United States District Court, S.D. Indiana, Indianapolis Division
ORDER ON PLAINTIFF'S BRIEF IN SUPPORT OF
BAKER UNITED STATES MAGISTRATE JUDGE
appeals the Social Security Administration's denial of
his application for disability benefits. Plaintiff claims
that he is disabled because he suffers from a learning
disorder, obesity, right eye blindness, and a skin condition
called Darier disease. Plaintiff raises several issues on
appeal including whether the Administrative Law Judge erred
in rejecting the opinion of Dr. Avashia-Khemka,
Plaintiff's treating dermatologist. The Court agrees the
ALJ erred by giving Dr. Avashia-Khemka's opinion little
weight despite its supportability and consistency with the
record. Therefore, the Court grants Plaintiff's request
for remand. [Filing No. 11.].
filed an application for supplemental security income and for
child's insurance benefits on March 30, 2015. The agency
denied the claims initially and upon review. After a hearing,
the ALJ determined that Plaintiff was not disabled.
considered Plaintiff's claim for child's insurance
benefits according to 20 C.F.R. § 416.924. At step one,
the ALJ determined that Plaintiff had not engaged in
substantial gainful activity. At step two, the ALJ determined
that Plaintiff had the following severe impairments: learning
disorder, obesity, right eye blindness, and Darier disease.
At step three, the ALJ determined that Plaintiff did not have
an impairment or combination of impairments that met or
medically equaled any of the listed impairments in 20 C.F.R
404, Subpart P, Appendix 1. Nor did Plaintiff have an
impairment or combination of impairments that functionally
equaled the listings. Therefore, the ALJ determined that
Plaintiff was not disabled before turning 18.
then considered Plaintiff's adult claims for supplemental
security income according to 20 C.F.R. § 404.1520(a). At
step one, the ALJ determined that Plaintiff had not engaged
in substantial gainful activity. At step two, the ALJ
determined that Plaintiff had not developed any new
impairments since turning 18, and that Plaintiff continued to
have at least one severe impairment. At step three, the ALJ
determined that Plaintiff did not have an impairment or
combination of impairments that met or medically equaled any
of the listings. Step four is not relevant to Plaintiff's
case because Plaintiff did not have any past relevant work
experience. The ALJ next determined that Plaintiff had the
residual functional capacity to perform medium work but was
limited to simple instructions and routine changes. The ALJ
determined that Plaintiff should only occasionally interact
with supervisors and coworkers and should not have to
interact with the public or work around food, personal health
care, or hazards. At step five, the ALJ determined that jobs
existed in the national economy that Plaintiff could have
performed since he turned 18. Therefore, the ALJ determined
that Plaintiff was not disabled from the time he turned 18.
argues that the ALJ failed to afford Dr. Avashia-Khemka due
consideration as a treating physician and a dermatology
specialist. Dr. Avashia-Khemka opined that Plaintiff was
limited to sedentary work and would miss work three to four
days per month. Defendant counters that the ALJ rightly
assigned little weight to Dr. Avashia-Khemka's opinion
because the opinion was inconsistent with Plaintiff's
normal consultative exam and record medical evidence showing
that Plaintiff's Darier disease improved with proper
treatment. [Filing No. 17, at ECF p. 30.]
physician is considered a “treating” physician if
he or she is the plaintiff's “own acceptable
medical source” and the physician has provided medical
treatment sufficient to form an “ongoing treatment
relationship” with the plaintiff. 20 C.F.R. §
404.1527(a)(2). Generally, treating physician opinions are
given greater weight because they “may bring a unique
perspective to the medical evidence that cannot be obtained
from the objective medical findings alone or from individual
examinations” by non-treating physicians. §
404.1527(c)(2). Additionally, the ALJ “generally gives
more weight to the medical opinion of a specialist about
medical issues related to his or her area of
specialty.” § 404.1527(c)(5).
opinion of a treating source is entitled to controlling
weight if it is “well-supported by medically acceptable
clinical and laboratory diagnostic techniques and is not
inconsistent with the other substantial evidence in [the]
case record.” § 404.1527(c)(2). The ALJ must
provide “good reasons” for the weight the ALJ
gives to a treating source's medical opinion. §
404.1527. It is not enough for the ALJ to merely assert that
a treating physician's opinion is internally inconsistent
or inconsistent with other medical opinions. The ALJ must at
least minimally articulate his or her reasons for concluding
that there is inconsistency. Clifford v. Apfel, 227
F.3d 863, 871 (7th Cir. 2000) (remanding for the ALJ to
reconsider whether the treating physician's findings of
disabling symptoms were entitled to controlling weight when
the ALJ did not adequately explain why those findings were
inconsistent with other record medical evidence); Gudgel
v. Barnhart, 345 F.3d 467, 470 (7th Cir. 2003)
(remanding when the ALJ did not explain how the evidence in
the record contradicted the treating physician's
diagnosis). Although this Court's review is deferential,
it “cannot uphold an administrative decision that fails
to mention highly pertinent evidence.” Parker v.
Astrue, 597 F.3d 920, 921 (7th Cir. 2010).
acknowledged that Dr. Avashia-Khemka was a treating source,
and Defendant argues that the ALJ rightly found that the
opinion lacked supportability and consistency with other
medical evidence. However, the cited evidence does not show
contradictions. As explained below, the ALJ pointed to one
physician who reached a different conclusion than Dr.
Avashia-Khemka, but the physicians' discussions show
consistent findings. In such cases, the treating physician
rule demands deference to the treating physician's
conclusions. Oakes v. Astrue, 258 Fed.Appx. 38,
43-44 (7th Cir. 2007) (remanding for deference to treating
physician when physicians disagreed about whether the
plaintiff could perform fulltime work).
cited Plaintiff's consultative physical exam with Dr.
John Heflin as record medical evidence that was inconsistent
with Dr. Avashia-Khemka's findings. Although Dr. Heflin
did conclude that Plaintiff's skin condition did not
appear to cause any functional limitations, [Filing No.
9-8, at ECF p. 52] Dr. Heflin also opined that,
Plaintiff, “has a skin condition that causes his back,
chest and face to break out with large dry scaly patches.
When his skin condition flares up, his skin becomes very dry
and itchy. He uses prescription creams that provide little
relief.” [Filing No. 9-8, at ECF p. 50.] This
description matches Dr. Avashia-Khemka's description of
Plaintiff's condition. [Filing No. 9-8, at ECF p.
also cited the Plaintiff's treatment record at Forefront
Dermatology as being inconsistent with the opinion of Dr.
Avashia-Khemka. However, the description of Plaintiff's
condition by Forefront Dermatology is very similar to Dr.
Avashia-Khekma's description. Both sources agree that
Plaintiff suffers from Darier disease, and describe the
location and symptoms similarly. [Compare Filing No. 9-9,
at ECF pp. 20, 23, 28, 33,
38, 48 (Forefront Dermatology),
withFiling No. 9-8, at ECF pp. 76, 79,
83, 86 (Dr. Avashia-Khemka).] Dr.
Avashia-Khemka describes Plaintiff's symptoms as chronic.
[Filing No. 9-8, at ECF p. 55.] Although Forefront
describes the condition as mild on most occasions, Forefront
also states that Plaintiff's symptoms ...