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Brown v. Commissioner Social Security Administration

United States Court of Appeals, Fourth Circuit

September 29, 2017

RICKY E. BROWN, Plaintiff-Appellant,
v.
COMMISSIONER SOCIAL SECURITY ADMINISTRATION, Defendant-Appellee.

          Argued: March 23, 2017

         Appeal from the United States District Court for the District Court of South Carolina, at Greenville. David C. Norton, District Judge. (6:14-cv-04486-DCN)

         ARGUED:

          Hannah Rogers Metcalfe, METCALFE & ATKINSON, LLC, Greenville, South Carolina, for Appellant.

          Melissa K. Curry, SOCIAL SECURITY ADMINISTRATION, Philadelphia, Pennsylvania, for Appellee.

         ON BRIEF:

          Timothy Clardy, DENNISON LAW FIRM, PC, Greenville, South Carolina, for Appellant.

          Nora 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.

          Before 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.

          KING, Circuit Judge.

         Ricky 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.

         I.

         Brown 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.

         As for 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.

         Nearly 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.

         In 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).

         II.

         Before 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 regulations.

         A.

         The 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 omitted).

         If the 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 marks omitted).

         Additionally, 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")).

         After 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.

         B.

         For 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).

         Significantly, 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.

         Under 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).

         The other three factors are used to determine the weight to be given to any medical opinion, whether from a treating or nontreating source:

• "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. § 404.1527(c)(5).

         Additionally, any other factors "which tend to support or contradict the medical opinion" are to be considered. Id. § 404.1527(c)(6).

         The 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. ยง 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 ...


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