Opinion ID: 1349375
Heading Depth: 1
Heading Rank: 2

Heading: The Need for a Meaningful Review of the ALJ's Decision

Text: The third reason given in Wilson as to why enforcement of the regulation requiring disclosure of specific reasons for the weight given to the treating physician's opinion is important is that it permits meaningful review of the ALJ's application of the regulation requiring an ALJ to give more weight to opinions from treating physicians. The need for a meaningful review applies with equal, if not greater force, in the present case. As noted earlier, the heart of the special technique for evaluating mental impairments is the mandatory application of that procedure and the disclosure of the required B criteria findings by the ALJ. Rather than just a requirement to disclose the ALJ's reasons for the ALJ's evaluation of a treating physician's opinion, the regulation in the present case requires that the ALJ make and also disclose the ALJ's own opinions regarding the B criteria which are critical to a finding of disability or no disability. As noted earlier, the fact that a reviewing court is of the opinion that based on the record presented to the court, the claimant would have little success on the merits anyway is not a sufficient reason to not enforce compliance with the regulation. Wilson, 378 F.3d at 546. A person is entitled by law to know how the ALJ evaluated the B criteria so that the claimant can argue whether the ALJ's evaluation is supported by or in conflict with the evidence and whether an appeal is warranted. A complete record, one that is required by law, is necessary not only for the benefit of the claimant but also for the benefit of a reviewing court.
I believe, for the reasons stated above, that the rationale of the Wilson case does apply, with equal, if not greater force, in the context of an ALJ's failure to rate the B criteria. The majority, however, states that the law specifically requiring an ALJ to assign a score to each functional area of the B criteria and to publish the ALJ's evaluations strikes us more as an `adjudicatory tool' designed to aid the SSA in determining the severity of a claimant's mental impairment. Majority Opinion, p. 656. I disagree. Wilson, of course, did draw the distinction between regulations intended primarily to confer important procedural benefits upon individuals and regulations adopted only for the orderly transaction of business before the agency. In the former case, an agency must follow its own procedures, whereas in the latter case the agency's action is not reviewable except upon a showing of substantial prejudice to the complaining party. Supra, p. 649-50. The only authority cited by the majority in support of its opinion that § 404.1520a is nothing more than an adjudicatory tool is an unpublished per curiam opinion, Clark v. Sullivan, No. 92-1030, 1992 WL 296709, at  (6th Cir. Oct.19, 1992) (per curiam). Clark is inapplicable in the present case. That case involved an allegation that the ALJ erred by not requiring a psychiatrist who had submitted a report of his examination to also complete the Psychiatric Review Technique form (PRT form), although two other doctors had in fact completed the PRT form. Id. The Clark decision contains a single sentence reference to the ALJ's failure to have a psychiatrist complete the PRT form[t]he failure to complete the Psychiatric Review Technique form, an adjudicatory tool, see 20 C.F.R. § 404.1520a(d) (1992), is not significant. It is followed by this statement: Moreover, nothing in the record indicates that Mrs. Clark has a mental impairment. None of her treating physicians noted any mental problems or recommended psychiatric treatment. Id. Thus, Clark is an unpublished per curiam opinion by a panel of this court with no analysis whatsoever for the bare conclusion that the regulation in effect at that time was an adjudicatory tool, and the remark was made in the context of a record that contained absolutely no evidence of any mental impairment. Furthermore, the regulations in effect at the time of the Clark decision required that the PRT form be completed at the initial and reconsideration levels and also at the administrative law judge hearing and Appeals Council levels. The administrative law judge, either alone or with the assistance of a medical advisor, was required to complete the form, and for all cases involving mental disorders at the administrative law judge hearing or Appeals Council levels, the form had to be appended to the decision. [3] The current regulations do not require that this form be completed at all levels of the process. Instead, it was recognized that the PRT form ... simply documents application of the technique with a checklist of our conclusions... Administrative law judge and Appeals Council decisions include a more detailed explanation of the findings and conclusions reached, supported by a narrative rationale. The decisions under these final rules must include, among other things, the pertinent findings and conclusions required in the application of the technique. Revised Medical Criteria for Evaluating Mental Disorders and Traumatic Brain Injury, 65 Fed.Reg. 50746, 50757 (August 21, 2000) (emphasis added). Therefore, while the form itself, being a checklist regarding application of the special technique at the lower initial and reconsideration levels, arguably could be considered an adjudicatory tool at those stages, it obviously is not an adjudicatory tool at the ALJ and Appeals Council levels. As explained above, the form is not needed at those levels because the decisions themselves must contain the pertinent findings and conclusions required in the application of the technique. Section 404.1520a(e)(2) provides: At the administrative law judge hearing and Appeals Council levels, and at the Federal reviewing official, administrative law judge, and the Decision Review Board levels in claims adjudicated under the procedures in part 405 of this chapter, the written decision must incorporate the pertinent findings and conclusions based on the technique. The decision must show the significant history, including examination and laboratory findings, and the functional limitations that were considered in reaching a conclusion about the severity of the mental impairment(s). The decision must include a specific finding as to the degree of limitation in each of the functional areas described in paragraph (c) of this section. (Emphasis added). The functional areas described in paragraph (c) of this section are the B criteria. The only other comment made by the majority regarding its belief that § 404.1520a is simply a regulation enacted for the benefit of the agency and not for the benefit of claimants is a reference to the difference between the word us and the word you. Section 404.1520a(a) states, in the introductory general section, that the special technique helps us to: (1) Identify the need for additional evidence to determine impairment severity; (2) Consider and evaluate functional consequences of the mental disorder(s) relevant to your ability to work; and (3) Organize and present our findings in a clear, concise, and consistent manner. To find that the use of the word us instead of you in the general introductory paragraph to § 404.1520a makes that regulation merely for the benefit of the agency, and not for the benefit of the claimant, is, in my view, unsupportable. How can it be said, for example, that a regulatory requirement imposed on the ALJ to set forth in the ALJ's opinion the specific findings as to the degree of limitation in each of the functional areas of the B criteria be solely for the benefit of the agency and not for claimants? Contrary to the majority opinion, I believe that the regulation governing evaluation of mental impairments was not enacted merely for the benefit of the agency but was obviously enacted for the benefit of persons claiming mental impairments who are entitled to have their claims processed fairly and in strict compliance with the special technique regulation and entitled to have the required findings made known to them in documentary form, especially in any decisions by the ALJ and the Appeals Council. While there may indeed be rare instances in which failure to comply with the regulation can be found to be harmless errorthe de minimis violation in Clark is an examplethe present case is obviously not such a case. The present case includes vastly different opinions regarding the claimant's disability, including specific findings of disability by the claimant's own treating psychiatrist. This is clearly a case of a regulation of exactly the same nature as the one in Wilson one intended to confer important procedural benefits on claimantsand is subject to exactly the same requirement that it be scrupulously observed, because [a]n agency's failure to follow its own regulations `tends to cause unjust discrimination and deny adequate notice' ... of an individual's constitutional right to due process. Wilson, 378 F.3d at 545 (citation omitted).