KAREN E. SCOTT, Magistrate Judge.
Plaintiff Eva Tolis de Tellez ("Plaintiff") appeals the final decision of the Social Security Commissioner denying her application for disability insurance benefits ("DIB"). For the reasons discussed below, the Commissioner's decision is AFFIRMED.
Plaintiff filed her DIB application on January 9, 2013, alleging a disability onset date of May 18, 2011. Administrative Record ("AR") 137-40, 151. An Administrative Law Judge ("ALJ") conducted a hearing on November 23, 2015, at which Plaintiff, who was represented by an attorney, appeared and testified. AR 39-62. The ALJ issued an unfavorable decision on January 11, 2016. AR 12-38.
The ALJ found that Plaintiff suffers from the severe impairments of status post L5-S1 discectomy with residual myofascial pain, and status post right shoulder repair with chronic impingement. AR 17. The ALJ also found that Plaintiff did not have a severe mental impairment, and she did not incorporate any mental limitations in Plaintiff's residual functional capacity ("RFC") assessment. AR 19.
Despite Plaintiff's impairments, the ALJ found that she retained the RFC to "lift and carry 10 pounds frequently, 20 pounds occasionally, [and] stand and walk at least four hours in an eight-hour day" with the following additional limitations: "cannot climb ladders, can occasionally climb stairs, balance, stoop, crouch, and crawl, can occasionally reach overhead bilaterally, can occasionally perform gross handling with right upper extremity, no limitations in fine fingering, cannot have concentrated exposure to vibrating tools, cannot work at unprotected heights or operation of hazardous moving machinery." AR 23.
Based on this RFC and the testimony of a vocational expert ("VE"), the ALJ found that Plaintiff could not perform her past relevant work of cosmetologist, Dictionary of Occupational Titles ("DOT") 332.271-010 or store manager, DOT 185.167-046. AR 30. The ALJ found that Plaintiff had transferable skills from her work as a salon manager of "supervisory, retail trade, merchandising, and sales skills, such as communication, customer service, and information giving." AR 31. With those transferable skills, the ALJ ruled at step five that Plaintiff could perform the semi-skilled occupations of companion, DOT 309.677-010, and case aide, DOT 195.367-010. AR 31. The ALJ found alternatively that if Plaintiff were limited to sedentary work instead of light, she could perform the semi-skilled occupation of information clerk, DOT 237.357-022. AR 32. The ALJ therefore concluded that Plaintiff was not disabled.
A person is "disabled" for purposes of receiving Social Security benefits if he is unable to engage in any substantial gainful activity owing to a physical or mental impairment that is expected to result in death or which has lasted, or is expected to last, for a continuous period of at least 12 months. 42 U.S.C. § 423(d)(1)(A);
The ALJ follows a five-step sequential evaluation process in assessing whether a claimant is disabled. 20 C.F.R. §§ 404.1520(a)(4), 416.920(a)(4);
If the claimant is not engaged in substantial gainful activity, the second step requires the Commissioner to determine whether the claimant has a "severe" impairment or combination of impairments significantly limiting his ability to do basic work activities; if not, the claimant is not disabled and the claim must be denied.
If the claimant has a "severe" impairment or combination of impairments, the third step requires the Commissioner to determine whether the impairment or combination of impairments meets or equals an impairment in the Listing of Impairments ("Listing") set forth at 20 C.F.R., Part 404, Subpart P, Appendix 1; if so, disability is conclusively presumed and benefits are awarded.
If the claimant's impairment or combination of impairments does not meet or equal an impairment in the Listing, the fourth step requires the Commissioner to determine whether the claimant has sufficient residual functional capacity to perform his past work; if so, the claimant is not disabled and the claim must be denied.
If that happens or if the claimant has no past relevant work, the Commissioner then bears the burden of establishing that the claimant is not disabled because he can perform other substantial gainful work available in the national economy. 20 C.F.R. §§ 404.1520(a)(4)(v), 416.920(a)(4)(v). That determination comprises the fifth and final step in the sequential analysis.
Under 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 from legal error and are supported by substantial evidence based on the record as a whole. 42 U.S.C. § 405(g);
"A decision of the ALJ will not be reversed for errors that are harmless."
All the issues Plaintiff raises on appeal concern her mental limitations rather than her exertional limitations, as follows:
There are three types of physicians who may offer opinions in Social Security cases: (1) those who directly treated the plaintiff, (2) those who examined but did not treat the plaintiff, such as Dr. Belen, and (3) those who did not treat or examine the plaintiff.
A claimant's RFC is the most that claimant can still do despite his or her limitations, and is based on all the relevant evidence in the case record. 20 C.F.R. § 416.945(a); Social Security Ruling ("SSR") 96-8. In making the RFC determination, the ALJ takes into account those limitations for which there is support in the record.
"The ALJ is the final arbiter with respect to resolving ambiguities in the medical evidence."
The ALJ's translation of the medical evidence into concrete functional assessments should be affirmed if the ALJ "applied the proper legal standard and his decision is supported by substantial evidence."
Plaintiff worked as a cosmetologist and manager at a Fantastic Sam's hair salon for many years. AR 264. In 2010, she slipped on a wet floor, injuring her back and right shoulder. AR 622, 720. She filed a workers' compensation claim, and she underwent back surgery in 2012 and shoulder surgery in 2013. AR 720.
In October 2013, Plaintiff amended her workers' compensation claim to include a claim for depression and anxiety arising out of chronic pain. AR 697. Dr. Dell, a Panel Qualified Medical Evaluator for the California workers' compensation system, evaluated Plaintiff twice.
Dr. Dell first evaluated Plaintiff on May 6, 2014, and he prepared a lengthy report. AR 616-735. He reviewed her medical history (noting no mental health treatment), discussed sources of stress in her life, administered psychological tests, and ultimately diagnosed Plaintiff as suffering from "an adjustment disorder with depressed mood." AR 725. He explained that he did not diagnose Plaintiff as having "major depressive disorder," because "she was slightly exaggerating her symptoms" during the evaluation. AR 726. As for psychiatric symptoms, he recorded that she reported changes in her sleeping and eating habits (such as taking two hours to fall asleep, decreased appetite, and a six-pound weight fluctuation), decreased libido, crying spells, and feelings of worthlessness. AR 721, 726. He gave her a Global Assessment of Functioning ("GAF") score of 62 because that score "corresponds to mild symptoms and `some' impairment of functioning." AR 726. He found that her mental condition did not cause any "moderate" functional limitations, because she was "active in several areas of her life, such as attending classes at an adult school and performing household duties. . . ." AR 726-27.
Dr. Dell concluded that Plaintiff's depressed mood arose out of her physical injuries, and was thus predominantly an industrial injury. AR 728. Regarding her "periods of disability," Dr. Dell opined as follows:
AR 729.
Dr. Dell evaluated Plaintiff a second time and issued a final report on February 2, 2015. AR 751-90. He noted that Plaintiff had still not received any therapy, counselling, or psychiatric medication since his 2014 evaluation. AR 761. He completed a lengthy assessment of Plaintiff's functional abilities, all of which he rated as either unimpaired or mildly impaired (i.e., a "1" or "2" on a 5-point scale). Dr. Dell observed that Plaintiff did not exaggerate her symptoms as much during the second evaluation, but he did not change his diagnosis, GAF score, or other findings, including his work restriction. AR 776-78.
The ALJ discussed both of Dr. Dell's reports and gave his opinions "great weight." AR 18-19. The ALJ did not, however, mention the work restriction imposed by Dr. Dell or incorporate into the RFC a requirement that Plaintiff be allowed to take a 20-minute break per a set schedule or whenever she experienced increased symptoms of depression or anxiety. AR 23.
At the hearing, Plaintiff's counsel asked the VE whether it would preclude employment if a hypothetical worker with Plaintiff's RFC were permitted "to take 20-minute breaks at her discretion throughout that day." AR 61. The VE responded that the question was "not really quantified enough" to answer, because it did not specify how many breaks the hypothetical worker would take. The VE, however, provided a quantified example, testifying that if the hypothetical worker took three 20-minute breaks each 8-hour workday, then that would preclude employment.
On appeal, Plaintiff contends that the ALJ was required either to explain why she rejected Dr. Dell's work restriction regarding 20-minute breaks or incorporate it into the RFC. (JS at 5.) Plaintiff argues that the ALJ's failure to do so affected her decision of non-disability because (1) Dr. Dell's opinion permits "20-minute discretionary work breaks," and (2) the VE testified that if Plaintiff were permitted to take the "breaks identified by Dr. Dell," then there would be no jobs available. (
Plaintiff reads Dr. Dell's work restriction too broadly. Dr. Dell did not opine that Plaintiff could only work if permitted to take as many 20-minute breaks as she might want. Rather, he imposed as a work restriction that she be allowed to take a 20-minute break "whenever she experiences increased symptoms of depression or anxiety." AR 729, 778. Dr. Dell did not indicate how often he expected Plaintiff to experience "increased symptoms of depression or anxiety" while working, but he rated her ability to complete a normal workday without interruptions from psychologically-based symptoms as only "mildly" impaired. AR 772. Whatever number of breaks Dr. Dell had in mind, it was clearly not a work-preclusive number (such as three breaks every day), because Dr. Dell opined that Plaintiff is not disabled from working "on a psychiatric basis." AR 778. Workers who, due to psychiatric symptoms, can only work if allowed to take 20-minute breaks whenever they choose, would be unemployable — a common-sense fact that would have been apparent to Dr. Dell. Rather than interpreting Dr. Dell's reports as having imposed a work-preclusive work restriction, it is far more reasonable to interpret his work restriction as consistent with the other parts of his lengthy reports — all of which conclude that Plaintiff's psychiatric symptoms, at worst, mildly limit her ability to perform some work-related tasks.
While ALJs are required to give specific, legitimate reasons for rejecting relevant medical opinions, they are not required to explain how they translated each relevant medical opinion into an RFC determination.
Regarding the requirement that the ALJ explain her reasons for accepting or rejecting medical evidence, ALJ thoroughly explained why she did not incorporate into the RFC Plaintiff's work-preclusive interpretation of Dr. Dell's work restriction. The ALJ explained that the medical evidence (including Dr. Dell's own evaluations) does not show that Plaintiff's psychiatric symptoms more than minimally affect her ability to work. (AR 18-22 [explaining why Plaintiff's mental impairments are not severe].)
Plaintiff was examined by consultative psychologist Dr. Wendel on January 23, 2014. AR 613-16. Plaintiff told Dr. Wendel that "she hears voices which denigrate her," "she has suicidal ideation," she "is not comfortable around people," and she "does not feel comfortable going out."
Dr. Wendel opined that Plaintiff has moderate difficulties conducting activities of daily living and social interactions. AR 616. Dr. Wendel also found, "Based on her report, the Claimant cannot sustain focus and concentration over a normal work week." AR 615. These opinions contradict Dr. Dell who found that Plaintiff was either unimpaired or mildly impaired in all functional areas related to daily living, social interactions, and maintaining concentration. AR 771-72.
The ALJ gave "little weight" to Dr. Wendel's opinion for several reasons. AR 19. First, the ALJ found it inconsistent with Plaintiff's reported activities.
The ALJ characterized Plaintiff and her brother as reporting that Plaintiff "has very little limitation" in her activities of daily living. AR 19. Citing Function Reports completed by Plaintiff and her brother, the ALJ noted that Plaintiff can make meals (including oatmeal, eggs, sandwiches, spaghetti, and Mexican food), go for 20-minute walks, adhere to her medication schedule, do light household cleaning and laundry, go grocery shopping, drive, handle money, and pay bills. AR 21, citing AR 164-71 and AR 173-80. What limitations she reported were due to physical pain, not mental impairments.
The ALJ also cited Plaintiff's reported ability to go out alone, talk to her sisters on the phone, interact with her two adult children, visit her mother often, and attend church weekly. AR 21, citing AR 165, 168, 177. This level of social functioning is inconsistent with Dr. Wendel's finding that Plaintiff is "moderately" limited in this area. AR 616. Indeed, in her Function Report, Plaintiff did not check the box indicating that her injuries affect her ability to get along with others. AR 169. Thus, the ALJ's finding of inconsistency between Plaintiff's activities and Dr. Wendel's opinions are supported by substantial evidence.
Dr. Wendel interviewed Plaintiff, performed a mental status examination, and administered some basic tests of concentration, reasoning, and memory. AR 614-15. From this, it appears Dr. Wendel relied heavily, but not exclusively, on Plaintiff's descriptions of her symptoms and resulting limitations.
Plaintiff argues that such reliance is inherent in psychiatric evaluations and therefore not a legitimate reason to discount Dr. Wendel's opinions. (JS at 19.) Here, however, Dr. Wendel's heavy reliance on Plaintiff's own reporting was coupled with evidence that Plaintiff had given Dr. Wendel inconsistent information and exaggerated her symptoms when describing them to Dr. Dell. The ALJ noted that Plaintiff told Dr. Wendel that she is "not comfortable around people," but also told Dr. Wendel that "she gets along with people." AR 19, citing AR 614.
Standing alone, Dr. Wendel's reliance on Plaintiff's subjective complaints alone might not be a legitimate reason to discount Dr. Wendel's opinions in favor of Dr. Dell's. That reliance, however, coupled with the other evidence of record in this case (e.g., Dr. Dell spent more time examining Plaintiff, detected via testing a tendency to exaggerate, and provided opinions regarding Plaintiff's functionality that are more consistent with Plaintiff's reported activities), does provide a specific and legitimate reason for the ALJ to have given more weight to Dr. Dell's opinions than to Dr. Wendel's.
ALJs should give more weight to medical opinions that are consistent with a claimant's overall health records.
Here, Dr. Wendel opined that Plaintiff would experience "repeated episodes of emotional decompensation in work-like situations secondary to depression and pain. . . ." AR 616. At the time of Dr. Wendel's examination, Social Security regulations defined "episodes of decompensation" as "exacerbations or temporary increases in symptoms or signs accompanied by a loss of adaptive functioning as manifested by difficulties in performing activities of daily living, maintaining social relationships, or maintaining concentration, persistence, or pace."
Plaintiff has no documented episodes of decompensation. AR 22, 84. Between her 2011 onset date and her second appointment with Dr. Dell in February 2015, she did not receive any therapy or counselling. AR 761. Even without mental health treatment, she conducted activities of daily living more complicated than "simple" work (such as driving and grocery shopping), with her limitations largely attributed to physical pain rather than mental impairments. AR 21 (citing AR 164-72, 241-57). Thus, the ALJ's third specific and legitimate reason is supported by substantial evidence.
The ALJ asserted that Dr. Wendel's opinion that Plaintiff has "marked" difficulties with memory and concentration (AR 616) "is not consistent with her half-page summary of test findings, which include the fact that during the memory test, the claimant was able to register 3/3 words immediately." AR 20. In fact, Dr. Wendel stated the results of the memory test as follows: "Registers 3/3 words immediately, but recalls just 1/3 after several minutes." AR 615. Dr. Wendel also said Plaintiff "struggles with simple abstract verbal reasoning questions" and concluded, "Concentration and/or ability to perform cognitive tasks was observed to be poor today."
As another purported internal inconsistency, the ALJ contrasted Dr. Wendel's finding that Plaintiff could not sustain focus and concentration over a normal work week with her finding that "claimant had adequate concentration." AR 22. Dr. Wendel characterized Plaintiff's memory as "adequate for interview purposes." AR 615. The fact that Plaintiff could adequately recount to Dr. Wendel her familial, educational, and occupational history (AR 613) is not necessarily inconsistent with Dr. Wendel's finding that Plaintiff's psychological symptoms would preclude her from sustaining concentration over a normal work week.
The ALJ's fourth reason is not supported by substantial evidence, but any error is harmless, because the ALJ gave three other legally sufficient reasons.
Two agency doctors — Drs. Balson and Solomon — reviewed Plaintiff's records and provided opinions concerning the degree to which her depression and anxiety limited her functional abilities. In May 2013, Dr. Balson opined that Plaintiff had no psychologically-based restrictions on activities of daily living or social functioning, and only mild difficulties maintaining concentration, persistence or pace. AR 70.
Dr. Solomon was subsequently asked if she would adopt Dr. Balson's assessment and was given information from Dr. Wendel's report, including "MSS [medical source statement]: unable to sustain focus and concentration over a normal work week." AR 83. In February 2014, Dr. Solomon opined that "MER [medical evidence of record] does not support the severity" of Dr. Wendel's medical source statement. AR 84. Dr. Solomon found that Plaintiff's affective disorder caused "mild" difficulties with activities of daily living and social functioning, and "moderate" difficulties maintaining concentration, persistence or pace.
The ALJ rejected Dr. Solomon's opinions, including the limitation to simple work, because "a preponderance of the evidence shows that the claimant has only mild [mental] limitation," and because Dr. Solomon relied too heavily on the discredited opinions of Dr. Wendel concerning Plaintiff's difficulties maintaining concentration, persistence or pace. AR 22.
The ALJ correctly concluded that most of the other evidence concerning Plaintiff's mental impairments — e.g., Dr. Balson's initial evaluation, Dr. Dell's two lengthy reports, and Plaintiff's self-reported ability to drive, shop, handle money, visit family, attend church, and maintain a schedule of exercise and chores — showed that Plaintiff's mental impairments did not limit her functional abilities more than mildly. Indeed, the fact that Dr. Solomon's opinions were inconsistent with those of examining physician Dr. Dell would have been sufficient reason to discount Dr. Solomon's opinions.
Plaintiff argues that Dr. Solomon opined Plaintiff should be limited to simple work "based on his own opinion that the claimant had mild limitations." (JS at 21.) In fact, Dr. Solomon opined that Plaintiff had "moderate" difficulties maintaining concentration, persistence or pace. AR 84. Contrary to Plaintiff's argument, Dr. Solomon's simple work restriction was not to accommodate merely "mild" limitations.
Plaintiff argues that the ALJ's "ruling that plaintiff did not have mental limitations is [not] supported by substantial evidence." (JS at 22.) Plaintiff characterizes the ALJ's opinion as ruling that Plaintiff's "mental impairment was not severe and that she had no resulting mental limitations."
Plaintiff mischaracterizes the ALJ's opinion. The ALJ did find that Plaintiff's mental impairment was not severe but also found that it caused "mild" limitations in the functional area of concentration, persistence, and pace. AR 21-22. This finding of mild limitations is supported by the medical opinions of Drs. Balson and Dell, as discussed above. Thus, Plaintiff's Issue Four fails to show legal error.
An ALJ's assessment of symptom severity and claimant credibility is entitled to "great weight."
If the ALJ finds testimony as to the severity of a claimant's pain and impairments is unreliable, "the ALJ must make a credibility determination with findings sufficiently specific to permit the court to conclude that the ALJ did not arbitrarily discredit claimant's testimony."
In evaluating a claimant's subjective symptom testimony, the ALJ engages in a two-step analysis.
Second, if the claimant meets the first test, the ALJ may discredit the claimant's subjective symptom testimony only if he makes specific findings that support the conclusion.
The ALJ may also use ordinary techniques of credibility evaluation, such as considering the claimant's reputation for lying and inconsistencies in his statements or between his statements and his conduct.
The ALJ found Plaintiff's subjective symptom testimony regarding her mental impairments "not entirely credible" because it was "inconsistent with her activities of daily living" and "weakened by the claimant's inconsistent statements." AR 24, 28.
Plaintiff argues that her activities are not inconsistent with depression and anxiety so extreme that she can only work with unlimited discretionary 20-minute breaks (a condition that renders her unemployable). (JS at 25.) As explained above, no medical source so opined. Dr. Dell imposed as a work restriction that Plaintiff be allowed to take a 20-minute break "whenever she experiences increased symptoms of depression or anxiety," which Dr. Dell and the ALJ apparently concluded would not be work preclusive. In any event, taken together, activities that include driving, shopping, eating out, going to church, preparing meals, performing household chores independently, handling money, and adhering to a medication schedule are inconsistent with Plaintiff's claim of disability arising from mental impairment.
As examples of Plaintiff's inconsistent statements, the ALJ pointed out that in her Function Report, Plaintiff stated that she talks to her sisters on the phone and/or visits her mom "every day" (AR 168), but Plaintiff told Dr. Dell that "she isolates herself from friends and family," causing Dr. Dell to note, "she later made statements that contradict this." AR 28, citing AR 168, 758. Dr. Dell noted that Plaintiff visits her mother two or three days per week and they "often go out to eat together." AR 761;
For the reasons stated above, IT IS ORDERED that judgment shall be entered AFFIRMING the decision of the Commissioner denying benefits.