JOHN E. McDERMOTT, Magistrate Judge.
On July 1, 2014, Vaughn Evans ("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 ("SSI") benefits. The Commissioner filed an Answer on October 22, 2014. On March 3, 2015, 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 before this Magistrate Judge. After reviewing the pleadings, transcripts, and administrative record ("AR"), the Court concludes that the Commissioner's decision must be reversed and this case remanded for further proceedings in accordance with this Memorandum Opinion and Order and with law.
Plaintiff is a 38-year-old male who applied for Supplemental Security Income benefits on April 29, 2011. (AR 15.) The ALJ determined that Plaintiff has not engaged in substantial gainful activity since April 29, 2011, the application date. (AR 17.)
Plaintiff's claim was denied initially on September 9, 2011. (AR 15.) Plaintiff filed a timely request for hearing, which was held before Administrative Law Judge ("ALJ") Alexander Weir, III on May 8, 2012 in Los Angeles, California. (AR 15.) Claimant appeared and testified at the hearing and was represented by counsel. (AR 15.) Vocational expert ("VE") Sandra Trost also appeared and testified at the hearing. (AR 15.)
The ALJ issued an unfavorable decision on June 15, 2012. (AR 15-25.) The Appeals Council denied review on May 2, 2014. (AR 1-3.)
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 29, 2011, the application date. (AR 17.)
At step two, the ALJ determined that Plaintiff has the following medically determinable severe impairments: back disorder, drug abuse and mood disorder; he also has asthma, which does not provide significant limitations on his ability to perform basic work activities and is not a severe impairment. (AR 17-18.)
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 18-19.)
The ALJ then found that Plaintiff has the RFC to perform medium work with the following additional limitations:
(AR 19-24.) In determining the above RFC, the ALJ made an adverse credibility determination. (AR 23.)
At step four, the ALJ found that Plaintiff is able to perform his past relevant work as a waiter, personal trainer, library assistant, automobile sander, and home attendant (as actually performed). (AR 24-25.)
Consequently, the ALJ found that Claimant was not disabled, within the meaning of the Social Security Act. (AR 25.)
The ALJ decision must be reversed. The ALJ's step one finding that Plaintiff engaged in substantial gainful activity and his step four finding that Plaintiff is capable of performing past relevant work are not supported by substantial evidence. The ALJ also failed to properly consider the evidence regarding Plaintiff's mental impairment and limitations. As a result, the ALJ's RFC is not supported by substantial evidence. The ALJ's nondisability determination is not supported by substantial evidence nor free of legal error.
Plaintiff contends that the ALJ erred in his step four PRW finding. The Court agrees.
Social Security regulations define past relevant work as "work that you have done in the past 15 years,
The Commissioner attempts to work around the ALJ's erroneous SGA finding by arguing that SGA earnings levels are not dispositive. 20 C.F.R. § 404.1571, for example, states that a claimant will be found not disabled if he or she is able to engage in substantial gainful activity. Section 1571 further states, "Even if the work you have done was not substantial gainful activity, it may show that you are able to do more work that you actually did." Section 1571 concludes by noting, "We will consider all of the medical and vocational evidence in your file to determine whether or not you have the ability to engage in substantial gainful activity." Section 1574(a)(1) provides that the primary consideration in determining SGA is earnings but the fact that earnings are not substantial "will not necessarily show that you are not able to do substantial gainful activity." Based on these regulations, the Commissioner argues that Plaintiff's prior work as a fitness consultant, library aid and waiter was essentially full time and shows he is capable of working at SGA levels even if his earnings from those jobs do not satisfy Social Security earnings guidelines in Section 1574(b).
There are several problems with the Commissioner's position. First, the Commissioner's analysis of Plaintiff's prior work does not appear in the ALJ's decision and cannot be considered here.
Second, a claimant has the burden of showing he or she cannot engage in past relevant work but a job qualifies as past relevant work only if it involved substantial gainful activity.
The ALJ's step one SGA finding and step four PRW finding are not supported by substantial evidence. If a claimant has no past relevant work, then the analysis moves to step five in which the ALJ determines if a claimant has the residual capacity to do other substantial gainful work. The ALJ here, however, made no step five finding in the alternative. Again, neither the Commissioner nor this Court can supply the findings required by the Regulations that the ALJ failed to make.
The ALJ's step one finding that Plaintiff engaged in substantial gainful activity and his step four finding that Plaintiff is capable of performing his past relevant work are not supported by substantial evidence.
Plaintiff contends that the ALJ did not properly consider the evidence of mental impairment and limitations. The Court agrees.
The ALJ's RFC is not a medical determination but 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.
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 found that Plaintiff has the severe impairment of mood disorder. (AR 17.) The ALJ relied on the July 25, 2011 opinion of consulting psychiatric examiner, Dr. Fahmy Ibrahim, for this diagnosis. (AR 20-21, 280-284.) Dr. Ibrahim found mild to moderate functional limitations (a) in Claimant's ability to interact with others, (2) ability to understand and carry out simple instructions, (3) ability to maintain focus and concentration, (4) ability to understand and carry out complex instructions and (5) ability to cop with workplace stress. (AR 20-21, 283.) Nonetheless, the ALJ's medium work RFC recognizes only moderate mental health limitations in performing complex instructions and in maintaining attention and concentration. (AR 19, 23.) The only physician opining to just those limitations is a State agency reviewing physician, Dr. R. E. Brooks. (AR 24, 78-79.)
The ALJ's mental health limitations are undermined by evidentiary insufficiency problems. First, the ALJ fails to provide specific, legitimate reasons for rejecting Dr. Ibrahim's other limitations based on the opinion of a State reviewing physician who never examined the Claimant. The ALJ's finding is especially puzzling because he says he gave great weight to Dr. Ibrahim's opinion. (AR 23-24.)
Second, the ALJ does not explain why he accepted Dr. Ibrahim's more limited diagnosis of mood disorder and rejected the more severe diagnoses of schizoaffective disorder and schizophrenia provided by other physicians. As the ALJ decision documents, medical records from the Los Angeles County Sheriff's Department from November 6, 2010 through May 2, 2011 indicate Plaintiff was treated for a schizoaffective disorder. (AR 20.) On September 8, 2010, Plaintiff was diagnosed with schizoaffective disorder by the West Central Family Mental Health Center. (AR 20.). Plaintiff was diagnosed with schizophrenia by the Exodus Recovery Urgent Care Center on September 3, 2010. (AR 21.) Dr. Kevin Christy, Ph.D., of the Los Angeles County Department of Mental Health diagnosed Plaintiff with schizoaffective disorder on December 28, 2011. (AR 333.) The March 13, 2012 joint report of Anthony Gaston, N.P., and Michelle Clark, M.D., indicates Plaintiff was diagnosed with schizoaffective disorder. (AR 22.) The ALJ failed to provide specific, legitimate reasons for rejecting these repeated diagnoses of schizoaffective disorder from treating physicians.
Third, the ALJ failed to provide specific, legitimate reasons for rejecting the joint opinion of Mr. Gaston and Dr. Clark set forth in a March 13, 2012 Mental Residual Functional Capacity Questionnaire. (AR 314-319.) They opined that Plaintiff had marked limitations in maintaining attention and concentration for extended periods, in sustaining an ordinary routine without special supervision and in completing a work week without interruptions. (AR 22, 317-318.) They opined Plaintiff would be absent from work for four days a month (AR 318), which would preclude all work. The ALJ gave the Questionnaire little weight because "neither Dr. Clark nor Nurse Gaston has provided any treatment to the Claimant" and their opinions are "not supported by any records of treatment." (AR 22.) It is simply untrue that Dr. Clark and Nurse Gaston did not treat Plaintiff as the Commissioner now concedes. It is also untrue that there are no records of treatment. Numerous treatment notes document assessments of Plaintiff's mental impairment and the prescription of psychotropic medications, specifically Wellbutrin and Serroquel. (AR 248-252, 256, 268-77, 333, 344-346.) The Commissioner argues that the ALJ's error was harmless because the Questionnaire submitted by Mr. Gaston and Dr. Clark was a check box opinion without objective findings. Their questionnaire, however, is supported by the treatment records described above. The Court also notes that Dr. Brooks' September 1, 2011 opinion (AR 79) and Dr. Ibrahim's July 25, 2011 opinion (AR 20) predate the RFC assessment of Mr. Gaston and Dr. Clark. The ALJ did not provide specific, legitimate reasons for rejecting the joint opinion of Mr. Gaston and Dr. Clark.
The ALJ's RFC is not supported by substantial evidence.
The ALJ's nondisability decision is not supported by substantial evidence nor free from legal error.
IT IS HEREBY ORDERED that Judgment be entered reversing the decision of the Commissioner of Social Security and remanding this case for further proceedings in accordance with this Memorandum Opinion and Order and with law.