Timothy Mark Truett v. Frank Bisignano, Commissioner of Social Security

Opinion

1 2 3 4 5 6 7 10 11 TIMOTHY MARK TRUETT, Case No. 2:24-cv-2985-JDP (SS) 12 Plaintiff, 13 v. ORDER 14 FRANK BISIGNANO, Commissioner of Social Security, 15 Defendant. 16 17 Plaintiff challenges the final decision of the Commissioner of Social Security 18 (“Commissioner”) denying his application for a period of disability and disability insurance 19 benefits (“DIB”) under Title II of the Social Security Act. Both parties have moved for summary 20 judgment. ECF Nos. 13 & 15. For the reasons discussed below, the court grants plaintiff’s 21 motion, denies the Commissioner’s, and remands for further proceedings. 22 Standard of Review 23 An Administrative Law Judge’s (“ALJ”) decision denying an application for disability 24 benefits will be upheld if it is supported by substantial evidence in the record and if the correct 25 legal standards have been applied. Stout v. Comm’r, Soc. Sec. Admin., 454 F.3d 1050, 1052 (9th 26 Cir. 2006). “‘Substantial evidence’ means more than a mere scintilla, but less than a 27 preponderance; it is such relevant evidence as a reasonable person might accept as adequate to 28 support a conclusion.” Lingenfelter v. Astrue, 504 F.3d 1028, 1035 (9th Cir. 2007). 1 “The ALJ is responsible for determining credibility, resolving conflicts in medical

2 testimony, and resolving ambiguities.” Edlund v. Massanari, 253 F.3d 1152, 1156 (9th Cir. 2001)

3 (citations omitted). “Where the evidence is susceptible to more than one rational interpretation,

4 one of which supports the ALJ’s decision, the ALJ’s conclusion must be upheld.” Thomas v.

5 Barnhart, 278 F.3d 947, 954 (9th Cir. 2002). However, the court will not affirm on grounds upon

6 which the ALJ did not rely. Connett v. Barnhart, 340 F.3d 871, 874 (9th Cir. 2003) (“We are

7 constrained to review the reasons the ALJ asserts.”).

8 A five-step sequential evaluation process is used in assessing eligibility for Social Security

9 disability benefits. Under this process the ALJ is required to determine: (1) whether the claimant

10 is engaged in substantial gainful activity; (2) whether the claimant has a medical impairment (or

11 combination of impairments) that qualifies as severe; (3) whether any of the claimant’s

12 impairments meet or medically equal the severity of one of the impairments in 20 C.F.R., Pt. 404,

13 Subpt. P, App. 1; (4) whether the claimant can perform past relevant work; and (5) whether the

14 claimant can perform other specified types of work. See Barnes v. Berryhill, 895 F.3d 702, 704

15 n.3 (9th Cir. 2018). The claimant bears the burden of proof for the first four steps of the inquiry,

16 while the Commissioner bears the burden at the final step. Bustamante v. Massanari, 262 F.3d

17 949, 953-54 (9th Cir. 2001).

18 Background

19 On March 15, 2023, plaintiff filed an application for a period of disability and DIB,

20 alleging disability beginning March 1, 2020. Administrative Record (“AR”) 98, 175-76. After his

21 application was denied both initially and upon reconsideration, plaintiff testified at a hearing

22 before an ALJ. AR 114-17, 120-22, 1764-96. On August 12, 2024, the ALJ issued a decision

23 finding that plaintiff was not disabled. AR 17-29. Specifically, the ALJ found:

25 1. The claimant last met the insured status requirements of the Social 26 Security Act on December 31, 2023.

27 2. The claimant did not engage in substantial gainful activity during the period from his alleged onset date of March 1, 2020, through 28 1 his date last insured of December 31, 2023.

2 3. Through the date last insured, the claimant had the following

severe impairments: lumbar degenerative disc disease, chronic pain 3 syndrome, and a seizure disorder. 4 * * * 5 4. Through the date last insured, the claimant did not have an 6 impairment or combination of impairments that meets or medically

7 equals the severity of one of the listed impairments in 20 CFR Part 404, Subpart P, Appendix 1. 8 * * * 9 5. After careful consideration of the entire record, I find that, through 10 the date last insured, the claimant had the residual functional

11 capacity to perform medium work as defined in 20 CFR 404.1567(c) except the claimant must avoid hazards, moving 12 machinery, working at heights, and operating a motor vehicle.

13 * * *

14 6. The claimant has no past relevant work.

15 7. The claimant was born [in] 1967, and was 56 years old, which is 16 defined as an individual closely approaching advanced age, on the date last insured. The claimant subsequently changed age category 17 to advanced age.

18 8. The claimant has at least a high school education.

19 9. Transferability of job skills is not an issue because the claimant 20 does not have past relevant work.

21 10. Through the date last insured, considering the claimant’s age,

education, work experience, and residual functional capacity, there 22 were jobs that existed in significant numbers in the national 23 economy that the claimant could have performed.

24 * * *

25 11. The claimant has not been under a disability, as defined in the Social Security Act, at any time from March 1, 2020, the alleged 26 onset date, through December 31, 2023, the date last insured. 27 28 1 AR 20-29 (citations to the code of regulations omitted).

2 Plaintiff requested review by the Appeals Council, which denied the request. AR 1-6. He

3 now seeks judicial review under 42 U.S.C. § 405(g).

4 Analysis

5 Plaintiff’s sole argument is that the ALJ erred in failing to explain how his degenerative

6 disc disease and chronic pain syndrome—impairments that the ALJ found severe at step two—

7 were considered in determining his residual functional capacity (“RFC”). ECF No. 13 at 7-10.

8 In between steps three and four of the sequential evaluation, the ALJ must determine the

9 claimant’s RFC. 20 C.F.R. § 404.1520(a)(4). The claimant’s RFC is the most that the claimant

10 can perform despite his or her limitations. Id. § 404.1545(a)(1). “In determining a claimant’s

11 RFC, an ALJ must consider all relevant evidence in the record, including, inter alia, medical

12 records, lay evidence, and ‘the effects of symptoms, including pain, that are reasonably attributed

13 to a medically determinable impairment.’” Robbins v. Soc. Sec. Admin., 466 F.3d 880, 883 (9th

14 Cir. 2006) (citations omitted). Although the ALJ need not address every piece of evidence, she

15 must “set forth the reasoning behind [her decision] in a way that allows for meaning review.”

16 Brown-Hunter v. Colvin, 806 F.3d 487, 492 (9th Cir. 2015); Treichler v. Comm’r Soc. Sec., 775

17 F.3d 1090, 1103 (9th Cir. 2014) (“Although the ALJ’s analysis need not be extensive, the ALJ

18 must provide some reasoning in order for us to meaningfully determine whether the ALJ's

19 conclusions were supported by substantial evidence.”).

20 The ALJ concluded that plaintiff had the RFC to perform medium work that involved no

21 exposure to hazards or moving machinery, working at heights, or operating a motor vehicle.1 AR

22 23. After summarizing the relevant medical evidence, the ALJ provided the following explanation

23 for her RFC determination:

24 Based on the entire record, including the testimony of the claimant, I conclude that the evidence fails to support allegations of total 25 disability. Despite the evidence demonstrating that the claimant has 26 been assessed with medically determinable “severe” impairments, 27 1 These environmental limitations were due to plaintiff’s seizure disorder and not his 28 chronic pain syndrome or lumbar degenerative disc disease. AR 27. 1 the evidence also establishes that the claimant retains the capacity to function adequately to perform many basic activities associated with 2 a reduced range of medium work. The record demonstrates that the

claimant has engaged in limited treatment during the relevant period 3 of adjudication despite assertions of chronic and disabling functional 4 limitations. While the claimant has been assessed with chronic pain syndrome, he engages in medication management where he endorses 5 adequate pain relief with his treatment regimen, has declined more aggressive forms of treatment such as injection therapy, and has 6 declined additional forms of non-pharmacologic therapy including

7 the use of TENS unit. Moreover, the limited physical examinations therein consistently documented intact clinical findings . . . . 8 Additionally, the claimant’s activities of daily living are inconsistent with his allegations of disability. As noted above, the records 9 repeatedly reference the claimant active engagement in demanding physical labor during the relevant period and his acknowledgment 10 that his pain was secondary to the demanding nature of his work. He

11 was also reportedly taking care of his elderly parents throughout the relevant period. Accordingly, I find that the claimant’s allegations 12 of disabling limitations since the alleged onset date of disability are inconsistent with the evidence of record. 13

14 AR 27.

15 Plaintiff does not challenge the ALJ’s characterization of the evidence or her conclusion

16 that his allegations of disabling limitations were inconsistent with the evidence of record. Instead,

17 plaintiff argues that the ALJ neither explains how the evidence establishes that he could perform

18 range of medium work nor describes how his chronic pain syndrome and lumbar degenerative disc

19 disease limited his ability to perform work related activities. ECF No. 13 at 7-10.

20 The ALJ acknowledged that plaintiff “might experience some levels of limitation

21 secondary [to] his combination of impairment,” but ultimately concluded that “[t]he restriction to

22 medium work adequately accommodates the claimant’s chronic pain syndrome, which is managed

23 with medications, and his history of lumbar degenerative disc disease, which is only mild in

24 severity.” AR 27. The ALJ observed that plaintiff’s impairments were primarily treated with 25 opioid medication and Lidocaine injections. AR 24-26. 26 It is not apparent, however, how the ALJ concluded that plaintiff’s examination findings 27 and relatively conservative treatment demonstrated an ability to perform medium work as opposed 28 to either light or heavy work. Critically, the record is devoid of any medical opinion assessing 1 plaintiff’s functional limitations. The two state agency physicians who reviewed plaintiff’s

2 records in connection with the initial and reconsideration decisions both concluded that there was

3 insufficient evidence to assess plaintiff’s functional limitations. AR 94, 101-02. And the record

4 does not contain an opinion from a treating or consulting physician. With no medical opinion in

5 the record, the ALJ apparently performed her own assessment of plaintiff’s functional capabilities

6 based on her independent review of the medical records.

7 Although ALJ’s are tasks with weighing competing medical opinions, which necessarily

8 involves “independently reviewing and forming conclusions about medical evidence,” Farlow v.

9 Fijakazi, 53 F.4th 485, 488 (9th Cir. 2022), they are not medical expert “qualified to interpret raw

10 medical date in functional terms,” Nguyen v. Chater, 172 F.3d 31, 35 (1st Cir. 1999); see Day v.

11 Weinberger, 522 F.2d 1154, 1156 (9th Cir. 1975) (holding that an ALJ should not make his “own

12 exploration and assessment as to claimant’s physical condition”); Rohan v. Chater, 98 F.3d 966,

13 970 (7th Cir. 1996) (“ALJs must not succumb to the temptation to play doctor and make their own

14 independent medical findings.”); see also Penny v. Sullivan, 2 F.3d 953, 958 (9th Cir. 1993)

15 (“Without a personal medical evaluation it is almost impossible to assess the residual functional

16 capacity of any individual.”); Nelson v. Heckler, 712 F.2d 346, 348 (8th Cir.1983) (per curiam)

17 (“‘[T]o attempt to evaluate disability without personal examination of the individual and without

18 evaluation of the disability as it relates to the particular person is medical sophistry at its best.’”)

19 (citation omitted)).

20 Because the ALJ’s RFC determination was based on her own, lay assessment of the

21 medical evidence, it is not supported by substantial evidence. Accordingly, remand for further

22 proceedings is warranted. Dominguez v. Colvin, 808 F.3d 403, 407 (9th Cir. 2015) (“A district

23 court may reverse the decision of the Commissioner of Social Security, with or without remanding

24 the case for a rehearing, but the proper course, except in rare circumstances, is to remand to the 25 agency for additional investigation or explanation.”) (internal quotes and citations omitted). 26 Accordingly, it is hereby ORDERED that: 27 1. Plaintiff’s motion for summary judgment, ECF No. 13, is GRANTED. 28 2. The Commissioner’s cross-motion for summary judgment, ECF No. 15, is DENIED. 1 3. The matter is remanded for further proceedings consistent with this order. 2 4. The Clerk of Court is directed to enter judgment in plaintiff’s favor and close this case. 3

Dated: _ March 20, 2026 q———_ 6 JEREMY D. PETERSON 7 UNITED STATES MAGISTRATE JUDGE 9 10 1] 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28