(SS) Rivera v. Commissioner of Social Security ( 2021 )

2 3 4 5 6 UNITED STATES DISTRICT COURT 7 EASTERN DISTRICT OF CALIFORNIA 8 9 JUAN JOSE RIVERA, Case No. 1:20-cv-00428-EPG 10 Plaintiff, FINAL JUDGMENT AND ORDER 11 REGARDING PLAINTIFF’S SOCIAL v. SECURITY COMPLAINT 12 COMMISSIONER OF SOCIAL (ECF Nos. 1, 16). 13 SECURITY, 14 Defendant. 15 This matter is before the Court on Plaintiff’s complaint for judicial review of an 16 unfavorable decision by the Commissioner of the Social Security Administration regarding his 17 application for Supplemental Security Income. The parties have consented to entry of final 18 judgment by the United States Magistrate Judge under the provisions of 28 U.S.C. § 636(c) with 19 any appeal to the Court of Appeals for the Ninth Circuit. (ECF Nos. 6, 10, 11.) 20 Having reviewed the record, administrative transcript, the briefs of the parties, and the 21 applicable law, the Court finds as follows: 22 I. ANALYSIS 23 A. Whether the ALJ Committed Error Regarding Plaintiff’s Treating Physician 24 Plaintiff argues that the ALJ committed legal error in failing to provide specific and 25 legitimate reasons for discounting the opinion of Plaintiff’s treating physician, Dr. Mariano. The 26 Ninth Circuit has held the following regarding such opinion testimony: 27 /// 28 wlaebiogrhatt”o rsyo dloianggn oass tiitc “tiesc whneilql-useusp apnodrt eisd nboyt minecdoincsailsltye natc cweipthta tbhlee octlhineirc asul basntda ntial 2 evidence in [the claimant’s] case record.” 20 C.F.R. § 404.1527(c)(2). When a treating physician’s opinion is not controlling, it is weighted according to factors 3 such as the length of the treatment relationship and the frequency of examination, 4 the nature and extent of the treatment relationship, supportability, consistency with the record, and specialization of the physician. Id. § 404.1527(c)(2)–(6). 5 “To reject [the] uncontradicted opinion of a treating or examining doctor, an ALJ 6 must state clear and convincing reasons that are supported by substantial evidence.” Ryan v. Comm’r of Soc. Sec., 528 F.3d 1194, 1198 (9th Cir. 2008) 7 (alteration in original) (quoting Bayliss v. Barnhart, 427 F.3d 1211, 1216 (9th Cir. 2005)). “If a treating or examining doctor’s opinion is contradicted by another 8 doctor’s opinion, an ALJ may only reject it by providing specific and legitimate reasons that are supported by substantial evidence.” Id. (quoting Bayliss, 427 F.3d 9 at 1216); see also Reddick v. Chater, 157 F.3d 715, 725 (9th Cir. 1998) (“[The] reasons for rejecting a treating doctor’s credible opinion on disability are 10 comparable to those required for rejecting a treating doctor’s medical opinion.”). “The ALJ can meet this burden by setting out a detailed and thorough summary of 11 the facts and conflicting clinical evidence, stating his interpretation thereof, and making findings.” Magallanes v. Bowen, 881 F.2d 747, 751 (9th Cir. 1989) 12 (quoting Cotton v. Bowen, 799 F.2d 1403, 1408 (9th Cir. 1986)). 13 Trevizo v. Berryhill, 871 F.3d 664, 675 (9th Cir. 2017).1 Here Dr. Mariano’s opinion was 14 contradicted by other doctors’ opinions, most notably those of Dr. Moura and Dr. McDonald. The 15 ALJ assigned great weight to the opinion of State agency medical consultant Dr. Moura, who 16 concluded that Plaintiff “had mild restriction of activities of daily living, moderate difficulties in 17 maintaining social functioning, moderate difficulties in maintaining concentration, persistence, or 18 paced.” (A.R. 34). And the ALJ assigned some weight to the opinion of Dr. McDonald, who 19 completed a psychiatric evaluation on Plaintiff and concluded that “he has moderate limitations 20 with concentration, persistence, or maintaining pace.” (Id.). Such opinions of mild to moderate 21 restrictions and difficulties contradict Dr. Mariano’s opinion that Plaintiff “was permanently and 22 totally disabled and unable to work to any extent despite treatment.” (Id. at 31). 23 Accordingly, the Court reviews the ALJ’s decision to see if she provided specific and 24 legitimate reasons that are supported by substantial evidence for the weight given to Dr. 25 Mariano’s opinions. In this case, the ALJ ultimately assigned Dr. Mariano’s opinion little weight, 26 1 Because Plaintiff filed her application before March 27, 2017, 20 C.F.R. § 404.1527 applies in 27 considering the weight given to her treating physician’s opinion. For applications filed on or after March 27, 2017, 20 C.F.R. § 404.1520c applies in considering medical opinions; notably, no deference or specific 28 evidentiary weight is given to medical opinions. 2 Little weight is assigned to the above noted opinion statements from Dr. Mariano from 2015 to 2018 in Exhibit 4F and 7F. Dr. Mariano had assigned Global 3 Assessment of Functioning (GAF) scores ranging from 50 to 55. He also made a statement that the claimant was not gravely disabled (impaired by a mental illness 4 to the point of being unable to have the basic needs met for food, clothing, and 5 shelter). His prognosis was poor and he was permanently and totally disabled and unable to work to any extent despite treatment. He had a chronic academic 6 handicap/disability and was unable to live independently. The claimant was unable to perform activities of daily living without supervision (Ex. 7F). This statement 7 was made within examination records and did not change, despite the claimant’s improvement over time, as documented in the objective examinations and as noted 8 by his sister in Exhibit 13E. His opinion statements are inconsistent with most of the medical status examinations and appeared to be based off the report of the 9 claimant. The claimant has not undergone extended hospitalization since June 2015 and had no inpatient treatment. He often described no hallucinations, 10 delusions, ideas of reference, obsessions, or compulsive behaviors during examination. Even when hallucinations were noted, they were described as 11 improved. The claimant also was frequently described as calm, cooperative, and friendly. He was sometimes sad, but more often than not, had a euthymic mood. 12 He was oriented and had no suicidal or homicidal ideation. The claimant was also volunteering and was getting along with others at the place he volunteered. 13 Moreover, it is noted than an opinion of disability is one typically reserved for the Commissioner. Therefore, I find little weight is assigned. 14 (A.R. 31.) 15 Plaintiff contends that the ALJ failed to cite specific and legitimate instances of sustained 16 improvement in symptoms relative to Plaintiff’s functional capacity for work tasks and that Dr. 17 Mariano’s opinion is not inconsistent with the record as a whole. (ECF No. 16, pp. 9-13.) In 18 opposition, the Commissioner cites to portions of the record in arguing that the ALJ offered 19 specific and legitimate reasons to assign Dr. Mariano’s opinion little weight. (See ECF No. 19, 20 pp. 18-21.) In reviewing the parties’ arguments, the Court concludes that the ALJ gave specific 21 and legitimate reasons, supported by substantial evidence in the record, for assigning Dr. 22 Mariano’s opinion little weight. 23 First, the ALJ noted that Dr. Mariano’s own treatment records “described as improved” 24 Plaintiff’s hallucinations and noted that “claimant also was frequently described as calm, 25 cooperative, and friendly.” (A.R. 31). While this summary section of the opinion does not contain 26 specific cites to the medical records indicating improvement, the ALJ’s prior summary of the 27 medical records in the opinion does. (See e.g., A.R. 29 (noting medical record describing Plaintiff 28 2 Mariano’s opinion, the ALJ provided specific reasons for this conclusion, e.g., inconsistencies 3 between Dr. Mariano’s opinion and the medical status reports, the same poor prognosis appearing 4 repeatedly despite indications the Plaintiff was improving, and the lack of evidence in the medical 5 record to indicate disability. 6 Such reasons are legitimate. It was proper for the ALJ to take issue with Dr. Mariano’s 7 conclusion that Plaintiff’s “prognosis was poor and he was permanently and totally disabled and 8 unable to work to any extent despite treatment,” in light of the medical status notes showing that 9 Plaintiff was not currently experiencing the same symptoms that had afflicted him before. (A.R. 10 31; see A.R. 522-25) (noting lack of hallucinations, delusions, obsessions, and compulsive 11 behavior yet opining that Plaintiff was totally disabled)). Moreover, the ALJ noted that Dr. 12 Mariano’s opinion that Plaintiff “was unable to perform activities of daily living without 13 supervision” contradicted notes reflecting that Plaintiff was able to undertake certain daily 14 activities, such as the fact that he “was [] volunteering and was getting along with others at the 15 place he volunteered.” (A.R. 31). 16 In opposition to the ALJ’s conclusions, Plaintiff argues that the ALJ improperly isolated 17 certain instances showing improvement while ignoring the record as a whole, asserting that 18 Plaintiff was still disabled despite any improvements that he made. (See ECF No. 16, pp. 10-11). 19 However, it was legitimate to look at multiple examples of improvement in weighing the 20 conflicting medical opinions. Moreover, the ALJ evaluated statements indicating improvement in 21 the context of voluminous medical evidence and multiple medical opinions. For example, the 22 ALJ noted that, prior to the alleged onset of disability, Plaintiff had been admitted to the hospital 23 after a suicide attempt. (A.R. 25). He had been smoking methamphetamine, had poor insight and 24 judgment, and alleged auditory hallucinations of commanding type. (Id.). After the alleged onset 25 of disability, medical records often included statements indicating progress, such as noting that 26 “[h]e was much improved overall.” (A.R. 28; see A.R. 29, 31). And medical examinations 27 generally indicated that Plaintiff had only moderate symptoms and limitations. (See A.R. 373, 28 411, 508, 522,557, 572, 580). Moreover, opinions from doctors other than Mr. Mariano, such as 2 and supervisors, which was consistent with Plaintiff’s demonstrated abilities, such as the fact that 3 he volunteered at Oak Wellness Program. (A.R. 29, 34). 4 Accordingly, the Court concludes that the ALJ provided specific and legitimate reasons, 5 supported by substantial evidence, for assigning little weight to Dr. Mariano’s opinion. 6 B. Whether the ALJ Improperly Rejected Plaintiff’s Subjective Complaints 7 Plaintiff next argues that the ALJ failed to offer any reason for rejecting his subjective 8 complaints. (ECF No. 16, p. 13-15). The Ninth Circuit has provided the following guidance 9 regarding a Plaintiff’s subjective complaints: 10 Once the claimant produces medical evidence of an underlying 11 impairment, the Commissioner may not discredit the claimant’s testimony as to subjective symptoms merely because they are 12 unsupported by objective evidence. Bunnell v. Sullivan, 947 F.2d 341, 343 (9th Cir. 1991) (en banc); see also Cotton v. Bowen, 799 13 F.2d 1403, 1407 (9th Cir. 1986) (“it is improper as a matter of law to discredit excess pain testimony solely on the ground that it is not 14 fully corroborated by objective medical findings”). Unless there is affirmative evidence showing that the claimant is malingering, the 15 Commissioner’s reasons for rejecting the claimant’s testimony must be “clear and convincing.” Swenson v. Sullivan, 876 F.2d 683, 687 16 (9th Cir. 1989). General findings are insufficient; rather, the ALJ must identify what testimony is not credible and what evidence 17 undermines the claimant’s complaints. 18 Lester v. Chater, 81 F.3d 821, 834 (9th Cir. 1995), as amended (Apr. 9, 1996). 19 The ALJ stated as follows regarding Plaintiff’s subjective complaints: 20 After careful consideration of the evidence, the undersigned finds 21 that the claimant’s medically determinable impairments could reasonably be expected to cause the alleged symptoms; however, 22 the claimant’s statements concerning the intensity, persistence and limiting effects of these symptoms are not entirely consistent with 23 the medical evidence and other evidence in the record for the reasons explained in this decision. 24 (A.R. 25). 25 Because the ALJ found that Plaintiff’s impairments could reasonably be expected to cause 26 his alleged symptoms and did not find malingering, the ALJ was required to provide clear and 27 convincing reasons to reject Plaintiff’s testimony. 28 2 support the ALJ’s finding regarding Plaintiff’s subjective symptom testimony. However, the rest 3 of the ALJ’s opinion providing sufficient reasoning for this finding. 4 In summarizing the medical record, the ALJ quoted specific statements made by Plaintiff 5 in the medical record that appeared to show greater function than he had claimed, including: 6 On January 5, 2016, the claimant treated at kings View Counseling Services and 7 was “doing a lot better” and he had more energy. He could focus better on tasks and his appetite had improved. He stopped using methamphetamines and 8 marijuana. He denied anger as a problem and stated he was calm now. He could sleep well . . . . The claimant had no suicidal or homicidal ideation. He had no 9 hallucinations, delusions, ideas of reference, obsessions, or compulsions noted. He had good insight . . . . 10 11 Thereafter, on February 29, 2016, the claimant treated at Kings View Counseling Services. He had been feeling better but sleeping too much. He could think more 12 clearly then when compared to his last appointment. He started working out which included lifting weights three to four times per week. He went out of the house a 13 few hours to walk, three to four days per week . . . On examination he was 14 passive . . . . 15 On May 31, 2016, the claimant treated at Kings View Counseling Services and reported “he is doing better.” 16 17 . . . . 18 On February 21, 2017, the claimant was “doing good” and was participating in the Oak Wellness Center two times per week. He will go out shopping with his mother 19 and go to doctor’s appointments. He goes out with his sisters. On examination, he 20 had fair personal hygiene. The claimant was calm, cooperative, and friendly in manner. 21 (A.R. 26-28). In these, and other explanations of the record, the ALJ noted Plaintiff’s comments 22 and italicized portions of those statements that appeared inconsistent with Plaintiff’s claim of 23 disability. With this emphasis, the ALJ indicated the specific comments that appeared 24 inconsistent with Plaintiff’s claims. While these references alone are not sufficient to make a 25 determination of disability, they are sufficient to support the ALJ’s finding that “claimant’s 26 statements concerning the intensity, persistence and limiting effects of these symptoms are not 27 28 entirely consistent with the medical evidence and other evidence in the record.” (A.R. 25). 1 I. CONCLUSION AND ORDER 2 In light of the foregoing, the Court finds that the decision of the Commissioner of Social 3 | Security is supported by substantial evidence, and the same is hereby affirmed. 4 The Clerk of the Court is directed to close this case. 5 6 | IS SO ORDERED. 7) Dated: _ June 25, 2021 [Jee hey — 8 UNITED STATES MAGISTRATE JUDGE 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28