Caseflicks

Court of Appeals for the Ninth Circuit • 2001

Kathryn C. Rollins v. Larry G. Massanari, Acting Commissioner of Social Security Administration

261 F.3d 853

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Takeaway

In short, this case affirms that an ALJ may discount treating-source and pain testimony when the ALJ supplies adequately specific, evidence-based reasons, while the dissent cautions that fibromyalgia and fluctuating daily functioning demand a more faithful reading of subjective evidence.

Background

Kathryn Rollins was injured in an August 1992 automobile accident and thereafter reported widespread muscle and joint pain, fatigue, and depression or stress related to chronic pain. In 1994, her treating rheumatologist, Dr. Carol Young, diagnosed fibromyalgia. Rollins exhibited tenderness at all eighteen recognized fibromyalgia tender points.

Rollins applied for Title II Social Security disability benefits. An administrative law judge denied the application, finding that Dr. Young's restrictive opinion was not controlling, discounting parts of Rollins's pain testimony, and concluding that Rollins could perform work identified through the vocational evidence. The Appeals Council denied review, making the ALJ's decision the Commissioner's final decision. A magistrate judge in the Central District of California granted summary judgment to the Commissioner. Rollins appealed.

Issues

Issue #1

Whether the ALJ improperly declined to give controlling weight to Dr. Young's treating-physician opinion.

Holding

No. The ALJ gave specific and legitimate reasons, supported by substantial evidence, for declining to fully credit Dr. Young's opinion.

Reasoning

A treating physician's contradicted opinion may be rejected only for specific and legitimate reasons supported by substantial evidence. The ALJ met that standard by identifying tensions within Dr. Young's own reports: although she declared Rollins disabled in October 1994, she had also reported improvement since July, and her July examination findings did not indicate total disability.

Dr. Young's July description of Rollins as a well-developed, well-nourished woman in no acute distress, together with her conservative recommendation to avoid strenuous activity, reasonably conflicted with a conclusion that Rollins was totally disabled under the Social Security Act.

The ALJ also reasonably questioned restrictions that barred virtually all bending, postural activities, and exposure to ordinary environmental conditions. The record supplied no medical basis for many of those limitations, Rollins had not claimed difficulty with many of them, and the restrictions appeared inconsistent with her household and child-care activities.

Issue #2

Whether the ALJ improperly discounted Rollins's testimony about the severity and disabling effects of her pain.

Holding

No. Assuming without deciding that fibromyalgia was a qualifying severe impairment, the ALJ gave clear and convincing reasons, supported by substantial evidence, for discounting portions of Rollins's pain testimony.

Reasoning

Once a claimant presents objective evidence of an impairment that could cause pain, the ALJ may not reject her subjective complaints solely because objective evidence does not fully corroborate the claimed severity. In the absence of malingering, however, the ALJ may discount testimony by providing clear and convincing, sufficiently specific reasons. Medical evidence remains relevant to assessing the severity and disabling effects of reported symptoms.

The ALJ permissibly relied in part on Rollins's discharge records from a behavioral-medicine program after treatment for painkiller addiction. Those records stated that she had no activity restrictions and assigned a Global Assessment of Functioning score of 70, reflecting only mild symptoms and generally adequate functioning.

The ALJ also reasonably found that Rollins's reported daily activities undermined a claim of wholly disabling pain. Her accounts included meeting her two children's needs, cooking, housekeeping, laundry, shopping, regularly leaving home, attending therapy and meetings, and taking her children to school and activities. Although her testimony allowed a different interpretation because her ability to perform those tasks fluctuated, the ALJ's interpretation was reasonable and supported by substantial evidence, so the appellate court would not second-guess it.

Issue #3

Whether the ALJ's hypothetical questions to the vocational expert were defective because they omitted limitations attributable to Rollins's alleged pain.

Holding

No. The ALJ properly omitted limitations that he reasonably found unsupported by the evidence.

Reasoning

A vocational hypothetical need include only limitations that the ALJ has found to exist and that are supported by substantial evidence. The omitted limitations were based on Rollins's allegations that the ALJ permissibly discounted, rather than on limitations the ALJ accepted as established.

Because the hypothetical incorporated all limitations the ALJ found credible and those findings survived substantial-evidence review, the vocational-expert testimony based on that hypothetical was not legally defective.

Issue #4

Whether the ALJ's remarks and conduct demonstrated impermissible bias requiring disqualification or reversal.

Holding

No. Rollins did not overcome the presumption that the ALJ was unbiased.

Reasoning

Administrative law judges are presumed impartial. A claimant must show a conflict of interest or another concrete ground for disqualification, and remarks must be so extreme, considered in the context of the full proceeding, that they reveal a clear inability to render fair judgment.

The ALJ occasionally displayed sarcasm or impatience, particularly concerning Dr. Young's reports. But ordinary expressions of impatience, dissatisfaction, annoyance, or anger do not establish disqualifying bias, and nothing in this record rose to the required level.

Dissents

Judge Ferguson

Reasoning

Judge Ferguson concluded that the majority effectively revived an objective-corroboration requirement that Ninth Circuit precedent had rejected. In his view, Rollins undisputedly had fibromyalgia, an impairment capable of causing her reported symptoms, and there was no affirmative evidence of malingering. The ALJ therefore could reject her symptom testimony only for clear and convincing reasons, not because the medical record did not objectively verify the degree of pain.

The dissent maintained that the ALJ distorted rather than fairly evaluated Rollins's daily activities. Rollins testified that she cooked only simple food, could not consistently finish dishes, needed help while shopping, sometimes could not transport her children, often had to leave meetings or church because of pain, and spent two or three days a week largely in bed. Her efforts to care for her children and attend treatment, Judge Ferguson reasoned, showed accommodations made in spite of fluctuating pain, not a capacity for sustained full-time work.

Judge Ferguson also emphasized that the lack of conventional objective findings is characteristic of fibromyalgia. Patients may appear healthy and have normal joints, strength, sensation, and reflexes despite severe symptoms; multiple tender points are the distinctive objective indication. Rollins had all eighteen tender points, so the absence of more conventional evidence did not undermine her credibility.

Because the ALJ improperly rejected Rollins's pain and fatigue testimony, the vocational hypothetical omitted crucial limitations. The vocational expert testified that Rollins's stated limits on sitting, standing, walking, and lifting, as well as an inability to function two or three unpredictable days per week, would preclude competitive employment. Judge Ferguson would therefore remand for an award of benefits rather than for additional proceedings.