ALJ failed to articulate good cause for discounting treating physicians’ opinions
Tuesday, September 10, 2019

ALJ failed to articulate good cause for discounting treating physicians’ opinions

By Payroll and Entitlements Editorial Staff

In a decision that reversed in part and remanded an Administrative Law Judge’s (ALJ) denial of disability benefits, the U.S. Court of Appeals for the Eleventh Circuit in Schink v. Commissioner, No. 17-14992 (2019), ruled that the ALJ failed to articulate good cause for discounting the opinions of two treating physicians. The court concluded that the ALJ should not have discounted the opinions based on what he perceived to be treatment for the claimant’s mental health issues.

Sporadic treatment rationale. The claimant received treatment for his mental health conditions from a number of providers who documented chronic mood swings, depression, anger, and anxiety. Two of the claimant’s treating physicians found that his mental impairments were severe and disabling. Generally, the ALJ must give a treating physician’s opinion substantial or considerable weight unless good cause is shown to the contrary. After the Appeals Council affirmed the denial of benefits, the claimant appealed, arguing that the ALJ erred by discounting the treating physicians’  opinions. Although an ALJ may be justified in discounting a treating physician’s opinion when the physician rarely saw the claimant and submitted only brief notes, the providers here administered significant treatment over the course of months before completing the questionnaires assessing the claimant mental impairments. The record demonstrated that they were treating physicians and their level of familiarity with the claimant’s conditions was sufficient to entitle their opinions to the presumption of substantial or considerable weight. Moreover, the ALJ gave significant weight to the opinions of consulting physicians who saw the claimant only once or not at all. The ALJ’s failure to apply this sporadic-treatment rationale across the board, with no explanation given for the inconsistency, made it impossible for the court to consider the rationale good cause to discount the treating phyicians’ opinions.

Questionnaire format. In addition, the court concluded that the ALJ improperly rejected the treating opinions due to the format of questionnaires completed.No specific form is required by the regulations. Rather, the regulations note that medical sources may use terms in a different way when describing a claimant’s condition. If no other evidence counters a treating physician’s opinion, the ALJ cannot reject the opinion merely because it is not in a particular format. Here, the terms that the ALJ found to be vague in the treating physicians’ opinions were defined in the questionnaire and were the same as used by the consultative doctor. Regardless, the ALJ should have interpreted the treating physicians’ questionnaire responses in light of their treatment notes which showed consistent conclusions about the claimant’s mental health.

Severity of impairment . Finally, the court ruled that the ALJ improperly determined that the claimant did not suffer from a severe mental impairment. Based on the regulatory standard, substantial evidence did not support the ALJ’s finding that the claimant’s mental impairments, specifically, his bipolar disorder, were not severe. The claimant’s ental impairments could not be considered only slight or trivial. Rather, the claimant’s mental health issues were serious enough to warrant treatment from medical professionals over a period of years. Every doctor who saw the claimant diagnosed him with bipolar disorder or a comparable disorder and opined that the condition significantly impacted his life. There was little evidence that medication ever durably improved the claimant’s condition. Also, the fact that the claimant at times seemed to be doing better did not support a finding that the mental impairments were not severe. The court agreed with the other circuit courts that people with chronic diseases can experience good and bad days. Accordingly, the case was remanded to the agency for further proceedings.

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