United States District Court, D. Arizona
ORDER
Douglas L. Rayes United States District Judge.
Plaintiff
Beatriz Lopez seeks judicial review of the Social Security
Administration's decision to deny her application for
disability insurance benefits and supplemental security
income. Lopez applied for benefits in December 2013, alleging
that she became unable to work as of June 5, 2013 because of
the effects of various impairments, including degenerative
disc disease, fibromyalgia, and headaches. Lopez argues that,
in denying her application, the Administrative Law Judge
(“ALJ”) improperly weighed the medical opinions
of one of her treating physicians, Dr. Hsu, and certified
physician's assistant (“PA-C”) Triplett. She
also argues that the ALJ improperly discounted her own
testimony concerning the severity of her pain and fatigue
symptoms.
The
Court has jurisdiction pursuant to 42 U.S.C. § 405(g)
and reviews only those issues raised by the party challenging
the ALJ's decision. See Lewis v. Apfel, 236 F.3d
503, 517 n.13 (9th Cir. 2001). The ALJ's determination
will be upheld unless it contains harmful legal error or is
not supported by substantial evidence. Orn v.
Astrue, 495 F.3d 625, 630 (9th Cir. 2007). Having
reviewed the parties' briefs and the administrative
record, the Court reverses the agency's decision and
remands for further proceedings.
1. The
ALJ provided a specific and legitimate explanation, supported
by substantial evidence, for assigning reduced weight to Dr.
Hsu's various functional assessments. See Lester v.
Chater, 81 F.3d 821, 830-31 (9th Cir. 1995) (discussing
standards for weighing competing medical opinions). The ALJ
discounted Dr. Hsu's opinions because portions lacked
enough explanation and were inconsistent with objective
medical findings and his own treatment records. See
20 C.F.R. § 404.1527(c)(4) (“Generally, the more
consistent a medical opinion is with the record as a whole,
the more weight we will give to that medical
opinion.”); Bayliss v. Barnhart, 427 F.3d
1211, 1216 (9th Cir. 2005); Batson v. Comm'r of Soc.
Sec. Admin., 359 F.3d 1190, 1195 (9th Cir. 2004). For
example, Dr. Hsu wrote in 2013 that Lopez could not work
because of pain and fatigue, noting that she came to his
office after being admitted to the hospital for a headache.
But the hospital records show that Lopez had negative CT and
MRI findings, was observed to be “fairly healthy
appearing” and did not appear to be in “any pain
whatsoever.” Moreover, despite the extreme limitations
he assessed, Dr. Hsu treated Lopez mostly by refilling her
medications. Likewise, despite opining in 2015 that Lopez
could only occasionally manipulate with her right hand and
could rarely manipulate with her left, the objective medical
evidence includes negative hand x-rays and normal hand
strength. The ALJ also noted that, even though Dr. Hsu had
opined in 2014 that Lopez would miss work because of her
headaches, Lopez reported to treating providers that her
headaches were infrequent before 2016. Although some of the
ALJ's stated reasons for discounting Dr. Hsu's
assessments are less persuasive (for example, her
characterization of the treatment relationship as
“sporadic”), her overall explanation is
sufficiently specific and legitimate, and adequately
supported.
In
arguing otherwise, Lopez primarily criticizes the ALJ for not
citing to specific records when interpreting the medical
evidence and evaluating Dr. Hsu's opinion. “An ALJ
can satisfy the substantial evidence requirement by setting
out a detailed and thorough summary of the facts and
conflicting clinical evidence, stating his interpretation
thereof, and making findings.” Garrison v.
Colvin, 759 F.3d 995, 1012 (9th Cir. 2014) (internal
quotation and citation omitted). The ALJ did so here. On
pages 35-39 of the administrative record, the ALJ set out a
detailed and thorough summary of the facts, clinical
evidence, and Dr. Hsu's various assessments, and on pages
39-40 of the administrative record the ALJ explained her
interpretation of that evidence as it related to Dr.
Hsu's assessments and made ultimate findings concerning
the consistency of Dr. Hsu's opinions with that evidence.
Although the ALJ did not include specific pin cites to the
medical records on pages 39-40, she did so in her discussion
of the medical evidence on pages 35-39. Thus, even though the
ALJ might have explained her “decision with less than
ideal clarity, ” the Court must affirm because the
ALJ's “path may reasonably be discerned.”
Molina v. Astrue, 674 F.3d 1104, 1121 (9th Cir.
2012) (internal quotation and citation omitted).
2. The
ALJ gave germane reasons, supported by substantial evidence,
for assigning reduced weight to the opinion of PA-C Triplett.
See Id. at 1111 (explaining that ALJ must give a
germane reason for discounting the opinion of an “other
source”). Indeed, for largely the same reasons
discussed above, the ALJ found that PA-C Triplett's
opinion was inconsistent with the medical record and not
supported by objective medical findings. Additionally, the
ALJ noted that PA-C Triplett's opinion seemed internally
inconsistent with respect to Lopez's hand limitations.
For example, PA-C Triplett opined that Lopez could
occasionally use her right hand for simple grasping, but
could rarely use it for pushing, pulling, or fine
manipulation. This assessment, by itself, would not be
unusual- someone with hand limitations might be able to use
her hands to do simpler tasks more frequently than more
difficult or complex tasks. But in the same assessment, PA-C
Triplett opined that Lopez could rarely use her left hand for
simple grasping, which would indicate that her left hand is
weaker or more painful than her right, given her right hand
could occasionally be used for simple grasping. Yet, PA-C
Triplett went on to opine that Lopez could frequently use her
left hand to push and pull, and could occasionally use it for
fine manipulation-meaning Lopez can more frequently use her
left hand to finely manipulate, push, and pull, than to
engage in simple grasping. That is, Lopez somehow can use her
left hand more frequently for harder and more complex tasks
than for simple ones. The ALJ reasonably found that this
unexplained discrepancy undermined the reliability of PA-C
Triplett's assessment.
3. On
balance, the ALJ did not clearly and convincingly explain her
decision to discount Lopez's symptom testimony. See
Smolen v. Chater, 80 F.3d 1273, 1281 (9th Cir. 1996). To
be sure, the ALJ gave clear, convincing, and adequately
supported reasons for not accepting some of these
allegations. For example, the ALJ reasonably discounted
Lopez's allegation that the side effects of her
medications limited her ability to work because the medical
records do not document such side effects. To the contrary,
medical records show that Lopez reported to treatment
providers that her medications improved her pain and helped
her maintain her quality of life. The ALJ reasonably
concluded that, if Lopez truly was experiencing significantly
limiting side effects from her medications, she would have
reported those side effects to a treatment provider. Notably,
Lopez's briefs do not cite records showing that she
reported medication side effects to her treating providers.
The ALJ also reasonably discounted Lopez's allegations
concerning the severity of her headaches. Lopez alleges
disability beginning June 2013. Yet during an April 12, 2016
office visit at The CORE Institute, Lopez reported that
before 2016 her headaches were infrequent, undermining her
allegation that her headaches have prevented her from
working.
With
that said, the remainder of the ALJ's evaulation of
Lopez's symptom testimony is not sufficiently clear and
convincing. For example, the ALJ relied on the psychological
examiner's opinion that Lopez was likely exaggerating her
reported symptoms, but the psychological examiner made this
comment with respect to Lopez's depression- and
anxiety-related symptoms, not with respect to Lopez's
pain and fatigue symptoms. The ALJ also highlighted the fact
that Lopez violated her narcotics agreement and had an
inconsistent urine sample but does not explain how or why
this fact undermines Lopez's testimony concerning the
severity of her pain and fatigue. The ALJ further notes that
Lopez once traveled out of state for a funeral and has
traveled to Mexico at least once for medication but does not
explain why this minimal travel undermines the severity of
Lopez's symptoms. Even those with severe pain and fatigue
might muster the energy or tolerate the discomfort of travel
to attend a loved one's funeral. Similarly, the ALJ found
that Lopez's daily activities are inconsistent with her
alleged symptoms, but only generalizes about these activities
without detailing the manner and frequency with which Lopez
engages in them and how they undermine allegations of
disabling pain and fatigue.
Although
the ALJ also found that Lopez's reported symptoms were
not corroborated by the objective medical evidence,
“subjective pain testimony cannot be rejected on the
sole ground that it is not fully corroborated by objective
medical evidence.” See Rollins v. Massanari,
261 F.3d 853, 857 (9th Cir. 2001). The ALJ gave adequate
reasons for discounting Lopez's allegations concerning
the side effects of her medications and the limiting effects
of her headaches but did not adequately explain why she
discounted Lopez's other allegations concerning the
severity of her pain and fatigue. Without other clear,
convincing, and adequately supported reasons, the ALJ cannot
fall back on the lack of objective corroboration. For these
reasons, the ALJ erred in discounting Lopez's symptom
testimony without giving clear, convincing, and adequately
supported reasons for a wholesale rejection.
4.
Although the ALJ erred in discounting Lopez's symptom
testimony, the Court finds that a remand for further
proceedings, rather than an award of benefits, is appropriate
because the record as a whole leaves doubt about whether
Lopez truly is unable to work. See Triechler v.
Comm'r of Soc. Sec., 775 F.3d 1090, 1100-01 (9th
Cir. 2014). As noted, the ALJ gave legally adequate reasons
for assigning reduced weight to the most limiting medical
opinions, and for discounting at least some of Lopez's
symptom testimony. That the ALJ might not have explained her
full evaluation of Lopez's symptoms with clarity does not
mean that Lopez should immediately be awarded benefits.
Instead, the Court will remand so that the ALJ can reassess
Lopez's symptom testimony, determine whether any aspects
should be credited and, if so, pose a modified hypothetical
to the vocational expert that accounts for whatever portion
or degree of Lopez's symptom testimony the ALJ accepts.
IT
IS ORDERED that the final decision of the Social
Security Administration is REVERSED and this
matter REMANDED for further proceedings. The
Clerk shall ...