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Lily Neva Estrada v. Michael J. Astrue

January 30, 2013


The opinion of the court was delivered by: Hon. Jay C. Gandhi United States Magistrate Judge


Lily Neva Estrada ("Plaintiff") challenges the Social Security Commissioner's decision denying her application for disability benefits. Specifically, Plaintiff contends that the Administrative Law Judge ("ALJ") improperly rejected the opinion of her treating physician, Dr. William Cusick. (Joint Stip. at 3-8, 14-15.) The Court agrees with Plaintiff for the reasons discussed below.

A. An ALJ Must Provide Specific and Legitimate Reasons to Reject the Contradicted Opinion of 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); accord Benton ex rel. Benton v. Barnhart, 331 F.3d 1030, 1036 (9th Cir. 2003). This is so because a treating physician "is employed to cure and has a greater opportunity to know and observe the patient as an individual." Sprague v. Bowen, 812 F.2d 1226, 1230 (9th Cir. 1987).

Where the "treating doctor's opinion is contradicted by another doctor, the [ALJ] may not reject this opinion without providing specific and legitimate reasons supported by substantial evidence in the record[.]" Lester, 81 F.3d at 830 (internal quotation marks and citation omitted). The ALJ can meet the requisite specific and legitimate standard "by setting out a detailed and thorough summary of the facts and conflicting clinical evidence, stating his interpretation thereof, and making findings." Magallanes v. Bowen, 881 F.2d 747, 751 (9th Cir. 1989) (internal quotation marks and citation omitted).

A. The ALJ Failed to Provide Specific and Legitimate Reasons for Rejecting Dr. Cusick's Treating Opinion Here, the ALJ gave four reasons for discrediting Dr. Cusick's opinion. (See AR at 23.) The Court discusses -- and rejects -- each of those reasons below.

First, the ALJ found that Dr. Cusick's opinion was inconsistent with "his own rather mild clinical findings." (AR at 23.) Nothing, however, was offered to substantiate this conclusion.*fn1 In fact, to the contrary, the record suggests that Dr. Cusick's findings were arguably more than mild. (See AR at 358 (diagnosing "lumbar disk DS/radiopathy"), 359 ("sciatica," "neuropathy," and "spinal fusion"); see generally AR at 356-60.) Thus, without some basis in the record, this reason must be rejected.

Second, the ALJ also found Dr. Cusick's opinion to be inconsistent with the "the degree of treatment [he] had provided to date." (AR at 23.) Again, no further explanation was given by the ALJ -- a noteworthy omission in light of Dr. Cusick's extensive treatment plan, which included surgery, albeit by referral. (See AR at 290 (surgery referral), 347-50 (surgery notes).) At minimum, then, to satisfy the specific and legitimate standard, the ALJ should have explained how Dr. Cusick's opinion actually conflicted with his degree of treatment. See Magallanes, 881 F.2d at 751 (requiring "a detailed and thorough summary of . . . conflicting clinical evidence.")

Third, the ALJ found that Dr. Cusick's assessment "appears to generally reflect [Plaintiff's] subjective complaints." (AR at 23.) Granted, an ALJ may reject a treating opinion if it is based "to a large extent" on a claimant's own statements that have been properly discredited. Tommasetti v. Astrue, 533 F.3d 1035, 1041 (9th Cir. 2008). But, here, no evidence can support a conclusion that Dr. Cusick based his opinion, even partially, on Plaintiff's complaints. Instead, the opposite appears to be true because Dr. Cusick has, in fact, diagnosed and treated Plaintiff. Because Dr. Cusick provided some "independent analysis [and] diagnosis," the ALJ thus improperly discredited Dr. Cusick's opinion on this ground. See id.

Fourth, the ALJ cited Dr. Simmonds' contrary opinion that Plaintiff "show[ed] no deficits of mobility and no deficits of gait or neurological functioning." (AR at 23.) However, a treating opinion cannot be rejected simply because a contrary opinion exists. Indeed, the very purpose of the specific and legitimate standard is to control the weight given to treating opinions when, as here, a contrary opinion exists. See Lester, 81 F.3d at 830. By failing to appreciate this nuance, the ALJ's reasoning misses the mark.

Accordingly, for the reasons stated above, the Court determines that the ALJ improperly discredited the opinion of Dr. Cusick.

C. Remand is Warranted

With error established, this Court has discretion to remand or reverse and award benefits. McAllister v. Sullivan, 888 F.2d 599, 603 (9th Cir. 1989). Where no useful purpose would be served by further proceedings, or where the record has been fully developed, it is appropriate to exercise this discretion to direct an immediate award of benefits. See Benecke v. Barnhart, 379 F.3d 587, 595-96 (9th Cir. 2004). But where there are outstanding issues that must be resolved before a determination can be made, or it is not clear from the record that the ALJ would be required to find plaintiff disabled if all the evidence were properly evaluated, remand is appropriate. See id. at 594.

Here, in light of the ALJ's error, Dr. Cusick's credibility must be properly assessed. Therefore, on remand, the ALJ shall reevaluate the opinions of Dr. Cusick and either credit them as true, or ...

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