ALICIA G. ROSENBERG, Magistrate Judge.
Plaintiff
Having reviewed the entire file, the court reverses the decision of the Commissioner and remands for reconsideration of Dr. Quion's opinions and Plaintiff's credibility in light of Dr. Quion's opinions.
On July 7, 2014, Plaintiff filed an application for disability insurance benefits and alleged an onset date of July 30, 2012. Administrative Record ("AR") 16. The application was denied initially and upon reconsideration. AR 16, 132, 144. Plaintiff requested a hearing before an Administrative Law Judge (ALJ). On May 31, 2017, the ALJ conducted a hearing at which Plaintiff and a vocational expert ("VE") testified. AR 96-121. On July 10, 2017, the ALJ issued a decision denying benefits. AR 13-25. On March 30, 2018, the Appeals Council denied the request for review. AR 1-6. This action followed.
Pursuant to 42 U.S.C. § 405(g), this court has authority to review the Commissioner's decision to deny benefits. The decision will be disturbed only if it is not supported by substantial evidence, or if it is based upon the application of improper legal standards. Moncada v. Chater, 60 F.3d 521, 523 (9th Cir. 1995) (per curiam); Drouin v. Sullivan, 966 F.2d 1255, 1257 (9th Cir. 1992).
"Substantial evidence" means "more than a mere scintilla but less than a preponderance — it is such relevant evidence that a reasonable mind might accept as adequate to support the conclusion." Moncada, 60 F.3d at 523. In determining whether substantial evidence exists to support the Commissioner's decision, the court examines the administrative record as a whole, considering adverse as well as supporting evidence. Drouin, 966 F.2d at 1257. When the evidence is susceptible to more than one rational interpretation, the court must defer to the Commissioner's decision. Moncada, 60 F.3d at 523.
A person qualifies as disabled, and thereby eligible for such benefits, "only if his physical or mental impairment or impairments are of such severity that he is not only unable to do his previous work but cannot, considering his age, education, and work experience, engage in any other kind of substantial gainful work which exists in the national economy." Barnhart v. Thomas, 540 U.S. 20, 21-22, 124 S.Ct. 376, 157 L. Ed. 2d 333 (2003) (citation omitted).
The ALJ found that Plaintiff meets the insured status requirements through December 31, 2017. AR 18.
Following the five-step sequential analysis applicable to disability determinations, Lounsburry v. Barnhart, 468 F.3d 1111, 1114 (9th Cir. 2006),
The ALJ gave substantial weight to treating physician Dr. Quion's opinion that Plaintiff is limited to occasional handling, fingering and reaching. AR 23. The ALJ gave little weight to the remainder of Dr. Quion's opinions as "overly restrictive given the claimant's activities of daily living and mostly conservative treatment." AR 23-24. Plaintiff contends the ALJ erred.
An opinion of a treating physician is given more weight than the opinion of non-treating physicians. Orn v. Astrue, 495 F.3d 625, 631 (9th Cir. 2007). To reject an uncontradicted opinion of a treating physician, an ALJ must state clear and convincing reasons that are supported by substantial evidence. Bayliss v. Barnhart, 427 F.3d 1211, 1216 (9th Cir. 2005). When a treating physician's opinion is contradicted by another doctor, "the ALJ may not reject this opinion without providing specific and legitimate reasons supported by substantial evidence in the record. This can be done by setting out a detailed and thorough summary of the facts and conflicting clinical evidence, stating his interpretation thereof, and making findings." Orn, 495 F.3d at 632 (citations and quotation marks omitted).
An examining physician's opinion constitutes substantial evidence when it is based on independent clinical findings. Orn v. Astrue, 495 F.3d 625, 632 (9th Cir. 2007). "`The opinion of a nonexamining physician cannot by itself constitute substantial evidence that justifies the rejection of the opinion of either an examining physician or a treating physician.'" Ryan v. Comm'r, 528 F.3d 1194, 1202 (9th Cir. 2008) (citation and emphasis omitted). However, a non-examining physician's opinion may serve as substantial evidence when it is supported by other evidence in the record and is consistent with it. Andrews v. Shalala, 53 F.3d 1035, 1041 (9th Cir. 1995). "When there is conflicting medical evidence, the Secretary must determine credibility and resolve the conflict." Thomas v. Barnhart, 278 F.3d 947, 956-57 (9th Cir. 2002) (citation and quotation marks omitted). Harmless error applies to social security cases. Marsh v. Colvin, 792 F.3d 1170, 1172 (9th Cir. 2015).
Dr. Quion reported seeing Plaintiff every six months during June 24, 2014 through March 1, 2017. AR 939. Plaintiff reported feeling constant pins and needles in all extremities due to diabetic neuropathy, and was on a high dose of gabapentin. AR 940. Dr. Quion opined that Plaintiff could sit for two hours and stand/walk for less than one hour in an eight-hour workday. After two hours of sitting, Plaintiff would need to get up and move around for about 15 minutes. She could frequently lift/carry up to five pounds, occasionally lift up to 20 pounds, and never lift more than 20 pounds. AR 941. She could occasionally handle, finger and reach. Her pain and fatigue would frequently be severe enough to interfere with attention and concentration. She would need a 30-minute break after two hours of work. AR 942. She would likely be absent more than three times per month. Dr. Quion noted that Plaintiff previously took morphine. Although Dr. Quion switched Plaintiff to gabapentin, it did not help much and neuropathy is "still a big problem." AR 943.
The ALJ discounted Dr. Quion's opinions due to conservative treatment and inconsistency with Plaintiff's activities of daily living. AR 23-24. Dr. Quion diagnosed diabetes and diabetic peripheral neuropathy, and in June 2014 prescribed gabapentin 600 mg three times per day and morphine concentrate 20 mg every four hours. AR 840. In July 2014 and January 2015, Dr. Quion noted a diabetic ulcer on the left big toe, referred her to a wound clinic and diagnosed peripheral vascular disease. AR 842, 844. In January 2016, Dr. Quion increased gabapentin to 800 mg three times per day. AR 846. Plaintiff remained on a morphine pump. AR 1011. The diabetic ulcer on the left toe did not heal. E.g., AR 857. Surgery was scheduled in June 2017. AR 947. The court cannot characterize a morphine pump combined with high doses of gabapentin as "conservative treatment." See Lamoureaux v. Astrue, 2012 U.S. Dist. LEXIS 28586, *24 (D. Or. Feb. 13, 2012) (declining to characterize morphine pump as conservative treatment).
Defendant argues that any error was harmless. See Marsh v. Colvin, 792 F.3d 1170, 1173 (9th Cir. 2015) (applying harmless error analysis when treating physician's opinion is not even mentioned). Defendant contends the ALJ's finding that Dr. Quion's opinions are inconsistent with Plaintiff's activities of daily living is supported by substantial evidence. The ALJ found that Plaintiff was able to care for her daughter who has spina bifida, care for her pets (three dogs and one cat), shop for groceries, clean her home, do the laundry, drive a car, and water the lawn and plants. AR 19, 22. Plaintiff testified that she does laundry for two hours twice per week, and dusts for one hour once per week. AR 301. Plaintiff testified that she can lift 10-15 pounds, and carries groceries from the car to her home once per week. She drives for 30 minutes, stops to walk around "for a few minutes" and continues. AR 298, 793. She walks short distances, waters the plants and grass for 30 minutes and cleans her house, including vacuuming and mopping the floors for 30 minutes. AR 297-98. She cares for her daughter, who has spina bifida.
"To determine whether a claimant's testimony regarding subjective pain or symptoms is credible, an ALJ must engage in a two-step analysis." Lingenfelter v. Astrue, 504 F.3d 1028, 1035-36 (9th Cir. 2007). At step one, "the ALJ must determine whether the claimant has presented objective medical evidence of an underlying impairment `which could reasonably be expected to produce the pain or other symptoms alleged.'" Id. (quoting Bunnell v. Sullivan, 947 F.2d 341, 344 (9th Cir. 1991) (en banc)). The ALJ found that Plaintiff's medically determinable impairments could reasonably be expected to cause the alleged symptoms. AR 22.
Second, when an ALJ concludes that a claimant is not malingering and has satisfied the first step, "the ALJ may `reject the claimant's testimony about the severity of her symptoms only by offering specific, clear and convincing reasons for doing so.'" Brown-Hunter v. Colvin, 806 F.3d 487, 493 (9th Cir. 2015) (citation omitted); Burrell v. Colvin, 775 F.3d 1133, 1136-37 (9th Cir. 2014). "A finding that a claimant's testimony is not credible `must be sufficiently specific to allow a reviewing court to conclude the adjudicator rejected the claimant's testimony on permissible grounds and did not arbitrarily discredit a claimant's testimony regarding pain.'" Brown-Hunter, 806 F.3d at 493 (citation omitted). "`General findings are insufficient; rather, the ALJ must identify what testimony is not credible and what evidence undermines the claimant's complaints.'" Id. (citation omitted).
The ALJ concluded that Plaintiff's statements concerning the intensity, persistence and limiting effects of her symptoms were not consistent with the objective medical evidence and other evidence, including inconsistencies in Plaintiff's statements in the record. AR 22. Although the fact that the objective medical evidence does not support the severity of the subjective allegations cannot form the sole basis for discounting testimony, "it is a factor that the ALJ can consider in his credibility analysis." Burch v. Barnhart, 400 F.3d 676, 681 (9th Cir. 2005). Because this matter is being remanded for reconsideration of Dr. Quion's opinions, the Commissioner is free to reevaluate Plaintiff's credibility as well.
IT IS HEREBY ORDERED that the decision of the Commissioner is reversed and remanded for reconsideration of Dr. Quion's opinions and Plaintiff's credibility in light of Dr. Quion's opinions.