KENLY KIYA KATO, Magistrate Judge.
Plaintiff Dennis A. Wilson ("Plaintiff") seeks review of the final decision of the Commissioner of the Social Security Administration ("Commissioner" or "Agency") denying his applications for Title II Disability Insurance Benefits ("DIB") and Title XVI Supplemental Security Income ("SSI"). The parties have consented to the jurisdiction of the undersigned United States Magistrate Judge, pursuant to 28 U.S.C. § 636(c). For the reasons stated below, the Commissioner's decision is REVERSED and this action is REMANDED for further proceedings consistent with this Order.
On September 27, 2011, Plaintiff filed separate applications for DIB and SSI. Administrative Record ("AR") at 192-99. Plaintiff's applications were denied initially on March 20, 2012, and upon reconsideration on September 28, 2012. AR at 68-93; 94-121. On October 16, 2012, Plaintiff requested a hearing before an Administrative Law Judge ("ALJ"). AR at 139-40. On May 21, 2013, Plaintiff appeared and testified at a hearing held before ALJ Helen E. Hesse. AR at 45-65. On May 31, 2013, the ALJ issued a decision denying Plaintiff's applications for DIB and SSI. AR at 29-44.
On July 26, 2013, Plaintiff filed a request for the Agency's Appeals Council to review the ALJ's decision. AR at 26-28. On November 7, 2014, the Appeals Council denied Plaintiff's request for review. AR at 5-10.
On February 6, 2015, Plaintiff filed the instant action. ECF Docket No. ("Dkt.") 1. This matter is before the Court on the parties' Joint Stipulation ("JS"), filed November 6, 2015, which the Court has taken under submission without oral argument. Dkt. 18.
Plaintiff was born on June 22, 1965, and his alleged disability onset date is September 1, 2011. AR at 192. He was 46 years old at the time of the onset date, and 47 years old at the time of the hearing before the ALJ. Plaintiff graduated from high school and completed approximately one year of college. AR at 48-49. Plaintiff alleges disability based on "osteoarthritus, back pain, hip pain, gout, cane used, [and] inflamation." AR at 234.
To qualify for DIB or SSI, a claimant must demonstrate a medically determinable physical or mental impairment that prevents him from engaging in substantial gainful activity, and that is expected to result in death or to last for a continuous period of at least twelve months.
To decide if a claimant is disabled, and therefore entitled to benefits, an ALJ conducts a five-step inquiry. 20 C.F.R. §§ 404.1520, 416.920. The steps are:
The claimant has the burden of proof at steps one through four, and the Commissioner has the burden of proof at step five.
At step one, the ALJ found Plaintiff "has not engaged in substantial gainful activity since September 1, 2011, the alleged onset date" of disability. AR at 34 (citations omitted).
At step two, the ALJ found Plaintiff had the following severe impairments: gout and osteoarthritis. AR at 35 (citations omitted).
At step three, the ALJ found Plaintiff "does not have an impairment or combination of impairments that meets or medically equals the severity of one of the listed impairments in 20 C.F.R. Part 404, Subpart P, Appendix 1." AR at 36 (citations omitted).
The ALJ found Plaintiff has the RFC "to perform light work as defined in 20 CFR 404.1567(b) and 416.967(b) and he has limitations as follows: he can sit six hours out of an eight-hour day; he can stand or walk six hours out of an eight-hour day with normal workday breaks; she [sic] can occasionally lift 20 pounds and frequently lift 10 pounds; he can occasionally climb stairs, bend, balance, stoop, kneel, crouch or crawl; and he is precluded from ladders, ropes, or scaffolding, or unprotected heights." AR at 37.
At step four, the ALJ found Plaintiff "is capable of performing past relevant work as a greeter and telemarketer. This work does not require the performance of work-related activities precluded by [Plaintiff]'s residual functional capacity." AR at 39 (citations omitted). The ALJ found Plaintiff "has not been under a disability, as defined in the Social Security Act, from September 1, 2011, through the date of this decision" and declined to proceed to step five.
Plaintiff presents two disputed issues:
JS at 4.
The Court finds the first issue dispositive of this matter, and thus does not address the remaining issue.
Pursuant to 42 U.S.C. § 405(g), a district court may review the Commissioner's decision to deny benefits. The ALJ's findings and decision should be upheld if they are free of legal error and supported by substantial evidence based on the record as a whole.
"Substantial evidence" is evidence that a reasonable person might accept as adequate to support a conclusion.
The Court may review only the reasons stated by the ALJ in her decision "and may not affirm the ALJ on a ground upon which [s]he did not rely."
For the reasons set forth below, the Court finds the ALJ failed to provide specific, clear, and convincing reasons for rejecting Plaintiff's testimony regarding the severity of his limitations.
The ALJ's RFC determination states Plaintiff "can sit six hours out of an eight-hour day; he can stand or walk six hours out of an eight-hour day with normal workday breaks; she [sic] can occasionally lift 20 pounds and frequently lift 10 pounds; he can occasionally climb stairs, bend, balance, stoop, kneel, crouch or crawl; and he is precluded from ladders, ropes, or scaffolding, or unprotected heights." AR at 37.
In determining Plaintiff's RFC, the ALJ described Plaintiff's testimony regarding his pain and limitations as follows:
Next, the ALJ found "[a]fter careful consideration of the evidence, the undersigned finds that the claimant's medically determinable impairments could reasonably be expected to cause some of the alleged symptoms; however, the claimant's statements concerning the intensity, persistence and limiting effects of these symptoms are not entirely credible for the reasons explained in this decision."
The ALJ went on to recite the medical evidence in support of her RFC determination. AR at 37-38. The ALJ concluded "the above residual functional capacity assessment is supported by medical records and consultative examiner's opinions." AR at 38.
Plaintiff argues the ALJ failed to provide specific, clear, and convincing reasons for rejecting Plaintiff's testimony regarding the severity of his pain. JS at 19.
Defendant argues the ALJ properly found Plaintiff not fully credible for the following reasons: (1) the ALJ relied on "inconsistencies between Plaintiff's testimony and the medical evidence"; (2) the ALJ "correctly noted that Plaintiff failed to show up for his physical therapy appointments"; and (3) the ALJ noted "in his [sic] discussion of Plaintiff's functional limitations [] the evidence showed no limitations in activities of daily living." JS at 11-17.
If "the record establishes the existence of a medically determinable impairment that could reasonably give rise to the reported symptoms, an ALJ must make a finding as to the credibility of the claimant's statements about the symptoms and their functional effect."
The ALJ is required to engage in a two-step analysis. "First, the ALJ must determine whether there is objective medical evidence of an underlying impairment which could reasonably be expected to produce the pain or other symptoms alleged."
"The ALJ may consider many factors in weighing a claimant's credibility, including (1) ordinary techniques of credibility evaluation, such as the claimant's reputation for lying, prior inconsistent statements concerning the symptoms, and other testimony by the claimants that appears less than candid; (2) unexplained or inadequately explained failure to seek treatment or to follow a prescribed course of treatment; and (3) the claimant's activities."
"If the ALJ's credibility finding is supported by substantial evidence, the court may not engage in second-guessing."
The Court finds the ALJ did not provide "specific, clear and convincing reasons" for finding Plaintiff incredible. As set forth below, the ALJ erred by merely reciting the medical evidence in support of her RFC determination without identifying which medical evidence specifically discredits which symptom testimony.
First, the ALJ appears to have discredited Plaintiff's claimed severity of impairment because "[t]he medical evidence record as a whole demonstrates little treatment." AR at 37. As an initial matter, it is unclear what the ALJ meant by "little treatment," because the medical record, even as recited by the ALJ, demonstrates a consistent course of treatment. AR at 37-38, 289-412. Further, the ALJ's conclusory statement does not identify inconsistencies between Plaintiff's testimony and the medical record, as Defendant argues. Rather, the ALJ merely recites the medical evidence in support of her RFC determination without identifying which medical evidence specifically discredits which symptom testimony. AR at 37-38. Defendant attempts to point out evidence that may have supported the ALJ's decision. However, the Court cannot affirm the ALJ's credibility decision based on evidence the ALJ did not discuss.
Second, Defendant argues the ALJ reasonably found Plaintiff not credible because Plaintiff failed to show up at rehabilitation appointments. JS at 13. However, the ALJ does not say she discredited Plaintiff's testimony because he failed to show up at these appointments.
Lastly, Defendant's attempt to justify the ALJ's decision by reference to the ALJ's earlier discussion at step two of Plaintiff's daily activities, cannot be used to determine whether the ALJ's credibility determination actually rested on permissible grounds.
The Court, thus, finds the ALJ did not provide specific, clear and convincing reasons to discredit Plaintiff's testimony regarding the severity of his pain.
"When an ALJ's denial of benefits is not supported by the record, the proper course, except in rare circumstances, is to remand to the agency for additional investigation or explanation."
In cases where an ALJ has improperly rejected "claimant testimony or medical opinion," a court must remand to the ALJ "with instructions to calculate and award benefits" if (1) "the record has been fully developed and further administrative proceedings would serve no useful purpose"; (2) "the ALJ has failed to provide legally sufficient reasons for rejecting evidence, whether claimant testimony or medical opinion"; and (3) assuming "the improperly discredited evidence were credited as true, the ALJ would be required to find the claimant disabled on remand."
In this case, the record has not been fully developed. The ALJ must reassess Plaintiff's credibility regarding the severity of his pain and its impact on the RFC determination. The error resulting from the ALJ's deficient credibility analysis cannot be deemed harmless.
For the foregoing reasons, IT IS ORDERED that judgment be entered REVERSING the decision of the Commissioner and REMANDING this action for further proceedings consistent with this Order. IT IS FURTHER ORDERED that the Clerk of the Court serve copies of this Order and the Judgment on counsel for both parties.