Opinion ID: 222918
Heading Depth: 3
Heading Rank: 1

Heading: The Commissioner’s Opinion

Text: In denying Monateri’s claim, the ALJ found, at step one of the sequential five-step social security analysis, that Monateri had engaged in substantial gainful activity within the period of her disability, from autumn of 2005 through the spring of 2006, when she was employed full-time at Cintas. The ALJ further concluded that Monateri had not engaged in such activity before or after her time with Cintas. (App. 314-23: ALJ Op. at 4.) At the second step, the ALJ determined that Monateri had no physical impairments, but that she had the following severe mental impairments: polysubstance abuse/dependance, depressive disorder, panic disorder, and post-traumatic stress disorder. (Id.) The ALJ based this conclusion on the medical records in evidence, including the records supplied by Dr. Svete and Katherine Proehl. 12 No. 09-4524 At the third step, the ALJ found that while Monateri’s mental impairments met or exceeded the listed impairments when her substance abuse addition was included, they did not when substance abuse was excluded. (Id. at 5.) The ALJ summarized Monateri’s history of substance abuse, including her several admissions to drug detox facilities. The ALJ also noted Monateri’s testimony that from 1990 to 1999, her longest drug and alcohol-free period, she was “depression free and was feeling very good.” The ALJ then reviewed the medical evidence provided by Dr. Svete, who was identified as Monateri’s treating physician. While the ALJ credited Dr. Svete’s assessment of Monateri’s functional capacity, he only did so “with the inclusion of the factor of substance abuse.” (Id.) The ALJ so limited the weight given to Dr. Svete’s opinion because Dr. Svete “was not aware of [Monateri’s] return to substance abuse until January 2004, which means that he did not have an accurate picture of [Monateri’s] level of functioning.” (Id. at 8.) In considering the materiality of Monateri’s substance abuse, the ALJ additionally adopted the opinion of the medical expert, psychiatrist Dr. Gottfried Spring. Dr. Spring opined that, with the inclusion of the drug abuse, Monateri exhibited “moderate” or “marked” limitations in activities of daily living, maintaining social function, and sustaining concentration; excluding the drug abuse, Dr. Spring opined that Monateri showed “mild” to “moderate” limtations in these categories. He also opined that she would have repeated episodes of decompensation (i.e., functional deterioration) when abusing substances, but would only be expected to have one or two such episodes absent the abuse. (Id. at 6.) Dr. Spring testified that he reached his conclusions after reviewing all of Monateri’s medical evidence. 13 No. 09-4524 The ALJ read Dr. Svete’s 2003 opinion, in which he opined that Monateri was unemployable, alongside that of Dr. Spring, who testified that Monateri’s “abuse of prescription medications would exacerbate symptoms of anxiety and depression.” (Id. at 8.) The ALJ also took into consideration Proehl’s opinions, notes and statements regarding Monateri’s improved condition during recent periods of sobriety. After doing so, the ALJ determined that Dr. Svete’s opinion of Monateri’s condition was “not supported by sufficient corroborative medical evidence independent of considerations of substance abuse” and therefore “not entitled to either controlling weight or special deference.” (Id.) In reaching its conclusion, the ALJ further reviewed Monateri’s medical records, noting that Monateri is reported as doing “okay” and “regaining stability” in 2001, but that her condition worsened in 2001, when she “resumed substance abuse after a long period of sobriety.” (Id. at 7.) The ALJ also noted that Monateri’s “depressive symptoms . . . increased” after she “started using again,” resulting in “the need for inpatient treatment.” (Id.) Monateri’s medical records from Proehl also show that when she again lessened her drug abuse in 2006, she began functioning better. The ALJ also reviewed Monateri’s daily activities, including her testimony regarding her ability to do everyday household activities, engage in leisure activities— such as “read[ing] books, watch[ing] DVDs, and glanc[ing] through newspapers.” The ALJ considered Monateri’s testimony that “she has problems with concentration and has to re-read things,” “that she does not feel she could sustain any employment, and that she suffers from severe anxiety and ‘peaks and valleys’ of depression.” (Id.) 14 No. 09-4524 The ALJ noted that while Monateri has “had a number of admissions and crises related to the need for detox and substance abuse . . . [her] impairments have not otherwise required acute inpatient or outpatient emergency care and treatment during the period under review. . . . .” (Id.) Monateri’s most recent treatment notes, the ALJ stated, also supported the conclusion that “[w]hen [Monateri] is not abusing medication . . . the record shows a higher level of functioning compatible with work activity, (id. at 8), and that she “was previously capable of working without abusing substances.” (Id.) In consideration of the aforementioned, the ALJ concluded that “[e]vidence in the record regarding [Monateri’s] daily activities independent of substance abuse is consistent with a residual functional capacity for work.” (Id. at 7) The ALJ then continued to the fourth step of the social security inquiry, where he determined that Monateri was incapable of performing her past relevant work. (Id. at 9.) After hearing testimony from a vocational expert, the ALJ determined that there are a significant number of jobs in the economy that can be performed with Monateri’s residual functioning capacity (“RFC”) “simple, routine work.” (Id.) Consequently, the ALJ denied Monateri’s claim, based on the conclusion that Monateri “has not been under a ‘disability’ as defined in the Social Security Act, at any time through the date of th[e] decision, independent of considerations of substance abuse.” (Id. at 10.) B. Substantial Evidence Supporting the Determination We find that the ALJ’s determination was supported by sufficient evidence, as Monateri’s substance abuse was a contributing factor to her mental impairments; the ALJ did not violate the 15 No. 09-4524 treating physician rule by omitting the opinion of Dr. Bertschinger; the ALJ provided “good reasons” why it did not give controlling weight to the opinion of treating physician Dr. Svete; the ALJ’s partial adverse credibility finding against Monateri was supported by record evidence; and the ALJ did not err, as a matter of law, in accepting the testimony of the vocational expert.
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.