ANDREW J. WISTRICH, Magistrate Judge.
Plaintiff filed this action seeking reversal of the decision of defendant, the Commissioner of the Social Security Administration (the "Commissioner"), denying plaintiff's application for disability insurance benefits. The parties have filed a Joint Stipulation ("JS") setting forth their contentions with respect to each disputed issue.
The parties are familiar with the procedural facts, which are summarized in the Joint Stipulation. [
The Commissioner's denial of benefits should be disturbed only if it is not supported by substantial evidence or is based on legal error.
Plaintiff contends that the ALJ erred in evaluating the opinions of treating physician Khalid Ahmed, M.D., examining physician Manikanda Raja, M.D., and examining psychologists Loren Green, Ph.D. and Gene Burg, Ph.D. [JS 6-28].
A treating or examining physician's opinion is not binding on the Commissioner with respect to the existence of an impairment or the ultimate issue of disability.
The ALJ must provide clear and convincing reasons, supported by substantial evidence in the record, for rejecting an uncontroverted treating source opinion. If contradicted by that of another doctor, a treating or examining source opinion may be rejected for specific and legitimate reasons that are based on substantial evidence in the record.
The record in this case contains numerous conflicting medical treating, examining, and nonexamining source opinions. Accordingly, the ALJ was entitled to reject the treating and examining source opinions so long as he articulated specific and legitimate reasons supported by substantial evidence for doing so.
Dr. Ahmed, an orthopedist, treated plaintiff from May 2009 to December 2011 in connection with a work-related injury that was the subject of a workers' compensation case. [AR 29, 32, 861-905, 955-971, 983-986, 988-990, 1005-1007, 1013-1016]. In April 2010, Dr. Ahmed completed a multiple impairment questionnaire diagnosing plaintiff with cervical and lumbar disc herniation with radiculopathy, bilateral shoulder impingement, and mid-back strain. In support of those diagnoses, he cited a cervical spine MRI that was positive for disc protrusion and a shoulder MRI showing impingement syndrome. [AR 964-965]. He opined that plaintiff had numerous work-related functional limitations that effectively would preclude all work, including a likelihood that she would miss work more than three times a month due to her impairments. [AR 969-970].
In disability opinion letters dated August 2010 and December 2011, Dr. Ahmed reiterated his diagnoses and said that he based those diagnoses on MRIs and EMG/NCV (electromyography and nerve conduction velocity) studies. He noted that plaintiff also had migraine headaches, and that he was treating her with medications. He opined that plaintiff was unable to work and should receive social security disability benefits. He also said that plaintiff was a candidate for cervical and lumbar spine surgery (cervical and lumbar arthrodesis with spinal instrumentation) and shoulder surgery (arthroscopic subacromial decompression), and that he had requested permission from the workers' compensation carrier to undertake those procedures. [AR 985-986, 1014-1016].
The ALJ articulated several reasons for rejecting Dr. Ahmed's disability opinions. First, he noted that Dr. Ahmed's disability opinion is not controlling and, under the Commissioner's regulations, is not entitled to the deference otherwise afforded a treating source opinion. Although Ninth Circuit law holds that a treating source opinion on the ultimate issue of disability is not binding on the Commissioner, the ALJ still must articulate specific, legitimate reasons supported by the record for rejecting a controverted treating source opinion.
Second, the ALJ noted that the record lacked objective medical evidence supporting Dr. Ahmed's opinion that plaintiff's limitations were of disabling severity. Dr. Ahmed said that he based his disability opinion on MRI and EMG/NCV studies, but he did not specify the date of those studies. MRIs of plaintiff's lumbar spine taken in March 2009 and May 2009 at Dr. Ahmed's request were normal and revealed no evidence of disc herniation. Plaintiff's May 2009 left shoulder MRI was also normal.[AR 30-32, 888-889]. A May 2009 right shoulder MRI taken at Dr. Ahmed's request showed evidence of mechanical impingement but was not definitive; "clinical correlation [was] needed. . . ." [AR 890]. A June 2008 thoracic and cervical spine MRI report that Dr. Ahmed cited in his "permanent and stationary" workers' compensation reports showed only "mild degenerative disc changes" at C4/5 and "subtle" disc protrusion at C4/5 through C6/7. [
Third, the ALJ noted that Dr. Ahmed's opinion was inconsistent with the record as a whole. [AR 35]. Generalizing about the record in this case is difficult due to its size and the number of medical opinions it contains; however, the ALJ did not err in concluding that Dr. Ahmed's opinion was inconsistent with other substantial treating and examining source evidence. Ian Brodie, M.D., another workers' compensation treating physician who reviewed the same imaging and diagnostic test results that Dr. Ahmed reviewed, who read reports from Dr. Ahmed, and who conducted his own physical and neurological examinations, reached very different conclusions about plaintiff's diagnoses and functional capacity. [AR 836-860]. He opined that plaintiff had post concussion headaches, chronic sprain/strain of the cervical spine with radiculopathy into the left upper extremity, and chronic sprain/strain of the thoracolumbar spine with midthoracic degenerative disc disease. The only work restrictions he advised were a restriction from repetitive upward gaze and rotational movements of the head and neck. [AR 840-841]. A workers' compensation qualified medical examiner, Selwyn J. Patrick, M.D., conducted a comprehensive medical records review and performed his own physical and neurological examination, which yielded independent clinical findings that differed from those of Dr. Ahmed. [AR 816-835]. Dr. Patrick's diagnoses were status post closed head trauma without loss of consciousness, slight posttraumatic head syndrome/analgesic rebound headaches, and musculoligamentous sprain of the cervical and lumbar spine. Dr. Patrick opined that plaintiff should be precluded from working at heights or on ladders and from working around dangerous and moving machinery. [AR 830]. Accordingly, the ALJ did not err in rejecting Dr. Ahmed's opinion in part because it is inconsistent with substantial medical evidence in the record as a whole.
Fourth, the ALJ noted that Dr. Ahmed's opinion demonstrates a lack of understanding of the social security disability program evidentiary requirements. That factor is entitled to some weight considering that Dr. Ahmed wrote his medical reports using the California workers' compensation terminology, and his disability opinion letters assert in conclusory fashion that plaintiff "will need to avail" or is "entitled" social security disability benefits. [AR 986, 1015].
Fifth, the ALJ cited plaintiff's "conservative treatment" with medication and the fact that she did not undergo "cervical or lumbar surgical procedures" as evidence that undermined the credibility of Dr. Ahmed's disability opinion. Plaintiff points out that Dr. Ahmed considered plaintiff a candidate for surgery. Since the recommended surgery was not approved by the workers' compensation insurance carrier and was never conducted, the evidence regarding its medical necessity is equivocal. Furthermore, treating physician Dr. Brodie stated that plaintiff "has received conservative care and treatment excepting for epidural injections." [AR 840]. Although not highly probative, plaintiff's relatively conservative treatment was a specific, legitimate reason, among others, supporting the ALJ's rejection of Dr. Ahmed's opinion that her impairments were totally disabling.
Faced with the difficult task of making sense of a voluminous medical record containing numerous sharply conflicting medical opinions, the ALJ's decision provides specific, legitimate reasons for rejecting Dr. Ahmed's controverted disability opinion.
Plaintiff contends that the ALJ improperly rejected the opinion of Dr. Raja, who conducted a consultative internal medicine examination at the Commissioner's request in March 2012. [AR 1191-1193]. He had a partial disability evaluation and a partial progress note, apparently from Dr. Ahmed, available for review. [AR 1191]. He opined that plaintiff had chronic headache, chronic back and neck pain, chronic anxiety, post-traumatic stress disorder, and chronic prescription opiate use. [AR 1191-1193]. He opined that plaintiff could perform a range of sedentary work. [AR 1193].
The ALJ concluded that Dr. Raja's opinion was not supported by the objective evidence and was inconsistent with the record as a whole. The ALJ noted that Dr. Raja documented only minimal abnormalities in his examination findings (primarily decreased range of joint motion), that the MRI and electrodiagnostic evidence discussed above showed only mild abnormalities, and that other physicians who had considered similar examination findings had not found plaintiff so limited. [AR 33, 35]. One such physician was treating physician Dr. Brodie, who found decreased range of motion in the cervical and lumbar spine but did not limit plaintiff to the extent that Dr. Raja did. [AR 836-859]. The ALJ articulated legally sufficient reasons for rejecting Dr. Raja's opinion.
Plaintiff contends that the ALJ improperly rejected the opinions of Dr. Green, a workers' compensation examining psychologist, and Dr. Berg, a psychologist to whom plaintiff was referred by her attorney. [
The ALJ permissibly rejected the opinions of Drs. Green and Berg, who opined that plaintiff was unable to work due to depression and anxiety, in favor of Dr. Adeyemo, who concluded that plaintiff had mood disorder and adjustment disorder with mixed anxiety and depressed mood, and also had mild psychiatric limitations, none of which impaired her capacity to perform simple, repetitive tasks. [AR 35-36]. Since all three doctors were examining sources, the ALJ was not required to give special weight to any of those opinions. Dr. Adeyemo's opinion was the most recent of the three, and he had reviewed Dr. Green's January 2009 report. [AR 1155]. As the ALJ noted, all three doctors gave plaintiff a Global Assessment of Function ("GAF") score of 55 or 56, which "is a rough estimate of an individual's psychological, social, and occupational functioning used to reflect the individual's need for treatment" and which signifies "moderate symptoms" or "any moderate difficulty in social, occupational, or school functioning."
Plaintiff contends that the ALJ erred in finding that plaintiff could perform jobs classified by the Dictionary of Occupational Titles ("DOT") as requiring "Level 2" reasoning because the ALJ limited her to "simple, repetitive tasks." [JS 28-32].
At step five of the sequential evaluation procedure, the Commissioner has the burden of establishing, through the testimony of a vocational expert or by reference to the Medical-Vocational Guidelines, that the claimant can perform other jobs that exist in substantial numbers in the national economy.
In his hypothetical questions to the vocational expert, the ALJ posited an individual who was limited as later described in his RFC finding, except that the hypothetical individual was limited to "unskilled" work rather than to "simple, repetitive tasks." The vocational expert testified that the hypothetical person could perform the unskilled jobs of small products assembler, DOT job number 706.684-022; office helper, DOT job number 239.567-010; and information clerk, DOT job number 237.367-018. [
The DOT classifies the jobs of small products assembler and office helper as requiring Level 2 reasoning, which requires the ability to use "common sense" to comply with "detailed but uninvolved instructions." "Uninvolved" means "not intricate or complex."
The ALJ erred in finding that plaintiff's RFC does not preclude performance of the DOT job of information clerk because that job requires Level 4 reasoning, which is inconsistent with a limitation to simple, repetitive tasks.
Plaintiff contends that the ALJ made an inadequately supported negative credibility finding. [JS 33-41].
Once a disability claimant produces evidence of an underlying physical or mental impairment that could reasonably be expected to produce the pain or other subjective symptoms alleged, the adjudicator is required to consider all subjective testimony as to the severity of the symptoms.
Plaintiff testified that she was "on the couch almost every day" due to pain from headaches and her other impairments, that she did no household chores, and that she did not drive. [AR 29, 117, 156, 163-166, 487, 489-490]. The ALJ found plaintiff's subjective complaints less than fully credible. He concluded that plaintiff's subjective complaints of totally disabling neck and back pain, headaches, and anxiety were not fully corroborated by the objective medical evidence. [AR 29]. Although that was a permissible consideration, the absence of medical findings to support the degree of severity alleged "is just one factor to be considered in evaluating the credibility of the testimony and complaints."
The ALJ also noted that some of plaintiff's admitted daily activities undermined the credibility of her subjective complaints. During the December 2012 hearing, plaintiff testified that she was a Jehovah's Witness. She said that she still attended meetings, although she "missed a lot," that she had been doing door-to-door witnessing regularly (three times a week for about three hours a day) during the alleged disability period and had only stopped doing it regularly about nine months earlier, and currently did phone witnessing when she felt up to it. [AR 166-172]. She watched television, went shopping twice a month with her husband, and drove to one of the hearings. [AR 29, 72, 490, 1157]. Although those activities are not necessarily transferable to a work setting, they are "grounds for discrediting [plaintiff's] testimony to the extent that they contradict claims of a totally debilitating impairment."
The Commissioner's decision is based on substantial evidence in the record and is free of legal error. Accordingly, the Commissioner's decision is