Cisneros v. Commissioner of Social Security

Western District of Texas, txwd-5:2018-cv-01000

ORDER that this case is REMANDED to the Commissioner for further administrative proceedings. Signed by Judge Elizabeth S. Chestney.

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9 IN THE UNITED STATES DISTRICT COURT FOR THE WESTERN DISTRICT OF TEXAS SAN ANTONIO DIVISION MARIA LILIA CISNEROS, § § Plaintiff, § SA-18-CV-01000-ESC § vs. § § NANCY A. BERRYHILL, ACTING § COMMISSIONER OF SOCIAL § SECURITY, § § Defendant. § ORDER Before the Court is Plaintiff Maria Lilia Cisneros' request for review of the administrative denial of her application for Disability Insurance Benefits under Title II of the Social Security Act. Having considered Plaintiff's Opening Brief [#11], Defendant's Brief in Support of the Commissioner's Decision [#13], and Plaintiff's Reply Brief [#14], as well as the Social Security Transcript [#7], the applicable legal authorities, and the entire record in this matter, the Court finds that the ALJ erred in applying the "treating-physician rule." The Court also finds that this error was not harmless. Accordingly, the final decision of the Commissioner of Social Security is VACATED, and this case is REMANDED for further administrative proceedings pursuant to the fourth sentence of 42 U.S.C. § 405(g). I. Jurisdiction This Court has jurisdiction to review a final decision of the Commissioner of Social Security ("the Commissioner") under § 405(g). The Court has authority to entire this Order based on the parties' Consent to Proceed Before a United States Magistrate Judge [#4, #6]. 1 9 II. Factual and Procedural Background Plaintiff Maria Lilia Cisneros ("Plaintiff") filed an application for Disability Insurance Benefits under Title II of the Social Security Act ("the Act"), 42 U.S.C. § 401 et seq., on November 12, 2015, alleging disability beginning July 18, 2013. (Social Security Tr. ("Tr.") [#7] at 176–78.) Plaintiff was born on January 10, 1957, and was sixty years old at the time of the Administrative Law Judge's ("ALJ") decision, which is defined as a "person closely approaching advanced age" under 20 C.F.R. § 404.1563(d). (Tr. 176.) Plaintiff has a high school education and attended, but did not graduate, from college. (Tr. 47.) She worked as a secretary from January 1998 to January 2000, and as an accountant from January 2000 to July 2013. (Tr. 205–06.) Plaintiff alleges that she became disabled due to orthopedic arthritis, diabetes mellitus type 2, low thyroid, migraines, glaucoma, hypertension, and high cholesterol. (Tr. 204.) Plaintiff's application was denied initially on February 2, 2016, and upon reconsideration on May 2, 2016. (Tr. 88, 103). On May 31, 2016, Plaintiff requested an administrative hearing. (Tr. 166.) On June 5, 2017, Plaintiff appeared and testified at a hearing before ALJ Susan Whittington. (Tr. 34–72.) Jessica Earl, a vocational expert ("VE"), and Adam Kastner, Plaintiff's attorney at the time, also appeared and testified at the hearing. The ALJ issued an unfavorable decision on November 29, 2017. (Tr. 12–27.) The ALJ found that Plaintiff met the insured status requirements of the Act and applied the five-step sequential evaluation process established by the Social Security Administration ("the Administration") to determine whether an individual is "disabled" within the meaning of the Act. (Tr. 17.) At step one, the ALJ found that Plaintiff has not engaged in substantial gainful activity 2 9 since July 18, 2013, the alleged onset date. (Tr. 17.) At step two, the ALJ found that Plaintiff has the following severe impairments: [D]iabetes mellitus; carpal tunnel syndrome status post release surgery with bilateral wrist and hand weakness; radial neuropathy and radial tunnel syndrome; mild to moderate spondylosis; history of left rotator cuff tear status post repair; right shoulder degenerative joint disease; left knee degenerative joint disease; history of ankle fracture (reconstructed in 2007), status post-surgery; migraine headaches; hypothyroidism; hypertension; and obesity. . . . (Tr. 18.) At step three, however, the ALJ found that Plaintiff does not have an impairment or combination of impairments that meets or medically equals the severity of one of the listed impairments in 20 C.F.R. Part 404, Subpart P, Appendix 1. (Tr. 18–20.) Before reaching step four, the ALJ found that Plaintiff has the residual functional capacity ("RFC") to perform sedentary work, as defined in 20 C.F.R. § 404.1567(a), except that she "cannot climb ladders, ropes, or scaffolds" and "cannot have more than occasional exposure to bright/flashing lights or industrial strength chemical fumes." (Tr. 20.) Based on this RFC, the ALJ found at step four that Plaintiff was able to perform her past relevant work as a bookkeeper. (Tr. 25–26.) Accordingly, the ALJ concluded that Plaintiff was not "disabled" within the meaning of the Act, and, therefore, not entitled to Social Security benefits. (Tr. 27.) Thereafter, Plaintiff requested review of the ALJ's decision, but her request for review was denied by the Social Security Appeals Council ("the Appeals Council") on July 24, 2018, leaving the ALJ's decision as the final decision of the Commissioner. (Tr. 1–6, 174–175.) On September 25, 2018, Plaintiff filed a complaint seeking judicial review of the Commissioner's final decision [#1]. For the reasons set forth below, the final decision of the Commissioner is vacated, and this matter is remanded for further proceedings consistent with this opinion. 3 9 III. Governing Legal Standards A. Standard of Review Judicial review of the denial of Social Security benefits is limited to a determination of "whether substantial evidence supports the final decision1 and whether the Commissioner used the proper legal standards to evaluate the evidence." Masterson v. Barnhart, 309 F.3d 267, 272 (5th Cir. 2002). If the Commissioner's findings are supported by substantial evidence, they are conclusive and must be affirmed. See Selders v. Sullivan, 914 F.2d 614, 617 (5th Cir. 1990). "Substantial evidence is 'more than a mere scintilla. It means such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.'" Brown v. Apfel, 192 F.3d 492, 496 (5th Cir. 1999) (quoting Richardson v. Perales, 402 U.S. 389, 401 (1971)). In applying the substantial evidence standard, this Court must "scrutinize the record to determine if, in fact, such evidence is present." Haywood v. Sullivan, 888 F.2d 1463, 1466 (5th Cir. 1989). In evaluating whether there is substantial evidence of disability, this Court weighs four elements of proof: "(1) the objective medical facts; (2) the diagnoses and opinions of treating and examining physicians; (3) the claimant's subjective evidence of pain and disability; and (4) the claimant's age, education, and work experience." Martinez v. Chater, 64 F.3d 172, 174 (5th Cir. 1995). While the relevant evidence "must do more than create a suspicion of the existence of the fact to be established," a finding of "no substantial evidence" is appropriate "only where there is a 'conspicuous absence of credible choices' or 'no contrary medical evidence.'" Abshire v. Bowen, 848 F.2d 638, 640 (5th Cir. 1988) (quoting Hames v. Heckler, 707 F.2d 162, 164 (5th Cir. 1983)). 1 In this case, because the Appeals Council declined to review the ALJ's decision, the decision of the ALJ constitutes the final decision of the Commissioner, and the ALJ's factual findings and legal conclusions are imputed to the Commissioner. See Higginbotham v. Barnhart, 405 F.3d 332, 336 (5th Cir. 2005); Harris v. Apfel, 209 F.3d 413, 414 (5th Cir. 2000). 4 9 In applying this standard, this Court is not permitted to re-weigh the evidence, try the issues de novo, or substitute its judgment for that of the Commissioner. See Myers v. Apfel, 238 F.3d 617, 619 (5th Cir. 2001) (citing Haywood, 888 F.3d at 1466). Conflicts in the evidence are for the Commissioner, rather than the courts, to resolve. See Martinez, 64 F.3d at 174. But, while substantial deference is given to the Commissioner's findings of fact, the Commissioner's legal conclusions, and claims of procedural error, are reviewed de novo. See Greenspan v. Shalala, 38 F.3d 232, 236 (5th Cir. 1994); Carr v. Apfel, 133 F. Supp. 2d 476, 479 (N.D. Tex. 2001). B. Entitlement to Benefits An individual is considered "disabled" for purposes of the Act "if he is unable to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than twelve months." 42 U.S.C. § 1382c(a)(3)(A). A physical or mental impairment is defined as "an impairment that results from anatomical, physiological, or psychological abnormalities which are demonstrable by medically acceptable clinical and laboratory diagnostic techniques." § 1382c(a)(3)(D). An individual is considered to be under a disability "only if his physical or mental impairment or impairments are of such severity that he is not only unable to do his previous work but cannot, considering his age, education, and work experience, engage in any other kind of substantial gainful work which exists in the national economy. . . ." § 1382c(a)(3)(B). C. Evaluation Process and Burden of Proof As noted above, the Administration uses a five-step sequential evaluation process to determine whether an individual is "disabled" within the meaning of the Act. See 20 C.F.R. §§ 5 9 404.1520, 416.920. At step one, the ALJ must determine whether the claimant is engaging in substantial gainful activity. See § 404.1520(a)(4)(i). "Substantial gainful activity" means "the performance of work activity involving significant physical or mental abilities for pay or profit." Newton v. Apfel, 209 F.3d 448, 452–53 (5th Cir. 2000) (citing 20 C.F.R. §§ 404.1572(a)–(b)). If the claimant engages in substantial work experience, he is not disabled regardless of how severe his physical or mental impairments are and regardless of his age, education, and work experience. See 20 C.F.R. § 416.924(b). If the claimant is not engaging in substantial work experience, the analysis proceeds to the next step. At step two, the ALJ must determine whether the claimant has a medically determinable impairment that is "severe" or a combination of impairments that is "severe." See § 404.1520(a)(4)(ii). An impairment or combination of impairments is considered severe if it significantly limits the claimant's physical or mental ability to do basic work activities. See §§ 404.1520(c), 416.920(c). "An impairment can be considered as not severe only if it is a slight abnormality having such minimal effect on the individual that it would not be expected to interfere with the individual's ability to work, irrespective of age, education or work experience." Stone v. Heckler, 752 F.2d 1099, 1101 (5th Cir. 1985) (quoting Estran v. Heckler, 745 F.2d 340, 341 (5th Cir. 1984)). If the claimant does not have a severe medically determinable impairment or combination of impairments, he is not disabled. See § 404.1520(c). If the claimant has a severe impairment or combination of impairments, the analysis proceeds to the next step. At step three, the ALJ must determine whether the claimant's impairment or combination of impairments is of a severity to meet or medically equal the criteria of an impairment found in the Listing of Impairments ("the Listings"), a set of medical criteria found at 20 C.F.R. Pt. 404, Subpt. P, App. 1. If the claimant has an impairment or combination of impairments that meets or 6 9 medically equals the criteria of a listing, and it has lasted or is expected to last for a continuous period of at least twelve months, the claimant is disabled. See 20 C.F.R. §§ 404.1520(d), 416.909. If not, the analysis proceeds to the next step. Before reaching step four of the five-step sequential evaluation process, however, the ALJ must first determine the claimant's RFC, which is the most that he can still do despite his limitations. See 20 C.F.R. § 416.945(a)(1). The ALJ uses the RFC assessment at step four to determine if the claimant can do his PRW and at step five to determine if the claimant can adjust to any other work existing in the national economy. See §§ 404.1520(e), 416.920(e). At step four, the ALJ reviews the RFC assessment and the demands of the claimant's PRW. See § 404.1520(f). The term "past relevant work" is defined as work that the claimant has done within the past fifteen years, that was substantial gainful activity, and that lasted long enough for the claimant to learn to do it. See § 404.1560(b)(1). If the claimant has the RFC to do his PRW, he is not disabled. See § 404.1560(3). If the claimant's impairment or combination of impairments preclude him from performing his PRW, the fifth and final step of the sequential evaluation process assesses the claimant's ability—given his residual capacities, age, education, and work experience—to do other work. See § 404.1520(g). If the claimant is able to do other work, he is not disabled. Id. If the claimant's impairment or combination of impairments precludes him from performing any other type of work, he will be found to be disabled. Id. The claimant bears the burden of proof at the first four steps of the sequential evaluation process. See Leggett v. Chater, 67 F.3d 558, 564 (5th Cir. 1995). Once the claimant satisfies his burden under the first four steps, the burden shifts to the Commissioner at step five to show that there is other gainful employment available in the national economy that the claimant is capable of performing. See Greenspan, 38 F.3d at 236. This burden may be satisfied either by reference 7 9 to the Medical-Vocational Guidelines found at 20 C.F.R. Pt. 404, Subpt. P, App. 2, expert vocational testimony, or other similar evidence. See Fraga v. Bowen, 810 F.2d 1296, 1304 (5th Cir. 1987). If the Commissioner adequately points to potential alternative employment, the burden shifts back to the claimant to prove that he is unable to perform that work. See Anderson v. Sullivan, 887 F.2d 630, 632–33 (5th Cir. 1989). A finding that a claimant is not disabled at any point in the five-step review is conclusive and terminates the analysis. See Lovelace v. Bowen, 813 F.2d 55, 58 (5th Cir. 1987). IV. Analysis On appeal, Plaintiff raises two points of error. She contends that the ALJ committed reversible error in: (1) failing to follow the "treating-physician rule" by improperly rejecting the opinions of one of her treating physicians, Ramesh C. Srinivasan, M.D.; and (2) failing to consider the opinions of her spouse, Anthony J. Cisneros. The Court agrees with the first contention, and therefore does not decide the second. The Commissioner's final decision is vacated and the case is remanded for further proceedings. A. The ALJ failed to comply with the treating-physician rule. The ALJ committed reversible error by not complying with the physician-treating rule in her consideration of the medical opinions of Plaintiff's physician, Dr. Srinivasan. Ordinarily, "the opinions, diagnoses, and medical evidence of a treating physician who is familiar with the claimant's injuries, treatments, and responses should be accorded considerable weight in determining disability." Perez v. Barnhart, 415 F.3d 457, 465–66 (5th Cir. 2005) (quoting Greenspan, 38 F.3d at 237). Under the "treating-physician rule,"2 a treating physician's opinion 2 The Social Security Administration published a new rule, applicable to claims filed on or after March 27, 2017, that eliminated the rule that treating sources be given controlling weight. See 20 C.F.R. § 404.1520c (effective Mar. 27, 2017). The pre-amendment version of 8 9 on the nature and severity of the claimant's medical condition is entitled to "controlling weight" if that opinion "is well-supported by medically acceptable clinical and laboratory diagnostic techniques and is not inconsistent with the other substantial evidence in [the] case record." 20 C.F.R. § 404.1527(c)(2). But a treating physician's opinions are not conclusive, and "the ALJ has sole responsibility for determining a claimant's disability status." Moore v. Sullivan, 919 F.2d 901, 905 (5th Cir. 1990); see also Scott v. Heckler, 770 F.2d 482, 485 (5th Cir. 1985) (stating that the ALJ "is entitled to determine the credibility of medical experts as well as lay witnesses and to weigh their opinions and testimony accordingly."). Accordingly, "[t]he ALJ is free to reject the opinion of any physician when the evidence supports a contrary conclusion." Martinez, 64 F.3d at 176 (quoting Bradley v. Bowen, 809 F.2d 1054, 1057 (5th Cir. 1987)). Still, if the ALJ assigns less-than-controlling weight to a treating source's opinion, she must articulate "good reasons" for doing so. See §§ 404.1527(c)(2), 416.927(c)(2); see also Greenspan, 38 F.3d at 237 ("[W]hen good cause is shown, less weight, little weight, or even no weight may be given to the physician's testimony."). "Good cause" exists to discount or reject a treating physician's opinion if it is brief and conclusory, unsupported by medically acceptable clinical and laboratory diagnostic techniques, or otherwise unsupported by the evidence. See Newton, 209 F.3d at 456. Section 404.1527(c)(2) requires an ALJ to consider several factors before discounting a treating physician's opinion. Specifically, this regulation requires consideration of: (1) the physician's length of treatment of the claimant, (2) the physician's frequency of examination, (3) the nature and extent of the treatment relationship, (4) the support of the physician's opinion afforded by the medical evidence of the rule applies to Plaintiff's case. See 20 C.F.R. § 404.1527(a)(2) (effective Aug. 24, 2012 to Mar. 26, 2017 (defining treating-source rule). 9 9 record, (5) the consistency of the opinion with the record as a whole; and (6) the specialization of the treating physician. Id. In Newton, the Fifth Circuit held that, "absent reliable medical evidence from a treating or examining physician controverting the claimant's treating specialist, an ALJ may reject the opinion of the treating physician only if the ALJ performs a detailed analysis of the treating physician's views under the criteria set forth in 20 C.F.R. § 404.1527[(c)(2)]." Id. at 453 (emphasis in original). The Fifth Circuit subsequently explained that "[t]he Newton court limited its holding to cases where the ALJ rejects the sole relevant medical opinion before it." Qualls v. Astrue, 339 Fed. App'x 461, 467 (5th Cir. 2009). Therefore, Newton is inapplicable when "there is competing first-hand medical evidence and the ALJ finds as a factual matter that one doctor's opinion is more well-founded than another." Newton, 209 F.3d at 458; see also Jones v. Colvin, 638 Fed. App'x 300, 304 (5th Cir. 2016) ("ALJs are not required to consider the § 404.1527(c) factors before dismissing a treating physician's opinion if there is competing first-hand medical evidence contradicting that opinion."). Nor does it apply when "the ALJ weighs the treating physician's opinion on disability against the medical opinion of other physicians who have treated or examined the claimant and have specific medical bases for a contrary opinion." Newton, 209 F.3d at 458. Plaintiff challenges the weight that the ALJ gave to the medical opinions of one of her treating physicians, Dr. Srinivasan. On January 8, 2016, Dr. Srinivasan completed a medical source statement (physical), in which he opined that Plaintiff would miss at least five days of work per month due to her medical conditions; that she could never lift or carry more than five pounds; that she could never use her hands for fine or gross manipulation; that she could never raise her left arm over her shoulder; that her condition causes severe pain; that she would be off- 10 9 task for seventy percent or more of an eight-hour workday due to her pain; and that she would need unscheduled breaks. (Tr. 537–58.) With respect to these opinions, the ALJ said: Little weight was given to the opinions of Dr. Sriniasan [sic] (Exhibit 13F). He found the claimant would miss more than five days of work per month due to her impairments; could never lift or carry 6 to 10 pounds; and never use her hands for fine or gross manipulation. Little weight was given to this opinion as Dr. Sriniasan [sic] failed to support these extreme limitations with objective medical evidence. (Tr. 24.) Plaintiff contends that the weight that the ALJ gave to Dr. Srinivasan's opinions was inconsistent with the "treating-physician rule." In response, the Commissioner argues that "the ALJ properly recognized that Dr. Srinivasan's opinion was unsupported by his own treatment notes, which showed mild findings that improved with treatment." (Def.'s Br. [#13] at 4.) But, in deciding the appropriate weight to give to Dr. Srinivasan's opinions, the ALJ did not explicitly mention Dr. Srinivasan's treatment notes or otherwise explain how the objective medical evidence in the case file does not support his opinions. Second, and more importantly, the ALJ did not consider the Newton factors when rejecting those opinions, and an ALJ is excused from addressing the Newton factors only if the ALJ cited "competing first-hand medical evidence" and found as a factual matter that another doctor's opinion is more well-founded than Dr. Srinivasan's. Newton, 209 F.3d at 458. Yet the ALJ did neither of these things. Nor did she explicitly or implicitly address the majority of the § 404.1527(c) factors. Rather, the ALJ faulted Dr. Srinivasan for failing to support his findings of "extreme limitations" with objective medical evidence, without considering each of the § 404.1527(c) factors. (Tr. 24.) Thus, the only factor the ALJ (implicitly) mentioned was "supportability." § 404.1527(c)(3). This was error, as "an analysis of some of the factors, but omission of others, does not comply with Newton's requirement 'that 11 9 an ALJ is required to consider each of the § 404.1527[(c)] factors before declining to give any weight to the opinions of the claimant's treating specialist.'" Stancle v. Colvin, No. 4:15-CV- 00405-CAN, 2016 WL 3172784, at *11 (E.D. Tex. June 7, 2016) (quoting Newton, 209 F.3d at 456) (emphasis added); see also Smith v. Colvin, No. 1:14CV195-SA-DAS, 2016 WL 762693, at *9–15 (N.D. Miss. Feb. 25, 2016) (remanding because the ALJ did not consider all of the § 404.1527(c) factors); Patino v. Colvin, No. 3:15-CV-618-BF, 2016 WL 1664912, at *6–8 (N.D. Tex. Apr. 25, 2016) (same). To be sure, the ALJ stated that, in determining Plaintiff's RFC, she "considered all symptoms and the extent to which these symptoms can reasonably be accepted as consistent with the objective medical evidence and other evidence, based on the requirements of 20 CFR 404.1529 and SSR 16-3p." (Tr. 20.) The ALJ also stated that she "considered opinion evidence in accordance with the requirement of 20 CFR 404.1527." (Tr. 20.) But courts may disregard blanket statements by ALJs that they have considered the entire record or otherwise acted in accordance with the regulations. See Kneeland v. Berryhill, 850 F.3d 749, 761 (5th Cir. 2017) ("[I]t should go without saying that cursory, boilerplate language about carefully considering the entire record does not constitute an explanation for rejecting a medical opinion."). The Commissioner's arguments to the contrary are unpersuasive. The Commissioner argues that no need exists to analyze each of the § 404.1527(c) factors because Dr. Srinivasan's January 8, 2016 assessment was contradicted by his own treatment notes. As this Court recently noted, "the Newton precedent does not necessarily apply when there are first-hand medical opinions by other examining doctors that are not fully consistent with the medical opinions of the treating physician." Zahraei v. Colvin, No. SA-16-CV-396-XR, 2017 WL 3034716, at *8 (W.D. Tex. July 17, 2017) (emphasis added) (citing Zimmerman v. Astrue, 288 F. App'x 931, 12 9 935 (5th Cir. 2008)). However, district courts have repeatedly held that inconsistencies between a treating physician's own opinions do not fall within the "competing first-hand medical evidence" exception noted in Newton. Newton, 209 F.3d at 458; see also Losasso v. Comm'r of Soc. Sec., No. 4:15-CV-00858-CAN, 2017 WL 1251076, at *8 (E.D. Tex. Mar. 24, 2017) (holding that inconsistencies between the treating physician's own opinions did not relieve the ALJ of his obligation to set out a detailed analysis of the six statutory factors). As the Northern District of Texas has observed: The competing first-hand medical evidence exception to avoiding the detailed analysis of the six § 1527(c)(2) factors does not contemplate using other evidence from the same physician. To the contrary, use of such evidence is fully anticipated within two of the six required factors—support for the physician's opinions in the medical evidence of record and consistency of the opinions with the record as a whole. Howeth v. Colvin, No. 12-CV-0979-P, 2014 WL 696471, at *8 (N.D. Tex. Feb. 24, 2014); see also Perry v. Colvin, No. 13-CV-2252-P, 2015 WL 5458925, at *9 (N.D. Tex. Sept. 17, 2015) ("Inconsistencies within a treating physician's own opinions do not justify bypassing the detailed analysis of the six factors."). The Commissioner also argues that the medical source statement completed by Dr. Srinivasan is a conclusory, two-page, check-box form, and that the ALJ may properly ignore statements of treating physicians that are conclusory and unsupported by the objective medical record. The Commissioner further argues that these statements were made in anticipation of litigation, and that the ALJ acted within her discretion in rejecting these statements and Dr. Srinivasan's medical source statement in general. The Court is unpersuaded. The ALJ based his decision to give "little weight" to Dr. Srinivasan's opinions on his alleged failure to support his findings with objective medical evidence. (Tr. 24.) It is well-established that courts may judge the propriety of an administrative agency's decision "solely by the grounds invoked by the 13 9 agency." Sec. & Exch. Comm'n v. Chenery Corp., 332 U.S. 194, 196 (1947). Thus, under Chenery, an agency may not defend an administrative decision on new grounds not set forth by the agency in its original decision. Since Chenery, the Fifth Circuit has repeatedly cautioned that "[t]he ALJ's decision must stand or fall with the reasons set forth in the ALJ's decision, as adopted by the Appeals Council." Newton, 209 F.3d at 455; see also Copeland v. Colvin, 771 F.3d 920, 927 (5th Cir. 2014); Cole ex rel. Cole v. Barnhart, 288 F.3d 149, 151 (5th Cir. 2002). Simply put, the ALJ did not rely on the arguments put forth by the Commissioner on appeal, and, therefore, they provide no basis for affirming the ALJ's decision. Finally, the Commissioner argues that, "[i]n addition to Dr. Srinivasan's own objective findings, the ALJ reviewed other objective findings of record, which further supports the ALJ's decision as it shows Dr. Srinivasan's opinion was inconsistent with the record as a whole." (Def.'s Br. at 6.) The Commissioner directs this Court's attention to the opinions of Ketti Awad. M.D., Thomas Pfeil, M.D., Ian Whitney, M.D., and Benjamin Hooker, M.D. The Commissioner also claims that Plaintiff's own testimony further undermined Dr. Srinivasan's opinions. From this, the Commissioner concludes that "the evidence as a whole shows, consistent with the ALJ's findings, that Plaintiff had 'severe' wrist and shoulder impairments that reduced her RFC, but were not totally disabling as Dr. Srinivasan opined." (Id. at 7.) In an effort to justify the ALJ's conclusion, the Commissioner attempts to show inconsistency between Dr. Srinivasan's medical source statement and the opinions of Drs. Awad, Pfeil, Whitney, and Hooker, as well as Plaintiff's own testimony. As with the Commissioner's other arguments, this was not an argument made by the ALJ, and is, therefore, an impermissible post-hoc rationalization. See Chenery Corp., 332 U.S. at 196. The ALJ did not compare the opinions of Dr. Srinivasan to any other medical source. Rather, the ALJ merely set out some of 14 9 the opinions and findings of Dr. Srinivasan and concluded, without analysis, that they were unsupported by objective medical evidence. At no point did the ALJ compare or weigh any opinion of Dr. Srinivasan against the opinions of Drs. Awad, Pfeil, Whitney, and Hooker. Nor did she find as a factual matter that the opinions of Drs. Awad, Pfeil, Whitney, and Hooker are more well-founded than those from Dr. Srinivasan. But Newton eliminates the requirement to provide a detailed analysis of the § 404.1527(c) factors only when "there is competing first-hand medical evidence and the ALJ finds as a factual matter that one doctor's opinion is more well- founded than another," or "the ALJ weighs the treating physician's opinion on disability against the medical opinion of other physicians who have treated or examined the claimant and have specific medical bases for a contrary opinion." Newton, 209 F.3d at 458. Neither of these scenarios is present here. Since the ALJ did not compare the opinions of Dr. Srinivasan to any other medical source, her decision cannot be upheld based upon speculation as to how she would have compared or weighed those opinions against the opinions of the other physicians who provided a medical opinion in this case. In short, under Newton, the ALJ was required to consider each of the § 404.1527(c) factors before giving "little weight" to the medical opinions of Dr. Srinivasan. The ALJ's failure to do so constitutes procedural error and, for the reasons that follow, requires remand. B. Plaintiff's substantial rights were affected by the ALJ's failure to properly apply the treating-physician rule, and remand is thus warranted. Because the ALJ failed to discuss each of the Newton factors, she discounted Dr. Srinivasan's opinions without the required analysis. However, not every error warrants reversal or remand. See Frank v. Barnhart, 326 F.3d 618, 622 (5th Cir. 2003); Villarreal v. Colvin, 221 F. Supp. 3d 835, 851 (W.D. Tex. 2016). "Procedural perfection in administrative proceedings is not required," and this Court will vacate a judgment only if "the substantial rights of a party have 15 9 been affected." Mays v. Bowen, 837 F.2d 1362, 1364 (5th Cir. 1988); see also Fed. R. Civ. P. 61 ("Unless justice requires otherwise, no error in admitting or excluding evidence—or any other error by the court or a party—is ground for granting a new trial, for setting aside a verdict, or for vacating, modifying, or otherwise disturbing a judgment or order. At every stage of the proceeding, the court must disregard all errors and defects that do not affect any party's substantial rights."). The Fifth Circuit has clarified that procedural errors affect the substantial rights of a claimant only when they "cast into doubt the existence of substantial evidence to support the ALJ's decision." Morris v. Bowen, 864 F.2d 333, 335 (5th Cir. 1988); see also Hammond v. Barnhart, 124 Fed. App'x 847, 852 n.10 (5th Cir. 2005) ("Procedural errors constitute bases for remand only where they cast into doubt the existence of substantial evidence to support the ALJ's decision.") (citing Morris, 864 F.2d at 335). Stated differently, "[r]emand is required only when there is a realistic possibility that the ALJ would have reached a different conclusion absent the procedural error." Wilder v. Colvin, No. 13-CV-3014-P, 2014 WL 2931884, at *5 (N.D. Tex. June 30, 2014) (citing January v. Astrue, 400 F. App'x 929, 933 (5th Cir. 2010)). Here, the ALJ's failure to consider each of the § 404.1527(c) factors before giving "little weight" to Dr. Srinivasan's opinions was harmful error. See Myers, 238 F.3d at 621–22; Newton, 238 F.3d at 621–22; Johnson v. Colvin, No. 3:16-CV-69-BN, 2017 WL 86139, at *6 (N.D. Tex. Jan. 10, 2017); Gullette v. Colvin, No. 3:14-CV-1497-BN, 2015 WL 4660968, at *6– 7 (N.D. Tex. Aug. 6, 2015). It is, of course, the ALJ's responsibility to weigh the evidence and assess the claimant's RFC. See 20 C.F.R. § 404.1546(c). But that assessment must be "based on all of the relevant medical and other evidence." Id. § 404.1545(a)(3). And, if the ALJ assigns 16 9 less-than-controlling weight to a treating source's opinion, she must articulate "good reasons" for doing so. § 416.927(c)(2). In this case, the Court is unable to determine what the ALJ would have decided had she properly considered each of the statutory factors. Dr. Srinivasan found, in the ALJ's own words, "extreme limitations" in Plaintiff's ability to meet the demands of work. (Tr. 24.) Specifically, Dr. Srinivasan opined that Plaintiff would miss at least five days of work per month due to her medical conditions; that she could never lift or carry more than five pounds; that she could never use her hands for fine or gross manipulation; that she could never raise her left arm over her shoulder; that her condition causes severe pain; that she would be off-task for seventy percent or more of an eight-hour workday due to her pain; and that she would need unscheduled breaks. (Tr. 537–58.) The ALJ, however, gave "little weight" to the opinions of Dr. Srinivasan and found that Plaintiff had the following RFC: [T]he claimant has the residual functional capacity to perform sedentary work as defined in 20 CFR 404.1567(a) in that she can occasionally lift and carry 10 pounds and frequently lift and carry less than 10 pounds; the claimant can stand and/or walk for about 2 hours in an 8-hour workday; and can sit for about 6 hours in an 8-hour workday. She can occasionally climb ramps and stairs and cannot climb ladders, ropes, or scaffolds. The claimant can occasionally overhead reach with her bilateral upper extremities and she can frequently handle, finger, and feel with her bilateral upper extremities. The individual cannot have more than occasional exposure to bright/flashing lights or industrial strength chemical fumes. (Tr. 20.) The assessment of Plaintiff's RFC is crucial in this case, and many of Dr. Srinivasan's opinions relate to that RFC. The opinions expressed by Dr. Srinivasan include significant limitations beyond those that the ALJ recognized in determining Plaintiff's RFC. These opinions, if given controlling weight, would contradict the ALJ's RFC finding. In fact, the VE testified that an individual with the limitations recognized by Dr. Srinivasan would be unable to perform any work in the national economy. (Tr. 64–66, 68–69.) Thus, had the ALJ given proper 17 9 consideration to the treating physician's assessment of Plaintiff's ability to engage in work- related activities, she might have reached a different decision as to disability. In sum, because the ALJ failed to discuss each of the § 404.1527(c) factors, she discounted Dr. Srinivasan's opinions without the required analysis. Additionally, the ALJ's failure to properly apply the treating-physician rule affected Plaintiff's substantial rights. Therefore, this case must be remanded for reconsideration of Dr. Srinivasan's medical opinions under the relevant factors. The Court expresses no opinion as to how much weight the ALJ should give to Dr. Srinivasan's opinions after she has performed a detailed analysis of the Newton factors.3 On remand, the ALJ is instructed to consider Dr. Srinivasan's opinions in the manner described in 20 C.F.R. § 404.1527(c), and to provide "good reasons" for the weight she gives the treating source's medical opinions. § 404.1527(c)(2). The Court expresses no opinion as to how the ALJ should rule on remand. V. Conclusion For the reasons set forth above, the Court finds that the ALJ committed reversible error in failing to consider each of the § 404.1527(c) factors before giving "little weight" to the opinions of Dr. Srinivasan. IT IS, THEREFORE, ORDERED that the Commissioner's decision finding that Plaintiff is not disabled is VACATED. IT IS FURTHER ORDERED that this case is REMANDED to the Commissioner for further administrative proceedings consistent with this opinion. 3 Of course, the ALJ need not consider the Newton factors if he cites "competing first- hand medical evidence" and finds as a factual matter that another doctor's opinion is more well- founded than Dr. Srinivasan's. Newton, 209 F.3d at 458. 18 9 SIGNED this 16th day of September, 2019. ELIZABETH S. ("BETSY") CHESTNEY UNITED STATES MAGISTRATE JUDGE 19