EDWARD M. CHEN, District Judge.
On February 9, 2009, Plaintiff Dan Kruger protectively filed for disability insurance benefits under Title II of the Social Security Act. Mr. Kruger claimed an inability to work beginning October 20, 1995, based on, inter alia, degenerative disc disease of the lumbar spine and Ehlers-Danlos syndrome. See AR 212 (disability report). Mr. Kruger has exhausted his administrative remedies with respect to his claim of disability. This Court has jurisdiction for judicial review pursuant to 42 U.S.C. § 405(g). Mr. Kruger has moved for summary judgment or, in the alternative, a remand for additional proceedings. The Commissioner has cross-moved for summary judgment. Having considered the parties' briefs and accompanying submissions, including but not limited to the administrative record, and good cause appearing therefor, the Court hereby
On February 9, 2009, Mr. Kruger applied for disability insurance, claiming an inability to work since October 20, 1995, due to, inter alia, degenerative disc disease of the lumbar spine and Ehlers-Danlos syndrome ("EDS").
Judge Benmour went through the five-step sequential evaluation process for disability required under 20 C.F.R. § 404.1520.
Celaya v. Halter, 332 F.3d 1177, 1180 (9th Cir. 2003).
However, before making the step one finding, Judge Benmour noted first that Mr. Kruger's date last insured ("DLI") for purposes of his claim for benefits was December 31, 2000. See AR 31 (ALJ decision). Mr. Kruger has not contested this finding as a part of this lawsuit. Thus, for purposes of this opinion, the question is whether Mr. Kruger was disabled between October 20, 1995, and December 31, 2000.
At step one, the ALJ found that Mr. Kruger did not engage in substantial gainful activity during the period from his alleged onset date through his DLI. See AR 31 (ALJ decision). At step two, the ALJ found that, through the DLI, Mr. Kruger had the following severe impairments: degenerative disc disease of the lumbar spine and EDS resulting in chronic pain. See AR 31. At step three, the ALJ concluded that Mr. Kruger did not have an impairment or combination of impairments that met or medically equaled one of the impairments listed in the relevant appendix. See AR 31. At step four, the ALJ found that, through the DLI, Mr. Kruger had the residual functional capacity to perform sedentary work as defined in 20 C.F.R. § 404.1567(a), with certain exceptions. See AR 32. The ALJ then found that, based on this residual functional capacity, Mr. Kruger was unable to perform any of his past relevant work, including acupuncture. See AR 36. At step five, the ALJ concluded that, through the DLI, there were jobs that existed in significant numbers in the national economy that Mr. Kruger could have performed. See AR 37. Consequently, the ALJ issued a decision adverse to Mr. Kruger. See AR 26-38.
Subsequently, Mr. Kruger sought review of the ALJ decision. See AR 25 (request for review of ALJ decision). For review by the Appeals Council, Mr. Kruger supplemented the record with a letter from a treating chiropractor, who is also a friend. See AR 521 (Sherman letter); AR 4 (exhibit list attached to notice of Appeals Council action). The Appeals Council denied the request for review on September 11, 2012. See AR 1 (notice of Appeals Council action). Mr. Kruger now seeks judicial review through this action.
Administrative decisions in Social Security Disability cases are typically reviewed under a "substantial evidence test." See Lewis v. Apfel, 236 F.3d 503, 509 (9th Cir. 2001). That is, a district court
Vasquez v. Astrue, 572 F.3d 586, 591 (9th Cir. 2009) (internal citations omitted).
In the instant case, Mr. Kruger makes two main arguments: (1) that the ALJ's findings regarding his credibility were not adequately substantiated and (2) that the ALJ erred in failing to give appropriate weight to the opinions of Dr. Saal, one of his treating physicians. Both parties have addressed Mr. Kruger's arguments through the lens of the above legal standard. The Court, however, in evaluating the arguments presented by Mr. Kruger, concludes that it is not appropriate to apply that legal standard here — at least, not yet — because further development of the record was needed before the ALJ and Appeals Council should have rendered a decision as to whether Mr. Kruger was disabled.
Even where a claimant is represented, an "ALJ in a social security case has an independent duty to fully and fairly develop the record and to assure that the claimant's interests are considered." Tonapetyan v. Halter, 242 F.3d 1144, 1150 (9th Cir. 2001) (internal quotation marks omitted). "The duty to develop the record extends to the Appeals Council." Butler v. Astrue, No. 11-cv-00452 (WGY), 2013 U.S. Dist. LEXIS 28082, at *29 (N.D.N.Y. Feb. 28, 2013); see also Sims v. Apfel, 530 U.S. 103, 111 (2000) (stating that "[i]t is the ALJ's duty to investigate the facts and develop the arguments both for and against granting benefits, and the [Appeals] Council's review is similarly broad"). The duty to develop the record is triggered "when there is ambiguous evidence or when the record is inadequate to allow for proper evaluation of the evidence." Mayes v. Massanari, 276 F.3d 453, 459-60 (9th Cir. 2001).
Here, the Court finds that that duty was triggered because (1) for the period October 1995 to October 1998 (i.e., from the alleged onset date up to the time that Mr. Kruger sought treatment from Dr. Saal), there was a clear gap in the record, as even the ALJ expressly recognized, see AR 33 (ALJ decision) (noting that Mr. Kruger claimed a serious injury as of October 1995 but "the earliest treatment record is from November of 1998, over three years after his injury"), and (2) for the period November 1998 to December 2000 (i.e., from the time that Dr. Saal treated Mr. Kruger to the DLI), there was a critical ambiguity regarding the opinion of Dr. Saal.
As indicated above, the period from October 1995 to October 1998 covers the time from the alleged onset date up to the date that Mr. Kruger sought treatment from Dr. Saal. This was clearly a critical time because it was right after Mr. Kruger sustained the injury at issue. At the hearing before the ALJ, Mr. Kruger claimed that some of the medical records for this period were not available — e.g., records from a physical therapy clinic and records from his treating physiatrist, Chaz Salzberg. See AR 60 (ALJ hearing). According to Mr. Kruger, the clinic "is no longer in existence [and so] doesn't have the record[s]"; as for Dr. Salzberg, he "is no longer in practice" and "[t]he people who've taken over his practice have not kept his records." AR 60-61.
The Court does not fault the ALJ for taking these statements by Mr. Kruger at face value — i.e., that the clinic and Dr. Salzberg records were not available. What is problematic is that other medical records might have been available but there is no indication that the ALJ did any follow up as to these records. At the hearing, for example, Mr. Kruger noted that not only did he contact Dr. Salzberg but he also contacted a chiropractor in a clinic.
The ALJ's failure to develop the record was not subsequently cured when Mr. Kruger submitted a letter to the Appeals Council from a chiropractor friend, Dr. Sherman, who treated him shortly after the alleged onset date. See AR 521-22 (Dr. Sherman letter). First, it is not clear that Dr. Sherman was the chiropractor that Mr. Kruger mentioned during the hearing before the ALJ. Second, even if he was, the Appeals Council should have solicited Dr. Sherman's records — particularly because Dr. Sherman's letter was somewhat conclusory, see, e.g., AR 521 (stating "conservative care" was provided and "ordered radiological studies [were] inconclusive") — and there is no indication that the Appeals Council did such. See 20 C.F.R. § 404.1512(d) ("Before we make a determination that you are not disabled, we will develop your complete medical history for at least the 12 months preceding the month in which you file your application unless there is a reason to believe that development of an earlier period is necessary or unless you say that your disability began less than 12 months before you filed your application."); see also id. § 404.950(d)(1) ("When it is reasonably necessary for the full presentation of a case, an administrative law judge or a member of the Appeals Council may, on his or her own initiative or at the request of a party, issue subpoenas for the appearance and testimony of witnesses and for the production of books, records, correspondence, papers, or other documents that are material to an issue at the hearing."). Finally, regardless of Dr. Sherman, there was still the unidentified acupuncturist who may have given some treatment to Mr. Kruger as well as the possibility of nonmedical sources who could have opined on Mr. Kruger's condition. Indeed, given the contents of Dr. Sherman's letter — which provided at least some corroboration or substantiation for Mr. Kruger's position — the Appeals Council arguably had even more of an obligation to make an inquiry as to whether there might be additional evidence.
For the period November 1998 to December 2000, it is clear — both from the parties' briefs as well as the administrative record — that the critical medical evidence of record was that provided by Dr. Saal.
To the extent the government suggests that the ALJ assumed or actually concluded that those limitations were in fact limitations found by Dr. Saal, it still is not clear that Dr. Saal expressed any opinion as to whether those limitations would persist or whether there would be a continued trend of improvement. For example, in his post-June 2009 letter, Dr. Saal does state that Mr. Kruger "never progressed significantly above this level" — i.e., able to sit for up to two hours a day, AR 511 (Dr. Saal letter), but there is ambiguity as to whether this was an opinion of Dr. Saal or a reported limitation by Mr. Kruger. See AR 511 (stating that, "[a]fter the November 1999 epidural, Dr. Kruger reported that he had not experienced any significant improvement to his overall functional status").
Given the ambiguity with respect to the opinion of Dr. Saal, the ALJ should have contacted Dr. Saal for clarification. Cf. Smolen, 80 F.3d at 1288 (stating that, "[i]f the ALJ thought he needed to know the basis of [the doctor's] opinions in order to evaluate them, he had a duty to conduct an appropriate inquiry, for example, by subpoenaing the physicians or submitting further questions to them").
To the extent the government suggests that the ALJ assumed or actually concluded that Dr. Saal found that the limitations would persist, then there would a contradiction between Dr. Saal's opinion and the opinion of state agency medical consultant, see AR 408 (Dr. Sheehy opinion) (concluding that there was no evidence to support a severe persistent impairment before the DLI), such that the ALJ could reject Dr. Saal's opinion only for specific and legitimate reasons supported by substantial evidence.
Because the ALJ and/or Appeals Council failed to adequately develop the record, the Court concludes that a remand is warranted so that the record may be so developed. As a part of the remand, the ALJ may also wish to consider development of the record as to the EDS disorder (e.g., is it in fact a genetic disorder, in which case the fact that Mr. Kruger was not diagnosed with the condition until 2007 does not mean that he did not have the disorder during the relevant period)
The Court underscores here that, in ordering a remand, it is not expressing any opinion that Mr. Kruger was in fact disabled during either the October 1995-October 1998 or November 1998-December 2000 timeframe. Indeed, the Court notes that, for the latter period, it shares some of the same concerns as articulated by the ALJ — e.g., why Mr. Kruger did not seek treatment after the second epidural in November 1999.
For the foregoing reasons, the Court grants in part and denies in part Mr. Kruger's motion for relief and denies the Commissioner's. The case is remanded to the ALJ for further development of the factual record.
This order disposes of Docket Nos. 10 and 13.
