Opinion ID: 810965
Heading Depth: 2
Heading Rank: 1

Heading: The ALJ’s Consideration of the Evidence

Text: [1] The ALJ found that Hill has the residual functional capacity “to perform light work . . . . that requires only occaHILL v. ASTRUE 12947 sional interaction with the public and co-workers . . . .” Hill argues that the ALJ ignored or failed to consider evidence favorable to Hill when making the residual functional capacity determination.
[2] Hill argues that the ALJ’s residual functional capacity determination failed to take into account an evaluation by Dr. Lynn Johnson, a psychologist who examined Hill on May 25, 2007. In her evaluation, Dr. Johnson found that Hill’s “combination of mental and medical problems makes the likelihood of sustained full time competitive employment unlikely.” (emphasis added). Hill correctly notes that the ALJ’s decision does not address this finding by Dr. Johnson. [3] In order to reject an examining physician’s opinion, “the ALJ has to give clear and convincing reasons. . . . Even if contradicted by another doctor, the opinion of an examining doctor can be rejected only for specific and legitimate reasons that are supported by substantial evidence in the record.” Regennitter v. Comm’r of Soc. Sec. Admin., 166 F.3d 1294, 1298-99 (9th Cir. 1999). [4] Here, the ALJ failed to provide Dr. Johnson’s statement any degree of review at all, and gave no reasons for doing so, let alone any clear and convincing reasons. See Matthews v. Shalala, 10 F.3d 678, 680 (9th Cir. 1993) (Although the ALJ “is not bound by the uncontroverted opinions of the claimant’s physicians on the ultimate issue of disability, . . . he cannot reject them without presenting clear and convincing reasons for doing so.” (internal quotation marks omitted)). [5] The Commissioner concedes that the ALJ’s decision does not address Dr. Johnson’s opinion that Hill’s “combination of mental and medical problems makes the likelihood of sustained full time competitive employment unlikely.” Nevertheless, the Commissioner argues that the ALJ’s failure to 12948 HILL v. ASTRUE consider Dr. Johnson’s opinion was harmless because an opinion that an individual cannot work is an opinion on an issue reserved to the Commissioner and, therefore, it is not binding. See 20 C.F.R. § 404.1527(d)(1) (“A statement by a medical source that you are ‘disabled’ or ‘unable to work’ does not mean that we will determine that you are disabled.”). We disagree. [6] Dr. Johnson’s statement that Hill would be “unlikely” to work full time was not a conclusory statement like those described in 20 C.F.R. § 404.1527(d)(1), but instead an assessment, based on objective medical evidence, of Hill’s likelihood of being able to sustain full time employment given the many medical and mental impairments Hill faces and her inability to afford treatment for those conditions. Thus, the ALJ’s disregard for Dr. Johnson’s medical opinion was not harmless error and Dr. Johnson’s opinion should have been considered. See 20 C.F.R. § 404.1527(c) (“Regardless of its source, we will evaluate every medical opinion we receive.”).
Dr. Kuka, a non-treating, non-examining medical consultant, testified at Hill’s hearing. Less weight is given to the opinion of a non-examining source than to an examining source. See Lester v. Chater, 81 F.3d 821, 830-31 (9th Cir. 1996). “The opinion of a nonexamining physician cannot by itself constitute substantial evidence that justifies the rejection of the opinion of either an examining physician or a treating physician.” Id. at 831. Hill argues that the ALJ ignored Dr. Kuka’s testimony that Hill was “markedly limited” at times when she was suffering panic attacks or manic episodes. But the ALJ clearly acknowledged this testimony, and based his decision in part on Dr. Kuka’s opinion that these severe panic attacks or manic episodes only occurred about two times a year for two or three days. HILL v. ASTRUE 12949 Nevertheless, Dr. Kuka failed to consider that Hill’s most recent panic attack, which occurred at the Dollar Tree store on March 7, 2008, kept Hill in bed for five days and out of work for about two weeks. Thus, Dr. Kuka’s conclusion that Hill’s most severe attacks lasted only two or three days was directly contradicted by the record. Dr. Kuka also noted that the medical records mention numerous panic attacks, sometimes daily and sometimes several times a week. When the ALJ asked if there was independent verification of this, Dr. Kuka replied that Hill’s panic attacks had been “observed on occasions but certainly not to the frequency that they’re reported[,] but then that’s normal too for therapist notes.” It makes sense that not every panic attack would be observed by Hill’s physicians, therapists, or counselors (or even family, friends, and co-workers), because these attacks would not always occur in their presence. There remains, however, a substantial amount of evidence in the record that Hill complained of anxiety and panic attacks, and some of those attacks were actually witnessed by Hill’s physicians, therapists and counselors.
Where the ALJ has found a severe medically determinable impairment at step two of the sequential analysis, “all medically determinable impairments must be considered in the remaining steps of the sequential analysis.” Orn v. Astrue, 495 F.3d 625, 630 (9th Cir. 2007) (citing 42 U.S.C. § 423(d)(2)(B)). In this case, the ALJ found, based in part on Dr. Kuka’s opinion, that Hill had severe mental impairments that included bi-polar disorder, mixed personality disorder, anxiety, and borderline intellectual functioning. But Hill was also diagnosed with panic disorder. The symptoms of Panic Disorder include sudden attacks of intense fear or anxiety, usually associated with numerous physical symptoms such 12950 HILL v. ASTRUE as heart palpitations, rapid breathing or shortness of breath, blurred vision, dizziness, and racing thoughts. Often these symptoms are thought to be a heart attack by the individual, and many cases are diagnosed in hospital emergency rooms . . . . Left untreated . . . symptoms can worsen and Agorapho- bia can develop. In these cases, the individual has developed such an intense fear that leaving the safety of home feels impossible. Index of Psychiatric Disorders, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition 2000), §§ 300.21 & 300.01. Hill described symptoms just like these when she testified before the ALJ. But the ALJ excluded the panic disorder diagnosis and improperly limited the definition of panic attack to only those attacks severe enough to collapse someone to the ground. [7] Because the ALJ excluded panic disorder from Hill’s list of impairments and instead characterized her diagnosis as anxiety alone, the residual functional capacity determination was incomplete, flawed, and not supported by substantial evidence in the record.