Opinion
Case No. 3:12-cv-257
11-20-2013
KOCHEN HARRIS, Plaintiff, v. COMMISSIONER OF SOCIAL SECURITY, Defendant.
Judge Timothy S. Black
ORDER THAT: (1) THE ALJ'S NON-DISABILITY FINDING IS FOUND
SUPPORTED BY SUBSTANTIAL EVIDENCE, AND AFFIRMED; AND
(2) THIS CASE IS CLOSED
This is a Social Security disability benefits appeal. At issue is whether the administrative law judge ("ALJ") erred in finding the Plaintiff "not disabled" and therefore unentitled to Supplemental Security Income ("SSI"). (See Administrative Transcript (PageID 57-69) (ALJ's decision)).
I.
Plaintiff filed an application for SSI on November 2, 2009 (PageID 179-81), due to the limiting symptoms of Hepatitis C; back, knee and shoulder problems; arthritis; breathing problems; acute bronchitis; mental disorder; and bullet fragments in his lungs. (PageID 201). His alleged onset date was April 15, 2008. (PageID 196). His claim was denied initially on March 18, 2010 (PageID 113-15), and on reconsideration September 15, 2010 (PageID 121-27). Subsequently, Plaintiff filed a request for hearing on October 5, 2010. (PageID 128-30).
The ALJ held a videoconference hearing on February 10, 2012, at which Plaintiff and a vocational expert testified. The ALJ issued a decision dated April 23, 2012, denying benefits. (PageID 57-69). Plaintiff timely filed an administrative request for review of the ALJ's decision. (PageID 175-77). By decision dated August 20, 2012, the Appeals Council declined to review the ALJ's decision. (PageID 49-52). Having exhausted his administrative remedies, Plaintiff filed this civil action in this Court seeking review of the administrative decisions pursuant to 42 U.S.C. §§ 405(g) and 1383.
Plaintiff was 51 years old at the time of filing. (PageID 67). He has at least a high school education. (Id.) Plaintiff's past relevant work includes work as a machine operator and as a truck driver. (Id.)
The ALJ's "Findings," which represent the rationale of her decision, were as follows:
1. The claimant has not engaged in substantial gainful activity since September 1, 2009, the application date (20 CFR 416.971 et seq.).(PageID 59-69).
2. The claimant has the following severe impairments: back impairment status post laminectomy, osteoarthritis of the knee, and chronic obstructive pulmonary disease (COPD) (20 CFR 416.920(c)).
3. The claimant does not have an impairment or combination of impairments that meets or medically equals one of the listed impairments in 20 CFR Part 404, Subpart P, Appendix 1 (20 CFR 404.1520(d), 404.1525, 404.1526, 416.920(d), 416.925 and 416.926).
4. After careful consideration of the entire record, the claimant has the residual functional capacity to perform medium work as defined in 20 CFR 416.967(c), except claimant cannot perform work on ladders, ropes or scaffolds. Additionally, the claimant is limited to occasional stooping, kneeling, crouching, and crawling.
5. The claimant is capable of performing past relevant work as a machine operator and truck driver. This work does not require the performance of work-related activities precluded by claimant's residual functional capacity (20 CFR 416.965).
6. The claimant has not been under a disability, as defined by the Social Security Act since September 1, 2009, the date the application was filed (20 CFR 416.20(f)).
In sum, the ALJ concluded that Plaintiff was not under a disability as defined by the Social Security Regulations and was therefore not entitled to SSI. (PageID 69).
On appeal, Plaintiff argues that: (1) the ALJ erred in failing to evaluate the treating source opinions for controlling weight; (2) the ALJ erred in failing to weigh the various opinions by the statutory factors and provide good reasons for the ALJ's determinations; and (3) the ALJ erred in failing to analyze the effects of Plaintiff's diagnosed intermittent explosive disorder. The Court will address each alleged error in turn.
II.
The Court's inquiry on appeal is to determine whether the ALJ's non-disability finding is supported by substantial evidence. 42 U.S.C. § 405(g). Substantial evidence is "such relevant evidence as a reasonable mind might accept as adequate to support a conclusion." Richardson v. Perales, 402 U.S. 389, 401 (1971). In performing this review, the Court considers the record as a whole. Hephner v. Mathews, 574 F.2d 359, 362 (6th Cir. 1978). If substantial evidence supports the ALJ's denial of benefits, that finding must be affirmed, even if substantial evidence also exists in the record upon which the ALJ could have found plaintiff disabled. As the Sixth Circuit has explained:
"The Commissioner's findings are not subject to reversal merely because substantial evidence exists in the record to support a different conclusion. The substantial evidence standard presupposes that there is a "zone of choice" within which the Commissioner may proceed without interference from the courts. If the Commissioner's decision is supported by substantial evidence, a reviewing court must affirm."Felisky v. Bowen, 35 F.3d 1027, 1035 (6th Cir. 1994).
The claimant bears the ultimate burden to prove by sufficient evidence that he is entitled to disability benefits. 20 C.F.R. § 404.1512(a). That is, he must present sufficient evidence to show that, during the relevant time period, he suffered an impairment, or combination of impairments, expected to last at least twelve months, that left him unable to perform any job in the national economy. 42 U.S.C. § 423(d)(1)(A).
A.
The record reflects that:
1. Treatment
In June 2007, Plaintiff began rehabilitation treatment for alcohol, cocaine, opioid, and nicotine dependence at McKinley Hall. (PageID 287). He was in inpatient treatment from September to October 2007 but was discharged early due to continued threats to other patients. (PageID 288). The lapse of time between initial treatment and beginning of inpatient care was caused by a one month incarceration in August 2007. (Id.). Plaintiff continued outpatient treatment until June 2008 when he stopped attending. (Id.) He was noted as having a great deal of difficulty accepting a cooperative relationship, having to be either in charge or apart. (Id.) Once in outpatient treatment he attended group sessions the minimum amount to be able to maintain care. (Id.) His status at discharge was no better than fair because of his tendency to hold himself aloof in a manipulative way. (Id.)
In August 2009, Plaintiff went to the Springfield Regional Medical Center emergency room for treatment for back pain, a shoulder abrasion, and dyspnea. (PageID 302-03). On physical examination wheezes and rhonchi were heard in his lungs. (PageID 302). In October 2009 a chest x-ray revealed chronic obstructive pulmonary disease. (PageID 300).
Dyspnea is commonly known as shortness of breath. Definition available at http://www.merriam-webster.com/dictionary/dyspnea.
Rhonchi describes abnormal sounds made while breathing that resemble snoring. University of Maryland Medical Center, available at http://umm.edu/health/medical/ency/articles/breath- sounds.
A November 2009 spinal x-ray revealed Plaintiff had minimal degenerative changes of the spine and retrolisthesis of L5 on S1. In December 2009, another x-ray revealed mild scoliosis and retrolisthesis at L5 with respect to S1 without change from the November x-ray. (PageID 352). In February 2010 another x-ray was taken showing severe disc space narrowing at L5-S1. (PageID 351, 362).
In March 2010, Plaintiff was briefly admitted to the hospital for supraventricular tachycardia, secondary to drug abuse and possible ischemic heart disease. (PageID 393, 399). He was diagnosed with cocaine abuse, tobacco abuse, alcohol abuse, narcotic dependence, and generalized anxiety disorder. (PageID 393). Plaintiff's mental status examination was tearful and anxious with decreased mood. (PageID 396). A chest x-ray showed COPD changes. (PageID 411). An ecocardiograph was mostly normal revealing mild pulmonary hypertension. (PageID 407).
Tachycardia is a rapid heart rhythm of the upper chambers of the heart. Stanford Hospital and Clinics, available at http://stanfordhospital.org/cardiovascularhealth/arrhythmia/conditions/supraventricular-tachycar dia.html.
In March 2008, Plaintiff also began treatment for chronic lower back pain, depression, and anxiety at the Salud Community Clinic. (PageID 432-36, 479-504, 526-50). He was prescribed Xanax, Vicodin, Alprazolam, and Celexa. (PageID 432). Plaintiff continued treatment with the clinic through August 2011. (PageID 526).
On April 13, 2011, Dr. Warren C. Morris, M.D., completed both a physical capacity assessment and a mental capacity assessment of Plaintiff's functional limitations based on his treatment at the clinic. (PageID 519-23). Dr. Morris opined that Plaintiff could stand one hour total for 15 minutes at a time, walk a half hour total for five minutes at a time, and sit for two hours total for five minutes at a time in an eight hour workday. (PageID 522). He found Plaintiff unable to lift weight on any continued basis, bend, squat, crouch, or crawl. (Id.) For mental functioning limitations Dr. Morris opined that Plaintiff had mild limitation in social interaction, no limitations in concentration, persistence and pace; and no impairments in adaptation. (PageID 519-21).
In July 2010, Plaintiff had a MRI of his lumbar spine taken. (PageID 472). This revealed mild to moderate multilevel degenerative changes, disc space narrowing, endplate degenerative change, grade 1 retrolisthesis of L5 on S1 causing moderate to severe bilateral neural foraminal stenosis, and slight effacement of the thecal sac. (Id.) Plaintiff was later examined by Dr. West for a neurosurgical consult in January 2011. (PageID 511). On examination Plaintiff had palpable tenderness, limited flexion, and negative straight leg raise test. (Id.) Dr. West recommended axial lumbar interbody fusion at L5-S1. (Id.) In September 2011, Plaintiff had the surgery. (PageID 565). Following surgery, Plaintiff began treatment for chronic pain with Dr. Poje. (PageID 599-612). Dr. Poje's physical examination results were lordosis of the lumbar spine, unsteady gait, unsteady heel walking, unsteady toe walking, limited flexion and extension with pain. (PageID 602). Plaintiff was prescribed MS Contin, Oxycodone, Zanaflex, Voltaren, and Neurontin. (PageID 602, 607, 610).
2. Examination
Plaintiff attended a consultative examination with Michael Firmin, Ph.D., on December 23, 2009. (PageID 325-30). Plaintiff related to Dr. Firmin that he had trouble at previous jobs because of difficulties with coworkers and supervisors. (PageID 326). Dr. Firmin found his conversation and thought contained pessimism and confusion, preoccupations, was anxious, and that he could not maintain eye contact. (Id.) His mood was worried and nervous, and his affect constricted. (PageID 327). Dr. Firmin assessed Plaintiff with a Global Assessment of Functioning score of 41 and diagnosed generalized anxiety disorder and intermittent explosive disorder. (PageID 329). He opined that Plaintiff was markedly impaired in social functioning; mildly impaired in understanding, remembering, and following instructions; moderately impaired in the ability to maintain attention, concentration, persistence and pace; and moderately impaired in ability to withstand the stress and pressure associated with day to day work. (PageID 328-30).
Health care clinicians perform a Global Assessment of Functioning ("GAF") to determine a person's psychological, social, and occupational functioning on a hypothetical continuum of mental illness. It is, in general, a snapshot of a person's "overall psychological functioning" at or near the time of the evaluation. Diagnostic and Statistical Manual of Mental Disorders, 4th ed., Text Revision at 32-34 ("DSM-IV"). The DSM-IV categorizes individuals with GAF scores of 41 to 50 as having "serious symptoms or serious impairment in social, occupational, or school functioning (e.g., no friends, unable to keep a job)...." See DSM-IV at 32.
3. Non-Examining Review
Plaintiff's file was reviewed by Catherine Flynn, Psy. D., on January 5, 2010. She diagnosed intermittent explosive disorder, generalized anxiety disorder, and alcohol and cocaine abuse. (PageID 332). Dr. Flynn found moderate limitations in social functioning, activities of daily living, and ability to maintain concentration, persistence and pace. (PageID 342). Dr. Flynn's opinion was reviewed by Walter Rucker, Ph.D., in August 2010 and confirmed as written. (PageID 446).
A second file review was conducted by Robyn Hoffman, Ph.D., in August 2010, again diagnosing Plaintiff with generalized anxiety disorder, intermittent explosive disorder, and alcohol and cocaine dependence. (PageID 452). The only difference in Dr. Hoffman's review was that the checkbox markings in the mental residual functional capacity form switched from marked to moderate. (PageID 466-67).
In March 2010 Gary Hinzman, M.D., completed a physical residual functional capacity assessment. He found Plaintiff retained the ability to lift and carry fifty pounds occasionally and twenty five pounds frequently. (PageID 425). Dr. Hinzman found he could never climb a ladder, rope, or scaffolds, and was limited to occasionally stooping. (PageID 426). Dr. Hinzman's opinion was affirmed by Michael Stock, M.D., in August 2010. (PageID 470).
4. Testimony
At the hearing, Plaintiff testified he could not work due to back pain, COPD, bad knees, arthritis, and a bad attitude. (PageID 89-90). He spent his days watching television in a hospital bed, and would occasionally ride the bus to the library to check out a movie. (PageID 93). He had difficulty getting in and out of the shower, and had a stool to sit on in the shower. (PageID 94). He estimated he could walk and stand five to ten minutes at a time and sit 10-15 minutes at a time. (PageID 94-95). Plaintiff estimated that he had panic attacks ranging from several per week to once every other week, unpredictably. (PageID 101).
5. ALJ Decision
In her decision, the ALJ found Plaintiff had the severe impairments of back impairment status post laminectomy, osteoarthritis of the knee, and chronic obstructive pulmonary disease. (PageID 59). She found shoulder pain, hepatitis C, general anxiety disorder, and substance abuse disorder to be non-severe impairments. (Id.) Plaintiff's severe impairments were found to not meet or equal the severity of Listings 1.04, 1.02, or 3.02. (PageID 61-62). The ALJ assigned the residual functional capacity ("RFC") to perform work at the medium exertion level limited to no climbing ladders, ropes or scaffolds; and occasional stooping, kneeling, crouching, and crawling. (PageID 62). In determining Plaintiff's RFC the ALJ gave significant weight to the State agency opinions to the extent they were consistent with the RFC, little weight to the State agency mental RFC assessments, significant weight to Dr. Morris's mental RFC assessment, and little weight to Dr. Morris's physical functioning opinion. (PageID 65-66). With the assigned RFC, and relying on the vocational expert's testimony, the ALJ found Plaintiff could perform his past work as a truck driver and was therefore not disabled for Social Security purposes. (PageID 67).
Listing 1.04: "Disorders of the spine (e.g., herniated nucleus pulposus, spinal arachnoiditis, spinal stenosis, osteoarthritis, degenerative disc disease, facet arthritis, vertebral fracture), resulting in compromise of a nerve root (including the cauda equina) or the spinal cord. With: (A) Evidence of nerve root compression characterized by neuro-anatomic distribution of pain, limitation of motion of the spine, motor loss (atrophy with associated muscle weakness or muscle weakness) accompanied by sensory or reflex loss and, if there is involvement of the lower back, positive straight-leg raising test (sitting and supine); or (B) Spinal arachnoiditis, confirmed by an operative note or pathology report of tissue biopsy, or by appropriate medically acceptable imaging, manifested by severe burning or painful dysesthesia, resulting in the need for changes in position or posture more than once every 2 hours; or (C) Lumbar spinal stenosis resulting in pseudoclaudication, established by findings on appropriate medically acceptable imaging, manifested by chronic nonradicular pain and weakness, and resulting in inability to ambulate effectively." 20 C.F.R. Pt. 404, Subpt. P, App. 1.
Listing 1.02: "Major dysfunction of a joint(s) (due to any cause): characterized by gross anatomical deformity (e.g., subluxation, contracture, bony or fibrous ankylosis, instability) and chronic joint pain and stiffness with signs of limitation of motion or other abnormal motion of the affected joint(s), and findings on appropriate medically acceptable imaging of joint space narrowing, bony destruction, or ankylosis of the affected joint(s). With: (A) involvement of one major peripheral weight-bearing joint (i.e., hip, knee, or ankle), resulting in inability to ambulate effectively ...; or (B) Involvement of one major peripheral joint in each upper extremity (i.e., shoulder, elbow, or wrist-hand), resulting in inability to perform fine and gross movements effectively." Id.
Listing 3.02 indicates chronic pulmonary insufficiency. Defined further in 20 C.F.R. Pt. 404, Subpt. P, App. 1.
The RFC is an indication of "the most [a claimant] can still do despite [the] limitations" caused by any impairments the claimant might have. 20 C.F.R. § 416.945.
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B.
Plaintiff first contends that the ALJ erred in failing to properly conduct the "treating-source rule" analysis. 20 C.F.R. § 404.1527(c)(2) dictates that the Commissioner will give controlling weight to a treating source opinion if this opinion "is well-supported by medically-acceptable clinical and laboratory diagnostic techniques and is not inconsistent with the other substantial evidence."
In the event a treating source opinion is not given controlling weight, the ALJ must consider "the length of the treatment relationship and the frequency of examination, the nature and extent of the treatment relationship, supportability of the opinion, consistency of the opinion with the record as a whole, and the specialization of the treating source" when deciding what weight to give to such opinions. Wilson v. Comm'r of Soc. Sec., 378 F.3d 541, 544 (6th Cir. 2004). This balancing of factors is required in order to satisfy the treating physician rule. Cole v. Astrue, 661 F.3d 931, 938 (6th Cir. 2011). The ALJ is required to provide "good reasons" for the weight she assigned to a treating source, 20 C.F.R. § 404.1527(c)(2), and the Court will remand cases in which ALJ opinions "do not comprehensively set forth the reasons for the weight assigned to a treating physician's opinion." Wilson, 378 F.3d at 545 (internal quotation marks omitted). The goal of directing the ALJ to follow the mandatory procedures is to allow the complainant "to understand the Commissioner's rationale and the procedure through which the decision was reached." Cole, 661 F.3d at 940.
In her opinion, the ALJ gave "significant weight" to the evaluation of mental impairments conducted by Dr. Morris of the Salud Community Clinic because "Salud Community Clinic is a treating facility and the opinion is consistent with the other medical evidence of record." (PageID 66). On the other hand, "little weight" was given to Dr. Morris's physical evaluation of the complainant because the opinion was purportedly not supported by the other objective evidence. (Id.). However, there is no reference anywhere in the opinion to "controlling weight" or the standard for evaluating a treating source opinion for such weight.
As detailed above, if a treating source opinion is supported by medically acceptable clinical and laboratory diagnostic techniques and not inconsistent with the other substantial evidence, it will receive controlling weight. 20 C.F.R. § 404.1527(c)(2). In Gayheart v. Comm'r of Soc. Sec., 710 F.3d 365 (6th Cir. 2013), the court found that the ALJ committed reversible error by failing to provide "good reasons" for why a treating physician's opinions failed to meet either prong of the controlling-weight test. Id. at 376. Similarly, in the present case, it is not readily apparent that the ALJ conducted controlling weight analysis.
The ALJ did, however, make clear that she was giving "significant weight" to Dr. Morris' mental evaluation and "little weight" to Dr. Morris' physical evaluation. (PageID 66). The ALJ found that the mental evaluation deserved significant weight because it was provided by a physician from a treating facility and it was consistent with the other medical evidence. (Id.) However, the ALJ did not make clear if this mental evaluation was given controlling weight or her reasoning for the same. As for the physical evaluation, which was given "little weight," the ALJ concluded that this opinion was not supported by Plaintiff's admitted daily activities and was not consistent with the other evidence in the case. (Id.) The ALJ did not articulate the test for controlling weight in this instance either, and made no specific comment as to why the opinion was denied controlling weight. The ALJ made some reference to both opinions' consistency with respect to the other evidence in the case; however, in neither instance did the ALJ evaluate or make reference to how any "diagnostic technique" supported the findings of the opinions. In Gayheart, the court noted that the ALJ discussed the nature of a treating physician's relationship with the complainant and alleged inconsistencies between the physician's opinion and portions of her prepared reports regarding the complainant, but the court pointed out that "these factors are properly applied only after the ALJ has determined that a treating-source opinion will not be given controlling weight." 710 F.3d at 376. Similarly, in this case the ALJ pointed out that the physical evaluation conducted by Dr. Morris was "overly restrictive" and "not supported by claimant's admitted activities of daily living." (PageID 66). As in Gayheart, these determinations would indeed be appropriate, but only after the ALJ had made a determination that the opinion was not entitled to controlling weight.
Despite the foregoing analysis, the Court cannot say, as was the case in Gayheart, that the procedural failure by the ALJ in this case "hinders a meaningful review of whether the ALJ properly applied the treating physician rule" to the extent that the oversight would constitute reversible error. 710 F.3d at 377. In Gayheart, the Sixth Circuit found that it was impermissible for the ALJ to apply a more exacting scrutiny to the opinions of a treating source than that applied to a non-treating source. 710 F.3d. at 380. In contrast, the ALJ's opinion in this case does not indicate that she scrutinized Dr. Morris's treating source opinions more strictly than the other opinions of record. In fact, the ALJ evaluated Dr. Morris's mental evaluation and afforded it "significant weight."
In the end, the procedural oversight committed by the ALJ in the case at hand does not denote a lack of substantial evidence. Therefore, the failure to expressly articulate the treating-source rule was harmless error.
C.
Next, Plaintiff alleges that the ALJ erred by failing to properly evaluate the treating source opinions for weight as specified in 20 C.F.R. § 416.927(c).
As discussed supra in Section II-B, when an ALJ does not grant a treating source's opinion controlling weight, she "must apply certain enumerated factors—namely, the length of the treatment relationship and the frequency of examination, the nature and extent of the treatment relationship, supportability of the opinion, consistency of the opinion with the record as a whole, and the specialization of the treating source—in determining what weight to give the opinion." Wilson v. Comm'r of Soc. Sec., 378 F.3d 541, 544 (6th Cir. 2004).
In this case, the ALJ gave the opinion of the treating doctor at the Salud Community Clinic (Dr. Morris) "significant weight" when considering his mental evaluation of Plaintiff. (PageID 66). The ALJ gave significant weight to Dr. Morris's opinion because it was from "a treating facility and the opinion [was] consistent with the other medical evidence." (Id.) Conversely, the ALJ gave Dr. Morris's physical assessment "little weight" because "[t]his overly restrictive opinion [was] not supported by the claimant's admitted activities of daily living, or the other objective medical evidence of record." (Id.)
Dr. Morris's mental evaluation found that Plaintiff "had no other restrictions in his ability to socially function, maintain concentration, persistence, or pace" other than a mild limitation in Plaintiff's ability to work with or around others. (PageID 66). The ALJ gave this opinion great weight because it came from a treating source and it was consistent with the other evidence. (Id.) These are sufficiently "good reasons" for the weight given to this particular opinion.
With respect to Dr. Morris's physical evaluation, the ALJ found that the opinion's restrictiveness was not borne out by the evidence of record, including Plaintiff's own descriptions of his daily activities. The fact that a medical opinion relied on the "subjective claims" of the patient rather than clinical data constitutes a "good reason" for giving little weight to the opinion. Gayheart, 710 F.3d at 378. Accordingly, the ALJ provided "good reasons" for the weight given to Dr. Morris's physical evaluation.
Even assuming arguendo, that the ALJ had failed to provide good reasons for the weight given to these opinions, the failure to follow the "good reasons" rule still constitutes harmless error if "(1) a treating source's opinion is so patently deficient that the Commissioner could not possibly credit it; (2) if the Commissioner adopts the opinion of the treating source or makes findings consistent with the opinion; or (3) where the Commissioner has met the goal of [the regulation] even though she has not complied with the terms of the regulation." Cole v. Astrue, 661 F.3d 931, 940 (6th Cir. 2011). With respect to Dr. Morris's mental evaluation, it is ambiguous whether the ALJ's giving the opinion "significant weight" amounted to an "adoption" of the opinion. However, it is clear that the ALJ made findings consistent with the opinion. Dr. Morris's evaluation indicated that Plaintiff had only a mild limitation in his ability to work with others (PageID 66), and the ALJ found that any mental impairments Plaintiff had were non-severe and that the record indicated that Plaintiff had submitted resumes for jobs, cutting against Plaintiff's claim of disability. Thus, the ALJ's findings were consistent with Dr. Morris's mental evaluation.
As for Dr. Morris's physical evaluation, the ALJ did in fact base her finding that little weight should be afforded to this opinion on the admissions made by Plaintiff and citations to the record. (PageID 66). This analysis adheres to the goal of the regulation by providing Plaintiff with the reasons behind the ALJ's decision. Wilson, 378 F.3d at 547.
In sum, the ALJ provided the requisite good reasons for the weight she gave to the treating source opinions. Moreover, the ALJ met the goal of the regulations because "the ALJ's decision leaves this Court [with] a clear understanding" of why she weighed the two opinions in the manner in which she did. Cole, 661 F.3d at 940. Therefore, any error committed by the ALJ was harmless.
D.
Finally, Plaintiff alleges that the ALJ erred in failing to evaluate or even mention his diagnosis of intermittent explosive disorder.
An ALJ's analysis of a claimant's disability claim consists of a mandated five-step process. See 20 C.F.R. § 416.920(a)(4)(i)-(v). At the second step, the ALJ must evaluate the severity of Plaintiff's impairments. 20 C.F.R. § 416.920(a)(4)(ii). In this case, the ALJ found that Plaintiff had the mental impairments of general anxiety disorder and substance abuse disorder, but that these impairments were not severe. (PageID 60). The ALJ found that Plaintiff had severe physical impairments owing to back problems, arthritis, and COPD, but no mention was ever made of intermittent explosive disorder. (PageID 59). "[O]nce the ALJ determines that a claimant has at least one severe impairment, the ALJ must consider all impairments, severe and non-severe, in the remaining steps." Pompa v. Comm'r of Soc. Sec., 73 F.App'x 801, 803 (6th Cir. 2003).
Plaintiff was diagnosed with intermittent explosive disorder by four psychological examiners, having first been diagnosed by the psychological specialist, Dr. Firmin. (PageID 329). In her opinion, the ALJ mentions that she "considered singly and in combination" Plaintiff's anxiety disorder and his substance abuse disorder when evaluating the severity of his mental impairments. (PageID 60). The opinion does not mention intermittent explosive disorder.
Before the fourth step of the analysis, the ALJ must make a finding of the claimant's RFC "based on all of the relevant medical and other evidence." 20 C.F.R. § 416.920(e). The ALJ then uses the RFC to determine whether the claimant can still perform his/her past relevant work. 20 C.F.R. § 416.920(a)(4)(iv). In this case, the ALJ's Step Four analysis made no mention of the intermittent explosive disorder. The ALJ did refer to the claimant's own testimony concerning his bad attitude and anger problems, but does not address the diagnoses of intermittent explosive disorder by separate examiners. (PageID 63).
The ALJ's silence on this issue makes it nearly impossible for this Court to determine how she evaluated the intermittent explosive disorder diagnosis, and if she in fact did so. The ALJ's omission is grounds for remand. However, given that it is Plaintiff's burden to prove disability and the severity of any impairment (20 C.F.R. § 404.1512(a); 42 U.S.C. § 423 (d)(1)(A)), the Court must conclude that the ALJ's non-disability finding is supported by substantial evidence and her failure to consider the intermittent explosive disorder does not alter this conclusion. For example, Dr. Morris found that Plaintiff had only mild limitations in his ability to function socially in work-type settings. (PageID 66). Also, the evidence does not suggest that the intermittent explosive disorder, in conjunction with other alleged impairments, rose to the level of disability. Plaintiff testified that he could ride the bus to the library in order to borrow movies or books, get himself something to eat, and do his own grocery shopping. (PageID 93). Also, Plaintiff testified that he was not receiving counseling for any mental impairment beyond talking to himself (PageID 91), and described the extent of his mental impairments as being "an attitude problem" and his "feeling a little worthless." (PageID 96).
Plaintiff simply did not put forth enough objective evidence of disability to establish that the ALJ's decision lacked substantial evidence supporting it. The ALJ's failure to consider the intermittent explosive disorder was harmless error.
III.
For the foregoing reasons, Plaintiff's assignments of error are unavailing. The ALJ's decision is supported by sufficient evidence and is affirmed.
IT IS THEREFORE ORDERED THAT the decision of the Commissioner, that Kochen Harris was not entitled to supplemental security income is found SUPPORTED BY SUBSTANTIAL EVIDENCE, and AFFIRMED; and, as no further matters remain pending for the Court's review, this case is CLOSED.
IT IS SO ORDERED.
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Timothy S. Black
United States District Judge