, the ALJ's only other specific concern related to bias was that the summary was a legal medical argument ... including even citations to Social Security Rulings and a discussion of the claimant's work history and quotations from portions of her doctor's opinions. However, Smolen's work history, the opinions of other physicians, and applicable legal standards were relevant to her claim and thus properly provided to the expert witnesses to enable them to fully understand the questions they were asked. 66 The second reason the ALJ gave for rejecting Dr. Smolen's and Dr. Hoeflich's opinions was that the questions to which they responded contained unsubstantiated assumptions. The ALJ cited only one example of an unsubstantiated assumption: that the claimant was so fatigued by anemia that she could not function during the relevant period. But Smolen's counsel did not ask Dr. Smolen and Dr. Hoeflich to assume that Smolen's fatigue resulted from anemia, or that Smolen's fatigue prevented her from functioning. Instead, he asked them to assume, for the purpose of question one, that Smolen suffered the fatigue she alleged and, for the purpose of question four, that she suffered that fatigue and other impairments related to her childhood cancer. These assumptions were fully substantiated. 11 67 The third reason the ALJ gave for rejecting Dr. Smolen's and Dr. Hoeflich's responses was that the questions were leading and called for only yes-or-no, check-the-box answers. However, the use of leading, hypothetical questions to elicit expert opinions is entirely appropriate. See Fed.R.Evid. 703, Notes of Advisory Committee on 1972 Proposed Rules. Moreover, the questions called not only for yes-or-no answers, but also for comments from the physicians in support of their answers. Dr. Smolen's responses were accompanied by comments explaining the reasons for each of his responses. Those comments do not reflect that they are based on assumptions derived from counsels summary or questions; on the contrary, they appear to be based on Dr. Smolen's knowledge of his sister's medical history and his experience in his specialty. 68 Dr. Hoeflich, on the other hand, did not provide comments to support his answers and did not testify at the hearing. Therefore, the ALJ did not know the basis for Dr. Hoeflich's opinions and thought that they might have been based on unwarranted assumptions. As a preliminary matter, we note that Dr. Hoeflich's responses are cumulative to Dr. Smolen's and not necessary to support Smolen's claim. However, the ALJ still could not reject those responses without clear and convincing reasons for doing so. 69 In Social Security cases the ALJ has a special duty to fully and fairly develop the record and to assure that the claimant's interests are considered. Brown v. Heckler, 713 F.2d 441, 443 (9th Cir.1983). This duty exists even when the claimant is represented by counsel. Id. If the ALJ thought he needed to know the basis of Dr. Hoeflich's opinions in order to evaluate them, he had a duty to conduct an appropriate inquiry, for example, by subpoenaing the physicians or submitting further questions to them. See 42 U.S.C. § 405(d)(1988); 20 C.F.R. § 404.950(d)(1991); 20 C.F.R. § 404.1527(c)(3). He could also have continued the hearing to augment the record. See 20 C.F.R. § 404.944 (1991). Having failed to fully develop the record regarding the basis for Dr. Hoeflich's opinions, the ALJ could not then reject those opinions--which were uncontroverted and corroborated--because they were given in response to leading, hypothetical questions. 70 In conclusion, we find that the reasons the ALJ gave for rejecting Dr. Smolen's testimony were not supported by substantial evidence in the record. Given that Dr. Smolen was an appropriate specialist who offered significant explanations for each of his opinions, we find that the ALJ's rejection of Dr. Smolen's testimony without substantiated grounds for doing so constituted legal error. In addition, we find that the ALJ rejected Dr. Hoeflich's opinions without clear and convincing reasons for doing so; therefore, such rejection constituted reversible error. See Cotton, 799 F.2d at 1408. 71