Opinion
CV 21-00440-TUC-JCH (LAB)
09-29-2022
Anita L. Watson, Plaintiff, v. Commissioner of Social Security Administration, Defendant.
REPORT AND RECOMMENDATION
Leslie A. Bowman United States Magistrate Judge
The plaintiff, Anita L. Watson, filed this action for review of the final decision of the Commissioner for Social Security pursuant to 42 U.S.C. § 405(g). (Doc. 1, p. 2)
The case has been referred to the United States Magistrate Judge pursuant to the Rules of Practice of this court. (Doc. 18)
The Magistrate Judge recommends that the District Court, after its independent review, reverse the final decision of the Commissioner and remand for further proceedings. The ALJ did not properly evaluate the medical opinions of Susan Jones, M.D., and Shelley Vaughn, F.N.P., in accordance with the new regulations. Substantial evidence does not support the ALJ's finding that Watson can perform light work with some additional limitations.
PROCEDURAL HISTORY
Watson filed an application for disability insurance benefits on January 4, 2018. (Doc. 23-4, p. 42) She alleged disability beginning on March 15, 2015 due to generalized anxiety disorder, peripheral neuropathy in legs and feet, atrial fibrillation, hypertension, and major depressive disorder. (Doc. 23-3, p. 16); (Doc. 23-4, p. 42); (Doc. 23-8, pp. 2, 5)
Watson's application was denied initially and upon reconsideration. (Doc. 23-4, p. 42) She requested review and appeared at a hearing before Administrative Law Judge (ALJ) Charles Davis on January 28, 2020. (Doc. 23-4, p. 42); (Doc. 23-5, p. 73); (Doc. 23-3, pp. 38-59), (Tr. 37-58)
At the hearing, Watson testified that she worked as a security guard until March of 2015 when her subcontract ended. (Doc. 23-3, pp. 41-42), (Tr. 40-41) She then looked for work in the secretarial or security field. (Doc. 23-3, p. 42)
At about the same time, Watson began experiencing foot pain and heart fibrillation. (Doc. 23-3, pp. 42-43) She was receiving medicaid benefits through AHCCCS, but she went through a “phase” where she was mentally unable to complete the application to extend her benefits, and she was dropped from the program. (Doc. 23-3, p. 43) She does not drive any more due to her foot pain. (Doc. 23-3, pp. 45-46)
Watson testified that she cannot work because she cannot stand or walk or control her left hand. (Doc. 23-3, p. 46) She contracted an infection in the bone of her right hand and had her pinky finger removed. (Doc. 23-3, pp. 46-47)
Washing clothes is difficult because she has to take so many breaks. (Doc. 23-3, p. 47) She can wash only two loads a day because she has difficulty standing and walking. Id. Sometimes her heart beats too fast, and she has to sit down and rest. Id. She takes medications, but they make her very tired and sleepy and disturb her equilibrium. (Doc. 23-3, p. 49) Watson uses a cane in the house, but she uses a “stroller” when she is outside. (Doc. 23-3, pp. 51-52)
The ALJ issued a decision denying benefits on February 5, 2020. (Doc. 23-4, p. 49) The Appeals Council subsequently granted review and remanded the case for further proceedings. (Doc. 23-4, p. 56) A second hearing was held before ALJ Davis on February 16, 2021. (Doc. 23-3, p. 15); (Doc. 23-3, pp. 60-80), (Tr. 59-79)
At the second hearing, John Kwok, M.D., testified as a medical expert. (Doc. 23-3, p. 62) He stated that he had reviewed the medical record up to Exhibit 21F, but he had not reviewed Exhibit 22F, which was from the neurologist at the Center for Neurosciences. (Doc. 23-3, p. 63) He suggested that if the ALJ read him the record, “I probably can get a sufficient gist of what those notes are implying,” and the ALJ attempted to do so. Id. The ALJ recited portions of the medical record that described Watson's history of numbness and pain in the hands and feet and recorded the physical signs observed by her doctors during their examinations. Id. The ALJ noted, “I'm kind of skipping around.” Id. The assessment in the Exhibit was “peripheral polyneuropathy.” Id.
Kwok gave the following clarification, “Well, again, I'm board certified in orthopedic surgery alone.” (Doc. 23-2, p. 67) “So I confine my comments to the musculoskeletal system and that's why, even with neuropathy, I didn't pay too much attention to it because that's not really a musculoskeletal condition.” Id. “So, I did not look at other issues beyond musculoskeletal.” Id. Kwok opined that Watson could lift up to 50 pounds frequently and 100 pounds occasionally and sit, stand, or walk for 8 hours in an 8-hour work day. Id.
Watson testified that she worked in 2015 for the Mount Graham Supply store as a clerk and bookkeeper. (Doc. 23-3, p. 69), (Tr. 68) The job entailed frequent walking, standing, and lifting in addition to frequent fingering. (Doc. 23-3, pp. 77-79)
Watson explained that she has lost feeling in the tips of her fingers, so she has difficulty preparing meals. (Doc. 23-3, pp. 72-73) She “can't stand long enough to actually prepare a meal, let alone serve it . . . .” (Doc. 23-3, p. 73) She does not shop for groceries any longer. (Doc. 23-3, p. 73) She explained, “I will start . . . having bad sharp pains in my feet, and I have to sit down and raise my feet up or lie down and raise my feet up . . . .” Id. She stopped driving because she cannot control the foot pedals with her feet. (Doc. 23-3, pp. 71-72), (Tr. 70-71) She uses a cane in the house and a four-wheeled walker when she is going somewhere. (Doc. 23-3, pp. 74-75) She can put clothes in the washer, but her husband carries the laundry baskets. (Doc. 23-3, p. 75) She can hang a load of clothes on the line to dry, but she usually has to do the job in three stages. (Doc. 23-3, p. 75) When she has an attack of foot pain, her heart races. (Doc. 23-3, p. 76) When that happens, she has to lie down and elevate her feet and calm herself. (Doc. 23-3, p. 76) These episodes occur at least twice per day. Id.
On April 13, 2021, ALJ Davis issued his decision in which he found that Watson was not disabled because she could perform light work and therefore could perform her past relevant work as a security guard or a sales clerk/bookkeeper. (Doc. 23-2, pp. 15-26), (Tr. 14-25)
The Appeals Council denied Watson's request for review on September 1, 2021, making the decision of the ALJ the final decision of the Commissioner. (Doc. 23-3, p. 2) Watson subsequently filed this action appealing that final decision.
Medical Opinions
In January of 2020, Susan Jones, M.D., completed a Treating Source Statement form. (Doc. 23-13, pp. 63-66), (Tr. 925-928) Jones opined that Watson would be “off task” more than 25% of the time and would be absent from work more than 4 days per month due to her “chronic pain, chronic neuropathic pain in bilateral hands and feet, worse in the feet.” Id. She can “rarely” lift or carry objects weighing less than 10 pounds. Id. She can sit, stand, or walk for one hour in an 8-hour work day. Id. She requires the use of a cane or other assistive device to “ambulate effectively.” Id. Without her cane, Watson can “ambulate” approximately 200 yards. Id. She should never reach, handle, finger, feel, push, or pull with either hand. Id. She should never use foot controls. Id. She should never climb stairs and ramps or ladders and scaffolds. Id. She should never balance, stoop, kneel, crouch, crawl, or rotate her head and neck. Id. Jones also included several environmental work limitations. Id.
In December of2020, Shelley Vaughn, F.N.P., “completed a Treating Source Statement form.” (Doc. 23-14, pp. 30-33), (Tr. 970-973) Vaughn opined that Watson would be “off task” more than 25% of the time and would be absent from work more than 4 days per month. Id. She can “rarely” lift or carry objects weighing less than 10 pounds. Id. She can sit or stand/walk for less than one hour in an 8-hour work day due to her atrial fibrillation and neuropathy. Id. She should lie down or recline and elevate her legs every hour. Id. She cannot ambulate without a cane or walker due to neuropathy in her feet. Id. She can occasionally reach, handle, finger, feel, or push/pull. Id. She should rarely use foot controls with her left foot and occasionally with her right foot. Id. She should never climb stairs and ramps or ladders and scaffolds. Id. She should never stoop, kneel, crouch, or crawl. Id. Vaughn also included several environmental work limitations. Id.
The form was co-signed by Catherine Romero, M.D., in accordance with the instructions on the signature page, but there is no indication that she endorsed Vaughn's opinions. The court assumes that the opinions on the form are those of Vaughn alone.
CLAIM EVALUATION
To qualify for disability benefits, the claimant must demonstrate, through medically acceptable clinical or laboratory standards, an inability to engage in substantial gainful activity due to a physical or mental impairment that can be expected to last for a continuous period of at least twelve months. 42 U.S.C. § 423(d)(1)(A). “An individual shall be determined to be under a disability only if [her] physical or mental impairment or impairments are of such severity that [she] is not only unable to do [her] previous work but cannot, considering [her] age, education, and work experience, engage in any other kind of substantial gainful work which exists in the national economy, regardless of whether such work exists in the immediate area in which [she] lives, or whether a specific job vacancy exists for [her] or whether [she] would be hired if [she] applied for work.” 42 U.S.C. § 423(d)(2)(A).
Social Security Administration (SSA) regulations require that disability claims be evaluated pursuant to a five-step sequential process. 20 C.F.R. § 404.1520. The first step requires a determination of whether the claimant is engaged in substantial gainful activity. 20 C.F.R. § 404.1520(a)(4). If so, then the claimant is not disabled and benefits are denied. Id.
If the claimant is not engaged in substantial gainful activity, the ALJ proceeds to step two, which requires a determination of whether the claimant has a severe impairment or combination of impairments. 20 C.F.R. § 404.1520(a)(4). In making a determination at step two, the ALJ uses medical evidence to evaluate whether the claimant has an impairment that significantly limits or restricts his or her physical or mental ability to do basic work activities. Id. If the ALJ concludes there is no severe impairment, the claim is denied. Id.
Upon a finding of severity, the ALJ proceeds to step three, which requires a determination of whether the impairment meets or equals one of several listed impairments that the Commissioner acknowledges are so limiting as to preclude substantial gainful activity. 20 C.F.R. § 404.1520(a)(4); 20 C.F.R. Pt. 404, Subpt. P, App.1. If the claimant's impairment meets or equals one of the listed impairments, then the claimant is presumed to be disabled, and no further inquiry is necessary. If the claimant's impairment does not meet or equal a listed impairment, evaluation proceeds to the next step.
The fourth step requires the ALJ to consider whether the claimant has sufficient residual functional capacity (RFC) to perform past relevant work. 20 C.F.R. § 404.1520(a)(4). If yes, then the claim is denied. Id. If the claimant cannot perform any past relevant work, then the ALJ must move to the fifth step, which requires consideration of the claimant's RFC to perform other substantial gainful work in the national economy in view of the claimant's age, education, and work experience. 20 C.F.R. § 404.1520(a)(4).
Residual functional capacity is defined as that which an individual can still do despite his or her limitations. 20 C.F.R. § 404.1545.
“There are two ways for the [ALJ] to meet the burden of showing that there is other work in ‘significant numbers' in the national economy that claimant can do: (1) by the testimony of a vocational expert, or (2) by reference to the Medical-Vocational Guidelines at 20 C.F.R. pt. 404, subpt. P, app. 2 [the grids].” Lounsburry v. Barnhart, 468 F.3d 1111, 1114 (9th Cir. 2006).
The ALJ's Findings
At step one of the disability analysis, the ALJ found that Watson “did not engage in substantial gainful activity during the period from her alleged onset date of March 15, 2015 through her date last insured of December 31, 2020 . . . .” (Doc. 20-3, p. 19) At step two, he found Watson “had the following severe impairments: atrial fibrillation, status post small right finger amputation, peripheral neuropathy, bilateral carpal tunnel syndrome . . . .” (Doc. 20-3, p. 19)
The ALJ then considered the four functional areas that, according to the social security regulations, should be evaluated when assessing mental disorders. “These four broad functional areas are known as the ‘paragraph B' criteria.” (Doc. 20-3, p. 18) First, the ALJ found that Watson has no limitation in the area of “understanding, remembering or applying information.” Id. Next, he found that Watson has no limitation in interacting with others. Id. Third, he considered the area of “concentrating, persisting or maintaining pace.” Id. He found Watson has mild limitation in this area. Id. Finally, the ALJ decided that Watson has mild limitation in the area of “adapting or managing oneself.” (Doc. 23-3, p. 20)
The ALJ concluded that “[b]ecause the claimant's medically determinable mental impairments caused no more than ‘mild' limitation in any of the functional areas and the evidence does not otherwise indicate that there is more than a minimal limitation in the claimant's ability to do basic work activities, they were nonsevere. . . .” (Doc. 23-3, p. 20)
At step three, the ALJ found that Watson “did not have an impairment or combination of impairments that met or medically equaled the severity of one of the listed impairments in 20 CFR, Part 404, Subpart P, Appendix 1 . . . .” (Doc. 23-3, p. 20)
The ALJ then analyzed Watson's residual functional capacity (RFC). He found that Watson had the residual functional capacity to perform light work “except she can frequently reach, handle, finger, and feel bilaterally.” (Doc. 23-3, p. 21) “The full range of light work requires standing or walking, off and on, for a total of approximately 6 hours of an 8-hour workday.” Campbellv. Saul, No. 2:18-CV-00320-WGC, 2020 WL 972750, at *5 (D. Nev. Feb. 28, 2020) (citing SSR 83-10, at * 6).
“Light work involves lifting no more than 20 pounds at a time with frequent lifting or carrying of objects weighing up to 10 pounds.” 20 C.F.R. § 404.1567(b). “Even though the weight lifted may be very little, a job is in this category when it requires a good deal of walking or standing, or when it involves sitting most of the time with some pushing and pulling of arm or leg controls.” Id.
At step four, the ALJ found that Watson “was capable of performing past relevant work as a security guard and in a composite job consisting of a sales clerk and bookkeeper.” (Doc. 23-3, p. 25) The ALJ therefore concluded that Watson was not disabled. (Doc. 23-3, p. 26)
STANDARD OF REVIEW
The findings of the Commissioner are meant to be conclusive. 42 U.S.C. § 405(g). The court will “set aside a denial of Social Security benefits only when the ALJ decision is based on legal error or not supported by substantial evidence in the record.” Revels v. Berryhill, 874 F.3d 648, 654 (9th Cir. 2017) (punctuation modified). “Substantial evidence means more than a mere scintilla, but less than a preponderance.” Revels, 874 F.3d at 654. “It means such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.” Id. “Where evidence is susceptible to more than one rational interpretation, the ALJ's decision should be upheld.” Id. But the court “must consider the entire record as a whole, weighing both the evidence that supports and the evidence that detracts from the [ALJ's] conclusion, and may not affirm simply by isolating a specific quantum of supporting evidence.” Id. The court will “review only the reasons provided by the ALJ in the disability determination and may not affirm the ALJ on a ground upon which he did not rely.” Id.
The ALJ need not accept the claimant's subjective testimony of disability, but if he decides to reject it, he must justify his decision. Valentine v. Comm 'r Soc. Sec. Admin., 574 F.3d 685, 693 (9th Cir. 2009). “[W]ithout affirmative evidence showing that the claimant is malingering, the [ALJ's] reasons for rejecting the claimant's testimony must be clear and convincing.” Id.
Discussion
Watson argues first that the ALJ failed to properly analyze the medical opinion evidence. (Doc. 24, p. 5) The court agrees. The court does not reach Watson's alternative allegations of error.
Under the new regulations, “[t]he agency must articulate how persuasive it finds all of the medical opinions from each doctor or other source, 20 C.F.R. § 404.1520c(b), and explain how it considered the supportability and consistency factors in reaching these findings.” Woods v. Kijakazi, 32 F.4th 785, 792 (9th Cir. 2022) (punctuation modified). “The more relevant the objective medical evidence and supporting explanations presented and the more consistent with evidence from other sources, the more persuasive a medical opinion or prior finding.” Machelle H. v. Kijakazi, No. 1:20-CV-00357-CWD, 2021 WL 4342313, at *7 (D. Idaho Sept. 22, 2021) (punctuation modified). “In sum, the [ALJ] must explain his reasoning and specifically address how he considered the supportability and consistency of the opinion, and his reasoning must be free from legal error and supported by substantial evidence. Id. The court finds that the ALJ in this case failed to properly evaluate the medical opinions of Susan Jones, M.D., and Shelley Vaughn, F.N.P. The ALJ's analysis reads in pertinent part as follows:
These opinions from Gila Valley Clinic providers are not fully persuasive. When the claimant established care in 2017, she was treated by Melinda Feely, M.D. (Ex 2F) Treatment notes through and including September 2018 are from Dr. Feely. (Ex 4F, 6F) Treatment notes in March 2019 are from Dr. Feely. She reported that musculoskeletal exam was normal with full range of motion. The claimant had pain on the soles of her feet when standing. (Ex 11F/15-17) Treatment notes in April 2019 were from Tanya Williams, N.P. and Todd Schwallier, N.P. (Id/3-14) Therefore, the statements in the opinions of Dr. Jones and Ms. Vaugh[n] that they have treated the claimant from February 2017 to current (Ex 15F/4, 20F/1) are inconsistent with the treatment notes. Dr. Jones' opinion that the claimant's symptoms and limitations first appeared in 2015 are similarly inconsistent with the record, as there is no evidence she was treating the claimant at that time.
Nurse Practitioner Vaughn did see the claimant in January 2020 and in December 2020. Those are her only appointment notes. (Ex 16F/3-5, 20F/5-6) She noted that the claimant was not able to afford to pay for routine visits. She had a primary care visit in October 2020. (Ex 20F/5) Dr. Susan Jones wrote a note in January 2020 saying she examined the claimant and reviewed Ms.Vaughn's note, and completed and signed the disability form. (Id/1)(Doc. 23-3, p. 24), (Tr. 23)
The ALJ's first criticism is that the opinions of Jones and Vaughn are “inconsistent with the treatment notes” because they stated that “they have treated the claimant from F ebruary 2017 to current” while, in reality, most of the examinations and treatments were performed by Melinda Feely, M.D., Tanya Williams, N.P., and Tod Schwallier, N.P. (Doc. 23-3, p. 24), (Tr. 23) The court finds the ALJ's criticism somewhat misplaced.
The questionnaire completed by Jones and Vaughn instructs as follows:
Please complete the following questions based upon your personal treatment of Anita Watson. Your opinion should be based on your findings with respect to medical history, clinical and laboratory findings, diagnosis, prescribed treatment, response to treatment and prognosis.(Doc. 23-13, p. 63), (Tr. 925) The questionnaire then asks: “For how long have you treated Anita Watson and how frequently?” Id. Jones wrote: “From 02/02/2017 to current. Patient is seen every 3 to 5 mo[nth]s.” (Doc. 23-13, p. 63) Vaughn wrote simply: “2//2017 to current.” (Doc. 23-14, p. 30) These answers, as the ALJ noted, are not literally accurate. The Gila Valley Clinic as a whole treated Watson from 02/02/2017 to present, but Jones and Vaughn did not personally treat Watson throughout that entire period. Their answers to the questionnaire are not entirely unexpected, however, considering the instructions to base “[y]our opinion” on the “medical history, clinical and laboratory findings,” etc. Id. Watson's medical history with the clinic extends back to 2017. Presumably that is what Jones and Vaughn meant to say, and it would have been more accurate to make this distinction explicit. The ALJ is correct to the extent that he is saying that the opinion of a physician who only reviews the medical record is ordinarily given less weight than the opinion of a physician who actually treats the patient. And the opinion of a physician who treats the patient only a few times is ordinarily given less weight than the opinion of a physician who treats the patient many times. His choice of the phrase “inconsistent with treatment notes,” however, is somewhat misleading. That phrase seems to indicate a substantive inconsistency between the patient's medical history and the physician's opinions about the patient's functional limitations. And that is not what happened here.
The ALJ noted in passing that Feely “reported that musculoskeletal exam was normal with full range of motion.” (Doc. 23-3, p. 24), (Tr. 23) He did not explain why this was significant, but the court will assume that he believed that these treatment notes were inconsistent with the functional limitations discussed by Jones and Vaughn. It is unclear, however, why he believed there was an inconsistency. The ALJ cited no evidence tending to show that a normal musculoskeletal exam or full range of motion would be unexpected for a person experiencing neurological pain in her extremities. The inference that the ALJ attempts to draw would not be obvious to a lay person. Moreover, the consulting expert, Kwok, indicated that limitations due to the musculoskeletal system would be separate from the limitations due to the neurological system. (Doc. 23-2, p. 67) Consequently, the court finds no inconsistency between these exam findings and the opinions of Jones and Vaughn. See, e.g., Avalos v. Colvin, 2015 WL 790715, at *2, n. 2 (C.D. Cal. Feb. 25, 2015) (The court would not accept the ALJ's assertion that the claimant's treatment was “routine and conservative” where none of the physicians said that and “treatment for this condition is not obvious to a lay person.”); see also Blakes ex rel. Wolfe v. Barnhart, 331 F.3d 565, 569 (7th Cir. 2003) (“We require the ALJ to build an accurate and logical bridge from the evidence to her conclusions so that we may afford the claimant meaningful review of the SSA's ultimate findings.”).
The ALJ further stated that “Dr. Jones' opinion that the claimant's symptoms and limitations first appeared in 2015 are similarly inconsistent with the record, as there is no evidence she was treating the claimant at that time.” (Doc. 23-3, p. 24) Again, the court finds that this criticism is somewhat misplaced. While it is true that Jones did not personally observe Watson's symptoms and limitations in 2015, a record of her symptoms and limitations dating from 2015 do appear in her medical record. The ALJ, himself, noted these records in his conversation with the medical consultant, Kwok. (Doc. 23-3, p. 64) Presumably, when Jones stated that “the claimant's symptoms and limitations first appeared in 2015,” she meant that the medical record contains this information. (Doc. 23-3, p. 24), (Tr. 23) She did not mean that she, herself, made those observations. As the court noted above, the medical form asks that the provider base her opinions on the claimant's “medical history” among other things. Therefore, it is not surprising that Jones stated simply that Watson's foot pain first appeared in 2 without explicitly clarifying that she did not examine Watson herself at that time. Again, the court finds that the ALJ's analysis of Jones' opinion is not entirely accurate.
The ALJ observed that “[n]o prescription for a cane or a walker was found in the treatment records.” (Doc. 23-3, p. 24), (Tr. 23) But, as Watson notes, doctors do not ordinarily prescribe things that can be obtained without a prescription. See Parker v. Astrue, 597 F.3d 920, 922 (7th Cir. 2010), as amended on reh'g in part (May 12, 2010) (“[T]he administrative law judge thought it suspicious that the plaintiff uses a cane, when no physician had prescribed a cane,” but “[a] cane does not require a prescription . . . .”). The fact that there is no prescription for a cane or walker in the medical record is not particularly good evidence that the opinions of Jones and Vaughn lacked supportability or consistency.
The ALJ also found that “[t]he limited general exam findings throughout the Gila Valley Clinic notes, as discussed above, fail to reflect an inability to stand for more than 1 hour, an inability to perform any manipulative or postural activities, and the need to recline or lie down throughout the day.” (Doc. 23-3, p. 24) (emphasis added) The ALJ, however, failed to acknowledge that the functional limitations identified by Jones and Vaughn are supported not only by the findings of the Gila Valley Clinic but also by the entire medical record. That record indicates that in 2015, Watson “complained of tingling/numbness in both toes and Dorsal pads of both her feet.” (Doc. 24, p. 9) (citing Tr. 927-928) “Examination revealed decreased sensation in the plantar pads and toes, and she was diagnosed with paresthesia and pain in the extremities.” Id. Watson notes that records from neurologist Dr. Song describe a “positive Romberg sign, 1+ reflexes in the upper extremities, decreased sensation below the knees, and abnormal tandem walk.” (Doc. 24, p. 10) She explains that other records indicate “lower extremity edema, absent reflexes in the lower extremities and reduced sensation to light touch below the knees, to pinprick below the knees, and to vibration in the toes, numbness to light touch of the dorsal surface of feet and lateral legs to mid-calf, no sensation with monofilament testing of feet bilaterally, very dry feet (suggesting no sweating), allodynia [anomalous pain] to light touch on toes and plantar surfaces, borderline ankle brachial index (ABI) test, positive Romberg sign and slow heel walking due to pain in the balls of the feet with abnormal tandem walk, pain on soles of feet when standing, and limited flexion/extension in feet bilaterally.” (Doc. 24, p. 11) The record seems replete with examination findings that support the functional limitations identified by Jones and Vaughn. The fact that many of those findings were recorded by other health care providers is not particularly good evidence to discount the opinions of Jones and Vaughn.
The ALJ also explained that he “considered the claimant's activities as reported” by “ [t]he claimant's daughter [who] indicated that the claimant had no problem with personal care, including dressing, bathing, and caring for her hair.” (Doc. 23-3, p. 24) “The claimant did light cleaning and small loads of laundry.” Id. “The claimant's hobbies and interests included watching television, reading, social media, and gardening.” Id. It does not appear, however, that any of those reported activities are inconsistent with the functional limitations identified by Jones and Vaughn. If the ALJ believed there was an inconsistency, he did not identify it or explain his thinking. See also Garrison v. Colvin, 759 F.3d 995, 1016 (9th Cir. 2014) (citing Bjornson v. Astrue, 671 F.3d 640, 647 (7th Cir. 2012)) (“The critical differences between activities of daily living and activities in a full-time job are that a person has more flexibility in scheduling the former than the latter, can get help from other persons, and is not held to a minimum standard of performance, as she would be by an employer.”).
In sum, the ALJ's decision fails to properly comply with the requirements in the new regulations to properly assess the supportability and consistency of the medical opinions offered by Jones and Vaughn.
Moreover, even if the ALJ's analysis of the medical opinions was correct, his finding that Watson is able to perform light work is not supported by substantial evidence. At best, the ALJ's analysis shows that the opinions of Jones and Vaughn are not entirely trustworthy, and the ALJ would be justified in giving more weight to a different medical opinion. There is, however, no other medical opinion in the record that purports to analyze Watson's functional limitations due to her atrial fibrillation and peripheral neuropathy. The ALJ, therefore, had no basis for concluding that she can perform light work in spite of her impairments. The ALJ is not a medical doctor and cannot calculate an RFC directly from the raw medical record. See Day v. Weinberger, 522 F.2d 1154, 1156 (9th Cir. 1975) (The ALJ is not a medical expert and may not offer his own expert evaluation of the raw medical data.); Nguyen v. Chater, 172 F.3d 31, 35 (1st Cir. 1999) (“As a lay person, however, the ALJ was simply not qualified to interpret raw medical data in functional terms and no medical opinion supported the determination.”); Balsamo v. Chater, 142 F.3d 75, 81 (2nd Cir. 1998) (“While an ALJ is free to . . . choose between properly submitted medical opinions, he is not free to set his own expertise against that of a physician who submitted an opinion to or testified before him.”); Ferguson v. Schweiker, 765 F.2d 31, 37 (3rd Cir. 1985) (similar); Liskowitz v. Astrue, 559 F.3d 736, 741 (7th Cir. 2009) (similar); Banks v. Barnhart, 434 F.Supp.2d 800, 805 (C.D. Cal. 2006) (“An ALJ cannot arbitrarily substitute his own judgment for competent medical opinion . . . and he must not succumb to the temptation to play doctor and make his own independent medical findings. Rather, the ALJ's RFC determination or finding must be supported by medical evidence, particularly the opinion of a treating or an examining physician.”) (punctuation modified); see, e.g., Dumond v. Commissioner of Social Sec., 875 F.Supp.2d 500, 509 (W.D.Pa. 2012) (rejecting the Commissioner's argument that “an ALJ is not required to rely on a medical opinion in formulating a claimant's RFC.”).
As the court explained above, the medical consultant Kwok opined that Watson could perform medium work, but Kwok explicitly stated that his opinion ignored any neurological limitations. (Doc. 23-2, p. 67) The Commissioner seems to accept that Watson's “primary impairments were atrial fibrillation and neuropathy.” (Doc. 28, pp. 1-2)
In exceptional circumstances, there might be enough other evidence in the record for the ALJ to properly evaluate the claimant's RFC without a medical opinion. For example, a claimant's activities of daily living could provide evidence that the claimant has the exertional or postural ability to perform light work. This, however, is not one of those cases. See above; see, e.g., Penny v. Sullivan, 2 F.3d 953, 958 (9th Cir. 1993) (“Without a personal medical evaluation it is almost impossible to assess the residual functional capacity of any individual.”).
The ALJ did not properly evaluate the medical opinions of Jones and Vaughn in accordance with the new regulations. Substantial evidence does not support the ALJ's RFC finding that Watson can perform light work with some additional limitations. Therefore, his finding that she is not disabled because she can perform past relevant work is without support.
RECOMMENDATION
F or the foregoing reasons, the Magistrate Judge recommends that the District Court, after its independent review, reverse the final decision of the Commissioner and remand for further proceedings.
Pursuant to 28 U.S.C. § 636(b), any party may file and serve written objections within 14 days after being served with a copy of this Report and Recommendation. If objections are not timely filed, the party's right to de novo review may be waived. The Local Rules permit the filing of a response to an objection. They do not permit the filing of a reply to a response without leave of the District Court.