United States District Court, W.D. Washington, Tacoma
ORDER REVERSING AND REMANDING DEFENDANT'S
DECISION TO DENY BENEFITS
W. Christel United States Magistrate Judge
filed this action, pursuant to 42 U.S.C. § 405(g), for
judicial review of Defendant's denial of Plaintiff's
applications for supplemental security income
(“SSI”) and disability insurance benefits
(“DIB”). Pursuant to 28 U.S.C. § 636(c),
Federal Rule of Civil Procedure 73 and Local Rule MJR 13, the
parties have consented to have this matter heard by the
undersigned Magistrate Judge. See Dkt. 2.
considering the record, the Court concludes the
Administrative Law Judge (“ALJ”) erred when she
failed to provide specific and legitimate reasons, supported
by substantial evidence, to discount medical opinion evidence
from Dr. Wayne Hwang, M.D.; Dr. Myrna Palasi, M.D.; Dr.
Margot Schwartz, M.D.; and Dr. Tasmyn Bowes, Psy.D. Had the
ALJ properly considered these medical opinions, the residual
functional capacity (“RFC”) may have included
additional limitations. The ALJ's errors are therefore
not harmless, and this matter is reversed and remanded
pursuant to sentence four of 42 U.S.C. § 405(g) to the
Social Security Commissioner (“Commissioner”) for
further proceedings consistent with this Order.
AND PROCEDURAL HISTORY
22, 2015, Plaintiff filed applications for DIB and SSI,
alleging disability as of June 30, 2007. See Dkt. 8,
Administrative Record (“AR”) 16. Plaintiff
subsequently amended the alleged onset date to May 22, 2015.
See AR 16. The applications were denied upon initial
administrative review and on reconsideration. See AR
16. ALJ Stephanie Martz held a hearing on December 5, 2017.
AR 36-67. In a decision dated February 7, 2018, the ALJ
determined Plaintiff to be not disabled. AR 13-35.
Plaintiff's request for review of the ALJ's decision
was denied by the Appeals Council, making the ALJ's
decision the final decision of the Commissioner. See
AR 1-7; 20 C.F.R. §§ 404.981, 416.1481.
Plaintiff's Opening Brief, Plaintiff maintains the ALJ
erred: (1) by failing to provide legally sufficient reasons
to discount opinion evidence from Drs. Hwang, Palasi,
Schwartz, and Bowes, and Ms. Meagan Collins, LICSWA; and (2)
in her assessment of Plaintiff's depression at Step Two
of the sequential evaluation process. Dkt. 10, pp. 2-17.
Plaintiff requests the Court remand this matter for an
immediate award of benefits. Id. at p. 18.
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
Whether the ALJ properly considered the opinion
contends the ALJ failed to properly reject opinion evidence
from Drs. Hwang, Palasi, Schwartz, and Bowes, and Ms.
Collins. Dkt. 10, pp. 2-14.
assessing acceptable medical sources, an ALJ must provide
“clear and convincing” reasons for rejecting the
uncontradicted opinion of either a treating or examining
physician. Lester v. Chater, 81 F.3d 821, 830 (9th
Cir. 1995) (citing Pitzer v. Sullivan, 908 F.2d 502,
506 (9th Cir. 1990)); Embrey v. Bowen, 849 F.2d 418,
422 (9th Cir. 1988)). When a treating or examining
physician's opinion is contradicted, the opinion can be
rejected “for specific and legitimate reasons that are
supported by substantial evidence in the record.”
Lester, 81 F.3d at 830-31 (citing Andrews v.
Shalala, 53 F.3d 1035, 1043 (9th Cir. 1995); Murray
v. Heckler, 722 F.2d 499, 502 (9th Cir. 1983)). The ALJ
can accomplish this by “setting out a detailed and
thorough summary of the facts and conflicting clinical
evidence, stating his interpretation thereof, and making
findings.” Reddick v. Chater, 157 F.3d 715,
725 (9th Cir. 1998) (citing Magallanes v. Bowen, 881
F.2d 747, 751 (9th Cir. 1989)).
medical source” testimony, which the Ninth Circuit
treats as lay witness testimony, “is competent evidence
an ALJ must take into account, ” unless the ALJ
“expressly determines to disregard such testimony and
gives reasons germane to each witness for doing so.”
Lewis v. Apfel, 236 F.3d 503, 511 (9th Cir. 2001);
see also Turner v. Comm'r of Soc. Sec. Admin.,
613 F.3d 1217, 1224 (9th Cir. 2010). In rejecting lay
testimony, the ALJ need not cite the specific record as long
as “arguably germane reasons” for dismissing the
testimony are noted. Lewis, 236 F.3d at 51
Plaintiff challenges the ALJ's assessment of the opinion
evidence from Plaintiff's treating cardiologist, Dr.
Hwang. Dkt. 10, pp. 12-13.
Hwang completed a medical assessment of Plaintiff's
ability to do physical work-related activities on December
15, 2017. AR 1155-58. On the opinion form, Dr. Hwang noted
his treatment history with Plaintiff included treating
Plaintiff after his heart attack and managing his
“ongoing chest pains.” AR 1155. Dr. Hwang opined
Plaintiff is limited to performing sedentary work. AR 1155.
Dr. Hwang noted he based this opinion on Plaintiff's
“ongoing” symptoms despite medical treatment for
chest pains. AR 1155. Dr. Hwang determined Plaintiff can
stand and walk for 2-4 hours, and sit for less than 4 hours,
in an 8-hour workday. AR 1156. Dr. Hwang found Plaintiff
limited in his ability to push and pull in his lower
extremities due to neuropathy in Plaintiff's feet. AR
1156. Additionally, Dr. Hwang opined Plaintiff can
occasionally climb, balance, stoop, crouch, kneel, and crawl
because of ongoing chest pains. See AR 1157. Dr.
Hwang determined Plaintiff has environmental restrictions
caused by his impairments, including restrictions in his
ability to tolerate moving machinery, temperature extremes,
dust, noise, humidity, and vibrations. AR 1157. Finally, Dr.
Hwang noted that while he found it “almost
impossible” to answer whether Plaintiff could sustain
full-time employment, he believed Plaintiff “would have
unpredictable reliability” based on his conditions,
such as “sudden unexplained and unexpected chest
pains[.]” AR 1158.
assigned “little weight” to Dr. Hwang's
(1) While [Dr. Hwang] opines the claimant is limited to
sedentary work, his last treatment note from early 2017
showed that he assessed the claimant with only mild cardiac
symptoms. (2) Dr. Hwang's records show no evidence of
neuropathy (3) and do not support the drastic limitations he
notes in this assessment.
AR 27 (numbering added).
the ALJ rejected Dr. Hwang's assessment because she found
Dr. Hwang's last treatment note showed he assessed
Plaintiff “with only mild cardiac symptoms.” AR
27. An ALJ may reject an opinion that is “inadequately
supported by clinical findings.” Bayliss, 427
F.3d at 1216 (citing Tonapetyan v. Halter, 242 F.3d
1144, 1149 (9th Cir. 2001)). Regardless, the ALJ's
reasons for discounting the doctor must be supported by
substantial evidence in the record. See Bayliss, 427
F.3d at 1214 n.1, 1216.
case, though the ALJ failed to cite or identify the date of
Dr. Hwang's “last treatment note from early 2017,
” the parties suggest - and the Court agrees - Dr.
Hwang's last treatment notes are from January 27, 2017.
See AR 1048-52; Dkt. 10, pp. 12-13; Dkt. 11, pp.
6-7. In this treatment note, Dr. Hwang noted Plaintiff
continued to experience chest pain, which Plaintiff
“describe[d] as discomfort in general, tightness,
” and as occurring “with exertion.” AR
1048. Dr. Hwang noted the chest pain occurred “even
with mild activities” and Plaintiff expressed that the
chest pain was “lifestyle limiting.” AR 1048.
After a physical examination of Plaintiff, Dr. Hwang
described data from prior stress tests and echocardiograms of
Plaintiff's heart. See AR 1051. Dr. Hwang noted,
in part, that Plaintiff's last stress test from June 2016
indicated “[i]ntermediate risk, ” but
infarct/ischemia had “escalat[ed] since then.”
in contrast to the ALJ's finding, this treatment note
does not show Dr. Hwang assessed Plaintiff with
“mild” cardiac symptoms. See AR 27,
1048-51. Rather, Dr. Hwang remarked Plaintiff was
experiencing chest pain on exertion, and some aspects of
Plaintiff's heart had escalated since 2016. See
AR 1051. As Dr. Hwang did not, as the ALJ found, assess
Plaintiff with only “mild” cardiac symptoms, the
Court finds this reason from the ALJ not supported by
substantial evidence in the record.
citing information from the New York Heart Association
(“NYHA”), argues the ALJ properly found
Plaintiff's cardiac symptoms were mild because Dr. Hwang
assessed his cardiac impairment as “Class II”
pursuant to NYHA criteria. Dkt. 11, pp. 6-7 (citing AR 1051).
Yet the ALJ did not rely on or reference the NYHA criteria in
finding Dr. Hwang assessed Plaintiff with mild cardiac
symptoms. See AR 27. The Court cannot “affirm
the decision of an agency on a ground the agency did not
invoke in making its decision.” Stout v. Comm'r
of Soc. Sec. Admin, 454 F.3d 1050, 1054 (9th Cir. 2006)
(internal quotation marks and citation omitted).
“Long-standing principles of administrative law require
us to review the ALJ's decision based on the reasoning
and actual findings offered by the ALJ - not post
hoc rationalizations that attempt to intuit what the
adjudicator may have been thinking.” Bray v.
Comm'r of Soc. Sec. Admin., 554 F.3d 1219, 1225-26
(9th Cir. 2009) (emphasis in original) (citing SEC v.
Chenery Corp., 332 U.S. 194, 196 (1947)) (other citation
omitted). Because the ALJ did not rely on NYHA criteria in
making her finding, Defendant's post hoc
argument is without merit. The Court concludes the ALJ's
first reason for rejecting Dr. Hwang's assessment is
the ALJ discounted Dr. Hwang's opinion because his
treatment records “show no evidence of
neuropathy[.]” AR 27. As stated above, an ALJ need not
accept a medical opinion that is unsupported by clinical
findings. Bayliss, 427 F.3d at 1216 (citing
Tonapetyan, 242 F.3d at 1149). But an ALJ cannot
reject a medical opinion for lacking support where the record
contains supporting treatment notes. See Garrison v.
Colvin, 759 F.3d 995, 1014 n. 17 (9th Cir. 2014);
see also Esparza v. Colvin, 631 Fed.Appx. 460, 462
(9th Cir. 2015). In this case, Dr. Hwang is one of
Plaintiff's treating physicians and the record contains
treatment notes and objective testing from the clinic where
Dr. Hwang practices. See, e.g., AR 629-870, 897-953,
1001-82. These treatment notes indicate Plaintiff experienced
foot pain and numbness, and that providers at the clinic
noted the symptoms could be due to neuropathy. See,
e.g., AR 1026-27 (“he is limited to walking 4 to 8
blocks before his feet go numb”; “[h]e has some
neuropathic symptoms”), 1036-37 (same), 1041 (noting
diagnoses of “[p]eripheral neuropathy” and right
foot pain); see also AR 734, 929, 992-93, 995, 1003,
1007, 1012, 1016, 1017, 1022, 1064. Considering the multiple
treatment notes and observations from other providers at Dr.
Hwang's clinic about foot pain, foot numbness, and
neuropathy, the ALJ's finding that Dr. Hwang's
records show “no evidence” of neuropathy is not
supported by substantial evidence. See Garrison, 759
F.3d at 1013 (a treating physician's opinion cannot be
rejected for lacking support if the opinion reflects and is
consistent with treatment notes in the record).
the Court notes Dr. Hwang only cited Plaintiff's
neuropathy as causing the opined pushing and pulling
limitations. See AR 1156. For the remainder of his
opined limitations, including his opinion that Plaintiff is
limited to sedentary work, Dr. Hwang found these limitations
supported by Plaintiff's “ongoing” symptoms
related to his “chest pains.” See AR
1155. The ALJ did not explain how Dr. Hwang's records
allegedly lacking “evidence of neuropathy”
undermines his opinion about the limitations he found
supported by Plaintiff's chest pains. See AR 27;
Treichler v. Comm'r of Soc. Sec. Admin., 775
F.3d 1090, 1103 (9th Cir. 2014) (citation omitted)
(“the ALJ must provide some reasoning in order for us
to meaningfully determine whether the ALJ's conclusions
were supported by substantial evidence”). Thus, the
ALJ's second reason for rejecting Dr. Hwang's opinion
is not legitimate and lacks support from substantial evidence
in the record.
the ALJ determined Dr. Hwang's records “do not
support the drastic limitations he notes in this
assessment.” AR 27. An ALJ, however, cannot reject a
physician's opinion in a vague or conclusory manner.
See Garrison, 759 F.3d at 1012-13 (citing Nguyen
v. Chater, 100 F.3d 1462, 1464 (9th Cir. 1996));
Embrey, 849 F.2d at 421-22. Instead, the ALJ must
state her interpretations and explain why they, rather than
the physician's interpretations, are correct. See
Embrey, 849 F.2d at 421-22.
the ALJ summarily stated Dr. Hwang's records do not
support “the drastic limitations” he opined.
See AR 27. But the ALJ failed to provide her
interpretation of the evidence and explain how she found Dr.
Hwang's records fail to support his limitations. Because
the ALJ failed to explain why her interpretations, rather
than Dr. Hwang's interpretations, are correct, this is
not a specific, legitimate reason to reject Dr. Hwang's
findings. See McAllister v. Sullivan, 888 F.2d 599,
602 (9th Cir. 1989) (an ALJ's rejection of a
physician's opinion on the ground that it was contrary to
the record was “broad and vague, failing to specify why
the ALJ felt the treating physician's opinion was
above stated reasons, the ALJ failed to provide any specific,
legitimate reason, supported by substantial evidence, to give
Dr. Hwang's ...