United States District Court, E.D. California
ORDER REGARDING PLAINTIFF'S SOCIAL SECURITY
Israel Cortez ("Plaintiff"), seeks judicial review
of a final decision by the Commissioner of Social Security
("Commissioner" or "Defendant") denying
his application for Supplemental Security Income
("SSI") benefits and Disability Insurance Benefits
("DIB") pursuant to Titles II and XVI of the Social
Security Act. The matter is currently before the Court on the
parties' briefs, which were submitted without oral
argument to the Honorable Erica P. Grosjean, United States
Magistrate Judge. Upon a review of the administrative
record, the Court finds the ALJ's decision is not
supported by substantial evidence and the case is remanded to
the agency for further proceedings.
BACKGROUND AND PRIOR PROCEEDINGS
filed applications for DIB and SSI in October 2012, alleging
a disability onset date of February 28, 2003. AR 210-213;
214-223. Both applications were denied initially in
June 2013, and on reconsideration in August 2013. AR 131;
135; 143; 149. A hearing was conducted before Administrative
Law Judge Trevor Skarda ("ALJ") on May 6, 2014. AR
38-70. On July 16, 2014, the ALJ issued a decision finding
that Plaintiff was not disabled. AR 25-33. The Appeals
Council denied Plaintiff's appeal, rendering the order
the final decision of the Commissioner. AR 1-5.
now challenges that decision, arguing that: (1) the ALJ
failed to give legally sufficient reasoning in rejecting the
treating opining of Dr. Jorge Urbina, M.D., and (2) the ALJ
did not provide legally sufficient reasons for finding
Plaintiff not fully credible. (Doc. 19, pgs. 6-14). Plaintiff
argues that the Court should reverse and remand with
instructions to award benefits. In the alternative, Plaintiff
contends the case should be remanded for further
administrative proceedings. (Doc. 19, pg. 16). In opposition,
Defendant argues: (1) that the ALJ properly evaluated the
medical evidence of record, giving greater weight to Dr.
Chandler's opinion than to Dr. Urbina's opinion; and
(2) the ALJ properly evaluated Plaintiff's subjective
symptom testimony. (Doc. 24, pgs. 6-10).
hearing was held in Stockton, California. AR 38. Plaintiff
and a vocational expert, Stephen Schmidt, testified. AR 38.
Plaintiff was 56 years old at the time of the hearing. AR 46.
He earned a GED in 2000 while incarcerated. AR 46. At the
time of the hearing, Plaintiff was enrolled in Modesto Junior
College and was receiving special accommodations, i.e.
private room for testing. AR 46-47. However, he was unable to
maintain being enrolled in four classes. AR 47-48.
reported having a history of drug and alcohol use but stopped
"using" and "drinking" about 10 years
ago. AR 52-53. He attributes the outset of his mental health
condition to suffering from verbal, physical, and sexual
abuse as a child. AR 55. He has lost over 100 jobs as a
result of being uneasy, angry, and unfocused due to his
mental health condition. AR 54. He testified he would become
violent and angry in a work environment, even while on
medication and undergoing counseling. AR 58-59.
Gardner Family Care Corp.
participated in mental health services at Gardner Family Care
Corp. (GFCC) from December 2009 to December 2010. AR 373.
Treatment plans dated March 2010 and June 2010 describe
Plaintiff as presenting with depressed mood, anger problems,
weight gain, hypersomnia, history of suicidal ideations as a
teenager, and hopelessness. AR 379-380. In July 2010,
Plaintiff's chief complaint was being scared all the time
and angry. AR 374. However, the psychiatric evaluation
describes his mood only as sad. AR 376. Plaintiff reported
using medically prescribed marijuana daily since September
2009 to ease his pain from Hepatitis C treatment. AR 375;
Stanislaus Behavioral Health
a psychiatric consultation at Stanislaus Behavioral Health in
November 2012, Plaintiff reported he slept most of the time,
had no energy, and felt hopeless and helpless for years. AR
369. He also reported feeling angry and anxious depending on
the situation. AR 369. SSRI's and therapy/anger
management were recommended. AR 370.
April, 2013, Plaintiff denied suicidal intent but reported
feeling like he wanted to die. AR 395. Plaintiff also
reported hearing voices and smoked marijuana to calm himself
down. AR 396. Rachel Acosta, M.F.T., described Plaintiff as
appearing paranoid and becoming confused and irrational when
attempting to talk about his thoughts. AR 396. Acosta also
described Plaintiff as sincere, hopeful, and pleasant. AR
396. During a mental status examination, Plaintiff had
decreased motor activity that was tense and teary, decreased
speech, poor concentration, poor judgement, and poor impulse
control. AR 398. However, Plaintiff was oriented to person,
time and place, had directed flow of thought, normal memory,
and average intellect. AR 398.
2013, Plaintiff was not taking medication and complained of
depression with suicidal ideation, anger issues, paranoia,
auditory hallucinations, and thoughts of violence. AR 390.
Medication was prescribed. AR 391. In July 2013, Plaintiff
claimed the medication was helping and did not produce any
side effects. AR 388; 394. He complained of paranoia but
denied auditory hallucinations. AR 388. At a check-up in
September 2013, Plaintiff was still taking medication and
denied both auditory hallucinations and paranoia. AR 406.
January 2014, Plaintiff had his initial visit with Dr.
Urbina. AR 405. Dr. Urbina reports that Plaintiff claimed to
be taking medication but the pharmacy confirmed Plaintiff had
not picked up the medication prescribed to him three months
earlier. AR 405. Plaintiff complained of depressed mood, lack
of motivation, and some level of frustration. AR 405. At a
February 2014 follow-up visit, Plaintiff reported he was
compliant with medication. AR 404. Dr. Urbina did not report
any complaints and described Plaintiff's mood as
"better." AR 404. In March 2014, Plaintiff claimed
to be compliant with medication. AR 403. Dr. Urbina did not
report any complaints and described Plaintiff's mood as
euthymic. AR 403.
Dr. Urbina completed a medical opinion questionnaire in
February 2014, while Plaintiff was on medication. AR 407;
404. Dr. Urbina states that Plaintiff has frequent anger
outbursts resulting in violent behaviors and impaired ability
to maintain concentration and attention. AR 407. Dr. Urbina
diagnosed Plaintiff as suffering from chronic major
depressive disorder and post-traumatic stress disorder. He
opined that exposing Plaintiff ...