Seventh Circuit Decision: Administrative Law Judge Must Properly Consider Treating Physician's Opinion

February 18, 2013

The Seventh Circuit issued its decision in Roddy v. Astrue on January 18, 2013. 2013 WL 197924 (7th Cir. 2013). In Roddy, the claimant appealed the Administrative Law Judge's denial of her Social Security Disability Insurance ("SSDI") claim. After the district court upheld the ALJ's decision, Ms. Roddy appealed to the Seventh Circuit. The Seventh Circuit held that the ALJ did not adequately explain why the treating physician's views should be set aside and that the ALJ wrongly based his credibility finding on 1) the claimant's failure to seek professional treatment for her back after 2006 and 2) her ability to perform household tasks.

Ms. Roddy suffers from severe lower back pain and was forced to stop working as a shift manager at Taco Bell. When she became unable to work, she applied for SSDI benefits, but her claim was denied both initially and at the ALJ hearing level. After her claim was denied by the ALJ, the Appeals Council declined review and the Southern District of Indiana affirmed the ALJ's denial. The Seventh Circuit, however, found numerous errors in the ALJ's decision and remanded her case back to the Social Security Administration.

Roddy's treatment for her lower back pain included treatment with a chiropractor, treatment with a pain management specialist, pain medication, nerveblock injections, and prolotherapy injections. An MRI revealed mild to moderate degeneration in one of the discs of her lower spine as well as a tear in the cartilage. Her pain management doctor recommended that she could work a maximum of six hours per day, five days a week. Her medical treatment decreased when she lost her health insurance in 2003 and could not afford prescriptions or further procedures.

When Ms. Roddy applied for SSDI benefits, the Disability Determination Service utilized an internist and two psychologists to evaluate her. The physician and psychologists determined that she had some limitations, but was not disabled. Roddy claimed that she could not lift more than 10 pounds, was limited in her ability to clean her house, had trouble using stairs, and had to lie down to rest and stretch her back. She did say that she was able to care for her dog and mow her lawn on a riding mower. At the hearing, a vocational examiner testified that Roddy could perform a wide range of sedentary jobs. The ALJ found that Roddy was not disabled because she could perform jobs that permit her to alternate sitting and standing on a regular basis.

Upon review, the Seventh Circuit found that the ALJ never mentioned her pain management specialist's conclusion that she could not handle a full-time job. Further, the ALJ omitted her pain management specialist's testimony from a personal injury lawsuit. In this testimony, her treating physician indicated that her "ability to work would continue to diminish where she could not remain in the workforce at all." Instead of accepting her treating physician's opinion, the ALJ credited the agency's physician's opinion that Roddy was capable of working. The Seventh Circuit called the ALJ's omission "serious" and stated that his opinion is lacking the accurate and logical bridge between the evidence and his conclusions.

A treating physician's medical opinion is entitled to controlling weight if it is well supported by objective medical evidence and consistent with other substantial evidence in the record. The ALJ was not required to give Roddy's treating physician's opinion controlling weight, but the ALJ was required to provide a sound explanation for his decision to reject it and accept the agency's physician's contrary opinion. The ALJ is to consider the treating physician's opinion with respect to the following factors: (1) whether the physician examined the claimant, (2) whether they treated a claimant frequently and for an extended period of time, (3) whether they are specialized in treating the claimant's condition, (4) whether they performed appropriate diagnostic tests on the claimant, and (5) whether they offered opinions that are consistent with objective medical evidence and the record as a whole. 20 C.F.R. ยง404.1527(c)(2)(i),(ii). The Seventh Circuit determined that when weighing these factors, the treating physician's opinion should have been given significant weight.

The Seventh Circuit also stated that the ALJ erred by basing his credibility finding on two additional points: her failure to seek professional treatment for her back after 2006, and her ability to perform household tasks. The court found that the ALJ unfairly drew inferences about the severity of her condition based on a failure to seek or pursue regular medical treatment. In this case, Roddy lost her health insurance and could not afford the costly procedures. The agency has expressly endorsed the inability to pay as an explanation that excuses a claimant's failure to seek treatment. SSR 96-7p. In fact, the agency requires that the ALJ inquire about a claimant's reasons for not seeking treatment.

Finally, the Seventh Circuit cautioned that a person's ability to perform daily activities does not necessarily translate into an ability to work full-time. Here, the ALJ cited to Roddy's daily activities in his denial of her claim. However, the ALJ ignored that she was unable to get through the day without lying down three to four times an hour. As a result of the ALJ's errors, the Seventh Circuit remanded this case back to the Social Security Administration.