Opinion ID: 782372
Heading Depth: 2
Heading Rank: 2

Heading: Failure to include consideration of Celaya's headaches and obesity.

Text: 14 Celaya claims that the ALJ failed to give due consideration to her headaches. The ALJ found that the headaches were attributable to her high blood pressure, and that because addressing the latter would alleviate the headaches, they need not be considered separately. Celaya presents no evidence that would contradict this finding. Macri v. Chater, 93 F.3d 540, 544 (9th Cir.1996) (plaintiff must submit sufficient evidence of impairment for a multiple impairment analysis to be required). 15 By contrast, Celaya's obesity was not merely a symptom of either of her diagnosed impairments (i.e., diabetes and hypertension), but an independent condition. The question is whether it should have been considered by the ALJ in analyzing Celaya's ability to work. Defendant argues that it should not, for two reasons. First, because Celaya did not meet the listing criteria for obesity, her obesity has no role in a step three analysis. In other words, defendant asserts that if obesity is not severe enough to establish a disability at step three by itself, even in the absence of any other impairment, it is not to be considered at all. Second, because she did not explicitly raise obesity as a factor contributing to her disability, the ALJ had no obligation to consider it. 16
17 Although Celaya did not meet the listing criterion for obesity, that does not mean that the ALJ should ignore it. The argument that since plaintiff did not meet the listed criteria for obesity, her obesity need not be considered in a multiple impairments analysis gets things backwards. If a claimant does meet the listing criterion for one or more impairments, she is judged to be disabled without the need to conduct any further analysis. It is precisely when a condition falls short of the criterion, as here, that such an analysis is appropriate. See 42 U.S.C. § 423(d)(2)(B) (In determining whether an individual's... impairments are of sufficient medical severity that such ... could be the basis of eligibility under this section, the Secretary shall consider the combined effect of all the individual's impairments without regard to whether any such impairment, if considered separately, would be of such severity.), 20 C.F.R. §§ 404.1545(e), 416.945(e) (we will consider the limiting effects of all your impairment(s), even those that are not severe, in determining your residual functional capacity.). Furthermore, agency ruling SSR 96-8p states that 18 [i]n assessing RFC, the adjudicator must consider limitations and restrictions imposed by all of an individual's impairments, even those that are not severe. While a not severe impairment may not significantly limit an individual's ability to do basic work activities, it may — when considered with limitations or restrictions due to other impairments — be critical to the outcome of a claim. 19 Celaya's diabetes and hypertension were admittedly each a severe impairment — i.e., one that imposes significant restrictions in the ability to perform basic work activities, id. — without themselves being dispositive at step three. Logically, her obesity, though barely short of the criterion, may have fallen into the same category. Given the potential effect of obesity on these conditions, the ALJ had a responsibility to consider their interactive effect. In determining whether a claimant equals a listing under step three of the Secretary's disability evaluation process, the ALJ must explain adequately his evaluation of alternative tests and the combined effects of the impairments. Marcia v. Sullivan, 900 F.2d 172, 176 (1990); see also Social Security Ruling 83-19, at 91. The ALJ was responsible for determining the effect of Celaya's obesity upon her other impairments, and its effect on her ability to work and general health, given the presence of those impairments. Defendant admits that the ALJ did not do so, even implicitly. On remand, that determination must be made. 2 20
21 Defendant argues that even if a multiple impairment analysis would have been appropriate had Celaya explicitly raised her obesity as a disabling factor, she did not do so. The ALJ should nevertheless have included it in such an analysis, for three reasons. First, it was raised implicitly in Celaya's report of symptoms. Second, it was clear from the record that Celaya's obesity was at least close to the listing criterion, and was a condition that could exacerbate her reported illnesses. Third, in light of Celaya's pro se status, the ALJ's observation of Celaya and the information on the record should have alerted him to the need to develop the record in respect to her obesity. 22 The ALJ's exclusion of obesity from his analysis is error in that he was addressing an illiterate, unrepresented claimant who very likely never knew that she could assert obesity as a partial basis for her disability. The ALJ always has a special duty to fully and fairly develop the record and to assure that the claimant's interests are considered ... even when the claimant is represented by counsel. Brown v. Heckler, 713 F.2d 441, 443 (9th Cir.1983) (citations omitted). When a claimant is not represented by counsel, this responsibility is heightened. Higbee v. Sullivan, 975 F.2d 558, 561 (9th Cir.1992) notes that: 23 [T]he ALJ is not a mere umpire at such a proceeding, but has an independent duty to fully develop the record, especially where the claimant is not represented:... it is incumbent upon the ALJ to scrupulously and conscientiously probe into, inquire of, and explore for all the relevant facts. He must be especially diligent in ensuring that favorable as well as unfavorable facts and circumstances are elicited. 24 (citations and internal quotation marks omitted). 25 The district court's judgment on this claim is therefore reversed. We direct the district court to remand the case to the ALJ for a step-three multiple impairment analysis that explicitly accounts for the direct and marginal effects of the plaintiff's obesity during the period in question and that culminates in reviewable, on-the-record findings. 3 26 C. Failure to make detailed and specific findings comparing Celaya's residual functioning capacity with the requirements of her past work as a presser. 27 The ALJ's conclusion that Celaya could work apparently rests upon his comparison of the August 30, 1996 Vocational Report (particularly the report on the prior work as a presser) to the December 10, 1996 PRFCA. The PRFCA was completed by Murray Mitts, M.D., a medical consultant. A stamp on its final page is signed by R.M. Good, M.D. and dated March 7, 1997. The stamp states I have reviewed all the evidence in file, and the assessment of 12/10/96 is affirmed, as written. An additional check mark indicates that These findings complete the medical portion of the disability determination. 28 The PRFCA states that no treating or examining source statement(s) regarding claimant's physical capacities were reviewed to aid in its completion. It recognizes no exertional, postural, manipulative, visual, communicative or environmental limitations on Celaya's activities, other than limits on how much she can lift. The instructions for the form state that the person completing the PRFCA should base ... conclusions on all evidence in file (including observations), describe how the evidence substantiates [the] conclusions, request appropriate treating and examining source statements regarding the individual's capacities, consider[] and respond[] to any alleged limitations imposed by symptoms (pain, fatigue, etc.) attributable ... to a medically determinable impairment, discuss[] assessment of symptom-related limitations in the explanation for your conclusions in each of the domains noted above, and respond[] to all allegations of physical limitations or factors which can cause physical limitations. The form, as completed, does none of these: aside from two check marks suggesting limitations on Celaya's lifting ability, it includes only eight check marks indicating a total lack of disability, without comment, rationale, or evident attention to the medical record. To the extent that the ALJ's judgment rests upon its conclusions, it does not rest upon substantial evidence. 29 The record gives clear reason for concern that the PRFCA failed to take Plaintiff's obesity into account. In his June 16, 1998 assessment of Celaya's postural limitations, Dr. John Clark indicated that she should never crawl, and only occasionally bend, squat, kneel, and reach above shoulder level. This assessment was made solely on the basis of Celaya's obesity, without consideration of her by-then-controlled diabetes and hypertension. The PRFCA, completed when Celaya was apparently at about the same weight, recognizes no limitations whatsoever on her ability to engage in these activities; it also indicates the she could stand and walk for about 6 hours in an eight hour workday; the maximum category listed. The form gives no indication that Dr. Mitts or Dr. Good were aware of Celaya's weight and height. 30 This report offers no confidence that the ALJ could make his decision on a record that had attempted to assess Plaintiff's ability to withstand the physical demands of a job that required a fair amount of standing, during a year in which she was not only diabetic and substantially obese, but when her hypertension was first out of, and then only marginally under, control. We therefore cannot conclude that the ALJ's decision was based on substantial evidence that took the totality of Celaya's medical condition into account. We vacate the district court's order and instruct the court to remand to the ALJ for a proper step-four analysis based on all of the evidence in the record currently and as it is supplemented.