Opinion ID: 783742
Heading Depth: 2
Heading Rank: 1

Heading: The Treating Physician's Opinion

Text: 6 In finding that Cox could return to her past relevant work as a shoe splitter, the ALJ improperly discounted the opinion of Dr. Van Alstine, Cox's treating physician. The ALJ maintained that Dr. Van Alstine's opinion was conclusory, invade[d] the province of the final decision maker, the Commissioner, and was inconsistent. (R. at 18.) None of the reasons put forth by the ALJ, however, are valid justifications for stripping Dr. Van Alstine's opinion of all its weight. 7 The ALJ is correct in stating that conclusory statements by a doctor, if unsupported by the medical record, do not bind the ALJ in his disability determination. Ward v. Heckler, 786 F.2d 844, 846 (8th Cir.1986) (per curiam) (Even statements made by a claimant's treating physician regarding the existence of a disability have been held to be properly discounted in favor of the contrary medical opinion of a consulting physician where the treating physician's statements were conclusory in nature.). It is the ALJ's job to reach a decision as to the claimant's legal disability by evaluating the objective medical evidence before him. Here, the ALJ found Dr. Van Alstine's June 21, 1999, letter to be conclusory, and an encroachment on his role as the adjudicator. In the letter, Dr. Van Alstine states: 8 Ms. Cox is a patient of mine who has significant problems with arthritis, especially in the costo-sternal area as well as having severe fibromyalgia. She is significantly dysfunction [sic] in terms of level of activity. Because of this, she is currently unable to work. I am in the process of adjusting medications in order to maximize her level of function and attempt to get her to a point where she may be able to work. At this time, she is not able to be gainfully employed. Office notes are available to you for review. 9 (R. at 161.) If this letter were the only available record from Dr. Van Alstine, the ALJ would have been correct in giving it little weight due to its conclusory nature. This letter, however, is only one part of a larger medical record supplied by Dr. Van Alstine and Cox's other treating physicians. 10 Dr. Cole, who treated Cox for approximately one year, referred her to a Pain Clinic expert, Dr. Van Alstine. (R. at 147.) By the time Dr. Van Alstine examined Cox, two doctors had already diagnosed her with fibromyalgia; 2 Dr. Van Alstine confirmed this diagnosis. Dr. Van Alstine continued to see Cox on a nearly monthly basis with Cox reporting significantly worsening pain problems. (R. at 176.) Each visit, the doctor prescribed a different combination of medications in order to alleviate Cox's pain. In January of 2000, Dr. Van Alstine recommended Cox join a fibromyalgia clinic in order to aid her in coping with the disease. 11 Viewed in context of her medical record, Dr. Van Alstine's letter is a culmination of the numerous visits Cox had with her past doctors, and his experience with treating her chronic pain. 3 See Turpin v. Bowen, 813 F.2d 165, 171 (8th Cir.1987) (refusing to characterize the treating physician's observations as conclusory since the doctor had numerous examinations and hospital visits with the claimant). 12 The ALJ further opined that Dr. Van Alstine's June 21, 1999, letter is inconsistent with an earlier observation the doctor made on May 3, 1999. In reference to his May 3, 1999, visit with Cox, 4 Dr. Van Alstine noted, [Cox] is an alert, oriented, white female who is neurologically unchanged. Overall, she is moving somewhat better. (R. at 151.) The June 21st letter, discussed above, states that Cox is not well enough to hold down a job. The ALJ found Dr. Van Alstine's earlier observation that she is moving somewhat better to be inconsistent with his ultimate opinion that Cox cannot be gainfully employed. We fail to see the inconsistency in these two statements. It is possible for a person's health to improve, and for the person to remain too disabled to work. 13 Having completely disregarded Dr. Van Alstine's medical opinion, the ALJ relied instead on the opinion of Dr. Leonard, a one-time consultative physician, and Disability Determination Service physicians who never examined Cox. We have stated many times that the results of a one-time medical evaluation do not constitute substantial evidence on which the ALJ can permissibly base his decision. See, e.g., Jenkins v. Apfel, 196 F.3d 922, 925 (8th Cir.1999) (stating that the opinion of a consultative physician does not generally satisfy the substantial evidence requirement). This is especially true when the consultative physician is the only examining doctor to contradict the treating physician. Id. 14 Dr. Leonard examined Cox on March 15, 2000. He completed a form entitled, Medical Source Statement of Ability to Do Work-Related Activities (Physical), and indicated in items 1-4 the following: Cox could lift fifty pounds both occasionally and frequently, and had no limitations on standing, walking, sitting, pulling, or pushing. (R. at 168-69.) On this form, Dr. Leonard was explicitly asked, What medical/clinical finding(s) support your conclusions in items 1-4 above? (R. at 169.) He did not answer this question, making it difficult to discern the basis for Dr. Leonard's medical opinion from the face of the form. We have no way of telling if Dr. Leonard accessed Cox's past medical records; 5 what tasks Cox performed during the examination; the length of Dr. Leonard's examination; or if Dr. Leonard is aware that the test for Cox's employability is whether she can work in a competitive national economy. See McCoy v. Schweiker, 683 F.2d 1138, 1147 (8th Cir.1982) (stating that the residual functional capacity of a claimant is the ability to perform the requisite physical acts day in and day out, in the sometimes competitive and stressful conditions in which real people work in the real world). These are all questions the ALJ should have asked in light of the ALJ's duty to develop the record. Hildebrand v. Barnhart, 302 F.3d 836, 838 (8th Cir.2002) ([T]he ALJ, on behalf of the Commissioner, is charged with the duty of fully and fairly developing the facts of the case. ( citing Cox 160 F.3d at 1209)). Even though the doctor provided no explanation for his conclusions as to Cox's abilities, the ALJ readily accepted Dr. Leonard's opinion. Instead, the ALJ should have obtained more information about the nature of Dr. Leonard's examination. This duty to uncover more facts is heightened because Dr. Leonard's evaluation directly contradicts Dr. Van Alstine's June letter, and the medical observations of several doctors leading up to the June letter.