Opinion
For Henry Rodriguez, Plaintiff: Bill LaTour, LEAD ATTORNEY, Law Offices of Bill LaTour, Colton, CA.
For Carolyn W. Colvin, Commissioner of Social Security, Defendant: Assistant U.S. Attorney LA-CV, LEAD ATTORNEY, AUSA - Office of U.S. Attorney, Los Angeles, CA; Assistant U.S. Attorney LA-SSA, LEAD ATTORNEY, Office of the General Counsel for Social Security Adm., San Francisco, CA; Sundeep R Patel, LEAD ATTORNEY, SAUSA - Office of the United States Attorney, San Francisco, CA.
DECISION AND ORDER
CARLA M. WOEHRLE, United States Magistrate Judge.
PROCEEDINGS
On May 30, 2014, Henry Rodriguez (" Plaintiff") filed a Complaint seeking review of the Commissioner's denial of his application for disability insurance benefits. Thereafter, the parties filed a Consent to Proceed Before United States Magistrate Judge Carla Woehrle. On November 24, 2014, Defendant filed an Answer to Complaint. On January 27, 2015, the parties filed their Joint Stipulation.
As discussed below, the Court finds that the Commissioner's decision should be reversed and this matter remanded for further proceedings.
BACKGROUND
On July 14, 2009, Plaintiff filed an application for disability insurance benefits. (Administrative Record [" AR" ] at 170-74.) Plaintiff alleged that, beginning on February 1, 1995, he was unable to work due to seizures, depression, and injuries to his back and head. (AR at 63, 170.) The Commissioner denied Plaintiff's application initially on October 13, 2009. (AR at 63-67.)
On November 19, 2009, Plaintiff requested a hearing before an Administrative Law Judge (" ALJ"). (AR at 68.) The hearing was set for September 14, 2010. (AR at 28-31.) However, neither Plaintiff nor his counsel appeared for the hearing, and, consequently, the ALJ issued an order of dismissal. (AR at 55-59.) Plaintiff asked the Appeals Council to review the ALJ's dismissal, and, on October 17, 2011, the Appeals Council remanded the case for further proceedings. (AR at 60-62.)
The ALJ held a second hearing on May 9, 2012. (AR at 32-41.) Plaintiff appeared at the hearing with his counsel and testified. (AR at 39.) A medical expert also testified. (AR at 35-38.) Proceedings were then continued in order to obtain additional evidence regarding Plaintiff's past work. (AR at 40-41.) A third hearing was held on September 11, 2012. (AR at 42-53.) Plaintiff again appeared with counsel and testified. (AR at 46-51.) A vocational expert also testified. (AR at 51-52.)
On October 19, 2012, the ALJ issued his decision denying benefits. (AR at 14-27.) The issue in this case was whether Plaintiff was disabled at any point during the period between his alleged onset date, February 1, 1995, and his date last insured, March 31, 2007. In his decision, the ALJ determined that, during this time, Plaintiff suffered from the following medically determinable impairments: " status post traumatic fall with complaints of pain, residual right leg weakness, and a seizure disorder; hypertension; diabetes mellitus; right shoulder joint problem; and inguinal hernia, status post repair surgery." (AR at 19.) The ALJ, however, determined that none of these impairments significantly limited Plaintiff's ability to perform basic work-related activities for a period of twelve consecutive months, and, therefore, Plaintiff did not have a " severe" impairment. Id. Ultimately, the ALJ concluded that Plaintiff was not disabled at any time between February 1, 1995 and March 31, 2007. (AR at 23.)
On October 31, 2012, Plaintiff filed a timely request with the Appeals Council for a review of the ALJ's decision. (AR at 12-13.) The Appeals Council subsequently affirmed the ALJ's decision. (AR at 1-4.)
PLAINTIFF'S CONTENTION
In the Joint Stipulation, Plaintiff raises the following issue:
1. Whether the ALJ properly developed the record regarding Plaintiff's impairments.
STANDARD OF REVIEW
Under 42 U.S.C. § 405(g), this Court reviews the ALJ's decision to determine whether the ALJ's findings are supported by substantial evidence and whether the proper legal standards were applied. DeLorme v. Sullivan, 924 F.2d 841, 846 (9th Cir. 1991). Substantial evidence means " more than a mere scintilla" but less than a preponderance. Richardson v. Perales, 402 U.S. 389, 401, 91 S.Ct. 1420, 28 L.Ed.2d 842 (1971); Desrosiers v. Secretary of Health & Human Servs., 846 F.2d 573, 575-76 (9th Cir. 1988). In other words, it is " such relevant evidence as a reasonable mind might accept as adequate to support a conclusion." Richardson, 402 U.S. at 401.
In determining whether substantial evidence supports the ALJ's findings, the Court must review the record as a whole and consider " both the evidence that supports and the evidence that detracts from the Commissioner's conclusion[s]." Reddick v. Chater, 157 F.3d 715, 720 (9th Cir. 1998). " If the evidence can reasonably support either affirming or reversing, " the Court " may not substitute its judgment" for that of the ALJ, and the ALJ's decision must be upheld. Id. at 720-21; see also Gallant v. Heckler, 753 F.2d 1450, 1452 (9th Cir. 1984).
DISCUSSION
A. The Sequential Evaluation
To be eligible for disability benefits a claimant must demonstrate a medically determinable impairment which prevents the claimant from engaging in substantial gainful activity and which is expected to result in death or to last for a continuous period of at least twelve months. Tackett v. Apfel, 180 F.3d 1094, 1098 (9th Cir. 1999); Reddick, 157 F.3d at 721; 42 U.S.C. § 423(d)(1)(A).
Disability claims are evaluated using a five-step test. See 20 C.F.R. § § 404.1520, 416.920. At step one, the ALJ determines if the claimant is engaging in " substantial gainful activity." 20 C.F.R. § § 404.1520(a)(4)(i), 416.920(a)(4)(i). If he is, the claimant is found not disabled. If he is not, the ALJ proceeds to step two.
At step two, the ALJ determines whether the claimant has a " severe" impairment or combination of impairments. 20 C.F.R. § § 404.1520(a)(4)(ii), 416.920(a)(4)(ii). An impairment is " severe" if it significantly limits the claimant's ability to perform basic work activities and is expected to persist for a period of twelve months or longer. See Bowen v. Yuckert, 482 U.S. 137, 141, 107 S.Ct. 2287, 96 L.Ed.2d 119 (1987). If the claimant does not have a " severe" impairment or combination of impairments, disability benefits are denied. 20 C.F.R. § § 404.1520(a)(4)(ii), 416.920(a)(4)(ii). If the impairment or combination of impairments is " severe, " the ALJ proceeds to step three.
At step three, the ALJ determines whether the claimant's impairment or combination of impairments meets or equals an impairment listed in 20 C.F.R., Part 404, Subpart P, Appendix 1. 20 C.F.R. § § 404.1520(a)(4)(iii), 416.920(a)(4)(iii). If so, the claimant is automatically determined disabled. See 20 C.F.R. § § 404.1520(d), 416.920(d). If not, the ALJ proceeds to step four.
At step four, the ALJ must assess the claimant's residual functional capacity (" RFC"). The RFC is the " most [one] can still do despite [his or her] limitations" and represents an assessment " based on all the relevant evidence." 20 C.F.R. § § 404.1545(a)(1), 416.945(a)(1). The ALJ then must determine whether the claimant's RFC is sufficient for the claimant to perform past relevant work. 20 C.F.R. § § 404.1520(a)(4)(iv), 416.920(a)(4)(iv). If the claimant is capable of performing past relevant work, the claimant is not disabled. If the claimant is no longer capable of past relevant work, the ALJ proceeds to step five. See 20 C.F.R. § § 404.1520(f), 416.920(f).
At the fifth and final step, the ALJ determines whether, considering claimant's RFC, age, education, and work experience, the claimant is able to perform other work that is available in significant numbers in the national economy. 20 C.F.R. § § 404.1520(a)(4)(v), 416.920(a)(4)(v). If he is, the claimant is not disabled. If he is not, the claimant is disabled and entitled to benefits. Id.
Claimants have the burden of proof at steps one through four, subject to the presumption that Social Security hearings are non-adversarial and to the Commissioner's affirmative duty to assist claimants in fully developing the record even if they are represented by counsel. Tackett, 180 F.3d at 1098 and n.3; Smolen v. Chater, 80 F.3d 1273, 1288 (9th Cir. 1996). If this burden is met, a prima facie case of disability is made, and the burden shifts to the Commissioner at step five. Tackett, 180 F.3d at 1098, 1100; Reddick, 157 F.3d at 721; 20 C.F.R. § § 404.1520, 416.920.
B. Duty to Develop the Record
In his sole claim, Plaintiff contends that the ALJ did not fully develop the record regarding his impairments. (Joint Stip. at 3-6.) As discussed below, the Court agrees.
The ALJ has a " 'special duty to fully and fairly develop the record and to assure that the claimant's interests are considered... even when the claimant is represented by counsel.'" Celaya v. Halter, 332 F.3d 1177, 1183 (9th Cir. 2003)(ellipsis in original)(quoting Brown v. Heckler, 713 F.2d 441, 443 (9th Cir. 1983)); Tonapetyan v. Halter, 242 F.3d 1144, 1150 (9th Cir. 2001). " Ambiguous evidence, or the ALJ's own finding that the record is inadequate to allow for proper evaluation of the evidence, triggers the ALJ's duty to 'conduct an appropriate inquiry.'" Tonapetyan, 242 F.3d at 1150 (quoting Smolen v. Chater, 80 F.3d 1273, 1288 (9th Cir. 1996)). Fulfilling this duty may require the ALJ to consult a medical expert or to obtain a consultative examination. Maxwell v. Comm'r Soc. Sec. Admin., 2013 WL 4087558, at *16 (D. Or. Aug. 12, 2013); see also 20 C.F.R. § § 404.1519a, 416.919a.
In this case, C. Friedman, M.D., a non-examining State Agency medical consultant, provided the sole medical opinion in the record. Dr. Friedman opined that there is insufficient evidence in the record to reach a conclusion on the severity of Plaintiff's alleged impairments. (AR at 437.) The ALJ rejected Dr. Friedman's opinion on the ground that it is " not consistent with the objective medical evidence of record, " and determined that Plaintiff's impairments were not severe. (AR at 19, 22.) However, it appears that the ALJ's findings were based solely on his lay interpretation of Plaintiff's treatment records, which could not serve as substantial evidence supporting the ALJ's decision. See Winters v. Barnhart, 2003 WL 22384784, at *6 (N.D. Cal. Oct. 15, 2003) (" The ALJ is not allowed to use his own medical judgment in lieu of that of a medical expert."); see also Morales v. Apfel, 225 F.3d 310, 317 (3d Cir. 2000)(an ALj may not reject a physician's opinion based on " speculation or lay opinion"); Manso-Pizarro v. Secretary of Health & Human Services, 76 F.3d 15, 17 (1st Cir. 1996)(An ALJ as a lay person is not qualified to interpret raw data in a medical record.); Gonzalez Perez v. Secretary of Health & Human Services, 812 F.2d 747, 749 (1st Cir. 1987)(ALJ may not " substitute his own layman's opinion for the findings and opinion of a physician"). Accordingly, there was insufficient medical evidence in the record to support the ALJ's non-disability determination, and the ALJ should have conducted a further inquiry. See Tonapetyan, 242 F.3d at 1150.
Although a medical expert testified at the May 9, 2012 hearing and opined that Plaintiff had severe physical impairments, his opinion was based on Plaintiff's impairments as of the date of the hearing. These impairments included the residual effects of a stroke that Plaintiff suffered in the latter part of 2007, after his date last insured. (See AR at 35-38.) As noted above, however, the issue in this case was whether Plaintiff was disabled prior to his date last insured. Accordingly, the ALJ properly disregarded the medical expert's opinion.
C. Remand is Required to Remedy the Defects in the ALJ's Decision
The decision whether to remand for further proceedings is within the discretion of the district court. Treichler v. Comm'r of Soc. Sec. Admin., 775 F.3d 1090 (9th Cir. 2014)(citing Harman v. Apfel, 211 F.3d 1172, 1175-1178 (9th Cir. 2000)). Where there are outstanding issues that must be resolved before a determination can be made, and it is not clear from the record that the ALJ would be required to find the claimant disabled if all the evidence were properly evaluated, remand is appropriate. Harman, 211 F.3d at 1179. However, where no useful purpose would be served by further proceedings, or where the record has been fully developed, it is appropriate to exercise this discretion to direct an immediate award of benefits. Id. (decision whether to remand for further proceedings turns upon their likely utility).
In this case, as discussed above, the record does not contain sufficient evidence supporting the ALJ's step two determination that Plaintiff's impairments were non-severe. Accordingly, remand for further administrative proceedings is appropriate in order to further develop the record and to properly complete the sequential evaluation.
ORDER
Accordingly, IT IS ORDERED that:
1. The decision of the Commissioner is REVERSED.
2. This action is REMANDED to defendant, pursuant to Sentence Four of 42 U.S.C. § 405(g), for further proceedings as discussed above.
3. The Clerk of the Court shall serve this Decision and Order and the Judgment herein on all parties or counsel.
JUDGMENT
IT IS ADJUDGED that this action is remanded to defendant for further proceedings pursuant to Sentence Four of 42 U.S.C. § 405(g) and consistent with the accompanying Decision and Order.