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Gabrielle S. v. Commissioner of Social Security

United States District Court, W.D. Washington, Seattle

September 13, 2019

GABRIELLE S., Plaintiff,



         Plaintiff Gabrielle S. seeks review of the denial of her application for Supplemental Security Income. She contends the ALJ misevaluated the medical opinion evidence and erred in assessing her residual functional capacity. Dkt. 10. The Court REVERSES the Commissioner's final decision and REMANDS the matter for an immediate award of benefits.


         Plaintiff is currently 35 years old, completed the 8th grade, and has no past relevant work. Tr. 35, 38-40. In June 2013, she applied for benefits, alleging disability as of September 2004. Tr. 154. The Social Security Administration issued a final decision finding her not disabled and denying her application. Tr. 1, 10-20. Plaintiff sought review and this court issued a decision reversing and remanding the case for further administrative proceedings. Tr. 514-26. On remand, the ALJ conducted another hearing and, on January 17, 2019, issued a second decision finding plaintiff not disabled. Tr. 433-46. Plaintiff again seeks review by this court.


         Utilizing the five-step disability evaluation process, [1] the ALJ found that plaintiff had not engaged in substantial gainful activity since the application date; she had the following severe impairments: obesity, affective disorder, anxiety disorder, and posttraumatic stress disorder; and these impairments did not meet or equal the requirements of a listed impairment.[2] Tr. 435-37. The ALJ found that plaintiff had the residual functional capacity to perform light work with additional postural and environmental limitations; she had limitations on the complexity of the work, the amount and nature of contact with others, and changes in the work environment; and she would be off-task up to 10% of the workday and may have 4 unexcused absences in a year. Tr. 438. The ALJ found that plaintiff had no past relevant work but, as there were jobs that exist in significant numbers in the national economy that she could perform, she was not disabled. Tr. 445-46.


         A. Medical opinions

         Plaintiff argues that the ALJ erred by improperly rejecting all the opinions from treating and examining providers in favor of the opinions from nonexamining state agency psychologists. Dkt. 10 at 5. The ALJ gave little weight to the opinions from treating social worker Caitlin Cotter, LICSW, examining psychologist Barbara Lui, Ph.D., examining psychologist Kenneth Hapke, Ph.D., examining physician Kathleen Andersen, M.D., examining psychologist Jan Kouzes, Ed.D., and treating social worker Alana Honigman, LICSW; the ALJ gave significant weight to the opinions of the state agency psychological consultants, Dr. van Dam and Dr. Clifford. Tr. 441-42.

         In general, the ALJ should give more weight to the opinion of a treating doctor than to that of a non-treating doctor, and more weight to the opinion of an examining doctor than to that of a non-examining doctor. 20 C.F.R. § 416.927; Lester v. Chater, 81 F.3d 821, 830 (9th Cir. 1996). The ALJ must give specific and legitimate reasons for rejecting a treating or examining doctor's opinion that is contradicted by another doctor, and clear and convincing reasons for rejecting a treating or examining doctor's uncontradicted opinion. Lester, 81 F.3d at 830-31. An ALJ does this by setting out a detailed and thorough summary of the facts and conflicting evidence, stating her interpretation of the facts and evidence, and making findings. Magallanes v. Bowen, 881 F.2d 747, 751 (9th Cir. 1989). The ALJ must do more than offer her conclusions; she must also explain why her interpretation, rather than the treating doctor's interpretation, is correct. Orn v. Astrue, 495 F.3d 625, 632 (9th Cir. 2007) (citing Embrey v. Bowen, 849 F.2d 418, 421-22 (9th Cir. 1988)). The opinion of a non-examining doctor cannot by itself constitute substantial evidence that justifies the rejection of the opinion of either an examining physician or a treating physician. Gallant v. Heckler, 753 F.2d 1450, 1456 (9th Cir. 1984).

         Licensed social workers are not acceptable medical sources who can give medical opinions. The ALJ may evaluate opinions of other medical sources using the same factors used to evaluate medical opinions of acceptable medical sources. 20 C.F.R. § 419.927(f). The ALJ must give specific, germane reasons for rejecting opinions from other sources that are not acceptable medical sources. Dodrill v. Shalala, 12 F.3d 915, 919 (9th Cir. 1993).

         The ALJ found that the treating and examining providers' opinions were inconsistent with the nature of plaintiff's treatment, which the ALJ found appeared to be more focused on methadone maintenance, situational stressors, parental support, relapse prevention, life skills, and family support rather than on addressing plaintiff's mood, anxiety, and PTSD symptoms. Tr. 442. The ALJ found that if plaintiff's mental condition was as severe as these providers assessed, one would expect that her treatment would be tailored to deal with that condition. Id. In making this finding, the ALJ essentially takes on the role of a doctor, giving his opinion about what type of treatment plaintiff should have received. The ALJ does not cite to any evidence to support this finding or explain how addressing the issues he identifies was not appropriate treatment for plaintiff's mental impairments or the symptoms she and her treating providers identified. The ALJ may not substitute his own interpretation of the medical evidence for the opinion of a medical professional. See Tackett v. Apfel, 180 F.3d 1094, 1102-03 (9th Cir. 1999). This was not a valid reason to reject these opinions.

         The ALJ also found these opinions to be inconsistent with the benign mental status examination findings during appointments, including findings of normal affect, cooperative behavior, appropriate motor activity, appropriate speech, normal thought processes, normal perceptual processes, full orientation, intact memory, average intellectual functioning, and normal judgment and insight. Tr. 443. The ALJ referred to his discussion of mental status examinations in his evaluation of plaintiff's subjective testimony, where he identified four mental status examinations with normal findings. Tr. 439 (citing Tr. 232, 253-54, 406, 654-55). Two of these were notations made at appointments for plaintiff's prediabetes that stated, in full: “Appropriate affect, goal-directed thought.” Tr. 232, 406. One of them included the findings the ALJ identified but also findings of unkempt appearance and poor hygiene, flat affect, depressed and anxious mood. Tr. 654. These were the only four mental status examinations the ALJ relied on to discount six treating and examining opinions. But four mental status examinations, two of which were documented with only five words, do not constitute substantial evidence sufficient to undermine the opinions of four examining psychologists and psychiatrists and two treating social workers. See Hill v. Astrue, 698 F.3d 1153, 1159 (9th Cir. 2012) (reviewing court must consider the record as a whole and may not affirm by isolating a specific quantum of supporting evidence). This was not a valid reason to discount these opinions.

         The ALJ found that treatment notes from group counseling sessions did not document significant problems with depression, anxiety, or PTSD, and that the examining doctors were unaware of the longitudinal evidence because they reviewed either minimal or no evidence. Tr. 443. The ALJ again substituted his own interpretation of the medical evidence when deciding what information these notes should have contained. And the fact that the examining doctors did not see the four mental status exams the ALJ identified does not ...

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