Opinion
No. C 03-0835 MJJ.
August 16, 2004
ORDER GRANTING PLAINTIFF'S MOTION FOR SUMMARY JUDGMENT
INTRODUCTION
Before the Court are cross-motions for summary judgment brought by Plaintiff Synithia King and Defendant Jo Anne Barnhardt, Commissioner of Social Security. Plaintiff brings this action pursuant to Section § 205(g) of the Social Security Act ("SSA") and 42 U.S.C. § 405(g), to obtain judicial review of an "unfavorable" final decision by Defendant. For the reasons set forth below, the Court GRANTS Plaintiff's motion and DENIES Defendant's motion.
FACTUAL BACKGROUND
The Social Securities Administration denied Plaintiff's applications for disability insurance benefits and Supplemental Security Income benefits under Title II and Title XVI of the SSA both initially and on reconsideration. Administrative Transcript ("Tr.") 61-77, 47-50, 54-58. A hearing was held on February 20, 2002. Tr. 29-44. On March 26, 2002, the Administrative Law Judge ("ALJ") issued a decision and a determination that Plaintiff had a somatoform disorder and anxiety but found that she was not disabled. Tr. 14-20. Plaintiff commenced this action pursuant to 42 U.S.C. sections 405(g) and 1383(c)(3) to obtain judicial review of the final decision by the Commissioner. Plaintiff's Motion for Summary Judgment and/or Remand ("Plaintiff's Motion") at 1.
Somatoform disorder is characterized by the presence of physical symptoms for which there are no demonstrable organic findings or known physiological mechanisms. 20 C.F.R., Part 404, Subpart P, App. 1, section 12.07.
In September 1999, Plaintiff began seeing treating physician Jerome Franz, M.D., because of "episodic pain and numbness of her left arm and leg since February 1999." Tr. 210. Plaintiff saw Dr. Franz on a monthly basis until December 2001. Tr. 185-200. In October 1999, Dr. Franz diagnosed thoracic myofascial pain with no objective medical findings, and suspected anxiety and somatization. Tr. 212. A December 1999 brain MRI was "essentially unremarkable." Tr. 211. Dr. Franz completed a medical health questionnaire in March 2001 and noted that anxiety triggered Plaintiff's stress, that Plaintiff had recurring problems with social functioning at work and limited adaptability to stresses common to work environments, and that she was likely under stress because authorities had threatened to remove her two-year-old daughter from her care. Tr. 144-145. Subsequently, Dr. Franz diagnosed panic disorder and somatization disorder. Tr. 146.
Jennifer Gallant, Psy.D., first examined Plaintiff on March 26, 2001. Tr. 151. Dr. Gallant reported Plaintiff's cognitive functioning was generally normal, and although Plaintiff was slightly depressed and had some impaired memory and judgment, she was capable of handling her own funds. Tr. 153. Dr. Gallant diagnosed panic disorder and conversion disorder in August 2001. Tr. 148. She stated that her August 2001 report to the Department of Social Services must be read cautiously because Plaintiff had only attended five sessions with her, although Plaintiff had been scheduled for weekly sessions after her referral on February 26, 2001. Tr. 148. Dr. Gallant also recommended that Plaintiff see a psychiatrist. Tr. 148-149.
Dr. Gallant completed a mental disorder assessment in February 2002. Tr. 182-183. She diagnosed conversion disorder and panic disorder without agoraphobia. Tr. 182. Dr. Gallant noted Plaintiff was seen for therapy "about" once a month. Tr. 182. Plaintiff was oriented to place and time, and had normal thought processes Tr. 182. Although Dr. Gallant had referred Plaintiff to a psychiatrist for formal assessment, Plaintiff "did not display interest in having an assessment." Tr. 182. Dr. Gallant's Mental Disorder Assessment set forth three specific significant functional limitations. Tr. 183. Dr. Gallant noted that Plaintiff is markedly limited in her ability to: (1) perform activities within a schedule (involving regular attendance and punctuality); (2) "perform at a consistent pace without an unreasonable number and length of rest periods;" and (3) "tolerate usual stresses encountered in competitive work." Id. These functional assessment limitations were explained with the following: "[c]lient's attendance at work related activities may be impaired due to the difficulty she displays in coming to therapy. She describes numerous physical complaints which may prevent her from attending work and performing activities." Id. The ALJ viewed Dr. Gallant's opinion as limited in value because Dr. Gallant met with Plaintiff on a sporadic basis, about once a month, and because her August report was based on Plaintiff's subjective complaints. Tr. 17.
In May 2001, Ronald Johnson, M.D., examined Plaintiff and diagnosed adjustment disorder with anxious mood, and somatoform disorder. Tr. 155-157. Dr. Johnson found Plaintiff to be of average intelligence, oriented to time and place, with adequate judgment. Tr. 156. From a "purely psychiatric standpoint" he could find no clear evidence of a formal thought disorder, psychotic disorder or obvious organicity in his clinical interview. Tr. 157. Dr. Johnson noted Plaintiff presented a general picture of an anxiety disorder stemming from her life circumstances and affected by her transition from adolescence to adulthood. Tr. 157. Dr. Johnson found that Plaintiff was only moderately limited with respect to her abilities to understand, remember and carry out detailed instructions. Tr. 158. Dr. Johnson did not find that Plaintiff was significantly limited in her ability to maintain regular attendance and punctuality, and complete a normal workday without an unreasonable number and length of rest periods. Id.
State agency physician Danilo Lucila, M.D., examined Plaintiff's mental health records and found that Plaintiff suffered recurrent severe panic attacks and diagnosed anxiety disorder and somatoform disorder. Tr. 173-174, 178. However, he determined Plaintiff suffered only mild functional limitations in the areas of ability to perform activities of daily living, social functioning and maintaining concentration, persistence or pace. Tr. 178.
The ALJ recognized that Plaintiff had severe mental impairments consisting of somatoform disorder and anxiety, but discounted the severity of Plaintiff's complaints. Tr. 19. Although Plaintiff stated that she experienced severe anxiety that caused paralysis of her left side, and that she experienced bloodshot eyes and had blisters on her feet, no health care professional ever observed these symptoms. Id. The most significant finding was a slightly decreased left hand grip. Tr. 17. The ALJ noted that Plaintiff's psychiatric treatment was inconsistent with a serious mental impairment. Tr. 19. Consequently, the ALJ determined that her physical and mental limitations were not so significant as to prevent her from performing her past relevant work as a food server. Tr. 19.
LEGAL STANDARD
Federal Rule of Civil Procedure 56(c) provides, in relevant part, that summary judgment shall be granted "if the pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any, show that there is no genuine issue as to any material fact and that the moving party is entitled to judgment as a matter of law."
The district court's scope of review of an ALJ's decision is limited to the question of whether the decision to deny benefits is supported by substantial evidence and whether proper legal standards were applied. Andrews v. Shalala, 53 F.3d 1035, 1039 (9th Cir. 1995). In reviewing the decision, the district court may consider only the Commissioner's final decision, the evidence in the administrative record on which the decision was based, and the pleadings. 42 U.S.C. § 405(g).
Substantial evidence is more than a scintilla, but less than a preponderance; it is such relevant evidence as a reasonable mind might accept as adequate to support a conclusion. Andrews, 53 F.3d at 1039. The district court may not overturn an ALJ's findings that are supported by substantial evidence, even though other evidence exists that supports the claimant's position. Sandgathe v. Chater, 108 F.3d 978, 980 (9th Cir. 1996). Where evidence is susceptible to more than one rational interpretation, the decision of the ALJ must be upheld. Magallanes v. Bowen, 881 F.2d 747, 750 (9th Cir. 1989).
ANALYSIS
A. Opinions of Treating Physicians Gallant and FranzPlaintiff raises two arguments: (1) the ALJ improperly rejected and discounted the opinions of her treating physicians, and (2) the ALJ improperly discounted Plaintiff's testimony and statements regarding her symptoms. Plaintiff's Motion at 4-5.
Plaintiff argues that the ALJ improperly discounted Dr. Gallant's opinion that Plaintiff was "markedly limited" in three functions. Plaintiff's Motion at 5. The three functions were: (1) the ability to perform activities within a schedule, maintain regular attendance, and be punctual within customary tolerances; (2) the ability to perform at a constant pace without an unreasonable number and length of rest periods; and (3) the ability to tolerate usual stresses encountered in competitive work. Tr. 183. The opinion of the plaintiff's treating physician is ordinarily entitled to substantial weight. See, e.g., Morgan v. Commissioner, 169 F.3d 595, 600-602 (9th Cir. 1999). The ALJ may reject a treating physician's opinion that is contradicted by another physician's opinion only if the ALJ provides specific and legitimate reasons supported by substantial evidence in the record. Reddick v. Chater, 157 F.3d 715 (9th Cir. 1998). Here, the ALJ noted Dr. Gallant's findings as to Plaintiff's functional capacity were contradicted by Dr. Johnson's findings. Tr. 158. Unlike Dr. Gallant, Dr. Johnson did not find that Plaintiff was markedly limited in her ability to maintain regular attendance and punctuality, and complete a normal workday without an unreasonable number and length of rest periods. Id. Thus, the ALJ was required to provide specific and legitimate reasons supported by the record for rejecting Dr. Gallants opinion.
The ALJ rejected Dr. Gallant's report because it was "primarily based on the claimant's subjective complaints" and such complaints were "unconfirmed by the objective observation of any reporting health professional." Tr. at 19. However, somotoform and somatization disorders are characterized by the absence of objective physical findings to explain a patient's subjective complaints. DSM-IV-TR at 487, 492. Given the nature of this case, this would not amount to substantial evidence in the record to reject Dr. Gallant's opinion. In Reddick v. Chater, after finding that the plaintiff was credible, the court concluded that the ALJ's rejection of a treating physicians' opinions "on the premise that they were based on the subjective complaints of the claimant [was] illsuited to CFS [Chronic Fatigue Syndrome]" because the nature of the illness was evidenced by " self-reported persistent or relapsing fatigue." 157 F.3d 715, 725-726 (9th Cir. 1998) (emphasis in original).
Similarly here, the absence of objective observation of Plaintiff's complaints is consistent with her diagnoses. In particular, Dr. Franz stated that the fact that Plaintiff's physical complaints were not demonstrable during examination, and that Plaintiff complained of pain in multiple body parts, suggested somatization disorder. Tr. 144. Thus, while Dr. Gallant's opinion stands alone in stating Plaintiff is "markedly limited" in certain areas of functioning, rejecting her opinion on the premise that it was based primarily on Plaintiff's subjective complaints is improper unless the Plaintiff's subjective complaints are not credible. As discussed below, the ALJ incorrectly discredited Plaintiff's subjective complaints and thus improperly rejected Dr. Gallant's opinion.
Plaintiff also argues that the ALJ did not consider Dr. Franz's opinion that Plaintiff has limited adaptability to stresses common to work environments. Plaintiff's Motion at 6. The ALJ stated, "[t]he claimant was said to be independent in activities of daily living, and despite limited ability to manage stress she was said to exhibit generally unimpaired family functioning, concentration, and task completion." Id. While the ALJ did consider Dr. Franz's opinion, it also appears that the ALJ mischaracterized Dr. Franz's February 2001 report. Id. For example, the ALJ stated that Dr. Franz found Plaintiff able to manage ADLs independently "despite limited ability to manage stress" and did not mention Dr. Franz's findings that Plaintiff is limited in her ability to adapt to work or work-like environments and had recurrent work problems. Tr. 145. Additionally, the ALJ stated that Dr. Franz found Plaintiff to "exhibit generally unimpaired family functioning and task completion." Tr. 16. Dr. Franz found Plaintiff's family functioning to be generally unimpaired, but he stated Plaintiff's concentration and task completion functions "seemed unimpaired outside of panic attacks." Tr. 145 (emphasis added). Dr. Gallant noted Plaintiff reported having three to four panic attacks a week. Tr. 148.
B. Plaintiff's Subjective Complaints
Plaintiff argues that the ALJ incorrectly discredited her testimony and statements regarding her symptoms and limitations. Because somatoform disorders often lack organic causes and "objective" impairments, the Court recognizes that "complaints of pain cannot be dismissed . . . merely because they stem in part from a psychological abnormality. . . ." 42 U.S.C. section 423(d)(5)(A). When an ALJ determines that a plaintiff's subjective complaints are not credible after the plaintiff has already produced medical evidence of an underlying impairment, the ALJ must identify what testimony is not credible and point to specific evidence undermining the plaintiff's complaints to discredit her testimony. Reddick, 157 F.3d at 722.
In Reddick, the court determined that the ALJ "provided unsatisfactory reasons for discounting [the plaintiff's] credibility . . . [because] his findings were unsupported by substantial evidence based on the record as a whole." Reddick, 157 F.3d at 724. Specifically, the court noted that the ALJ mischaracterized the content and tone of statements and documents in the record to support his conclusion that the plaintiff had exaggerated her symptoms, and did not "fully account for the nature of CFS and its symptoms." Id. at 723.
Here, the ALJ determined that the medical evidence established Plaintiff had severe somotoform disorder and anxiety, but found Plaintiff's complaints of frequent episodes of paralysis to be "unconfirmed by objective observation of any reporting health professional," and inconsistent with the fact that Plaintiff had not required in-patient hospital treatment. Tr. at 19. Similar to the ALJ in Reddick, the ALJ here failed to fully account for the nature of Plaintiff's illness and symptoms by pointing to the lack of physical evidence confirming Plaintiff's subjective complaints to discredit her testimony. As noted above, Plaintiff suffers from an illness "remarkable for the absence of objective findings to fully explain the many subjective complaints." DSM-IV-TR at 487 (2000).
Defendant's reliance upon Sandgrathe v. Chater in support of the argument that an ALJ may disregard a treating physician's opinion which is based on a claimant's properly discounted subjective complaints is misplaced. 108 F.3d 978, 980 (1996). In Sandgrathe, the ALJ met the specific and legitimate reasons standard because the ALJ determined that the claimant's self-reports were exaggerated, and the treating physician's report unreliable as the record indicated the claimant suffered from "`unspecified physical problems'" and that his psychological problems "may have been volitional or affected by his physical impairments." Id.
Here, however, Plaintiff suffers from a diagnosed illness characterized by physical symptoms that are not intentional and subjective complaints that are often "in colorful, exaggerated terms." DSM-IV-TR at 485-486. Also, although the ALJ determined that Plaintiff's complaints of physical pain were unconfirmed, he did not state that she exaggerated her symptoms. Further, in his summarization of physician reports, he pointed out Dr. Johnson's finding of no evidence of conscious misrepresentation. Tr. 17.
Next, the ALJ found Plaintiff's infrequent visits with Dr. Gallant, and refusal to be referred to a psychiatrist, to be inconsistent with the "presence of such disabling symptoms." Tr. 19. However, Dr. Gallant is a psychologist, and as her August 28, 2001 report indicates, the nature of Plaintiff's illness is such that one afflicted with it pursues a "medical cure," not psychological or psychiatric care. Tr. 148. Therefore, Plaintiff's infrequent visits to a psychologist and refusal to undergo psychiatric treatment are not inconsistent with her diagnoses and do not provide adequate support for rejecting Plaintiff's subjective complaints.
Finally, the ALJ also found Plaintiff's complaints to be inconsistent with Dr. Johnson's findings that Plaintiff is capable of daily care of herself and her daughter (which includes simple food preparation). Tr. 19. Specifically, Dr. Johnson reported that Plaintiff was "capable of her daily self-care in terms of basic personal hygiene and neat clean appearance." Tr. 156. However, he also reported a "typical day is difficult to clarify" and that while Plaintiff takes care of her daughter and does some simple food preparation, Plaintiff stated she still was "prone to panic attacks." Tr. 156. Dr. Johnson also noted that her mother drove her to the examination. Tr. 156. Plaintiff's subjective complaints are not inconsistent with this report, particularly given her sister's testimony that when Plaintiff is "ill," her sister assists both Plaintiff and Plaintiff's daughter with daily care, including grooming. Tr. 42. Notably, the ALJ did not provide any reason for discrediting the testimony of Plaintiff's sister.
The above indicates that the ALJ failed to adequately consider the nature of severe somatization and anxiety disorders when discrediting Plaintiff's subjective complaints. Consequently, the ALJ improperly rejected Dr. Gallant's controverted report without providing specific and legitimate reasons supported by substantial evidence in the record for doing so.
CONCLUSION
For the foregoing reasons, Plaintiff's motion for summary judgment is GRANTED and Defendant's motion is DENIED. The case is REMANDED for a re-examination of the record beginning at step three of the five-step sequential process, with proper consideration given to the nature of the disability in question.
IT IS SO ORDERED.
JUDGMENT IN A CIVIL CASE
() Jury Verdict. This action came before the Court for a trial by jury. The issues have been tried and the jury has rendered its verdict.(X) Decision by Court. This action came to trial or hearing before the Court. The issues have been tried or heard and a decision has been rendered.
IT IS SO ORDERED AND ADJUDGED
Plaintiff's Motion for Summary Judgment is granted.