Another Treating Physician Rule Victory

Empire Justice Center April 30, 2019

In a recent decision from the U.S. District Court for the S.D.N.Y., Magistrate Judge Robert Lehrburger ordered a remand, finding the ALJ erred in giving a treating physician’s opinion less weight than the opinion of a consultative examiner.  Reid v. Berryhill, 2019 WL 1284275 (S.D.N.Y. Mar. 20, 2019).


The Court found that throughout the opinion below, the ALJ was conclusory and failed to identify evidence that would allow him to get around the treating physician rule.  The ALJ gave five reasons why he did not follow the treating physician rule, none of which the court found convincing.


First, the ALJ believed the plaintiff’s pain and fatigue related to her diagnosis of lupus was only mild to moderate, a finding that was not accurate.  There was nothing in the record to reflect that this was the opinion held by the treating physician at the onset of the alleged disability.  The ALJ improperly substituted his own layperson opinion for the opinion of a medical professional.


Second, there were no current lab reports, which the ALJ claimed undermined the plaintiff’s claims.  The Court found there was no reason to assume testing would need to be done again, and it again faulted the ALJ for submitting his own opinion instead of that of a medical professional.


Third, because the treating physician did not address cardiac problems that were in the record, his opinion should not be controlling, according to the ALJ.  The Court did not find the ALJ’s reasoning compelling. Since the treating doctor was a rheumatologist who worked with joint diseases, it would be illogical for him to discuss the cardiac issues.


Next, the ALJ attempted to characterize the treating doctor’s and the consultative examiner’s opinions as conflicting.  However, neither the consultative examiner nor the ALJ cited to specific facts in evidence that would make the treating physician’s opinion  invalid.


Finally, the ALJ claimed that because the treating physician found both a disability and only minor issues with walking and standing, both opinions were inherently impossible.  The Court found this reasoning not compelling, since the disability diagnosis provided by the treating physician did not hinge on either walking or standing.


Congratulations to Michelle Spadafore of NYLAG for her advocacy in this case, resulting in a most excellent outcome.  Thanks to Albany Law student Alexandrea Nuwer for her summary of this decision.