Coates v. Colvin
ORDER REVERSING AND REMANDING DEFENDANT'S DECISION TO DENY BENEFITS, Nancy A. Berryhill (Acting Commissioner of Social Security) added. Carolyn W. Colvin (Acting Commissioner of Social Security) terminated.Signed by Judge Robert J. Bryan. (JL)
UNITED STATES DISTRICT COURT
WESTERN DISTRICT OF WASHINGTON
Case No. 2:16-cv-01322-RJB
ORDER REVERSING AND
DECISION TO DENY BENEFITS
NANCY A. BERRYHILL, Acting
11 Commissioner of Social Security,
Plaintiff Faith Coates seeks review of the denial of her applications for disability
14 insurance and supplemental security income (“SSI”) benefits. Plaintiff contends that the
15 administrative law judge (“ALJ”) erred by failing to develop the record, in evaluating the
16 medical evidence, and in assessing her residual functional capacity (“RFC”). Dkt. 9 at 1. As
17 discussed below, the Court REVERSES Defendant Commissioner Nancy A. Berryhill’s (“the
18 Commissioner”) final decision and REMANDS the case for further administrative proceedings.
On October 4, 2012, plaintiff protectively filed applications for disability insurance and
Nancy A. Berryhill is now the Acting Commissioner of the Social Security Administration.
Pursuant to Federal Rule of Civil Procedure 25(d), Nancy A. Berryhill is substituted for Carolyn
23 W. Colvin as defendant in this suit. The Clerk is directed to update the docket, and all future
filings by the parties should reflect this change.
ORDER - 1
1 SSI benefits, alleging disability as of December 31, 2008. Dkt. 7, Administrative Record (“AR”)
2 18. Plaintiff’s applications were denied initially and on reconsideration. Id. After the ALJ
3 conducted a hearing on July 31, 2014, the ALJ issued a decision finding plaintiff not disabled.
4 AR 18-28.
THE ALJ’S DECISION
Utilizing the five-step disability evaluation process,2 the ALJ found:
Step one: Plaintiff has not engaged in substantial gainful activity since December 31,
2008, the alleged onset date.
Step two: Plaintiff has the following severe impairments: obesity, degenerative disc
disease, affective disorder, and borderline intellectual functioning.
Step three: Plaintiff’s impairments do not meet or equal the requirements of a listed
RFC: Plaintiff has the ability to perform sedentary work except she can climb ramps and
stairs occasionally, but never scaffolding, ropes, or ladders. She can occasionally stoop
and never kneel, crouch, or crawl. She is able to perform unskilled, simple, routine work
tasks with customary breaks and lunch. She can have frequent contact with coworkers,
but primary work tasks should require no more than occasional collaborative work tasks.
She cannot perform production-rate work. She needs one additional break of customary
Step four: Plaintiff is unable to perform any past relevant work.
Step five: As there are jobs that exist in significant numbers in the national economy that
plaintiff can perform, plaintiff has not disabled from December 31, 2008, through the
date of the decision.
See AR 18-28. The Appeals Council denied plaintiff’s request for review, making the ALJ’s
decision the Commissioner’s final decision. See AR 1-6.4
20 C.F.R. § 416.920.
20 C.F.R. Part 404, Subpart P, Appendix 1.
The rest of the procedural history is not relevant to the outcome of the case and is thus omitted.
ORDER - 2
Pursuant to 42 U.S.C. § 405(g), this Court may set aside the Commissioner’s denial of
2 social security benefits if the ALJ’s findings are based on legal error or not supported by
3 substantial evidence in the record as a whole. Bayliss v. Barnhart, 427 F.3d 1211, 1214 n.1 (9th
4 Cir. 2005) (citing Tidwell v. Apfel, 161 F.3d 599, 601 (9th Cir. 1999)).
Plaintiff asserts that the ALJ erred by failing to develop the record regarding plaintiff’s
The ALJ’s Duty to Develop the Record
7 mental functional capabilities. See Dkt. 9 at 3-6. The Court agrees.
An ALJ has the duty “to fully and fairly develop the record and to assure that the
9 claimant’s interests are considered.” Tonapetyan v. Halter, 242 F.3d 1144, 1150 (9th Cir. 2001).
10 An ALJ’s duty to further develop the evidence in the record is triggered when the record contains
11 ambiguous evidence or when it “is inadequate to allow for proper evaluation of the evidence.”
12 See id.; Mayes v. Massanari, 276 F.3d 453, 459 (9th Cir. 2001). When a claimant is
13 unrepresented, “the ALJ must be especially diligent in exploring for all the relevant facts.” See
14 Tonapetyan, 242 F.3d at 1150. Furthermore, the ALJ’s duty to develop the record is “also
15 heightened where the claimant may be mentally ill and thus unable to protect her own interests.”
16 See id. at 1150-51.
Here, the ALJ found that plaintiff had the severe impairments of affective disorder and
18 borderline intellectual functioning. See AR 20. However, the record contained only two
19 examining physicians’ opinions that assessed plaintiff’s mental functional limitations, and the
20 ALJ rejected both opinions. See AR 25-26. The ALJ assessed plaintiff with an RFC containing
21 some mental functional limitations but did not explain how he chose those particular limitations.5
The ALJ rejected plaintiff’s testimony regarding her mental health because of plaintiff’s lack of
mental health treatment. See AR 24.
ORDER - 3
1 See AR 25.
Therefore, it appears that the ALJ’s findings were based solely on the ALJ’s own lay
3 interpretation of plaintiff’s treatment records, which is not permissible. See Gonzalez Perez v.
4 Sec’y, Health & Human Services, 812 F.2d 747, 749 (1st Cir. 1987) (ALJ may not “substitute his
5 own layman’s opinion for the findings and opinion of a physician”). To the extent the ALJ found
6 the examining physicians’ opinions inadequate, the ALJ should have had another physician
7 examine plaintiff to assess her mental abilities or called a medical expert to assist in determining
8 the extent to which the medical records reflected any limitation on plaintiff’s ability to work. See
9 Mayes, 276 F.3d at 459-60. This duty was heightened in this case because plaintiff was
10 unrepresented and diagnosed with mental impairments. See AR 35, 395-405, 422-28. Moreover,
11 the examining physicians both recommended further memory and intelligence testing. See AR
12 397, 424. Therefore, the ALJ erred by failing to further develop the record when it was
13 inadequate to allow for proper evaluation of the evidence.
Plaintiff also alleges that the ALJ erred in evaluating the medical evidence in the record
Remand for Further Administrative Proceedings
16 and assessing her RFC. See Dkt. 9. However, the medical record and RFC must be re-assessed
17 on remand due to the ALJ’s error in failing to develop the record regarding plaintiff’s mental
18 functional capabilities.
The Court may remand this case “either for additional evidence and findings or to award
20 benefits.” Smolen v. Chater, 80 F.3d 1273, 1292 (9th Cir. 1996). Generally, when the Court
21 reverses an ALJ’s decision, “the proper course, except in rare circumstances, is to remand to the
22 agency for additional investigation or explanation” unless it is clear from the record that the
23 claimant cannot “perform gainful employment in the national economy.” Benecke v. Barnhart,
ORDER - 4
1 379 F.3d 587, 595 (9th Cir. 2004). Here, issues still remain regarding plaintiff’s mental
2 functional capacity and her ability to perform work despite any additional assessed limitations.
3 Accordingly, remand for further consideration is warranted in this matter.
For the foregoing reasons, the Commissioner’s final decision is REVERSED and this
6 case is REMANDED for further administrative proceedings under sentence four of 42 U.S.C. §
DATED this 8th day of February, 2017.
ROBERT J. BRYAN
United States District Judge
ORDER - 5
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