Opinion ID: 1302959
Heading Depth: 3
Heading Rank: 1

Heading: Dr. Burstain's Opinion

Text: On June 16, 2006, Dr. Todd Burstain, Wildman's treating physician, completed several forms describing Wildman's physical ailments and work-related physical limitations. On the forms, Dr. Burstain noted that Wildman suffered from liver disease, chronic alcoholic pancreatitis, and flares of acute pancreatitis that occur about monthly. As for Wildman's work-related physical limitations, Dr. Burstain concluded that Wildman could only work one hour per day, sit a total of one hour per workday, stand a total of one hour per workday, lift ten pounds occasionally, and lift five pounds frequently. The ALJ gave little weight to this opinion, emphasizing, among other reasons, that the opinion was conclusory and did not take Wildman's noncompliance into consideration. Wildman argues that the ALJ erroneously discounted Dr. Burstain's opinion. We disagree. Generally, [a] treating physician's opinion is due controlling weight if that opinion is well-supported by medically acceptable clinical and laboratory diagnostic techniques and is not inconsistent with the other substantial evidence in the record. Brown, 390 F.3d at 540 (alteration in original) (internal quotation omitted). However, [a]n ALJ may discount or even disregard the opinion of a treating physician where other medical assessments are supported by better or more thorough medical evidence, or where a treating physician renders inconsistent opinions that undermine the credibility of such opinions. Goff v. Barnhart, 421 F.3d 785, 790 (8th Cir.2005) (internal quotation omitted). First, the ALJ properly discounted Dr. Burstain's opinion because it was conclusory. The opinion consists of three checklist forms, cites no medical evidence, and provides little to no elaboration. The checklist format, generality, and incompleteness of the assessments limit [the assessments'] evidentiary value. Holmstrom v. Massanari, 270 F.3d 715, 721 (8th Cir.2001). Indeed, [a] treating physician's opinion deserves no greater respect than any other physician's opinion when [it] consists of nothing more than vague, conclusory statements. Piepgras v. Chater, 76 F.3d 233, 236 (8th Cir.1996). Furthermore, the ALJ properly discounted Dr. Burstain's opinion because it did not take Wildman's noncompliance into account. [A] claimant's noncompliance can constitute evidence that is inconsistent with a treating physician's medical opinion and, therefore, can be considered in determining whether to give that opinion controlling weight. Owen v. Astrue, 551 F.3d 792, 800 (8th Cir.2008). While our review of the record confirms that Wildman suffered from abdominal pain flares about monthly, a closer look at Dr. Burstain's notes reveals that a vast majority of such flares were precipitated by Wildman's failure to comply with her prescribed diet and medications, and her failure to totally abstain from drugs and alcohol. First, Wildman failed to completely abstain from drugs and alcohol. On November 6, 2002, Wildman sought treatment in the emergency room for abdominal pain. The physician on duty attributed Wildman's pain to pancreatitis and instructed her to stop alcohol consumption. Yet, Dr. Burstain's treatment notes reveal that Wildman subsequently suffered from abdominal pain flares after drinking alcohol in 2003 and using three lines of cocaine at a party in 2005. Wildman also failed to take her medications as prescribed. On June 29, 2005, Dr. Burstain noted that Wildman was suffering from another pancreatitis flare. When Dr. Burstain questioned Wildman about whether she had been taking her Creon, [2] Wildman said yes, but now says that she has actually not been using that. Dr. Burstain concluded that Wildman's chronic pancreatitis is worse right now, probably secondary to noncompliance of the Creon. I have emphasized the importance of going back on that. On July 7, 2005, Dr. Burstain noted that Wildman still has not filled her Creon prescription and he again encouraged her to get the Creon filled. Finally, Wildman repeatedly failed to follow her prescribed diet. On February 27, 2004, Wildman reported to Dr. Burstain with a pancreatitis flare and Dr. Burstain instructed her to limit her diet to simple starches. The following week, Wildman told Dr. Burstain that she thought the pancreatitis flare may have been triggered by eating a McDonald's hamburger and that she was able to simplify her diet, take her medications, and resolve her symptoms. However, despite Dr. Burstain's repeated admonitions, Wildman suffered from numerous subsequent abdominal pain flares after failing to comply with her diet. Specifically, Dr. Burstain's treatment notes reveal that Wildman had abdominal pain exacerbations and flares after she: (1) ate pork (January 8, 2005); (2) ate two Krispy Kreme doughnuts (February 7, 2005); (3) ate fairly high fat meat meals (March 29, 2005); (4) had not been eating or following the diet as ha[d] been recommended (April 29, 2005); (5) had not been following her diet (May 27, 2005); (6) ate a large meal during which she had a steak and a burger (August 2, 2005); (7) ate a McDonald's hamburger (September 26, 2005); and (8) had not been watching her sugars (February 24, 2006). Importantly, Dr. Burstain's notes also indicate that when Wildman was compliant, her abdominal pain was generally under fairly good control. [3] In fact, during one such period of compliance, Wildman told Dr. Burstain that she was going to try to go back to work. On another similar occasion, Wildman reported to Dr. Burstain that she injured her shoulders while doing some work recently. If an impairment can be controlled by treatment or medication, it cannot be considered disabling. Brown, 390 F.3d at 540 (quotations omitted). Wildman argues that her noncompliance is justified because it is a symptom of her mental problemsi.e., her depression and alleged concentration and memory limitations. Specifically, Wildman argues that her mental limitations prevent her from remembering and following directions and that she therefore cannot comply with doctors' instructions. To support this argument, she relies on our recent decision in Pate-Fires v. Astrue, 564 F.3d 935 (8th Cir.2009). In Pate-Fires, the claimant suffered from severe schizoaffective disorder that caused the claimant's manic behavior, homicidal threats, paranoid delusions, significantly impaired insight, and complete denial of her illness. Id. at 946. Although there was overwhelming evidence in the record expressly indicating that the claimant's severe mental disorder caused her noncompliance with psychiatric medication, the ALJ held that such noncompliance was not justified. Id. We reversed, concluding that the ALJ's decision failed to recognize that the claimant's noncompliance was a manifestation of her schizoaffective disorder and that noncompliance with psychiatric medication is common among persons with such disorders. Id. at 945. Pate-Fires is distinguishable from the present case in several ways. Wildman suffers from depression, not schizoaffective disorder, and Wildman's noncompliance consisted mostly of failing to follow her prescribed diet, not failing to take her psychiatric medication. Moreover, unlike in Pate-Fires, there is little or no evidence expressly linking Wildman's mental limitations to such repeated noncompliance. In fact, there is conflicting evidence in the record regarding the severity of Wildman's alleged memory and concentration impairments. While two examining psychologists noted that Wildman had concentration and memory limitations, an examining neurologist concluded that Wildman's memory and concentration were normal. Accordingly, Pate-Fires is inapposite and Wildman's noncompliance is not justified. Thus, the ALJ did not err in discounting Dr. Burstain's opinion because it was conclusory and failed to account for Wildman's unjustified noncompliance. Since these reasons are sufficient to support the ALJ's decision to discount the opinion, we need not discuss the ALJ's other reasons for doing so. Goff, 421 F.3d at 790-91.