Court: District Court, D. Arizona; December 28, 2017; Federal District Court
Diane Carol Roberts has appealed the Social Security Administration's denial of her application for supplemental security income, with jurisdiction established under 42 U.S.C. 405(g) and 1383(c). The Court, having received consent for U.S. Magistrate Judge jurisdiction, reviewed the Administrative Record and determined that the Administrative Law Judge (ALJ) made a harmful legal error. Consequently, the Court reversed the ALJ's decision and remanded the case for an immediate award of benefits.
The excerpt outlines the legal standards governing disability analysis under the Social Security Act, which provides benefits to individuals who are aged, blind, or disabled with limited income. To qualify, a claimant must demonstrate a medically determinable impairment that significantly restricts substantial gainful activity and is expected to last for at least 12 months.
The sequential five-step evaluation process performed by the ALJ includes:
1. **Step One**: Determines if the claimant is engaged in substantial gainful activity; if so, benefits are denied.
2. **Step Two**: Assesses whether the claimant has a medically severe impairment; a lack of severity results in denial of benefits.
3. **Step Three**: Compares the impairment to listed impairments acknowledged as disabling; if matched, the claimant is presumed disabled.
4. **Step Four**: Evaluates if the claimant can perform past relevant work; if they can, benefits are denied.
5. **Step Five**: Shifts the burden to the Commissioner to show that the claimant can perform other work available in the national economy based on their residual functional capacity, age, education, and work experience.
This structured approach ensures a thorough assessment of the claimant’s eligibility for disability benefits.
An ALJ's decision must be upheld if it is supported by substantial evidence and adheres to correct legal standards. "Substantial evidence" is defined as more than a mere scintilla but less than a preponderance, comprising relevant evidence that a reasonable mind could accept as adequate to support a conclusion. The Court evaluates the entire record, considering both supportive and contradictory evidence, and cannot substitute its judgment for that of the ALJ if substantial evidence exists to support the latter's determination. When evidence allows for multiple rational interpretations, the ALJ's conclusion prevails. The ALJ is responsible for resolving evidence conflicts and determining credibility. Errors made by the ALJ do not require remand if they are deemed harmless, meaning they do not affect the ultimate nondisability determination.
The plaintiff, born in 1962 with no past relevant work, applied for supplemental security income in October 2014, claiming inability to work due to major depression and anxiety since March 31, 2001. The onset date was later amended to October 14, 2014. The Social Security Administration denied the application in March 2015, with a subsequent affirmation in September 2015 after reconsideration. Following a hearing in July 2016, the ALJ issued a decision on September 19, 2016, concluding that the plaintiff was not disabled according to the Social Security Act. The Appeals Council denied further review, rendering the ALJ's decision final. On January 20, 2017, the plaintiff filed a Complaint seeking judicial review and reversal of the ALJ's decision.
In the five-step disability analysis, the ALJ found that the plaintiff had not engaged in substantial gainful activity since the alleged onset date. The presence of severe impairments—including osteoarthritis, anxiety disorder, affective disorder (depression), and personality disorder—was confirmed and remains undisputed. The ALJ also determined that the plaintiff did not have an impairment that meets or medically equals any listed in the relevant regulations, a determination that was not challenged by either party.
The ALJ determined that the Plaintiff has the residual functional capacity (RFC) to perform light work, allowing for unlimited sitting, standing for up to 6 hours with breaks, and walking for 6 hours with breaks. The Plaintiff can frequently reach and handle objects bilaterally, climb ramps and stairs frequently, but can only occasionally climb ladders or scaffolds, and should avoid unprotected heights. The Plaintiff can maintain attention and carry out simple instructions, with occasional interaction with coworkers and the public. With no past relevant work, the ALJ proceeded to Step Five, concluding that the Plaintiff could perform jobs such as cashier, document preparer, and addressing clerk, based on the RFC and Vocational Expert testimony.
The Plaintiff contests the ALJ's decision, particularly regarding the treatment of Dr. Diane Papke's opinions, the Plaintiff's treating psychiatrist. The ALJ is required to provide clear, convincing reasons supported by substantial evidence to reject a treating or examining physician's uncontradicted opinion. Dr. Papke's assessment indicated "moderately severe" to "severe" limitations in various mental capacities and noted that psychiatric symptoms would significantly impact work sustainability. Despite this, the ALJ assigned only "partial weight" to her assessment, arguing it lacked consistency with Dr. Papke's treatment notes and findings. The ALJ cited discrepancies regarding medication side effects in the context of Dr. Papke's notes not supporting the severity claimed.
There is a lack of evidence supporting the claim that the Plaintiff's medications cause side effects, as Dr. Papke's treatment notes indicate that the Plaintiff did not report any such effects. The Court finds substantial evidence backing the Administrative Law Judge's (ALJ) decision to reject Dr. Papke's assertion that these medications impose "moderately severe" limitations. However, the Court criticizes the ALJ for failing to provide valid reasons to discount Dr. Papke's other opinions.
The ALJ's interpretation of a 2015 treatment note, which suggested that the Plaintiff felt better with an increased dosage and experienced improved sleep and mood, is deemed a mischaracterization. The actual note indicated that the Plaintiff's mood was still depressed and dysphoric, with low energy and blunted affect. The Court emphasizes that improvement in mental health symptoms does not negate the existence of serious impairments affecting workplace functionality, as observed in relevant case law.
Additionally, the ALJ's claim that Dr. Papke's opinions were overly sympathetic and based on the Plaintiff's subjective complaints rather than objective findings is considered insufficient. The Court notes that Dr. Papke's professional judgment was not shown to be impaired by sympathy, and the commentary on the purpose of medical reports does not justify their rejection. The Court asserts that medical findings should carry equal weight regardless of their procurement context, rejecting any presumption that doctors may provide biased assessments to benefit their patients in disability claims.
Dr. Papke's treatment notes show consistent mental status examinations at every appointment, and she indicated that her opinions regarding the Plaintiff's limitations were based on objective clinical findings rather than subjective complaints. The ALJ discounted Dr. Papke's opinions but did not provide substantial objective evidence to support this decision, as required by the Ninth Circuit's precedent. Specifically, the ALJ failed to demonstrate the Plaintiff's lack of credibility based on substantial evidence. Additionally, the ALJ incorrectly interpreted Dr. Papke's opinion on the Plaintiff's ability to work as an ultimate disability determination, which is reserved for the Commissioner. The Court determined that while the ALJ appropriately discounted Dr. Papke’s opinion on medication side effects, the rejection of her other opinions was not supported by substantial evidence, necessitating a remand for further proceedings. The Ninth Circuit’s "credit-as-true" rule outlines that remand for benefits is warranted when (1) the ALJ fails to provide sufficient reasons for rejecting evidence, (2) the record is fully developed without outstanding issues, or (3) further proceedings would be useful. The Court found that further proceedings were not useful in this case due to the ALJ's errors.
The court evaluated whether, if certain discredited evidence were accepted as true, the Administrative Law Judge (ALJ) would be mandated to find the claimant disabled upon remand. It noted that if a claimant fails to meet any criteria of the "credit-as-true" rule, the court need not assess the other criteria. Despite potentially satisfying all three factors of the rule, a court has discretion to either remand for further evidence or directly award benefits when serious doubts about the claimant’s disability exist per the Social Security Act.
In this case, the court determined that there were no unresolved factual issues and that Dr. Papke's assessment indicated the claimant would be off task for over 21% of a workday, conflicting with the vocational expert's testimony that only 10% off-task time would be acceptable for employment. The court concluded that, if Dr. Papke's opinions were credited, the ALJ must find the claimant disabled and found no evidence to doubt this conclusion. The court criticized the notion of allowing the Commissioner a second chance to contest the claim, likening it to an unfair game. Consequently, it ordered an immediate award of benefits effective from the claimant's disability onset date of October 14, 2014, reversing the Commissioner's decision and directing judgment accordingly. Additionally, it clarified that the specific and legitimate standard applies to Dr. Papke’s opinions since they were contradicted by other acceptable medical sources. The court dismissed the defendant's reliance on an unpublished decision as only persuasive and not binding.
