Opinion ID: 222918
Heading Depth: 4
Heading Rank: 1

Heading: Mental Impairments and Drug Dependency

Text: Upon review, we find that the ALJ’s determination was supported by substantial evidence, as the record supports the conclusion that Monateri’s substance abuse materially contributed to her mental impairments. Monateri does not dispute the ALJ’s conclusion that her impairments, with the inclusion of the factor of substance abuse, equal or exceed an impairment listed in the Social Security Regulations. She instead argues that her substance abuse is immaterial, and that her impairments are sufficiently severe to qualify for disability, absent consideration of her drug use. Under the Social Security Regulations, “[t]he key factor [the Commissioner] will examine in determining whether drug addiction or alcoholism is a contributing factor material to the determination of disability is whether [the Commissioner] would still find [the claimant] disabled if [the claimant] stopped using drugs or alcohol.” 20 C.F.R. § 404.1535(b)(1). The ALJ is further instructed to “evaluate which of [the claimant’s] current physical and mental limitations. . . would remain if [the claimant] stopped using drugs or alcohol and then determine whether any or all of [the claimant’s] remaining limitations would be disabling.” 20 CFR § 416.935(b)(2). In practice, we have allowed an ALJ to look at a claimant’s periods of sobriety and compare those periods to times when the claimant was abusing substances, in order to make this evaluation. 16 No. 09-4524 See, e.g., Bartley v. Barnhart, 117 F. App’x. 993, 998 (6th Cir. 2004) (approving of the ALJ’s approach of “look[ing] to periods of sobriety in the record to determine whether [the claimant] suffers from a work-limiting mental illness independent of substance abuse”). This is exactly what the ALJ did in this case. The ALJ considered Monateri’s mental condition prior to 1999, when she admittedly was not abusing either alcohol or drugs. He also looked at the period between August 2005 and May 2005, when Monateri was working full-time and in remission from drug abuse. Finally, the ALJ evaluated Monateri’s condition in 2006, when Proehl reported that she was in partial remission, and determined that her mental impairments had improved, which is supported by the fact that she began taking computer classes and did some work through a temporary agency. Contrary to Monateri’s assertion, this is not an instance where the ALJ lacked evidence sufficient to separate the substance abuse from the mental illness. Because Monateri had periods of both sobriety and partial remission, and the medical records reflected her improvement during such periods, the ALJ was able to compare those times to others when Monateri was in addiction. In doing so, the ALJ determined that Monateri’s drug abuse exacerbated her mental impairments, and that absent this effect on her condition, the depth of her depression, anxiety and panic disorders would not prevent her from working. 2. Omission of Medical Opinions of Dr. Bertschinger Monateri argues that the ALJ’s opinion is not supported by substantial evidence because it failed “to discuss Dr. Bertschinger’s opinion at all,” and that this “failure to so much as discuss Dr. Bertschinger’s findings constitutes reversible error,” as he should be considered a treating physician. 17 No. 09-4524 In affirming the ALJ’s determination, the district court held that the ALJ’s failure to mention Dr. Bertschinger’s opinion, while error, was de minimis and as such did not require reversal. (Dist. Ct. Op. at 5.) In doing so, the district court also distinguished between “medical notes” and “medical opinions,” finding that the records supplied by Dr. Bertschinger constituted only medical notes and as such did not require deference. (Id. at 6.) We reach the same outcome as the district court, but on different grounds. In this Court's decision in Rogers, we held that a failure to follow the procedural requirement of giving good reasons for discounting a treating physician's opinion constituted a lack of substantial evidence. Rogers, 486 F.3d at 242. We held that an ALJ's failure to set forth reasons for according weight to the medical opinion of a treating physician justified reversal and remand because it precluded meaningful appellate review of the determination. See id. at 242–43. Therefore, the complete omission of a treating physician's opinion in an ALJ's decision would generally constitute a lack of substantial evidence and compel remand. We have not yet held that such an error is subject to a harmless error exception and it is not necessary to do so today. Instead, assuming that Dr. Bertschinger was indeed a treating physician, we find that the ALJ's failure to specifically mention Dr. Bertschinger by name does not constitute a lack of substantial evidence, because Dr. Bertschinger's medical records and opinions were explicitly incorporated into the medical opinion given by Dr. Svete, and were considered by the ALJ. After being seen by Dr. Bertschinger at Pathways, Monateri was treated by several other physicians, including Dr. Felker and Dr. Immerman. Her final treating physician at Pathways was Dr. Svete. In providing his medical opinion, Dr. Svete asserted that he reached all conclusions 18 No. 09-4524 regarding Monateri's medical condition based both on his personal medical observations and on his review of Monateri's entire medical record from Pathways. In a letter dated July 11, 2003, Dr. Svete stated that he had reviewed [Monateri's] past medical records and [had] incorporated the clinical findings and history as set forth by [his] professional colleagues. (R. 226: Ex. 14F) At her hearing before the ALJ, Monateri acknowledged that it was her intent that Dr. Svete's opinion convey the medical determination of all of her physicians at Pathways, and argued that though she had been seen by four psychologists at . . . Pathways, Dr. Svete's medical opinions should be given controlling weight because he had the benefit of [Monateri's] entire record there at Pathways since she was first seen in February of 2000. (R. 261: Hearing Tr. at 15.) Because Dr. Svete incorporated Dr. Bertchinger's notes and opinions, and because Monateri asked that the ALJ treat Dr. Svete's opinion as incorporating her entire medical record from Pathways, the ALJ's failure to mention Dr. Bertschinger by name, under these circumstances, does not constitute a lack of substantial evidence. 3. Deference to the Medical Opinions of Dr. Svete Monateri next argues that the ALJ erred in “declin[ing] to give controlling weight to the opinion of . . . Dr. Svete.” She further contends that the ALJ “misconstrued temporary periods of improvement . . . as indicative that Monateri was functional when not using drugs,” instead of interpreting such periods as acceptable variations in the level of her functioning. In making its determination, the ALJ credited the opinion of Dr. Svete, “but only with the inclusion of the factor of substance abuse.” 19 No. 09-4524 Monateri acknowledges that at the time that Dr. Svete completed his initial assessment of her condition in 2003, he was completely unaware of her drug abuse and so was incapable of assessing the extent of her impairments absent such abuse.8 In 2006, when Dr. Svete reaffirmed his assessment of Monateri, she was still struggling with drug abuse, as evidenced by her multiple admissions to detox facilities. In his one-paragraph reaffirmation, Dr. Svete nowhere indicated that his medical conclusions, as of 2006, were made exclusive of Monateri’s drug abuse. Notably, there is also no indication in the record that Monateri was ever drug-free (for more than a nominal period of time) between 2001 and 2006, which means that Dr. Svete never had the opportunity to assess her condition when she was completely free from substance dependance. The ALJ properly considered testimony from the medical examiner, Dr. Spring, who not only reviewed Monateri’s medical records from Pathways, but also those from Laurelwood, Huron, Rosary Hall, and Neighboring, some of which document Monateri’s mental condition during her periods of remission from drug abuse. Because Dr. Svete could provide no insight into Monateri’s condition when sober, the ALJ properly supplemented Dr. Svete’s medical opinions with those of Dr. Spring. In reaching its determination regarding whether Monateri suffered from severe impairments independent of her drug dependency, the ALJ provided a good reason why it did not fully defer to 8 Monateri argues that “instructive language prefacing Dr. Svete’s opinion,” in which she requested that Dr. Svete confine his opinion to her “performance when not under the influence of drugs or alcohol,” is sufficient to demonstrate that Dr. Svete’s assessment accurately reflects Monateri’s drug-free condition. (Reply at 15.) But this is insensible. If Dr. Svete did not know that Monateri was abusing drugs, then he could not exclude the effects of those drugs when considering Monateri’s symptoms. 20 No. 09-4524 the medical opinion of Dr. Svete, to wit, his unawareness of her drug abuse; and it reasonably weighed the opinion of Dr. Spring, which took into account both periods of drug abuse and periods of sobriety. 4. Adverse Credibility Finding Monateri claims that the ALJ’s finding that her “statements concerning the intensity, duration and limiting effects of [her] symptoms are not entirely credible” is not supported by substantial evidence. Monateri contends that the ALJ erroneously based this conclusion on the belief “that Monateri was only ever hospitalized because of drug use.” On the contrary, the ALJ justified its partial adverse credibility finding on several factors, including the accurate conclusion that Monateri’s impairments have—excluding occasions also involving substance abuse detox—“not otherwise required acute inpatient or outpatient emergency care and treatment.” In addition, the ALJ considered Monateri’s daily activities, including housework, meal preparation and reading; her social interactions, including those with her family and a boyfriend that she had between 2002 and 2005; and the observations of treating physicians as embodied in her medical records. The ALJ also considered Monateri’s condition during periods of sobriety, when the medical records indicate that she showed improvement in her functioning levels and the ability to engage in gainful employment. The contrast between Monateri’s periods of sobriety and periods of substance abuse is emphasized by her success from 1990 to 1999; her employment in 2004-2005; and her ability to take classes when she went into partial remission again in 2006. 21 No. 09-4524 This evidence is sufficiently substantial to justify the ALJ’s credibility finding. See Smith v. Halter, 307 F.3d 377, 379 (6th Cir. 2001) (adverse credibility finding will be set aside only for “compelling reason”). 5. Reliance on Vocational Expert Testimony Monateri’s final argument is that, based on the ALJ’s determination that Monateri’s RFC was limited to simple work, the Vocational Expert (“VE”) should have been instructed to present only “the availability of jobs in the national economy which have a reasoning level of ‘1,’ as defined in the Dictionary of Occupational Titles (DOT).” As the Commissioner accurately points out, “Monateri cites no authority for the proposition that jobs requiring reasoning levels two or three are inconsistent as a matter of law with a limitation to simple work.” While the Commissioner “will take administrative notice of reliable job information available from . . . [the] Dictionary of Occupational Titles,” 20 C.F.R. § 404.1566(d), “the Social Security regulations do not obligate [the ALJ and consulting vocational experts] to rely on the Dictionary’s classifications.” Wright v. Massanari, 321 F.3d 611, 616 (6th Cir. 2003) (citing Conn v. Sec. of Health and Human Servs., 51 F.3d 607, 609 (6th Cir. 1995)). Because neither the Commissioner nor the VE has an obligation to employ the DOT, and there is no precedent that requires the Commissioner to align DOT “reasoning levels” with RFC classifications, Monateri’s argument is without merit.