Caseflicks

Court of Appeals for the Ninth Circuit • 2012

Molina v. Astrue

674 F.3d 1104 | 2012 U.S. App. LEXIS 6570

Full access

Unlock the video and quiz

The written brief is free to read below. Subscribe to watch the video explainer and take the quiz.

Create an account Log in

Takeaway

In short, this case confirms that an ALJ may discount unsupported “other source” opinions and claimant testimony for well-supported reasons, while treating an unexplained failure to address cumulative lay testimony as harmless when it could not change the disability outcome.

Background

Edilia Molina applied for disability insurance benefits and supplemental security income in 2006, alleging that panic and anxiety attacks had prevented her from working since 2002. Her physician’s assistant, Molly Wheelwright, described a longstanding panic disorder and later submitted a questionnaire stating that Molina had extreme functional limits and could not meet competitive work standards. But the questionnaire was largely a check-box form without supporting clinical explanation, and Wheelwright herself said a psychiatrist would likely need to supplement her assessment.

An examining psychiatrist, Dr. Hunter Yost, found that Molina was alert, congenial, coherent, and not excessively anxious during examination. He concluded that her panic disorder was controlled by Lorazepam and self-calming measures and imposed no work-related limitations. Molina also reported activities including caring for grandchildren, walking them to and from school, attending church, shopping, attending family gatherings, and taking neighborhood walks.

The ALJ found that Molina could return to her past work as an assembler. The ALJ credited Dr. Yost over Wheelwright, found Molina’s account of disabling symptoms not fully credible, and did not meaningfully explain the rejection of written statements from five family members. The district court affirmed the denial of benefits. On de novo review of that judgment, the Ninth Circuit affirmed as well.

Issues

Issue #1

Whether the ALJ improperly discounted the functional-capacity opinion of Molina’s physician’s assistant, Molly Wheelwright.

Holding

No. Wheelwright was an “other source,” not an acceptable medical source entitled to treating-source deference, and the ALJ gave germane, record-supported reasons for discounting her opinion.

Reasoning

A physician’s assistant is ordinarily classified as an “other source” under the governing Social Security regulations, rather than an acceptable medical source. Because the record did not show that Wheelwright worked under a physician’s close supervision as an agent of that physician, the ALJ needed only to provide reasons germane to Wheelwright for giving her opinion reduced weight.

The ALJ reasonably found Wheelwright’s assessment conclusory. Her principal functional assessment was a standardized check-box form that identified severe restrictions but supplied no supporting reasoning or clinical findings, even though the form specifically requested them. An ALJ may permissibly give less weight to unexplained check-off reports.

Wheelwright’s assertion that Molina was unable to work also conflicted with her earlier records describing Molina’s anxiety episodes as intermittent. Her view further conflicted with Dr. Yost’s specialized psychiatric evaluation, which found no work-related limitation. The regulations favor a relevant specialist’s opinion on matters within that specialty, and Wheelwright herself acknowledged that psychiatric input would likely be needed to supplement her assessment.

Issue #2

Whether the ALJ improperly found Molina’s testimony about the severity and disabling effects of her panic disorder not fully credible.

Holding

No. The ALJ gave specific, clear, and convincing reasons, supported by substantial evidence, for discounting Molina’s claims of disabling limitations.

Reasoning

Once a claimant produces evidence of an impairment that could cause the alleged symptoms and there is no evidence of malingering, an ALJ must provide specific, clear, and convincing reasons to reject testimony about symptom severity. The ALJ may nevertheless use ordinary credibility techniques, including considering inconsistencies between testimony, conduct, treatment history, daily activities, and medical evidence.

Molina’s reported daily activities reasonably undermined her claim that even minimal contact with other people caused debilitating panic attacks. She cared for grandchildren, walked them to and from school, attended church, shopped, and took walks. The ALJ could reasonably conclude that these activities required social interaction comparable to Molina’s past assembler job, which involved working independently at a machine in a room with only four or five other people and little need for interaction.

The ALJ also relied on medical evidence inconsistent with Molina’s claimed degree of impairment. Dr. Yost observed that she was alert, oriented, congenial, coherent, and not excessively anxious, and concluded that her condition was controlled with medication and self-calming techniques. A state-agency physician reached a similar conclusion. These were additional, valid grounds for finding her allegations overstated.

To the extent the ALJ considered Molina’s failure to pursue recommended counseling, that consideration was proper. Repeatedly declining treatment may cast doubt on allegations of disabling symptoms when treatment frequency is inconsistent with the claimed severity and the claimant lacks an adequate explanation. Molina’s stated reasons for resisting counseling reflected personal preferences and past experiences; the record did not establish that her refusal was itself caused by her mental impairment. The rule concerning denial of benefits for failure to follow treatment did not apply, because the ALJ found Molina not disabled and used her treatment history only as a credibility consideration.

Issue #3

Whether the ALJ committed reversible error by failing to explain the rejection of statements from Molina’s family members.

Holding

The ALJ erred by failing to give germane reasons for disregarding the lay testimony, but the error was harmless because the family statements described no limitations beyond those the ALJ validly rejected in Molina’s own testimony.

Reasoning

Lay testimony about a claimant’s symptoms and functional limitations is competent evidence that an ALJ must consider. Although an ALJ need not discuss each witness separately when multiple witnesses provide similar evidence, the ALJ must at least give germane reasons for rejecting the testimony. The ALJ’s bare statement that she had considered third-party statements established review of the evidence but did not explain why it was discounted.

The court rejected a categorical rule that an ALJ’s failure to discuss any facially material lay testimony automatically requires reversal. Harmless-error review is case-specific: the question is whether the error was consequential to the ultimate nondisability determination. Under Shinseki v. Sanders and Ninth Circuit precedent, a reviewing court examines the whole record rather than applying a mandatory presumption of prejudice.

The lay statements were cumulative of Molina’s own descriptions of her anxiety, reluctance to travel or be around people, trouble eating in restaurants, and physical symptoms during panic attacks. The ALJ had already rejected those same claimed limitations for clear and convincing reasons grounded in Molina’s activities, her presentation to Dr. Yost, and medical evidence showing controlled symptoms and no work limitation.

Because the ALJ’s valid reasons for rejecting Molina’s account applied equally to the family members’ similar accounts, the court could confidently conclude that expressly addressing the statements would not have changed the outcome. The omission was therefore inconsequential to the finding that Molina was not disabled.

Dissents

Judge Graber

Reasoning

Judge Graber agreed that the ALJ properly weighed Wheelwright’s opinion and properly discounted Molina’s own symptom testimony. She also agreed that the ALJ erred by failing to comment on the family members’ lay testimony. But she would have remanded because, in her view, the majority applied harmless-error review too broadly.

Under Stout, Judge Graber reasoned, a reviewing court must assess ignored lay testimony by fully crediting it, rather than making an independent credibility determination that belongs to the ALJ. Fully crediting testimony that merely repeats a claimant’s subjective complaints may not matter when substantial evidence already shows that the claimant’s reported limitations are overstated.

Some of the family statements, however, contained independent observations rather than simple repetition of Molina’s reports. They described Molina’s reluctance to travel, her inability to remain at a restaurant through a meal, and observable physical symptoms such as shakiness and sweating during panic attacks. Those observations could support Molina’s claimed impairment in a way that her own testimony did not.

Because an ALJ could reasonably view these independent observations differently from Molina’s subjective complaints, Judge Graber could not conclude that no reasonable ALJ would reach a different disability determination after crediting them. She would remand so that the ALJ could evaluate the credibility and significance of the lay testimony in the first instance.