Opinion ID: 2814833
Heading Depth: 3
Heading Rank: 2

Heading: Physician opinions

Text: Bainbridge contends that the ALJ inadequately explained why she afforded some weight to Dr. Craig Shapiro’s opinion that Bainbridge “may return to work,” -7- Aplt. App. at 252, and no weight to Dr. Bates’s later request, in an open to-whom-it-may-concern letter, that Bainbridge “be considered for disability,” id. at 381. We disagree. Like Dr. Bates, Dr. Shapiro is a pulmonary specialist. Dr. Shapiro examined Bainbridge in January 2010, finding “symmetrical breath sounds” and a bilaterally clear chest. Id. at 257. He thought Bainbridge’s persistent cough was “multifactorial, including GE reflux disease, asthma, and postnasal drainage.” Id. He referred Bainbridge for a bronchoscopy. His review of that test revealed “significant moderate airway inflammation and upper airway edema . . . consistent with acid reflux,” and “acute tracheobronchitis.” Id. at 252. Dr. Shapiro noted that Bainbridge had been on a prescription stomach-acid reducer for two weeks, gave him two weeks of Augmentin (an antibiotic), and instructed him to continue “nebulized therapy.” Id. Dr. Shapiro opined that “within four more weeks [Bainbridge] should feel better” and that he “may return to work.” Id. The ALJ considered Dr. Shapiro’s opinion that Bainbridge could return to work somewhat vague because he did not make clear whether he meant a return to past work or to any substantial gainful activity (i.e., a step-five finding). Despite that, the ALJ gave it “some weight” because she “agree[d] the claimant was not suffering from any disabling limitations.” Id. at 28. Bainbridge takes issue with this statement, arguing that the ALJ gave Dr. Shapiro’s opinion some weight because it aligned with her lay opinion, in violation of McGoffin v. Barnhart, where we stated -8- that an ALJ “‘may reject a treating physician’s opinion outright only on the basis of contradictory medical evidence and not due to [the ALJ’s] own credibility judgments, speculation, or lay opinion,’” 288 F.3d 1248, 1252 (10th Cir. 2002) (emphasis omitted) (quoting Morales v. Apfel, 225 F.3d 310, 317 (3d Cir. 2000)). But Bainbridge overlooks the ALJ’s next sentences: “As discussed, the medical evidence of record does not support the existence of any disabling impairments during the alleged period of disability. Dr. Shapiro also had a treatment relationship with [Bainbridge]. I therefore give this opinion some weight.” Aplt. App. at 28-29. Viewed in context, the ALJ’s agreement with Dr. Shapiro that Bainbridge was not disabled is most naturally read as a conclusion that Dr. Shapiro’s opinion was consistent with the objective medical evidence and the ALJ’s conclusion that the objective medical evidence did not support a finding of disability. The ALJ did not err with regard to Dr. Shapiro’s opinion. Bainbridge also argues that the ALJ’s rejection of Dr. Bates’s request that he be considered for disability violated McGoffin because her analysis is “essentially conjecture.” Aplt. Opening Br. at 36. We disagree. As she was required to do, the ALJ provided “specific, legitimate” reasons for affording no weight to Dr. Bates’s opinion. A treating physician’s opinion is not entitled to controlling weight if it is not “well-supported by medically acceptable clinical and laboratory diagnostic techniques,” but such an opinion is “still entitled to deference and must be weighed using all the factors provided in 20 C.F.R. § 404.1527.” Watkins v. Barnhart, -9- 350 F.3d 1297, 1300 (10th Cir. 2003) (quoting SSR 96-2P, 1996 WL 374188, at , ). The § 404.1527 factors are: (1) the length of the treatment relationship and the frequency of examination; (2) the nature and extent of the treatment relationship, including the treatment provided and the kind of examination or testing performed; (3) the degree to which the physician’s opinion is supported by relevant evidence; (4) consistency between the opinion and the record as a whole; (5) whether or not the physician is a specialist in the area upon which an opinion is rendered; and (6) other factors brought to the ALJ’s attention which tend to support or contradict the opinion. Watkins, 350 F.3d at 1301 (quotation omitted). The ALJ reasoned that the medical evidence did not support Dr. Bates’s opinion. She pointed out that although Dr. Bates referred in his letter to the fact that an “airway biopsy” documented Bainbridge’s “chronic respiratory condition characterized by chronic airway inflammatory change,” Aplt. App. at 381, his own treatment notes consistently showed normal physical exams and contained statements and diagnoses that did not square with his opinion that Bainbridge should be put on disability. The ALJ referred to a number of those statements: “believe[d]” his “[i]nflammatory airway disease [was] under control,” id. at 371 (September 2010); there was “no good explanation for [his fatigue] and he is never bad off when I see him . . . not sure if there are secondary gain issues going on or am I just missing something” id. at 367 (November 2010); “[e]ach time I see him he appears healthy,” id. at 388 (January 2011); and he has “asthma, mild persistent,” id. at 398 (April 2011). Hence, the ALJ reasonably concluded that Dr. Bates’s own medical records did not support his opinion that Bainbridge was disabled. - 10 - The ALJ recognized that both Dr. Bates and Dr. Shapiro had a treating relationship with Bainbridge, and both reviewed diagnostic test results.4 Although the ALJ did not note that Bainbridge saw Dr. Bates six or seven times and Dr. Shapiro only twice, we find that omission inconsequential in light of the other factors supporting the ALJ’s rejection of Dr. Bates’s opinion. In particular, the ALJ found that the opinion was not supported by the other medical evidence and was inconsistent with the record as a whole, including the opinions of three other doctors, including Dr. Shapiro, that Bainbridge did not have disabling impairments. In addition, the ALJ considered Dr. Bates’s opinion “vague and conclusory” because it was “not based on a function-by-function analysis of what [Bainbridge] is capable of doing despite his impairments” and did not specify whether Bainbridge was unable to perform his past work or any substantial gainful activity at all. Id. at 30. Although Dr. Shapiro’s opinion suffered from these same shortcomings, the ALJ’s decision to reject Dr. Bates’s opinion and afford some—but not controlling— weight to Dr. Shapiro’s contrary opinion was permissible because the other factors weighed against Dr. Bates’s opinion but not against Dr. Shapiro’s opinion. The ALJ also reasoned that, although difficult to confirm, the likelihood a treating physician provides a disability note out of sympathy for a patient or in response to the patient’s insistent demands for one is greater where, as here, the opinion “departs substantially from the rest of the evidence of record.” Id. An 4 We note that both were pulmonary specialists. - 11 - assertion that a treating physician “naturally advocates his patient’s cause” is not a good reason “to reject [his] opinion” unless the ALJ “suggest[s] some exceptional basis in the facts of [the] case.” Frey, 816 F.2d at 515. Here, the ALJ suggested an exceptional basis—that Dr. Bates’s opinion was markedly at odds with the rest of the medical evidence, including his own treatment notes. But even if this reason was improper, the other reasons the ALJ gave were more than sufficient for rejecting Dr. Bates’s opinion.