[PUBLISH]
IN THE UNITED STATES COURT OF APPEALS
FOR THE ELEVENTH CIRCUIT ________________________ FILED U.S. COURT OF APPEALS No. 10-10620 ELEVENTH CIRCUIT ________________________ JAN 24, 2011 JOHN LEY CLERK D.C. Docket No. 6:08-cv-01750-DAB
MICHAEL JOHN WINSCHEL,
lllllllllllllllllllll Plaintiff - Appellant,
versus
COMMISSIONER OF SOCIAL SECURITY, SOCIAL SECURITY ADMINISTRATION,
llllllllllllllllllll Defendants - Appellees.
________________________
Appeal from the United States District Court for the Middle District of Florida ________________________
(January 24, 2011)
Before WILSON, PRYOR and ANDERSON, Circuit Judges.
WILSON, Circuit Judge:
Michael Winschel appeals the district court’s order affirming the
Administrative Law Judge’s (“ALJ”) denial of his application for disability insurance benefits and supplemental security income, pursuant to 42 U.S.C. §§
405(g) and 1383(c)(3), respectively. First, Winschel asserts that the ALJ erred by
failing to consider and to specify the weight he accorded to the medical opinions
of a treating physician and an examining physician. Second, Winschel contends
that the ALJ erred by posing an incomplete hypothetical question to the vocational
expert and then by relying on the vocational expert’s response to conclude that
there were significant numbers of jobs in the national economy that Winschel
could perform. Winschel argues that these errors demonstrate that the ALJ’s
denial of benefits was not based on proper legal standards and was not supported
by substantial evidence. We agree, and for the following reasons, we reverse and
remand.
In Social Security appeals, we must determine whether the Commissioner’s
decision is “‘supported by substantial evidence and based on proper legal
standards. Substantial evidence is more than a scintilla and is such relevant
evidence as a reasonable person would accept as adequate to support a
conclusion.’” Crawford v. Comm’r of Soc. Sec., 363 F.3d 1155, 1158 (11th Cir.
2004) (per curiam) (internal citation omitted) (quoting Lewis v. Callahan, 125
F.3d 1436, 1439 (11th Cir. 1997)). “We may not decide the facts anew, reweigh
the evidence, or substitute our judgment for that of the [Commissioner].” Phillips
2 v. Barnhart, 357 F.3d 1232, 1240 n.8 (11th Cir. 2004) (alteration in original)
(quoting Bloodsworth v. Heckler, 703 F.2d 1233, 1239 (11th Cir. 1983)).
The Social Security Regulations outline a five-step, sequential evaluation
process used to determine whether a claimant is disabled: (1) whether the claimant
is currently engaged in substantial gainful activity; (2) whether the claimant has a
severe impairment or combination of impairments; (3) whether the impairment
meets or equals the severity of the specified impairments in the Listing of
Impairments; (4) based on a residual functional capacity (“RFC”) assessment,
whether the claimant can perform any of his or her past relevant work despite the
impairment; and (5) whether there are significant numbers of jobs in the national
economy that the claimant can perform given the claimant’s RFC, age, education,
and work experience. See Phillips, 357 F.3d at 1237–39; 20 C.F.R. §§
404.1520(a)(4)(i)–(v), 416.920(a)(4)(i)–(v).
I.
Winschel first argues that the ALJ’s treatment of medical opinions at the
fourth and fifth steps of the sequential evaluation process constitutes reversible
error. “Medical opinions are statements from physicians and psychologists or
other acceptable medical sources that reflect judgments about the nature and
severity of [the claimant’s] impairment(s), including [the claimant’s] symptoms,
3 diagnosis and prognosis, what [the claimant] can still do despite impairment(s),
and [the claimant’s] physical or mental restrictions.” 20 C.F.R. §§ 404.1527(a)(2),
416.927(a)(2). Absent “good cause,” an ALJ is to give the medical opinions of
treating physicians “substantial or considerable weight.” Lewis, 125 F.3d at 1440;
see also 20 C.F.R. §§ 404.1527(d)(1)–(2), 416.927(d)(1)–(2). Good cause exists
“when the: (1) treating physician’s opinion was not bolstered by the evidence; (2)
evidence supported a contrary finding; or (3) treating physician’s opinion was
conclusory or inconsistent with the doctor’s own medical records.” Phillips, 357
F.3d at 1241. With good cause, an ALJ may disregard a treating physician’s
opinion, but he “must clearly articulate [the] reasons” for doing so. Id. at
1240–41.
Moreover, the ALJ must state with particularity the weight given to
different medical opinions and the reasons therefor. Sharfarz v. Bowen, 825 F.2d
278, 279 (11th Cir. 1987) (per curiam). “In the absence of such a statement, it is
impossible for a reviewing court to determine whether the ultimate decision on the
merits of the claim is rational and supported by substantial evidence.” Cowart v.
Schweiker, 662 F.2d 731, 735 (11th Cir. 1981). Therefore, when the ALJ fails to
“state with at least some measure of clarity the grounds for his decision,” we will
decline to affirm “simply because some rationale might have supported the ALJ’s
4 conclusion.” Owens v. Heckler, 748 F.2d 1511, 1516 (11th Cir. 1984) (per
curiam). In such a situation, “to say that [the ALJ’s] decision is supported by
substantial evidence approaches an abdication of the court’s duty to scrutinize the
record as a whole to determine whether the conclusions reached are rational.”
Cowart, 662 F.2d at 735 (quoting Stawls v. Califano, 596 F.2d 1209, 1213 (4th
Cir. 1979)) (internal quotation marks omitted).
The Commissioner argues that the ALJ was not required to consider the
treating physician’s treatment notes because they did not constitute a “medical
opinion,” but this argument ignores the language of the regulations. The treating
physician’s treatment notes included a description of Winschel’s symptoms, a
diagnosis, and a judgment about the severity of his impairments, and clearly
constituted a “statement[] from [a] physician . . . that reflect[s] judgments about
the nature and severity of [Winschel’s] impairment(s), including [Winschel’s]
symptoms, diagnosis and prognosis, what [Winschel] can still do despite
impairment(s), and [Winschel’s] physical or mental restrictions.” 20 C.F.R. §§
404.1527(a)(2), 416.927(a)(2).
In this case, the ALJ referenced Winschel’s treating physician only once,
and that reference merely noted that Winschel saw the doctor monthly. The ALJ
did not mention the treating physician’s medical opinion, let alone give it
5 “considerable weight.” Likewise, the ALJ did not discuss pertinent elements of
the examining physician’s medical opinion, and the ALJ’s conclusions suggest
that those elements were not considered. It is possible that the ALJ considered
and rejected these two medical opinions, but without clearly articulated grounds
for such a rejection, we cannot determine whether the ALJ’s conclusions were
rational and supported by substantial evidence. Accordingly, we reverse. On
remand, the ALJ must explicitly consider and explain the weight accorded to the
medical opinion evidence.
II.
Next, Winschel argues that the ALJ’s finding of no disability is not
supported by substantial evidence because the hypothetical question upon which
the vocational expert based his testimony omitted Winschel’s moderate limitations
in maintaining concentration, persistence, and pace, despite the ALJ’s finding that
Winschel’s mental impairments caused such limitations.
At step five, the Commissioner must determine that significant numbers of
jobs exist in the national economy that the claimant can perform. Phillips, 357
F.3d at 1239; 20 C.F.R. §§ 404.1520(a)(4)(v), 416.920(a)(4)(v). An ALJ may
make this determination either by applying the Medical Vocational Guidelines or
by obtaining the testimony of a vocational expert. Phillips, 357 F.3d at 1239–40.
6 “In order for a vocational expert’s testimony to constitute substantial evidence, the
ALJ must pose a hypothetical question which comprises all of the claimant’s
impairments.” Wilson v. Barnhart, 284 F.3d 1219, 1227 (11th Cir. 2002) (per
curiam).
We have never addressed in a published opinion whether a hypothetical
question to a vocational expert must specifically account for limitations in
concentration, persistence, and pace identified during the Psychiatric Review
Technique (“PRT”).1 The Commissioner contends that to include such limitations
in a hypothetical question would inappropriately conflate independent
inquiries—the PRT, at steps two and three, and the RFC, at step four. Other
circuits have rejected this argument, see Ramirez v. Barnhart, 372 F.3d 546, 554
(3d Cir. 2004); Kasarsky v. Barnhart, 335 F.3d 539, 544 (7th Cir. 2003) (per
curiam); Newton v. Chater, 92 F.3d 688, 695 (8th Cir. 1996), and so do we.
Though the PRT and RFC evaluations are undeniably distinct, see 20 C.F.R. §§
404.1520a(d)(3), 416.920a(d)(3), nothing precludes the ALJ from considering the
results of the former in his determination of the latter. See Ramirez, 372 F.3d at
555 (“While [Social Security Ruling] 96-8p does state that the [PRT] findings are
1 We have, however, noted that an ALJ must incorporate the results of the PRT into his findings and conclusions. See Moore v. Barnhart, 405 F.3d 1208, 1213–14 (11th Cir. 2005) (per curiam).
7 ‘not an RFC assessment’ and that step four requires a ‘more detailed assessment,’
it does not follow that the findings on the [PRT] play no role in steps four and
five, and [Social Security Ruling] 96-8p contains no such prohibition.”).
Other circuits have also rejected the argument that an ALJ generally
accounts for a claimant’s limitations in concentration, persistence, and pace by
restricting the hypothetical question to simple, routine tasks or unskilled work.
See Stewart v. Astrue, 561 F.3d 679, 684–85 (7th Cir. 2009) (per curiam);
Ramirez, 372 F.3d at 554; Newton, 92 F.3d at 695. But when medical evidence
demonstrates that a claimant can engage in simple, routine tasks or unskilled work
despite limitations in concentration, persistence, and pace, courts have concluded
that limiting the hypothetical to include only unskilled work sufficiently accounts
for such limitations. See Simila v. Astrue, 573 F.3d 503, 521–22 (7th Cir. 2009);
Stubbs-Danielson v. Astrue, 539 F.3d 1169, 1173–76 (9th Cir. 2008); Howard v.
Massanari, 255 F.3d 577, 582 (8th Cir. 2001). Additionally, other circuits have
held that hypothetical questions adequately account for a claimant’s limitations in
concentration, persistence, and pace when the questions otherwise implicitly
account for these limitations. See White v. Comm’r of Soc. Sec., 572 F.3d 272,
288 (6th Cir. 2009) (concluding that the ALJ’s reference to a moderate limitation
in maintaining “attention and concentration” sufficiently represented the
8 claimant’s limitations in concentration, persistence, and pace); Thomas v.
Barnhart, 278 F.3d 947, 956 (9th Cir. 2002) (concluding that the hypothetical
question adequately incorporated the claimant’s limitations in concentration,
persistence, and pace when the ALJ instructed the vocational expert to credit fully
medical testimony related to those limitations).
In this case, the ALJ determined at step two that Winschel’s mental
impairments caused a moderate limitation in maintaining concentration,
persistence, and pace. But the ALJ did not indicate that medical evidence
suggested Winschel’s ability to work was unaffected by this limitation, nor did he
otherwise implicitly account for the limitation in the hypothetical. Consequently,
the ALJ should have explicitly included the limitation in his hypothetical question
to the vocational expert.
Because the ALJ asked the vocational expert a hypothetical question that
failed to include or otherwise implicitly account for all of Winschel’s impairments,
the vocational expert’s testimony is not “substantial evidence” and cannot support
the ALJ’s conclusion that Winschel could perform significant numbers of jobs in
the national economy. Accordingly, we reverse. On remand, the ALJ must pose a
hypothetical question to the vocational expert that specifically accounts for
Winschel’s moderate limitation in maintaining concentration, persistence, and
9 pace.
REVERSED and REMANDED.
10