Sababu v. Colvin

Filing 17

ORDER on Cross Motions for Summary Judgment 14 , 15 by Magistrate Judge Donna M. Ryu. The court remands this case for further development of the medical record consistent with this order. (dmrlc3, COURT STAFF) (Filed on 3/22/2016)

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1 2 3 4 UNITED STATES DISTRICT COURT 5 NORTHERN DISTRICT OF CALIFORNIA 6 7 OLUFOLA SABABU, Case No. 14-cv-05139-DMR Plaintiff, 8 v. ORDER ON CROSS MOTIONS FOR SUMMARY JUDGMENT 9 10 CAROLYN W. COLVIN, Re: Dkt. Nos. 14, 15 Defendant. United States District Court Northern District of California 11 Plaintiff Olufola Sababu moves for summary judgment to reverse the Commissioner of the 12 13 Social Security Administration’s (the “Commissioner’s”) final administrative decision, which 14 found Plaintiff not disabled and therefore denied his application for Supplemental Security Income 15 (“SSI”) benefits under Title XVI of the Social Security Act (“Act”), 42 U.S.C. § 1382c(a)(3)(A). 16 [Docket No. 14.] The Commissioner cross-moves to affirm. [Docket No. 15.] For the reasons 17 stated below, the court grants Plaintiff’s motion and denies the Commissioner’s motion, and 18 remands the action for further proceedings. 19 I. 20 PROCEDURAL HISTORY Plaintiff filed an application for SSI benefits on November 15, 2011 alleging disability 21 since August 18, 2008. Administrative Record (“AR”) 317- 25. His application was initially 22 denied on May 11, 2012 and again on reconsideration on December 28, 2012. AR 223-28, 232- 23 37. On January 2, 2013, Plaintiff filed a request for a hearing before an Administrative Law Judge 24 (“ALJ”). The first hearing before ALJ Richard P. Laverdure was held on October 16, 2013. 25 Plaintiff testified at the hearing, as well as an impartial vocational expert. On October 31, 2013, 26 the ALJ issued a decision finding that Plaintiff was not disabled. AR 202-20. 27 28 Plaintiff requested a review by the Appeals Council. On January 13, 2014, the Appeals Council granted Plaintiff’s request for review under the substantial evidence, error of law, and new 1 and material evidence provisions of the Social Security Administration regulations, 20 CFR 2 416.1470, and remanded the case for further proceedings before the ALJ. AR 196-200. The 3 Appeals Council stated that the ALJ had discounted the opinions of two psychological examining 4 sources (Dr. Franklin and Dr. Taylor) because both were based on Plaintiff’s subjective 5 complaints and over-estimated Plaintiff’s symptoms. However, the Appeals Council noted that 6 the longitudinal record demonstrated that the findings and conclusions in these two opinions were 7 consistent with each other, even though the examinations were performed at different times. The 8 Appeals Council also found them to be consistent in certain key respects with two other examining 9 sources, Dr. El-Sokkary and Dr. Boroff. AR 198-199. In light of these findings, the Appeals 10 Council remanded the matter with specific instructions to: United States District Court Northern District of California 11 12  13 14 15 16  17 18  19 20  21 22 23 24 25 26 27 28  Obtain additional evidence concerning the claimant’s impairments including posttraumatic stress disorder in order to complete the administrative record in accordance with the regulatory standards regarding consultative examinations and existing medical evidence (20 CFR 416.912-913). The additional evidence may include, if warranted and available, consultative examinations with psychological testing and medical source statements about what the claimant can still do despite the impairments. Further evaluate the claimant’s mental impairments in accordance with the special technique described in 20 CFR 416.920a, documenting application of the technique in the decision by providing specific findings and appropriate rationale for each of the functional areas described in 20 CFR 416.920a(c). Further, if necessary, obtain evidence from a medical expert to clarify the nature and severity of the claimant’s mental impairments (20 CFR 416.927(e) and Social Security Ruling 96-6p). Give further consideration to the claimant’s maximum residual functional capacity during the entire period at issue and provide rationale with specific references to evidence of record in support of assessed limitations (Social Security Ruling 9680). In so doing, evaluate the treating and nontreating source opinions pursuant to the provisions of 20 CFR 416.927 and Social Security Rulings 96-2p and 96-5p, and explain the weight given to such opinion evidence. As appropriate, the Administrative Law Judge may enlist the aid and cooperation of the claimant’s representative in developing evidence from the claimant’s treating sources. Obtain supplemental evidence from a vocational expert to clarify the effect of the assessed limitations on claimant’s occupational base (Social Security Ruling 8515). The hypothetical questions should reflect the specific capacity/limitations established by the record as a whole. The Administrative Law Judge will ask the vocational expert to identify examples of appropriate jobs and to state the incidence of such jobs in the national economy (20 CFR 416.966). Further, before relying on the vocational expert evidence the Administrative Law Judge will identify and 2 1 resolve any conflicts between the occupational evidence provided by the vocational expert and information in the Dictionary of Occupational Titles (DOT) and its companion publication, the Selected Characteristics of Occupations (Social Security Ruling 00-4p). 2 3 4 AR 199-200. On June 10, 2014, the ALJ held a remand hearing and took testimony from Plaintiff, a 5 6 vocational expert, and a medical expert. AR 90-118. The ALJ issued a second decision on 7 August 12, 2014. AR 9-35. The ALJ determined that Plaintiff has the following severe 8 impairments: poly-substance abuse, in questionable remission; narcissistic personality disorder; 9 delusional disorder; and post-traumatic stress disorder (“PTSD”). AR 14. The ALJ found that Plaintiff retains the following residual functional capacity (“RFC”) to perform a full range of work 11 United States District Court Northern District of California 10 at all exertional levels but with the following nonexertional limitations: no public contact, only 12 occasional coworker contact, and work limited to simple, repetitive tasks with no production 13 quotas. AR 19-28. The ALJ relied on the opinion of the vocational expert, who testified that an 14 individual with such an RFC could perform other jobs existing in the economy, including cleaner 15 and laboratory sample carrier. AR 29. Accordingly, the ALJ concluded that Plaintiff is not 16 disabled. Plaintiff again requested Appeals Council review. AR 8. The Appeals Council denied 17 18 Plaintiff’s request on October 31, 2014. AR 1-3. The ALJ’s decision therefore became the 19 Commissioner’s final decision. Taylor v. Comm’r of Soc. Sec. Admin., 659 F.3d 1228, 1231 (9th 20 Cir. 2011). Plaintiff then filed suit in this court pursuant to 42 U.S.C. § 1383(c) and 42 U.S.C. § 21 405(g). 22 II. THE FIVE-STEP SEQUENTIAL EVALUATION PROCESS To qualify for disability benefits, a claimant must demonstrate a medically determinable 23 24 physical or mental impairment that prevents him from engaging in substantial gainful activity1 25 and that is expected to result in death or to last for a continuous period of at least twelve months. 26 Reddick v. Chater, 157 F.3d 715, 721 (9th Cir. 1998) (citing 42 U.S.C. § 423(d)(1)(A)). The 27 1 28 Substantial gainful activity means work that involves doing significant and productive physical or mental duties and is done for pay or profit. 20 C.F.R. §§ 404.1510, 416.910. 3 1 impairment must render the claimant incapable of performing the work he previously performed 2 and incapable of performing any other substantial gainful employment that exists in the national 3 economy. Tackett v. Apfel, 180 F.3d 1094, 1098 (9th Cir. 1999) (citing 42 U.S.C. § 423(d)(2)(A)). To decide if a claimant is entitled to benefits, an ALJ conducts a five-step inquiry. 20 4 5 C.F.R. §§ 404.1520, 416.920. The steps are as follows: 1. 6 7 claimant is doing substantial gainful activity, the ALJ will find that the claimant is not disabled. 2. 8 9 At the first step, the ALJ considers the claimant’s work activity, if any. If the At the second step, the ALJ considers the medical severity of the claimant’s impairment(s). If the claimant does not have a severe medically determinable physical or mental impairment that meets the duration requirement in [20 C.F.R.] § 416.909, or a combination of 11 United States District Court Northern District of California 10 impairments that is severe and meets the duration requirement, the ALJ will find that the claimant 12 is not disabled. 3. 13 At the third step, the ALJ also considers the medical severity of the claimant’s 14 impairment(s). If the claimant has an impairment(s) that meets or equals one of the listings in 20 15 C.F.R., Pt. 404, Subpt. P, App. 1 [the “Listings”] and meets the duration requirement, the ALJ will 16 find that the claimant is disabled. 4. 17 At the fourth step, the ALJ considers an assessment of the claimant’s residual 18 functional capacity (“RFC”) and the claimant’s past relevant work. If the claimant can still do his 19 or his past relevant work, the ALJ will find that the claimant is not disabled. 5. 20 At the fifth and last step, the ALJ considers the assessment of the claimant’s RFC 21 and age, education, and work experience to see if the claimant can make an adjustment to other 22 work. If the claimant can make an adjustment to other work, the ALJ will find that the claimant is 23 not disabled. If the claimant cannot make an adjustment to other work, the ALJ will find that the 24 claimant is disabled. 25 20 C.F.R. § 416.920(a)(4); 20 C.F.R. §§ 404.1520; Tackett, 180 F.3d at 1098-99. 26 III. FACTUAL BACKGROUND 27 A. Plaintiff’s Testimony and Relevant Evidence from the Record 28 The record contains the following information. Plaintiff was born in 1954. He has a 4 1 Master’s degree from California State University, Los Angeles in Urban Education with a minor 2 in Pan-African Studies. AR 461. He is divorced and lives alone. AR 318. He has five children, 3 whom he talks to on a regular basis, and three grandchildren. AR 132. Plaintiff has struggled with homelessness over the years and is currently homeless. AR 4 5 126, 279, 492, 624. On August 18, 2008, during a period of homelessness, Plaintiff was attacked 6 and stabbed in the neck with a knife. Emergency surgery was performed to repair Plaintiff’s 7 jugular vein and he remained in the hospital for several days before being discharged. AR 492. Shortly after the attack, Plaintiff moved into Senior Housing Apartment with support from 8 9 federal and county sources. He lived independently in this apartment from August 2008 to May 2013. AR 109, 279, 318, 319, 492. Since losing his housing in 2013, Plaintiff has been homeless. 11 United States District Court Northern District of California 10 AR 94, 279. He has never had health insurance and has only had sporadic medical care. AR 129. The record does not contain a complete work history for Plaintiff. It appears that he has 12 13 had only intermittent work activity. Plaintiff wrote a book on Ebonics in 1984 that has since gone 14 out of print. AR 578-79. Around 1988, Plaintiff worked full-time as a long-term substitute 15 teacher in Emeryville. AR 145. Plaintiff also had some past work as a musician. Plaintiff worked 16 a full-time position as a homeless shelter counselor at Watts Labor Community Action in Los 17 Angeles at some point in 2001. AR 146-47, 346, 359. From January to April 2006 he worked full 18 time as a food packager and dishwasher for Project Open Hand in Oakland. AR 125, 359, 378. 19 Plaintiff stopped working at Project Open Hand because he was “overqualified for the job.” He 20 quit his job when his supervisor “cursed [him] out,” and has not worked since that time. AR 126, 21 450. 22 Although he has not been employed since leaving Project Open Hand, Plaintiff collects 23 cans and bottles to recycle and has received General Assistance. AR 111, 128, 131. He had also 24 volunteered from time to time, including teaching teens at a local art studio, teaching children how 25 to fix bicycles, and bringing toys and pencils to the community center. His volunteer efforts were 26 not on a regular schedule. He stopped volunteering altogether at some time prior to the June 2014 27 remand hearing. AR 108-09, 165-66, 493. 28 5 1 B. Plaintiff’s Relevant Medical History 1. Dr. Warren Taylor 2 On February 27, March 14 and 20, 2012, Warren Taylor, Ph.D., conducted a psychological 3 evaluation of Plaintiff. AR 456-72. Dr. Taylor conducted a mental status examination and pre4 test interview, and administered six psychological tests. Based on Plaintiff’s presentation, history, 5 interview, psychological test responses and results, and reported symptomatology, Dr. Taylor 6 diagnosed Plaintiff with PTSD, delusional disorder (persecutory and grandiose), rule out cognitive 7 disorder, rule out polysubstance dependence (marijuana, alcohol, and cocaine), personality 8 disorder with paranoid and passive aggressive features with narcissistic and histrionic traits. AR 9 469. He assigned Plaintiff a Global Assessment of Functioning (“GAF”) score of 45, indicating 10 that the Plaintiff had a serious impairment in social, occupational, or school functioning. Id. Dr. 11 United States District Court Northern District of California Taylor noted that Plaintiff appeared to have difficulty with his short-term memory because he 12 could only remember one out of the three objects that Dr. Taylor gave him after five minutes had 13 passed. AR 458-59. 14 Dr. Taylor concluded that Plaintiff would “be unable to work on a regular and consistent 15 basis within the next 12 to 18 months based on his unresolved issues vis-a-vis being stabbed in the 16 17 neck.” AR 469. Dr. Taylor diagnosed Plaintiff with chronic PTSD because he had “many symptoms in excess of those required to make the diagnosis,” several “particularly severe” 18 symptoms, and exhibited marked impairment in social and occupational functioning.” AR 469-70. 19 He concluded that Plaintiff had “severe psychopathology that precludes an effective and consistent 20 work effort.” AR 470. He noted that any substance use issues that Plaintiff had were secondary 21 to his more chronic and pervasive mental health problems, specifically his PTSD, Delusional 22 Disorder and Personality Disorder. AR 470. 23 Dr. Taylor opined that Plaintiff had an extreme level of impairment with respect to his 24 ability to perform activities within a schedule and maintain regular attendance. He noted that in 25 his twenty-one years as a licensed clinical psychologist, Plaintiff was the third person who, 26 without out a very good excuse, needed three sessions to complete the evaluation. AR 456-57, 27 471. Dr. Taylor also opined that Plaintiff had marked impairment with regard to his ability to 28 6 1 respond appropriately to changes in work settings, to complete a normal workday and workweek 2 without interruptions from psychologically based symptoms, to maintain concentration, attention 3 and persistence, to make judgments on simple work-related decisions, and to carry out detailed 4 (complex) instructions. AR 471. 5 6 2. Dr. Ahmed El-Sokkary On March 7, 2012, consultative examiner Ahmed El-Sokkary, Psy.D., evaluated Plaintiff 7 at the Social Security Administration’s request. AR 448-450. Dr. El-Sokkary diagnosed Plaintiff 8 with Anxiety disorder, rule out PTSD (chronic with delayed onset), personality disorder, and a 9 GAF level of 63. AR 452. He concluded that Plaintiff had the capacity to understand, remember, and perform simple to moderately difficult tasks, and that Plaintiff was able to maintain a 11 United States District Court Northern District of California 10 sufficient level of concentration, persistence, and pace to do basic to moderately complex work in 12 an environment that his health condition would allow. Id. Dr. El-Sokkary also noted that Plaintiff 13 was capable of adequately communicating and therefore would be able to interact with supervisors 14 and co-workers, but “could have difficulties from time to time keeping a regular 15 workday/workweek schedule without interruptions from psychiatric symptoms.” Id. 16 17 3. Dr. Lesleigh Franklin On October 31, 2012, Lesleigh Franklin, Ph.D., conducted a psychological evaluation of 18 Plaintiff. She performed a clinical interview and a number of tests, and reviewed Plaintiff’s 19 records. AR 490. Dr. Franklin noted that Plaintiff had many good functional living skills despite 20 his mental health problems and that he understood all independent living concepts. AR 493. She 21 found that Plaintiff had difficulties with work related skills including trouble following a work 22 schedule, difficulty following simple or complex directions due to poor short term memory, and 23 trouble taking direction from authority figures. AR 493. She observed that although Plaintiff was 24 able to attend a very part time volunteer job, he was able to do so because the organization was 25 forgiving of his tardiness and times when he failed to show up. Id. 26 Dr. Franklin diagnosed Plaintiff with PTSD (Chronic), Narcissistic Personality Features 27 and a GAF score of 45. AR 498. Dr. Franklin found that Plaintiff “clearly” met all of the criteria 28 for PTSD, observing that he became “highly distressed when he is exposed to reminders of the 7 1 attack, and avoids talking about it or thinking about it whenever possible,” had recurrent thoughts 2 about the attack, and ongoing nightmares. AR 499. She noted that Plaintiff could not follow a 3 normal work schedule at all, had impaired executive functioning and attention skills, that his 4 immediate memory was poor, and that he needed time and practice to remember things. Id. 5 6 4. Dr. Michael Boroff Michael Boroff, Psy.D., treated Plaintiff at the Alameda County Healthcare for the 7 Homeless- TRUST clinic in October and November 2013. AR 601. Dr. Boroff prepared a 8 psychological evaluation of Plaintiff based on his sessions with Plaintiff and a review of the 9 psychological evaluations prepared by Drs. Taylor, Franklin, and El-Sokkary. Id. 10 Dr. Boroff reported that Plaintiff was “one of the most difficult clients to enter our clinic,” United States District Court Northern District of California 11 remarking that this was especially noteworthy because the TRUST clinic serves a severely 12 mentally ill population that is often challenging and difficult to engage. AR 602. He diagnosed 13 Plaintiff with severe mental illness in the form of Delusional Disorder (Persecutory and 14 Grandiose), PTSD, and Narcissistic Personality Disorder, and assigned him a GAF level of 40. 15 AR 602-03. 16 Plaintiff’s PTSD symptoms included nightmares, intrusive memories, avoidance of people 17 that remind him of his trauma, hypervigilance, irritability, angry outbursts, mistrust of others, and 18 a negative perception of the world. AR 602. He also found that Plaintiff had a persecutory 19 delusion that housing companies and social services had conspired to make him homeless and 20 keep him so. Id. Plaintiff’s Narcissistic Personality Disorder manifest in symptoms including a 21 grandiose sense of self-importance, profound sense of entitlement, lack of empathy, interpersonal 22 exploitativeness, and arrogant, haughty behaviors and attitudes. Id. 23 Dr. Boroff opined that Plaintiff’s personality disorder was the most disabling, as it severely 24 disrupted his ability to be socially appropriate with others. Plaintiff had “seemingly constant 25 contempt” for others, and could not successfully engage with staff at the clinic who were working 26 hard to help him. Dr. Boroff concluded that it was “difficult to imagine” Plaintiff holding a job 27 that involved any engagement with others, even in minimal ways. AR 602. 28 In July 2014, Dr. Boroff provided an update. He noted that Plaintiff had not participated in 8 1 further therapy, but continued to frequent the TRUST clinic and interact with the case managers. 2 Dr. Boroff stated that Plaintiff is “often disruptive,” and is “rude, hostile and entitled toward 3 everyone with whom he speaks.” He reported that the TRUST clinic specializes in providing 4 intensive services to the homeless population, and the clinic had never before had to consider 5 restricting a client from accessing services due to behavior issues, but that clinic staff had 6 contemplated banning Plaintiff from the premises due to his extreme behavior. Referring to this 7 situation, Dr. Boroff concluded: 8 This is a unique situation in our clinic’s history and speaks to the severity of Mr. Sababu’s narcissism. Given his level of intelligence and cognitive functioning, as well as his education, it would be expected that Mr. Sababu would have been much more able to provide for himself, stay housed, and stay employed. However, he has struggled in these areas for much of his adult life. Clearly, his personality disorder has interfered with his ability to function in these areas and has done so for many years. 9 10 United States District Court Northern District of California 11 12 13 14 15 AR 624. 5. Dr. Martin Cary Dr. Martin Cary reviewed Plaintiff’s medical records and testified as a medical expert at 16 the June 10, 2014 remand hearing. AR 96-114. Dr. Cary testified that Plaintiff’s primary 17 impairment was his personality disorder, and that he also appeared to have mild PTSD. AR 98. 18 He noted that “social functioning is where [Plaintiff] seems to have the biggest problem,” but 19 opined that Dr. Boroff’s experience with Plaintiff appeared to be an “outlier,” and was perhaps 20 the result of the evaluations occurring during “an especially bad period of [Plaintiff’s] life” in 21 October and November 2013. AR 104. Dr. Cary noted that with something like a personality 22 disorder, “a person can control that behavior if they’re so motivated.” AR 105. Dr. Cary testified 23 that there was no suggestion that Plaintiff was malingering, and if anything, he seemed to 24 minimize his problems. AR 102. In relation to deterioration, Dr. Cary noted that there were no 25 indicators that Plaintiff had been hospitalized for psychiatric reasons or been jailed for fights or 26 difficulties with other people. AR 104. With regard to work-related limitations, Dr. Cary opined 27 that Plaintiff could perform simple, detailed, and complex tasks, but that Plaintiff’s public contact 28 should be “limited.” AR 105. Dr. Cary noted that Plaintiff had been able to sit through two and a 9 1 half to three and a half hours of evaluations. AR 101. Dr. Cary also opined that Plaintiff would be 2 able to get along with supervisors because he was “cooperative” when he went in for medical 3 treatment and he had been able to volunteer and spend time at the senior center. AR 108. 4 6. Treatment Records for Physical Impairments The record also contains various physical treatment records, including providers’ opinions 5 6 about Plaintiff’s physical limitations. The court does not discuss the physical treatment records, 7 because Plaintiff does not challenge the ALJ’s findings that Plaintiff’s reported physical ailments 8 did not qualify as severe impairments. These include pain and nerve damage in the right neck and 9 right side of his face, and eye damage that blurs his vision resulting from an August 2008 stabbing in the right side of his neck, difficulty with his left foot due to a car accident in December 2013, 11 United States District Court Northern District of California 10 and a head injury from an assault in March 2014. AR 14-15. 12 IV. 13 STANDARD OF REVIEW Pursuant to 42 U.S.C. § 405(g), this court has the authority to review a decision by the 14 Commissioner denying a claimant disability benefits. “This court may set aside the 15 Commissioner’s denial of disability insurance benefits when the ALJ’s findings are based on legal 16 error or are not supported by substantial evidence in the record as a whole.” Tackett v. Apfel, 180 17 F.3d 1094, 1097 (9th Cir. 1999) (citations omitted). Substantial evidence is evidence within the 18 record that could lead a reasonable mind to accept a conclusion regarding disability status. See 19 Richardson v. Perales, 402 U.S. 389, 401 (1971). It is more than a mere scintilla, but less than a 20 preponderance. See Saelee v. Chater, 94 F.3d 520, 522 (9th Cir.1996) (internal citation omitted). 21 When performing this analysis, the court must “consider the entire record as a whole and may not 22 affirm simply by isolating a specific quantum of supporting evidence.” Robbins v. Soc. Sec. 23 Admin., 466 F.3d 880, 882 (9th Cir. 2006) (citation and quotation marks omitted). 24 If the evidence reasonably could support two conclusions, the court “may not substitute its 25 judgment for that of the Commissioner” and must affirm the decision. Jamerson v. Chater, 112 26 F.3d 1064, 1066 (9th Cir. 1997) (citation omitted). “Finally, the court will not reverse an ALJ’s 27 decision for harmless error, which exists when it is clear from the record that the ALJ’s error was 28 inconsequential to the ultimate nondisability determination.” Tommasetti v. Astrue, 533 F.3d 10 1 1035, 1038 (9th Cir. 2008) (citations and internal quotation marks omitted). 2 V. ISSUES PRESENTED 3 1. Whether the ALJ erred in weighing the medical opinions; 4 2. Whether the ALJ erred in rejecting Plaintiff’s testimony; and 5 3. Whether the ALJ erred by failing to follow the Appeals Council Remand Order. 6 VI. DISCUSSION 7 A. The ALJ’s Evaluation of the Medical Opinions 8 Plaintiff argues that the ALJ erred in weighing the medical opinions. Specifically, he 9 argues that the ALJ erred by improperly rejecting the examining opinions of Drs. Taylor and Franklin and the treating opinion of Dr. Boroff, in favor of the opinions of Dr. Cary and Dr. El- 11 United States District Court Northern District of California 10 Sokkary. 12 1. Legal Standard 13 Courts employ a hierarchy of deference to medical opinions based on the relation of the 14 doctor to the patient. Namely, courts distinguish between three types of physicians: those who 15 treat the claimant (“treating physicians”) and two categories of “nontreating physicians:” those 16 who examine but do not treat the claimant (“examining physicians”), and those who neither 17 examine nor treat the claimant (“non-examining physicians”). See Lester v. Chater, 81 F.3d 821, 18 830 (9th Cir. 1996). A treating physician’s opinion is entitled to more weight than an examining 19 physician’s opinion, and an examining physician’s opinion is entitled to more weight than a non- 20 examining physician’s opinion. Id. 21 The Social Security Act tasks the ALJ with determining credibility of medical testimony 22 and resolving conflicting evidence and ambiguities. Reddick v. Chater, 157 F.3d 715, 722 (9th 23 Cir. 1998). A treating physician’s opinion, while entitled to more weight, is not necessarily 24 conclusive. Magallanes v. Bowen, 881 F.2d 747, 751 (9th Cir. 1989) (citation omitted). To reject 25 the opinion of an uncontradicted treating physician, an ALJ must provide “clear and convincing 26 reasons.” Lester, 81 F.3d at 830; see, e.g., Roberts v. Shalala, 66 F.3d 179, 184 (9th Cir. 1995) 27 (affirming rejection of examining psychologist’s functional assessment which conflicted with his 28 own written report and test results); see also 20 C.F.R. § 416.927(d)(2); SSR 96-2p, 1996 WL 11 374188 (July 2, 1996).2 If another doctor contradicts a treating physician, the ALJ must provide 2 “specific and legitimate reasons” supported by substantial evidence to discount the treating 3 physician’s opinion. Lester, 81 F.3d at 830. The ALJ meets this burden “by setting out a detailed 4 and thorough summary of the facts and conflicting clinical evidence, stating his interpretation 5 thereof, and making findings.” Reddick, 157 F.3d at 725 (citation omitted). “[B]road and vague” 6 reasons do not suffice. McAllister v. Sullivan, 888 F.2d 599, 602 (9th Cir. 1989). This same 7 standard applies to the rejection of an examining physician’s opinion as well. Lester, 81 F.3d at 8 830-31. A non-examining physician’s opinion alone cannot constitute substantial evidence to 9 reject the opinion of an examining or treating physician, Pitzer v. Sullivan, 908 F.2d 502, 506 n.4 10 (9th Cir. 1990); Gallant v. Heckler, 753 F.2d 1450, 1456 (9th Cir. 1984), though a non-examining 11 United States District Court Northern District of California 1 physician’s opinion may be persuasive when supported by other factors. See Tonapetyan v. 12 Halter, 242 F.3d 1144, 1149 (9th Cir. 2001) (noting that opinion by “non-examining medical 13 expert . . . may constitute substantial evidence when it is consistent with other independent 14 evidence in the record”); Magallanes, 881 F.2d at 751-55 (upholding rejection of treating 15 physician’s opinion given contradictory laboratory test results, reports from examining physicians, 16 and testimony from claimant). An opinion that is more consistent with the record as a whole 17 generally carries more persuasiveness. See 20 C.F.R. § 416.927(c)(4). 18 2. Analysis 19 a. The ALJ’s Weighing of the Psychological Opinions 20 The ALJ accorded the greatest weight to the non-examining opinion of Dr. Cary. The ALJ 21 noted that Dr. Cary was the only professional to review the entire record, his opinion was the most 22 thorough and well-reasoned analysis based on all the evidence, and not merely on the claimant’s 23 subjective complaints and reporting, and Dr. Cary also considered Plaintiff’s activities of daily 24 living, as well as his behavior with other examiners and treating sources. The ALJ accorded great 25 26 27 28 2 “[Social Security Rulings (“SSRs”) do not carry the ‘force of law,’ but they are binding on ALJs nonetheless.” Bray v. Comm'r of Soc. Sec. Admin., 554 F.3d 1219, 1224 (9th Cir. 2009). The Ninth Circuit gives them deference so long as they do not produce “a result inconsistent with the statute and regulations.” Bunnell v. Sullivan, 947 F.2d 341, 346 n. 3 (9th Cir. 1991). 12 1 weight to consultative examiner Dr. El-Sokkary, little weight to the examining opinions of Drs. 2 Taylor and Franklin, and no weight to the treating opinion of Dr. Boroff. AR 26-28. Plaintiff 3 argues that the ALJ erred by giving too much weight to Drs. Cary and El-Sokkary, and improperly 4 discounted the opinions of Drs. Taylor, Franklin and Boroff. 5 6 i. Dr. Taylor and Dr. Franklin’s Opinions As discussed above, the Appeals Council remanded the matter because the ALJ had 7 discounted Dr. Taylor and Dr. Franklin’s opinions even though their findings and conclusions 8 demonstrated longitudinal consistency, and important aspects of their opinions were consistent 9 with other opinions in the record. AR 198-199. The Appeals Council instructed the ALJ to obtain additional evidence regarding the claimant’s impairments, including if warranted, further 11 United States District Court Northern District of California 10 consultative examinations. AR 199. It does not appear that the ALJ developed the medical record 12 as instructed. 13 Curiously, the ALJ’s decision on remand accords Dr. Taylor and Dr. Franklin’s opinions a 14 slight promotion (from “no weight” to “little weight”), even though the ALJ appears to discount 15 their opinions for much the same reasons as given in the first decision. While all of the ALJ’s 16 reasons for discounting the opinions are specific, none are legitimate, nor are they supported by 17 substantial evidence. 18 First, the ALJ expressed concern that both examiners took Plaintiff’s self-report about his 19 past work activities at face value (e.g., Plaintiff’s statements that he had worked in the past as a 20 teacher, author, and musician), even though his official earnings record is sparse. The ALJ 21 discounted their opinions on this basis, stating that neither examiner actually “knew” Plaintiff’s 22 “baseline” before the 2008 stabbing, and therefore did not have a firm basis from which to 23 conclude that Plaintiff’s executive functioning had been impaired as a result of the stabbing 24 incident. AR 23. As an initial matter, there is no record evidence that Plaintiff is either a 25 malingerer, or is prone to exaggeration. Indeed, when the ALJ asked Dr. Cary whether there was 26 any suggestion in the record of embellishment or malingering, Dr. Cary responded that the 27 opposite was true – that Plaintiff seemed to be “minimizing” his problems, and that he did not 28 show “malingering behavior.” AR 102. Moreover, Plaintiff’s earnings record does not cast doubt 13 1 on Plaintiff’s statements about his past work. Plaintiff stated that he had worked as a substitute 2 teacher in Emeryville and as a shelter counselor at Watts Labor Community Action in Los 3 Angeles, and that he did some work for Catholic Charities, along with some past work as a 4 musician. He also reported that he wrote a book on Ebonics. AR 145-47, 578-79. Plaintiff did 5 not claim that these jobs were lucrative. His earnings record shows that he earned some income 6 from 1980-99 [AR 341-42], including from Skid Row Development Corp. [AR 343], Watts Labor 7 Community Action in Los Angeles [AR 346], Shreveport Staffing LLC Command Labor & 8 Staffing [AR 347], LFI For Pierce Inc. Labor Finders [AR 347], and Catholic Charities of the 9 Dioceses of Oakland [AR 365]. AR 334-338, 356-57, 365-68. Plaintiff never stated that he held full-time employment as a musician, and he told Dr. Franklin that when the economy started to 11 United States District Court Northern District of California 10 fail he was not as well paid for his music. AR 492. And as for Plaintiff’s statement that he 12 authored a book on Ebonics in 1984 that has since gone out of print, Dr. Taylor was able to 13 confirm that fact through an internet search. AR 578-79. 14 On this record, the ALJ did not have a legitimate basis for discounting Dr. Taylor and Dr. 15 Franklin’s opinions based on their acceptance of Plaintiff’s self-reports about his past work. On 16 the present record, the two examiners were entitled to credit Plaintiff’s recounting of his past 17 work-related activities. Regennitter v. Comm’r of Soc. Sec. Admin., 166 F.3d 1294, 1300 (9th Cir. 18 1999) (substantial evidence did not support ALJ’s finding that examining psychologists took 19 claimant’s “statements at face value” where psychologists’ reports did not contain “any indication 20 that [the claimant] was malingering or deceptive”). 21 Next, the ALJ found that Plaintiff’s lack of mental health treatment prior to October 2013 22 undercut Drs. Franklin and Taylor’s opinion that Plaintiff suffered from PTSD symptoms that 23 were “so severe that he was unable to function at all.” AR 23. First of all, this is an 24 overstatement. The opinions do not state that Plaintiff was “unable to function at all.” Moreover, 25 Plaintiff need not show that he was “unable to function at all” in order to qualify for benefits. 26 Cooper v. Bowen, 815 F.2d 557, 561 (9th Cir. 1987) (noting that a disability claimant need not 27 “vegetate in a dark room” in order to be deemed eligible for benefits). More to the point, the 28 Ninth Circuit has repeatedly and particularly criticized the use of a lack of treatment to reject 14 1 mental complaints both because mental illness is “notoriously underreported” and because “it is a 2 questionable practice to chastise one with a mental impairment for the exercise of poor judgment 3 in seeking rehabilitation.” Nguyen v. Chater, 100 F.3d 1462, 1465 (9th Cir. 1996) (citing 4 Blankenship v. Bowen, 874 F.2d 1116, 1124 (6th Cir. 1989)); Regennitter, 166 F.3d at 1299-300. 5 Under the Social Security Rulings, the ALJ must not draw any inferences about an 6 individual’s symptoms and their functional effects from a failure to seek or pursue regular medical 7 treatment without first considering any explanations that the individual may provide, or other 8 information in the case record, that may explain infrequent or irregular medical visits or failure to 9 seek medical treatment. SSR 96-7P, 1996 WL 374186 (July 2, 1996). The regulation also provides examples of reasons why an individual may not seek regular medical treatment, including 11 United States District Court Northern District of California 10 that the individual may be unable to afford treatment and may not have access to free or low-cost 12 medical services, and that an individual may decide not to take prescription medication because 13 the side effects are less tolerable than the symptoms. 14 There is evidence in the record that Plaintiff’s conditions led him to avoid treatment. Dr. 15 Franklin noted that after the stabbing, Plaintiff coped by trying “not to consider his emotions at 16 all,” “avoid[ing] therapy” and “rush[ing] through discussions of the trauma.” AR 499. She 17 opined that his narcissistic personality features contributed to his avoidance of treatment and 18 “exacerbate his difficulties because he does not believe that others can understand him or are 19 competent enough to help him, so he avoids treatment.” AR 497-99. When Dr. Franklin 20 discussed strategies with Plaintiff to improve his memory and executive functioning, he “regarded 21 them with suspicion and skepticism,” was “highly uncomfortable being told that he appeared to 22 have some problems” and repeated that most people could not understand him. AR 499. 23 Dr. Taylor concluded that Plaintiff should be referred for long-term psychotherapy and 24 targeted psychopharmacologic medications, but opined that Plaintiff was “not likely to sustain a 25 therapeutic course without a heavy dose of repeated caring and empathy” and that “even reactions 26 of rage may be expected.” AR 470. After attempting to treat Plaintiff, Dr. Boroff concluded that 27 due to Plaintiff’s personality order and accompanying attitude, it is unlikely that Plaintiff would 28 benefit significantly from therapy. AR 602. 15 1 Plaintiff’s own testimony reveals two additional reasons for his sparse medical treatment: 2 his lack of health insurance, as well as his resistance to psychotropic medicines because of side 3 effects (doctors are “always trying to give me those psychotropic drugs, which have people like 4 zombies. I don’t want to be no zombie.”). AR 129, 133. On this record, Plaintiff’s lack of mental 5 health treatment prior to October 2013 is not a legitimate basis for discounting Dr. Taylor and Dr. 6 Franklin’s opinions. 7 The ALJ next attacks the validity and reliability of Dr. Taylor’s opinion by pointing to a typographical error and suggesting that Dr. Taylor copied and pasted material from another 9 evaluation into Plaintiff’s evaluation. AR 24. This is patently unfair, and does not provide a 10 legitimate reason for discounting Dr. Taylor’s opinion. Dr. Taylor’s seventeen-page report is 11 United States District Court Northern District of California 8 replete with personalized details, analysis of test results, impressions and conclusions that leave no 12 doubt in the reader’s mind that he took care in preparing Plaintiff’s evaluation. The single error 13 cited by the ALJ, which uses a name other than Plaintiff’s, appears in a boilerplate two-sentence 14 paragraph which describes the format for reporting diagnostic impressions. AR 469. It is 15 completely understandable that a psychologist might cut and paste such a standard descriptive 16 paragraph, instead of inventing the same wheel anew. Judges have been known to take the same 17 short cut. 18 Finally, the ALJ did not find Dr. Franklin’s report credible because it “clearly overstates” 19 the claimant’s report of his symptoms. AR 23. This itself is an overstatement, and is not a 20 legitimate basis for discounting Dr. Franklin’s report. To begin with, the ALJ misquotes Dr. 21 Franklin, thereby setting up a false attack. The ALJ says: 22 23 24 25 Dr. Franklin concludes that the claimant “clearly meets” all of the criteria for PTSD, citing “recurrent thoughts,” “ongoing nightmares,” irritability, and anger (...), but these symptoms do not reflect what the claimant himself reported in the interview. Earlier, Dr. Franklin noted that the claimant stated he has a sleep disturbance, eating problems, and nightmares (...), but there is no indication that he stated these were “recurrent” or “ongoing.” 26 27 AR 23 (citations omitted). Thus, the ALJ’s criticism focuses on Dr. Franklin’s alleged 28 overstatements about the “recurrent” or “ongoing” nature of Plaintiff’s sleep disturbance, eating 16 1 problems and nightmares. Dr. Franklin’s actual use of the words “recurrent” and “ongoing” are as follows: Plaintiff clearly meets all of the criteria for [PTSD]. He has recurrent thoughts about the attack on him, and he has ongoing nightmares. He becomes highly distressed when he is exposed to reminders of the attack, and he avoids talking about it or thinking about it whenever possible. He is irritable and angry and has a sleep disturbance. 2 3 4 5 6 AR 499 (emphasis added). Thus, Dr. Franklin did not state what the ALJ accuses her of 7 overstating. Moreover, all of her observations are confirmed within her report. And most 8 importantly, all are confirmed across evaluations by numerous examiners. See Taylor at 458 9 (recurrent thoughts about attack, sleep disturbance, nightmares, loss of appetite); El-Sokkary at 450-451 (nightmares, recurrent thoughts about the trauma, sleep and appetite problems); Boroff at 11 United States District Court Northern District of California 10 590, 601-602 (nightmares, intrusive memories, appetite disturbance). In sum, upon review of the record, the court finds that the ALJ did not provide legitimate 12 13 reasons supported by substantial evidence for discounting Dr. Taylor and Dr. Franklin’s opinions. 14 This legal error alone provides a basis for remand. ii. Dr. Boroff’s Opinion 15 The ALJ accorded “no weight” to Dr. Boroff’s opinion, in favor of the contradicting 16 17 opinions of consultative non-examiner Dr. Cary and consultative examiner Dr. El-Sokkary. As 18 noted above, the ALJ must provide “specific and legitimate reasons” supported by substantial 19 evidence to discount the treating physician’s contradicted opinion. Lester, 81 F.3d at 830. The 20 ALJ provided two reasons for rejecting Dr. Boroff’s opinion. First, Dr. Boroff reported extremely 21 uncooperative behavior by Plaintiff, which was an “outlier” when viewed against the rest of the 22 record. Other records demonstrate that even though Plaintiff has a personality disorder with 23 narcissistic traits as well as PTSD, he has been able to relate reasonably well with others, 24 including his other examiners. Second, Plaintiff’s reported activities of daily living, including 25 Plaintiff’s volunteer work with youth to fix bicycles and teach art, undercut Dr. Boroff’s 26 observations about Plaintiff.3 AR 26-27. 27 3 28 The ALJ also construed Dr. Boroff’s opinion regarding Plaintiff’s extremely impaired social functioning as contradicted by examining Drs. El Sokkary and Franklin’s opinions that Plaintiff 17 1 With respect to the ALJ’s first stated reason, it is fair to say that Dr. Boroff’s experiences 2 with Plaintiff appear to be more extreme when compared with the experiences of others. For 3 example, although Dr. Franklin observed that Plaintiff “demonstrated severe anxiety, irritability, 4 and anger” when speaking about the stabbing incident, he was otherwise “open and cooperative” 5 during the evaluation. AR 494. Dr. Taylor does not discuss whether Plaintiff was cooperative, 6 but his detailed report demonstrates that he was able to engage Plaintiff at length in the interview 7 and testing process. Dr. Taylor did, however, remark upon the fact that Plaintiff took three 8 separate days to complete his evaluation without adequate excuses for doing so. AR 471. Dr. El- 9 Sokarry described Plaintiff as “agitated and angry and at times not cooperative,” but also 10 United States District Court Northern District of California 11 determined that Plaintiff was “capable of adequately communicating.” AR 451-452. The ALJ’s “outlier” reasoning is nevertheless troubling. In accepting Dr. Cary’s opinion 12 that Dr. Boroff’s examination was “an outlier,” the ALJ cited to Dr. Cary’s explanation that 13 “perhaps the claimant was undergoing a particularly bad period during those two months from 14 October to November 2013.” AR 18. Dr. Cary’s explanation amounts to pure speculation, for it 15 completely ignores Dr. Boroff’s July 2014 record, which establishes that Plaintiff was still 16 behaving in an extremely antisocial manner nearly a year later. AR 601-603. Reviewing the 17 record as a whole, it is entirely possible that Dr. Boroff’s opinions and observations accurately 18 reflect Plaintiff’s limitations as of 2014, especially with respect to social functioning. It may well 19 be that Plaintiff’s condition had deteriorated by the time he started visiting Dr. Boroff’s clinic, for 20 Dr. Boroff’s examinations took place a year or more after the others. See AR 450 (El-Sokarry; 21 March 2012); AR 456 (Taylor; February and March 2012); (Franklin; October 2012). And as 22 noted above, the reports of all three examiners contain some evidence of the seeds of non- 23 cooperation, agitation, and antisocial behavior. While Plaintiff’s presentation was most extreme 24 before Dr. Boroff, it was not wholly inconsistent with the examining opinions of Drs. Taylor and 25 26 27 had, at most, moderate limitations in social function. AR 24. 28 18 1 Franklin, which resulted in diagnoses for the same conditions.4 The problem lies with the fact that the ALJ did not follow the Appeals Council’s first 2 3 instruction – to obtain more medical information. On remand, the ALJ “shall take any action that 4 is ordered by the Appeals Council and may take any additional action that is not inconsistent with 5 the Appeals Council's remand order.” § 404.977(b). Additionally, an ALJ deciding a Social 6 Security case has an independent duty to develop the record, which is especially important in the 7 case of mental impairments. DeLorme v. Sullivan, 924 F.2d 841, 849 (9th Cir.1991). This duty 8 exists even when the claimant is represented by counsel. Id. If the ALJ is uncertain as to the basis 9 of a doctor's opinion, he has a duty to conduct an “appropriate inquiry.” Smolen, 80 F.3d at 1288. After noting certain key consistencies between the opinions of Drs. Taylor, Franklin, El- 10 United States District Court Northern District of California 11 Sokkary and Boroff, the Appeals Council directed the ALJ to obtain additional information 12 concerning the claimant’s impairments, including consultative examinations with psychological 13 testing. AR 199. The record does not reflect that this occurred. The only act the ALJ took to 14 “develop” the medical record was to obtain the testimony of Dr. Cary, but this implemented a 15 separate Appeals Council instruction. (See AR 199: “Further, if necessary, obtain evidence from a 16 medical expert to clarify the nature and severity of the claimant’s mental impairments”). Had the 17 ALJ followed the Appeal Council’s first instruction, the record would contain updated medical 18 opinions, which could provide the ALJ with a sound basis for determining whether or not Dr. 19 Boroff provided an “outlier” opinion. For this reason, the ALJ’s “outlier” justification for 20 according no evidentiary weight to Dr. Boroff’s opinion is not fully supported. The ALJ’s second reason for according no weight to Dr. Boroff’s opinion is that Plaintiff’s 21 22 reported activities of daily living conflicted with Dr. Boroff’s assessment of Plaintiff’s 23 functioning. AR 17-18, 24, 598-99 602. Plaintiff reported that he was able to sustain himself and 24 maintain his own apartment for five years, ride a bicycle for transport, and get food from food 25 4 26 27 28 Drs. Franklin or Taylor both diagnosed Plaintiff with a personality disorder, noting the narcissistic feature, and PTSD. AR 470-71, 497-99. Dr. Taylor concluded that Plaintiff had “severe psychopathology that precludes an effective and consistent work effort,” had “an extremely low tolerance” for frustration, and avoids and does not like interacting with others, and found that he had marked difficulty with social functioning. AR 469-70. 19 1 banks and churches when he ran out of food stamps. AR 17-18, 24. For the most part, this is a specific and legitimate reason supported by substantial 2 3 evidence. Dr. Boroff’s evaluation does not focus on the physical aspects of Plaintiff’s activities of 4 daily living, and his opinion therefore does not conflict with Plaintiff’s reports about his ability to 5 take care of his personal grooming, maintain an apartment, or ride a bicycle. However, Dr. 6 Boroff’s opinions do conflict with Plaintiff’s reported activities to the extent they implicate social 7 functioning. Dr. Boroff opined that Plaintiff had extreme difficulties in maintaining social 8 functioning. AR 599. This is inconsistent with some of Plaintiff’s reports. In February 2012, 9 Plaintiff self-reported that he spent time with others, although rarely, and did not have any problems getting along with family, friends, neighbors, or others. AR 387-88. He also stated that 11 United States District Court Northern District of California 10 he visited the senior citizen center and volunteered in afterschool programs where he fixed 12 bicycles for children. AR 444. In March 2012, he reported that he was often in contact with his 13 five children and three grandchildren. AR 450. In October 2012, Plaintiff reported that he 14 volunteered at a local art studio teaching teens once a week and that he saw the volunteer work as 15 therapy that was helping him to overcome anger and fearfulness. AR 492. Dr. Franklin noted that 16 he was able to attend a “very part time” volunteer job, in part, because the organization was 17 forgiving of his tardiness and times when he failed to show up.5 AR 493. Plaintiff also reported 18 good relationships with several of his children and that he had some friends he saw when he felt 19 up to it. AR 493. In sum, the ALJ’s reasons for discounting Dr. Boroff’s opinion were partially but not 20 21 wholly specific and legitimate, or supported by substantial evidence. In particular, the ALJ did 22 not adequately supplement the medical record as instructed by the Appeals Council in order to 23 properly assess Dr. Boroff’s evaluation. 24 B. The ALJ’s Credibility Determination 25 Plaintiff next challenges the ALJ’s finding that his statements concerning the intensity, 26 27 28 5 At the June 2014 remand hearing, Plaintiff reported that he no longer volunteers, and that even when he did, it was never a regular or everyday occurrence. AR 108-09. 20 1 2 persistence, and limiting effects of his symptoms were “not entirely credible.” 1. Legal Standard In general, credibility determinations are the province of the ALJ. “It is the ALJ’s role to 4 resolve evidentiary conflicts. If there is more than one rational interpretation of the evidence, the 5 ALJ’s conclusion must be upheld.” Allen v. Sec’y of Health & Human Servs., 726 F.2d 1470, 6 1473 (9th Cir. 1984) (citations omitted). An ALJ is not “required to believe every allegation of 7 disabling pain” or other nonexertional impairment. Fair v. Bowen, 885 F.2d 597, 603 (9th Cir. 8 1989) (citing 42 U.S.C. § 423(d)(5)(A)). Nevertheless, the ALJ’s credibility determinations “must 9 be supported by specific, cogent reasons.” Reddick v. Chater, 157 F.3d 715, 722 (9th Cir. 1998) 10 (citation omitted). If an ALJ discredits a claimant’s subjective symptom testimony, the ALJ must 11 United States District Court Northern District of California 3 articulate specific reasons for doing so. Greger v. Barnhart, 464 F.3d 968, 972 (9th Cir. 2006). In 12 evaluating a claimant’s credibility, the ALJ cannot rely on general findings, but “must specifically 13 identify what testimony is credible and what evidence undermines the claimant’s complaints.” Id. 14 at 972 (quotations omitted); see also Thomas v. Barnhart, 278 F.3d 947, 958 (9th Cir. 2002) (ALJ 15 must articulate reasons that are “sufficiently specific to permit the court to conclude that the ALJ 16 did not arbitrarily discredit claimant’s testimony.”). The ALJ may consider “ordinary techniques 17 of credibility evaluation,” including the claimant’s reputation for truthfulness and inconsistencies 18 in testimony, and may also consider a claimant’s daily activities, and “unexplained or inadequately 19 explained failure to seek treatment or to follow a prescribed course of treatment.” Smolen v. 20 Chater, 80 F.3d 1273, 1284 (9th Cir. 1996). 21 The determination of whether or not to accept a claimant’s testimony regarding subjective 22 symptoms requires a two-step analysis. 20 C.F.R. §§ 404.1529, 416.929; Smolen, 80 F.3d at 1281 23 (citations omitted). First, the ALJ must determine whether or not there is a medically 24 determinable impairment that reasonably could be expected to cause the claimant’s symptoms. 20 25 C.F.R. §§ 404.1529(b), 416.929(b); Smolen, 80 F.3d at 1281-82. Once a claimant produces 26 medical evidence of an underlying impairment, the ALJ may not discredit the claimant’s 27 testimony as to the severity of symptoms “based solely on a lack of objective medical evidence to 28 fully corroborate the alleged severity of” the symptoms. Bunnell v. Sullivan, 947 F.2d 341, 345 21 1 (9th Cir. 1991) (en banc) (citation omitted). Absent affirmative evidence that the claimant is 2 malingering,6 the ALJ must provide specific “clear and convincing” reasons for rejecting the 3 claimant’s testimony. Smolen, 80 F.3d at 1283-84. 4 2. Analysis The ALJ found that Plaintiff’s “medically determinable impairments could reasonably be 5 6 expected to cause some alleged symptoms; however, the claimant’s statements concerning the 7 intensity, persistence and limiting effects of these symptoms are not entirely credible.” AR 20. 8 Since there was no evidence that Plaintiff was malingering, the ALJ was required to provide 9 specific “clear and convincing” reasons for rejecting his testimony. Smolen, 80 F.3d at 1283-84. The ALJ provided three reasons for not finding Plaintiff’s testimony credible: 1) Plaintiff’s lack of 11 United States District Court Northern District of California 10 treatment undercut his allegations of disabling mental impairments; 2) Plaintiff’s reported 12 activities of daily living under cut his allegations of disability; and 3) Plaintiff made inconsistent 13 statements regarding his substance use and work history. AR 24-25. As to the ALJ’s first reason, as analyzed above with respect to the opinions of Drs. Taylor 14 15 and Franklin, the ALJ should not have discounted Plaintiff’s credibility due to his lack of 16 treatment. Carmickle v. Comm’r, Soc. Sec. Admin., 533 F.3d 1155, 1162 (9th Cir. 2008) (rejecting 17 argument that conservative course of treatment undermined claimant’s allegations of debilitating 18 condition where he testified that he resisted taking other medications due to adverse side effects 19 and his insurance did not cover the only medication that provided significant relief). 20 The ALJ’s second reason is partially well-taken, for as discussed above, Plaintiff’s 21 accounts of his daily life activities were inconsistent with his claim of disability, in some respects. 22 Engaging in daily activities that are incompatible with the severity of symptoms alleged can 23 support an adverse credibility determination. See Orn v. Astrue, 495 F.3d 625, 639 (9th Cir. 24 2007); Batson v. Comm'r of Soc. Sec. Admin., 359 F.3d 1190, 1196 (9th Cir. 2004). However, 25 substantial evidence does not support the ALJ’s finding that Plaintiff made inconsistent statements 26 27 28 6 The ALJ did not conclude that Plaintiff was a malingerer. Dr. Cary testified that Plaintiff did not exhibit malingering behavior and “seemed to be minimizing” his problems and that the record did not reflect any malingering behavior. AR 102. 22 1 2 about his work history. See discussion of Drs. Taylor and Franklin, above. With respect to the third and final reason, Plaintiff did not challenge the ALJ’s finding 3 that Plaintiff’s inconsistent statements about substance use hindered his credibility. Pl.’s Reply at 4 5 (conceding that Plaintiff did not challenge this issue). In conclusion, some but not all of the 5 ALJ’s analysis constituted clear and convincing reasons for not fully crediting Plaintiff’s 6 statements. 7 C. The Appeals Council Remand Order 8 Plaintiff contends that the ALJ’s August 2014 decision erred by failing to comply with the Appeals Council Remand Order. Specifically Plaintiff asserts that the ALJ failed to comply with 10 the Appeal Council’s fourth instruction to give further consideration to the claimant’s maximum 11 United States District Court Northern District of California 9 residual functional capacity during the entire period at issue, and to provide rationale with specific 12 references to evidence of record in support of assessed limitations. AR 199. 13 Plaintiff points out that the Remand Order specifically notes that in evaluating the nature 14 and severity of the Plaintiff’s mental impairments, the ALJ “discounted the opinions of 15 psychological examining sources W. Taylor, PhD., and L. Franklin, PhD. because the opinions are 16 based on the claimant’s subjective complaints and they over-estimate the claimant’s symptoms. 17 However, review of the longitudinal record indicates that the opinions of both examiners contain 18 findings and conclusions that are consistent with each other even though the examinations were 19 performed at different times.” AR 198. The Appeals Council also noted that Drs. Taylor and 20 Franklin had opinions that were “consistent with other evidence of record, including an examining 21 source opinion from Ahmed El-Sokkary, Psy.D., that received significant weight in the hearing 22 decision.” AR 198. The Appeals Council found that that Drs. Taylor and Franklin diagnosed 23 Plaintiff with post-traumatic stress disorder and a narcissistic disorder (as part of a personality 24 order, and Dr. El-Sokkary’s diagnosed rule out post-traumatic stress disorder (chronic with 25 delayed onset) and a personality disorder. AR 198-99. 26 Plaintiff’s argument regarding the ALJ’s failure to follow the Appeals Council Order on 27 remand is substantively an argument that the ALJ failed to properly consider and weigh the 28 medical opinions in the record. The court has already analyzed this substantive issue above. 23 D. Remand 1 The court finds that the ALJ committed legal error in according little weight to Drs. Taylor 2 and Franklin. The court also finds that the ALJ’s failure to develop the medical record as 3 instructed by the Appeals Council prevented the ALJ from conducting a proper assessment of Dr. 4 Boroff’s opinions. Finally, the court finds that some but not all of the analysis provided by the 5 ALJ amounted to clear and convincing reasons for finding Plaintiff not fully credible. 6 7 8 A court may remand a disability case for further proceedings “if enhancement of the record would be useful.” It may only remand for benefits, on the other hand, “where the record has been fully developed and further administrative proceedings would serve no useful purpose.” Benecke 9 v. Barnhart, 379 F.3d 587, 593 (9th Cir. 2004). 10 For the reasons set forth in this order, the court finds that the record would benefit from 11 United States District Court Northern District of California further development, particularly of the medical evidence. 12 13 VII. CONCLUSION For the foregoing reasons, the court remands this case for further development of the 14 medical record consistent with this order. 15 16 17 IT IS SO ORDERED. 18 Dated: March 22, 2016 19 20 ______________________________________ Donna M. Ryu United States Magistrate Judge 21 22 23 24 25 26 27 28 24

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