ALJ's Reasons For Discounting Treating Physician's Opinion Were Inadequate
CAMPBELL v. ASTRUE (December 6, 2010)
Curtis Campbell applied for Social Security benefits in January of 2004, based principally on his mental impairments. The agency arranged for Campbell to be seen by Dr. Mason, who concluded that his problems were mostly related to his substance abuse. Another agency psychologist, Dr. Boyenga, reviewed Campbell's record and concluded that he was capable of performing simple and detailed tasks. Another mental health assessment was conducted in May of 2004. A therapist recommended evaluation, medication, and therapy and a psychiatrist diagnosed Campbell with major depression and substance abuse. In October, Campbell began a regular course of treatment with Dr. Powell. Powell saw Campbell almost 20 times over the following 15 months. Throughout that time, she assessed his Global Assessment of Functioning Scale score between 45-50, an indication of severe social impairment. Early on, she noted his excessive use of alcohol. She diagnosed Major Depressive Disorder with psychotic features. She also noted that he was not a malingerer. In mid-2005, Powell diagnosed Campbell with Bipolar Disorder, but continued to question the effect of his excessive alcohol use. Later in 2005, Campbell reported that he was no longer using alcohol. Powell’s treatment notes from that point on mention alcohol use only in the sense of her continued support of his abstinence. Her clinical assessment remained much the same. The agency conducted a hearing in January of 2006. The agency's medical expert testified that Campbell had a history of substance abuse, that he was currently using alcohol, and that he was capable of simple, repetitive work. The expert was unaware of Powell's Bipolar Disorder diagnosis. Campbell testified that he had not used alcohol for six or seven months. The ALJ found that Campbell was not disabled, siding more with the testifying expert and the other agency consultants then with Dr. Powell. Judge Darrah (N.D. Ill.) affirmed. Campbell appeals.
In their opinion, Seventh Circuit Judges Wood, Evans, and Tinder reversed and remanded. Normally, the treating doctor's opinion is entitled to controlling weight if it is adequately supported. The ALJ rejected the treating doctor's opinion for two reasons -- the absence of any significant abnormal findings in a December 2005 evaluation and Powell’s failure to determine the effect of alcohol on Campbell's symptoms. The Court found both reasons wanting. First, with respect to the December report, the Court determined that the ALJ focused on one aspect of the report and ignored other aspects of the same report as well as Powell's other reports. That, an ALJ may not do. With respect to the alcohol use, the Court noted that Powell's treatment notes suggested she had ruled out alcohol abuse. The fact that she began recommending "continued abstinence" in September and noted that his symptoms persisted makes it clear that she thought something other than alcohol abuse was the cause of his symptoms. The Court then stated that, even if the ALJ was correct in discounting the treating doctor's opinion, she is required to apply the Larson factors to determine the proper weight to give the opinion. Here, the ALJ did not address those factors -- several of which support Powell. Finally, the Court noted that the opinions the ALJ gave the greatest weight to were, on the one hand, opinions of doctors given prior to the 15 month course of treatment and, on the other hand, the opinion of the expert whose own testimony showed that he was unfamiliar with the medical records.
Lynn Larson has been suffering from anxiety and depression for years. Her already fragile condition worsened in early 2004 when she was raped and suffered several additional physical injuries. Her psychiatrist continued to describe and adjust dosages of several medications throughout this time. Larson applied for Social Security benefits in June of 2004. Her troubles continued -- she was drinking, she had a "nervous breakdown," the nephew she had been raising was taken from her home, and she was arrested for driving under the influence. Her application for benefits was denied in 2004, and again on reconsideration in 2005. Her psychiatrist submitted a new questionnaire with a diagnosis of "severe, recurrent depression." A hearing was held before an ALJ in 2007. Larson testified about her employment history -- that she quit her part-time job at a gas station because she had to hide in the bathroom, she was fired from her bus driver job after a breakdown, and that she worked two hours a week at a restaurant owned by a friend. A psychologist testified that Larson met the "A criteria" but not the "B criteria." Her psychiatrist testified that Larson met all criteria. The ALJ denied the claim. Larson appeals.
Brian Ketelboeter was a truck driver. He claims that he was injured in 1995, although he continued working until 2003. During those eight years, he complained of several additional injuries and increasing pain. Many physicians examined Ketelboeter over those years. Most tests showed no physical problems, at least none consistent with the degree of pain Ketelboeter claimed to experience. Dr. Dickson began treating Ketelboeter in 2002. Dickson treated his pain with muscle relaxants and therapy. Dickson reported that Ketelboeter’s pain was not consistent with the objective physical findings. Ketelboeter stopped working in June of 2003 and applied for disability in September. A hearing was held in April of 2005. The record contained the medical conclusions of Dickson and a state medical expert who reviewed Ketelboeter’s records. A vocational expert opined that, although Ketelboeter could no longer perform his truck driving job, he could perform other jobs. The vocational expert relied on the testimony of the medical expert in reaching his conclusion. He admitted that Dickson’s testimony would support an opinion that Ketelboeter would not be able to perform any job. The ALJ denied Ketelboeter’s claim. The ALJ granted Ketelboeter a second hearing based on additional testimony from Dickson. Again, a state-agency expert testified. He testified that there was little objective evidence of Ketelboeter’s pain. The vocational expert identified several additional jobs that Ketelboeter could perform. Again, the ALJ denied Ketelboeter’s claim. The ALJ placed more weight on the testimony of non-treating experts than Ketelboeter’s treating physician. He did so because of the lack of objective evidence of pain and Dickson’s own conclusions that Ketelboeter’s reports of pain were not supported by physical findings. Ketelboeter appeals.