Opinion
08-26-2013
DAYNA PERKINS, Plaintiff, v. COMMISSIONER OF SOCIAL SECURITY, Defendant.
Judge Timothy S. Black
ORDER THAT: (1) THE ALJ'S NON-DISABILITY FINDING IS FOUND NOT
SUPPORTED BY SUBSTANTIAL EVIDENCE, AND IS REVERSED; AND
(2) JUDGMENT BE ENTERED IN FAVOR OF PLAINTIFF
AWARDING BENEFITS
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 disability insurance benefits ("DIB") and Supplemental Security Income ("SSI"). (See Administrative Transcript ("Tr.") (Tr. 9-23) (ALJ's decision)).
I.
In December 2006, Plaintiff applied for DIB and SSI alleging disability as of December 31, 2001 due to a variety of mental impairments (Tr. 9, 116-118, 124-126). The state agency denied Plaintiff's applications initially and upon reconsideration, and Plaintiff timely requested a hearing. (Tr. 9, 62-64, 65-67, 75-77, 82-83, 85). In January 2010, Administrative Law Judge Amelia Lombardo (the ALJ) held a hearing at which Plaintiff and a vocational expert testified. (Tr. 9, 32- 49). In April 2010, the ALJ determined that Plaintiff was not entitled to DIB or SSI benefits during the relevant time (i.e., from December 31, 2001 through April 23, 2010). (Tr. 9-23). In March 2012, the Appeals Council upheld the ALJ's decision, thereby rendering it the Commissioner's final and appealable decision. (Tr. 1-4); see 20 C.F.R. §§ 404.955, 404.981. Plaintiff filed this action for judicial review in this Court under 42 U.S.C. §§ 405(g) and 1383(c)(3).
The ALJ's "Findings," which represent the rationale of her decision, were as follows:
1. The claimant last met the insured status requirements of the Social Security Act through December 31, 2008, but not thereafter.
2. The claimant has not engaged in substantial gainful activity since December 31, 2001, the alleged onset date (20 CFR 404.1571, et seq., and 416.971 et seq.).
3. The claimant has the following severe impairments: bi-polar disorder, depressive disorder, and substance abuse, in remission (20 CFR 404.1520(c) and 416.920(c)).
4. 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).
5. After careful consideration of the entire record, the undersigned finds that the claimant has the residual functional capacity to perform a full range of work at all exertional levels but with the following nonexertional limitations: she can perform only simple, repetitive tasks that are low stress in nature, defined as no assembly line production quotas, not fast paced, no contact with the public, and only minimal contact with supervisors and co-workers.
6. The claimant is unable to perform past relevant work (20 CFR 404.1565 and 416.965).
7. The claimant was born on June 30, 1960 and was 41 years old, which is defined as a younger individual age 18-49, on the alleged disability onset date (20 CFR 404.1563 and 416.963).(Tr. 11-23).
8. The claimant has at least a high-school education and is able to communicate in English (20 CFR 404.1564 and 416.964).
9. Transferability of job skills is not material to the determination of disability because using the Medical-Vocational Rules as a framework supports a finding that the claimant is "not disabled," whether or not the claimant has transferable job skills (See SSR 82-41 and 20 CFR Part 404, Subpart P, Appendix 2).
10. Considering the claimant's age, education, work experience, and residual functional capacity, there are jobs that exist in significant numbers in the national economy that the claimant can perform (20 CFR 404.1569, 404.1569(a), 416.969, and 416.969(a)).
11. The claimant has not been under a disability, as defined in the Social Security Act, from December 31, 2001, through the date of this decision (20 CFR 404.1520(g) and 416.920(g)).
In sum, the ALJ concluded that Plaintiff was not under a disability as defined by the Social Security Regulations, and she was therefore not entitled to DIB. (Tr. 23).
On appeal, Plaintiff argues that the ALJ erred by failing to grant proper weight to the opinion of Plaintiff's treating psychiatrist, Dr. Siddiqi.
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 she is entitled to disability benefits. 20 C.F.R. § 404.1512(a). That is, she must present sufficient evidence to show that, during the relevant time period, she suffered an impairment, or combination of impairments, expected to last at least twelve months, that left her unable to perform any job in the national economy. 42 U.S.C. § 423(d)(1)(A).
A.
The record reflects that:
1. Evidence of Record
Plaintiff was born on June 30, 1960 and has at least a high school education. (Tr. 183, 195). She alleged disability on her initial application due to bipolar disorder, severe depression, and anxiety attacks. (Tr. 188).
Plaintiff began treatment with psychologist Dr. Birdi's office in January 2003. Upon initial psychiatric evaluation on January 7, 2003, mental status examination observed Plaintiff to be easily distracted with a constricted affect. (Tr. 340). The diagnosis was bipolar disorder and polysubstance abuse, rule out borderline personality disorder. She was assigned a GAF of 40.. (Tr. 341). On 10/25/03, Plaintiff was suffering from memory problems and continued to use cocaine. (Tr. 334). On June 3, 2004, Dr. Birdi noted that Plaintiff was still suffering from panic attacks. (Tr. 332). On August 11, 2004, Plaintiff was out of medication for three weeks and was observed to be manic and irritable. (Tr. 330).
The GAF scale is used to report a clinician's judgment of an individual's overall level of functioning. Clinicians select a specific GAF score within the ten-point range by evaluating whether the individual is functioning at the higher or lower end of the range. A GAF score between 31 and 40 indicates some impairment in reality testing or communication (e.g., speech is at times illogical, obscure, or irrelevant) OR major impairment in several areas, such as work or school, family relations, judgment, thinking, or mood (e.g., depressed adult avoids friends, neglects family, and is unable to work); a GAF score between 41 and 50 indicates serious symptoms (e.g., suicidal ideation, severe obsessional rituals, frequent shoplifting) OR any serious impairment in social, occupational, or school functioning (e.g., no friends, unable to keep a job); and a GAF score between 51 and 60 indicates moderate symptoms (e.g., flat affect and circumstantial speech, occasional panic attacks) OR moderate difficulty in social, occupational, or school functioning (e.g., few friends, conflicts with peers or co-workers). See American Psychiatric Ass'n, Diagnostic and Statistical Manual of Mental Disorders 33-34 (American Psychiatric Ass'n, 4th ed. text rev. 2000) (DSM-IV-TR).
Plaintiff has been psychiatrically admitted to the hospital and seen in the emergency room for psychiatric complaints on numerous occasions. She was admitted on May 21, 2004 with complaints of depression and suicidal ideation, having been off her medications for several weeks. (Tr. 274). The impression was major depression with suicidal ideation and cocaine abuse. (Tr. 275). She was later admitted to a dual diagnosis program in June 2004, which she attended for approximately one week. The diagnosis was major depression, recurrent; panic disorder with agoraphobia; and cocaine addiction in early full remission. (Tr. 295). She was discharged on June 25, 2004 due to "inability to attend." (Tr. 289).
Plaintiff was admitted again to a dual diagnosis program in September 2004. (Tr. 351). The diagnosis was panic disorder with agoraphobia and cocaine abuse. (Tr. 356). She was assigned GAF of 45. (Id.) On mental status examination, she was easily distracted with psychomotor retardation, slowed rate of speech, constricted and blunted affect, and a sad, anxious mood. (Tr. 320). After being discharged from the dual diagnosis program, Plaintiff was seen in the emergency room on October 13, 2004 for anxiety. (Tr. 398). She reported a relapse of cocaine two days prior. Id.
Plaintiff was admitted to the hospital on June 16, 2005, at which time she was requesting cocaine detoxification. (Tr. 410). She reported manic episodes up to four days and depressive episodes. (Tr. 411). On mental status examination, Plaintiff's speech was slightly pressured with a slightly elevated affect and tangential speech. (Tr. 414). She was referred to mental health treatment by the hospital. (Tr. 419).
Plaintiff began residential treatment at the Women's Recovery Center in late 2005. (Tr. 431, 478). Upon initial assessment, she was diagnosed with cocaine dependence and bipolar disorder NOS. (Tr. 439). She was discharged in November 2005 and referred to aftercare treatment at DayMont West. (Tr. 577).
Plaintiff was seen for an initial psychiatric evaluation at DayMont West by Dr. Siddiqi on December 1, 2005. (Tr. 506). Plaintiff complained of decreased sleep, depression, anxiety, and mood swings. (Id.) Dr. Siddiqi diagnosed bipolar disorder, most recent episode depressed and cocaine dependence. (Tr. 508). She assigned a GAF of 50. Id.
The record contains progress notes from Dr. Siddiqi beginning in February 2006 and continuing through November 2009. On February 22, 2006, Plaintiff reported sleeping and eating "pretty good" but she maintained a restricted affect. (Tr. 504). On March 22, 2006, Plaintiff complained of increasing anxiety and poor sleep and displayed a restricted affect. (Tr. 502). On May 11, 2006, Plaintiff's affect was again restricted with anxious mood and racing thoughts. (Tr. 500). On August 8, 2006, Plaintiff complained of increasing anxiety and depression. (Tr. 634). She was observed to be alert, appropriate, and anxious. Id.
Plaintiff was admitted to the hospital on October 23, 2006 with complaints of increasing depression, suicidal ideation, and delusional thinking. (Tr. 583). She reported feeling very depressed and stated that she had been off her medications for a number of weeks. (Tr. 585). A urine screen was positive for cocaine. Id. The final diagnosis was major depression, acute. (Tr. 583).
Plaintiff was seen for a psychological consultative examination performed by Dr. Olson on March 28, 2007. (Tr. 640-46). Plaintiff reported that her father does most of the household chores and she does not socialize. She tries to "stay asleep as much as I can." (Tr. 642-43). She reported panic attacks occurring daily for "a considerable portion of the day." (Tr. 643). She particularly worries about leaving her home and is afraid of crowds. Id. On mental status examination, speech was normal, conversation was logical with occasional rambling, voice was slurred at times, and she exhibited fair eye contact. (Tr. 642). Affect was blunted, occasionally slightly labile, during the interview with a "depressed, down, hurt, and disappointed" mood. Id. There was psychomotor retardation, attributed possibly to medication. Id. Dr. Olsen observed "a number of overt automnomic signs of anxiety" including rocking in her seat and being restless with her hands. (Tr. 643). Consciousness flowed appropriately "for the most part" but there was some flight of ideas. Id. Concentration and attentional skills were fair. Id. Plaintiff stated that she last used cocaine in November 2006. (Tr. 642).
Dr. Olsen diagnosed bipolar I disorder, most recent episode depressed and cocaine abuse by history. (Tr. 645). He assigned a GAF of 50. Id. Dr. Olson opined that Plaintiff would be at least moderately impaired in her ability to maintain attention, concentration, persistence and pace for simple, repetitive tasks. Id. He opined that Plaintiff would also be moderately impaired in her ability to relate to others due to her mood disorder and anxiety symptoms. Id. He opined that Plaintiff is severely impaired in her ability to withstand the stress and pressures associated with day-to-day work activity. Id. Dr. Olsen concluded that "she does not have the mental ability to perform even simple repetitive work tasks in a day-today competitive job environment at this time." (Tr. 645-46).
Dr. Siddiqi completed a form at the request of the Bureau of Disability Determination (BDD) on June 26, 2007, at which time she had been treating Plaintiff for approximately one and a half years. (Tr. 668-70). She described Plaintiff's ability to remember, understand, and follow instructions as "impaired due to poor concentration and focus, poor memory and easy distractibility." (Tr. 669). She described Plaintiff's ability to sustain concentration and persist at tasks to be "poor." Id. In response to the question: "how would the patient react to the pressures, in work settings or elsewhere, involved in simple and routine, or repetitive tasks?" Dr. Siddiqi opined: "poorly due to impairment in concentration, memory and impulse control." Id.
State Agency psychologists reviewing the file in May and October of 2007 thought that Plaintiff would be capable of performing simple, repetitive tasks with no production quotas and minimal social interaction. The consultative examination performed by Dr. Olsen was acknowledged, however the BDD reviewers felt that Plaintiff's activities of daily living and her ability to maintain sobriety were unsupportive of Dr. Olsen's opinion that Plaintiff has serious limitations in her ability to tolerate stress. (Tr. 650, 705).
Plaintiff continued to treat with Dr. Siddiqi at DayMont West. On April 11, 2007, Plaintiff reported "doing pretty good" and sleeping fine. (Tr. 683). Affect was anxious with depressed mood. Id. On May 10, 2007, Plaintiff complained of feeling depressed and having increasing difficulty with sleep. (Tr. 681). She was observed to be alert, restless, depressed, and tired. Id. For the next several months, Dr. Siddiqi reported that Plaintiff was "doing fine" or "doing ok." (Tr. 679, 675, 726, 720, 717, 715). Despite this, Plaintiff's treating counselor at the time, Ellen Miller, opined in August 2007 that Plaintiff was "unable to handle stress of employment right now." (Tr. 728).
In March 2008, Plaintiff was working as a counselor at Job Corp. (Tr. 711). Plaintiff held this position for only three months and left because the position was "too much for me." (Tr. 36).
On June 28, 2008, Plaintiff was seen by Dr. Siddiqi after approximately three months away, reporting that she had stopped taking her medication in April because she "felt like a zombie." (Tr. 787). On July 2, 2008, Plaintiff reported feeling "slightly better" but continued to stay in her room and was suffering from racing thoughts. (Tr. 784). On August 14, 2008, Plaintiff reported feeling very anxious and she was experiencing daily panic attacks. She was subdued, quiet, and cooperative. (Tr. 778). On 8/28/08, Plaintiff was feeling sad, depressed, and complained of increasing anxiety, auditory hallucinations and racing thoughts. (Tr. 775). She reported that that she "tends to stay in her room." Id. Her affect was restricted, her mood was tired, and she was depressed with paranoia and feelings of hopelessness. Id. On 9/11/08, Plaintiff was "feeling ok" but demonstrated a flat affect, depressed mood, monotone speech, and poverty of thought. (Tr. 770). She complained of feeling tired, depressed, and reported continuing panic attacks. Id. On September 30, 2008, Plaintiff was alert and cooperative and was attending narcotics anonymous (NA) meetings. (Tr. 767). On November 6, 2008, Plaintiff was feeling tired and complained of auditory hallucinations and poor sleep. (Tr. 774). She was alert, tired, and cooperative. She reported no use of illegal substances in two years. Id.
On January 15, 2009, Plaintiff reported to Dr. Siddiqi that she was "doing ok" but feeling drowsy due to her medications. (Tr. 762). On March 26, 2009, Plaintiff complained of feeling depressed and anxious and reported that she "stays in bed." (Tr. 759). Her affect was restricted and mood was depressed. Id. On May 7, 2009, Plaintiff complained of sleeping too much. (Tr. 799). She stated that she had been clean since November 2006. Id. Her speech was low and monotone with restricted affect, tired mood, limited insight, and reported auditory hallucinations. Id. On May 27, 2009, Plaintiff reported having a "good weekend" during which she went to the park with her son, but she also reported that she "mostly stays at house." (Tr. 797). On September 15, 2009, Plaintiff was "doing ok" but continued to isolate herself and was feeling depressed, anxious, and paranoid. (Tr. 795). On October 21, 2009, Plaintiff was experiencing difficulty with sleep, hearing voices at night, and having flashbacks. (Tr. 793). She continued to attend NA meetings but suffered feelings of paranoia. Id. She reported being clean since November 2006. Id. Her affect was restricted and mood was anxious and worried. Id. On November 4, 2009, Plaintiff complained of poor memory and concentration and stated that she had recently misplaced her medications. (Tr. 791).
Dr. Siddiqi completed a psychiatric review technique form and mental impairment questionnaire on December 16, 2009. (Tr. 805-18). She diagnosed Plaintiff with an affective disorder with depressive syndrome characterized by: loss of interest in activities, appetite disturbance, sleep disturbance, psychomotor agitation/retardation, decreased energy, feelings of guilt/worthlessness, difficulty concentrating, hallucinations, delusions, and paranoid thinking. (Tr. 808). She also identified manic syndrome characterized by decreased sleep, easy distractibility, and hallucinations. (Tr. 808-09). In her mental impairment questionnaire, Dr. Siddiqi described clinical symptoms of impaired memory and concentration, depressed mood, poor sleep, lack of interest and motivation, and increased tiredness. (Tr. 816). She felt that Plaintiff's response to treatment has been "limited" and her prognosis is guarded. (Tr. 817). She opined that Plaintiff would be absent more than three times per month due to her psychological impairments. (Tr. 817-18).
At the hearing, Plaintiff testified that she is unable to work due to her bipolar diagnosis. (Tr. 37). She described a "depressed state" during which she has feelings and thoughts about death, has a hard time getting out of bed, and feels tired and fatigued. Id. She testified that she no longer visits or talks with friends. Id. She testified that she has been sober since November 2006. Id. She previously saw a counselor at DayMont West but no longer did so because "they've had a hard time keeping staff" and because "I have a hard time talking." (Tr. 38-39). She continued to see her psychiatrist approximately every two weeks for about the last year. Id. Each session lasts approximately an hour and a half. (Tr. 39). Plaintiff testified that when she wakes up on a typical morning, has a panic attack, and tends to stay in bed all day. (Tr. 40). She began hearing voices approximately three years ago. (Tr. 43). She felt that the voices were telling her to quit her job and she therefore quit. Id.
2. The ALJ's Decision
In the ALJ's decision, dated April 23, 2010, she determined that Plaintiff had not engaged in substantial gainful activity since her alleged onset date of December 31, 2001. (Tr. 11). She found that the Plaintiff had the following severe impairments: bipolar disorder, depressive disorder, and substance abuse in remission. (Tr. 12). She found that Plaintiff retained the residual functional capacity to perform a full range of work at all exertional levels but with the following nonexertional limitations: she can perform only simple, repetitive tasks that are low stress in nature, defined as no assembly line production quotas, not fast-paced, no contact with the public, and only minimal contact with supervisors and co-workers. (Tr. 14). The ALJ concluded that the Plaintiff could not perform any of her past relevant work; however jobs existed in significant numbers in the national economy that Plaintiff could perform, including industrial cleaner, crate liner, machine packager, microfilm processer, garment sorter, and marker II. (Tr. 22). Plaintiff was not found to be under a disability as defined by the Social Security Act during the alleged period. (Tr. 64).
B.
Plaintiff alleges that the ALJ erred by failing to grant proper weight to the opinion of her treating physician, Dr. Siddiqi.
The ALJ is required to give a treating source's opinion controlling weight if it "is well supported by medically acceptable clinical and laboratory diagnostic techniques and is not inconsistent with the other substantial evidence in your case record." 20 C.F.R. 404.1527(d)(2). If the ALJ declines to give a treating source's opinion controlling weight, she must then balance the following factors to determine what weight to give it: "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 specialization of the treating source." Wilson v. Comm'r of Soc. Sec., 378 F.3d 541, 544 (6th Cir. 2004) (citing 20 C.F.R. 404.1527(d)(2)). The ALJ may not focus only on evidence which supports her foregone conclusions. See, e.g. Loza v. Apfel, 219 F.3d 378, 393 (5th Cir. 2000) ("ALJ must consider all the record evidence and cannot 'pick and choose' only the evidence that supports his position."), Switzer v. Heckler, 742 F.2d 382, 385-86 (7th Cir. 1984), and Kuleszo v. Barnhart, 232 F. Supp. 2d 44, 57 (S.D.N.Y. 2002).
Dr. Siddiqi completed a psychiatric review technique form ("PRTF") and mental impairment questionnaire on December 16, 2009. (Tr. 805-18). She diagnosed Plaintiff with bipolar disorder, most recent episode depressed, and assigned a GAF score of 50. (Tr. 815). In her questionnaire, Dr. Siddiqi opined that Plaintiff experiences marked difficulties in social functioning and moderate difficulties in her activities of daily living and concentration, persistence, and pace. (Tr. 818). In her PRTF, Dr. Siddiqi opined that Plaintiff suffers marked difficulties in social functioning and in concentration, persistence, and pace. (Tr. 813). She opined that Plaintiff has moderate limitations in performing activities of daily living. Id. The slight variance in these two assessments is likely related to the varied terminology on the two forms and is of little import as the ALJ should rely on substantive content rather than conclusions, and the assessments are consistent in their description of Plaintiff's symptoms.
In Dr. Siddiqi's PRTF, she diagnosed Plaintiff with an affective disorder with depressive syndrome characterized by: loss of interest in activities, appetite disturbance, sleep disturbance, psychomotor agitation/retardation, decreased energy, feelings of guilt/worthlessness, difficulty concentrating, hallucinations, delusions, and paranoid thinking. (Tr. 808). She also identified manic syndrome characterized by decreased sleep, easy distractibility, and hallucinations. (Tr. 808-09). In her mental impairment questionnaire, Dr. Siddiqi described clinical symptoms of impaired memory and concentration, depressed mood, poor sleep, lack of interest and motivation, and increased tiredness. (Tr. 816).
The ALJ granted all of the assessments from Dr. Siddiqi only "little weight," finding that the conclusions were not supported by objective signs and findings in the treatment notes from DayMont West. (Tr. 21). The ALJ also found:
Dr. Siddiqi's findings of marked limitations in a number of areas are inconsistent with the GAF scores of 50, which reflects the high end of 'serious symptoms,' and is inconsistent with her note in December 2005 that the claimant's noncompliance and substance abuse lead to decompensation. Further, Dr. Siddiqi's findings are inconsistent with her continual recommendations that the claimant exercise and be more active.
Id.
The ALJ cites to GAF scores of 50 as evidence that marked limitations are not appropriate, but the ALJ also earlier conceded that "a number of the GAF scores in the record were at 50 or below" and were discounted in order to deny benefits. (Tr. 18). Also, in addition to Dr. Siddiqi, Dr. Olson assigned a GAF score of 50 during his evaluation and opined that Plaintiff was severely impaired in at least one functional area. The fact that two psychological experts both assigned GAF scores of 50 and still opined a marked or severe impairment undermines the ALJ's rationale.
The treatment note referenced by the ALJ is not inconsistent with Dr. Siddiqi's opinions. Plaintiff has been sober since November 2006. The opinions from Dr. Siddiqi are dated well past her sobriety date. While Dr. Siddiqi may have felt in December 2005 that Plaintiff's ongoing substance abuse and noncompliance were contributing factors to episodes of decompensation at that time, Dr. Siddiqi recently opined that Plaintiff's symptoms continue to lead to decompensation, despite her sobriety, as evidenced by her questionnaire and PRTF.
The ALJ failed to acknowledge Plaintiff's sobriety beginning in November 2006 and Plaintiff's ongoing symptomology thereafter. The ALJ cited to a reference in September 2008 where Plaintiff told her counselor she had been clean for "at least" 9 months, which the ALJ interpreted as being inconsistent with Plaintiff's testimony. (Tr. 773). This statement may be vague, but it is not inconsistent. Plaintiff is very clear as to her date of sobriety throughout the record, as reported on several occasions to several different sources. Her date of sobriety was November 2006, which is consistent with her testimony at the hearing. (Tr. 642, 731, 764, 793, 799). As the treatment note dated September 2008 is nine months into the year, Plaintiff may have indicated she had been clean for the past year or some similar report, and regardless the note states "at least" nine months, which includes the possibility of the longer period of sobriety Plaintiff otherwise reported.
The ALJ also stated that Dr. Siddiqi's findings are inconsistent with her continual recommendations that Plaintiff exercise. There is no explanation from the ALJ as to how or why this type of prescribed treatment means that Plaintiff is less than markedly impaired in any work-related area of functioning. While the ALJ doesn't address what she feels is the "appropriate" treatment to support Dr. Siddiqi's findings, this is a determination that must be left to the medical professionals, not to the ALJ. "While the Secretary may have expertise in respect of some matters, we do not believe he supplants the medical expert." Hall v. Celebreeze, 314 F.2d 686, 690 (6th Cir. 1963).
In addition, psychological consultative examiner Dr. Olson examined Plaintiff on March 28, 2007. He opined that Plaintiff was at least moderately impaired in her ability to maintain attention, concentration, persistence, and pace to perform simple, repetitive tasks and moderately impaired in her ability to maintain social functioning. (Tr. 645). Most importantly, he opined that Plaintiff was severely impaired in her ability to withstand the stress and pressures associated with day-to-day work activity. Id. The ALJ afforded "some weight" to the assessment of Dr. Olson, but only "little weight" to Dr. Olson's statement that the claimant was markedly impaired in her ability to tolerate work stress. (Tr. 19). The ALJ found that, while Dr. Olson's assessment was generally supported by medical signs and findings, it was performed only months after Plaintiff stopped using drugs, after which the ALJ felt Plaintiff had shown continued improvement. (Tr. 20).
In reality, the treatment notes from DayMont West fail to show sustained improvement. For example, in treatment notes dated 1/31/08, mental status revealed a restricted affect, anxious mood, decreased motivation, and limited insight. (Tr. 713). This is very similar to the mental status exam performed during Plaintiff's initial psychiatric assessment in December 2005, finding a constricted affect, depressed and anxious mood, impaired judgment, memory, and insight, and impaired ability to concentrate. (Tr. 506).
The ALJ also cites to Plaintiff's "wide range of daily activities" in support of a showing of improvement, which is an overbroad and inaccurate description of Plaintiff's day-to-day life. The ALJ's recitation of Plaintiff's daily activities includes: prepared her own meals, did "some" cleaning, went to the store regularly, visited her son on the weekends, and talked to her mother on the telephone. (Tr. 18). Instead, a more complete review of the record reveals Plaintiff's isolating behavior, often staying in her home and/or sleeping too much. (Tr. 775, 784, 795, 797, 799). Plaintiff testified at the hearing: "I'm just so depressed I'm thinking about death a lot. I used to get out of bed but it just seems impossible." (Tr. 43).
Finally, the ALJ erred by discounting Dr. Siddiqi's conclusions because she found they were "not supported by objective signs and findings in the treatment notes." (Tr. 21). Psychiatric evidence is not discounted because it is based on subjective complaints, as psychiatric reports "do not easily lend themselves to the same degree of substantiation as other medical impairments." Walker v. Sec'y of H.H.S., 980 F.2d 1066, 1071 n.3 (1992). Thus, the Sixth Circuit has found that a psychological opinion that is established "through clinical observations" or "proper psychological techniques" can suffice to demonstrate a "medically determinable" disability. Crum v. Sullivan, 921 F.2d 642, 645 (6th Cir. 1990). The diagnosis and observations of professionals, such as Dr. Siddiqi, trained in the field of psychopathology, are sufficient to substantiate a psychiatric impairment. While the ALJ cites to "relatively normal mental status examinations," she failed to establish that the record is inconsistent with Dr. Siddiqi's opinion. Dr. Siddiqi's opinions are consistent with the weight of the evidence, including the opinion from psychological consultative examiner Dr. Olson, and as such are entitled to controlling weight. The ALJ's decision is therefore not supported by substantial evidence.
III.
When, as here, the non-disability determination is not supported by substantial evidence, the Court must decide whether to reverse and remand the matter for rehearing or to reverse and order benefits granted. The Court has authority to affirm, modify or reverse the Commissioner's decision "with or without remanding the cause for rehearing." 42 U.S.C. § 405(g); Melkonyan v. Sullivan, 501 U.S. 89, 100 (1991).
Generally, benefits may be awarded immediately "only if all essential factual issues have been resolved and the record adequately establishes a plaintiff's entitlement to benefits." Faucher v. Sec'y of Health & Human Servs., 17 F.3d 171, 176 (6th Cir. 1994); see also Abbott v. Sullivan, 905 F.2d 918, 927 (6th Cir. 1990); Varley v. Sec'y of Health & Human Servs., 820 F.2d 777, 782 (6th Cir. 1987).
The Court may award benefits where the proof of disability is strong and opposing evidence is lacking in substance, so that remand would merely involve the presentation of cumulative evidence, or where the proof of disability is overwhelming. Faucher, 17 F.3d at 176; see also Felisky, 35 F.3d at 1041; Mowery v. Heckler, 772 F.2d 966, 973 (6th Cir. 1985). Such is the case here.
Here proof of disability is overwhelming and remand will serve no purpose other than delay. As fully recited here, in view of the extensive medical record of evidence of disability, and the credible and controlling findings and opinions of Dr. Siddiqi, her treating physician, and Dr. Olson, the psychological consultative examiner, the ALJ failed to meet her burden of finding substantial evidence that Plaintiff is able to engage in substantial gainful activity. Instead, proof of disability is overwhelming.
IT IS THEREFORE ORDERED THAT:
The decision of the Commissioner, that Dayna Perkins was not entitled to disability insurance benefits and supplemental security income beginning December 31, 2001 is hereby found to be NOT SUPPORTED BY SUBSTANTIAL EVIDENCE, and it is REVERSED; and this matter is REMANDED to the ALJ for an immediate award of benefits. The Clerk shall enter judgment accordingly.
__________________
Timothy S. Black
United States District Judge