United States District Court, S.D. California
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
NITA L. STORMES UNITED STATES MAGISTRATE JUDGE.
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.
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.
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.
Plaintiff's Background and Testimony
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.
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. 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. 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.
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.
her examination by her attorney, Plaintiff testified to
hearing and seeing things and to attempting suicide on two
occasions. 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.
Documentary Medical Evidence
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.
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.
Dr. Wong and Dr. Bitonte
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.
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.
Dr. Khatchatrian and Mary Ellen Bennett,
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.
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.
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.
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.
Lee Reback Psy. D., P.A. and Brady Dalton, Psy.
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 ...