United States District Court, N.D. California
ORDER REGARDING CROSS-MOTIONS FOR SUMMARY JUDGMENT
RE: DKT. NOS. 18, 19
PHYLLIS J. HAMILTON, United States District Judge.
Timothy Needham seeks judicial review of the Commissioner of
Social Security's (the “Commissioner”) final
decision denying Needham's claim for disability benefits
pursuant to 42 U.S.C. § 405(g). This action is before
the court on the parties' cross-motions for summary
judgment. Having considered the parties' cross-motions,
the pertinent legal authorities, and having reviewed the
administrative record, the court hereby remands this case to
the Commissioner for further proceedings in accordance with
this court's order.
October 2013, Needham applied for Supplemental Security
Income, alleging disability beginning in September 2006.
Administrative Record (“A.R.”) 61. Needham
attended school through the tenth grade, obtained his GED,
and attended community college for a semester or two. A.R.
39, 539, 770, 913. Needham worked as a truck driver from at
least 1996 (perhaps earlier) to about 2001, when he was
attacked on the job and experienced trauma-related anxiety.
A.R. 243-44, 258, 270, 289, 389, 519. Around 2006, he
divorced his wife, and in 2012 he became homeless. A.R. 240,
389, 520, 769-70, 913. He has used methamphetamine off and on
throughout his life. A.R. 519.
September 7, 2013, Needham attempted to commit suicide. A.R.
518. After being injured in an altercation and admitted into
Eden Medical Center's emergency room, he entered a
bathroom, slit his wrists, took a mixture of pills, wrote a
suicide note on the mirror, and hit the call button. A.R.
408, 417, 420, 518, 543, 788, 808. Medical staff gave him
medication and transferred him to John George Psychiatric
Pavilion at the Highland Campus, where he was diagnosed with
depressive disorder not otherwise specified
(“NOS”) and alcohol abuse and assigned a Global
Assessment Functioning (“GAF”) score of 20.
A.R. 443-45, 810. While at John George Psychiatric Pavilion,
Dr. John Fenton, M.D. evaluated Needham and diagnosed him
with major depressive disorder, alcohol abuse, and history of
amphetamine abuse. A.R. 542. Dr. Fenton reported improvement
in Needham's mood and that medication doses had been
adjusted to “therapeutic effect.” A.R. 544.
was thereafter admitted to Woodroe Place Crisis Resolution, a
residential mental health facility operated by Bay Area
Community Services (“BACS”). A.R. 541, see
also A.R. 904. At Woodroe Place, Dr. Edward Maxwell
observed that Needham was restless with a dysphoric,
expansive mood and mildly impaired judgment. A.R. 905-06.
Needham continued to receive therapy from mental health
counselors and was assessed GAF scores ranging from 45 to 55.
A.R. 893, 907.
October 9, 2013, Needham was discharged from Woodroe Place
and moved to the A Street shelter. A.R. 893. On October 10,
2013, Needham began participating in mental health treatment
and case management with BACS Oakland Project Connect. A.R.
1074. He continued almost weekly contact with therapists and
case managers until July 28, 2016. E.g., A.R. 922.
October 2013 and December 2013, Needham was also treated at
the Sausal Creek Outpatient Stabilization Clinic, a drop-in
mental health clinic. A.R. 485- 505. On October 28, 2013, Dr.
Emma Castro observed that he was alert and had anxious mood,
irritable affect, logical thought process, and marginal
judgment. A.R. 495. She also saw him on November 8, November
22, 2013, and December 6, 2013, diagnosing him with psychotic
disorder NOS, bipolar disorder, and polysubstance dependence
in partial remission, and assigning GAF scores of 50, 52, and
55. A.R. 486, 490, 495. By the last visit, “the meds
seem[ed] to be working good” and Needham's insight
and judgment were good. A.R. 486.
December 2013, Needham had several evaluations at the Winton
Wellness Center. On December 4, 2013, he saw Dr.
Srilekha Puranam for his hypertension and bipolar disorder.
A.R. 763, 768. He reported aggravation of the bipolar
disorder by drug use as well as decreased sleep, depressed
mood, and racing thoughts, but no suicidal ideation. A.R.
763. On December 13, 2013, Needham had an initial psychiatric
evaluation with Dr. Catalina Villa. A.R. 769-72. He reported
symptoms of severe depression at least one week per month,
including crying, staying in bed, and decreased appetite.
A.R. 769. Dr. Villa noted that despite a
“constricted” affect, Needham showed
“unremarkable” behavior, good impulse control,
and no suicidal or homicidal ideation. A.R. 771. She
diagnosed him with unspecified bipolar disorder, alcohol
dependence in early remission, and amphetamine dependence in
full remission. Id.
January 29, 2014, Needham returned to Sausal Creek with
increased symptoms, reporting he was “up/down with
depression” for three weeks and that his medications
were not helping. A.R. 734. On February 24, 2014, he returned
again to Sausal Creek requesting medication for depression.
A.R. 729. The staff psychiatrist noted his euthymic affect
and depressed mood and diagnosed him with psychotic disorder
NOS, bipolar disorder, and polysubstance abuse with a GAF
score of 55. A.R. 730. He prescribed him the same dosage of
Remeron, Risperdone, Depakote, and Benadryl, and added
Buproprin. A.R. 728.
February 14, 2014, psychologist Dr. Deepa Abraham examined
Needham and conducted a records review. A.R. 516. She noted
he had “somewhat pressured” speech, intact
concentration, and average results on the Wechsler Adult
Intelligence Scales. A.R. 521-23. She reported that Needham
exhibited symptoms of depression such as lethargy, insomnia,
and social withdrawal and a manic presentation including
grandiosity, racing thoughts, and reckless behavior. A.R.
526. She diagnosed him with mood disorder NOS and
polysubstance dependence while assigning him a GAF score of
35. A.R. 527. Because of his symptoms, she opined that he
would “experience difficulty competing for jobs in an
open labor market” and “difficulty coping with
daily or the usual stresses encountered in a competitive work
environment.” A.R. 528-29. She also noted his low
auditory memory scores that “might reflect in
difficulty with remembering work assignments, processing
complex instructions or in completing tasks.” A.R. 528.
She concluded that he had mild impairments in understanding,
comprehending, and remembering information; no significant
impairment in social interaction; and moderate impairment in
adaptation. A.R. 528-29.
April 1, 2014, Dr. Puranam reported Needham's bipolar
disorder and insomnia were “[w]ell controlled”
and noted he had not used alcohol in two months and
amphetamines in four months. A.R. 756. Around this time,
Needham moved to transitional housing. A.R. 1056-58.
2014, Needham continued services at BACS Oakland Project
Connect. He met with MacKenzie Stuart, a BACS unlicensed
marriage and family therapist and Tiffany Smith, a BACS
personal services coordinator, on a weekly basis for therapy
and help with tasks and appointments. A.R. 1031-63. Ms.
Stuart diagnosed Needham with a consistent GAF score of 45.
A.R. 1031-63. His symptoms included “overwhelming
sadness” (A.R. 1039), suicidal ideation (A.R. 1045-46),
anhedonia (A.R. 1039-44, 1047), hypersomnia (A.R. 1039,
1050), and fear of leaving the house (A.R. 1054). He also
presented with pressured speech, racing thoughts, and
anxiety. A.R. 1033, 1037, 1049. Other times, he presented as
euthymic (A.R. 1050-53) and reported having
“significantly better” mood (A.R. 1037) and no
recent manic or severe depressive episodes (A.R. 1053).
December 15, 2014, Needham had an intake appointment with
psychiatrist Dr. Catherine Reed at Pathways to Wellness
(“Pathways”), a mental health clinic. A.R. 531,
536. Needham reported mood swings, insomnia, and nighttime
auditory hallucinations that affected his activities of daily
living. A.R. 531, 535-36. Dr. Reed diagnosed him with bipolar
disorder, depression, with psychotic features, and
amphetamine dependence in remission with a GAF score of 65.
A.R. 535. She noted he had normal behavior, normal speech,
depressed mood but was “hopeful, ” and
appropriate affect. A.R. 534. She added Latuda to his
medications (A.R. 537) and opined that he had moderate
restrictions in activities of daily living; moderate
difficulties in social functioning; mild difficulties in
maintaining, concentrating, and persistence of pace; and
moderate episodes of decomposition and increase of symptoms
continued treatment at Pathways throughout 2015. On March 19,
2015, Needham reported improvement with medications and mild
sadness. A.R. 889. Dr. Reed assessed a GAF score of 60-65.
A.R. 888. On April 8, 2015, Needham told Dr. Puranam that he
felt better as his medication changed from Risperdone to
Latuda. A.R. 846. On July 9, 2015, Dr. Reed upgraded his GAF
score to 65 after noting a good response to medications, his
attendance in DUI classes, and lack of psychosis or mania.
A.R. 884-85. On August 26, 2015, Needham reported feeling
very sad after a friend's death and had not taken
medication for two weeks. A.R. 882-83. On September 28, 2015,
Needham reported fewer auditory hallucinations and better
sleep after increased dosage of Latuda. A.R. 880-81. Starting
in August 2015, Dr. Reed reduced Needham's Wellbutrin
dosage because of his increased blood pressure, and on
December 16, 2015 Nurse Practitioner Sarah Levine noted that
Needham's depression was exacerbated by the holiday
season. A.R. 876-77.
2015 and 2016, Needham continued to work with BACS for
housing, employment, and symptom management. A.R. 990, 922.
Shandra Guzman diagnosed him with major depressive disorder
(severe without psychotic features), alcohol dependence, and
amphetamine dependence (sustained remission) with a GAF score
of 45. A.R. 990. On March 25, 2015, Ms. Stuart
“supported” Needham to an internal medicine
consultation and observed that he was anxious about attending
the appointment. A.R. 1019. Needham reported needing help to
complete tasks and periods of increased depression. A.R.
953-55, 986, 1008-11, 1025.
January 2016, Needham moved to permanent supportive housing,
and he continued treatment at Pathways until November 2016.
A.R. 939, 1078. On February 24, 2016, Needham reported
anxiety over the recent move and increased auditory
hallucinations. A.R. 875. On March 23, 2016, he reported
improvement in mood since increasing his Latuda dosage. A.R.
872. On April 27, 2016, Needham reported he was doing fairly
well but still spent most of the day in bed about once a
week; Nurse Levine assigned a GAF score of 60. A.R. 870. As
of June 23, 2016, a Pathways psychiatrist reported that
Needham was stable on medications “after so many
trials.” A.R. 869. On September 29, 2016, Needham said
he was “doing well with his med[ication]s” and
presented with normal speech and euthymic mood. A.R. 1077.
April 2017, Needham began therapy, social groups, and case
management at Lifelong Medical Care. A.R. 1082. On April 27,
2017, Needham felt stable on his medications and denied
suicidal ideation. On April 28, 2017, therapist Ann Sussman
observed Needham had rapid speech, tangential thought
processes with grandiose content, and that he “mostly
blame[d] others for [his] problems.” A.R. 1093. On May
5, 2017, Needham said he was “doing pretty well”
and admitted to “drinking and smoking pot on
occasion[.]” A.R. 1096-97.
October 25, 2013, Needham filed a Title II application for a
period of disability and disability insurance benefits as
well as a Title XVI application for supplemental security
income. A.R. 15, 61, 85-86. Both applications stated an
alleged onset date of September 29, 2006 for disability. A.R.
61. The Commissioner denied Needham's claims both
initially and again upon reconsideration on September 17,
2014 and June 3, 2015, respectively. A.R. 84, 116. On July
13, 2015, Needham requested a hearing before an ALJ which
took place on May 19, 2017. A.R. 145, 196. At the hearing,
plaintiff amended his disability onset date to September 7,
2013. A.R. 15, 59, 390. Vocational expert Christopher Salvo
testified at the proceeding. A.R. 54-59. Needham also
testified and answered questions from the ALJ and his
counsel. A.R. 38-54.
2017, the ALJ found that plaintiff was not disabled. The
ALJ's May 2017 decision became the Commissioner's
final decision when the Appeals Council denied
plaintiff's request for review. A.R. 1-7.
AND REGULATORY FRAMEWORK
Social Security Act provides for the payment of disability
insurance benefits to people who have contributed to the
social security system and who suffer from a physical or
mental disability. See 42 U.S.C. § 423(a)(1).
To evaluate whether a claimant is disabled within the meaning
of the Act, the ALJ is required to use a five-step sequential
analysis. See 20 C.F.R. § 416.920(a). The ALJ
may terminate the analysis at any step if he determines that
the claimant is or is not disabled. Pitzer v.
Sullivan, 908 F.2d 502, 504 (9th Cir. 1990).
one, the ALJ determines whether the claimant is engaging in
any “substantial gainful activity, ” which would
automatically preclude the claimant receiving disability
benefits. 20 C.F.R. §§ 416.920(a)(4)(i) & (b).
If not, at step two, the ALJ considers whether the claimant
suffers from a severe impairment which “significantly
limits [her] physical or mental ability to do basic work
activities.” 20 C.F.R. §§ 416.920(a)(4)(ii)
third step, the ALJ is required to compare the claimant's
impairment(s) to a listing of impairments provided in an
appendix to the regulations. 20 C.F.R. §
416.920(a)(4)(iii). If the claimant's impairment or
combination of impairments meets or equals the severity of
any medical condition contained in the listing, the claimant
is presumed disabled and should be awarded benefits.
Id.; 20 C.F.R. § 416.920(d).
claimant's condition does not meet or equal a listing, at
step four the ALJ considers whether the claimant has
sufficient residual functional capacity (“RFC”)
to perform his past work despite the limitations caused by
the impairments. 20 C.F.R. §§ 416.920(a)(4)(iv)
& (e)-(f). An individual's RFC is what he can still
do in a workplace setting despite his physical and mental
limitations. 20 C.F.R. § 416.945. In determining the
RFC, the ALJ must consider all of the claimant's
impairments, including those that are not severe, taking into
account all relevant medical and other evidence. 20 C.F.R.
§§ 416.920(e), 416.945. If the claimant cannot
perform his past work, the Commissioner is required to
determine, at step five, whether the claimant can perform
other work that exists in significant numbers in the national
economy, taking into consideration the claimant's RFC,
age, education, and work experience. See 20 C.F.R.
§§ 416.920(a)(4)(v) & (g).
steps one through four, the claimant has the burden to
demonstrate a severe impairment and an inability to engage in
his previous occupation. Andrews v. Shalala, 53 F.3d
1035, 1040 (9th Cir. 1995). If the analysis proceeds at step
five, the burden shifts to the Commissioner to demonstrate
that the claimant can perform other work. Id.
31, 2017, the ALJ applied the sequential analysis and found
that Needham was not disabled, concluding that he could
perform jobs within the national economy. A.R. 12-27.
The ALJ's Sequential Analysis
one, the ALJ determined Needham had not engaged in
“substantial gainful activity” since his amended
onset date of September 7, 2013. A.R. 17.
two, the ALJ found Needham suffered from severe impairments
of bipolar disorder, amphetamine dependence, alcohol
dependence, and obesity. A.R. 18. The ALJ also found that
Needham's hypertension and sarcoidosis were non-severe
impairments and that Needham did not provide evidence that
these impairments would result in a significant limitation in
basic work-related activities. A.R. 18-19.
three, the ALJ concluded that the impairments failed to meet
the criteria or severity of any section of the listing of
impairments in 20 CFR Part 404, subpart P, Appendix 1. A.R.
19-23. In making that finding, the ALJ considered whether the
“paragraph B” criteria were satisfied. The ALJ
found that disability could not be established under
paragraph B in light of the medical facts. A.R. 19-23. The
mental health records “reveal one major crisis but are
inconsistent with disability.” A.R. 19. The ALJ
reviewed medical records, evaluated the persuasiveness of
various sources in the record, and concluded that
plaintiff's mental impairments do not cause at least two
“marked” limitations or one “extreme”
limitation, so paragraph B criteria were not satisfied. A.R.
23. The ALJ also briefly addressed paragraph C and determined
plaintiff did not satisfy its requirements. A.R. 23.
found that Needham did not suffer from a listed impairment,
the ALJ determined Needham's RFC. The ALJ applied a
two-step process that considered all symptoms regardless of
severity. A.R. 23. First, the ALJ determined whether there
was an underlying medically-determinable physical or mental
impairment that could reasonably be expected to produce
Needham's pain or other symptoms. A.R. 23. The ALJ
concluded that Needham's medically-determinable
impairments could reasonably be expected to cause the alleged
symptoms. A.R. 24. Second, the ALJ evaluated the intensity,
persistence, and limiting effects of Needham's symptoms
to determine the extent to which they limited his
functioning. A.R. 23. The ALJ concluded that Needham's
testimony about the intensity, persistence and limiting
effects of the symptoms was not entirely consistent with
medical evidence and other evidence in the record. A.R. 24.
Where Needham reported symptoms that did not match the
objective medical evidence, the ALJ made a credibility
determination based on the entire medical record:
Claimant alleges he quit working as a truck driver in 2004
because of his conditions. . . However, he has submitted no
evidence from that time, and the current medical evidence of
record shows claimant . . . lost his license/job after
crashing into a pole and received a DUI. Claimant testified
he is unable to work due to his depression . . . [and] hears
voices, which prevents him from concentrating. On April 27,
2016, claimant reported he is not bothered by his auditory
hallucinations . . . He reported “doing well with his
meds, ” and was assigned a GAF score of 60 . . . .
Recent records from Lifelong Medical indicate claimant
remains stable on medications.
AT 24 (internal quotation marks and citations omitted). The
ALJ determined that plaintiff has the RFC to perform light
work, with certain exceptions. A.R. 23.
four of the sequential analysis, the ALJ determined that
Needham had no past relevant work. A.R. 25.
five, based on the vocational expert's testimony, the ALJ
determined that jobs existed in significant numbers in the
national economy that Needham could perform. A.R. 25-26.
Specifically, Needham's RFC did not prevent him from
working as a “small products assembler”,
“production assembler”, or “maid” as
described in the Dictionary of Occupational Titles. A.R. 26.
The ALJ therefore determined that Needham was not disabled
and not eligible for disability benefits under the Social
Security Act. A.R. 26.
The ALJ's Weighing of the Medical Opinions and
considered and weighed the testimony and opinions of several
medical professionals. The primary medical opinions were
Dr. Deepa Abraham
Abraham administered a psychological evaluation of Needham on
February 14, 2014. A.R. 516. She opined that he would have
“difficulty coping with [the] daily or  usual
stresses encountered in a competitive work environment”
and that he has “mood changes that interfere with his
ability to sustain effort or adapt to changes in tasks or
responsibilities.” A.R. 529. She concluded he had mild
impairments in understanding information, no significant
impairment in social interaction, and moderate impairment in
adaptation. A.R. 528-29.
Abraham was an examining psychologist, and the ALJ gave her
opinion “great weight” because her opinions were
“consistent with the medical evidence…and based
upon a thorough examination and records review.” A.R.
Dr. Catherine Reed
Reed conducted an initial psychological intake of Needham on
December 15, 2014 (A.R. 536) and treated him from February
11, 2015 to October 26, 2015 (A.R. 879, 891). At intake, she
assessed that he had moderate restrictions in activities of
daily living; moderate difficulties in social functioning;
mild difficulties in maintaining, concentrating, and
persistence of pace; and moderate episodes of decomposition
and increase of symptoms. A.R. 535.
Reed was a treating psychiatrist, and the ALJ gave her
opinion “great weight” because it was
“consistent with the medical evidence of record.”
Dr. Margaret Pollack
30, 2014, Dr. Pollack, Psy.D. conducted a psychological
consultative review of the medical records that guided the
Social Security Administration's determination of
“Not Disabled.” A.R. 69, 72. Dr. Pollack noted
that in Dr. Abraham's evaluation, Needham alleged
auditory hallucinations, but “there was no evidence
that he was responding to internal stimuli and no other
evidence of psychosis.” A.R. 69. Dr. Pollack opined
that his depression and bipolar disorder were negatively
impacted by lack of reasonable compliance and
“significant” substance abuse problems. A.R. 69.
She believed that with sustained sobriety, Needham
“should be capable of simple & detailed work-like
activity for full workday/work week.” A.R. 69. She
found his allegations about the severity of his condition to
be “partially credible, ” enough to establish
mild cognitive impairment but not enough to preclude all
work-like activity. A.R. 70.
Needham's social interaction, Dr. Pollack found he was
not significantly limited in interacting with the general
public and getting along with peers, however, his ability to
respond to criticism from supervisors was moderately limited.
A.R. 71. As for Needham's adaptation, she found he was
not significantly limited in traveling to unfamiliar places
or using public transportation, not significantly limited in
setting realistic goals and being aware of hazards, but
moderately limited in responding to changes in the work
setting. A.R. 71. Accordingly, Dr. Pollack concluded
plaintiff had mild restriction in activities of daily living;
moderate difficulties in social functioning; mild
difficulties in concentration, persistence, or pace; and no
repeated episodes of decompensation of extended duration.
Pollack was a non-examining, state consultant physician, and
the ALJ gave her opinion “most weight” because it
was “consistent with the medical evidence of record.