Source: http://openjurist.org/157/f3d/715/16105b-v-dar-reddick
Timestamp: 2016-10-21 12:03:46
Document Index: 427738991

Matched Legal Cases: ['§ 200', '§ 404', '§ 404', '§ 200', '§ 404', '§ 404', '§ 200', '§ 404']

We recognize that the ALJ is responsible for determining credibility, resolving conflicts in medical testimony, and for resolving ambiguities. Andrews v. Shalala, 53 F.3d 1035, 1039 (9th Cir.1995). The ALJ's findings, however, must be supported by specific, cogent reasons. Rashad v. Sullivan, 903 F.2d 1229, 1231 (9th Cir.1990). Once the claimant produces medical evidence of an underlying impairment, the Commissioner may not discredit the claimant's testimony as to the severity of symptoms merely because they are unsupported by objective medical evidence. Bunnell v. Sullivan 947 F.2d 341, 343 (9th Cir.1991) (en banc). Unless there is affirmative evidence showing that the claimant is malingering, the Commissioner's reasons for rejecting the claimant's testimony must be "clear and convincing." Lester v. Chater, 81 F.3d 821, 834 (9th Cir.1995) (internal quotation marks omitted); Swenson, 876 F.2d at 687. "General findings are insufficient; rather, the ALJ must identify what testimony is not credible and what evidence undermines the claimant's complaints." Lester, 81 F.3d at 834; Dodrill v. Shalala, 12 F.3d 915, 918 (9th Cir.1993).
We conclude that the ALJ's finding that Claimant's activities indicate an ability to work is unsupported by the record. The activities Claimant described to her doctors, on disability forms, and at her hearing, were fully consistent with CFS. Her activities were sporadic and punctuated with rest. Even more prolonged undertakings might be consistent with the disease, as CFS is "characterized by periods of exacerbation and remission." Cohen v. Secretary of Dept. of Health & Human Servs., 964 F.2d 524, 530 (6th Cir.1992) (describing the episodic nature of CFS). Several courts, including this one, have recognized that disability claimants should not be penalized for attempting to lead normal lives in the face of their limitations. See, e.g., Cohen, 964 F.2d at 530-31 (ruling that a claimant should not be penalized for attempting to maintain some sense of normalcy in her life); Cooper v. Bowen, 815 F.2d 557, 561 (9th Cir.1987)(noting that a disability claimant need not "vegetate in a dark room" in order to be deemed eligible for benefits). See also Fair v. Bowen, 885 F.2d 597, 603 (9th Cir.1989) ("Many home activities are not easily transferable to ... the more grueling environment of the workplace, where it might be impossible to periodically rest or take medication."). Only if the level of activity were inconsistent with Claimant's claimed limitations would these activities have any bearing on Claimant's credibility.
Our examination of the record shows that the ALJ has erred in characterizing statements and documents contained therein to reach the conclusion that Claimant exaggerated her symptoms. Examples include the ALJ's description of Claimant's aerobic activity and Tupperware sales,1 and his characterization of an activities report completed by Claimant's sister-in-law.2 In essence, the ALJ developed his evidentiary basis by not fully accounting for the context of materials or all parts of the testimony and reports. His paraphrasing of record material is not entirely accurate regarding the content or tone of the record. We conclude that his approach and conclusions do not fully account for the nature of CFS and its symptoms.3 See, e.g., Sarchet v. Chater, 78 F.3d 305, 307-09 (7th Cir.1996) (reversal required where ALJ's characterization of the record reflected misunderstanding of CFS); Sisco v. Dept. of Health & Human Servs., 10 F.3d 739, 743-46 (10th Cir.1993) (reversal required where ALJ's credibility findings and interpretation of the record were not supported by substantial evidence).4
There is considerable evidence in the record that detracts from the ALJ's conclusions. Nowhere has the ALJ pointed to affirmative evidence of malingering. Instead, he quotes a general comment by a consulting examiner, Dr. Ng, about the facility with which CFS symptoms can be exaggerated. This fact is true, and makes CFS cases difficult to adjudicate, but a general observation such as this in an insufficient reason to discount Claimant's credibility. In fact, Dr. Ng concluded that Claimant met the CDC's criteria for the diagnosis of CFS and was disabled.5 Nor did the ALJ emphasize that four other doctors agreed with the CFS diagnosis, a fifth doctor diagnosed possible CFS, and a sixth diagnosed a fatigue syndrome. None of the examining doctors provided medical evidence countering the CFS diagnosis. Claimant tested positive for the Epstein-Barr antibody, which frequently correlates with CFS. She exhibited the constellation of symptoms often associated with CFS, including a persistent low-grade fever.6 She also underwent years of testing and examination to rule out other possible illnesses. In addition, the record shows that Claimant periodically advised her doctors when she was feeling somewhat better. This is unlikely behavior for a person intent on overstating the severity of her ailments. We conclude that the ALJ provided unsatisfactory reasons for discounting Claimant's credibility, and that his findings were unsupported by substantial evidence based on the record as a whole.
Social Security regulations define residual functional capacity as the "maximum degree to which the individual retains the capacity for sustained performance of the physical-mental requirements of jobs." 20 C.F.R. 404, Subpt. P, App. 2 § 200.00(c) (emphasis added). In evaluating whether a claimant satisfies the disability criteria, the Commissioner must evaluate the claimant's "ability to work on a sustained basis." 20 C.F.R. § 404.1512(a); Lester, 81 F.3d at 833 (internal quotation marks omitted). The regulations further specify: "When we assess your physical abilities, we first assess the nature and extent of your physical limitations and then determine your residual functional capacity for work activity on a regular and continuing basis." Id. at § 404.1545(b). This court has noted that "[o]ccasional symptom-free periods--and even the sporadic ability to work-are not inconsistent with disability." Lester, 81 F.3d at 833.
Because the ALJ's evaluation of residual functional capacity failed to address claimant's ability to undertake sustained work activity, his analysis did not comport with the Social Security Administration's regulatory requirements. See Cohen, 964 F.2d at 529 ("Although her mental capacity perhaps would have been more than adequate, Cohen simply would have lacked the stamina for such employment."); Rose, 34 F.3d at 19 ("The question here is the extent to which claimant's fatigue in fact restricts his residual functional capacity."); Williams v. Shalala, 1995 WL 328487, at * 6 (holding that, where the ALJ failed to consider claimant's non-exertional limitations, the "ALJ's decision, on the whole, reflect[ed] an analysis inconsistent with the appropriate framework for assessing disability claims premised on CFS."). The ALJ's finding on residual functional capacity was not supported by substantial evidence as it failed to account for the effects of fatigue on Claimant's ability to function in the workplace.
The opinions of treating doctors should be given more weight than the opinions of doctors who do not treat the claimant. Lester, 81 F.3d at 830. Where the treating doctor's opinion is not contradicted by another doctor, it may be rejected only for "clear and convincing" reasons supported by substantial evidence in the record. Id. (internal quotation marks omitted). Even if the treating doctor's opinion is contradicted by another doctor, the ALJ may not reject this opinion without providing "specific and legitimate reasons" supported by substantial evidence in the record. Id. at 830, quoting Murray v. Heckler, 722 F.2d 499, 502 (9th Cir.1983). This can be done by setting out a detailed and thorough summary of the facts and conflicting clinical evidence, stating his interpretation thereof, and making findings. Magallanes, 881 F.2d at 751. The ALJ must do more than offer his conclusions. He must set forth his own interpretations and explain why they, rather than the doctors', are correct. Embrey v. Bowen, 849 F.2d 418, 421-22 (9th Cir.1988).
In disability benefits cases such as this, physicians may render medical, clinical opinions, or they may render opinions on the ultimate issue of disability--the claimant's ability to perform work. As we stated in Matthews v. Shalala, 10 F.3d 678 (9th Cir.1993), " '[t]he administrative law judge is not bound by the uncontroverted opinions of the claimant's physicians on the ultimate issue of disability, but he cannot reject them without presenting clear and convincing reasons for doing so.' " Id. at 680 (quoting Montijo v. Secretary of Health & Human Servs., 729 F.2d 599, 601 (9th Cir.1984)). See also Lester, 81 F.3d at 830; Embrey, 849 F.2d at 422.7 A treating physician's opinion on disability, even if controverted, can be rejected only with specific and legitimate reasons supported by substantial evidence in the record. Lester, 81 F.3d at 830. In sum, reasons for rejecting a treating doctor's credible opinion on disability are comparable to those required for rejecting a treating doctor's medical opinion.
In Burkhart v. Bowen, 856 F.2d 1335 (9th Cir.1988), we rejected a doctor's opinion in a letter requested by counsel where the opinion was unsupported by medical findings, personal observations, or test reports. Id. at 1339-40. We noted in Burkhart that "given the evidence before the ALJ, [the fact that the letter had been solicited by counsel] was not the only reason the ALJ gave for rejecting (the doctor's) statements." Id. at 1339. However, In Lester, where there was no sound basis for rejecting a doctor's opinion that had been solicited by counsel, we stated that "the purpose for which medical reports are obtained does not provide a legitimate basis for rejecting them." 81 F.3d at 832. In Saelee v. Chater, 94 F.3d 520 (9th Cir.1996), citing Lester, we rejected a doctor's opinion letter where "actual improprieties" had been found. Id. at 523. In Saelee, the doctor's opinion letter varied from his treatment notes and "was worded ambiguously in an apparent attempt to assist [the claimant] in obtaining social security benefits." Id. at 522. In that case, the ALJ found that there was "no objective medical basis for the opinion." Id. at 523.
We also conclude that the record provides no basis for the ALJ's finding that Social Security consulting examiners Wood and Moseley were more objective than Drs. Charney or Jacobson. Dr. Charney, who agreed with the CFS diagnosis and found Claimant to be disabled, was hired by Claimant's disability carrier to evaluate her eligibility for long-term benefits. If any bias were to exist, it would have been expected to be against Claimant. In addition, there is nothing in the record to show a lack of objectivity in Dr. Jacobson, who treated Claimant for over three years. In contrast, Drs. Wood and Moseley examined Claimant on a one-time basis. In the absence of Claimant's key medical records, Dr. Moseley performed standard psychological tests, and from that limited information pronounced that "she may be expected to resume ... an eight-hour workday routine and 40-hour work week."
Claimant contends that the ALJ also erred by characterizing her case as an "excess pain" case, and applying Social Security Ruling (SSR) 88-13, which provides guidance for evaluating complaints of disabling pain. SSR 88-13, Soc. Sec. Rep. Ser. 652, 1988 WL 236011. Claimant did not allege excess pain as the basis for her claim,8 yet the ALJ decision stated:
In evaluating the claimant's allegation of 'disabling pain' in this instance, the ALJ has given consideration not only to the medical evidence of record, but also to the type, dosage, effectiveness, and side effects of any prescribed pain medication and to other treatment for pain symptoms. The claimant's daily activities and functional restrictions during the relevant period have been considered as well in evaluating the credibility of the claimant's alleged disabling pain complaints.
Although SSR 88-13 applies to the evaluation of pain "and other symptoms,"9 the ALJ considered only pain and its effect on Claimant's activities and the potential relief by medication, rather than fatigue which is the basis of Claimant's disability claim. The ALJ's focus on pain medication and treatment is misplaced, as the CDC has made it clear that no definitive treatment for CFS exists.10 But even more salient is the fact that the ALJ failed to consider the Program Operations Manual System ("POMS") guidelines on CFS issued by the Social Security Administration in 1993. The POMS policy states in pertinent part:
The final question for us to resolve is whether to remand for further proceedings or for an award of benefits. The decision whether to remand a case for additional evidence or simply to award benefits is within the discretion of the court. Swenson v. Sullivan, 876 F.2d 683, 689 (9th Cir.1989) (citing Varney v. Secretary of HHS, 859 F.2d 1396, 1399 (9th Cir., 1988) (Varney II)). In Varney II, we held that in cases where the record is fully developed, a remand for further proceedings is unnecessary:
Varney II, 859 F.2d at 1401. See also Swenson, 876 F.2d at 689 (directing an award of benefits where no useful purpose would be served by further proceedings); Rodriguez v. Bowen, 876 F.2d 759, 763 (9th Cir.1989) (same); Winans v. Bowen, 853 F.2d 643, 647 (9th Cir.1987) (accepting uncontradicted testimony as true and awarding benefits where the ALJ failed to provide clear and convincing reasons for discounting the opinion of claimant's treating physician).
In general, if a claimant suffers only from exertional limitations, e.g., strength limitations, the ALJ at step five may apply the Commissioner's Medical-Vocational Guidelines [the "grids"] to match the claimant with appropriate work. 20 C.F.R. Pt. 404, Subpt. P, App. 2, § 200.00(b). The grids are based on strength factors only. Id.11 The ALJ may apply the grids in lieu of taking testimony of a vocational expert only when the grids accurately and completely describe the claimant's abilities and limitations. Jones v. Heckler, 760 F.2d 993, 998 (9th Cir.1985) (citation omitted). If the grids fail accurately to describe a claimant's limitations, the ALJ may not rely on the grids alone to show the availability of jobs for the claimant. Id. (citations omitted). See also Bapp v. Bowen, 802 F.2d 601, 605-06 (2d Cir.1986) (stating that application of the grids is inappropriate where a claimant's work capacity is significantly diminished beyond that caused by an exertional impairment). In these cases, the ALJ must also hear the testimony of a vocational expert. Desrosiers v. Secretary of Health & Human Servs. 846 F.2d 573, 578 (9th Cir.1988) (Pregerson, J., concurring) (citing Perminter v. Heckler, 765 F.2d 870, 872 (9th Cir.1985)).12
At Claimant's hearing before the ALJ, a vocational expert did testify about the nature of Claimant's limitations. The expert testified that if Claimant's testimony were credited concerning her fatigue, she would be unable to perform her past work, due to her need to take frequent naps and an inability to carry out repetitive tasks. See Kornock v. Harris, 648 F.2d 525, 527 (9th Cir.1980) (citations omitted) ("The ability to work only a few hours at day or to work only on an intermittent basis is not the ability to engage in 'substantial gainful activity.' "). The vocational expert also testified that if Claimant were to require just one day per week of rest, she would be unable to perform her past work or any other work.13
Clamant's past work as a payroll clerk is classified as sedentary work, which is the lowest classification under the regulations. 20 C.F.R. § 404.1565. In Sisco, which involved similar facts, the Tenth Circuit determined that "[b]ecause sedentary work is the lowest classification under the statute, there is no need for further proceedings in this matter other than a remand for an award of benefits." 10 F.3d at 745-46.
"Some days she stays home in bed all day.... Some she can go run errands but she tires out easily ... some days she sleeps a lot.... She has gained a lot of weight and isn't as critical about the clothes she wears. Sometimes she doesn't care about how she looks. She was never this way before her illness.... [Sometimes she cooks meals], her daughter, stepson and husband all take turns.... Sue shops occasionally. She never goes alone.... She misses (Bible study) a lot because she has no energy even to just sit and listen.... She gets tired a lot. Real lethargic. She always comes to our house and ends up falling asleep.... [S]he finishes things but sometimes it takes a few days because she gets tired so easily."
Chronic fatigue syndrome is a disease that did not become widely known in the medical community until 1988 when the first diagnostic article was published. It was also in 1988 that the CDC accepted chronic fatigue syndrome as a disease. Reed v. Secretary of Health & Human Services, 804 F.Supp. 914, 916 (E.D.Mich.1992)
See also Sabo v. Chater, 955 F.Supp. 1456, 1463 (M.D.Fla.1996) (ruling that a reversal was required where the ALJ failed to apply standards appropriate to CFS); Fragale v. Chater, 916 F.Supp. 249, 254 (W.D.N.Y.1996)("CFS ... may produce symptoms which 'significantly impair [a] claimant's ability to perform even sedentary work ....' ") (quoting Rose v. Shalala, 34 F.3d 13, 17 (1st Cir.1994)); Williams v. Shalala, 1995 WL 328487, at * 6 (W.D.N.Y. May 19, 1995) (holding that a remand was required where the ALJ's decision "reflects an analysis inconsistent with the appropriate framework for assessing disability claims premised on CFS."); Irwin v. Shalala, 840 F.Supp. 751, 770 (D.Or.1993) (holding that a reversal was required where the ALJ discredited testimony of CFS claimant and doctors); Powell v. Chater, 959 F.Supp. 1238, 1245 (C.D.Cal.1997) (ruling that a remand was required where the ALJ's perceived inconsistencies in the record were "minimal at best.")
Dorland's Medical Dictionary outlines some of the symptoms commonly associated with CFS. The dictionary defines chronic fatigue syndrome as a "persistent debilitating fatigue of recent onset, with reduction of physical activity to less than half of usual, accompanied by some combination of muscle weakness, sore throat, mild fever, tender lymph nodes, headaches, and depression, with the symptoms not attributable to any other known causes." Dorland's Illustrated Medical Dictionary 1627 (28th ed.1994)
In Embrey we rejected the ALJ's conclusory statements rejecting the treating doctor's opinion on disability: "Here, the ALJ does not give sufficiently specific reasons for rejecting the conclusion of [Embrey's treating orthopedist] that Embrey is 'permanently disabled....' Nor does the ALJ explain why he disagrees with Dr. Baker's conclusion that Embrey is permanently unemployable.... Instead, he merely states that the objective factors point toward an adverse conclusion and makes no effort to relate any of these objective factors to any of the specific medical opinions and findings he rejects. This approach is inadequate." Embrey, 849 F.2d at 422
SSR 88-13, 1988 WL 236011; 20 C.F.R. §§ 404.1598, 404.1528-29, 416.908, 416.928-29
Centers for Disease Control, "The Chronic Fatigue Syndrome: A Comprehensive Approach to its Definition and Study," 121 Annals of Internal Medicine 953 (1994). See also, "The Chronic Fatigue Syndrome," 90 American Journal of Medicine 730, 736 (June 1991)
Since the rules are predicated on an individual's having an impairment which manifests itself by limitations in meeting the strength requirements of jobs, they may not be fully applicable where the nature of an individual's impairment does not result in such limitations....
C.F.R. Pt. 404, Subpt. P, App 2 § 200.00(e). See also 20 C.F.R. § 404.-1569(a) (defining non-exertional limitations as limitations that do not directly affect a claimant's [muscular] strength)
In Periminter, we held that pain is a non-exertional limitation. We also determined that, absent other reliable evidence that the claimant could perform specific jobs, a vocational expert was necessary. 765 F.2d at 872