Opinion ID: 1447761
Heading Depth: 2
Heading Rank: 1

Heading: The ALJ's Decision to Discount Dr. Caillier's Letter of March 1, 2006

Text: Simila first argues that the ALJ erroneously declined to place significant weight on Dr. Caillier's findings regarding the intensity of Simila's impairments. The ALJ did not challenge the underlying diagnoses that Simila had a somatoform disorder and chronic pain syndrome. Rather, she discounted Dr. Caillier's conclusions concerning the degree of functional limitation that Simila's ailments cause, because they were not supported by the objective evidence of record and [were] inconsistent with claimant's testimony. The ALJ instead concluded that Simila's disorders resulted in only mild restrictions of activities of daily living; mild difficulties maintaining social functioning; moderate difficulties maintaining concentration, persistence, and pace; and zero episodes of decompensation. Consequently, at step three in the sequential analysis, the ALJ found that Simila's impairments did not meet or equal a Listing Level, which would have automatically declared Simila disabled, 20 C.F.R. § 404.1520(a)(4)(iii), and at steps four and five, the ALJ found that Simila had an RFC for light, unskilled work, id. § 404.1520(a)(4)(iv)-(v). Before we evaluate whether the ALJ properly weighed Dr. Caillier's conclusions, we must first determine what type of medical source Dr. Caillier is. If Dr. Caillier is deemed a treating source, then the regulations require that the ALJ give his opinions controlling weight, as long as they were supported by medical findings and consistent with substantial evidence in the record. See 20 C.F.R. § 404.1527(d)(2); Skarbek v. Barnhart, 390 F.3d 500, 503 (7th Cir.2004). If Dr. Caillier is a nontreating source, however, the ALJ was not required to assign his opinion controlling weight. White v. Barnhart, 415 F.3d 654, 658 (7th Cir.2005). Instead, the ALJ was permitted to evaluate the opinion's weight in light of other factors. See 20 C.F.R. § 404.1527(d)(2)-(6); Elder, 529 F.3d at 415. A nontreating source is a physician, psychologist, or other acceptable medical source who has examined you but does not have, or did not have, an ongoing treatment relationship with you. 20 C.F.R. § 404.1502. Dr. Caillier falls squarely within this definition. He examined Simila only once, and nothing in the record suggests anything ongoing about their treatment relationship. Furthermore, the regulations specifically define a nontreating source as any doctor with whom the claimant's relationship was not based on your medical need for treatment or evaluation, but solely on your need to obtain a report in support of your claim for disability. Id. Dr. Caillier evaluated Simila at the behest of Simila's attorney, evidenced by the fact that Dr. Caillier's report was in fact a letter addressed to the attorney and not to Simila. Accordingly, Dr. Caillier's opinions were not entitled to controlling weight. Simila attacks the ALJ's decision to discount Dr. Caillier's conclusions on a number of grounds. Primarily, Simila contends that the ALJ improperly rejected the opinion of the only psychologist in the case, which left the ALJ without an adequate basis to assess the effect of Simila's somatoform disorder. In this sense, Simila argues that the ALJ played doctor, because she had no other psychological expert opinion in which to ground her findings. See Blakes ex rel. Wolfe v. Barnhart, 331 F.3d 565, 570 (7th Cir. 2003). We find Simila's view of the ALJ's role in evaluating psychological evidence too narrow. Although another psychologist's opinion would have augmented the ALJ's analysis, neither the regulations nor our prior decisions require the ALJ to rely on such specific evidence to rebut a nontreating physician. [T]he administrative law judge is not required or indeed permitted to accept medical evidence if it is refuted by other evidence  which need not itself be medical in nature .... Wilder v. Chater, 64 F.3d 335, 337 (7th Cir. 1995) (emphasis added). Instead, an ALJ is required to determine the weight a nontreating physician's opinion deserves by examining how well Dr. Caillier supported and explained his opinion, whether his opinion is consistent with the record, whether Dr. Caillier is a specialist in pain disorders, and any other factor of which the ALJ is aware. 20 C.F.R. § 404.1527(d)(3)-(6). This is precisely what the ALJ did here, declining to give Dr. Caillier's opinion substantial weight because it lacked consistency and supportability. The ALJ noted that Dr. Caillier found that Simila had marked restrictions of daily living activities. But she concluded that this was inconsistent with Simila's testimony that he regularly took his children to school, often made dinner for his family, went hunting and fishing with friends and family, attended his son's traveling hockey team games, and worked with friends on side-projects. Dr. Caillier discussed none of these activities in his March 1 letter, despite the fact that Dr. Caillier appeared to base his conclusions concerning Simila's functional limitations on Simila's subjective complaints (Dr. Caillier did not claim that the MMPI-2 results  the only arguably objective measurement Dr. Caillier took  revealed the intensity of Simila's mental disorder). Furthermore, the ALJ discounted Dr. Caillier's opinion as to Simila's social functioning because it, too, was unsupported by and inconsistent with the evidence. Nothing in the record (or in Dr. Caillier's letter) suggests that Simila had problems getting along with his family or friends or with the crowds at hockey games. Instead, the ALJ pointed out that, throughout his medical treatment, Simila's doctors consistently described him as pleasant and enjoyable. The ALJ also found little support for Dr. Caillier's conclusions that Simila had marked difficulties maintaining concentration, persistence, or pace, and had experienced one or two episodes of decompensation. Dr. Caillier's letter mentioned Simila's capacity for concentration only once, in which he noted that Simila had adequate attention and concentration to the task at hand. This was consistent with what Dr. Chukwudelunzu observed several years earlier when he found that Simila demonstrate[d] adequate ... concentration and memory during history and neurologic examination. Simila argues that this does not prove that Simila can maintain attention and concentration throughout the workday. But Simila's argument misses the point. In determining what weight to give a nontreating physician's opinion, the ALJ is required to look for support. Id. § 404.1527(d)(3). Although these observations may not prove whether Simila can concentrate on full-time work, they certainly do not support Dr. Caillier's opinion that Simila is markedly deficient in that area. Simila also attacks the ALJ's finding that Dr. Caillier did not perform a mental status exam, citing the fact that Dr. Caillier prefaced his observations with the words on exam. Whether these two words prove the ALJ incorrect, we cannot say. Those two words don't tell us much about what kind of exam Dr. Caillier was performing. Nonetheless, any error here was harmless given the other reasons the ALJ cited for discounting Dr. Caillier's opinions. We agree with the ALJ that Simila's hunting and fishing, attending travel hockey games, and helping friends with maintenance and construction projects are inconsistent with Dr. Caillier's conclusions about Simila's functional limitations. Simila presents a barrage of other arguments, but to no avail. Simila contends that the ALJ ignored objective evidence supporting Dr. Caillier's opinions, such as the MMPI-2 results, Dr. Michet's note about Simila needing chronic pain rehab, and Dr. Steiner's testimony that it is not unusual for doctors treating a person with somatoform to not find any physical causes. But the ALJ did discuss the MMPI-2, and as we mentioned, the results of that test said nothing about the intensity of Simila's pain, but only that Simila had a somatoform disorder, which the ALJ accepted as true. Moreover, the ALJ is not required to discuss every piece of evidence but is instead required to build a logical bridge from the evidence to her conclusions. Craft, 539 F.3d at 673. Although snippets of Dr. Michet's notes and Dr. Steiner's testimony might support Dr. Caillier's opinions, other objective evidence is inconsistent with it: Many of Simila's medical records state that Simila had a normal, pain-free range of motion and normal strength, and Dr. Kent wrote that it was unclear to me why [Simila] is totally disabled and he saw no reason he couldn't perform clerical work. Simila also argues that the ALJ erred by failing to mention that Dr. Caillier is a neuropsychologist whose opinions deserve more weight. See 20 C.F.R. § 404.1527(d)(5). But the regulations state that a specialist's opinion is generally entitled to more weight; it is not presumptively so (unlike treating physicians). Id. (emphasis added). Mentioning Dr. Caillier's specialty might have made the ALJ's opinion more complete, but in light of the other evidence the ALJ cited, it would not have changed the outcome. Finally, Simila argues that the ALJ erred by not seeking additional evidence before rendering a decision. See id. § 404.1527(c)(3). An ALJ has a duty to solicit additional information to flesh out an opinion for which the medical support is not readily discernable. Barnett, 381 F.3d at 669. Simila relies on Barnett to contend that the ALJ was required to recontact Dr. Caillier because she found his opinion unsupported by the record. Simila reads Barnett too broadly. An ALJ is entitled to evaluate the evidence and explanations that support a medical source's findings. See 20 C.F.R. § 404.1527(d)(3). And she need not recontact the source every time she undertakes such an evaluation, but only if, as we said in Barnett, the medical support is not readily discernable.  381 F.3d at 669 (emphasis added); see also Skinner v. Astrue, 478 F.3d 836, 843 (7th Cir.2007) (ALJs may contact treating physicians for further information when the information already in the record is `inadequate' to make a determination of disability....). Here, the ALJ discerned and discussed the evidence upon which Dr. Caillier relied: the MMPI-2 results, his review of Simila's medical records, and Simila's subjective complaints. This record was not inadequate. The ALJ simply found that this evidence failed to support Dr. Caillier's conclusions, a finding the regulations entitled her to make. In one instance, though, the ALJ should have recontacted Dr. Caillier. The ALJ observed that [I]t is unclear whether Dr. Caillier had access to the records indicating some concern with claimant's narcotic usage. We agree with Simila that unclear is tantamount to not readily discernable. However, we believe the ALJ's error did not affect the outcome. And, again, the ALJ need not mention every strand of evidence in her decision but only enough to build an accurate and logical bridge from evidence to conclusion. Craft, 539 F.3d at 673. The ALJ's discussion of the lack of consistency and support for Dr. Caillier's opinion built that bridge. Accordingly, the ALJ's decision to discount that opinion was supported by substantial evidence.