MARGARET A. NAGLE, Magistrate Judge.
Plaintiff filed a Complaint on April 25, 2013, seeking review of the denial of plaintiff's application for supplemental security income ("SSI"). On May 28, 2013, the parties consented, pursuant to 28 U.S.C. § 636(c), to proceed before the undersigned United States Magistrate Judge. The parties filed a Joint Stipulation on January 6, 2014, in which: plaintiff seeks an order reversing the Commissioner's decision and remanding this case for the payment of benefits or, alternatively, for further administrative proceedings; and the Commissioner requests that her decision be affirmed or, alternatively, remanded for further administrative proceedings. The Court has taken the parties' Joint Stipulation under submission without oral argument.
Plaintiff filed his application for SSI on June 20, 2011. (Administrative Record ("A.R.") 22.) Plaintiff, who was born on June 1, 1954, claims to have been disabled since February 1, 1999, due to human immunodeficiency virus ("HIV") and acquired immune deficiency syndrome ("AIDS") conditions. (A.R. 68, 179, 192, 196.) Plaintiff has no past relevant work. (A.R. 31.)
After the Commissioner denied plaintiff's claim initially and upon reconsideration, plaintiff requested a hearing. (A.R. 22.) On August 6, 2012, plaintiff, who was represented by counsel, appeared, and testified at a hearing before Administrative Law Judge Jesse J. Pease (the "ALJ"). (A.R. 36-67.) Vocational expert Aida Washington also testified at the hearing. (Id.) On August 17, 2012, the ALJ denied plaintiff's claim (A.R. 22-32), and the Appeals Council subsequently denied plaintiff's request for review of the ALJ's decision (A.R. 1-7). That decision is now at issue in this action.
The ALJ found that plaintiff has not engaged in substantial gainful activity since June 20, 2011, the application date. (A.R. 24.) The ALJ determined that plaintiff has the severe impairments of HIV infection, hepatitis C, and a psychotic disorder, not otherwise specified. (Id.) The ALJ concluded that plaintiff does not have an impairment or combination of impairments that meets or medically equals the listed impairments in 20 C.F.R. Part 404, Subpart P, Appendix 1 (20 C.F.R. §§ 416.920(d), 416.925, 416.926). (Id.)
After reviewing the record, the ALJ determined that plaintiff has the residual functional capacity ("RFC") to perform:
(A.R. 26.) In making this finding, the ALJ considered the subjective symptom testimony of plaintiff and his daughter, which the ALJ found was not entirely credible, as well as the medical evidence and opinions of record. (A.R. 26-31.)
Based on plaintiff's age,
Thus, the ALJ concluded that plaintiff has not been under a disability, as defined in the Social Security Act, since June 20, 2011, the date his application was filed. (A.R. 32.)
Under 42 U.S.C. § 405(g), this Court reviews the Commissioner's decision to determine whether it is free from legal error and supported by substantial evidence in the record as a whole.
Although this Court cannot substitute its discretion for that of the Commissioner, the Court nonetheless must review the record as a whole, "weighing both the evidence that supports and the evidence that detracts from the [Commissioner's] conclusion."
The Court will uphold the Commissioner's decision when the evidence is susceptible to more than one rational interpretation.
Plaintiff claims that the ALJ erred in: (1) rejecting the opinion of consultative psychiatrist Dr. Khushro Unwalla; and (2) finding that plaintiff could perform medium work despite his impairments of HIV and hepatitis C. (Joint Stipulation ("Joint Stip.") at 5.)
Plaintiff asserts the ALJ erred in rejecting the mental functional limitations assessed by Dr. Khushro Unwalla, a consultative/examining psychiatrist. (Joint Stip. at 5-10.)
An ALJ is obligated to take into account all medical opinions of record. 20 C.F.R. § 416.927(c). It is the responsibility of the ALJ to resolve conflicts in medical testimony and analyze evidence.
When an examining physician's opinion is not contradicted by another physician, it may be rejected only for "clear and convincing" reasons.
"The opinion of a nonexamining physician cannot by itself constitute substantial evidence that justifies the rejection of the opinion of . . . an examining physician."
Under the Social Security regulations, the opinions of consultative psychiatrists and State Agency reviewing psychologists both constitute "medical opinions" that must be evaluated pursuant to the rules for according weight to medical opinions set forth above. See, e.g., 20 C.F.R. § 416.913(a)(1) (b) (acceptable medical sources include licensed or certified psychologists) and § 416.927(a)(2) & (e) (defining medical opinions as "statements from physicians and psychologists and other acceptable medical sources," which includes nonexamining sources such as State agency psychologists); see also
On November 18, 2011, Dr. Unwalla conducted a consultative psychiatric evaluation of plaintiff. (A.R. 309-12.) Dr. Unwalla described plaintiff as: exhibiting a normal posture, gait, and psychomotor activity, with no evidence of involuntary movements; engaged and cooperative, and able to establish a good rapport; displaying good eye contact; alert and oriented to place, time, and situation; able to concentrate; and possessing an adequate fund of knowledge. (A.R. 309, 311.) Plaintiff did not exhibit any evidence of auditory or visual hallucinations, delusions, or illusions, and he did not report any obsessions, compulsions, or paranoia. (A.R. 311.) Plaintiff denied any suicidal ideation. Plaintiff's thought processes were "linear and goal-directed, without looseness of associations, flight of ideas, racing thoughts, thought insertions, thought withdrawal, or thought broadcasting," although plaintiff's speech "exhibit[ed] thought blocking with slow and deliberate rate and rhythm" and he answered questions mechanically. (Id.) Plaintiff's mood was depressed and flat; his affect was flat, reactive, and dysphonic; he reported poor sleep and appetite; "and is controlled by medication." (A.R. 309, 311.) Dr. Unwalla stated, without explanation, that plaintiff's insight and judgment are "impaired." (A.R. 311.) Dr. Unwalla diagnosed plaintiff with schizoaffective disorder and assessed a GAF score of 48.
The ALJ discussed Dr. Unwalla's opinion in detail, but ultimately gave greater weight to the opinion of Dr. Kim Morris, a State agency reviewing psychologist, in determining plaintiff's mental functional limitations. The Court concludes that this does not constitute reversible error, for the following reasons.
As an initial matter, plaintiff's argument that the ALJ was required to give "clear and convincing" reasons for discounting Dr. Unwalla's opinion is incorrect. (Joint Stip. at 7.) As discussed below, Dr. Unwalla and Dr. Morris opined that plaintiff had different mental limitations, and thus, their opinions were contradictory. Accordingly, the ALJ's decision was not erroneous as long as the ALJ provided "specific and legitimate reasons" supported by substantial evidence.
Dr. Unwalla assessed significant mental functional limitations for plaintiff, finding that he would: be unable to perform work activities on a consistent basis without special or additional supervision; have marked limitations completing a normal workday or workweek; have marked limitations accepting instructions from supervisors and interacting with coworkers and the public; and be unable to handle the usual stresses, changes and demands of gainful employment. (A.R. 312.) The ALJ gave "little weight" to these limitations, for two reasons.
First, the ALJ noted that — as set forth repeatedly in Dr. Unwalla's report itself (see A.R. 309, 312) — plaintiff's symptoms based on his mental condition were "currently controlled by medications." (A.R. 29.) As the ALJ correctly noted, plaintiff stated, in September 2011, that he was doing well on his current medication regimen, and "[o]ne of the last clinical notes in December 2011 [citation omitted] state[s] that [plaintiff] is feeling and functioning well on current medication with no side effects." (A.R. 28, citing A.R. 266, 316) Dr. Unwalla's examination, which occurred between the dates of these two medical records, indicated a consistent finding, i.e., that adverse effects from plaintiff's mental condition were being controlled by his medication. Indeed, there is ample evidence in the record indicating that plaintiff's psychiatric medications were helping with his symptoms and that he was doing well on his medications. (See A.R. 312, 315-26). Thus, the ALJ's first finding was a specific and legitimate reason to give little weight to the mental limitations assessed by Dr. Unwalla. See
Second, the ALJ gave the mental limitations assessed by Dr. Unwalla little weight, because the ALJ found them to be inconsistent with Dr. Unwalla's report. (A.R. 29.) Specifically, the ALJ noted Dr. Unwalla's findings that plaintiff: exhibited only mild difficulty in interacting with the clinic staff and doctor; had no difficulty maintaining composure and an even temperament; had some difficulty maintaining concentration, persistence and pace, but was able to register 3 out of 3 items at zero minutes and 3 out of 3 items at five minutes; was able to do serial sevens and threes; was able to spell the word "world" forward and backward; and, finally, was noted by the doctor to be "intellectually and psychologically capable of performing activities of daily living." (Id.; see A.R. 311-12.) Further, Dr. Unwalla's report indicated that plaintiff was in no apparent distress, maintained good eye contact, and was able to establish rapport with the examiner. (Id.) Dr. Unwalla found that plaintiff could focus and maintain attention for short periods of time, did not exhibit auditory and visual hallucination, and was "alert and oriented to person, place, time, and situation." (Id.)
In determining plaintiff's mental RFC, the ALJ gave "great weight" to the opinion of Dr. Morris. (A.R. 30.) The ALJ acknowledged that, generally, the opinions of non-examining medical sources are entitled to less weight than those of treating and examining sources, but observed that there are a number of facts that, in a particular case, can warrant giving greater weight to the opinion of a non-examining source. (Id.) The ALJ concluded that such circumstances existed in plaintiff's case, because Dr. Morris's opinion is "well supported by the objective medical evidence and is consistent with the record as a whole" and, thus, was entitled to greater weight than the limitations assessment by Dr. Unwalla, (Id.) The ALJ's finding was specific and legitimate, as well as supported by substantial evidence, for the following reasons.
Unlike Dr. Unwalla, Dr. Morris considered plaintiff's medical record. (A.R. 69-73.)
Dr. Morris gave "[l]arge weight" to an October 20, 2011 Medical Disorder Questionnaire Form ("MDQF") completed by licensed clinical social worker Brian Cunningham ("Cunningham"), finding that it was consistent with plaintiff's treatment notes. (A.R. 73.) In the MDQF, Cunningham noted that he first examined plaintiff on June 28, 2011, and saw plaintiff one to two times per month; the record shows that Cunningham continued to see plaintiff through 2011 and into early 2012. (A.R. 268-72, 289, 315-22.) Cunningham noted plaintiff's earlier diagnosis of a mood disorder, not otherwise specified, and a psychotic disorder, not otherwise specified. (A.R. 289; see A.R. 273-74, 324-25.) He assessed plaintiff with a GAF score of 60, which indicates moderate symptoms, such as those that would affect speech or reflect moderate difficulty in social, occupational, or school functioning. DSM-IV-TR, at 34. Cunningham noted plaintiff's statement that he "began hearing voices at the age 42," and the "voices were telling him to kill himself," but also noted plaintiff represented that he "has not heard voices in two years, [and] he is not currently depressed or paranoid." (A.R. 285; see also A.R. 286: "He denies any recent depression.") Cunningham observed that plaintiff: presented with appropriate affect, even if guarded at times; was oriented to person, place, situation, and time; had an intact memory, both recent and remote; had fair concentration; could manage funds on his own; and could communicate. (A.R. 286. 288.) Plaintiff recently presented with depressed affect apparently due to a family issue, but he did not have any current psychotic symptoms, including hallucinations. (A.R. 287-88.) Cunningham found that plaintiff had no difficulties in the area of concentration and task completion; however, it appeared that he would not adapt to stress well and, like most parolees, had some issues with authority. (A.R. 288.)
The 2011 treatment notes prepared by a treating psychiatrist (Dr. John Benson) and Cunningham, as well as by Sofia Carranza, MA and MFT, as a whole, are consistent with the MDQF and with Dr. Morris's December 2011 opinion regarding plaintiff's mental limitations. On numerous occasions in 2011, upon mental status examination, plaintiff, inter alia: was "[a]lert, in good contact and sensorium clear;" was oriented in all spheres; exhibited no symptoms of psychosis, audio/visual hallucinations, or paranoia; denied having any hallucinations or delusions or hearing voices; denied any paranoia or depression; displayed no formal thought disorder; and displayed a thought process that was goal directed, intact, and linear, and a thought content that was appropriate, coherent, and within normal limits. (A.R. 273 (4/13/11); 274 (6/28/11); 269-70 (7/25/11); 268-69 (9/21/11); 268 (10/19/11); 317 (11/30/11).) Treatment notes post-dating Dr. Morris's opinion are consistent. (See A.R. 316 (12/19/11); 316 (1/10/12); 315 (3/15/12).)
In sum, Dr. Morris's opinion is consistent with the record as a whole and is supported by other evidence in the record, and therefore, the opinion of Dr. Morris constitutes substantial evidence. Given the internal inconsistencies in Dr. Unwalla's opinion and that his findings regarding plaintiff's limitations are contradicted by the medical evidence of record, it was not error for the ALJ to give Dr. Unwalla's opinion little weight, based upon the specific and legitimate reasons stated by the ALJ, and to give Dr. Morris's opinion greater weight. See
Plaintiff contends the ALJ's finding that he could perform medium work is not supported by substantial evidence in the record, because the ALJ relied on "no affirmative medical evidence whatsoever of [plaintiff's] physical capacity."
On July 18, 2012, a state agency reviewing physician (F. Kalman, M.D.) assessed plaintiff as having a physical RFC of heavy/very heavy work. (A.R. 90-91.) At the August 6, 2012 hearing, the ALJ asked plaintiff to identify the physical problems he had as a result of his claimed impairments. The sole physical limitation plaintiff claimed was that it was "hard to pick up things" and he could not "pick up more than 20 pounds of stuff." (A.R. 46, 48.) The ALJ found much of plaintiff's subjective complaint testimony to lack credibility — a finding that plaintiff does not contest here.
The ALJ concluded that assessing a medium work physical RFC gave plaintiff the benefit of the doubt based upon his subjective complaints. (A.R. 27.) The ALJ explained that he reached this conclusion based upon the following factors, none of which are disputed by plaintiff. The medical records show that, although plaintiff suffered from HIV infection, his condition was stable and under control. (A.R. 27, citing A.R. 235 (plaintiff's statement that he had been told by his treating sources that his condition was "stable"), A.R. 254 (February 8, 2011 treatment note listing plaintiff's HIV condition as stable), and A.R. 251 (January 5, 2011 treatment note describing plaintiff's HIV status as under good control.) The ALJ noted some of the numerous medical records in which plaintiff had advised medical providers that he was "doing well on his current regimen," had no problem with medications, and had "no complaints," and on examination, he was "noted to be in no apparent distress." (A.R. 27; see, e.g., A.R. 251-53, 255-58.) As the ALJ correctly noted, the medical records shows that plaintiff's CD4 repeatedly was found to be "good," and increased significantly during the first half of 2011. (A.R. 27; see A.R. 247, 249, 258, 293.) As for plaintiff's hepatitis C, the ALJ noted that, based upon the medical record, there was "no evidence of liver decompensation, ascites, spider hamangiomas, jaundice, palmar erythema, asterisis, or tremors" and his "[m]otor, gait, and station [we]re all within normal limits with no abnormal movements." (A.R. 28.) The ALJ also noted that, in his Disability Report submitted in connection with his request for reconsideration, plaintiff stated there had been no change in his illness, condition, or daily activities since he submitted his July 6, 2011 Disability Report. (A.R. 27; see also A.R. 221, 223.)
Here, plaintiff does not identify any medical evidence establishing physical limitations he believes may exist due to his HIV infection and hepatitis C. Indeed, plaintiff so much as concedes that there is no medical evidence that would support a finding that plaintiff has physical limitations stemming from his HIV infection and hepatitis C. (See Joint Stip. at 19, stating that there is a "total absence of medical evidence" regarding plaintiff's physical limitations.)
Plaintiff's second issue arguments ignore the fundamental rule that the claimant bears the burden of proving that he is disabled. See, e.g.,
In any event, the statements of plaintiff and his daughter alone would not be sufficient to establish that plaintiff is limited to lifting no more than 20 pounds, given the lack of objective medical evidence that might support his subjective claim. See 20 C.F.R. § 416.929(a). The medical evidence simply does not support plaintiff's contention that he is unable to perform medium level work. The mere fact that plaintiff has the impairments of HIV infection and hepatitis C is not, by itself, sufficient to establish disability or to show that plaintiff cannot perform medium level work. There must be proof of the impairment's disabling severity. See, e.g.,
The Court notes plaintiff's contention that the ALJ was obligated to develop the record on the question of plaintiff's physical RFC. Plaintiff ignores the fact that a state agency physician did render a physical RFC finding. In any event, an ALJ's duty to develop the record is triggered only when the medical evidence of record is so conflicting, ambiguous, or inadequate that the ALJ cannot make a disability determination. See
For all of the foregoing reasons, the Court finds that the Commissioner's decision is supported by substantial evidence and free from material legal error. Neither reversal of the ALJ's decision nor remand is warranted.
Accordingly, IT IS ORDERED that Judgment shall be entered affirming the decision of the Commissioner of the Social Security Administration. IT IS FURTHER ORDERED that the clerk of the Court shall serve copies of this Memorandum Opinion and Order and the Judgment on counsel for plaintiff and for defendant.
The ALJ gave little weight to Dr. Unwalla's GAF score of 48 (A.R. 28-29), and plaintiff apparently does not contest this. Even if plaintiff did, however, there was no error. The ALJ characterized GAF scores as "subjectively assessed scores [that] reveal only snapshots of impaired and improved behaviors and state nothing in terms of function-by-function capacity or limitations." (A.R. 28.) This was a specific and legitimate reason, because a GAF score is not determinative of a mental disability for social security claim purposes. See Revised Medical Criteria for Evaluating Mental Disorders and Traumatic Brain Injury, 65 Fed. Reg. 50746, 50764-50765 (August 21, 2000)("We did not mention the GAF scale to endorse its use in the Social Security and SSI disability programs.... [The GAF scale] does not have a direct correlation to the severity requirements in our mental disorder listings"). Nor is it an "absolute determiner of an ability to work."