Villareal v. Commissioner of Social Security Administration

Filing 24

ORDER ADOPTING REPORT AND RECOMMENDATION for 21 Report and Recommendation, this action is reversed and remanded for further consideration, as more fully set out. Signed by Honorable David L. Russell on 6/19/18. (jw)

IN THE UNITED STATES DISTRICT COURT
FOR THE WESTERN DISTRICT OF OKLAHOMA
KARLA M. VILLAREAL,
Plaintiff,
v.
NANCY M. BERRYHILL, Acting
Commissioner of the Social
Security Administration,
Defendant.

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Case No. CIV-17-1122-R

ORDER
Plaintiff filed this action seeking review of the final decision of the Commissioner
denying her disability insurance benefits and benefits for a period of disability. Pursuant to
28 U.S.C. § 636(b)(1)(B) and (C), the matter was referred to United States Magistrate
Judge Gary M. Purcell for preliminary review. On May 29, 2018, Judge Purcell issued a
Report and Recommendation wherein he recommended the matter be remanded to the
Commissioner for further proceedings. (Doc. No. 21). The Commissioner filed a timely
objection to the Report and Recommendation (Doc. No. 22) to which Plaintiff has filed a
response (Doc. No. 23). The timely objection gives rise to the Court’s obligation to
undertake a de novo review of those portions of the Report and Recommendation to which
a party makes specific objection. Having conducted this de novo review, the Court finds as
follows.
Defendant contends Judge Purcell erred in concluding that the administrative law
judge did not properly assess the opinion of Plaintiff’s treating physician, Daisy Matias,

M.D. Specifically, Judge Purcell concluded that the Commissioner erred in assessing the
September 14, 2016 opinion of Dr. Mattias, wherein she stated:
Karla has severe Psoriasis complicated by Psoriatic Arthopathy and
Fibromyalgia.
Due to her illness, Karla cannot stand longer than 45 minutes, cannot
lift more than one gallon, cannot sit for more than one hour and has trouble
making it to the bathroom on time.
Tr. 577. In assessing this opinion of Plaintiff’s treating physician, the administrative law
judge stated:
The opinion at Exhibit 16F, from the claimant’s treating physician, cannot
be given any weight. The opinion is clearly based on the claimant’s report to
her doctor of her limitations. Furthermore, the doctor makes no attempt to
determine what limitations would reasonably result from her conditions.
Tr. 65. Judge Purcell concluded the administrative law judge failed to follow the procedure
to analyze the opinion of a treating source, specifically because he failed to consider
whether, despite not being entitled to controlling weight, the opinion should be given some
weight in light of the factors set forth in the regulations, including the length of the
treatment relationship, frequency of examination, the degree to which the opinion of the
physician is supported by relevant evidence, consistence between the opinion and the
record, and whether the physician offering the opinion is a specialist. Doc. No. 21, pp. 67. Judge Purcell concluded that although the administrative law judge summarized
Plaintiff’s medical records, the summary did not specifically identify which records were
those of Dr. Mattias, only mentioning her by name when he rejected her opinion. He thus
concluded that the Commissioner’s decision was legally insufficient and therefore subject
to remand.
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The Commissioner cites to Dr. Mattias’ normal findings, specifically with regard to
gait, skin lesions and strength, during the treatment relationship with Plaintiff and contends
that the failure to specifically link the rejection of Dr. Mattias’ opinion with her clinical
findings in assessing the weight of the opinion does not undercut the conclusion or the
methodology. The Court concurs with Judge Purcell’s conclusion that the administrative
law judge applied the incorrect legal standard in assessing the treating physician’s opinion,
because he made speculative inferences from medical reports. McGoffin v. Barnhart, 288
F.3d 1248, 1252 (10th Cir. 2002). The Tenth Circuit has addressed treating physician
analysis similar to that presented here in Victory v. Barnhart, 121 Fed.Appx. 819 (10th Cir.
Feb. 4, 2005).
Therein the court noted the general standard for assessing the opinion of a treating
physician: “even if a treating physician’s opinion is not entitled to controlling weight,
however, treating source medical opinions are still entitled to deference and must be
weighed using all of the factors provided in 20 C.F.R. § 404.1527 and 416.927.” Id.
(internal quotations and citations omitted). If an administrative law judge rejects a treating
physician’s opinion, the administrative law judge must give specific reasons. Here the
administrative law judge gave a specific reason, that the opinion was clearly based on the
claimant’s report to the doctor of her limitations. “The ALJ’s finding that [Dr. Mattias’s]
opinion was based on claimant’s own subjective report of her symptoms impermissibly
rests on his speculative unsupported assumption.” Id. at 823. In Langley v. Barnhart, 373
F.3d 1116 (10th Cir. 2004), the court made a similar conclusion, finding that the

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administrative law judge erred in rejecting an opinion based on speculation that the report
was based only on the claimant’s subjective conclusion.
Furthermore, although an administrative law judge is not required to specifically
cite to each element of the test for weighing expert opinions, here the administrative law
judge made no attempt to tie his rejection of Dr. Mattias’ opinion to her treatment records.
See also Cook v. Astrue, 554 F. Supp. 2d 1241, 1246-47 (D. Kan. 2008); see also Garcia
v. Barnhart, 188 Fed.Appx. 760, 764 (10th Cir. 2006) (unpublished) (“This court has made
it clear that when an ALJ rejects a medical opinion...based on his speculation that the doctor
was unduly swayed by a patient's subjective complaints, the ALJ deviates from [the]
correct legal standards and his decision is not supported by substantial evidence”) (citation
omitted); Johnson v. Berryhill, No. 16-cv-3050-WJM2018 WL 1566838, *5 (D. Colo. Mar.
30, 2018)(rejecting administrative law judge’s decision concluding that treatment reports
documented subjective complaints as substituting lay opinion and declining to engage in
post hoc evaluation). In the instant case the administrative law judge did not specifically
tie his rejection of the treating physician’s opinion to any evidence of record. Although the
administrative law judge summarized the evidence, as noted by Judge Purcell, in the
summary the administrative law judge did not specifically indicate that Dr. Mattias, who
had a long treatment relationship with Plaintiff, was the treating physician. The Court
cannot conclude based on the administrative law judge’s decision that he engaged in the
required assessment of the factors set forth in the regulations before assigning the opinion
of Dr. Mattias no weight.

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For the reasons set forth herein, the Report and Recommendation is ADOPTED in
its ENTIRETY and this action is reversed and remanded for further consideration.
IT IS SO ORDERED this 19th day of June 2018.

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