Opinion ID: 152300
Heading Depth: 2
Heading Rank: 1

Heading: Exertional limitations

Text: Four treating physicians (Drs. Rashid, Smith, Powell, and Murray) classified O’Neal’s work level as “sedentary” or “severely limited,” meaning that she is unable to walk for more than brief periods, if at all, and can carry no more than ten pounds. The ALJ nonetheless concluded that she is capable of walking or sitting for six hours a day and lifting twenty pounds occasionally. A treating physician’s opinion is generally due “controlling weight,” 20 C.F.R. § 404.1527(d)(2), and where, as here, it is contradicted by another doctor, it can be rejected only if the ALJ provides “specific and legitimate reasons supported by substantial evidence in the record.” Lester v. Chater, 81 F.3d 821, 830 (9th Cir. 1995). We conclude that Page 3 of 11 none of the ALJ’s reasons for rejecting the treating physicians’ assessment of O’Neal’s ability meet that standard. The ALJ’s primary reason for rejecting the treating physicians’ opinions in favor of the reviewing physicians’ was that O’Neal’s failure to take her medications as prescribed and her “addictive behavior,” as evidenced by her repeated trips to the emergency room to obtain pain medication for headaches, undermined her credibility. Where medical reports are based solely on a claimant’s self-reporting, it may be reasonable for an ALJ who finds the claimant not credible to also question the reliability of the medical reports. See Brawner v. Sec. of Health & Human Serv’s, 839 F.2d 432, 434 (9th Cir. 1988). There is no indication in this record, however, that the treating physicians’ diagnoses of hypertension and renal insufficiency were based solely, if at all, on O’Neal’s own reports. Rather, the diagnoses were based on objective medical tests. Nor is there evidence that the treating physicians’ assessments of the impact O’Neal’s hypertension and renal insufficiency would have on her ability to exert herself were based solely on O’Neal’s own reports. Rather they were based, at least in substantial part, on the same objective evidence that supported the diagnoses. The ALJ’s finding that O’Neal lacked credibility thus provided no reason to question the reliability of her physicians’ assessments. Page 4 of 11 Moreover, the ALJ’s reasons for doubting O’Neal’s credibility are not “specific and legitimate reasons supported by substantial evidence in the record.” Lester, 81 F.3d at 830. The record does not indicate that O’Neal received pain medication by complaining of hypertension and renal insufficiency; rather, the pain medication was prescribed in response to her complaints of persistent headaches.2 Thus, an addiction to pain medication would not have provided her with an incentive to exaggerate her symptoms of hypertension and renal insufficiency, even were such exaggeration possible. And the record reveals two reasons for O’Neal’s failure to comply with her physicians’ treatment regimen that have nothing to do with her credibility. First, as found by Dr. Ankuta, an examining psychologist whose opinion the ALJ credited, O’Neal has “difficulty recalling even simple instructions.” Her treatment regimen, which includes up to 16 different medications, is fairly described as complex, and thus is likely beyond her capacity to manage. Second, O’Neal testified that she sometimes goes without her medications because she cannot pay for them. Under these circumstances, O’Neal’s failure to comply with prescribed treatment does not provide substantial evidence for questioning the credibility of her accounts of her symptoms. See 2 The ALJ found that O’Neal’s headaches were not a “severe impairment,” and she does not challenge that finding. Page 5 of 11 Regennitter v. Soc. Sec. Comm’r, 166 F.3d 1294, 1297 (9th Cir. 1999) (“[W]e have proscribed the rejection of a claimant’s complaints for lack of treatment when the record establishes that the claimant could not afford it.”). The ALJ’s other reason for rejecting the treating physicians’ opinions was that he found them to be inconsistent with O’Neal’s “wide range of activities.”3 Those activities were: “spen[ding] an hour getting her hair and nails done,” going on a week-long beach vacation with her sisters, and caring for her daughter’s children. The only one of these activities that might possibly require any physical exertion beyond sitting, walking, or standing for “brief periods” and lifting 10 pounds maximum is caring for children. It is clear from the record, however, that O’Neal assumed care of her grandchildren for a brief period due to exigent circumstances, and there is no evidence regarding the level of care that O’Neal provided. That a grandmother attempts to care for her grandchildren when necessity demands is not substantial evidence supporting a finding that, contrary to the opinion of her treating physicians, she is able to stand, walk or sit for six hours a day and lift twenty pounds occasionally. Cf. Vertigan v. Halter, 260 F.3d 1044, 3 The ALJ also stated that the treating physicians’ opinions were inconsistent with objective medical evidence. AR 26. The ALJ did not identify the particular “objective medical evidence” to which he was referring, however. “[C]onclusory reasons will not justify an ALJ’s rejection of a medical opinion.” Regennitter, 166 F.3d at 1299. Page 6 of 11 1050 (9th Cir. 2001) (“A patient may do [physical] activities despite pain for therapeutic reasons, but that does not mean she could concentrate on work despite the pain or could engage in similar activity for a longer period given the pain involved.”). Because the ALJ’s reasons for rejecting the opinions of O’Neal’s treating physicians were not specific, legitimate, and supported by substantial evidence, the treating physicians’ opinions must be credited as a matter of law, Lester, 81 F.3d at 834, and are due controlling weight. 20 C.F.R. § 404.1527(d)(2). We thus conclude that O’Neal is limited to a sedentary or lower level of work.
The ALJ also rejected a function report prepared by O’Neal’s daughter on the ground that it was “inconsistent with [O’Neal’s] wide-range of activities.” For the reasons discussed above, the “wide-range of activities” referred to by the ALJ is not relevant to an assessment of O’Neal’s capacity for more than minimal physical and mental exertion. Because the ALJ failed to provide “germane” reasons for rejecting O’Neal’s daughter’s report, we credit that report as true. See Lewis v. Apfel, 236 F.3d 503, 510-12 (9th Cir. 2001). The report provides further evidence that O’Neal is limited to a sedentary or lower level of work. Page 7 of 11
it is clear that O’Neal was disabled as of her 50th birthday The conclusion that O’Neal is limited to sedentary work mandates a determination that she was disabled as of her 50th birthday on January 8, 2008. That is because the Medical-Vocational Guidelines provide that a 50-54 year old individual with a high school education, past unskilled work or no transferable skills, who is limited to sedentary work is disabled. 20 C.F.R. pt. 404, subpt. P, Rule 201.12 & 201.14. This describes O’Neal as of her 50th birthday. Accordingly, she is entitled to benefits as of that date. On remand, the ALJ shall award those benefits. Our conclusion that O’Neal is limited to sedentary work does not resolve the question whether she was disabled prior to her 50th birthday, and was thus entitled to benefits prior to that date. Under the Guidelines, a woman with O’Neal’s exertional limits, education, and work experience who is younger than 50 is not disabled. See 20 C.F.R. pt. 404, subpt. P, Rule 201.27. The Guidelines do not, however, take into account O’Neal’s non-exertional limitations. Whether the combination of O’Neal’s exertional and non-exertional limitations rendered her disabled prior to her 50th birthday is a question the ALJ will be required to answer on remand. Page 8 of 11