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finding no error at Step Two when treating psychiatrist found only slight limitations
Summary of this case from Whittle v. AstrueOpinion
No. C-03-01613 CRB
October 23, 2003
MEMORANDUM AND ORDER
Plaintiff Hengameh Raboubi seeks supplemental security income benefits ("SSI") under Title XVI of the Social Security Act. Plaintiff and defendant have filed cross-summary judgment motions. Because the ALJ's findings are supported by substantial evidence in the administrative record and because the ALJ's rejection of plaintiff's treating physicians' opinions was not an abuse of discretion, the plaintiff's motion for summary judgment is DENIED and the defendant's cross-motion for summary judgment is GRANTED.
I. BACKGROUND
A. Procedural History
Plaintiff Hengameh Raboubi is a forty-six-year-old woman who filed her current application for SSI benefits under Title XVI of the Social Security Act on May 31, 2000.
She alleged she has been disabled since May 3, 2000, due to forgetfulness, depression, asthma, leg pain from a car accident, an ulcer, and carpal tunnel syndrome. The Social Security Administration ("SSA") denied the application initially and on reconsideration, and plaintiff requested a hearing before an administrative law judge ("ALJ"). In a decision dated February 28, 2002, the ALJ denied plaintiff's application and this decision become final when the appeals council declined to review it on February 20, 2003. Plaintiff commenced the instant action for judicial review pursuant to 42 U.S.C. § 405(g).
B. Plaintiff's Disability Claim
Plaintiff is a forty-six-year-old woman who has a bachelor's degree in psychology and who additionally has made some progress toward a master's degree in the same subject. She is married with an eighteen-year-old son who has Down's Syndrome, and a twenty-one-year old daughter. Plaintiff suffered severe right ankle injuries at the age of fifteen as the result of a car accident in which her mother was killed. Plaintiff has been arrested four times and was incarcerated for domestic violence. Tr. 137-138.
Plaintiff was previously found to be disabled in a favorable decision issued January 25, 1991 based on findings of severe depression, with an underlying personality disorder, and carpal tunnel, ankle, and back pain. Plaintiff's disability payments were stopped, however, on June 1, 1996 due to medical improvement. Plaintiff filed her current claim on May 31, 2000, alleging disabling forgetfulness, depression, asthma, leg pain, an ulcer, and carpal tunnel syndrome beginning May 3, 2000.
During the 15 years prior to her application, plaintiff's only earnings occurred in the year 2000 and amounted to $5400. During that year, plaintiff worked three months as a courier first for a travel agency and later for a flower shop. She also worked in a coffee shop and for a child-care business for several months. Plaintiff reports that she was laid-off from these jobs for being too "spacey." The ALJ held these jobs to constitute "unsuccessful work attempts per Social Security Ruling 84-25." On October 15, 2001, however, plaintiff began working two to three days per week, driving elderly people to and from doctor appointments. Plaintiff's earnings at this work exceed the regulatory standards for significant gainful activity; therefore, her claim for benefits was considered by the ALJ to be for a closed period of disability beginning May 3, 2000 and ending October 15, 2001.
At the administrative hearing, plaintiff claimed that depression, pain, and forgetfulness, and multiple other ailments rendered her unable to work.
B. Medical Evidence
1. Treating Physicians
Plaintiff was treated by Alexander Chyorny, M.D., Annie Thomas, M.D., and psychiatric social worker, Stacey Miller. Dr. Chyorny found that plaintiff met the American Rheumatological criteria for Fibromyalgia and concluded that she was incapable of low stress jobs due to pain, mood changes, and a poor attention span. Tr. 254. Ms. Miller diagnosed plaintiff with Post Traumatic Stress Syndrome and major depression with recurrent, severe, psychotic features. Tr. 196. Dr. Thomas also diagnosed plaintiff with Post Traumatic Stress Disorder and major depression. Tr. 241. Plaintiff contends that copious notes from the Santa Clara Valley Mental Health Clinic "indicate the following symptoms: nightmares, sleep disturbance, low energy, low appetite, high anxiety, suicidal ideation, irritable mood, and racing thoughts." PL Memorandum at 4.
2. Consulting Physicians
Plaintiff was consultatively examined at government expense by Eugene McMillan, M.D., a Board-certified internist, on August 16, 2000, and by E. Chang, M.D., a psychiatrist, on September 12, 2000. Plaintiff was also psychologically evaluated at government expense by D. Ashley Cohen, Ph.D., a psychologist on February 2, 2001. Finally, Fara Rana, M.D., a neurologist, conducted an internal medicine examination of plaintiff at government expense on February 28, 2001.
Dr. McMillan found plaintiff to have mild carpal tunnel syndrome, mild intermittent asthma, and a history of right ankle fracture. Tr. 134. Dr. McMillan recommended that plaintiff avoid exposure to dust and chemical fumes, but found that she would have no limitations with seeing, hearing, or speaking, and would be able to engage in activities requiring bending, kneeling and climbing. Tr. 134-5. Dr. McMillan further concluded that plaintiff should be able to lift twenty pounds frequently, but should lift no more than forty pounds. Tr. 135. Finally, Dr. McMillan found that plaintiff would be able to sit, stand and walk for eight hours per day. Tr. 135.
After examining plaintiff, Dr. Chang observed that she "gave a very odd overall presentation with a suggestion of malingering." Tr. 140. Specifically, Dr. Chang listed several details from the exam that he found questionable, including: plaintiff's description of dreaming as a visual hallucination; plaintiff's inability to do basic subtraction despite her college degree; plaintiff's vague description of symptoms in a manner inconsistent with what is generally accepted; and plaintiff's frequent assertions that her mental disability prevents her from holding a job." Id. Dr. Chang concluded that plaintiff appeared to be overly exaggerating in presentation. Id.
D. Ashley Cohen, Ph.D. similarly reported that plaintiff was uncooperative throughout the evaluation and that she appeared to be an unreliable historian. Tr. 141. Dr. Cohen noted that plaintiff reported a large number of health problems she described as very severe, but that plaintiff had trouble listing and describing them. Id. Dr. Cohen also found after administering the Wechsler Adult Intelligence Test-Ill that plaintiff's scores were invalid and did not represent her true and typical abilities. Tr. 143. Dr. Cohen states that plaintiff's "[t]est behavior suggests deliberate but highly unsophisticated attempts to feign cognitive impairment." Id. With respect to plaintiff's performance on a different evaluation, Dr. Cohen wrote that plaintiff often attempted to choose the most obviously incorrect selection.Id. Dr. Cohen found these test results also to be invalid. On a third test, Dr. Cohen again found "poor motivation coupled with deliberate attempts to appear impaired." Id. In conclusion, Dr. Cohen wrote, "there is nothing about her presentation that suggests serious mental disorder or significant cognitive deficit that would result in marked functional impairment with respect to sustained employment." Tr. 144.
Finally, Dr. Rana, after conducting an internal medicine examination of plaintiff, concluded that she had no sitting, standing, walking, weight-lifting or postural limitations as a result of any physical condition, that she did not have any communication or comprehension deficits, and that she "should be able to carry out everyday life activities normally." Tr. 148.
II. STANDARD OF REVIEW
The Court's jurisdiction is limited to determining whether the Social Security Administration's denial of benefits is supported by substantial evidence in the administrative record. 42 U.S.C. § 405(g). A district court may overturn a decision to deny benefits only if it is not supported by substantial evidence or if the decision is based on legal error. Andrews v. Shalala, 53 F.3d 1035, 1039 (9th Cir. 1995);Magallenes v. Bowen, 881 F.2d 747, 750 (9th Cir. 1989). The Ninth Circuit defines substantial evidence as "more than a mere 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. Determinations of credibility, resolution of conflicts in medical testimony and all other ambiguities are to be resolved by the ALJ. Id; Magallenes, 881 F.2d at 750. The decision of the ALJ will be upheld if the evidence is "susceptible to more than one rational interpretation." Andrews, 53 F.3d at 1040.
III. DISCUSSION
A. The ALJ's Decision
In considering whether a claimant is entitled to benefits, an ALJ conducts a five-step sequential inquiry. 20 C.F.R. § 416.920. At the first step, the ALJ considers if the claimant is engaged in substantial gainful activity; if the claimant is not engaged in substantial gainful activity, the second step asks if the claimant has a severe impairment (i.e. an impairment that has a significant effect on the claimant's ability to function); if the claimant has a severe impairment, the third step asks if the claimant has a condition which meets or equals the conditions outlined in the Listings of Impairments in Appendix 1 of the Regulations (the "Listings"); if the claimant does not have such a condition, the fourth step asks if the claimant is capable of performing his past relevant work; if the claimant is not capable of performing his past relevant work, the fifth step asks if the claimant is capable of performing other work which exists in substantial numbers in the national economy. 20 C.F.R. § 404.1520(b)-404.1520(f)(1).
Here, the ALJ defined plaintiff's claim as limited to the closed period beginning May 3, 2000 and ending October 15, 2001. During that period, plaintiff was employed at several jobs, but the ALJ ruled that all of these jobs constituted "unsuccessful work attempts per Social Security Ruling 84-25." Tr. 14. Therefore, under the first step of the analysis, plaintiff did not engage in substantial gainful activity during the period for which the claim is made.
Under the second step of the analysis, the ALJ found that the medical evidence indicated that plaintiff's depression was non severe, but that plaintiff had suffered the severe impairments of mild arthritis and asthma. Tr. 16. Under the third step of the analysis, however, the ALJ held that plaintiff's mild arthritis and asthma were not severe enough to meet or medically equal one of the impairments listed in Appendix 1, Subpart P, Regulations No. 4. Id. Because plaintiff has no history of past work other than the unsuccessful work attempts made during the period of plaintiff s claim, the ALJ skipped the fourth step of the analysis and considered the final step of the analysis: whether plaintiff retained the residual functional capacity to perform other work existing in significant numbers in the national economy. Tr. 16-17.
Accordingly, the ALJ found that plaintiff retained the residual functional capacity to perform a substantial range of medium exertional work activity, citing the findings by Dr. McMillan that plaintiff could lift twenty pounds frequently, and could sit, stand and walk up to eight hours a day and the findings by Dr. Rana that plaintiff should be able to carry out everyday life activities normally. Id. Noting further the behavior by plaintiff that Dr. Chang and Dr. Cohen found to suggest malingering, the ALJ concluded that plaintiff's subjective complaints of debilitating pain and mental duress render her incapable for medium work "less than fully credible when compared with the record as a whole." Tr. 17. Accordingly, the ALJ found that plaintiff retained "the capacity to adjust to work that exists in significant numbers in the national economy" because plaintiff possessed a four-year college education and had the capacity to perform substantially all of the seven primary strength demands required of medium work. Tr. 18.
Plaintiff bears the burden of establishing that the ALJ's decision was not based on substantial evidence or that the ALJ's decision was based on legal error. See generally Andrews, 53 F.3d at 1039;Magallenes, 881 F.2d at 750.
B. Substantial Evidence Supports the ALJ's Rejection of Treating Physician Opinions.
Plaintiff claims that the ALJ committed legal error by rejecting the medical opinions of plaintiff s treating physician, her social worker, and her treating psychiatrist. More weight is given to a treating physician's opinion than to the opinion of a nontreating physician because a treating physician "is employed to cure and has a greater opportunity to know and observe the patient as an individual."See Magallenes, 881 F.2d at 751 (quoting Sprague v. Bowen, 812 F.2d 1226, 1230 (9th Cir. 1987)). Nevertheless, in appropriate circumstances, the opinion of a treating physician may be disregarded. See Magallenes, 881 F.2d at 751. An ALJ must at a minimum give specific and legitimate reasons for rejecting the treating physician's opinion and those reasons must be supported by substantial evidence in the record. See Lester v. Chater, 81 F.3d 821, 830 (9th Cir. 1996).
When the opinion of a plaintiff's treating physician is contradicted, and the opinion of a nontreating source is based on independent clinical findings that differ from those of the treating physician, the opinion of the nontreating source may itself be substantial evidence; it is then solely the province of the ALJ to resolve the conflict. See Magallenes, 881 F.2d at 751. The Ninth Circuit has consistently held that "[t]he ALJ is responsible for determining credibility and resolving conflicts in medical testimony." Magallenes, 881 F.2d at 750; see also Allen v. Heckler, 749 F.2d 577, 580 n. 1 (9th Cir. 1985) ("questions of credibility and resolutions of conflicts in the testimony are functions solely for the Secretary"). The ALJ's credibility assessment of a plaintiff s testimony also impacts upon the weight given to a treating physician's opinion: when an ALJ properly discounts plaintiff's subjective complaints, the ALJ may properly disregard the opinion of a treating physician which is premised upon those complaints. See Fair v. Bowen, 885 F.2d 597, 605 (9th Cir. 1989).
Here, the ALJ's rejection of the opinions of Dr. Chyorny, Dr. Thomas, and Ms. Miller was a permissible determination. First, the ALJ properly relied upon the medical opinions of Dr. Chang and Dr. Cohen regarding plaintiff's mental condition. Both Dr. Chang and Dr. Cohen concluded, contrary to Dr. Thomas and Ms. Miller, that plaintiff's mental condition was suggestive of malingering, rather than a valid mental disability. Dr. Chang found plaintiff's description of her numerous complaints to be vague and inconsistent with what is normally accepted, that she exaggerated her presentation, that her inability to perform basic subtraction was inconsistent with her college degree, and that her description of dreams as visual hallucinations lacked credibility.
Dr. Cohen reported plaintiff made deliberate attempts to score poorly on diagnostic evaluations he administered to plaintiff and that the results of these evaluations were invalid and not reflective of plaintiff's actual mental condition. The ALJ discussed the evidence supporting the suggestion of plaintiff s malingering and explained, "because the claimant's subjective complaints of debilitating pain and mental duress appear to be significantly in excess of the findings in the objective record, the undersigned has made a thorough analysis of these contentions." Tr. 16. The ALJ then concluded: ". . . to the extent that the claimant contends that her subjective complaints of debilitating pain and medical duress render her incapable of medium work, the undersigned finds these contentions to be less than fully credible when compared with the record as a whole." Tr. 17.
Additionally, the ALJ based his decision on findings by Dr. McMillan and Dr. Rana that plaintiff was physically able to maintain "medium work." Tr. 17. After independent evaluation, Dr. McMillan found that plaintiff could lift twenty pounds frequently and could sit, stand, and walk for eight hours a day. Tr. 16. Similarly, after independent evaluation, Dr. Rana concluded that plaintiff had no functional limitations at all and that "she should be able to carry out every day life activities normally." Id. Significantly, Dr. Chyorny relied on plaintiff's symptoms to support his contrary opinion, not on any clinical findings. The ALJ had discretion to discount Dr. Chyorny's opinion because it was based on plaintiff's subjective complaints, which the ALJ had already held to be less than credible.
Plaintiff argues that the ALJ improperly rejected Dr. Chyorny's opinion that plaintiff could not sit for more than thirty minutes because the ALJ personally observed plaintiff to sit for longer than thirty minutes at the hearing. The independent evaluations by Dr. McMillan and Dr. Rana, however, are substantial evidence to support the ALJ's rejection of Dr. Chyorny's opinion without relying upon the ALJ's own personal observations.
Because the ALJ properly determined plaintiff was not credible, the ALJ could properly discount the opinions of Dr. Chyorny, Dr. Thomas, and Ms. Miller because these opinions were premised on plaintiff's self-reported symptoms. Given the many inconsistencies in the conclusions drawn from independent examination by treating physicians and consulting physicians, it was solely within the province of the ALJ to make credibility determinations and resolve the conflicts. In his decision, the ALJ provided specific and legitimate reasons for rejecting the opinions of plaintiff s treating physician, social worker, and psychiatrist and those reasons were supported by the findings made by consulting physicians after independent examination of plaintiff. Because these findings constitute substantial evidence in the record, the ALJ had discretion to disregard the opinions of plaintiff s treating physician, social worker, and psychiatrist.
C. The ALJ Properly Found No Severe Mental Impairment
Plaintiff also contends that the ALJ erred by finding that her mental impairment was not severe in the second step of the disability analysis. Specifically, plaintiff argues that the second step inquiry is a "de minimis screening device to dispose of groundless claims." Smolen v. Chater, 80 F.3d 1273, 1285 (9th Cir. 1996). An impairment is severe when "evidence establishes more than a minimal effect on an individual's ability to do basic work activities." Powell v. Chater, 959 F. Supp. 1238, 1242 (C.D. Cal. 1997).
Here, however, the evidence of mental impairment is subjective and was properly rejected as uncredible in light of evidence of mental competency such as a college degree, a valid driver's license, two grown children, and a job driving elderly patients to medical appointments and because her consulting psychiatrist and psychologist found that she behaved uncooperatively and deceptively during diagnostic tests. The ALJ additionally cited the state agency medical evaluators' determination that plaintiff had "no medically determinable (mental) impairments," and plaintiff's treating psychiatrist, Dr. Thomas, who found "only `slight' limitations in concentration, persistence and pace." Tr. 15. Although plaintiff argues her mental impairment was severe, she cites no specific evidence in the record to support this argument other than the diagnosis by Dr. Thomas of Post Traumatic Stress Disorder. Given the conflict in the diagnoses made by Dr. Thomas and Dr. Chang, the ALJ's finding that plaintiff's mental condition did not have more than a minimal effect on her ability to work was not an abuse of discretion.
IV. CONCLUSION
The ALJ did not commit legal error in reaching his decision. Rather, the ALJ made legitimate credibility determinations based on substantial evidence in the record and properly concluded that plaintiff is not disabled under the Act.
For the foregoing reasons, plaintiff's motion for summary judgment is DENIED and the defendant's cross-motion for summary judgment is GRANTED.