Summary
holding that "conservative treatment with only medical management" constitutes substantial evidence to support an ALJ's decision to give less weight to one medical source than another
Summary of this case from Scott v. SaulOpinion
No. 15-1871
04-28-2016
WILLIAM PATRICK MCNELLEY, Plaintiff, Appellant, v. CAROLYN W. COLVIN, Acting Commissioner of Social Security, Defendant , Appellee.
Before Howard, Chief Judge, Torruella and Lynch, Circuit Judges.
JUDGMENT
Claimant William McNelley appeals from a decision of the district court upholding the Commissioner's denial of his claim for Social Security disability and Supplement Security Income benefits. After carefully reviewing the briefs and record on appeal, we affirm.
1. Weight of medical opinions.
On appeal, McNelley argues the Administrative Law Judge (ALJ) gave too little weight to Dr. Dedesma's medical opinions - as expressed in her December 10, 2012 letter, September 23, 2013 psychiatric impairment questionnaire, and November 25, 2013 report - and too much weight to Dr. Kasdan's November 5, 2012 mental residual functional capacity assessment ("MRFC"). We disagree.
As an initial matter, Dr. Dedesma's medical opinions did not deserve controlling weight. Generally, a treating source's opinion on the nature or severity of impairments is given controlling weight if well-supported by medically acceptable clinical techniques and consistent with other substantial evidence in the record. See 20 C.F.R. § 404.1527(c)(2). Here, Dr. Dedesma's medical opinions conflicted with Dr. Kasdan's MRFC.
The ALJ properly gave Dr. Dedesma's opinions little weight and gave "good reasons" for doing so. The ALJ reasoned that Dr. Dedesma's medical opinions were not well-supported by the medical evidence and inconsistent with substantial evidence in the record showing that McNelley's treatment consisted solely of medication management. There is substantial evidence supporting this finding. Dr. Dedesma's progress notes documented that McNelley discontinued psychotherapy in October 2012 and repeatedly refused to resume that treatment, even if referred to a different therapist. Consequently, Dr. Dedesma was treating McNelley solely with medication management. These are proper reasons for discounting a treating physician's medical opinions. See 20 C.F.R. § 404.1527(c)(2)(ii) (nature and extent of treatment relationship); Irlanda Ortiz v. Sec'y of Health & Human Servs., 955 F.2d 765, 770 (1st Cir. 1991) (per curiam) (regarding failure to follow prescribed treatment); Perkins v. Astrue, 648 F.3d 892, 898-99 (8th Cir. 2011) (regarding conservative treatment).
The ALJ also found Dr. Dedesma's medical opinions inconsistent with her assessment of his GAF scores, "which repeatedly indicate that the claimant has only mild-to-moderate symptoms." McNelley is correct that this is a mischaracterization of his GAF score history. But this error is harmless. In August 2013, Dr. Dedesma rated McNelley's GAF at a 55 to 60, placing him in the moderately impaired range. Her September 2013 psychiatric impairment questionnaire, however, inexplicably downgraded the GAF assessment to 50 even though the record reflects no intervening office visits. This unexplained inconsistency is a sufficiently compelling reason for discounting the weight of Dr. Dedesma's opinions, and the ALJ's mischaracterization of the GAF score history is, therefore, harmless. See Perez Torres v. Sec'y of Health & Human Servs., 890 F.2d 1251, 1255 (1st Cir. 1989) (per curiam) (finding ALJ's misreading of record harmless after review of entire record).
We need not discuss the ALJ's third reason for discounting Dr. Dedesma's medical opinions on the basis of inconsistency - McNelley's positive response to treatment - where his other two reasons find substantial support in the record as a whole.
The ALJ also did not err by failing to expressly address each of the factors provided in § 404.1527(c)(2) in discussing Dr. Dedesma's medical opinions. McNelley cites no authority stating that the ALJ was required to do so. The ALJ's decision makes clear that he considered the factors, including the insupportability of Dr. Dedesma's medical opinions and the inconsistency of these opinions with the record as a whole. He was not required to expressly mention each factor. See Morales v. Comm'r of Soc. Sec., 2 F.App'x 34, 36 (1st Cir. 2001) (per curiam) (explaining that ALJ properly declined to give treating physician's opinions controlling weight due to insupportability and inconsistency with rest of record evidence, without mentioning other factors).
Turning next to Dr. Kasdan's MRFC, McNelley argues that the ALJ improperly gave this opinion substantial weight because, inter alia, the doctor reviewed treatment records only through October 2012. We see no appreciable changes in McNelley's symptoms or functional limitations in the evidence post-dating Dr. Kasdan's report, however. Cf. Alcantara v. Astrue, 257 F.App'x 333, 335 (1st Cir. 2007) (unpublished per curiam) (holding it was error to give significant weight to opinion of non-examining reviewing consultant who reviewed only part of medical evidence because evidence not reviewed showed deterioration in claimant's condition.) We do, however, agree that some of the ALJ's reasons for giving Dr. Karsdan's MRFC assessment substantial weight - activities of daily living and positive response to treatment - are less than compelling. But even if we put aside these reasons, there remains substantial evidence - McNelley's conservative treatment with only medical management - to support the ALJ's decision to give Dr. Kasdan's MRFC more weight than Dr. Dedesma's medical opinions.
2. Credibility.
"The credibility determination by the ALJ, who observed the claimant, evaluated his demeanor, and considered how that testimony fit in with the rest of the evidence, is entitled to deference, especially when supported by specific findings." Frustaglia v. Sec'y of Health & Human Servs., 829 F.2d 192, 195 (1st Cir. 1987) (per curiam) (citation omitted). We defer to the ALJ's credibility finding in this case because it is substantially supported by medical evidence showing that McNelley was indeed being treated conservatively with only medication management and that he discontinued psychotherapy treatment. The extremely limited description of his functional abilities he described at the hearing are not consistent with statements he made to Dr. Dedesma about getting out, riding his bike, and the like. See Baez Velez v. Sec'y of Health & Human Servs., 993 F.2d 1530, *6 (1st Cir. 1993) (unpublished per curiam) (upholding ALJ's credibility finding based, inter alia, on evidence of claimant's conservative treatment and medical records showing activities of daily living that conflicted with claimant's hearing testimony).
McNelley next argues that the ALJ erred in finding him "not credible because he did not seek treatment until April 2012 despite statements of a long history of mental illness, and because he stopped attending therapy against the advice of his psychiatrist." An ALJ may properly consider duration, frequency, and intensity of symptoms; treatment received for relief of symptoms; and measures used to relieve symptoms in assessing credibility. See 20 C.F.R. § 404.1529(c)(3); Hurter v. Astrue, 465 F.App'x 648, 650 (9th Cir. 2012) (unpublished memorandum).
As for McNelley's refusal to continue psychotherapy, he faults the ALJ for allegedly failing to consider his reasons for doing so. It appears, though, that the ALJ did consider McNelley's explanations. His summary of McNelley's hearing testimony mentions this evidence. Just because the ALJ did not reiterate the evidence when discussing McNelley's credibility does not necessarily mean that the ALJ failed to consider it.
McNelley further claims that his discontinuance of therapy was due to his mental impairments. While it is true that Dr. Dedesma variously assessed McNelley's judgment and insight as fair to poor, she does not attribute McNelley's decision to stop going to therapy with his mental impairments. Cf. Pate-Fires v. Astrue, 564 F.3d 935, 946 (8th Cir. 2009) (per curiam) (noting records associating discontinuance of medications with poor judgment). McNelley's discomfort with exposure therapy may reasonably be attributable to his mental impairments, but blaming McEntee for the denial of disability benefits or reluctance to speak freely with McEntee out of concern of getting into trouble would seem far removed from panic attacks and agoraphobia.
McNelley's remaining arguments are without merit: the ALJ explained what medical evidence he found contradictory to McNelley's hearing testimony, did not base his negative credibility finding on medical evidence alone, and considered the factors set forth in 20 C.F.R. § 404.1529(c).
The judgment of the district court is affirmed. See 1st Cir. R. 27.0(c).
By the Court:
/s/ Margaret Carter, Clerk cc:
Stephen L. Raymond
Daniel S. Jones
Susan M. Poswistilo
Dina Michael Chaitowitz
Thomas D. Ramsey