ORDER REVERSING AND REMANDING DEFENDANT'S DECISION TO DENY BENEFITS
ROBERT J. BRYAN, District Judge.
Plaintiff Faith Coates seeks review of the denial of her applications for disability insurance and supplemental security income ("SSI") benefits. Plaintiff contends that the administrative law judge ("ALJ") erred by failing to develop the record, in evaluating the medical evidence, and in assessing her residual functional capacity ("RFC"). Dkt. 9 at 1. As discussed below, the Court
On October 4, 2012, plaintiff protectively filed applications for disability insurance and SSI benefits, alleging disability as of December 31, 2008. Dkt. 7, Administrative Record ("AR") 18. Plaintiff's applications were denied initially and on reconsideration. Id. After the ALJ conducted a hearing on July 31, 2014, the ALJ issued a decision finding plaintiff not disabled. AR 18-28.
THE ALJ'S DECISION
Utilizing the five-step disability evaluation process,
See AR 18-28. The Appeals Council denied plaintiff's request for review, making the ALJ's decision the Commissioner's final decision. See AR 1-6.
Pursuant to 42 U.S.C. § 405(g), this Court may set aside the Commissioner's denial of social security benefits if the ALJ's findings are based on legal error or not supported by substantial evidence in the record as a whole. Bayliss v. Barnhart, 427 F.3d 1211, 1214 n.1 (9th Cir. 2005) (citing Tidwell v. Apfel, 161 F.3d 599, 601 (9th Cir. 1999)).
I. The ALJ's Duty to Develop the Record
Plaintiff asserts that the ALJ erred by failing to develop the record regarding plaintiff's mental functional capabilities. See Dkt. 9 at 3-6. The Court agrees.
An ALJ has the duty "to fully and fairly develop the record and to assure that the claimant's interests are considered." Tonapetyan v. Halter, 242 F.3d 1144, 1150 (9th Cir. 2001). An ALJ's duty to further develop the evidence in the record is triggered when the record contains ambiguous evidence or when it "is inadequate to allow for proper evaluation of the evidence." See id.; Mayes v. Massanari, 276 F.3d 453, 459 (9th Cir. 2001). When a claimant is unrepresented, "the ALJ must be especially diligent in exploring for all the relevant facts." See Tonapetyan, 242 F.3d at 1150. Furthermore, the ALJ's duty to develop the record is "also heightened where the claimant may be mentally ill and thus unable to protect her own interests." See id. at 1150-51.
Here, the ALJ found that plaintiff had the severe impairments of affective disorder and borderline intellectual functioning. See AR 20. However, the record contained only two examining physicians' opinions that assessed plaintiff's mental functional limitations, and the ALJ rejected both opinions. See AR 25-26. The ALJ assessed plaintiff with an RFC containing some mental functional limitations but did not explain how he chose those particular limitations.
See AR 25.
Therefore, it appears that the ALJ's findings were based solely on the ALJ's own lay interpretation of plaintiff's treatment records, which is not permissible. See Gonzalez Perez v. Sec'y, Health & Human Services, 812 F.2d 747, 749 (1st Cir. 1987) (ALJ may not "substitute his own layman's opinion for the findings and opinion of a physician"). To the extent the ALJ found the examining physicians' opinions inadequate, the ALJ should have had another physician examine plaintiff to assess her mental abilities or called a medical expert to assist in determining the extent to which the medical records reflected any limitation on plaintiff's ability to work. See Mayes, 276 F.3d at 459-60. This duty was heightened in this case because plaintiff was unrepresented and diagnosed with mental impairments. See AR 35, 395-405, 422-28. Moreover, the examining physicians both recommended further memory and intelligence testing. See AR 397, 424. Therefore, the ALJ erred by failing to further develop the record when it was inadequate to allow for proper evaluation of the evidence.
II. Remand for Further Administrative Proceedings
Plaintiff also alleges that the ALJ erred in evaluating the medical evidence in the record and assessing her RFC. See Dkt. 9. However, the medical record and RFC must be re-assessed on remand due to the ALJ's error in failing to develop the record regarding plaintiff's mental functional capabilities.
The Court may remand this case "either for additional evidence and findings or to award benefits." Smolen v. Chater, 80 F.3d 1273, 1292 (9th Cir. 1996). Generally, when the Court reverses an ALJ's decision, "the proper course, except in rare circumstances, is to remand to the agency for additional investigation or explanation" unless it is clear from the record that the claimant cannot "perform gainful employment in the national economy." Benecke v. Barnhart, 379 F.3d 587, 595 (9th Cir. 2004). Here, issues still remain regarding plaintiff's mental functional capacity and her ability to perform work despite any additional assessed limitations. Accordingly, remand for further consideration is warranted in this matter.
For the foregoing reasons, the Commissioner's final decision is