JOHN E. MCDERMOTT, Magistrate Judge.
On June 24, 2016, Ronald Richardson ("Plaintiff" or "Claimant") filed a complaint seeking review of the decision by the Commissioner of Social Security ("Commissioner") denying Plaintiff's application for Supplemental Security Income benefits. The Commissioner filed an Answer on October 31, 2016. On October 3, 2017, the parties filed a Joint Stipulation ("JS"). The matter is now ready for decision.
Pursuant to 28 U.S.C. § 636(c), both parties consented to proceed bef ore this Magistrate Judge. After reviewing the pleadings, transcripts, and administrative record ("AR"), the Court concludes that the Commissioner's decision must be affirmed and this case dismissed with prejudice.
Plaintiff is a 57 year-old male who applied for Supplemental Security Income benefits on April 22, 2013, alleging disability beginning January 1, 1995. (AR 34.) Plaintiff subsequently submitted a written request on March 21, 2014, to amend the onset date from January 1, 1995, to the application filing date of April 22, 2013. (AR 34.) The ALJ determined that Plaintiff has not engaged in substantial gainful activity since April 22, 2013, the application date. (AR 38.)
Plaintiff's claim was denied initially on November 6, 2013. (AR 34.) Plaintiff filed a timely request for hearing, which was held before Administrative Law Judge ("ALJ") Alexander Weir III on July 31, 2014, in Los Angeles, California. (AR 34.) Plaintiff appeared and testified at the hearing and was represented by counsel. (AR 34.) Vocational expert ("VE") Sandra Trost also appeared and testified at the hearing. (AR 34.)
The ALJ issued an unfavorable decision on August 18, 2014. (AR 34-51.) The Appeals Council denied review on April 27, 2016. (AR 1-4.)
As reflected in the Joint Stipulation, Plaintiff raises the following disputed issues as grounds for reversal and remand:
Under 42 U.S.C. § 405(g), this Court reviews the ALJ's decision to determine whether the ALJ's findings are supported by substantial evidence and free of legal error.
Substantial evidence means "`more than a mere scintilla,' but less than a preponderance."
This Court must review the record as a whole and consider adverse as well as supporting evidence.
The Social Security Act defines disability as the "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 . . . can be expected to last for a continuous period of not less than 12 months." 42 U.S.C. §§ 423(d)(1)(A), 1382c(a)(3)(A). The Commissioner has established a five-step sequential process to determine whether a claimant is disabled. 20 C.F.R. §§ 404.1520, 416.920.
The first step is to determine whether the claimant is presently engaging in substantial gainful activity.
If the claimant cannot perform his or her past relevant work or has no past relevant work, the ALJ proceeds to the fifth step and must determine whether the impairment prevents the claimant from performing any other substantial gainful activity.
In this case, the ALJ determined at step one of the sequential process that Plaintiff has not engaged in substantial gainful activity since April 22, 2013, the application date. (AR 38.)
At step two, the ALJ determined that Plaintiff has the following medically determinable severe impairments: human immunodeficiency virus ("HIV") infection, asymptomatic; hepatitis C; left blind eye; left ear deaf; mood disorder, not otherwise specified; and poly-substance dependence. (AR 38-40.) The ALJ also found that Plaintiff has the nonsevere impairment of Bell's palsy. (AR 38.)
At step three, the ALJ determined that Plaintiff does not have an impairment or combination of impairments that meets or medically equals the severity of one of the listed impairments. (AR 40-45.)
The ALJ then found that Plaintiff had the RFC to perform medium work with the following limitations:
(AR 45-49.) In determining the above RFC, the ALJ made a determination that Plaintiff's subjective symptom allegations were "not entirely credible," which Plaintiff does not challenge here. (AR 47-49.)
At step four, the ALJ found that Plaintiff has no past relevant work. (AR 49.) The ALJ, however, also found that, considering the Claimant's age, education and RFC, there are jobs that exist in significant numbers in the national economy that the Claimant can perform, including the jobs of warehouse worker and kitchen helper. (AR 49-50.)
Consequently, the ALJ found that Claimant is not disabled, within the meaning of the Social Security Act. (AR 51.)
Plaintiff was found not disabled in a prior administrative law judge decision of April 18, 2012. (AR 34.) Although Plaintiff was found to have the medically determinable impairments of HIV infection, hepatitis C, mood disorder, and schizophrenia (AR 96), these impairments were found not to be severe and Plaintiff, therefore, not disabled through the April 18, 2012 date of decision. (AR 34, 96, 101.) The new ALJ found no basis to reopen and revise this prior determination. (AR 34.)
In this proceeding, the ALJ found that Plaintiff showed changed circumstances showing greater disability since the April 18, 2012 ALJ decision to overcome the presumption of continuing nondisability.
Plaintiff claims he is unable to work because of schizophrenia, mental impairments, HIV infection, and high blood pressure (AR 46), but the ALJ found that the medical evidence disclosed that Plaintiff's impairments were well controlled with medication and asymptomatic with compliance. (AR 47.) Prison treatment records from 2012 show an undetectable HIV viral load and that Plaintiff's HIV, hepatitis, and hypertension were stable, well controlled, and asymptomatic. (AR 46.) Treating records from Hubert Humphrey Comprehensive Health Center ("HHC") for 2013 and 2014 reflect insignificant findings and chiefly normal results. (AR 46-47.) Dr. Concepcion Enriquez, a consulting internist, examined Plaintiff on October 30, 2013, and diagnosed HIV infection absent any lesions and hepatitis C absent liver stigmata. (AR 47.) She opined that Plaintiff could lift up to 50 pounds, and stand, walk, and sit each for 6 hours in an 8 hour workday. (AR 47.) On October 31, 2013, State agency medical consultant Dr. Bill F. Payne determined the record fails to establish any severe impairment; indeed, he found the record is insufficient to make any such determination. (AR 47.)
The ALJ's RFC is further supported by an adverse credibility finding which Plaintiff does not challenge. The ALJ found that Plaintiff's subjective symptom allegations were inconsistent with the objective medical evidence. (AR 47.) An ALJ is permitted to consider whether there is a lack of medical evidence to corroborate a claimant's alleged symptoms so long as it is not the only reason for discounting a claimant's credibility.
At the July 31, 2014 hearing, the ALJ ruled that the record would remain open until August 7, 2014, for submission of additional medical evidence but none was submitted by that date. (AR 34.) Plaintiff did submit for the first time to the Appeals Council after the ALJ decision a two page check the box RFC Questionnaire from Dr. Stephen Puentes dated January 16, 2015. (AR 410-411.) Dr. Puentes diagnosed Plaintiff with extreme stabismus (double vision), symptomatic HIV, and chronic active Hepatitis C. (AR 411.) Dr. Puentes found that Plaintiff could lift up to 10 pounds only occasionally, could sit, stand and walk only 2 hours in an 8 hour work day, and had other limitations that precluded all but part-time work. (AR 410.) Dr. Puentes further opined that the limitations he assessed relate back to July 19, 2010. (AR 411.)
The Appeals Council found that Dr. Puentes' RFC assessment "does not provide a basis for changing the Administrative Law Judge's decision." (AR 2.) The Appeals Council also found that Dr. Puentes' assessment is about a later time and does not affect the decision whether Plaintiff was disabled before August 18, 2014.
This Court has no jurisdiction to review the decision of the Appeals Council denying review.
Nothing in the record through the date of the August 18, 2014 ALJ decision suggests that Plaintiff had the sort of limitations found by Dr. Puentes. Dr. Puentes provides no factual basis whatsoever for attributing his January 2015 opinions to that earlier time period. An ALJ may reject a treating physician's opinion that does not have supportive evidence, is contradicted by other assessments, is unsupported by the record as a whole, and is unsupported by or inconsistent with his or her treatment notes.
Plaintiff's argument that the ALJ did not consider Dr. Puentes' opinion is of no consequence. The Court under
Plaintiff contends that the ALJ improperly rejected Dr. Hindman's assessment of Plaintiff's mental impairments. The Court disagrees.
The ALJ's RFC is not a medical determination but is an administrative finding or legal decision reserved to the Commissioner based on consideration of all the relevant evidence, including medical evidence, lay witnesses, and subjective symptoms. See SSR 96-5p; 20 C.F.R. § 1527(e). In determining a claimant's RFC, an ALJ must consider all relevant evidence in the record, including medical records, lay evidence, and the effects of symptoms, including pain reasonably attributable to the medical condition. Robbins, 446 F.3d at 883.
In evaluating medical opinions, the case law and regulations distinguish among the opinions of three types of physicians: (1) those who treat the claimant (treating physicians); (2) those who examine but do not treat the claimant (examining physicians); and (3) those who neither examine nor treat the claimant (non-examining, or consulting, physicians).
Where a treating doctor's opinion is not contradicted by another doctor, it may be rejected only for "clear and convincing" reasons.
The ALJ rejected the opinions of Dr. David Hindman, Ph.D., for specific, legitimate reasons supported by substantial evidence. The primary reason that the ALJ rejected Dr. Hindman's opinions that Plaintiff has serious mental limitations is because those opinions are unsupported or contradicted by his treating notes which indicate mental impairments that result in some mild to moderate functional limitations. (AR 43.) As already noted, an ALJ may reject a physician's opinion if it is contradicted by or unsupported by his or her treatment notes,
Here, Dr. David Hindman diagnosed Plaintiff with schizophrenia and a relational problem, but underlying treatment notes indicate mood disorder. (AR 42-43.) Dr. Hindman noted a prison diagnosis of schizophrenia (AR 391), but there is nothing in the medical records to indicate Plaintiff suffered from symptoms of schizophrenia during the relevant time period. Dr. Hindman stated Plaintiff had one to two episodes of decompensation lasting at least two weeks. (AR 387.) Yet there is no evidence in the record that Plaintiff has had any episodes of decompensation. Dr. Hindman found Plaintiff had no limits in getting along with co-workers and peers and in maintaining socially appropriate behavior and limited but satisfactory interaction with the general public. (AR 386.) In a contradictory finding, Dr. Hindman indicated Plaintiff had moderate difficulties in social functioning. (AR 387) Dr. Hindman found serious limitation in performing simple tasks but zero to mild limitation in daily activities. (AR 43.)
Other evidence supports the ALJ decision. In October 2013, State agency reviewer Dr. Bill Payne determined that the record fails to establish the existence of any severe mental impairment. (AR 43-44, 47-48.) Plaintiff himself reported that medication "helps" and allows him to stay "calm and think." (AR 43.) Impairments controlled by medication are not disabling.
Plaintiff disagrees with the ALJ's interpretation of the evidence, but it is the ALJ's responsibility to resolve conflicts in the medical evidence and ambiguities in the record.
The ALJ rejected Dr. Hindman's opinions for specific, legitimate reasons supported by substantial evidence. The ALJ's RFC is supported by substantial evidence.
The ALJ's nondisability determination is supported by substantial evidence and free of legal error.
The ALJ has offered an independent, alternative basis to find Plaintiff not disabled. The ALJ found that Claimant failed to provide any explanation why he failed to be present to the consulting psychiatric examination. (AR 40, 80-82.) The Commissioner may find a claimant not disabled for failing to attend a consultative examination without good reason. 20 C.F.R. § 416.918(a).
The ALJ repeatedly asked Plaintiff at the hearing why he did not attend the scheduled consulting examination but Plaintiff failed to provide any reason for not attending. (AR 80-82.) Plaintiff suggests he did not understand the ALJ's questions because of his alleged mental impairments but the ALJ specifically found that Plaintiff's presentation at the hearing "was that of an attentive witness who did not appear to have noticeable deficits." (AR 48.) The ALJ, moreover, found Plaintiff's testimony was not credible, a finding Plaintiff does not challenge. (AR 41.)
Again, it is the ALJ's responsibility to resolve ambiguities in the record.
In any event, even if the ALJ's finding was in error, the error was harmless because of the alternate finding that Plaintiff was not disabled due to his ability to perform work in the national economy.
The ALJ's nondisability determination is supported by substantial evidence and free of legal error.
IT IS HEREBY ORDERED that Judgment be entered affirming the decision of the Commissioner of Social Security and dismissing this case with prejudice.