MICHELLE H. BURNS, Magistrate Judge.
Pending before the Court is Plaintiff Barbara Bradley's appeal from the Social Security Administration's final decision to deny her claim for disability insurance benefits. After reviewing the administrative record and the arguments of the parties, the Court now issues the following ruling.
On January 13, 2013, Plaintiff filed an application for disability insurance benefits pursuant to Title II of the Social Security Act. She alleged disability beginning July 1, 2011. The application was initially denied on June 6, 2013. It was again denied upon reconsideration on September 26, 2013. Plaintiff requested a hearing, and on February 3, 2015, she appeared and testified before the ALJ. On March 20, 2015, the ALJ issued a decision finding that Plaintiff was not disabled. The Appeals Council denied Plaintiff's request for review, making the ALJ's decision the final decision of the Commissioner. Thereafter, Plaintiff sought judicial review of the ALJ's decision pursuant to 42 U.S.C. § 405(g).
The ALJ's decision to deny benefits will be overturned "only if it is not supported by substantial evidence or is based on legal error."
"The inquiry here is whether the record . . . yields such evidence as would allow a reasonable mind to accept the conclusions reached by the ALJ."
The ALJ is responsible for resolving conflicts in medical testimony, determining credibility, and resolving ambiguities.
Notably, the Court is not charged with reviewing the evidence and making its own judgment as to whether a plaintiff is or is not disabled. Rather, the Court's inquiry is constrained to the reasons asserted by the ALJ and the evidence relied upon in support of those reasons.
In order to be eligible for disability or social security benefits, a claimant must demonstrate an "inability 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 12 months." 42 U.S.C. § 423(d)(1)(A). An ALJ determines a claimant's eligibility for benefits by following a five-step sequential evaluation:
At step one, the ALJ determined that Plaintiff had not engaged in substantial gainful activity since June 1, 2011—the alleged onset date. (Transcript of Administrative Record ("Tr.") at 15.) At step two, she found that Plaintiff had the following severe impairments: essential hypertension, hyperlipidemia, lumbar degenerative disc disease, and dysfunction of her left knee. (Tr. at 15-18.) At step three, the ALJ stated that Plaintiff did not have an impairment or combination of impairments that met or medically equaled an impairment listed in 20 C.F.R. Part 404, Subpart P, Appendix 1 of the Commissioner's regulations. (Tr. at 18.) After consideration of the entire record, the ALJ found that Plaintiff retained "the residual functional capacity to perform light work as defined in 20 CFR 404.1567(b) except she can occasionally climb ramps and stairs, but never ladders, ropes, and scaffolds. She can frequently balance. She can occasionally stoop, kneel, crouch, and crawl. She can have frequent contact with fumes, odors, dust, gases, and poor ventilation
In her brief, Plaintiff contends that the ALJ erred by: (1) failing to properly consider her subjective complaints; and (2) failing to properly weigh medical source opinion evidence. Plaintiff requests that the Court remand for determination of benefits.
Plaintiff argues that the ALJ erred in rejecting her subjective complaints in the absence of clear and convincing reasons for doing so. Plaintiff specifically refutes the ALJ's analysis and conclusions drawn from the objective medical evidence, Plaintiff's medical treatment and activities of daily living, and the fact that Plaintiff received unemployment benefits.
To determine whether a claimant's testimony regarding subjective pain or symptoms is credible, the ALJ must engage in a two-step analysis. "First, the ALJ must determine whether the claimant has presented objective medical evidence of an underlying impairment `which could reasonably be expected to produce the pain or other symptoms alleged.' The claimant, however, `need not show that her impairment could reasonably be expected to cause the severity of the symptom she has alleged; she need only show that it could reasonably have caused some degree of the symptom.'"
In weighing a claimant's credibility, the ALJ may consider many factors, including, "(1) ordinary techniques of credibility evaluation, such as the claimant's reputation for lying, prior inconsistent statements concerning the symptoms, and other testimony by the claimant that appears less than candid; (2) unexplained or inadequately explained failure to seek treatment or to follow a prescribed course of treatment; and (3) the claimant's daily activities."
On March 15, 2013, Plaintiff filled out a function report in which she outlined her impairments and symptoms and how they affect her activities of daily living. (Tr. 182-89.) Plaintiff stated she could not sit for long periods because it caused stiffness and back pain. She suffered from anxiety and panic attacks under stress and found long hours at work debilitating. Plaintiff reported chronic neck pain and her knees would swell from walking too much. She could not get comfortable and had broken sleep at night. Plaintiff alleged that her impairments affected her ability to lift, stand, walk, sit, climb stairs, kneel, squat, bend, and reach. (Tr. 182-89.)
At the hearing held on February 3, 2015, Plaintiff testified that she lives with three grandchildren. (Tr. at 37.) She testified that she left her job in 2011 due to mini heart attacks and two prior strokes. Her prior job as a case manager required lifting files weighing up to 25 pounds. (Tr. at 38.) Plaintiff stated that she was taking courses toward a bachelor's degree in psychology through an online college. Plaintiff stated that she uses a text-to-talk program so she does not have to type. (Tr. at 40.) Plaintiff stated that she is not able to work because it is difficult and painful to sit still, stand and bend for long periods of time. (Tr. at 41.) She testified that chronic pain and depression interfere with returning to work. Plaintiff said that she takes her grandchildren back and forth to school but she is not able to do any other activities with them. She stated that depression "sits" on her. (Tr. at 42.) Plaintiff testified that her 11-year old grandchild helps her with household duties such as packing lunches. Plaintiff stated that since a car accident in January, she has had a lot of stiffness. (Tr. at 43.) She testified that deadlines and schedules cause anxiety and panic. (Tr. at 44.) She described her prior work as being overwhelming. Her doctor increased her behavioral medication to treat her panic attacks but she continues to have panic attacks twice a month that interrupt whatever she is doing until she takes Xanex. (Tr. at 46.) She stated that sometimes the Xanex does not relieve her panic attack. (Tr. at 47.) Plaintiff stated that she was experiencing panic attacks at work due to stress that included chest pain. (Tr. at 49.) Plaintiff described her fibromyalgia as a gnawing, uncomfortable pain in her hands, feet, neck or other parts of her body. She testified that she experiences pain from reaching to buckle her grandson into his car seat and from doing laundry. (Tr. at 50.) She can only do school work for 30-35 minutes and then she needs to take a break for 3-4 hours. She is given extra time to get her school work completed. (Tr. at 52.) Plaintiff explained that due to fatigue, she has difficulty getting her school work done, resulting in poor grades, failed classes and a feeling of being burnt out. (Tr. at 53.) Plaintiff attended the hearing with a cane that she testified she used due to weakness in her legs. (Tr. at 54.) She also stated that she will sometimes need a scooter in the store. She testified that she has been diagnosed with a bulging disc and arthritis in her back and neck. (Tr. at 54-55.)
The ALJ found that Plaintiff's statements were not entirely credible. The ALJ based her credibility determination on Plaintiff's: (1) statements and testimony being inconsistent with the objective medical evidence; (2) conservative medical treatment; (3) receipt of unemployment benefits; and (4) activities of daily living.
The ALJ first noted that Plaintiff's allegations regarding the severity of her physical symptoms and limitations were not supported by the objective medical findings of record. While an ALJ may reject a Plaintiff's testimony about the severity of her symptoms, he must "point to specific facts in the record which demonstrate that [the claimant] is in less pain than she claims."
The ALJ discussed the medical evidence in the administrative record with regards to Plaintiff's complaints and impairments related to her hypertension, hyperlipidemia, lumbar degenerative disc disease, and dysfunction of her left knee. She identified some areas of Plaintiff's allegations wherein Plaintiff's ability to function was qualified or contradicted by the medical record.
In discussing Plaintiff's knee issues, citing to medical records from Earl Feng, M.D., at the Orthopedic Clinic Association, the ALJ first noted that Plaintiff had a slow and halting gait, mild intra-articular swelling bilaterally, pain in flexion on both sides, pain along the joint line, and minimal crepitation. However, the ALJ also noted that Plaintiff was ambulating without support, could get up on the examination table without difficulty, she had good maintenance of her range of motion, no instability, and her distal strength and neurovascular strength were intact. (Tr. at 272-73.)
The ALJ noted additional inconsistencies in the record stating that some examinations showed that Plaintiff had a slight antalgic gait of the left, but other examinations showed that her gait was normal. The ALJ further found that medical reports had not shown that Plaintiff relied on a cane or other assistive device to move around. (Tr. at 272-73, 282-438, 445-85, 502-855, 871-1071.)
Generally, the ALJ found that Plaintiff's routine physical examinations often showed "few significant results" and "most exams showed no limitations." The ALJ specifically cited to an August 2012 report from Pioneer Cardiovascular Consultants indicating that Plaintiff was well developed and in no apparent distress. She had a regular heart rate and rhythm; her extremities showed no signs of clubbing or cyanosis, or edema; her gross motor and sensory functions were symmetric; and she was alert and answered all questions appropriately. (Tr. at 275.) The ALJ found similar findings throughout the record. (Tr. at 279-81, 1072-92.) Likewise, the ALJ found that physical examinations at the East Valley Family Medical Center were consistent, again, indicating a well-developed general appearance in no acute distress—Plaintiff's chest was clear, she had no other complications in her systems, and her gait was normal. (Tr. at 282.) These findings were similar to other examinations completed at this same medical center. (Tr. at 282-438, 502-855, 871-979.)
Regarding Plaintiff's hypertension and hyperlipidemia, citing to medical records from East Valley Family Medical, although the ALJ noted inconsistencies in Plaintiff's blood pressure, she also found that the record demonstrated that Procardia medication appeared to control her condition. (Tr. at 871-979.) "Impairments that can be controlled effectively with medication are not disabling for the purpose of determining eligibility for [disability] benefits."
The Court finds that the inconsistencies between Plaintiff's testimony and the objective medical record are a clear and convincing reason to discount parts of Plaintiff's testimony.
The ALJ also discounted Plaintiff's symptom testimony finding that she received "rather benign, conservative medical treatment." A conservative course of treatment may discredit a claimant's allegations of disabling symptoms.
Here, the ALJ merely provided a general, conclusory assertion regarding Plaintiff's treatment despite a bulk of information set forth in the medical record. The Court fails to find this a clear and convincing reason to discount Plaintiff's testimony.
The ALJ also discounted Plaintiff's allegations about the severity of her symptoms and limitations because she received unemployment benefits. The receipt of unemployment benefits may undermine a claimant's alleged inability to work full time.
Here, Plaintiff's unemployment benefits application is not in the record before this Court. As such, the Court cannot determine the details regarding Plaintiff's availability for full-time work. And, her receipt of unemployment benefits does not constitute a clear and convincing reason for discrediting Plaintiff's credibility.
Lastly, the ALJ determined that Plaintiff's allegations are not consistent with her activities of daily living. An ALJ may reject a claimant's symptom testimony if it is inconsistent with the claimant's daily activities.
Here, the ALJ discussed Plaintiff's activities of daily living as follows:
(Tr. at 21.)
Plaintiff argues that these activities are not inconsistent with her statements that she is not able to walk for more than a half block, has pain with several positions, needs frequent breaks, and needs additional time to complete tasks.
The Court fails to find Plaintiff's activities of daily living a clear and convincing reason to discount Plaintiff's testimony. Rather than explaining how Plaintiff's activities detract from Plaintiff's testimony, and providing an analysis of why Plaintiff's activities were inconsistent with the limitations asserted by Plaintiff, the ALJ simply dismisses her allegations in a conclusory fashion. The listing of activities and implying that said activities are performed consistently and regularly over an eight hour day is insufficient.
In summary, the Court finds that the ALJ has failed to provide a sufficient basis to find Plaintiff's allegations not entirely credible. While perhaps any one of the individual factors identified by the ALJ could arguably detract from Plaintiff's credibility, such factors viewed in isolation are not sufficient to uphold the ALJ's decision to discredit Plaintiff's allegations as a whole. Thus, the Court concludes that the ALJ has failed to support her decision to discredit Plaintiff's credibility with specific, clear and convincing reasons and, therefore, the Court finds error.
Plaintiff contends that the ALJ erred by improperly weighing medical opinion evidence. Plaintiff specifically states that the ALJ failed to properly weigh the opinions of her treating pain management doctor, Shimul Sahai, M.D., and treating physician, Manju Krishna Pillai, M.D.
The Commissioner is responsible for determining whether a claimant meets the statutory definition of disability, and need not credit a physician's conclusion that the claimant is "disabled" or "unable to work." 20 C.F.R. § 404.1527(d)(1). But, the Commissioner generally must defer to a physician's medical opinion, such as statements concerning the nature or severity of the claimant's impairments, what the claimant can do, and the claimant's physical or mental restrictions. § 404.1527(a)(2), (c).
In determining how much deference to give a physician's medical opinion, the Ninth Circuit distinguishes between the opinions of treating physicians, examining physicians, and non-examining physicians.
If a treating or examining physician's medical opinion is not contradicted by another doctor, the opinion can be rejected only for clear and convincing reasons.
When a treating or examining physician's opinion is contradicted by another doctor, it can be rejected "for specific and legitimate reasons that are supported by substantial evidence in the record."
Since Drs. Sahai and Pillai's opinions were contradicted by other objective medical evidence of record, the specific and legitimate standard applies.
According to the record, Dr. Sahai completed a student disability questionnaire in which he stated that based on x-rays, MRIs and physical exams, Plaintiff needed flexibility to stand at will and that her pain would cause some distraction. (Tr. at 486.)
The ALJ gave this assessment and the fact that Plaintiff was granted a disability parking identification little weight stating that other government agencies and private entities have a different set of requirements for determining disability. The ALJ properly noted that the Social Security Administration has its own determinations for permanent disability, giving a specific and legitimate reason for affording Dr. Sahai's opinion little weight.
The Court declines to discuss this argument at length as Plaintiff's ability to perform in the educational environment (or qualify for a disabled parking permit) does not necessarily bear on Plaintiff's residual functional capacity to perform work.
As to Dr. Pillai, he completed a check-the-box form stating Plaintiff had chronic back problems and was currently on medical treatment. He stated that Plaintiff had been disabled since 2011, but that her condition was not an emergency medical condition. Dr. Pillai stated Plaintiff had mental or physical limitations that prevented her from performing substantially gainful employment for which she is qualified. (Tr. at 22, 1105-06.) The record also contains a February 11, 2015 note from Dr. Pillai simply listing Plaintiff's conditions, and another note on July 30, 2008, stating that Plaintiff has severe neck pain, wrist pain, chest pain, and hypertension and needed to do half of the amount of work load that she had until evaluated later. (Tr. at 22, 1119, 823.)
The ALJ afforded Dr. Pillai's opinion that Plaintiff is disabled little weight his opinion was memorialized on a check-the-box form that provided little explanation. The ALJ found the opinion vague and general, and found that Dr. Pillai provided an ultimate conclusion regarding disability, which is a decision reserved for the Commissioner. The ALJ noted internal inconsistencies in Dr. Pillai's opinions, and also found that his notes in the record are vague and conclusory, and do not reflect Plaintiff's current symptoms or complaints.
The Court finds that the ALJ properly gave specific and legitimate reasons that are supported by substantial evidence in the record for affording Dr. Pillai's opinion little weight. An ALJ may properly reject the opinion of a treating physician "`if that opinion is brief, conclusory, and inadequately supported by clinical findings.'"
Where the ALJ improperly rejects a claimant's testimony regarding her limitations, and the claimant would be disabled if her testimony were credited, "we will not remand solely to allow the ALJ to make specific findings regarding that testimony."
"[R]emand for further proceedings is appropriate where there are outstanding issues that must be resolved before a determination can be made, and it is not clear from the record that the ALJ would be required to find claimant disabled if all the evidence were properly evaluated."
For the reasons discussed in this Order, the Commissioner's decision will be vacated and this matter will be remanded for further administrative proceedings consistent with this Order.
Accordingly,