United States District Court, D. Alaska
RUSSEL HOLLAND UNITED STATES DISTRICT JUDGE
an action for judicial review of the denial of disability
benefits under Title II and Title XVI of the Social Security
Act, 42 U.S.C. §§ 401-434, 1381-1383f. Plaintiff
Bonnie Rose Adams has timely filed her opening brief,
to which defendant, the Commissioner of the Social Security
Administration, has timely responded. Oral argument was
not requested and is not deemed necessary.
December 22, 2015, plaintiff filed applications for
disability benefits under Title II and Title XVI of the
Social Security Act, alleging that she became disabled on
August 1, 2015. Plaintiff alleged that she was disabled
because of PTSD, depression, anxiety, nerve damage,
arthritis, and diabetes. Plaintiff's applications were
denied initially, and plaintiff requested a hearing.
Administrative hearings were held on November 30, 2016, March
22, 2017, August 23, 2017, and February 15, 2018. An
administrative law judge (ALJ) then denied plaintiff's
applications. Plaintiff sought review of the ALJ's
unfavorable decision. On October 31, 2018, the Appeals
Council denied plaintiff's request for review, thereby
making the ALJ's April 9, 2018 decision the final
decision of the Commissioner. On December 3, 2018, plaintiff
commenced this action in which she asks the court to review
defendant's final decision.
was born on September 1, 1958. She was 56 years old on her
alleged onset date. Plaintiff has a college education.
Plaintiff's past relevant work was as a child protection
worker, an outreach worker, a social services aide, a
corporate manager, a shareholder relations worker, a youth
residential counselor, an office manager, and a cultural
first determined that plaintiff met “the insured status
requirements of the Social Security Act through December 31,
then applied the five-step sequential analysis used to
determine whether an individual is disabled.
one, the ALJ found that plaintiff had “not engaged in
substantial gainful activity since August 1, 2015, the
alleged onset date. . . .”
two, the ALJ found that plaintiff had “the following
severe impairments: post-traumatic stress disorder and
anxiety disorder. . . .”
three, the ALJ found that plaintiff did “not have an
impairment or combination of impairments that meets or
medically equals the severity of one of the listed
impairments in 20 CFR Part 404, Subpart P, Appendix 1. . .
.” The ALJ considered Listings 12.06
(anxiety and obsessive-compulsive disorders) and 12.15
(trauma- and stressor-related disorders). The ALJ considered
the “paragraph B” criteria and found that
plaintiff had mild to moderate limitations in understanding,
remembering, or applying information; moderate limitations in
interacting with others; moderate to marked limitations with
regard to concentration, persistence, or pace; and moderate
limitations as to adapting or managing oneself. The ALJ also
considered the “paragraph C” criteria and found
that they had not been met.
steps three and four, the ALJ must, as an intermediate step,
assess the claimant's RFC.” Bray v. Comm'r
of Social Security Admin., 554 F.3d 1219, 1222-23 (9th
Cir. 2009). The ALJ found that plaintiff had the
residual functional capacity to perform medium work as
defined in 20 CFR 404.1567(c) and 416.967(c) with the
following exceptions[:] The claimant can frequently climb
ramps or stairs, balance, stoop, kneel, crouch, and crawl.
The claimant can occasionally climb ladders, ropes, or
scaffolds. The claimant should avoid moderate exposure to
unprotected heights and hazardous machinery. The claimant is
limited to a low stress job with only occasional
decision-making and changes in the work setting. The claimant
can perform no assembly line work or production rate work.
The claimant can have only occasional interaction with the
public, occasional interaction with supervisors, and
occasional interaction with coworkers with no tandem
found plaintiff's symptom statements less than credible
because they were not consistent with the objective findings
in treatment notes, because they were not consistent with her
daily activities, and because she “worked at the Boys
and Girls Home after her alleged onset
gave little weight to Dr. Thurston-Hicks'
opinion. The ALJ gave little weight to Dr.
Clifford's March 2017 opinion. The ALJ gave little
weight to Dr. Weiss' opinions. The ALJ gave some
weight to Dr. Scott's
opinion. The ALJ gave great weight to Dr.
Buechner's opinion. And, the ALJ considered the lay
testimony of Rhiannon Haile but found that it was
“not consistent with the objective medical
four, the ALJ found that plaintiff was “unable to
perform any past relevant work. . . .”
five, the ALJ found that “there are jobs that exist in
significant number in the national economy that the claimant
can perform[, ]” including working as a laundry worker,
a store laborer, a kitchen helper, or an industrial
the ALJ concluded that plaintiff had “not been under a
disability, as defined in the Social Security Act, from
August 1, 2015, through the date of this decision. . .
to 42 U.S.C. § 405(g), the court has the “power to
enter, upon the pleadings and transcript of the record, a
judgment affirming, modifying, or reversing the decision of
the Commissioner. . . .” The court “properly
affirms the Commissioner's decision denying benefits if
it is supported by substantial evidence and based on the
application of correct legal standards.” Sandgathe
v. Chater, 108 F.3d 978, 980 (9th Cir. 1997).
“Substantial evidence is ‘more than a mere
scintilla but less than a preponderance; it is such relevant
evidence as a reasonable mind might accept as adequate to
support a conclusion.'” Id. (quoting
Andrews v. Shalala, 53 F.3d 1035, 1039 (9th Cir.
1995)). “‘To determine whether substantial
evidence supports the ALJ's decision, [the court]
review[s] the administrative record as a whole, weighing both
the evidence that supports and that which detracts from the
ALJ's conclusion.'” Id. (quoting
Andrews, 53 F.3d at 1039). If the evidence is
susceptible to more than one reasonable interpretation, the
court must uphold the Commissioner's decision.
Id. But, the Commissioner's decision cannot be
affirmed “‘simply by isolating a specific quantum
of supporting evidence.'” Holohan v.
Massanari, 246 F.3d 1195, 1201 (9th Cir. 2001) (quoting
Tackett v. Apfel, 180 F.3d 1094, 1098 (9th Cir.
first argues that the ALJ erred in rejecting Dr.
Clifford's March 2017 opinion. On March 8, 2017, Dr.
Clifford opined that plaintiff was not significantly impaired
in her ability to understand and remember short and simple
instructions, ask simple questions or request assistance,
maintain socially appropriate behavior and adhere to basic
standards of neatness and cleanliness; was moderately
impaired as to her ability to carry out very short and simple
instructions, sustain an ordinary routine without special
supervision, make simple work-related decisions, respond
appropriately to changes in the work setting, be aware of
normal hazards and take appropriate precautions, travel in
unfamiliar places or use public transportation, and set
realistic goals or make plans independently of others; and
was markedly impaired as to her ability to remember locations
and work-like procedures, understand/remember/carry out
detailed instructions, maintain attention and concentration
for extended periods, work in coordination with and proximity
of others without being distracted by them, complete a normal
workday and workweek without interruptions from
psychologically based symptoms, perform at a consistent pace
without an unreasonable number and length of rest periods,
interact appropriately with the general public, accept
instructions and respond appropriately to criticism from
supervisors, and get along with coworkers or peers without
distracting them or exhibiting behavioral
Clifford was a treating physician. “As a general rule,
more weight should be given to the opinion of a treating
source than to the opinion of doctors who do not treat the
claimant.” Lester v. Chater, 81 F.3d 821, 830
(9th Cir. 1995). “At least where the treating
doctor's opinion is not contradicted by another doctor,
it may be rejected only for ‘clear and convincing'
reasons.” Id. (quoting Baxter v.
Sullivan, 923 F.2d 1391, 1396 (9th Cir. 1991)).
“[I]f the treating doctor's opinion is contradicted
by another doctor, the Commissioner may not reject this
opinion without providing ‘specific and legitimate
reasons' supported by substantial evidence in the record
for so doing.” Id. (quoting Murray v.
Heckler, 722 F.2d 499, 502 (9th Cir. 1983)). Dr.
Clifford's opinion was contradicted by Dr. Buechner's
and Dr. Scott's opinions; and so, the ALJ was required to
give specific and legitimate reasons for rejecting Dr.
gave little weight to Dr. Clifford's March 2017 opinion
because it was “not consistent with the objective
findings in his treatment notes.” By way of
example, the ALJ cited to plaintiff's mental status exam
from November 10, 2016. Plaintiff argues that this was
not a legitimate reason for the ALJ to reject Dr.
November 10, 2016, plaintiff's mental status exam showed
that she was
“[a]lert and oriented in all spheres. Eye contact is
good. Develops good rapport with examiner. Dress and grooming
are casual and appropriate to the environment. Speech is
regular in rate, rhythm, tone and prosody. Language use is
normal without slurring or pressure. No. tics, tremors, or
adventitious movements present. There is no evidence of
psychomotor slowing or agitation. Mood is described as:
“I cannot get it together to do anything except take
care of the kids when I have them[.]” Affect is
congruent to the stated mood, mildly restricted. Thought
process is linear, logical and goal directed. Thought content
is without suicidal ideation, intent or plan, which were
specifically queried. There is no evidence of homicidal
ideation, intent or plan, which were also specifically
queried. The patient does not report perceptual distortions
of any kind, and there is no evidence of attention to
internal stimuli. The pt does not give evidence of delusions.
The pt is not paranoid. The pt's memory and cognition are
within normal limits by confrontation, though formally not
tested. The pt's judgment is good, and insight is within
normal limits. The pt does not give evidence of impulsivity
during the exam. The patient does not describe the presence
of pain at this interview.
an ALJ may reject a medical opinion if it is inconsistent
with the objective medical evidence, Tommasetti v.
Astrue, 533 F.3d 1035, 1041 (9th Cir. 2008), this was
not a legitimate reason to reject Dr. Clifford's opinion.
As the ALJ pointed out, plaintiff had a generally normal
mental status exam on November 10, 2016. In fact,
plaintiff's mental status exam at each of more than 60
appointments with Dr. Clifford was exactly the same as her
November 10, 2016 exam, except each time plaintiff described
her mood differently. But, the mental status exam results
were not the only objective evidence in Dr. Clifford's
treatment notes. For example, on November 10, 2016, D.
Clifford noted that he was seeing plaintiff for
“[c]ontinued medical management of PTSD, including
Prozac 80 mg daily, Ambien and prazosin for sleep and
nightmare management, and Xanax XR 4 mg daily for panic and
anxiety management.” Dr. Clifford's
assessment included that “[s]ituational problems
continue to be constant and I provide support. We work on
refining what she can do and what she cannot do. I provide
strong support and encouragement as we make these
boundaries.” This is also objective evidence. As
the Ninth Circuit has pointed out, “[p]sychiatric
evaluations may appear subjective, especially compared to
evaluation in other medical fields. Diagnoses will always
depend in part on the patient's self-report, as well as
on the clinician's observations of the patient. But such
is the nature of psychiatry.” Buck v.
Berryhill, 869 F.3d 1040, 1049 (9th Cir. 2017). While
mental status exams are objective evidence, they are not the
only objective evidence contained in Dr. Clifford's
focused on plaintiff's mental status exams and ignored
the other objective medical evidence in Dr. Clifford's
treatment notes. While plaintiff did in fact have essentially
normal mental status exams, Dr. Clifford's notes
contained other objective evidence that is consistent with
the ALJ ignored Dr. Clifford's explanation as to why
plaintiff had seemingly normal mental status exams, yet he
still felt she had significant limitations. Dr. Clifford
[t]he mental status exam in psychiatry paints a pretty low
bar. It's the bar, can they leave my office without a
custodian. In a supported environment where I'm her
therapist and we know each other very well, it would be
expected that elevated anxiety symptoms, language use
problems, obvious memory deficits wouldn't be present
because we're in a circumstance where she's at rest.
We've had an hour to . . . talk. And it is true that this
patient has the ability in situations . . . where there's
sufficient support, to be able to exercise reasonable
judgment and make choices that are in [her] best self
Clifford testified, however, that “[i]n situations of
increased emotional tone, ” plaintiff would
“experience difficulties in formulating, giving good
answers, giving concise answers that pertain to the question
that you asked, being able to manage the emotional
environment, being able to recall facts.” Dr.
Clifford testified that his “concern for her in terms
of being able to work or compose herself in situations where
there's a lot of stress, even in stores and . . . other
public settings [is] that she's going to display
inappropriate emotionality, not be able to state her case in
a way that's either circumspect or rapid enough[, ] that
she's going to forget things and not organize tasks
appropriately.” The ALJ did not indicate that she
considered this explanation and rejected it. Rather, the ALJ
did not even mention this explanation. Given the ALJ's
focus on plaintiff's mental status exam, she should have
addressed Dr. Clifford's explanation and set out her