United States District Court, D. South Carolina
Richard Mark Gergel, United States District Judge
has brought this action pursuant to 42 U.S.C. § 405(g)
seeking judicial review of the final decision of the
Commissioner of Social Security denying his application for
child insurance benefits based upon disability. In accordance
with 28 U.S.C. § 636(b) and Local Civil Rule 73.02 DSC,
this matter was referred to a United States Magistrate Judge
for pre-trial handling. The Magistrate Judge issued a Report
and Recommendation ("R & R") on May 31, 2019
recommending that the Court affirm the decision of the
Commissioner. (Dkt. No. 15). Plaintiff filed objections to
the R & R, arguing that the opinions of Plaintiff s
treating physicians were not given appropriate weight. (Dkt.
No. 17). As set forth more fully below, the Court reverses
the decision of the Commissioner and remands this matter to
the agency for further action consistent with this Order.
Magistrate Judge makes only a recommendation to this Court.
The recommendation has no presumptive weight, and the
responsibility to make a final determination remains with the
Court. Mathews v. Weber, 423 U.S. 261 (1976). The
Court is charged with making a de novo determination
of those portions of the Report and Recommendation to which
specific objection is made. The Court may accept, reject, or
modify, in whole or in part, the recommendation of the
Magistrate Judge. 28 U.S.C. § 636(b)(1).
role of the federal judiciary in the administrative scheme
established by the Social Security Act is a limited one. The
Act provides that the "findings of the Commissioner of
Social Security as to any fact, if supported by substantial
evidence, shall be conclusive." 42 U.S.C. § 405(g).
"Substantial evidence has been defined innumerable times
as more than a scintilla, but less than preponderance."
Thomas v. Celebrezze, 331 F.2d 541, 543 (4th Cir.
1964). This standard precludes de novo review of the
factual circumstances that substitutes the Court's
findings of fact for those of the Commissioner. Vitek v.
Finch, 438 F.2d 1157 (4th Cir. 1971).
the federal court's review role is a limited one,
"it does not follow, however, that the findings of the
administrative agency are to be mechanically accepted. The
statutorily granted right of review contemplates more than an
uncritical rubber stamping of the administrative
action." Flack v. Cohen, 413 F.2d 278, 279 (4th
Cir. 1969). Further, the Commissioner's findings of fact
are not binding if they were based upon the application of an
improper legal standard. Coffman v. Bowen, 829 F.2d
514, 519 (4th Cir. 1987).
the regulations of the Social Security Administration, the
Commissioner is obligated to consider all medical evidence
and the opinions of medical sources, including treating
physicians. 20 C.F.R § 404.1545. The regulation, known
as the "Treating Physician Rule," imposes a duty on
the Commissioner to "evaluate every medical opinion we
receive." Id. § 404.1527(c). The
Commissioner "[g]enerally . . . give[s] more weight to
opinions from . . . treating sources" based on the view
that "these sources are likely to be the medical
professionals most able to provide a detailed, longitudinal
picture of [the claimant's] medical impairment(s) and may
bring a unique perspective to the medical evidence that
cannot be obtained from objective medical findings alone or
from reports of individual examinations, such as consultative
examinations or brief hospitalizations." Id.
§ 404.1527(c)(2). Further, the Commissioner
"[g]enerally .. . give[s] more weight to the opinion of
a source who has examined [the claimant] than to the opinion
of a source who has not examined [the claimant]."
Id. § 404.1527(c)(1).
some circumstances, the opinions of the treating physicians
are to be accorded controlling weight. Even where the
opinions of the treating physicians of the claimant are not
accorded controlling weight, the Commissioner is obligated to
weigh those opinions in light of a broad range of
specifically identified factors, including the examining
relationship, the nature and extent of the treatment
relationship, supportability of the opinions in the medical
record, consistency, and whether the treating physician is a
specialist. Id. §§ 4O4.l527(c)(1)-(5). The
Commissioner is obligated to weigh the findings and opinions
of treating physicians and to give "good reasons"
in the written decision for the weight given to a treating
source's opinions. SSR 96-2P, 61 Fed. Reg. 34490, 34492
(July 2, 1996).
opinions of non-examining sources and state agency medical
consultants must be weighed under the same standards of the
Treating Physician Rule, including the source's
"medical specialty and expertise ..., the supporting
evidence in the case record, supporting explanations ... and
other factors relevant to the weighing of opinions."
Id. §§ 404.1527(e)(2)(ii). The
Commissioner further pledges that the opinions of
non-examining sources will be evaluated on "the degree
to which these opinions consider all the pertinent evidence
.. ., including the opinions of treating and other examining
sources." Id. §§
born on October 27, 1992, applied for child insurance
benefits based upon a disability arising from his diagnosis
of schizophrenia and claimed an onset date of October 27,
2010. Plaintiff has been treated by Dr. McLeod Gwynette, a
board certified Child and Adolescent Psychiatrist and
director of the residency training program at the Medical
University of South Carolina, who began his treatment of the
claimant in December 2009. He continuously provided
psychiatric care for Plaintiff over the ensuing seven years,
and personally had at least two dozen office visits with the
claimant, with the last office note in the record from May
19, 2016. (Tr. 257, 261, 276, 277, 279, 281, 284, 285, 287,
291, 303, 304, 305, 306, 307, 308, 311, 313, 314, 326,
327-28, 341-43, 390, 393, 398).
Gwynette also completed a number of questionnaires and
letters summarizing his treatment, diagnoses and opinions
regarding Plaintiff and consistently offered to provide the
Social Security Administration additional information if
needed. (Tr. 259, 334-338, 339, 378-82, 383). Dr. Gwynette
described in these documents and his office notes Plaintiffs
illogical thinking, difficulty concentrating, paranoia,
irrational fears, delusions, and audio hallucinations, all
secondary to his schizophrenia. He opined that Plaintiffs
mental illness was exacerbated by stress, which rendered him
at "high risk for decompensation in work and work-like
settings due to his difficulty in coping with stressors and
changes in environment." (Tr. 335, 336, 383, 378, 379,
380). Dr. Gwynette noted that while Plaintiffs mental health
symptoms worsened when he was non-compliant in taking his
prescribed anti-psychotic medications, he continued to have
"breakthrough" incidents of hearing voices one to
two times per week even when he took his medications, which
caused Plaintiff "significant impairment." (Dkt.
No. 339, 341, 383, 389, 392, 394, 398). Dr. Gwynette opined
that Plaintiffs chronic mental illness "profoundly
impacted the patient's ability to function" and
rendered him incapable of working in a competitive
environment. (Tr. 336, 339, 380, 383). Plaintiffs family
physician, Dr. James Dantzler, shared that same view about
Plaintiffs inability to function in the workplace. (Tr. 252).
record documents the struggles of Plaintiff s family in
attempting to manage his chronic mental illness, sometimes
resulting in violent confrontations with family members and
requiring the intervention of law enforcement or medical
personnel. (Tr. 41, 44, 46, 371, 394). These conflicts often
arose when his mother sought to supervise and confirm that
Plaintiff had taken his anti-psychotic medicine, which he at
times resisted because of the unfounded belief that the drugs
were somehow tainted or that his mother was attempting to
harm him. (Tr. 50, 329). Due to Plaintiffs periodic episodes
of decompensation, rapid mood swings, and extreme agitation,
Plaintiffs mother told the Social Security staff she does not
leave Plaintiff alone with his little brother, fearing he
might try to harm him, and has refused to help Plaintiff
obtain a driver's license, fearing he might hurt someone
in the car. (Tr. 329).
only contrary views offered in the administrative record
involved in-house physicians working with the Social Security
Administration who did not examine or treat Plaintiff and
reviewed only a limited number of medical records (all before
September 15, 2014). They concluded that Plaintiff was not
disabled, each providing abbreviated entries in the
administrative record. (Tr. 65, 67, 79, 90-91). Due to their
time limited review of the record, these chart reviewing
physicians did not have access to and did not review Dr.
Gwynette's letters and questionnaire responses that were
produced on September 30, 2014, May 19, 2016, or August 30,
2016, or his office notes of January 12, 2015, August 4,
2015, November 3, 2015, and February 9, 2016. These notes and
documents, all produced subsequent to the last review by the
in-house chart reviewers, provided some of the most detailed