Opinion ID: 4535028
Heading Depth: 3
Heading Rank: 2

Heading: Evaluating/Weighing Medical Opinions

Text: An ALJ evaluates opinion evidence under the rules set forth in 20 C.F.R. § 416.927. “Generally, [the ALJ] give[s] more weight to the medical opinion of a source who has examined [the claimant] than to the medical opinion of a medical source who has not examined [the claimant].” Id. § 416.927(c)(1). In addition to considering the treatment relationship, specialization, and other factors, the ALJ looks at supportability and consistency. Specifically, “[t]he more a medical source presents relevant evidence to support a medical opinion, particularly medical signs and laboratory findings, the more weight [the ALJ] will give that medical opinion. The more explanation a source provides for a medical opinion, the more weight [the ALJ] will give that medical opinion.” Id. § 416.927(c)(3). And “[t]he more consistent a medical opinion is with the record as a whole, the more weight [the ALJ] will give to that medical opinion.” Id. § 416.927(c)(4).
Based on his own diagnosis of ADHD, Dr. Taylor’s neuropsychological examination, and the results of an MRI and EKG, Dr. Maqbool opined, without any explanation, that R.M.B. had three “extreme” and three “marked” limitations in the six domains of functioning. The ALJ gave Dr. Maqbool’s opinion “less weight” because it is “not fully supported by [R.M.B.’s] school records, and [it is] inconsistent with the medical expert testimony.” Aplt. App., Vol. 2 at 34. We disagree that the ALJ erred when he assigned less weight to Dr. Maqbool’s opinion. 13 First, Dr. Maqbool’s opinion is not supported by his only treatment note in the record, when, in December 2014, he assessed R.M.B. with symptoms of ADHD, but otherwise found no joint pain, gait abnormalities, or strength deficits. Although Dr. Maqbool re-tested R.M.B. in October 2015, and diagnosed her with ADHD, none of his testing is part of the record. 7 Second, Dr. Maqbool relied on a neuropsychological examination and MRI and EKG for his opinion. But Dr. Taylor found that R.M.B. did not meet the diagnostic criteria for ADHD, and R.M.B.’s MRI and EKG were normal. Third, Dr. Maqbool’s opinion is inconsistent with the record taken as a whole. In this regard, Bridges complains that the ALJ “certainly failed to note [that Dr. Maqbool’s opinion is] supported by, and [is] supportive of, findings and opinions from [Dr. Ray], the Commissioner’s own consultative examiner.” Aplt. Opening Br. at 22. But Dr. Ray’s and Dr. Maqbool’s reports do not support each other. Although Dr. Ray opined that R.M.B. had some physical limitations, such as how much weight she could lift or how long she could stand or sit without a break, he never expressed or suggested, in any way, that R.M.B. had limitations in her ability to acquire and use information, attend to and complete tasks, or interact and relate to others. 7 In October 2015, Dr. Maqbool wrote a letter addressed to whom it may concern that said nothing more than that R.M.B. was being followed for ADHD, among other diagnoses. 14
Dr. Ray examined R.M.B. following the administrative hearing. Other than noting hyperextension of R.M.B.’s elbows, fifth digits, and legs, along with mildly elastic and translucent skin, Dr. Ray’s examination findings were normal; nonetheless, Dr. Ray found R.M.B. had physical limitations that “affect[] her ability to function secondary to difficulty standing, walking, lifting and bending.” Aplt. App., Vol. 6 at 851. The ALJ said that he “considered” Dr. Ray’s opinions and that they were “incorporated into the findings that [R.M.B.] had less than marked limitation in health and physical well-being [and] moving [about] and manipulating objects.” Id., Vol. 2 at 34. Bridges maintains that the ALJ was not telling the truth when he said he considered Dr. Ray’s opinions and incorporated them into his findings because “if this were true, R.M.B. would have been found disabled.” Aplt. Opening Br. at 23. We disagree. “Where, as here, the ALJ indicates he has considered all the evidence our practice is to take the ALJ at his word.” Wall v. Astrue, 561 F.3d 1048, 1070 (10th Cir. 2009) (brackets and internal quotation marks omitted). More to the point, nothing in Dr. Ray’s evaluation requires a finding that R.M.B. is disabled. And in any event, Dr. Ray’s opinion “is not dispositive because final responsibility for determining the ultimate issue of disability is reserved to the [Commissioner].” Castellano v. Sec’y of Health & Human Servs., 26 F.3d 1027, 1029 (10th Cir. 1994); see also 20 C.F.R. § 416.927(d)(1). 15
According to Bridges, the ALJ failed to adequately discuss evidence from: (1) Nurse Jacob, who, in November 2014, referred R.M.B. for occupational and physical therapy to build core strength, develop gross and fine motor skills, provide protection for her joints, and increase her ability to perform activities of daily living; (2) Dr. Taylor, who, in April 2015, found that R.M.B. did not meet the diagnostic criteria for ADHD, but offered some suggestions that might be helpful to R.M.B. in a school setting; and (3) Dr. Francomano, who, in February 2016, diagnosed R.M.B. with the hypermobility type of EDS, and recommended some specialists Bridges could see to determine whether R.M.B. had a tethered cord and help with pain management. It is well-established that “[t]he ALJ is not required to discuss every piece of evidence.” Wall, 561 F.3d at 1067 (internal quotation marks omitted). “[W]e will generally find the ALJ’s decision adequate if it discusses the uncontroverted evidence the ALJ chooses not to rely upon and any significantly probative evidence the ALJ decides to reject.” Id. (internal quotation marks omitted). Here, the ALJ did not ignore the evidence that R.M.B.: (1) received physical therapy; (2) was diagnosed with the hypermobility type of EDS; and (3) needed some adjustments at school. Nor did he reject any significantly probative evidence because none of the three medical providers offered opinions on R.M.B.’s functional limitations. No further discussion or analysis was necessary. 16