Contreras v. Saul

          REPORT AND RECOMMENDATION FOR ORDER: (1) DENYING PLAINTIFF'S MOTION FOR SUMMARY JUDGMENT [ECF NO. 12]; AND (2) GRANTING DEFENDANT'S MOTION FOR SUMMARY JUDGMENT [ECF NO. 16]

          HON. NITA L. STORMES UNITED STATES MAGISTRATE JUDGE.

         Precila Contreras (“Plaintiff”) brings this action under the Social Security Act, 42 U.S.C. § 405(g), and seeks judicial review of the Social Security Administration's (“Defendant”) final decision denying her claim for disability insurance benefits. This case was referred for a report and recommendation on the parties' cross motions for summary judgment. See 28 U.S.C. § 636(b)(1)(B); ECF Nos. 12, 16, 20. After considering the papers submitted, the administrative record, and the applicable law, the Court RECOMMENDS that Plaintiff's motion for summary judgment be DENIED and that Defendant's cross motion for summary judgment be GRANTED.

         I. Background

         A. Procedural History

         Plaintiff filed a Title II application for Social Security Disability Insurance on September 28, 2015. Administrative Record (“AR”) 182-183. She alleges a disability onset date of June 30, 2014. AR 182. The Commissioner denied Plaintiff's claim initially on December 21, 2015 and on reconsideration on March 2, 2016. AR 84-108. Plaintiff then requested a hearing before an Administrative Law Judge (“ALJ”), which was held on December 8, 2017. AR 20, 36. Plaintiff was represented by counsel at the hearing. Id. Plaintiff and vocational expert Sonia Peterson testified at the hearing. AR 36-37.

         On March 15, 2018, the ALJ issued a decision denying Plaintiff's request for benefits, finding that Plaintiff had not been under a disability within the meaning of the Social Security Act from June 30, 2014 through the date of the decision. AR 30. Plaintiff filed a Request for Reconsideration on May 7, 2018. AR 176-77. On February 13, 2019, the Appeals Council denied Plaintiff's request for review, making the ALJ's decision the final decision of the Commissioner for judicial review purposes. AR 1-3. Plaintiff timely commenced this action in federal court.

         B. Plaintiff's Background and Testimony

         Plaintiff was born on April 4, 1955. AR 85. Plaintiff claims that she suffers from hypertension, kidney problems related to high blood pressure, anxiety, panic attacks, depression, “heart condition, prior MI infarction, ” high cholesterol, headaches, and “poor sleep.” AR 248.

         Regarding education, Plaintiff has received advanced education. AR 249. Plaintiff has held several jobs in the medical field. From 1987-1995, Plaintiff worked as a telemetry technician at Scripps Green Clinic. AR 265; see also AR 53-54. Plaintiff started working as a Registered Nurse in 1995, and worked in that capacity at Scripps Green Clinic until 2002. AR 265. Starting in 2002, Plaintiff worked as a Registered Nurse at Palomar Hospital. AR 265. Plaintiff stopped working there after an incident where she was accused of making a mistake while treating a patient, although Plaintiff testified that she felt that those accusations were unfair.^[1] AR 45-47. Plaintiff testified that she suffered from high blood pressure from the stress caused by being accused on the mistake. AR 51. However, Plaintiff did not stop working immediately after the incident.^[2] AR 48-49. Plaintiff briefly returned to work at the hospital, but stopped working three days later after the hospital expressed dissatisfaction with her performance. AR 57-59. The ALJ asked Plaintiff whether she would have continued working at Palomar if the incident and resulting high blood pressure had not occurred. AR 52. Plaintiff answered “Yes. As long as they want me to work, I will work, ” and indicated that she would have remained at Palomar until she reached retirement age. AR 52. The ALJ also ascertained that Plaintiff had received a disability settlement from her insurance company in the amount of approximately $50, 000, exclusive of attorney's fees. AR 50.

         Plaintiff lives in a home with her husband and son. AR 55-56; 104. Plaintiff engages in several daily activities. Plaintiff occupies herself with housework, including cleaning, gardening, cooking and grocery shopping. AR 65-66; 57. She also watches television and is still able to sometimes drive. AR 66, 57. Plaintiff testified that she was unable to return to work because of physical and mental impairments. AR 61. When probed by the ALJ as to what her physical limitations were, Plaintiff responded “[d]riving or thinking or walking.” AR 61. The ALJ attempted to clarify this point by asking Plaintiff how far she could walk. AR 61. Plaintiff replied, “not so far.” AR 61. Plaintiff testified that she had difficulty walking following an incident in which she had fallen from a tree and had left her suffering from scoliosis and broken ribs. AR 61-62.

         During her examination by her attorney, Plaintiff testified to hearing and seeing things and to attempting suicide on two occasions.^[3] AR 67-68. Plaintiff also testified to suffering from memory loss and being unable to recall the questions asked by the ALJ or her answers. AR. 72-73.

         C. Documentary Medical Evidence

         1. Physical Health^[4]

         A. Dr. Chang

         Plaintiff's medical records show that she was a patient at Sharp Rees-Stealy Med Group (“SRSMG”), that Dr. Chang acted as her primary care physician, and that Plaintiff received medical treatment from Dr. Chang between June 30, 2014 and February 24, 2016. See generally AR 311-342; 348-366; 435; 437; 561-568; 576-78; 674-76. The records show that Plaintiff visited Dr. Chang at regular intervals for check-ups and follow-ups related to her visit to the emergency room on June 30, 2014. See generally Id. These intervals varied and included several appointments in quick succession following Plaintiff's visits to the emergency room in June 2014 and February 2015, as well as more routine check-ups on a monthly to several monthly basis. AR 312-325; 484; 348-356; 357-366; 327-342. Records also show that Dr. Chang prescribed Plaintiff with medication for high-blood pressure, high cholesterol, and depression. See id.

         On September 25, 2015, Dr. Chang answered a request from Plaintiff to answer questions regarding her medical condition as part of her effort to obtain disability benefits from her insurance company. AR 581; see also AR 435-36. In his written responses, Dr. Chang diagnosed Plaintiff with “Hypertension, CKD, Pre[-]Diabetes, High Cholesterol, Old MI, [and] Stress.” AR 435. In response to Plaintiff's query as to whether she was “totally disabled from doing [her] job as a nurse” as of June 2014, Dr. Chang wrote “Yes, unfortunately you have not been able to work due to job stress.” Id. Finally, in response to Plaintiff's question about why she was disabled and what her limitations were, Dr. Chang responded “Uncontrolled HTN, stress from work [sic] will need to reduce overall stress.” Id.

         B. Dr. Wong and Dr. Bitonte

         Dr. Wong prepared a Disability Determination Explanation opinion for the initial stage of Plaintiff's process and Dr. Bitonte issued a Disability Determination Explanation opinion at the reconsideration stage of Plaintiff's process. AR 84-95; 96-108. Dr. Wong found Plaintiff partially credible. AR 90. Dr. Wong noted that Plaintiff had been non-compliant with her blood-pressure medication, that her physical examination was “entirely unremarkable, ” and concluded that “[t]he evidence does not support fully disabling severity.” AR 90. Dr. Bitonte also determined that Plaintiff's statements were partially credible on reconsideration. AR 105. Both doctors found that Plaintiff was not disabled, issued the same ratings for Plaintiff's exertional limitations, and determined that Plaintiff had the requisite residual functional capacity to continue her previous work as a registered nurse. AR 93-95; 106-08.

         2. Mental Health

         A. Dr. Greytak

         Dr. Greytak performed a Comprehensive Psychiatric Evaluation of Plaintiff on December 2, 2015. AR 543. As part of that evaluation, Dr. Greytak opined that Plaintiff was “not delusional, ” denied hallucinations, was euthymic in mood, and that her speech was normal. AR. 546. Dr. Greytak determined that Plaintiff's condition was “most consistent with . . . a DSM 5 diagnosis of generalized anxiety disorder.” AR 548. With respect to Plaintiff's functional capacity, Dr. Greytak opined that Plaintiff was not impaired from the performance of simple instructions, but mildly impaired in other activities including, but not limited to, her ability to perform complex tasks, concentrate and perform work tasks “without special or additional supervision.” AR 547-48. Dr. Greytak opined that Plaintiff's psychiatric prognosis was “fair.” AR 548.

         B. Dr. Khatchatrian and Mary Ellen Bennett, LCSW

         Plaintiff's medical records indicate that she started receiving treatment from Psychiatric Centers at San Diego (“PCSD”) on February 16, 2016. AR 623. On intake, Plaintiff was described as presenting with a variety of symptoms including “anxious/fearful thoughts . . . depressed mood, [and] difficulty concentrating.” Id. Plaintiff was seen by two practitioners at PCSD. See AR 594-672.

         Plaintiff had an initial psychiatric evaluation with Dr. Khatchatrian on September 21, 2016. AR 658. Dr. Khatchatrian noted that Plaintiff reported suffering from a number of different symptoms including irritability, agitation, hyperactivity, insomnia, impaired memory and concentration, and “impulsivity and spending sprees.” AR 658. Plaintiff “reported fleeting suicidal ideation, but denied any intentions or plans.” AR 658. Dr. Khatchatrian assessed Plaintiff's mental status as follows: “Patient's appearance is appropriate . . . . Behavior is described as unremarkable . . . . Patient's mood is anxious, irritable, and hyper. Short term memory is impaired and recalled 0/3 words in 5 min . . . . Attention is maintained and serial 3 intact . . . . Thought processes show flight of ideas. Thought processes are 1, 1, 1, 1 and 1. Patient has visual hallucinations. Thought content reveals paranoia and ideas of reference . . . .” AR 660. On October 5, 2016 Dr. Khatchatrian noted “moderate improvement” in Plaintiff's condition. AR 654. By October 26, 2016, Dr. Khatchatrian reported “good improvement” in Plaintiff's condition and further noted “good improvement” in Plaintiff's condition on November 17, 2016, December 8, 2016, and January 6, 2017. AR 642, 632, 625.

         Plaintiff also had numerous sessions with a therapist, Mary Ellen Bennett, beginning on March 3, 2016 and continuing through December 8, 2016. AR 620, 636; see also AR 594-622; 629-631; 636-641; 644-649; 664-672. During the course of her therapy sessions Plaintiff described suffering from anxiety, financial issues, and struggles with her working situation. See e.g., AR 618, 636. Plaintiff's therapist encouraged her avoid activities such as trips to the casino. AR 667. On April 18, 2016, Plaintiff's therapist reported that she agreed with Dr. Chang's opinion that Plaintiff was “too impaired to work as a nurse.” AR 609.

         C. Dr. Chang

         Plaintiff began reporting more substantial issues with her mental health to Dr. Chang, her primary care physician, on December 10, 2015. AR 561. Dr. Chang noted that Plaintiff “ha[d] not expressed the extent of the stress and how it was affecting her until today's visit.” Id. Dr. Chang gave Plaintiff a prescription for Zoloft and referred her to psychiatry. AR 564. On January 11, 2016, Dr. Chang reported that Plaintiff had disclosed the full extent of her family history of mental illness. AR 565. Plaintiff reported that her sister had committed suicide and that her daughters also suffer from depression. Id. Dr. Chang stated that “this seems to be a very strong family history of mental illness.” Id. Dr. Chang opined that “[a]t this time [Plaintiff] is clearly not able to work or function because of the mental illness, ” but noted that Plaintiff “seems to be doing well with Zoloft 50 mg daily.” AR 568. In his treatment notes from February 24, 2016, Dr. Chang opined that Plaintiff's stress “will clearly affect her ability to perform work as a nurse, ” described that Plaintiff's recent openness about her condition explained why “she was not able to perform at her job, ” and led him to conclude that Plaintiff “should not work.” AR 576. Dr. Chang also noted in his assessment that Plaintiff's son had attempted to commit suicide and that Plaintiff “is now a caregiver at home for him.” AR 578.

         D. Lee Reback Psy. D., P.A. and Brady Dalton, Psy. D.

         As part of Plaintiff's initial disability determination, Lee Reback Psy. D., P.A. reviewed Plaintiff's medical records. AR 90-92. On December 20, 2015, Reback concluded that Plaintiff's mental status was “mildly impaired” and that “[f]rom a mental health perspective, the ...