Krista Miller v. Frank Bisignano

• Court: Court of Appeals for the Fourth Circuit
• Decided: May 15, 2025
• Docket: 24-1014
• Status: Unpublished

Opinion

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UNPUBLISHED

UNITED STATES COURT OF APPEALS FOR THE FOURTH CIRCUIT

No. 24-1014

KRISTA KAY MILLER,

Plaintiff - Appellant,

v.

FRANK BISIGNANO, Commissioner of Social Security,

Defendant - Appellee.

Appeal from the United States District Court for the District of Maryland, at Baltimore. J. Mark Coulson, Magistrate Judge. (1:21-cv-02474-MMJM)

Submitted: February 24, 2025 Decided: May 15, 2025

Before RUSHING and HEYTENS, Circuit Judges, and TRAXLER, Senior Circuit Judge.

Vacated and remanded by unpublished per curiam opinion.

ON BRIEF: Theodore A. Melanson, MIGNINI, RAAB, DEMUTH AND MURAHARI, LLP, Towson, Maryland, for Appellant. Brian C. O’Donnell, Associate General Counsel, David N. Mervis, Senior Attorney, Paul B. Waxler, Special Assistant United States Attorney, Office of the General Counsel, SOCIAL SECURITY ADMINISTRATION, Baltimore, Maryland; Erek L. Barron, United States Attorney, OFFICE OF THE UNITED STATES ATTORNEY, Baltimore, Maryland, for Appellee.

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PER CURIAM:

Krista Kay Miller appeals the magistrate judge’s order granting summary judgment

to the Commissioner of Social Security and upholding the Administrative Law Judge’s

(ALJ) denial of Miller’s applications for disability insurance benefits and supplemental

security income. Miller claimed entitlement to disability benefits on the basis of several

impairments, including depression, anxiety, and post-traumatic stress disorder. On appeal,

Miller argues that the ALJ erred by declining to accord controlling weight to her treating

psychiatrist’s opinion, or, alternatively, that the ALJ failed to consider all the relevant

factors in assessing how much weight to accord each of the physicians’ opinions in the

record.

“We review [a Social Security Administration] decision only to determine if it is

supported by substantial evidence and conforms to applicable and valid regulations.”

Patterson v. Comm’r of Soc. Sec. Admin., 846 F.3d 656, 658 (4th Cir. 2017). Accordingly,

“[w]e must uphold the ALJ’s decision if the ALJ applied correct legal standards and if the

factual findings are supported by substantial evidence.” Dowling v. Comm’r of Soc. Sec.

Admin., 986 F.3d 377, 382-83 (4th Cir. 2021) (internal quotation marks omitted). In this

context, “[s]ubstantial evidence is such relevant evidence as a reasonable mind might

accept as adequate to support a conclusion.” Shelley C. v. Comm’r of Soc. Sec. Admin., 61

F.4th 341, 353 (4th Cir. 2023) (internal quotation marks omitted). “Though the threshold

for such evidentiary sufficiency is not high, it requires that more than a mere scintilla of

evidence support the ALJ’s findings.” Dowling, 986 F.3d at 383 (internal quotation marks

omitted).

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“[W]e do not undertake to reweigh conflicting evidence, make credibility

determinations, or substitute our judgment for that of the ALJ” in evaluating whether a

decision is supported by substantial evidence; “[r]ather, where conflicting evidence allows

reasonable minds to differ as to whether a claimant is disabled, we defer to the ALJ’s

decision.” Shinaberry v. Saul, 952 F.3d 113, 123 (4th Cir. 2020) (cleaned up). “However,

we do not reflexively rubber-stamp an ALJ’s findings,” Dowling, 986 F.3d at 383 (internal

quotation marks omitted), and, to enable meaningful judicial review, “[t]he record should

include a discussion of which evidence the ALJ found credible and why, and specific

application of the pertinent legal requirements to the record evidence,” Radford v. Colvin,

734 F.3d 288, 295 (4th Cir. 2013). “In other words, the ALJ must both identify evidence

that supports his conclusion and build an accurate and logical bridge from that evidence to

his conclusion.” Woods v. Berryhill, 888 F.3d 686, 694 (4th Cir. 2018) (cleaned up),

superseded on other grounds as recognized in Rogers v. Kijakazi, 62 F.4th 872, 878-80

(4th Cir. 2023).

“When reviewing whether a claimant is disabled, the ALJ must evaluate every

medical opinion received against the record evidence” and “determine the level of weight

given to each medical opinion provided and received.” Shelley C., 61 F.4th at 353. For

claims, like Miller’s, that were filed before March 27, 2017, 1 an ALJ is normally required

to accord more weight to the medical opinion of a treating source than to that of a non-

1 The SSA has established a new regulatory framework for applications filed on or after March 27, 2017. See 20 C.F.R. §§ 404.1520c, 416.920c (2023).

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treating source when evaluating conflicting medical opinion evidence. 20 C.F.R.

§§ 404.1527(c)(2), 416.927(c)(2) (2023). “Accordingly, the treating physician rule

requires that ALJs give controlling weight to a treating physician’s opinion . . . if that

opinion is (1) well-supported by medically acceptable clinical and laboratory diagnostic

techniques and (2) not inconsistent with the other substantial evidence in the record.”

Arakas v. Comm’r, Soc. Sec. Admin., 983 F.3d 83, 106 (4th Cir. 2020) (internal quotation

marks omitted). The ALJ must “provide a narrative discussion of how the evidence

supported his conclusion,” including by “identify[ing] which medical evidence” is

inconsistent with the relevant physician’s opinion. Shelley C., 61 F.4th at 354 (internal

quotation marks omitted). “[W]here an ALJ fails to specify which specific objective

evidence supports his conclusion, that analysis is incomplete and precludes meaningful

review.” Id. at 358 (internal quotation marks omitted).

When the ALJ does not give controlling weight to a treating source’s opinion, he

must consider a nonexclusive list of factors to determine the weight to give all the medical

opinions in the record: (1) examining relationship; (2) treatment relationship;

(3) supportability of the physician’s opinion; (4) consistency of the opinion with the record;

(5) specialization of the physician; and (6) any other relevant factors. 20 C.F.R.

§§ 404.1527(c)(1)-(6), 416.927(c)(1)-(6) (2023); Shelley C., 61 F.4th at 354. The ALJ is

not required to discuss each factor in his decision. See Dowling, 986 F.3d at 385. However,

“it must nonetheless be apparent from the ALJ’s decision that he meaningfully considered

each of the factors before deciding how much weight to give the opinion.” Id. (emphasis

omitted). “Mere acknowledgement of the regulation’s existence is insufficient and falls

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short of the ALJ’s duties.” Shelley C., 61 F.4th at 354. Rather, the “ALJ should give

adequate attention to each . . . factor,” id. at 355, and “must include a narrative discussion

describing how the evidence supports his explanation of the varying degrees of weight he

gave to differing opinions concerning the claimant’s conditions and limitations,” Woods,

888 F.3d at 695 (cleaned up); see also 20 C.F.R. §§ 404.1527(c)(2), 416.927(c)(2).

“[I]n many cases, a treating physician’s medical opinion will be entitled to the

greatest weight and should be adopted, even if it does not meet the test for controlling

weight.” Arakas, 983 F.3d at 106-07 (alterations, emphases, and internal quotation marks

omitted). However, “if a physician’s opinion is . . . inconsistent with other substantial

evidence, it should be accorded significantly less weight.” Mastro v. Apfel, 270 F.3d 171,

178 (4th Cir. 2001) (internal quotation marks omitted); see 20 C.F.R. §§ 404.1527(c)(4),

416.927(c)(4).

We conclude that the ALJ failed to conform to applicable and valid regulations

when assessing how much weight to accord the opinion of Miller’s psychiatrist, Dr.

Rajendra Lowtan. First, the ALJ erroneously denied Lowtan’s 2017 opinion controlling

weight because it was based on Miller’s subjective reports. True, a treating physician’s

opinion must be “well-supported by medically acceptable clinical and laboratory

diagnostic techniques” to receive controlling weight. Arakas, 983 F.3d at 106. But as this

Court has pointed out, “depression is incredibly subjective to each individual, with signs

and symptoms experienced through intrusive feelings and thoughts, low and isolated

moods, and even body aches and pains.” Shelley C., 61 F.4th at 357. “[N]o laboratory test

has yielded results of sufficient sensitivity and specificity to be used as a diagnostic tool

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for [depression]”; rather, symptoms of depression are “entirely subjective, determined on

a case-by-case basis.” Id. at 361 (emphasis in original). In such cases, a physician’s use

of subjective complaints “hardly undermines his opinion as to [the patient’s] functional

limitations, as a patient’s report of complaints, or history, is an essential diagnostic tool.”

Easterbrook v. Kijakazi, 88 F.4th 502, 514 (4th Cir. 2023) (cleaned up). And indeed,

“subjective statements from claimants should be treated as evidence substantiating the

claimant’s impairment.” Shelley C., 61 F.4th at 362 (internal quotation marks omitted).

Therefore, the ALJ’s decision to discount Lowtan’s opinion because it was based on

Miller’s subjective reports was erroneous.

Second, the ALJ erred in finding that Lowtan’s 2017 opinion was not entitled to

controlling weight because it was inconsistent with other evidence in the record. Lowtan

opined that Miller would struggle to concentrate, interact with coworkers appropriately,

and attend work regularly. The ALJ made two findings that he deemed inconsistent with

that opinion: (1) Miller’s mental status examinations were unremarkable; and (2) her

treatment was conservative. However, the ALJ did not adequately explain how Lowtan’s

findings were inconsistent with the record, which also included evidence regarding Miller’s

major depressive disorder and other diagnoses, the numerous medications prescribed to

Miller, and the many years she underwent treatment.

Because Lowtan’s opinion was based on acceptable diagnostic tools and consistent

with the record, the ALJ’s refusal to grant that opinion controlling weight fails to comply

with the treating physician rule, codified in 20 C.F.R. § 404.1527(c)(2).

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Moreover, even if the ALJ had adequately explained his decision not to accord

Lowtan’s 2017 opinion controlling weight, he did not sufficiently address each of the 20

C.F.R. § 404.1527(c) factors in explaining why he accorded the opinion only “little

weight.” JA 1087. The ALJ acknowledged that Lowtan was Miller’s psychiatrist and, thus,

was an examining source who had an established treating relationship with Miller. See 20

C.F.R. §§ 404.1527(c)(1), (2)(ii), 416.927(c)(1), (2)(ii). The ALJ also clearly considered

whether Lowtan’s opinion was supported by his treatment notes and consistent with the

rest of the record. 20 C.F.R. §§ 404.1527(c)(3)-(4), 416.927(c)(3)-(4). The ALJ also

appears to have considered Lowtan’s specialty in psychiatry. 20 C.F.R. §§ 404.1527(c)(5),

416.927(c)(5). It is not apparent, however, that the ALJ considered the extent of Lowtan’s

treating relationship with Miller. See 20 C.F.R. §§ 404.1527(c)(2)(i), 416.927(c)(2)(i).

Although the record shows that Lowtan had been treating Miller’s mental conditions

since before her alleged onset date, the ALJ did not acknowledge that fact. The earliest of

Miller’s appointments with Lowtan that the ALJ discussed was from March 2017, even

though the record shows Miller had been seeing Lowtan since 2012. Although the ALJ is

not required to discuss each piece of evidence or each factor in his decision, the failure to

acknowledge at least five years of a treatment relationship makes it difficult to conclude

that the ALJ adequately considered the length of this treatment relationship. Moreover,

although the ALJ generally stated that he considered opinion evidence in accordance with

the regulatory requirements, this Court has held that such “[m]ere acknowledgement of the

regulation’s existence is insufficient and falls short of the ALJ’s duties,” Shelley C., 61

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F.4th at 354. Thus, the ALJ’s decision not to accord any significant weight to Lowtan’s

opinion contravenes the applicable legal standards.

We therefore vacate the district court’s order and remand the case with instructions

to remand for further administrative proceedings consistent with this opinion. 2 We

dispense with oral argument because the facts and legal contentions are adequately

presented in the materials before this court and argument would not aid the decisional

process.

VACATED AND REMANDED

2 By this decision, we express no opinion on the ultimate outcome of Miller’s applications for benefits. And although we need not reach the question of whether the ALJ adequately explained his decision in relation to the other opinion evidence in the record, we note that if the ALJ on remand should decline to accord Lowtan’s opinions controlling weight, then the ALJ must consider each of the relevant factors when deciding how much non-controlling weight to accord each opinion in the record.