Vaughn v. Berryhill
242 F. Supp. 3d 998
E.D. Cal.2017Background
- Perry Vaughn applied for Disability Insurance Benefits alleging disability from April 18, 2012, due to lumbar degenerative disc disease, cardiac issues (atrial fibrillation), sleep apnea, obesity, and degenerative joint disease in multiple joints; administrative denial followed by an ALJ hearing and unfavorable decision; Appeals Council denied review.
- Treating specialists (orthopedist Dr. Cash, cardiologist Dr. Tsai) and a chiropractor (Douglas Roberts) supplied medical source statements finding severe functional limits or total disability; pain management and injections produced intermittent improvement.
- Two non‑examining state agency physicians (Drs. Ocrant and Blando) reviewed limited records and concluded a more generous sedentary/light RFC than treating specialists’ opinions.
- ALJ adopted a sedentary RFC with postural and environmental limits, gave little weight to the treating specialists and chiropractor as “overly restrictive,” and relied substantially on the non‑examining reviewers; concluded Vaughn could perform past work.
- District court found the ALJ’s reasons for discounting treating opinions inadequate because the non‑examining reviewers had not seen significant later records; remanded for further proceedings under sentence four of 42 U.S.C. § 405(g).
Issues
| Issue | Vaughn’s Argument | Berryhill’s Argument | Held |
|---|---|---|---|
| Whether ALJ gave specific and legitimate reasons to reject treating specialists’ and chiropractor’s opinions | ALJ improperly rejected treating opinions without adequate, individualized reasons and relied instead on non‑examining reviewers | ALJ permissibly relied on medical record, conservative treatment, positive response to injections, and non‑examining opinions | Court: Rejection was improper — ALJ failed to give specific, legitimate reasons and relied on reviewers who did not consider later records; remand required |
| Whether ALJ permissibly relied on non‑examining physicians over treating specialists | Treating specialists’ opinions entitled to deference; non‑examining opinions cannot alone justify rejection of treating opinions | Non‑examining opinions can constitute substantial evidence if consistent with the record | Court: Non‑examining opinions did not constitute substantial evidence here because they did not review significant subsequent records; ALJ erred in relying on them alone |
| Whether ALJ improperly drew RFC without medical expert after rejecting treating opinions | ALJ impermissibly substituted his own medical judgment and created RFC without a medical expert who reviewed the full record | ALJ is responsible for RFC assessment and may consider the record as a whole | Court: ALJ overstepped by effectively interpreting later medical evidence without a medical expert who reviewed it; error requires remand |
| Remedy: remand for benefits or further proceedings | Vaughn requested immediate award of benefits or alternatively remand for development | Commissioner opposed immediate award, sought affirmance | Court: Remanded for further administrative proceedings (not an immediate award); directed ALJ to re‑weigh treating opinions, consider specialists, and, if needed, obtain further specialist review or development |
Key Cases Cited
- Carmickle v. Commissioner, 533 F.3d 1155 (9th Cir.) (substantial‑evidence standard)
- Hoopai v. Astrue, 499 F.3d 1071 (9th Cir.) (review scope and standard)
- Thomas v. Barnhart, 278 F.3d 947 (9th Cir.) (definition of substantial evidence; non‑examining opinions may support ALJ if consistent)
- Ghanim v. Colvin, 763 F.3d 1154 (9th Cir.) (need for specific and legitimate reasons to reject controverted treating‑physician opinions)
- Matney v. Sullivan, 981 F.2d 1016 (9th Cir.) (ALJ need not accept conclusory opinions)
- Lester v. Chater, 81 F.3d 821 (9th Cir.) (non‑examining opinion cannot by itself justify rejection of treating/examining opinion)
- Vertigan v. Halter, 260 F.3d 1044 (9th Cir.) (RFC is ALJ’s responsibility but must be grounded in medical evidence)
- Nguyen v. Chater, 172 F.3d 31 (1st Cir.) (ALJ cannot play doctor; may not substitute lay interpretation for medical opinion)
- Benecke v. Barnhart, 379 F.3d 587 (9th Cir.) (treating physician generally afforded more weight)
- Holohan v. Massanari, 246 F.3d 1195 (9th Cir.) (specialist’s opinion relevant and entitled to deference)
- Garrison v. Colvin, 759 F.3d 995 (9th Cir.) (standards for remand for benefits vs. further proceedings)
- Brown‑Hunter v. Colvin, 806 F.3d 487 (9th Cir.) (court retains flexibility as to remedy after error)