Caseflicks

Court of Appeals for the Eleventh Circuit • 2011

Winschel v. Commissioner of Social Security

631 F.3d 1176 | 2011 U.S. App. LEXIS 1396

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Takeaway

In short, this case requires ALJs to explain the weight they give medical opinions and to ensure vocational-expert hypotheticals capture all material limitations, including moderate limits in concentration, persistence, and pace.

Background

Michael Winschel applied for disability insurance benefits and supplemental security income. An Administrative Law Judge denied both applications after applying the Social Security Administration’s five-step disability process. At steps four and five, the ALJ assessed Winschel’s residual functional capacity and concluded that jobs existed in significant numbers that he could perform.

The ALJ mentioned Winschel’s treating physician only to note that Winschel saw the doctor monthly. The decision did not discuss the physician’s treatment notes, which described Winschel’s symptoms, diagnosis, and the severity of his impairments. The ALJ also omitted pertinent parts of an examining physician’s opinion.

The ALJ found that Winschel’s mental impairments moderately limited his concentration, persistence, and pace. But the hypothetical question posed to the vocational expert did not expressly include that limitation or otherwise explain how it was accounted for. Relying on the expert’s answer, the ALJ found Winschel not disabled. The district court affirmed, and Winschel appealed.

Issues

Issue #1

Whether the ALJ reversibly erred by failing to evaluate and specify the weight given to the opinions of Winschel’s treating physician and examining physician.

Holding

Yes. The ALJ was required to consider the medical opinions, state the weight assigned to them, and explain the reasons for that weight; his failure to do so required reversal and remand.

Reasoning

Judicial review asks whether the Commissioner applied proper legal standards and supported the decision with substantial evidence. Although a reviewing court may not reweigh evidence or decide facts anew, it must be able to determine from the ALJ’s decision why the agency reached its conclusion.

A medical opinion includes a physician’s judgments about the nature and severity of impairments, including symptoms, diagnoses, prognoses, functional ability, and physical or mental restrictions. The treating physician’s notes fell within that definition because they described Winschel’s symptoms, diagnosis, and impairment severity. The Commissioner therefore could not dismiss those notes as something other than a medical opinion.

Absent good cause, a treating physician’s opinion receives substantial or considerable weight. Good cause may exist where the opinion is unsupported by the evidence, contradicted by other evidence, conclusory, or inconsistent with the physician’s own records. But even when good cause exists, the ALJ must clearly articulate the reasons for discounting the treating opinion.

The ALJ referred to the treating physician only once, merely observing that Winschel visited the doctor monthly. He did not address the physician’s actual opinion or state what weight he assigned it. Likewise, the ALJ failed to discuss pertinent aspects of the examining physician’s opinion. Without an articulated evaluation, the court could not determine whether the ALJ rationally rejected those opinions or whether substantial evidence supported the result.

The court declined to affirm based on rationales that the ALJ might have had but did not state. On remand, the ALJ must expressly consider the medical-opinion evidence and explain the weight given to each relevant opinion.

Issue #2

Whether the vocational expert’s testimony constituted substantial evidence when the ALJ’s hypothetical omitted Winschel’s moderate limitation in concentration, persistence, and pace.

Holding

No. Because the hypothetical neither included nor implicitly accounted for Winschel’s moderate limitation in concentration, persistence, and pace, the vocational expert’s testimony could not support the step-five finding.

Reasoning

At step five, the Commissioner bears the burden of showing that significant numbers of jobs exist in the national economy that the claimant can perform. The ALJ may use vocational-expert testimony to make that showing, but the testimony is substantial evidence only if the hypothetical question includes all of the claimant’s impairments.

The Psychiatric Review Technique and the residual-functional-capacity assessment are distinct inquiries. Still, the regulatory distinction does not bar an ALJ from considering Psychiatric Review Technique findings when formulating the RFC or a vocational-expert hypothetical. A moderate limitation found at the earlier stages cannot simply be ignored at the later work-capacity stages.

A limitation to simple, routine tasks or unskilled work does not automatically account for moderate difficulties in concentration, persistence, and pace. Such a restriction can be sufficient if medical evidence shows that the claimant can perform simple or unskilled work despite those difficulties, or if the hypothetical otherwise implicitly incorporates the limitation.

Here, the ALJ found at step two that Winschel had a moderate limitation in maintaining concentration, persistence, and pace. Yet the ALJ did not identify medical evidence showing that the limitation left his work ability unaffected, and the hypothetical did not otherwise implicitly account for it. The limitation therefore had to be expressly included in the question posed to the vocational expert.

Because the vocational expert answered an incomplete hypothetical, the expert’s testimony was not substantial evidence supporting the finding that Winschel could perform jobs existing in significant numbers. On remand, the ALJ must pose a hypothetical that specifically accounts for the moderate limitation in concentration, persistence, and pace.