Opinion ID: 2766705
Heading Depth: 2
Heading Rank: 1

Heading: Doctors’ Opinions

Text: On appeal Czarnecki principally argues that the ALJ should have given controlling weight to the opinions of her treating psychiatrist, Dr. Beresford, and treating physicians, Dr. Mirshed and Dr. Myint. “A treating physician’s opinion is entitled to controlling weight if it’s supported by medical findings and consistent with substantial evidence in the record,” Bates v. Colvin, 736 F.3d 1093, 1099 (7th Cir. 2013), and even if not controlling, that opinion cannot simply be discarded by an ALJ, Scrogham, 765 F.3d at 697. Here, the ALJ’s refusal to give any weight—let alone controlling weight—to the opinions of Czarnecki’s treating doctors is not supported by substantial evidence. Starting with Dr. Beresford, we agree with Czarnecki that the ALJ did not provide a sound explanation for rejecting the assessment of her mental impairments. The ALJ criticized the Mental Impairment Questionnaire completed by Dr. Beresford as contradicted by treatment notes, which, according to the ALJ, “document good functioning on medications, and normal memory and concentration.” But the ALJ did not identify which treatment notes purportedly support this characterization, and, in fact, the treatment notes suggest just the opposite. Dr. Beresford began treating Czarnecki in June 2007, when he rated her current GAF at 50 and her highest GAF at 75. Then, before completing the questionnaire, he treated her twice more in 2007, twice in 2008, five times in 2009, and six times in 2010, and his treatment notes consistently document that Czarnecki was depressed, anxious, restless, and having trouble sleeping. The remaining treatment notes from Dr. Beresford’s colleagues at the clinic in October and December 2010 and in March and April 2011 show that Czarnecki continued to experience depression, anxiety, and difficulty sleeping. And though the notes from Czarnecki’s appointment in May 2011 do indicate that she was then sleeping well, managing her anxiety, and able to “multitask,” the ALJ did not mention these notes, which, despite their few positive comments, still are generally consistent with Dr. Beresford’s pessimistic views expressed in the August 2010 questionnaire. That document, therefore, should have formed the basis of the ALJ’s determination. See Bates, 736 F.3d at 1099–1100. The ALJ did not explain why she seemingly ignored all but a few lines in Dr. Beresford’s treatment records, leaving us unable to engage in meaningful review. See Scrogham, 765 F.3d at 697. The ALJ also credited, without explanation, the opinions of the two state‐agency reviewing psychologists over that of Dr. Wagner, the state‐agency psychologist who personally evaluated Czarnecki in 2010, diagnosed her with major depressive disorder No. 14‐1815 Page 9 and panic disorder, and rated her GAF at 40. Although an ALJ is not required to accept the views of an agency examining physician if there is a contrary opinion from a later reviewer or other compelling evidence, the ALJ still must have a good explanation for rejecting or discounting the examining physician’s opinion. See Beardsley v. Colvin, 758 F.3d 834, 839 (7th Cir. 2014). Here, the ALJ gave “great weight” to the state‐agency reviewing psychologists simply because she deemed them, without any explanation or record support, “qualified mental health professionals” who are “experts in Social Security disability review.” Thus, the ALJ gave hardly any explanation at all, let alone a valid one, for rejecting Dr. Wagner’s opinion. See Beardsley, 758 F.3d at 839. The Commissioner is correct that the ALJ did not need to specifically discuss the GAF score from Dr. Wagner. See Denton v. Astrue, 596 F.3d 419, 425 (7th Cir. 2010) (explaining that GAF score does not necessarily reflect doctor’s opinion of functional capacity because the score measures severity of symptoms and functional level). Indeed, the American Psychiatric Association no longer uses this metric. See Am. Psychiatric Ass’n, Diagnostic & Statistical Manual of Mental Disorders 16 (5th ed. 2013). But at the time of Czarnecki’s psychological evaluations, clinicians still used GAF scores to report their judgment of an “individual’s overall level of functioning.” See Am. Psychiatric Ass’n, Diagnostic & Statistical Manual of Mental Disorders 32 (4th ed. text revision 2000). The ALJ did not mention any of the GAF scores from any physicians who examined Czarnecki, even though all of her GAF scores after the alleged onset of disability were between 40 and 50. As in another recent case, the problem here was the ALJ’s “larger general tendency to ignore or discount” favorable evidence, “which included GAF scores from multiple physicians suggesting a far lower level of functioning” than the ALJ assigned. See Yurt v. Colvin, 758 F.3d 850, 860 (7th Cir. 2014). As for Czarnecki’s physical impairments, the ALJ should not have rejected Dr. Myint’s views because he was a treating physician whose opinions about Czarnecki’s physical limitations were consistent with the other medical evidence. See Roddy v. Astrue, 705 F.3d 631, 636 (7th Cir. 2013). The ALJ took issue with the fact that Dr. Myint had treated Czarnecki for only a month before providing his first assessment and criticized his examinations as having “minimal findings,” his treatment as “consisting only of prescription medications,” and his assessment as “highly conclusory.” But Dr. Myint’s views are consistent with his treatment records, and “conclusory” better describes the ALJ’s analysis. At Czarnecki’s first appointment, Dr. Myint diagnosed her as having degenerative disc disease, sleep disturbance, and depression, and he later opined that these impairments prevented her from sitting, standing, or walking more than ten minutes, lifting more than five pounds, or No. 14‐1815 Page 10 maintaining meaningful employment. The ALJ doesn’t say why she rejected the conclusion that Czarnecki could not keep a job or explain what difference it would make if Dr. Myint had treated Czarnecki conservatively with medication, which anyway is inaccurate, since he also referred her to a pain‐management center for more aggressive treatment. The ALJ minimizes this step by declaring that the center’s treatment records indicate that Czarnecki’s back pain was “relatively mild and tolerable until July of 2010.” In fact, this comment is from a single progress note, and the ALJ quoted it selectively; the progress note goes on to say that Czarnecki’s pain had become “unbearable” in July 2010. And other notes made by center staff, such as Czarnecki repeatedly rating her back pain as between 7 and 9 on a 10‐point scale, are fully consistent with Dr. Myint’s assessment. Moreover, the ALJ does not acknowledge that progress notes from every other physician confirm that Czarnecki had complained about severe back pain—even while taking medication—long before July 2010. See Yurt, 758 F.3d at 860 (explaining that we have “repeatedly forbidden” ALJs from cherry‐picking only the medical evidence that supports their conclusion); Moore v. Colvin, 743 F.3d 1118, 1124 (7th Cir. 2014) (“The ALJ simply cannot recite only the evidence that is supportive of her ultimate conclusion without acknowledging and addressing the significant contrary evidence in the record.”). The ALJ similarly gave “little weight” to Dr. Mirshed’s September 2010 assessment that Czarnecki should not bend, lift, or stoop. The ALJ characterized this opinion as inconsistent with the medical record, which—the ALJ declared—doesn’t “contain any basis for such extreme restrictions,” and with Dr. Mirshed’s own treatment notes, which—according to the ALJ—document only a “reduced range of motion of the back without other significantly limiting findings.” Again, the ALJ did not identify specific treatment notes contradicting Dr. Mirshed’s assessment or provide any other sound explanation for rejecting it. See Punzio v. Astrue, 630 F.3d 704, 710 (7th Cir. 2011). Instead, the ALJ gave “great weight” to the two state‐agency reviewing physicians, whom she believed were “qualified specialist physicians” and “experts in Social Security disability review.” But the ALJ did not explain their qualifications or specialties, and in any event, non‐examining physicians’ opinions, by themselves, are insufficient to summarily reject the examining physicians’ opinions. See Gudgel v. Barnhart, 345 F.3d 467, 470 (7th Cir. 2003). No. 14‐1815 Page 11