Opinion
For Edna 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, Civil Division, Los Angeles, CA; Assistant U.S. Attorney LA-SSA, LEAD ATTORNEY, Office of the General Counsel for Social Security Adm., San Francisco, CA; Francesco P Benavides, LEAD ATTORNEY, SAUSA - U.S. Attorney's Office, San Francisco, CA.
ORDER AFFIRMING DECISION OF ADMINISTRATIVE LAW JUDGE
HON. MICHAEL R. WILNER, UNITED STATES MAGISTRATE JUDGE.
I. SUMMARY OF RULING
Plaintiff Rodriguez challenges the denial of her application for Social Security benefits. On appeal, Plaintiff contends that the Administrative Law Judge (ALJ) improperly evaluated the record and provided insufficient support for his adverse credibility finding.
The Court disagrees. There is no basis to conclude that the ALJ failed to consider material evidence from Plaintiff's treating physicians. To the extent that the ALJ erred in disregarding a couple of semi-legible, non-probative letters, that error was certainly harmless. The Court further concludes that the ALJ stated specific, clear, and convincing reasons for disbelieving Plaintiff's symptom testimony. As a result, the Court affirms the ALJ's decision.
II. PLAINTIFF'S CONDITIONS AND PROCEEDINGS BELOW
Plaintiff applied for disability benefits. After an administrative hearing, the ALJ found that Plaintiff's physical conditions, including fibromyalgia, were " severe impairments" as that term is used under the federal regulations.
The Court finds that Plaintiff's step-two argument is without merit. The severity requirement is a " de minimis screening device used to dispose of groundless claims." Webb v. Barnhart, 433 F.3d 683, 687 (9th Cir. 2005) (citation omitted). While the ALJ described Plaintiff's impairment as " history of fibromyalgia" at step two, he clearly did not dispose of Plaintiff's claim at that step. Instead, the ALJ considered Plaintiff's functional limitations later in the sequential analysis and bifurcated her RFC based on the date she was diagnosed with fibromyalgia.
The ALJ determined that, before the May 2010 onset and diagnosis of Plaintiff's fibromyalgia, Plaintiff had the ability to perform " medium work" as defined by federal regulations. (AR 18.) However, after that time, the ALJ determined that Plaintiff had a more limited RFC under which she could only perform " light work" with several postural limitations. (Id.)
At the hearing, a vocational expert testified that someone with Plaintiff's RFC could perform her past work as a companion. (AR 44.) From this, the ALJ concluded that Plaintiff was not disabled and denied benefits. (AR 23.)
III. STANDARD OF REVIEW
Under 42 U.S.C. § 405(g), a district court may review the agency's decision to deny benefits. The ALJ's findings and decision must be upheld if they are supported by substantial evidence and are free of legal error. Hill v. Astrue, 698 F.3d 1153, 1158 (9th Cir. 2012). Substantial evidence is proof in an amount or of a nature that " a reasonable mind might accept as adequate to support a conclusion." Burch v. Barnhart, 400 F.3d 676, 679 (9th Cir. 2005). If the evidence presented in an administrative proceeding " can reasonably support either affirming or reversing the decision" of the agency, this Court " may not substitute [its] judgment for that of the Commissioner" or the ALJ. Parra v. Astrue, 481 F.3d 742, 746 (9th Cir. 2007).
IV. DISCUSSION
Plaintiff contends that the ALJ erred in evaluating the medical evidence and assessing Plaintiff's credibility.
A. ALJ's Evaluation of the Record (Ground 1)
Plaintiff argues that the ALJ impermissibly rejected opinions and evidence from her treating doctors. Additionally, Plaintiff contends that the ALJ failed to develop the record because he disregarded two illegible letters from her treating doctors.
1. Facts and Decision Below
Plaintiff's treating physician (Dr. Tsai) and two rheumatologists (Dr. Anuntiyo and Dr. Su), diagnosed Plaintiff with fibromyalgia. None of these doctors specifically opined about Plaintiff's physical limitations or work restrictions. (AR 23.)
A consulting internist (Dr. Karamlou) examined Plaintiff. Dr. Karamlou also diagnosed Plaintiff with fibromyalgia. However, the consultant opined that Plaintiff could perform the equivalent of medium work with normal breaks and frequent changes in position. (AR 496.)
The ALJ established an RFC -- light work with additional limitations -- that was more favorable to Plaintiff than that which the agency's consultant recommended. (AR 18.) The ALJ summarized the treatment history and medical records from Plaintiff's treating physicians. The ALJ expressly noted that " [a]lthough Dr. Tsai and Dr. Anuntiyo agree the claimant has significant pain, they did not state any specific limitations due [to] the claimant's physical impairment." (AR 23.)
Additionally, the ALJ briefly noted that the medical records included two barely legible letters from Dr. Tsai and Dr. Anuntiyo. The ALJ described the letters as " difficult to discern" and did not mention them substantively in the written decision. (AR 22, 634, 644.) Although not fully readable, the Court understands the letters to describe Plaintiff's prescribed receipt of hydrocodone (AR 634) and a summary transmittal of one physician's opinion to another in response to a referral (AR 644). Notably, based on the review of the materials by the Court and its staff, neither letter addresses Plaintiff's functional limitations or any other issue relevant to this disability benefits appeal.
2. Relevant Law
In determining a claimant's RFC, an ALJ must consider all relevant evidence in the record. Robbins v. Social Sec. Admin., 466 F.3d 880, 883 (9th Cir. 2006). However, an ALJ is not required to discuss every piece of cumulative evidence regarding Plaintiff's symptoms. Howard ex rel. Wolff v. Barnhart, 341 F.3d 1006, 1012 (9th Cir. 2003). The ALJ must provide an explanation only when rejecting significant probative evidence. Vincent v. Heckler, 739 F.2d 1393, 1395 (9th Cir. 1984).
An ALJ has a " special duty to fully and fairly develop the record" in a disability benefits proceeding. Webb v. Barnhart, 433 F.3d 683, 687 (9th Cir. 2005). That duty is triggered when there is " ambiguous evidence or when the record is inadequate to allow for proper evaluation of the evidence." Ludwig v. Astrue, 681 F.3d 1047, 1054 n.30 (9th Cir. 2012).
If an ALJ commits error by failing to obtain additional evidence on a claimant's behalf, the matter is reviewed for harmless error. McLeod v. Astrue, 640 F.3d 881, 886 (9th Cir. 2010). Reversal " is not automatic, but requires a determination of prejudice." Ludwig, 681 F.3d at 1054. Among other things, a reviewing court must consider " the likelihood that the result would have been different" but for the error, and " the impact of the error on the public perception" of the proceeding. Shinseki v. Sanders, 556 U.S. 396, 411-12, 129 S.Ct. 1696, 173 L.Ed.2d 532 (2009). If the " circumstances of the case show a substantial likelihood of prejudice, remand is appropriate[.] By contrast, where harmlessness is clear and not a borderline question, remand for reconsideration is not appropriate." McLeod, 640 F.3d at 888.
3. Analysis
Plaintiff contends that the ALJ's " rejection of [her] treating physician's opinions [was] legally flawed." (Docket # 19 at 5.) That argument is entirely without merit. Nowhere in the written decision did the ALJ expressly reject the opinions of Drs. Tsai, Anuntiyo, or Su regarding Plaintiff's fibromyalgia diagnosis. To the contrary, the ALJ accepted that diagnosis and clearly incorporated it throughout the written decision. Plaintiff's boilerplate contention that the ALJ rejected a treating physician's opinion is simply inapplicable to this case.
Plaintiff's real gripe is her claim that the ALJ did not include additional limitations in the RFC to adequately reflect the doctors' diagnoses. Yet, none of the treating physicians affirmatively offered a specific opinion or limitation regarding Plaintiff's ability to work for the ALJ to consider. In the written decision, the ALJ recited the relevant medical evidence from the practitioners, noted (and rejected) the specific recommendation from the agency's consulting examiner, and formulated the light work RFC for Plaintiff.
Plaintiff fails to convincingly demonstrate that the ALJ did not consider or improperly rejected any significant probative evidence in the written decision. Robbins, 466 F.3d at 883; Vincent, 739 F.2d at 1395. Rather, the ALJ apparently did what he was required to do; translate the raw medical evidence into a work-related limitation as part of the regulatory sequential analysis.
To the extent that Plaintiff claims that the ALJ failed to properly evaluate the evidence from Dr. Su, that argument is too cursory to warrant relief. The ALJ obviously accepted Dr. Su's cumulative diagnosis of fibromyalgia. Howard, 341 F.3d at 1012. And, because this practitioner did not provide additional recommendations or work limitations, the ALJ was not required to explain the consideration of the medical records in any substantive detail. Vincent, 739 F.2d at 1395.
The ALJ may have been obliged to develop the record in order to understand the poorly reproduced letters from Drs. Tsai and Anuntiyo. Webb, 433 F.3d 687; Ludwig, 681 F.3d at 1054 n.30. The ALJ possessed ambiguous information from Plaintiff's treating physicians that could have contained relevant information. However, even if the ALJ committed error by failing to get clearer copies of the letters, that error was surely harmless in this specific case. McLeod, 640 F.3d at 886. Although the ALJ and the lawyers in the case apparently could not make out the letters' contents, the Court could -- they constituted ministerial correspondence about Plaintiff's medications and a thank-you letter to a referring colleague.
Crucially, the letters shed no light on the issues at play in this appeal. Plaintiff cannot demonstrate that she suffered any real prejudice likely to affect the outcome of the disability determination as a result of the ALJ's failure to decrypt the letters. Ludwig, 681 F.3d at 1054. Further, the Court discerns no impact on the " public perception" of the proceeding. Shinseki, 556 U.S. at 411-12. Plaintiff and her lawyers submitted illegible evidence to the ALJ and now seek to capitalize on the issue. That reflects negatively on the practitioner, not the agency. As such, any error is not the type of " borderline" decision that warrants remand. McLeod, 640 F.3d at 888.
B. Adverse Credibility Determination (Ground 2)
Plaintiff challenges the adequacy of the ALJ's adverse credibility determination.
1. Facts and Decision Below
Plaintiff testified that her ability to work was greatly limited by her fibromyalgia pain, a knee condition, headaches, and other physical limitations. (AR 32-43.) Plaintiff stated that she had fluid in her left knee and that something was " happening with my ligaments and my bones" in her knee. (AR 34.) She claimed she was given crutches by an emergency room doctor three weeks before the hearing and required them to walk. (AR 34, 39.) Plaintiff also testified that she " get[s] migraines" but couldn't remember what medication she was taking for them. (AR 41.)
The ALJ did not fully believe her pain testimony. The ALJ found Plaintiff's statements to be " out of proportion" with the objective medical record and " observed functional restrictions." (AR 22.) The ALJ specifically noted Dr. Tsai's and Dr. Anuntiyo's records indicating that Plaintiff's fibromyalgia responded well to corticosteroids. (AR 23.) The ALJ also referenced a treatment note from Dr. Tsai stating that Plaintiff was " moving with ease" and skipped an appointment because she felt well. (AR 21.) Additionally, the ALJ found that Plaintiff's daily activities (cooking, cleaning, caring for her family) were inconsistent with her claims of debilitating pain. (AR 23.)
As for Plaintiff's claims regarding her knee, the ALJ again found that Plaintiff's testimony was inconsistent with the objective medical record. Several doctors observed that Plaintiff walked normally without a cane or other assistive device. (AR 21.) Additionally, the ALJ referenced a three-year-old MRI that showed " mild and minimal" degenerative changes. (AR 22.) Plaintiff apparently submitted no proof that a physician prescribed her crutches shortly before the administrative hearing. (AR 19.) The ALJ noted that he left the record open for Plaintiff to submit the results of a recent MRI of her left knee, but Plaintiff failed to do so. (AR 21.)
Likewise, the ALJ rejected Plaintiff's testimony about her headaches. Her treating doctors' notes " do not show that she has constant, frequent, prolonged and severe headaches" that would preclude work on a regular basis. (AR 20.) The ALJ also noted that Plaintiff did not complain to her doctors about daily headaches. (Id.)
2. Relevant Law
Certain disability decisions require an evaluation of a claimant's subjective symptomatic complaints. An ALJ may not " arbitrarily discredit a claimant's testimony." Thomas v. Barnhart, 278 F.3d 947, 958 (9th Cir. 2002). If an ALJ determines that there is objective medical evidence of an underlying impairment that reasonably could cause the alleged pain or symptoms, the ALJ may disregard the individual's statements regarding the severity of those symptoms if, in the absence of evidence that the claimant is malingering, the ALJ provides " specific, clear and convincing reasons" for rejecting the claimant's testimony. Burrell v. Colvin, 775 F.3d 1133, 1136 (9th Cir. 2014) (citation omitted).
An ALJ may consider a variety of factors in weighing a claimant's believability, including ordinary techniques of credibility evaluation (including testimony by the claimant that " appears less than candid"), " unexplained or inadequately explained failure to seek treatment or to follow a prescribed course of treatment, " and the claimant's daily activities. Ghanim v. Colvin, 763 F.3d 1154, 1163 (9th Cir. 2014) (quotations omitted).
A claimant's favorable response to conservative treatment can undermine the claimant's testimony and reports of disabling pain. Tommasetti v. Astrue, 533 F.3d 1035, 1040 (9th Cir. 2008). An ALJ may also discredit a claimant's testimony for " lack of consistent treatment" or because the claimant " did not seek any treatment or evaluation" for the condition. Burch, 400 F.3d at 681; Orn v. Astrue, 495 F.3d 625, 638 (9th Cir. 2007).
If a claimant " engages in numerous daily activities involving skills that could be transferred to the workplace, the ALJ may discredit the claimant's allegations upon making specific findings relating to those activities." Burch, 400 F.3d at 681. However, the mere fact that a claimant " carried on certain daily activities, such as grocery shopping, driving a car, or limited walking or exercise, does not in any way detract" from his or her credibility as to overall disability. Vertigan v. Halter, 260 F.3d 1044, 1049-50 (9th Cir. 2001). The ALJ must make " specific findings related to [the daily] activities and their transferability to conclude that a claimant's daily activities warrant an adverse credibility determination." Orn, 495 F.3d at 639 (quotation omitted).
An ALJ may also consider whether there is a lack of objective medical evidence supporting a claimant's allegations. This factor " cannot form the sole basis for discounting" subjective symptom testimony. Burch, 400 F.3d at 681. Even if an ALJ impermissibly relies " on one of several reasons in support of an adverse credibility determination, " the error is considered harmless if " the ALJ's remaining reasoning and ultimate credibility determination were adequately supported by substantial evidence in the record." Carmickle v. Comm'r, Soc. Sec. Admin, 533 F.3d 1155, 1162 (9th Cir. 2008) (citation and emphasis omitted).
3. Analysis
The ALJ was obliged to identify " specific, clear, and convincing" reasons for rejecting the claimant's testimony. Burrell, 775 F.3d at 1136. The analysis in the written decision adequately meets this standard and is supported by substantial evidence to survive appellate review.
The ALJ was entitled to disbelieve Plaintiff's pain testimony based on her favorable response to medications and conservative treatment. The ALJ did not err in concluding that Plaintiff's treating doctors repeatedly noted that she responded well to her medications. Also, Plaintiff skipped a doctor's appointment because she felt well. The ALJ was entitled to find that Plaintiff's own statements and favorable response to her medications undermined her testimony regarding the severity of her pain and limitations. Tommasetti, 533 F.3d at 1040.
Moreover, the ALJ identified a clear and convincing reason to discount Plaintiff's testimony regarding migraines. Plaintiff did not raise the issue of migraines with her treating doctors or with the consulting examiner. Burch, 400 F.3d at 681; Orn, 495 F.3d at 638. The ALJ also adequately rejected Plaintiff's testimony about her knee condition and need for crutches because it contradicted her doctors' observations that she walked normally without a cane or other device. Carmickle, 533 F.3d at 1161; Ghanim, 763 F.3d at 1163 (ALJ may use ordinary techniques of credibility assessment in weighing claimant's testimony).
With those conclusions regarding Plaintiff's testimony, the ALJ did not err in making reference to the lack of objective medical evidence regarding that testimony. Burch, 400 F.3d at 681. Although some of the medical evidence favored Plaintiff's position, the ALJ was entitled to consider as a factor in the decision whether the overall objective medical evidence refuted Plaintiff's testimony about her pain and limitations. That determination, too, was supported by evidence sufficient to allow a reasonable person to reach that conclusion. Hill, 698 F.3d at 1158; Burch, 400 F.3d at 679. Overall, the ALJ was entitled to disbelieve Plaintiff's statements about the severity of pain and limitations associated with her fibromyalgia and other conditions.
The Court declines to accept the ALJ's rejection of Plaintiff's believability based on her minimal daily activities, though. Plaintiff described rather basic household functions that she was able to accomplish for herself and her family. Plaintiff's ability to engage in these meager activities does not, on its face, undermine the credibility of her symptom testimony. Vertigan, 260 F.3d at 1049-50. Moreover, the ALJ made no specific findings that those activities transferred to a work setting (even in Plaintiff's former profession as a caregiver). Orn, 495 F.3d at 639. However, to the extent that the ALJ erred by relying on Plaintiff's daily activities as a basis to reject his symptom testimony, that error was certainly harmless in light of the other acceptable reasons that the ALJ stated. Carmickle, 533 F.3d at 1162.
V. CONCLUSION
The ALJ's denial of Plaintiff's application for disability benefits was supported by substantial evidence in the record and contained no legal error. Therefore, the Court AFFIRMS the decision.
IT IS SO ORDERED.
JUDGMENT
It is the judgment of this Court that the decision of the Administrative Law Judge is AFFIRMED. Judgment is hereby entered in favor of Defendant.