Quiambao v. Berryhill
Filing
16
ORDER granting Plaintiff's 12 Motion for Summary Judgment and 12 Motion for Reversal or Remand; denying Defendant's 13 Cross-Motion for Summary Judgment. Court remands this action for further proceedings consistent with this Order. Signed by Judge Cynthia Bashant on 7/26/2018. (cc: Social Security) (jah)
1
2
3
4
5
6
7
8
UNITED STATES DISTRICT COURT
9
SOUTHERN DISTRICT OF CALIFORNIA
10
11
ARLEEN Y. QUIAMBAO,
Plaintiff,
12
13
Case No. 17-cv-02305-BAS-RBB
ORDER:
(1) GRANTING PLAINTIFF’S
MOTION FOR SUMMARY
JUDGMENT (ECF No. 12);
v.
14
15
16
17
(2) DENYING THE
COMMISSIONER’S CROSSMOTION FOR SUMMARY
JUDGMENT (ECF No. 13);
AND
NANCY A. BERRYHILL, Acting
Commissioner of Social Security,
Defendant.
(3) REMANDING ACTION FOR
FURTHER PROCEEDINGS
18
19
20
21
Plaintiff Arleen Quiambao seeks judicial review of a final decision by the
22
Acting Commissioner of Social Security (“Commissioner”) denying his application
23
for disability insurance benefits under Title II of the Social Security Act, 42 U.S.C.
24
§§ 401-434. The Court has jurisdiction to review the Commissioner’s final decision
25
pursuant to 42 U.S.C. § 405(g).
26
Before the Court are Plaintiff’s Motion for Summary Judgment (ECF No. 12)
27
and the Commissioner’s Cross-Motion for Summary Judgment (ECF No. 13).
28
Plaintiff moves for summary judgment on the grounds that the Administrative Law
–1–
17cv2305
1
Judge (“ALJ”) committed a reversible error by incorrectly rejecting a treating
2
physician’s medical opinion and improperly weighing a nonexamining physician’s
3
opinion. (Pl.’s Mot. 13:8-22.) Plaintiff requests that the Court remand his case for
4
the payment of benefits or, alternatively, further administrative proceedings. (Id.
5
13:23-14:4.)
6
decision is appropriate because the ALJ permissibly rejected the treating physician’s
7
opinion and properly relied on the nonexamining physician’s testimony. (Def.’s Mot.
8
3:21-4:5.)
Conversely, the Commissioner argues that upholding the ALJ’s
9
The Court finds these motions are suitable for determination on the papers
10
submitted and without oral argument. See Fed. R. Civ. P. 78(b); Civ. L.R. 7.1(d)(1).
11
For the reasons that follow, the Court GRANTS Plaintiff’s Motion for Summary
12
Judgment, DENIES the Commissioner’s Cross-Motion for Summary Judgment, and
13
REMANDS this matter to the agency for further proceedings.
14
I.
BACKGROUND
15
Plaintiff alleges he became unable to work due to his disabling conditions on
16
June 1, 2013, when he was 47 years old. (Administrative Record (“AR”) 164-67,
17
ECF No. 7.) Prior to allegedly becoming unable to work, Plaintiff worked as a sheet
18
metal mechanic where he manufactured, repaired, and painted airplane parts. (AR
19
195.) He started this position in 2005, and testified that he stopped working in April
20
2013 due to his health conditions. (AR 39.) Before that job, he worked as an aviation
21
mechanic for the U.S. Navy for 20 years. (AR 49, 188.) He was honorably
22
discharged from the military in 2004. (AR 49, 188.) Plaintiff has a 12th grade
23
education. (AR 39.)
24
According to the administrative record and hearing testimony, Plaintiff suffers
25
from: lower and upper back pain with two millimeter degenerative disc disease at L4-
26
5; neck pain with mild multilateral degenerative disc disease at C3-4 through C3-5/6;
27
left shoulder pain; left thigh pain due to meralgia paresthetica resulting from the
28
superficial femoral nerve entrapment; right knee pain with patellar chondromalacia;
–2–
17cv2305
1
obstructive sleep apnea; obesity; allergic rhinitis; bilateral hearing loss; anxiety;
2
hypertension; and hyperlipidemia. (AR 22-23, 64, 153-55.)
3
Plaintiff had a benign parotid tumor surgically removed from his neck in 1991,
4
and he underwent hyperhidrosis back surgery in 2001. (AR 303.) He reported
5
experiencing allergy problems that started sometime after he joined the Navy. (AR
6
275-76.) Medical records indicate he was diagnosed with and treated for bilateral
7
hearing loss as early as August 2004, allergic rhinitis and hyperlipidemia as early as
8
August 2005, and hypertension as early as October 2013. (AR 291, 474-75, 479.)
9
He reported experiencing right knee pain regularly starting in February 2009. (AR
10
456-58.) Plaintiff was diagnosed with and treated for left thigh pain due to meralgia
11
paresthetica no later than May 2011, obstructive sleep apnea no later than July 2011,
12
and anxiety and obesity no later than September 2013. (AR 295-96, 405, 438, 447-
13
48.) An MRI conducted in June 2014 revealed two millimeter degenerative disc
14
disease in Plaintiff’s spine at L4-5. (AR 561.) Subsequently, an MRI conducted in
15
March 2015 showed mild multilateral degenerative disc disease in his neck at C3-4
16
through C3-5/6. (AR 786-94.)
17
Plaintiff received ongoing medical care for his conditions from the U.S.
18
Department of Veterans Affairs (“VA”). As early as August 2005, the VA awarded
19
Plaintiff a service-connected disability rating of 30%. (AR 473.) At some point
20
between October 2013 and July 2014, Plaintiff’s VA disability rating was increased
21
to 70%. (AR 288-89, 893.)
22
In addition, Plaintiff was examined and treated by physicians who were
23
independent from the VA. Plaintiff received physical therapy from Silver Strand
24
Spine & Sport from September 2013 through April 2016, and was seen by Dr. Ziad
25
Abu Khaled Tamimi there. (AR 486, 673.) Dr. Glen Balfour, a neurologist and spinal
26
cord injury specialist, began treating Plaintiff as early as January 2015. (AR 748.)
27
As of August 2016, Dr. Balfour was still treating Plaintiff. (AR 156.) Additionally,
28
Dr. Richard B. Mantell examined Plaintiff in early 2016. (AR 731-33.)
–3–
17cv2305
1
Plaintiff filed an application for disability insurance benefits under Title II of
2
the Social Security Act (“Act”) on November 13, 2013.
3
application was denied on initial administrative review and on reconsideration.
4
Plaintiff requested his claim be heard before an ALJ. (AR 20.) Plaintiff appeared
5
and testified at a hearing before ALJ Keith Dietterle on May 26, 2016. Dr. Lowell
6
Sparks, Jr., a reviewing medical expert, and Victoria Rei, an impartial vocational
7
expert, also testified. (AR 64-68.)
(AR 164-67.)
The
8
At the hearing, Plaintiff testified that his physical abilities are limited because
9
of his injuries. (AR 40-63.) He stated that, among other limitations, he can sit, stand,
10
and walk for only one hour at a time. (AR 44-45.) Dr. Sparks testified that Plaintiff
11
is unable to perform work that requires: overhead work; lifting more than 20 pounds;
12
frequent extreme neck motion; exposure to extreme hot or cold; climbing ladders,
13
ropes, or scaffolds; working from unprotected heights; exposure to noisy
14
environments; or working with dangerous machinery. (AR 45, 65.)
15
In a decision dated July 11, 2016, the ALJ determined that Plaintiff was not
16
disabled under the meaning of the Act. (AR 30.) Plaintiff’s request for review was
17
denied by the Appeals Council on September 25, 2017, making the ALJ’s decision
18
the final decision of the Commissioner. (AR 1-4.) Plaintiff now seeks judicial
19
review. (Compl., ECF No. 1.)
20
II.
LEGAL STANDARD
21
Under 42 U.S.C. § 405(g), an applicant for social security disability benefits
22
may seek judicial review of a final decision of the Commissioner in federal district
23
court. “As with other agency decisions, federal court review of social security
24
determinations is limited.” Treichler v. Comm’r of Soc. Sec. Admin., 775 F.3d 1090,
25
1098 (9th Cir. 2014).
26
Commissioner’s decision is (1) free of legal error and (2) is supported by substantial
27
evidence.” Bruce v. Astrue, 557 F.3d 1113, 1115 (9th Cir. 2009) (quoting Moore v.
28
Comm’r, Soc. Sec. Admin., 278 F.3d 920, 924 (9th Cir. 2002)). Federal courts will
The court “must independently determine whether the
–4–
17cv2305
1
uphold the Commissioner’s disability determination “unless it contains legal error or
2
is not supported by substantial evidence.” Garrison v. Colvin, 759 F.3d 995, 1009
3
(9th Cir. 2014) (citing Stout v. Comm’r, Soc. Sec. Admin., 454 F.3d 1050, 1052 (9th
4
Cir. 2006)).
5
“‘Substantial evidence’ means more than a mere scintilla, but less than a
6
preponderance; it is such relevant evidence as a reasonable person might accept as
7
adequate to support a conclusion.” Lingenfelter v. Astrue, 504 F.3d 1028, 1035 (9th
8
Cir. 2007). In reviewing whether the Commissioner’s decision is supported by
9
substantial evidence, the court must consider the record as a whole, “weighing both
10
the evidence that supports and the evidence that detracts from the Commissioner’s
11
conclusion.” Id. at 1035 (quoting Reddick v. Chater, 157 F.3d 715, 720 (9th Cir.
12
1998)). “Where evidence is susceptible to more than one rational interpretation, the
13
ALJ’s decision should be upheld.” Ryan v. Comm’r of Soc. Sec., 528 F.3d 1194,
14
1198 (9th Cir. 2008) (internal quotation marks and citation omitted). However, the
15
court “review[s] only the reasons provided by the ALJ in the disability determination
16
and may not affirm the ALJ on a ground upon which he did not rely.” Garrison, 759
17
F.3d at 1010 (citation omitted).
18
III.
ADMINISTRATIVE DECISION
19
A.
20
The Act defines “disability” as the “inability to engage in any substantial
21
gainful activity by reason of any medically determinable physical or mental
22
impairment which . . . has lasted or can be expected to last for a continuous period of
23
not less than 12 months.” 42 U.S.C. § 423(d)(1)(A). Under the Act’s implementing
24
regulations, the Commissioner applies a five-step sequential evaluation process to
25
determine whether an applicant for benefits qualifies as disabled. See 20 C.F.R. §
26
404.1520(a)(4). “The burden of proof is on the claimant at steps one through four,
27
but shifts to the Commissioner at step five.” Bray v. Comm’r of Soc. Sec. Admin.,
28
554 F.3d 1219, 1222 (9th Cir. 2009).
Standard for Determining Disability
–5–
17cv2305
1
At step one, the ALJ must determine whether the claimant is engaged in
2
“substantial gainful activity.” 1 20 C.F.R. § 404.1520(a)(4)(i). If so, the claimant is
3
not disabled. If not, the ALJ proceeds to step two.
4
At step two, the ALJ must determine whether the claimant has a severe medical
5
impairment, or combination of impairments, that meets the duration requirement in
6
the regulations. 20 C.F.R. § 404.1520(a)(4)(ii). If the claimant’s impairment or
7
combination of impairments is not severe, or does not meet the duration requirement,
8
the claimant is not disabled. If the impairment is severe, the analysis proceeds to
9
step three.
10
At step three, the ALJ must determine whether the severity of the claimant’s
11
impairment or combination of impairments meets or medically equals the severity of
12
an impairment listed in the Act’s implementing regulations.2
13
404.1520(a)(4)(iii). If so, the claimant is disabled. If not, the analysis proceeds to
14
step four.
20 C.F.R. §
15
At step four, the ALJ must determine whether the claimant’s residual
16
functional capacity (“RFC”)—that is, the most he can do despite his physical and
17
mental limitations—is sufficient for the claimant to perform his past relevant work.
18
20 C.F.R. § 404.1520(a)(4)(iv). The ALJ assesses the RFC based on all relevant
19
evidence in the record. Id. § 416.945(a)(1), (a)(3). If the claimant can perform his
20
past relevant work, he is not disabled. If not, the analysis proceeds to the fifth and
21
final step.
22
At step five, the Commissioner bears the burden of proving that the claimant
23
can perform other work that exists in significant numbers in the national economy,
24
taking into account the claimant’s RFC, age, education, and work experience. 20
25
26
1
27
“Substantial gainful activity” is work activity that (1) involves significant physical or mental
duties and (2) is performed for pay or profit. 20 C.F.R. § 404.1510.
28
2
The relevant impairments are listed at 20 C.F.R. part 404, subpart P, appendix 1.
–6–
17cv2305
1
C.F.R. § 404.1560(c)(1)-(2); see also 20 C.F.R. § 404.1520(g)(1). The ALJ usually
2
meets this burden through the testimony of a vocational expert, who assesses the
3
employment potential of a hypothetical individual with all of the claimant’s physical
4
and mental limitations that are supported by the record. Hill v. Astrue, 698 F.3d 1153,
5
1162 (9th Cir. 2012) (citations omitted). If the claimant is able to perform other
6
available work, he is not disabled. If the claimant cannot make an adjustment to other
7
work, he is disabled. 20 C.F.R. § 404.1520(a)(4)(iv).
8
B.
9
On July 11, 2016, the ALJ issued a written decision concluding that Plaintiff
10
was not disabled within the meaning of the Act, and therefore not entitled to benefits.
11
(AR 30.) The ALJ followed the five-step evaluation procedure to determine whether
12
Plaintiff is disabled pursuant to the Act. At step one, the ALJ found Plaintiff had not
13
engaged in substantial gainful activity since June 1, 2013, the alleged onset date of
14
his disability. (AR 22.)
The ALJ’s Disability Determination
15
At step two, the ALJ concluded that Plaintiff has severe impairments as defined
16
by the Act. (AR 22.) The ALJ found that Plaintiff has obstructive sleep apnea,
17
bilateral hearing loss, left thigh pain due to meralgia parestherica, degenerative disc
18
disease of the lumbar and cervical spine, right knee patellar chondromalacia, and
19
obesity. (Id.) He determined that those impairments are severe as they “more than
20
minimally limit his basic work activities” and have lasted longer than 12 months.
21
(Id.) However, in consideration of the record and Plaintiff’s testimony, the ALJ
22
deemed that Plaintiff’s hypertension, hyperlipidemia, and allergic rhinitis are treated
23
with medication. (Id.) As such, the ALJ concluded that these conditions “have such
24
a minimal effect on [Plaintiff] that they would not be expected to interfere with [his]
25
ability to work irrespective of age, education, or work experience.” (AR 22-23.) The
26
ALJ consequently found that these conditions are nonsevere. (Id.) Lastly, the ALJ
27
concluded that Plaintiff’s anxiety “does not cause more than minimal limitation [on
28
///
–7–
17cv2305
1
Plaintiff’s] ability to perform basic mental work activities and is therefore
2
nonsevere.” (AR 23.)
3
At step three, the ALJ concluded that Plaintiff’s impairments, alone and in
4
combination, did not meet or medically equal the severity of the impairments listed
5
in the regulations. (AR 24.)
6
7
At step four, the ALJ found that Plaintiff has the RFC to perform “light work”
as defined in the social security regulations with the following limitations:
8
14
The claimant can sit six hours in an eight-hour day, and stand/walk six
hours in an eight-hour day. She [sic] can occasionally lift 20 pounds
and frequently lift 10 pounds. She [sic] can occasionally climb stairs,
balance, stoop, kneel, crouch, and crawl. The claimant can never climb
ladders, ropes, or scaffolds. She [sic] can never perform overhead work
or work requiring frequently [sic] neck movement. She [sic] must
avoid unprotected heights, dangerous or fast moving machinery, and
extreme temperatures. The claimant must avoid concentrated exposure
to noises, dust, fumes, and gasses.
15
(AR 24.) To make this finding, the ALJ summarized Plaintiff’s medical records and
16
noted diagnoses, tests, complaints, and treatments. (AR 25-27.)
9
10
11
12
13
17
Next, the ALJ evaluated the medical opinion evidence within the record. (AR
18
27-28.) First, he gave “great weight” to the testimony of nonexamining reviewing
19
physician Dr. Sparks. The ALJ determined that Dr. Sparks’ findings are consistent
20
with his own assessment of Plaintiff’s RFC and are also supported by the listed
21
medical impairments and reports regarding Plaintiff’s hearing loss, degeneration of
22
the lumbar and cervical spine, and pain in his left thigh and right knee. (AR 27.)
23
Second, the ALJ gave little weight to the opinions of state agency medical consultants
24
Drs. John Vorhies, Jr., and G. Lockie. (Id.) He concluded that the consultants’
25
opinions that Plaintiff had no exertional limitations but some postural and
26
environmental limitations were inconsistent with the record, in particular the
27
“objective evidence” of degeneration of Plaintiff’s lumbar and cervical spine. (Id.)
28
///
–8–
17cv2305
1
The ALJ furthermore addressed the opinions of Drs. Balfour and Mantell. (AR
2
27.) Here, the Court notes that the ALJ’s written evaluation confusingly comingles
3
these two opinions as follows:
4
5
6
7
8
9
10
11
12
The undersigned has also considered the opinions of Glen Balfour, and
Richard B. Mantell, M.D., who completed a functional assessment of
the claimant and opined that he could perform work at less than the
sedentary exertional level with additional postural and other
limitations. (Exhibits 15F; and 16F/10-12). His findings are
inconsistent with the medical record of evidence, which suggests great
improvement of the claimant’s condition with the help of physical
therapy, and recent examinations that show full strength, stability and
range of motion in the claimant’s spine and knees. (Exhibits 5F/6; and
19F/27, 32). Additionally, the objective testing revealed mild changes
that did not require additional surgery or cause changes to his gait.
(Exhibit 5F). Accordingly, the undersigned gives his opinion
little weight.
13
14
(AR 27.)
15
As seen above, the ALJ’s decision addresses the separate, independent
16
opinions of Drs. Balfour and Mantell simultaneously as one. (AR 27.) In addition to
17
the ALJ’s statements, the ALJ’s citations to the record fail to provide clarity. In the
18
first sentence, the ALJ’s cites to both physicians’ opinions in the record. (Id.)
19
However, the subsequent record citations all refer to documents authored by other
20
medical providers. (Id.) Thus, the ALJ’s statements and citations fail to distinguish
21
which of his conclusions correlates to which physician’s opinion. (Id.) The resulting
22
ambiguity effectively forces the Court to speculate as to the ALJ’s overall meaning.
23
Hence, this imprecise discussion impedes the Court from completing meaningful
24
judicial review of the ALJ’s analysis and falls short of Ninth Circuit standards.
25
“[A]lthough we will not fault the agency merely for explaining its decision with less
26
than ideal clarity, we still demand that the agency set forth the reasoning behind its
27
decisions in a way that allows for meaningful review.” Brown-Hunter v. Colvin, 806
28
F.3d 487, 492 (9th Cir. 2015) (citation and quotation omitted).
–9–
17cv2305
1
Nevertheless, the parties assume that the ALJ gave little weight to Dr.
2
Balfour’s opinion. (AR 27; Pl.’s Mot. 11:24-12:3; Def.’s Mot. 3:21-4:2.) The
3
Commissioner also assumes that the ALJ gave little weight to Dr. Mantell’s opinion.
4
(Def.’s Mot. 6:26-7:2.) Plaintiff does not address the ALJ’s mention of Dr. Mantell,
5
but cites to Dr. Mantell’s opinion to support his arguments. (Pl.’s Mot. 9:4-16, 12:10-
6
18.) Although the ALJ’s decision lacks clarity, the Court will adopt the assumption
7
that the ALJ gave little weight to both Dr. Balfour’s and Dr. Mantell’s opinions to
8
resolve the parties’ opposing claims.
9
Next, the ALJ found Plaintiff’s disability ratings from the VA to be of “little
10
probative value.” (AR 27-28.) He stated that when determining this rating, the VA
11
does not adhere to the SSA’s evaluation procedures for determining if a claimant is
12
disabled. (AR 28.) Specifically, the ALJ noted that the VA does not determine an
13
individual’s RFC or if the individual is able to perform his past relevant work or other
14
work that exists in significant numbers in the national economy. (Id.) As such, the
15
ALJ gave Plaintiff’s VA disability ratings “little weight.” (Id.)
16
17
Lastly, the ALJ assessed Plaintiff’s credibility, finding:
20
[Plaintiff’s] medically determinable impairments could reasonably be
expected to cause the alleged symptoms; however, the claimant’s
statements concerning the intensity, persistence, and limiting effects of
these symptoms are not entirely consistent with the medical evidence
and other evidence in the record . . . .
21
(AR 28.) The ALJ stated that Plaintiff claimed that he was unable to work because
22
he could not perform heavy lifting or be exposed to chemicals. (Id.) The ALJ noted
23
these claims were inconsistent with Plaintiff’s assertions that he applied for jobs that
24
he did not think he could perform with such limitations. (Id.) The ALJ also pointed
25
to reports that Plaintiff’s condition improved with physical therapy and that he
26
maintained full strength and range of motion in his spine and knees. (Id.) The ALJ
27
cited the VA’s 2015 finding that Plaintiff’s knee and lower leg conditions did not
28
impact his ability to perform any occupational task. (AR 28, 1030.)
18
19
– 10 –
17cv2305
1
At the conclusion of step four, the ALJ determined that Plaintiff could not
2
perform his past relevant work as a sheet metal mechanic or an assembler installer
3
for aircraft. (AR 28-29.) He based this decision on Plaintiff’s RFC and the testimony
4
of the vocational expert, who considered the impact of Plaintiff’s limitations. (Id.)
5
Lastly at step five, the ALJ concluded that Plaintiff could perform jobs that
6
exist in significant numbers in the national economy pursuant to 20 C.F.R. §
7
404.1569(a). (AR 29.) He stated that Plaintiff did not have the RFC to perform the
8
full range of exertional demands of light work. (Id.) Considering Plaintiff’s age,
9
education, work experience, and RFC, the ALJ agreed with the vocational expert’s
10
determination that Plaintiff could perform the work requirements of an inspector,
11
ticket taker, and marker. (AR 29-30.)
12
Based on his conclusions for each of the five steps of the evaluation procedure,
13
the ALJ ultimately determined that Plaintiff is not disabled. (AR 30.)
14
IV.
DISCUSSION
15
Plaintiff challenges the ALJ’s decision on two grounds. First, he argues that
16
the ALJ committed legal error when he failed to sufficiently justify discounting the
17
opinion of Plaintiff’s treating neurologist, Dr. Balfour. (Pl.’s Mot. 11:24-12:5.)
18
Second, Plaintiff argues that the ALJ improperly weighed the testimony of
19
nonexamining medical expert Dr. Sparks. (Id.) The Commissioner contends the ALJ
20
properly justified dismissing Dr. Balfour’s opinion. (Def.’s Mot. 4:3-5.) In addition,
21
the Court will determine whether the ALJ erred in disregarding the opinion of
22
Plaintiff’s examining physician, Dr. Mantell, as well as the VA’s disability rating.
23
Lastly, if there is error, Plaintiff asserts that the Court should reverse the ALJ’s
24
decision and order benefits to be paid. (Pl.’s Mot. 14:1-4.) The Court will examine
25
each issue in turn.
26
///
27
///
28
///
– 11 –
17cv2305
1
A.
2
Treating Specialist Dr. Balfour
1.
Legal Standard for Treating Physicians
3
The Act’s regulations distinguish among the opinions of three types of
4
physicians: “(1) those who treat the claimant (treating physicians); (2) those who
5
examine but do not treat the claimant (examining physicians); and (3) those who
6
neither examine nor treat the claimant (nonexamining physicians).” Holohan v.
7
Massanari, 246 F.3d 1195, 1201-02 (9th Cir. 2001) (alteration omitted) (quoting
8
Lester v. Chater, 81 F.3d 821, 830 (9th Cir. 1995)). As a general rule, the opinion of
9
a treating doctor is entitled to greater weight than the opinion of doctors who do not
10
treat the claimant. Lester, 81 F.3d at 830 (citation omitted). “The rationale for giving
11
greater weight to a treating physician’s opinion is that he is employed to cure and has
12
a greater opportunity to know and observe the patient as an individual.” Sprague v.
13
Bowen, 812 F.2d 1226, 1230 (9th Cir. 1987) (citation omitted).
14
The degree of deference afforded to a treating source’s opinion depends partly
15
upon whether, and to what extent, that opinion is contradicted. A treating physician’s
16
opinion is given “controlling weight” if it is “well-supported by medically acceptable
17
clinical and laboratory techniques” and is “not inconsistent with the other substantial
18
evidence in [the] case record.” 20 C.F.R. § 404.1527(c)(2). Such opinions may be
19
rejected “only for ‘clear and convincing’ reasons supported by substantial evidence
20
in the record.” Orn v. Astrue, 495 F.3d 625, 632 (9th Cir. 2007) (quoting Lester, 81
21
F.3d at 830).
22
When a treating physician’s opinion is contradicted, this “means only that the
23
opinion is not entitled to ‘controlling weight,’ not that the opinion should be
24
rejected.” Orn, 495 F.3d at 632 (quoting Social Security Ruling 96–2p at 4 (Cum.
25
Ed. 1996)). To determine the amount of deference owed, the opinion must be
26
weighed using the six factors outlined in 20 C.F.R. § 404.1527(c)(2)-(6). These
27
factors include the length of the treatment relationship and frequency of examination,
28
the extent to which the opinion is supported by medical signs and laboratory findings,
– 12 –
17cv2305
1
the consistency of the opinion with the record as a whole, and whether or not the
2
treating source is a specialist regarding the issue in question. Id. “In many cases, a
3
treating source’s medical opinion will be entitled to the greatest weight and should
4
be adopted, even if it does not meet the test for controlling weight.” Ghanim v.
5
Colvin, 763 F.3d 1154, 1161 (9th Cir. 2014) (quoting Orn, 495 F.3d at 361).
6
In cases where a treating doctor’s opinion is contradicted, an ALJ’s rejection
7
of that opinion may only be upheld if it contains “specific and legitimate reasons that
8
are supported by substantial evidence” in the record. See Burrell v. Colvin, 775 F.3d
9
1133, 1140 (9th Cir. 2014) (quoting Bayliss v. Barnhart, 427 F.3d 1211, 1216 (9th
10
Cir. 2005)). “The ALJ can meet this burden by setting out a detailed and thorough
11
summary of the facts and conflicting clinical evidence, stating his interpretation
12
thereof, and making findings.” Trevizo, 862 F.3d at 997 (quoting Magallanes, 881
13
F.2d at 751). “The ALJ must do more than offer his conclusions. He must set forth
14
his own interpretations and explain why they, rather than the doctors’, are correct.”
15
Reddick, 157 F.3d at 725. “[A]n ALJ errs when he rejects a medical opinion or
16
assigns it little weight while doing nothing more than ignoring it, asserting without
17
explanation that another medical opinion is more persuasive, or criticizing it with
18
boilerplate language that fails to offer a substantive basis for his conclusion.”
19
Garrison, 759 F.3d at 1012-13.
20
21
2.
Dr. Balfour’s Opinion
Dr. Balfour, a neurologist and spinal cord injury specialist, began treating
22
Plaintiff as early as January 2015.
23
examination notes dated January through October 2015, Plaintiff regularly
24
complained of back pain, left shoulder pain, peroneal neuropathy, neck pain,
25
headaches, and right knee pain. (AR 748-73.) During these examinations, Dr.
26
Balfour diagnosed Plaintiff with lumbosacral radiculopathy, osteoarthritis in his
27
knees, a left rotator cuff injury, thoracic spine neuropathy, and left peroneal and
28
femoral neuropathy. (AR 751, 754, 759, 762, 766, 769.)
(AR 748.)
According to Dr. Balfour’s
– 13 –
17cv2305
1
While treating Plaintiff, Dr. Balfour performed and ordered multiple objective
2
medical tests. These tests yielded both normal and abnormal results. On February
3
27, 2015, Dr. Balfour performed an EMG and Nerve Conduction Studies of
4
Plaintiff’s lower extremities. (AR 773-76.) The study yielded normal results. (Id.)
5
In March 2015, several x-rays were performed. X-rays of Plaintiff’s knees showed
6
unremarkable results. (AR 777-82.) However, an x-ray of Plaintiff’s cervical spine
7
showed straightening of the cervical lordosis and restricted range of motion. (AR
8
786-89.) Also, an x-ray of Plaintiff’s lumbar spine showed restricted range of motion,
9
anterior inferior endplate osteophyte at L3, and anterior superior endplate osteophyte
10
at L4. (AR 783-85.) Next, a June 26, 2015 magnetic resonance imaging study
11
(“MRI”) of Plaintiff’s brain presented normal results. (AR 790.) On the same date,
12
an MRI of Plaintiff’s cervical spine showed multilevel mild degenerative changes
13
greatest along the left side at C3-4, disc protrusions at C6-7, no spinal cord
14
abnormalities, and mild foraminal narrowing at C3-4 and C5-6 due to uncovertebral
15
osteophytes and facet arthropathy. (AR 791-92.) Lastly, an October 10, 2015 MRI
16
of Plaintiff’s lumbar spine showed a two millimeter broad-based posterior
17
disk/endplate osteophyte complex at L4-L5 level, indenting the anterior aspect of the
18
thecal sac. (AR 793.)
19
In two letters dated April 10, 2015, Dr. Balfour stated that Plaintiff’s medical
20
conditions “severely compromised his ability to perform his job as a Metal Sheet
21
Worker Mechanic.” (AR 718-21.) According to these letters, Plaintiff’s “severe right
22
knee pain” prevented him from kneeling for any extended period of time. (Id.)
23
Plaintiff was “not able to perform short periods of standing, kneeling, crouching,
24
stooping and working in strained and awkward positions.” (AR 720.) He was also
25
unable to maintain neck, shoulder, and low back postures for more than 30 minutes
26
because of severe pain; these posture restrictions limited his ability to work overhead
27
for more than one hour. (Id.) Plaintiff’s neck pain caused “severe daily headaches,”
28
which compromised his ability to function at work. (AR 718.) “His left peroneal
– 14 –
17cv2305
1
neuropathy and left femoral neuropathy are aggravated by standing and maintaining
2
body positions.” (Id.) In addition, his left rotator cuff injury made it very difficult
3
for him to lift more than 35 pounds, as well as grab, hold, and climb ladders. (AR
4
718-21.) Plaintiff’s thoracic radiculopathy was aggravated by performing sanding,
5
grinding, lifting, or “certain positional maneuvers.” (AR 718.) Because of his sleep
6
apnea and allergy rhinitis, he was unable to work with hazardous materials. (AR
7
720.) Furthermore, Plaintiff had a diminished ability to be alert and oriented due to
8
depression and sleep disorders. (Id.) Dr. Balfour concluded that he expected all of
9
Plaintiff’s medical conditions “to last for several years in spite of medical therapy.”
10
(AR 718.)
11
3.
ALJ’s Rejection of Dr. Balfour’s Opinion
12
As the Court explained above, the ALJ presumably gave Dr. Balfour’s opinion
13
little weight. (See AR 27.) He stated that Dr. Balfour’s opinions were inconsistent
14
with the medical record in two respects. (Id.) The Court agrees that at least some
15
medical evidence in the record contradicts Dr. Balfour’s opinion. As such, the Court
16
will apply the “specific and legitimate” reasons standard to the ALJ’s rejection of Dr.
17
Balfour’s opinion. See Burrell, 775 F.3d at 1140.
18
i.
Reported Improvement, Strength, and Range of Motion
19
First, the ALJ asserted Dr. Balfour’s opinion contradicted Plaintiff’s reported
20
improvement with physical therapy, as well as recent examinations showing full
21
strength, stability, and range of motion in Plaintiff’s spine and knees. (AR 27.) For
22
this claim, the ALJ cited the initial medical evaluation completed by Plaintiff’s
23
physical therapy provider on September 25, 2013. (Id.) He additionally cited a VA
24
Compensation and Pension Examination Report dated March 14, 2016. (Id.)
25
The physical therapy report notes that Plaintiff was seen for pain in his left
26
shoulder, left thigh, and lower back. (AR 486-88.) It indicates that Plaintiff
27
maintained full strength, normal gait, and full range of motion in his left shoulder and
28
spine.
(AR 487.)
However, the same report further notes he had stiffness,
– 15 –
17cv2305
1
discomfort, tenderness, and muscle spasm in his shoulder. (Id.) Likewise, it states
2
that Plaintiff had tenderness and stiffness in his lumbo-sacral spine, and tenderness
3
and muscle spasm in his left thigh. (Id.)
4
The 2016 VA examination report consists of Disability Benefits
5
Questionnaires that evaluate Plaintiff’s neck, back, knees, and lower leg conditions.
6
(AR 908-35.) The ALJ cited only two pages of the knee and lower leg questionnaire.
7
The referenced pages indicate that Plaintiff maintained normal range of motion in his
8
left knee and had no instability in his right knee. (AR 920, 924.) Yet the rest of the
9
28-page report also includes the following findings: abnormal range of motion in his
10
spine and neck; arthritis in his right knee and neck; mild difficulty with turning his
11
neck; and difficulty walking, standing, bending, lifting, and carrying due to his spine
12
and knee conditions. (AR 911, 917, 928, 930-31, 935.) The report states that these
13
conditions contribute to functional loss as well as impact Plaintiff’s ability to work
14
and perform occupational tasks. (AR 911, 917, 928, 930-31.)
15
ii.
Surgery Recommendations and Normal Gait
16
Second, the ALJ deemed that Dr. Balfour’s opinion was inconsistent with the
17
absence of recommendations for Plaintiff to undergo additional surgery and reports
18
that Plaintiff’s conditions did not impact his gait. (AR 27.) The ALJ’s decision cites
19
Plaintiff’s physical therapy reports dated September 25, 2013 through May 28, 2014
20
for this claim. (AR 27, 482-503.) In accordance with the ALJ’s assertions, these
21
reports note that during this 2013 to 2014 time period, Plaintiff’s gait remained within
22
normal limits.
23
recommended surgery. (Id.) Further, these records report that Plaintiff indicated that
24
his symptoms significantly improved over the course of physical therapy treatment.
25
(Id.)
26
improved, at the same time he described ongoing pain in his right knee, back and left
27
shoulder, as well as some pain in his neck and left thigh. (AR 489, 492, 495, 498,
28
501.)
(Id.)
These reports also do not mention that Plaintiff was
However, these reports note that while Plaintiff’s symptoms reportedly
– 16 –
17cv2305
1
4.
Analysis of ALJ’s Rejection of Dr. Balfour’s Opinion
2
The Court finds that the ALJ failed to meet his burden of providing specific
3
and legitimate reasons supported by substantial evidence to discount Dr. Balfour’s
4
opinion. Conceivably, the ALJ may have been justified in not giving “controlling
5
weight” to Dr. Balfour’s opinion. Overall, however, the ALJ’s reasons for giving the
6
opinion of a treating medical specialist “little weight” instead of the “greatest weight”
7
were legally insufficient for two reasons. (AR 27.)
8
First, the ALJ based his determination that Dr. Balfour’s opinion was
9
inconsistent on conclusory references to narrow selections from the record. The ALJ
10
may not cherry-pick the record to support his disability determination. Yurt v. Colvin,
11
758 F.3d 850, 859 (7th Cir. 2014); Denton v. Astrue, 596 F.3d 419, 425 (7th Cir.
12
2010) (“An ALJ has the obligation to consider all relevant medical evidence and
13
cannot simply cherry-pick facts that support a finding of non-disability while
14
ignoring evidence that points to a disability finding.”). Moreover, the ALJ may not
15
rely upon insufficient evidence of alleged inconsistencies as the basis for rejecting an
16
examining physician’s opinion. See Nguyen v. Chater, 100 F.3d 1462, 1465 (9th Cir.
17
1996) (“Where the purported existence of an inconsistency is squarely contradicted
18
by the record, it may not serve as the basis for the rejection of an examining
19
physician’s conclusions.”).
20
Here, the ALJ selected brief segments from the medical records he cited,
21
ignoring the record as a whole. In doing so, he failed to recognize the various
22
consistencies between Dr. Balfour’s opinion and other medical records. The ALJ
23
ignored that Dr. Balfour’s opinion as well as Plaintiff’s physical therapy and VA
24
records all reported that Plaintiff had difficulty with moving his neck, walking,
25
bending, standing, lifting, and carrying.
26
independently documented Plaintiff’s ongoing complaints of persistent back, neck,
27
left shoulder, left thigh, and right knee pain. See Nguyen, 100 F.3d at 1465.
28
Moreover, the ALJ did not address Plaintiff’s more recent physical therapy notes
He overlooked that both sources
– 17 –
17cv2305
1
when evaluating Dr. Balfour’s opinion. Physical therapy records from early 2016
2
indicate that Plaintiff experienced ongoing pain and had a 50% to 70% decrease in
3
the range of motion of his left shoulder. (AR 673-83.) Further, by relying on only
4
these excerpts, the ALJ failed to provide a “detailed and thorough summary of the
5
facts and conflicting clinical evidence” or “a substantive basis for his conclusions.”
6
See Trevizo, 862 F.3d at 997 (quoting Magallanes, 881 F.2d at 751); see also
7
Garrison, 759 F.3d at 1012-13.
8
Furthermore, the ALJ’s brief reference to the fact that additional surgery was
9
not recommended for Plaintiff similarly fails to give meaningful consideration to all
10
relevant medical evidence. As such, this reasoning is likewise insufficient to reject
11
Dr. Balfour’s opinion. See Kager v. Astrue, 256 F. App’x 919, 923 (9th Cir. 2007)
12
(finding that an ALJ’s reasoning for rejecting physicians’ opinions about a diagnosis
13
“simply by observing that no measures, such as surgery, were undertaken” was
14
insufficient because “[t]his reasoning lacks the specificity required ‘to allow a
15
reviewing court to confirm that the [evidence] was rejected on permissible grounds
16
and not arbitrarily.’” (quoting Benton ex rel. Benton v. Barnhart, 331 F.3d 1030, 1041
17
(9th Cir. 2003))). As a result of relying on bare references to excerpts from the record,
18
the ALJ erred because his dismissal of Dr. Balfour’s opinion did not contain specific
19
and legitimate reasons supported by substantial evidence.
20
To substantiate the ALJ’s finding that Dr. Balfour’s opinion was contradicted
21
by other medical evidence, the Commissioner points to a substantial number of
22
physical therapy records dating from May 2014 through April 2016. (Def.’s Mot.
23
4:4-6:26; AR 673-717.) The Commissioner lists multiple instances in these records
24
that indicate that Plaintiff’s impairments significantly improved with physical
25
therapy and that Plaintiff exhibited full range of motion, full strength, and normal
26
gait. (Id.) But like the ALJ’s decision, the Commissioner’s support only consists of
27
more cherry-picked selections from the record to endorse a finding that Plaintiff is
28
not disabled. The Commissioner likewise ignores the reports of Plaintiff’s ongoing
– 18 –
17cv2305
1
complaints of pain and limited range of motion in his shoulder contained in the
2
records she cited. As such, the Commissioner’s similarly incomplete portrayal of the
3
record does not compensate for the shortcomings of the ALJ’s decision.
4
Second, even if the ALJ had sufficiently established that Dr. Balfour’s opinion
5
was substantially contradicted by the record, he also failed to determine the amount
6
of deference owed to the opinion of a treating physician in accordance with the factors
7
established in 20 C.F.R. § 404.1527(c)(2)-(6). See Ghanim, 763 F.3d at 1161 (“Even
8
if a treating physician’s opinion is contradicted, the ALJ may not simply disregard it.
9
The ALJ is required to consider the factors set out in 20 C.F.R. § 404.1527(c)(2)-
10
(6) in determining how much weight to afford the treating physician’s medical
11
opinion.”). The ALJ’s decision did not mention any of the following: the length of
12
Dr. Balfour’s treatment of Plaintiff; how frequently he examined Plaintiff; the
13
consistency of Dr. Balfour’s opinion with the record as a whole; the extent to which
14
his opinion is supported by medical signs and laboratory findings; or Dr. Balfour’s
15
medical specialty and how it related to Plaintiff’s conditions. Therefore, the ALJ
16
committed legal error by failing to satisfy regulation requirements when weighing
17
the medical opinion of treating specialist Dr. Balfour.
18
19
B.
Examining Physician Dr. Mantell
1.
Legal Standard for Examining Physicians
20
While an examining physician is not entitled to the same degree of deference
21
as a treating physician, the ALJ may not simply reject an examining physician’s
22
opinion. Rather, the opinions of examining physicians, even if contradicted by
23
another doctor, “can only be rejected for specific and legitimate reasons that are
24
supported by substantial evidence.” Lester, 81 F.3d at 830-31; see also Nguyen, 100
25
F.3d at 1465. An ALJ errs by failing to provide valid reasoning for discrediting the
26
opinion of an examining physician, particularly when a nonexamining physician’s
27
opinion is afforded greater weight. See Cain v. Barnhart, 74 F. App’x 755, 756 (9th
28
Cir. 2003); Feskens v. Astue, 804 F. Supp. 2d 1105, 1115 (D. Or. 2011).
– 19 –
17cv2305
1
2.
Dr. Mantell’s Opinion
2
Dr. Mantell examined Plaintiff during a two-day, 3.5-hour functional capacity
3
evaluation. (AR 731-33.) He opined in an April 16, 2016 report that Plaintiff could
4
perform work at the sedentary level with limitations. (Id.) He restricted Plaintiff to
5
standing for no more than 10 minutes and lifting no more than 15 pounds. (AR 733.)
6
According to Dr. Mantell’s evaluation, Plaintiff did not meet the minimal physical
7
demands required to safely work as a sheet metal worker. (Id.) Dr. Mantell also
8
reported that Plaintiff “demonstrated poor quality of movement overall due to pain
9
limitations” and showed “[d]ecreased strength and endurance of both upper
10
extremities.” (AR 732.) He noted that Plaintiff’s lower back and knee pain “severely
11
limits” squatting and climbing. (Id.)
12
Plaintiff asserts that Dr. Mantell’s opinion supports Plaintiff’s functional and
13
work limitations. (Pl.’s Mot. 12:10-18.) The Commissioner argues that Dr. Mantell’s
14
opinion contradicts Plaintiff’s treatment record. (Def.’s Mot. 7:2-6) As such, the
15
Commissioner claims that Dr. Mantell’s findings regarding Plaintiff’s physical
16
limitations fail to “rehabilitate” Dr. Balfour’s similar conclusions. (Id. 7:6-7.)
17
3.
ALJ’s Rejection of Dr. Mantell’s Opinion
18
Because the ALJ indistinguishably evaluated the opinions of Drs. Balfour and
19
Mantell together, the ALJ seemed to also give Dr. Mantell’s opinion little weight
20
based on alleged inconsistencies with the medical record. (See AR 27.) As with Dr.
21
Balfour’s opinion, the Court agrees that at least some medical evidence contradicts
22
Dr. Mantell’s opinion, and thus the Court will apply the “specific and legitimate”
23
reasons standard to the ALJ’s dismissal of Dr. Mantell’s opinion. See Lester, 81 F.3d
24
at 830-31; Cain, 74 F. App’x at 756; Feskens, 804 F. Supp. 2d
25
at 1115.
26
As with Dr. Balfour, the ALJ first asserted Dr. Mantell’s opinion contradicted
27
Plaintiff’s reported improvement with physical therapy, as well as recent
28
examinations showing full strength, stability, and range of motion in Plaintiff’s spine
– 20 –
17cv2305
1
and knees. (AR 27.) He also cited the September 2013 physical therapy evaluation
2
and the March 2016 VA Compensation and Pension Examination Report. (Id.)
3
Second, the ALJ stated Dr. Mantell’s opinion was inconsistent with the lack of
4
any recommendations for Plaintiff to undergo more surgery and reports that
5
Plaintiff’s conditions did not impact his gait. (AR 27.) The ALJ’s decision cites
6
Plaintiff’s physical therapy reports dated September 25, 2013 through May 28, 2014.
7
(AR 27, 482-503.)
8
4.
Analysis of ALJ’s Rejection of Dr. Mantell’s Opinion
9
As with the ALJ’s rejection of Dr. Balfour’s opinion, the Court finds that the
10
ALJ failed to provide specific and legitimate reasons supported by the record to
11
discredit Dr. Mantell’s opinion. For the same reasons the Court explained above for
12
Dr. Balfour’s opinion, the ALJ’s conclusion that Dr. Mantell’s determinations were
13
inconsistent with other medical documentation is based on narrow cherry pickings
14
from the record. By ignoring the record as a whole, the ALJ failed to acknowledge
15
the consistencies between Dr. Mantell’s opinion and separate medical sources. He
16
omitted that both Dr. Mantell and other providers noted Plaintiff’s reports of pain in
17
his back, upper extremity, and knee. See Nguyen, 100 F.3d at 1465. Furthermore,
18
the ALJ compared Dr. Mantell’s 2016 evaluation only with physical therapy records
19
from 2013. The ALJ did not cite to Plaintiff’s physical therapy notes from the same
20
year as Dr. Mantell’s evaluation. Yet, physical therapy records from early 2016 state
21
that Plaintiff complained of continuing pain and had a 50% to 70% decrease in the
22
range of motion of his left shoulder. (AR 673-83.) In addition, the ALJ’s short
23
reference to the fact that additional surgery was not recommended for Plaintiff lacks
24
specificity. See Kager, 256 F. App’x at 923. By only citing to narrow selections
25
from the record, the ALJ failed to weigh all of the medical evidence and failed to
26
provide a thorough summary of the record. See Trevizo, 862 F.3d at 997 (quoting
27
Magallanes, 881 F.2d at 751). Overall, the ALJ erred in rejecting Dr. Mantell’s
28
///
– 21 –
17cv2305
1
opinion by not substantiating his decision with specific and legitimate reasons
2
supported by the record.
3
4
C.
Reviewing Physician Dr. Sparks
1.
Legal Standard for Nonexamining, Reviewing Physicians
5
Plaintiff also argues that the ALJ committed legal error by improperly
6
affording greater weight to the opinion of Dr. Sparks, a nonexamining testifying
7
medical expert, over that of Dr. Balfour, Plaintiff’s treating specialist, and Dr.
8
Mantell, Plaintiff’s examining physician. (Pl.’s Mot. 11:24-12:5.) “As a general rule,
9
more weight should be given to the opinion of a treating source than to the opinion
10
of doctors who do not treat the claimant.” Garrison, 759 F.3d at 1012 (quoting
11
Lester, 81 F.3d at 830). “When a nonexamining physician’s opinion contradicts an
12
examining physician’s opinion and the ALJ gives greater weight to the nonexamining
13
physician’s opinion, the ALJ must articulate her reasons for doing so.” See Feskens,
14
804 F. Supp. 2d at 1115 (citing Morgan v. Comm’r of Soc. Sec. Admin, 169 F.3d 595,
15
600-01 (9th Cir. 1999)). More specifically, an ALJ errs when he or she “accord[s]
16
greater weight to the opinion of a non-examining, non-treating physician than to the
17
opinions of [a claimant’s] treating and examining physicians without providing
18
‘specific’ and ‘legitimate’ reasons supported by ‘substantial evidence in the record’
19
for doing so.” Cain, 74 F. App’x at 756 (citing Lester, 81 F.3d at 830-31).
20
2.
Dr. Sparks’ Opinion
21
Dr. Sparks is a non-treating, nonexamining internist and endocrinologist who
22
reviewed Plaintiff’s medical records for this case. (AR 63, 669.) He testified during
23
the administrative hearing that Plaintiff had the following medically determinable
24
impairments: hypertension that is controlled by medication; hyperlipidemia;
25
obstructive sleep apnea; allergic rhinitis; sensory neuro high-pitch bilateral hearing
26
loss; left thigh pain due to meralgia paresthetica resulting from the superficial femoral
27
nerve entrapment; low back pain with two millimeter degenerative disc disease at L4-
28
5; right knee pain with patellar chrondromalacia; neck pain with mild multilateral
– 22 –
17cv2305
1
degenerative disc disease at C3-4 through C3-5/6; and obesity. (AR 64.) Dr. Sparks
2
then opined that Plaintiff should have the following work restrictions: can
3
occasionally lift 20 pounds and frequently lift 10 pounds; no use of ladders, ropes, or
4
scaffolding; no overhead work; no frequent extreme motion of the neck; no exposure
5
to extreme hot or cold; no exposure to noisy environments; no work from unprotected
6
heights; no work with dangerous machinery; and can stand, walk, and sit six hours
7
out of an eight-hour day. (AR 65.)
8
3.
ALJ’s Acceptance of Dr. Sparks’ Opinion
9
The ALJ assigned “great weight” to Dr. Sparks’ opinion. (AR 27.) He justified
10
this consideration by stating that Dr. Sparks’ findings were “consistent” with his own
11
assessment of Plaintiff’s RFC and are “supported by the listed medical impairments
12
and reports that the claimant has decreased hearing sensitivity, degeneration of the
13
lumbar and cervical spine, and pain in his left thigh and right knee.” (Id.)
14
4.
Analysis of ALJ’s Acceptance of Dr. Sparks’ Opinion
15
The Court finds the ALJ’s decision lacks legal justification for giving Dr.
16
Sparks’ opinion great weight, particularly over the little weight given to Plaintiff’s
17
treating and examining physicians. An ALJ’s statement that a physician’s opinion
18
matches the ALJ’s own conclusions is not a legitimate explanation for why that
19
physician’s opinion should be granted more weight. See Ressler v. Berryhill, 687 F.
20
App’x 560, 562 (9th Cir. 2017) (“The ALJ explained that he gave weight to the
21
medical opinions and medical evidence in the record ‘to the extent that they are
22
consistent with this decision.’ Such a standard is nowhere reflected in our case law
23
and the ALJ’s application of it constitutes an error of law.”). Though the ALJ states
24
that Dr. Sparks’ opinion is supported by the listed medical impairments and some of
25
Plaintiff’s medical conditions, he does not explain how or why said support is
26
significant. Therefore, this conclusion is also devoid of sufficient legal reasoning.
27
Moreover, the ALJ’s assessment failed to justify why he favored Dr. Sparks’
28
opinion over the opinions of Dr. Balfour, a treating physician, and Dr. Mantell, an
– 23 –
17cv2305
1
examining physician. Dr. Sparks is a nonspecialist testifying physician who reviewed
2
Plaintiff’s record. (AR 63-64.) He has never spoken to Plaintiff, examined him, or
3
treated him. (Id.) Contrary to Dr. Sparks’ opinion, Dr. Balfour determined after
4
repeatedly examining and treating Plaintiff that he is “not able to perform short
5
periods of standing.” (AR 720.) In addition, Dr. Mantell deemed that Plaintiff could
6
perform work at the sedentary level only with limitations. (AR 731-33.) After
7
completing a two-day functional capacity evaluation of Plaintiff, Dr. Mantell
8
restricted Plaintiff to standing for no more than 10 minutes and lifting no more than
9
15 pounds. (Id.) These findings directly contradict Dr. Sparks’ conclusions. (AR
10
65, 733.) By favoring Dr. Sparks, a reviewing physician, the ALJ went against the
11
law’s directive to generally give “more weight to the medical opinion of a source who
12
has examined [the claimant] than to the medical opinion of a medical source who has
13
not examined [the claimant].” 20 C.F.R. § 404.1527(c)(1); see also Garrison, 759
14
F.3d at 1012. Therefore, he failed to provide legally sufficient reasons for giving the
15
opinions of Drs. Balfour and Mantell little weight and for giving Dr. Sparks greater
16
and ultimately determinative weight. Consequently, the ALJ committed legal error
17
when weighing Dr. Sparks’ opinion.
18
D.
19
VA Disability Determination
1.
Legal Standard for VA Disability Determination
20
Furthermore, the ALJ committed legal error by neglecting to adequately
21
explain his dismissal of Plaintiff’s VA disability rating. Though Plaintiff fails to
22
identify this issue, it is properly before the Court due to the Court’s independent
23
burden to determine whether the Commissioner’s decision is free of legal error. See,
24
e.g., Bruce, 557 F.3d at 1115. Given the great weight accorded to a VA determination
25
of disability by the Ninth Circuit and the ALJ’s conclusory rejection of Plaintiff’s
26
VA rating, the Court will examine this issue.
27
///
28
///
– 24 –
17cv2305
1
“[T]he ALJ must consider the VA’s finding in reaching his decision and the
2
ALJ must ordinarily give great weight to a VA determination of disability.” McLeod
3
v. Astrue, 640 F.3d 881, 886 (9th Cir. 2011) (internal quotation marks omitted)
4
(quoting McCartey v. Massanari, 298 F.3d 1072, 1076 (9th Cir. 2002)). Given this
5
requirement, the ALJ has a duty to inquire about the VA disability rating and include
6
evidence of the rating in the record to allow for proper evaluation. See id. The Ninth
7
Circuit has found “great weight to be ordinarily warranted” for the VA rating because
8
of the “marked similarity” between the federal disability programs of the VA and the
9
Social Security Administration (“SSA”). See Luther v. Berryhill, 891 F.3d 872, 876
10
(9th Cir. 2018). However, a VA disability rating is not conclusive in a social security
11
disability matter. See 20 C.F.R. § 404.1504. “An ALJ may give less weight to a VA
12
rating if he gives persuasive, specific, valid reasons for doing so that are supported
13
by the record.” Luther, 891 F.3d at 876-77 (internal quotation marks omitted)
14
(quoting Valentine v. Comm’r Soc. Sec. Admin., 574 F.3d 685, 695 (9th
15
Cir. 2009)).
16
2.
VA Disability Rating
17
According to his medical records from the VA, Plaintiff was awarded a 30%
18
disability rating by the VA as early as August 2005. (AR 473.) At some time between
19
October 2013 and July 2014, the VA increased Plaintiff’s disability rating to 70%.
20
(AR 288-89, 893.) However, the record does not include Plaintiff’s official VA rating
21
decision records issued by a VA regional office. Such records articulate the VA’s
22
decision, reasons for decision, and evidence that supports its decision.
23
Compensation,
24
https://www.benefits.va.gov/compensation/process.asp (last visited June 22, 2018).
25
3.
Claims
Process,
U.S.
Department
of
Veterans
See
Affairs,
ALJ’s Rejection of VA Disability Determination
26
Here, the ALJ asserted that the disability determination processes utilized by
27
the SSA and VA are “fundamentally different.” (AR 28.) He pointed out that the
28
VA does not determine a claimant’s RFC. He also noted that the VA does not
– 25 –
17cv2305
1
establish whether the claimant is capable of performing his past relevant work or
2
work that exists in significant numbers in the national economy. (Id.) Based on these
3
differences, the ALJ found the VA’s rating “is of little probative value” and assigned
4
the VA’s assessments “little weight.” (Id.)
5
4.
Analysis of ALJ’s Rejection of VA Disability Rating
6
The Court finds the ALJ improperly rejected the VA’s disability determination
7
for Plaintiff. The ALJ’s rationales conflict with the Ninth Circuit’s controlling
8
determination that there is “marked similarity” between the VA’s and SSA’s
9
disability programs. See Luther, 891 F.3d at 876; McCartey, 298 F.3d at 1076.
10
Though the VA does not determine a claimant’s RFC or the jobs he is capable of
11
performing, it does determine a claimant’s functional loss as well as the impact of his
12
conditions on his ability to work and perform occupational tasks. (AR 917, 928, 936.)
13
The ALJ did not articulate any further reasons based on the record for giving the
14
VA’s disability assessment little weight. Thus, he erred by failing to provide
15
persuasive, specific, valid reasons for dismissing the VA’s disability determination.
16
See Luther, 891 F.3d at 876-77.
17
V.
Harmless Error Analysis
18
Having concluded that the ALJ erred in giving little weight to the opinions of
19
Drs. Balfour and Mantell, in giving favoring weight to Dr. Sparks, and improperly
20
disregarding the VA’s determination of disability, the Court must now determine
21
whether these errors were harmless. “[A]n ALJ’s error is harmless where it is
22
‘inconsequential to the ultimate nondisability determination.’” Molina v. Astrue, 674
23
F.3d 1104, 1115 (9th Cir. 2012) (quoting Carmickle, 533 F.3d at 1162). In assessing
24
whether an error is harmless, the court “look[s] at the record as a whole to determine
25
whether the error alters the outcome of the case.” Id.
26
Here, the ALJ’s errors were not harmless. The ALJ’s RFC determination that
27
Plaintiff could perform light work with some limitations was effectively identical to
28
that of Dr. Sparks. (AR 24, 65.) This finding directly contradicts Dr. Mantell’s
– 26 –
17cv2305
1
determination that Plaintiff was only capable of sedentary work with limitations of
2
standing for no more than 10 minutes and lifting no more than 15 pounds. (AR 731-
3
33.) The ALJ further ignored the VA’s most recent determination that Plaintiff’s
4
thoracolumbar spine, knee, and cervical spine conditions impacted his ability to work.
5
(AR 917, 928, 936.)
6
Plaintiff’s capacity to work. See Valentine, 574 F.3d at 690 (“[A]n RFC that fails to
7
take into account a claimant’s limitations is defective.”).
8
assessment, in turn, distorted the ALJ’s determination of whether Plaintiff could
9
adjust to other work in the national economy. Consequently, the ALJ’s final decision
10
on whether Plaintiff is disabled and entitled to benefits was tainted. Accordingly, the
11
Court finds the ALJ committed harmful legal error.
12
VI.
Consequently, the ALJ’s RFC determination overstated
This incorrect RFC
Appropriate Remedy
13
Having determined that harmful legal error was committed, the Court must
14
decide the appropriate remedy. Plaintiff requests that the Court reverse and award
15
benefits. (Pl. Mot. 14:1-4.) The Court finds that remanding to the agency for further
16
proceedings is the correct course.
17
“[T]he proper course, except in rare circumstances, is to remand to the agency
18
for additional investigation or explanation.” Benecke v. Barnhart, 379 F.3d 587, 595
19
(9th Cir. 2004). This “ordinary remand rule” respects the Commissioner’s role in
20
developing the factual record, and helps guard against the displacement of
21
administrative judgment by judicial decree. See Treichler, 775 F.3d at 1099-00.
22
When an ALJ makes a legal error, but there are ambiguities or outstanding issues in
23
the record, the proper approach is to remand for further proceedings, not to apply the
24
“credit as true” rule. See id. at 1105.
25
For this Court to depart from the ordinary remand rule and award benefits
26
under the “credit as true” rule, three requirements must be met. Garrison, 759 F.3d
27
at 1019-21. First, the court must determine that the ALJ committed legal error, such
28
as by failing to provide legally sufficient reasons for rejecting certain evidence.
– 27 –
17cv2305
1
Dominguez v. Colvin, 808 F.3d 403, 407 (9th Cir. 2015). Second, if the court finds
2
such error, it must determine whether “the record has been fully developed and
3
further administrative proceedings would serve no useful purpose.” Garrison, 759
4
F.3d at 1020. In making this determination, the court reviews the record as a whole
5
and asks whether there are conflicts, ambiguities, or gaps in the record such that
6
essential factual issues have not been resolved. Dominguez, 808 F.3d at 407 (citation
7
omitted). Where there are outstanding issues that require resolution, the proper
8
approach is to remand the case to the agency for further proceedings. See Treichler,
9
775 F.3d at 1101, 1105.
10
If the court determines that the record has been fully developed and there are
11
no outstanding issues left to be resolved, the court lastly must consider whether “the
12
ALJ would be required to find the claimant disabled on remand” if the “improperly
13
discredited evidence were credited as true.” Dominguez, 808 F.3d at 407 (quoting
14
Garrison, 759 F.3d at 1020). “If so, the district court may exercise its discretion to
15
remand the case for an award of benefits.” Id. However, even when the requirements
16
of the credit as true rule are satisfied, district courts retain flexibility to remand for
17
further proceedings when the record as a whole creates “serious doubt” as to whether
18
the claimant is disabled. Id. at 1021. “The touchstone for an award of benefits is the
19
existence of a disability, not the agency’s legal error.” Brown-Hunter v. Colvin, 806
20
F.3d 487, 495 (9th Cir. 2015).
21
In this matter, the first “credit as true” requirement is met as the ALJ committed
22
legal error by failing to provide legally sufficient bases for granting little weight to
23
the opinions of Plaintiff’s treating specialist Dr. Balfour and examining physician Dr.
24
Mantell, weighing the opinion of nonexamining expert Dr. Sparks, and discounting
25
the VA’s disability assessment.
26
However, neither the second nor the third requirement of the “credit as true”
27
rule is met. Here, the Court is not satisfied that the record has been fully developed
28
or that further administrative proceedings would serve no useful purpose. First, the
– 28 –
17cv2305
1
admitted evidence lacks a complete record of the VA’s disability rating
2
determination.
3
information regarding Plaintiff’s disability rating, they do not articulate the reasons
4
for the VA’s decision or the evidence supporting said decision. In particular, the
5
record lacks evidence as to why the VA increased Plaintiff’s disability rating from
6
30% to 70%. (See AR 288-89, 473, 893.) Without the official VA rating decision
7
records, the ALJ was incapable of adequately considering and evaluating the VA’s
8
disability analysis. See McLeod, 640 F.3d at 886 (holding that inadequacy of the
9
record can inhibit proper evaluation of a plaintiff’s VA disability rating). As such,
10
While the VA medical documents in the record provide some
the record has not been fully developed.
11
Moreover, as to the third “credit as true” requirement, it is unclear from the
12
record if the ALJ would be required to find Plaintiff disabled on remand if the
13
improperly discredited opinions of Drs. Balfour and Mantell were credited as true.
14
Dr. Balfour only directly addressed Plaintiff’s functional capacity in two letters dated
15
April 2015. (AR 718-21.) He stated in one of the letters that Plaintiff “is not able to
16
perform short periods of standing, kneeling, crouching, stooping and working in
17
strained and awkward positions.” (AR 720.) However, his statement did not specify
18
what length of time constituted a “short period.” Moreover, this letter addressed
19
whether Plaintiff was capable of performing his most recent position as a sheet metal
20
worker, and neither of the two letters specifically addressed Plaintiff’s ability to work
21
any job at all. (AR 718-21.) Furthermore, Dr. Mantell concluded that Plaintiff was
22
capable of sedentary work with limitations of standing for no more than 10 minutes
23
and lifting no more than 15 pounds. (AR 731-733.) Yet, the ALJ did not ask the
24
vocational expert about the job availability for someone with the exact work
25
limitations determined by Dr. Balfour or Dr. Mantell. The ALJ did ask the vocational
26
expert about a hypothetical person of the same age, education level, and work
27
experience as Plaintiff with the functional limitations that the ALJ found Plaintiff
28
had, except that person could only lift and carry a maximum of 10 pounds. (AR 67.)
– 29 –
17cv2305
1
The vocational expert testified that she could not cite any jobs that could be
2
performed by such a person. (AR 68.) But these limitations are not identical to those
3
provided by Plaintiff’s discredited physicians. Consequently, there is not enough
4
information in the record to determine if the ALJ would be required to find Plaintiff
5
disabled on remand if the opinions of Drs. Mantell and Balfour were credited as true
6
and considered with the vocational expert’s testimony.
7
Considering the ALJ’s errors in his evaluation of Dr. Balfour’s and Dr.
8
Mantell’s opinions, the incomplete VA record, and the uncertainty about whether the
9
ALJ would be required to find Plaintiff disabled on remand, the record is not “free
10
from conflicts, ambiguities, or gaps.” See Treichler, 775 F.3d at 1103. Therefore,
11
the requirements for the credit-as-true rule are not satisfied, and the Court will not
12
depart from the ordinary remand rule. See id. at 1105. Accordingly, the Court will
13
remand for further proceedings.
14
VII. CONCLUSION
15
In light of the foregoing reasons, the ALJ erred in discounting the opinions of
16
Drs. Balfour and Mantell, crediting the opinion of Dr. Sparks, and dismissing the
17
VA’s disability assessment. The Court finds that the ALJ failed to provide “specific
18
and legitimate reasons that are supported by substantial evidence” in his decision to
19
discredit the opinions of Dr. Balfour, Plaintiff’s treating specialist, and Dr. Mantell,
20
Plaintiff’s examining physician, in favor of affording more weight to the opinion of
21
Dr. Sparks, a nonexamining physician. See Burrell v. Colvin, 775 F.3d 1133, 1137
22
(9th Cir. 2014) (quoting Bayliss v. Barnhart, 427 F.3d 1211, 1216 (9th Cir. 2005));
23
Cain v. Barnhart, 74 Fed. App’x 755, 756 (9th Cir. 2003) (quoting Lester, 81 F.3d at
24
830-31).
25
The Court also finds that remanding for further proceedings is the appropriate
26
remedy.
27
Judgment (ECF No. 12) and DENIES the Commissioner’s Cross-Motion for
28
///
Accordingly, the Court GRANTS Plaintiff’s Motion for Summary
– 30 –
17cv2305
1
Summary Judgment (ECF No. 13). Finally, the Court REMANDS this action for
2
further proceedings consistent with this order. See 42 U.S.C. § 405(g).
3
IT IS SO ORDERED.
4
5
DATED: July 26, 2018
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
– 31 –
17cv2305
Disclaimer: Justia Dockets & Filings provides public litigation records from the federal appellate and district courts. These filings and docket sheets should not be considered findings of fact or liability, nor do they necessarily reflect the view of Justia.
Why Is My Information Online?