STEPHEN M. McNAMEE, Senior District Judge.
Carl G. Burkin seeks judicial review under 42 U.S.C. §§ 405(g), 1383(c)(3) of the final decision of the Commissioner of Social Security ("Commissioner"), which denied him disability insurance benefits and supplemental security income under the Social Security Act. (Doc. 1.
Carl Burkin was born on October 11, 1975. (Tr 26.) Burkin was diagnosed with a bipolar mental disorder at the age of 5 and placed on medication. (Tr. 29.) Burkin is a high school graduate. (
Burkin filed an application for Social Security disability insurance benefits and supplemental security income on February 16, 2007. (Tr. 95-98, 103-05.) In his application, Burkin alleged that he became disabled as of February 3, 2007. (
When reviewing a Social Security appeal, the Commissioner's decision must be affirmed if it is supported by substantial evidence and he applied the correct legal standards.
To qualify for Social Security disability benefits, Burkin must show that he suffers from a "medically determinable physical or mental impairment" that prevents him from performing his prior work activities and any other substantial gainful employment that exists in the national economy, and that the impairment "can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months."
Social Security regulations prescribe a five-step evaluation process for an ALJ to determine if a claimant is disabled within the meaning of the Social Security Act.
In this case, Burkin's last insured date was March 31, 2011. (Tr. 24.) In determining whether or not Burkin was disabled since the date of onset of alleged disability, February 3, 2007, the ALJ moved through steps one, two and three finding that Burkin was not disabled. (Tr. 15-16.) Prior to a step four evaluation, the ALJ evaluated Burkin's RFC and found that he was limited to simple work with minimal social and public contact. (Tr. 17-19.) Based on Burkin's RFC assessment and the vocational expert's testimony, at step four the ALJ found that Burkin could not perform his past relevant work due to his limitation with public contact. (Tr. 19.) However, the ALJ found at step five that the Commissioner established that Burkin retained sufficient RFC to adjust to perform other jobs existing in significant numbers either in the region where he lives or in several regions of the country.
At the fifth step, the burden shifts to the Social Security Administration to demonstrate that the claimant is not disabled and that he can engage in some type of substantial gainful activity that exists in "significant numbers" in the national economy. The ALJ considers the fact that the claimant cannot do the work that he has done in the past because of a severe impairment, considers the claimant's RFC, the claimant's age, education, and work experience, and determines whether the claimant can do any other work in the national economy. The ALJ will find the claimant disabled if she determines the claimant unable to adjust to any other work.
The step five analysis includes a detailed assessment of the medical evidence, the claimant's daily activities, prior work record, any functional restrictions and limitations, medication and other treatment for relief of symptoms, and information and observations by treating and examining physicians and third parties regarding the nature and extent of the claimant's symptoms.
The ALJ found conflicting opinion evidence in this case. (Tr. 16-19.) The ALJ weighed the conflicting opinions and concluded that Burkin was not disabled. (Tr. 19-20.) The ALJ also rejected Burkin's subjective symptom testimony that he could not continue to work. (Tr. 19.) The ALJ found that although Burkin could not return to his past relevant work, he had acquired work skills that were transferable to other occupations with jobs existing in significant numbers in the national economy. (Tr. 19-20.) The ALJ credited the vocational expert testifying that Burkin could perform work as a janitor, an assembly worker, or in quality control. (Tr. 20.)
Burkin argues that the ALJ decision is based on reversible legal error and does not rest upon substantial evidence. Burkin specifically argues that the ALJ erroneously rejected the opinion of his treating physician, Dr. Jayant Geete, who concluded that he was unable to work; erred by failing to assign proper weight to the opinion of state agency examining psychiatrist, Dr. Robert Narvaiz, who concluded that Burkin had several marked mental limitations affecting his ability to work; and erred by assigning improper weight to the opinions of non-examining state agency physicians who reviewed his file, opined that he had only moderate mental limitations, and found him able to work.
Social Security Rules expressly require that a treating doctor's opinion on an issue of a claimant's impairment be given controlling weight if it is well-supported by medically acceptable clinical and laboratory diagnostic techniques and is not inconsistent with the other substantial evidence in the record.
Similarly, the Ninth Circuit generally holds that greater weight is to be given to the opinion of an examining physician over and above the opinion of a non-examining physician.
Dr. Jayant Geete, M.D., a psychiatrist at Value Options/Magellan, is Burkin's treating psychiatrist. (Doc. 18 at 5.) Dr. Geete's consistent diagnosis has been bipolar disorder. (
On October 17, 2007, Dr. Geete reported, "I am treating Mr. Carl Burkin on [a] regular basis with medication monitoring. He is currently unable to work because of his serious mental illness (SMI)." (Tr. 269.) Dr. Geete continued to treat Burkin from October through December 2007 with diagnoses including bipolar disorder and anxiety disorder. GAF scores were in the 61-70 range. On October 17, 2007, Dr. Geete described Burkin as cooperative, but depressed and anxious. (Tr. 273.) Burkin was described as "stable." Diagnoses were bipolar disorder, anxiety disorder; GAF 65. (Tr. 273.) On November 21, 2007, Dr. Geete described Burkin as cooperative, but anxious. (Tr. 275.) Diagnoses were bipolar disorder and anxiety disorder; GAF 70. (Tr. 276.) On December 19, 2007, Dr. Geete noted Burkin reported feeling "manic." Burkin was cooperative, but depressed and anxious, with paranoia. (Tr. 277.) Diagnoses were bipolar disorder, attention deficit/hyperactivity disorder, and anxiety disorder; GAF was 55 and that over the past year, Burkin's highest GAF was 70. (Tr. 278.) On January 2, 2008, Dr. Geete participated in Burkin's annual behavioral health update and review. (Tr. 279-87.) Diagnosis was Bipolar I Disorder. (Tr. 283.) The justification for the diagnosis was anxiety, paranoia, racing thoughts, fluctuation in mood, irritability, depression, and inability to sleep. (Tr. 283.) GAF was 65. (Tr. 284.)
The ALJ decision noted, but rejected Dr. Geete's opinion that Burkin was unable to work because of his serious mental illness. (Tr. 18.) The ALJ discounted Dr. Geete's opinion because Dr. Geete did not refer to any specific limitations that Burkin had that would preclude him from working and because Burkin's GAF scores did not reflect significant functional impairment. (
First, regarding the ALJ discounting Dr. Geete's opinion because it was conclusory without any reference to supporting evidence in the treatment record (Tr. 269), an ALJ need not accept the opinion of any physician, including a treating physician, if that opinion is brief, conclusory, and inadequately supported by clinical findings.
Next, regarding the ALJ's conclusion that Burkin's moderate GAF scores outweighed Dr. Geete's opinion, Burkin argues that GAF scores do not directly correlate with a claimant's work abilities. (Doc. 18 at 18-20.) Burkin argues that there is no direct correlation between the two because GAF scores are assessed in a treatment setting, not a work setting. (
The parties do not dispute that Burkin's GAF scores are relevant. Burkin disputes the weight that the ALJ assigned to Burkin's GAF scores in the context of her determination regarding his ability to work. (Tr. 17-19; Doc. 18 at 18-19.) However, it is solely the duty of the ALJ to weigh the evidence and resolve conflicts in the record.
Specifically, the ALJ found that throughout the time period at issue, Burkin's GAF scores suggested no significant functional impairments that would preclude substantial gainful activity. (Tr. 17-19.) The fact that Plaintiff routinely had GAF scores that reflected no more than moderate symptoms or limitations was a legitimate reason for the ALJ to consider when determining whether Burkin was unable to work. There is substantial evidence of Burkin's moderate GAF scores in the record. (
In May 2007, following Burkin's application for disability benefits, at the behest of the state Disability Determination Services, Robert Narvaiz, M.D., a psychiatrist, examined Burkin and prepared a report and mental work capacity assessment. (Tr. 245.) Dr. Narvaiz diagnosed bipolar disorder, alcohol abuse four months partial remission, and marijuana abuse four months partial remission. (Tr. 237.) Dr. Narvaiz's mental work assessment reported that Burkin had marked limitations (i.e., having poor to no capacity) in his ability to work in coordination with others without being distracted by them; complete a normal workday and workweek without interruptions from psychologically based symptoms; perform at a consistent pace without an unreasonable number and length of rest periods; interact appropriately with the general public; accept instructions and respond appropriately to criticism from supervisors; and get along with coworkers or peers without distracting them or exhibiting behavioral extremes. (Tr. 239-43.) Dr. Narvaiz assessed that Burkin had moderate limitations (i.e. fairly limited, but not precluded) in his ability to understand, remember, and carry out detailed instructions; maintain attention and concentration for extended periods; perform activities within a schedule, maintain regular attendance and be punctual within customary tolerances; sustain an ordinary activity without special supervision; ask simple questions or request assistance. (
At the hearing, the ALJ conceded that if she accepted the "marked" mental work limitations assessed by Dr. Narvaiz, it would preclude Burkin from performing sustained work. (Tr. 38.) The ALJ reviewed Dr. Narvaiz's mental status evaluation and diagnosis of Burkin in some detail. (Tr. 17-18.) The ALJ then acknowledged but did not discuss Dr. Narvaiz's listing of two marked mental limitations, task completion and accepting instruction/criticism appropriately from supervisors. (Tr. 18.) However, the ALJ failed to acknowledge or discuss Dr. Narvaiz's listing of Burkin's three other marked mental limitations. (
Despite the ALJ's concession that if she accepted the "marked" mental work limitations assessed by Dr. Narvaiz, it would preclude Burkin from performing sustained work (Tr. 38), the Commissioner contends that the ALJ accommodated Dr. Narvaiz's opinion in her finding of non-disability. (Doc. 19 at 14.) The Court does not agree; Dr. Narvaiz concluded that Burkin had five marked mental work limitations. The substance of these limitations were not accommodated by the ALJ's finding of non-disability. The Ninth Circuit requires a higher standard, finding that an ALJ must explicitly discuss her rejection of the opinion of Dr. Narvaiz and setting forth specific reasons for crediting the opinions of the non-examining state agency psychologists over Dr. Narvaiz that are supported by the record.
On June 25, 2007, Maryanne Bongiovani, Ph.D., a state agency psychologist, reviewed the record as part of Burkin's initial determination but did not examine Burkin, and disagreed with Dr. Narvaiz's assessment: "The CE [consultative examination] doctor felt that claimant would have marked limitations in task completion and social interaction. It is likely that there would be moderate limitations in these areas of functioning but evidence in file does not argue for marked limitations." (Tr. 252.) Dr. Bongiovani followed this statement with observations that Burkin improved on medication (referencing a note before Dr. Narvaiz's examination or even the onset of disability), interacted with friends, was cooperative, and kept his mental health appointments. (Tr. 252.) Dr. Bongiovani felt Burkin would do best working by himself but would be able to understand, remember and carry out simple instructions, performing simple, repetitive work with some limitations. (Tr. 253.) The ALJ agreed with and credited Dr. Bongiovani's statements. (Tr. 16.)
On January 30, 2008, Brady Dalton, Psy.D, reviewed the record as part of the Commissioner's reconsideration of disability determination. (Tr. 300.) Dr. Dalton did not examine Burkin, and recommended denying reconsideration concluding that Burkin appears capable of simple work in a setting with limited social contacts. (Tr. 300.) The ALJ relied upon this statement in her decision under review: "Specifically, the limitations described by Dr. Dalton . . . are accepted, i.e., simple work in a setting with minima[l] social/public contacts." (Tr. 16.)
If a non-examining physician's opinion contradicts the opinion of an examining physician, but is not based on independent clinical findings or rests on clinical findings also considered by the examining physician, then the ALJ may rely on the non-examining physician's testimony to reject the examining physician's testimony only by providing specific, legitimate reasons that are supported by substantial evidence.
Here, the Court initially notes that the Ninth Circuit discounts the conclusions of a non-examining physician when they do not testify at a hearing and subject themselves to cross-examination.
Next, as explained above, the ALJ failed to provide sufficient explanation for why she was rejecting Dr. Narvaiz's opinion. The ALJ never stated that she was rejecting his opinion based on the finding of Drs. Bongiovani and Dalton; the ALJ only stated that she agreed with the findings of Drs. Bongiovani and Dalton. (Tr. 16,18.) Even assuming that the ALJ did intend to incorporate that weight into her rationale for rejecting the examining doctor's opinion, the ALJ still failed to provide any explanation beyond stating that Drs. Bongiovani and Dalton's findings were consistent with the evidence as a whole. (Tr. 16, 18.) Thus, the ALJ did not meet her burden of laying out "specific, legitimate reasons" for rejecting Dr. Narvaiz's opinion by providing "a detailed and thorough summary of the facts and conflicting clinical evidence, stating her interpretation thereof, and making findings."
Burkin contends that the ALJ improperly refused to credit his testimony about the severity of his subjective symptoms. (Doc. 18 at 27-32.)
"Pain of sufficient severity caused by a medically diagnosed `anatomical, physiological, or psychological abnormality' may provide the basis for determining that a claimant is disabled."
Burkin testified that his mental impairments prevent him from working because of his nervous breakdown at his last job, the side effects from his medication, his inability to stay on task, his conflicts with people, particularly supervisors, and his fear that he may hurt someone in retaliation for being reprimanded. (Tr. 27-33.)
The ALJ concluded that "the claimant's medically determinable impairments could reasonably be expected to produce the alleged symptoms; however, the claimant's statements concerning the intensity, persistence, and limiting effects of these symptoms are not credible to the extent they are inconsistent with the above residual functional capacity assessment." (Tr. 17.) In finding Burkin not credible, the ALJ relied on three factors: (1) Burkin's inconsistent testimony regarding his isolated lifestyle; (2) that Burkin's medication was generally effective in controlling his symptoms; and (3) the records from Burkin's ongoing treatment provider rating Burkin with a moderate limitation on his GAF scores. (Tr. 19.)
The ALJ relied on Burkin's contact with friends, his girlfriend, taking the bus and making doctor's appointments to support inconsistency in Burkin's testimony that he lives an isolated lifestyle. Here, the ALJ did not sufficiently explain how Burkin's social activity affected his RFC, which in this case is defined by his mental limitations, not by any physical limitations. Similarly, the ALJ did not properly explain or support her conclusion that Burkin's medication controls his symptoms given the variation in Burkin's GAF scores and the opinion of an examining psychiatrist to the contrary. Thus, the ALJ's findings are not "sufficiently specific to permit the court to conclude that the ALJ did not arbitrarily discredit claimant's testimony."
In this case, because the ALJ made findings unsupported by substantial evidence at step five, the Court sets aside the ALJ's denial of benefits.
The Court is mindful of the challenges and difficulties before the ALJ when adjudicating these cases. The ALJ's are confronted with a significant caseload and limited resources. Also, the ALJ must apply conflicting standards against complex factual matters, a situation that probably must be resolved through Congressional action. And, as may be noted, the circuit's case law is sometimes at odds with the standards of the Commissioner, but this Court is bound by circuit precedent, which in this instance requires reversal.
Accordingly,