“[T]he ALJ has a special duty to fully and fairly 20 develop the record to assure the claimant’s interests are considered. This duty 21 exists even when the claimant is represented by counsel.”
How later courts described this case
- “[T]he ALJ has a special duty to fully and fairly 20 develop the record to assure the claimant’s interests are considered. This duty 21 exists even when the claimant is represented by counsel.”
- an ALJ is forbidden from making his or her own medical assessment 5 beyond that demonstrated by the record
- ALJ’s duty to develop the record further is triggered 17 “when there is ambiguous evidence or when the record is inadequate to allow for 18 the proper evaluation of the evidence”
- “The 7 revised social security regulations are clearly irreconcilable with our caselaw 8 according special deference to the opinions of treating and examining physicians 9 on account of their relationship with the claimant.”
Written by the judges who cited it.
The opinion
Case 2:21-cv-05672-JC Document 22 Filed 08/17/22 Page 1 of 11 Page ID #:805
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UNITED STATES DISTRICT COURT
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CENTRAL DISTRICT OF CALIFORNIA
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11 SHERRY L. R.,1 Case No. 2:21-cv-05672-JC
12 Plaintiff,
MEMORANDUM OPINION AND
13 v. ORDER OF REMAND
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KILOLO KIJAKAZI, Acting
15 Commissioner of Social Security,
16 Defendant.
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I. SUMMARY
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On July 13, 2021, plaintiff filed a Complaint seeking review of the
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Commissioner of Social Security’s denial of plaintiff’s application for benefits.
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The parties have consented to proceed before the undersigned United States
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Magistrate Judge.
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This matter is before the Court on the parties’ cross motions for summary
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judgment, respectively (“Plaintiff’s Motion”) and (“Defendant’s Motion”)
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27 1Plaintiff’s name is partially redacted to protect plaintiff’s privacy in compliance with
28 Federal Rule of Civil Procedure 5.2(c)(2)(B) and the recommendation of the Committee on
Court Administration and Case Management of the Judicial Conference of the United States.
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Case 2:21-cv-05672-JC Document 22 Filed 08/17/22 Page 2 of 11 Page ID #:806
1 (collectively “Motions”). The Court has taken the Motions under submission
2 without oral argument. See Fed. R. Civ. P. 78; L.R. 7-15; July 14, 2021 Case
3 Management Order, ¶ 5.
4 Based on the record as a whole and the applicable law, the decision of the
5 Commissioner is REVERSED AND REMANDED for further proceedings
6 consistent with this Memorandum Opinion and Order of Remand. Substantial
7 evidence does not support the Administrative Law Judge’s (“ALJ’s”) residual
8 functional capacity assessment.
9 II. BACKGROUND AND SUMMARY OF ADMINISTRATIVE
10 DECISION
11 On or about May 9, 2018, plaintiff protectively filed an application for
12 Disability Insurance Benefits, alleging disability beginning on April 4, 2018, due
13 to high blood pressure, diabetes, foot neuropathy, gout, spinal problems, sleep
14 apnea, restless leg syndrome, and ovarian cysts. (Administrative Record (“AR”)
15 15, 164-70, 192-93). The ALJ subsequently examined the medical record and
16 heard testimony from plaintiff (who was represented by counsel) and a vocational
17 expert. (AR 30-58).
18 On January 7, 2021, the ALJ determined that plaintiff had not been disabled
19 through the date of the decision. (AR 15-25). Specifically, the ALJ found:
20 (1) plaintiff suffered from the following severe impairments: lumbar spine
21 degenerative changes with stenosis, cervical spine degenerative changes, diabetes
22 mellitus, and obesity (AR 18-19); (2) plaintiff’s impairments, considered
23 individually or in combination, did not meet or medically equal a listed impairment
24 (AR 19); (3) plaintiff retained the residual functional capacity to perform sedentary
25 work (20 C.F.R. §§ 404.1567(a)), with additional limitations2 (AR 20-23);
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27 2The ALJ determined that plaintiff would be limited to: (1) jobs allowing changing
28 position every 30 minutes for one to two minutes in the immediate vicinity of the work station;
(continued...)
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Case 2:21-cv-05672-JC Document 22 Filed 08/17/22 Page 3 of 11 Page ID #:807
1 (4) plaintiff was unable to perform her past relevant work (AR 23-24); and
2 (5) plaintiff could perform other work existing in significant numbers in the
3 national economy and therefore was not disabled (AR 24-25 (purportedly adopting
4 vocational expert testimony at AR 54-56)).
5 On June 7, 2021, the Appeals Council denied plaintiff’s application for
6 review. (AR 1-3).
7 III. APPLICABLE LEGAL STANDARDS
8 A. Administrative Evaluation of Disability Claims
9 To qualify for disability benefits, a claimant must show that she is unable “to
10 engage in any substantial gainful activity by reason of any medically determinable
11 physical or mental impairment which can be expected to result in death or which
12 has lasted or can be expected to last for a continuous period of not less than
13 12 months.” Molina v. Astrue, 674 F.3d 1104, 1110 (9th Cir. 2012) (quoting
14 42 U.S.C. § 423(d)(1)(A)) (internal quotation marks omitted), superseded by
15 regulation on other grounds as stated in Sisk v. Saul, 820 Fed. App’x 604, 606 (9th
16 Cir. 2020); 20 C.F.R. §§ 404.1505(a), 416.905(a). To be considered disabled, a
17 claimant must have an impairment of such severity that she is incapable of
18 performing work the claimant previously performed (“past relevant work”) as well
19 as any other “work which exists in the national economy.” Tackett v. Apfel, 180
20 F.3d 1094, 1098 (9th Cir. 1999) (citing 42 U.S.C. § 423(d)).
21 To assess whether a claimant is disabled, an ALJ is required to use the five-
22 step sequential evaluation process set forth in Social Security regulations. See
23 Stout v. Commissioner, Social Security Administration, 454 F.3d 1050, 1052 (9th
24 Cir. 2006) (describing five-step sequential evaluation process) (citing 20 C.F.R.
25 §§ 404.1520, 416.920). The claimant has the burden of proof at steps one through
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27 2(...continued)
28 (2) occasionally climbing stairs, balancing, stooping, kneeling, and crouching, but no crawling or
climbing ladders, ropes, or scaffolds; and (3) no exposure to vibration. (AR 20).
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Case 2:21-cv-05672-JC Document 22 Filed 08/17/22 Page 4 of 11 Page ID #:808
1 four – i.e., determination of whether the claimant was engaging in substantial
2 gainful activity (step 1), has a sufficiently severe impairment (step 2), has an
3 impairment or combination of impairments that meets or medically equals one of
4 the conditions listed in 20 C.F.R. Part 404, Subpart P, Appendix 1 (“Listings”)
5 (step 3), and retains the residual functional capacity to perform past relevant work
6 (step 4). Burch v. Barnhart, 400 F.3d 676, 679 (9th Cir. 2005) (citation omitted).
7 The Commissioner has the burden of proof at step five – i.e., establishing that the
8 claimant could perform other work in the national economy. Id.
9 B. Federal Court Review of Social Security Disability Decisions
10 A federal court may set aside a denial of benefits only when the
11 Commissioner’s “final decision” was “based on legal error or not supported by
12 substantial evidence in the record.” 42 U.S.C. § 405(g); Trevizo v. Berryhill, 871
13 F.3d 664, 674 (9th Cir. 2017) (citation and quotation marks omitted). The standard
14 of review in disability cases is “highly deferential.” Rounds v. Commissioner of
15 Social Security Administration, 807 F.3d 996, 1002 (9th Cir. 2015) (citation and
16 quotation marks omitted). Thus, an ALJ’s decision must be upheld if the evidence
17 could reasonably support either affirming or reversing the decision. Trevizo, 871
18 F.3d at 674-75 (citations omitted). Even when an ALJ’s decision contains error, it
19 must be affirmed if the error was harmless. See Treichler v. Commissioner of
20 Social Security Administration, 775 F.3d 1090, 1099 (9th Cir. 2014) (ALJ error
21 harmless if (1) inconsequential to the ultimate nondisability determination; or
22 (2) ALJ’s path may reasonably be discerned despite the error) (citation and
23 quotation marks omitted).
24 Substantial evidence is “such relevant evidence as a reasonable mind might
25 accept as adequate to support a conclusion.” Trevizo, 871 F.3d at 674 (defining
26 “substantial evidence” as “more than a mere scintilla, but less than a
27 preponderance”) (citation and quotation marks omitted). When determining
28 whether substantial evidence supports an ALJ’s finding, a court “must consider the
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Case 2:21-cv-05672-JC Document 22 Filed 08/17/22 Page 5 of 11 Page ID #:809
1 entire record as a whole, weighing both the evidence that supports and the evidence
2 that detracts from the Commissioner’s conclusion[.]” Garrison v. Colvin, 759 F.3d
3 995, 1009 (9th Cir. 2014) (citation and quotation marks omitted).
4 Federal courts review only the reasoning the ALJ provided, and may not
5 affirm the ALJ’s decision “on a ground upon which [the ALJ] did not rely.”
6 Trevizo, 871 F.3d at 675 (citations omitted). Hence, while an ALJ’s decision need
7 not be drafted with “ideal clarity,” it must, at a minimum, set forth the ALJ’s
8 reasoning “in a way that allows for meaningful review.” Brown-Hunter v. Colvin,
9 806 F.3d 487, 492 (9th Cir. 2015) (citing Treichler, 775 F.3d at 1099).
10 A reviewing court may not conclude that an error was harmless based on
11 independent findings gleaned from the administrative record. Brown-Hunter, 806
12 F.3d at 492 (citations omitted). When a reviewing court cannot confidently
13 conclude that an error was harmless, a remand for additional investigation or
14 explanation is generally appropriate. See Marsh v. Colvin, 792 F.3d 1170, 1173
15 (9th Cir. 2015) (citations omitted).
16 IV. DISCUSSION
17 Plaintiff takes issue with, among other things, the ALJ’s residual functional
18 capacity determination and resultant step five finding. (Plaintiff’s Motion at 2-9).
19 For the reasons stated below, the Court finds that substantial evidence does not
20 support the ALJ’s residual functional capacity assessment. Since the Court cannot
21 find that such error was harmless, a remand is warranted.
22 A. Summary of the Relevant Medical Record
23 The record reflects treatment for, inter alia: (1) cervical, thoracic, and
24 lumbar spine pain radiating to the legs with medication including Norco, some
25 physical therapy, and some emergency room visits for immediate pain relief , and
26 some facet block injections (AR 249-365, 568-72, 576-611); (2) gout with
27 medication (AR 690-97); and (3) diabetes with medication (AR 709-13).
28 ///
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Case 2:21-cv-05672-JC Document 22 Filed 08/17/22 Page 6 of 11 Page ID #:810
1 Various providers with High Desert Medical Group treated plaintiff and
2 occasionally provided letters after treatment indicating when plaintiff would be
3 able to return to work, as follows: (1) a letter dated April 3, 2017, stating that
4 plaintiff would be able to return to work on April 4, 2017, after plaintiff presented
5 with chronic low back pain with sciatica (AR 509-10); (2) a letter dated June 26,
6 2017, stating that plaintiff would be able to return to work on June 29, 2017, with
7 no restrictions, after plaintiff presented with muscle spasms (AR 481-83); (3) a
8 letter dated September 15, 2017, stating that plaintiff would be able to return to
9 work on September 16, 2017, after plaintiff presented with muscle cramps (AR
10 462-63); (4) a letter dated November 1, 2017, stating that plaintiff would be able to
11 return to work on November 4, 2017, with no restrictions, after plaintiff presented
12 with a cough/acute viral syndrome (cold/flu) (AR 451-53); (5) a letter dated
13 January 22, 2018, stating that plaintiff would be able to return to work on January
14 25, 2018, after plaintiff presented with bronchitis (AR 440-41); (6) a letter dated
15 March 16, 2018, stating that plaintiff would be able to return to work on March 19,
16 2018, after plaintiff had presented with vaginal bleeding and nausea/vomiting (AR
17 419-20); (7) a letter dated April 10, 2018, stating that plaintiff would be able to
18 return to work on April 17, 2018, after plaintiff complained of declining health,
19 shortness of breath, stress and anxiety from commuting to Los Angeles to work
20 and the toll it was taking on her, and depression, at a time when she reportedly was
21 using a walker to ambulate (AR 376-77, 388); (8) a letter dated April 19, 2018,
22 stating that plaintiff would be able to return to work on July 10, 2018, after
23 plaintiff’s provider diagnosed plaintiff with shortness of breath (AR 369-75).
24 State agency physicians reviewed the record initially in July 2018, and found
25 plaintiff capable of a range of medium work. (AR 59-70). On reconsideration in
26 ///
27 ///
28 ///
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Case 2:21-cv-05672-JC Document 22 Filed 08/17/22 Page 7 of 11 Page ID #:811
1 March 2019, state agency physicians again found plaintiff capable of a range of
2 medium work. (AR 71-86).3
3 B. Pertinent Law
4 For claims filed after March 27, 2017 (such as plaintiff’s present claim), new
5 regulations govern the evaluation of medical opinion evidence. Under these
6 regulations, ALJs no longer “weigh” medical opinions; rather, ALJs determine
7 which opinions are the most “persuasive” by focusing on several factors:
8 (1) supportability; (2) consistency; (3) relationship with the claimant (including the
9 length of treatment, frequency of examinations, purpose of treatment, extent of
10 treatment, whether the medical source examined the claimant); (4) the medical
11 source’s specialty; and (5) “other” factors. See 20 C.F.R. §§ 404.1520c(c)(1)-(5),
12 416.920c(c)(1)-(5). The two most important factors in determining the
13 persuasiveness of medical opinions are supportability and consistency with the
14 evidence. See 20 C.F.R. §§ 404.1520c(a), 416.920c(a). ALJs must explain how
15 they considered the factors of supportability and consistency, but need not explain
16 how they considered any other factor. See 20 C.F.R. §§ 404.1520c(b),
17 416.920c(b).
18 Supportability means the extent to which a medical source supports
19 the medical opinion by explaining the “relevant. . . objective medical
20 evidence.” Consistency means the extent to which a medical opinion
21 is “consistent. . . with the evidence from other medical sources and
22 nonmedical sources in the claim.
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3The record does not appear to contain any other opinion evidence. Plaintiff was
25 scheduled to attend a consultative examination in February 2019, but apparently did not keep her
appointment. (AR 665 (letter warning plaintiff that her failure to respond within 10 days
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regarding her missed appointment could result in her claim being “processed with the evidence
27 in [the] file,” and a decision that she is not disabled.); AR 79 (state agency physician on
reconsideration noting that plaintiff had failed to cooperate with the scheduled consultative
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examination, and that the available record was “insufficient for definitive adjudication.”)).
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1 Woods v. Kijakazi, 32 F.4th 785, 791-92 (9th Cir. 2022) (internal citations
2 omitted; citing 20 C.F.R. § 404.1520c(c)(1), (2)).
3 The new regulations also eliminated the term “treating source,” as well as
4 the rule previously known as the treating source rule or treating physician rule,
5 which formerly required special deference to the opinions of treating sources. See
6 20 C.F.R. §§ 404.1520c, 416.920c; Woods v. Kijakazi, 32 F.4th at 792 (“The
7 revised social security regulations are clearly irreconcilable with our caselaw
8 according special deference to the opinions of treating and examining physicians
9 on account of their relationship with the claimant.”). Even so, in evaluating
10 medical opinion evidence “under the new regulations, an ALJ cannot reject an
11 examining or treating doctor’s opinion as unsupported or inconsistent without
12 providing an explanation supported by substantial evidence.” Woods v. Kijakazi,
13 32 F.4th at 792. Finally, the new regulations command that an opinion
14 that a claimant is disabled or not able to work is “inherently neither valuable nor
15 persuasive,” and an ALJ need not provide any analysis about how such evidence is
16 considered. See 20 C.F.R. §§ 404.1520b(c)(3), 416.920b(c)(3).
17 As explained below, while the ALJ appears to have followed these new
18 regulations in making the relevant findings based on the available record,
19 substantial evidence does not support the ALJ’s resultant residual functional
20 capacity determination.
21 C. Analysis
22 In determining plaintiff’s residual functional capacity, the ALJ found “not
23 persuasive” the state agency physicians’ opinions, which had found plaintiff
24 capable of a range of medium work. (AR 23). The ALJ reasoned that the opinions
25 were not consistent with the medical evidence, including imaging studies of the
26 spine and clinical findings and observations showing a history of complaints of
27 neck pain, back pain, radiculopathy, diabetes, neuropathy, anatomical
28 abnormalities and functional limitations of the spine and lower extremities. (AR
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1 23). The ALJ also noted that the consultants offered their opinions more than one
2 year prior to the ALJ’s decision, and therefore they did not have the opportunity to
3 review the updated record. (AR 23). The ALJ concluded,
4 In light of the objective medical evidence. . . , the claimant’s
5 testimony regarding the limiting effects of her pain and her
6 neuropathy. . ., and the claimant’s obesity, the undersigned finds a
7 limitation to work at the sedentary level to be appropriate.
8 (AR 23).
9 The ALJ acknowledged the letters from providers with the High Desert
10 Medical Group between 2017 and 2018 – prior to the state agency physicians’
11 review – indicating when plaintiff could return to work (sometimes without
12 limitation) after certain visits, noting they were not a specific assessment of
13 plaintiff’s functional limitations, but also finding the opinions were “at least
14 partially persuasive in that they further undermine the claimant’s allegations of
15 totally disabling symptoms and functional limitations.” (AR 23).
16 It appears that the ALJ’s residual functional capacity determination is based,
17 at least in part, on the ALJ’s lay interpretation of the updated medical record. No
18 medical source reviewed the updated medical record which the ALJ had found
19 significant enough to render “not persuasive” the only available medical source
20 statements. The “off work” letters from the High Desert Medical Group are not
21 specific enough to support the ALJ’s findings.
22 An ALJ’s decision must be supported by substantial evidence. See 42
23 U.S.C. § 405(g) (“The findings of the Commissioner of Social Security as to any
24 fact, if supported by substantial evidence, shall be conclusive. . . .”). An ALJ
25 cannot properly rely on the ALJ’s own lay knowledge to make medical
26 interpretations of examination results or to determine the severity of medically
27 determinable impairments. See Tackett v. Apfel, 180 F.3d 1094, 1102-03 (9th Cir.
28 1999); Nguyen v. Chater, 172 F.3d 31, 35 (1st Cir. 1999); Balsamo v. Chater, 142
9
Case 2:21-cv-05672-JC Document 22 Filed 08/17/22 Page 10 of 11 Page ID #:814
1 F.3d 75, 81 (2d Cir. 1998); see also Rohan v. Chater, 98 F.3d 966, 970 (7th Cir.
2 1996) (“ALJs must not succumb to the temptation to play doctor and make their
3 own independent medical findings”); Day v. Weinberger, 522 F.2d 1154, 1156 (9th
4 Cir. 1975) (an ALJ is forbidden from making his or her own medical assessment
5 beyond that demonstrated by the record); McAnally v. Berryhill, 2020 WL
6 1443734, at *6 (S.D. Cal. March 25, 2020) (“In making an RFC determination, an
7 ALJ may not act as his own medical expert as he is simply not qualified to interpret
8 raw medical data in functional terms”) (citations and quotations omitted).
9 In the present case, absent expert medical assistance, and in light of the
10 treatment evidence suggesting plaintiff continued to complain of spine pain
11 radiating to the lower extremity between 2017 and 2020 (AR 21 (ALJ discussing
12 same)), the ALJ could not competently translate the updated medical evidence into
13 a physical residual functional capacity assessment. See Tackett v. Apfel, 180 F.3d
14 at 1102-03 (ALJ’s residual functional capacity assessment cannot stand in the
15 absence of evidentiary support); see generally Mayes v. Massanari, 276 F.3d 453,
16 459-60 (9th Cir. 2001) (ALJ’s duty to develop the record further is triggered
17 “when there is ambiguous evidence or when the record is inadequate to allow for
18 the proper evaluation of the evidence”) (citation omitted); Brown v. Heckler, 713
19 F.2d 441, 443 (9th Cir. 1983) (“[T]he ALJ has a special duty to fully and fairly
20 develop the record to assure the claimant’s interests are considered. This duty
21 exists even when the claimant is represented by counsel.”).4
22 In sum, substantial evidence does not support the ALJ’s conclusion that the
23 limitations the ALJ found to exist adequately account for plaintiff’s severe
24 impairments. The state agency physician opinions finding plaintiff capable of
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4Although plaintiff has a duty to prove disability (see 20 C.F.R. § 404.1512(a)(1)) and
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plaintiff may bear some responsibility for the lack of evidence to support the ALJ’s residual
27 functional capacity assessment because she did not attend her scheduled consultative
examination (see AR 665), this does not alter the fact that the record as it exists does not provide
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substantial evidence to support the ALJ’s residual functional capacity determination.
10
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1 medium work, while also noting that the record was insufficient to evaluate
2 plaintiff’s claim, do not constitute substantial evidence. Compare Sonja S. R. v.
3 Berryhill, 2018 WL 3460165, at *6-7 (C.D. Cal. July 16, 2018) (substantial
4 evidence failed to support residual functional capacity determination where state
5 agency physicians’ opinions did not consider later medical evidence supporting
6 additional impairments and reflecting “potentially long-term conditions,” and the
7 ALJ had rendered ALJ’s own lay interpretation of the updated medical record).
8 V. CONCLUSION
9 For the foregoing reasons,5 the decision of the Commissioner of Social
10 Security is REVERSED and this matter is REMANDED for further administrative
11 action consistent with this Opinion.
12 LET JUDGMENT BE ENTERED ACCORDINGLY.
13 DATED: August 17, 2022
14 _____________/s/____________________
Honorable Jacqueline Chooljian
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UNITED STATES MAGISTRATE JUDGE
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5The Court need not, and has not adjudicated plaintiff’s other challenges to the ALJ’s
25 decision, except insofar as to determine that a reversal and remand for immediate payment of
benefits would not be appropriate. When a court reverses an administrative determination, “the
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proper course, except in rare circumstances, is to remand to the agency for additional
27 investigation or explanation.” Immigration & Naturalization Service v. Ventura, 537 U.S. 12, 16
(2002) (citations and quotations omitted); Treichler, 775 F.3d at 1099 (noting such “ordinary
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remand rule” applies in Social Security cases) (citations omitted).
11