Sousa v. Callahan
| Decision Date | 11 May 1998 |
| Docket Number | No. 96-17256,96-17256 |
| Citation | 143 F.3d 1240 |
| Parties | , Unempl.Ins.Rep. (CCH) P 16035B, 98 Cal. Daily Op. Serv. 3549, 98 Daily Journal D.A.R. 4871 Dennis SOUSA, Surviving Spouse of Anna M. Sousa, Deceased, Plaintiff-Appellant, v. John J. CALLAHAN, * Acting Commissioner, Social Security Administration, Defendant-Appellee. |
| Court | U.S. Court of Appeals — Ninth Circuit |
James L. Bianchi, Benicia, California, for the appellant.
Jeffrey H. Baird, Assistant Regional Counsel, San Francisco, California, for the appellee.
Appeal from the United States District Court for the Eastern District of California; Gregory G. Hollows, Magistrate Judge, Presiding. D.C. No. CV-95-00560-GGH.
Before: FLETCHER and T.G. NELSON, Circuit Judges, and WHALEY, ** District Judge.
Plaintiff Dennis Sousa appeals the district court's order granting summary judgment to defendant Commissioner of Social Security ("Commissioner") and dismissing his deceased spouse's claim for disability insurance benefits under Title II of the Social Security Act. The district court dismissed Sousa's claims because it found that his spouse was ineligible to receive benefits under 42 U.S.C. § 423(d)(2)(C). We have jurisdiction under 28 U.S.C. § 1291. We reverse and remand with instructions.
Anna M. Sousa ("claimant") first applied for both disability insurance benefits ("DIB") and supplemental security income ("SSI") in 1988. The claims were denied, both initially and upon reconsideration. Because she failed to request a timely review of the decision by the Appeals Council, the April 1989 determination became the Commissioner's final decision on the matter. 1
A second application for DIB was filed in 1992, alleging disability since February 11, 1987, due to mental illness and depression. This application was supported by additional evidence, consisting primarily of a single medical report dated March 31, 1987, that was not considered with the original filing. The Social Security Administration once again denied benefits both initially and upon reconsideration. Claimant then requested a hearing before an administrative law judge ("ALJ"). After a March 24, 1994, hearing, the ALJ determined this second application was barred by the principle of res judicata. As the Commissioner's determination on the first application, which covered essentially the same time period, had become the final determination of the Commissioner, the ALJ held that the case should not be reopened or revised because the claimant had failed to show the requisite "good cause" as defined in 20 C.F.R. § 404.989.
The Appeals Council granted review of the ALJ decision and reopened the matter, finding good cause 2 to reconsider the original 1989 decision. However, the Appeals Council did not hold a new hearing or remand the case to the ALJ. Instead, the Council reviewed the transcript from the 1994 hearing and considered the evidence itself, concluding that plaintiff was not entitled to receive DIB. It found both Anna and Dennis Sousa's testimony at the 1994 hearing not credible, and Anna's medically determinable impairments, dysthymia and substance abuse, not sufficiently severe to preclude her from working at any time prior to December 31, 1987, the last date of her insured status.
Claimant then filed a complaint in federal court seeking review of the Appeals Council's determination, 3 proceeding before a United States Magistrate Judge pursuant to the parties' consent. 4 She then moved for summary judgment. Defendant filed a cross-motion also seeking summary judgment.
While those motions were pending, the law was amended to add 42 U.S.C. § 423(d)(2)(C), which precludes the award of benefits to certain claimants whose disability is based, in whole or in part, on alcoholism and drug addiction or either of them. The district court ordered briefing from the parties "on the effective date of that amendment," and subsequently found that the Appeals Council's conclusion-that claimant had not met her burden of proving a mental impairment severe enough to preclude her from working during the relevant time period-was not supported by substantial evidence. However, the court held that "the recent amendments are effective to preclude an award of benefits" because "plaintiff's mental problems during the pertinent period were intertwined and exacerbated by longstanding substance abuse." This timely appeal followed. 5
A district court's order upholding the denial of social security benefits by the Commissioner is reviewed de novo. Smolen v. Chater, 80 F.3d 1273, 1279 (9th Cir.1996). The decision of the Commissioner must stand if it is supported by substantial evidence and it applies the appropriate legal standards. Id. Substantial evidence is "more than a mere scintilla, but less than a preponderance." Saelee v. Chater, 94 F.3d 520, 522 (9th Cir.1996) (citation omitted), cert. denied, --- U.S. ----, 117 S.Ct. 953, 136 L.Ed.2d 840 (1997). "If the evidence can reasonably support either affirming or reversing the Secretary's conclusion, the court may not substitute its judgment for that of the Secretary." Flaten v. Secretary, 44 F.3d 1453, 1457 (9th Cir.1995). However, the Appeals Council's decision cannot be affirmed simply by isolating a specific quantum of supporting evidence. Hammock v. Bowen, 879 F.2d 498, 501 (9th Cir.1989). The record as a whole must be considered. Howard v. Heckler, 782 F.2d 1484, 1487 (9th Cir.1986).
A district court's interpretation of a statute is a question of law reviewed de novo. Allen v. Shalala, 48 F.3d 456, 457 (9th Cir.1995).
We begin by examining whether the Appeals Council's determination, that claimant's impairments were not severe enough to support a finding of disability during the relevant time period, is supported by substantial record evidence. If it is, we do not need to consider whether the claimant is precluded from receiving DIB under the amendment because of her alcohol and drug abuse. If it is not, we must consider whether the amendments disqualify claimant from DIB eligibility.
In denying Sousa's claim, the Appeals Council substantially relied on its rejection of her and her husband's lay testimony. It also rejected the analysis of Dr. Lundeen, primarily due to his reliance on this testimony in formulating his conclusions. These decisions led the Appeals Council to conclude that Sousa was not disabled during the relevant time period. Because the rejection of the testimony was not supportable on the stated grounds, the Appeals Council's conclusion cannot be sustained.
Anna Sousa testified that she was "unable to cope with everyday living" in 1987 and that she had "difficulty taking care of her personal needs." Her husband testified that she plugged electrical outlets up with paper, boiled her clothes, and often could not sleep for days at a time.
The Commissioner can only reject lay testimony as incredible under certain conditions. "The ALJ is responsible for determining credibility, resolving conflicts in medical testimony, and for resolving ambiguities." Andrews v. Shalala, 53 F.3d 1035, 1039 (9th Cir.1995). However, "once the claimant produces objective medical evidence of an underlying impairment, an adjudicator may not reject a claimant's subjective complaints based solely on a lack of objective medical evidence to fully corroborate the alleged severity of pain." Bunnell v. Sullivan, 947 F.2d 341, 345 (9th Cir.1991). The adjudicator may, however, disregard self-serving statements made by claimants if it finds them to be incredible on other grounds. Rashad v. Sullivan, 903 F.2d 1229, 1231 (9th Cir.1990). Relevant factors can include the claimant's engagement in activities inconsistent with a claim of disability, an unexplained or inadequately explained failure to seek treatment, or other ordinary methods of credibility determination. Bunnell, 947 F.2d at 346.
Here, the lay testimony at issue was given at a 1994 hearing in front of an ALJ who concluded that the principles of res judicata and administrative finality prohibited him from reopening the case to reconsider the merits. The Appeals Council disagreed and found good cause to reopen the matter. The Council then proceeded on the merits without conducting a new hearing or remanding the case to the presiding ALJ.
The Appeals Council found the Sousas' testimony not credible. In support of this conclusion, it cited "the length of time between the actual events and the testimony"; the lack of corroborating objective evidence of "paranoid behavior on or before December 31, 1987, as reported in the testimony," even though evidence existed concerning a similar incident in 1991; and the fact that plaintiff had obtained "other nonmental medical treatment during 1987 for short term physical problems, but not related to the mental problems," which did not result in a "mention of a mental problem in the other treatment notes." The Appeals Council concluded its adverse credibility finding by saying:
The claimant was able to function well enough to leave her home to obtain treatment for physical problems and it seems reasonable to assume if the claimant had the marked restrictions alleged for that period, they would have been noticed and remarked upon by nonmental health sources. Therefore the Council cannot find the testimony of the claimant and her husband concerning her functional restrictions on or before December 31, 1987, credible.
These justifications for the rejection of the lay testimony are not sufficient. The substantial amount of time between the events at issue and the testimony given is an inevitable by-product of the procedural posture of this case. The existence of objective evidence of a paranoid incident in 1991 is not determinative of whether those events also took place in 1987, but is at least some...
To continue reading
Request your trial
-
Almazan v. Colvin
...disability claim. 42 U.S.C. §§ 423(d)(2)(C) and 1382(a)(3)(J); Bustamante v. Massanari, 262F.3d 949 (9th Cir. 2001); Sousa v. Callahan, 143 F.3d 1240, 1245 (9th Cir. 1998). If there is evidence of DAA and the individual succeeds in proving disability, the Commissioner must determine whether......
-
Chavez v. Astrue, EDCV 08-1431-RC.
...“The Commissioner may reject the opinion of a nonexamining physician by reference to specific evidence in the medical record.” Sousa, 143 F.3d at 1244. However, while “not bound by findings made by State agency or other program physicians and psychologists, [the ALJ] may not ignore these op......
-
Reese v. Berryhill
...claimant). An ALJ "may reject the opinion of a non-examining physician by reference to specific evidence in the medical record." Sousa, 143 F.3d at 1244. An opinion that is more consistent with the record as a whole generally carries more persuasiveness. See 20 C.F.R. § 416.927(c)(4). 2. An......
-
Salin v. Berryhill
...an ALJ "may reject the opinion of a non-examining physician by reference to specific evidence in the medical record." Sousa v. Callahan, 143 F.3d 1240, 1244 (9th Cir. 1998) (citing Gomez v. Chater, 74 F.3d 967, 972 (9th Cir. 1996)). All of the determinative findings by the ALJ must be suppo......
-
Case survey
...may discount the opinion of a non-examining physician by reference to particular evidence in the medical record. Sousa v. Callahan , 143 F.3d 1240, 1244 (9th Cir. 1998). i. Tenth Circuit (1) A Kansas district court held that the ALJ erred by rendering a decision which conflicted with that o......
-
Synopses of Briefs
...to periods of drug and alcohol abuse. The court also determined that the ALJ made the same mistake as the ALJ in Sousa v. Callahan , 143 F.3d 1240, 1243 (9th Cir. 1998), in making a medical assessment, without expert testimony, concerning the causative effect of drug use on plaintiff’s unde......
-
Issue Topics
...may discount the opinion of a non-examining physician by reference to particular evidence in the medical record. Sousa v. Callahan , 143 F.3d 1240, 1244 (9th Cir. 1998). “Generally, an ALJ should give greatest weight to a treating physician’s opinion and more weight to the opinion of an exa......
-
Synopses of Briefs
...to periods of drug and alcohol abuse. The court also determined that the ALJ made the same mistake as the ALJ in Sousa v. Callahan , 143 F.3d 1240, 1243 (9th Cir. 1998), in making a medical assessment, without expert testimony, concerning the causative effect of drug use on plaintiff’s unde......