United States District Court, D. Arizona
Honorable G. Murray Snow United States District Judge
before the Court is Claimant Arthur Benavidez's appeal of
the Social Security Administration's decision to deny
benefits. (Doc. 1.) For the reasons set forth below, the
Court remands for further proceedings.
week in October 2010 and then for about a month thereafter
during most of November 2010 and part of December 2010, Mr.
Benavidez was hospitalized for unexplained fainting episodes.
Those episodes were eventually diagnosed as being caused by
orthostatic hypotension - a drop in blood pressure when
standing-that was secondary to autonomic dysfunction caused
by Mr. Benavidez's diabetes mellitus. See, e.g.,
(R. at 584) (10/27/10 discharge summary noting a
discharge diagnosis of “orthostatic hypotension with
autonomic insufficiency, likely diabetic.”), (R. at
535) (12/16/10 Discharge summary diagnosing “profound
refractory orthostatic hypotension presumably secondary to
diabetic autonomic neuropathy”) (R. at 530) (consult
noting “he has refractory orthostatic hypotension felt
due to autonomic dysfunction with his diabetes”), (R.
at 511) “So far, the working diagnosis has been
autonomic dysfunction secondary to his diabetes
mellitus.” (R. at 529) “been felt by the
Neurology Service to have autonomic dysfunction related to
diabetes with his profound refractory OH.” R. at 530
(Mr. Benavidez “has refractory [OH] felt due to
autonomic dysfunction with his diabetes.”).
result, as Mr. Benavidez acknowledges, his treatment plan was
to receive continued high dose medications-apparently those
medications being for diabetes and sinus tachycardia. Doc. 15
at 6, R. at 530, 536.
2011, Mr. Benavidez applied for disability insurance benefits
and supplemental security income, alleging a disability onset
date of November 1, 2010. (R. 25.) He claimed that his
disabling conditions were his orthostatic hypotension, his
diabetes, his agoraphobia and his bipolar disorder. During
the course of his claim evaluation, he had appointments in
September 2011 with both Dr. Steingard and Dr. Fruchtman. He
acknowledged in his appointment with Dr. Steingard that he
had not been taking his medications for depression for seven
months prior to their visit.
in October 2011, Mr. Benavidez began seeing treating
physician Dr. Ravi Galholtra. He acknowledged to Dr.
Galholtra that he had not been taking his diabetes
medications for the past year.
Benavidez's claim was reviewed by physicians at the
administration and denied both initially and upon
reconsideration leading Claimant to appeal to an
Administrative Law Judge (“ALJ”).
conducted a hearing on the matter on December 13, 2013. (R.
43-68.). By the time of the administrative hearing, Mr.
Benavidez's orthostatic hypotension had improved so that
he apparently no longer had need of assistance to
ambulate. But as it pertained to his qualification
for disability, his counsel noted that, even though then
improved, his orthostatic hypotension “had certainly
lasted over a year” from the time it began. He further
claimed that Mr. Benavidez's lack of insurance had
resulted in his recent inability to afford medications so
that, despite its amelioration, his orthostatic hypotension
had worsened some recently. (R. at 46).
significantly, at hearing Mr. Benavidez based his disability
claim on newly developed emotional impairments which included
“auditory, visual and olfactory hallucinations, as well
as significant depression, and probably most significantly
anxiety and agoraphobia with panic disorder.” Mr.
Benavidez's attorney noted at hearing that “while
we recognize that at least initially the emotional
impairments weren't as significant, the orthostatic
hypotension was certainly disabling and, and the improvement,
I don't believe has restored the ability to work in that
regard. But it-even if it has, Judge, the emotional
impairments are independently disabling at this point, so a
combination of impairments leading to a step 5argument, Your
Honor.” (R. at 47). Consistently with his
attorney's summary, at hearing, Mr. Benavidez
consistently testified that he initially left work due to the
orthostatic hypotension, but presently the biggest problem in
his inability to work was his inability to be out in public
(agoraphobia). Id. at 48. The claimant also
testified that he didn't get out of bed much mainly due
to his depression, but also due to his orthostatic
hypotension which still caused him to get dizzy and often
faint when he lifted his arms above his shoulders. R. at 53.
He did testify, however, that while he had not been on his
medication for depression when he met with Dr. Steingard, he
had, in the interim, qualified for mental health care
benefits and was on his medication for depression which was
of some help. R. at 50-51.
evaluating whether the Claimant was disabled, the ALJ
undertook the five-step sequential evaluation for determining
disability. (R. 25-36.) At step one the ALJ determined
that the Claimant had not engaged in substantial gainful
activity since the alleged onset date. (R. 27.) At step two,
the ALJ determined that the Claimant suffered from the
following severe impairments: orthostatic hypotension
(“OH”), sinus tachycardia (“ST”), and
bipolar disorder with agoraphobia. (R. 27.) At step three,
the ALJ determined that none of those impairments, either
alone or in combination, met or equaled any of the Social
Security Administration's listed impairments. (R. 28.)
point, the ALJ made a determination of the Claimant's
residual functional capacity (“RFC”),
concluding that the Claimant could perform sedentary work as
defined in 20 CFR § 404.1567(a). (R. 29.) The ALJ
concluded that the Claimant was unable to perform any past
relevant work, (R. 34), thus, the ALJ reached step five and
determined that Claimant could perform jobs that exist in
significant numbers in the national economy that met his RFC
limitations. (R. 35.) Given this analysis, the ALJ concluded
that Claimant was not disabled. (R. 36.)
Appeals Council declined to review the decision. (R. 1-6.)
The Council accepted the ALJ's statements of the law, the
issues in the case, and the evidentiary facts, as well as the
ALJ's findings and ultimate conclusions regarding whether
Claimant was disabled. (R. 1-5.) Claimant filed the complaint
on September 3, 2015. (Doc. 1.) The matter is now fully briefed.
(Docs. 14, 15, 19.)
reviewing federal court will only address the issues raised
by the claimant in the appeal from the ALJ's decision.
See Lewis v. Apfel, 236 F.3d 503, 517 n.13 (9th Cir.
2001). A federal court may set aside a denial of disability
benefits only if that denial is either unsupported by
substantial evidence or based on legal error. Robbins v.
Soc. Sec. Admin., 466 F.3d 880, 882 (9th Cir. 2006).
Substantial evidence is “more than a scintilla but less
than a preponderance.” Id. (quotation
omitted). “Substantial evidence is relevant evidence
which, considering the record as a whole, a reasonable person
might accept as adequate to support a conclusion.”
Id. (quotation omitted).
the ALJ is responsible for resolving conflicts in testimony,
determining credibility, and resolving ambiguities. See
Andrews v. Shalala, 53 F.3d 1035, 1039 (9th Cir. 1995).
“When the evidence before the ALJ is subject to more
than one rational interpretation, we must defer to the
ALJ's conclusion.” Batson v. Comm'r Soc.
Sec. Admin., 359 F.3d 1190, 1198 (9th Cir. 2004). This
is so because “[t]he [ALJ] and not the reviewing court
must resolve conflicts in evidence, and if the evidence can
support either outcome, the court may not substitute its
judgment for that of the ALJ.” Matney v.
Sullivan, 981 F.2d 1016, 1019 (9th Cir. 1992) (citations
omitted). At the same time, the Court “must consider
the entire record as a whole and may not affirm simply by
isolating a ‘specific quantum of supporting
evidence.'” Id. (citing Hammock v.
Bowen, 879 F.2d 498, 501 (9th Cir. 1989)). The Court
also may not “affirm the ALJ's . . . decision based
on evidence that the ALJ did not discuss.” Connett
v. Barnhart, 340 F.3d 871, 874 (9th Cir. 2003); see
also SEC v. Chenery Corp., 332 U.S. 194, 196 (1947)
(emphasizing the fundamental rule of administrative law that
a reviewing court “must judge the propriety of
[administrative] action solely by the grounds invoked by the
agency” and stating that if “those grounds are
inadequate or improper, the court is powerless to affirm the
administrative action”). Even if the ALJ erred,
however, “[a] decision of the ALJ will not be reversed
for errors that are harmless.” Burch v.
Barnhart, 400 F.3d 676, 679 (9th Cir. 2005).
appeal Mr. Benavidez bases his claim for benefits on his
physical impairments only. He no longer asserts, as he did at
hearing that his principal disabling ailments were either his
depression or his agoraphobia. See, e.g., (Doc. 15 at 4)
(“this appeal will focus on the effects of
Benavidez's physical impairments on his ability to
perform sustained work activity.”). Mr. Benavidez's
claim thus centers on his orthostatic hypotension
Benavidez asserts that the ALJ erred in two ways in denying
his benefits: first, by improperly rejecting the medical
assessment of Mr. Benavidez's treating physician, Ravi
Galholtra, M.D.; second, by improperly rejecting Mr.
Benavidez's subjective symptom testimony. (Doc. 15 at 1.)
Treating Physician Dr. Galholtra's Medical
Galholtra became Mr. Benavidez's PCP five months after
Mr. Benavidez filed his instant application for benefits.
Three months after Dr. Golholtra began treating him, on
January 23, 2012, Dr. Galholtra filled out three check box
questionnaires related to Mr. Benavidez's disability. In
the first check-box questionnaire-- a Peripheral Neuropathy
Residual Functional Capacity Questionnaire, (R. at 375-76)--
Dr. Galholtra noted that Mr. Benavidez has peripheral
neuropathy which caused him limitations including postural
hypotension. He also noted that Mr. Benavidez has a separate