Purser v. Commissioner Social Security Administration

Filing 20

OPINION AND ORDER. The decision of the Commissioner is REVERSED and REMANDED for further proceedings. See formal OPINION AND ORDER. Signed on 3/21/2016 by Judge Ann L. Aiken. (rh)

IN THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF OREGON
SHERRI PURSER,
Plaintiff,

v.
CAROLYN W. COLVIN, Acting
Commissioner of Social Security,
Defendant.
Merrill Schneider
Schneider Kerr Law Offices
P.O. Box 14490
Portland, OR 97293
Attorney for plaintiff
Janice E. Hebe1t
Assistant United States Attorney
United States Attorney's Office
1000 S.W. Third Avenue, Suite 600
Portland, Oregon 97204
Jordan D. Goddard
Special Assistant United States Attorney
Office of General Counsel
Social Security Administration
701 Fifth Avenue, Suite 2900 MIS 221A
Seattle, Washington 98104
Attorneys for defendant
Page 1 - OPINION AND ORDER

Case No. 3:15-cv-00606-AA
OPINION AND ORDER

AIKEN, Judge:
Plaintiff Sherri Purser brings this action pursuant to the Social Security Act, 42 U.S.C. §
405(g), to obtain judicial review of the Commissioner's decision denying her application for
disability benefits under Title II of the Social Security Act. For the reasons set fotth below, the
Commissioner's decision is reversed and remanded for further proceedings.
BACKGROUND

On July 26, 2011, plaintiff protectively filed an application for disability benefits, alleging
disability beginning February 4, 2011 due to ve1tigo, reflex sympathetic dystrophy ("RSD"), 1 chronic
stress, depression, anxiety, complex regional pain syndrome, and nerve damage. Tr. 160, 164. Her
application was denied initially and on reconsideration. Tr. 90, 98. On August 20, 2013, plaintiff
was represented by an attorney and testified at a hearing held by an Administrative Law Judge
("ALJ"). Tr. 33. On September 25, 2013, the ALJ issued an unfavorable decision. Tr. 16. On
February 11, 2015, the Appeals Council denied plaintiff's request for review, rendering the ALJ' s
decision the final decision of the Commissioner. Tr. I. Plaintiff now seeks judicial review.
STANDARD OF REVIEW

The district coutt must affirm the Commissioner's decision if it is based upon proper legal
standards and the findings are suppotted by substantial evidence in the record. 42 U.S.C. § 405(g);
Berry v. Astrue, 622 F.3d 1228, 1231 (9th Cir. 2010). "Substantial evidence is more than a mere

scintilla but less than a preponderance; it is such relevant evidence as a reasonable mind might accept
as adequate to support a conclusion." Gutierrez v. Comm 'r ofSoc. Sec., 740 F.3d 519, 522 (9th Cir.
2014) (internal quotation marks omitted). The court must weigh "both the evidence that suppotts
and the evidence that detracts from the ALJ's" decision. Mayes v. Massanari, 276 F.3d 453, 459
(9th Cir. 2001).

If the evidence is susceptible to more than one interpretation but the

Commissioner's decision is rational, the Commissioner must be affirmed, because "the comt may

1

RSD "is a syndrome of burning pain, hyperesthesia, swelling, hyperhidrosis, and trophic
changes in the skin and bone of the affected extremity." Knapp v. Sullivan, 1989 WL 138746, *2
(D. Or. Nov. I, 1989).
Page 2 - OPINION AND ORDER

not substitute its judgment for that of the Commissioner." Edlund v. Massanari, 253 F.3d 1152,
1156 (9th Cir. 2001).
COMMISSIONER'S DECISION
The initial burden ofproofrests upon the plaintiff to establish disability. Howardv. Heckler,
782 F.2d 1484, 1486 (9th Cir. 1986). To meet this burden, plaintiff must demonstrate an "inability
to engage in any substantial gainful activity by reason of any medically determinable physical or
mental impairment which can be expected ... to last for a continuous period of not less than 12
months[.]" 42 U.S.C. § 423(d)(l)(A).
The Commissioner employs a five-step sequential process to determine whether a person is
disabled under the Act. Bowen v. Yuckert, 482 U.S. 137, 140 (1987); 20 C.F.R. § 404.1520. At step
one, the ALJ found plaintiff had not engaged in "substantial gainful activity" since the alleged
disability onset date. Tr. 21. At step two, the ALJ found plaintiff has the following medically severe
impairments: vertigo, RSD, and migraines.

Tr. 21; 20 C.F.R. § 404.1520(c).

The ALJ

acknowledged plaintiffs medically detetminable impairments of posttraumatic stress disorder
("PTSD"), major depressive disorder, and generalized anxiety disorder, but deemed those
impairments nonsevere.

Tr. 21.

At step three, the ALJ found plaintiff's medically severe

impairments did not meet or medically equal the severity of one of the listed impairments the
Commissioner acknowledges are so severe as to preclude substantial gainful activity. Tr. 21; 20
C.F.R. § 404.1520(d).
At step four, the ALJ found plaintiff retained the residual functional capacity ("RFC") to
perform light work as defined in 20 C.F.R. § 404. l 567(b), subject to the following limitations: no
more than occasional pushing and pulling with the right upper arm; no more than occasional
stooping, kneeling, crouching, crawling, or climbing ramps/stairs; and no exposure to hazards such
as machinety and heights. Tr. 23. Based on this RFC and the testimony of a vocational expe1i, the
ALJ found plaintiff was able to perform her past relevant work as a call center worker and sales
associate. Tr. 26. Accordingly, the ALJ found plaintiff not disabled. Tr. 27.
Page 3 - OPINION AND ORDER

DISCUSSION
Plaintiff contends the ALJ committed two significant legal eiTOrs in finding her not disabled.
First, she asse1ts the ALJ erred by failing to categorize her mental health problems as severe
impairments at step two, leading to prejudicial enor at step five. Second, plaintiff avers the ALJ
gave little weight to the opinion of Dr. Lee, the physician who treats her for vertigo and migraines,
without legally sufficient justification.

I.

Step Two Analysis

Plaintiff first challenges the ALJ's finding her PTSD, depression, and anxiety, either singly
or in combination, were not severe impairments.
The Social Security Regulations and Rulings, as well as case law applying them,
discuss the step two severity determination in terms of what is "not severe."
According to the Commissioner's regulations, "an impairment is not severe ifit does
not significantly limit [the plaintiffs] physical ability to do basic work activities[.]"

Smolen v. Chafer, 80 F.3d 1273, 1290 (9th Cir. 1996) (quoting 20 C.F.R. §§ 401.1520(c),
404.1521 (a)). Step two is a "de minimis screening device to dispose of groundless claims." Id. As
a result, a finding of"not severe" is appropriate "only if the evidence establishes a slight abnormality
that has 'no more than a minimal effect on an individual[']s ability to work."' Id. (quoting SSR 8528). To support a finding an impairment is not severe, the ALJ must (1) carefully evaluate the
medical findings that describe the impairment, which include "the objective medical evidence and
any impairment-related symptoms"; and (2) make "an informed judgment about the limitations and
restrictions the impairment(s) and related symptom(s) impose on the individual's physical and
mental ability to do basic work activities." SSR 96-3P.
Plaintiff argues the ALJ found her mental impairments nonsevere only by ignoring the weight
of the evidence and discrediting the opinions of three physicians without sufficient justification. The
ALJ discussed five portions of the medical record in deeming plaintiffs mental impahments
nonsevere: the opinion and treatment records of Stephen Huggins, Psy.D., plaintiffs treating mental
health provider from May 2011 to March 2012; intake notes from Cascadia Behavior Healthcare,
a clinic plaintiff visited in Januaiy 2013; two letters from William Madison, Ph.D., plaintiffs
Page 4 - OPINION AND ORDER

treating mental health provider from Februaty 2013 through at least September 2013; and the
opinions of agency reviewing physicians Michael J. Dennis, Ph.D, and Paul Rethinger, Ph.D. The
ALJ discredited the opinions of Dr. Huggins, Dr. Madison, and Dr. Rethinger; gave great weight to
the opinion of Dr. Dennis; and concluded the Cascadia health record supported the conclusion
plaintiffs mental impairments were nonsevere. After a careful review of the relevant portions of
the record and the ALJ' s opinion, I conclude the ALJ erred in weighing the medical evidence
regarding plaintiffs mental impairments.
First, in his decision, the ALJ made several statements about the medical source opinions that
are plainly incorrect. For example, the ALJ stated Dr. Dennis deemed plaintiffs mental impairments
nonsevere, but Dr. Dennis categorized both anxiety and affective disorder as severe impairments.
Compare Tr. 23 with Tr. 67. The ALJ also declared Dr. Rethinger assessed both "mild limitations

in social functioning" and "no social limitations"; these statements cannot simultaneously be true,
and the record shows Dr. Rethinger in fact assessed mild limitations in this area. Compare Tr. 23
with Tr. 81. Finally, the ALJ summarized Dr. Huggins's treatment notes as opining plaintiff had

"mild to minimal impairment in marital, family, and interpersonal functioning." Tr. 22. Although
this is an accurate characterization of some isolated treatment notes, e.g. Tr. 419, the full record
shows Dr. Huggins generally assessed mild to moderate impairment in these areas, with one
treatment note indicating serious impairment of family functioning. See generally Tr. 401-28, 47389. These errors raise serious questions about whether the ALJ's decision at step two rested on a
complete and cot1'ect understanding of the record.
Second, the ALJ failed to address relevant medical evidence.

Because a finding an

impairment is nonsevere is appropriate only if that nonseverity is "clearly established by medical
evidence," an ALJ is bound to consider all relevant medical evidence at step two. See Webb v.
Barnhart, 433 F.3d 683, 687 (9th Cir. 2005) (quoting SSR 85-28). The record contains two letters

from Dr. Madison: a one-page letter dated June 27, 2013 ("June Letter"), Tr. 521, and a three-page
supplemental letter dated September 13, 2013 ("September Letter"), Tr. 583-85. In the June Letter,
Page 5 - OPINION AND ORDER

Dr. Madison explained plaintiff was "very overwhelmed by her mental and physical issues" and
opined symptoms caused by those issues were "among the worst [he had] witnessed in [his] 24 years
in mental health." Tr. 521. Dr. Madison concluded plaintiffs "right[ful] pre-occup[ation] with these
issues ... would preclude herability to think clearly on the job and even follow simple instructions."
Tr. 521. After the disability hearing, the ALJ asked Dr. Madison to submit treatment notes
supp01ting his conclusions. Tr. 231. Dr. Madison explained he did "not keep detailed clinic notes,
so there are none to send." Tr. 231. He offered instead "to write a letter stating [plaintiffs]
symptoms and prognosis." Tr. 231. The ALJ responded "another letter ... would not be helpful."
Tr. 231.
Dr. Madison submitted the September Letter anyway. The September Letter summarizes Dr.
Madison's treatment histoty with plaintiff, describing in some detail the focus of twenty-one
individual visits. Tr. 583-84. Dr. Madison opined plaintiff"did not exaggerate" and "[i]f anything,
... under reports her symptoms." Tr. 583. He also repeated his opinion from the June Letter
regarding symptom severity and predicted she would be absent from work "definitely ... more than
2 or 3 days ... a month, perhaps even in a week." Tr. 584-85.
The ALJ gave little weight to the June Letter because it was "conclusoty" and because
"[o]ther treatment notes do not suggest the severity opined by Dr. Madison." Tr. 22. The ALJ
further noted Dr. Madison's failure to provide "treatment notes to suppott his conclusion despite my
request." Tr. 22. The ALJ expressed skepticism regarding Dr. Madison's explanation for the
absence of treatment notes, characterizing it as "contraty to my understanding of regular medical
protocol and standards of practice to document sessions and keep notes." Tr. 22. The ALJ did not
mention the September Letter.
The ALJ permissibly discredited the June Letter as conclus01y. See Thomas v. Barnhart, 278
F.3d 947, 957 (9th Cir. 2002) ("The ALJ need not accept the opinion of any physician, including a
treating physician, if that opinion is brief, conclusoty, and inadequately supported by clinical
findings."). The September Letter, however, contained substantially more detail than the June Letter
Page 6 - OPINION AND ORDER

and described a course of treatment. The ALJ' s failure to even consider the contents of the
September Letter, and apparent determination its contents would not inform his decision before even
seeing the letter, was eTI'or.
Third, the ALJ did not provide legally sufficient reasons to reject the opinions of Dr. Huggins
and Dr. Rethinger. There are three types of medical opinions in social security cases: treating
physicians, examining physicians, and non-examining physicians. Lester v. Chater, 81 F.3d 821,
830 (9th Cir. 1995). "Generally, a treating physician's opinion carries more weight than an
examining physician's, and an examining physician's opinion can'ies more weight than a reviewing
physician's." Holohan v. Massanari, 246 F.3d 1195, 1202 (9th Cir. 2001); 20 C.F.R. § 404.1527(d).
"When there is conflicting medical evidence, the [ALJ] must determine credibility and resolve the
conflict." Thomas, 278 F.3d at 956-57 (citing Matney v. Sullivan, 981 F.2d 1016, 1019 (9th Cir.
1992)). If a treating or examining doctor's opinion is contradicted by another doctor's opinion, it
may be rejected only for specific and legitimate reasons. Lester, 81 F.3d at 830-31. "The opinion
of a nonexamining physician cannot by itself constitute substantial evidence that justifies the
rejection of the opinion of either an examining physician or a treating physician." Id. at 831.
Dr. Huggins treated plaintiff for anxiety and depression. Tr. 425. His treatment notes also
regularly mention plaintiffs vetiigo. See, e.g., Tr. 401, 405-08, 413, 425. In a check-the-box
portion of his treatment notes, he consistently opined plaintiff could not function in a job setting.
See generally Tr. 401-28, 473-89; but see Tr. 405, 407, 412, 421, 474-76, 478-80, 482-83, 486

("NIA" box checked for job-related ability to function); Tr. 420 (indicating "serious impairment"
in job functioning); Tr. 423 (indicating "moderate impairment" in job functioning); Tr. 477
(checking both "NIA" and "cannot function" in job category). As explained above, he also assessed
mild to moderate problems with marital, family, and interpersonal relationships.

The ALJ

discredited Dr. Huggins's opinion because it was "unclear" what objective findings supported his
assessment ofplaintiffs limitations, Dr. Huggins' s treatment notes "suggest[ed] mild symptoms, and
stress related to various interpersonal issues," and plaintiff stopped treatment with Dr. Huggins in
Page 7 - OPINION AND ORDER

March 2012. Tr. 22. The ALJ also found the limitations assessed by Dr. Huggins unsupp01ted by
the treatment notes of other mental health providers. Tr. 22. Finally, the ALJ interpreted Dr.
Huggins' opinion about plaintiff's ability to function in a work setting as resting on plaintiff's
complaints about her vertigo, and thus irrelevant to determining whether her mental health
impairments were severe. Tr. 22.
Dr. Huggins's notes do not tie his work-restriction opinion to any paiticular ailment. In
addition, when the notes mention work, they relate to plaintiff's vertigo. See, e.g., Tr. 481 ("Went
& resigned at work as not able to work w/ vettigo. ") The ALJ rationally linked this portion of Dr.

Huggins's opinion to plaintiff's physical limitations. Accordingly, this Coutt must defer to that
finding. See Batson v. Comm'r of Soc. Sec. Admin., 359 F.3d 1190, 1193 (9th Cir. 2004) ("[I]f
evidence exists to supp01t more than one rational interpretation, [the comt] must defer to the
Commissioner's decision[.]")
Dr. Huggins's treatment notes on plaintiff's depression and anxiety do contain significant
discussion of interpersonal problems. But that is not a sufficient reason to support the ALJ's
determination plaintiff's mental problems were not severe. Situational depression may be chronic
and is regularly categorized as a severe limitation at step two. See, e.g., Spelatz v. Astrue, 2011 WL
4544085, *5 (D. Or. Sept. 28, 2011); Fennen v. As/rue, 2010 WL 605251, *4 (E.D. Wash. Feb. 18,
2010). Defendants cite Gates v. Astrue, 627 F.3d 1080, I 082 (8th Cir. 2010) for the proposition that
"situational depression is not disabling." Def. 's Br. 17. In Gates, the Eighth Circuit affirmed the
ALJ' s finding the plaintiff's situational depression was nonsevere because the record revealed the
depression had improved with a regimen of medication and counseling. Gates, 627 F.3d at 1082.
At step two, the appropriate focus for any impairment, including situational depression, is whether
the impairment meets the durational and severity requirements. Here, Dr. Huggins continued to
assess mild to moderate limitations related to anxiety and depression throughout his treatment
relationship with plaintiff. That plaintiff's depression was situational is not a legitimate reason to
discount Dr. Huggins's opinion.
Page 8 - OPINION AND ORDER

The ALJ also erred to the extent he took the end of plaintiffs treatment with Dr. Huggins in
March 2012 as evidence her mental health problems were mild, as the record clearly shows she
stopped treatment because she lost her health insurance. Tr. 473, 516. Moreover, the ALJ did not
specify which portions of other mental health providers' notes were inconsistent with or
unsupportive of the difficulties Dr. Huggins assessed with interpersonal relationships. The only
inconsistency apparent to the court is the assessment agency reviewing physicians' assessment of
mild difficulties with social functioning. See Tr. 67, 81. As explained above, the opinion of a
nonexamining physician, standing alone, does not justify rejecting the opinion of a treating
physician. Lester, 81 F.3d at 831. TheALJ's decision to discredit Dr. Huggins's assessment of mild
to moderate difficulties in family, marital, and interpersonal relationships is not supported by
substantial evidence.
Finally, the ALJ did not adequately explain his decision to discredit the opinion of Dr.
Rethinger while crediting the opinion of Dr. Dennis. Dr. Dennis reviewed the medical records and
assessed no restrictions in activities of daily living; mild restrictions in social functioning; and mild
restrictions in concentration, persistence, or pace. Tr. 67. On reconsideration, Dr. Rethinger
assessed no restrictions in activities of daily living; mild restrictions in social functioning; and

moderate restrictions in concentration, persistence, or pace. Tr. 81 (emphasis added). Dr. Rethinger
also recommended restricting plaintiff to jobs requiring no more than one- to two-step instructions,
opining she would "be incapable of understanding/remembering more complex instructions d/t sxs
of depression." Tr. 85. The ALJ gave significant weight to Dr. Dennis' s opinion because he found
it consistent with the treatment record, and little weight to Dr. Rethinger's opinion because he found
it inconsistent with the treatment record. Tr. 23. The ALJ did not explain which portions of the
record, other than Dr. Dermis's opinion, were inconsistent with the concentration, persistence, or
pace limitations in Dr. Rethinger's opinion. Moreover, that restriction is consistent with other
evidence in the record, most notably Dr. Madison's opinion plaintiff would have trouble "think[ing]
clearly on the job and even follow[ing] simple instructions." Tr. 585. Accordingly, substantial
Page 9 - OPINION AND ORDER

evidence does not support the ALJ' s decision to discredit Dr. Rethinger' s opinion.
Considering the record as a whole, I find the evidence establishes plaintiffs mental
impairments "constituted more than a 'slight abnormality' that had 'no more than a minimal effect
on [plaintiffs] ability to do work."' Smolen, 80 F .3d at 1290. Accordingly, the ALJ erred at step two
in failing to designate those impairments as severe. Because the ALJ resolved step two in plaintiffs
favor, however, that e1rnr is harmless unless it prejudiced plaintiff at step three (listing impairment
determination) or step five (formulation of RFC and assessment of plaintiffs ability to perform
particular jobs). Burch v. Barnhart, 400 F.3d 676, 682 (9th Cir. 2005). Plaintiff does not point to
any prejudice at step three. Accordingly, the question is whether plaintiff was prejudiced at step five
by the error at step two.
On the current record, I cannot conclude the error at step two was harmless. First, some of
the restrictions in the discredited opinions clearly would exclude the jobs the ALJ found plaintiff
could do. Both call center worker and sales associate require Level Three Reasoning.2 The Ninth
Circuit has held there is an apparent conflict between a restriction to simple, repetitive work and the
demands of Level Three Reasoning. Zavalin v. Colvin, 778 F.3d 842, 847 (9th Cir. 2015).
Moreover, the Ninth Circuit recently found an apparent conflict between a one- to two-step task
limitation and the lower demands of Level Two Reasoning. Rounds v. Comm 'r Soc. Sec. Admin.,
807 F.3d 996, 1003 (9th Cir. 2015). Dr. Rethinger and Dr. Madison both identified restrictions
related to simple, repetitive work, and Dr. Rethinger specifically recommended a one- to two-step
task limitation. The apparent conflict between these restrictions and the reasoning requirements of
call center worker and sales associate prevents me from determining whether the ALJ' s step five
finding was suppmted by substantial evidence.
Second, the RFC contains no adjustments for plaintiffs mental limitations regarding social
functioning. In the section of the opinion addressing RFC, the only discussion oflimitations tied to

2

The Dictionary of Occupational Titles assigns each job a General Educational
Development score, one component of which is Reasoning Development. Dictionaiy of
Occupational Titles app. C §III (4th ed. 1991), 1991WL688702.
Page 10 - OPINION AND ORDER

depression, anxiety, or PTSD is the ALJ's reiteration these problems are not severe. Tr. 24. In
assessing RFC, an ALJ is bound to consider limitations and restrictions imposed by all of an
individual's impairments, even those deemed not severe. Burch, 400 F.3d at 683 (citing Social
Security Ruling 96-8p); 20 C.F.R. § 404.1545(a)(2). A proper function-by-function analysis must
explain why the RFC contains no limitations related to a medically determinable impairment. It is
not clear how moderate limitations in social functioning (as reflected in the Dr. Huggins's opinion)
or severe limitations in social functioning (as reflected in Dr. Madison's opinion) would translate
into RFC limitations or restrict plaintiffs ability to perform the identified jobs. Because I cannot
conclude the step two error was harmless, the Commissioner's decision must be remanded.
IL

Treatment ofDr. Lee's Opinion

Plaintiff also asserts the ALJ ened in giving little weight to the opinion of Harold G. Lee,
M.D. Dr. Lee treated plaintiff over the course of more than two years, primarily for complaints
related to ve1tigo and migraines. Tr. 429-48, 566-75. In the months preceding plaintiffs resignation
from her job, Dr. Lee authorized time off from work as a result of these conditions. E.g. Tr. 566.
Dr. Lee completed a medical source statement in August 2013. He explained plaintiff suffers from
"frequent" and "unpredictable" migraine and ve1tigo attacks. Tr. 581. He opined these attacks
would preclude her from "sustaining even a simple routine and sedentmy job on an ongoing basis,"
and predicted the attacks would cause "more than three to four" absences per month. Tr. 581. The
ALJ found Dr. Lee's opinion "inconsistent with the clinical findings" and gave it little weight. Tr.
25.
To reject the uncontested opinion of a treating or examining doctor, the ALJ must present
elem· and convincing reasons. Bayliss v. Barnhart, 427 F.3d 1211, 1216 (9th Cir. 2005) (citing

Lester, 81 F.3d at 830-31). If the opinion is contradicted by another doctor's opinion, it may be
rejected only for specific and legitimate reasons. Lester, 81 F.3d at 830-31. Assuming without
deciding there is a conflict between Dr. Lee's opinion and other medical evidence in the record, the
ALJ's blanket statement regarding inconsistency with other evidence is insufficiently specific. The
Page 11 - OPINION AND ORDER

ALJ did not point to any specific portions of the record that conflicted with Dr. Lee's opinions
regarding plaintiffs vetiigo and migraines, and no such conflicts are apparent to this Court. To the
extent the ALJ relied on clinical findings demonstrating mild problems with balance, he failed to
address the episodic nature of plaintiffs vetiigo as documented in Dr. Lee's treatment notes.
Plaintiff asks this Court to credit as true Dr. Lee's opinion she would be absent from work
more than three to four days per month and remand for an immediate award of benefits. The
"ordinary remand rule" requires a court to remand for further proceedings unless a ce11ain set of
criteria are met. Treichler v. Comm. ofSoc. Sec. Admin., 775 F.3d 1090, 1099 (9th Cir. 2014). In
this case, remand for further proceedings is the correct course because I caIB1ot conclude "further
administrative proceedings would serve no useful purpose." Brown-Hunter v. Colvin, 806 F.3d 487,
495 (9th Cir. 2015). It is unclear how Dr. Lee assessed plaintiffs level of absenteeism. Nothing in
his treatment notes documents the frequency of attacks, and Dr. Lee did not disaggregate absences
due to migraines (which, as the ALJ noted, plaintiff appears to treat with over-the-counter
medication, Tr. 49) from absences due to vertigo. I conclude remand on an open record is
appropriate to assess the credibility of Dr. Lee's absenteeism prediction.
CONCLUSION

The decision ofthe Commissioner is REVERSED and REMANDED for further proceedings.
On remand, the ALJ must (1) at step two, deem plaintiffs PTSD, anxiety, and depression a "severe"
combination of impairments; (2) address and resolve conflicts in the medical evidence regarding the
extent of limitations stemming from plaintiffs mental impairments, including specifically
discussing Dr. Madison's September Letter; (3) in formulating the RFC, expressly consider the
limitations caused by the mental impaitments; (4) adequately address Dr. Lee's opinion, including
supplementing the record if necessary; and (5) at step five, resolve any conflicts between Reasoning
Level and limitations in the RFC related to concentration, persistence, or pace.

Page 12 - OPINION AND ORDER

IT IS SO ORDERED.
Dated thi~ day of March 2016.

Ann Aiken
United States District Judge

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