Clark v. SSA, Commissioner of
2:16-cv-12167
E.D. Mich.Aug 17, 2017Background
- Plaintiff (filed 2016) sought review of ALJ denial of Title II and XVI benefits for alleged disability beginning Sept 1, 2012; ALJ denied benefits in a March 12, 2015 decision; Appeals Council denied review.
- ALJ found severe impairments including lumbar degenerative disc disease, right shoulder and knee degenerative joint disease, diabetes, chronic anemia, obesity, anxiety and affective disorder, and assessed a limited light-work RFC with various postural, manipulative, and simple-work/low-stress limitations.
- At step three the ALJ concluded plaintiff’s impairments neither met nor medically equaled a Listing, but the administrative record contained no medical advisor opinion addressing equivalence for the physical impairments; the DDT form lacked a medical advisor signature for physical issues.
- Plaintiff argued (inter alia) ALJ erred by: (1) failing to obtain a medical-expert opinion on Listing equivalence; (2) lacking a function-by-function RFC supported by a medical opinion; (3) improperly discounting her treating therapist’s opinion; and (4) failing to obtain updated medical review after new evidence.
- Commissioner defended the decision, arguing the ALJ need not obtain an updated medical opinion absent evidence suggesting equivalence, that substantial evidence supports the RFC, and that the ALJ permissibly weighed the state agency psychologist and discounted the therapist’s opinion because she was not an "acceptable medical source."
- Magistrate Judge recommended remand: failure to obtain any medical advisor opinion on equivalence at step three (especially given multiple severe impairments) was reversible error and required an expert opinion and re-assessment of RFC.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether ALJ erred by failing to obtain a medical-expert opinion on whether impairments medically equal a Listing at Step 3 | Clark: ALJ must obtain medical expert on equivalence; record lacks any such opinion for physical impairments | Comm’r: No duty to obtain updated opinion absent evidence suggesting equivalence; plaintiff bears burden to prove equivalence | Remand required: absence of any medical-advisor opinion on equivalence was error; obtain qualified medical advisor and reassess RFC |
| Whether RFC is unsupported because there was no non-examining physician physical RFC opinion | Clark: RFC lacks support from a medical source and ALJ failed to do function-by-function assessment per SSR 96-8p | Comm’r: ALJ may formulate RFC based on the record; not obliged to rely on a medical opinion; substantial evidence supports RFC | Court did not decide RFC issue on merits because remand for step-three medical opinion necessitates full RFC re-evaluation |
| Weight given to treating mental health therapist’s opinion | Clark: ALJ improperly discounted therapist’s opinion contrary to agency guidance | Comm’r: Therapist is not an acceptable medical source; opinions inconsistent with other treatment records justified discount | Court declined to resolve because remand on equivalence requires reassessment of medical opinions and weightings |
| Whether ALJ should have obtained updated medical review after additional evidence | Clark: ALJ should have obtained updated review when new records were added after state consultant’s review | Comm’r: Only required if new evidence might change the state consultant’s finding of non-equivalence | Court: Because no initial medical-equivalence opinion existed, remand is required to obtain a medical advisor and re-evaluate equivalence and RFC |
Key Cases Cited
- Sullivan v. Zebley, 493 U.S. 521 (U.S. 1990) (burden and framework for Listing equivalence at step three)
- Bowen v. Yuckert, 482 U.S. 137 (U.S. 1987) (overview of administrative-review scheme)
- Mullen v. Bowen, 800 F.2d 535 (6th Cir. 1986) (scope of judicial review of SSA decisions)
- Rogers v. Commissioner of Social Security, 486 F.3d 234 (6th Cir. 2007) (ALJ credibility determinations and standard of review)
- Rabbers v. Commissioner of Social Security, 582 F.3d 647 (6th Cir. 2009) (caution on harmless-error review of step-three findings)
- Barnett v. Barnhart, 381 F.3d 664 (7th Cir. 2004) (medical-expert opinion required for Listing equivalence)
- McClanahan v. Commissioner of Social Security, 474 F.3d 830 (6th Cir. 2006) (substantial-evidence standard)