Kay v. Barnhart , 148 F. App'x 711 ( 2005 )

F I L E D
United States Court of Appeals
Tenth Circuit
UNITED STATES COURT OF APPEALS
September 12, 2005
FOR THE TENTH CIRCUIT
PATRICK FISHER
Clerk
MELANIE JEAN KAY,
Plaintiff-Appellant,
No. 04-4104
v. (D.C. No. 1:02-CV-65-DAK)
(D. Utah)
JO ANNE B. BARNHART,
Commissioner of the Social Security
Administration,
Defendant-Appellee.
ORDER AND JUDGMENT *
Before LUCERO, PORFILIO, and BALDOCK, Circuit Judges.
After examining the briefs and appellate record, this panel has determined
unanimously that oral argument would not materially assist the determination of
this appeal. See Fed. R. App. P. 34(a)(2); 10th Cir. R. 34.1(G). The case is
therefore ordered submitted without oral argument.
*
This order and judgment is not binding precedent, except under the
doctrines of law of the case, res judicata, and collateral estoppel. The court
generally disfavors the citation of orders and judgments; nevertheless, an order
and judgment may be cited under the terms and conditions of 10th Cir. R. 36.3.
Plaintiff-appellant Melanie J. Kay appeals from an order of the district
court affirming the Commissioner’s decision denying her application for Social
Security disability and Supplemental Security Income benefits. Appellant filed
for these benefits on June 26, 2000, alleging disability based on fibromyalgia,
chronic depression, and a learning disability. Following a de novo hearing, the
administrative law judge (ALJ) determined appellant retained the residual
functional capacity (RFC) to perform light, semi-skilled work, including her past
relevant work as a cashier/checker, and therefore concluded she was not disabled
at step four of the controlling sequential evaluative process. See generally
Williams v. Bowen, 844 F.2d 748, 750-52 (10th Cir. 1988). The Appeals Council
denied review, making the ALJ’s decision the Commissioner’s final decision. We
review the Commissioner’s decision to determine whether the factual findings are
supported by substantial evidence in the record and whether the correct legal
standards were applied. See Andrade v. Sec’y of Health & Human Servs.,
985 F.2d 1045, 1047 (10th Cir. 1993).
Appellant raises three issues on appeal: that the ALJ erred by not adopting
the medical opinions of Dr. Chris Ghicadus, her treating physician; that the ALJ
erred by failing to make certain required findings regarding her mental
impairments, and that the ALJ erred by failing to address her mental impairments
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in his RFC finding. Concluding that reversal is required on the first issue, we
need not reach the second and third issues.
Dr. Ghicadus was one of a group of medical professionals at Davis
Behavioral Health, Inc., that treated appellant numerous times from December
1999, through October 2001. Dr. Ghicadus treated appellant a number of times
personally and also had access to his colleagues’ notes on their treatment
sessions. Under 20 C.F.R. §§ 404.1502 and 416.902, a treating source is a
physician who the claimant sees “with a frequency consistent with accepted
medical practice for the type of treatment and/or evaluation required for [the
claimant’s] medical condition(s).” While the ALJ did not make a specific finding
regarding whether he considered Dr. Ghicadus to be a “treating source” under the
regulations, it seems clear the doctor would qualify as such as one of appellant’s
treating physicians.
Dr. Ghicadus’s evaluation consists of three pages rating appellant’s
limitations in twenty work-related categories. The evaluation form instructs the
evaluator to choose among six descriptions for each category: no limitation,
slight limitation, moderate limitation, marked limitation, extreme limitation, or
unknown. App. at 254. Dr. Ghicadus evaluated appellant as having marked
limitations in six of the rated categories: “the ability to understand and remember
detailed instructions,” “the ability to carry out detailed instructions,” “the ability
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to work in coordination with or in proximity to others without being distracted by
them,” “the ability to complete a normal workweek without interruptions from
psychologically based symptoms,” “the ability to perform at a consistent pace
with a standard number and length of rest periods,” and “the ability to respond
appropriately to changes in the work setting.” Id. at 254-55. A “marked”
limitation is defined as severely limiting but not precluding the ability to function
in an area. Id. at 254. Appellant was also evaluated as having moderate
limitations in nine other areas.
Dr. Ghicadus was also asked to evaluate the severity of appellant’s
impairments by indicating to what degree four broad functional limitations existed
as a result of her mental disorders. He marked that appellant’s mental disorders
caused moderate restriction on her activities of daily living, moderate difficulties
in maintaining social functioning, and marked difficulties in maintaining
concentration, persistence or pace; but that there was insufficient evidence
regarding any repeated episodes of decompensation. Id. at 256.
“An ALJ should ‘[g]enerally, . . . give more weight to opinions from
[claimant’s] treating sources.’” Watkins v. Barnhart, 350 F.3d 1297, 1300 (10th
Cir. 2003) (alterations in original) (quoting 20 C.F.R. § 404.1527(d)(2)). “The
ALJ is required to give controlling weight to the opinion of a treating physician as
long as the opinion is supported by medically acceptable clinical and laboratory
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diagnostic techniques and is not inconsistent with other substantial evidence in
the record.” Hamlin v. Barnhart, 365 F.3d 1208, 1215 (10th Cir. 2004)
(following 20 C.F.R. § 404.1527(d)). If an opinion fails on one of these
conditions, it “means only that the opinion is not entitled to ‘controlling weight,’
not that the opinion should be rejected.” Watkins, 350 F.3d at 1300 (quoting SSR
96-2p, 1996 WL 374188, at *4). Non-controlling opinions “‘are still entitled to
deference and must be weighed using all of the factors provided in 20 C.F.R.
§ 404.1527 and 416.927.’” Id. Those 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.
Id. at 1301 (quotation omitted). “[I]f [an] ALJ rejects [a treating source’s
opinion] completely, he must . . . give ‘specific, legitimate reasons’ for doing so.”
Id. (quoting Miller v. Chater, 99 F.3d 972, 976 (10th Cir. 1996)) (further
quotation omitted).
It is not possible to quantify precisely what weight the ALJ accorded
Dr. Ghicadus’s evaluation, but it is clear that he did not consider it controlling.
The ALJ stated that he had “given [it] less weight than the examination conducted
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by Dr. Elizabeth Allen . . . because Dr. [Ghicadus’s] opinion is not consistent
with the [appellant’s] work history, and general mental capability as determined
by the objective testing performed by Dr. Allen.” 1 App. at 47. It is also evident
from the ALJ’s questioning of the vocational expert that the ALJ did not accept
several of Dr. Ghicadus’s specific, and potentially dispositive, findings. The ALJ
presented the vocational expert with a hypothetical regarding appellant’s ability to
perform her past relevant work. In his hypothetical, the ALJ listed a number of
mental limitations for the hypothetical claimant; none of which were “marked”
limitations. For instance, in the ALJ’s hypothetical, he asked the vocational
expert to envision a claimant who had no limitations in her ability to follow
simple instructions and moderate limitations in her ability to follow detailed
instructions. This portion of the hypothetical is in direct conflict with
Dr. Ghicadus’s evaluation that appellant had moderate limitations in
understanding, remembering, and carrying out simple instructions, and marked
limitations in understanding, remembering, and carrying out detailed instructions. 2
1
We note that the report of the examination that the ALJ refers to as having
been conducted by Dr. Allen was also signed by a Dr. Sue Roberts. We will
continue to refer only to Dr. Allen for consistency with the ALJ’s decision.
2
In her opening brief appellant claims that “[w]hen asked, the vocational
expert stated that a person would not be able to sustain employment with the
limitations assessed by Dr. Ghicadus.” Aplt. Opening Br. at 19. The transcript of
this portion of the hearing before the ALJ shows that the vocational expert was
questioned regarding this subject but records the substantive portion of her
(continued...)
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The ALJ’s rationale for discounting Dr. Ghicadus’s evaluation consisted of
two points: that the doctor’s evaluation was inconsistent with appellant’s “work
history, and general mental capability as determined by the objective testing
performed by Dr. Allen.” App. at 47. The ALJ made no effort to explain what
portions of appellant’s work history or Dr. Allen’s report he felt were in conflict
with Dr. Ghicadus’s evaluation. This lack of specificity is especially problematic
since Dr. Ghicadus’s evaluation consisted of many findings regarding particular
areas of mental and social functioning; Dr. Allen’s report made no specific
findings regarding the areas of mental and social functioning evaluated by
Dr. Ghicadus; and any conflict between the two doctors’ determinations, if it
exists, is not obvious. The “Occupational Information” section of Dr. Allen’s
report states that appellant was unemployed and receiving financial aid, that she
had held a number of part-time jobs, and that she told Dr. Allen: “If I get hired,
they think I’m normal at first. I start getting these looks, and their personality
changes to me. They expect me to be fast and smart.” Id. at 152. Also, Dr. Allen
tested appellant as having a verbal IQ of 77, and as achieving her lowest IQ sub-
test scores on the “Information” and “Arithmatic” verbal sub-tests. Id. at 155.
Dr. Allen also observed that “when situations become even moderately complex
2
(...continued)
answers as “INAUDIBLE.” App. at 306.
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and demanding, [appellant] is easily disorganized and rendered out of control.”
Id. at 153. These portions of Dr. Allen’s report do not conflict with
Dr. Ghicadus’ findings, in particular his determination that appellant had marked
limitations understanding and carrying out detailed instructions. Since the ALJ’s
findings were insufficient to justify discounting a treating source’s medical
opinion, we must remand.
Our decision to remand on the basis of appellant’s first point makes
reveiew of her remaining points unnecessary. The form and content of the ALJ’s
findings regarding appellant’s mental impairments, and his treatment of the same,
are intimately related to the form and content of the ALJ’s findings regarding
Dr. Ghicadus’s evaluation, and the form of all three will likely be modified on
remand. We do note, however, that appellant claims in her second point that the
ALJ did not “specifically evaluate four functional areas: activities of daily living;
social functioning; concentration, persistence, or pace; and episodes of
decompensation” as required by 20 C.F.R. § 404.1520a(c & e). Aplt. Opening Br.
at 15. While respondent argues that such findings are required only in regard to
the determinations made by the ALJ at steps two and three of the sequential
evaluative process, we would caution that the absence of those specific findings
certainly diminishes this court’s ability to discern the ALJ’s intent and reasoning
at step four and to provide meaningful review.
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That said, we REVERSE the judgment of the district court and REMAND
with directions to remand the case to the agency for further proceedings
consistent with this opinion.
Entered for the Court
John C. Porfilio
Circuit Judge
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