Source: https://law.justia.com/cases/federal/appellate-courts/F3/143/1240/562691/
Timestamp: 2019-06-26 10:38:24
Document Index: 535148813

Matched Legal Cases: ['§ 423', '§ 1291', '§ 423', '§ 423', '§ 404', '§ 404', '§ 404']

57 Soc.sec.rep.ser. 22, Unempl.ins.rep. (cch) P 16035b,98 Cal. Daily Op. Ser v. 3549,98 Daily Journal D.a.r. 4871dennis Sousa, Surviving Spouse of Anna M. Sousa, Deceased,plaintiff-appellant, v. John J. Callahan,* Acting Commissioner,social Security Administration, Defendant-appellee, 143 F.3d 1240 (9th Cir. 1998) :: Justia
Justia › US Law › Case Law › Federal Courts › Courts of Appeals › Ninth Circuit › 1998 › 57 Soc.sec.rep.ser. 22, Unempl.ins.rep. (cch) P 16035b,98 Cal. Daily Op. Ser v. 3549,98 Daily Journa...
57 Soc.sec.rep.ser. 22, Unempl.ins.rep. (cch) P 16035b,98 Cal. Daily Op. Ser v. 3549,98 Daily Journal D.a.r. 4871dennis Sousa, Surviving Spouse of Anna M. Sousa, Deceased,plaintiff-appellant, v. John J. Callahan,* Acting Commissioner,social Security Administration, Defendant-appellee, 143 F.3d 1240 (9th Cir. 1998)
U.S. Court of Appeals for the Ninth Circuit - 143 F.3d 1240 (9th Cir. 1998)
Argued and Submitted Dec. 12, 1997. Decided May 11, 1998
Plaintiff Dennis Sousa appeals the district court's order granting summary judgment to defendant Commissioner of Social Security ("Commissioner") and dismissing his deceased spouse's claim for disability insurance benefits under Title II of the Social Security Act. The district court dismissed Sousa's claims because it found that his spouse was ineligible to receive benefits under 42 U.S.C. § 423(d) (2) (C). We have jurisdiction under 28 U.S.C. § 1291. We reverse and remand with instructions.
While those motions were pending, the law was amended to add 42 U.S.C. § 423(d) (2) (C), which precludes the award of benefits to certain claimants whose disability is based, in whole or in part, on alcoholism and drug addiction or either of them. The district court ordered briefing from the parties "on the effective date of that amendment," and subsequently found that the Appeals Council's conclusion-that claimant had not met her burden of proving a mental impairment severe enough to preclude her from working during the relevant time period-was not supported by substantial evidence. However, the court held that "the recent amendments are effective to preclude an award of benefits" because "plaintiff's mental problems during the pertinent period were intertwined and exacerbated by longstanding substance abuse." This timely appeal followed.5 II.
A district court's order upholding the denial of social security benefits by the Commissioner is reviewed de novo. Smolen v. Chater, 80 F.3d 1273, 1279 (9th Cir. 1996). The decision of the Commissioner must stand if it is supported by substantial evidence and it applies the appropriate legal standards. Id. Substantial evidence is "more than a mere scintilla, but less than a preponderance." Saelee v. Chater, 94 F.3d 520, 522 (9th Cir. 1996) (citation omitted), cert. denied, --- U.S. ----, 117 S. Ct. 953, 136 L. Ed. 2d 840 (1997). "If the evidence can reasonably support either affirming or reversing the Secretary's conclusion, the court may not substitute its judgment for that of the Secretary." Flaten v. Secretary, 44 F.3d 1453, 1457 (9th Cir. 1995). However, the Appeals Council's decision cannot be affirmed simply by isolating a specific quantum of supporting evidence. Hammock v. Bowen, 879 F.2d 498, 501 (9th Cir. 1989). The record as a whole must be considered. Howard v. Heckler, 782 F.2d 1484, 1487 (9th Cir. 1986).
A district court's interpretation of a statute is a question of law reviewed de novo. Allen v. Shalala, 48 F.3d 456, 457 (9th Cir. 1995).
The Commissioner can only reject lay testimony as incredible under certain conditions. "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). However, "once the claimant produces objective medical evidence of an underlying impairment, an adjudicator may not reject a claimant's subjective complaints based solely on a lack of objective medical evidence to fully corroborate the alleged severity of pain." Bunnell v. Sullivan, 947 F.2d 341, 345 (9th Cir. 1991). The adjudicator may, however, disregard self-serving statements made by claimants if it finds them to be incredible on other grounds. Rashad v. Sullivan, 903 F.2d 1229, 1231 (9th Cir. 1990). Relevant factors can include the claimant's engagement in activities inconsistent with a claim of disability, an unexplained or inadequately explained failure to seek treatment, or other ordinary methods of credibility determination. Bunnell, 947 F.2d at 346.
Even if these reasons were offered by an ALJ who was present at the hearing and observed the demeanor of the witnesses, they would be suspect. Here, the Appeals Council based its decision on its own independent review of the transcript testimony more than one year after it was taken. This fact further supports our conclusion. Because the Appeals Council's justifications are not supported by specific, cogent reasoning, we cannot uphold them. Lewin v. Schweiker, 654 F.2d 631, 635 (9th Cir. 1981).
Plaintiff submitted a letter, dated November 1, 1994, containing the opinion testimony of Dr. Richard Lundeen. Dr. Lundeen concluded that "there is sufficient medical and lay evidence to establish with reasonable medical certainty that Mrs. Anna Dangler Sousa was, in 1987, suffering from the identifiable mental health disorder known as Dysthymia [leading to] a marked impairment of Mrs. Sousa's psychological, social, and occupational functioning." The Appeals Council agreed with Dr. Lundeen's conclusion that plaintiff had dysthymia prior to December 31, 1987; however, it " [did not] agree that the evidence of record supports the degree of restrictions shown in his evaluation." In rejecting Dr. Lundeen's opinion, the Appeals Council noted that Dr. Lundeen "based much of his assessment of the claimant's functional ability on the testimony of the claimant and her husband at the [March, 1994] hearing."
The Commissioner may reject the opinion of a non-examining physician by reference to specific evidence in the medical record. Gomez v. Chater, 74 F.3d 967, 972 (9th Cir.), cert. denied, --- U.S. ----, 117 S. Ct. 209, 136 L. Ed. 2d 144 (1996); Andrews v. Shalala, 53 F.3d 1035, 1041 (9th Cir. 1995). In rejecting Dr. Lundeen's opinion, the Appeals Council noted that Dr. Lundeen "based much of his assessment of the claimant's functional ability on the testimony of the claimant and her husband at the [March, 1994] hearing." As discussed above, the Appeals Council offered insufficient justification for rejecting that testimony. If the lay testimony is found credible, then Dr. Lundeen's reliance on it does not undermine the validity of his analysis. Accordingly, his opinion remains a substantial hurdle standing in the way of a finding that the claimant was not disabled. Because this improper discreditation of the lay testimony formed the basis for the rejection of Dr. Lundeen's analysis, that rejection fails. We therefore conclude that the Appeals Council's conclusion that claimant was not disabled during the relevant time period is not supported by substantial evidence.
Title 42 U.S.C. § 423(d) (2) (C) ("the amendment") provides that " [a]n individual shall not be considered to be disabled for purposes of this subchapter if drug addiction or alcoholism would ... be a contributing factor material to the Commissioner's determination that the individual is disabled." The "key factor ... in determining whether alcoholism or drug addiction is a contributing factor material to the determination of disability" is whether an individual would still be found disabled if she stopped using alcohol or drugs. 20 C.F.R. § 404.1535(b) (1). "In making this determination, [the Commissioner] will evaluate which of [the claimant's] current physical and mental limitations ... would remain if [she] stopped using drugs or alcohol and then determine whether any or all of [her] remaining limitations would be disabling." 20 C.F.R. § 404.1535(b) (2).
The Appeals Council indicated that " [g]ood cause was furnished by the claimant's mental impairment which may have hampered her ability to properly appeal the reconsideration determination."
If on remand the Commissioner finds that plaintiff is entitled to receive benefits, the Commissioner must also determine whether the benefits are payable to plaintiff's surviving spouse under 42 U.S.C. § 404(d) (1)