United States District Court, W.D. Washington, Seattle
ORDER REVERSING DEFENDANT'S DECISION TO DENY
L. ROBART, UNITED STATES DISTRICT JUDGE
Charisse Ford seeks review of the denial of her application
for disability insurance and supplemental security income
benefits. Ms. Ford contends the Administrative Law Judge
("ALJ") misevaluated the medical opinion evidence
concerning her mental impairments and her testimony. (Op. Br.
(Dkt. # 8) at 1.) Ms. Ford contends these errors impacted the
ALJ's residual functional capacity determination and the
findings at Step Five of the disability evaluation process.
(Id.) As discussed below, the court REVERSES the
Commissioner's final decision and REMANDS the matter for
further administrative proceedings under sentence four of 42
U.S.C. § 405(g).
THE ALJ'S DECISION
the five-step disability evaluation process,  the ALJ found:
Step one: Ms. Ford has not engaged in
substantial gainful activity since August 15, 2012.
Step two: Ms. Ford has the following severe
impairments: degenerative disc disease; affective disorder;
and anxiety disorder.
Step three: These impairments do not meet or
equal the requirements of a listed impairment.
Residual functional capacity: Ms. Ford can
perform light work as defined in 20 C.F.R. §§
404.1567(b) and 416.97(b). Ms. Ford can stand and/or walk
with normal breaks for about four hours in an eight-hour
workday. She can sit with normal breaks for a total of about
six hours in an eight-hour workday. Ms. Ford can frequently
stoop and kneel. She can occasionally climb ramps, stairs,
ladders, ropes, and scaffolds. Ms. Ford can occasionally
crouch and crawl. Ms. Ford is capable of unskilled work
involving short and simple tasks. She can have superficial
contact with supervisors for work tasks, and can have
occasional changes to the work environment. Ms. Ford is not
able to perform at a production rate pace, but can perform
Step four: Ms. Ford cannot perform past
relevant work, including institutional cook, receptionist,
teacher assistant, home attendant, and packager.
Step five: Ms. Ford can perform jobs that
exist in significant numbers in the national economy,
including housekeeping. Therefore, Ms. Ford has not been
disabled since August 15, 2012, the alleged disability onset
(Administrative Record ("AR") (Dkt. # 7)
at 27-36.) The Appeals Council denied Ms. Ford's
request for review, thus rendering the ALJ's decision
final. (AR at 5.)
Evaluation of the Medical Evidence Concerning Ms. Ford's
Ford contends that the ALJ erred in evaluating the medical
evidence in the record concerning her mental impairments.
(See Op. Br. at 2-9.) Questions of credibility and
conflicts in the evidence are solely the ALJ's
responsibility, so long as the medical evidence in the record
is not conclusive. See Sample v. Schweiker, 694 F.2d
639, 642 (9th Cir. 1982). The ALJ's findings resolving
credibility and evidentiary issues "must be supported by
specific, cogent reasons." See Reddick v.
Chater, 157 F.3d 715, 722 (9th Cir. 1998).
the ALJ rejects the opinion of an examining doctor, even if
it is contradicted by another doctor, the ALJ must provide
"specific and legitimate reasons that are supported by
substantial evidence in the record" for rejecting the
opinion. See Lester v. Chater, 81 F.3d 821, 830-31
(9th Cir. 1996) (citing Andrews v. Shalala, 53 F.3d
1035, 1042 (9th Cir. 1995)). The ALJ can satisfy this
requirement "by setting out a detailed and thorough
summary of the facts and conflicting clinical evidence,
stating his interpretation thereof, and making
findings." Reddick, 157 F.3d at 725 (citing
Magallanes v. Bowen, 881 F.2d 747, 751 (9th Cir.
1989)). The court may also draw "specific and legitimate
inferences from the ALJ's opinion."
Magallanes, 881 F.2d at755. The court now reviews
the ALJ's evaluation of the relevant medical evidence.
R.A. Cline, Psv.D.
Cline examined Ms. Ford on December 6, 2012. (AR at 316-23.)
During the examination, Dr. Cline conducted a clinical
interview, during which she documented Ms. Ford's subject
complaints and her own observations. (Id. at
316-17.) Dr. Cline noted Ms. Ford was "visibly anxious
with her hands trembling and being very tearful throughout
the initial portion of the interview." (Id. at
316.) Dr. Cline also remarked that she did not have records
available to review. (Id.)
Cline conducted several tests during her examination of Ms.
Ford. (Id. at 317.) Ms. Ford's score on the Beck
Anxiety Inventory ("BAI") "indicate[d] a
marked to severe level of anxiety, " which Dr. Cline
stated was congruent with Ms. Ford's presentation during
the examination. (Id.) Dr. Cline further noted that
Ms. Ford's score on the Beck Depression Inventory-II
"indicate[d] a moderate to marked level of depression at
this time and over the last two weeks." (Id.)
Based upon her observations, Dr. Cline diagnosed Ms. Ford
with depressive disorder, generalized anxiety disorder with
features of panic disorder, and posttraumatic stress
disorder. (Id. at 318.) Dr. Cline additionally
concluded that Ms. Ford had marked limitations in both her
ability to communicate and perform effectively in a work
setting, and her ability to complete a normal work day or
week without interruptions from her psychological symptoms.
(Id. at 318-19.)
rejected Dr. Cline's opinions on Ms. Ford's mental
limitations because (1) they were based on a single
examination; and (2) Dr. Cline relied heavily on Ms.
Ford's subjective report of symptoms. (Id. at
33.) The ALJ accepted Dr. Cline's opinion "that the
most that the claimant can still do are unskilled tasks with
reduced social interaction because of severe mental
erred in rejecting Dr. Cline's opinions. He gave only two
vague reasons, neither of which satisfies the "specific
and legitimate" standard. First, the fact that Dr. Cline
performed only a single examination is not a legitimate
reason to reject her opinion. Examining doctors commonly
conduct only a single examination. If the court were to
reject medical opinions every time they were based on a
single examination, then only opinions from treating doctors
would be considered, contrary to federal regulation.
See 20 C.F.R. § 416.927(c) (noting that the
Social Security Administration ("SSA") "will
evaluate every medical opinion we receive, " including
opinions from non-treating doctors). Furthermore, the ALJ
contradicted his own logic by placing "significant
weight" on the opinions of the state-agency reviewers,
Jan Lewis, Ph.D. and Patricia Kraft, Ph.D., neither of whom
performed even a single examination. If an opinion should be
rejected solely because it was based on a single examination,
then one that was based on no examination at all should also
be rejected. As that is not the law, the ALJ was not entitled
to reject Dr. Cline's opinion on the basis of her having
performed a single exam.
the ALJ's rejection of Dr. Cline's opinions because
they were based on Ms. Ford's subjective complaints,
without more, is insufficient. An ALJ does not provide clear
and convincing reasons for rejecting an examining
psychologist's opinion by questioning the credibility of
the patient's complaints where the psychologist does not
discredit those complaints, and supports her ultimate opinion
with her own observations. Edlund v. Massanari, 253
F.3d 1152, 1159 (9th Cir. 2001). At no point does the record
indicate that Dr. Cline discredited Ms. Ford's
complaints. (See AR at 316-23.) To the contrary, the
record indicates that Dr. Cline supported her opinions with
her observations and testing. (See id.) Dr. Cline
reported that Ms. Ford "achieved a score of 44 on the
BAI[, ] which indicates a marked to severe level of anxiety,
" and was "congruent with her presentation in the
interview." (AR at 317.)
Ninth Circuit's recent opinion in Buck v.
Berryhill,869 F.3d 1040 (9th Cir. 2017), is
informative. The Buck Court noted that psychiatric
evaluations "will always depend in part on the
patient's self-report" because "unlike a broken
arm, a mind cannot be x-rayed." Id. at 1049
(internal quotation marks omitted) (quoting Poulin v.
Bowen,817 F.2d 865, 873 (D.C. Cir. 1987)). "Thus,
the rule allowing an ALJ to reject opinions based on
self-reports does not apply in the same manner to opinions
regarding mental illness." Buck, 869 F.3d at
1049. The Ninth Circuit further noted that clinical
interviews and mental status evaluations "are objective
measures and cannot be discounted as
'self-report.'" Id. The ALJ thus erred
in rejecting Dr. Cline's opinions as based on Ms.
Ford's subjective ...