RONALD E. BUSH, Chief Magistrate Judge.
Pending is Petitioner Melanie Long's Petition for Review (Dkt. 1), appealing the Social Security Administration's final decision finding her minor child I.P.L.
On September 5, 2014, an application for supplemental security income was protectively filed on behalf of the Claimant, I.P.L.
On June 28, 2017, the ALJ issued a Decision denying Claimant's claim, finding that Claimant was not disabled within the meaning of the Social Security Act. (AR 33.) Review was timely requested from the Appeals Council on Claimant's behalf on or about August 25, 2017. (AR 184.) On May 23, 2018, the Appeals Council denied Claimant's Request for Review, making the ALJ decision the final decision of the Commissioner of Social Security. (AR 1.)
Claimant's administrative remedies having been exhausted, Petitioner timely filed the instant action on Claimant's behalf, arguing that "[t]he decision denying Petitioner's claim is not in accordance with the purpose and intent of the Social Security Act, nor is it in accordance with the law, nor is it in accordance with the evidence, but contrary thereto and to the facts and against the evidence, in that Petitioner
To be upheld, the Commissioner's decision must be supported by substantial evidence and based on proper legal standards. 42 U.S.C. § 405(g); Trevizo v. Berryhill, 871 F.3d 664 (9th Cir. 2017). Findings as to any question of fact, if supported by substantial evidence, are conclusive. 42 U.S.C. § 405(g). In other words, if there is substantial evidence to support the ALJ's factual decisions, they must be upheld, even when there is conflicting evidence. See Treichler v. Comm'r of Social Sec. Admin., 775 F.3d 1090, 1098 (9th Cir. 2014).
"Substantial evidence" is "such relevant evidence as a reasonable mind might accept as adequate to support a conclusion." Richardson v. Perales, 402 U.S. 389, 401 (1971); Ludwig v. Astrue, 681 F.3d 1047, 1051 (9th Cir. 2012). The standard requires more than a scintilla but less than a preponderance (Trevizo, 871 F.3d at 674), and "does not mean a large or considerable amount of evidence." Pierce v. Underwood, 487 U.S. 552, 565 (1988).
With respect to questions of fact, the role of the Court is to review the record as a whole to determine whether it contains evidence that would allow a reasonable mind to accept the conclusions of the ALJ. Richardson, 402 U.S. at 401; see also Ludwig, 681 F.3d at 1051. The ALJ is responsible for determining credibility, resolving conflicts in medical testimony, and resolving ambiguities. Treichler, 775 F.3d at 1098. Where the evidence is susceptible to more than one rational interpretation, the reviewing court must uphold the ALJ's findings if they are supported by inferences reasonably drawn from the record. Ludwig, 681 F.3d at 1051. In such cases, the reviewing court may not substitute its judgment or interpretation of the record for that of the ALJ. Batson v. Comm'r of Social Sec., 359 F.3d 1190, 1196 (9th Cir. 2004).
With respect to questions of law, the ALJ's decision must be based on proper legal standards and will be reversed for legal error. Zavalin v. Colvin, 778 F.3d 842, 845 (9th Cir. 2015); Treichler, 775 F.3d at 1098. Considerable weight must be given to the ALJ's construction of the Social Security Act. See Vernoff v. Astrue, 568 F.3d 1102, 1105 (9th Cir. 2009). However, reviewing federal courts "will not rubber-stamp an administrative decision that is inconsistent with the statutory mandate or that frustrates the congressional purpose underlying the statute." Smith v. Heckler, 820 F.2d 1093, 1094 (9th Cir. 1987).
In evaluating the evidence presented at an administrative hearing, the ALJ must follow a sequential process in determining whether a person is disabled in general (20 C.F.R. §§ 404.1520, 416.920) — or continues to be disabled (20 C.F.R. §§ 404.1594, 416.994) — within the meaning of the Social Security Act. For individuals under the age of 18, this is a three-step sequential evaluation process. 20 C.F.R. § 416.924(a).
The first step requires the ALJ to determine whether the claimant is engaged in substantial gainful activity ("SGA"). 20 C.F.R. §§ 404.1520(a)(4)(i), 416.920(a)(4)(i). SGA is work activity that is both substantial and gainful. 20 C.F.R. §§ 404.1572, 416.972. "Substantial work activity" is work activity that involves doing significant physical or mental activities. 20 C.F.R. §§ 404.1572(a), 416.972(a). "Gainful work activity" is work that is usually done for pay or profit, whether or not a profit is realized. 20 C.F.R. §§ 404.1572(b), 416.972(b). If the claimant is engaged in SGA, disability benefits are denied regardless of his medical condition, age, education, and work experience. 20 C.F.R. §§ 404.1520(b), 416.920(b). If the claimant is not engaged in SGA, the analysis proceeds to the second step. Here, the ALJ found that Claimant did not engage in substantial gainful activity during the period from the application date of September 5, 2014 through the date of the ALJ's decision. (AR 18.)
The second step requires the ALJ to determine whether the claimant has a medically determinable impairment, or combination of impairments, that is severe and meets the duration requirement. 20 C.F.R. § 404.1520(a)(4)(ii), 416.920(a)(4)(ii). For claimants under the age of 18, an impairment or combination of impairments is not "severe" within the meaning of the Social Security Act if it "is a slight abnormality or a combination of slight abnormalities that causes no more than minimal functional limitations." 20 C.F.R. § 416.924(c). If a claimant does not have a severe medically determinable impairment or combination of impairments, disability benefits are denied. Id. Here, the ALJ found that Claimant has the following severe impairments: "communication (language and speech) disorder and unspecified neurocognitive disorder (central auditory processing disorder)." (AR 18.)
The third step requires the ALJ to determine the medical severity of any impairments; that is, whether the claimant's impairments meet, medically equal, or functionally equal a listed impairment under 20 C.F.R. Part 404, Subpart P, Appendix 1. 20 C.F.R. § 416.924(d). If the answer is yes, the claimant is considered disabled under the Social Security Act and benefits are awarded. 20 C.F.R. § 416.924(d)(1). If a minor claimant's impairments neither meet nor equal a listed impairment, the claimant is deemed not disabled. 20 C.F.R. § 416.924(d)(2). To determine whether an impairment or combination of impairments functionally equals a listing, the ALJ must assess the claimant's functioning in terms of six separate domains: (i) Acquiring and using information; (ii) Attending and completing tasks; (iii) Interacting and relating with others; (iv) Moving about and manipulating objects; (v) Caring for yourself; and (vi) Health and physical well-being. 20 C.F.R. § 416.926a. Marked limitation in two domains or extreme limitation in one domain mandates a finding that the claimant is disabled. 20 C.F.R. § 416.926a(a).
Here, after a lengthy discussion, the ALJ found that Claimant did not have an impairment or combination of impairments that met, medically equaled, or functionally equaled the severity of one of the listed impairments. (AR 19-33.) Based on that finding, the ALJ ultimately concluded that Claimant "has not been disabled, as defined in the Social Security Act, since September 5, 2014, the date the application was filed." (AR 33.)
Petitioner raises three primary issues with the ALJ's decision. First, she argues the ALJ erred by relying on the opinion of a non-examining psychologist over Claimant's treating provider. Second, she argues the ALJ erred in his analysis of the functional domains by ignoring evidence of a significant chromosome abnormality. Third, she argues the ALJ erred by rejecting Petitioner's testimony without providing clear and convincing reasons. See generally Pet'r's Mem. ISO Pet. for Review (Dkt. 14). Each assignment of error will be addressed in turn.
Petitioner contends the ALJ erred by relying on the opinion of a non-examining psychologist over Claimant's treating provider. Id. at 8-12. She argues that the impartial medical expert Dr. Pelc, who did not examine Claimant, ignored significant medical records and his opinion was therefore necessarily incomplete or inaccurate. Accordingly, Petitioner argues, it was error for the ALJ to rely on Dr. Pelc's opinion. She specifically argues that Dr. Pelc is not a specialist in the fields of child psychology, pediatrics, or genetics and that his failure to mention Claimant's diagnosis of Klinefelter syndrome drastically reduces the probative value of his opinion. She does not identify specific components of Dr. Pelc's opinion with which she disagrees; her argument is that the opinion is not entitled to the weight the ALJ gave it because it ignores relevant medical evidence.
Petitioner contrasts Dr. Pelc's opinion with the opinions of various treating clinicians who opined that Claimant was significantly limited as compared to his peers. Most significantly, she notes that certified physician assistant Julie Scott, who is Claimant's primary care provider and whose opinion the ALJ rejected, opined that Claimant suffers from "significant difficulty with impulse control, listening, following directions that he doesn't want to follow, and is constantly in motion." (AR 710-711.) Her opinion, which she rendered after the ALJ hearing but before the ALJ issued his decision, also indicated that Claimant had recently been diagnosed with 47,XXY Klinefelter syndrome.
The ALJ rejected Ms. Scott's opinion because she is not a mental health specialist; because she is not trained in testing for autism spectrum disorders, impulse control disorders, attention deficit hyperactivity disorders, or communication/language/speech disorders; because she is not familiar with the Social Security listing of impairments; because her opinion is inconsistent with the objective medical evidence; and because her opinion appeared to be based in part on the allegations of Claimant's mother. (AR 26.)
Petitioner contends that Ms. Scott's opinion is consistent with the entire record, the ALJ's finding to the contrary notwithstanding. She cites the opinion of Dr. Brad Levitt, Psy.D., who examined Claimant in November 2016 and opined that Claimant was somewhat hyperactive, aloof, and impulsive and that Claimant had difficulty related to sustaining accuracy throughout the testing. (AR 426-430.) She also cites the opinion of Dr. Tosha Strickland, an audiologist who examined Claimant in November and December 2016 and opined that Claimant quickly fatigued with testing, had a melt-down, and could not complete all the testing. (AR 439.)
Petitioner accurately states the standard for how ALJs must weigh medical opinion evidence: opinions from treating sources are generally entitled to greater weight than opinions from non-treating sources, and opinions from medical sources who examine a claimant are generally entitled to greater weight than opinions from medical sources who did not examine a claimant. 20 C.F.R. § 416.927(c)(1), (2). An ALJ must provide "clear and convincing" reasons to reject a treating provider's uncontradicted opinion, and "specific and legitimate" reasons to reject a treating provider's opinion when it is contradicted. Winans v. Bowen, 853 F.2d 643, 647 (9th Cir. 1987); Murray v. Heckler, 722 F.2d 499, 502 (9th Cir. 1983); Baxter v. Sullivan, 923 F.2d 1391, 1396 (9th Cir. 1991). The same standards apply when an ALJ rejects an examining provider's opinion. Andrews v. Shalala, 53 F.3d 1035, 1041 (9th Cir. 1995); Gallant v. Heckler, 753 F.2d 1450, 1454 (9th Cir. 1984).
Petitioner criticizes any reliance upon non-examining expert psychologist Dr. Pelc because he is not a pediatrician having a specialization or expertise in child psychology or genetics. Pet'r's Mem. ISO Pet. for Review 9 (Dkt. 14). But Dr. Pelc's curriculum vita indicates that he provides "therapy and evaluation services with children, adolescents, and adults," that his "evaluation services emphasize child custody" (among other matters), that his Ph. D. course of study included a minor in child development, that he has previously been court appointed as a family children investigator, and that he was previously a consultant for a children's advocacy center. (AR 387.) He has also given presentations involving assessing allegations of child sexual assault, child custody evaluations, and the special needs of disruptive adopted children. (AR 389.) Moreover, counsel did not object to the admission of Dr. Pelc's curriculum vita into the record. (AR 47.) Due to the extensive history working with matters of child psychology outlined in Dr. Pelc's curriculum vita, and the fact that there was no objection to Dr. Pelc serving as a medical expert at the hearing, there is substantial evidence supporting the ALJ's decision to treat him as a qualified expert in this domain. His decision will not be overturned on the basis that Dr. Pelc was unqualified to render an opinion.
The Court's next task is to consider the relative weight the ALJ assigned to the opinions of treating provider Ms. Scott, PA-C, and non-examining medical expert Dr. Pelc.
SSR 06-03P, 2006 WL 2329939 at *5 (Aug. 9, 2006).
The ALJ gave Ms. Scott's opinion little weight because she was not a mental health specialist, was not trained in the relevant disorders, was unfamiliar with the Social Security listing of impairments, and her opinion was inconsistent with the evidence and appeared to be based on Petitioner's subjective allegations. (AR 26.) Nothing in Petitioner's argument persuades the Court that the ALJ's weighing of Ms. Scott's opinion was improper or unsupported by substantial evidence. Even though Ms. Scott was not an acceptable medical source, the ALJ could have found Ms. Scott's opinion more probative and afforded it greater weight than the opinion of Dr. Pelc given the circumstances described in SSR 06-03P. But he was not obliged to do so. Indeed, he was required to evaluate both opinions following Social Security regulations as outlined in 20 C.F.R. § 416.927(c) and SSR 06-03P. But the ALJ determined that Dr. Pelc's opinion was more probative than Ms. Scott's, and therefore gave it greater weight. Petitioner has not shown that he erred in doing so.
Petitioner contends that Ms. Scott's opinion was consistent with the entire record, but she does not persuade this Court, which acts in a reviewing capacity, how the ALJ's finding to the contrary is unsupported by substantial evidence. It is the ALJ's duty ultimately to resolve conflicting evidence, Treichler v. Comm'r of Social Sec. Admin., 775 F.3d 1090, 1098 (9th Cir. 2014). The Court is not persuaded that the ALJ erred in his assessment of Ms. Scott's opinion against the rest of the record.
Nor has Petitioner shown that the ALJ's reliance on Dr. Pelc's opinion was improper. As stated in the decision, Dr. Pelc had the benefit of a longitudinal review of Claimant's entire medical history. Petitioner contends that Dr. Pelc "completely ignored the evidence of auditory processing disorder, a component of Klinefelter." Pet'r's Mem. ISO Pet. for Review 10 (Dkt. 14). She specifically notes that "there is no evidence that Dr. Pelc considered the audiology report found in Exhibit 12F [AR 431-439] as his notes contain no reference to those records." Id. But Dr. Pelc received Exhibit 12F (AR 51-52) and he answered "yes" to a medical interrogatory asking, "Have you read the evidence we furnished to you?" Hand-written nearby is the text "1F-22F Numerous exhibits related to educat. records." (AR 701.) And, regardless of what Dr. Pelc took away from his consideration of such records as to any auditory issues, the ALJ added to Claimant's severe impairments the "unspecified neurocognitive disorder (central auditory processing disorder)," precisely as the audiologist had diagnosed. (AR 18, 439.)
As to Klinefelter syndrome, such a diagnosis does not lead directly to a determination that a child claimant is disabled. Rather, whether a child claimant with Klinefelter syndrome is disabled depends on whether the effects of the syndrome result in an impairment that, "either alone or in combination with another impairment(s), ... meet or medically equal the criteria of a listing in an affected body system(s)." SSR 14-3P, 2014 WL 2472009 at *8 (June 2, 2014). That analysis involves consideration of whether the mental disorders listings (112.00) are met. The ALJ undertook precisely such an analysis in this case: "The severity of the claimant's mental impairments, considered singly and in combination, do not meet or medically equal the criteria of listings 112.02, 112.08, 112.10, or 112.11." (AR 19.)
Ultimately, Petitioner has not shown that the ALJ's weighing of the psychological opinions of record was unsupported by substantial evidence or that he otherwise erred with respect to this issue. The ALJ's decision will not be reversed on such a basis.
Petitioner contends that the ALJ erred in assessing whether Claimant's impairments functionally equal the listings in the domains of acquiring and using information, attending and completing tasks, and caring for Claimant's self. Functional equivalence to a listing is shown when a claimant suffers from "marked" limitation in two domains of functioning or "extreme" limitation in one domain. 20 C.F.R. § 416.926a(d). Social Security regulations describe "marked" and "extreme" limitations, in part, as follows:
20 C.F.R. § 416.926a(e)(2)(i), (e)(3)(i).
The ALJ found Claimant has no limitation in the domains of moving about and manipulating objects (AR 31) and health and physical well-being (AR 33); less than marked limitation in the domains of acquiring and using information (AR 27), attending and completing tasks (AR 28), and caring for one's self (AR 32); and marked limitation in the domain of interacting and relating with others (AR 30).
Petitioner challenges the ALJ's findings with respect to the functional domains of acquiring and using information, attending and completing tasks, and caring for one's self. Pet'r's Mem. ISO Pet. for Review 12-18 (Dkt. 14). With respect to the domain of acquiring and using information, Petitioner argues that the ALJ apparently ignored most of Claimant's educational records, including two Individualized Education Plan ("IEP") assessments indicating Claimant's academic performance lagged standard expectations by more than one grade level across multiple subjects. She also points out that audiology testing indicated that Claimant's "talker advantage score on the LiSN-S was outside of 2 standard deviations and is an indication of [Claimant's] low concentration ability during the testing when [Claimant] is saturated with auditory stimulus. [Claimant] is not able to tolerate these conditions well and overall affects [Claimant's] ability to learn in a noisy environment." (AR 439.) Petitioner interprets the audiology testing results — which resulted in a diagnosis of central auditory processing disorder that the ALJ characterized as a severe impairment — as evidence that Claimant has marked limitation in the ability to concentrate and acquire knowledge. She holds up Claimant's lack of progress in school as further evidence of this.
The ALJ's assessment of Claimant's function in this domain was that:
(AR 27-28.)
The ALJ did not discuss Claimant's progress in school. This is notable because "school records are often a significant source of information about limitations in the domain of `Acquiring and using information.' Poor grades or inconsistent academic performance are among the more obvious indicators of a limitation in this domain ..." SSR 09-3P, 2009 WL 396025 at *3 (Feb. 17, 2009). Thus, where school records evidence limitations in this domain that are inconsistent with the ALJ's finding, it cannot be said that the finding is based on substantial evidence if the ALJ does not discuss any reasoning for ignoring or discrediting such records.
In this case, Petitioner's arguments are supported by the contents of Claimant's academic records contained in the record: Halfway through first grade, objective reports indicate that Claimant was reading at a beginning kindergarten level and struggling with kindergarten sight words, would "shut down" when asked to write and spell out grade-level words, struggled with grade-level math problems, and required specialized instruction. (AR 272-275.) During second grade, Claimant was able to read kindergarten sight words with only 59% accuracy and was only 45% accurate with word problems and 68% accurate with adding and subtracting numbers through 15. (AR 672-673.) The ALJ failed to discuss — or even cite — these records in his assessment of the functional domain of acquiring and using information. Given the substance of such records, the ALJ's failure constitutes reversible error.
Moreover, audiology testing identified that, as to one component of Claimant's listening ability (the "talker advantage score on the LiSN-S" test instrument), Claimant scored two standard deviations outside the norm. (AR 439.) The audiologist said the score indicated Claimant's "low concentration ability during the testing when [Claimant] is saturated with auditory stimulus." (Id.) Thus, the audiologist tied the hearing deficits directly to a functional limitation. Because a marked limitation "is the equivalent of the functioning we would expect to find on standardized testing with scores that are at least two, but less than three, standard deviations below the mean," 20 C.F.R. § 416.926a(d)(2)(i), it was error for the ALJ to find less than marked limitation in this functional domain without addressing the audiologist's findings.
Petitioner also argues the ALJ erred in assessing Claimant's functional limitations with respect to attending and completing tasks. Pet'r's Mem. ISO Pet. for Review 13-15 (Dkt. 14). She cites various evidence of record supporting her contention that Claimant is markedly limited in this domain. She also suggests that the ALJ did not cite to specific records to support his decision that Claimant's limitations in this domain were less than marked.
The ALJ found that:
(AR 28-29.)
Although the ALJ did not cite to specific pages of the record when making these findings, his representations of the contents of the record are nonetheless accurate; the exhibits he cited do contain the information to which he refers and they generally support his findings. Petitioner's argument on this point amounts to a disagreement with the ALJ's interpretation of the evidence. But it is the ALJ's duty to resolve conflicts or inconsistencies in the record, and the ALJ's decision must be upheld if it is supported by substantial evidence. Treichler v. Comm'r of Social Sec. Admin., 775 F.3d 1090, 1098 (9th Cir. 2014). Although Petitioner interprets the evidence differently than the ALJ did, she has not shown that the ALJ's interpretation is unsupported by substantial evidence. Therefore, this Court cannot conclude the ALJ erred in his findings with respect to the functional domain of attending and completing tasks.
Finally, Petitioner argues the ALJ erred in assessing Claimant's functional limitations in the domain of caring for one's self. Pet'r's Mem. ISO Pet. for Review 16-18 (Dkt. 14). She again cites record evidence supporting her interpretation that Claimant is markedly limited in this domain, and she again challenges the ALJ's decision for being too general in this regard.
The ALJ stated:
(AR 32.)
Once again, the exhibits the ALJ cited do contain the evidence he represents that they contain. And, once again, Petitioner's argument asks this Court to reweigh the evidence, which is disallowed under the applicable standards. Because Petitioner has not shown error in the ALJ's finding that Claimant has less than marked limitation in the ability to self-care, her petition will not be granted on this basis.
However, as described above, Petitioner has shown that the ALJ erred in his assessment of the functional domain of acquiring and using information. Her petition will be granted on that basis. The proper remedy for that error is remand for further proceedings.
Petitioner contends the ALJ erred by rejecting Petitioner's opinion without providing clear and convincing reasons. Pet'r's Mem. ISO Pet. for Review 18-20 (Dkt. 14). She argues the ALJ's assessment of her testimony was improper because he "delv[ed] into wide-ranging scrutiny of her character and apparent truthfulness" and he judged her for her involvement in "contentious child custody proceedings with Claimant's father."
The ALJ noted "significant inconsistencies between the claimant's mother's allegations regarding the claimant's impairments and functioning and the objective medical evidence." (AR 21.) He specifically noted, at some length, Petitioner's repeated claims to various medical providers that Claimant has autism despite multiple psychological evaluations which did not show concern for autism. He referred to evidence of record that "testing showed non-spectrum results and it was noted that the claimant's performance on testing suggested a wide range of skills that would be uncommon for a child with autism spectrum disorder." (AR 21-22.) He further noted that "to the extent that there is a diagnosis related to autism from an acceptable medical source, it is that the claimant does not suffer from this condition." (AR 22.) He recounted the concern of a nurse practitioner who met with Petitioner that Petitioner "may be seeking some type of secondary gain" in relation to the autism diagnosis. (AR 22, 650.) All of these factors support the ALJ's finding that Petitioner's "continued allegations of autism spectrum disorder are inconsistent with the objective medical evidence." (AR 22.)
The ALJ also referred, as Petitioner indicates, to "contentious child custody proceedings between the claimant's parents." (AR 22.) But in context, this reference and the rest of the paragraph in which it appears do not evince a judgment about Petitioner's character. Rather, the paragraph details Petitioner's unsubstantiated claims, over a period of years, that Claimant's father abused him. (AR 22-23.) It details Claimant's alleged "full-blown addiction to pornography" that Petitioner "backed off of" when questioned at the hearing and that is not well-supported by objective medical evidence of record. (AR 23.) And it notes that Petitioner indicated Child Protective Services had threatened her due to the number of referrals she had made regarding the father's care of Claimant. (AR 23.) These facts all color Petitioner's credibility and it was not error for the ALJ to acknowledge them.
Petitioner acknowledges that she is not a medical provider and she therefore "described her child's behavior in the best way she knew — labeling him as autistic." Pet'r's Mem. ISO Pet. for Review 19 (Dkt. 14). She says the ALJ criticizes her for continuing to seek an autism diagnosis after several examinations found that Claimant did not meet the criteria, but she says that it was only through her persistence that Claimant was ultimately correctly diagnosed with Klinefelter syndrome. Id. She says she was "advocating for her child to get ... the help [Claimant] needed, not intentionally attempting to mislead the ALJ or anyone else." Id.
That may well be so. But the record nonetheless contains numerous instances, cited by the ALJ, where Petitioner made representations about Claimant's functional limitations or diagnoses that were either inconsistent with, or at least unsubstantiated by, the record. Such representations bear directly on Petitioner's credibility. In some instances, medical providers expressed their concern that Petitioner may have been exaggerating Claimant's symptoms and limitations, possibly for financial gain, and such facts also imply the possibility of bias. Although the ALJ did not expressly echo such concerns, there is clear implication of such concerns in the three lengthy paragraphs describing his reasoning for not giving Petitioner's testimony greater weight. In short, he provided clear and convincing reasons for finding Petitioner less than credible and rejecting her testimony. Her petition will not be granted on the basis that her testimony was rejected improperly.
Petitioner has shown that the ALJ erred in his assessment of whether Claimant has marked limitation in acquiring or using information. Because Petitioner has shown that the ALJ's decision includes legal error and is not based on substantial evidence, her petition will be granted. The case will be remanded for further proceedings.
Based on the foregoing, Petitioner's Petition for Review (Dkt. 1) is