MARGARET A. NAGLE, Magistrate Judge.
Plaintiff filed a Complaint on January 18, 2013, seeking review of the denial of plaintiff's application for a period of disability, disability insurance benefits ("DIB"), and supplemental security income ("SSI"). (ECF No. 3.) On February 12, 2013, the parties consented, pursuant to 28 U.S.C. § 636(c), to proceed before the undersigned United States Magistrate Judge. (ECF No. 10.) The parties filed a Joint Stipulation on September 18, 2013, 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. (ECF No. 14.) The Court has taken the parties' Joint Stipulation under submission without oral argument.
On April 20, 2010, plaintiff filed an application for DIB and SSI. (Administrative Record ("A.R.") 12.) Plaintiff, who was born on March 22, 1962 (id. 20),
After the Commissioner denied plaintiff's application initially and upon reconsideration, plaintiff requested a hearing. (A.R. 12.) On October 18, 2011, plaintiff, who was represented by counsel, appeared and testified at a hearing before Administrative Law Judge Keith Dietterle (the "ALJ"). (Id. 12, 21, 28-53.) Medical expert Steven B. Gerber, M.D., and vocational expert ("VE") Alan Boroskin, also testified. (Id. 12, 48-52.) On November 4, 2011, the ALJ denied plaintiff's claim (id. 21), and on November 30, 2012, the Appeals Council denied plaintiff's request for review of the ALJ's decision (id. 1-4). That decision is now at issue in this action.
In his November 4, 2011, decision, the ALJ found that plaintiff has not engaged in substantial gainful activity since September 25, 2005, the alleged onset date of her disability. (A.R. 14.) The ALJ determined that plaintiff has the severe impairments of irritable bowel syndrome, migraine headaches, malignant neoplasm of the breast, and affective mood disorder. (Id.) The ALJ also determined that plaintiff has the medically determinable impairment of fibromyalgia but that this impairment is nonsevere, because the "medical record does not well document" this condition and does not reflect any limitations resulting from it. (Id. 14-15.) 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. §§ 404.1520(d), 404.1525, 404.1526, 416.920(d), 416.925, 416.926). (Id. 15.)
After reviewing the record, the ALJ determined that plaintiff has the residual functional capacity ("RFC") to perform light work, including lifting up to 20 pounds occasionally and ten pounds frequently, standing and/or walking up to six hours in an eight-hour workday, and sitting up to six hours in an eight-hour workday, but is limited to simple routine tasks. (A.R. 16.) In making this finding, the ALJ considered the subjective symptom testimony of plaintiff, which the ALJ found was not entirely credible, as well as the medical evidence and opinions of record. (Id. 16-19.)
The ALJ found that plaintiff unable to perform her past relevant work as a mail carrier. (A.R. 19-20.) Based on plaintiff's age, education,
Thus, the ALJ concluded that plaintiff has not been under a disability, as defined in the Social Security Act, since September 25, 2005, the alleged onset date, through November 4, 2011, the date of the ALJ's decision. (Id. 20.)
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 alleges two sources of error. First, she claims that the ALJ failed to properly consider and evaluate the opinion of plaintiff's treating physician at Kaiser, Cynthia Freel, M.D. (Joint Stip. at 3.) Second, she claims the ALJ failed to properly consider plaintiff's credibility. (Id.)
An ALJ is obligated to take into account all medical opinions of record. 20 C.F.R. §§ 404.1527(b) and 416.927(b). It is the responsibility of the ALJ to resolve conflicts in medical testimony and analyze evidence.
The opinions of treating physicians are entitled to the greatest weight, because the treating physician is hired to cure and has a better opportunity to know and observe the claimant.
Plaintiff claims that the ALJ completely disregarded the opinion of her treating physician, Dr. Cynthia Freel, failed to provide specific and legitimate reasons based on substantial evidence of record for rejecting that opinion, and, indeed, completely failed to mention Dr. Freel's opinion, let alone state whether he accepted or rejected that opinion, or indicate the weight, if any, he was giving it. (Joint Stip. at 3-6.) Plaintiff contends that the fact Dr. Freel found her unable to work due to her physical and mental conditions "would certainly have an impact on the ALJ's determination of plaintiff's RFC and in the jobs that plaintiff was capable of performing." (Id. at 4.)
Specifically, plaintiff refers to a December 3, 2006, letter in which Dr. Freel stated that she had been treating plaintiff since 2001, and that plaintiff suffers from "severe disorders that significantly affect her ability to perform" necessary job duties and have caused her a great deal of pain and suffering. (A.R. 307.) Dr. Freel stated that plaintiff is most severely affected by gastroparesis, "causing recurrent bouts of nausea and vomiting which are usually several hours or sometimes days in length," and also suffers from fibromyalgia, major depression, and chronic pain, due to both the gastroparesis and the depression. (Id.) Dr. Freel concluded that, in her medical opinion, plaintiff "should be granted complete and total disability."
The ALJ's decision never specifically mentions Dr. Freel's opinion. He makes a brief mention that a June 11, 2006 record from Kaiser, where Dr. Freel practiced, shows that plaintiff has a "history of irritable bowel syndrome, with complaints of vomiting, diarrhea, abdominal cramps and nausea." (A.R. 17 (citing A.R. 236 - 06/11/06).) Other than that, he refers to none of plaintiff's Kaiser medical records regarding her physical conditions. With respect to her physical issues, the ALJ does note that, in both August and September 2008, plaintiff presented to a non-Kaiser emergency room with vomiting and in pain. (A.R. 17 (citing A.R. 333-45 - 09/07/08, 08/20/08).)
While an ALJ need not discuss every piece of evidence, an ALJ must explain why significant and probative evidence — such as the findings and opinions of treating physician Dr. Freel — has been rejected. See
Plaintiff's approximately monthly medical records from Kaiser dated between September 2004, and June 2006, show continuous and ongoing issues with irritable bowel syndrome/gastroparesis, pain, and depression. For instance, the records show the following: lower abdominal pain for six days with nausea, vomiting, and diarrhea; small amount of red blood in stool (A.R. 234 - 06/06/06); vomiting ten times a day (A.R. 257 - 09/24/04); increased symptoms of stomach pain and vomiting five times that day alone (A.R. 258 - 05/05/04); abdominal pain "waxed/waned" but not resolved (A.R. 259 - 11/04/04); plaintiff started on Prozac (A.R. 260 - 11/04/04); plaintiff feeling "overwhelmed," with "active" suicidal ideation or intent, switched from Prozac to Celexa (A.R. 265, 267, 295 - 05/16/05); bouts of nausea and pain, but had been sick for only one day since the last visit (A.R. 262 - 01/18/05); a lot of vomiting and pain, excessive weight gain, more "depressed lately" (A.R. 268 - 06/14/05); vomiting daily for a week, crying, nauseated (A.R. 269 - 09/28/05); stomach symptoms getting worse, incontinence, lots of nausea and pain, watery diarrhea, and cramping, plaintiff was "in obvious pain[,] crying[,] had to vomit 2x during visit[,] BM x1" (A.R. 270 - 11/01/05); cyclic vomiting and gastroparesis increasing and now with pain, completely interfering with ability to do ADLs, gastric emptying study ordered (A.R. 271 - 11/01/05); significant symptoms of nausea, vomiting, diarrhea, pain, tearful, depression diagnosed (A.R. 272 - 12/05/0); continued gastroparesis and cramping with increased pain and nausea (A.R. 274 - 03/23/06); persistent/chronic abdominal pain, severe gastroparesis now complicated by major depression (A.R. 275 - 04/05/06); "G.I. symptoms flared a lot this week," increased nausea and vomiting, feels dehydrated (A.R. 276 - 06/09/06); had gone to the Fontana ER for mostly vomiting, daily diarrhea with lower abdominal cramping, on Celexa for depression, colonoscopy ordered (A.R. 277 - 06/16/06); gastric emptying study showed "significant delay in gastric emptying of solid meal and appears to be worse than the previous study of 07/17/03" (A.R. 286 - 01/17/06); between September 2004, and March 2006, plaintiff gained 38 pounds (compare A.R. 257 - 09/24/04 — with A.R. 274 - 03/23/06); and vomiting, diarrhea, abdominal cramps, and nausea for five days, lasting longer than usual and more severe (A.R. 238-39 - 06/11/06).
At the hearing, the nonexamining medical expert, Dr. Gerber, testified that (1) he had examined the medical records and determined that plaintiff had a "history of Irritable Bowel Syndrome with gastroparesis, a history of migraines and a history of breast cancer . . ." but that the "record doesn't indicate any physical restrictions until 12 of '09,[
The Court disagrees with both Dr. Gerber's characterization of what the medical records show and with the ALJ's assessment of Dr. Gerber's opinion as "consistent with and supported by he substantial medical evidence of record." (A.R. 19.) Dr. Gerber's brief testimony and opinion — that no physical restrictions were indicated in plaintiff's medical record until December 2009 — is not consistent with or supported by plaintiff's extensive 2004-2006 medical records from Kaiser. Additional medical records further undermine Dr. Gerber's finding of no physical restrictions prior to December 2009. In fact, in August and September 2008, plaintiff went twice to the Corona Regional Medical Center emergency room complaining of abdominal pain, cramping, vomiting, and diarrhea. (Id. 335, 339). In August 2008, she complained of vomiting more than 50 times since the prior day. (Id.) She also indicated that she had pain like this for eight years, had not seen a doctor in two years, and had a colonoscopy two years before. (Id. 339.) In September 2008, she reported she had experienced abdominal pain for three weeks that was worse that day, was experiencing diarrhea and vomiting, and had been diagnosed with diverticulitis after a CT scan the previous month. (Id. 334.)
Records from Riverside County Regional Medical Center also support the conclusion that plaintiff's physical (and mental) impairments were ongoing at least after 2006. For instance, a June 8, 2010, progress notes indicates that her depression is "not controlled," and Lexapro should be increased (A.R. 351); in May 2010, she presented with abdominal pain, cramping, nausea, and vomiting, and stated that these symptoms had been occurring for 25 years, and "ha[d] gotten worse in the past year," with mucus in the stool, a 50 pound weight loss in the past year, and a hospitalization in October 2009 for abdominal pain (id. 361 - 05/27/10). Similar records show complaints in November 2009 (A.R. 407 - 11/04/09 — abdominal pain and nausea, vomiting, 50 pound weight loss in three months); December 2009 (A.R. 391, 392-93 - 12/08/09 — nausea and vomiting for four years; 56 pound weight loss in the past year, daily abdominal pain, bowel movements 7-8 times a day); February 2010 (A.R. 375 - 02/23/10 — nausea, vomiting); March 2010 (A.R. 370 - 03/23/10 — chronic diarrhea), April 2010 (A.R. 366 - 04/20/10 — nauseated, "having pain"); and March 2011 (A.R. 494-95 - 03/16/11 — abdominal pain, nausea, vomiting, psychiatric medication switched from Lexapro to Cymbalta, in part due to her chronic pain and fibromyalgia).
Moreover, "[t]he opinion of a nonexamining physician cannot by itself constitute substantial evidence that justifies the rejection of the opinion of . . . a treating physician."
Based on the foregoing, the Court cannot find harmless error in the great weight the ALJ gave to Dr. Gerber's opinion, and the ALJ's complete failure to mention and/or provide specific and legitimate reasons for discounting the opinions of plaintiff's treating physician.
Plaintiff contends the ALJ did not provide clear and convincing reasons for rejecting her subjective pain testimony. (Joint Stip. at 16.)
As noted by the ALJ, in her November 14, 2006 Adult Function Report, plaintiff stated that: on most days she woke up with pain in her stomach and would sit on the toilet for about three hours, some days vomiting due to the severe pain; medications did not always work; she had no appetite, and experienced headaches and nausea; she stayed in her room, watched tv, and talked to her family; she had no social activities; and she could not pay attention for long, and had difficulty following instructions. (A.R. 17 (citing id. 159).) At the October 18, 2011 hearing plaintiff testified that: she needs to go to the restroom "a lot"; she experiences cramping and pain that causes her to vomit; the pain exhausts her, and she has depression for which she takes medication but does not receive treatment from a psychiatrist or psychologist; she has headaches at least four times a week, and one headache can last as long as three days; she no longer drives, does any cleaning, laundry, or grocery shopping; she goes to church once a month; she can sit 15 minutes and walks less than a block; she does not lift and carry anything; she does not go out to eat, to the movies, or out by herself; she has difficulty sleeping; and she stopped working, because she was constantly vomiting and had nausea. (Id. (citing id. 32-47).)
Once a disability claimant produces objective medical evidence of an underlying impairment that is reasonably likely to be the source of claimant's subjective symptom(s), all subjective testimony as to the severity of the symptoms must be considered.
Here, the ALJ found that "[a]fter careful consideration of the evidence . . . [plaintiff]'s medically determinable impairments could reasonably be expected to cause the alleged symptoms." (A.R. 19.) The ALJ cited no evidence of malingering by plaintiff. (Id.) Nonetheless, the ALJ concluded that plaintiff's "statements concerning the intensity, persistence and limiting effects of these symptoms are not credible" to the extent they are inconsistent with the ALJ's RFC assessment. (Id.) Accordingly, the ALJ's reasons for finding that plaintiff was not credible with respect to her subjective symptom and pain testimony must be "clear and convincing."
Specifically, the ALJ discounted plaintiff's credibility for the asserted reasons that: (1) the clinical findings do not support the degree of limitation alleged, because (a) her allegations that she can only sit 15 minutes, walk less than a block, and lift and carry no weight were not supported by the objective evidence, (b) she only received conservative treatment, never received psychiatric treatment or hospitalizations, reported "no fevers or weight loss due to her irritable bowel syndrome, and her examinations were generally normal," and (c) her medical records to not show any recurrence of her cancer;
Preliminarily, the Court notes that the ALJ misstates at least some of plaintiff's subjective complaints. For instance, he states that she testified she can only sit for 15 minutes, walk less than a block, and cannot lift and carry any weight. (A.R. 19.) However, she actually testified that she can sit for 15 minutes then needs to get up because of the pain in her back and in her head; she had walked a "super block" a few days back, but was "walking with the pain . . . tolerating it"; and after the ALJ asked whether she "limit[s] the amount of weight" that she lifts and carries, she responded that, because she experienced pain for days after lifting her 30 pound grandson, she no longer lifts her grandchildren. (Id. 41-42.)
With respect to the ALJ's finding that plaintiff's allegations were contradictory to her testimony, the Court does not find the cited examples to be convincing. Certainly, dressing, showering, introducing oneself to others during church attendance, and chatting on a computer do not appear to be inconsistent with subjective complaints of chronic pain, and recurring nausea, diarrhea, or vomiting. The divergence between statements that plaintiff made years before the hearing that she was able to do household chores, cook, and drive herself and plaintiff's testimony at the hearing that she no longer was able to do any cleaning, laundry, grocery shopping, or driving, and that her cooking consists of microwaving Marie Callender frozen dinners may be explained by the worsening of her conditions over time and, thus, does not provide a sound basis for undermining plaintiff's credibility. (A.R. 37-39.) Further, plaintiff's "very good relationship" with her family would appear to have no bearing on her credibility at all.
Next, the ALJ terms plaintiff's treatment for her conditions as "conservative,"
Based on the foregoing, the Court does not find the ALJ's reasons for discounting plaintiff's credibility to be clear and convincing. On remand, therefore, the ALJ must either credit plaintiff's subjective symptom testimony, or provide clear and convincing reasons why plaintiff's testimony is not credible.
The decision whether to remand for further proceedings or order an immediate award of benefits is within the district court's discretion.
The Court finds that in this case remand is the appropriate remedy to allow the ALJ the opportunity to remedy the above-mentioned deficiencies and errors.
Accordingly, for the reasons stated above, IT IS ORDERED that the decision of the Commissioner is REVERSED, and this case is REMANDED for further proceedings consistent with this Memorandum Opinion and Order.
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.