United States District Court, W.D. Washington, Seattle
REPORT AND RECOMMENDATION
JAMES P. DONOHUE, Magistrate Judge.
Plaintiff Leslie Sanders, on behalf of her deceased husband Jeffrey Scott Sanders, appeals the final decision of the Commissioner of the Social Security Administration ("Commissioner") which denied his applications for Disability Insurance Benefits ("DIB") under Title II of the Social Security Act, 42 U.S.C. §§ 401-33, after a hearing before an administrative law judge ("ALJ"). For the reasons set forth below, the Court recommends that the Commissioner's decision be REVERSED and REMANDED for an award of benefits.
I. FACTS AND PROCEDURAL HISTORY
Born in 1967, plaintiff was forty-two years old on his alleged disability onset date. Administrative Record ("AR") at 15, 221. He had a high school education, although he suffered from dyslexia and was in special educations classes for reading and writing as a child. AR at 24, 226, 325. His past work experience includes employment as a building maintenance laborer, furniture mover, school bus driver, shipyard laborer, and shuttle bus driver. AR at 42, 92, 195-96. Plaintiff was last gainfully employed in August 2009, before he suffered a subarachnoid hemorrhage ("SAH") on August 24, 2009 that required neurosurgery and a 10-day hospitalization in the intensive care unit at Harborview Medical Center ("HRM"). AR at 41, 196, 285, 288, 711.
Plaintiff applied for DIB on June 10, 2011, alleging an onset date of August 24, 2009. AR at 197-207. The Commissioner denied plaintiff's claim initially and on reconsideration. AR at 100-25. Plaintiff requested a hearing, but died one month prior to the scheduled hearing date. AR at 15, 701, 703. Plaintiff contends that he was disabled due to blood clots in his legs (deep vein thromboses) and lungs (pulmonary embolisms) as a result of his Factor VIII disorder which caused his blood to over-coagulate, as well as congenital hydrocephalus in his head. AR at 711. Plaintiff was given Coumadin to thin his blood and instructed to walk every day one to two hours to prevent clot formation, as well as elevate his legs at rest. AR at 711. In June 2011, August 2011, and January 2012, plaintiff developed additional blood clots in his legs and groin. AR at 244, 374. In July 2012, he had another SAH. At that time, an MRI of his brain and full spine were performed, revealing multiple tumors on his lumbar spine. AR at 700. When doctors performed a laminectomy for resection of one of the masses, plaintiff developed a pulmonary embolism and died on July 29, 2012, at age 45. AR at 700-03. His wife, Leslie Sanders, was substituted as a party and attended the administrative hearing on August 29, 2012. AR at 32-99, 263.
On November 16, 2012, the ALJ issued a partially favorable decision. Specifically, the ALJ denied benefits prior to January 21, 2012, based on her finding that plaintiff could perform a specific job existing in significant numbers in the national economy. AR at 11-31. The ALJ found that plaintiff's severe impairments included adjustment disorder, intracranial injury (subarachnoid hemorrhage), venous insufficiency (both superficial and deep vein thrombosis), hydrocephalus, headaches, lumbar tumors and laminectomy, and pulmonary embolism. AR at 17. The ALJ concluded that plaintiff became disabled as of January 21, 2012, and remained disabled through July 29, 2012, the date he died. AR at 25.
Plaintiff's request for review by the Appeals Council was denied, AR at 1-5, making the ALJ's ruling the "final decision" of the Commissioner as that term is defined by 42 U.S.C. § 405(g). On April 7, 2014, plaintiff timely filed the present action challenging the Commissioner's decision. Dkt. 1.
Jurisdiction to review the Commissioner's decision exists pursuant to 42 U.S.C. §§ 405(g) and 1383(c)(3).
III. STANDARD OF REVIEW
Pursuant to 42 U.S.C. § 405(g), this Court may set aside the Commissioner's denial of social security benefits when 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 (9th Cir. 2005). "Substantial evidence" is more than a scintilla, less than a preponderance, and is such relevant evidence as a reasonable mind might accept as adequate to support a conclusion. Richardson v. Perales, 402 U.S. 389, 401 (1971); Magallanes v. Bowen, 881 F.2d 747, 750 (9th Cir. 1989). The ALJ is responsible for determining credibility, resolving conflicts in medical testimony, and resolving any other ambiguities that might exist. Andrews v. Shalala, 53 F.3d 1035, 1039 (9th Cir. 1995). While the Court is required to examine the record as a whole, it may neither reweigh the evidence nor substitute its judgment for that of the Commissioner. Thomas v. Barnhart, 278 F.3d 947, 954 (9th Cir. 2002). When the evidence is susceptible to more than one rational interpretation, it is the Commissioner's conclusion that must be upheld. Id.
The Court may direct an award of benefits where "the record has been fully developed and further administrative proceedings would serve no useful purpose." McCartey v. Massanari, 298 F.3d 1072, 1076 (9th Cir. 2002) (citing Smolen v. Chater, 80 F.3d 1273, 1292 (9th Cir. 1996)). The Court may find that this occurs when:
(1) the ALJ has failed to provide legally sufficient reasons for rejecting the claimant's evidence; (2) there are no outstanding issues that must be resolved before a determination of disability can be made; and (3) it is clear from the record that the ALJ would be required to find the claimant disabled if he considered the claimant's evidence.
Id. at 1076-77; see also Harman v. Apfel, 211 F.3d 1172, 1178 (9th Cir. 2000) (noting that erroneously rejected evidence may be credited when all three elements are met).
IV. EVALUATING DISABILITY
As the claimant, Mr. Sanders bears the burden of proving that he is disabled within the meaning of the Social Security Act (the "Act"). Meanel v. Apfel, 172 F.3d 1111, 1113 (9th Cir. 1999) (internal citations omitted). The Act defines disability as the "inability to engage in any substantial gainful activity" due to a physical or mental impairment which has lasted, or is expected to last, for a continuous period of not less than twelve months. 42 U.S.C. §§ 423(d)(1)(A), 1382c(a)(3)(A). A claimant is disabled under the Act only if his impairments are of such severity that he is unable to do his previous work, and cannot, considering his age, education, and work experience, engage in any other substantial gainful activity existing in the national economy. 42 U.S.C. §§ 423(d)(2)(A); see also Tackett v. Apfel, 180 F.3d 1094, 1098-99 (9th Cir. 1999).
The Commissioner has established a five step sequential evaluation process for determining whether a claimant is disabled within the meaning of the Act. See 20 C.F.R. §§ 404.1520, 416.920. The claimant bears the burden of proof during steps one through four. At step five, the burden shifts to the Commissioner. Id. If a claimant is found to be disabled at any step in the sequence, the inquiry ends without the need to consider subsequent steps. Step one asks whether the claimant is presently engaged in "substantial gainful activity." 20 C.F.R. §§ 404.1520(b), 416.920(b). If he is, disability benefits are denied. If he is not, the Commissioner proceeds to step two. At step two, the claimant must establish that he has one or more medically severe impairments, or combination of impairments, that limit his physical or mental ability to do basic work activities. If the claimant does not have such impairments, he is not disabled. 20 C.F.R. §§ 404.1520(c), 416.920(c). If the claimant does have a severe impairment, the Commissioner moves to step three to determine whether the impairment meets or equals any of the listed impairments described in the regulations. 20 C.F.R. §§ 404.1520(d), 416.920(d). A claimant whose impairment meets or equals one of the listings for the required twelve-month duration requirement is disabled. Id.
When the claimant's impairment neither meets nor equals one of the impairments listed in the regulations, the Commissioner must proceed to step four and evaluate the claimant's residual functional capacity ("RFC"). 20 C.F.R. §§ 404.1520(e), 416.920(e). Here, the Commissioner evaluates the physical and mental demands of the claimant's past relevant work to determine whether he can still perform that work. 20 C.F.R. §§ 404.1520(f), 416.920(f). If the claimant is able to perform his past relevant work, he is not disabled; if the opposite is true, then the burden shifts to the Commissioner at step five to show that the claimant can perform other work that exists in significant numbers in the national economy, taking into consideration the claimant's RFC, age, education, and work experience. 20 C.F.R. §§ 404.1520(g), 416.920(g); Tackett, 180 F.3d at 1099, 1100. If the Commissioner finds the claimant is unable to perform other work, then the claimant is found disabled and benefits may be awarded.
V. DECISION BELOW
On November 16, 2012, the ALJ issued a decision finding the following:
1. The claimant met the insured status requirements of the Social Security Act through July 29, 2012.
2. The claimant has not engaged in substantial gainful activity since the alleged onset date.
3. The claimant has had the following severe impairments: adjustment disorder, intracranial injury (subarachnoid hemorrhage), venous insufficiency (superficial and deep vein thrombosis), hydrocephalus, headaches, lumbar tumor and laminectomy, and pulmonary embolism.
4. Since August 24, 2009, the claimant has not had an impairment or combination of impairments that meets or medically equals the severity of one of the listed impairments in 20 CFR Part 404, Subpart P, Appendix 1.
5. I find that prior to January 21, 2012, the claimant had the residual functional capacity to perform light work as defined in 20 CFR 404.1567(b) except he was able to lift or carry up to 20 pounds occasionally and 10 pounds frequently; he was able to stand or walk up to 2 hours at a time and sit up to 6 hours total in an 8-hour workday; he needed to change positions after 1 hour of sitting for a few minutes at or near his workstation; he was able to occasionally climb ramps/stairs and balance; he was able to frequently stoop, kneel, crouch, and crawl; he was required to avoid concentrated exposure to heights and machinery (i.e. hazards); and he had sufficient concentration to understand, remember, and carry out simple repetitive tasks and to deal with simple workplace changes.
6. I find that since January 21, 2012, the claimant had the residual functional capacity to perform light work as defined in 20 CFR 404.1567(b) except he was able to lift or carry up to 20 pounds occasionally and 10 pounds frequently; he was able to stand or walk up to 2 hours and sit up to 6 hours per 8-hour workday; he needed to change positions after 1hour of sitting for a few minutes at or near his workstation; he was able to occasionally climb ramps/stairs and balance; he was able to frequently stoop, kneel, crouch, and crawl; he was required to avoid concentrated exposure to heights and machinery (i.e. hazards); and he had sufficient concentration to understand, remember, and carry out simple repetitive tasks and to deal with simple workplace changes. However, he would have been off-task 20% of the workday.
7. The claimant was unable to perform any past relevant work.
8. Prior to the established disability onset date, the claimant was a younger individual age 18-49. The claimant's age category had not changed since the established disability onset date.
9. The claimant had at least a high school education and is able to communicate in English.
10. Prior to January 21, 2012, transferability of job skills was not material to the determination of disability because using the Medical-Vocational Rules as a framework supports a finding that the claimant was "not disabled, " whether or not the claimant had transferable job skills. Beginning on January 21, 2012, the claimant had not been able to transfer job skills to other occupations.
11. Prior to January 21, 2012, considering the claimant's age, education, work experience, and residual functional capacity, there were jobs that existed in significant numbers in the national economy that the claimant could have performed.
12. Beginning on January 21, 2012, considering the claimant's age, education, work experience, and residual functional capacity, there were no jobs that existed in significant numbers in the national economy that the claimant can perform.
13. The claimant was not disabled prior to January 21, 2012, but became disabled on that date and has continued to be disabled through ...