Kaplowitz v. Acting Commissioner of Social Security

Background

Greg Kaplowitz applied for Supplemental Security Income in 2014, alleging disability beginning November 27, 2013. An administrative law judge held a hearing and denied the application on January 19, 2017. The administrative law judge found that Kaplowitz had severe impairments consisting of psoriatic arthritis, sacroiliitis, and obesity. The judge determined that he had the residual functional capacity for light work with additional limitations and could perform his past work as a graphic designer and other jobs existing in significant numbers in the national economy.

After the Social Security Appeals Council denied review, Kaplowitz sought review in the district court. The parties filed cross-motions for summary judgment, which ask the court to decide the case based on the existing record without a trial.

Issue

The issue was whether the administrative law judge improperly gave more weight to the opinions of state consultants and a medical expert than to the opinions of Kaplowitz’s two treating rheumatologists, Drs. Wahl and Margaretten, and his primary care physician, Dr. Kimberg.

Analysis

The administrative law judge gave the treating physicians’ opinions little weight for two stated reasons: the opinions imposed substantially different limitations even though they were issued relatively close together, and the opinions were inconsistent with the physicians’ treatment records.

The court held that the first reason was insufficient. A conflict among medical opinions can affect the legal standard for rejecting a treating physician’s opinion, but the conflict alone does not provide substantial evidence for rejecting that opinion. The administrative law judge did not identify evidence showing why one physician’s opinion should receive more weight than the others or explain why the physicians’ limitations were “drastically different.” The court also noted that some opinions had similar findings, including limitations on lifting and carrying, and that the administrative law judge did not explain why those findings were rejected or why a bathroom-access limitation was omitted from the residual functional capacity assessment.

The court also found the second reason inadequately explained. The administrative law judge referred generally to treatment records that allegedly lacked swelling or joint tenderness, showed decreased inflammatory markers, and described the psoriatic arthritis as controlled. But the judge did not identify particular entries in the more than 275 pages of treating records that supported this conclusion. The Commissioner cited portions of the record in an effort to supply the missing explanation, but the court stated that the administrative law judge—not the Commissioner after the fact—must make those findings in the first instance. The court therefore concluded that neither stated reason was a specific and legitimate reason, supported by substantial evidence, for discounting the treating physicians’ opinions.

Disposition

The court concluded that the administrative law judge erred in evaluating the medical evidence. Because it was not clear that proper evaluation of the evidence would require finding Kaplowitz disabled, the court remanded for further proceedings rather than ordering an immediate award of benefits. On remand, the administrative law judge must properly evaluate the medical evidence under applicable law and the court’s guidance; the court stated that it did not intend to limit the scope of the remand.

The court GRANTED Kaplowitz’s motion for summary judgment, DENIED the Acting Commissioner’s cross-motion for summary judgment, and REMANDED the case for further proceedings.