RICKY E. BROWN, Plaintiff-Appellant,
COMMISSIONER SOCIAL SECURITY ADMINISTRATION, Defendant-Appellee.
Argued: March 23, 2017
from the United States District Court for the District Court
of South Carolina, at Greenville. David C. Norton, District
Rogers Metcalfe, METCALFE & ATKINSON, LLC, Greenville,
South Carolina, for Appellant.
Melissa K. Curry, SOCIAL SECURITY ADMINISTRATION,
Philadelphia, Pennsylvania, for Appellee.
Timothy Clardy, DENNISON LAW FIRM, PC, Greenville, South
Carolina, for Appellant.
Koch, Regional Chief Counsel, Taryn Jasner, Supervisory
Attorney, Office of the General Counsel, SOCIAL SECURITY
ADMINISTRATION, Philadelphia, Pennsylvania; Beth Drake,
Acting United States Attorney, Marshall Prince, Assistant
United States Attorney, OFFICE OF THE UNITED STATES ATTORNEY,
Columbia, South Carolina, for Appellee.
NIEMEYER, KING, and WYNN, Circuit Judges.
Vacated and remanded by published opinion. Judge King wrote
the majority opinion, in which Judge Wynn joined. Judge
Niemeyer wrote a dissenting opinion.
E. Brown appeals from the judgment of the district court in
South Carolina affirming the Commissioner of Social
Security's denial of his claim for disability insurance
benefits. In pursuing his appeal, Brown contends that the
administrative law judge (the "ALJ") erred in
various respects, including by improperly evaluating the
medical opinion evidence and failing to heed the
"treating physician rule." As explained below, we
agree that the ALJ erred and therefore vacate the judgment of
the district court and remand with instructions for that
court to remand for further proceedings.
filed his claim for disability insurance benefits in August
2008, alleging that the onset of his disability occurred on
July 19, 2006, when he was injured in a workplace accident
and became unemployed. Brown asserts that he has not been
able to work since the accident because of chronic pain and
both physical and mental impairments. For Brown to qualify
for disability insurance benefits, there must be a finding
that he was disabled on or before his date last insured, June
30, 2011. Brown was forty-two years old at the time of his
workplace accident and forty-seven years old on his date last
insured. His primary source of income since the workplace
accident has been workers' compensation benefits.
Brown's claim for disability insurance benefits, the
Commissioner denied the claim initially in January 2009 and
upon reconsideration in October 2009. In December 2009, Brown
requested an ALJ hearing, which was conducted in August 2010.
Shortly after the hearing, in September 2010, the ALJ issued
a decision denying the claim (the "First ALJ
Decision"). Brown sought review of the First ALJ
Decision by the Social Security Administration's Appeals
Council. In May 2011, however, the Appeals Council denied
Brown's request for review. Brown thereafter filed a
complaint against the Commissioner in the District of South
Carolina pursuant to 42 U.S.C. § 405(g), seeking
judicial review of the First ALJ Decision. In July 2012, the
district court reversed the First ALJ Decision and remanded
for further proceedings. See Brown v. Comm'r Soc.
Sec. Admin., No. 6:11-cv-01500 (D.S.C. July 24, 2012),
ECF No. 26.
a year later, in May 2013, the ALJ conducted another hearing.
By a decision issued in February 2014, the ALJ again denied
Brown's claim for disability insurance benefits (the
"Second ALJ Decision"). Brown's subsequent
request for Appeals Council review was denied in September
2014. At that time, the Second ALJ Decision became the final
decision of the Commissioner.
November 2014, Brown initiated this civil action against the
Commissioner in the District of South Carolina, seeking
judicial review of the Second ALJ Decision. In January 2016,
the magistrate judge issued a report recommending that the
Second ALJ Decision be affirmed. See Brown v. Comm'r
Soc. Sec. Admin., No. 6:14-cv-04486, ECF No. 21 (D.S.C.
Jan. 29, 2016) (the "Report"). By an order of March
2016, the district court adopted the Report and affirmed the
Second ALJ Decision. See Brown v. Comm'r Soc. Sec.
Admin., 6:14-cv-04486 (D.S.C. Mar. 30, 2016), ECF No. 26
(the "Order"). Brown has timely appealed, and we
possess jurisdiction pursuant to 28 U.S.C. § 1291 and 42
U.S.C. § 405(g).
delving into the particulars of this case, we identify some
of the legal principles essential to the analysis.
Specifically, we first outline the five-step process -
established by the relevant regulations - that an ALJ is
obliged to utilize in assessing a claim for disability
insurance benefits. We then discuss the standards for
evaluating medical opinion evidence, including the
"treating physician rule" embodied in those
five-step process for assessing a claim for disability
insurance benefits is spelled out in 20 C.F.R. §
404.1520(a)(4)(i)-(v). At steps one and two, the ALJ
determines whether the claimant (1) is currently gainfully
employed and (2) has a severe impairment, i.e., an impairment
that significantly limits the claimant's physical or
mental ability to perform basic work activities. The claimant
bears the burden of proof with respect to those initial
steps. If the claimant is employed or does not have a severe
impairment, he is not disabled and the analysis ends. See
Monroe v. Colvin, 826 F.3d 176, 179 (4th Cir. 2016).
When the analysis proceeds to step three, the ALJ decides
whether the claimant has an impairment that meets or equals
an impairment listed in the regulations for being severe
enough to preclude a person from doing any gainful activity.
The step three "burden remains on the claimant, and he
can establish his disability if he shows that his impairments
match a listed impairment." Id. (citations
claimant fails at step three, the ALJ must then determine the
claimant's residual functional capacity
("RFC"), which has been defined as "the most
you can still do despite your [physical and mental]
limitations." See 20 C.F.R. §
416.945(a)(1). In making the RFC determination, the ALJ must
identify the claimant's "functional limitations or
restrictions" and assess his "work-related
abilities on a function-by-function basis, including the
functions listed in the regulations." See
Monroe, 826 F.3d at 179 (internal quotation marks
omitted). The ALJ "must consider all of the
claimant's medically determinable impairments of which
the ALJ is aware, including those not labeled severe at step
two." Id. (alterations and internal quotation
the claimant is entitled to have the ALJ "consider all
your symptoms, including pain, and the extent to which your
symptoms can reasonably be accepted as consistent with the
objective medical evidence and other evidence."
See 20 C.F.R. § 404.1529(a); see also Lewis
v. Berryhill, 858 F.3d 858, 862 (4th Cir. 2017). Where
"the medical signs or laboratory findings show that you
have a medically determinable impairment [or impairments]
that could reasonably be expected to produce your symptoms,
such as pain, [the ALJ] must then evaluate the intensity and
persistence of your symptoms so that [the ALJ] can determine
how your symptoms limit your capacity for work."
See 20 C.F.R. § 404.1529(c)(1). In so doing,
the ALJ must "assess the credibility of the
claimant's statements about symptoms and their functional
effects." See Lewis, 858 F.3d at 866 (citing,
inter alia, 20 C.F.R. § 404.1529(c)(4) (providing, e.g.,
that the ALJ will consider whether there are "any
conflicts between your statements and the rest of the
evidence, including your history, the signs and laboratory
findings, and statements by your medical sources or other
persons about how your symptoms affect you")).
determining the claimant's RFC, the ALJ proceeds to step
four, "where the burden rests with the claimant to show
that he is not able to perform his past work." See
Monroe, 826 F.3d at 180. If the claimant succeeds at
step four, the ALJ finishes at step five, where the burden
shifts to the Commissioner. In order to withhold disability
insurance benefits, the Commissioner must prove, "by a
preponderance of the evidence, that the claimant can perform
other work that exists in significant numbers in the national
economy, considering the claimant's [RFC], age,
education, and work experience." Id. (internal
quotation marks omitted). If the Commissioner satisfies that
burden, the claimant is not disabled and his claim for
benefits must be denied.
claims - like Brown's - filed before March 27, 2017, the
standards for evaluating medical opinion evidence are set
forth in 20 C.F.R. § 404.1527. That regulation defines
"medical opinions" as "statements from
acceptable medical sources that reflect judgments about the
nature and severity of your impairment(s), including your
symptoms, diagnosis and prognosis, what you can still do
despite impairment(s), and your physical or mental
restrictions." See 20 C.F.R. §
404.1527(a)(1). For purposes of the regulation, an
"acceptable medical source" includes a licensed
physician or psychologist. Id. § 404.1502(a).
The regulation provides that the ALJ "will evaluate
every medical opinion" presented to him,
"[r]egardless of its source." Id. §
404.1527(c). Generally, however, more weight is given
"to the medical opinion of a source who has examined you
than to the medical opinion of a medical source who has not
examined you." Id. § 404.1527(c)(1).
the regulation embodies a treating physician rule that
accords the greatest weight - controlling weight - to the
opinions of the claimant's "treating sources."
See 20 C.F.R. § 404.1527(c)(2). The regulation
defines a "treating source" as "your own
acceptable medical source who provides you, or has provided
you, with medical treatment or evaluation and who has, or has
had, an ongoing treatment relationship with you."
Id. § 404.1527(a)(2). The regulation explains:
Generally, [the ALJ gives] more weight to medical opinions
from your treating sources, since these sources are likely to
be the medical professionals most able to provide a detailed,
longitudinal picture of your medical impairment(s) and may
bring a unique perspective to the medical evidence that
cannot be obtained from the objective medical findings alone
or from reports of individual examinations, such as
consultative examinations or brief hospitalizations.
Id. § 404.1527(c)(2). The regulation promises
that the ALJ "will always give good reasons in [his]
decision for the weight [he gives] your treating source's
medical opinion." Id.
the regulation's treating physician rule, controlling
weight is to be accorded to "a treating source's
medical opinion on the issue(s) of the nature and severity of
your impairment(s)" if that opinion "is
well-supported by medically acceptable clinical and
laboratory diagnostic techniques and is not inconsistent with
the other substantial evidence in your case record."
See 20 C.F.R. § 404.1527(c)(2). When a treating
source's medical opinion is not given controlling weight,
five factors are utilized to determine what lesser weight
should instead be accorded to the opinion. The first two of
those factors are specific to treating sources:
• "Length of the treatment relationship and the
frequency of examination, " see 20 C.F.R.
§ 404.1527(c)(2)(i); and
• "Nature and extent of the treatment relationship,
" id. § 404.1527(c)(2)(ii).
other three factors are used to determine the weight to be
given to any medical opinion, whether from a treating or
• "Supportability" in the form of the quality
of the explanation provided for the medical opinion and the
amount of relevant evidence - "particularly medical
signs and laboratory findings" - substantiating it,
id. § 404.1527(c)(3);
• "Consistency, " meaning how consistent the
"medical opinion is with the record as a whole, "
id. § 404.1527(c)(4); and
• "Specialization, " favoring "the
medical opinion of a specialist about medical issues related
to his or her area of specialty, " id. §
any other factors "which tend to support or contradict
the medical opinion" are to be considered. Id.
regulation identifies several issues that are reserved to the
Commissioner, including whether a claimant's impairment
matches a listed impairment, the claimant's RFC, and
whether the claimant ultimately meets the statutory
definition of disabled. See 20 C.F.R. §
404.1527(d). Thus, for example, when a medical source renders
an opinion that a claimant is "'disabled' or
'unable to work, '" the ALJ will consider
"all of the medical findings and other evidence that
support" the ...