Opinion ID: 2978412
Heading Depth: 2
Heading Rank: 2

Heading: analysis

Text: In social security cases, the Commissioner determines whether a claimant is disabled within the meaning of the Social Security Act and, thereby, entitled to benefits. 42 U.S.C. § 405(h). Our review of the ALJ’s decision is limited to whether the ALJ applied the correct legal standards and whether the findings of the ALJ are supported by substantial evidence. Key v. Callahan, 109 F.3d 270, 273 (6th Cir. 1997). The substantial-evidence standard is met if a “reasonable mind might accept the relevant evidence as adequate to support a conclusion.” Warner v. Comm’r of Soc. Sec., 375 F.3d 387, 390 (6th Cir. 2004). “The substantial-evidence standard . . . presupposes that there is a zone of choice within which the No. 08-6270 Blakley v. Comm’r of Soc. Sec. Page 9 decisionmakers can go either way, without interference by the courts.” Mullen v. Bowen, 800 F.2d 535, 545 (6th Cir.1986). Therefore, if substantial evidence supports the ALJ’s decision, this Court defers to that finding “even if there is substantial evidence in the record that would have supported an opposite conclusion.” Callahan, 109 F.3d at 273. We give de novo review to the district court’s conclusions on each issue. Valley v. Comm’r of Soc. Sec., 427 F.3d 388, 390 (6th Cir. 2005). B. The Treating Physician Rule and the “Reason-Giving Requirement” In assessing the medical evidence supporting a claim for disability benefits, the ALJ must adhere to certain standards. One such standard, known as the treating physician rule, requires the ALJ to generally give greater deference to the opinions of treating physicians than to the opinions of non-treating physicians because “these sources are likely to be the medical professionals most able to provide a detailed, longitudinal picture of [the claimant’s] medical impairment(s) and may bring a unique perspective to the medical evidence that cannot be obtained from the objective medical findings alone or from reports of individual examinations, such as consultative examinations or brief hospitalizations.” Wilson, 378 F.3d at 544 (quoting 20 C.F.R. § 404.1527(d)(2)). The ALJ “must” give a treating source opinion controlling weight if the treating source opinion is “well-supported by medically acceptable clinical and laboratory diagnostic techniques” and is “not inconsistent with the other substantial evidence in [the] case record.” Wilson, 378 F.3d at 544 (quoting 20 C.F.R. § 404.1527(d)(2)). On the other hand, a Social 1 Security Ruling explains that “[i]t is an error to give an opinion controlling weight simply because it is the opinion of a treating source if it is not well-supported by medically acceptable clinical and laboratory diagnostic techniques or if it is inconsistent the with other substantial evidence in the case record.” Soc. Sec. Rul. 96-2p, 1996 WL 374188, at  (July 2, 1996). If the ALJ does not accord controlling weight to a treating physician, the ALJ must still determine how much weight is appropriate by considering 1 Although Social Security Rulings do not have the same force and effect as statutes or regulations, “[t]hey are binding on all components of the Social Security Administration” and “represent precedent final opinions and orders and statements of policy” upon which we rely in adjudicating cases. 20 C.F.R. § 402.35(b). No. 08-6270 Blakley v. Comm’r of Soc. Sec. Page 10 a number of factors, including the length of the treatment relationship and the frequency of examination, the nature and extent of the treatment relationship, supportability of the opinion, consistency of the opinion with the record as a whole, and any specialization of the treating physician. Wilson, 378 F.3d at 544; see also 20 C.F.R. § 404.1527(d)(2). Closely associated with the treating physician rule, the regulations require the ALJ to “always give good reasons in [the] notice of determination or decision for the weight” given to the claimant’s treating source’s opinion. 20 C.F.R. § 404.1527(d)(2). Those good reasons must be “supported by the evidence in the case record, and must be sufficiently specific to make clear to any subsequent reviewers the weight the adjudicator gave to the treating source’s medical opinion and the reasons for that weight.” Soc. Sec. Rul. 96-2p, 1996 WL 374188, at . The Wilson Court explained the two-fold purpose behind this procedural requirement: “The requirement of reason-giving exists, in part, to let claimants understand the disposition of their cases,” particularly in situations where a claimant knows that his physician has deemed him disabled and therefore “might be especially bewildered when told by an administrative bureaucracy that she is not, unless some reason for the agency’s decision is supplied.” Snell v. Apfel, 177 F.3d 128, 134 (2d Cir. 1999). The requirement also ensures that the ALJ applies the treating physician rule and permits meaningful review of the ALJ’s application of the rule. Wilson, 378 F.3d at 544. Because the reason-giving requirement exists to “ensur[e] that each denied claimant receives fair process,” we have held that an ALJ’s “failure to follow the procedural requirement of identifying the reasons for discounting the opinions and for explaining precisely how those reasons affected the weight” given “denotes a lack of substantial evidence, even where the conclusion of the ALJ may be justified based upon the record.” Rogers v. Comm’r of Soc. Sec., 486 F.3d 234, 243 (6th Cir. 2007) (emphasis added). Here, the ALJ favored the opinions of the state agency physicians over Blakley’s treating sources, but as we demonstrate in the next section, the ALJ violated Agency regulations by failing to adequately explain the weight given to the treating physicians in her decision. No. 08-6270 Blakley v. Comm’r of Soc. Sec. Page 11 C. The ALJ Failed to Properly Evaluate Blakley’s Treating Physicians
The ALJ has placed nothing on the record indicating that she considered the opinion of Dr. Kiefer as a treating physician. “Classifying a medical source requires us to interpret the definitions in [20 C.F.R.] § 404.1502, a question of law we review de novo.” Smith v. Comm’r of Soc. Sec., 482 F.3d 873, 876 (6th Cir. 2007). We accord substantial deference to any factual finding by the ALJ that bears on the question, however. Id. Here, the ALJ did not make any findings on the record with respect to Dr. Kiefer, so we do not defer to the ALJ’s decision. A physician is a treating source if he has provided medical treatment or evaluation and has had an ongoing treatment relationship with the claimant . . . “with a frequency consistent with accepted medical practice for the type of treatment and/or evaluation [that is] typical for the [treated condition(s)].” 20 C.F.R. § 404.1502. Dr. Kiefer treated Blakley’s neck injury and performed the discectomy. As such, Dr. Kiefer developed an extensive treatment relationship, spanning over one year, and qualifies as one of Blakley’s treating physicians. In addition to performing Blakley’s discectomy in July 2004, Dr. Kiefer provided ongoing medical notes for Blakley from April 2004 through April 2005. Dr. Kiefer also continued to send Blakley for MRIs, CT scans, and x-rays based on Blakley’s complaints of pain. And those studies revealed objective findings of degenerative disc disease in the cervical and thoracic spine. Dr. Kiefer expressed concern that the degenerative disc disease in Blakley’s thoracic spine may require “aggressive” treatment. Dr. Kiefer also made Blakley’s diagnosis of carpal tunnel syndrome. Therefore, as a treating physician, any opinions Dr. Kiefer made should have been given controlling weight absent justifiable reasons–made on the record–for discounting those opinions. Soc. Sec. Rul. 96-2p, 1996 WL 374188, at -5. However, Dr. Kiefer is not mentioned anywhere in the ALJ’s opinion. No. 08-6270 Blakley v. Comm’r of Soc. Sec. Page 12
Dr. Kibler performed two surgeries on Blakley, a rotator cuff repair in October 2004 and AC joint repair in May 2005, and provided notes on Blakley from February 2004 through February 2006. The ALJ rejected Dr. Kibler’s assessment as follows: Although a treating physician [i.e., Dr. Kibler] indicated [Blakley] should not do more than 20 pounds lifting to his waist and no overhead lifting on a repetitive basis, the possibility always exists that a doctor may express an opinion in an effort to assist a patient with whom he or she sympathizes for one reason or another. Another reality which should be mentioned is that patients can be quite insistent and demanding in seeking supportive notes or reports from their physicians, who might provide such a note in order to satisfy their patient’s requests and avoid unnecessary doctor/patient tension. While it is difficult to confirm the presence of such motives, they are more likely in situations where the opinion in question departs substantially from the rest of the evidence of record, as in the current case. Even assuming arguendo that the ALJ correctly reached her determination that Dr. Kibler should be discredited, the ALJ’s summary rejection of Dr. Kibler without explaining the weight given his opinions falls short of the Agency’s own procedural requirements: “[A] finding that a treating source medical opinion . . . is inconsistent with the other substantial evidence in the case record means only that the opinion is not entitled to ‘controlling weight,’ not that the opinion should be rejected.” Soc. Sec. Rul. 96-2p, 1996 WL 374188, at . “Treating source medical opinions are still entitled to deference and must be weighed using all of the factors provided in 20 C.F.R. § 404.1527 and 416.927.” Id.
Dr. Raza began his relationship with Blakley as a consulting psychiatrist in 2004. That relationship expanded to include treatment at the Cumberland River Comprehensive Care Center in 2005. Though the ALJ summarizes Blakley’s time at Cumberland, which is Dr. Raza’s place of practice, the ALJ does not explain in her decision whether she weighed Dr. Raza as an expert, a treater, or both. Here again, the No. 08-6270 Blakley v. Comm’r of Soc. Sec. Page 13 ALJ failed to account for Dr. Raza’s opinions as a treating physician in disregard of 20 C.F.R. § 404.1527. D. The State Agency Physicians’ Opinions The ALJ adopted the 2005 findings of the state agency physicians, as well as a state agency psychologist, in finding that Blakley was not disabled.2 As justification, the ALJ mentions only that “[t]he finding that the claimant can perform a range of medium work is consistent with the opinion of the State Agency medical consultants.” Certainly, the ALJ’s decision to accord greater weight to state agency physicians over Blakley’s treating sources was not, by itself, reversible error. “In appropriate circumstances, opinions from State agency medical . . . consultants . . . may be entitled to greater weight than the opinions of treating or examining sources.” Soc. Sec. Rul. 966p, 1996 WL 374180, at  (July 2, 1996). One such circumstance may occur, for example, when the “State agency medical . . . consultant’s opinion is based on a review of a complete case record that . . . provides more detailed and comprehensive information than what was available to the individual’s treating source.” Id. Here, however, the Agency’s non-examining sources offered their opinions, upon which the ALJ relied, on June 30, 2005, and September 21, 2005. Consequently, those non-examining sources did not have the opportunity to review, at minimum, Dr. Kibler’s October 2005 assessment, Dr. Kibler’s December 2005 restrictions, Dr. Muffly’s June 2006 review, and Dr. Raza’s psychiatric treatment records. And because much of the over 300 pages of medical evidence reflects ongoing treatment and notes by Blakley’s treating sources, “we require some indication that the ALJ at least considered these facts before giving greater weight to an opinion that is not ‘based on a review of a complete 2 In adopting the opinions and RFC determination given by the state agency physicians, the ALJ also dismissed Dr. Muffly and Dr. Belew’s consultative opinions, stating that their “conclusory statements are inconsistent with the claimant’s benign clinical examinations, objective tests, and conservative treatment history.” The ALJ further discredited Dr. Muffly’s “generalized statements of disability” because (1) those “statements are inconsistent with the claimant’s benign clinical examinations, objective tests, and conservative treatment history,” (2) because Dr. Muffly saw Blakley “through attorney referral,” and (3) because Dr. Muffly’s opinion that Blakley is disabled requires a vocational analysis that is reserved to the Commissioner. No. 08-6270 Blakley v. Comm’r of Soc. Sec. Page 14 case record.’” Fisk v. Astrue, 253 F. App’x 580, 585 (6th Cir. 2007) (quoting Soc. Sec. Rul. 96-6p, 1996 WL 374180, at ). E. The Agency’s Failure to Follow its Regulations Was Not Excusable Harmless Error The Wilson Court instructs that where the ALJ fails to give good reasons on the record for according less than controlling weight to treating sources, we reverse and remand unless the error is a harmless de minimis procedural violation. See Wilson, 378 F.3d at 547. Such harmless error may include the instance where “a treating source’s opinion is so patently deficient that the Commissioner could not possibly credit it,” or where the Commissioner “has met the goal of . . . the procedural safeguard of reasons.” Wilson, 378 F.3d at 547. However, the ALJ’s failure to follow the Agency’s procedural rule does not qualify as harmless error where we cannot engage in “meaningful review” of the ALJ’s decision. Id. at 544. In this case, the ALJ’s incomplete weighing of Blakley’s treating sources is not an excusable de minimis procedural violation. First, we cannot engage in meaningful review of the ALJ’s decision because her reasoning is not “sufficiently specific to make clear,” Soc. Sec. Rul. 96-2p, 1996 WL 374188, at , that the ALJ recognized and evaluated the treating relationships of Drs. Kiefer, Kibler, and Raza. Second, we cannot tell whether the ALJ recognized that Dr. Raza treated Blakley for a significant period of time after his injury and was not only a consulting source. Third, there is no evidence in the record that any of the recommendations of these treating sources is “so patently deficient that the Commissioner could not possibly credit it.” Wilson, 378 F.3d at 547. To the contrary, Blakley’s numerous x-rays, CT scans, and MRIs present objective findings that are, at the very least, not inconsistent with his treating physicians’ opinions. And finally, even if we were to agree that substantial evidence supports the ALJ’s weighing of each of these doctors’ opinions, substantial evidence alone does not excuse non-compliance with 20 C.F.R. § 404.1527(d)(2) as harmless error. See Wilson, 378 F.3d at 546 (“[T]o recognize substantial evidence as a defense to non-compliance with § 1527(d)(2)[] would afford the Commissioner the No. 08-6270 Blakley v. Comm’r of Soc. Sec. Page 15 ability [to] violate the regulation with impunity and render the protections promised therein illusory. The general administrative law rule, after all, is for a reviewing court, in addition to whatever substantive factual or legal review is appropriate, to ‘set aside agency action . . . found to be . . . without observance of procedure required by law.’” (quoting Administrative Procedure Act, 5 U.S.C. § 706(2)(D) (2001))). The Wilson Court cautioned that an agency’s failure to follow its own regulations may cause “unjust discrimination,” “deny adequate notice,” and consequently “may result in a violation of an individual’s constitutional right to due process.” Wilson, 378 F.3d at 545 (quoting Sameena, Inc., v. U. S. Air Force, 147 F.3d 1148, 1153 (9th Cir. 1998)). We publish this decision as a modest reminder--that the Commissioner must follow his own procedural regulations in crediting medical opinions.