Opinion ID: 782372
Heading Depth: 3
Heading Rank: 2

Heading: What triggers inclusion of a factor in a multiple impairment analysis.

Text: 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.