Blakley v. Commissioner of Social Security

A treating-source opinion receives controlling weight when it is well supported by medically acceptable clinical and laboratory diagnostic techniques and is not inconsistent with other substantial evidence. Even when an ALJ properly decides that controlling weight is unwarranted, the ALJ must still determine the appropriate lesser weight by considering the treatment relationship, frequency of examination, nature and extent of treatment, supportability, consistency, and specialization.

The regulations require the ALJ to give “good reasons” for the weight assigned to a treating opinion. Those reasons must be supported by the record and specific enough to let the claimant and a reviewing court understand both the weight assigned and the basis for it. This procedural obligation protects fair process and permits meaningful judicial review; it is not merely a preference for fuller administrative explanations.

Dr. Kiefer was plainly a treating physician. He treated Blakley over more than a year, performed the cervical discectomy, ordered and reviewed diagnostic studies, diagnosed carpal tunnel syndrome, and monitored continued symptoms and objective evidence of degenerative disease. Yet the ALJ did not mention Dr. Kiefer at all, much less recognize his treating relationship or explain the weight given to his opinions.

The ALJ’s treatment of Dr. Kibler was also inadequate. Dr. Kibler performed two shoulder surgeries, treated Blakley over an extended period, and imposed a 20-pound lifting restriction with limits on repetitive overhead lifting. Rather than applying the regulatory factors and explaining the assigned weight, the ALJ speculated that a treating doctor might sympathize with a patient or yield to a demanding request. A finding that an opinion lacks controlling weight does not permit outright rejection without further evaluation and explanation.

The ALJ likewise failed to clarify how she treated Dr. Raza’s opinions. Although Dr. Raza began as a consultative psychiatrist, he later provided regular psychiatric treatment. The ALJ summarized treatment at his facility but did not identify whether she regarded him as a treating source, an examining source, or both, and did not explain the weight she assigned his opinions. That omission prevented review of whether the treating-physician rule had been applied.

An ALJ may, in appropriate circumstances, give greater weight to a state-agency consultant than to a treating or examining source. But that can be appropriate where the consultant reviewed a complete record or otherwise possessed more detailed and comprehensive information than the treating source.

The state-agency physicians rendered their opinions in June and September 2005. They therefore did not review later evidence including Dr. Kibler’s October and December 2005 assessments and restrictions, Dr. Muffly’s 2006 assessment, and later psychiatric-treatment records from Dr. Raza. Because the record contained substantial ongoing treatment after the agency reviews, the ALJ needed to indicate that she considered the reviewers’ incomplete access to the record before adopting their medium-work residual-functional-capacity assessment.

The ALJ’s bare statement that medium work was consistent with the state-agency consultants’ opinions did not supply that indication. The court did not hold that reliance on nonexamining opinions is always improper, but it held that this record required an explanation showing that the ALJ accounted for the later evidence.

Under Wilson, a failure to give good reasons may be harmless in narrow circumstances, such as where the treating opinion is patently deficient or where the agency’s decision otherwise accomplishes the purpose of the procedural safeguard. Harmlessness is unavailable, however, when the court cannot meaningfully review the ALJ’s treatment of the treating evidence.

Meaningful review was impossible here because the ALJ did not make clear that she recognized and evaluated the treating relationships of Drs. Kiefer, Kibler, and Raza. The court could not tell whether the ALJ recognized that Dr. Raza had become a long-term treating psychiatrist, nor could it determine the actual weights assigned to the treating opinions.

The treating opinions were not so deficient that no reasonable adjudicator could credit them. Objective MRIs, CT scans, x-rays, surgeries, and continuing clinical findings at least supported and were not inconsistent with the treating sources’ assessments. Moreover, even if substantial evidence might ultimately support denying benefits, substantial evidence cannot excuse the agency’s failure to observe its own mandatory procedure.

The court therefore reversed the district court’s judgment and remanded the matter to the Commissioner for further proceedings. It did not decide whether the record compelled an award or a denial of benefits, because the Commissioner must make that determination after properly evaluating the medical opinions.