KAREN E. SCOTT, Magistrate Judge.
Plaintiff Danny R. ("Plaintiff") applied for Supplemental Security Income disability benefits on August 2, 2014, alleging disability commencing January 1, 2012, when he was 46 years old. Administrative Record ("AR") 172-76. An Administrative Law Judge ("ALJ") conducted a hearing on July 10, 2017, at which Plaintiff, who was represented by an attorney, appeared and testified, as did a vocational expert ("VE"). AR 59-83.
On August 25, 2017, the ALJ issued an unfavorable decision. AR 13-29. The ALJ found that Plaintiff suffered from severe impairments of "peripheral neuropathy, cholecystitis, osteoarthritis in bilateral hands, and schizoaffective disorder." AR 18. Despite these impairments, the ALJ found that Plaintiff had a residual functional capacity ("RFC") to perform light work as defined in 20 C.F.R. § 416.967(b) with some additional manipulative, postural, and mental restrictions, including the following: "Assigned work must be limited to simple tasks learned in 30 days or less or by brief demonstration. The assigned tasks must have minimal change in the tasks as assigned and require less than occasional (little to no) travel to unfamiliar places." AR 21.
Based on the RFC and the VE's testimony, the ALJ found that Plaintiff could not do his past relevant work (which included working as an industrial truck operator, auto detailer, and landscaper), but he could work as a cashier (Dictionary of Occupational Titles ["DOT"] 211.462-010), electronics worker (DOT 726.687-010), and mail clerk (DOT 209.687-026). AR 23-25. The ALJ concluded that Plaintiff was not disabled. AR 25.
For the reasons discussed below, the ALJ erred as to Issue One, and remand for further administrative proceedings is appropriate. However, this Opinion discusses all of the issues raised by Plaintiff because the Court believes that discussion will help guide the ALJ during proceedings on remand. For ease of discussion, the Court addresses Issues Two and Three first, then turns to Issue One.
The ALJ gave "great" weight to the opinions of state agency consultants Drs. Hughes and Jacobs concerning Plaintiff's physical impairments. AR 22. Dr. Hughes found that Plaintiff could "stand and/or walk" about six hours in and eight-hour workday with normal breaks. AR 93. Dr. Hughes commented that Plaintiff's impairments would preclude "constant standing and walking" but he "would be capable of standing and walking for six hours with routine breaks." AR 95. These limitations were found consistent with "light" work. AR 96. Dr. Jacobs agreed. AR 106-09.
The ALJ's initial hypothetical question to the VE did not specify an exertional level or a limit on standing/walking. AR 77-78. The ALJ then clarified that the hypothetical worker was limited to "light exertional" work.
The ALJ's RFC determination refers to "light work as defined by 20 C.F.R. § 416.967(b)" but does not otherwise specify a limit on standing or walking. AR 21. The cited regulation defines light work as follows:
20 C.F.R. § 416.967(b) (2017).
SSR 83-10, 1983 SSR LEXIS 30, 1983 WL 31251 (Jan. 1, 1983).
Plaintiff contends that by limiting him to "light" work, the ALJ did not effectively limit him to walking or standing for six hours/day and did not give any reason for rejecting the opinions of Drs. Hughes and Jacobs that he could only walk or stand for six hours/day. According to Plaintiff, since "light" work requires walking or standing during two-thirds of the workday (i.e., for six hours) to accomplish "frequent" lifting/carrying, and sitting is only "intermittent" during the remaining third of the workday, then light work logically requires more than six hours of walking/standing. (JS at 17-22.)
Courts, however, have generally interpreted the above-cited authorities as establishing that "light" work is consistent with a limitation to standing or walking for six hours/day.
Thus, in finding that Plaintiff could do "light" work, the ALJ did not "reject" the opinions of Drs. Hughes and Jacobs. Plaintiff is not entitled to relief on Issue Two.
The ALJ limited Plaintiff to "simple tasks." AR 21. A limitation to simple, repetitive tasks conflicts with doing work rated by the DOT as requiring reasoning level 3.
Defendant argues that any error was harmless because the electronics worker position (DOT 726.687-010) only requires level 2 reasoning and the VE testified that there were 206,000 such jobs in the national economy (AR 81), which is sufficiently numerous to constitute a significant number of jobs. (JS at 37).
The DOT classifies this job under the category of jobs involving assembly and repair of electronic equipment. Typical tasks include cleaning and preparing components for assembly, trimming molded parts, applying coatings, cutting wires, fastening components together, and moving parts around a production facility. DOT 726.687-010.
Plaintiff argues that the ALJ erred in finding that he could work as an electronics worker because that job requires (1) a high school degree, which he does not have, and (2) training in excess of the limits in his RFC. (JS at 26-32.) He also argues that the VE's testimony concerning the number of available jobs is unreliable. (JS at 34.)
The ALJ asked the VE to assume that the hypothetical individual had the same educational background as Plaintiff.
Another reference publication, the Occupational Outlook Handbook ("OOH"), lists "high school diploma or equivalent" as the "typical" educational requirement for entry-level positions for production workers, a group that would include electronics workers. (JS at 27-28.) The Commissioner "will take administrative notice" of job information from the OOH. 20 C.F.R. § 416.966(d)(5). Plaintiff argues that this regulation means that the ALJ was compelled to ask the VE if his testimony conflicted with the OOH, or that the ALJ's finding that Plaintiff could work as an electronics worker lacks substantial evidentiary support because it conflicts with the OOH. (JS at 31-32.)
In
Further, because the ALJ had no independent duty to consider the existence of conflict between the OOH and the VE's testimony, Plaintiff was required to raise the issue at the administrative hearing. Plaintiff could have cross-examined the VE concerning the alleged conflicts between his educational background and the OOH, but he did not. AR 82-83. The failure to do so means that the issue is now waived.
The DOT rates the electronics worker job as having a specific vocational preparation ("SVP") of 2. SVP levels are defined in the DOT as "the amount of lapsed time required by a typical worker to learn the techniques, acquire the information, and develop the facility needed for average performance in a specific job-worker situation."
Thus, the VE's testimony was consistent with the DOT, and the ALJ was entitled to rely on it to find that the training requirements for the electronics worker job were consistent with Plaintiff's RFC. Plaintiff's arguments to the contrary fail for the same reasons stated in the "Educational Requirements" section above.
Plaintiff argues that the VE's testimony that there are 206,000 electronics worker jobs available came from the 2013 Occupational Employment Statistics. (JS at 34.) According to Plaintiff, this testimony overstated the real number, because (1) it is from 2013, and the OOH rates production worker jobs as having a "slower than average" growth rate, and (2) it applies to the whole range of production workers, not just electronics workers. (JS at 28-34.) As a result of the overstatement, Plaintiff argues, the ALJ's finding of 206,000 available jobs (AR 25) lacks substantial evidentiary support.
Plaintiff's counsel raised none of this at the hearing where the VE could have addressed it. Plaintiff argues that this did not create a waiver, because the number of electronics workers jobs was not critical until the Court found that the two other suggested jobs, as described by the DOT, conflicted with Plaintiff's RFC. (JS at 34-35.) Plaintiff relies on
However, the unpublished decision in
After Plaintiff applied for benefits, the state agency arranged for a psychiatric evaluation in December 2014; Plaintiff failed to appear. AR 283. Plaintiff also failed to appear at the internal medicine evaluation. AR 284. (
Plaintiff's doctors noted no abnormal psychological symptoms in March, April, and June 2014, and February 2015. AR 360, 389-93, 396.
In early 2015, he spent time in prison.
Plaintiff visited the CHSB ER twice more in 2015 for physical problems and did not report mental health symptoms. AR 483-84, 488. He was observed to have "normal judgment" and "appropriate mood and affect," but he was also noted to be a "poor historian." AR 485, 489.
Records from CHSB (AR 424-94) and Arrowhead Regional Medical Center ("Arrowhead") (AR 495-570) show that, in 2016 and 2017, Plaintiff sought treatment for and was hospitalized multiple times for mental health crises.
The first hospitalization was March 5-7, 2016, when Plaintiff was voluntarily admitted for depression with "methamphetamine and marijuana abuse." AR 481. After he was "stabilized on Zoloft," he was observed to have "fair" insight, judgment, and impulse control.
On April 20, 2016, Linda Lay, DO, of the Phoenix Clinic completed a questionnaire about Plaintiff's ability to do work-related mental activities. AR 413-14;
Of particular relevance to his ability to maintain substantial gainful activity, Dr. Lay opined that Plaintiff's abilities in the following areas were "seriously limited": (a) maintaining attention for 2-hour segments, (b) sustaining an ordinary routine without special supervision, (c) completing a normal workday or work week without interruption from psychologically based symptoms, and (d) accepting instructions and responding appropriately to criticism from supervisors.
The second hospitalization was on May 11-21, 2016. AR 548. Dr. Lay found that Plaintiff was a danger to himself and referred him to Arrowhead for a psychiatric evaluation . AR 531, 540-41. Plaintiff reported that he had tried to hang himself over the weekend and was increasingly depressed by his sister's decision to evict him and seek a restraining order. AR 540. He also reported a "command auditory hallucination of his deceased mother telling him to kill himself," which he thought "was possibly from not being able to sleep."
On May 25, 2016, four days after his discharge from Arrowhead, Plaintiff visited the CHSB ER seeking treatment for depression. AR 477. He reported suffering from depression for 4-5 years.
Plaintiff was hospitalized for a third time as a danger to self on May 29-June 4, 2016. AR 474. The hospital noted "noncompliance and substance abuse" as precipitating factors, but did not explain the "noncompliance" comment or list his then-prescribed medications.
Plaintiff was hospitalized for a fourth time on June 20-24, 2016. AR 467. He reported to the CHSB ER that he had auditory hallucinations, suicidal ideation, and "want[ed] to overdose on his medication." AR 469. The ER staff nevertheless observed that he was "calm and cooperative" and "in no visible distress." AR 469. He said he had "been on the street" and had not taken his medication "in the last few days." AR 469, 472. The hospital again diagnosed depression and methamphetamine dependence.
Plaintiff returned to the CHSB ER nine days later, and he was hospitalized for a fifth time from June 29-July 5, 2016. He complained of suicidal thoughts and "hear[ing] voices." AR 461. He reported being off his psychiatric medications for 3 days because he ran out. AR 461, 465. He was admitted and given Seroquel, Zoloft, and hydroxyzine.
Plaintiff was admitted to the hospital for a sixth time from July 26-August 1, 2016. AR 517. His admitting diagnosis was "major depressive disorder with recurrent severe and psychotic features." AR 517, 524. He presented as "disheveled and dirty" with mumbling speech, no teeth, auditory hallucinations, and impaired judgment. AR 524, 529. He reported "suicidal ideation with the plan to hang himself or to overdose on unspecified medication" and "positive command auditory hallucinations telling him to hurt himself." AR 523. He reported that he had been off his medications "for several weeks" because they were at his sister's house and she had evicted him. AR 517. He was discharged after he was observed to be "calm" and "cooperative" and denied any hallucinations or suicidal ideation.
Plaintiff was admitted to CHSB's psychiatric ward for the seventh time between August 10-19, 2016. AR 447, 456. He reported to the ER that he had been hearing voices for 8 days telling him to kill himself. AR 447. He admitted being "off medications," and he tested positive for cannabinoid use.
It appears Plaintiff did not receive any mental health treatment for nearly 5 months after being discharged in August 2016. However, he was hospitalized for the eighth time on January 3-8, 2017 as a danger to self with "severe" symptoms. AR 424. He reported to the CHSB ER that he had been hearing voices for three months and had suicidal ideations. AR 427. The hospital noted "noncompliance" and amphetamine and cannabis use. AR 424; AR 427 ("Pt has been off his medications x months."); AR 435 ("history of hearing voices due to methamphetamine use"). At the time, he was homeless. AR 435. Although it was two days after the New Year's Day holiday, he told doctors that he did not know what month it was. AR 436. He was treated with Risperdal and Zoloft. AR 425. Upon discharge, he was working with a social worker to receive additional support. AR 424.
About a week later, on January 14, 2017, Plaintiff was brought to Arrowhead for a psychiatric evaluation after he "called 911," "threatening to run into the traffic" and "jump off the bridge." AR 506. His symptoms were "severe" and "acute" including suicidal ideation. AR 495. He was "yelling, screaming, [and] cursing" and deemed a danger to self and others. AR 506. He presented with hostility and paranoid delusions. AR 510. He was admitted to the behavioral health unit on a 72-hour suicide hold. AR 499.
Plaintiff reported that he had been "off medication for a few months." AR 506, 513. He was prescribed more medications. AR 506. He was still homeless at that time. AR 506, 508. His doctor assessed that he was "unable/unwilling to comply with medication schedule without repeated prompting," was "unable to provide basic self care" such as "acquiring medication," and was "unable to understand [the] seriousness of [his mental] illness [and the] need for treatment...." AR 511.
He was discharged on January 18, 2017. AR 513. The discharge examiner noted that Plaintiff had "improved," that there "were no problems between [Plaintiff] and staff or between [Plaintiff] and other patients," and that he no longer felt suicidal or experienced hallucinations.
At the hearing before the ALJ on July 10, 2017, when asked why he could not work, Plaintiff did not mention his mental health. AR 67. He testified that he was taking mental health medication and smoking marijuana to treat his pain. AR 68. He described physical and emotional abuse during his childhood that caused him to feel depressed and suicidal. AR 71-72 (testifying that his mother "had [his] brother hit [him] in the face with pipe" and "hit [him] in the head with a shovel," and that his brother "stabbed [him] six times, shot [him] once, [and] tried to burn [him]");
In his Function Report, he stated that he enjoyed watching movies on TV "all through the day." AR 212. He would take someone with him to medical appointments because he could not understand the paperwork. AR 212. He reported impairments in remembering, concentrating, understanding, following instructions, and getting along with others. AR 213. He attributed some of his mental impairments to being hit in the face with a pipe by his brother in the 1990s. AR 71, 215, 393.
The ALJ found that Plaintiff suffers from schizoaffective disorder. AR 18. She also found that Plaintiff was mildly limited in social interactions and moderately limited in the other three functional areas affected by mental illness: (1) understanding, remembering, or applying information, (2) maintaining concentration, persistence, or pace, and (3) managing or adapting himself. AR 20.
The ALJ summarized some of Plaintiff's hospitalization records for mental health issues. AR 22-23. The ALJ characterized the records as showing that the exacerbation of his symptoms was due to "chemical dependence and noncompliance with psychiatric medications," and that his symptoms "showed significant improvement" by the time of discharge. AR 23. She concluded, "This evidence strongly suggests these symptoms with proper medication adherence are not as severe as alleged."
Because the state agency consultants only addressed Plaintiff's physical impairments and Plaintiff did not attend the scheduled psychological consultative examination, Dr. Lay is the only medical source who offered opinions about how Plaintiff's mental illness affected his functional abilities. Nevertheless, the ALJ gave "little weight" to Dr. Lay's questionnaire.
ALJs must consider the following factors in deciding how much weight to give medical opinion evidence: (1) the length and nature of the medical source's relationship with the patient, (2) whether the medical source identified supporting medical signs and laboratory findings, (3) whether the opinion is consistent with other evidence in the record, and (4) the medical source's specialization. 20 CFR § 416.927; SSR 96-2p, 1996 WL 374188 (July 2, 1996). ALJs need not discuss each factor in their written decisions, but they commit legal error if their decisions about weighing medical opinions lack substantial evidentiary support.
Here, it appears that Dr. Lay treated Plaintiff at the Phoenix Clinic. In April 2016, she was willing to complete the functional questionnaire. AR AR 413-14. In May 2016, she authorized a 5150 hold and referred him to Arrowhead where Dr. Pham agreed that he was a danger to self and admitted him for 10 days. AR 531, 540-41.
The Court did not see — and the parties did not cite — any treating records from the Phoenix Clinic in the AR. Due to the lack of records, the ALJ correctly concluded that it is "unclear" how long Dr. Lay had a treating relationship with Plaintiff. It is similarly unclear, however, which treating doctor had the best longitudinal view of Plaintiff's mental health, because the manner in which he sought treatment (i.e., frequent visits to the ER) caused him to obtain treatment from many different medical sources.
The ALJ also correctly concluded that Dr. Lay did not explain her opinions in the questionnaire. Her opinions, however, have some degree of consistency with Plaintiff's treating records and even the RFC determined by the ALJ. For example, both Dr. Lay and the ALJ determined that Plaintiff could do simple tasks but had trouble traveling to new places. AR 20-23, 414.
Ultimately, the Court does not decide whether the ALJ erred in evaluating Dr. Lay's opinion because other legal error, discussed below, requires remand.
Plaintiff argues that the RFC determined by the ALJ does not adequately account for the functional limitations caused by Plaintiff's mental impairments. (JS at 9-11.) The ALJ found that Plaintiff has moderate difficulty maintaining concentration, persistence, and pace. AR 20. The RFC, however, does not restrict Plaintiff against working in a fast-paced environment. AR 21. To the contrary, the one job that is not inconsistent with "simple" work (i.e., the electronics worker position) involves assembly tasks, per the DOT.
Courts have held that a step two finding of a moderate limitation in the ability to maintain persistence or pace is not necessarily accommodated by within a limitation to simple, routine, and repetitive tasks.
Relying on
For these reasons, the ALJ erred in not restricting Plaintiff against fast-paced work. The Court cannot conclude that the error was harmless, because a restriction against fast-paced work may significantly erode the number of electronics worker jobs available. Remand for further proceedings, rather than remand for an award of benefits, is appropriate because it is not clear from the record that Plaintiff is entitled to benefits.
For the reasons stated above, IT IS ORDERED that the decision of the Social Security Administration is reversed, and this matter is remanded for further proceedings consistent with this Opinion.