Opinion
For Miriam M. Long, Plaintiff: Manuel D Serpa, LEAD ATTORNEY, Binder and Binder PC, Orange, CA.
For Carolyn W. Colvin, Acting Commissioner of Social Security, Defendant: Assistant U.S. Attorney LA-CV, LEAD ATTORNEY, AUSA - Office of U.S. Attorney, Los Angeles, CA; Assistant U.S. Attorney LA-SSA, LEAD ATTORNEY, Office of the General Counsel for Social Security Adm., San Francisco, CA; Tova D Wolking, SAUSA - U.S. Attorney's Office, San Francisco, CA.
ORDER AFFIRMING DECISION OF ADMINISTRATIVE LAW JUDGE
HON. MICHAEL R. WILNER, UNITED STATES MAGISTRATE JUDGE.
I. SUMMARY OF RULING
Plaintiff Long challenges the denial of her application for disability insurance benefits. The Administrative Law Judge (ALJ) found that Plaintiff was capable of performing work in the economy and denied benefits.
The Court concludes that the ALJ identified reasons adequate to discount the opinions of the Plaintiff's treating and examining medical experts. As a result, the Court affirms the ALJ's decision.
II. PLAINTIFF'S CONDITIONS AND PROCEEDINGS BELOW
Plaintiff initially applied for disability benefits in 2009 based on various physical and mental conditions. An ALJ found that Plaintiff was not disabled and denied benefits. On appeal, this Court vacated the agency's determination based on the ALJ's improper evaluation of the medical evidence. (Long v. Astrue, No. CV 11-1361 MRW, (C.D. Cal. 2011)). (AR 733.)
A different ALJ conducted a new hearing in 2012. After that hearing, the ALJ found that Plaintiff's anemia, depression, and other conditions constituted " severe impairments" as the term is used under federal regulations. (AR 664.)
The ALJ determined that Plaintiff had the residual functional capacity (RFC) to perform work subject to a variety of exertional and non-exertional limitations. (AR 666.) In establishing the RFC, the ALJ expressly gave little weight to more considerable restrictions recommended by Plaintiff's treating and examining medical experts. (AR 667-72.)
A vocational expert testified at the hearing that an individual with Plaintiff's RFC could perform several identified jobs. (AR 673, 728-29.) The ALJ concluded that Plaintiff was not disabled and denied benefits.
III. DISCUSSION
On appeal to this Court, Plaintiff argues that the ALJ failed to provide legally sufficient reasons for discounting the opinions of her treating physician and two mental health specialists.
A. Standard of Review
Under 42 U.S.C. § 405(g), a district court may review the agency's decision to deny benefits. The ALJ's findings and decision must be upheld if they are supported by substantial evidence and are free of legal error. Hill v. Astrue, 698 F.3d 1153, 1158 (9th Cir. 2012). A court must uphold the ALJ's conclusion even if the evidence in the record " is susceptible to more than one rational interpretation." Ludwig v. Astrue, 681 F.3d 1047, 1052 (9th Cir. 2012) (quotation omitted.) Indeed, if the record evidence " can reasonably support either affirming or reversing the decision, " this Court " may not substitute [its] judgment for that of the Commissioner" of the ALJ. Molina v. Astrue, 674 F.3d 1104, 1120 (9th Cir. 2012); Orn v. Astrue, 495 F.3d 625, 630 (9th Cir. 2007).
B. Rejection of Medical Opinion Evidence
1. Relevant Law
" In determining a claimant's RFC, an ALJ must consider all relevant evidence in the record." Robbins v. Social Sec. Admin., 466 F.3d 880, 883 (9th Cir. 2006) (quotations omitted). In addition, an ALJ's findings " must be supported by specific, cogent reasons." Reddick v. Chater, 157 F.3d 715, 722 (9th Cir. 1998). " The ALJ must set out in the record his reasoning and the evidentiary support for his interpretation of the medical evidence." Tackett v. Apfel, 180 F.3d 1094, 1098 (9th Cir. 1999). If the ALJ rejects significant probative evidence, the ALJ must explain why. Vincent v. Heckler, 739 F.2d 1393, 1395 (9th Cir. 1984).
An ALJ generally gives the most weight to medical evidence from a claimant's treating physician, and progressively less weight to the opinions of examining and nonexamining physicians. Under Social Security Administration regulations, a treating physician's opinion as to the nature and severity of an impairment will be given controlling weight if it is " well-supported by medically acceptable clinical and laboratory diagnostic techniques and is not inconsistent with the other substantial evidence in [the] case record." Orn, 495 F.3d at 631 (quoting 20 C.F.R. § 404.1527). When presented with an uncontroverted medical opinion of a treating physician, an ALJ may reject that opinion only by giving clear and convincing reasons for doing so. Lester v. Chater, 81 F.3d 821, 830 (9th Cir. 1995).
However, when a treating physician's opinion is contradicted by another medical evaluation, the ALJ " must determine credibility and resolve the conflict" between the medical opinions. Batson v. Comm'r of Soc. Sec. Admin., 359 F.3d 1190, 1195 (9th Cir. 2004). In that circumstance, the ALJ " must provide specific and legitimate reasons supported by substantial evidence" for rejecting a treating physician's opinion. Lester, 81 F.3d at 830. An opinion of a non-examining physician -- without more -- does not constitute substantial evidence to support the rejection of an examining physician's opinion. Id. Such opinions may serve as substantial evidence, though, " when they are supported by other evidence in the record and are consistent with it." Morgan v. Comm'r of Soc. Sec. Admin., 169 F.3d 595, 600 (9th Cir. 1999); Trego v. Astrue, 350 F.App'x 158, 159 (9th Cir. 2009).
An ALJ meets the burden of identifying a proper basis for rejecting a treating physician's opinion by " setting out a detailed and thorough summary of the facts and conflicting clinical evidence, stating [the ALJ's] interpretation thereof, and making findings." Tommasetti v. Astrue, 533 F.3d 1035, 1041 (9th Cir. 2008). An ALJ may also discredit a treating physician's opinion that is " conclusory, brief, and unsupported by the record as a whole [ ] or by objective medical findings." Batson, 359 F.3d at 1195. An ALJ identifies a valid reason to discredit a physician by noting a material contradiction in the physician's opinion or inconsistent evidence in the treatment notes. Valentine v. Comm'r of Soc. Sec. Admin., 574 F.3d 685, 692-93 (9th Cir. 2009).
2. Treating Physician (Claim 1)
A general practitioner (Dr. Willis) treated Plaintiff at a clinic in 2006 and 2007. Dr. Willis reported that Plaintiff suffered from peripheral vascular disease, anemia, and other impairments. (AR 308.) The physician opined that Plaintiff was considerably limited in her ability to work, and likely could not hold a full-time job. (AR 226, 313.)
The ALJ concluded that Dr. Willis's assessments of Plaintiff " lack basic indicia of reliability." (AR 671.) The ALJ noted that the treating physician " offered her assessment subject to the caveat" that the physician was " uncertain" whether Plaintiff was malingering, doctor-shopping for a disability opinion, or an unreliable source of information. (Id.) Further, the ALJ observed that Dr. Willis failed to " meaningfully address or identify limitations associated with" Plaintiff's " most significant impairment" -- her anemia condition -- and rarely mentioned Plaintiff's mental health issues in the medical notes. Moreover, the ALJ stated that the physician's diagnosis of peripheral vascular disease was essentially refuted by a subsequent ultrasound examination. (Id.) That paralleled the ALJ's observation that Plaintiff's back pain and limitation claims were not supported by imaging study evidence or other objective findings.
As a result, the ALJ adopted the findings and minimal limitations recommended by a non-examining, consulting physician, Dr. Weingarten. The consultant agreed that Plaintiff suffered from various impairments. (AR 707-08.) However, the consultant opined that Plaintiff could perform work-related functions with various limitations. (AR 709-10.) The ALJ expressly found that Dr. Weingarten's opinion was supported by " considerably more of the medical record." (AR 671.)
3. Mental Health Specialists (Claim 2)
Dr. Alkhouri, a psychiatrist treated Plaintiff in 2007 and 2008. (AR 354.) In a written questionnaire, the psychiatrist reported that he saw Plaintiff five times during that period. (Id.) Dr. Alkhouri diagnosed Plaintiff with major depression disorder. (AR 354.) The psychiatrist reported that Plaintiff had " marked limitations" in several areas of work-related mental functioning.
A consulting psychologist, Dr. Griffin, examined Plaintiff in October 2008. (AR 398.) Dr. Griffin noted that Plaintiff's " response style" might indicate a " broad tendency to magnify." (AR 401.) Dr. Griffin conducted various tests on Plaintiff, found considerable personal limitations, and opined that Plaintiff's " current psychological condition is incompatible with competitive gainful employment." (AR 403.)
The ALJ rejected the limiting opinions of the treating psychiatrist and the examining psychologist. (AR 666-68.) The ALJ noted that Plaintiff sought only minimal treatment for her mental health conditions, and rarely mentioned her problems to her medical practitioners. The psychologist noted (as did the physician above) that Plaintiff may have exaggerated her conditions. In addition, the ALJ found that the practitioners came to widely varying GAF scores in assessing Plaintiff. The ALJ ultimately incorporated into Plaintiff's RFC lower non-exertional limitations recommended by a non-examining consulting psychologist.
Scores on the Global Assessment of Functioning (GAF) scale " do not control determinations of whether a person's mental impairments rise to the level of a disability, " although they can be " a useful measurement" of one's ability to function. Garrison v. Colvin, 759 F.3d 995, 1003 (9th Cir. 2014). However, because there is no " direct correlation" between the GAF score and the agency's listings regarding mental impairments, it is not error for an ALJ to disregard a GAF score in evaluating a claimant's limitations. Doney v. Astrue, 485 F.App'x 163, 165 (9th Cir. 2012) (citing agency regulations).
4. Analysis
The ALJ's written decision contains a series of reasonably detailed reasons for discrediting the opinion of Plaintiff's treating physician. Whether evaluated under the clear-and-convincing (uncontroverted by other opinion) or specific-and-legitimate (controverted) reason standard, the ALJ's conclusions are adequate to survive appellate review. Lester, 81 F.3d at 830.
The ALJ gave a powerful reason for disbelieving Dr. Willis's assessment of her patient -- her medical records essentially fail to mention Plaintiff's key impairment of anemia. Although Plaintiff correctly points out that the physician included the anemia condition in passing in one opinion letter (AR 226), the physician's records do not demonstrate any substantive evaluation of the condition or Plaintiff's specific symptoms -- and, presumably, any work-related limitations -- over the course of the physician-patient relationship. That telling inconsistency provided a clear and convincing reason supported by substantial evidence for the ALJ to doubt the merits of Dr. Willis's opinion. Valentine, 574 F.3d at 692-93.
Further, the ALJ was entitled to reject the treating physician's opinion when other diagnoses of vascular disease and spinal stenosis were refuted by objective medical tests conducted independently. The ALJ provided a detailed explanation regarding both diagnoses. The ALJ convincingly explained why the conflicting medical evidence undercut Dr. Willis's analysis and credibility as to Plaintiff's limitations. Tommasetti, 533 F.3d at 1041; Batson, 359 F.3d at 1195. In light of this evidence, the ALJ reasonably turned to the limitations recommended by the non-examining consultant in assessing Plaintiff's RFC. Morgan, 169 F.3d at 600.
The Court closely reviewed Plaintiff's claim that the physician wrote " strain" instead of " stenosis" when diagnosing Plaintiff's back and neck ailments. (Docket # 13 at 9, AR 210.) Interpretation of a physician's handwriting, like all factual disputes, is soundly reserved to the discretion of the ALJ. Ludwig, 681 F.3d at 1052. Because the form could be read either way, the ALJ's reasonable analysis on this point is not reviewable on appeal.
Because the ALJ identified sufficient reasons to reject Dr. Willis's opinion, the Court need not take up the ALJ's reference to Plaintiff's suspected malingering or doctor-shopping. The physician took care not to reach any conclusion on this issue. Even though the ALJ found Plaintiff not to be credible in describing her symptoms (AR 671-72) -- a finding that she does not challenge on appeal -- it was not legitimate or convincing for the ALJ to rely on the physician's inchoate suspicion as a basis for disbelieving her medical opinion.
As to the mental health specialists, the ALJ's reasons for rejecting their conclusions present a somewhat closer question. The ALJ fairly noted that psychiatric conditions may " wax and wane" over time. At bottom, though, the ALJ observed that Plaintiff presented minimal evidence to support her claim of severely disabling psychological conditions. The ALJ noted that Plaintiff sought treatment for her conditions only during a limited period of time (explainable, perhaps, by her lack of insurance and an inability to pay for assistance). She did not regularly raise or discuss these conditions with her primary care giver. Further, the ALJ noted the considerable variation in GAF scores obtained by Drs. Alkhouri and Griffin in evaluating Plaintiff's condition. (AR 667-68.)
The ALJ was entitled to find that the opinions of both professionals -- which recommended grave limitations on Plaintiff's ability to function -- were not adequately supported by sufficient evidence. Orn, 495 F.3d at 631. As the finder of fact, the ALJ was allowed to doubt the specialists' opinions that Plaintiff had extremely limited functional abilities when she essentially failed to seek treatment or testing for these mental health conditions, or even raise them with her doctors over time. And, while GAF scores are not sufficient to prove or disprove a disability, the ALJ convincingly explains that Plaintiff's significantly different scores undermine confidence in the opinions of the professionals who relied on them. Valentine, 574 F.3d at 692-93. Further, the ALJ noted the opinion of the non-examining psychologist who examined Plaintiff's psychiatric records, and interacted with and observed Plaintiff at the hearing in rendering an assessment of Plaintiff's limitations. That analysis constitutes sufficient evidence for the alternative non-exertional limitations in the RFC.
The ALJ conducted a detailed evaluation of the medical and psychological evidence in the written decision. Further, the ALJ obtained additional opinions from experts in two fields who testified at the administrative hearing. On appeal, this Court is not entitled to re-evaluate the evidence anew. Rather, this Court's role is to ensure that the ALJ's analysis comported with federal law and was adequately supported by evidence. The Court finds that it was.
IV. CONCLUSION
The ALJ's denial of Plaintiff's application for benefits was supported by substantial evidence and contained no legal error. Therefore, the Court AFFIRMS the decision.
IT IS SO ORDERED.