Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-akd-3_14-cv-00159/USCOURTS-akd-3_14-cv-00159-0/pdf.json

Nature of Suit Code: 863
Nature of Suit: Social Security - DIWC/DIWW (405(g))
Cause of Action: 42:205 Denial Social Security Benefits

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IN THE UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF ALASKA

DENNIS JAY BAILEY,

Plaintiff,

v.

CAROLYN W. COLVIN, Acting

Commissioner of Social Security,

Defendant.

Case No. 3:14-cv-0159-RRB

ORDER REMANDING FOR

FURTHER PROCEEDINGS

Docket 15

I. INTRODUCTION

Claimant Dennis Jay Baileyfiled anapplicationfor DisabilityInsurance Benefits and Supplemental

SecurityIncome whichDefendant, the Commissioner of Social Security, denied. Baileyhas exhausted his

administrative remedies and seeks relief from this Court, arguingthat the Commissioner’s decision that he

is not disabled within the meaning of the Social Security Act is not supported by substantial evidence. 

Bailey seeks a remand for a new administrative hearing. Defendant opposes, arguing the denial of benefits

is supported by substantial evidence and free of legal error. Bailey has replied.1 For the reasons set forth

1

 Docket nos. 15, 16, and 17.

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below, Bailey’s Motion at Docket 15 is GRANTED and this matter is REMANDED for further

consideration.

II. STANDARD OF REVIEW

The findings of the Administrative Law Judge (“ALJ”) or Commissioner of Social Security

regardinganyfactshallbe conclusive ifsupported bysubstantialevidence.

2 A decisionto denybenefits will

not be overturned unless it either is not supported by substantial evidence or is based upon legal error.

3

“Substantial evidence” has been defined by the United States Supreme Court as “such relevant evidence

as a reasonable mind might accept as adequate to support a conclusion.”4 Such evidence must be “more

than a mere scintilla,” but also “less than a preponderance.”5In making its determination, the Court

considersthe evidence initsentirety, weighingboththe evidence thatsupports and that whichdetractsfrom

the Commissioner’s conclusion.

6

 If the evidence issusceptible to more thanone rationalinterpretation, the

ALJ’s conclusion must be upheld.7

2

 See 42 U.S.C. § 405(g)(2010).

3

 Matney ex rel. Matney v. Sullivan, 981 F.2d 1016, 1019 (9th Cir. 1992)(citing Gonzalez v.

Sullivan, 914 F.2d 1197, 1200 (9th Cir. 1990)).

4 Richardson v. Perales, 402 U.S. 389, 401 (1971)(quoting Consol. Edison Co. v. NLRB, 305

U.S. 197, 229 (1938)).

5 Perales, 402 U.S. at 401; Sorenson v. Weinberger, 514 F.2d 1112, 1119 n.10 (9th Cir.

1975).

6

 Jones v. Heckler,760 F.2d 993, 995 (9th Cir. 1985).

7 Gallant v. Heckler, 753 F.2d 1450, 1452-53 (9th Cir. 1984).

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III. DETERMINING DISABILITY

The Social Security Act (the “Act”) provides for the payment of disability insurance benefits

(“DIB”) to people who have contributed to the Social Security program and who suffer from a physical

or mental disability.

8

In addition, supplemental security income benefits (“SSI”) may be available to

individuals who are age 65 or over, blind or disabled, but who do not have insured status underthe Act.

9

Disability is defined in the Social Security Act as follows:

[I]nability to engage in any substantial gainful activity by reason of any medically

determinable physical or mental impairment which can be expected to result in death or

which has lasted or can be expected to last for a continuous period of not less than 12

months.

10

 The Act further provides:

An individual shall be determined to be under a disability only if his physical or mental

impairments are of such severity that he is not only unable to do his previous work but

cannot, considering his age, education, and work experience, engage in any other kind of

substantial gainful work which existsin the national economy, regardless of whether such

work exists in the immediate area in which he lives, or whether a specific job vacancy

exists for him, or whether he would be hired if he applied for work. For purposes of the

preceding sentence (with respect to any individual), “work which exists in the national

economy”means work which exists in significant numbers either in the regionwhere such

individual lives or in severalregions of the country.

11

8

 42 U.S.C. § 423(a) (2011).

9

 42 U.S.C. § 1381 (2011). 

10

 42 U.S.C. § 423(d)(1)(A) (2011).

11 42 U.S.C. § 423(d)(2)(A) (2011).

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The Commissioner has established a five-step process for determining disability. Claimant bears

the burdenofproofatsteps one through four, and the burdenshiftsto the Commissioner atstep five.

12 The

steps, and the ALJ’s findings in this case, are as follows:

Step 1. Determine whether the claimant is involved in “substantial gainful activity. The ALJ

concluded the Claimant had not engaged in substantial gainful activity since his alleged onset

date. Tr. 23.

Step 2. Determine whether the claimant has a medically severe impairment or combination of

impairments. A severe impairmentsignificantlylimits a claimant’sphysicalormentalabilityto do basic work

activities, and does not consider age, education, or work experience. The severe impairment or

combination of impairments must satisfy the twelve-month duration requirement. The ALJ concluded

that the Claimant has these severe impairments: degenerative disk and joint disease of the

cervicalspine, chronicobstructivepulmonarydisease (COPD), and asthma. The ALJ found that

Claimant’s alleged left shoulder injury and lumbar spine impairment imposed minimal, if any,

limitations on Claimant’s abilities. Tr. 23.

Step3. Determine whetherthe impairment isthe equivalent ofa numberoflisted impairmentslisted

in 20 C.F.R. pt. 404, subpt. P, App. 1 that are so severe as to preclude substantialgainful activity. If the

impairment is the equivalent of one of the listed impairments and meets the duration requirement, the

claimant is conclusively presumed to be disabled. If not, the evaluation goes on to the fourth step. 

12

 Id.

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According to theALJ, theClaimant does not have an impairment or combination ofimpairments

that meets or medically equals the severity of a listed impairment. Tr. 24. 

Residual Functional Capacity. Before proceeding to step four, a claimant’sresidual functional

capacity (“RFC”) is assessed. This RFC assessment is used at both step four and step five.

13

In

evaluating his RFC, the ALJ concluded that Claimant had the RFC to perform light work, with

some limitations. Tr. 25. 

Step4. Determine whetherthe impairment preventsthe claimantfromperformingwork performed

inthe past. At this point the analysis considersthe claimant’sresidualfunctionalcapacityand pastrelevant

work. If the claimant can still do his or her past relevant work, the claimant is deemed not to be disabled. 

Otherwise, the evaluation process movesto the fifthand finalstep. The ALJ found that Claimant was

unable to perform any past relevant work. Tr. 31.

Step5. Determine whether the claimant is able to perform other work inthe nationaleconomyin

view of his or her age, education, and work experience, and in light of the residual functional capacity. If

so, the claimant is not disabled. If not, the claimant is considered disabled. Based on the testimony of

the vocational expert, the ALJ found that there are jobs that exist in significant numbersin the

national economy that the Claimant can perform, including Retail Storage Clerk, Flagger, and

Assembler of Small Parts. Tr. 32. 

13

 20 C.F.R. §§ 404.1520(a)(4)(2011); §416.920(a)(4) (2011).

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IV. DISCUSSION

The Court finds no error in the ALJ’s analysis and findings under Step 1, and Claimant does not

contest theALJfindings underthisstep. Nor does Claimant complainoferror at Step 2 or Step 3. Rather,

Claimant complains that the ALJ’s determination of the RFC was flawed, that the credibility assessment

was unsupported by substantial evidence, and that the ALJ relied on vocational testimony elicited in

response to an incomplete hypothetical.

14

A. Duty to Develop the Record

The ALJ has a dutyto develop the record “when there is ambiguous evidence or whenthe record

is inadequate to allow for proper evaluation of the evidence.”15 The ALJ bears this duty even when the

claimant is represented by counsel.

16

Claimant argues that the ALJ failed to develop the record by failing to obtain an opinion froman

examining or treating physician, and because the non-examining physician’s opinion (Dr. Caldwell) was

rendered priorto the completionofthe administrative record. Claimant argues more thanhalfofthemedical

records were obtained after Dr. Caldwell issued his opinion.

17

 The Commissioner does not dispute that

Dr. Caldwelldid nothave a complete medicalhistorywhenrenderinghis non-examiningopinion. The Court

14

 Docket 15 at 1.

15 Mayes v. Massanari, 276 F.3d 453, 459–60 (9th Cir. 2001).

16 Brown v. Heckler, 713 F.2d 441, 443 (9th Cir. 1983). 

17

 Docket 15 at 12-14, citing Tr. 305-12. 

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findsthatreliance almost entirelyonthe opinionof a non-examining physician who did not have the benefit

of a complete medical history is unfair. Furthermore, 

[m]edical source statements are medical opinions submitted by acceptable medical

sources, includingtreatingsourcesand consultative examiners, about what anindividualcan

stilldo despite a severe impairment(s), inparticular about anindividual's physicalor mental

abilitiesto performwork-related activities ona sustained basis. Adjudicators are generally

required to request that acceptable medical sources provide these statements with their

medical reports. Medical source statements are to be based on the medical sources'

records and examinationofthe individual;i.e., their personalknowledge ofthe individual.

18

Here the ALJ had a duty to seek some medicalsource opinionto informhis decision. “Without a personal

medicalevaluationit is almostimpossible to assessthe residualfunctionalcapacityofanyindividual.”19 This

could be obtained most easily through medical source statements, which are routinely obtained in these

matters. At the very least, Dr. Caldwell’s opinion should have been fully-informed.

B. Residual Functional Capacity

Claimant argues that when relyingonDr. Caldwell’s opinioninformulatingthe RFC, the ALJthen

failed to adopt the very limitations identified by Dr. Caldwell. Specifically, Dr. Caldwellspecificallynoted

that Claimant is only occasionally able to reach overhead, but the ALJ found him capable of frequent

reaching.20In turn, the ALJ’s hypothetical presented to the vocational expert allowed for frequent

reaching, rather than occasional reaching. Claimant argues that the ALJ’s ultimate determination was

accordingly unsupported by substantial evidence because she erred in relying on vocational testimony

18

 SSR 96-5p. 

19

 Docket 18 at 15, citing Penny v. Sullivan, 2 F.3d 953, 958 (9th Cir. 1993). 

20

 Tr. 308, 25. 

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elicited inresponse to anincomplete orinaccurate hypotheticalquestion.

21 Everyjob cited bythevocational

expertrequiresfrequentreaching. TheCommissioner’sresponse issimplythat the ALJ’sfindingsregarding

Claimant’s ability to reach overhead were harmless.

22 But this argument is not responsive to the concern

that the hypothetical presented to the vocational expert was flawed. The ALJ gave great weight to

Dr. Caldwell’s opinion, but thendid notarticulate whyshe didn’t include Dr. Caldwell’s overhead reaching

limitations in the hypothetical. Given that the jobs the vocational expert identified all require frequent

reaching, this distinction is important, and failure to explain the finding was not harmless. 

The Commissioner entirelyfailed to addressClaimant’s argument that while the RFC indicatesthat

he “must avoid all exposure to extreme cold and irritants,” the DOT job description of “flagger” requires

“constant exposure” to weather.

23

 Claimant argues that given the extreme environmental limitations in the

RFC, Claimant would be precluded from performing the job offlagger. The Court agrees. 

The ALJ cannot base herfindings onthe decisionofone non-examiningphysicianbut, onthe other

hand, decline to include certainlimitationsfound bythat physician without explanation. This matter must be

remanded for an accurate RFC and new vocational expert testimony. 

C. Claimant’s Credibility

Claimant requests this matter be remanded for a proper credibility determination. The ALJ found

that the Claimant’s allegations ofchronic shortnessofbreathwere not consistent withthe objective medical

21

 Docket 15 at 17-18. 

22

 Docket 16 at 9-12. 

23

 Docket 15 at 18 (citations omitted). 

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evidence.

24 The ALJfurther noted that the Claimant was not compliant withmedicationrecommendations,

althoughshe acknowledged that this mayhave beenrelated to aninabilityto pay. The ALJ determined that

Claimant’s pulmonary condition was exacerbated by environmental factors under his own control. She

found that the medical records reflect no evidence to support Claimant’s allegations of left shoulder

weakness, fatigue, sleeplessness, and cramping of hands and feet.

25

 The ALJ also found that Claimant’s

allegations of chronic neck pain, painradiatingto botharms, and right hand weakness and numbness were

not whollyconsistent with the objective evidence, his treatment providers’ observations, and histreatment

seeking behavior.

26

Claimant argues that these credibilityfindings were notsupported by substantial evidence.

27

 First,

the ALJrejected Claimant’s allegations because the objective medical findings supporting his claims postdated the alleged onset date.

28 Thisistrue inspite ofthe ALJ’s acknowledgment that “MRIresults and later

x-rayresultsrevealsignificant findingsthat would appearto support the Claimant’s allegations.”

29 The ALJ

took issue withthe fact that the alleged onset date pre-dated these MRIresults, and thatthe medicalrecord

24

 Tr. 28. 

25

 Tr. 29. 

26

 Tr. 27.

27

 Docket 15 at 15-16. 

28

 Tr. 28. 

29

Id. 

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reveals “no suddenonset ofillness orinjuryat that time.”30 As discussed below, Claimant testified (and the

record supports) that he could not afford medicalcare. The fact that MRIresults whichverify his physical

claims post-date hislast date of employment should not negate his claimorreflect poorlyonhis credibility. 

Regardingthe findingthatClaimant’srespiratorydistressis a result ofenvironmentalfactors “within

his control,” Claimant argues that this credibility finding is “patently absurd, as the ALJ’s decision

specifically indicates that Plaintiff, an indigent disability claimant, should simply have found another home

free of environmental irritants.”31 Claimant has had repeated hospitalizations for respiratory distress,

shortness of breath, and low oxygen saturation levels. The Court agrees that a Claimant should not be

automatically punished with a negative credibility finding simply for not seeking a different living

environment.

The Commissioner notes that the ALJ also found thatClaimantstopped working because he was

fired, not do to illness or injury, and that prior to his alleged disability onset date, Claimant worked only

sporadically.

32 The Commissioner argues that the ALJ reasonably questioned whether Claimant’s

continuing unemployment was actually due to medical impairments.

33

 The Court observes that Claimant

did report that he “was fired” on August 31, 2011.34 However, he explained at the hearing that “I think

30

Id. 

31

 Docket 15 at 16, citing Tr. 29.

32

 Docket 16 at 8, citing Tr. 30. 

33

Id. 

34

 Tr. 209. 

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the main reason they let me go was because I can’t be fitted in a respirator anymore, for one, and I can’t

keep up.” He explained that due to asthma and COPD, he cannot be fitted with a respirator which was

necessaryfor his job. He also testified that he could not perform the physical aspects ofthe job, and that

was why they let him go.

35

 

“To determine whetherthe claimant'stestimony regardingthe severityofhersymptomsis credible,

the ALJ may consider . . . unexplained or inadequately explained failure to seek treatment orto follow

a prescribed course of treatment.”

36 The fact that Claimant was “fired” and that he failed to follow up on

medication and medicalrecommendations is explained inthe record, i.e. he couldn’t perform his job due

to his limitations, and he didn’t have money to seek medical help.

In short, the ALJ’s finding that Petitioner lacked credibility is not supported by substantial

evidence. Uponremand, the ALJis directed to make a new credibilityfinding. As anaside, the Court notes

that the Claimant further testified that he can only look down whenhe bends over, and he cannot look up. 

He also is clumsy with his right hand, a finding supported by Dr. Caldwell.

37

Inthe absence ofan adverse

credibilityfinding, suchtestimonywouldhave to be credited.38 The Court questions whethersuchlimitations

would allow Claimant to work as a small parts assembler. This is an issue for the vocational expert to

address at a new hearing. 

35

 Tr. 64. 

36 Smolen v. Chater, 80 F.3d 1273, 1284 (9th Cir. 1996) (emphasis added). 

37

 Tr. 67-68, 308.

38 See Lester v. Chater, 81 F.3d 821, 834 (9th Cir. 1996)

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V. CONCLUSION

A decision of the Commissioner to deny benefits will not be overturned unless it either is not

supported by substantial evidence, or is based upon legal error. “Substantial evidence” is such relevant

evidence as a reasonable mind might accept as adequate to support a conclusion. The Court has carefully

reviewed the administrative record, including medical records. The Court concludes, based upon the

record as a whole, that the ALJ’s decision denying disability benefits to Claimant was not supported by

substantial evidence, as discussed herein.

VI. ORDER

Based onthe foregoing, IT IS HEREBY ORDERED that the Claimant’s Motionfor Summary

Judgment at Docke t 15 is GRANTED and this matter is REMANDED for further proceedings

consistent with this opinion, including a de novo hearing and decision, including new vocational expert

testimony. 

IT IS SO ORDERED this 18th day of May, 2015.

S/RALPH R. BEISTLINE

UNITED STATES DISTRICT JUDGE

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