Opinion ID: 2977656
Heading Depth: 2
Heading Rank: 1

Heading: standard of review

Text: “This court’s review of the Commissioner’s decision is limited to determining whether it is supported by substantial evidence and was made pursuant to proper legal standards.” Rogers v. Comm’r of Soc. Sec., 486 F.3d 234, 241 (6th Cir. 2007). “Substantial evidence is ‘such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.’” Howard v. Comm’r of Soc. Sec., 276 F.3d 235, 237-38 (6th Cir. 2002) (quoting Richardson v. Perales, 402 U.S. 389, 401 (1971)). A social security disability determination is made in accordance with the five-step sequential analysis set forth in 20 C.F.R. § 404.1520: 9 First, [White] must demonstrate that [he] is not currently engaged in substantial gainful employment at the time of the disability application. 20 C.F.R. § 404.1520(b). Second, [White] must show that [he] suffers from a severe impairment. 20 C.F.R. § 404.1520(c). Third, if [White] is not engaged in substantial gainful employment and has a severe impairment which is expected to last for at least twelve months, which meets or equals a listed impairment, [he] will be considered disabled without regard to age, education, and work experience. 20 C.F.R. § 404.1520(d). Fourth, if the Commissioner cannot make a determination of disability based on medical evaluations and current work activity and [White] has a severe impairment, the Commissioner will then review [White’s] residual functional capacity (RFC) and relevant past work to determine if [he] can do past work; if so, [he] is not disabled. 20 C.F.R. § 404.1520(e). Howard, 276 F.3d at 238. In White’s case, The ALJ determined that the first four parts did not entitle [White] to disability benefits, so this case turns on the fifth: if [White’s] impairment prevents [him] from doing past work, the Commissioner will consider [his] RFC, age, education and past work experience to determine if [he] can perform other work. If [he] cannot perform other work, the Commissioner will find [him] disabled. 20 C.F.R. § 404.1520(f). The Commissioner has the burden of proof only on “the fifth step, proving that there is work available in the economy that the claimant can perform.” Her v. Comm’r of Soc. Sec., 203 F.3d 388, 391 (6th Cir. 1999). To meet the burden of showing that [White] could perform work that is available in the national economy, the Commissioner must make a finding “supported by substantial evidence that [White] has the vocational qualifications to perform specific jobs.” Varley v. Sec’y of Health & Human Servs., 820 F.2d 777, 779 (6th Cir. 1987). This kind of “[s]ubstantial evidence may be produced through reliance on the testimony of a vocational expert (VE) in response to a ‘hypothetical’ question, but only ‘if the question accurately portrays [White’s] individual physical and mental impairments.’” Id. (citations omitted). Id. After considering White’s age, education, past relevant work experience, and RFC, along with the testimony of the vocational expert, the ALJ determined that White was able to perform other work and was not disabled. White argues that this determination is not supported by substantial evidence. 10 B. Whether the ALJ’s Decision Is Supported by Substantial Evidence White argues that the ALJ’s decision was not supported by substantial evidence for three reasons. First, White argues that the ALJ did not properly consider the opinions of White’s treating physicians, Dr. Basch and Dr. Smith. Second, White argues that the ALJ erred by not finding that White had a significant mental impairment. Finally, White argues that substantial evidence does not support the finding that White could have performed a limited range of light work and that the ALJ failed to follow the vocational expert’s responses to the hypothetical questions that accurately portrayed White’s physical and mental state. We first discuss whether the ALJ’s RFC determination that White could perform a limited range of light work was supported by substantial evidence and then discuss whether the vocational expert’s testimony in response to the ALJ’s hypothetical question provides substantial evidence to support the ALJ’s finding that White could perform other work. We conclude that both the ALJ’s RFC determination and the ALJ’s finding of other work were not supported by substantial evidence.
A claimant’s “RFC is an assessment of an individual’s ability to do sustained work-related physical and mental activities in a work setting on a regular and continuing basis,” which is defined as “8 hours a day, for 5 days a week, or an equivalent work schedule.” Soc. Sec. Rul. 96-8p, 1996 WL 374184, at  (July 2, 1996) (Policy Interpretation Ruling Titles II and XVI: Assessing Residual Functional Capacity in Initial Claims). The ALJ found that White “retains the following residual functional capacity: light work with a sit/stand option; occasional pushing and pulling with [right lower extremity]; and occasional bending, kneeling, squatting, crouching, and crawling.” A.R. at 19 (ALJ Decision at 6). White argues that the ALJ erred in making this finding by not properly 11 considering the opinions of White’s treating physicians, by not considering White’s significant mental impairment, and by not crediting White’s testimony, particularly on the effects of his pain and his pain medication.
Under the “treating source” rule, the ALJ must “‘give good reasons’ for not giving weight to a treating physician in the context of a disability determination.” Wilson v. Comm’r of Soc. Sec., 378 F.3d 541, 544 (6th Cir. 2004) (quoting 20 C.F.R. § 404.1527(d)(2)). Pursuant to this rule, “if the opinion of the treating physician as to the nature and severity of a claimant’s conditions is ‘well-supported by medically acceptable clinical and laboratory diagnostic techniques and is not inconsistent with other substantial evidence in [the] case record,’ then it will be accorded controlling weight.” Rogers, 486 F.3d at 242 (quoting Wilson, 378 F.3d at 544). “When the treating physician’s opinion is not controlling, the ALJ, in determining how much weight is appropriate, must consider a host of factors, including the length, frequency, nature, and extent of the treatment relationship; the supportability and consistency of the physician’s conclusions; the specialization of the physician; and any other relevant factors.” Id. “However, in all cases there remains a presumption, albeit a rebuttable one, that the opinion of a treating physician is entitled to great deference, its non-controlling status notwithstanding.” Id. “It is true, however, that the ultimate decision of disability rests with the administrative law judge.” Walker v. Sec’y of Health & Human Servs., 980 F.2d 1066, 1070 (6th Cir. 1992). White argues that, because his treating physicians, Dr. Basch and Dr. Smith, advised him not to return to work, the ALJ erred by discounting their opinions regarding White’s disability when there was nothing in the record, except the state agency physician’s report, that supported a conclusion that White could perform limited light work. The Commissioner argues 12 that a treating physician’s opinion that a claimant cannot return to work is not conclusive on the ultimate issue of disability and that the ALJ gave the requisite “good reasons” for discounting the opinions of the treating physicians. We conclude that the ALJ did not give sufficient reasons for discounting the opinion of Dr. Basch as to White’s limitations. Although the ALJ was correct that the opinions of Dr. Basch and Dr. Smith were not conclusive on disability, particularly because they referred to White’s ability to perform his current job rather than other jobs, the ALJ does not give good reasons for entirely discounting the remainder of Dr. Basch’s opinions. The ALJ stated that he did not give Dr. Basch’s opinion great weight “because his opinion is inconsistent with his own office notes that indicate the claimant receives good pain relief for four to seven weeks from nerve block injections.” A.R. at 18 (ALJ Decision at 5). However, although Dr. Basch did find that White obtained temporary relief from the nerve blocks, the key is that this relief was temporary, lasting for only three to seven weeks. Dr. Basch’s notes repeatedly state that, aside from the temporary relief from the injections, no viable treatments are working and there is nothing more that can be done to relieve White’s pain. This is in no way inconsistent with the conclusion that White’s pain would prevent him from consistently holding a job and therefore is not a good reason for entirely discounting Dr. Basch’s opinion as internally inconsistent. As we have previously stated, a doctor’s report is not inconsistent with a finding of disability merely because it states that the claimant’s physical impairment has improved. Walker, 980 F.2d at 1071. As the magistrate judge noted, Dr. Basch found that White could not perform work involving sitting, squatting, or twisting, because it places too much pressure on his nerve. This is inconsistent with the RFC, which allows for occasional pushing and pulling with the right leg and occasional 13 bending, kneeling, squatting, crouching, and crawling. Although, as the district court noted, Dr. Basch found that White should walk more, he also found that when White did walk more as instructed, the pain became unbearable. The ALJ stated that Dr. Basch’s recent office notes reported that White was becoming more active, but the ALJ failed to note that in that same sentence Dr. Basch reported that the increased activity was increasing White’s pain. As we have noted, “the fact that a patient is encouraged to remain active does not reflect the manner in which such activities may aggravate the patient’s symptoms.” Rogers, 486 F.3d at 249.
White also argues that the ALJ erred by failing to find that White had a significant mental impairment even though Dr. McDowell diagnosed White with adjustment disorder and depression, giving him a GAF of score of 55, indicating moderate symptoms. In discussing White’s mental impairment, the ALJ found that it was not severe because, although he was diagnosed with “adjustment disorder” and was prescribed an anti-depressant medication, the anti-depressant was “more for pain relief and sleep than for depressive symptoms,” and White “does not participate in mental health counseling on a consistent basis and has only mild to no limitations in his activities . . . due to a mental health impairment.” A.R. at 18 (ALJ Decision at 5). Although the ALJ did not err in finding that White’s mental impairment was not severe, the ALJ gave no explanation for totally discounting the objective evidence of White’s mental impairment in determining White’s RFC. Once one severe impairment is found, the combined effect of all impairments must be considered, even if other impairments would not be severe. See 20 C.F.R. §§ 404.1523, 404.1545(a)(2). The Commissioner correctly states that Dr. McDowell did not note any limitations caused by White’s mental impairment and that the ALJ was therefore not 14 required to include the GAF finding in the RFC. Howard, 276 F.3d at 241. The ALJ’s total discounting of White’s mental impairments, however, is not supported by substantial evidence, because the ALJ mischaracterizes the evidence and misstates Dr. Basch’s reasons for prescribing anti-depressants. When first prescribing them, Dr. Basch stated “[White] is becoming depressed and discouraged. His wife concurs. . . . The chronic pain plus what appears to be an impending disability is weighing heavily upon him.” A.R. at 229 (Basch Office Notes 9/15/2003). At a later visit, Dr. Basch increased the dosage because White “feels overwhelmingly depressed because of the combination of the chronic pain and inability to sleep because of pain.” A.R. at 252 (Basch Office Notes 1/21/2005). Contrary to the ALJ’s statement, the anti-depressants were not prescribed for “pain relief and sleep,” A.R. at 18 (ALJ Decision at 5), but because the pain and lack of sleep were causing depression. Because the ALJ does not accurately state the evidence used to support his finding, his total discounting of the mental impairment is not supported by substantial evidence.
White argues that substantial evidence does not support the ALJ’s discounting of White’s testimony about his impairments. We recently discussed the two-part analysis “used in evaluating complaints of disabling pain”: First, the ALJ will ask whether the there is an underlying medically determinable physical impairment that could reasonably be expected to produce the claimant’s symptoms. 20 C.F.R. § 416.929(a). Second, if the ALJ finds that such an impairment exists, then he must evaluate the intensity, persistence, and limiting effects of the symptoms on the individual’s ability to do basic work activities. Id. Relevant factors for the ALJ to consider in his evaluation of symptoms include the claimant’s daily activities; the location, duration, frequency, and intensity of symptoms; factors that precipitate and aggravate symptoms; the type, dosage, effectiveness, and side effects of any medication taken to alleviate the symptoms; other treatment undertaken to relieve symptoms; other measures taken to relieve 15 symptoms, such as lying on one’s back; and any other factors bearing on the limitations of the claimant to perform basic functions. Id. Rogers, 486 F.3d at 247; see also 20 C.F.R. § 404.1529(a). Although it is “for the ALJ, and not the reviewing court, to evaluate the credibility of witnesses, including that of the claimant,” “the ALJ is not free to make credibility determinations based solely upon an ‘intangible or intuitive notion about an individual’s credibility.’” Rogers, 486 F.3d at 247 (quoting Soc. Sec. Rul. 96-7p, 1996 WL 374186, at  (July 2, 1996) (Policy Interpretation Ruling Titles II and XVI: Evaluation of Symptoms in Disability Claims: Assessing the Credibility of an Individual’s Statements)). In Rogers, the claimant asserted disability based on pain caused by fibromyalgia, and we reversed and remanded the ALJ’s decision, in part because the ALJ failed to evaluate properly the claimant’s credibility by over-emphasizing objective findings, mischaracterizing the scope of the claimant’s daily activities, and placing unwarranted significance on a physician’s testimony that the best treatment was regular exercise. Id. at 248-49. Here, the ALJ found that White’s “description of his limitations exceeds medical substantiation, is not consistent with other evidence and is not credible.” A.R. at 19 (ALJ Decision at 6). The ALJ stated that he “considered all symptoms, including pain, and the extent to which these symptoms can reasonably be accepted as consistent with the objective medical evidence and other evidence based on the requirements of 20 CFR § 404.1529, and Social Security Ruling 96-7p” and relevant medical opinions, id., but he did not explain how the objective evidence was inconsistent with White’s testimony. He seems to have based this finding on the fact that White testified that “[h]e is able to drive, handle the family finances, help care for six children, and use a computer” and that he “was teaching his son how to do yard work.” Id. But this “mischaracterizes 16 [White’s] testimony regarding the scope of [his] daily activities [and] fails to examine the physical effects coextensive with their performance.” Rogers, 486 F.3d at 248-49. White testified, for example, that he drove very little because of pain and his medications, that he was supervising his sons in doing yard work because he could no longer do it himself, and that he could no longer help his children get ready in the morning or help with their homework. White’s subjective complaints are consistent with this testimony and with the activities questionnaires he completed as part of his application. Further, White’s extensive work history and attempts to continue working despite his disability support his credibility, a factor not even considered by the ALJ. See Schaal v. Apfel, 134 F.3d 496, 502 (2d Cir. 1998) (“[A] good work history may be deemed probative of credibility . . . .”); Soc. Sec. Rul. 96-7p, 1996 WL 374186, at . Much of White’s testimony would affect his RFC determination. For example, White testified that he experienced fatigue and forgetfulness with his medication. The ALJ also found no evidence that White had trouble walking because he had not been prescribed a cane, but White testified that he already had obtained one without a prescription. As in Rogers, we conclude that the ALJ’s decision “fails to ‘contain specific reasons for the finding on credibility, supported by the evidence in the case record’” and is not “‘sufficiently specific to make clear to the individual and to any subsequent reviewers the weight the adjudicator gave to [White’s] statements and the reasons for that weight.’” Rogers, 486 F.3d at 248-49 (quoting Soc. Sec. Rul. 96-7p, 1996 WL 374186, at ). 17
White argues that, because the ALJ did not have substantial evidence to support the finding that White could perform limited light work, the hypothetical question posed to the vocational expert was inaccurate, and the ALJ should not have relied on the answer in finding that there were other jobs that White could perform. White argues that later hypothetical questions asked of the vocational expert by White’s attorney accurately portrayed White’s limitations. The ALJ posed three hypothetical questions to the vocational expert and relied on the answer to the third question in determining that White could perform other work. That question asked the vocational expert to assume an individual the same age as the claimant, same educational background and with the journeyman’s card and same past work you described. This person is limited to doing light exertional work with occasional postural movement, and occasional pushing and pulling with the right lower extremity and also needing to alternate sitting and standing at will, so I’ll call that a sit/stand at will option. A.R. at 315-16 (Hr’g Tr. at 46-47). Because the hypothetical question simply restates the RFC, and because, as discussed above, the RFC does not accurately portray White’s limitations, the hypothetical question suffers from the same problems as the RFC, and thus the ALJ erred in relying on the answer to this question. Moreover, we have explained that the purpose of a hypothetical question is different than that of an RFC: “while the RFC should focus on [White’s] abilities or, in other words, what [White] can and cannot do, the hypothetical question should focus on [White’s] overall state including [White’s] mental and physical maladies.” Howard, 276 F.3d at 239. The “RFC is to be an ‘assessment of [White’s] remaining capacity for work’ once [his] limitations have been taken into account.’” Id. (quoting 20 C.F.R. § 416.945). In other words, the RFC “is an assessment of what [White] can and cannot do, not what [he] does and does not suffer from.” Id. “The hypothetical question posed to 18 a [vocational expert] for purposes of determining whether [White] can perform other work, on the other hand, should be a more complete assessment of [his] physical and mental state and should include an ‘accurate[ ] portray[al] [of his] individual physical and mental impairment[s].’” Id. (quoting Varley v. Sec’y of Health & Human Servs., 820 F.2d 777, 779 (6th Cir. 1987); Myers v. Weinberger, 514 F.2d 293, 294 (6th Cir. 1975)). In Howard, we found that the vocational expert’s testimony was not sufficient evidence to support the ALJ’s finding that the claimant could perform “other work,” because the question did not include the ALJ’s findings on the claimant’s physical ailments and diagnoses and because the question did not accurately portray the claimant’s mental state. 276 F.3d at 241. Here, the ALJ’s reliance on the answer to the hypothetical question is further flawed to the extent that it did not accurately portray White’s physical and mental impairments. Specifically, the question made no mention of White’s mental state. Dr. McDowell, White’s treating psychologist, diagnosed him with adjustment disorder and depression and gave him a GAF score of 55, which indicates moderate symptoms or moderate difficulties in social, occupational, or school functioning. As discussed above, the ALJ did not have to include this finding in the RFC. Howard, 276 F.3d at 241. However, Howard does direct the ALJ to include the diagnosis of mental impairment in the hypothetical question. Further, the question did not account for the side effects of the pain medication. When questioned by White’s attorney, the vocational expert admitted that the listed jobs would be eliminated if the person dozes off during the day or has mental confusion and forgetfulness. The Commissioner argues that these symptoms correctly were not included in the question because the ALJ found that White’s testimony was not credible. As discussed above, there was not substantial 19 evidence to discount White’s testimony that the pain medication left him drowsy and fatigued. White has been on several potent pain medications, including Valium, Vicodin, and a Duragesic patch, which are known to have powerful side effects such as drowsiness, fatigue, light-headedness, and weakness. Further, Dr. Basch’s office notes indicate that, far from abusing these medications, White was concerned about the side effects and at times asked to have his dosage decreased. The ALJ’s determination is thus not entitled to substantial weight to the extent that it discounted the side effects of White’s medications. C. Award of Benefits “If a court determines that substantial evidence does not support the [Commissioner’s] decision, the court can reverse the decision and immediately award benefits only if all essential factual issues have been resolved and the record adequately establishes a plaintiff's entitlement to benefits.” Faucher v. Sec’y of Health & Human Servs., 17 F.3d 171, 176 (6th Cir. 1994). Otherwise, the court should remand to the Commissioner for further consideration. Although the ALJ did not provide substantial evidence to support his conclusions, we cannot say that there is compelling evidence that White is entitled to benefits. We therefore must remand for further consideration.