LaChapelle-Banks v. Colvin

Filing 12

ORDER REVERSING and REMANDING this matter for further administrative proceedings; signed by Judge Ronald B. Leighton. (DN)

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1 2 3 UNITED STATES DISTRICT COURT WESTERN DISTRICT OF WASHINGTON AT TACOMA 4 5 6 TERI JEAN LACHAPELLE-BANKS, 7 Plaintiff, 8 9 Case No. 2:16-cv-01956-RBL v. NANCY A. BERRYHILL, Acting Commissioner of Social Security, ORDER REVERSING AND REMANDING DEFENDANT’S DECISION TO DENY BENEFITS 10 Defendant. 11 12 THIS MATTER is before the Court on Plaintiff LaChapelle-Banks’ Complaint [Dkt. 3] 13 for review of the Social Security Commissioner’s denial of her application for disability 14 15 16 insurance benefits. LaChapelle-Banks suffers from lumbar sprain/strain, status post laminectomy, and colitis 17 or Crohn’s disease. See Dkt. 7, Administrative Record 11. She applied for disability insurance 18 benefits in September 2013, alleging she became disabled beginning in July 2013. See AR 9. 19 20 That application was denied upon initial administrative review and on reconsideration. See id. A hearing was held before Administrative Law Judge Timothy Mangrum in January 2015. See id. 21 22 23 24 LaChapelle-Banks, represented by counsel, appeared and testified, as did a vocational expert. See AR 28-69. The ALJ determined LaChapelle-Banks not to be disabled. See AR 6-27. The Appeals 25 Council denied LaChapelle-Banks’ request for review, making the ALJ’s decision the final 26 decision of the Commissioner of Social Security. See AR 1-4; 20 C.F.R. § 404.981. In January ORDER - 1 1 2017, LaChapelle-Banks filed a complaint seeking judicial review of the Commissioner’s 2 decision. See Dkt. 3. 3 4 LaChapelle-Banks argues the Commissioner’s decision to deny benefits should be reversed and remanded for an immediate award of benefits, or for further administrative 5 proceedings, because the ALJ erred in evaluating the medical evidence in the record and in 6 7 8 9 finding at step five of the sequential evaluation process that LaChapelle-Banks could perform work available in the national economy. The Commissioner argues the ALJ did not err in evaluating the medical evidence, so the 10 ALJ’s finding that LaChapelle-Banks was not disabled was supported by substantial evidence 11 and should be affirmed. 12 I. DISCUSSION 13 The Commissioner’s determination that a claimant is not disabled must be upheld by the 14 15 Court if the Commissioner applied the “proper legal standards” and if “substantial evidence in 16 the record as a whole supports” that determination. See Hoffman v. Heckler, 785 F.2d 1423, 1425 17 (9th Cir. 1986); see also Batson v. Comm’r, Soc. Sec. Admin., 359 F.3d 1190, 1193 (9th Cir. 18 2004); Carr v. Sullivan, 772 F.Supp. 522, 525 (E.D. Wash. 1991) (“A decision supported by 19 20 substantial evidence will, nevertheless, be set aside if the proper legal standards were not applied in weighing the evidence and making the decision.”) (citing Brawner v. Sec’y of Health and 21 22 23 Human Services, 839 F.2d 432, 433 (9th Cir. 1987)). Substantial evidence is “such relevant evidence as a reasonable mind might accept as 24 adequate to support a conclusion.” Richardson v. Perales, 402 U.S. 389, 401 (1971) (citation 25 omitted); see also Batson, 359 F.3d at 1193 (“[T]he Commissioner’s findings are upheld if 26 supported by inferences reasonably drawn from the record.”). “The substantial evidence test ORDER - 2 1 requires that the reviewing court determine” whether the Commissioner’s decision is “supported 2 by more than a scintilla of evidence, although less than a preponderance of the evidence is 3 required.” Sorenson v. Weinberger, 514 F.2d 1112, 1119 n.10 (9th Cir. 1975). “If the evidence 4 admits of more than one rational interpretation,” the Commissioner’s decision must be upheld. 5 Allen v. Heckler, 749 F.2d 577, 579 (9th Cir. 1984) (“Where there is conflicting evidence 6 7 sufficient to support either outcome, we must affirm the decision actually made.”) (quoting 8 Rhinehart v. Finch, 438 F.2d 920, 921 (9th Cir. 1971)).1 9 A. 10 11 12 The Medical Evidence in the Record. The ALJ determines credibility and resolves ambiguities and conflicts in the medical evidence. See Reddick v. Chater, 157 F.3d 715, 722 (9th Cir. 1998). Where the medical evidence in the record is not conclusive, “questions of credibility and resolution of conflicts” are solely the 13 functions of the ALJ. Sample v. Schweiker, 694 F.2d 639, 642 (9th Cir. 1982). In such cases, “the 14 15 ALJ’s conclusion must be upheld.” Morgan v. Comm’r, Soc. Sec. Admin., 169 F.3d 595, 601 (9th 16 Cir. 1999). Determining whether inconsistencies in the medical evidence “are material (or are in 17 fact inconsistencies at all) and whether certain factors are relevant to discount” the opinions of 18 medical experts “falls within this responsibility.” Id. at 603. 19 20 In resolving questions of credibility and conflicts in the evidence, an ALJ’s findings “must be supported by specific, cogent reasons.” Reddick, 157 F.3d at 725. The ALJ can do this 21 22 1 23 24 25 26 As the Ninth Circuit has further explained: . . . It is immaterial that the evidence in a case would permit a different conclusion than that which the [Commissioner] reached. If the [Commissioner]’s findings are supported by substantial evidence, the courts are required to accept them. It is the function of the [Commissioner], and not the courts to resolve conflicts in the evidence. While the court may not try the case de novo, neither may it abdicate its traditional function of review. It must scrutinize the record as a whole to determine whether the [Commissioner]’s conclusions are rational. If they are . . . they must be upheld. Sorenson, 514 F.2d at 1119 n.10. ORDER - 3 1 “by setting out a detailed and thorough summary of the facts and conflicting clinical evidence, 2 stating his interpretation thereof, and making findings.” Id. The ALJ also may draw inferences 3 “logically flowing from the evidence.” Sample, 694 F.2d at 642. Further, the Court may draw 4 “specific and legitimate inferences from the ALJ’s opinion.” Magallanes v. Bowen, 881 F.2d 5 747, 755 (9th Cir. 1989). 6 7 The ALJ must provide “clear and convincing” reasons for rejecting the uncontradicted 8 opinion of a treating physician. Lester v. Chater, 81 F.3d 821, 830 (9th Cir. 1996). Even when a 9 treating physician’s opinion is contradicted, that opinion “can only be rejected for specific and 10 legitimate reasons that are supported by substantial evidence in the record.” Id. at 830-31. In 11 general, more weight is given to a treating physician’s opinion than to the opinions of those who 12 do not treat the claimant. See id. at 830. 13 LaChapelle-Banks argues the ALJ erred by failing to give a specific and legitimate 14 15 16 reason supported by substantial evidence to discount the opinion of treating physician Friedrich Loura, M.D. See Dkt. 9 at 5-11. The Court agrees. 17 Loura began treating LaChapelle-Banks for abdominal pain in November 2012 and 18 diagnosed her with Crohn’s disease of the small bowel with possible enterovesical fistula healing 19 20 in March 2013. See AR 693, 698-99. Loura identified LaChapelle-Banks’ symptoms as nausea, abdominal pain and cramping, malaise, fatigue, frequent vomiting, abdominal distention, and 21 22 23 fistulas resulting in feces in urine. See AR 693. In January 2015, Loura completed a residual functional capacity questionnaire. See AR 693-95. In the questionnaire, Loura opined that, 24 because of LaChapelle-Banks’ impairments, she would be capable of only low-stress jobs, would 25 need to shift positions from sitting to standing at will, and would need ready access to a 26 restroom, and would sometimes need unscheduled restroom breaks. See AR 694. Loura stated ORDER - 4 1 LaChapelle-Banks’ symptoms would frequently interfere with the attention and concentration 2 needed to perform even simple work tasks. See id. Loura stated that the episodic aspects of 3 LaChapelle-Banks’ impairments were random in nature, severity, duration, and frequency. See 4 AR 693. Ultimately, Loura opined LaChapelle-Banks would be likely to be absent from work 5 because of her impairments or treatment about four days a month. See AR 695. The ALJ gave 6 7 8 9 Loura’s opinion little weight for several reasons, none of which is specific, legitimate, and supported by substantial evidence. See AR 18-19. First, the ALJ found Loura’s opinion was vague, noting Loura did not specify how 10 frequently or for how long LaChapelle-Banks would need to take unscheduled restroom breaks. 11 See AR 18. Loura stated LaChapelle-Banks would “sometimes” need to take unscheduled 12 restroom breaks, but he declined to state how often or for how long, presumably due to the 13 “random” nature of her symptoms. See AR 693-94. Loura’s inability to predict with any certainty 14 15 the frequency or duration of the breaks is not alone a legitimate reason for the ALJ to discount 16 the necessity of the breaks entirely and to assess LaChapelle-Banks with an RFC containing no 17 allowances for unscheduled restroom breaks. See AR 13; see also Vincent on Behalf of Vincent v. 18 Heckler, 739 F.2d 1393, 1394-95 (9th Cir. 1984) (stating that the ALJ must explain why 19 20 “significant probative evidence has been rejected”). Furthermore, the rest of the limitations to which Loura opined, including needing to shift positions and being absent about four days a 21 22 23 month, were not vague. See AR 693-95. Next, the ALJ stated Loura’s opinion was “inconsistent with the totality of the evidence.” 24 See AR 18. This reason is not sufficiently specific, particulary because the ALJ cited no 25 examples. See id. It is insufficient for an ALJ to reject the opinion of a treating physician by 26 merely stating, without more, that there is a lack of objective medical evidence in the record to ORDER - 5 1 support that opinion. See Embrey v. Bowen, 849 F.2d 418, 421 (9th Cir. 1988). “[A]n ALJ errs 2 when he rejects a medical opinion or assigns it little weight while doing nothing more than 3 ignoring it, asserting without explanation that another medical opinion is more persuasive, or 4 criticizing it with boilerplate language that fails to offer a substantive basis for his conclusion.” 5 Garrison v. Colvin, 759 F.3d 995, 1012-13 (9th Cir. 2014) (citing Nguyen v. Chater, 100 F.3d 6 7 1462, 1464 (9th Cir. 1996)). The ALJ also discounted Loura’s opinion because LaChapelle-Banks’ Crohn’s disease 8 9 symptoms allegedly improved with medication and without need for surgery. See AR 18. 10 However, the records cited by the ALJ to support this alleged improvement are from 11 LaChapelle-Banks’ hospitalizations in 2014 due to Crohn’s flare-ups. See AR 18, 657, 659-79. 12 The records indicate LaChapelle-Banks came to the emergency room complaining of nausea, 13 vomiting, and abdominal pain, which a physician attributed to her Crohn’s disease and fistula. 14 15 See AR 659. While that physician noted LaChapelle-Banks’ symptoms “improved with 16 antiemetics,” the physician still admitted her to the hospital because she continued to experience 17 nausea and would benefit from a nasogastric tube. See id. LaChapelle-Banks was later 18 discharged but returned to the hospital two weeks later with recurring symptoms. See AR 660. A 19 20 physician noted surgical repair of the fistula might be necessary. See AR 669. LaChapelle-Banks was restarted on steroids, which improved her symptoms until she returned to the hospital two 21 22 23 weeks later, in the middle of her steroid regimen, complaining of recurring symptoms. See AR 675. These records, rather than showing any improvement that would discredit Loura’s opinion, 24 in fact support Loura’s opinion that LaChapelle-Banks’ impairments and treatment would cause 25 significant absenteeism. 26 // ORDER - 6 1 Next, the ALJ noted Loura believed LaChapelle-Banks had a good prognosis. See AR 18. 2 However, whatever Loura meant by a “good” prognosis, which was unquantified, does not 3 change his specific opinion regarding the functional limitations resulting from LaChapelle- 4 Banks’ impairments, which Loura found had lasted or were expected to last at least 12 months. 5 See AR 693-94. 6 7 Finally, the ALJ noted LaChapelle-Banks testified she was “able to assist her neighbor 8 with activities of daily living at least several days a week.” See AR 18-19. An ALJ may reject a 9 physician’s opinion in part because other evidence of the claimant’s ability to function 10 contradicts that opinion. See Morgan, 169 F.3d at 601-02. However, LaChapelle-Banks’ 11 testimony, viewed in full context, does not contradict Loura’s opinion. LaChapelle-Banks 12 testified that she cared for her neighbor about 13 hours a week. See AR 33. She noted she did not 13 have to do any heavy physical transfers. See AR 37. She testified that her husband accompanied 14 15 her 90% of the time and that he would carry the laundry basket and the groceries because she 16 was unable. See AR 37-38. LaChapelle-Banks testified that her schedule was very flexible and 17 that if she was having a “particularly rough day,” she did not have to go. See AR 38. This 18 testimony does not contradict Loura’s opinion regarding LaChapelle-Banks’ functional 19 20 limitations and absenteeism. Therefore, the ALJ erred by failing to provide a specific and legitimate reason supported by substantial evidence for discounting Loura’s opinion. 21 22 23 “[H]armless error principles apply in the Social Security context.” Molina v. Astrue, 674 F.3d 1104, 1115 (9th Cir. 2012). An error is harmless, however, only if it is not prejudicial to the 24 claimant or “inconsequential” to the ALJ’s “ultimate nondisability determination.” Stout v. 25 Comm’r, Soc. Sec. Admin., 454 F.3d 1050, 1055 (9th Cir. 2006); see Molina, 674 F.3d at 1115. 26 The determination on whether an error is harmless requires a “case-specific application of ORDER - 7 1 judgment” by the reviewing court, based on an examination of the record made “‘without regard 2 to errors’ that do not affect the parties’ ‘substantial rights.’” Molina, 674 F.3d at 1118-19 3 (quoting Shinseki v. Sanders, 556 U.S. 396, 407 (2009)). Had the ALJ fully credited Loura’s 4 opinion, the RFC would have included additional limitations, as would the hypothetical 5 questions posed to the vocational expert. For example, Loura stated LaChapelle-Banks would 6 7 miss about four days of work a month, but the vocational expert testified that employers would 8 only tolerate half a day of absenteeism a month. See AR 66, 695. Therefore, the ALJ’s error 9 affected the ultimate disability determination and is not harmless. 10 B. 11 12 Scope of Remand. The Court may remand a case “either for additional evidence and findings or to award benefits.” Smolen v. Chater, 80 F.3d 1273, 1292 (9th Cir. 1996). When the Court reverses an 13 ALJ’s decision, “the proper course, except in rare circumstances, is to remand to the agency for 14 15 additional investigation or explanation.” Benecke v. Barnhart, 379 F.3d 587, 595 (9th Cir. 2004) 16 (citations omitted). It is “the unusual case in which it is clear from the record that the claimant is 17 unable to perform gainful employment in the national economy,” that “remand for an immediate 18 award of benefits is appropriate.” Id. 19 20 Benefits may be awarded where “the record has been fully developed” and “further administrative proceedings would serve no useful purpose.” Smolen, 80 F.3d at 1292; Holohan v. 21 22 Massanari, 246 F.3d 1195, 1210 (9th Cir. 2001). Specifically, benefits should be awarded where: (1) the ALJ has failed to provide legally sufficient reasons for rejecting [the claimant’s] evidence, (2) there are no outstanding issues that must be resolved before a determination of disability can be made, and (3) it is clear from the record that the ALJ would be required to find the claimant disabled were such evidence credited. 23 24 25 26 // ORDER - 8 1 Smolen, 80 F.3d 1273 at 1292; McCartey v. Massanari, 298 F.3d 1072, 1076-77 (9th Cir. 2002). 2 Here, while the ALJ erred in evaluating Loura’s opinion, issues remain regarding conflicts in the 3 medical opinions over LaChapelle-Banks’ functional capabilities. Remand for further 4 consideration is warranted. 5 CONCLUSION 6 7 The Court finds the ALJ improperly concluded LaChapelle-Banks was not disabled. The 8 Commissioner’s decision to deny benefits is REVERSED, and this matter is REMANDED for 9 further administrative proceedings as detailed in this order. 10 DATED this 7th day of August, 2017. 11 12 13 A 14 15 Ronald B. Leighton United States District Judge 16 17 18 19 20 21 22 23 24 25 26 ORDER - 9

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