Opinion ID: 483886
Heading Depth: 2
Heading Rank: 3

Heading: Evidence of Mental Condition

Text: 22 A second ground for reversal is that the ALJ stated no reasons for ignoring the substantial evidence of Mrs. Sprague's mental state and its impact on her ability to work. The only conflict in the medical opinions in this case has to do with the disabling impact of Mrs. Sprague's pain and mental condition when they are considered in conjunction with her physical ailments. Dr. Gehlen's and Dr. McCornack's opinions do not actually conflict because only Dr. Gehlen offered evidence of Mrs. Sprague's mental state and its cumulative effect on her overall ability to function. The case is thus not one of conflicting medical viewpoints but one in which differing opinions are not drawn from the same facts. Beecher v. Heckler, 756 F.2d 693, 695 (9th Cir.1985) (quoting Dressel v. Califano, 558 F.2d 504, 508 n. 6 (8th Cir.1977). 23 The Secretary argues that Dr. Shibata made a detailed examination of Mrs. Sprague's mental condition and noted her mental status as normal, thus providing substantial evidence contrary to Dr. Gehlen's findings. We do not consider this cursory observation, made during one physical examination, to constitute substantial evidence. Because it conflicts with the findings of the physician who knew and treated Mrs. Sprague for 25 years, the ALJ could accept Dr. Shibata's conclusion only if he stated specific reasons for rejecting her treating physician's opinion as required by Murray, 722 F.2d at 502. 24 The ALJ not only failed to give reasons for disregarding Dr. Gehlen's opinion, he failed even to mention the other evidence of Mrs. Sprague's mental condition. The ALJ said only that under 20 C.F.R. Sec. 404.1508 a physical or mental impairment must be established by medical evidence and an unsubstantiated statement of symptoms by the claimant cannot determine the ultimate legal issue of disability. This conclusory statement will not suffice. 25 The statements Mrs. Sprague made about her mental and physical limitations and about her pain and depression are not mere unsubstantiated statements of symptoms. First, there is medical evidence of conditions which would normally produce pain, and the ALJ may not choose to disbelieve Mrs. Sprague's testimony unless he makes specific findings justifying that decision. Cotton, 799 F.2d at 1407; Miller v. Heckler, 770 F.2d 845, 848 (9th Cir.1985); Murray, 722 F.2d at 502. 26 Second, there is medical evidence of Mrs. Sprague's mental state which substantiates her own testimony. The Secretary argues that the ALJ did not have to state reasons for disregarding evidence of Mrs. Sprague's mental state because no competent evidence was offered since Dr. Gehlen has not identified himself as a psychiatrist. This would appear to be the basis of the magistrate's brief conclusion that no psychiatric or other qualified evidence was introduced to support a claim of mental disorder under Sec. 12.04 of Appendix 1, Functional Nonpsychotic Disorders. This conclusion is clearly erroneous. We emphasize that even if her symptoms fail to meet or equal those of a listed mental disorder, the ALJ must consider the effect of her mental state on her physical ability to perform gainful activity. Beecher, 756 F.2d at 694. As we indicated in Beecher, 756 F.2d at 694-95, [b]ecause a person's ability to engage in gainful employment is dependent upon both physical and psychological capabilities, ... '[a] claimant's illnesses must be considered in combination and must not be fragmentized in evaluating their effects.'  (quoting Dressel, 558 F.2d at 508). 27 We believe there was both psychiatric and other qualified evidence of Mrs. Sprague's mental state. The evidence introduced included her treating physician's opinion of her mental state as well as Mrs. Sprague's testimony and that of her friend and her daughter. This medical opinion and lay testimony constitutes qualified evidence which the ALJ must address on remand. 28 If the Magistrate's conclusion that there was no psychiatric evidence is based on an assumption that such evidence must be offered by a Board-certified psychiatrist, it is clearly erroneous. There is no such requirement in the regulations. Under general principles of evidence law Dr. Gehlen is qualified to give a medical opinion as to Mrs. Sprague's mental state as it relates to her physical disability even though Dr. Gehlen is not a psychiatrist. Heinze v. Heckler, 581 F.Supp. 13, 14 (E.D.Pa.1983), (citing Alvarado v. Weinberger, 511 F.2d 1046, 1049 (1st Cir.1975); accord Payton v. Abbott Labs, 780 F.2d 147, 155 (1st Cir.1985). 29 Dr. Gehlen is a duly licensed physician and as such, under the laws of most states, including the claimant's state of Washington, he can practice and render psychiatric services, i.e., prescribe psychotropic medication, conduct psychotherapy, etc. Wash.Rev.Code Sec. 18.71.011 (defining the practice of medicine); Joseph T. Smith, M.D., Medical Malpractice: Psychiatric Care 576 (1986). While the medical profession has standards which purport to restrict the practice of psychiatry to physicians who have completed residency training programs in psychiatry, Smith, supra at 576, it is well established that primary care physicians (those in family or general practice) identify and treat the majority of Americans' psychiatric disorders. C. Tracy Orleans, Ph.D., Linda K. George, Ph.D., Jeffrey L. Houpt, M.D., and H. Keith H. Brodie, M.D., How Primary Care Physicians Treat Psychiatric Disorders: A National Survey of Family Practitioners, 142:1 Am.J. Psychiatry 52 (Jan.1985). 30 Not only is Dr. Gehlen permitted by state law and professional custom to practice psychiatry, by virtue of his treatment of Mrs. Sprague's condition, including the prescription of psychotherapeutic drugs, he in fact was practicing psychiatry. Thus his evidence is medically acceptable. 20 C.F.R. Sec. 404.1513(a)(1). Dr. Gehlen's opinion is competent psychiatric evidence, based on his clinical observations of Mrs. Sprague's depression.  'Disability may be proved by medically-acceptable clinical diagnoses, as well as by objective laboratory findings.'  Bilby v. Schweiker, 762 F.2d 716, 719 (9th Cir.1985) (quoting Day v. Weinberger, 522 F.2d 1154, 1156 (9th Cir.1975)). 31 Dr. Gehlen referred in his March 15, 1983 letter to her depression, characterized by weight loss due to lack of appetite, tension headaches, sleep loss, nightmares and upset stomach. In another letter on January 24, 1984, which was not available to the ALJ, but was available to the Appeals Council, Dr. Gehlen stated that her depression had worsened, requiring antidepressant medication and resulting in decreased activity and ability to care for herself, as well as increased thoughts of suicide. 32 We also believe that the testimony of Mrs. Sprague's daughter and friend is fully competent to substantiate her doctor's diagnosis of depression. Disregard of this evidence violates the Secretary's regulation that he will consider observations by non-medical sources as to how an impairment affects a claimant's ability to work. 20 C.F.R. Sec. 404.1513(e)(2). Descriptions by friends and family members in a position to observe a claimant's symptoms and daily activities have routinely been treated as competent evidence. See, e.g., Bilby, 762 F.2d at 719 n. 3.