United States District Court, D. Connecticut
RULINGS ON PLAINTIFF'S MOTION TO REVERSE COMMISSIONER'S DECISION, AND DEFENDANT'S CROSS-MOTION TO AFFIRM COMMISSIONER'S DECISION
CHARLES S. HAIGHT, JR. SENIOR UNITED STATES DISTRICT JUDGE
Plaintiff Rhonda Denise Thornton applied to the Social Security Administration for disability benefits and supplemental security income. The Administration denied Thornton's applications in a written decision (Jane A. Crawford, Administrative Law Judge) which the Defendant Commissioner declined to disturb on appeal.
Thornton brings this action under § 205(g) of the Social Security Act as amended, 42 U.S.C. 405(g), in order to obtain a review by the Court of the Commissioner's final decision denying her applications for benefits. Thornton now moves [Doc. 11] for an order reversing the Commissioner's decision. The Commissioner cross-moves [Doc. 17] for an order affirming that decision. This Ruling resolves the motions.
Thornton filed her applications for benefits on June 14, 2010. She alleged disability beginning on May 3, 2010. Thornton was born on September 1, 1967, and so was 44 years old at the time of her applications.
Thornton's applications for disability benefits were based on the contention that she is disabled by systemic lupus erythematosus ("lupus" or "SLE"). In her decision denying benefits at 4, ALJ Crawford found that Thornton has the "severe impairment" of "systemic lupus erythematosus." The phrase "severe impairment, " as used by the ALJ in her opinion, is of central import in Social Security Act analysis because the regulations propounded under the Act require an ALJ, when deciding an individual's eligibility for benefits, to determine at one step in the five-step process whether the claimant has a medically determinable impairment or a combination of impairments that is "severe." 20 C.F.R. §§ 404.1521 and 416.920(c).
"An impairment or combination of impairments is 'severe' within the meaning of the regulations if it significantly limits an individual's ability to perform basic work activities." ALJ Crawford's decision at 2 (citing regulations). The regulations list lupus under the caption "Immune System disorders, " 20 C.F.R. Part 404, Subpart P, Appendix 1, § 14.00, and define the disease in sobering terms, § 14.00(D)(1): "Systemic lupus erythematosus (SLE) is a chronic inflammatory disease that can affect any organ or body system." Claims of disability caused by lupus form the subject matter of numerous lawsuits filed under the Social Security Act. See Borgos-Hansen v. Colvin, 109 F.Supp.3d 509, 514 (D. Conn. 2015) (collecting cases).
The administrative record ("AR.") before the ALJ in this case includes reports of two office visits, on March 4 and June 3, 2010, Thornton had with Aryeh M. Abeles, M.D., an attending rheumatologist at the University of Connecticut Health Center. The reports signed by Dr. Abeles, AR. 289 and AR. 291, each state "This is a followup appointment, " but the record does not include records of earlier office visits by Thornton to this facility. Dr. Abeles' June 3, 2010 report describes Thornton as "this 42-year-old woman with lupus characterized by positive antinuclear skin rashes, and strongly positive autoantibodies (Ro, Smith, and RNP antibodies)." AR 289. Under the caption "Impression, " Dr. Abeles states in part: "Ms. Thornton is a 42-year old woman with systemic lupus erythematosus." The record does not show when Thornton was first diagnosed with SLE. It is apparent that she was suffering from that disease in March 2010, when she consulted Dr. Abeles, and had been for some time previous to that.
As noted, the ALJ's decision, which is dated March 26, 2012, found that Thornton had the severe impairments" of "systemic lupus erythematosus." AR. 15. However, the ALJ concluded that Thornton was not disabled, and consequently not entitled to disability benefits. The ALJ found that Thornton's impairment did not equal the severity of one of the listed impairments in the regulations that would if present mandate a finding of disability, AR. 17, and also found that Thornton had a residual functional capacity to perform "light work" of an exertional nature, as that phrase is defined in the regulations, AR. 18. The ALJ further found: "Although the claimant is capable of performing past relevant work [that is, gainful work of the sort she had performed previously], there are other jobs existing in the national economy that she is also able to perform." AR. 22. Given those findings, the ALJ reached the conclusion mandated by the statutory and regulatory scheme that Thornton was not "disabled, " and consequently was not entitled to Social Security Act benefits. On administrative appeal, the Commissioner affirmed the ALJ's decision. This action followed.
Thornton appeals to this Court on the ground that in order to reach that unfavorable decision, it was necessary for the ALJ to disregard the contrary opinion of Thornton's primary care physician, Michael B. Teiger, M.D. There is no question that Dr. Teiger played that central role in Thornton's care; the ALJ's decision refers to Dr. Teiger as Thornton's "primary care physician." AR. 18.
The medical records generated by Dr. Teiger during his care of Thornton, AR. 314-331, include office visit reports, lab results, and medical impressions and opinions. The period of care reflected by these records is from March 13, 2009 to September 9, 2011. The first of these documents, AR. 314, appears to be a form Dr. Teiger completed concerning an office visit Thornton made on March 13, 2009. AR. 315-318 are laboratory results based on a urine sample Thornton gave during that visit. Dr. Teiger's report on an office visit with Thornton on August 26, 2010, records his Impression: "Lupus is stable." Dr. Treiger's records presented to the ALJ do not reveal whether March 13, 2009 was the first time Thornton consulted Dr. Teiger, or when during Dr. Teiger's care of Thornton he first made or confirmed the diagnosis that she had lupus. As noted supra, on the occasion of a June 3, 2010 office visit, Dr. Abeles of the UConn Health Center described Thornton as "a 42-year old woman with systemic lupus erythematosus."
The most recent pertinent document in Dr. Teiger's records is a medical opinion Dr. Teiger expressed, with which the appeal to this Court is principally concerned. That opinion takes the form of Dr. Teiger completing and signing a six-page written statement, AR. 326-331, captioned "MEDICAL SOURCE STATEMENT OF ABILITY TO DO WORK-RELATED ACTIVITIES (PHYSICAL)." The statement refers at the outset to "Rhonda Denise Thornton" and instructs the "medical source" involved (here, Dr. Teiger): "To determine this individual's ability to do work-related activities on a regular and continuous basis, please give us your opinion for each activity shown below." Dr. Teiger complied by checking boxes on the form, adding comments at various places, writing an opinion in response to the request that he "identify the particular medical findings" which "support your assessment or any limitations and why the findings support the assessment, " dating the form on February 20, 2012, and signing it.
Dr. Teiger's responses to this statement need not be recounted in full. It is sufficient for present purposes to say that Dr. Teiger's opinions, expressed in his answers to the form he completed, cannot be reconciled with the ALJ's subsequent finding that Thornton was capable of light exertional work. Dr. Teiger's basic opinion is that Thornton's lupus symptoms preclude her from engaging the sort of work the ALJ later decided she could perform. In a letter to the ALJ dated February 28, 2012, AR. 272, Mr. Grabow, counsel for Thornton, stressed the physical limitations diagnosed by Dr. Teiger:
I am attaching hereto a MSS – physical completed by Dr. Michael Teiger, the claimant's primary care physician. I note that Dr. Teiger opines that the claimant retains only a part-time, or less than sedentary, work capacity secondary to systemic lupus. I further note that the claimant's treater opines in section II.A., that the claimant would be unable to report to work 4 or more times a month as a result of her medical condition.
Mr. Grabow read Dr. Teiger's February 20, 2012 opinions as stating that Thornton was disabled by her lupus, within the statutory and regulatory scheme. There is no other way to read it. That is why Mr. Grabow sent Dr. Teiger's opinions to ALJ Crawford, with the request in his February 28 letter that "Dr. Teiger's opinions be afforded substantial or controlling weight."
ALJ Crawford received Dr. Teiger's opinion, read and considered it, acknowledged its import, and then, rejecting counsel's submission, decided to give Dr. Treiger's opinion no weight on the issue of disability vel non. The following passages in the ALJ's decision reveal her reasoning on the point:
In a February 20, 2012 Medical Resource Statement, Dr. Teiger reported that the claimant is limited due to lupus symptoms, primarily with her vision and joint pain. . . . The undersigned affords little weight to the findings of the claimants primary care physician, Dr. Michael Teiger, as it is inconsistent with the objective medical evidence. Dr. Teiger proffered his opinion on February 20, 2012 without any current supporting treatment notes to bolster his opinion. The most recent treatment notes from his office dated September 9, 2011, show that the claimant was in no acute distress and had no clubbing, cyaosis or edema of her extremities, had intact peripheral pulses, and was intact neurologically. He continued the claimant on the same medication regimen, which suggests that the medications were effective in controlling her symptoms and if she was experiencing any side effects, they were not severe enough for him to make any changes or adjustment. There is no evidence in the medical records to support the exertional, postural manipulative and visual limitations he ascribed to the claimant. On the other hand, the undersigned affords great weight to treating opthalmologist Dr. Barry Kels, who found that the claimant did not present with a vision loss that impacted her work related abilities. Unlike Dr. Teiger, Dr. Kels has expertise in the field of ophthalmology and is adequately qualified to make an assessment of the claimant's visual abilities and limitations, which renders his opinion more persuasive.
AR 20, 21. The ALJ's averment that she afforded "little weight" to Dr. Teiger's opinions and findings is an exercise in politesse. In reality, the ALJ entirely disregarded Dr. Teiger's opinion that Thornton was disabled by lupus symptoms.
On her appeal to this Court, Thornton's brief [Doc. 11-1] contends principally that the ALJ failed improperly to give appropriate weight to the opinion of Dr. Teiger, the treating physician, and that the case should be remanded to the Commissioner in order to develop the record, by which counsel means that the ALJ "should have sought clarification from the claimant's treating source, Dr. Teiger." Brief at 7. That is the alternative form of relief Thornton seeks in her concluding prayer, that the Commissioner's denial of benefits be "reversed and/or remanded." Id. at 9.
The Commissioner, on her cross-motion, contends that the denial should be affirmed because the ALJ's decision is supported by substantial evidence on the present record, and there is no occasion for a remand.
The effect of a treating physician's medical opinion upon the Social Security Administration's determination of whether an individual is "disabled" is a complex question, with which judges and regulators have wrestled.
On the one hand, a treating physician is trained in medicine and has cared for – treated – the individual in question. The professional relationship between patient and physician is sometimes enhanced by the personal bond of friendship. One need not surrender to cynicism in order to suppose that on occasion a physician may phrase a medical opinion in a manner intended to improve a patient-friend's prospects of obtaining disability benefits. As the regulations and judicial decisions have evolved, it is clear that a treating physician's opinion that the individual claimant is disabled is not always binding upon an administrative law judge, whose responsibility under the statutory and regulatory scheme is to determine whether or not that is so.
On the other hand, a "treating physician" qualifies for that designation by caring for the individual over time, either by the general practice of medicine or for a particular malady. In a gentler and less complicated day, we called the first such doctor a "general practitioner" or "GP, " whose ...