ANN AIKEN, Chief District Judge.
Plaintiff Lena Navarro brings this action pursuant to the Social Security Act ("Act") to obtain judicial review of a final decision of the Commissioner of Social Security ("commissioner") denying his application for disability insurance benefits ("DIB") and supplemental security income ("SSI"). For the reasons set forth below, the Commissioner's decision is REVERSED and REMANDED for payment of benefits.
On April 8, 2010, plaintiff filed her applications for DIB and SSI. Tr. 182, 186. After the applications were denied initially and on reconsideration, plaintiff timely requested a hearing before an administrative law judge ("ALJ"). Tr. 133. On March 14, 2012, an ALJ hearing was held before the Honorable Stuart Waxman; plaintiff was represented by counsel and testified therein; a vocational expert ("VE") also testified. Tr. 13-47. On April 2, 2012, ALJ Waxman issued a decision finding plaintiff not disabled within the meaning of the Act. Tr. 103-113. After the Appeals Council declined review, plaintiff filed a complaint in this court. Tr. 100-102.
Born on June 20, 1970, plaintiff was 34 years old on the alleged onset date of disability and 41 years old at the time of the hearing. Tr. 13, 182, 186. Plaintiff dropped out of high school after completing the tenth grade. Tr. 15, 221. She previously worked as a gas station attendant, fast food worker, cook helper, administrative clerk, and residence leasing agent. Tr. 41-42. Plaintiff alleges she became disabled on September 1, 2004 due to degenerative disc disease, neuropathy, severe back arthritis, shoulder bursitis, depression, weight gain, bilateral carpal tunnel syndrome ("CTS"), pinched nerves in elbows, dyslexia, and chronic pain.
The court must affirm the Commissioner's decision if it is based on proper legal standards and the findings are supported by substantial evidence in the record.
The initial burden of proof rests upon the plaintiff to establish disability.
The Commissioner has established a five-step sequential process for determining whether a person is disabled.
At step two, the Commissioner determines whether the plaintiff has a "medically severe impairment or combination of impairments."
At step three, the Commissioner determines whether the impairment meets or equals "one of a number of listed impairments that . . . are so severe as to preclude substantial gainful activity."
At step four, the Commissioner determines whether the plaintiff can still perform "past relevant work." 20 C.F.R. § 416.920(e). If plaintiff can work, she is not disabled. If she cannot perform past relevant work, the burden shifts to the Commissioner. At step five, the Commissioner must establish that the plaintiff can perform other work that exists in the national economy.
At step one of the five step sequential evaluation process, the ALJ found that plaintiff had not engaged in substantial gainful activity since the application date. Tr. 105. At step two, the ALJ determined that plaintiff has the following severe impairments: spine syndrome, failed back syndrome or post laminectomy syndrome, myalgia myositis, lumbago, tardy ulnar palsy, status post left ulnar nerve transposition in June 2006, status post right ulnar nerve transposition in September 2006, degenerative disc disease of the lumbar spine with some central canal stenosis, status post laminectomies and fusion, lumbar radiculopathy, minimal degenerative changes of the thoracic spine, bilateral CTS, status post bilateral carpal tunnel releases, obesity, fibromyalgia, muscle spasm, a history of edema, and mild to moderate obstructive sleep apnea. Tr. 105-106. At step three, the ALJ found that plaintiff's impairments did not meet or equal the requirements of a listed impairment. Tr. 107.
As plaintiff did not establish disability at step three, the ALJ continued to evaluate how plaintiff's impairments affected her ability to work. The ALJ resolved that plaintiff had the residual functional capacity ("RFC") to perform sedentary work as defined in 20 C.F.R. §§ 404.1567(a) and 416.9679(a), except that she should never climb ladders, ropes, scaffolds, ramps, or stairs; should never balance, kneel, crouch, or crawl; can occasionally stoop, push and/or pull bilaterally, reach overhead bilaterally; and should avoid all exposure to unprotected heights, walking on uneven terrain, and all use of "moving machinery." Tr. 107.
At step four, the ALJ found that plaintiff was capable of performing her past relevant work as an administrative clerk. Tr. 111. Accordingly, the ALJ concluded that plaintiff was not disabled within the meaning of the Act. Tr. 113.
Plaintiff alleges the ALJ erred by (1) not fully crediting her pain testimony, (2) failing to properly credit the opinion of Dr. Jeffrey Bert, and (3) finding plaintiff capable of performing her past relevant work.
Plaintiff contends the ALJ failed to provide clear and convincing reasons, supported by substantial evidence, to reject her subjective symptom statements concerning the extent and severity of her impairments. When a plaintiff has medically documented impairments that could reasonably be expected to produce some degree of the symptoms complained of, and the record contains no affirmative evidence of malingering, "the ALJ can reject the claimant's testimony about the severity of . . . symptoms only by offering specific, clear and convincing reasons for doing so."
In assessing a plaintiff's credibility, an ALJ may consider a range of factors, including ordinary techniques of credibility evaluation, such as (1) plaintiff's reputation for lying or prior inconsistent statements concerning symptoms; (2) unexplained or inadequately explained failure to seek treatment or to follow a prescribed course of treatment; and (3) evaluation of plaintiff's daily activities.
The ALJ found that objective medical evidence did not "fully support" plaintiff's alleged level of impairment. Tr. 108-109. The ALJ explained that although MRIs of plaintiff's lumbosacral and thoracic spine revealed abnormal findings, her extreme symptoms were nonetheless disproportionate.
First, the ALJ indicated plaintiff demonstrated positive Waddell's signs on examination in March 2005. Tr. 288. Plaintiff references a medical journal abstract which states that Waddell's testing "does not distinguish between malingering and psychological conditions." Pl.'s Reply Br. 3 (citing Gordon Waddell et al.,
Next, plaintiff argues it was improper to use plaintiff's reported "somatization" to undermine her credibility. Pl.'s Reply Br. 4. Indeed, there are only two references to somatization in the record. In 2008, Dr. Rusu reported, "I expect there is a degree of somatization but I am not sure about the secondary gains . . . ." Tr. 584. In 2010, another physician, after reviewing Dr. Rusu's notes, indicated "[plaintiff] has some degree of somatization." Tr. 410. The physicians appeared to be inferring that plaintiff was exaggerating symptoms in order to obtain pain medication, and both discussed limiting plaintiff's access to narcotics. Tr. 410, 584. Nonetheless, neither the ALJ nor the treating doctors explicitly mentioned drug-seeking behavior, commented on the degree of any symptom exaggeration, or whether her "somatization" was willful deception or rather a psychiatric response consistent with somatization disorder. Further, the court notes that the two incidents where somatization disorder appears in the record were fairly isolateq considering the seven-year relevant time period. Further, the defendant does not proffer any further evidence of somatization in support of the ALJ's findings. Accordingly, the ALJ's reference to isolated "possible somatization" is not a sufficient rationale to discount plaintiff's credibility.
The ALJ also questioned plaintiff's credibility because she missed medical appointments. Tr. 110. The parties agree plaintiff missed medical appointments on two occasions during the relevant time period. Pl.'s Reply Br. 5; Def.'s Br. 5; Tr. 570. Although failure to follow a prescribed course of treatment or an inadequately explained failure to seek treatment may impact credibility, plaintiff's absence from two appointments over a seven-year time period is not probative, particularly considering she provided reasons for her absences. Pl.'s Opening Br. 17;
The ALJ next noted that plaintiff's ADL's, as reported by plaintiff and her daughter, demonstrated functionality which belied disability. Tr. 109, 242-48, 250-56. The ALJ noted that plaintiff is able to clean, watch television, cook, and provide care for her granddaughter, who lives with her.
Activities such as light household chores, grocery shopping, and occasional preparation of meals are activities that do not necessarily translate to a full-time work environment.
Plaintiff further argues that the ALJ misinterpreted her alleged self-limiting behavior during some medical examinations. For example, in 2006, Dr. Bert reported plaintiff appeared to be voluntarily limiting her spine bending on examination due to pain. Tr. 109, 306. Dr. Alina Rizea indicated on two separate encounters in 2005 that plaintiff "would not bend" during examination, citing back pain. Tr. 316, 318. In 2012, an examining nurse reported plaintiff's performance on a neurological examination was inconsistent, and noted plaintiff may be "consciously limiting her responses." Tr. 722. In 2011, a nurse practitioner indicated plaintiff was "unwilling/unable to put shoulder through ROM" due to pain. Tr. 696.
Despite these incidents, not one of the physicians performing the examinations indicated that plaintiff was being uncooperative, and only one mentioned that plaintiff "may" have been consciously limiting herself. Tr. 291, 306, 316, 318, 585, 696, 722. That a plaintiff "may" have been consciously limiting herself during a single examination is not clear and convincing grounds to impugn a plaintiff's credibility. While the court recognizes that self-limiting behavior is generally a valid reason to discount a plaintiff's testimony pursuant to
Therefore, based on the record as a whole, the court does not find that "possible" self-limiting behavior on a handful of back examinations in the context of degenerative disc disease of the lumbar spine, lumbago, spine syndrome, and failed back syndrome (or post-laminectomy syndrome) to be determinative of plaintiff's overall credibility.
The ALJ assigned little weight to Dr. Bert's opinion that plaintiff was "unemployable," "completely disabled," and "fits the criteria for Social Security complete and total disability." Tr. 110, 496, 558. The ALJ further found that Dr. Bert's assessment was not consistent with the objective evidence, that the doctor relied heavily on plaintiff's own subjective complaints, and that the opinions were improper because the issue was reserved to the Commissioner. Tr. 110.
The ALJ must consider all medical opinion evidence. 20 C.F.R. § 404.1527(b). Physicians may provide medical or clinical opinions, or they may provide opinions on the ultimate issue of disability.
The parties dispute whether Dr. Bert's opinion statements were conclusory. Pl.'s Opening Br. 19; Def.'s Br. 12. In 2010, Dr. Bert wrote that plaintiff was "unemployable."
Nevertheless, Dr. Bert provided other medical opinion evidence in February 2012 that was more detailed in describing various aspects of plaintiff's impairments. Tr. 735-37. Dr. Bert indicated via questionnaire that plaintiff's diagnoses were spinal stenosis at L2-3 and status post-fusion at L3-L5. Tr. 735. He indicated plaintiff experienced back and leg pain, would have to rest one hour per day, had weakness, should not drive, could stand and walk for less than 2 hours per day, could sit less than 6 hours per day, could occasionally lift up to ten pounds, could never lift 20 pounds or more, and would likely miss more than two days per month due to her impairments. Tr. 736-37. Defendant argues that Dr. Burt's 2012 opinion is invalid because it is unsupported by objective findings or explanation for the restrictions, and was based on plaintiff's subjective reports. Def.'s Br. 12.
While Dr. Bert's February 2012 opinion predominantly consists of 1-2 word answers and check-the-box responses, it nonetheless sets out necessary details that were lacking in the doctor's previous opinions. The 2012 opinion indicates plaintiff's diagnoses, symptoms, treatment plan (surgery at L2-3), and a functional assessment. Tr. 735-37. Further, Dr. Bert, in a treatment note from June 20, 2011, reported:
Tr. 744. In October 2011, Dr. Bert found, among other things, "marked limitation of motion . . . [in] back flexion and extension." Tr. 740. Plaintiff then underwent a lumbar MRI on November 18, 2011. Tr. 746-47. Dr. Bert reviewed the findings and reported plaintiff had a "9-mm spinal canal at [L] 2-3 with foraminal stenosis." Tr. 738. He also noted decreased strength in the left anterior thigh, left foot numbness, and positive straight leg raising on the right.
The ALJ also found that Dr. Bert failed to adequately address plaintiff's "increasingly more obvious symptom exaggeration" around the time of his 2012 opinion. Tr. 111. As described above, although plaintiff reported increasing symptoms, it was Dr. Bert's opinion that they were related to progressively worsening transition syndrome in the area of her spine above her spinal fusion. Tr. 744. Further, the ALJ's assertion that plaintiff's symptoms were due to exaggeration was largely based on the ALJ's assessment of her "significantly diminished credibility" regarding subjective complaints and effort-dependent testing. Tr. 111. However, because the ALJ failed to give specific clear and convincing reasons for discrediting plaintiff's testimony as explained above, that assessment is not a valid reason to discredit Dr. Bert's opinion.
Accordingly, the ALJ did not provide legitimate reasons supported by substantial evidence for giving little weight to Dr. Bert's 2012 assessment.
Plaintiff argues that the ALJ's step four finding was erroneous because it did not account for the limitations set forth in the discredited testimony of plaintiff and Dr. Bert. Pl.'s Br. 20. As described above, the ALJ determined plaintiff could perform work at a sedentary exertion level with additional restrictions. Tr. 107. Based on the ALJ's RFC, the VE indicated plaintiff was capable of performing her previous work as an administrative clerk. Tr. 44, 111. Providing alternative step five findings, the VE indicated plaintiff's RFC would allow her to perform the occupations of cashier II (660 positions in Oregon), microfilming document preparer (117 positions in Oregon), and food and beverage clerk (less than 25 positions in Oregon). Tr. 45, 112. When the ALJ posed hypothetical questions applying the restrictions imposed by Dr. Bert, including an hour-long break in addition to regular breaks and missing more than two days per month, the VE indicated plaintiff would be precluded from all sedentary work. Tr. 44.
However, as the ALJ's RFC did not include impairments set forth by plaintiff through her testimony or by Dr. Bert's 2012 opinion, it was not based on substantial evidence and is therefore invalid. Accordingly, all the jobs — including plaintiff's past relevant work and alternative step five jobs — identified by the VE based upon the RFC were invalid.
The ALJ erred in assessing the credibility of plaintiff's pain testimony and the weight provided to the treating physician's testimony in this case. Courts are empowered to affirm, modify, or reverse the decision by the Commissioner "with or without remanding the case for a rehearing." 42 U.S.C. § 405(g). Remand for the calculation of benefits is one possible remedy.
Defendant argues that even if plaintiff's 2012 testimony and Dr. Bert's 2012 opinion were credited and plaintiff found disabled, remand would be necessary for further proceedings including calculation of an onset date. Def.'s Br. 15-16. The Ninth Circuit has repeatedly stated, "allowing the Commissioner to decide the issue again would create an unfair `heads we win; tails, let's play again' system of disability benefits adjudication."
Here, the record does not require supplementation. In 2012, plaintiff's treating physician outlined functional impairments based on a recent MRI and examination findings. Tr. 734-37. The ALJ failed to provide legally sufficient reasons for discrediting Dr. Bert, who had a lengthy longitudinal record of treating plaintiff. His opinion should therefore have been afforded significant, if not controlling, weight. 20 C.F.R. § 404.1527;
Moreover, despite finding both plaintiff and Dr. Bert not credible, the ALJ determined plaintiff could only perform limited sedentary work, and only identified four jobs in the national economy she could perform. Tr. 112-13. Although the VE did not provide job numbers for plaintiff's past relevant work, the three alternative jobs plaintiff was found able to perform exist only in small numbers in the state economy. Tr. 112;
Finally, in reviewing the record as a whole, the court is satisfied that plaintiff is disabled. Both objective and testimonial evidence support a litany of severe impairments that affect her ability to function in the workplace. Tr. 105-106. In combination, and based on her own pain allegations and the opinion of her treating physician, these impairments would substantially limit her ability to succeed in even a sedentary position. Therefore, if the improperly rejected evidence were credited as true, an ALJ would be required to find plaintiff disabled on remand. Accordingly, no further proceedings are necessary.
For the reasons set forth herein, this case is REVERSED and REMANDED for immediate calculation and payment of DIB and SSI benefits.
IT IS SO ORDERED.