Opinion ID: 3134207
Heading Depth: 3
Heading Rank: 1

Heading: Examining Physician’s Report

Text: Dipesh Amin, M.D., an examining physician, evaluated Ms. Hays in March 2008. He produced a report that primarily addressed her complaints of right hand and wrist pain but also addressed her complaints of knee problems. Regarding the latter, Dr. Amin wrote in the narrative portion of his report that Ms. Hays could “stand approximately four hours out of a day with appropriate breaks due to pain in her right lower extremity.” Aplt. App., Admin. R. Vol. 2, at 409. In another part of the report, Dr. Amin checked a box indicating Ms. Hays could stand for four hours “at one time without interruption” and another box indicating she could walk for four hours “at one time without interruption.” He also checked a box indicating she could stand for four hours “total in an 8 hour workday” and another box indicating she could walk for four hours “total in an 8 hour workday.” Id. at 411. During the hearing, the ALJ posed a hypothetical question to the vocational expert that supposed a person who “could stand or walk with normal breaks for a 3 total of six hours in an eight-hour workday.” Id., Vol. 3, at 679. In response, the vocational expert opined that such an individual could perform light work jobs, including furniture rental consultant, investigator of car dealer accounts, and usher. The question and response were consonant with SSR 83-10, 1983 WL 31251, at , which provides: “[T]he full range of light work requires standing or walking, off and on, for a total of approximately 6 hours of an 8-hour workday.” The ALJ found Ms. Hays had three severe impairments: right upper extremity pain status post surgeries, right knee degenerative joint disease, and obesity. Nonetheless, the ALJ determined Ms. Hays had the residual functional capacity (RFC) to perform light work, with the following limitations: claimant could lift and/or carry ten pounds frequently and twenty pounds occasionally with her left non-dominant upper extremity; should avoid lifting and/or carrying with her right dominant upper extremity and should not use her right upper extremity other than as an assist; could perform pushing and/or pulling motions with her left upper and lower extremities within the aforementioned weight restrictions but should not push and/or pull with her right upper or lower extremities; could perform activities requiring bilateral dexterity for both fine and gross manipulation with handling and reaching but should only occasionally perform overhead reaching, handling, fingering and feeling with her right upper extremity; should avoid unprotected heights and should not climb ladders, ropes or scaffolds. Aplt. App., Admin. R. Vol. 3, at 643-44. The ALJ’s decision refers just briefly to Dr. Amin’s assessment, without assigning an explicit weight to it, and that reference is to only the portion of the report discussing Ms. Hays’s impairment of her upper right extremity. 4 Ms. Hays contends that this was error because the report is inconsistent with the ALJ’s RFC determination in two critical ways. First, Dr. Amin’s report includes restrictions on standing and walking that were not incorporated into the RFC limitations and that are inconsistent with the requirements to perform light work. Second, Dr. Amin’s report included a restriction on handling papers (also not adopted by the ALJ) which would preclude her from performing the jobs listed by the vocational expert. Though we are not persuaded by Ms. Hays’s argument concerning her ability to handle papers, we agree that the ALJ erred by failing to adequately address Dr. Amin’s standing and walking restrictions. “It is the ALJ’s duty to give consideration to all the medical opinions in the record. He must also discuss the weight he assigns to such opinions.” Mays v. Colvin, 739 F.3d 569, 578 (10th Cir. 2014) (internal quotation marks omitted). An ALJ’s failure to weigh a medical opinion may be deemed harmless error if the opinion is “generally consistent” with the RFC determination. Keyes-Zachary v. Astrue, 695 F.3d 1156, 1163 (10th Cir. 2012). However, “this court may not create or adopt post-hoc rationalizations to support the ALJ’s decision that are not apparent from the ALJ’s decision itself.” Haga v. Astrue, 482 F.3d 1205, 1207-08 (10th Cir. 2007); see also Krauser v. Astrue, 638 F.3d 1324, 1331 (10th Cir. 2011) (“[T]he ALJ’s findings must be sufficiently specific to make clear to any subsequent reviewers the weight he gave to the treating source’s medical opinion and the reason for that weight.” (internal quotation marks omitted)). 5
The ALJ determined Ms. Hays had the RFC to perform light work with the limitations quoted above, none of which directly pertains to standing or walking. In doing so, the ALJ did not adequately assess Dr. Amin’s report and its standing and walking restrictions. An ALJ must “give consideration to all the medical opinions in the record.” Keyes-Zachary, 695 F.3d at 1161. Further, the ALJ must discuss the weight being given to the opinions, though the need for express analysis is less where the opinions are not inconsistent with each other or the ALJ’s RFC determination. Id. at 1161-62. Here, the ALJ mentioned Dr. Amin’s report only in connection with Ms. Hays’s upper right extremity, with no discussion of the weight being given to it. The ALJ did not even mention or weigh Dr. Amin’s report as it related to her knee or her ability to stand and walk. Since the report as it relates to Ms. Hays’s ability to stand and walk is consistent with neither the ALJ’s RFC determination nor the hypothetical posed to the vocational expert in formulating the determination, the failure to consider and weigh it was error. The district court concluded that the ALJ did not err by failing to weigh Dr. Amin’s opinion because it was consistent with other medical opinions in the record. The report is consistent with some of the other evidence in the record that the ALJ found persuasive, most notably the report of Robert E. Tuchler, M.D., the independent medical examiner. But neither Dr. Tuchler’s report nor the ALJ’s RFC determination addresses knee problems or restrictions on standing and walking. The 6 Commissioner argues on appeal that the RFC determination can be reconciled with Dr. Amin’s report because by checking boxes for four hours of both standing and walking, Dr. Amin meant she could do four hours of each activity in an eight-hour workday. However, we decline to interpret the report in such a manner for several reasons. First, in the narrative section of the report, Dr. Amin restricts Ms. Hays to four hours of standing but makes no mention of additional time for walking. Second, this interpretation would still leave an inconsistency with the hypothetical posed to the vocational expert, which contemplated up to six hours of either standing or walking, without placing a four-hour limit on either activity. Moreover, such an interpretation would create redundancy within the form itself. Because the ALJ’s decision does not adequately address the standing and walking restrictions in Dr. Amin’s report, a remand for clarification on this issue is required.
Dr. Amin also checked a box in his report indicating Ms. Hays could not “sort, handle, [or] use paper/files.” Aplt. App., Admin. R. Vol. 2, at 415. Notations in the report state this was due to the limited use of her right hand and that the restriction would not last for twelve months, once her wrist healed. Nothing in the record suggests this restriction still would have been relevant more than four years later, when the ALJ formulated Ms. Hays’s RFC, or that it was not addressed within the limitations the ALJ placed on her RFC. In addition, the vocational expert stated the occupations that fit Ms. Hays’s profile could be performed one-handed. Id., 7 Vol. 3, at 681. Therefore, we discern no error with respect to the ALJ’s assessment of Ms. Hays’s ability to handle papers.