Report and Recommendation
[ECF Nos. 17, 19].
JILL L. BURKHARDT, Magistrate Judge.
This matter is before the Court on cross-motions for summary judgment. (ECF Nos. 17, 19.) Plaintiff John Willard Snyder moves under 42 U.S.C. § 405(g)
This Report and Recommendation is submitted to United States District Judge Roger T. Benitez pursuant to 28 U.S.C. § 636(b) and Civil Local Rule 72.1(c) of the United States District Court for the Southern District of California. After careful review of the moving and opposing papers, the administrative record, the facts, and the applicable law, the Court hereby RECOMMENDS that Plaintiff's motion for summary judgment (ECF No. 17) be GRANTED IN PART AND DENIED IN PART. The Court further RECOMMENDS that the Commissioner's cross-motion for summary judgment affirming the Administrative Law Judge's ("ALJ") decision (ECF No. 19) be DENIED and the case be REMANDED for further administrative proceedings.
Plaintiff filed an application for a period of disability and disability insurance benefits on November 4, 2011, alleging disability commencing September 1, 2003.
Thereafter, the Social Security Administration Appeals Council denied Plaintiff's request for review of the ALJ's unfavorable decision, making the ALJ's decision the final decision of the Commissioner. (Id. at 2.) Plaintiff then commenced this instant action for judicial review pursuant to 42 U.S.C. §§ 405(g) and 1383(c)(3).
II. STANDARD OF REVIEW
The Social Security Act allows for unsuccessful applicants to seek judicial review of the Commissioner's final agency decision.
In making this determination, the Court must consider the record as a whole, weighing both the evidence that supports and the evidence that detracts from the ALJ's conclusion.
III. THE ALJ'S DECISION
Utilizing the five-step disability evaluation process,
At step five, the ALJ determined that, considering Plaintiff's age, education, work experience, and RFC, there were jobs in significant numbers in the national economy that Plaintiff could perform. (Id. at 28.) The ALJ relied on the testimony of the vocational expert to determine that Plaintiff could work as a silver wrapper, a cleaner, or a housekeeper.
A. Plaintiff's Background
Plaintiff is a fifty-three-year-old homeless male with a tenth-grade education. (ECF No. 12-2 at 41, 48.) He was last employed as a driver by County Motor Parts in 2013 but claims he was fired because his job duties were too physically and mentally difficult for him to perform. (Id. at 38-39.) In 2001, Plaintiff was hired as a Domino's Pizza delivery driver and worked for two years, but was laid off from that position as well. (ECF No. 12-6 at 7, 32.) He also worked as a video salesman "on and off" from 1996 to 2011. (Id. at 7.)
Plaintiff's daily activities are limited in that he does not prepare meals for himself and he does not perform any household chores. (Id. at 28-29.) Using food stamps, he shops for food about ten minutes every day, often for a sandwich or at a fast food restaurant. (ECF No. 12-2 at 49; ECF No. 12-6 at 29.) He has no hobbies and does not engage in any social activities. (ECF No. 12-6 at 30.) A "typical day" for him includes sitting in the park and going over his life. (ECF No. 12-2 at 48.)
Concerning the severity of Plaintiff's symptoms, Plaintiff alleges in his disability application that acute anxiety, depression, high blood pressure, high cholesterol and an enlarged prostate limit his ability to work. (ECF No. 12-6 at 6.) He takes medication for his anxiety, high blood pressure, and prostate. (ECF No. 12-2 at 46; ECF No. 12-6 at 56.) In Plaintiff's Social Security Administration Function Report, he also alleges constant pain in his back and hips, arthritis in his fingers, and difficulty walking. (ECF No. 12-6 at 24.)
Throughout the Administrative Record, Plaintiff also alleges the following: He cannot walk half a block before needing to rest. (Id. at 31, 54.) Most days he spends approximately six hours lying down on his back and standing for more than fifteen minutes is difficult for him. (ECF No. 12-2 at 51.) His arthritis affects his ability to hold things. (Id.) In 1997, Plaintiff's ability to use his left hand decreased "due to a `severe infection,'" which required surgery. (ECF No. 12-7 at 16, 35, 121.) Since January 1, 2006, Plaintiff alleges to have been homeless. (ECF No. 12-5 at 3; ECF No. 12-7 at 34.) He is constantly anxious and deals with anxiety problems four times a week minimally. (ECF No. 12-2 at 39; ECF No. 12-6 at 46.) He has anxiety from being in enclosed rooms and often feels overwhelmed. (ECF No. 12-2 at 45, 47.) Following written and spoken instructions is difficult for him, and he has trouble staying focused. (Id. at 42; ECF No. 12-6 at 31, 54.) He can only pay attention for five to fifteen minutes. (ECF No. 12-6 at 202, 225.) For the last fifteen to twenty years Plaintiff has suffered from depression and has thoughts of suicide. (ECF No. 12-2 at 44, 52; ECF No. 12-6 at 55.) He "burns himself with cigarettes" and "cut his leg with a machete in 2005." (ECF No. 12-6 at 75.) He was sexually abused as a child and has a history of polysubstance abuse but has been sober for more than twenty years. (ECF No. 12-3 at 7; ECF No. 12-7 at 36-38, 135-36.) Sleeping is difficult for him, and he goes without sleeping for days or sleeps only two to three hours in a night. (ECF No. 12-6 at 27, 55, 75; ECF No. 12-7 at 6-7, 9, 35.)
B. The ALJ Erred in Evaluating Plaintiff's Credibility
In the hearing decision, the ALJ concluded that Plaintiff's "statements concerning the intensity, persistence and limiting effects of [his] symptoms are not entirely credible." (ECF No. 12-2 at 26.) The ALJ discredited statements concerning Plaintiff's symptoms from arthritis and anxiety, but did not specifically address Plaintiff's statements concerning symptoms from his other severe impairments: sleep apnea, mixed personality disorder, and depression. (See ECF No. 12-2.) With respect to Plaintiff's alleged symptoms caused by arthritis and anxiety, the ALJ's reasons for discrediting Plaintiff's testimony appear to be that: (1) the medical record does not support the alleged severity of Plaintiff's symptoms; (2) Plaintiff has a limited medical record and pursued a conservative course of treatment; and (3) Plaintiff did not appear anxious or uncomfortable at the hearing. (ECF No. 12-2 at 26-27.)
Plaintiff moves for summary judgment on the ground that the ALJ failed to meet the clear and convincing legal standard for discrediting Plaintiff's testimony concerning the intensity of his symptoms.
i. Legal Standard
If an ALJ finds that a claimant's testimony as to the severity of his pain and impairments is unreliable, the ALJ is required to make "a credibility determination with findings sufficiently specific to permit the court to conclude that the ALJ did not arbitrarily discredit claimant's testimony."
To support a finding that the claimant was not credible, the ALJ must "point to specific facts in the record which demonstrate that [the claimant] is in less pain than [he] claims."
The reviewing court must bear in mind that it should not "second-guess" an ALJ's credibility determination.
Courts may only review the ALJ's articulated rationale, and "[i]f the [ALJ's] decision on its face does not adequately explain how a conclusion was reached, that alone is grounds for remand."
Here, the parties do not dispute that the ALJ reasonably concluded that Plaintiff's "medically determinable impairments could reasonably be expected to cause some of the alleged symptoms." (ECF No. 12-2 at 26.) The ALJ did not find any evidence of malingering, but nonetheless discredited Plaintiff's statements concerning the intensity, persistence and limiting effects of the alleged symptoms reasonably caused by his medically determinable impairments. (Id.) Plaintiff argues that the ALJ's decision must be reversed as legally erroneous because the ALJ failed to articulate sufficient reasons to find Plaintiff not credible. (ECF No. 17-1 at 3:24-25, 4:1-2.) Defendant disagrees, contending that the ALJ provided "specific, independent, and well supported bases for discounting [Plaintiff]'s allegations." (ECF No. 19-1 at 7.) Consequently, the Court must assess whether the ALJ provided clear and convincing reasons for discrediting Plaintiff's testimony concerning his subjective pain that are supported by substantial evidence in the record.
ii. Objective Medical Evidence
Plaintiff argues that the ALJ improperly rejected his credibility solely on the basis that Plaintiff's testimony was unsupported by objective medical evidence, and thus, the ALJ's adverse credibility finding is insufficient as a matter of law. (ECF No. 17-1 at 7:4-6, 8:1-2 (emphasis added).) Plaintiff further argues that once the ALJ established the presence of a severe medical impairment, the ALJ was required to articulate clear and convincing reasons to reject Plaintiff's testimony, but failed to do so. (Id. at 8.) Defendant counters by arguing that Plaintiff misstates the ALJ's findings because the ALJ properly relied on Plaintiff's overall medical record and not solely on objective medical evidence. (ECF No. 19-1 at 5-6 (emphasis added).) Defendant points out that the overall medical record upon which the ALJ relied included limited and conservative medical treatment as well as objective medical evidence. (Id. at 6-8.) Although the ALJ's opinion is not a model of clarity on this point, the Court agrees with Defendant that the ALJ based his credibility determination on Plaintiff's overall medical record and not solely on objective medical evidence.
The ALJ did certainly consider the objective medical evidence as a relevant factor when discrediting Plaintiff's statements concerning the intensity, persistence and limiting effects of his symptoms. "While subjective pain testimony cannot be rejected on the sole ground that it is not fully corroborated by objective medical evidence, the medical evidence is still a relevant factor in determining the severity of the claimant's pain and its disabling effects."
In the context of the ALJ's credibility analysis, the only symptom testimony of Plaintiff that the ALJ specifically referenced was his testimony that: (1) "he cannot work due to anxiety and being fearful, and also due to pain in his neck, back, feet and hands" (ECF No. 12-2 at 26); (2) "he has stress when in an enclosed room" and that he was feeling anxiousness at his hearing (id.); and (3) he has "severe and disabling pain from arthritis and problems with anxiety" (id. at 27).
The Court agrees with Plaintiff that the ALJ did not present clear and convincing reasons for basing his adverse credibility determination on objective medical evidence. As described below, the ALJ fails to adequately articulate the nexus between the statements of Plaintiff that the ALJ discredits and the objective medical evidence that purportedly undermines them. In addressing the credibility of Plaintiff's testimony, the ALJ recited selections from Plaintiff's medical record, beginning with a list of Plaintiff's visits to medical facilities in recent years:
(Id. at 26. (citations omitted).)
The ALJ then referenced the evaluations of two examining physicians, beginning with Plaintiff's psychiatric consultation with Dr. Jaga Nath Glassman. (Id.) The ALJ cited to Dr. Glassman's diagnosis stating that Plaintiff suffers from "anxiety disorder, not otherwise specified, dysthymic disorder, polysubstance abuse in long term remission, mixed personality disorder, borderline antisocial features, sleep apnea," and has a Global Assessment of Functioning ("GAF") score of 60, indicating moderate symptoms. (Id.) Next, the ALJ cited to Dr. Frederick W. Close's evaluation of Plaintiff where he states that Plaintiff "could work at a medium exertional level," but has "some mild bilateral lumbar spasm and limited range of motion in both hips." (Id. at 27.)
After listing Plaintiff's visits to medical facilities and diagnoses from two examining physicians, the ALJ concluded that "the medical record, as highlighted above, casts doubt on the credibility of the claimant's allegations." (ECF No. 12-2 at 27.) Nowhere did the ALJ connect the testimony he discredited with the medical evidence which undermined it, nor did he analyze that connection. Instead, the ALJ made a generalized and conclusory finding that Plaintiff's medical record undermines his credibility. The ALJ's credibility determination lacks findings sufficiently specific to permit this Court to conclude that the ALJ did not arbitrarily discredit claimant's testimony about the intensity of his symptoms.
iii. Limited Medical Record and Conservative Course of Treatment
As set forth above, the ALJ also discredited Plaintiff's pain testimony on the grounds that Plaintiff's medical record is limited and reflects a conservative course of treatment for Plaintiff's arthritis and anxiety symptoms. (ECF No. 12-2 at 27.) In assessing a claimant's credibility, an ALJ may rely upon an "unexplained or inadequately explained failure to seek treatment or to follow a prescribed course of treatment."
Here, the ALJ relied upon the limited nature of Plaintiff's medical records and the conservative treatment regimen followed by Plaintiff and prescribed by physicians to discredit Plaintiff's statements concerning the severity of his symptoms from arthritis and anxiety. The ALJ referenced Plaintiff's limited records and failure to seek more substantive treatment, stating that "[a]lthough the claimant alleges severe and disabling pain from arthritis and problems with anxiety, the medical record is fairly limited. The claimant has not sought the type of treatment one would expect of a totally disabled individual." (ECF No. 12-2 at 27.) In light of the record before the ALJ in this case concerning Plaintiff's homelessness and lack of insurance and income, the ALJ should have articulated whether he explored Plaintiff's limited resources as a possible reason why Plaintiff might not have a treatment record consistent with the alleged severity of his symptoms.
Plaintiff is a homeless individual, a fact the ALJ recognized twice in his hearing decision but failed to discuss when addressing Plaintiff's limited medical records. (Id. 25-26.) At the hearing, Plaintiff described a number of ways in which his homelessness and adverse financial situation hinder his ability to seek and afford medical treatment: He relies on food stamps as his sole source of income. (Id. at 40.) He suffers from high blood pressure and resorts to checking his blood pressure at Rite Aid's free monitors. (Id. at 46.) He has not sought medical treatment in the past because he was uninsured. (Id. at 47, 53.) He is sparing with his anxiety medication because it is difficult for him to obtain without insurance. (Id. at 55.) He cannot afford to take public transportation and must walk everywhere he goes. (Id. at 51.) He claims that he left a hospital against medical advice because he could not pay for the further testing doctors wanted to perform. (Id. at 55; ECF No. 12-7 at 138.) These facts, separately or in combination, could provide reasons why Plaintiff sought only the degree and amount of medical treatment that he did.
Another indication that the nature and extent of the medical care Plaintiff pursued was driven by his limited resources is Plaintiff's pattern of emergency room visits. As the ALJ identified, Plaintiff often resorts to emergency rooms when experiencing painful symptoms or to refill his anxiety, blood pressure, or prostate medications. (ECF No. 12-2 at 26-27; ECF No. 12-7 at 6, 9, 12, 16, 133, 144, 153.) Other district courts in the Ninth Circuit have found such behavior to be consistent with a plaintiff having a limited medical history because his lack of income precludes him from regularly visiting a primary care physician.
At multiple emergency room visits, the emergency room physician providing care noted Plaintiff's need to seek regular treatment from a primary care physician. One emergency room physician stated Plaintiff needed "to be under the direct care of a primary care doctor, especially because [Plaintiff] has elevated blood pressure." (ECF No. 12-7 at 14.) Another emergency room physician provided Plaintiff with discharge instructions to "contact primary care doctor in 1 day" for both a cardiology and psychiatry referral. (ECF No. 12-7 at 138.)
An "ALJ must consider all relevant evidence in the record" when making credibility findings.
In addition to noting the conservative nature of the medical treatment Plaintiff sought, the ALJ discussed the conservative nature of the treatment Plaintiff's physicians recommended as a factor undermining Plaintiff's credibility, stating that:
(ECF No. 12-2 at 27.)
With respect to anxiety,
In conclusion, although the treatment prescribed by physicians in regard to Plaintiff's anxiety may be conservative in nature, the ALJ's analysis of Plaintiff's limited medical record and course of treatment for arthritis and anxiety is not sufficiently specific to allow this Court to conclude that the ALJ rejected Plaintiff's testimony on permissible grounds.
iv. The ALJ's Observations of Plaintiff at the Hearing
Here, the ALJ used his observations of Plaintiff at the hearing as a third factor in assessing Plaintiff's credibility. Specifically, the ALJ stated that "[d]espite [Plaintiff's] allegations of anxiety in an enclosed room and particularly at this hearing," Plaintiff "did not appear anxious or uncomfortable." (ECF No. 12-2 at 27.) When forming a conclusion about a claimant's credibility, an ALJ may use "ordinary techniques of credibility evaluation."
The ALJ considered Plaintiff's "apparent lack of discomfort during the hearing" as a factor in reaching his credibility conclusion, while also acknowledging the correct legal standard that his observation is not a "conclusive indicator" of Plaintiff's day-to-day anxiety levels.
As the above analysis details, the ALJ took three factors into consideration to assess Plaintiff's credibility. The first two were not supported by clear and convincing reasons, and the third one cannot stand alone.
Additionally, although only indirectly raised in this appeal, the ALJ's analysis at step four of the hearing decision is further deficient in that his credibility discussion of Plaintiff's testimony is seemingly limited to Plaintiff's alleged symptoms from anxiety and arthritis only. The ALJ recognized at step two that Plaintiff, in addition to arthritis and anxiety, suffers from the severe impairments of sleep apnea, mixed personality disorder, and depression. (ECF No. 12-2 at 23.) The Court finds no explanation from the ALJ as to why Plaintiff's statements concerning the intensity, persistence and limiting effects of symptoms from these additional severe impairments are not entirely credible. Thus, the Court is left to speculate as to whether and why the ALJ discredited Plaintiff's allegations and testimony concerning his "constant depression," which allegedly rendered him suicidal and incapable of performing even basic work. (See ECF No. 12-2 at 52; ECF No. 12-3 at 3; ECF No. 12-7 at 34.)
In sum, the ALJ erred in failing to articulate clear and convincing reasons for his conclusion that Plaintiff's "statements concerning the intensity, persistence and limiting effects of [his] symptoms are not entirely credible." (ECF No. 12-2 at 26.) Because the ALJ appears to have based Plaintiff's disability status in large part on his credibility analysis, the ALJ committed legal error that is not harmless, and thus, warrants remedy.
C. Remand is Appropriate
Plaintiff asks the Court to reverse for the payment of benefits, or in the alternative, remand for the correction of legal errors. (ECF No. 17-1 at 11:11, 21-22.) Defendant maintains the position that the ALJ's decision is "free from reversible legal error," but if the Court overturns the ALJ's decision, remand is the proper remedy. (ECF No. 19-1 at 8.)
When an ALJ commits error that is not harmless, "[t]he decision whether to remand for further proceedings or simply to award benefits is within the discretion of [the] court."
Here, the ALJ committed legal error that was not harmless, but this is not a case where further administrative proceedings would lack purpose. Therefore, remand for further proceedings is the appropriate remedy.
For the reasons stated above, the Court
(1) Plaintiff's motion for summary judgment (ECF No. 17) be
(2) The Commissioner's cross-motion for summary judgment (ECF No. 19) be
IT IS HEREBY ORDERED that any written objections to this Report and Recommendation must be filed with the Court and served on all parties
IT IS FURTHER ORDERED that any reply to the objections shall be filed with the Court and served on all parties no later than
Garrison, 759 F.3d at 1020.