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Casas v. Commissioner of Social Security Administration

United States District Court, D. Arizona

May 22, 2017

Alma Casas, Plaintiff,
Commissioner of Social Security Administration, Defendant.


          James A. Teilbrorg Senior United States District Judge.

         Pending before the Court is Plaintiff Alma Casas's appeal from the Social Security Commissioner's (the “Commissioner's”) denial of her request for expedited reinstatement of disability insurance benefits under Title II of the Social Security Act. (Tr. 24-40). Plaintiff argues that the administrative law judge (the “ALJ”) erred by: (1) applying the wrong legal framework; (2) presuming Plaintiff engaged in substantial gainful activity (“SGA”); (3) finding Plaintiff's impairments had medically improved; (4) inappropriately weighing medical testimony; (5) inappropriately weighing Plaintiff's credibility; and (6) violating Plaintiff's due process rights. (See Docs. 16; 22). The Court now rules on Plaintiff's appeal.[1]

         I. BACKGROUND

         A. Procedural Background

         Plaintiff filed an application for Period of Disability and Disability Insurance Benefits on September 11, 2002, alleging an inability to work since August 19, 2002. (Tr. 262). In October 2003, ALJ Gerald R. Cole (“ALJ Cole”) determined Plaintiff was disabled due to a gunshot wound to her right femur, resulting in a fracture, vascular injury, and pain. (Tr. 264-65).

         At some point during or before 2011, the Social Security Administration (“SSA”) terminated Plaintiff's disability benefits. (Doc. 16 at 7). On November 3, 2011, Plaintiff requested expedited reinstatement of her benefits. (Tr. 272). In 2012, the SSA conducted a continuing disability review and determined that Plaintiff's disability had ceased on November 14, 2011. (Tr. 27, 267, 271). Specifically, the SSA concluded that “current medical evidence shows that [Plaintiff's] leg has healed” and “there has been medical improvement when comparing the severity of [Plaintiff's] impairment at the time of the most recent favorable decision to the severity of [Plaintiff's] impairment now.” (Tr. 271). On July 9, 2012, the SSA denied Plaintiff's request for reinstatement of her benefits. (Tr. 279). Plaintiff's request for reconsideration, (Tr. 282), was denied, and Plaintiff requested a hearing by an ALJ, stating that she was “entitled to ongoing disability benefits.” (Tr. 283).

         On May 2, 2014, five days before Plaintiff's scheduled hearing before the ALJ, Plaintiff's former counsel withdrew from her case. (Tr. 298). At the hearing, Plaintiff appeared without representation of counsel. (Tr. 609, 612-13). The ALJ advised Plaintiff that she would grant a postponement if Plaintiff wanted to retain counsel. (Tr. 612). When Plaintiff voiced her trepidation in waiving her right to counsel, the ALJ told her, “[I]f you're unsure, take the time to find somebody.” (Tr. 613). Nevertheless, Plaintiff waived her right to counsel. (Tr. 613). The ALJ issued an unfavorable decision, (Tr. 24), and the Appeals Council denied Plaintiff's request for review, (Tr. 5). This timely request for judicial review followed.

         B. Continuing Disability Review

         In order to determine whether a claimant's disability is continuing or has ceased, and, therefore, whether the claimant is still entitled to disability benefits, ALJs are required to follow an eight-step process. See 20 C.F.R. § 404.1594(f).

         At step one, the ALJ determines whether the claimant is engaged in SGA. Id. § 404.1594(f)(1). SGA is defined as work activity that is both substantial and gainful. Id. § 404.1572. “Substantial work activity” is work activity that involves doing significant physical or mental activities. Id. § 404.1572(a). “Gainful work activity” is work that is usually done for pay or profit, whether or not a profit is realized. Id. § 404.1572(b). If the claimant has engaged in SGA, the claimant's disability is deemed to have ceased and benefits are terminated. Id. § 404.1594(f)(1). If the claimant is not engaging in SGA, the analysis proceeds to step two. Id.

         At step two, the ALJ analyzes whether the claimant's impairment meets or equals the impairments set out in the Listing of Impairments found in 20 C.F.R. Part 404, Subpart P, Appendix 1. Id. § 404.1594(f)(2). If a Listing is met, the claimant continues to be disabled, and the evaluation stops. Id. If not, the analysis proceeds to step three. Id.

         At step three, the ALJ evaluates whether medical improvement has occurred since the original determination of disability. Id. § 404.1594(f)(3). If a medical improvement resulted in a decrease in the medical severity of the claimant's impairments, the analysis proceeds to the next step. If no medical improvement occurred, the analysis skips to step five. Id.

         At step four, the ALJ determines whether the medical improvement is related to the claimant's ability to work. Id. § 404.1594(f)(4). Medical improvement is related to the ability to work if it results in an increase in the claimant's capacity to perform basic work activities. Id. If the improvement is related, the analysis skips to step six. Id. However, if the improvement is not related, the analysis proceeds to step five. Id.

         Step five applies in one of the follow situations: (1) there has been no medical improvement; or (2) the improvement is unrelated to the claimant's ability to work. Id. § 404.1594(f)(3)-(4). At step five, the ALJ analyzes whether any exception to medical improvement exists. Id. § 404.1594(f)(5). If no exception applies to the claimant, the ALJ must still find the claimant to be disabled. Id. If the first group of exceptions applies to the claimant, see Id. § 404.1594(d), the analysis advances to step six, id. If the second group of exceptions applies to the claimant, see Id. § 404.1594(e), the ALJ will find that the claimant's disability has ended, id. § 404.1594(f)(5).

         At step six, the ALJ evaluates whether the claimant's impairments are sufficiently severe to limit her physical or mental abilities to do basic work activities. Id. § 404.1594(f)(6). If the impairments are not sufficiently severe, the claimant is no longer disabled. Id. Otherwise, the analysis proceeds to step seven. Id.

         At step seven, the ALJ assesses the claimant's current residual functioning capacity (“RFC”) to determine whether she can perform past related work. Id. § 404.1594(f)(7). If the claimant has the capacity to perform past relevant work, the claimant is no longer disabled. Id. If not, the analysis proceeds to step eight. Id.

         Finally, at step eight, the ALJ determines whether the claimant can perform any other SGA. Id. § 404.1594(f)(8). If so, the claimant is no longer disabled. Id. If not, the claimant's disability continues. Id.

         C. Summary of the ALJ's Decision

         The ALJ stated that the issue before her was whether Plaintiff was entitled to expedited reinstatement of benefits. (Tr. 28). The ALJ set forth the applicable test for expedited reinstatement of benefits under 20 C.F.R. §§ 404.1592b & 404.1592c, and she elaborated that one of the steps for reinstatement required a continuing disability review. (Tr. 28-29).

         The ALJ began her findings by determining that the most recent favorable decision finding Plaintiff disabled-the comparison point decision (“CPD”)-was October 3, 2003. (Tr. 29). The ALJ also determined that at the time of the CPD, Plaintiff's medically determinable impairments consisted of a right lower extremity gunshot wound and fracture. (Tr. 29). The ALJ then proceeded through the sequential analysis for continuing disability review. (Tr. 29-39).

         At step one, the ALJ found that the claimant did not engage in SGA through November 14, 2011, the date the ALJ determined Plaintiff's disability ended. (Tr. 29). At step two, the ALJ determined that Plaintiff did not have an impairment or combination of impairments that met or equaled the severity of impairments listed in the regulations. (Tr. 31). At step three, the ALJ found Plaintiff experienced medical improvement since November 14, 2011; and, at step four, she noted that the improvement was related to Plaintiff's ability to work-rendering step five inapplicable. (Tr. 32).

         At step six, the ALJ found that Plaintiff's impairments of a right lower extremity gunshot wound and fracture were severe impairments that cause more than minimal functional impairments. (Tr. 29). The ALJ also found at step six that Plaintiff's additional complaints of high cholesterol, acid reflux disease/gastroesophageal reflux disease, vitamin D deficiency, diabetes, headaches, irritable bowel syndrome, colitis, neuropathy, fibromyalgia, asthma, chronic obstructive pulmonary disease, carpal tunnel syndrome, and depression did not constitute severe medically determinable impairments because they presented only transient and mild limitations or were well controlled with treatment. (Tr. 29-31).

         At step seven, the ALJ found that, as of November 14, 2011, Plaintiff had the RFC to perform light work activity. (Tr. 32). The additional limitations found by the ALJ were that Plaintiff must avoid concentrated exposure to dangerous machinery with moving and mechanical parts and unprotected high and exposed heights. (Tr. 32). In carrying out the remainder of step seven, the ALJ found Plaintiff was capable of performing her past relevant work as a surgical attendant and hotel housekeeper; thus, the ALJ did not proceed to step eight. (Tr. 39). Based on these findings, the ALJ concluded that Plaintiff's disability ended on November 14, 2011, and, consequently, Plaintiff was not entitled to reinstatement of benefits. (Tr. 39).


         The ALJ's decision to deny benefits will be overturned “only if it is not supported by substantial evidence or is based on legal error.” Magallanes v. Bowen, 881 F.2d 747, 750 (9th Cir. 1989) (quotation omitted). “Substantial evidence” means more than a mere scintilla, but less than a preponderance. Reddick v. Chater, 157 F.3d 715, 720 (9th Cir. 1998).

         “The inquiry here is whether the record, read as a whole, yields such evidence as would allow a reasonable mind to accept the conclusions reached by the ALJ.” Gallant v. Heckler, 753 F.2d 1450, 1453 (9th Cir. 1984) (citation omitted). In determining whether there is substantial evidence to support a decision, the Court considers the record as a whole, weighing both the evidence that supports the ALJ's conclusions and the evidence that detracts from the ALJ's conclusions. Reddick, 157 F.3d at 720. “Where evidence is susceptible of more than one rational interpretation, it is the ALJ's conclusion which must be upheld; and in reaching his findings, the ALJ is entitled to draw inferences logically flowing from the evidence.” Gallant, 753 F.2d at 1453 (citations omitted); see Batson v. Comm'r of the Soc. Sec. Admin., 359 F.3d 1190, 1193 (9th Cir. 2004). This is because “[t]he trier of fact and not the reviewing court must resolve conflicts in the 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); see also Young v. Sullivan, 911 F.2d 180, 184 (9th Cir. 1990).

         The ALJ is responsible for resolving conflicts in medical testimony, determining credibility, and resolving ambiguities. See Andrews v. Shalala, 53 F.3d 1035, 1039 (9th Cir. 1995). Thus, if on the whole record before the Court, substantial evidence supports the Commissioner's decision, the Court must affirm it. See Hammock v. Bowen, 879 F.2d 498, 501 (9th Cir. 1989); see also 42 U.S.C. § 405(g) (2012). On the other hand, the Court “may not affirm simply by isolating a specific quantum of supporting evidence.” Orn v. Astrue, 495 F.3d 625, 630 (9th Cir. 2007) (quotation omitted).

         Notably, the Court is not charged with reviewing the evidence and making its own judgment as to whether Plaintiff is or is not disabled. Rather, the Court's inquiry is constrained to the reasons asserted by the ALJ and the evidence relied upon in support of those reasons. See Connett v. Barnhart, 340 F.3d 871, 874 (9th Cir. 2003).

         III. ANALYSIS

         Plaintiff makes six broad arguments for why the Court should either reverse the ALJ's decision or remand the case for a new administrative hearing. Specifically, Plaintiff asserts that the ALJ committed the following errors: (1) applying an erroneous legal framework on review, (Doc. 16 at 8-13); (2) presuming Plaintiff engaged in SGA, (Docs. 16 at 12-15; 22 at 1-2); (3) finding Plaintiff experienced medical improvement, (Doc. 16 at 15-20); (4) inappropriately weighing medical opinion evidence, (Docs. 16 at 20-24; 22 at 4-9); (5) finding Plaintiff was not entirely credible, (Docs. 16 at 26-28; 22 at 3); and (6) violating Plaintiff's due process rights during the hearing, (Docs. 16 at 24-26; 22 at 9-11). The Court will now address each argument in turn.

         A. Applicable Legal Framework

         Plaintiff requested a hearing before the ALJ, arguing she was “entitled to ongoing [d]isability benefits.” (Tr. 283). The ALJ applied the review standard set forth in 20 C.F.R. §§ 404.1592b & 404.1592c, which includes an analysis of whether Plaintiff is still disabled under 20 C.F.R. § 404.1594. (Tr. 28-29). Plaintiff argues that the ALJ erred in two respects: (1) failing to apply the standard set forth in 42 U.S.C. § 423(f) for reviewing a decision to terminate disability benefits; and (2) presuming Plaintiff was not disabled. (Doc. 16 at 8-13).

         Plaintiff's first argument, that the ALJ should have applied the 42 U.S.C. § 423(f) standard of review, is contradicted by record. Section 423(f) applies when reviewing whether to terminate a claimant's entitlement to disability benefits. 42 U.S.C. § 423(f). However, Plaintiff requested review of the SSA's decision denying reinstatement of benefits. (See Tr. 279). Thus, the ALJ was correct to apply the standard set forth in 20 C.F.R. §§ 404.1592b & 404.1592c.

         Plaintiff next argues that, by using the expedited reinstatement review standard instead of the continuing disability review standard, the ALJ erred by presuming Plaintiff was not disabled. (Doc. 16 at 9-13). Plaintiff premises this argument on the assertion that Plaintiff “appealed both the continuing disability review process and expedited reinstatement denial.” (Doc. 16 at 9). The Court cannot find-and Plaintiff fails to cite- anywhere in the record that states the bases for Plaintiff's hearing request in such clear terms. Plaintiff's request for a hearing simply states that she disagreed with the SSA determination because she was “entitled to ongoing [d]isability benefits.” (Tr. 283). This is the same argument Plaintiff used in requesting reconsideration of the SSA's denial of reinstatement of Plaintiff's benefits. (Tr. 282).

         Even if Plaintiff properly appealed the SSA's continuing disability review determination, the ALJ applied the continuing disability review standard in her decision. (Tr. 29-39). In applying this standard, the ALJ relied on objective evidence in the record before determining medical improvement. (Tr. 29-39). Thus, in reviewing whether Plaintiff's disability was ongoing, the ALJ appeared to presume Plaintiff was still disabled. (Tr. 29-31). Plaintiff fails to state how the ALJ's analysis was erroneous or even how such an erroneous analysis constituted harmful error. McLeod v. Astrue, 640 F.3d 881, 887 (9th Cir. 2011) (“Where harmfulness of the error is not apparent from the circumstances, the party seeking reversal must explain how the error caused harm.”). Because Plaintiff neglected to specify where exactly in the ALJ's opinion the ALJ presumed non-disability-or what harm arose from such presumption-Plaintiff cannot establish that this case should be remanded for further proceedings on this basis.

         B. Presumption of SGA

         Plaintiff next argues that the ALJ committed harmful error by presuming Plaintiff engaged in SGA. (See Docs. 16 at 12-14; 22 at 1-2). In addition, Plaintiff somewhat relatedly argues that the ALJ erred by considering Plaintiff's work activity despite such work activity failing to amount to SGA. (Doc. 22 at ...

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