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Federal District Court Overturns Unfavorable Decision in Social Security Disability Claim

On March 3, 2014, the Federal District Court for the Eastern District of Tennessee sitting at Knoxville overturned the Commissioner's decision to deny Social Security Disability benefits to Rhonda Jackson, one of the firm's clients. The case will be remanded back to the Office of Disability Adjudication and Review for another hearing.

As noted by the court, Mrs. Jackson worked as a registered nurse from 1990 until 2005, and though she maintains her license as a registered nurse, this license is now in inactive status, and she has not worked since 2005. Mrs. Jackson alleges that she has been disabled since February 2005 due to chronic depression, lack of sleep, panic attacks, anxiety, and hand problems. She adds that she has trouble being around people and even leaving her house, noting that she is depressed as a result of various events that have occurred in her life. Mrs. Jackson testified that her inability to focus, forgetfulness, and pain are the worst of the medical maladies that have prevented her from returning to work.

When Hurricane Katrina made landfall, Mrs. Jackson was living and working on the gulf coast, near New Orleans. She testified that her home was engulfed by the storm and that her family needed three days to cut its way out of the home with axes. The hospital where Mrs. Jackson had worked was "completely submerged and destroyed," and thus Mrs. Jackson lost her job. Subsequently, Mrs. Jackson's father passed away, she had a hysterectomy, she became unable to sleep, her father-in-law died, her best friend died of breast cancer, and she suffered from major depressive disorder. Dr. Randall May ("Dr. May"), Mrs. Jackson's treating psychiatrist, diagnosed her with post-traumatic stress disorder ("PTSD") and bipolar disorder. Dr. Berta Bergia ("Dr. Bergia"), Mrs. Jackson's treating neurologist, diagnosed her with "widespread pain" aggravated by severe insomnia, as well as "very significant cognitive dysfunction and poor overall functioning." Dr. Bergia also noted pain, numbness, tingling, and weakness in Mrs. Jackson's legs, arms, and torso.

Under the treating source rule, "the Commissioner has mandated that the ALJ 'will' 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 [a claimant's] case record.'" Cole v. Astrue, 661 F.3d 931, 937 (6th Cir. 2011) (quoting 20 C.F.R. § 404.1527(d)(2)). If, however, an ALJ decides not to give the opinion of a treating physician controlling weight, he or she must then apply the following factors in determining the weight to give the opinion: "the length of the treatment relationship and the frequency of examination, the nature and extent of the treatment relationship, [the] supportability of the opinion, [the] consistency of the opinion with the record as a whole, and the 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 has a clear duty to "always give good reasons in [the] notice of determination or decision for the weight [he or she] give[s] [a] treating source's opinion." 20 C.F.R. § 404.1527[d][2]. Such good reasons must always be supported by evidence of record and must be "'sufficiently specific to make clear to any subsequent reviewers the weight the adjudicator gave to the treating source's medical opinion and the reasons for that weight.'" Cole, 661 F.3d at 937 (quoting SSR 96-2p, 1996 WL 374188 (July 2, 1996)). This good reasons requirement is designed "to safeguard the claimant's procedural rights" and "is intended 'to let claimants understand the disposition of their cases, particularly in situations where a claimant knows that his physician has deemed him disabled and therefore might be especially bewildered when told by an administrative bureaucracy that [s]he is not.'" Cole, 661 F.3d at 937-38 (quoting Wilson,

378 F.3d at 544). Importantly, "[a] finding that a treating source medical opinion . . . is not entitled to controlling weight [does] not [mean] that the opinion should be rejected." Blakley v.

Comm'r of Soc. Sec., 581 F.3d 399, 408 (6th Cir. 2009). "In addition to balancing the factors to determine what weight to give a treating source opinion denied controlling weight, the agency specifically requires the ALJ to give good reasons for the weight actually assigned." Cole, 661 F.3d at 938. "On the other hand, opinions from nontreating and nonexamining sources are never assessed for 'controlling weight.'" Gayheart v. Comm'r of Soc. Sec., 710 F.3d 365, 376 (6th Cir. 2013). Such opinions are instead weighed "based on the examining relationship [or lack thereof], specialization, consistency, and supportability, but only if a treating-source opinion is not deemed controlling." Id. (citing 20 C.F.R. § 404.1527(c)).

Here, Dr. May and Dr. Bergia, both specialists, provided opinions indicating that plaintiff was suffering from medical conditions and related limitations which, if accepted, support a finding of disability. Indeed, this was the testimony of the vocational expert at the hearing [Tr. 55-57]. The Court finds that the ALJ erred by failing to adequately address, evaluate, and assign weight to these treating source opinions, and thus his opinion was not reached through application of the correct legal standards and in accordance with the procedure mandated by the regulations and rulings promulgated by the Commissioner.

Importantly, as mentioned, even finding that a treating source opinion is not entitled to controlling weight does not automatically mean that it should be entitled to no weight, Blakley, 581 F.3d at 408, and not assigning a specific weight to a treating source opinion "alone constitutes error." Cole, 661 F.3d at 938 (citing Blakley, 581 F.3d at 408).

Therefore, in light of the foregoing, the Court finds that the ALJ did not properly apply the treating source rule to the present matter, thereby depriving plaintiff of a substantial right and important benefit or safeguard. Moreover, though the ALJ gave "little weight" to the opinions of every medical expert in the case and questioned plaintiff's credibility, there was little in the record upon which the ALJ could conclude that plaintiff had the residual functional capacity to

"perform a full range of work at all exertional levels" with limitations only as to simple instructions, occasional interaction with the public, and occasional changes in job settings or routines [Tr. 16].

Accordingly, the Court finds that the ALJ failed to appropriately and fully apply the proper legal and procedural framework to plaintiff's case in rendering his opinion, and the Court must therefore decide whether this error requires that the case be remanded. The Sixth Circuit "has made clear that '[it] do[es] not hesitate to remand when the Commissioner has not provided good reasons for the weight given to a treating physician's opinion and [it] will continue remanding when [it] encounter[s] opinions from ALJ's that do not comprehensively set forth the reasons for the weight assigned to a treating physician's opinion.'" Cole, 661 F.3d at 939 (quoting Hensley v. Astrue, 573 F.3d 263, 267 (6th Cir. 2009) (citation and internal quotation marks omitted)).

If you need more information about a Social Security Disability/SSI, personal injury, EEOICPA, long or short-term disability, VA disability, Railroad Retirement Board disability, or a workers compensation matter, please contact the Law Offices of Tony Farmer and John Dreiser for a free case evaluation. We can be reached at (865) 584-1211 or (800) 806-4611 or through our website. Our office handles claims throughout East Tennessee, including Knoxville, Chattanooga, Kingsport, Bristol, Johnson City, Morristown, Maryville, Rogersville, Dandridge, Tazewell, New Tazewell, Jefferson City, Strawberry Plains, Sevierville, Gatlinburg, Loudon, Kingston, Halls, Maynardville, Crossville, Cookeville, Jamestown, Sweetwater, Lenoir City, Athens, Oak Ridge, Clinton, LaFollette, Lake City, Jacksboro, Bean Station, Cosby, Newport, White Pine, Mosheim, Wartburg, Sunbright, Pigeon Forge, Greeneville, Harriman, Dayton, Spring City, and Deer Lodge.

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