Source: https://casetext.com/case/nguyen-v-chater-2
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Nguyen v. Chater, 100 F.3d 1462 | Casetext
100 F.3d 1462 (9th Cir. 1996)
Nguyenv.Chater
United States Court of Appeals, Ninth CircuitNov 20, 1996
Nylander v. Astrue
…Tonapetyan, supra, 242 F.3d at 1149 (citing Magallanes, supra, 881 F.2d at 752). "In order to discount the…
…When a mental illness is involved, assuming that a failure to comply with prescribed treatment suggests a…
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holding that lay witness testimony as to a plaintiff&apos;s symptoms is competent evidence
holding that a doctor&apos;s opinion that a medical condition existed prior to that doctor&apos;s examination of a claimant is competent evidence that an ALJ must consider
Summary of this case from Margaret H. v. Comm&apos;r of Soc. Sec.
holding that competent lay witness testimony "cannot be disregarded without comment."
Summary of this case from Pluhar v. Berryhill
Argued and Submitted August 9, 1996 — Pasadena, California
Martin Taller, Anaheim, CA, for plaintiff-appellant.
Donna W. Anderson, Assistant Regional Counsel, United States Social Security Administration, San Francisco, CA, for defendant-appellee.
Appeal from the United States District Court for the Central District of California. Rupert J. Groh, Magistrate Judge, Presiding.
D.C. No. CV-90-5473-JG
Before: Stephen Reinhardt, Edward Leavy, Circuit Judges and Robert E. Coyle, District Judge.
Honorable Robert E. Coyle, United States District Judge for the Eastern District of California, sitting by designation.
REINHARDT, Circuit Judge:Page 1463
Claimant, Kim Van Nguyen, appeals from a denial of Social Security Disability benefits and Social Security Income benefits. While he has a history of numerous medical problems, including the effects of having been shot in both legs by the Communists in 1970 when he was a soldier in the South Vietnamese army, the two principal issues in this case concern the ALJ's consideration of claimant's affective disorder and the effects of his chronic bronchial asthma. Specifically, claimant contends that the ALJ improperly credited a nontreating medical advisor over an examining psychologist because the ALJ failed to set forth specific legitimate reasons for doing so and the ALJ erred by not considering the lay testimony of claimant and his wife in evaluating claimant's residual functional capacity (RFC) or giving specific reasons for rejecting that lay testimony. We agree with claimant and therefore vacate and remand.
He also suffers from hypertension, hypercholesterolemia, gastritis, headaches, borderline diabetes and bronchial asthma. The parties do not disagree that claimant's leg problems restrict him to sedentary work. Nor do they dispute that his hypertension and hypercholesterolemia are controlled with medication or that these problems and his diabetes and gastritis do not materially affect his ability to work.
Claimant contends that the ALJ erred by not crediting the conclusion of the examining psychologist, Dr. Brown, who determined that claimant met listing 12.04 for affective disorders. 20 CFR Pt. 404, Subpt. P., App 1, 12.04. The ALJ did not explicitly reject the opinion of Dr. Brown; he did, however, rely on the opinion of Dr. Walter, the nonexamining psychologist called by the Commissioner. In Dr. Walter's opinion, claimant did not meet the listing 12.04. We hold that the ALJ erred because he neither explicitly rejected the opinion of Dr. Brown, nor set forth specific, legitimate reasons for crediting Dr. Walter over Dr. Brown. E.g., Andrews v. Shalala, 53 F.3d 1035, 1041 (9th Cir. 1995); see also Lester v. Chater, 81 F.3d 821, 831 (9th Cir. 1996) (as amended) ("The opinion of an examining doctor, even if contradicted by the opinion of another [nonexaming] doctor, can only be rejected for specific and legitimate reasons that are supported by the record.").
The ALJ also stated that Dr. Walter had pointed out that "the evidence was devoid of any findings or complaints relative to a mental disorder of the claimant during the period of May 1988 until November 18, 1991, when the claimant was examined by a psychologist, R. Wayne Brown, Ph.D., at the request of the claimant's attorney." This is not a legitimate basis on which to discount Dr. Brown's opinion that claimant has a severe depressive disorder. First, the fact that the examination was conducted at the request of an attorney is relevant where the opinion itself provides grounds for suspicion as to its legitimacy. We have held the source of a referral to be relevant where there is no objective medical basis for the opinion, Burkhart v. Bowen, 856 F.2d 1335, 1339 (9th Cir. 1988), and where there is evidence of "actual improprieties" on the part of the doctor whose report the ALJ chooses to reject. Saelee v. Chater, 94 F.3d 520, 523 (9th Cir. 1996) (per curiam). In Saelee, the ALJ noted among other things that there was no objective medical basis for the doctor's opinion and that the report was inconsistent with the doctor's own treatment notes. Id. Saelee relied on Burkhart for the proposition that under certain circumstances the ALJ may consider the purpose for which a doctor's report was obtained. In Burkhart, we held that consideration of the fact that a doctor's report was solicited by claimant's counsel was "a permissible credibility determination given the evidence before the ALJ." Burkhart, 856 F.2d at 1339 (emphasis added). In that case, the evidence before the ALJ was that the report of the doctor that the ALJ rejected consisted of no more than a wholly conclusory opinion unsupported by any objective medical findings, personal observations or test reports, and was directly contradicted by the conclusions of a number of other treating physicians whose opinions were based on objective medical findings. Id.
For some unexplained reason the ALJ referred to Dr. Brown on a number of occasions as R. Wayne Brown, Ph.D., and Dr. Walter as Dr. Walter, even though both are clinical psychologists with similar credentials.
Second, it is common knowledge that depression is one of the most underreported illnesses in the country because those afflicted often do not recognize that their condition reflects a potentially serious mental illness. See, e.g., Warren E. Leavy, Hidden Depression, Chi. Trib., Feb. 1, 1996 at 7 (noting that nearly 17 million adult Americans suffer from depression in a given year and that two-thirds of them do not get treatment). Thus, the fact that claimant may be one of millions of people who did not seek treatment for a mental disorder until late in the day is not a substantial basis on which to conclude that Dr. Brown's assessment of claimant's condition is inaccurate. As the Sixth Circuit has noted in finding invalid an ALJ's reasons for rejecting claimant's assertions about his depression, `[a]ppellant may have failed to seek psychiatric treatment for his mental condition, but it is a questionable practice to chastise one with a mental impairment for the exercise of poor judgment in seeking rehabilitation.' Blankenship v. Bowen, 874 F.2d 1116, 1124 (6th Cir. 1989).
The government contends that the ALJ legitimately discounted Dr. Brown's report because it is inconsistent with claimant's own testimony. We disagree. Where the purported existence of an inconsistency is squarely contradicted by the record, it may not serve as the basis for the rejection of an examining physician's conclusions. The ALJ stated that Dr. Brown indicated that claimant had testified that he never travelled outside or played with his children and that he sits in a chair most of the day. However, the record contains facts to the contrary to the claimant's testimony as he has indicated during the previous examinations that he was able to watch television for several hours a day, play with his children, and attend church on a weekly basis. He drove an automobile.
In order to discount the opinion of an examining physician in favor of the opinion of a nonexamining medical advisor, the ALJ must set forth specific, legitimate reasons that are supported by substantial evidence in the record. The ALJ failed to do so here. E.g., Lester, 81 F.3d at 831.
Even if the ALJ had properly credited Dr. Walter's testimony regarding the extent of claimant's mental impairment, the ALJ erred by simply concluding that "the claimant's mental symptomology does not significantly impact his ability to perform at least entry level sedentary work including as an assembler of food or pharmaceuticals in a clean environment." Restrictions on activities of daily living, social functioning, and completing work in a timely fashion, clearly have the potential to affect a claimant's residual functional capacity (RFC), and therefore his ability to work. See 20 CFR § 404, Subpt. P. App. 1, 12.00 (Introduction). According to Dr. Walter, claimant's restrictions do not meet the listing and are not marked; however, they are nonetheless restrictions. These restrictions must be considered, in conjunction with claimant's physical impairments, in determining his residual functional capacity. 20 CFR § 404.1523; Beecher v. Heckler, 756 F.2d 693, 694-95 (9th Cir. 1985) (where claimant suffers both physical and mental impairments both must be considered together in evaluating their effects). The ALJ failed to include any of claimant's mental restrictions, as set forth by Dr. Walter, in the hypothetical to the vocational expert — except perhaps the concentration restriction to the extent that the hypothetical called for claimant to do "simple one-two-three jobs". Because the hypothetical was incomplete, it does not constitute competent evidence to support a finding that claimant could do the jobs set forth by the vocational expert. E.g., Varney v. Secretary, 846 F.2d 581, 585 (9th Cir. 1988) (vocational expert's response to incomplete hypothetical had "no evidentiary value.")
The ALJ determined that claimant's asthma in combination with his leg injuries did not preclude him from doing sedentary work in a clean room as a packager/assembler. He did so apparently on the basis of the medical examiner's report that claimant's asthma is mild. He also determined, apparently based on evidence from Dr. De Los Santos, the medical examiner and Dr. Dickstein, that although the claimant experiences occasional discomfort and shortness of breath, his "symptoms are managed on a daily basis with medications including inhalant and that by avoidance of working in areas in which he would be exposed to noxious or irritating fumes, the claimant could avoid exacerbation of his mild pulmonary condition." The ALJ also relied on the testimony of the vocational expert that claimant could work as a packager or assembler in a clean room environment. Claimant contends that the ALJ erred by failing to take into account his testimony and that of his wife as to the extent and effects of his asthma, primarily his regular wheezing and cough. The ALJ took account of claimant's asthma in his hypothetical to the vocational expert only to the extent he asked whether relevant work was available in clean rooms. Claimant's attorney, however, asked the vocational expert whether claimant could do an assembler/packager's job in a clean room if he had a repeated chronic coughing problem. The vocational expert indicated that employers would not tolerate employees who coughed excessively in a clean room job. But the vocational expert refused to be pinned down as to what constituted "excessive coughing" or whether claimant's condition could be considered excessive coughing. After the attorney reexamined claimant and established that there were some days where he coughed repeatedly throughout the day, the ALJ refused to let counsel's attorney ask more questions of the vocational expert to establish if that amount of coughing would preclude work in a clean room environment. Claimant's wife also testified at one of the hearings. She reported that her husband had trouble sleeping and that he woke up a lot due to coughing. She also stated that he had a hard time breathing and had coughing problems all the time, both day and night.
The ALJ also appeared to conclude that claimant was not disabled on the basis of the "grids." That finding constitutes error because it is not appropriate to rely on the grids where the claimant suffers, as Van Nguyen does, from both an exertional limitation and an environmental restriction such as intolerance of fumes. Kail v. Heckler, 722 F.2d 1496, 1498 (9th Cir. 1984) (holding it is error to rely on the grids where claimant has both an exertional limitation and an inability to tolerate fumes).
The ALJ included neither claimant nor his wife's descriptions of his serious coughing problems in the hypothetical to the vocational expert, nor did he expressly state that he would discount their testimony or give any reasons therefore. By failing to include in the hypothetical the physical manifestations that were described by the witnesses or expressly rejecting the testimony for legitimate reasons, the ALJ erred. Lay testimony as to a claimant's symptoms is competent evidence which the Secretary must take into account, Dodrill v. Shalala, 12 F.3d 915, 919 (9th Cir. 1993), unless he expressly determines to disregard such testimony, in which case "he must give reasons that are germane to each witness." Id. The government contends, relying on Vincent v. Heckler, 739 F.2d 1393, 1395 (9th Cir. 1984), that it was not error for the ALJ to disregard the lay testimony without giving specific reasons for doing so. It asserts that the ALJ need not discuss "lay witness testimony that conflict[s] with the available medical evidence." The reliance on Vincent is misplaced. In that case, lay witnesses were making medical diagnoses, e.g., that the claimant had a serious mental impairment as a result of a stroke. Such medical diagnoses are beyond the competence of lay witnesses and therefore do not constitute competent evidence. 20 CFR § 404.1513(a). However, lay witness testimony as to a claimant's symptoms or how an impairment affects ability to work is competent evidence, 20 CFR § 404.1513(e), Sprague v. Bowen, 812 F.2d 1226, 1232 (9th Cir. 1987), and therefore cannot be disregarded without comment. Dodrill, 12 F.3d at 919.
[20] LEAVY, Circuit Judge, concurring in part and dissenting in part:
In Andrews, the ALJ credited the testimony of a nontreating, consulting medical advisor over that of a nontreating, examining psychologist. On appeal we stated that, just as the opinion of a treating physician is ordinarily accorded greater weight than that of a nontreating physician, "greater weight is accorded to the opinion of an examining physician than a nonexamining physician." 53 F.3d at 1041 (citing a federal regulation and a footnote to a Ninth Circuit case). We did not hold, however, that an ALJ must provide specific, legitimate reasons for giving greater weight to the opinion of a consulting physician than to that of an examining physician; in fact, we applied a much lower standard, different from that used in the treating versus nontreating physician situation:
20 C.F.R. § 416.927(d)(1); Pitzer v. Sullivan, 908 F.2d 502, 506 n. 4 (9th Cir. 1990).
Here, substantial record evidence supports the ALJ's finding that the claimant was not mentally disabled. The ALJ explicitly found that there was no evidence of any mental impairment on the part of the claimant prior to 1991, and that "[t]he claimant has not been under any `disability' as defined in the Social Security Act, as amended, at any time through the date of this decision." ER vol. II at 180, Finding #9. In reviewing the ALJ's decision in the light of the administrative record, the district court reached the following conclusion:
See ER vol. II at 173 ("the evidence was devoid of any findings or complaints relative to a mental disorder of the claimant during the period of May 1988 until November 18, 1991"); id. at 178 ("prior to the examination conducted of the claimant at the request of his attorney in November 1991, the record is devoid of any findings of any mental disorder of the claimant").
ER vol. I, #29 at 8-9 (internal citations and footnotes omitted; emphasis in original).