Lourdes Casillas v. Carolyn W Colvin, No. 2:2015cv01912 - Document 24 (C.D. Cal. 2015)

Court Description: MEMORANDUM OPINION AND ORDER by Magistrate Judge Gail J. Standish. IT IS THEREFORE ORDERED that Judgment be entered reversing the Commissioner's decision and remanding this matter for further administrative proceedings consistent with this Memorandum Opinion and Order. (ec)

Download PDF

Lourdes Casillas v. Carolyn W Colvin Doc. 24 1 2 3 4 5 6 7 8 UNITED STATES DISTRICT COURT 9 CENTRAL DISTRICT OF CALIFORNIA 10 11 12 13 14 15 16 17 WESTERN DIVISION ) Case No. CV 15-01912 -GJS LOURDES CASILLAS, ) ) Plaintiff, ) MEMORANDUM OPINION AND ) ORDER v. ) ) CAROLYN W. COLVIN, Acting ) Commissioner of Social Security, ) ) ) Defendant. ) ) ) 18 I. 19 20 PROCEEDINGS Plaintiff Lourdes Casillas (“Plaintiff”) filed a complaint seeking review of 21 the Commissioner’s denial of her application for Disability Insurance Benefits. 22 The parties filed consents to proceed before the undersigned United States 23 Magistrate Judge, and a Joint Stipulation addressing disputed issues in the case. 24 The Court has taken the Joint Stipulation under submission without oral argument. 25 26 27 28 II. BACKGROUND AND SUMMARY OF ADMINISTRATIVE DECISION Plaintiff asserts disability since November 17, 2009, based primarily on a herniated disc at L4-5. (Administrative Record (“AR”) 83-84, 147, 188, 219). Dockets.Justia.com 1 After a hearing, an Administrative Law Judge (“ALJ”) applied the five-step 2 sequential evaluation process to find Plaintiff not disabled. See 20 C.F.R. § 3 404.1520(b)-(g)(1).1 At step one, the ALJ found that Plaintiff has not engaged in 4 substantial gainful employment since her alleged onset date. (AR 16). At step 5 two, the ALJ found that Plaintiff has the severe impairment of degenerative disc 6 disease. (AR 16). At step three, the ALJ found that Plaintiff does not have an 7 impairment or combination of impairments that meets or equals the requirements 8 of any impairment listed in 20 C.F.R. Part 404, Subpart P, Appendix 1. (AR 19). 9 The ALJ then assessed Plaintiff with the residual functional capacity (“RFC”) for 10 the full range of light work, 20 C.F.R. § 404.1567(b), and found at step four that 11 Plaintiff is capable of performing her past relevant work as an inspector of paper 12 goods. (AR 19, 25). Therefore, the ALJ concluded that Plaintiff was not disabled. 13 (AR 29). 14 The Appeals Council denied Plaintiff’s request for review. (AR 1-3). 15 On March 16, 2015, Plaintiff filed a complaint before this Court seeking 16 review of the ALJ’s decision denying benefits. Plaintiff raises the following 17 arguments: (1) the ALJ failed to properly assess the medical evidence; (2) the ALJ 18 failed to provide adequate reasons for discrediting Plaintiff’s subjective 19 complaints; and (3) the ALJ erred in finding Plaintiff can perform past work. 20 21 22 23 24 25 26 27 1 To decide if a claimant is entitled to benefits, an ALJ conducts a five-step inquiry. 20 C.F.R. § 404.1520. The steps are as follows: (1) Is the claimant presently engaged in substantial gainful activity? If so, the claimant is found not disabled. If not, proceed to step two; (2) Is the claimant’s impairment severe? If not, the claimant is found not disabled. If so, proceed to step three; (3) Does the claimant’s impairment meet or equal the requirements of any impairment listed at 20 C.F.R. Part 404, Subpart P, Appendix 1? If so, the claimant is found disabled. If not, proceed to step four; (4) Is the claimant capable of performing her past work? If so, the claimant is found not disabled. If not, proceed to step five; (5) Is the claimant able to do any other work? If not, the claimant is found disabled. If so, the claimant is found not disabled. 20 C.F.R. § 404.1520(b)-(g)(1). 28 2 1 (Joint Stipulation (“Joint Stip.”) at 3-9, 20-23, 27-28). The Commissioner asserts 2 that the ALJ’s decision should be affirmed. (Joint Stip. at 9-20, 23-27, 28-30). III. 3 4 STANDARD OF REVIEW Under 42 U.S.C. § 405(g), the Court reviews the Administration’s decision 5 to determine if: (1) the Administration’s findings are supported by substantial 6 evidence; and (2) the Administration used correct legal standards. See Carmickle 7 v. Commissioner, 533 F.3d 1155, 1159 (9th Cir. 2008); Hoopai v. Astrue, 499 F.3d 8 1071, 1074 (9th Cir. 2007). Substantial evidence is “such relevant evidence as a 9 reasonable mind might accept as adequate to support a conclusion.” Richardson v. 10 Perales, 402 U.S. 389, 401, 91 S. Ct. 1420, 28 L.Ed.2d 842 (1971) (citation and 11 quotations omitted); see also Hoopai, 499 F.3d at 1074. IV. 12 DISCUSSION 13 A. Medical Opinion Evidence 14 Plaintiff contends, inter alia, that the ALJ erred in failing to articulate valid 15 reasons for rejecting the opinion of an agreed medical examiner, orthopedic 16 surgeon Donald A. Dinwoodie, M.D. (Joint Stip. at 6-8). As discussed below, the 17 Court agrees. 18 An ALJ may reject the uncontroverted opinion of a treating or examining 19 physician by providing “clear and convincing reasons that are supported by 20 substantial evidence.” Bayliss v. Barnhart, 427 F.3d 1211, 1216 (9th Cir. 2005) 21 (citing Lester v. Chater, 81 F.3d 821, 830-31 (9th Cir. 1995)). Where a treating or 22 examining physician’s opinion is contradicted by another doctor’s opinion, an ALJ 23 may reject the opinion “by providing specific and legitimate reasons that are 24 supported by substantial evidence.” Bayliss, 427 F.3d at 1216. An ALJ may 25 provide “substantial evidence” for rejecting a medical opinion by “setting out a 26 detailed and thorough summary of the facts and conflicting clinical evidence, 27 stating his interpretation thereof, and making findings.” Reddick v. Chater, 157 28 F.3d 715, 725 (9th Cir. 1998); Magallanes v. Bowen, 881 F.2d 747, 751 (9th Cir. 3 1 1989). An ALJ “must do more than offer his conclusions.” Reddick, 157 F.3d at 2 725; McAllister v. Sullivan, 888 F.2d 599, 602 (9th Cir. 1989) (“broad and vague” 3 reasons for rejecting treating physician’s opinion insufficient) (citation omitted). 4 “[The ALJ] must set forth his own interpretations and explain why they, rather 5 than the [physician’s], are correct.” Reddick, 157 F.3d at 725; (citing Embrey v. 6 Bowen, 849 F.2d 418, 421-22 (9th Cir. 1988)). 7 In February 2011, Dr. Dinwoodie issued an agreed medical evaluation 8 following an orthopedic examination of Plaintiff. (AR 354-76). Dr. Dinwoodie 9 reported that Plaintiff injured her back while working as a stock worker in 10 November 2009. (AR 354-55). Although Plaintiff indicated that her symptoms 11 had improved since she last worked, Plaintiff complained of lower back pain that 12 was aggravated by standing, walking, prolonged sitting, bending, lifting, and 13 twisting while lifting. (AR 358). An MRI of Plaintiff’s lumbar spine revealed a 3 14 millimeter central L4-5 disc protrusion, and moderate facet hypertrophy producing 15 a slight central canal narrowing and slight bilateral foraminal narrowing. (AR 16 363). Plaintiff demonstrated somewhat poor effort on motion testing, but Dr. 17 Dinwoodie noted that Plaintiff’s range of motion was reasonably reduced 18 secondary to pain. (AR 361-62, 370). Dr. Dinwoodie diagnosed Plaintiff with 19 acute L4-5 disc protrusion, history of radiculopathy, resolved, and gastrointestinal 20 problems causing stomach pain and poor sleep. (AR 371). Plaintiff was not a 21 candidate for surgery at that time. (AR 370). Although epidural injections had 22 been recommended, they had not been performed because Plaintiff had 23 uncontrolled hypertension and was not interested in receiving injections. (AR 357, 24 370). Dr. Dinwoodie stated that Plaintiff’s complaints and limitations were 25 supported by the findings on MRI and examination, and that Plaintiff had reached 26 maximum medical improvement resulting in an 8-percent whole person 27 impairment. (AR 372-73). Dr. Dinwoodie opined that Plaintiff was not able to 28 return to her usual employment as a stock worker, as that job was actually 4 1 performed by Plaintiff. (AR 354, 374). Dr. Dinwoodie recommended that 2 Plaintiff be provided with pain management, orthopedic re-evaluations, diagnostic 3 studies, epidural injections if beneficial, and possible lumbar surgery. (AR 371, 4 374). 5 In April 2011, Dr. Dinwoodie issued a supplemental report addressing 6 Plaintiff’s work restrictions. (AR 377-79). Dr. Dinwoodie opined that Plaintiff 7 was limited as follows: no lifting or carrying more than 25 pounds; no repetitive 8 bending and twisting; and no prolonged sitting or prolonged weight bearing, i.e., 9 sitting or constant weight bearing more than two hours without a 15-minute break 10 to change positions. (AR 378). 11 In the decision, the ALJ summarized Dr. Dinwoodie’s findings from the 12 February 2011 agreed medical evaluation, but did not discuss Dr. Dinwoodie’s 13 April 2011supplemental report or his assessment of Plaintiff’s work-related 14 restrictions. (AR 22, 377-79). The ALJ dismissed Dr. Dinwoodie’s opinion that 15 Plaintiff could not return to past work as a stock worker as actually performed 16 because Dr. Dinwoodie’s opinion was elicited in Plaintiff’s workers’ compensation 17 case and Social Security claims require application of a different standard for 18 determining disability. (AR 22, 372, 374). The ALJ stated generally that he gave 19 “little weight” to multiple medical source statements from physicians associated 20 with Plaintiff’s workers’ compensation claim, as the “reports and opinions of these 21 doctors were done in anticipation” of Plaintiff’s workers’ compensation claim. 22 (AR 24). The ALJ further indicated that Dr. Dinwoodie’s opinion regarding 23 Plaintiff’s inability to perform her past work was not entitled to any weight 24 because his opinion was “outside of the doctor’s area of expertise,” as he was not a 25 vocational expert. (AR 22). The ALJ failed to provide legally sufficient reasons 26 for rejecting Dr. Dinwoodie’s opinion. 27 28 It was improper for the ALJ to disregard Dr. Dinwoodie’s medical opinion simply because it was initially generated in a workers’ compensation case. 5 1 Although “[t]he categories of work under the Social Security disability scheme are 2 measured quite differently” than under the state workers’ compensation scheme, 3 Desrosiers v. Secretary of Health & Human Services, 846 F.2d 573, 576 (9th Cir. 4 1988), an ALJ must give a medical opinion prepared for a workers’ compensation 5 case proper consideration and articulate reasons if that opinion is rejected. See 6 Booth v. Barnhart, 181 F.Supp.2d 1099, 1105 (C.D. Cal. Jan. 22, 2002) (“[t]he 7 ALJ’s decision . . . should explain the basis for any material inference the ALJ has 8 drawn from those opinions so that meaningful judicial review will be facilitated”); 9 Lester, 81 F.3d at 832 ([t]he purpose for which medical reports are obtained does 10 not provide a legitimate basis for rejecting them”). An ALJ must evaluate the 11 objective medical findings in such opinions “just as he or she would [for] any other 12 medical opinion.” Booth, 181 F.Supp.2d at 1105-06 (an ALJ is entitled to draw 13 inferences “logically flowing from” findings in workers’ compensation medical 14 opinions) (citations and internal quotation marks omitted). Here, the ALJ did not 15 even mention Dr. Dinwoodie’s assessment of Plaintiff’s physical limitations, as set 16 forth in the April 2011 supplemental report. The ALJ’s failure to provide any 17 analysis or legitimate reasons for disregarding Dr. Dinwoodie’s assessment was 18 error. See Booth, 181 F.Supp.2d at 1105; see also Soc. Sec. Ruling 96-8p (“SSR”) 19 (explaining that the RFC assessment must always consider and address medical 20 source opinions, and if the assessment conflicts with an opinion from a medical 21 source, the ALJ must explain why the opinion was not adopted). The ALJ’s 22 general dismissal of all of Plaintiff’s medical source statements associated with her 23 workers’ compensation claim was not a specific, legitimate basis for rejecting Dr. 24 Dinwoodie’s April 2011 work capacity assessment. See Reddick, 157 F.3d at 725 25 (ALJ can meet the requisite specific and legitimate standard “by setting out a 26 detailed and thorough summary of the facts and conflicting clinical evidence, 27 stating his interpretation thereof, and making findings”); Lester, 81 F.3d at 832. 28 Further, the ALJ was not entitled to reject Dr. Dinwoodie’s opinion simply 6 1 because he found that Plaintiff was unable to perform her past work as a stock 2 worker. (AR 22, 374). Although the ALJ did not need to accept Dr. Dinwoodie’s 3 opinion of disability, the ALJ erred by failing to offer specific and legitimate 4 reasons supported by substantial evidence in the record before rejecting it. See 5 Holohan v. Massanari, 246 F.3d 1195, 1202 (9th Cir. 2001) (Medical sources may 6 provide “two types of opinions: medical opinions that speak to the nature and 7 extent of a claimant’s limitations, and opinions concerning the ultimate issue of 8 disability, i.e., opinions about whether a claimant is capable of any work, given her 9 or his limitations.”); Reddick, 157 F.3d at 725 (explaining that an opinion on the 10 ultimate issue of disability, if controverted, can be rejected only with “specific and 11 legitimate reasons supported by substantial evidence”); SSR 96-5p (ALJ “must 12 always carefully consider medical source opinions about any issue, including 13 opinions about issues that are reserved to the Commissioner.”). 14 The Commissioner attempts to support the ALJ’s rejection of Dr. 15 Dinwoodie’s opinion based on several reasons not cited by the ALJ. For example, 16 the Commissioner argues that the ALJ properly rejected Dr. Dinwoodie’s opinion 17 because it conflicted with his examination notes, lacked objective support, and was 18 inconsistent with Plaintiff’s daily activities. (Joint Stip. at 12, 14). However, the 19 ALJ never offered any of these reasons as a basis for discounting Dr. Dinwoodie’s 20 opinion. The Commissioner further suggests that the ALJ properly relied on 21 evidence of improvement in Plaintiff’s condition and a history of conservative 22 treatment. (Joint Stip. at 12; AR 22). Although the ALJ noted in summarizing Dr. 23 Dinwoodie’s February 2011 evaluation that Plaintiff was not a candidate for 24 lumbar surgery or epidural injections, and that Plaintiff’s symptoms had improved 25 since her injury, the ALJ did not cite conservative treatment or improvement in 26 Plaintiff’s condition to support rejection of Dr. Dinwoodie’s opinion. (AR 22). 27 The ALJ’s decision cannot be affirmed based on the Commissioner’s post hoc 28 rationalizations. See Bray v. Comm’r of Soc. Sec. Admin., 554 F.3d 1219, 1225 7 1 (9th Cir. 2009) (“Long-standing principles of administrative law require [the 2 Court] to review the ALJ’s decision based on the reasoning and factual findings 3 offered by the ALJ - not post hoc rationalizations that attempt to intuit what the 4 [ALJ] may have been thinking.”); Molina v. Astrue, 674 F.3d 1104, 1121 (9th Cir. 5 2012) (“we may not uphold an agency’s decision on a ground not actually relied on 6 by the agency”). The Commissioner further asserts that Dr. Dinwoodie’s finding that Plaintiff 7 8 could not perform her past work as a stock worker, which was performed at the 9 medium level, does not conflict with the ALJ’s determination that Plaintiff is 10 capable of performing her past work as an inspector of paper goods, which requires 11 light work, as actually and generally performed. (Joint Stip. at 13-14; AR 25, 99- 12 100). To the extent the Commissioner may be arguing that the ALJ’s error in 13 rejecting Dr. Dinwoodie’s opinion was harmless, the Court disagrees. By 14 disregarding Dr. Dinwoodie’s April 2011 supplemental report, the ALJ failed to 15 include in the RFC Dr. Dinwoodie’s opinion that Plaintiff is precluded from 16 repetitive bending or twisting, and sitting or weightbearing for more than 2 hours, 17 without a 15-minute break to change positions. (AR 19, 378). As these limitations 18 would likely impact Plaintiff’s ability to perform the full range of light work, see 19 Desrosiers, 846 F.2d at 579-80 (Pregerson, J., concurring), the ALJ’s error in 20 rejecting Dr. Dinwoodie’s opinion cannot be considered harmless. See Robbins v. 21 Soc. Sec. Admin., 466 F.3d 880, 885 (9th Cir. 2006) (an error is harmless if it is 22 “clear from the record that an ALJ’s error ‘was inconsequential to the ultimate 23 nondisability determination’”) (quoting Stout v. Commissioner, 454 F.3d 1050, 24 1055 (9th Cir. 2006)). 25 /// 26 /// 27 /// 28 /// 8 CONCLUSION AND ORDER 1 2 The decision whether to remand for further proceedings or order an 3 immediate award of benefits is within the district court’s discretion. Harman v. 4 Apfel, 211 F.3d 1172, 1175-78 (9th Cir. 2000). When no useful purpose would be 5 served by further administrative proceedings, or where the record has been fully 6 developed, it is appropriate to exercise this discretion to direct an immediate award 7 of benefits. Id. at 1179 (“the decision of whether to remand for further 8 proceedings turns upon the likely utility of such proceedings”). But when there are 9 outstanding issues that must be resolved before a determination of disability can be 10 made, and it is not clear from the record the ALJ would be required to find the 11 claimant disabled if all the evidence were properly evaluated, remand is 12 appropriate. Id. 13 The Court finds that remand is appropriate because the circumstances of this 14 case suggest that further administrative review could remedy the ALJ’s errors. See 15 INS v. Ventura, 537 U.S. 12, 16, 123 S. Ct. 353 (2002) (upon reversal of an 16 administrative determination, the proper course is remand for additional agency 17 investigation or explanation, “except in rare circumstances”); Harman, 211 F.3d at 18 1180-81. 19 IT IS THEREFORE ORDERED that Judgment be entered reversing the 20 Commissioner’s decision and remanding this matter for further administrative 21 proceedings consistent with this Memorandum Opinion and Order.2 22 23 DATED: October 29, 2015 24 __________________________________ GAIL J. STANDISH UNITED STATES MAGISTRATE JUDGE 25 26 27 2 The Court has not reached any other issue raised by Plaintiff except as to determine that reversal with a directive for the immediate payment of benefits would not be appropriate at this time. 28 9

Some case metadata and case summaries were written with the help of AI, which can produce inaccuracies. You should read the full case before relying on it for legal research purposes.

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.