1 2 3 4
5 UNITED STATES DISTRICT COURT 6 WESTERN DISTRICT OF WASHINGTON AT SEATTLE 7 TINA S., 8 Plaintiff, CASE NO. C19-547 BAT 9 v. ORDER REVERSING AND 10 REMANDING COMMISSIONER OF SOCIAL SECURITY, 11 Defendant. 12
13 Plaintiff appeals the ALJ’s decision finding her not disabled. The ALJ found depression, 14 anxiety, and migraine headaches are severe impairments; plaintiff has the residual functional 15 capacity (RFC) to perform work at all exertional levels subject to numerous limitations; plaintiff 16 has no past relevant work experience but is not disabled because she can perform jobs in the 17 national economy. Tr. 26-37. Plaintiff contends the ALJ erroneously rejected limitations assessed 18 in 2016 by examining doctor Luci Carsten, Ph.D., and the Court should therefore remand the 19 matter for further proceedings. Dkt. 12. 20 As discussed below, the Court REVERSES the Commissioner’s final decision and 21 REMANDS the matter for further administrative proceedings under sentence four of 42 U.S.C. § 22 405(g) 23 1 DISCUSSION 2 Plaintiff contends the ALJ misevaluated Dr. Carstens’ opinions. The ALJ must provide 3 clear and convincing reasons to reject an uncontradicted medical opinion, or specific and 4 legitimate reasons where contradicted. Lester v. Chater, 81 F.3d 821, 830-31 (9th Cir. 1996).
5 The ALJ must do more than offer his or her conclusions; the ALJ must also explain why his or 6 her interpretation, rather than the doctor’s interpretation, is correct. Orn v. Astrue, 495 F.3d 625, 7 632 (9th Cir. 2007). The opinion of a non-examining doctor cannot by itself constitute 8 substantial evidence that justifies the rejection of the opinion of either an examining physician or 9 a treating physician. Gallant v. Heckler, 753 F.2d 1450, 1456 (9th Cir. 1984). 10 The ALJ noted Dr. Carstens evaluated plaintiff in January and December 2016, and 11 opined plaintiff’s mental and physical issues would cause plaintiff to have problems with 12 timeliness, and cause marked difficulty adapting to changes in a routine work setting, 13 interpersonal relationships, and completing a normal work day. Tr. 34. 14 The ALJ rejected Dr. Carstens’ opinions first finding them “inconsistent with the
15 longitudinal treatment notes.” Id. The ALJ found plaintiff’s treatment notes regularly indicate 16 plaintiff has normal mood/affect, normal thoughts/process/orientation/motor activity and 17 cognition/insight/judgment. Id. The ALJ erred. An ALJ may reject a medical opinion that is 18 inconsistent with the medical record. See Meanel v. Apfel, 172 F.3d 1111, 1113-14 (9th Cir. 19 1999). Here, however, there is no inconsistency as Dr. Carstens also found plaintiff was alert, 20 responsive, cooperative, had normal speech and thought processes, was fully oriented, had 21 sufficient memory, fund of knowledge and concentration and adequate insight and judgment. See 22 e.g. Tr. 504-505. 23 1 The ALJ’s reliance on the notes above do not address the basis of Dr. Carstens’ opinions. 2 Dr. Carstens opined plaintiff can complete simple repetitive tasks; can follow complex 3 instructions; and can perform routine tasks without special supervision. Id. at 506. The 4 limitations Dr. Carstens assessed do not flow from plaintiff’s cognitive limitations. Rather the
5 doctor diagnosed plaintiff with generalized anxiety disorder; post-traumatic stress disorder, 6 chronic; major depressive disorder, severe without psychosis; and other specified personality 7 disorder with avoidant and personality traits. Id. Dr. Carstens opined these mental health 8 problems would affect the timeliness and quality of plaintiff’s work; plaintiff’s ability to adapt to 9 changes in routine work and incorporate new funtions or processes; and plaintiff’s interpersonal 10 relationships. Id. 11 Second, the ALJ rejected Dr. Carsterns’ opinions as inconsistent with the nature of 12 plaintiff;’s treatment and how her treatment notes focused on situational stressors instead of 13 dealing with plaintiff’s symptoms. Tr. 34. Substantial evidence does not support the ALJ’s 14 determination. Plaintiff’s treatment notes indicate plaintiff’s depression, anxiety and PTSD are
15 long-standing impairments. The record shows plaintiff received mental health treatment at 16 Sunrise Services. See Tr. 515-655. The ALJ did not explain why plaintiff’s treatment undercut 17 Dr. Carstens’ opinions. Conclusory reasons do not justify an ALJ’s rejection of a medical 18 opinion. Embrey v. Bowen, 849 F.2d 418, 421-22 (9th Cir.1988). The ALJ did note “the 19 treatment notes mostly focus on situational stressors instead of dealing with [plaintiff’s] 20 symptoms.” Tr. 34. This is inaccurate. While the treatment notes documented situational 21 stressors, the notes do not show plaintiff has no mental problems, and is simply stressed by her 22 situation. Rather the notes show plaintiff has preexisting mental health problems such as 23 depression, anxiety and PTSD; that stressors do not make these conditions better; and that 1 plaintiff struggles with these mental conditions whether there are stressors in her life of not. 2 Plaintiff’s providers also documented how they observed plaintiff’s anxiety and depression and 3 created a treatment plan or contract with plaintiff. 4 Third, the ALJ found Dr. Carstens’ opinions “are inconsistent with plaintiff’s activities.”
5 Tr. 34. The ALJ found the evidence shows plaintiff can interact cooperatively with her doctors, 6 can maintain relationships with family and a few friends, cared for her daughter, works for a 7 roommate in exchange for rent, and traveled by train to Oregon, Las Vega and California. Id. 8 The ALJ erred. These activities involve small groups of family or friends, not workplace 9 activities. Plaintiff also has never indicated that she cannot travel. Rather she indicates travel is 10 difficult due to anxiety. Additionally, Dr. Carstens did not opine plaintiff was non-functional, 11 and could not travel or interact with others at all. Rather the doctor opined plaintiff’s limitations 12 flow from mental decompensation and deterioration; that plaintiff cannot sustain work effort, 13 cannot maintain emotional stability and cannot sustain effective work relationships with co- 14 workers and others in the workplace. See e.g. Tr. 506. Hence while plaintiff can take a trip to
15 Oregon, or be with a few family members or help her roommate, she lacks the ability sustain 16 workplace activities that must be completed consistently both on a daily and monthly basis. 17 Fourth, the ALJ rejected Dr. Carstens’ opinion as inconsistent with plaintiff’s formal 18 mental status testing. Tr. 34. Plaintiff testing showed some problems with serial 7’s but also 19 showed she was alert, oriented, had logical thought process, sufficient recall, etc. Tr. 34. 20 However, as discussed above, Dr. Carsten did not opine plaintiff’s limitations are caused by 21 cognitive problems, but instead found they are caused by her mental health conditions: 22 generalized anxiety disorder; post-traumatic stress disorder, chronic; major depressive disorder, 23 1 severe without psychosis; and other specified personality disorder with avoidant and personality 2 traits. 3 Fifth, the ALJ found Dr. Carsten relied heavily upon plaintiff’s unreliable “self-report.” 4 Tr. 34.
Free access — add to your briefcase to read the full text and ask questions with AI
1 2 3 4
5 UNITED STATES DISTRICT COURT 6 WESTERN DISTRICT OF WASHINGTON AT SEATTLE 7 TINA S., 8 Plaintiff, CASE NO. C19-547 BAT 9 v. ORDER REVERSING AND 10 REMANDING COMMISSIONER OF SOCIAL SECURITY, 11 Defendant. 12
13 Plaintiff appeals the ALJ’s decision finding her not disabled. The ALJ found depression, 14 anxiety, and migraine headaches are severe impairments; plaintiff has the residual functional 15 capacity (RFC) to perform work at all exertional levels subject to numerous limitations; plaintiff 16 has no past relevant work experience but is not disabled because she can perform jobs in the 17 national economy. Tr. 26-37. Plaintiff contends the ALJ erroneously rejected limitations assessed 18 in 2016 by examining doctor Luci Carsten, Ph.D., and the Court should therefore remand the 19 matter for further proceedings. Dkt. 12. 20 As discussed below, the Court REVERSES the Commissioner’s final decision and 21 REMANDS the matter for further administrative proceedings under sentence four of 42 U.S.C. § 22 405(g) 23 1 DISCUSSION 2 Plaintiff contends the ALJ misevaluated Dr. Carstens’ opinions. The ALJ must provide 3 clear and convincing reasons to reject an uncontradicted medical opinion, or specific and 4 legitimate reasons where contradicted. Lester v. Chater, 81 F.3d 821, 830-31 (9th Cir. 1996).
5 The ALJ must do more than offer his or her conclusions; the ALJ must also explain why his or 6 her interpretation, rather than the doctor’s interpretation, is correct. Orn v. Astrue, 495 F.3d 625, 7 632 (9th Cir. 2007). The opinion of a non-examining doctor cannot by itself constitute 8 substantial evidence that justifies the rejection of the opinion of either an examining physician or 9 a treating physician. Gallant v. Heckler, 753 F.2d 1450, 1456 (9th Cir. 1984). 10 The ALJ noted Dr. Carstens evaluated plaintiff in January and December 2016, and 11 opined plaintiff’s mental and physical issues would cause plaintiff to have problems with 12 timeliness, and cause marked difficulty adapting to changes in a routine work setting, 13 interpersonal relationships, and completing a normal work day. Tr. 34. 14 The ALJ rejected Dr. Carstens’ opinions first finding them “inconsistent with the
15 longitudinal treatment notes.” Id. The ALJ found plaintiff’s treatment notes regularly indicate 16 plaintiff has normal mood/affect, normal thoughts/process/orientation/motor activity and 17 cognition/insight/judgment. Id. The ALJ erred. An ALJ may reject a medical opinion that is 18 inconsistent with the medical record. See Meanel v. Apfel, 172 F.3d 1111, 1113-14 (9th Cir. 19 1999). Here, however, there is no inconsistency as Dr. Carstens also found plaintiff was alert, 20 responsive, cooperative, had normal speech and thought processes, was fully oriented, had 21 sufficient memory, fund of knowledge and concentration and adequate insight and judgment. See 22 e.g. Tr. 504-505. 23 1 The ALJ’s reliance on the notes above do not address the basis of Dr. Carstens’ opinions. 2 Dr. Carstens opined plaintiff can complete simple repetitive tasks; can follow complex 3 instructions; and can perform routine tasks without special supervision. Id. at 506. The 4 limitations Dr. Carstens assessed do not flow from plaintiff’s cognitive limitations. Rather the
5 doctor diagnosed plaintiff with generalized anxiety disorder; post-traumatic stress disorder, 6 chronic; major depressive disorder, severe without psychosis; and other specified personality 7 disorder with avoidant and personality traits. Id. Dr. Carstens opined these mental health 8 problems would affect the timeliness and quality of plaintiff’s work; plaintiff’s ability to adapt to 9 changes in routine work and incorporate new funtions or processes; and plaintiff’s interpersonal 10 relationships. Id. 11 Second, the ALJ rejected Dr. Carsterns’ opinions as inconsistent with the nature of 12 plaintiff;’s treatment and how her treatment notes focused on situational stressors instead of 13 dealing with plaintiff’s symptoms. Tr. 34. Substantial evidence does not support the ALJ’s 14 determination. Plaintiff’s treatment notes indicate plaintiff’s depression, anxiety and PTSD are
15 long-standing impairments. The record shows plaintiff received mental health treatment at 16 Sunrise Services. See Tr. 515-655. The ALJ did not explain why plaintiff’s treatment undercut 17 Dr. Carstens’ opinions. Conclusory reasons do not justify an ALJ’s rejection of a medical 18 opinion. Embrey v. Bowen, 849 F.2d 418, 421-22 (9th Cir.1988). The ALJ did note “the 19 treatment notes mostly focus on situational stressors instead of dealing with [plaintiff’s] 20 symptoms.” Tr. 34. This is inaccurate. While the treatment notes documented situational 21 stressors, the notes do not show plaintiff has no mental problems, and is simply stressed by her 22 situation. Rather the notes show plaintiff has preexisting mental health problems such as 23 depression, anxiety and PTSD; that stressors do not make these conditions better; and that 1 plaintiff struggles with these mental conditions whether there are stressors in her life of not. 2 Plaintiff’s providers also documented how they observed plaintiff’s anxiety and depression and 3 created a treatment plan or contract with plaintiff. 4 Third, the ALJ found Dr. Carstens’ opinions “are inconsistent with plaintiff’s activities.”
5 Tr. 34. The ALJ found the evidence shows plaintiff can interact cooperatively with her doctors, 6 can maintain relationships with family and a few friends, cared for her daughter, works for a 7 roommate in exchange for rent, and traveled by train to Oregon, Las Vega and California. Id. 8 The ALJ erred. These activities involve small groups of family or friends, not workplace 9 activities. Plaintiff also has never indicated that she cannot travel. Rather she indicates travel is 10 difficult due to anxiety. Additionally, Dr. Carstens did not opine plaintiff was non-functional, 11 and could not travel or interact with others at all. Rather the doctor opined plaintiff’s limitations 12 flow from mental decompensation and deterioration; that plaintiff cannot sustain work effort, 13 cannot maintain emotional stability and cannot sustain effective work relationships with co- 14 workers and others in the workplace. See e.g. Tr. 506. Hence while plaintiff can take a trip to
15 Oregon, or be with a few family members or help her roommate, she lacks the ability sustain 16 workplace activities that must be completed consistently both on a daily and monthly basis. 17 Fourth, the ALJ rejected Dr. Carstens’ opinion as inconsistent with plaintiff’s formal 18 mental status testing. Tr. 34. Plaintiff testing showed some problems with serial 7’s but also 19 showed she was alert, oriented, had logical thought process, sufficient recall, etc. Tr. 34. 20 However, as discussed above, Dr. Carsten did not opine plaintiff’s limitations are caused by 21 cognitive problems, but instead found they are caused by her mental health conditions: 22 generalized anxiety disorder; post-traumatic stress disorder, chronic; major depressive disorder, 23 1 severe without psychosis; and other specified personality disorder with avoidant and personality 2 traits. 3 Fifth, the ALJ found Dr. Carsten relied heavily upon plaintiff’s unreliable “self-report.” 4 Tr. 34. Substantial evidence does not support the finding. Dr. Carsten repeatedly discussed her
5 personal observations and indicated based upon clinical findings, plaintiff has significant 6 functional impairment. There is no evidence Dr. Carsten’s opinion is simply a rehash of what 7 plaintiff told her or that the doctor failed to apply professional standards in evaluating plaintiff 8 and arriving at her conclusions. When a medical opinion is not more heavily based on a patient’s 9 self-reports than on clinical observations, there is no evidentiary basis for rejecting the opinion. 10 See Ryan v. Comm’r of Soc. Sec., 528 F.3d 1194, 1199–1200 (9th Cir. 2008). Additionally, an 11 ALJ does not provide clear and convincing reasons for rejecting an examining doctor’s opinion 12 by questioning the credibility of the patient’s complaints where the doctor does not discredit 13 those complaints and supports her ultimate opinion with her own observations. Edlund v. 14 Massanari, 253 F.3d 1152, 1159 (9th Cir. 2001).
15 And lastly the ALJ discounted Dr. Carstens’ opinion because the doctor indicated 16 plaintiff’s limitations were due in part on plaintiff’s physical problems which the ALJ found was 17 outside the doctor’s area of expertise. This is a conclusory statement and without more is not a 18 sufficient basis to reject Dr. Carsten’s opinions. A claimant’s physical and mental problems can 19 be intertwined causing limitations from the combined impact of both problems. The ALJ may 20 not therefore automatically dismiss the opinion of a psychologist who indicates a claimant’s 21 limits flow from physical and mental problems. See Farris v. Barnhart, 147 Fed. Appx. 638, 639 22 (9th Cir. 2005) (ALJ erred in rejecting psychologist’s opinion based upon the combined impact 23 of back pain and mental impairment which the ALJ found was outside the doctor’s expertise.). 1 CONCLUSION 2 The Court REVERSES the Commissioner’s final decision REMANDS the case for 3 further administrative proceedings under sentence four of 42 U.S.C. § 405(g). Plaintiff raises 4 one ground for relief and the matter is remanded limited to that ground. On remand, the ALJ
5 shall reassess the opinions of Dr. Carstens, develop the record and redetermine plaintiff’s RFC as 6 necessary and proceed to step-five as appropriate. 7 DATED this 20th day of November, 2019. 8 A 9 BRIAN A. TSUCHIDA Chief United States Magistrate Judge 10
12 13 14 15 16 17 18 19 20 21 22 23