Opinion ID: 796994
Heading Depth: 3
Heading Rank: 2

Heading: The ALJ's failure to address the opinion of Bowen's treating psychologist

Text: 21 In order to make a determination under the fourth and fifth steps of the inquiry outlined above, the ALJ posed two hypothetical questions to a vocational expert (VE) trained to evaluate whether a claimant with a given RFC is capable of performing the various types of work available in the national economy. First, the ALJ posed a hypothetical based primarily on Dr. Brake's assessment of Bowen's abilities. This hypothetical claimant was said to be, at worst, moderately limited in his RFC. The VE determined that such a claimant could not return to Bowen's past work, but would be capable of making an adjustment to occupations that exist in significant numbers in the national economy. This hypothetical claimant would therefore not be entitled to receive disability insurance benefits. 22 Next, the ALJ posed a second hypothetical in which the claimant was said to be limited in the manner described by Dr. Cohen, that is, with a poor RFC. The ALJ made no mention of Dr. Holean's virtually identical assessment. Given these limitations, the VE concluded not only that such a hypothetical claimant would be unable to return to Bowen's past relevant work, but also that no jobs exist in the national economy that could accommodate a claimant so impaired. The VE specifically emphasized that the combined effect of a poor ability to deal with stress, maintain attention and concentration, and behave in an emotionally stable manner would likely preclude employability. This second hypothetical claimant would therefore be entitled to receive disability insurance benefits based on the VE's opinion. 23 Bowen's eligibility for benefits essentially hinged on the determination of whether his mental impairments corresponded more closely with the first hypothetical claimant possessing only moderate limitations as described by Dr. Brake or with the second hypothetical claimant afflicted with the severe limitations described by Drs. Cohen and Holean. Required to choose between these two possibilities, the ALJ ultimately d[id] not accept the severe limitations as assessed by Dr. Cohen and instead adopted the modest limitations set forth by Dr. Brake. 24 The key problem with the ALJ's decision, however, is that it completely fails to acknowledge the expert opinion of Dr. Holean, Bowen's treating psychologist. Nowhere in the ALJ's 12-page opinion does the ALJ mention Dr. Holean's name, the fact that she treated Bowen for over three years, or the fact that she submitted an RFC assessment in this case that corresponds with the severe limitations assessed by Dr. Cohen. Dr. Holean's opinion is noted only in a long listing of medical records appended to the ALJ's decision, but any mention of her assessment is totally absent from the decision itself. 25 This court has frequently recognized that where the opinion of a treating source is not accorded controlling weight, an ALJ must apply certain factors . . . in determining what weight to give the opinion. Wilson, 378 F.3d at 544 (emphasis added). Specifically, § 404.1527(d) of the SSA's regulations prescribes that the ALJ is to consider (1) the length of the treatment relationship and the frequency of examination, (2) the nature and extent of the treatment relationship, (3) the supportability of the opinion, (4) the consistency of the opinion with the record as a whole, and (5) the specialization of the treating source. 20 C.F.R. § 404.1527(d). The regulation further assures claimants that [w]e will always give good reasons in our notice of determination or decision for the weight we give your treating source's opinion. 20 C.F.R. § 404.1527(d)(2). 26 Here, the ALJ's complete failure to mention Dr. Holean plainly violated the terms of § 1527(d)(2). This court held in Wilson that, because § 1527(d)(2) provides claimants with an important procedural safeguard, the SSA was not free to relax or disregard the rule in an ad hoc fashion. 378 F.3d at 547. The Wilson court determined that the ALJ's failure to give good reasons for rejecting the opinion of the claimant's treating physician in that case required a remand because it violated the substantive protection afforded by the regulation. Id. at 546 (quotation marks omitted). In so holding, however, Wilson left open the possibility that a violation of § 1527(d)(2) might amount to harmless error in other situations, including where the Commissioner has met the goal of § 1527(d)(2)—the provision of the procedural safeguard of reasons—even though she has not complied with the terms of the regulation. Id. at 547. Wilson made clear, however, that the harmless-error inquiry required more than a showing that the claimant simply had little chance of winning on the merits. Id. at 546. 27 Two recent cases interpreting this harmless-error exception help to outline its contours. One is Hall v. Comm'r of Soc. Sec., 148 Fed.Appx. 456, 461-62 (6th Cir.2005), where this court considered the Commissioner's argument that the ALJ's failure to directly address the conclusions of a treating physician amounted to harmless error. Hall involved a claimant who asserted total disability based on both physical and psychological impairments. Id. at 458. The ALJ addressed the opinion of Hall's treating physician in the course of discussing Hall's psychological impairment, but failed to address the physician's findings with regard to Hall's physical limitations. Id. at 463. Two particular aspects of the ALJ's decision troubled the court. First, the court emphasized that the ALJ's decision was inconsistent in that it accepted the treating physician's opinion in some respects but rejected it in others without explanation. Id. at 465. The court also noted that, although the ALJ addressed other medical opinions related to Hall's physical limitations, none of them supported the specific RFC that the ALJ ultimately adopted. Id. at 465-66. Because the court was unable to discern the ALJ's reasons for the weight that he gave to the opinion of Hall's treating physician, the § 1527(d)(2) violation necessitated a remand. Id. at 467. 28 In contrast, this court in Nelson v. Comm'r of Soc. Sec., 195 Fed.Appx. 462, 472 (6th Cir.2006) (per curiam), held that the ALJ's failure to abide by the letter of § 1527(d)(2) amounted to harmless error. The court determined that the ALJ's analysis satisfied the goals of § 1527(d)(2) by indirectly attacking the treating physicians' opinions. Id at 471. In Nelson, the ALJ had briefly referred to the opinions of two of the claimant's treating physicians, but had not fully explained why he accorded them little weight as required by § 1527(d)(2). Id at 470. Nevertheless, the court held that those brief references, which arose in the context of discussing a multitude of contrary medical evidence, met the regulatory goal of addressing the opinions of the treating sources as well as their inconsistency with the record as a whole. Id. at 472. 29 We first note that the ALJ's adoption in this case of an assessment contrary to Dr. Holean's opinion—without even addressing her involvement—transgressed § 1527(d)(2) beyond even the violations in Hall, Nelson, and Wilson, where the treating source was at least mentioned. This fact alone counsels strongly in favor of a remand. Neither we nor Bowen can even be certain that the ALJ was aware that Dr. Holean's assessment represented that of a treating source. In fact, the conspicuous absence of any reference to her as such tends to indicate the contrary. The ALJ specifically acknowledged Dr. Cohen's virtually identical RFC assessment at several points in the hearing and in his opinion, but failed to mention that the psychologist who treated Bowen for over three years happened to agree with it. 30 Nonetheless, the Commissioner argues that the violation of § 1527(d)(2) was harmless because the ALJ met the goals of the rule by discussing Bowen's psychological condition generally and by explicitly deciding to adopt Dr. Brake's assessment over Dr. Cohen's. In other words, the ALJ allegedly met the goals of § 1527(d)(2) insofar as he rejected Dr. Holean's RFC assessment through the proxy of Dr. Cohen's similar opinion. We find this argument unpersuasive for several reasons. 31 First, although we agree that the ALJ might have discounted Dr. Holean's opinion for the same reason that he discounted Dr. Cohen's, another possibility is that the ALJ simply overlooked Dr. Holean's opinion altogether. In addition, the ALJ's opinion explains only that he d[id] not find such severe restrictions [described by Dr. Cohen] to be warranted based upon the rationale provided by Dr. Cohen.  (Emphasis added.) This statement indicates that the ALJ might have rejected Dr. Cohen's assessment as a matter of credibility, perhaps based upon Dr. Cohen's self-contradictory notation that there are no marked functional limitations. In discrediting Dr. Cohen's opinion, the ALJ also expressed concern over Bowen's possible malingering in his SSA examinations and subjective complaints, as suggested by several sources. We are unsure, however, whether the ALJ drew the additional conclusion that Bowen malingered in the course of his three-year treating relationship with Dr. Holean, given the ALJ's silence on that issue. 32 Moreover, the ALJ's rationale for crediting Dr. Brake's assessment raises an additional concern. The ALJ adopted Dr. Brake's assessment in part because he found it to be supported by Bowen's treatment records at MCCC. Those records, the ALJ concluded, offer[] the most accurate reflection of [Bowen's] mental status and . . . [are] generally benign. The ALJ failed to note, however, that the vast majority of those treatment records are initialed by none other than Dr. Holean. This presents a problem of inconsistency similar to that found in Hall because the ALJ lent credence to Dr. Holean in one respect (albeit unwittingly), but then ignored her RFC assessment without explanation. 33 On the one hand, this could be seen as indirectly attacking the supportability of Dr. Holean's opinion on the basis that Dr. Holean's treatment records are inconsistent with her RFC assessment. See Nelson, 195 Fed.Appx. at 471. Alternatively, it might be viewed as further evidence that the ALJ simply overlooked Dr. Holean's opinion. We see no rational explanation for crediting Dr. Holean's treatment notes as accurate, but then discounting her RFC assessment without the slightest mention. The problem, again, is that we just do not know why the ALJ disregarded Dr. Holean's RFC assessment, and the goals of § 1527(d)(2) cannot be satisfied by bald speculation. 34 Attempting to salvage this omission, the Commissioner highlights the fact that the ALJ relied heavily on the opinion of Dr. Dumas, Bowen's treating psychiatrist, in choosing to adopt Dr. Brake's assessment over Dr. Cohen's. Properly addressing or adopting one treating physician's opinion, however, does not obviate the need to comply with § 1527(d)(2) in addressing the opinions of other treating sources that reach contrary conclusions. See Sharp v. Barnhart, 152 Fed.Appx. 503, 508 (6th Cir.2005) (remanding a claim to the Commissioner where the ALJ satisfied these [§ 1527(d)(2)] procedural requirements with respect to the opinions of some of [the claimant's] treating physicians but not with respect to others of them.) Moreover, exclusive reliance on Dr. Dumas's opinion is misplaced because he did not submit an RFC assessment of Bowen. Although Dr. Dumas's general findings are certainly relevant considerations, they do not speak directly to what became the heart of this dispute: whether Bowen's RFC permitted him to work despite his psychological impairment. 35 This case is unlike Nelson because there is not even a passing reference to Dr. Holean's opinion in the ALJ's decision that allows us to infer that the ALJ intended to indirectly attack it. In Nelson, this court cautioned that the scenario there represented the rare case in which a § 1527(d)(2) violation was deemed harmless because the ALJ's analysis met the goal, but not the letter, of the rule. 195 Fed.Appx. at 472. Although Wilson contemplated other scenarios in which a § 1527(d)(2) violation might be considered harmless, such as where the treating physician's opinion is patently deficient or where the ALJ adopts a treating source's opinion without discussion, that is not the situation here. See Wilson, 378 F.3d at 547. 36 We are not unsympathetic to the plight of an ALJ confronted, as in this case, with the opinions of eight different psychological medical sources, in addition to multiple opinions relating to alleged physical impairments. Nevertheless, invoking the harmless-error exception here—where the ALJ entirely failed to address the primary treating source's presumptively supportable opinion—plainly risks having the exception swallow up the rule. A remand is therefore necessary so that the ALJ may fully consider and address Dr. Holean's opinion consistent with § 1527(d)(2).