Marshall v. Commissioner of Social Security, 3:16-cv-00190

Background

Plaintiff applied for DIB and SSI alleging disability beginning February 28, 2012, claiming fibromyalgia, chronic pain, anxiety, and depression.
After initial denial, Plaintiff testified at an ALJ hearing; the ALJ issued a decision on December 13, 2014 finding Plaintiff not disabled and adopted an RFC for a reduced range of medium work.
The Appeals Council denied review, and Plaintiff appealed to the district court.
Multiple mental-health evaluations exist: treating psychiatrist Ellen Ballerene, M.D. (monthly treatment beginning March 2013) and two examining psychologists (Mary Ann Jones, Ph.D.; Donald Kramer, Ph.D.) all reported marked or significant mental limitations.
Two non-examining record-review psychologists (Bruce Goldsmith, Ph.D.; Mel Zwissler, Ph.D.) concluded only moderate limitations and ability to perform limited routine tasks.
The ALJ gave significant weight to the record reviewers and to Dr. Kramer, but rejected Drs. Ballerene and Jones without adequately explaining inconsistencies; the district court found the ALJ’s weighing unsupported by substantial evidence and remanded.

Issues

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether the ALJ properly weighed mental health opinions	ALJ improperly discounted treating and examining opinions (Ballerene, Jones) that showed marked limitations	ALJ permissibly weighed opinions and reasonably relied on non‑examining reviewers and portions of Kramer’s opinion	Court: ALJ’s explanation is inadequate; weight given to non‑examining reviewers and rejection of treaters not supported by substantial evidence — remand required
Whether the ALJ’s RFC and Step 5 finding are supported by substantial evidence	RFC not supported because ALJ failed to reconcile and explain divergent medical opinions showing more severe mental limitations	Commissioner defends RFC as supported by the evidence relied upon by the ALJ	Court: substantial‑evidence review fails because ALJ did not adequately explain why she favored non‑examining reviewers over treating/examining clinicians; remand appropriate
Whether the treating‑physician rule was applied correctly	Treating psychiatrist’s opinion required controlling weight or a detailed §404.1527(c) analysis if not controlling	Commissioner contends ALJ permissibly discounted the treating opinion	Court: ALJ did not provide sufficient, specific reasons evaluating and reconciling the treating opinion under the proper factors — remand for reassessment
Whether immediate award of benefits is warranted	Plaintiff implicitly seeks benefits given consistent opinions of examiners and treater	Commissioner opposes, arguing further factfinding is necessary	Court: record does not overwhelmingly establish disability; remand for further proceedings under sentence four of 42 U.S.C. § 405(g)

Key Cases Cited

Casey v. Sec’y of Health & Human Servs., 987 F.2d 1230 (6th Cir. 1993) (Appeals Council denial makes ALJ decision final)
Bowen v. Comm’r of Soc. Sec., 478 F.3d 742 (6th Cir. 2007) (standard of review and legal error can warrant reversal)
Richardson v. Perales, 402 U.S. 389 (U.S. 1971) (definition of substantial evidence)
Buxton v. Halter, 246 F.3d 762 (6th Cir. 2001) (ALJ has a zone of choice when supported by substantial evidence)
Rabbers v. Comm’r of Soc. Sec., 582 F.3d 647 (6th Cir. 2009) (legal error can require reversal even if substantial evidence exists)
Blakley v. Comm’r of Soc. Sec., 581 F.3d 399 (6th Cir. 2009) (factors for evaluating treating source opinions)
Colvin v. Barnhart, 475 F.3d 727 (6th Cir. 2007) (five‑step sequential evaluation framework)
Melkonyan v. Sullivan, 501 U.S. 89 (U.S. 1991) (court’s authority under § 405(g) to remand or order benefits)