KENDALL J. NEWMAN, Magistrate Judge.
Plaintiff, who is represented by counsel, seeks judicial review of a final decision of the Commissioner of Social Security ("Commissioner" or "defendant") denying plaintiff's application for Supplemental Security Income benefits under Title XVI of the Social Security Act ("Act").
Defendant filed a cross-motion for summary judgment and opposition to plaintiff's motion. (Opp'n, ECF No. 16.) Plaintiff filed reply briefing in support of his motion. (Reply, ECF No. 17.) For the reasons stated below, the court grants plaintiff's motion for summary judgment, denies the Commissioner's cross-motion for summary judgment, and remands this case for further proceedings.
Plaintiff filed an application for supplemental security income on June 27, 2008, alleging a disability onset date of December 1, 1981.
In a decision dated May 28, 2010, the ALJ denied plaintiff's application for benefits based on a finding that plaintiff is capable of performing work that exists in significant numbers in the national economy, including work as a hand packer, cleaner, and laborer. (AT 24.) The ALJ's decision became the final decision of the Commissioner when the Appeals Council denied plaintiff's request for review. (AT 1-5.) Plaintiff subsequently filed this action.
The ALJ conducted the required five-step evaluation and concluded that plaintiff is not disabled within the meaning of the Act. At step one, the ALJ concluded that plaintiff had not engaged in substantial gainful activity since his application date of June 27, 2008. (AT 19.) At step two, the ALJ concluded that plaintiff had the following "severe" impairments: "bilateral vision loss (left worse than right), obesity, organic mental disorder, and mental retardation." (
At step three, the ALJ determined that plaintiff's impairments, whether alone or in combination, did not meet or medically equal any impairment listed in the applicable regulations, 20 C.F.R. Pt. 404, Subpt. P, App. 1. (AT 19-20.) In particular, the ALJ found that plaintiff's impairments did not meet Listing 12.05C because "the claimant does not have a valid verbal, performance, or full scale IQ of 60 through 70 and a physical or other mental impairment imposing an additional and significant work-related limitation of function." (AT 20.)
The ALJ further 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: cannot be exposed to hazards; cannot engage in any job duties requiring fine visual acuity; and is limited to simple, routine tasks." (AT 20.) In making this RFC determination, the ALJ found that plaintiff's statements regarding "the intensity, persistence and limiting effects of" his symptoms were "not credible to the extent they are inconsistent with the above residual functional capacity assessment." (AT 21.)
The ALJ gave "significant" or "great" weight to several medical opinions of record. He gave "significant weight" to the opinion of Dr. Jackson (AT 247-51), a non-examining physician who opined that plaintiff had "no exertional limitations but must avoid concentrated exposure to hazards and could not do jobs requiring binocular vision or fine, detailed work." (AT 22.) The ALJ also gave "great weight" to the opinion of Dr. Lucila (AT 233-38), a non-examining physician who opined that plaintiff "can perform simple work." (AT 23.)
The ALJ gave "little" weight to several other medical opinions of record. He gave "little weight" to the opinion of Dr. Hernandez (AT 218-21), an examining physician who opined that plaintiff could perform "medium exertion with decreased visual acuity of the left eye." (AT 22.) The ALJ also gave "little weight" to the opinion of Dr. Scaramozzino (AT 212-17), an examining physician who diagnosed plaintiff with borderline intellectual functioning and attention deficit hyperactivity disorder (ADHD), and who opined that plaintiff had "moderate limitations in several areas" of functioning. (AT 22.)
At step four, the ALJ considered the VE's testimony and concluded that plaintiff was unable to perform his past work because he does not have past relevant work. (AT 23.) The ALJ concluded, however, that plaintiff could perform other work, and that plaintiff was "not disabled" based on his ability to perform jobs that exist in significant numbers in the national economy. (AT 23-24.)
The court reviews the Commissioner's decision to determine whether it is: (1) free of legal error and (2) supported by substantial evidence in the record as a whole.
However, the court "must consider the entire record as a whole and may not affirm simply by isolating a `specific quantum of supporting evidence.'"
"If additional proceedings can remedy defects in the original administrative proceeding, a social security case should be remanded."
Plaintiff argues that the ALJ erred in failing to address the opinion of examining physician Dr. Tobias and the IQ test results stated within that opinion, and that the ALJ therefore erred in analyzing the applicability of Listing 12.05C.
Although the ALJ's opinion makes no mention of it, the record contains a "Psychological Disability Evaluation" dated October 3, 2006, and signed by Dr. Faith Tobias, Ph.D., and Jacklyn Chandler, Psychological Assistant. (AT 194-98.) The Psychological Disability Evaluation followed an examination of plaintiff that included the administration of IQ tests. (
At minimum, Dr. Tobias' opinion amounts to evidence that plaintiff has a valid full-scale IQ score of 69. (AT 196.) As described below, the existence of a valid IQ score below 70 is relevant to whether plaintiff's condition satisfies the requirements of Listing 12.05C.
At Step Three, the ALJ asks whether the claimant's impairment or combination of impairments meets or equals an impairment listed in 20 C.F.R., Pt. 404, Subpt. P, App.1 ("the Listings"), and if the answer is yes, the claimant is automatically determined to be disabled.
Listing 12.05C, mental retardation, "refers to significantly subaverage general intellectual functioning with deficits in adaptive functioning initially manifested during the developmental period; i.e., the evidence demonstrates or supports onset of the impairment before age 22." 20 C.F.R. Pt. 404, Subpt. P, App. 1 § 12.05. The Listing can be met by satisfying the requirements of paragraph C: "A valid verbal, performance, or full scale IQ of 60 through 70 and a physical or other mental impairment imposing an additional and significant work-related limitation of function."
Thus, a plaintiff meets Listing 12.05C's requirements if he: (1) has an IQ score between 60 and 70 and the evidence demonstrates or supports onset of the impairment before age 22; and (2) he has a physical or other mental impairment imposing an additional and significant work-related limitation of function (i.e., a "severe" impairment). As described below, evidence in the record indicates that plaintiff has an IQ score between 60 and 70, evidence in the record potentially supports onset before age 22, and plaintiff has other "severe" impairments that impose significant work-related limitations.
The ALJ analyzed Listing 12.05C as follows: "[T]he `paragraph C' criteria of [L]isting 12.05 are not met because the claimant does not have a valid verbal, performance, or full scale IQ of 60 through 70 and a physical or other mental impairment imposing an additional and significant work-related limitation of function." (AT 20.)
Crucially, the ALJ never acknowledged that the record contains evidence of plaintiff's full scale IQ score of 69 (AT 196), and the ALJ neither analyzed the validity of that score nor gave any reasons for rejecting the score's validity. The Ninth Circuit Court of Appeals has not delineated what evidence an ALJ should consider in assessing whether IQ scores are "valid"; however, it has found error where an ALJ failed to address the validity of an IQ score in applying Listing 12.05.
In any event, while an ALJ can consider various types of evidence to determine whether IQ scores are "valid," in this particular case, the ALJ did not explicitly consider any evidence before concluding that plaintiff lacks a "valid" IQ score. (AT 20.) Indeed, the ALJ never mentioned the evidence of plaintiff's IQ scores, let alone discussed whether or why those scores might be invalid. Instead, the ALJ conclusorily found only that plaintiff "does not have a valid verbal, performance, or full scale IQ score," offering no explanation for that finding and making no reference to the only IQ scores in the record — those in Dr. Tobias' opinion. (AT 20.) The ALJ is "always" obligated to "consider" and "evaluate every medical opinion" the Commissioner receives in the record,
Defendant contends that this error was harmless for various reasons, but the arguments are not well-taken. While an ALJ's failure to acknowledge or analyze an IQ score in the "60 through 70" range might potentially be harmless if there was no evidence in the record to support the remaining elements of Listing 12.05C, the record in this case contains evidence that could potentially satisfy those remaining elements. For example, there is at least some evidence in the record supporting a potential onset of plaintiff's mental impairment before age 22. (AT 183-88 (school records identifying plaintiff as a "learning disabled student" with a 1.3 grade reading level in tenth grade).)
Defendant argues that the ALJ's error was harmless given that plaintiff was diagnosed with "borderline intellectual functioning, rather than mental retardation."
Defendant argues that "substantial evidence support[s] the ALJ's decision despite the fact that Dr. Tobias' opinion was not discussed." (Opp'n at 8.) With respect to plaintiff's IQ scores and the application of Listing 12.05C, however, this is not the case. As noted above, the only evidence in the record regarding plaintiff's IQ scores indicates that the scores were "valid." (AT 196.) Thus, it cannot be said that "substantial evidence" supports the ALJ's finding that plaintiff "does not have a valid verbal, performance, or full scale IQ" score in the record. (AT 20.)
Defendant also argues that because the ALJ considered Dr. Lucila's opinion and Dr. Scaramozzino's opinion, and because those physicians considered Dr. Tobias' opinion, the ALJ essentially considered Dr. Tobias' opinion and the IQ scores therein. (Opp'n at 8-9.) On the facts of this particular case, the argument is unpersuasive. Even though Drs. Lucila and Scaramozzino referenced Dr. Tobias' opinion within their own opinions, neither physician specifically opined that the IQ scores within Dr. Tobias' opinion were invalid. (AT 212 (Dr. Scaramozzino notes only that he reviewed records dated "October 3, 2006," the date of Dr. Tobias' opinion); 236-37 (Dr. Lucila notes that plaintiff previously obtained scores of "WAIS 69-75" and that "scores are considered still valid").) There is no medical opinion evidence in the record addressing the validity of the IQ scores other than Dr. Tobias' opinion. Thus, even if the ALJ somehow considered Dr. Tobias' opinion by proxy when he considered the opinions of Drs. Lucila and Scaramozzino, which the undersigned does not find, the ALJ nevertheless failed to explain why he deemed the only IQ scores in the record invalid even though Drs. Scaramozzino and Lucila did not do so.
Plaintiff also makes the related argument that the ALJ failed to give specific and legitimate reasons for not crediting Dr. Scaramozzino's opinion, especially given that Dr. Scaramozzino's opinion was partially based upon Dr. Tobias' opinion. (Mot. for Summ. J. at 6, 9-10; Reply at 2). In particular, plaintiff argues that "[s]ince the ALJ failed to realize that Dr. Scaramozzino's opinion was partially based up on Dr. Tobias' report which is based on detailed intellectual functioning testing, the ALJ failed to articulate specific and legitimate reasons for not crediting Dr. Scaramozzino's opinion" on grounds that the physician's examination findings did not support his conclusions. (Mot. for Summ. J. at 9-10.) Plaintiff's argument is well-taken. As described above, in analyzing Listing 12.05C, the ALJ appeared to ignore both Dr. Tobias' opinion and the various test results (including IQ test results) stated in that opinion. (AT 20.) The ALJ also discounted Dr. Scaramozzino's opinion in part because the ALJ believed it to be unsupported by examination findings (AT 22-23), but Dr. Tobias' examination and resulting opinion (upon which Dr. Scaramozzino relied (AT 212)) could potentially suffice as such supporting evidence.
While defendant is correct that "[a]n IQ score is not dispositive" (Opp'n at 9), here, plaintiff's IQ scores are squarely relevant to the application of Listing 12.05C and the ALJ erred in not addressing them. Indeed, the existence of a valid IQ score will itself satisfy the first prong of Listing 12.05C, as described above. Moreover, plaintiff does not argue that his IQ scores are "dispositive"; instead, plaintiff argues that his IQ scores should have been part of the ALJ's Listing 12.05C analysis, and should not have been ignored or silently rejected without any meaningful discussion as to why.
Defendant also argues that the ALJ's error was harmless given that Dr. Tobias rendered her opinion on October 3, 2006, "a little less than two years before Plaintiff filed his SSI application, and prior to the relevant period," such that the ALJ properly gave more weight to the other medical opinions that were rendered more recently. (Opp'n at 7-8.) The gist of this argument appears to be that the evidence supports the ALJ's decision to credit medical opinions other than Dr. Tobias'. The validity of more recent medical opinions, however, does not render harmless the ALJ's error in analyzing Listing 12.05C without considering Dr. Tobias' opinion and thus ignoring record evidence of plaintiff's IQ scores. None of the other medical opinions included their own IQ tests or offered any assessment of the validity of the IQ scores stated within Dr. Tobias' opinion. Indeed, the only evidence in the record pertaining to the IQ scores suggests that the scores are "valid." (AT 196.) Accordingly, even if the ALJ had good reasons for giving weight to medical opinions other than Dr. Tobias', this does not render harmless the ALJ's failure to acknowledge and address plaintiff's IQ scores as part of his analysis of Listing 12.05C.
Defendant also offers no authorities regarding the weight to be given to medical evidence outside the "relevant period." At most, defendant cites authorities for the proposition that plaintiff "is statutorily ineligible for any SSI benefits prior to the protective filing date of the application at issue," which is June 27, 2008, making the "relevant period" for benefits payments from that date to the ALJ's decision date. (Opp'n at 1 n.2 (citing 20 C.F.R. §§ 416.330(a); 416.335).) However, defendant has not shown that plaintiff's ineligibility for benefits payments prior to a certain period necessarily dictates the court's (or the ALJ's) ability to examine medical evidence in the record but predating that period. Defendant has not offered authorities suggesting that, based on date alone, more recent medical opinions should necessarily be deemed weightier than older opinions in the record. Moreover, as plaintiff notes, IQ scores are sometimes held to remain constant over time absent intervening circumstances.
Defendant also argues that plaintiff's IQ scores "were on the higher end" of the range stated within Listing 12.05C, such that the ALJ's failure to address plaintiff's IQ scores was harmless. (Opp'n at 9.) However, while plaintiff's "verbal" and "performance" IQ scores fall outside the "60 through 70" range stated within Listing 12.05C, the regulations also specify that when verbal, performance, and full scale scores are provided by an IQ test, the ALJ must consider the lowest of these scores. 20 C.F.R., Pt. 404, Subpt. P, App. 1, § 12.00(D)(6)(c) ("In cases where more than one IQ is customarily derived from the test administered, e.g., where verbal, performance, and full scale IQs are provided in the Wechsler series, we use the lowest of these in conjunction with 12.05.") Plaintiff's "Full Scale" score was 69 and thus falls within the range stated in Listing 12.05C. (AT 196.) Accordingly, the argument that the ALJ did not err in ignoring plaintiff's IQ scores because they were "were on the higher end" (Opp'n at 9) is not well-taken.
For all the foregoing reasons, the ALJ erred in failing to address the evidence of plaintiff's full scale IQ score of 69 and Dr. Tobias' opinion that the score was "valid." (AT 196.) Defendant has not shown that the error was harmless. Accordingly, plaintiff's motion is granted in part, and the matter is remanded to the Commissioner for clarification regarding the nature of the ALJ's considerations at Step 3 and precisely what was decided and why with respect to plaintiff's IQ scores (AT 196).
Plaintiff requests that the case be remanded for immediate payment of benefits. (Mot. for Summ. J. at 15.) However, an award of benefits is only appropriate where "no useful purpose would be served by further administrative proceedings," where "the record has been thoroughly developed," and where "there are no outstanding issues that must be resolved before a proper disability determination can be made."
Plaintiff also argues that the ALJ erred in failing to resolve an internal inconsistency in the medical opinion evidence regarding plaintiff's visual abilities. (Mot. for Summ. J. at 13-15.) In particular, plaintiff argues that consultative examining ophthalmologist Dr. Contreras opined that plaintiff's left eye vision "could be rehabilitated to 20/50 level" with cataract surgery (AT 240), but also somewhat confusingly appeared to opine that plaintiff presently has "20/50" vision (AT 239). (Mot. for Summ. J. at 13.) Plaintiff thus argues that Dr. Contreras' opinion is "internally inconsistent as far as Mr. Halyday's present condition, without surgery." (
(AT 240 (emphasis added).) In reliance on Dr. Contreras' opinion, the ALJ concluded that plaintiff's "corrected vision [was] 20/50" and crafted plaintiff's RFC so as to limit plaintiff's work activities to those not requiring "fine visual acuity" or exposure to "hazards." (AT 20, 22 (citing AT 239-40).)
As plaintiff compellingly argues, the ALJ never addressed the fact that Dr. Contreras' assessment of plaintiff's functional limitations was contingent on plaintiff's first undergoing cataract surgery. (Mot. for Summ. J. at 13-15.) Plaintiff argues that, because Dr. Contreras conditioned his functional assessment upon plaintiff's surgery, the fact that plaintiff has not had such surgery means that Dr. Contreras' opinion should be read as evidence that plaintiff is not presently "functional in the work setting," is not presently able to perform work so long as it "avoid[s] hazards," and is not presently able to perform work requiring the handing of "small objects." (AT 240.)
Defendant's only counter argument is that Dr. Contreras actually opined that plaintiff could presently "avoid hazards" and "handle small objects" without surgery and with his current vision. (Opp'n at 10 ("Consistent with Dr. Contreras's statement of Plaintiff's current visual abilities, the ALJ found Plaintiff should avoid hazards and could not perform job duties requiring fine visual acuity, which suggests that he would be unable to handle small objects.").) Defendant's argument is not well-taken. On the undersigned's reading of the evidence, Dr. Contreras opined that plaintiff could perform such tasks only "if" he underwent surgery. (AT 240.)
In any case, the debate about what Dr. Contreras actually opined indicates that there is a material ambiguity in the record with respect to plaintiff's visual abilities and functional limitations resulting therefrom. The ALJ failed to resolve that ambiguity, and the ALJ's opinion is unclear regarding plaintiff's present visual abilities, without surgery. Perhaps the ALJ determined that plaintiff's visual limitations, without surgery, presently permit plaintiff to work as long as the work does not require "fine visual acuity" or exposure to "hazards." Perhaps the ALJ determined that plaintiff could perform such work only after surgery, as Dr. Contreras hypothesized (AT 240). From the ALJ's opinion, however, it is unclear whether the ALJ believed plaintiff first needs eye surgery before he can perform the sorts of work described in the vision-related medical opinions of record. (AT 239-46; 247-51.) The ALJ's RFC assessment simply does not distinguish between plaintiff's pre-surgery functional limitations and plaintiff's hypothetical post-surgery functional limitations as Dr. Contreras described them. It is unclear whether the ALJ accepted or rejected Dr. Contreras' opinion that plaintiff's having 20/50 vision and an ability to work are contingent on surgery. The ALJ's failure to resolve this inconsistency in the vision-related medical evidence amounts to error. On remand, the ALJ should thoroughly address the matter of plaintiff's need for eye surgery, which may potentially include seeking clarification(s) from Dr. Contreras or other examining physician(s) as the ALJ deems necessary.
While plaintiff argues that he cannot afford eye surgery and should not be penalized for this inability (Mot. for Summ. J. at 14), the argument is not well-taken. Plaintiff identifies evidence suggesting plaintiff's inability to afford eye surgery. (AT 41.) However, the ALJ's opinion makes no mention of eye surgery. There is no indication that the ALJ construed plaintiff's lack of eye surgery against plaintiff anywhere in the five-step analysis. As discussed above, the threshold issue is whether the ALJ's RFC assessment is properly based upon plaintiff's present visual abilities versus the hypothetical visual abilities he may have after eye surgery. Because the ALJ did not address the record's ambiguities regarding this threshold issue, the ALJ also did not address the secondary issue of whether plaintiff could afford such surgery.
Depending on the circumstances of a given case, "disability benefits may not be denied because of the claimant's failure to obtain treatment [he or she] cannot obtain for lack of funds."
As plaintiff also argues, the ALJ gave "significant weight" to the opinion of non-examining physician Dr. Jackson (AT 247-51), who reviewed Dr. Contreras' opinion and other medical evidence. (AT 22, 239-40.) Yet Dr. Jackson made no mention of Dr. Contreras' apparent belief that plaintiff needed surgery before he would be "functional in the work setting." (AT 22; 240, 247-51.) The ALJ's reliance on Dr. Jackson's opinion thus does not resolve the record's above-described ambiguity with respect to plaintiff's need for eye surgery.
Further, Dr. Jackson opined that plaintiff's visual abilities limited plaintiff to work that would not require "binocular vision" or "fine, detailed work." (AT 249.) As plaintiff notes, however, although the ALJ gave Dr. Jackson's opinion "significant weight," the ALJ's RFC assessment did not clearly include these limitations. (AT 20, 22.) Defendant argues that any error with the ALJ's RFC assessment was harmless given that the RFC effectively encompassed these limitations by excluding work requiring "fine visual acuity" or exposure to "hazards." (Opp'n at 10-11.) Yet defendant does not cite to authorities or compellingly explain how limiting plaintiff to work not involving "fine visual acuity" or exposure to "hazards" adequately encompasses jobs not involving "fine, detailed work" or "binocular vision." Upon remand, the ALJ will have an opportunity to consider whether his RFC assessment should or should not be revised to materially account for all limitations within Dr. Jackson's opinion. (AT 22.)
For the foregoing reasons, IT IS HEREBY ORDERED that:
IT IS SO ORDERED.
Additionally, to the extent the undersigned uses the present tense in referring to or describing plaintiff's alleged conditions or functional abilities, or the ALJ's or Appeals Council's characterizations of the same, the undersigned clarifies that such references are to plaintiff's conditions or functional abilities at the time of the ALJ's or Appeals Council's decision, unless otherwise indicated.
The claimant bears the burden of proof in the first four steps of the sequential evaluation process.
20 C.F.R. Pt. 404, Subpt. P, App. 1 § 12.05C.