Pickens v. Commissioner of Social Security

Filing 19

ORDER signed by Magistrate Judge Kendall J. Newman on 8/24/11 ORDERING 15 Motion for Summary Judgment is granted in part and this matter is remanded for further proceedings; To the extent that the Commissioner's opposition to plaintiff's motion for summary judgment (Dkt. No. 17) constitutes a cross-motion for summary judgment, it is denied; and the Clerk is directed to enter judgment in favor of plaintiff. Civil Case Terminated. CASE CLOSED.(Matson, R)

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1 2 3 4 5 6 7 8 IN THE UNITED STATES DISTRICT COURT 9 FOR THE EASTERN DISTRICT OF CALIFORNIA 10 CYNTHIA WILLMETT, for A.P., 11 12 13 Plaintiff, No. 2:10-cv-01201 KJN v. MICHAEL J. ASTRUE, Commissioner of Social Security, 14 Defendant. 15 ORDER / 16 Plaintiff filed an application for social security benefits on behalf of her minor 17 daughter, referred to in this order as “A.P.” Plaintiff herein seeks judicial review through 18 counsel of a final decision of the Commissioner of Social Security (“Commissioner”) denying an 19 application for Supplemental Security Income (“SSI”) child benefits under Title XVI of the 20 Social Security Act (“Act”).1 Presently before the court is plaintiff’s motion for summary 21 judgment, to which the Commissioner filed an opposition. (Pl.’s Mot. for Summ. J., Dkt. 22 No. 15; Commissioner’s Opp’n to Mot. for Summ. J., Dkt. No. 17.) 23 For the reasons stated below, the court grants plaintiff’s motion for summary 24 1 25 26 This case was referred to the undersigned pursuant to Eastern District of California Local Rule 302(c)(15) and 28 U.S.C. § 636(c), and both parties have voluntarily consented to proceed before a United States Magistrate Judge, 28 U.S.C. § 636(c)(1); Fed. R. Civ. P. 73; E. Dist. Local Rule 301. (Dkt. Nos. 8, 12.) 1 1 judgment in part and remands this matter to the Commissioner for further proceedings. 2 Specifically, the undersigned concludes that on the present record, the administrative law judge 3 (“ALJ”) and the Appeals Council of the Office of Disability Adjudication and Review (“Appeals 4 Council”) did not comply with 42 U.S.C. § 1382c(a)(3)(I), as interpreted in Howard ex. rel. 5 Wolff v. Barnhart, 341 F.3d 1006 (9th Cir. 2003), and Social Security Acquiescence Ruling 04- 6 1(9), 69 Fed. Reg. 22,578-03, 2004 WL 875081 (Apr. 26, 2004) (“Acquiescence Ruling 04- 7 1(9)”). Although this case presents a close call, the record does not support the conclusion that 8 the ALJ and the Appeals Council made a reasonable effort to obtain a case evaluation by a 9 pediatrician or other appropriate specialist that was based on the entire record. Because this legal 10 error warrants remanding this matter for further proceedings, the undersigned does not reach the 11 remainder of plaintiff’s arguments seeking reversal of the ALJ’s and Appeals Council’s 12 decisions. 13 I. BACKGROUND2 14 In February 2006, plaintiff filed an application for SSI on behalf of her minor 15 daughter, alleging a disability onset date October 2, 1998.3 (Admin. Tr. (“AT”) 101, 112, 124.) 16 The application was made on the basis of A.P.’s alleged mental impairments consisting of social 17 anxiety and social phobias, and the physical manifestations thereof. The Social Security 18 Administration denied plaintiff’s application initially and upon reconsideration. (AT 79-84, 89- 19 92.) Plaintiff requested a hearing before an ALJ, and the ALJ conducted a hearing on 20 January 16, 2008. (AT 45-78, 93.) Plaintiff and her daughter, who were represented by counsel 21 at the hearing, testified. 22 23 24 2 Because the parties are familiar with the factual background of this case, including A.P.’s medical history, the undersigned does not exhaustively relate those facts here. The facts related to A.P.’s impairments and medical history will be addressed insofar as they are relevant to the issues presented by the parties. 25 3 26 The Commissioner does not dispute that A.P. met, and still meets, the age and financial eligibility requirements to seek SSI child benefits. 2 1 In a decision dated February 22, 2008, the ALJ denied plaintiff’s application, 2 finding that A.P. was not disabled within the meaning of the Act. (See AT 9-22.) Plaintiff 3 administratively appealed the ALJ’s decision and submitted additional exhibits, including a 4 report from James Margolis, M.D. dated March 5, 2008, which the Appeals Counsel ordered to 5 be made part of the record. (AT 4.) After considering the ALJ’s decision and the additional 6 evidence, the Appeals Council denied plaintiff’s request for review without any substantive 7 explanation. (AT 1-3.) Plaintiff subsequently filed this action. 8 B. 9 Summary of the ALJ’s Findings The ALJ conducted the required three-step evaluation attendant to applications for 10 SSI benefits by individuals under the age of 18 and concluded that A.P. was not disabled within 11 the meaning of the Act.4 At step one, the ALJ found that A.P. was a school-age child who had 12 not engaged in substantial gainful activity at any time relevant to the decision. (AT 12.) At step 13 two, the ALJ concluded that A.P. had the following “severe” impairment: “Social Phobia, rule 14 out Obsessive-Compulsive Disorder.” (Id.) At step three, the ALJ determined that A.P. did not 15 16 17 18 19 20 21 22 23 24 25 26 4 Pursuant to 42 U.S.C. § 1382c(a)(3)(C)(i)-(ii), an individual under the age of 18 shall be considered disabled if he or she has not engaged in “substantial gainful activity” and “has a medically determinable physical or mental impairment, which results in marked and severe functional limitations, and which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.” Claims for SSI by such minors are analyzed under a three-step framework, see 20 C.F.R. § 416.924(a), which “requires the ALJ to determine (1) whether the claimant is currently engaged in substantial gainful activity, (2) whether the claimant has a medically determinable impairment or combination of impairments that is severe, and (3) whether the claimant’s impairment or combination of impairments meets or medically equals the requirements of a listed impairment, or functionally equals the listings.” Robinson v. Astrue, No. CIV S-08-2296 DAD, 2010 WL 3733993, at *2 (E.D. Cal. Sept. 21, 2010) (unpublished) (citing 20 C.F.R. § 416.924(b)-(d)). If the analysis reaches the question of “functional” equivalence at step three, the question of whether an impairment or combination of impairments functionally equals a listing is determined in reference to the following six “broad areas of functioning intended to capture all of what a child can or cannot do,” which are referred to as “domains”: “(i) Acquiring and using information; (ii) Attending and completing tasks; (iii) Interacting and relating with others; (iv) Moving about and manipulating objects; (v) Caring for yourself; and, (vi) Health and physical well-being.” See 20 C.F.R. § 416.926a(b)(1)(i)-(vi). The applicable regulation also provides: “By ‘functionally equal the listings,’ we mean that your impairment(s) must be of listing-level severity; i.e., it must result in ‘marked’ limitations in two domains of functioning or an ‘extreme’ limitation in one domain.” 20 C.F.R. § 416.926a(a); see also Howard, 341 F.3d at 1012. 3 1 have an impairment or combination of impairments that met or medically equaled one of the 2 impairments listed in the applicable regulations. (AT 13.) 3 Because the ALJ concluded that A.P. did not have an impairment or combination 4 of impairments that met or medically equaled a listing, the ALJ analyzed whether A.P. had an 5 impairment or combination of impairments that functionally equaled a listing. (See AT 13-22.) 6 In regards to the six domains relevant to the inquiry, the ALJ found that A.P.: (1) had “no 7 limitation” in acquiring and using information, attending and completing tasks, and moving 8 about and manipulating objects; (2) had “marked limitation” in interacting and relating with 9 others; and (3) had “less than marked limitation” in the ability to care for herself and in health 10 and physical well-being. (See AT 16-22). Because the ALJ found that A.P. did not have 11 “marked” limitations in two domains or an “extreme” limitation in one domain, he found that 12 A.P.’s mental impairment did not functionally equal a listing. Accordingly, the ALJ found that 13 A.P. was not disabled within the meaning of the Act. (See AT 22.) 14 II. 15 DISCUSSION Plaintiff’s main argument is that the ALJ’s evaluation of A.P.’s claim for SSI 16 benefits does not comply with the requirements of 42 U.S.C. § 1382c(a)(3)(I), as interpreted in 17 Howard, 341 F.3d 1006, and Acquiescence Ruling 04-1(9). In relevant part, 42 U.S.C. 18 § 1382c(a)(3)(I) provides: 19 22 In making any determination under this subchapter with respect to the disability of an individual who has not attained the age of 18 years . . . , the Commissioner of Social Security shall make reasonable efforts to ensure that a qualified pediatrician or other individual who specializes in a field of medicine appropriate to the disability of the individual (as determined by the Commissioner of Social Security) evaluates the case of such individual. 23 In Howard, the Ninth Circuit Court of Appeals interpreted Section 1382c(a)(3)(I) 20 21 24 in the context of an appeal of the denial of SSI benefits to a minor. See Howard, 341 F.3d 25 at 1013-14. The record in Howard included evaluations, reports, and records of myriad treating 26 and examining professionals and, as a result, the ALJ denied the claimant’s multiple requests that 4 1 a pediatrician or other similar specialist appear at the hearing and evaluate the minor’s case. The 2 district court affirmed the ALJ’s decision on the basis of the well-developed record. 3 Although the Ninth Circuit Court of Appeals concluded that substantial evidence 4 supported the ALJ’s decision, it reversed the decision of the ALJ based on a finding of legal error 5 and remanded the matter for further development of the record. See Howard, 341 F.3d at 1014. 6 In reversing and remanding, the Court of Appeals interpreted 42 U.S.C. § 1382c(a)(3)(I) “to 7 mean that the ALJ is required to make a reasonable effort to obtain a case evaluation, based on 8 the record in its entirety, from a pediatrician or other appropriate specialist, rather than simply 9 constructing his own case evaluation from the evidence in the record.” Howard, 341 F.3d 10 at 1014. Acknowledging that the record contained numerous experts’ reports, the Court of 11 Appeals further stated: “There is a distinction, however, between having an expert evaluate a 12 claimant with respect to that expert’s particular specialty, and having an expert evaluate a 13 claimant’s case in its entirety, considering all of the medical records and determining whether 14 those indicate that the claimant is disabled within the meaning of the Social Security Act.” Id. at 15 1014 n.2. It ultimately concluded that “[d]espite the various reports of doctors and specialists 16 indicating their independent views of [the minor’s] situation, at no point did the ALJ have her 17 case evaluated as a whole, nor did he indicate that there was a ‘case’ evaluation in the record.” 18 Id. at 1014. 19 The Social Security Administration disagreed with the breadth of the 20 interpretation of Section § 1382c(a)(3)(I) provided in Howard. As a result, it issued 21 Acquiescence Ruling 04-1(9), which explains how the holding of Howard is to be applied in 22 administrative proceedings taking place within the Ninth Circuit. Acquiescence Ruling 04-1(9) 23 provides that: 24 25 26 For cases that are subject to this Ruling, ALJs and AAJs (when the Appeals Council makes a decision) must make reasonable efforts to ensure that a qualified pediatrician or other individual who specializes in a field of medicine appropriate to the disability of the individual (as identified by the ALJ or AAJ) evaluates the case of the individual. To satisfy this 5 1 2 3 4 5 requirement, the ALJ or AAJ may rely on case evaluation made by a State agency medical or psychological consultant that is already in the record, or the ALJ or AAJ may rely on the testimony of a medical expert. When the ALJ relies on the case evaluation made by a State agency medical or psychological consultant, the record must include the evidence of the qualifications of the State agency medical or psychological consultant. In any case, the ALJ or AAJ must ensure that the decision explains how the State agency medical or psychological consultant’s evaluation was considered. 6 69 Fed. Reg. at 22,580. Acquiescence Ruling 04-1(9) expressly applies to decisions made at the 7 Administrative Law Judge and Appeals Council levels of the administrative review process. Id. 8 at 22,579 and 22,580. 9 The undersigned concludes that plaintiff’s argument premised on Howard and 10 Acquiescence Ruling 04-1(9) is well-taken for several reasons. In regards to the ALJ’s written 11 decision, the undersigned is unable to discern with any certainty that the ALJ considered the 12 requirements of Howard and Acquiescence Ruling 04-1(9). The ALJ’s otherwise detailed, 13- 13 page decision does not reference Howard or Acquiescence Ruling 04-1(9), the standards set forth 14 in Howard or Acquiescence Ruling 04-1(9), or which expert opinion the ALJ relied on to satisfy 15 the requirement of a case evaluation. Thus, it is difficult to identify the report upon which the 16 ALJ relied to meet the requirement that he rely on an expert’s evaluation of A.P.’s entire case 17 that is based on the entire record. 18 Having been left to guess regarding which report in the record, if any, served as 19 the complete case evaluation, plaintiff’s motion for summary judgment focuses on the Childhood 20 Disability Evaluation Form completed by state agency physician Robert A. McAuley, M.D. on 21 June 30, 2006, which Dr. McAuley subsequently reviewed and “confirmed” on August 9, 2006, 22 and which was “affirmed” by state agency physician Howard Grindlinger, M.D. on February 7, 23 2007. (See AT 213-18, 220-22, 225-30.) Tellingly, however, the Commissioner’s opposition 24 brief does not rely on the reports of Drs. McAuley and Grindlinger or even suggest that those 25 reports satisfied the requirements of Howard and Acquiescence Ruling 04-1(9). The undersigned 26 concludes, on the basis of the Commissioner’s lack of support for the reports of Drs. McAuley 6 1 and Grindlinger, that the Commissioner has conceded that those reports do not constitute 2 complete case evaluations that satisfy Howard and Acquiescence Ruling 04-1(9). 3 Substantively, the ALJ’s discussion of Drs. McAuley’s and Grindlinger’s reports 4 does not meet the requirements of Howard and Acquiescence Ruling 04-1(9). First, Dr. 5 McAuley completed his June 30, 2006 report over 18 months before the ALJ’s issued his 6 decision, and Dr. McAuley did not consider the entire record. At a minimum, Dr. McAuley did 7 not consider the “Multidisciplinary Evaluation Summary” completed by clinical psychologists 8 Lynne Calonico, Ph.D. and Ceri Dierst-Davies, Ph.D., which was prepared on or around 9 September 19, 2007. (See AT 280-90.) Because Dr. McAuley did not consider significant 10 portions of the record including the Multidisciplinary Evaluation Summary, Dr. McAuley’s 11 report, as affirmed by Dr. Grindlinger, does not satisfy the requirements of Howard and 12 Acquiescence Ruling 04-1(9). 13 Second, the record does not include evidence of the qualifications of Drs. 14 McAuley and Grindlinger, which violates Acquiescence Ruling 04-1(9). See Acquiescence 15 Ruling 04-1(9), 69 Fed. Reg. 22,580 (“When the ALJ relies on the case evaluation made by a 16 State agency medical or psychological consultant, the record must include the evidence of the 17 qualifications of the State agency medical or psychological consultant.”). Although a footnote in 18 the Commissioner’s opposition to plaintiff’s motion for summary judgment notes in passing that 19 “Dr. McAuley’s medical specialty code is ‘37’ for psychiatry” (Commissioner’s Opp’n at 2 n.1), 20 the Commissioner does not expressly contend that this reference to the number “37” meets the 21 requirement of Acquiescence Ruling 04-1(9). Again, in any event, the Commissioner does not 22 rely on Dr. McAuley’s report in opposing plaintiff’s arguments based on Acquiescence 23 Ruling 04-1(9). 24 Third, the ALJ’s decision does not describe in any concrete way how the reports 25 of the state agency physicians were considered, which again violates Acquiescence Ruling 04- 26 1(9). See Acquiescence Ruling 04-1(9), 69 Fed. Reg. 22,580 (stating that “the ALJ or AAJ must 7 1 ensure that the decision explains how the State agency medical or psychological consultant’s 2 evaluation was considered”). The ALJ’s discussion of Dr. McAuley’s opinion appears in one 3 paragraph toward the end of the ALJ’s decision and states that the ALJ’s conclusion regarding 4 the domains “is supported by the opinion of State agency psychologist, Dr. R. A. McAuley.” 5 (AT 22.) Although the paragraph addressing Dr. McAuley’s opinion summarizes Dr. McAuley’s 6 opinion and states that the opinion supports the ALJ’s findings, it does not indicate in any clear 7 way how the opinion was actually considered. Indeed, the ALJ’s decision more accurately 8 reflects that the ALJ cited Dr. McAuley’s report in order to bolster the ALJ’s analysis, not in 9 order to satisfy Howard or Acquiescence Ruling 04-1(9). 10 In addressing plaintiff’s arguments premised on Howard and Acquiescence 11 Ruling 04-1(9), the Commissioner relies entirely on the Multidisciplinary Evaluation Summary 12 completed by Drs. Calonico and Dierst-Davies. (AT 280-90.) As noted above, Drs. Calonico 13 and Dierst-Davies completed the Multidisciplinary Evaluation Summary on or around 14 September 19, 2007, which was approximately five months prior to the date the ALJ issued his 15 decision. In concluding that A.P. did not have an impairment or combination of impairments that 16 functionally equaled a listing, the ALJ stated that he accorded “substantial weight to the opinions 17 of” Drs. Calonico and Dierst-Davies. (AT 13; see also AT 16 (stating that “the undersigned finds 18 that the opinions of [Drs. Calonico and Dierst-Davies] are supported by the medical evidence in 19 the record”).) 20 As an initial matter, the undersigned notes that A.P. was referred to Drs. Calonico 21 and Dierst-Davies by A.P.’s primary care pediatrician, not the ALJ. (See AT 280, 290.) 22 However, the holding in Howard contemplates that an ALJ may satisfy 42 U.S.C. 23 § 1382c(a)(3)(I) by pointing to a complete case evaluation that already exists in the record. See 24 Howard, 341 F.3d at 1014. 25 26 Additionally, Drs. Calonico and Dierst-Davies, who are clinical psychologists, appear to be specialists who could appropriately conduct the required complete case evaluation. 8 1 Nevertheless, the undersigned cannot conclude on the current record that the Multidisciplinary 2 Evaluation Summary satisfies Howard and Acquiescence Ruling 04-1(9). The undersigned’s 3 concern relates to the materials in the record that were considered, or not considered, by Drs. 4 Calonico and Dierst-Davies. At the outset, the undersigned cannot conclude from the 5 administrative record that Drs. Calonico and Dierst-Davies reviewed “the entire record.” 6 Although the Multidisciplinary Evaluation Summary states, under the heading “Evaluation 7 Procedures,” that Drs. Calonico and Dierst-Davies conducted a “Review of Patient Records,” it is 8 unclear from the report which records were considered.5 The Ninth Circuit Court of Appeals’s 9 decision in Howard provides that the expert who conducts the case evaluation must consider the 10 “record in its entirety,” and the court expressly referred to the consideration of “all of the medical 11 records.” Howard, 341 F.3d at 1014 & n2. The undersigned cannot conclude from the text of 12 the Multidisciplinary Evaluation Summary that it was based on a review of the record in its 13 entirety. 14 Furthermore, it appears that Drs. Calonico and Dierst did not review—and in one 15 case, could not have reviewed—some of the records that were made part of the record by the 16 Appeals Council after the hearing before the ALJ. These records include: (1) a Teacher 17 Questionnaire completed by a teacher at Skycrest Elementary School, dated April 4, 2006, which 18 noted that A.P. had functional problems in at least two domains (see AT 153-63); (2) records 19 relating to A.P.’s Individualized Education Program that are dated October 17, 2006, and January 20 26, 2007 (AT 174-82, 293-97)6; and a medical report prepared by Dr. Margolis and dated March 21 22 23 24 5 It is also apparent from the Multidisciplinary Evaluation Summary that Drs. Calonico and Dierst-Davies also considered a 2005 assessment of A.P. by San Diego State University’s Center for Behavioral Teratology and a “psycho-educational evaluation” by A.P.’s school district. (See AT 282.) But it is unclear what else these psychologists considered. For example, it does not appear from the Multidisciplinary Evaluation Summary that Drs. Calonico and Dierst-Davies reviewed Dr. McAuley’s assessment. 25 6 26 The Multidisciplinary Evaluation Summary refers to a “psycho-educational evaluation” that the school district administered to A.P. in October 2006. (AT 282.) However, it is unclear if the 9 1 5, 2008 (AT 298-300). These documents raise questions about the completeness of the record 2 reviewed by Drs. Calonico and Dierst-Davies in preparing their report. 3 Moreover, the Appeals Council made Dr. Margolis’s report part of the 4 administrative record and then made a decision unfavorable to A.P. after considering that report. 5 (See AT 1-2, 4.) However, there is no indication that the Appeals Council made a reasonable 6 effort to seek a case evaluation based on the entire record, which would include Dr. Margolis’s 7 report. Although the Commissioner argues that the Appeals Council is entitled to resolve 8 conflicts in the medical evidence, Acquiescence Ruling 04-1(9) applies to ALJs and the Appeals 9 Council. The Appeals Council made a determination based not only on the ALJ’s decision and 10 the record before the ALJ, but also based on the newly submitted materials. The Commissioner 11 has not provided authority for the proposition that the Appeals Council may avoid the 12 requirements of Howard and Acquiescence Ruling 04-1(9) when it decides an administrative 13 appeal that is based, in part, on newly ascertained materials that the Appeals Council has made 14 part of the administrative record. In the absence of such authority, and given the unexplained 15 decision of the Appeals Council, the undersigned cannot conclude that the ALJ and Appeals 16 Council complied with Howard and Acquiescence Ruling 04-1(9). 17 On the present record and in light of the foregoing discussion, the undersigned 18 concludes that the ALJ and Appeals Council committed legal error. The undersigned concludes 19 that reasonable efforts were not made to obtain a case evaluation by an appropriate specialist 20 based on a review of the entire record. The undersigned also has significant concerns regarding 21 which expert report, if any, was relied on by the ALJ insofar as Howard and Acquiescence 22 Ruling 04-1(9) are concerned. Accordingly, the undersigned grants plaintiff’s motion for 23 summary judgment in part, and remands this matter for further proceedings consistent with this 24 order, Howard, and Acquiescence Ruling 04-1(9). 25 26 psycho-educational evaluation is synonymous with the Individualized Education Program records referred to above. 10 1 III. CONCLUSION 2 For the foregoing reasons, IT IS HEREBY ORDERED that: 3 1. Plaintiff’s motion for summary judgment (Dkt. No. 15) is granted in part, 4 and this matter is remanded for further proceedings pursuant to sentence four of 42 U.S.C. 5 § 405(g). 6 7 2. To the extent that the Commissioner’s opposition to plaintiff’s motion for summary judgment (Dkt. No. 17) constitutes a cross-motion for summary judgment, it is denied. 8 3. 9 IT IS SO ORDERED. 10 The Clerk of Court is directed to enter judgment in favor of plaintiff. DATED: August 24, 2011 11 12 13 _____________________________________ KENDALL J. NEWMAN UNITED STATES MAGISTRATE JUDGE 14 15 16 17 18 19 20 21 22 23 24 25 26 11

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