Opinion ID: 772880
Heading Depth: 3
Heading Rank: 1

Heading: Dr. Oh's Opinion

Text: 17 In a letter dated June 11, 1997, Dr. Oh stated that Holohan's 18 depressive disorder superimposed by a panic disorder,effectively prevent her from pursuing gainfulemployment. Specifically, she experiences spells ofterror and panic leading to cognitive breakup. She alsoexperiences anxiety, off and on, all day with gravesymptoms of depression, including feeling no interest inthings, feeling hopeless, and having difficulty makingdecisions. With these disabling cognitive and affectivesymptoms, compounded by the stressor of residingwith a physically and verbally abusive spouse, markedlyimpair her ability to function in a work place like shedid for nearly 20 years before her current disability.... [Holohan's ]ability to concentrate on work relatedtasks is markedly impaired due to her anxiety and poorconcentration. She is able to maintain rudimentaryactivities of daily living. 19 Dr. Oh's letter, in conjunction with his treatment notes, is evidence that Holohan qualified as disabled at step three of the five step inquiry. 20 In order to qualify as disabled at step three of the evaluation, a claimant must meet or exceed the listed impairments in Appendix 1 to Part 404 of the regulations. 20 C.F.R. 404.1520(d). In order to meet a listing in Appendix 1 for a mental disorder, a claimant must satisfy criteria in paragraph A of the listings, which medically substantiate the presence of a mental disorder, and the criteria in paragraphs B or C, which describe the functional limitations associated with the disorder which are incompatible with the ability to work. 20 C.F.R. Pt. 404, Subpt. P, App. 1 12.00A. Dr. Oh has diagnosed Holohan with major depression and panic disorder without agoraphobia. She therefore satisfies the paragraph A criteria for both affective disorders and anxiety related disorders. Compare 20 C.F.R. Pt. 404, Subpt. P, App. 1 12.04A. 1. (depressive syndrome) with Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) 345, 349-52, 369 (Michael B. First ed., 4th ed., text rev. 2000) (criteria for major depressive disorder), and 20 C.F.R. Pt. 404, Subpt. P, App. 1 12.06A. 3. (panic attacks) with DSM-IV 429, 430-32, 433-34 (criteria for panic disorder without agoraphobia). 21 In order to satisfy the criteria in paragraph B, Holohan's paragraph A impairments must result in at least two of the following: 22 1. Marked restriction in the activities of daily living;or 23 2. Marked difficulties in maintaining socialfunctioning; or3. Deficiencies of concentration, persistence or paceresulting in frequent failure to complete tasks in atimely manner (in work settings or elsewhere); or 24 4. Repeated episodes of deterioration or decompensationin work or work-like settings which cause the individualto withdraw from that situation or experienceexacerbation of signs and symptoms (which may include deterioration of adaptive behaviors). 25 20 C.F.R. Pt. 404, Subpt. P, App. 1 12.04B; see also id. 12.06B. Dr. Oh's opinion letter provides weighty evidence that Holohan's impairments meet three of the paragraph B criteria. First, Dr. Oh states that Holohan's social circle is limited to her AA meetings, otherwise she remains significantly socially isolated. The regulations include as examples of impaired social functioning social isolation and the avoidance of interpersonal relationships. See 20 C.F.R. Pt. 404, Subpt. P, App. 1 12.00C. 2. Dr. Oh's statement is evidence that Holohan has marked difficulties in maintaining social functioning. 3 Second, Dr. Oh states that Holohan's ability to concentrate on work related tasks is markedly impaired due to her anxiety and poor concentration. This is evidence that Holohan's impairments would cause her to fail to complete work-related tasks in a timely manner. Finally, Dr. Oh states that Holohan experiences spells of terror and panic leading to cognitive break up ... [as well as] anxiety, off and on, all day with grave symptoms of depression, including feeling no interest in things, feeling hopeless, and having difficulty making decisions. Dr. Oh concludes that these disabling cognitive and affective symptoms ... markedly impair[Holohan's] ability to function in a work place. The regulations explain that the fourth B criterion refers to repeated failure to adapt to stressful circumstances common to the work environment. Id. 12.00C. 4. They specifically identify making decisions as a stress common to work situations. Id. Dr. Oh's opinion is, therefore, evidence that Holohan satisfies the fourth B criterion. 4 26 Dr. Oh's opinion thus provides evidence that Holohan qualifies as disabled because she meets the impairments listed in Appendix 1. The ALJ rejected Dr. Oh's opinion that Holohan is markedly impaired with respect to performance of any work activity due to anxiety/panic attacks and poor concentration because he found it to be totally inconsistent with [Dr. Oh's] own treatment notes and records at [San Francisco General Hospital]. The ALJ stated that Dr. Oh's treatment notes indicate control of panic attacks with Ativan, and a great improvement in [Holohan's] condition. Dr. Oh in fact noted that [Holohan's] panic attack problem increased with inactivity, and that she was happy when she joined the YMCA. 27 Holohan argues that the ALJ committed legal error in rejecting Dr. Oh's opinion concerning the scope of her limitations. Her argument has merit. As Holohan points out, the ALJ is selective in his reliance on Dr. Oh's treatment notes, exaggerates in his description of their contents, and misattributes statements to Dr. Oh. Although he makes hopeful comments about Holohan's attending classes, Dr. Oh also lists as Holohan's symptoms demoralization, feeling trapped ... anxiety ... depressed mood. Dr. Oh never describes a great improvement in [Holohan's] condition as the ALJ suggests. While he does state on November 8, 1996, that Holohan is doing better, he explains that this means (less [unintelligible] panics--'15% better') but when inactive[upward arrow sign, read: increase in] panic. Finally, the ALJ states that Dr. Oh described Holohan as having infrequent panic attacks. However, it was not Dr. Oh but some other physician at San Francisco General Hospital who so characterized Holohan's attacks. 5 28 Dr. Oh's statements must be read in context of the overall diagnostic picture he draws. That a person who suffers from severe panic attacks, anxiety, and depression makes some improvement does not mean that the person's impairments no longer seriously affect her ability to function in a workplace. 6 See, e.g., Kellough v. Heckler, 785 F.2d 1147, 1153 (4th Cir. 1986) ('Feels well' and 'normal activity' must be read in context; the claimant has established that she suffered a severe cardiac impairment in 1975. A note entered in November 1975, just one month before she was hospitalized for open heart surgery, also stated that she 'feels well. 'Kellough testified without contradiction that her 'normal activity' following her surgery was very limited.). 29 The ALJ's specific reason for rejecting Dr. Oh's opinion was that it conflicted with Dr. Oh's treatment notes. Although such a conflict could justify a decision not to give the treating physician's opinion controlling weight, see 20 C.F.R. 404.1527(c)(2), (d)(2), (d)(4), in this case there is not substantial evidence in the record to support the reason the ALJ gave for rejecting Dr. Oh's opinion. When read in full and in context, Dr. Oh's treatment notes are consistent with his opinion letter. Because substantial evidence does not support the specific reason the ALJ gave for rejecting Dr. Oh's opinion concerning the question of Holohan's disability, we conclude that the ALJ erred in rejecting Dr. Oh's opinion.