Melissa Storey v. Nancy A. Berryhill ( 2019 )


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  •                                                                      [DO NOT PUBLISH]
    IN THE UNITED STATES COURT OF APPEALS
    FOR THE ELEVENTH CIRCUIT
    ______________________
    No. 17-14138
    ______________________
    D.C. Docket No. 5:16-cv-00328-LJA-CHW
    MELISSA STOREY,
    Plaintiff-Appellant,
    versus
    NANCY A. BERRYHILL,
    Defendant-Appellee.
    _______________________________
    Appeal from the United States District Court
    for the Middle District of Georgia
    _______________________________
    (June 13, 2019)
    Before WILLIAM PRYOR and ROSENBAUM, Circuit Judges, and CONWAY, ∗
    District Judge.
    ∗
    Honorable Anne C. Conway, United States District Judge for the Middle District of Florida,
    sitting by designation.
    PER CURIAM:
    Melissa Storey appeals the district court’s order affirming the
    Commissioner of the Social Security Administration’s (the “Commissioner”)
    denial of a period of disability and disability-insurance benefits, pursuant to 42
    U.S.C. § 405(g). On appeal, Storey asserts the Administrative Law Judge
    (ALJ) erred by finding that she had the residual functional capacity (“RFC”) to
    perform light work, including her past relevant work, and in discounting the
    opinions of her treating physicians.
    I. BACKGROUND
    Storey alleges disability as of March 10, 2014, based on a combination
    of physical impairments, including stage II endometrial cancer, arthritis in the
    right hip, back pain, high blood pressure, and diabetes. 1 She was 53 years old
    at the alleged onset date and had turned 55 years old by the time of the ALJ’s
    hearing in November 2015. Storey is a high-school graduate and has past work
    experience as a hotel manager, secretary, receptionist, office manager, and a
    patient coordinator.
    A. Medical Records and Opinion Evidence
    Storey’s medical records reflect that she was diagnosed with stage II
    endometrial cancer in March 2014. She had a hysterectomy and her lymph
    1
    Storey also alleged the mental impairments of depression and anxiety, but her physical
    impairments are the sole focus of this appeal.
    2
    nodes removed, followed by radiation and chemotherapy through April 2014.
    Towards the end of her cancer treatment, Storey complained to the oncologist
    that she was having intense pain in her right hip and lower back. The
    oncologist ordered a magnetic-resonance-imaging scan (“MRI”) of Storey’s
    right hip to determine whether the cancer had spread to her pelvis or hip. While
    the MRI did not show her cancer had spread, the MRI did show inflammation,
    an exacerbation of chronic sciatica, bursitis, and “significant arthritic changes”
    compatible with osteoarthritis in her right hip.
    The oncologist referred Storey to an orthopedic surgeon, Dr. Reid, who
    began treating her on May 7, 2014 for hip pain. According to Dr. Reid’s
    diagnosis, the cause was bursitis in the right hip and localized primary
    osteoarthritis of the pelvic region and thigh, with low-back pain. Dr. Reid
    prescribed a cane for her at that time. On June 10, 2014, in response to Storey’s
    continuing complaints of hip pain on the right side, Dr. Reid noted on
    examination tenderness in the greater trochanter and hip flexor muscle,
    reduced range of motion, and positive Ober’s test 2; he reiterated his diagnosis
    of Storey’s hip pain. In his physical examination of Storey’s lower back, he
    noted decreased lordosis, tenderness of the paraspinals on the right at L4, and
    2
    Ober’s Test is commonly used in orthopedic examinations of the hip to test for tightness in the
    Tensor Fascia Lata or contractures in the iliotibial band that limit hip adduction.
    https://physicaltherapyweb.com/obers-test-orthopedic-examination-of-the-hip/ (visited on May
    22, 2019).
    3
    positive straight leg raising tests in supine and seated positions, with tenderness
    of the iliolumbar region and reduced range of motion; Dr. Reid added the
    diagnosis of acute sciatica and lumbago. He referred Storey for physical
    therapy and prescribed lumbar stretching exercises, pain medications, and
    supportive back brace. He also specifically advised Storey to avoid prolonged
    sitting and elevate her foot if sitting in one position for a long time. And he
    included generic instructions for “the patient” to follow a low glycemic diet so
    “they” could reduce joint inflammation and lose weight; these general
    instructions are included at the end of each set of treatment notes. Dr. Reid
    determined that Storey displayed “no evidence of surgical indications with
    respect to the presenting spinal pain” at that point, but he ordered an MRI of
    her lumbar spine.
    The June 23, 2014 MRI of Storey’s spine showed mild multilevel
    degenerative disc disease, 3 with the addition of a Grade 1 anterolisthesis of
    about 3 mm and mild to moderate spinal canal narrowing causing impingement
    of the right L4, left S1, and left L5 nerve roots. At Storey’s appointment on
    June 30, 2014, Dr. Reid continued to note tenderness in her hip flexors, limited
    range of motion, and positive results on Ober’s test and straight leg raising test.
    Dr. Reid interpreted the spine MRI as showing L4-5 “hnp” or herniation of
    3
    At T12-L1, L2-L3 and L3-L4, the findings were “mild” and, at L1-L2, they were unremarkable.
    4
    the nucleus pulposus, 4 listhesis, 5 and foramen stenosis on the right. With the
    benefit of the spine MRI, Dr. Reid changed Storey’s diagnosis to degeneration
    of lumbar intervertebral disc, spinal stenosis of lumbar region, and low back
    pain in addition to the acute sciatica and bursitis he had previously diagnosed.
    He prescribed pain medications and an anti-inflammatory and gave Storey a
    referral to pain-management specialists.
    In December 2014, in her request for the state disability agency to
    reconsider its initial administrative denial of her application for disability
    benefits, Storey was asked to describe how her condition had changed since the
    Social Security Administration’s (“SSA”) initial decision. Storey explained
    that, beginning in Spring 2014, she had severe right hip pain which went into
    her groin area and down the leg, and the doctors could not pin down the
    problem even though she had undergone MRIs. She could not sit or stand for
    long periods of time and she now had to use a cane and walked with a limp.
    She described the MRIs as showing a bulging disk and severe inflammation in
    her hip joint and down the sciatic nerve.
    4
    Herniated nucleus pulposus is a condition in which part or all of the soft, gelatinous central
    portion of an intervertebral disk is forced through a weakened part of the disk, resulting in back
    pain and nerve root irritation. https://medlineplus.gov/ency/imagepages/9700.htm (visited on
    May 22, 2019).
    5
    Spondylolisthesis is a condition in which one of the bones of the spine (vertebrae) slips out of
    place onto the vertebra below it. If it slips too much, the bone might press on a nerve, causing
    pain. https://my.clevelandclinic.org/health/diseases/10302-spondylolisthesis (visited on May 22,
    2019).
    5
    As part of the reconsideration process, the state agency medical
    consultant, Dr. Cochran, reviewed Storey’s medical records on February 20,
    2015 and opined, based on the medical records he reviewed from June and July
    2014, that Storey could perform light work which required lifting 20 pounds
    occasionally and 10 pounds frequently and could stand, walk, and sit for six
    hours each in an eight-hour workday. 6 Dr. Cochran concluded that no
    medically determinable impairment limited Storey to lifting no more than ten
    pounds, limiting her time sitting to five minutes at a time and sit/stand/walk for
    less than two hours total in the workday as Dr. Powell, her primary care
    physician, had opined in his treating-source statement. In Dr. Cochran’s
    opinion, Storey had not been prescribed the cane “longitudinally” and did not
    need one to ambulate.
    Dr. Reid referred Storey to another orthopedic surgeon—a “spine
    surgeon,” named Dr. Kelley—to determine whether Storey should have
    surgery on her lumbar spine for spinal stenosis. Dr. Kelley noted Storey’s hip
    pain was her number-one complaint, along with buttock pain that radiated to
    the groin accompanied by a burning sensation and pain in her calf which
    radiated down her leg and led to numbness in her toes, but the MRIs also
    6
    Dr. Cochran also opined that Storey could frequently climb ramps and stairs, stoop, kneel,
    crouch, and crawl, and she could occasionally climb ladders, ropes, and scaffolds.
    6
    showed right foraminal stenosis at L4-L5 and left frontal stenosis at L5-S1. 7
    Dr. Kelley found on examination Storey had reduced motor strength in her
    right hip and diminished ankle reflexes, and he diagnosed Storey with lumbar
    stenosis, lumbosacral spondylosis with radiculopathy, and L4-L5
    spondylolisthesis. Dr. Kelley recommended that Storey proceed with her hip
    replacement first, and once she recovered from that surgery, follow up for
    further treatment of the lumbar spine. In the meantime, he advised her to
    continue using the back brace Dr. Reid had prescribed.
    In February 2015, Dr. Reid also recommended a total hip replacement
    because he estimated that Storey had a permanent partial impairment 8 due to
    the arthritis and bursitis in her hip, but she could reduce the permanent
    impairment “if she proceeded with total hip replacement.” However, as the
    ALJ noted, Storey testified at the hearing that she had been told “because of
    her age, the hip replacement would not work.”
    In July 2014, Storey also received treatment from physicians at Pain
    Management Specialists, on referral from Dr. Reid, for treatment of the pain in
    her lower back. Storey subsequently told Dr. Reid that the steroid injection to
    7
    Dr. Kelley specifically assessed Storey with spinal stenosis of lumbar region, spondylolisthesis,
    degenerative spondylolisthesis, and spondylolisthesis, grade 1 based on his review of the MRI.
    8
    When an injured employee has reached maximum medical improvement, a physician will often
    provide a rating of permanent partial impairment (“PPI”), a medically based determination of
    physical functioning. See, e.g., https://www.dol.gov/owcp/dlhwc/contacts/jac/6lsrb.htm (visited
    May 13, 2019).
    7
    her lower back made her back pain worse. In January 2015, Dr. Leggett from
    the pain management practice also diagnosed Storey with arthritis in her hip
    joint and lumbar spondylosis based on a November 2014 MRI which showed
    moderate narrowing of the joint space with irregularity of contour of the
    femoral head with marginal osteophytes, compatible with degenerative
    changes in the right hip. His practice group continued to provide pain
    management through May 2015, and although the physicians—or at one
    appointment, the physician’s assistant 9—examined Storey, their exams were
    not as thorough as those of the two orthopedic surgeons. At the May 2015
    appointment, there was no physical examination of Storey’s lumbar spine
    conducted by the physician’s assistant, even though Storey continued to be
    treated for the pain in her lower back and hip.
    Dr. Reid completed a medical-source statement of ability to do work-
    related activities on February 11, 2015. He determined that Storey had
    limitations that would essentially preclude her from full-time work: 10 she had
    to avoid prolonged sitting of more than one hour at a time, could stand no more
    9
    Physician’s Assistant Ogletree performed the examination on May 22, 2015; the record was not
    signed until five days later by the supervising physician. The ALJ repeatedly relied on the
    treatment notes which opined Storey’s gait was normal”; however, the same notes reflect that the
    range of motion in her hips was “restricted with abduction, internal rotation, and external
    rotation,” and she received an intra-articular hip injection and an increase in the prescription for
    pain medications at that visit.
    10
    The opinion of Dr. Powell was based on Dr. Reid’s diagnosis of Storey as having severe
    arthritis, trouble with weight-bearing activity, and requiring a cane for walking.
    8
    than 15 minutes at one time, elevate her foot, and rest laying down twice per
    workday, and take four breaks per day. Dr. Reid’s Medical Source Statement
    was not submitted until March 23, 2015 and thus was not in Storey’s file when
    Dr. Cochran reviewed the medical records on February 20, 2015.
    Records dated June 30, 2014 to February 26, 2015 from Dr. Reid’s
    office—which contained Dr. Kelley’s February 26, 2015 notes diagnosing
    spine impairments but recommending Storey have hip surgery before treatment
    of her lumbar problems—were sent to SSA on November 2, 2015. These
    records were timely sent prior to the ALJ’s November 20, 2015 hearing and
    two months before the ALJ issued his unfavorable decision on January 12,
    2016. However, Dr. Kelley’s records were not discussed in the ALJ’s decision.
    B. The Unfavorable Decision of the ALJ
    In January 2016, the ALJ issued an unfavorable decision finding Storey
    not disabled. The ALJ determined that Storey was able to perform work at the
    light exertional level except insofar as she was limited to occasional stooping,
    kneeling, crouching, crawling, and climbing stairs, and she could never climb
    ladders, ropes or scaffolds, or work near vibrations and hazards. The ALJ
    opined that Storey would have to be permitted to use a cane to ambulate to and
    from her workstation. Relying on the testimony of a vocational expert, the ALJ
    determined that Storey was able to perform her past relevant work as a hotel
    9
    clerk, hospital admitting clerk, insurance clerk, and receptionist, all of which
    are at the light or sedentary exertional level.
    In reaching the conclusion that Storey was capable of performing light
    work, the ALJ reviewed the medical evidence and found that, although the
    evidence was consistent with Storey’s diagnosed orthopedic conditions—
    multilevel degenerative disc disease of the lumbar spine with associated disc
    bulging, spondylosis of the thoracic spine, sciatica, osteoarthritis and bursitis in
    the right hip—the objective findings were “mild” or “normal,” and the
    prescribed treatment was “routine and conservative.”
    The ALJ rejected Storey’s testimony that her hip and lumbar problems
    progressively worsened, and, as a result, she required a cane for walking, with
    limitations in sitting, standing, walking and lifting. The ALJ found that the
    MRI of Storey’s right hip, which revealed degenerative changes, showed “a
    small joint effusion, but there was no focal suspicious mass lesion, fracture, or
    osteonecrosis.” Storey’s MRI of the lumbar spine, the ALJ found, showed
    “only mild” multilevel degenerative disc disease, her straight leg raising tests
    were negative, and there was no clonus of the ankle or knee. The ALJ further
    found that the diagnosed arthritis in her right hip did not confirm that a cane
    was medically necessary, but “even if it is,” he opined, “the medical evidence
    of record [did] not show that she has a case of hip arthritis or bursitis that
    10
    requires surgical intervention.” The ALJ believed that Storey’s hip bursitis was
    “the main issue” but the medical records “suggested” Storey’s hip impairments
    “would improve with weight loss.”
    The ALJ gave “little weight” to the opinions of Dr. Powell and Dr. Reid
    because he found both of their opinions were conclusory, provided “very little
    explanation of the evidence relied on,” and failed to “reveal the type of
    significant clinical and laboratory abnormalities one would expect if [Storey]
    were in fact disabled.” The ALJ also found that Dr. Reid’s opinion of Storey’s
    limitations from her hip and lower back impairments was “vague” and “lacking
    the specificity which might otherwise make it more convincing.” The ALJ
    listed multiple “normal” or negative findings from Dr. Reid’s physical
    examination notes, such as axial alignment pelvis level, heel-to-shin
    coordination, normal ankle and knee reflexes, sensation on both sides, and the
    absence of a leg-length discrepancy, as well as findings showing a lack of
    tenderness in the specific muscle areas in the mid and lower back. The ALJ
    also cited Dr. Powell’s reports of normal reflexes and “some tenderness,” but
    no edema in the musculoskeletal area. And the ALJ cited other treatment notes
    for all of the symptoms Storey did not have, such as the absence of tingling,
    swelling, redness, warmth, ecchymosis, catching/locking, popping/clicking,
    buckling, grinding, instability, weight loss, or a change in bowel/bladder
    11
    habits.
    The ALJ gave “significant weight” to the opinion of the state agency
    medical consultant, Dr. Cochran, and determined that his opinion that Storey
    was capable of light work “was reasonably supported.” The ALJ did, however,
    make a point of adding “limitations to accommodate hip issues.” Dr. Cochran
    discounted the medical-source statement from Storey’s treating primary care
    physician, Dr. Powell, that she was limited in sitting, standing, and walking to
    less than two hours per workday, had to keep her leg elevated 90% of the time
    in a sedentary job, and would miss more than 4 days per month because of her
    impairments as “preposterous [o]n its face with claimant clearly not bed-bound
    for 22/24 hours” and “inconsistent with activities of daily living.” In addition,
    Dr. Cochran found Storey’s statements on her application were only “partially
    credible” because, although her symptoms and limitations were “consistent
    with a medically determinable impairment,” the severity she alleged was
    inconsistent with objective findings, including her activities of daily living. Dr.
    Cochran opined that Storey’s lumbar spine pain, right-hip pain, and bursitis
    could be managed with physical therapy, pain medications, exercises, a weight
    loss diet, and that her lumbar spine MRI results were “mild.” He concluded
    that Storey was able to perform light work on a “sustained basis,” based on his
    review of the available medical records in the file at the time of his review.
    12
    But Dr. Cochran did not review any of the later records from Dr. Reid or
    the other specialists to whom Dr. Reid referred Storey for consultation
    regarding surgery on her lumbar-spine impairment and pain management. Dr.
    Cochran did not have the benefit of the medical-source statements from Dr.
    Reid or the records of Dr. Kelley, who recommended that Storey undergo hip-
    replacement surgery before receiving surgery for her lumbar radiculopathy. Dr.
    Cochran also did not have access to the records from Storey’s treating pain
    management physicians, which were submitted on November 2, 2015.
    Although dysfunction of major joints was listed in the SSA’s
    reconsideration report from Dr. Cochran, he did not conclude that Storey’s
    hip/joint “dysfunction” was a “primary” or “secondary” impairment; instead,
    he determined that Storey’s hip dysfunction was “non-severe.”
    The ALJ concluded that “the evidence as a whole does not confirm
    disabling limitations arising from the claimant’s underlying medical
    conditions, nor . . . are [they] of such severity that they could reasonably be
    expected to give rise to disabling limitations” and would not prevent Storey
    from performing light work with some non-exertional limitations.
    In June 2016, the Appeals Council denied review of the ALJ’s decision.
    The district court affirmed the ALJ’s decision. On appeal, Storey argues that
    the ALJ’s finding that she was capable of performing her past relevant work at
    13
    the light exertional level was not supported by substantial evidence and that the
    ALJ erred in discounting the opinions of her treating physicians. After careful
    review, we conclude that the ALJ’s decision to deny benefits was not based on
    substantial evidence. We vacate and remand.
    II. DISCUSSION
    In social security appeals, we review the decision of an ALJ to deny
    benefits as a final decision of the Commissioner of the Social Security
    Administration when the Appeals Council denies review. Doughty v. Apfel,
    
    245 F.3d 1274
    , 1278 (11th Cir. 2001). We review the Commissioner’s decision
    to determine if it is “supported by substantial evidence and based on proper
    legal standards.” Winschel v. Comm’r of Soc. Sec., 
    631 F.3d 1176
    , 1178 (11th
    Cir. 2011) (citation and internal quotation marks omitted). We must affirm a
    decision that is supported by substantial evidence even if the evidence
    preponderates against the Commissioner’s factual findings. Ingram v. Comm’r
    of Soc. Sec., 
    496 F.3d 1253
    , 1260 (11th Cir. 2007). “Substantial evidence is
    more than a scintilla and is such relevant evidence as a reasonable person
    would accept as adequate to support a conclusion.” Lewis v. Callahan, 
    125 F.3d 1436
    , 1440 (11th Cir. 1997).
    We may not decide the facts anew, reweigh the evidence, or substitute
    our judgment for that of the Commissioner. 
    Winschel, 631 F.3d at 1178
    . But
    14
    we review de novo whether the Administration applied the correct legal
    standards. Moore v. Barnhart, 
    405 F.3d 1208
    , 1211 (11th Cir. 2005).
    Although our review is deferential, “[w]e must scrutinize the record as a
    whole to determine if the decision reached is reasonable and supported by
    substantial evidence.” MacGregor v. Bowen, 
    786 F.2d 1050
    , 1053 (11th Cir.
    1986). A decision is not supported by substantial evidence if the ALJ “reached
    the result that [he] did by focusing upon one aspect of the evidence and
    ignoring other parts of the record.” McCruter v. Bowen, 
    791 F.2d 1544
    , 1548
    (11th Cir. 1986). The ALJ must state with at least some measure of clarity the
    grounds for the decision, and we will not affirm “simply because some
    rationale might have supported the ALJ’s conclusions.” 
    Winschel, 631 F.3d at 1179
    (citation and internal quotation marks omitted).
    A claimant must have a disability to be eligible for disability insurance
    benefits. See 42 U.S.C. § 423(a)(1)(E). A claimant is disabled if she is unable
    to engage in substantial gainful activity by reason of a medically determinable
    impairment that can be expected to result in death or which has lasted or can be
    expected to last for a continuous period of at least 12 months. 
    Id. § 423(d)(1)(A).
    The claimant bears the burden of proving his disability and “is
    responsible for producing evidence in support of his claim.” Ellison v.
    Barnhart, 
    355 F.3d 1272
    , 1276 (11th Cir. 2003).
    15
    The Social Security Regulations outline a five-step, sequential evaluation
    process to decide whether a claimant is disabled which requires the ALJ to
    determine (1) whether the claimant is currently engaged in substantial gainful
    activity; (2) whether the claimant has a severe impairment or combination of
    impairments; (3) whether the impairment meets or equals the severity of the
    specified impairments in the Listing of Impairments; (4) based on a residual
    functional capacity assessment, whether the claimant can perform any of his or her
    past relevant work despite the impairment; and (5) whether there are significant
    numbers of jobs in the national economy that the claimant can perform given the
    claimant’s RFC, age, education, and work experience.” 
    Winschel, 631 F.3d at 1178
    ; see 20 C.F.R. § 404.1520(a)(4). A claimant who can perform her past
    relevant work is not disabled. See 
    id. §§ 404.1560(a)(iv),
    (f) & 404.1560(b)(3).
    At step four of the sequential analysis, the ALJ must determine a
    claimant’s RFC by considering “all relevant medical and other evidence in
    the case.” Phillips v. Barnhart, 
    357 F.3d 1232
    , 1238 (11th Cir. 2004). The
    RFC is an assessment of a claimant’s ability to do work despite her
    impairments. 
    Lewis, 125 F.3d at 1440
    . Relevant evidence includes a
    claimant’s medical history, medical signs, laboratory findings, and
    statements about how the symptoms affect the claimant. 20 C.F.R. §§
    404.1545(a)(3), 416.945(a)(3).
    16
    An ALJ must consider all medical opinions in a claimant’s case record,
    together with other relevant evidence. 20 C.F.R. § 404.1527(b). “Medical
    opinions are statements from physicians and psychologists or other acceptable
    medical sources that reflect judgments about the nature and severity of [the
    claimant’s] impairment(s), including the claimant’s symptoms, diagnosis, and
    prognosis.” 
    Winschel, 631 F.3d at 1178
    -79 (20 C.F.R. §§ 404.1527(a)(2),
    416.927(a)(2)). Absent “good cause,” an ALJ must give the medical opinions of
    treating physicians “substantial or considerable weight.” 
    Lewis, 125 F.3d at 1440
    ;
    see also 20 C.F.R. §§ 404.1527(d)(1)-(2), 416.927(d)(1)-(2). Good cause exists
    “when the: (1) treating physician’s opinion was not bolstered by the evidence; (2)
    evidence supported a contrary finding; or (3) treating physician’s opinion was
    conclusory or inconsistent with the doctor’s own medical records.” 
    Phillips, 357 F.3d at 1241
    . If good cause exists, an ALJ “may disregard a treating physician’s
    opinion, but he ‘must clearly articulate [the] reasons’ for doing so.” 
    Id. at 1240–41.
    Storey argues that the ALJ lacked good cause to reject the opinions of her
    treating physicians, but we need not resolve this question because we conclude that
    the ALJ’s determination that Storey has the residual functional capacity to perform
    her past relevant work was not supported by substantial evidence. After rejecting
    the opinions of Storey’s treating physicians as conclusory and inconsistent with the
    evidence in the record, the ALJ found that Storey was not disabled by relying
    17
    principally on the RFC determination of the state-agency medical
    consultant that Storey could perform light work. But Dr. Cochran did not
    examine Storey, and as we have explained, “reports of physicians who do not
    examine the claimant, taken alone, do not constitute substantial evidence on which
    to base an administrative decision.” Spencer on Behalf of Spencer v. Heckler, 
    765 F.2d 1090
    , 1094 (11th Cir. 1985); see also Sharfarz v. Bowen, 
    825 F.2d 278
    , 280
    (11th Cir. 1987) (“The opinions of nonexamining, reviewing physicians . . .
    standing alone do not constitute substantial evidence.”).
    Dr. Cochran’s RFC assessment was also based on only a limited
    portion of the medical records submitted at the time of his assessment,
    when there was no opinion or functional assessment by Dr. Reid in the file
    he reviewed; the only materials from Dr. Reid in the file were his treatment
    notes from June-July 2014 timeframe and the lumbar spine MRI. As a
    result, the set of records Dr. Cochran reviewed did not contain Dr. Reid’s
    subsequent finding that Storey required hip replacement surgery and had
    lumbar spine radiculopathy, or the treatment notes from the second
    orthopedic surgeon, Dr. Kelley, who concurred in that opinion. Dr.
    Cochran also did not have Dr. Reid’s June 30, 2014 treatment notes with
    findings of degeneration of lumbar intervertebral disc and spinal stenosis of
    lumbar region or Dr. Kelley’s subsequent diagnosis of lumbar stenosis and
    18
    lumbosacral spondylosis with radiculopathy because these records were
    submitted three weeks before the ALJ’s hearing in November 2015.
    True, the ALJ also had access to Storey’s medical records, which
    included all of Dr. Reid’s, Dr. Kelley’s, and the Pain Management
    Specialists records. But we cannot say that the ALJ properly “[took] into
    account and evaluate[d] the record as a whole.” McCruter v. Bowen, 
    791 F.2d 1544
    , 1548 (11th Cir. 1986); see Schnorr v. Bowen, 
    816 F.2d 578
    , 581 (11th
    Cir. 1987) (holding ALJ erred in not properly considering treating physicians’
    opinions that claimant with arthritis in knees was limited in ability of standing,
    walking, climbing, and alternate sitting and standing in whether he could perform
    “light work”).
    Despite having all of Storey’s medical records, the ALJ
    mischaracterized the records as showing a history of “routine and
    conservative” treatment. The ALJ relied on portions of the physical
    examination notes and diagnostic testing that were not relevant to Storey’s
    orthopedic impairments—such as the oncologist’s statements 11 that Storey
    was “otherwise doing well” or her pain medications were helping
    11
    The ALJ noted Storey’s treatment records from the oncologist’s office showed that she had
    “returned to work 3 weeks ago doing much more lifting and moving than previously” in “August
    2014.” However, this same “history of present illness” was listed as “per Dr. Wahab,” a previous
    treating radiology oncologist with Dr. Medberry, who had treated Storey’s cancer in April 2014
    and there were none of those previous notes in the record.
    19
    “significantly” with her hip pain. The ALJ also relied on records that did
    not accurately reflect the more significant results found on Storey’s hip and
    lumbar MRIs, and which failed to recognize Storey’s combination of
    orthopedic impairments that the orthopedic specialists had some difficulty
    diagnosing and treating due to symptomatic pain interactions in the areas of
    the hip and the lower back.
    The ALJ also mischaracterized Storey’s 2014 MRI of her hip as
    showing “only mild” degenerative changes with a “small joint effusion”
    without “lesion, fracture, or osteonecrosis,” omitting the other hip MRI
    findings of “significant” arthritic changes. The MRI showed “a small bone
    island” in the femoral head, a “moderate decrease in the joint space with
    marginal osteophytes, compatible with osteoarthrosis” and a “small amount
    of pelvic free fluid.” Dr. Reid diagnosed the right hip pain in May-June
    2014 as bursitis with localized primary osteoarthritis of the pelvic region
    and thigh, with low back pain, and he prescribed a cane for her at that point
    in time. 12 Dr. Reid’s examinations of Storey in June 2014 noted tenderness
    in the greater trochanter and hip flexor muscle, reduced range of motion
    limited to 30% internally and externally, and positive Ober’s test consistent
    12
    The ALJ found that Storey was using a cane but the “medical evidence of record do not
    necessarily confirm that a cane is medically ‘necessary.’” However, the medical records from Dr.
    Reid note that he prescribed a cane for Storey in May and June 2014.
    20
    with a hip impairment, even though the ALJ cited only categories from
    these same treatment notes as showing “no muscle aches” and “no
    arthralgias/joint pain” 13 and categories with “normal” or negative results.
    Additionally, because Storey reported “still having right hip pain,
    [medications] not helping, [injection] last month did not help,” Dr. Reid
    examined her lumbar spine and noted decreased lordosis, tenderness of the
    paraspinals on the right at L4, and positive straight leg raising tests in
    supine and seated positions, with tenderness of the iliolumbar region and
    reduced range of active and passive motion. The ALJ’s selective inclusion
    of only “normal” or negative examination results to support the ALJ’s
    “mild” characterization of her condition was not based on substantial
    evidence.
    The ALJ found Storey had “only mild” degenerative disc disease in
    her spine and she received “routine, conservative” treatment. But in
    describing Storey’s spine MRI, the ALJ cited only the first line as if it were
    the summary of the radiologist’s much lengthier report. The ALJ did not
    include the other conclusions—that Storey had a Grade 1 anterolisthesis
    and mild to moderate spinal canal narrowing which caused impingement of
    13
    To the extent the ALJ implied Storey did not require an “assistive device” or cane and had no
    limp, he misunderstood Dr. Reid’s notes which said: Storey “ambulated with no assistive devices
    and limp.”
    21
    three nerve roots—the right L4, and the left S1 and L5. With the benefit of
    the spine MRI, showing L4-5 herniation of the nucleus pulposus, listhesis,
    and foramen stenosis on the right, Dr. Reid diagnosed degeneration of
    lumbar intervertebral disc, spinal stenosis of lumbar region, and low back
    pain in addition to the acute sciatica and bursitis he had previously
    diagnosed. He prescribed the spinal brace, pain medications and an anti-
    inflammatory, and gave Storey a referral to pain-management specialists.
    Because Dr. Reid also found spinal stenosis of the lumbar region with
    neurogenic claudication, he referred Storey to Dr. Kelley, who diagnosed
    Storey with lumbar radiculopathy, but the ALJ omitted any mention of Dr.
    Kelley’s diagnosis of radiculopathy from his decision.
    The ALJ stated that, in his opinion, Storey’s hip bursitis was the
    “main issue,” and he found the medical records did not show her right hip
    impairment “required surgical intervention.” But it is generally improper
    for an ALJ to substitute his own judgment for that of a medical expert
    because ALJs are not medical experts. Graham v. Bowen, 
    786 F.2d 1113
    ,
    1115 (11th Cir. 1986); Freeman v. Schweiker, 
    681 F.2d 727
    , 731 (11th Cir.
    1982). Moreover, the ALJ’s non-medical opinion of Storey’s hip
    impairment was contradicted by the records from Dr. Reid, who
    recommended to Storey a total hip replacement. Dr. Reid opined Storey’s
    22
    permanent partial impairment in her hip would be reduced “if she
    proceeded with total hip replacement.” 14 As a result, we conclude that in
    this circumstance, remand is necessary to permit consideration of the
    evidence ignored by the ALJ. See Henry v. Comm’r of Soc. Sec., 
    802 F.3d 1264
    , 1267 (11th Cir. 2015) (“Remand for further factual development of
    the record before the ALJ is appropriate where the record reveals
    evidentiary gaps which result in unfairness or clear prejudice.” (citation and
    internal quotation marks omitted)).
    III. CONCLUSION
    We VACATE the ruling of the district court and REMAND for further
    proceedings consistent with this opinion.
    14
    Storey testified at the ALJ hearing that she could not afford medical treatment and her
    healthcare deductible was $6,000.
    23