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Deanne L. Lee v. Michael J. Astrue

March 16, 2012

DEANNE L. LEE, PLAINTIFF,
v.
MICHAEL J. ASTRUE, COMMISSIONER OF SOCIAL SECURITY, DEFENDANT.



The opinion of the court was delivered by: Kendall J. Newman United States Magistrate Judge

ORDER

Plaintiff seeks judicial review of a final decision of the Commissioner of Social Security ("Commissioner") terminating Disability Insurance Benefits that were previously granted to plaintiff under Title II of the Social Security Act ("Act") on August 2, 2001.*fn1 In her motion for summary judgment (Dkt. No. 17), plaintiff contends that the Administrative Law Judge ("ALJ"), who affirmed the decision to terminate benefits effective May 1, 2005, based on a finding of medical improvement, erred in three respects. First, plaintiff contends that the ALJ failed to adequately develop the record in regards to the prior decision granting benefits such that neither plaintiff nor this court can properly evaluate the ALJ's finding that plaintiff had experienced medical improvement since the favorable decision in 2001. Second, and related in part to her first argument, plaintiff argues that the record lacks substantial evidence supporting the ALJ's finding that plaintiff experienced medical improvement. Third, plaintiff argues that the ALJ erred by ignoring a portion of the medical opinion of an examining psychologist, James D. Doornink, Ph.D. The Commissioner filed an opposition to plaintiff's motion and a cross-motion for summary judgment (Dkt. No. 15). For the reasons stated below, the court grants plaintiff's motion for summary judgment in part and remands this matter for further proceedings.

I. BACKGROUND

Plaintiff initially filed an application for Disability Insurance Benefits on October 17, 2000, alleging that she had been disabled since March 17, 1998. (Administrative Transcript ("AT") 98-100.) On August 2, 2001, the Commissioner determined that plaintiff was disabled beginning on March 17, 1998. (AT 44.) The only document in the Administrative Transcript reflecting this ultimate determination by the agency is what appears to be an internal agency form entitled "Disability Determination and Transmittal," which indicates a "Primary Diagnosis" of "Affective (Mood) Disorder" and a "Secondary Diagnosis" of "Anxiety Related Disorders." (Id.) This one-page form conveys that plaintiff was found to be disabled on the grounds that her mental impairments met Listing 12.06 in the applicable regulations, 20 C.F.R. Part 404, Subpart P, Appendix 1, addressing "anxiety related disorders." (See id.) For the purpose of evaluating whether plaintiff experienced medical improvement, which is central to this appeal, the August 2, 2001 favorable decision serves as what is referred to as the "comparison point decision," or "CPD." (See AT 19.)

By way of a letter dated May 2, 2007, the Commissioner advised plaintiff that plaintiff's benefits would cease because plaintiff's health had improved since the last review of her case, i.e., the August 2, 2001 comparison point decision, such that plaintiff was now able to work. (AT 55.) The letter informed plaintiff that she was no longer disabled as of "May, 2005." (AT 55, 57.) Although the "Explanation of Determination" portion of this letter strongly suggests that the termination of benefits was premised, in substantial part, on plaintiff's failure to cooperate in the review process, the termination of plaintiff's benefits was formally premised on plaintiff's medical improvement and the resulting ability to work.*fn2 (See AT 55, 57; see also AT 20-22.)

Plaintiff requested that the cessation of benefits determination be reviewed by an administrative law judge. (AT 60.) In February 2008, the ALJ held a hearing in regards to the cessation of plaintiff's benefits and subsequently issued a decision finding that plaintiff was no longer disabled as of May 1, 2005. (AT 438-45, 565-619.) Upon plaintiff's submission of additional evidence, the ALJ reopened the case and held a second hearing in November 2009. (See AT 17, 460-63, 620-52.) In a decision dated December 11, 2009, the ALJ again found that plaintiff ceased to be disabled as of May 1, 2005, a finding premised on plaintiff's medical improvement and ability to work. (AT 17-25.) The ALJ's decision became the agency's final decision on September 1, 2010, after the Appeals Council denied plaintiff's request for review of the ALJ's decision. (AT 9-12.) Plaintiff subsequently filed this action.

II. LEGAL STANDARDS

Where the issue of continued disability or medical improvement is concerned, "a presumption of continuing disability arises" in the claimant's favor once that claimant has been found to be disabled. Bellamy v. Sec'y of Health & Human Servs., 755 F.2d 1380, 1381 (9th Cir. 1985) (citing Murray v. Heckler, 722 F.2d 499, 500 (9th Cir. 1983)); accord Parra v. Astrue, 481 F.3d 742, 748 (9th Cir. 2007). The Commissioner has the "burden of producing evidence sufficient to rebut [the] presumption of continuing disability." Bellamy, 755 F.2d at 1381; see also Murray, 722 F.2d at 500 ("The Secretary . . . has the burden to come forward with evidence of improvement."). However, a reviewing court will not set aside a decision to terminate benefits unless the determination is based on legal error or is not supported by substantial evidence in the record as a whole.*fn3 Allen v. Heckler, 749 F.2d 577, 579 (9th Cir. 1984).

Relevant here, a claimant's benefits may be terminated where the Commissioner produces substantial evidence that: "(A) there has been any medical improvement in the individual's impairment or combination of impairments (other than medical improvement which is not related to the individual's ability to work), and (B) the individual is now able to engage in substantial gainful activity."*fn4 42 U.S.C. § 423(f)(1). The applicable regulation defines "medical improvement" as follows:

Medical improvement is any decrease in the medical severity of your impairment(s) which was present at the time of the most recent favorable medical decision that you were disabled or continued to be disabled. A determination that there has been a decrease in medical severity must be based on changes (improvement) in the symptoms, signs and/or laboratory findings associated with your impairment(s) (see § 404.1528).

20 C.F.R. § 404.1594(b)(1).*fn5

The Commissioner evaluates whether a claimant continues to be entitled to Disability Insurance Benefits under an eight-part analytical framework, which the applicable regulation describes as follows:

(1) Are you engaging in substantial gainful activity? If you are (and any applicable trial work period has been completed), we will find disability to have ended (see paragraph (d)(5) of this section).

(2) If you are not, do you have an impairment or combination of impairments which meets or equals the severity of an impairment listed in appendix 1 of this subpart? If you ...


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