Opinion ID: 1998760
Heading Depth: 2
Heading Rank: 3

Heading: Application of the Treating Physician Preference to the Record

Text: In this case, the ALJ's stated reason for rejecting the opinions of Dr. Glor and Dr. Mills was that the reports were too remote in time to give due consideration as to whether [Ms. Changkit's] condition has changed. His explanation of his rejection of Dr. Noel's July 11, 2006 and January 10, 2007 reports was that these evaluations were based on a review of the reports from Drs. Mills and Glor which have been rejected as stale. Id. We conclude that the ALJ's decision to reject the opinions of Dr. Glor, Dr. Mills and (especially) Dr. Noel was based on dispositive mistakes of fact and law. [6] To the extent that the ALJ's characterization of the opinions of Dr. Glor and Dr. Mills as stale was meant only to suggest that a patient's condition may change over the years, it was not unreasonable, although in this case Dr. Mills' 1998 and 1999 evaluations, quoted at p. 385, supra, did suggest that Ms. Changkit's prospects for improvement were less than auspicious. If the ALJ intended, on the other hand, to suggest that the views of the two initial treating physicians were so stale as to be irrelevant and unworthy of any considerationand his tone and language are susceptible of that constructionthen that suggestion is surely unreasonable. At the very least, in this kind of case, the past is prologue, and it sheds much needed light upon the contested present. It is difficult to understand how a physician (or a trier of fact) could determine whether the patient's condition has improved sufficiently to warrant termination of benefits without a thorough examination and understanding of the nature of the patient's injuries and of his or her condition at the time they were incurred or soon thereafter. But even assuming that the ALJ's characterization of the earlier examinations as stale was merely a reference to the inevitable consequences of the lapse of time, his rejection of the opinion of the current treating physicianDr. Noelcannot be reconciled with the record or with the treating physician preference. The essence of this aspect of the ALJ's decision is that Dr. Noel's opinion was based, largely or exclusively, on the earlier evaluations by Dr. Glor and Dr. Mills, and it is true that Dr. Noel attached substantial significance to these evaluations. See pp. 385-86, supra. But we agree with counsel for Ms. Changkit that [i]t should require no citation to medical texts to conclude that when a doctor begins treating a new patient he has a duty to familiarize himself with a patient's past treatment history, and that the doctor may rely on that history in making treatment decisions. Indeed, this court has approved an Administrative Law Judge's rejection of a doctor's medical report because, inter alia, the doctor `did not review pertinent medical reports of the treating physician.' Washington Metro. Area Transit Auth. v. District of Columbia Dep't of Employment Servs., 827 A.2d 35, 42 (D.C.2003). To the extent that the ALJ rejected Dr. Noel's opinion because Dr. Noel reliedeven relied heavilyon the evaluations of the original treating physicians, we conclude that the ALJ's stated rationale runs afoul of the treatment physician preference. [7] Moreover, the record discloses that the ALJ's rejection of Dr. Noel's opinion was based on an evident misapprehension of the reasons for Dr. Noel's opinion. Although the ALJ mentioned in his Compensation Order that Dr. Noel treated Ms. Changkit in 2004 and saw her on two dates in 2006, we discern little, if any, recognition, in the ALJ's analysis, of the fact that Dr. Noel was Ms. Changkit's treating physician and that he had seen or treated her at least fifteen times, and eleven times prior to writing his report of July 11, 2006. Since it is agreed upon by all concerned that the issue before the ALJ was whether Ms. Changkit's disability still existed at the time of the hearing and decision, and since it cannot reasonably be doubted that Dr. Noel was fully familiar with Ms. Changkit's condition, it is contrary to common sense to conclude that, in determining that Ms. Changkit remained disabled, Dr. Noel ignored his own examinations and treatment of her, and that he based his assessment of her condition solely on the opinions of Dr. Glor and Dr. Mills many years earlier. [8] The ALJ's apparent conclusion that Dr. Noel relied solely on the earlier reports and had nothing useful of his own to offer, when Dr. Noel had written on May 28, 2004 that he had reviewed the entire record, was not, in our view, based on relevant evidence such as a reasonable mind might accept as adequate to support a conclusion. Black v. District of Columbia Dep't of Employment Servs., 801 A.2d 983, 985 (D.C.2002) (internal quotation marks and citation omitted); see also Mills, 838 A.2d at 328 ( quoting Black ). Therefore, it was not based on substantial evidence. Moreover, the ALJ's reliance on Dr. Levitt's third IME report as a basis for rejecting Dr. Noel's opinion is fraught with problems. In 1995, the employer relied on Dr. Levitt's first evaluation, which was unfavorable to Ms. Changkit, but that evaluation was rejected both by the hearing examiner and by the Deputy Director of DOES. In 1999, Dr. Levitt's second report, again proposing termination of benefits, was rejected by the Hearing and Appeals Examiner, who seriously questioned Dr. Levitt's impartiality. [9] In the third proceeding now under review, the ALJ incorporate[d] by reference the 1995 and 1999 proceedings, but neither he nor the CRB made any reference to the doubts raised by an impartial Hearing and Appeals Examiner who ultimately ruled in the employer's favor. The unusual history of the caseDr. Levitt had twice recommended that Ms. Changkit's benefits be terminated and, in each case, his opinion had been rejected, once on the grounds of lack of impartialitymakes it somewhat surprising that he was selected to conduct the IME in the third proceeding involving Ms. Changkit. This odd sequence of events should surely caution the decision-maker in determining whether Dr. Levitt's third recommendation should be followed over those of the current treating physician, Dr. Noel, and of Dr. Noel's predecessors. We recognize that, in cases of this kind, our review is, and should be, deferential. Nevertheless, we are constrained to conclude that the CRB's decision affirming the Compensation Order is not supported by substantial evidence. Accordingly, the decision of the CRB is reversed. For the reasons stated in this opinion, we conclude that, on this record, no impartial trier of fact could reasonably find in favor of the employer, because there is no substantial evidence to support such a finding. We therefore remand the case with directions that Ms. Changkit's benefits be reinstated and that she be granted all other appropriate relief consistent with this opinion. So ordered. [10]