Administrative – Social Security Disability – Treating Physician – Weight

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The administrative law judge cited specific examples to explain why the 2018 opinion of treating physician Dr. Paul Weaver was not entitled to controlling weight: (1) Weaver’s treatment records “reflect no significantly adverse mental health findings” and (2) Weaver noted in April 2018 that plaintiff was riding a bicycle for exercise. However, the ALJ did not adequately explain why the lack of substantial mental status findings in Weaver’s treatment notes was inconsistent with his 2018 opinion, which focused largely on plaintiff’s physical limitations. Moreover, the ALJ similarly did not explain why Weaver’s note that plaintiff had ridden a bicycle for exercise because she tolerated that better than walking was inconsistent with his opinion that she could not stand or walk, and instead would need to sit, for most of the workday. The ALJ abused her discretion when assessing how much weight to accord Weaver’s opinion.

We vacate the district court order, which upheld the ALJ’s denial of plaintiff’s applications for disability insurance benefits and supplemental security income. We remand for further administrative proceedings.

The ALJ must specify which specific objective evidence supports her conclusion to enable meaningful judicial review. Thus, neither the ALJ’s general discussion of the evidence in the record nor her blanket assertion that Weaver’s opinion was unsubstantiated by his clinical findings and inconsistent with the additional evidence in plaintiff’s case file provides an adequate explanation of her findings on this issue. Moreover, even if the ALJ had adequately explained her finding that Weaver’s 2018 opinion was not entitled to controlling weight, she did not sufficiently explain her assessment of how much non-controlling weight to accord that opinion.

It is also not apparent that the ALJ considered that Weaver was a specialist in internal medicine or, most significantly, that she considered the extent of his treating relationship with plaintiff. Although the ALJ is not required to discuss each piece of evidence or each factor in her decision, the failure to acknowledge at least eight months of treatment records makes it difficult to conclude that the ALJ adequately considered the length of this treatment relationship. Thus, the ALJ’s decision not to accord significant weight to Weaver’s 2018 opinion is not in accordance with the applicable legal standards.

Vacated and remanded.

Dissent

(Traxler, J.) The ALJ adequately explained why she declined to give controlling weight to Weaver’s opinion. Her decision denying benefits is supported by substantial evidence, so I would affirm.

Siders v. Commissioner of Social Security Administration (Lawyers Weekly No. 003-028-23, 9 pp.) (Per Curiam) (William Traxler, S.J., dissenting) No. 21-2329. Appealed from USDC at Orangeburg, S.C. (David Norton, J.) Dana Duncan for appellant; Brian O’Donnell, Thomas Moshang, Jordana Cooper, Corey Ellis and Marshall Prince for appellee. United States Court of Appeals for the Fourth Circuit (unpublished)