Opinion ID: 2982560
Heading Depth: 3
Heading Rank: 1

Heading: Weight Assigned to Dr. Papadakis’ Opinion

Text: Plaintiff asserts that the ALJ improperly accorded Papadakis’ opinion little to no weight. In rejecting Papadakis’ opinion, the ALJ stated the following, and only the following: The record contains no evidence of a treating relationship between Dr. Papadakis and the claimant. Furthermore, Dr. Papadakis’ opinion was based on a one-time examination. The claimant’s presentation to Dr. Papadakis was totally different than at another physical examination that same day. The only plausible explanation for his pessimistic assessment of the claimant’s functional capabilities is that such assessment was based on an unquestioning acceptance of claimant’s subjective complaints. Furthermore, the doctor’s opinion is unsupported by other evidence, especially treatment records from the claimant’s therapist. For these reasons, the opinion of Dr. Papadakis is given little, if any weight. A.R. 23–24 (internal citation omitted). This Court reviews this analysis and conclusion to determine whether they are supported by substantial evidence. First, the ALJ’s claim that Papadakis’ opinion and assignment of a GAF of 46 were based solely on an unquestioning acceptance of Plaintiff’s subjective complaints is inaccurate and not supported by evidence in the record. As the notes from Papadakis’ examination demonstrate, his opinion was only based in part on Plaintiff’s own self-reporting regarding his conditions. In 16 No. 13-4360 addition to those reports, Papadakis recorded notes regarding his own observations of Plaintiff’s physical symptoms and behavior. Papadakis observed that Plaintiff had difficulty walking, was sloppily dressed, and was quite tearful during the appointment, especially when discussing a friend killed in Vietnam. Papadakis observed that Plaintiff was anxious, “demonstrated above average levels of psychomotor agitation . . . was hypervigilant, suspicious, [and] looked around the room.” A.R. 238. Even if Papadakis had based his medical opinion solely on Plaintiff’s own reports of hallucinations, nightmares, flashbacks, isolation, and psychological numbness, that likely would not have provided a sufficient basis for the ALJ’s rejection of his medical opinion. This Court has acknowledged the difficulty inherent in proving psychological disabilities as follows: [A] psychiatric impairment is not as readily amenable to substantiation by objective laboratory testing as a medical impairment . . . consequently, the diagnostic techniques employed in the field of psychiatry may be somewhat less tangible than those in the field of medicine . . . . In general, mental disorders cannot be ascertained and verified as are most physical illnesses, for the mind cannot be probed by mechanical devices . . . in order to obtain objective clinical manifestations of medical illness . . . . [W]hen mental illness is the basis of a disability claim, clinical and laboratory data may consist of the diagnosis and observations of professionals trained in the field of psychopathology. The report of a psychiatrist should not be rejected simply because of the relative imprecision of the psychiatric methodology or the absence of substantial documentation, unless there are other reasons to question the diagnostic techniques. Blankenship v. Bowen, 874 F.2d 1116, 1121 (6th Cir. 1989) (quoting Poulin v. Bowen, 817 F.2d 865, 873–74 (D.C. Cir. 1987)). In the instant case, Papadakis based his conclusions regarding Plaintiff’s disability, in part, on the observed physical manifestations of Plaintiff’s symptoms and, in part, on Plaintiff’s self-reporting and descriptions of his own conditions. It would be impossible for a doctor to observe the contents of Plaintiff’s dreams, the intensity of his 17 No. 13-4360 hallucinations, or his flashbacks to the Vietnam War. Instead, Papadakis had to rely on these reports, most of which have been consistent throughout the time Plaintiff sought treatment from the VA. Even until his last recorded appointments in 2009, Plaintiff reported hallucinations, flashbacks, and bad dreams to Hugger and Sehbi. Although Plaintiff’s descriptions of his daily activities during this time period were not completely consistent, there is no indication in the record that Plaintiff’s reports to Papadakis were inaccurate or embellished for purposes of procuring disability benefits from the VA. Additionally, Papadakis observed Plaintiff’s physical symptoms, finding that he suffered from anxiety, agitation, and overwhelming emotion. Therefore, the ALJ’s articulated reason for rejecting Papadakis’ opinion is insufficient and not supported by the evidence in the record. The ALJ also rejected Papadakis’ opinion because Plaintiff presented differently later that same day at a physical examination following his appointment with Papadakis. This, however, is an insufficient basis for the ALJ’s rejection of the medical opinion. Plaintiff did attend a physical examination later that day, but it was unrelated to his PTSD and was specifically focused on his heart and lungs. Although the medical examiner’s notes do not mention difficulty walking, as was documented by Papadakis earlier that day, it is not evident that such a condition would have been acknowledged in the notes, as the majority of these notes are concerned with Plaintiff’s heart and lungs.4 Instead, the medical examiner noted Plaintiff’s elevated heart rate, which is consistent with the anxiety observed by Papadakis. Finally, the ALJ stated that Papadakis’ opinion was inconsistent with the rest of the evidence in the record, especially treatment records from Hugger, Plaintiff’s therapist. It is unclear from this statement which portions of the record are inconsistent with Papadakis’ 4 Perhaps, had Plaintiff walked into the appointment teary-eyed and limping, those conditions might have been documented in the notes. 18 No. 13-4360 opinion, but this Court reviews the record as a whole to determine whether the ALJ’s decision is supported by substantial evidence. Garner v. Heckler, 745 F.2d 383, 388 (6th Cir. 1984). As late as January 2009, Plaintiff’s treating psychiatrist increased one of Plaintiff’s depression and paranoia medications. Although Plaintiff’s GAF score had increased to 50 by 2009, such a score is still indicative of serious functional impairment and is consistent with a finding of disability. The ALJ failed to mention Sehbi and Sanders, both of whom found that Plaintiff faced difficulties and was properly diagnosed with PTSD. Both of their findings from 2005 through 2009 are consistent with a finding that Plaintiff is disabled. In particular, notes from Sanders’ August 2005 examination of Plaintiff was consistent with Papadakis’ opinion, stating that Plaintiff had slow speech and slow spontaneous movement, his mood was depressed, and his affect was congruent, often tearing. There is, however, some evidence in the record that Plaintiff’s condition has improved. Plaintiff met less frequently with his therapist and often demonstrated improvement over the course of individual therapy sessions. Even with his serious PTSD, Plaintiff is able to interact on a weekly basis with his family, attend his grandson’s sporting events, and drink coffee with a group of veterans every day. He is able to drive himself to and from the coffee shop on an almost daily basis and he drives his wife to the store, where he prefers not to interact with people and either remains in the car or sits at the front of the store while his wife shops. Although the record contains some evidence supporting the ALJ’s decision to accord Papadakis’ opinion little weight, it is not clear that the ALJ would have come to the same conclusion had she not mischaracterized the record, supported her conclusion with inaccurate and improper reasoning, and ignored the opinions of Sehbi and Sanders. Therefore, without more explanation for the rejection of Papadakis’ opinion and a more accurate characterization of 19 No. 13-4360 the record, this panel cannot find that the ALJ’s rejection of Papadakis’ opinion was proper and supported by substantial evidence. 2. Failure to Mention the Opinions of Drs. Sanders and Sehbi Additional grounds for remand are found in the ALJ’s failure to consider the opinions of—or even mention by name—two examining physicians, Dr. Sanders and Dr. Sehbi, one of which maintained a treating relationship with Plaintiff over a period of years. Dr. Sanders examined Plaintiff in 2005 and diagnosed him with combat related PTSD. He assigned him a GAF score of 45, reflecting serious symptoms or serious impairment, and recorded observations that support those findings, including that Plaintiff exhibited slow spontaneous movement and speech, that he was wary of noise in the hallway and positioned himself to keep an eye on the door, that Plaintiff’s thoughts centered on hopelessness and his mood was depressed and teary, that Plaintiff experienced survival guilt, and that he reported auditory and visual hallucinations. Sanders concluded that Plaintiff’s condition had “negative effects on work productivity, domestic relations, and quality of life” that “persist to the present time.” A.R. 271. Because Dr. Sanders’ findings provide evidence tending to support disability, and moreover provide additional support for Papadakis’ opinion by corroborating his observations of Plaintiffs’ depressive mood, tearfulness, hypervigilance, and reported hallucinations, the ALJ’s failure to consider these findings is troubling. An ALJ must consider all medical opinions provided in the record, and the opinion of an examining medical source like Sanders is generally given greater weight than the opinion of a non-examining source. 20 C.F.R. § 404.1527(c). Of course, an ALJ may depart from that general rule in light of her application of the factors set out 20 No. 13-4360 in § 404.1527(c), but here the ALJ gave no indication that she applied those factors to discount Sanders’ findings. On these facts, and particularly in light of Sanders’ examination of Plaintiff and the consistency of his observations with other examining medical sources in the record whose opinions were ignored or discounted, the ALJ’s failure to discuss Sanders’ opinion in any substantive way violates the requirement that administrative agencies must explain their reasoning. See S.E.C. v. Chenery Corp., 332 U.S. 194, 196-97 (1947) (the basis for an agency decision “must be set forth with such clarity as to be understandable” in order to enable judicial review); Hyatt Corp. v. NLRB, 939 F.2d 361, 367 (6th Cir. 1991) (the requirement that an agency state its reasons for a decision “imposes a discipline on the agency which prevents haphazard or arbitrary administrative action”). The ALJ’s failure to mention Dr. Sehbi by name or discuss his findings in any depth is even more concerning, since Sebhi treated Plaintiff from 2005 to 2009. Sehbi agreed with Plaintiff’s diagnosis of PTSD, and his notes reflect Plaintiff’s consistent symptoms of agitation and irritability, visual and auditory hallucinations, survival guilt, nightmares and difficulty sleeping, and a depressive and tearful affect. Sehbi assigned scores of 48, 52, 50, and 50 in 2005, 2006, 2007, and 2009. As late as January 30, 2009, notes from Sehbi’s appointment with Plaintiff indicate that Plaintiff continued to have dreams and flashbacks and that he was growing increasingly depressed. At that time, Sehbi increased the dosage for one of Plaintiff’s medications for depression, insomnia, and paranoia. As an initial matter, because Sehbi’s observations and opinions are consistent with the observations and opinions of both Papadakis and Sanders, and because taken together the findings of these three examining medical sources provide strong evidence of disability, the 21 No. 13-4360 ALJ’s omission of any substantive discussion of Sehbi’s findings deprives the Court of an adequate explanation of her findings. See Chenery Corp., supra; Hyatt Corp., supra. The failure to discuss Sehbi’s findings also runs contrary to the treating source rule set out at 20 C.F.R. § 404.1527(c)(2). If an ALJ finds that a treating source’s opinion is wellsupported and is not inconsistent with other evidence in the record, the ALJ gives it controlling weight. Even if the ALJ finds that the treating medical source’s opinion is not entitled to controlling weight, that determination must be fully explained. 29 C.F.R. § 404.1527(c)(2); SSR 96-2p. “Claimants are entitled to receive good reasons for the weight accorded their treating sources independent of their substantive right to receive disability benefits.” Smith v. Comm’r of Soc. Sec., 482 F.3d 873, 875 (6th Cir. 2007). The reasons provided by the ALJ 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 the weight.” SSR 96-2p. “An ALJ’s failure to follow [this rule] denotes a lack of substantial evidence, even where the conclusion of the ALJ may be justified based upon the record.” Cole v. Astrue, 661 F.3d 931, 939-40 (6th Cir. 2011) (internal quotation marks omitted). Sehbi was Plaintiff’s treating psychiatrist and he evaluated Plaintiff and prescribed medications during the relevant time period, yet the ALJ almost entirely ignored his opinions and reports in the record.5 The ALJ failed to even mention Sehbi by name and only considered some 5 The instant case is distinguishable from Heston v. Comm’r of Soc. Sec., 245 F.3d 528, 536 (6th Cir. 2001) in which this Court held that “[a]lthough the ALJ should have included a reference to the [treating doctor’s] report in its findings, the failure to do so . . . was harmless error.” The Court found the error harmless because the treating doctor’s report was outdated and unsupported. Additionally, the ALJ had clearly considered the treating doctor’s report and included some of its findings in the hypothetical question posed to the vocational expert. This case is also distinguishable from Vance v. Comm’r of Soc. Sec., 260 F. App’x 801, 805 (6th Cir. 22 No. 13-4360 isolated excerpts from his notes. This does not satisfy the requirements set forth in this Court’s case law, and this does not constitute a harmless error. Sehbi’s opinions were not “so patently deficient that the Commissioner could not possibly credit [them],” and the ALJ did not adopt Sehbi’s opinions or make findings consistent with them. Cole, 661 F.3d at 940. The most glaring inconsistent finding made by the ALJ is that Papadakis’ opinion was unsupported by other evidence in the record, despite the similarities between Papadakis’ and Sehbi’s observations and opinions. Additionally, although three out of the four GAF scores assigned to Plaintiff by Sehbi reflected Sehbi’s opinion that Plaintiff had serious symptoms or impairments, the ALJ minimized Plaintiff’s symptoms and concluded that Plaintiff’s impairments were either moderate or mild.6 Although there may be evidence in the record to support the ALJ’s departure from Sehbi’s finding, Plaintiff was entitled to receive “good reasons” why Sehbi’s opinion with regard to the “nature and severity” of his impairments were not given controlling weight. See 20 C.F.R. § 404.1527(c)(2). Additionally, we cannot “say that the goal of § 1527(d)(2)” was met because it is not clear that the ALJ properly considered these opinions, and it is not clear that the outcome would have been the same had the opinions been considered. 3. Weight Assigned to the VA’s Disability Determination A claimant may submit a broad range of evidence to prove that he or she is disabled, including decisions of governmental or non-governmental agencies about whether a claimant is disabled. 20 C.F.R. § 404.1512(b)(5). A disability determination made by another governmental 2008), because the ALJ in that case “did not summarily dismiss the treating physicians’ opinions; rather, the ALJ provided a lengthy, accurate, and thorough discussion of [the] treating physicians’ reports and findings.” 6 The GAF scores Sehbi assigned show that Plaintiff’s symptoms or impairments mostly remained “serious” over the course of his treatment. He did assign a score of 52 in 2006, placing Plaintiff on the serious end of the “moderate” spectrum, but Sehbi reduced the score to 50 in 2007 and repeated the score of 50 in 2009 at their last appointment. 23 No. 13-4360 agency is not binding on the Administration, but it “constitutes relevant evidence within the definition of [42 U.S.C.] § 405(g)” and therefore should be considered as part of the medical records presented by a claimant. Deloge v. Comm’r of Soc. Sec. Admin., 540 F. App’x 517, 518 (6th Cir. 2013). In the instant case, the VA’s disability determination was based on Papadakis’ assessment, Hugger’s notes, examinations by Sanders and Sehbi, and Plaintiff’s various GAF scores. In according minimal weight to the VA’s disability determination, the ALJ noted that the Plaintiff’s GAF score had increased to 50 by January 30, 2009, which the ALJ interpreted as a sign of Plaintiff’s improved condition. In rejecting the VA’s disability determination, the ALJ stated, The statement from the VA is based on the claimant’s therapist assigning the claimant a GAF score of “46” and the claimant’s statements that he continues to be depressed and isolates himself. However, the claimant’s GAF score rose by January 30, 2009, indicating improvement in his condition. In fact, the statement from the therapist referred to in the VA letter dated January 2007 is not credible because in 2006 the claimant and therapist agreed that the claimant no longer needed to be seen routinely and the claimant would call if he needed an appointment. This decision was based, in part, on the fact that the therapist had not seen the claimant for a year. Since that decision, the evidence shows that the claimant was seen by the therapist in August 2008, November 2008, March 2009, and October of 2009, certainly not evidence of continues [sic] severe PTSD and depression. In fact, the claimant said he had gotten better. The VA opinion is not supported by the great weight of the evidence. A.R. 27 (internal citations omitted). The ALJ’s description of the record is incorrect and lacks support in a number of respects. First, an examining doctor and a treating psychiatrist assigned Plaintiff’s GAF scores, not Plaintiff’s therapist. Sehbi’s assignment of a GAF score of 50 in 2009 is still indicative of 24 No. 13-4360 serious functional impairment, not of significantly improved mental health. Additionally, since April 2006, Plaintiff saw a psychiatrist or therapist on six additional, unaccounted-for occasions. In rejecting the VA’s disability determination, the ALJ did not explicitly consider the opinions of Sehbi and Sanders, selectively referred to notes from Plaintiff’s therapy appointments with Hugger, and improperly characterized a GAF score of 50 as showing significant improvement. Some of the ALJ’s conclusions rejecting the VA’s disability determination are inaccurate and reflect selective characterization of the record. However, the VA’s disability determination occurred in 2006, and the record shows that since that time, Plaintiff’s condition has shown some improvement. Plaintiff has an increased GAF score, meets less frequently with his therapist, socializes with other veterans at a local coffee shop, and attends his grandson’s sporting events. Although these factors might have been sufficient for according little weight to the VA’s disability determination in the absence of the ALJ’s errors, it is not clear that the ALJ’s decision would have been the same without these errors and without improper consideration of the treating sources’ opinions. 4. Weight Assigned to Dr. Lewis’ Opinion In according the non-examining state consulting psychologist’s opinion great weight, the ALJ stated, “Dr. Lewis’s opinion is given great weight as it is a credible estimation of the claimant’s work-related mental capacity and is not inconsistent with the evidence of record or the residual functional capacity found herein.” A.R. 25. On the other hand, the ALJ discredited part of Lewis’ analysis that found Plaintiff was moderately limited in his ability to perform activities of daily living because the evidence, including Plaintiff’s own testimony during the hearing, showed that Plaintiff was not as limited or isolated as Lewis believed. 25 No. 13-4360 Although the ALJ failed to articulate any reasons for elevating part of Lewis’ opinion over the other opinions in the record, her opinion is consistent with the record and is not contradicted by the findings of Sehbi, Sanders, or Hugger.7 Following a partial review of Plaintiff’s medical records, Lewis acknowledged Plaintiff’s treatment history and reviewed the record to gain an understanding of Plaintiff’s ability to perform daily life skills. Her report accurately summarized much of Plaintiff’s medical history, and there is no direct evidence in the record that contradicts Lewis’ findings. As a result, the ALJ did not err in according substantial weight to Lewis’ opinion.