MARGARET A. NAGLE, Magistrate Judge.
On May 28, 2014, plaintiff filed a Complaint seeking review of the denial of his application for a period of disability, Disability Insurance Benefits ("DIB"), and Supplemental Security Income ("SSI"). (ECF No. 3.) On July 9, 2014, the parties consented, pursuant to 28 U.S.C. § 636(c), to proceed before the undersigned United States Magistrate Judge. (ECF No. 11.) On February 28, 2015, the parties filed a Joint Stipulation ("Joint Stip."), in which: plaintiff seeks an order reversing the Commissioner's decision and directing the immediate payment of benefits or, in the alternative, remanding the matter for further proceedings; and the Commissioner requests that her decision be affirmed or, alternatively, remanded for further administrative proceedings. (Joint Stip. at 30-33.) The Court has taken the parties' Joint Stipulation under submission without oral argument.
On November 19, 2010, plaintiff protectively filed his application for a period of disability, DIB, and SSI. (Administrative Record ("A.R.") 15, 145-51, 152-61.) Plaintiff, who was born on October 7, 1971
After the Commissioner denied plaintiff's claim initially (A.R. 15, 97-105) and on reconsideration (id. 15, 107-12), plaintiff requested a hearing (id. 15, 113). On October 4, 2012, plaintiff, who was represented by an attorney, appeared and testified at a hearing before Administrative Law Judge Lawrence D. Wheeler (the "ALJ"). (Id. 15, 64-91.) On November 21, 2012, the ALJ denied plaintiff's claim (id. 15-23), and the Appeals Council subsequently denied plaintiff's request for review of the ALJ's decision (id. 1-6). That decision is now at issue in this action.
In his decision, the ALJ found that plaintiff met the insured status requirements of the Social Security Act through December 31, 2011, and that plaintiff has not engaged in substantial gainful activity since November 22, 2006, the alleged onset date of his disability. (A.R. 17.) The ALJ determined that plaintiff has the severe impairments of bipolar disorder, post-traumatic stress disorder, and a history of substance abuse. (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. (Id. 18.)
After reviewing the record, the ALJ determined that plaintiff has the residual functional capacity ("RFC") to "perform a full range of work at all exertional levels but with the following nonexertional limitations: no work involving fast paced quotas; no work requiring public contact; and no work involving more than occasional contact with peers." (A.R. 18.) The ALJ further determined that plaintiff is capable of performing his past relevant work as a warehouse worker, because "[t]his work does not require the performance of work-related activities precluded by [plaintiff]'s [RFC]." (Id. 22.)
Accordingly, the ALJ concluded that plaintiff has not been under a disability, as defined in the Social Security Act, from November 22, 2006, the alleged onset date, through the date of the ALJ's decision. (Id. 22.)
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 failing to properly: (1) consider the opinion of his treating psychiatrist, Dr. Amanda Ruiz, and consultative examiner, Dr. Estelle Toby Goldstein, a board-certified psychiatrist; (2) consider his subjective complaints; (3) consider lay witness statements; and (4) pose a proper hypothetical to the vocational expert ("VE"). (Joint Stip. at 2-3.)
An ALJ is obligated to take into account all medical opinions of record, resolve conflicts in medical testimony, and analyze evidence. 20 C.F.R. §§ 404.1527(c), 416.927(c);
On June 5, 2012, plaintiff's treating psychiatrist, Dr. Amanda Ruiz, completed a "Medical Source Statement of Ability to do Work-Related Activities (Mental)" form. (A.R. 326-28.) On the form, Dr. Ruiz opined that plaintiff would have "marked" difficulties in: understanding and remembering both short, simple instructions and detailed instructions; carrying out detailed instructions; making simple work-related decisions; interacting with the public, supervisors, and coworkers; responding appropriately to work pressures in a usual work setting; and experiencing changes in a routine work setting. (Id. 326-27.) Dr. Ruiz assessed plaintiff as "moderately" limited in his ability to carry out short, simple instructions. (Id. 326.)
On March 8, 2011, Dr. Estelle Goldstein, a board-certified psychiatrist, performed a consultative psychiatric evaluation of plaintiff. (A.R. 250-55.) In her report, Dr. Goldstein detailed: her general observations; plaintiff's description of his symptoms and medical history; plaintiff's description of his family and social history; and plaintiff's description of his current level of functioning. (Id. 250-52.) Dr. Goldstein also performed a mental status examination of plaintiff and diagnosed him with: polysubstance abuse, resolved for four years; bipolar illness; and post-traumatic stress disorder. (Id. 252-54.) Plaintiff was assessed as having a GAF score of 50.
(Id. 254.)
On April 25, 2011, Deborah Hartley, a state agency reviewing psychiatrist, opined that plaintiff was markedly limited in his ability to understand, remember, and carry out detailed instruction and in his ability to interact appropriately with the general public. (A.R. 273-74.) Dr. Hartley found that, given his limitations, plaintiff can perform simple tasks with routine supervision, relate to supervisors and peers on a superficial work basis, and adapt to a work situation, but he cannot relate to the general public. (Id. 275.)
In determining plaintiff's RFC, the ALJ noted that "based upon [plaintiff's] overall condition. . . [plaintiff] would be able to perform at all exertional levels not involving fast-paced quotas, public contact, or more than occasional contact with peers." (A.R. 22.) The ALJ did not specify which medical opinion(s) he credited or discuss how he weighed the three psychiatrists' opinions, but his RFC assessment reflects some of the limitations assessed by Drs. Goldstein and Hartley. (See id.) Accordingly, it appears that the ALJ accorded greater weight to the opinions of the examining and reviewing psychiatrists than to the opinions of plaintiff's treating psychiatrist, Dr. Ruiz.
The ALJ did not give "controlling weight" to Dr. Ruiz's opinion as set forth in the June 2012 form she completed, because as explained below, he found that her opinion was: inconsistent with treatment notes demonstrating plaintiff's progress in response to therapy and medications; inconsistent with plaintiff's ability to perform certain daily activities and obtain passing grades in college welding courses; and not well supported. (A.R. 21-22.) However, the ALJ's reasons for discounting Dr. Ruiz's opinion are not legitimate reasons supported by substantial evidence, and thus, they do not support the ALJ's rejection of Dr. Ruiz's opinion.
First, the ALJ improperly determined that Dr. Ruiz's opinion should be discounted because, although plaintiff's mental and emotional condition fluctuated, his "condition clearly responded to therapy and medications on many documented occasions" and "deteriorated when he has not taken his medications as prescribed, or has relapsed on drugs and/or alcohol." (A.R. 21.) "Reports of `improvement' in the context of mental health issues must be interpreted with an understanding of the patient's overall well-being and the nature of her symptoms."
The ALJ also erred in finding that Dr. Ruiz's opinion should be discounted as inconsistent with plaintiff's daily activities and his performance in college courses. (A.R. 21-22.) It is not clear that plaintiff's ability to perform "all personal self-care activities independently; perform some household chores, errands, shopping and cooking; and manage his own money despite living in a transitional care facility" conflicts with Dr. Ruiz's opinion that plaintiff is moderately or markedly limited in all areas with respect to understanding, remembering, and carrying out instructions, and responding to work pressures in a work setting. More specifically, there is no indication that those activities required a level of concentration beyond what Dr. Ruiz assessed. Further, although plaintiff received passing grades in welding courses at Long Beach City College, he completed only 12 of the 60 units needed to complete the course, could not finish because he was unable to socialize with other students or even the teacher, and stopped going to class because he was experiencing panic attacks, mood swings, and problems concentrating and remembering. (A.R. 71; see also id. at 21 (ALJ states that plaintiff was unable to finish the welding program due to his "anxiety and depressive symptoms").) Accordingly, substantial evidence does not support the ALJ's determination that Dr. Ruiz's assessment of plaintiff's limitations is inconsistent with his very limited daily activities and his unsuccessful attempt to complete a vocational program at Long Beach City College. See also
Finally, the ALJ erred in finding that Dr. Ruiz's opinion was inconsistent with plaintiff's medical records and not well supported. The ALJ identified no specific inconsistency between Dr. Ruiz's opinion and plaintiff's treatment records. Instead, the ALJ merely stated that Dr. Ruiz's opinion is "not consistent with the actual medical records, and therefore [is] not given controlling weight." (A.R. 22.) The ALJ's conclusory assertion that Dr. Ruiz's opinion is not adequately supported is also not a specific reason supported by substantial evidence for discounting her opinion. See
Thus, the Court finds that the ALJ failed to give legally sufficient reasons for rejecting Dr. Ruiz's opinion.
The ALJ's assessment of plaintiff's RFC reflects many of the limitations identified by Dr. Goldstein, the examining psychiatrist, which suggests that the ALJ accorded more weight to Dr. Goldstein's opinion than to the opinion of either Dr. Ruiz or Dr. Hartley. For example, like Dr. Goldstein, the ALJ found that plaintiff was unable to perform work involving fast-paced quotas, public contact, and more than occasional contact with peers. However, plaintiff contends that the ALJ erred, because he failed to similarly adopt Dr. Goldstein's assessment that plaintiff is moderately limited in his ability to interact with supervisors. (Joint Stip. at 7-8.) In response, the Commissioner argues that the ALJ did not reject Dr. Goldstein's limitation regarding plaintiff's contact with supervisors, because the term "peers," as is used in the ALJ's RFC determination encompasses both plaintiff's coworkers and his supervisors. (Id. at 14.)
Although the ALJ was not required to accept Dr. Goldstein's opinion in full, he was required to articulate specific and legitimate reasons for rejecting portions of it. See
For a VE's testimony to constitute substantial evidence, the hypothetical question posed must "consider all of the claimant's limitations."
Plaintiff stated in his 2011 Function Report that, because of his mental impairments and resulting symptoms, including mood swings and panic attacks, he finds it hard to "get along with others," including his family, and is "fatigue[d] and tired all day." (A.R. 207, 212.) He stated that he sleeps most of the day, even falling asleep at school, and sometimes neglects to bathe or perform basic personal hygiene. (Id. 208.) At the hearing, plaintiff testified that he gets panic attacks, "always fear[s] something happening," does not trust anyone, has nightmares, and believes that he would be "too depressed to even show up" for a simple, low stress job with no public contact. (Id. 71-72.) He testified that his fear of people and his "mood swings that [go] up and down" had kept him from applying for jobs. (Id. 75.)
The ALJ did not summarize plaintiff's testimony but found that: plaintiff's "statements concerning the intensity, persistence and limiting effects of [his alleged] symptoms are not credible to the extent that they are inconsistent with the residual functional capacity assessment in this decision," and plaintiff's statements that "he frequently felt fatigued, and did not like to be around other people" were inconsistent with his daily activities.
An ALJ must make two findings before determining that a claimant's pain or symptom testimony is not credible.
The ALJ cited no evidence of malingering by plaintiff and concluded that "[plaintiff]'s medically determinable impairments could reasonably be expected to cause the alleged symptoms." (A.R. 21.) Nevertheless, the ALJ also determined that plaintiff's statements concerning the intensity, persistence, and limiting effects of his symptoms were not credible to the extent they were inconsistent with the ALJ's RFC assessment. (Id.) Because the ALJ found no evidence of malingering, the ALJ was required to articulate "clear and convincing" reasons for discounting plaintiff's subjective symptom testimony.
Although the ALJ limited plaintiff to no work requiring public contact and no work involving more than occasional contact with peers, he specifically rejected plaintiff's statement in the 2011 Function Report that he "frequently felt fatigued, and did not like to be around other people." (A.R. 22.) The ALJ found that this statement to be inconsistent with plaintiff's ability to attend school and perform his daily activities, i.e. preparing meals, doing laundry, making the bed, using public transportation, going shopping occasionally, and socializing with his girlfriend and family. (Id.) However, the ALJ failed to specifically articulate how plaintiff's ability to prepare meals, do laundry, make the bed, shop occasionally, use public transportation, and socialize with his girlfriend and family conflicts with plaintiff's allegations that he experiences severe anxiety, panic attacks, mood swings, fatigue, and depression. Furthermore, plaintiff's ability to perform these limited daily activities does not indicate an ability to hold down a full-time job. In addition, although plaintiff stated that he did socialize with his girlfriend and family, the record showed that his mental impairments made it difficult for him to get along with his family. (A.R. 212, 214.) Finally, as explained in connection with the ALJ's rejection of Dr. Ruiz's opinion, plaintiff's unsuccessful attempt to attend school, is not a clear and convincing reason for discrediting plaintiff's symptom testimony about the intensity, persistence, and limiting effects of his mental impairments.
Accordingly, the ALJ failed to give clear and convincing reasons for discrediting plaintiff's testimony. Thus, on remand, the ALJ must reevaluate plaintiff's credibility and provide clear and convincing reasons for discounting any portion of plaintiff's subjective symptom testimony, so that a reviewing court may know the basis for the ALJ's decision and have the ability to assess the propriety of that decision.
Plaintiff's final argument is that the ALJ failed to provide germane reasons for rejecting the third-party statement of his girlfriend, Samantha Jones. (Joint Stip. at 25-26.) In a February 13, 2011 Third Party Function Report, Jones reported that plaintiff has difficulty concentrating, fears socializing and being around others, and suffers mood swings and depression. (A.R. 199.) She wrote that plaintiff "sleeps most of the day" and "sleeps too much," is sometimes too depressed to bathe and too tired to shave, is "very forgetful" about his personal needs, and needs to be encouraged to wash his clothes. (Id. 200-01.) She stated that plaintiff performs about two hours worth of household chores and two hours of shopping over the course of a week. (Id. 201, 202.) Jones reported that plaintiff's mood swings and depression "cause confrontations with family and friends" and he "lacks interest in social activities." (Id. 204.) She added that "[o]ut of nowhere [plaintiff] will have paranoia and anxiety attacks [that affect] his ability to communicate" and "[h]is mood swings are very frequent[,] which affects [his] ability to get along with others" as well as Jones' willingness to be around him. (Id. 206.)
In evaluating the credibility of a claimant's assertions of functional limitations, the ALJ must consider lay witnesses' reported observations of the claimant.
Where, as here, an ALJ fails to discuss competent lay witness testimony favorable to the claimant, "a reviewing court cannot consider the error harmless unless it can confidently conclude that no reasonable ALJ, when fully crediting the testimony, could have reached a different determination."
The Commissioner contends that any error was harmless, because Jones' statement mirrored plaintiff's testimony and, thus, the ALJ presumably rejected Jones' statement for the same reasons that he rejected plaintiff's testimony — namely, plaintiff's ability to perform limited daily activities and his unsuccessful attempt to complete a welding program. (Joint Stip. at 17.) As explained above, the reasons the ALJ gave for rejecting plaintiff's testimony were not legitimate reasons for discrediting plaintiff's subjective symptom testimony. They are also not germane reasons for discrediting Jones' statements, because neither plaintiff's daily activities nor his educational efforts indicate that the intensity, persistence, and limiting effects of his symptoms are less than what he alleges. Accordingly, on remand, the ALJ must reevaluate the lay witness testimony and articulate specific and germane reasons for rejecting any portion of it.
The decision whether to remand for further proceedings or order an immediate award of benefits is within the district court's discretion.
Thus, on remand, the ALJ must: (1) reconsider the medical opinions, including those provided by Drs. Ruiz and Goldstein, and either credit those opinions or provide specific and legitimate reasons for rejecting them in accordance with the appropriate legal standards; (2) reevaluate plaintiff's credibility and provide clear and convincing reasons for discounting any portion of plaintiff's subjective symptom testimony; (3) reconsider the statements of lay witness Samantha Jones and either credit it or provide germane reasons for rejecting it; (4) reevaluate plaintiff's RFC determination in the light of the reconsidered evidence; and then (5) proceed through steps four and five to determine what work, if any, plaintiff is capable of performing.
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.