1 2 3 4 5 UNITED STATES DISTRICT COURT 6 WESTERN DISTRICT OF WASHINGTON AT SEATTLE 7 8 KELLY J., 9 Plaintiff, Case No. C20-1006-MLP 10 v. ORDER 11 COMMISSIONER OF SOCIAL SECURITY, 12 Defendant. 13 I. INTRODUCTION 14 Plaintiff seeks review of the denial of her application for Supplemental Security Income.1 15 Plaintiff contends the administrative law judge (“ALJ”) erroneously evaluated the opinions of 16 Aileen Loranger, Ph.D., and Karen Sheridan, LMHC, and crafted a residual functional capacity 17 (“RFC”) determination that is deficient. (Dkt. # 23.) As discussed below, the Court REVERSES 18 the Commissioner’s final decision and REMANDS the matter for further administrative 19 proceedings under sentence four of 42 U.S.C. § 405(g). 20 21 22 23 1 Plaintiff also filed an application for Disability Insurance Benefits. Plaintiff amended her alleged onset date that 24 was after her date last insured at her ALJ hearing, and the ALJ therefore dismissed her application. AR at 1164. 1 II. BACKGROUND 2 Plaintiff was born in 1987 and has a limited education. AR at 1163. Plaintiff applied for 3 benefits on June 19, 2013. Id. at 1148. Plaintiff’s application was denied initially and on 4 reconsideration. The ALJ held a hearing in August 2014, taking testimony from Plaintiff, 5 Plaintiff’s therapist, and a vocational expert. See id. at 46-118. In November 2015, the ALJ
6 issued a decision finding Plaintiff not disabled. Id. at 18-45. Plaintiff appealed the decision to 7 this Court, which reversed the ALJ’s decision and remanded for reevaluation of certain medical 8 opinions, including the opinions of the medical sources addressed herein. Id. at 1245-1260. On 9 remand, Plaintiff amended her alleged onset date to June 19, 2013, id. at 1148, and the ALJ held 10 a hearing in April 2019, taking testimony from Plaintiff and a vocational expert. See id. at 1184- 11 1216. In July 2019, the ALJ issued a decision finding Plaintiff not disabled from June 19, 2013, 12 through the date of the decision. See id. at 1148-1164. In relevant part, the ALJ found Plaintiff’s 13 severe asthma, spine disorder, affective disorders, anxiety disorder, PTSD, attention deficit 14 hyperactivity disorder, and personality disorder limited her to medium work subject to a series of
15 further limitations. Id. at 1151, 1154. Based on vocational expert testimony, the ALJ found 16 Plaintiff could perform medium and light jobs that exist in significant numbers in the national 17 economy. Id. at 1163-64. Plaintiff appealed this final decision of the Commissioner to this Court. 18 (Dkt. # 4.) 19 III. LEGAL STANDARDS 20 Under 42 U.S.C. § 405(g), this Court may set aside the Commissioner’s denial of social 21 security benefits when the ALJ’s findings are based on legal error or not supported by substantial 22 evidence in the record as a whole. Bayliss v. Barnhart, 427 F.3d 1211, 1214 (9th Cir. 2005). As a 23 general principle, an ALJ’s error may be deemed harmless where it is “inconsequential to the 24 1 ultimate nondisability determination.” Molina v. Astrue, 674 F.3d 1104, 1115 (9th Cir. 2012) 2 (cited sources omitted). The Court looks to “the record as a whole to determine whether the error 3 alters the outcome of the case.” Id. 4 “Substantial evidence” is more than a scintilla, less than a preponderance, and is such 5 relevant evidence as a reasonable mind might accept as adequate to support a conclusion.
6 Richardson v. Perales, 402 U.S. 389, 401 (1971); Magallanes v. Bowen, 881 F.2d 747, 750 (9th 7 Cir. 1989). The ALJ is responsible for determining credibility, resolving conflicts in medical 8 testimony, and resolving any other ambiguities that might exist. Andrews v. Shalala, 53 F.3d 9 1035, 1039 (9th Cir. 1995). While the Court is required to examine the record as a whole, it may 10 neither reweigh the evidence nor substitute its judgment for that of the Commissioner. Thomas v. 11 Barnhart, 278 F.3d 947, 954 (9th Cir. 2002). When the evidence is susceptible to more than one 12 rational interpretation, it is the Commissioner’s conclusion that must be upheld. Id. 13 IV. DISCUSSION 14 A. The ALJ Erred in Evaluating the Medical Evidence
15 A treating doctor’s opinion is generally entitled to greater weight than an examining 16 doctor’s opinion, and an examining doctor’s opinion is entitled to greater weight than a non- 17 examining doctor’s opinion. Garrison v. Colvin, 759 F.3d 995, 1012 (9th Cir. 2014). An ALJ 18 may only reject the contradicted opinion of a treating or examining doctor by giving “specific 19 and legitimate” reasons. Revels v. Berryhill, 874 F.3d 648, 654 (9th Cir. 2017). Less weight may 20 be assigned to the opinions of other sources. Gomez v. Chater, 74 F.3d 967, 970 (9th Cir. 1996). 21 However, the ALJ’s decision should reflect consideration of such opinions, see SSR 06-3p, and 22 the ALJ may discount the evidence by providing reasons germane to each source. Molina v. 23 24 1 Astrue, 674 F.3d 1104, 1111 (9th Cir. 2012). Plaintiff argues the ALJ misevaluated two medical 2 opinions. 3 1. The ALJ Erred by Discounting the Opinion of Treating Therapist Aileen Loranger, LMHC, Ph.D. 4 Dr. Loranger “provided several statements in the record, and also testified in the August 5 2014 hearing.” AR at 1161. On March 28, 2014, Dr. Loranger opined it is “very difficult to get 6 this woman out of her home. This therapist makes house calls. She needs help getting to her 7 monthly medication appointments. She is still very anxious with strangers and being in our 8 facility for medication.” Id. at 958. On July 2, 2014, Dr. Loranger opined Plaintiff’s mental 9 impairments “have very marked restrictions on [Plaintiff’s] activities of daily living as well as 10 impinging on her social life (her former friends are dwindling because she can’t overcome her 11 anxieties and fears of leaving home). She is extremely socially isolated due to her persistent 12 agoraphobia with panic (despite medications and coping skills). [Plaintiff] wants to participate in 13 life and attempts to, but is consistently overcome by terror and fear.” Id. at 974. She further 14 assessed “[Plaintiff’s] emotional distress becomes so overwhelming (even with medication), this 15 therapist cannot foresee [Plaintiff] being reliably and consistently able to sustain employment 16 that requires her to stay focused, on task and dedicated to the job outside her home for longer 17 than two-three hours a week at this point.” Id. at 975. Finally, at the August 2014 hearing, Dr. 18 Loranger testified Plaintiff could not “on a reliabl[y] and consistent basis now, without direct 19 intervention on an hourly basis … go out of the home and stay on task for even the simplest of 20 jobs, six hours out of an eight-hour day.” Id. at 60. 21 The ALJ first discounted Dr.
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1 2 3 4 5 UNITED STATES DISTRICT COURT 6 WESTERN DISTRICT OF WASHINGTON AT SEATTLE 7 8 KELLY J., 9 Plaintiff, Case No. C20-1006-MLP 10 v. ORDER 11 COMMISSIONER OF SOCIAL SECURITY, 12 Defendant. 13 I. INTRODUCTION 14 Plaintiff seeks review of the denial of her application for Supplemental Security Income.1 15 Plaintiff contends the administrative law judge (“ALJ”) erroneously evaluated the opinions of 16 Aileen Loranger, Ph.D., and Karen Sheridan, LMHC, and crafted a residual functional capacity 17 (“RFC”) determination that is deficient. (Dkt. # 23.) As discussed below, the Court REVERSES 18 the Commissioner’s final decision and REMANDS the matter for further administrative 19 proceedings under sentence four of 42 U.S.C. § 405(g). 20 21 22 23 1 Plaintiff also filed an application for Disability Insurance Benefits. Plaintiff amended her alleged onset date that 24 was after her date last insured at her ALJ hearing, and the ALJ therefore dismissed her application. AR at 1164. 1 II. BACKGROUND 2 Plaintiff was born in 1987 and has a limited education. AR at 1163. Plaintiff applied for 3 benefits on June 19, 2013. Id. at 1148. Plaintiff’s application was denied initially and on 4 reconsideration. The ALJ held a hearing in August 2014, taking testimony from Plaintiff, 5 Plaintiff’s therapist, and a vocational expert. See id. at 46-118. In November 2015, the ALJ
6 issued a decision finding Plaintiff not disabled. Id. at 18-45. Plaintiff appealed the decision to 7 this Court, which reversed the ALJ’s decision and remanded for reevaluation of certain medical 8 opinions, including the opinions of the medical sources addressed herein. Id. at 1245-1260. On 9 remand, Plaintiff amended her alleged onset date to June 19, 2013, id. at 1148, and the ALJ held 10 a hearing in April 2019, taking testimony from Plaintiff and a vocational expert. See id. at 1184- 11 1216. In July 2019, the ALJ issued a decision finding Plaintiff not disabled from June 19, 2013, 12 through the date of the decision. See id. at 1148-1164. In relevant part, the ALJ found Plaintiff’s 13 severe asthma, spine disorder, affective disorders, anxiety disorder, PTSD, attention deficit 14 hyperactivity disorder, and personality disorder limited her to medium work subject to a series of
15 further limitations. Id. at 1151, 1154. Based on vocational expert testimony, the ALJ found 16 Plaintiff could perform medium and light jobs that exist in significant numbers in the national 17 economy. Id. at 1163-64. Plaintiff appealed this final decision of the Commissioner to this Court. 18 (Dkt. # 4.) 19 III. LEGAL STANDARDS 20 Under 42 U.S.C. § 405(g), this Court may set aside the Commissioner’s denial of social 21 security benefits when the ALJ’s findings are based on legal error or not supported by substantial 22 evidence in the record as a whole. Bayliss v. Barnhart, 427 F.3d 1211, 1214 (9th Cir. 2005). As a 23 general principle, an ALJ’s error may be deemed harmless where it is “inconsequential to the 24 1 ultimate nondisability determination.” Molina v. Astrue, 674 F.3d 1104, 1115 (9th Cir. 2012) 2 (cited sources omitted). The Court looks to “the record as a whole to determine whether the error 3 alters the outcome of the case.” Id. 4 “Substantial evidence” is more than a scintilla, less than a preponderance, and is such 5 relevant evidence as a reasonable mind might accept as adequate to support a conclusion.
6 Richardson v. Perales, 402 U.S. 389, 401 (1971); Magallanes v. Bowen, 881 F.2d 747, 750 (9th 7 Cir. 1989). The ALJ is responsible for determining credibility, resolving conflicts in medical 8 testimony, and resolving any other ambiguities that might exist. Andrews v. Shalala, 53 F.3d 9 1035, 1039 (9th Cir. 1995). While the Court is required to examine the record as a whole, it may 10 neither reweigh the evidence nor substitute its judgment for that of the Commissioner. Thomas v. 11 Barnhart, 278 F.3d 947, 954 (9th Cir. 2002). When the evidence is susceptible to more than one 12 rational interpretation, it is the Commissioner’s conclusion that must be upheld. Id. 13 IV. DISCUSSION 14 A. The ALJ Erred in Evaluating the Medical Evidence
15 A treating doctor’s opinion is generally entitled to greater weight than an examining 16 doctor’s opinion, and an examining doctor’s opinion is entitled to greater weight than a non- 17 examining doctor’s opinion. Garrison v. Colvin, 759 F.3d 995, 1012 (9th Cir. 2014). An ALJ 18 may only reject the contradicted opinion of a treating or examining doctor by giving “specific 19 and legitimate” reasons. Revels v. Berryhill, 874 F.3d 648, 654 (9th Cir. 2017). Less weight may 20 be assigned to the opinions of other sources. Gomez v. Chater, 74 F.3d 967, 970 (9th Cir. 1996). 21 However, the ALJ’s decision should reflect consideration of such opinions, see SSR 06-3p, and 22 the ALJ may discount the evidence by providing reasons germane to each source. Molina v. 23 24 1 Astrue, 674 F.3d 1104, 1111 (9th Cir. 2012). Plaintiff argues the ALJ misevaluated two medical 2 opinions. 3 1. The ALJ Erred by Discounting the Opinion of Treating Therapist Aileen Loranger, LMHC, Ph.D. 4 Dr. Loranger “provided several statements in the record, and also testified in the August 5 2014 hearing.” AR at 1161. On March 28, 2014, Dr. Loranger opined it is “very difficult to get 6 this woman out of her home. This therapist makes house calls. She needs help getting to her 7 monthly medication appointments. She is still very anxious with strangers and being in our 8 facility for medication.” Id. at 958. On July 2, 2014, Dr. Loranger opined Plaintiff’s mental 9 impairments “have very marked restrictions on [Plaintiff’s] activities of daily living as well as 10 impinging on her social life (her former friends are dwindling because she can’t overcome her 11 anxieties and fears of leaving home). She is extremely socially isolated due to her persistent 12 agoraphobia with panic (despite medications and coping skills). [Plaintiff] wants to participate in 13 life and attempts to, but is consistently overcome by terror and fear.” Id. at 974. She further 14 assessed “[Plaintiff’s] emotional distress becomes so overwhelming (even with medication), this 15 therapist cannot foresee [Plaintiff] being reliably and consistently able to sustain employment 16 that requires her to stay focused, on task and dedicated to the job outside her home for longer 17 than two-three hours a week at this point.” Id. at 975. Finally, at the August 2014 hearing, Dr. 18 Loranger testified Plaintiff could not “on a reliabl[y] and consistent basis now, without direct 19 intervention on an hourly basis … go out of the home and stay on task for even the simplest of 20 jobs, six hours out of an eight-hour day.” Id. at 60. 21 The ALJ first discounted Dr. Loranger’s opinion as inconsistent with Plaintiff’s “ability 22 to attend medical [appointments] [sic] on a regular basis and her unremarkable presentation 23 during the visits.” AR at 1162. This is not a valid ground upon which to discount Dr. Loranger’s 24 1 opinion. The record is not inconsistent with Dr. Loranger’s assessment that, to the extent 2 Plaintiff has been able to perform certain activities – including attending medical visits – she 3 does so “[w]ith considerable dread.” Id. at 974. Further, Plaintiff’s “unremarkable presentation” 4 is not inconsistent with Dr. Loranger’s opinion concerning Plaintiff’s psycho-social impairments: 5 normal speech, concentration, and memory are neither mutually exclusive with nor contradictory
6 of Plaintiff’s paranoia and fears. Rather, that Plaintiff presented normally to doctors whom she 7 knows is particularly consistent with Dr. Loranger’s assessment that Plaintiff’s psychological 8 symptoms are often triggered by strangers and unfamiliar situations. See, e.g., id. at 958 (“[s]he 9 is still very anxious with strangers”); id. at 974 (“[Plaintiff] expresses a persistent, irrational fear 10 of danger lurking unpredictably outside her front door”). 11 Next, the ALJ discounted Dr. Loranger’s opinion as inconsistent with Plaintiff’s 12 activities. AR at 1162. In specific, the ALJ pointed to Plaintiff “taking her daughter to a pumpkin 13 patch via public bus and going on a field trip to the zoo with her daughter,” “walk[ing] her 14 daughter to school,” “volunteer[ing] at her daughter’s school” one day, and going “to a meeting
15 at school.” Id. As a preliminary matter, the Ninth Circuit has held “disability claimants should 16 not be penalized for attempting to lead normal lives in the face of their limitations,” Reddick v. 17 Chater, 157 F.3d 715, 722 (9th Cir. 1998), and, in the mental health context, “[c]ycles of 18 improvement and debilitating symptoms are a common occurrence.” Garrison, 759 F.3d at 1017; 19 see id. (“Reports of ‘improvement’ in the context of mental health issues must be interpreted 20 with an understanding of the patient’s overall well-being and the nature of her symptoms.”). 21 Here, the ALJ erred by mischaracterizing the record, giving the impression Plaintiff 22 functions at a higher level. For example, treatment notes from October 5, 2015 indicate Plaintiff 23 walked her daughter to school. Id. at 2080. Plaintiff was driven to do so, however, because of her 24 1 pathology: Plaintiff was “worried” about her daughter taking the bus, telling her therapist, “Kids 2 are big, hanging out of windows, fighting[,] why is she in the middle of the bus? She should be 3 in the front of the bus!” Id. Less than a month later, Plaintiff reported being “unable to walk” her 4 daughter to school because her “anxiety has been too bad.” Id. at 2069. Plaintiff was “worrie[d]” 5 about her daughter taking the bus, and accordingly was considering “pulling her out of school.”
6 Id. Plaintiff also “[p]ut new locks on the doors” at this time. Id. The same note indicates 7 Plaintiff’s depression was “[p]retty high” and “[p]retty hard,” and Plaintiff “sometimes feels 8 suicidal but doesn’t think she’d do it.” Id. The ALJ accordingly erred by mischaracterizing the 9 record. See Attmore v. Colvin, 827 F.3d 872, 877 (9th Cir. 2016) (an ALJ “cannot simply pick 10 out a few isolated instances” of medical health that support her conclusion, but must consider 11 those instances in the broader context “with an understanding of the patient’s overall well-being 12 and the nature of her symptoms”); Reddick, 157 F.3d at 722–23 (reversing ALJ’s decision where 13 his “paraphrasing of record material is not entirely accurate regarding the content or tone of the 14 record”).
15 2. The ALJ Erred in Assessing the Opinion of Treating Therapist Karen Sheridan, LMHC. 16 The ALJ found Ms. Sheridan “provided an assessment that essentially reflects the same 17 limitations indicated by Dr. Loranger” and, accordingly, discounted her opinion on the same 18 grounds as she discounted Dr. Loranger’s. AR at 1162. Because the ALJ erred in discounting Dr. 19 Loranger’s opinion, she necessarily erred in discounting Ms. Sheridan’s opinion as consistent 20 with Dr. Loranger’s opinion. 21 V. CONCLUSION 22 Because the ALJ misevaluated the medical evidence, the ALJ will necessarily need to 23 determine whether the RFC needs to be adjusted. For this reason, the Court need not address 24 1 Plaintiff’s assignment of error regarding the RFC. For the foregoing reasons, the Commissioner’s 2 final decision is REVERSED and this case is REMANDED for further administrative 3 proceedings under sentence four of 42 U.S.C. § 405(g). On remand, the ALJ shall reevaluate the 4 opinions of Dr. Loranger and Ms. Sheridan, develop the record and redetermine Plaintiff’s RFC 5 as necessary, and proceed to the remaining steps as appropriate.
6 Dated this 26th day of April, 2021. 7 A 8 MICHELLE L. PETERSON United States Magistrate Judge 9
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