Paulk v. Commissioner of Social Security Administration

          ORDER

         Plaintiff Luke Paulk seeks judicial review of the denial of his application for disability insurance benefits under the Social Security Act, 42 U.S.C. § 405(g).

         Plaintiff argues that the Administrative Law Judge (“ALJ”) erred by: (1) according inadequate weight to the opinions of Plaintiff's treating providers; (2) failing to consider Plaintiff's carpal and cubital tunnel syndromes as medically determinable impairments; and (3) rejecting Plaintiff's subjective complaints.

         A person is considered “disabled” for the purpose of receiving social security benefits if he or she is unable to “engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.” 42 U.S.C. § 423(d)(1)(A). The Social Security Administration's decision to deny benefits should be upheld unless it is based on legal error or is not supported by substantial evidence. Ryan v. Comm'r of Soc. Sec., 528 F.3d 1194, 1198 (9th Cir. 2008). “Substantial evidence is more than a mere scintilla but less than a preponderance.” Bayliss v. Barnhart, 427 F.3d 1211, 1214 n.1 (9th Cir. 2005) (citation omitted). “It means such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.” Richardson v. Perales, 402 U.S. 389, 401 (1971) (citation omitted). The Court must review the record as a whole and consider both the evidence that supports and the evidence that detracts from the ALJ's determination. Jones v. Heckler, 760 F.2d 993, 995 (9th Cir. 1985).

         I. DISCUSSION

         A. MEDICAL OPINIONS

         Plaintiff argues that the ALJ accorded inadequate weight to the opinions of Plaintiff's treating providers Nurse Practitioner Martha Benavides, Dr. Tushar Modi, Dr. Srinivasa Palnati, and Dr. Kulbashan Paul. In particular, Plaintiff notes that Nurse Practitioner Benavides, Dr. Modi, Dr. Palnati, and Dr. Paul all opined that Plaintiff can sit, stand, and walk less than one hour each during an eight-hour work day (AR^[1] 469, 510, 617-618).

To reject an uncontradicted opinion of a treating or examining doctor, an ALJ must state clear and convincing reasons that are supported by substantial evidence. If a treating or examining doctor's opinion is contradicted by another doctor's opinion, an ALJ may only reject it by providing specific and legitimate reasons that are supported by substantial evidence.

Bayliss, 427 F.3d at 1216 (internal citation omitted). “The ALJ can meet this burden by setting out a detailed and thorough summary of the facts and conflicting clinical evidence, stating his interpretation thereof, and making findings.” Magallanes v. Bowen, 881 F.2d 747, 751 (9th Cir. 1989) (citation omitted).

         First, the ALJ accorded little weight to the combined medical opinion of Nurse Practitioner Benavides and Dr. Modi because their assessments of Plaintiff's ability to sit, stand, and walk “are overly restrictive given the minimal positive findings on the physical examinations, ” and because “despite the claimant's allegations of back and leg pain, the findings from the physical examinations generally documented normal gait” (AR 38). An ALJ may consider the supportability of a medical opinion as a factor in determining its weight, giving more weight to opinions that cite more relevant evidence, “particularly medical signs and laboratory findings.” 20 C.F.R. § 404.1527(c)(3).

         In reviewing the record, the Court finds a lack of substantial evidence to support the ALJ's assertion of minimal objective findings to support Nurse Practitioner Benavides and Dr. Modi's opinion. Their records repeatedly note objective findings that Plaintiff suffered limited flexion and extension of the lumbar spine, hypersensitivity in the sacroiliac joints and lumbar paraspinous areas, and, at times, sacroilitis (AR 390, 395, 398, 401, 404, 407, 410, 414, 418, 422, 478, 481, 485, 491, 494). Their records further include Plaintiff's MRI results showing “left paracentral and left lateral recess disc extrusion at ¶ 4-L5 which causes prominent mass effect on the transiting left L5 nerve root” (AR 421).

         To support her conclusion, the ALJ cited Dr. Paul's repeated notes that Plaintiff was able to ambulate without an assistive device (AR 38). The ALJ, however, has not explained how these findings of normal gait are inconsistent with the limitations assessed by Nurse Practioner Benavides and Dr. Modi. In fact, the same medical reports on which the ALJ relied also noted repeatedly that Plaintiff was “[u]nable to sit down” (AR 541, 544, 547, 549, 551, 554, 557, 561, 565, 569, 573, 576). The Court thus finds the ALJ lacked a specific and legitimate reason to discount the opinion of Nurse Practitioner Benavides and Dr. Modi. See Elgrably v. Comm'r of Soc. Sec. Admin., No. CV-17-04760-PHX-JAT, 2018 WL 5264074, at *7 (D. Ariz. Oct. 23, 2018) (finding broad statement that a claimant showed normal gait was not a specific and legitimate reason for giving medical opinions little weight).

         Second, the ALJ accorded little weight to Dr. Palnati's medical opinion in part because “[s]he only examined the claimant a small number of times over a relatively brief period, ” and “the treating relationship did not last long enough for Dr. Palnati to have obtained a longitudinal picture of the claimant's medical condition” (AR 38). An ALJ may give a treating physician's medical opinion little weight “if the treating physician has not seen the patient long enough to ‘have obtained a longitudinal picture' of the patient's impairments.” Holohan v. Massanari, 246 F.3d 1195, 1202 n.2 (9th Cir. 2001) (quoting 20 C.F.R. § 404.1527(c)(2)(i)). The Court finds the ALJ properly weighed Dr. Palnati's medical opinion based on the short length of the treating relationship.

         Third, the ALJ accorded little weight to Dr. Paul's medical opinion because “it is conclusory and unsupported by the record” (AR 39). In reviewing the record, however, the Court finds a lack of substantial evidence to support the ALJ's assertion. Dr. Paul documented Plaintiff's reduced range of motion in a positive supine straight leg raising test, reflex loss, muscle spasms, and muscle weakness (AR 617). Dr. Paul cited Plaintiff's MRI results and repeatedly noted a diagnosis of “[d]egeneration of lumbar or lumbosacral intervertebral disc” (AR 557; see also AR 545, 547, 549, 552, 554, 561, 566, 570, 574, 577, 616). Dr. Paul also indicated repeatedly that Plaintiff was “[u]nable to sit down” at his examinations (AR 541, 544, 547, 549, 551, 554, 557, 561, 565, 569, 573, 576). In addition to Dr. Paul's records, the ALJ cited the medical records of Nurse Practitioner Benavides and Dr. Modi to assert that there were minimal clinical findings to support Dr. Paul's opinion (AR 39). However, as discussed above, the Court finds ample objective evidence in the record to support the opinion of Nurse Practitioner Benavides and Dr. Modi, which was in accord with Dr. Paul's opinion as to Plaintiff's ability to sit, stand, and walk for less than one hour each during an eight-hour workday (AR 469, 618). Thus, the Court finds the ALJ lacked a specific and legitimate reason to discount the opinion of Dr. Paul.

         B. CARPAL AND ...