Opinion
CIVIL 4:22-CV-1922
05-31-2024
ANGELA ATKINSON, Plaintiff, v. MARTIN O'MALLEY,[1] Commissioner of Social Security Defendant.
Brann, Chief Judge.
REPORT AND RECOMMENDATION
Martin C. Carlson, United States Magistrate Judge.
I. Introduction
For Administrative Law Judges (ALJs), Social Security disability determinations frequently entail an informed assessment of competing medical opinions coupled with an evaluation of a claimant's subjective complaints. Once the ALJ completes this task, on appeal it is the duty and responsibility of the district court to review these ALJ findings, judging the findings against a deferential standard of review which simply asks whether the ALJ's decision is supported by substantial evidence in the record, see 42 U.S.C. § 405(g); Johnson v. Comm'r of Soc. Sec., 529 F.3d 198, 200 (3d Cir. 2008); Ficca v. Astrue, 901 F.Supp.2d 533, 536 (M.D. Pa. 2012), a quantum of proof which “does not mean a large or considerable amount of evidence, but rather such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.” Pierce v. Underwood, 487 U.S. 552, 565 (1988).
Yet, while this is a deferential substantive standard of review, it is also incumbent upon the ALJ to sufficiently articulate the rationale for the decision to allow for meaningful judicial review. Thus, the ALJ's decision must be accompanied by “a clear and satisfactory explication of the basis on which it rests.” Cotter v. Harris, 642 F.2d 700, 704 (3d Cir. 1981). Conflicts in the evidence must be resolved and the ALJ must indicate which evidence was accepted, which evidence was rejected, and the reasons for rejecting certain evidence. Id. at 706-07. In addition, “[t]he ALJ must indicate in his decision which evidence he has rejected and which he is relying on as the basis for his finding.” Schaudeck v. Comm'r of Soc. Sec., 181 F.3d 429, 433 (3d Cir. 1999). Where this duty of articulation is not fully satisfied, a remand is appropriate.
So it is here.
In this case, the plaintiff, Angela Atkinson, filed a claim for supplemental security benefits on July 2, 2020, alleging that she was disabled due to carpel tunnel syndrome, degenerative disc disease, anxiety, depression, panic, and post-traumatic stress disorders. (Tr. 11, 13). A hearing was held before an ALJ on this application, and on June 3, 2021, the ALJ found that Atkinson could perform a limited range of light work. (Tr. 8-27). In doing so the ALJ found that Atkinson's emotional impairments were not disabling. However, in reaching this result the ALJ rejected the opinion of the sole treating physician and failed to acknowledge the existence of another treating source opinion and clinical history which supported this disability claim.
Therefore, the pivotal issue in this case relates to the consideration of medical opinion evidence regarding Atkinson's emotional impairments. Atkinson now appeals this decision, advancing a twofold argument. According to Atkinson, the ALJ erred in evaluating the severity of her symptoms and in failing to give greater persuasive power to the medical opinion of her treating psychiatrist, Dr. Bredow.Dr. Bredow, who had been treating Atkinson since 2017, twice opined that her emotional impairments were disabling. (Tr. 818,1680-91). The ALJ, however, concluded that this opinion was not persuasive, reasoning that Dr. Bredow's opinions were inconsistent with the other clinical evidence. Instead, the ALJ assigned greater persuasive power to the opinions of state agency experts who had never treated, examined, or seen Atkinson.
We note that the ALJ misspelled this treating source's name, identifying him as Dr. “Bedrow” instead of Dr. Bredow. (Compare Tr. 24 with Tr. 492).
Yet in reaching this conclusion regarding the persuasive power of these medical opinions, the ALJ's decision did not analyze, address, or even acknowledge a significant body of additional evidence; namely, the treatment notes and medical opinions expressed by Atkinson's counselor, LCSW Aimee Mickey. Fairly construed, these treatment notes and this medical opinion provided information which was consistent with and supported Dr. Bredow's findings regarding the severity of Atkinson's emotional impairments. Yet, this evidence was never considered or addressed when evaluating Dr. Bredow's opinion.
In our view, more is needed here before we can engage in an informed analysis of this claim. Therefore, for the reasons set forth below, it is recommended that this case be remanded to the Commissioner for further proceedings.
II. Statement of Facts and of the Case
The administrative record of Atkinson's disability application reveals the following essential facts: On July 2, 2020, Angela Atkinson applied for supplemental security income benefits under the Social Security Act, alleging an onset of disability beginning July 2, 2020. (Tr. 11). According to Atkinson she was totally disabled due to the combined effects of the following impairments: carpal tunnel syndrome, degenerative disc disease, generalized anxiety disorder, major depressive disorder, panic disorder, and posttraumatic stress disorder. (Tr. 13). Thus, Atkinson's reported impairments were primarily emotional and psychological. (Id.) At the time of this application, Atkinson, who was born in 1979, was 41 years old, which was defined as a younger individual under the Commissioner's regulations. She had at least a high school education but possessed no past relevant work experience. (Tr. 25).
A. Atkinson's Clinical History and the Medical Opinion Evidence.
With respect to Atkinson's emotional impairments, the clinical record disclosed that Atkinson had a longstanding individual and familial history of mental illness, which was exacerbated by a constellation of stressors and had led, in April of 2021, to a brief emergency room hospitalization of Atkinson for suicidal ideation. This significant clinical history was documented by two primary treating sources, only one of whom was acknowledged by the ALJ in the decision denying benefits to Atkinson.
The treating source acknowledged by the ALJ was Dr. Gregory Bredow, a psychiatrist. Dr. Bredow had an extensive, longitudinal treatment history with Atkinson having provided her with mental health care and treatment since 2017. (Tr. 486-575, 708-80, 1048-1248, 1337-1423, 1424-1558, 1680). In the course of this treatment, Dr. Bredow documented Atkinson's extended family history of serious mental illness, noting that her father was an alcoholic with a history of suicide attempts, her mother suffered from depression, her sister dealt with profound mental illness, and her four-year-old son had significant, violent, destructive behavioral issues. (Tr. 490).
Dr. Bredow also diagnosed Atkinson as suffering from a cascading array of emotional impairments including anxiety, depression, panic, and post-traumatic stress disorders, as well as a binge eating disorder. (Id.) Moreover, during the relevant time period Dr. Bredow's treatment notes documented a series of profound, and intractable, stressors which compounded the severity of her emotional impairments. Thus, treatment notes reveal that Atkinson's four-year-old son was suffering from profound behavioral issues, which included assaultive and violent destructive conduct. (Tr. 1091, 1452). By February of 2021 Atkinson was reporting that: “She is worried about her son Logan who has a lot of behavioral issues and is now making statements to kill people and is walking around the house holding knives.” (Tr. 1348). Atkinson also “stated that Logan has been threatening to stab and kill them or he says he is going to kill himself.” (Tr. 1356). Given Atkinson's own mental health history, which had been marked by past violence, these violent episodes had a significant, triggering effect upon her. (Tr. 1348, 1437). Atkinson also experienced great marital stress. Her spouse suffered from drug and gambling addictions. These conditions became more severe in 2020, with Atkinson suspecting that he had relapsed into drug use and discovering that he was engaging in an active gambling addiction. (Tr. 1097, 1101, 1127, 1141). These stressors, in turn, had a cascading effect upon Atkinson. Because of her spouse's gambling losses, the family was unable to make home payments, and faced housing insecurity. (Tr. 1074, 1101, 1120, 1127). Her spouse's drug use also reportedly led to him stealing or extorting Adderall from Atkinson. (Tr. 490, 1097).
Dr. Bredow frequently saw and treated Atkinson during the relevant time frame embraced by this disability application in 2020 and 2021. (Tr. 486-575, 70880, 1048-1248, 1337-1423, 1424-1558). And while the doctor's treatment notes contained some positive observations in that they described Atkinson as experiencing coherent thought processes, (id.), the clinical record also revealed that Atkinson's exacerbated emotional impairments took her to a desperate place on April 6, 2021, when she reported to the emergency room complaining of suicidal ideation. (Tr. 1578).
It was against this clinical backdrop that Dr. Bredow twice opined regarding whether Atkinson's emotional impairments were disabling. Initially on November 2, 2020, the doctor wrote a letter which stated that the doctor was treating Atkinson for a major depressive disorder, generalized anxiety disorder, PTSD, a panic disorder, and a binge eating disorder. (Tr. 818). According to Dr. Bredow, Atkinson was “not stable with her psychiatric symptoms,” and had enjoyed “only limited success her progress.” (Id.) Dr. Bredow stated that he supported Atkinson's decision to seeks disability benefits observing that “her symptoms have greatly impacted her quality of life and ability to maintain gainful employment.” (Id.)
Dr. Bredow expanded upon this opinion in a March 23, 2021, medical source statement. (Tr. 1680-91). In that statement, which was prepared days before Atkinson reported to the emergency room suffering from suicidal thoughts, Dr. Bredow explained that he had been treating Atkinson since October of 2017 and had diagnosed her as suffering from generalized anxiety disorder, binge eating disorder, panic disorder, depression, and PTSD. (Tr. 1680). Dr. Bredow opined that Atkinson would experience moderate and marked impairments in multiple spheres of workplace functioning due to these impairments; would miss four days or more of work each month due to her impairments; and would be able to perform sustained work less than 80% of the workday. (Tr. 1681).
Moreover, Dr. Bredow's opinions and clinical evidence, while significant, were not the only treating source evidence documenting the severity of Atkinson's emotional impairments. There was a second treating source, a licensed counselor and social worker (LCSW) named Aimee Mickey, whose clinical records also confirmed the gravity of Atkinson's mental health in 2020 and 2021. Furthermore, LCSW Mickey provided an opinion letter supporting Atkinson's claim of disability. Remarkably, the ALJ's decision denying this disability application does not appear to analyze, address, or even acknowledge this body of treating source clinical and opinion evidence.
This is a significant oversight since these treating source clinical notes confirmed a number of Dr. Bredow's findings. For example, LCSW Mickey also diagnosed Atkinson as suffering from depression, anxiety, PTSD, and related disorders. (Tr. 1065, 1072, 1082, 1102, 1109, 1368, 1383, 1411, 1450). The treatment notes also graphically described the severity of her symptoms during the pertinent time frame. Thus, by September of 2020, Atkinson was reporting that “she thought she was having a nervous breakdown,” (Tr. 1084), and described her anxiety as “bad.” (Tr. 1091). Two months later Atkinson shared suicidal thoughts with LCSW Mickey in November 2020, stating that she:
Discussed the past abuse by her sister. She shared that her sister, who is 7 years older, molested her and was physically abusive to her. Her mother either denies or ignores that it happened possibly due to being abused by her own brother. Angie shared that her sister would pour scalding hot water on her while giving her a bath. She stated that she has tried to have a relationship with her sister but
she becomes suicidal when they have contact since she feels the only way this will end is if one of them die.(Tr. 1413).
December 2020 treatment notes recorded that Atkinson had “been having a lot of anxiety lately.” (Tr. 1402). In January 2021, Atkinson reported that “she worries about leaving the home since she thinks about being shot by someone.” (Tr. 1370). By February 2021, Atkinson reported that her binge eating has been bad, and her anxiety was high. (Tr. 1356). Further, on April 5, 2021, Atkinson was reporting that:
[H]er depression is 9/10 mainly due to their financial situation. She stated that on Saturday she became really close to not wanting to be alive anymore since she feels overwhelmed and feels alone. She stated that her children are the only thing keeping her from hurting herself. Discussed a safety plan which included reaching out to her mother and friends.(Tr. 1448-49). One day later, on April 6, 2021, Atkinson was treated in the emergency room complaining of suicidal ideation. (Tr. 1578).
Thus, LCSW Mickey's treatment records documented a constellation of severe emotional impairments which included passive thoughts of self-harm. Moreover, notably these treatment notes described Atkinson's condition as prolonged, protracted, and resistant to treatment, frequently observing that she made slight or no progress in her treatment. (Tr. 1073, 1087, 1091, 1097, 1100, 1107, 1120, 1126, 1356, 1378, 1448).
Furthermore, on November 4, 2020, LCSW Mickey issued what seems clearly to have been a medical opinion statement supporting Atkinson's disability claim. In that correspondence Ms. Mickey stated that Atkinson suffered from a major depressive disorder, generalized anxiety disorder, PTSD, a panic disorder, and a binge eating disorder. (Tr. 972). LCSW Mickey noted that Atkinson had made limited progress in her treatment of these multiple disorders, and supported her disability application, stating that:
Her diagnoses interfere with her ability to complete activities of daily living. Her anxiety and panic symptoms limit her ability to leave her home. Angela's symptoms have greatly impacted her ability to maintain gainful employment.(Id.) Yet, in denying Atkinson's claim, the ALJ made no reference to the treating source opinion of LCSW Mickey and gave short shrift to her extensive treatment notes. Thus, it is against the backdrop of this medical record, a record which was only partially acknowledged by the ALJ, that this case was decided.
B. The ALJ Hearing and Decision
A disability hearing was conducted in this case on May 12, 2021, at which Atkinson and a vocational expert testified. (Tr. 48-69). Following the hearing, on June 3, 2021, the ALJ issued a decision denying Atkinson's application for benefits. (Tr. 8-26). In that decision, the ALJ first concluded that Atkinson had not engaged in substantial gainful activity since July 2, 2020, the application date. (Tr. 13). At Step 2 of the sequential analysis that governs Social Security cases, the ALJ found that Atkinson had the following severe impairments: carpal tunnel syndrome, degenerative disc disease, generalized anxiety disorder, major depressive disorder, panic disorder, and posttraumatic stress disorder (Id.)
At Step 3, the ALJ determined that Atkinson did not have an impairment or combination of impairments that met or medically equaled the severity of one of the disability listing impairments. (Tr. 14-16). Between Steps 3 and 4, the ALJ then fashioned a residual functional capacity (“RFC”) for the plaintiff which considered Atkinson's impairments as reflected in the medical record, and found that:
After careful consideration of the entire record, the undersigned finds that the claimant has the residual functional capacity to perform light work as defined in 20 CFR 416.967(b) except she can stand and/or walk 4 hours per 8-hour workday; she is limited to occasional postural movements except she is precluded from climbing ladders, ropes, and scaffolds; she can frequently engage in handling and fingering with the right upper extremity; she must avoid concentrated exposure to extreme cold, wetness, humidity, vibration, dangerous machinery, and unprotected heights; she requires work that is limited to simple and routine tasks involving only simple work-related decisions and with few, if any, workplace changes; she is precluded from production pace work; and she is limited to only occasional interaction with supervisors and coworkers.(Tr. 16).
In fashioning this RFC, the ALJ relied heavily upon the medical opinions of two non-treating, non-examining state agency medical sources, stating that:
The undersigned has found persuasive the August 20, 2020 (Ex. 1A) and December 16, 2020 (Ex. 2A) assessments of the State agency psychological consultants finding that the claimant's mental impairments are severe and that they result in mild limitations in understanding, remembering, and applying information, moderate limitations in interacting with others, moderate limitations in concentrating, persisting, or maintaining pace, and moderate limitations in adapting or managing herself and that she is able to meet the mental demands for simple, routine tasks on a sustained basis despite the limitations associated with her impairments. These opinions are consistent with and supported by overall rather benign clinical signs and findings and the conservative nature of treatment required for mental health impairments. In this regard, the clinical signs show that insight and judgment were appropriate; she was cooperative; eye contact was fair; thought process was coherent and goal directed; she was well groomed; and she had adequate fund of knowledge (Ex. 22F). Additionally, treatment for mental health impairments is limited to the use of medications.(Tr. 24). Notably, these non-examining medical opinions were prepared prior to Atkinson's April 2021 report of suicidal ideation, a fact which was not acknowledged by the ALJ. Likewise, the ALJ characterization of Atkinson's treatment history as “limited to the use of medications” failed to account for her extensive and intensive outpatient counseling with LCSW Mickey or her April 2021 emergency room treatment of an acute mental health crisis.
In contrast, the ALJ discounted Dr. Bredow's treating source opinion, stating that:
The undersigned has found not persuasive the March 23, 2021 assessment of Gregory J. Bedrow, M.D., a treating psychiatrist, essentially finding that the claimant's mental impairments meet the requirements of the Listings, as he found that she has moderate limitations in understanding, remembering, and applying information, marked limitations in interacting with others, marked limitations in concentrating, persisting, or maintaining pace, and marked limitations in adapting or managing herself (Ex. 25F). This assessment is not consistent with or supported by Dr. Bedrow's own relatively benign clinical signs and findings upon mental status examination. In particular, the clinical signs and findings at Exhibit 22F, Pp. 18, 19, 34, and 77 do not support such a degree of limitations. In this regard, these examination findings show that she was well groomed; she was engaged and cooperative; she had fair eye contact; speech was fluent and spontaneous (Ex. 22F, P. 18); affect was brighter; thought process was coherent and goal-directed; she denied suicidal or homicidal ideations; she denied auditory or visual hallucinations; no delusions were noted; she was alert and interactive; there was no internal stimulation; she had adequate fund of knowledge; and insight and judgment were fair (Ex. 22F, P. 19). Dr. Bedrow also found on another mental status examination that she was well groomed; she was engaged, cooperative, and had fair eye contact; speech was spontaneous and fluent; thought process was coherent and goal-directed; no delusions were noted; she denied suicidal or homicidal ideation and denied auditory and visual hallucinations; there was no internal stimulation; she was alert and interactive and had adequate fund of knowledge; and insight and judgment were appropriate (Ex. 22F, P. 34).(Tr. 24-25).
On this score, the ALJ's evaluation of this treating source opinion was noteworthy for several reasons. First, the ALJ's treatment of this opinion evidence completely ignored the degree to which LCSW Mickey's clinical notes and opinion provided corroborating support for Dr. Bredow. Additionally, the ALJ's finding that Atkinson “denied suicidal or homicidal ideation” is plainly contradicted by the treatment notes and medical records which document suicidal thoughts in 2020 during treatment sessions and reflect an April 2021 episode in which Atkinson sought emergency medical care because of these suicidal thoughts.
Having made these determinations regarding the persuasive power of the medical opinions and reached an RFC assessment based upon this flawed medical opinion evaluation, the ALJ concluded that considering her age, education, and RFC, there were jobs that existed in the significant numbers in the national economy that Atkinson could perform. The ALJ therefore found she had not been under a disability during the relevant period. (Tr. 25-26).
This appeal followed. (Doc. 1). On appeal, Atkinson argues, in part, that the ALJ failed to properly evaluate the opinion of her treating physician, Dr. Bredow. Because we find that the ALJ failed to adequately articulate the rationale which led the ALJ to discount one treating source opinion without acknowledging the corroborating treatment records and the opinion of a second treating source, it is recommended that this case be remanded for further consideration by the Commissioner.
III. Discussion
A. Substantial Evidence Review - the Role of this Court
When reviewing the Commissioner's final decision denying a claimant's application for benefits, this Court's review is limited to the question of whether the findings of the final decision-maker are supported by substantial evidence in the record. See 42 U.S.C. §405(g); Johnson v. Comm'r of Soc. Sec., 529 F.3d 198, 200 (3d Cir. 2008); Ficca v. Astrue, 901 F.Supp.2d 533, 536 (M.D. Pa. 2012). Substantial evidence “does not mean a large or considerable amount of evidence, but rather such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.” Pierce v. Underwood, 487 U.S. 552, 565 (1988). Substantial evidence is less than a preponderance of the evidence but more than a mere scintilla. Richardson v. Perales, 402 U.S. 389, 401 (1971). A single piece of evidence is not substantial evidence if the ALJ ignores countervailing evidence or fails to resolve a conflict created by the evidence. Mason v. Shalala, 994 F.2d 1058, 1064 (3d Cir. 1993). But in an adequately developed factual record, substantial evidence may be “something less than the weight of the evidence, and the possibility of drawing two inconsistent conclusions from the evidence does not prevent [the ALJ's decision] from being supported by substantial evidence.” Consolo v. Fed. Maritime Comm'n, 383 U.S. 607, 620 (1966). “In determining if the Commissioner's decision is supported by substantial evidence the court must scrutinize the record as a whole.” Leslie v. Barnhart, 304 F.Supp.2d 623, 627 (M.D. Pa. 2003).
The Supreme Court has recently underscored for us the limited scope of our review in this field, noting that:
The phrase “substantial evidence” is a “term of art” used throughout administrative law to describe how courts are to review agency factfinding. T-Mobile South, LLC v. Roswell, 574 U.S.__, __, 135 S.Ct. 808, 815, 190 L.Ed.2d 679 (2015). Under the substantial-evidence standard, a court looks to an existing administrative record and asks whether it contains “sufficien[t] evidence” to support the agency's factual determinations. Consolidated Edison Co. v. NLRB, 305 U.S. 197, 229, 59 S.Ct. 206, 83 L.Ed. 126 (1938) (emphasis deleted). And whatever the meaning of “substantial” in other contexts, the threshold for such evidentiary sufficiency is not high. Substantial evidence, this Court has said, is “more than a mere scintilla.” Ibid.; see, e.g., Perales, 402 U.S. at 401, 91 S.Ct. 1420 (internal quotation marks omitted). It means-and means only-“such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.” Consolidated Edison, 305 U.S. at 229, 59 S.Ct. 206. See Dickinson v. Zurko, 527 U.S. 150, 153, 119 S.Ct. 1816, 144 L.Ed.2d 143 (1999) (comparing the substantial-evidence standard to the deferential clearly-erroneous standard).Biestek, 139 S.Ct. at 1154.
The question before this Court, therefore, is not whether the claimant is disabled, but rather whether the Commissioner's finding that he is not disabled is supported by substantial evidence and was reached based upon a correct application of the relevant law. See Arnold v. Colvin, No. 3:12-CV-02417, 2014 WL 940205, at *1 (M.D. Pa. Mar. 11, 2014) (“[I]t has been held that an ALJ's errors of law denote a lack of substantial evidence”) (alterations omitted); Burton v. Schweiker, 512 F.Supp. 913, 914 (W.D. Pa. 1981) (“The Secretary's determination as to the status of a claim requires the correct application of the law to the facts.”); see also Wright v. Sullivan, 900 F.2d 675, 678 (3d Cir. 1990) (noting that the scope of review on legal matters is plenary); Ficca, 901 F.Supp.2d at 536 (“[T]he court has plenary review of all legal issues ....”).
Several fundamental legal propositions which flow from this deferential standard of review. First, when conducting this review “we are mindful that we must not substitute our own judgment for that of the fact finder.” Zirnsak v. Colvin, 777 F.3d 607, 611 (3d Cir. 2014) (citing Rutherford v. Barnhart, 399 F.3d 546, 552 (3d Cir. 2005)). Thus, we are enjoined to refrain from trying to re-weigh the evidence. Rather our task is to simply determine whether substantial evidence supported the ALJ's findings. However, we must also ascertain whether the ALJ's decision meets the burden of articulation demanded by the courts to enable informed judicial review. Simply put, “this Court requires the ALJ to set forth the reasons for his decision.” Burnett v. Comm'r of Soc. Sec. Admin., 220 F.3d 112, 119 (3d Cir. 2000). As the Court of Appeals has noted on this score:
In Burnett, we held that an ALJ must clearly set forth the reasons for his decision. 220 F.3d at 119. Conclusory statements . . . are insufficient. The ALJ must provide a “discussion of the evidence” and an “explanation of reasoning” for his conclusion sufficient to enable meaningful judicial review. Id. at 120; see Jones v. Barnhart, 364 F.3d 501, 505 & n. 3 (3d Cir.2004). The ALJ, of course, need not employ particular “magic” words: “Burnett does not require the ALJ to use particular language or adhere to a particular format in conducting his analysis.” Jones, 364 F.3d at 505.Diaz v. Comm'r of Soc. Sec., 577 F.3d 500, 504 (3d Cir. 2009). Further, it is clear that this duty of articulation extends to analysis of a claimant's mental and emotional limitations. See generally Hess v. Comm'r Soc. Sec., 931 F.3d 198, 212 (3d Cir. 2019).
Thus, in practice ours is a twofold task. We must evaluate the substance of the ALJ's decision under a deferential standard of review, but we must also give that decision careful scrutiny to ensure that the rationale for the ALJ's actions is sufficiently articulated to permit meaningful judicial review.
B. Initial Burdens of Proof, Persuasion, and Articulation for the ALJ
To receive benefits under the Social Security Act by reason of disability, a claimant must demonstrate an inability to “engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.” 42 U.S.C. §423(d)(1)(A); see also 20 C.F.R. §404.1505(a). To satisfy this requirement, a claimant must have a severe physical or mental impairment that makes it impossible to do his or her previous work or any other substantial gainful activity that exists in the national economy. 42 U.S.C. §423(d)(2)(A); 20 C.F.R. §404.1505(a). To receive benefits under Title II of the Social Security Act, a claimant must show that he or she contributed to the insurance program, is under retirement age, and became disabled prior to the date on which he or she was last insured. 42 U.S.C. §423(a); 20 C.F.R. §404.131(a).
In making this determination at the administrative level, the ALJ follows a five-step sequential evaluation process. 20 C.F.R. §404.1520(a). Under this process, the ALJ must sequentially determine: (1) whether the claimant is engaged in substantial gainful activity; (2) whether the claimant has a severe impairment; (3) whether the claimant's impairment meets or equals a listed impairment; (4) whether the claimant is able to do his or her past relevant work; and (5) whether the claimant is able to do any other work, considering his or her age, education, work experience and residual functional capacity (“RFC”). 20 C.F.R. §404.1520(a)(4).
Between Steps 3 and 4, the ALJ must also assess a claimant's residual functional capacity (RFC). RFC is defined as “that which an individual is still able to do despite the limitations caused by his or her impairment(s).” Burnett v. Comm'r of Soc. Sec., 220 F.3d 112, 121 (3d Cir. 2000) (citations omitted); see also 20 C.F.R. §§404.1520(e), 404.1545(a)(1). In making this assessment, the ALJ considers all of the claimant's medically determinable impairments, including any non-severe impairments identified by the ALJ at step two of his or her analysis. 20 C.F.R. §404.1545(a)(2).
There is an undeniable medical aspect to an RFC determination, since that determination entails an assessment of what work the claimant can do given the physical limitations that the claimant experiences. Yet, when considering the role and necessity of medical opinion evidence in making this determination, courts have followed several different paths. Some courts emphasize the importance of medical opinion support for an RFC determination and have suggested that “[r]arely can a decision be made regarding a claimant's residual functional capacity without an assessment from a physician regarding the functional abilities of the claimant.” Biller v. Acting Comm'r of Soc. Sec., 962 F.Supp.2d 761, 778-79 (W.D. Pa. 2013) (quoting Gormont v. Astrue, Civ. No. 11-2145, 2013 WL 791455 at *7 (M.D. Pa. Mar. 4, 2013)). In other instances, it has been held that: “There is no legal requirement that a physician have made the particular findings that an ALJ adopts in the course of determining an RFC.” Titterington v. Barnhart, 174 Fed.Appx. 6, 11 (3d Cir. 2006). Further, courts have held in cases where there is no evidence of any credible medical opinion supporting a claimant's allegations of disability that “the proposition that an ALJ must always base his RFC on a medical opinion from a physician is misguided.” Cummings v. Colvin, 129 F.Supp.3d 209, 214-15 (W.D. Pa. 2015).
These seemingly discordant legal propositions can be reconciled by evaluation of the factual context of these decisions. Those cases which emphasize the importance of medical opinion support for an RFC assessment typically arise in the factual setting where a well-supported medical source has identified limitations that would support a disability claim, but an ALJ has rejected the medical opinion which supported a disability determination based upon a lay assessment of other evidence. Biller, 962 F.Supp.2d at 778-79. In this setting, these cases simply restate the commonplace idea that medical opinions are entitled to careful consideration when making a disability determination, particularly when those opinions support a finding of disability. In contrast, when an ALJ is relying upon other evidence, such as contrasting clinical or opinion evidence or testimony regarding the claimant's activities of daily living, to fashion an RFC courts have adopted a more pragmatic view and have sustained the ALJ's exercise of independent judgment based upon all of the facts and evidence. See Titterington v. Barnhart, 174 Fed.Appx. 6, 11 (3d Cir. 2006); Cummings v. Colvin, 129 F.Supp.3d 209, 214-15 (W.D. Pa. 2015). In either event, once the ALJ has made this determination, our review of the AL''s assessment of the plaintiff's RFC is deferential, and that RFC assessment will not be set aside if it is supported by substantial evidence. Burns v. Barnhart, 312 F.3d 113, 129 (3d Cir. 2002); see also Metzger v. Berryhill, No. 3:16-CV-1929, 2017 WL 1483328, at *5 (M.D. Pa. Mar. 29, 2017), report and recommendation adopted sub nom. Metzgar v. Colvin, No. 3:16-CV-1929, 2017 WL 1479426 (M.D. Pa. Apr. 21, 2017); Rathbun v. Berryhill, No. 3:17-CV-00301, 2018 WL 1514383, at *6 (M.D. Pa. Mar. 12, 2018), report and recommendation adopted, No. 3:17-CV-301, 2018 WL 1479366 (M.D. Pa. Mar. 27, 2018).
At Steps 1 through 4, the claimant bears the initial burden of demonstrating the existence of a medically determinable impairment that prevents him or her in engaging in any of his or her past relevant work. Mason, 994 F.2d at 1064. Once this burden has been met by the claimant, it shifts to the Commissioner at Step 5 to show that jobs exist in significant number in the national economy that the claimant could perform that are consistent with the claimant's age, education, work experience and RFC. 20 C.F.R. §404.1512(f); Mason, 994 F.2d at 1064.
The ALJ's disability determination must also meet certain basic substantive requisites. Most significant among these legal benchmarks is a requirement that the ALJ adequately explain the legal and factual basis for this disability determination. Thus, in order to facilitate review of the decision under the substantial evidence standard, the AL''s decision must be accompanied by “a clear and satisfactory explication of the basis on which it rests.” Cotter v. Harris, 642 F.2d 700, 704 (3d Cir. 1981). Conflicts in the evidence must be resolved and the ALJ must indicate which evidence was accepted, which evidence was rejected, and the reasons for rejecting certain evidence. Id. at 706-07. In addition, “[t]he ALJ must indicate in his decision which evidence he has rejected and which he is relying on as the basis for his finding.” Schaudeck v. Comm'r of Soc. Sec., 181 F.3d 429, 433 (3d Cir. 1999).
C. Benchmarks for the ALJ's Assessment of Opinion Evidence.
The plaintiff filed this disability application after a paradigm shift in the manner in which medical opinions were evaluated when assessing Social Security claims. Prior to March 2017, ALJs were required to follow regulations which defined medical opinions narrowly and created a hierarchy of medical source opinions with treating sources at the apex of this hierarchy. However, in March of 2017, the Commissioner's regulations governing medical opinions changed in a number of fundamental ways. The range of opinions that ALJs were enjoined to consider were broadened substantially, and the approach to evaluating opinions was changed from a hierarchical form of review to a more holistic analysis. As one court as aptly observed:
The regulations regarding the evaluation of medical evidence have been amended for claims filed after March 27, 2017, and several of the prior Social Security Rulings, including SSR 96-2p, have been rescinded. According to the new regulations, the Commissioner “will no longer give any specific evidentiary weight to medical opinions; this includes giving controlling weight to any medical opinion.” Revisions to Rules Regarding the Evaluation of Medical Evidence (“Revisions to Rules”), 2017 WL 168819, 82 Fed.Reg. 5844, at 5867-68 (Jan. 18, 2017), see 20 C.F.R. §§ 404.1520c(a), 416.920c(a). Instead, the Commissioner must consider all medical opinions and “evaluate their persuasiveness” based on the following five factors: supportability; consistency; relationship with the claimant; specialization; and “other factors.” 20 C.F.R. §§ 404.1520c(a)-(c), 416.920c(a)-(c).
Although the new regulations eliminate the perceived hierarchy of medical sources, deference to specific medical opinions, and assigning “weight” to a medical opinion, the ALJ must still “articulate how [he or she] considered the medical opinions” and “how persuasive [he or she] find[s] all of the medical opinions.” Id. at §§ 404.1520c(a) and (b)(1), 416.920c(a) and (b)(1). The two “most important factors for determining the persuasiveness of medical opinions are consistency and supportability,” which are the “same factors” that formed the foundation of the treating source rule. Revisions to Rules, 82 Fed.Reg. 5844-01 at 5853.
An ALJ is specifically required to “explain how [he or she] considered the supportability and consistency factors” for a medical opinion. 20 C.F.R. §§ 404.1520c (b)(2), 416.920c(b)(2). With respect to “supportability,” the new regulations provide that “[t]he more relevant the objective medical evidence and supporting explanations presented by a medical source are to support his or her medical opinion(s) or prior
administrative medical fmding(s), the more persuasive the medical opinions or prior administrative medical finding(s) will be.” Id. at §§ 404.1520c(c)(1), 416.920c(c)(1). The regulations provide that with respect to “consistency,” “[t]he more consistent a medical opinion(s) or prior administrative medical finding(s) is with the evidence from other medical sources and nonmedical sources in the claim, the more persuasive the medical opinion(s) or prior administrative medical finding(s) will be.” Id. at §§ 404.1520c(c)(2), 416.920c(c)(2).
Under the new regulations an ALJ must consider, but need not explicitly discuss, the three remaining factors in determining the persuasiveness of a medical source's opinion. Id. at §§ 404.1520c(b)(2), 416.920c(b)(2). However, where the ALJ has found two or more medical opinions to be equally well supported and consistent with the record, but not exactly the same, the ALJ must articulate how he or she considered those factors contained in paragraphs (c)(3) through (c)(5). Id. at §§ 404.1520c(b)(3), 416.920c(b)(3).Andrew G. v. Comm'r of Soc. Sec., No. 3:19-CV-0942 (ML), 2020 WL 5848776, at *5 (N.D.N.Y. Oct. 1, 2020).
Oftentimes, as in this case, an ALJ must evaluate various medical opinions. Judicial review of this aspect of ALJ decision-making is still guided by several settled legal tenets. First, when presented with a disputed factual record, it is well-established that “[t]he ALJ - not treating or examining physicians or State agency consultants - must make the ultimate disability and RFC determinations.” Chandler v. Comm'r of Soc. Sec., 667 F.3d 356, 361 (3d Cir. 2011). Thus, when evaluating medical opinions “the ALJ may choose whom to credit but ‘cannot reject evidence for no reason or for the wrong reason.'” Morales v. Apfel, 225 F.3d 310, 317 (3d Cir. 2000) (quoting Mason, 994 F.2d at 1066). Therefore, provided that the decision is accompanied by an adequate, articulated rationale, it is the province and the duty of the ALJ to choose which medical opinions and evidence deserve greater weight.
Further, in making this assessment of medical evidence:
An ALJ is [also] entitled generally to credit parts of an opinion without crediting the entire opinion. See Thackara v. Colvin, No. 1:14-CV-00158-GBC, 2015 WL 1295956, at *5 (M.D. Pa. Mar. 23, 2015); Turner v. Colvin, 964 F.Supp.2d 21, 29 (D.D.C. 2013) (agreeing that “SSR 96-2p does not prohibit the ALJ from crediting some parts of a treating source's opinion and rejecting other portions”); Connors v. Astrue, No. 10-CV-197-PB, 2011 WL 2359055, at *9 (D.N.H. June 10, 2011). It follows that an ALJ can give partial credit to all medical opinions and can formulate an RFC based on different parts from the different medical opinions. See e.g., Thackara v. Colvin, No. 1:14-CV-00158-GBC, 2015 WL 1295956, at *5 (M.D. Pa. Mar. 23, 2015).Durden v. Colvin, 191 F.Supp.3d 429, 455 (M.D. Pa. 2016). Finally, where there is no evidence of any credible medical opinion supporting a claimant's allegations of disability “the proposition that an ALJ must always base his RFC on a medical opinion from a physician is misguided.” Cummings, 129 F.Supp.3d at 214-15.
D. Legal Benchmarks for the ALJ's Assessment of a Claimant's Alleged Symptoms.
The interplay between the deferential substantive standard of review that governs Social Security appeals, and the requirement that courts carefully assess whether an ALJ has met the standards of articulation required by law, is also illustrated by those cases which consider analysis of a claimant's reported pain. When evaluating lay testimony regarding a claimant's reported degree of pain and disability, we are reminded that:
[T]he ALJ must necessarily make certain credibility determinations, and this Court defers to the ALJ's assessment of credibility. See Diaz v. Comm'r, 577 F.3d 500, 506 (3d Cir.2009) (“In determining whether there is substantial evidence to support an administrative law judge's decision, we owe deference to his evaluation of the evidence [and] assessment of the credibility of witnesses....”). However, the ALJ must specifically identify and explain what evidence he found not credible and why he found it not credible. Adorno v. Shalala, 40 F.3d 43, 48 (3d Cir. 1994) (citing Stewart v. Sec'y of Health, Education and Welfare, 714 F.2d 287, 290 (3d Cir.1983)); see also Stout v. Comm'r, 454 F.3d 1050, 1054 (9th Cir.2006) (stating that an ALJ is required to provide “specific reasons for rejecting lay testimony”). An ALJ cannot reject evidence for an incorrect or unsupported reason. Ray v. Astrue, 649 F.Supp.2d 391,402 (E.D.Pa.2009) (quoting Mason v. Shalala, 994 F.2d 1058, 1066 (3d Cir.1993)).Zirnsak v. Colvin, 777 F.3d 607, 612-13 (3d Cir. 2014).
Yet, it is also clear that:
Great weight is given to a claimant's subjective testimony only when it is supported by competent medical evidence. Dobrowolsky v. Califano, 606 F.2d 403, 409 (3d Cir. 1979); accord Snedeker v. Comm'r of Soc. Sec., 244 Fed.Appx. 470, 474 (3d Cir. 2007). An ALJ may reject a claimant's subjective testimony that is not found credible so long as there is an explanation for the rejection of the testimony. Social Security Ruling (“SSR”) 96-7p; Schaudeck v. Comm'r of Social Security, 181 F.3d 429, 433 (3d Cir. 1999). Where an ALJ finds that there is an underlying medically determinable physical or mental
impairment that could reasonably be expected to produce the individual's pain or other symptoms, however, the severity of which is not substantiated by objective medical evidence, the ALJ must make a finding on the credibility of the individual's statements based on a consideration of the entire case record.McKean v. Colvin, 150 F.Supp.3d 406, 415-16 (M.D. Pa. 2015) (footnotes omitted). Thus, we are instructed to review an ALJ's evaluation of a claimant's subjective reports of pain under a standard of review which is deferential with respect to the ALJ's well-articulated findings but imposes a duty of clear articulation upon the ALJ so that we may conduct meaningful review of the ALJ's conclusions.
In the same fashion that medical opinion evidence is evaluated, the Social Security Rulings and Regulations provide a framework under which the severity of a claimant's reported symptoms are to be considered. 20 C.F.R. §§ 404.1529, 416.929; SSR 16-3p. It is important to note that though the “statements of the individual concerning his or her symptoms must be carefully considered, the ALJ is not required to credit them.” Chandler v. Comm'r of Soc. Sec., 667 F.3d 356, 363 (3d. Cir. 2011) (referencing 20 C.F.R. §404.1529(a) (“statements about your pain or other symptoms will not alone establish that you are disabled.”). It is well-settled in the Third Circuit that “[a]llegations of pain and other subjective symptoms must be supported by objective medical evidence.” Hantraft v. Apfel, 181 F.3d 358, 362 (3d Cir. 1999) (referring to 20 C.F.R. §404.1529). When evaluating a claimant's symptoms, the ALJ must follow a two-step process in which the ALJ resolves whether a medically determinable impairment could be the cause of the symptoms alleged by the claimant, and subsequently must evaluate the alleged symptoms in consideration of the record as a whole. SSR 16-3p.
First, symptoms, such as pain or fatigue, will only be considered to affect a claimant's ability to perform work activities if such symptoms result from an underlying physical or mental impairment that has been demonstrated to exist by medical signs or laboratory findings. 20 C.F.R. §§ 404.1529(b), 416.929(b); SSR 16-3p. During the second step of this credibility assessment, the ALJ must determine whether the claimant's statements about the intensity, persistence or functionally limiting effects of his or her symptoms are substantiated based on the ALJ's evaluation of the entire case record. 20 C.F.R. § 404.1529(c), 416.929(c); SSR 163p. This includes but is not limited to medical signs and laboratory findings, diagnosis and other medical opinions provided by treating or examining sources, and other medical sources, as well as information concerning the claimant's symptoms and how they affect his or her ability to work. Id. The Social Security Administration has recognized that individuals may experience their symptoms differently and may be limited by their symptoms to a greater or lesser extent than other individuals with the same medical impairments, signs, and laboratory findings. SSR 16-3p.
Thus, to assist in the evaluation of a claimant's subjective symptoms, the Social Security Regulations identify seven factors which may be relevant to the assessment of the severity or limiting effects of a claimant's impairment based on a claimant's symptoms. 20 C.F.R. §§ 404.1529(c)(3), 416.929(c)(3). These factors include: activities of daily living; the location, duration, frequency, and intensity of the claimant's symptoms; precipitating and aggravating factors; the type, dosage, effectiveness, and side effects of any medication the claimant takes or has taken to alleviate his or her symptoms; treatment, other than medication that a claimant has received for relief; any measures the claimant has used to relieve his or her symptoms; and, any other factors concerning the claimant's functional limitations and restrictions. Id.; see George v. Colvin, No. 4:13-CV-2803, 2014 WL 5449706, at *4 (M.D.Pa. Oct. 24, 2014); Koppenaver v. Berryhill, No. 3:18-CV-1525, 2019 WL 1995999, at *9 (M.D. Pa. Apr. 8, 2019), report and recommendation adopted sub nom. Koppenhaver v. Berryhill, No. 3:18-CV-1525, 2019 WL 1992130 (M.D. Pa. May 6, 2019); Martinez v. Colvin, No. 3:14-CV-1090, 2015 WL 5781202, at *8-9 (M.D. Pa. Sept. 30, 2015).
It is against this backdrop that we evaluate the decision of the ALJ in this case.
E. This Case Should be Remanded for Further Evaluation of The Medical Opinions.
As we have noted, an ALJ's decision must be accompanied by “a clear and satisfactory explication of the basis on which it rests.” Cotter, 642 F.2d at 704. Furthermore, the ALJ must also “indicate in his decision which evidence he has rejected and which he is relying on as the basis for his finding.” Schaudeck, 181 F.3d at 433. This cardinal principle applies with particular force to the assessment made in the instant case by the ALJ. With respect to the instant case, it is well settled that “[t]he ALJ must consider all relevant evidence when determining an individual's residual functional capacity.” Fargnoli v. Massanari, 247 F.3d 34, 41 (3d Cir. 2001).
Here the plaintiff argues that the ALJ failed to properly evaluate the medical source opinions in fashioning the RFC. Specifically, Atkinson contends that the ALJ failed to adequately address the medical opinion of her longstanding treating physician, Dr. Bredow.
We agree and this analysis was insufficient. Indeed, in our view, the ALJ's evaluation of this evidence is flawed in at least three fundamental ways.
First, a number of the factual findings which served as lynchpins for the ALJ's medical opinion persuasiveness analysis simply are not supported by substantial evidence. For example, the ALJ gave greater persuasive power to the opinions of the state non-examining, non-treating sources but failed to acknowledge a crucial fact. These non-examining medical opinions were prepared on August 20, 2020, and December 16, 2020, prior to Dr. Bredow's March 2021 assessment, and months before Atkinson's April 2021 emergency room hospitalization for suicidal ideation, a fact which was the ALJ failed to recognize. Likewise, the ALJ's characterization of Atkinson's treatment history as “limited to the use of medications” is inaccurate. This description failed to account for Atkinson's extensive and intensive outpatient counseling with LCSW Mickey or her April 2021 emergency room treatment for an acute mental health crisis which led to passive suicidal thoughts.
Similarly, the ALJ's evaluation of Dr. Bredow's medical opinion was flawed in several basic ways. First, the ALJ's treatment of the opinion evidence completely ignored the degree to which LCSW Mickey's clinical notes and opinion provided strong corroborating support for Dr. Bredow. Further, the ALJ's finding that Atkinson “denied suicidal or homicidal ideation” is plainly contradicted by the LCSW Mickey's treatment notes and medical records which document suicidal thoughts in 2020 and 2021 during treatment sessions. For example, Atkinson shared suicidal thoughts with her LCSW Mickey in November 2020, stating that she:
Discussed the past abuse by her sister. She shared that her sister, who is 7 years older, molested her and was physically abusive to her. Her mother either denies or ignores that it happened possibly due to being
abused by her own brother. Angie shared that her sister would pour scalding hot water on her while giving her a bath. She stated that she has tried to have a relationship with her sister but she becomes suicidal when they have contact since she feels the only way this will end is if one of them die.(Tr. 1413) (emphasis added).
Likewise, on April 5, 2021, Atkinson reported that:
[H]er depression is 9/10 mainly due to their financial situation. She stated that on Saturday she became really close to not wanting to be alive anymore since she feels overwhelmed and feels alone. She stated that her children are the only thing keeping her from hurting herself. Discussed a safety plan which included reaching out to her mother and friends.(Tr. 1448-49) (emphasis added). These treatment notes belie the suggestion that Atkinson never experienced suicidal thoughts. Moreover, one day after this April 5 notation that Atkinson's children were the only thing keeping her from engaging in self-harm, on April 6, 2021, Atkinson was treated in the emergency room complaining of suicidal ideation. (Tr. 1578).
Beyond these factual errors, a number of the findings made by the ALJ in support of this medical opinion analysis lacked essential context. Thus, the ALJ discounted Dr. Bredow's medical opinion, in part, because the doctor's treatment notes for April 9, 2021, stated that Atkinson's “affect was brighter.” (Tr. 22). While this observation, viewed in isolation, might support a finding of well-being, the ALJ's reliance on this treatment note ignored crucial context. Specifically, three days earlier, on April 6, 2021, Atkinson had sought emergency room intervention because of passive suicidal thoughts. Thus, when considered in context the doctor's observation on April 9, 2021, that Atkinson's affect was brighter simply indicated that she had improved from her passively suicidal frame of mind three days prior. This is hardly and endorsement of Atkinson's well-being or mental health.
Finally, the ALJ's assessment of Dr. Bredow's opinion rests on the fatally flawed premise that Dr. Bredow was the sole treating source in this case who supported Atkinson's disability application. This premise is incorrect because it ignores LCSW Mickey's extensive treatment notes, and utterly fails to address her November 4, 2020, opinion, which confirmed Atkinson's mental health diagnoses, found that she had made limited progress in her treatment of these multiple disorders, and supported her disability application, opining that:
Her diagnoses interfere with her ability to complete activities of daily living. Her anxiety and panic symptoms limit her ability to leave her home. Angela's symptoms have greatly impacted her ability to maintain gainful employment.(Tr. 972).
The ALJ's treatment of this substantial and significant body of evidence is puzzling. In the decision denying this claim, the ALJ does not address, analyze, or even acknowledge the existence of this evidence. Thus, we cannot discern whether the ALJ discounted this clinical and opinion evidence, ignored it, or simply failed to recognize its existence. Given these shortcomings in the consideration of the medical opinion evidence, in the absence of some further explanation and articulation, the ALJ's decision cannot be reconciled with the revised medical opinion regulations that we are obliged to follow. Those regulations eschew any hierarchical ranking of opinions, but call upon ALJ's to evaluate medical opinions against the following benchmarks:
(1) Supportability. The more relevant the objective medical evidence and supporting explanations presented by a medical source are to support his or her medical opinion(s) or prior administrative medical finding(s), the more persuasive the medical opinions or prior administrative medical finding(s) will be.
(2) Consistency. The more consistent a medical opinion(s) or prior administrative medical finding(s) is with the evidence from other medical sources and nonmedical sources in the claim, the more persuasive the medical opinion(s) or prior administrative medical finding(s) will be.
(3) Relationship with the claimant. This factor combines consideration of the issues in paragraphs (c)(3)(i) through (v) of this section.
(i) Length of the treatment relationship. The length of time a medical source has treated you may help demonstrate whether the medical source has a longitudinal understanding of your impairment(s). (ii) Frequency of examinations. The frequency of your visits with the medical source may help demonstrate whether the medical source has a longitudinal understanding of your impairment(s).
(iii) Purpose of the treatment relationship. The purpose for treatment you received from the medical source may help demonstrate the level of knowledge the medical source has of your impairment(s). (iv) Extent of the treatment relationship. The kinds and extent of examinations and testing the medical source has performed or ordered from specialists or independent laboratories may help demonstrate the level of knowledge the medical source has of your impairment(s). (v) Examining relationship. A medical source may have a better understanding of your impairment(s) if he or she examines you than if the medical source only reviews evidence in your folder.20 C.F.R. § 404.1520c.
In this case, a dispassionate assessment of Dr. Bredow's opinion shows that a host of these factors called for giving the opinion closer consideration. Dr. Bredow had a longstanding, frequent, extensive, treatment relationship with Atkinson, all of which favored affording persuasive power to that opinion under the Commissioner's regulations. 20 C.F.R. § 404.1520c(3). While the ALJ justified discounting Dr. Bredow's opinion based upon its alleged lack of consistency and supportability, in reaching this result the ALJ's decision misstates the evidence and relies upon treatment notes that are divorced from their crucial factual context. Moreover, the ALJ's consistency and supportability findings ignore a substantial body of clinical and opinion evidence from a second treating source, LCSW Mickey, which fully supports Dr. Bredow's opinion.
Given these shortcomings in the medical opinion analysis, more is needed here. Thus, we conclude that the ALJ's decision in this case is not supported by substantial evidence, as the ALJ did not offer an adequate explanation for the analysis of persuasiveness of the treating source medical opinion evidence, an assessment the ALJ relied upon in crafting the RFC. Accordingly, we recommend that this case be remanded to the Commissioner for further consideration of this evidence. Yet, while we reach this conclusion, we note that nothing in this Report and Recommendation should be deemed as expressing a judgment on what the ultimate outcome of any reassessment of this evidence should be. Rather, that task should remain the duty and province of the ALJ on remand.
IV. Recommendation
For the foregoing reasons, IT IS RECOMMENDED that the decision of the Commissioner in this case should be REMANDED for further consideration of the medical opinion evidence.
The parties are further placed on notice that pursuant to Local Rule 72.3:
Any party may object to a magistrate judge's proposed findings, recommendations or report addressing a motion or matter described in 28 U.S.C. § 636 (b)(1)(B) or making a recommendation for the disposition of a prisoner case or a habeas corpus petition within fourteen (14) days after being served with a copy thereof. Such party shall file with the clerk of court, and serve on the magistrate judge and all parties, written objections which shall specifically identify the 39 portions of the proposed findings, recommendations or report to which objection is made and the basis for such objections. The briefing requirements set forth in Local Rule 72.2 shall apply. A judge shall make a de novo determination of those portions of the report or specified proposed findings or recommendations to which objection is made and may accept, reject, or modify, in whole or in part, the findings or recommendations made by the magistrate judge. The judge, however, need conduct a new hearing only in his or her discretion or where required by law, and may consider the record developed before the magistrate judge, making his or her own determination on the basis of that record. The judge may also receive further evidence, recall witnesses, or recommit the matter to the magistrate judge with instructions.