Opinion
CASE NO. 3:16-CV-05106-DWC
07-01-2016
SHAWNA LYNNETTE STEIGER, Plaintiff, v. CAROLYN W. COLVIN, Acting Commissioner of Social Security, Defendant.
ORDER ON PLAINTIFF'S COMPLAINT
Plaintiff filed this action, pursuant to 42 U.S.C § 405(g), seeking judicial review of the denial of Plaintiff's applications for Disability Insurance Benefits ("DIB") and Supplemental Security Income ("SSI") benefits. The parties have consented to proceed before a United States Magistrate Judge. See 28 U.S.C. § 636(c), Fed. R. Civ. P. 73 and Local Magistrate Judge Rule MJR 13. See also Consent to Proceed before a United States Magistrate Judge, Dkt. 4.
After reviewing the record, the Court concludes the Administrative Law Judge ("ALJ") erred by failing to properly evaluate the opinion of one of Plaintiff's examining psychologists. Therefore, this matter is reversed and remanded, pursuant to sentence four of 42 U.S.C. § 405(g), for further proceedings.
PROCEDURAL& FACTUAL HISTORY
On January 23, 2013, Plaintiff filed an application for DIB, and on January 30, 2013, Plaintiff filed an application for SSI. See Dkt. 7, Administrative Record ("AR") 201-10. Plaintiff alleges she became disabled on July 23, 2012, due to depression, anxiety, acid reflux, urinary frequency, and carpal tunnel syndrome. See AR 201, 275. Plaintiff's applications were denied upon initial administrative review and on reconsideration. See AR 66-67, 116-17. A hearing was held before an ALJ on June 11, 2014, at which Plaintiff, represented by counsel, appeared and testified. See AR 34.
On June 27, 2014, the ALJ found Plaintiff was not disabled within the meaning of Sections 1614(a)(3)(A), 216(i), and 223(d) of the Social Security Act. AR 26. Plaintiff's request for review of the ALJ's decision was denied by the Appeals Council on January 19, 2016, making that decision the final decision of the Commissioner of Social Security (the "Commissioner"). See AR 1, 20 C.F.R. § 404.981, § 416.1481. On February 10, 2016, Plaintiff filed a complaint in this Court seeking judicial review of the Commissioner's final decision.
Plaintiff argues the denial of benefits should be reversed and remanded for further proceedings, because the ALJ failed to provide legally sufficient reasons to reject the opinion of one of Plaintiff's examining psychologists Dkt. 9, p. 1.
Plaintiff also initially alleged the ALJ erred in evaluating her subjective symptom testimony. Dkt. 9, p. 1. However, Plaintiff made no argument to that effect, and subsequently conceded she was not challenging the ALJ's adverse finding on Plaintiff's subjective testimony. Dkt. 11, p. 2. --------
STANDARD OF REVIEW
Under 42 U.S.C. § 405(g), this Court may set aside the Commissioner's denial of social security benefits only if the ALJ's findings are based on legal error or not supported by substantial evidence in the record as a whole. Bayliss v. Barnhart, 427 F.3d 1211, 1214 n.1 (9th Cir. 2005) (citing Tidwell v. Apfel, 161 F.3d 599, 601 (9th Cir. 1999)). "Substantial evidence" is more than a scintilla, less than a preponderance, and is such "'relevant evidence as a reasonable mind might accept as adequate to support a conclusion.'" Magallanes v. Bowen, 881 F.2d 747, 750 (9th Cir. 1989) (quoting Davis v. Heckler, 868 F.2d 323, 325-26 (9th Cir. 1989)).
DISCUSSION
I. Whether the ALJ Properly Evaluated the Medical Opinion Evidence.
A. Standard
The ALJ must provide "clear and convincing" reasons for rejecting the uncontradicted opinion of either a treating or examining physician or psychologist. Lester v. Chater, 81 F.3d 821, 830 (9th Cir. 1996) (citing Embrey v. Bowen, 849 F.2d 418, 422 (9th Cir. 1988); Pitzer v. Sullivan, 908 F.2d 502, 506 (9th Cir. 1990)). However, "[i]n order to discount the opinion of an examining physician in favor of the opinion of a nonexamining medical advisor, the ALJ must set forth specific, legitimate reasons that are supported by substantial evidence in the record." Nguyen v. Chater, 100 F.3d 1462, 1466 (9th Cir. 1996) (citing Lester, 81 F.3d at 831). The ALJ can accomplish this by "setting out a detailed and thorough summary of the facts and conflicting clinical evidence, stating his interpretation thereof, and making findings." Reddick v. Chater, 157 F.3d 715, 725 (9th Cir. 1998) (citing Magallanes, 881 F.2d at 751). In addition, the ALJ must explain why the ALJ's own interpretations, rather than those of the doctors, are correct. Reddick, 157 F.3d at 725 (citing Embrey, 849 F.2d at 421-22). The ALJ "may not reject 'significant probative evidence' without explanation." Flores v. Shalala, 49 F.3d 562, 570-71 (9th Cir. 1995) (quoting Vincent v. Heckler, 739 F.2d 1393, 1395 (9th Cir. 1984) (quoting Cotter v. Harris, 642 F.2d 700, 706-07 (3d Cir. 1981))). The "ALJ's written decision must state reasons for disregarding [such] evidence." Flores, 49 F.3d at 571.
B. Application of Standard
The ALJ assigned Plaintiff the residual functional capacity ("RFC") to perform unskilled light work. AR 19. The ALJ also found Plaintiff could work in positions that do not require public contact, and Plaintiff could have occasional coworker contact. Id. Plaintiff contends this RFC finding was erroneous, as the ALJ improperly rejected the more restrictive limitations opined to by Dr. R.A. Cline, Psy.D.
Dr. Cline examined Plaintiff on November 30, 2012. AR 282, 285. During the examination, Plaintiff reported a recent suicide attempt, as well as a history of prior suicide attempts and depression. AR 279-80. On mental status examination, Dr. Cline documented a depressed and dysthymic mood, and a sad and withdrawn affect. AR 283. Dr. Cline also documented minor lapses during digit span tasks (a measure of concentration), found Plaintiff was unable to interpret proverbs (a measure of capacity for abstract thought), demonstrated poor insight and judgment, and had some level of impairment in socialization. AR 283-85. However, Plaintiff demonstrated normal: thought process and content; orientation to day, date, and time; perception; memory; and fund of knowledge. AR 283-84. Dr. Cline also administered the Rey 15 question test, Beck Anxiety Inventory ("BAI") and the Beck Depression Inventory-II ("BDI-II"). AR 280. Dr. Cline found the Rey test results indicated Plaintiff was exhibiting excellent effort and cooperation, and reduced the likelihood Plaintiff was malingering. AR 280. Dr. Cline also found Plaintiff's BAI score suggests mild to moderate levels of anxiety, but also found Plaintiff's BDI-II score suggested a marked to severe level of depression, congruent with her clinical interview. AR 280.
Dr. Cline diagnosed Plaintiff with: major depressive disorder, recurrent, severe without psychotic features; anxiety disorder NOS with features of GAD and panic disorder; and cognitive disorder, NOS. AR 281. As a result of these impairments, Dr. Cline opined Plaintiff would have: marked limitations in her ability to complete a normal workday and workweek without interruptions from psychologically based symptoms and maintain appropriate behavior in a work setting; moderate to marked limitations in her ability to understand, remember, and persist in tasks by following detailed instructions; and mild to moderate limitations in numerous other areas, including understanding, remembering, and persisting in tasks by following very short and simple instructions, learning new tasks, and being aware of normal hazards and taking appropriate precautions. AR 281-82.
The ALJ gave little weight to Dr. Cline's opinion for the following four reasons:
[1][Dr. Cline's opinion] is largely based on the claimant's subjective statements regarding the severity of her impairments. [2] Although the claimant claims to have severe psychological limitations, these limitations are not supported by mental status examinations in the record [3] and even Dr. Cline's own testing of the claimant. [4] Furthermore, her allegations are not supported by her own statements regarding her abilities.AR 24. Plaintiff argues these were not specific and legitimate reasons, supported by substantial evidence, to give Dr. Cline's opinion little weight. The Court agrees.
First, the ALJ's finding Dr. Cline's opinion is based largely on Plaintiff's subjective statements is unsupported by substantial evidence. An "ALJ may reject a treating physician's opinion if it based 'to a large extent' on a claimant's self-reports that have been properly discounted as incredible. Tommasetti v. Astrue, 533 F.3d 1035, 1041 (9th Cir. 2008). However, this is distinguishable from a situation where a treating or examining physician makes independent observations and supports his or her conclusions with other evidence. See Ryan v. Comm'r of Soc. Sec. Admin., 528 F.3d 1194, 1199-1200 (9th Cir. 2008); see also Edlund v. Massanari, 253 F.3d 1152, 1159 (9th Cir. 2001). "[W]hen an opinion is not more heavily based on a patient's self-reports than on clinical observations, there is no evidentiary basis for rejecting the opinion." Ghanim v. Colvin, 763 F.3d 1154, 1162 (9th Cir. 2014). Here, Dr. Cline did document Plaintiff's subjective statements as a component of his analysis. AR 279-80. However, Dr. Cline also performed a mental status examination, where he observed Plaintiff's dysthymic mood and sad, withdrawn affect, and documented deficits in concentration, abstract thought, and insight and judgment. AR 283-84. Dr. Cline also supported his opinion using several tests and inventories, at least one of which was administered to assess—and discount—the possibility Plaintiff was malingering. AR 280. There is no indication Dr. Cline based his opinions to a larger extent on Plaintiff's subjective reporting as opposed to Dr. Cline's independent clinical findings and objective medical evidence, including the mental status examination and the BAI, BDI-II, and Rey test results; thus, the ALJ's finding is not supported by substantial evidence. See Blessing v. Astrue, 2013 WL 316153, *7 (W.D.Wash. 2013) ("Like the physical examination, the Mental Status Examination is termed the objective portion of the patient evaluation.") (quoting Paula T. Trzepacz and Robert W. Baker, The Psychiatric Mental Status Examination, 3-4 (Oxford University Press 1993)).
Second, the ALJ's conclusion Dr. Cline's opinion was inconsistent with other mental status examinations in the record is not supported by substantial evidence. The ALJ does not cite to any of the mental status examinations in his discussion of Dr. Cline's opinion, nor does he attempt to explain how other providers' mental status examinations are actually inconsistent with Dr. Cline's opinion. In order to reject the opinion of a treating or examining physician, an ALJ must do more than state his or her conclusions; he or she must set forth their own interpretations and explain why they, rather than the doctors' are correct. Reddick, 157 F.3d at 725 (citing Embrey, 849 F.2d at 421-22). See Garrison v. Colvin, 759 F.3d 995, 1012 (9th Cir. 2014). The ALJ's failure to do so here was error. See, e.g., McAllister v. Sullivan, 888 F.2d 599, 602-03 (9th Cir. 1989) (finding similar reasoning for rejecting a treating physician's opinion was "broad and vague, failing to specify why the ALJ felt the treating physician's opinion was flawed").
Even if the Court were to consider other parts of the written decision to find support for the ALJ's conclusions, the medical evidence of record cited by the ALJ is not actually inconsistent with Dr. Cline's opinion. The ALJ cites four separate mental status examinations at various points throughout the written decision. AR 20-21, 400, 582, 848, 925. These mental status examinations document euthymic, rather than depressed, mood, and fair, rather than poor, insight and judgment. AR 400, 582, 848, 925. However, several of the mental status examinations are missing categories (e.g., AR 925), and none of the other mental status examinations purport to address Plaintiff's capacity for abstract thought or socialization. AR 400, 582, 848, 925. Further, none of the other mental status examinations are accompanied by other testing as performed by Dr. Cline, all of the mental status examinations were completed anywhere from several months to several years after Dr. Cline's assessment, and were also completed during different phases of Plaintiff's medication management. AR 400, 582, 848, 925. "Consistency does not require similarity in findings over time despite a claimant's evolving medical status." Orn v. Astrue, 495 F.3d 625, 634 (9th Cir. 2007). Further, less extensive findings rendered by other providers who were not tasked with assessing Plaintiff's functional limitations do not warrant discounting Dr. Cline's opinion in this case. See Orn v. Astrue, 495 F.3d 625, 632 (9th Cir. 2007). See also Ryan v. Commissioner of Social Sec. Admin, 528 F.3d 1194, 1200 (9th Cir. 2008) ("Nothing in [one examining doctor's report] rules out [another examining doctor's] more extensive findings") (quoting Regennitter v. Commissioner of Social Sec. Admin., 166 F.3d 1294, 1299 (9th Cir. 1999)).
Third, the ALJ's conclusion Dr. Cline's mental status examination results were inconsistent with his own opinion is not supported by substantial evidence. As with the other mental status examinations, the ALJ fails to explain how Dr. Cline's testing is inconsistent with his opinions. Further, Dr. Cline opined Plaintiff would have moderate to marked difficulty in following simple and detailed instructions, moderate to marked difficulty in communicating and performing effectively in a work setting, and marked difficulty maintaining appropriate behavior in a work setting and completing a normal workday and workweek without interruption from her psychological symptoms. AR 281-82. These conclusions are not out of line with the poor insight and judgment, impairments in abstract thought and socialization, and high scores on the BDI-II Dr. Cline documented throughout his evaluation. AR 280-85. "[W]here the purported existence of an inconsistency is squarely contradicted by the record, it may not serve as the basis for the rejection of an examining physician's conclusion." Nguyen v. Chatter, 100 F.3d 1462, 1465 (9th Cir. 1996).
Finally, the ALJ's remaining reason to discount Dr. Cline's opinion—Plaintiff's allegations are not supported by her own statements regarding her abilities—is essentially a restatement of the ALJ's first basis for discounting Dr. Cline's opinion. Again, Dr. Cline based his evaluation on more than Plaintiff's subjective statements; he relied on his clinical interview and objective testing in the form of a mental status examination, Rey, BAI, and BDI-II in formulating his opinions. As there is no indication Dr. Cline based his opinions more on Plaintiff's self reports rather than his own independent clinical observations, the ALJ has not stated a legally sufficient basis to reject Dr. Cline's opinion. See Ghanim, 763 F.3d at 1162.
Because the ALJ did not offer specific and legitimate reasons, supported by substantial evidence, for discounting Dr. Cline's opinion, the ALJ erred. Further, as Dr. Cline opined to limitations more restrictive than those the ALJ included in the RFC, the error was not "inconsequential to the ultimate nondisability determination," and was therefore harmful. Molina v. Astrue, 674 F.3d 1104, 1115 (9th Cir. 2012). See Batson v. Comm'r of Soc. Sec. Admin., 359 F.3d 1190, 1197 (9th Cir. 2004).
CONCLUSION
Based on the above stated reasons and the relevant record, the undersigned finds the ALJ erred by failing to properly evaluate Plaintiff's examining psychologist. Therefore, the court orders this matter be reversed and remanded pursuant to sentence four of 42 U.S.C. § 405(g). On remand, the ALJ should reevaluate and reweigh all of the medical opinion evidence and proceed on to Step Four and/or Step Five of the sequential evaluation, as appropriate. On remand, the ALJ should also develop the record as needed. Judgment should be for Plaintiff and the case should be closed.
Dated this 1st day of July, 2016.
/s/_________
David W. Christel
United States Magistrate Judge