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Steagall v. Berryhill

United States District Court, C.D. California

May 16, 2017

NANCY BERRYHILL, Acting Commissioner of the Social Security Administration, Defendant.





         Zina Steagall (“Plaintiff”) brings this action seeking to overturn the decision by the Commissioner of the Social Security Administration (hereinafter the “Commissioner” or the “Agency”) denying her application for Supplemental Security Income (“SSI”). The parties consented, pursuant to 28 U.S.C. § 636, to the jurisdiction of the undersigned United States Magistrate Judge. For the reasons stated below, the decision of the Commissioner is AFFIRMED.



         Plaintiff filed an application for SSI on July 23, 2012. (Administrative Record (“AR”) 166). The Agency initially denied Plaintiff's claim for SSI on November 7, 2012. (AR 197). Plaintiff filed a Request for Reconsideration. (AR 203). The Agency denied the request for reconsideration. (AR 204). Plaintiff filed a Request for Hearing by Administrative Law Judge on July 26, 2013. (AR 211). On April 18, 2014, Administrative Law Judge (“ALJ”) Tamara Turner-Jones conducted a hearing to review Plaintiff's claim. (AR 28-44). On October 23, 2014, ALJ Dana McDonald conducted a supplemental hearing. (AR 45-56). On November 7, 2014, ALJ McDonald found that Plaintiff was not disabled. (AR 7, 22). Plaintiff sought review of the ALJ's decision before the Appeals Council on November 26, 2014. (AR 5). On April 18, 2016, the Appeals Council denied review. (AR 1-3). As such, the ALJ's decision became the final decision of the Commissioner. (AR 1). Plaintiff commenced the instant action on May 12, 2016. (Dkt. No. 1).



         A. Plaintiff's History

         Plaintiff was born on July 13, 1967. (AR 20, 33). Plaintiff left school after completing the eleventh grade. (AR 876). Plaintiff worked as a hairstylist until 2007. (AR 508). At the April 2014 hearing, Plaintiff testified that she also previously worked in childcare, watching two young children for her sister-in-law. (AR 35-36). Plaintiff testified, however, that she stopped working because she heard voices telling her not to work. Plaintiff has not sought work since 2005 or 2006. (AR 36).

         Medical records dated July 2, 2014 note that Plaintiff has seven children between the ages of 14 and 26. (AR 876). While Plaintiff testified to living with her daughters (AR 34), medical records state that she lives with one daughter, her sister, her sister's children, as well as several pets. (AR 876).

         Plaintiff's May 17, 2013 medical records list “TANF, Food Stamps” under “Current Source of Income”. (AR 508). Additionally, Plaintiff testified that she receives benefits for her minor children. (AR 38).

         Medical records from the Riverside County Department of Mental Health, Alcohol and Drug Services, dated January 14, 2013 state that Plaintiff's mother denied that Plaintiff had any current or past use of alcohol or street drugs. (AR 716). However, an Emergency Room Continuation of Care Report dated February 9, 2013 notes that Plaintiff “was brought in by Emergency Medical Services, secondary to doing PCP today” (AR 800) and that Plaintiff “stated she smoked some PCP and [] doesn't remember what happen[ed].” (AR 804). Medical records from this date also list “drug use” under “Past Medical History”. (AR 803).

         On May 17, 2013, Plaintiff denied substance abuse to consultative physician Dr. Paul Martin. However, Dr. Martin's comments state that “her behavior on exam certainly raises concerns regarding this area.” (AR 507-508).

         On August 5, 2013, an Emergency Room Continuation of Care Report notes that Plaintiff's “urine drugs screen” tested positive for PCP. (AR 774). Additionally, an August 10, 2013 Emergency Room Report notes PCP abuse under past medical history. (AR 766). This same report states that Plaintiff had been discharged from Menifee Valley Medical Center a few days prior with a diagnosis of “altered level of consciousness and delirium, secondary to PCP [] abuse.” (AR 767).

         On August 13, 2013, another Emergency Room Report states that Plaintiff came in complaining of severe pain and wanting pain medications, however had “slurred speech” and “was positive for PCP”. (AR 763).

         Mental health records from August 16, 2013 note that Plaintiff's landlord reported concerns about Plaintiff's well-being. Specifically, the landlord reported that she had recently seen Plaintiff and that she “could hardly talk and appeared to be under the influence of medications that made her look ‘out of it'. [The Landlord] verbalized concern that [Plaintiff] was driving in this condition and that she also drove her two children this way as well.” (AR 691). Case management records from January 2013 indicate that Plaintiff received a DUI while driving under the influence of her prescription medications. (AR 684).

         On October 8, 2013, Plaintiff stated during an interview that she “‘had just started using PCP this past year', but that she ‘has been clean for x4 months.' Later, during the interview [Plaintiff] stated that she ‘has been using [PCP] a long time.'” (AR 687). She further stated that she “hears voices (‘not now, I took my meds') that tell her to use.” (Id.). That same day, Plaintiff “stated that she has been clean and sober for x45 days from PCP” and expressed “how she feels she ‘gets worse when using' and ‘the voices tell her to do bad things, worse when on PCP.'” Plaintiff also denied auditory or visual hallucinations. However, she stated that she experiences hallucinations when not on her medication. (AR 688). Additionally, notes from Plaintiff's group mental health service on April 8, 2014 state that Plaintiff “checked into group, introduced herself, drug of choice as PCP”. (AR 894).

         Notes from Plaintiff's orthopedic consultation with Dr. Mario Luna on June 30, 2014 report, however, that Plaintiff “has never used drugs”. (AR 864). Likewise, on July 2, 2014, Plaintiff had a psychological evaluation with Dr. Kathy Vandenburgh. Under “Habits, ” Dr. Vandenburgh's report states that Plaintiff “denies a history of drug or alcohol abuse.” (AR 877).

         Under “Legal, ” this report also states that Plaintiff “reports a history of incarceration in prison for two years in 2003 due to trying to hurt somebody else.” (Id.). Medical records from May 17, 2013 similarly state that plaintiff “acknowledged some involvement with the legal system, including serving a prison term, but she would not elaborate on the details.” (AR 508).

         Plaintiff's July 23, 2012 application for SSI alleged disability beginning on March 27, 2007 due to a variety of conditions, including asthma, hypertension, and severe carpal tunnel syndrome. (AR 166). Beginning in January 2013, Plaintiff sought mental health treatment and participated in group therapy. (AR 648-720, 891-898). Treatment notes indicate that Plaintiff exhibited restless motor activity, illogical thought processes, bizarre thought content, paranoid delusions, auditory and visual hallucinations, poor eye contact, irritability and a depressed mood. (AR 648-702). On February 20, 2013, Plaintiff received a diagnosis of “psychosis, NOS.” (AR 675).

         B. Plaintiff's Testimony

         On April 18, 2014, Plaintiff testified about her work history, symptoms, and limitations in response to the ALJ's questions. (AR 32-43). Plaintiff testified that she could no longer work due to back pain, auditory hallucinations and difficulty being around others. (AR 42-43). In reference to her imaginary person, Plaintiff stated that “Susan tells me don't work. She doesn't want me to do anything. Susan just wants me all to herself and we sit there and we talk to each other and we talk to each other and those people and stuff in my head.” (AR 42). She further stated that she does not “like to be around a lot of people. They put - Susan tells me to - she just wants me all to herself and she doesn't want me to be around a lot of people.” (Id.).

         Plaintiff testified about her daily living, stating that she could not do household chores. (AR 38). She testified that her mother and daughters help her to get dressed and take care of her personal hygiene needs. (AR 37-38). She testified that she goes to the grocery store once a month with her family. However, she does not walk around the store but, rather, sits in a “wheelie cart.” (AR 39). She further testified that she watches TV “all day” and likes to lay down. (AR 39).

         C. Treating Physicians

         1. Niraj Gupta, M.D.

         Plaintiff had a mental health appointment with her treating physician, Dr. Niraj Gupta, on September 17, 2014. (AR 891-898). During this appointment, Dr. Gupta diagnosed Plaintiff with “Schizophrenia, Paranoid Type” and “Mental Retardation, Severity Unspecified.” (AR 896). Dr. Gupta completed a “Narrative Report” based on this appointment, noting that Plaintiff suffered from auditory and visual hallucinations, that delusions and paranoid thoughts influenced her actions or behavior, that she had a severe memory deficit and a moderate judgment deficit, that she was not able to complete a forty-hour work week without decompensating, and that her diagnosis was “chronic.” (AR 895). Dr. Gupta also noted, however, that Plaintiff was able to manage her own funds in her best interest. (AR 895). At this appointment, Dr. Gupta provided a Global Assessment of Functioning (“GAF”) score of 50 for Plaintiff, indicating that her mental impairment symptoms fell within the “serious” range of severity. (AR 896).

         2. Marianne Tahl, M.D.

         On October 10, 2011, Plaintiff's treating Physician, Dr. Marianne Tahl, wrote a letter on Plaintiff's behalf stating that Plaintiff was currently under her care and “may not return to work at this time.” (AR 482). On March 15, 2013, Plaintiff called Dr. Tahl's office “requesting a letter stating she needs to be off work from January 2013 [until] . . . further notice.” (AR 576). On March 29, 2013, Dr. Tahl wrote a letter on Plaintiff's behalf stating that she “may not return to work indefinitely as of 1/13/2013, due to a medical condition.” (AR 862). On April 11, ...

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