Vergara v. Colvin , 535 F. App'x 687 ( 2013 )

FILED
United States Court of Appeals
UNITED STATES COURT OF APPEALS Tenth Circuit
FOR THE TENTH CIRCUIT September 19, 2013
Elisabeth A. Shumaker
Clerk of Court
NATHANIEL VERGARA,*
Plaintiff-Appellant,
v. No. 13-2020
(D.C. No. 1:11-CV-00764-WDS)
CAROLYN W. COLVIN, Acting (D. N.M.)
Commissioner of Social Security
Administration,
Defendant-Appellee.
ORDER AND JUDGMENT**
Before TYMKOVICH, ANDERSON, and MATHESON, Circuit Judges.
*
In accordance with Fed. R. App. P. 43(b), Nathaniel Vergara is substituted
for Marion Loera, on behalf of N.V., as the plaintiff-appellant in this action.
Plaintiff-Appellant’s counsel has advised this court that the caption should include
Mr. Vergara’s full name. Further, in accordance with Fed. R. App. P. 43(c)(2),
Carolyn W. Colvin is substituted for Michael J. Astrue as the defendant-appellee in
this action.
**
After examining the briefs and appellate record, this panel has determined
unanimously to grant the parties’ request for a decision on the briefs without oral
argument. See Fed. R. App. P. 34(f); 10th Cir. R. 34.1(G). The case is therefore
ordered submitted without oral argument. This order and judgment is not binding
precedent, except under the doctrines of law of the case, res judicata, and collateral
estoppel. It may be cited, however, for its persuasive value consistent with
Fed. R. App. P. 32.1 and 10th Cir. R. 32.1.
Nathaniel Vergara (“Claimant”) appeals from a district court order issued by a
magistrate judge under 28 U.S.C. § 636(c). The order upheld the Commissioner’s
decision to deny supplemental security income (SSI) benefits based on childhood
disability.
We independently review the Commissioner’s decision to determine whether it
is free of legal error and supported by substantial evidence. Krauser v. Astrue,
638 F.3d 1324, 1326 (10th Cir. 2011). Exercising jurisdiction under 28 U.S.C.
§§ 636(c)(3) and 1291, we reverse and remand for further proceedings.
I. BACKGROUND
In April 2005, when Claimant was eleven years old, his mother applied for SSI
benefits on his behalf. She alleged that he became disabled in February 2001 due to
a learning disability that caused him difficulties in school. The agency denied
benefits initially and on reconsideration. Claimant’s mother then requested and
received a hearing before an administrative law judge (ALJ).
The ALJ issued an unfavorable ruling, finding Claimant not disabled at step
three of the three-step sequential evaluation process for determining childhood
disability. See Adams ex rel. D.J.W. v. Astrue, 659 F.3d 1297, 1298 (10th Cir. 2011)
(citing 20 C.F.R. § 416.924); cf. Sullivan v. Zebley, 493 U.S. 521, 526 (1990)
(observing that “test for determining whether a child claimant is disabled is an
abbreviated version of the adult [5-step] test”). The Appeals Council, however,
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issued an order vacating the ALJ’s decision and remanding the case for further
proceedings.
The ALJ held a second hearing and, in September 2009, again denied benefits
at step three. Under the three steps, a child under eighteen years of age is “disabled”
and eligible for SSI benefits if the child (1) is not doing substantial gainful activity
(SGA); (2) has a medically determinable impairment or combination of impairments
that is severe; and (3) the impairment or combination of impairments meets,
medically equals, or functionally equals the listings for disability (20 C.F.R. Part
404, Subpart P, Appendix 1 (the listings)), and otherwise meets the applicable
duration requirement. 20 C.F.R. § 416.924(a)-(d); see also id. § 416.906 (specifying
duration requirement).
Here, the ALJ found at step one that Claimant had not engaged in SGA at any
time relevant to his application for benefits. At step two, the ALJ assessed Claimant
with a severe combination of attention deficit hyperactivity disorder (ADHD),
hearing loss, and a learning disorder. But at step three, the ALJ concluded that
Claimant did not have an impairment or combination of impairments that meets,
medically equals, or functionally equals the listings. The ALJ therefore found
Claimant not disabled and denied benefits.
The Appeals Council denied review, making the ALJ’s 2009 decision the
Commissioner’s final decision for judicial review. Krauser, 638 F.3d at 1327. The
Appeals Council accepted and considered additional evidence (dated April 2008 to
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July 2010) submitted by Claimant’s mother, but concluded that the additional
evidence did not provide a basis for altering the ALJ’s determination. Aplt. App.
at 90-91, 93. The district court upheld the denial of benefits, and this appeal
followed. Claimant challenges the ALJ’s step-three determination that his severe
impairments do not result “in limitations that functionally equal the listings.”
20 C.F.R. § 416.926a.1
II. DISCUSSION
A. Legal Background on Functional Equivalency
Title 20 C.F.R. § 416.926a governs functional equivalence. When a child’s
“severe impairment or combination of impairments . . . does not meet or medically
equal any listing,” the ALJ “will decide whether it results in limitations that
functionally equal the listings.” Id. § 416.926a(a). Cf. id. § 416.926a(d) (explaining
that ALJ does “not compare [the child’s] functioning to the requirements of any
specific listing” (emphasis added)). A “severe impairment or combination of
impairments” “functionally equals the listings” if it causes “marked limitations” in at
least two of the six domains of functioning or an “extreme limitation” in at least one
of the six domains. Id. § 416.926a(a) (internal quotation marks omitted).2
1
Claimant does not challenge the ALJ’s step-three conclusion that he does not
have an impairment or combination of impairments that meets or medically equals
any one of the listings. The ALJ considered listings sections 112.11 (ADHD), 102.00
(Hearing Loss), and 112.00 (Learning Disorder).
2
The ALJ will find a “‘marked’ limitation in a domain when [the child’s]
impairment(s) interferes seriously with [his] ability to independently initiate, sustain,
(continued)
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The ALJ first considers how the child functions as a whole. This consists of
looking at all of the child’s “activities,” which include everything the child does “at
home, at school, and in [his] community,” and evaluating “how appropriately,
effectively, and independently” he functions compared to children the same age who
do not have impairments. Id. § 416.926a(b); see also id. § 416.926a(c) (“[W]e will
look first at [the child’s] activities and [his] limitations and restrictions.”); Social
Security Ruling (SSR) 09-1p, 2009 WL 396031, *1 (Feb. 17, 2009) (explaining that
first step in functional-equivalence evaluation is assessing “child’s functioning
without considering the domains or individual impairments”).
Among other things, the ALJ evaluates what the child cannot do, has difficulty
doing, needs help doing, or is restricted from doing because of the child’s
impairment(s), 20 C.F.R. § 416.926a(a); how well he initiates, sustains, and
completes his activities, id. § 416.924a(b)(5); and the effects of medication,
id. § 416.924a(b)(9)(i)(E). See also id. § 416.926a(a) (observing that ALJ “will
assess the interactive and cumulative effects of all of the [child’s] impairments . . . .,
including any impairments” the child has “that are not ‘severe’”).
The ALJ then evaluates the impact of the child’s impairment(s) by rating the
degree to which the impairment(s) limit(s) functioning (in other words, “activities”)
or complete activities.” 20 C.F.R. § 416.926a(e)(2)(i) (emphasis added). The ALJ
will find “an ‘extreme limitation’ in a domain,” when the child’s “impairment(s)
interferes very seriously with [his] ability to independently initiate, sustain, or
complete activities.” Id. § 416.926a(e)(3)(i) (emphasis added).
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in the following six domains of functioning: (1) acquiring and using information,
(2) attending and completing tasks, (3) interacting and relating with others,
(4) moving about and manipulating objects, (5) caring for oneself, and (6) health and
physical well-being. Id. § 416.926a(b); SSR 09-1p, 2009 WL 396031, *2 (After
identifying which of the child’s “activities . . . are limited, we determine which
domains are involved in those activities. We then determine whether the child’s
impairment(s) could affect those domains and account for the limitations. . . .
[Finally,] we . . . rate the severity of the limitations in each affected domain.”).
B. ALJ Decision and Claimant’s Issues
Here, the ALJ determined that Claimant’s impairments result in “marked
limitations” in only one of the six domains—acquiring and using information.
Aplt. App. at 115. The ALJ found Claimant’s impairments result in “less than
marked limitations” in the domains of attending and completing tasks, interacting and
relating with others, and health and physical well-being. Id. at 116-17, 120. He
found Claimant’s impairments result in “no limitations” in the domains of moving
about and manipulating objects and the ability to care for oneself. Id. at 118-19.
On appeal, Claimant asserts that the ALJ’s findings in two domains,
(1) attending and completing tasks and (2) interacting and relating to others, “were
based on incorrect legal standards and not supported by substantial evidence.” Aplt.
Opening Br. at 21. He contends that the ALJ failed to resolve evidentiary conflicts
and ignored contradictory evidence.
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We reach only the attending-and-completing-tasks domain and, in doing so,
reach only one of the pieces of evidence Claimant cites in support of his position:
the opinion of state agency psychiatry consultant E. Chiang, M.D. Dr. Chiang opined
that Claimant’s severe impairments cause “marked” limitations in the domain of
attending and completing tasks. Aplt. App. at 379.
C. Attending and Completing Tasks and Dr. Chiang’s Opinion
Attending and completing tasks refers to how well a child is able to focus and
maintain attention, and how well the child begins, carries through, and finishes
activities, including the pace the child performs activities and the ease the child
changes activities. 20 C.F.R. § 416.926a(h); see also SSR 09-4p, 2009 WL 396033(Feb. 18, 2009) (“consolidate[ing] information . . . about the functional equivalence
domain of ‘Attending and completing tasks’”). The regulations also describe
age-appropriate behaviors and expectations relevant to this domain. 20 C.F.R.
§ 416.926a(h)(2)(iv) (“age 6 to attainment of age 12”); id. § 416.926a(h)(2)(v) (“age
12 to attainment of age 18”).
In finding Claimant’s limitations in this domain “less than marked,” the ALJ
stated:
The claimant’s mother testified at the [2009] hearing that her son was
doing better in completing his homework, cleaning his room, and caring
for and feeding his dog, but he still had to be prompted. Based on an
October 3, 2008 evaluation [entitled Los Lunas Schools Individualized
Education Program], the examiner wrote that the claimant . . . works
well in class some days and is very capable of completing work, and
identified this as a great potential that needs to be harnessed in a
positive manner. Further, she said that the claimant gets along well
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with peers and teachers most of the time. He also helps neighbors with
their yards. She also stated that he can be lazy.
Aplt. App. at 116.
Claimant submits that the record contains evidence contradicting the ALJ’s
less-than-marked finding in the attending-and-completing-tasks domain and argues
that the ALJ failed to follow applicable rules of law in weighing particular types of
evidence. In particular, Claimant asserts that the ALJ erroneously failed to discuss
Dr. Chiang’s opinion. We agree.
ALJs must consider all medical opinions in the record. See 20 C.F.R.
§ 416.927(c). “State agency medical and psychological consultants and . . . other
medical specialists are highly qualified” and serve as “experts in Social Security
disability evaluation.” Id. § 416.927(e)(2)(i). “Therefore, administrative law judges
must consider findings and other opinions of State agency medical and psychological
consultants . . . and other medical specialists as opinion evidence,” and “evaluate
[their] findings using the relevant factors in paragraphs (a) through (d) of
[§ 416.927].” Id. § 416.927(e)(2)(i), (ii).
“Unless a treating source’s opinion is given controlling weight,”3 the ALJ
“must explain in the decision the weight given to the opinions of a State agency
medical or psychological consultant . . . or other medical specialist.” Id.
§ 416.927(e)(2)(i), (ii) (emphasis added); see also SSR 96-6p, 1996 WL 374180, *2
3
In this case, the ALJ did not explicitly give controlling weight to a treating
source’s opinion.
-8-
(July 2, 1996) (observing that ALJs “are not bound by findings made by State agency
or other program physicians and psychologists, but they may not ignore these
opinions and must explain the weight given to the opinions in their decisions”)
(emphasis added)).
In this case, the ALJ did not mention Dr. Chiang’s opinion.4 Claimant asserts
that the ALJ’s failure to discuss Dr. Chiang’s opinion violates the regulatory
requirement that the ALJ explain the weight given to a state agency medical
consultant’s opinion. We agree. “In the absence of ALJ findings supported by
specific weighing of the evidence, we cannot assess whether relevant evidence
adequately supports the ALJ’s conclusion . . ., and whether he applied the correct
legal standards to arrive at that conclusion.” Clifton v. Chater, 79 F.3d 1007, 1009
(10th Cir. 1996); see also id. at 1009-10 (remanding for ALJ to weigh evidence and
give reasons for rejecting medical evidence). Accordingly, we reverse and remand
for the ALJ to explain what weight should be given to Dr. Chiang’s opinion.
See Jensen v. Barnhart, 436 F.3d 1163, 1165 (10th Cir. 2005) (observing that failure
to apply the correct legal standards is grounds for reversal).5
4
We note that in 2008, when the Appeals Council vacated the ALJ’s first
decision, it instructed the ALJ on remand to “address and explain the weight given to
the opinion evidence (20 CFR 416.927).” Aplt. App. at 181 (emphasis added).
5
Because additional proceedings on remand may affect the ALJ’s severity
ratings in each affected domain, we do not reach Claimant’s other arguments that the
ALJ should have found marked limitations in the domains of attending and
completing tasks and interacting and relating to others. Our reasoning is two-fold.
(continued)
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III. CONCLUSION
We reverse and remand this case to the district court with directions to remand
to the Commissioner for further proceedings consistent with this order and judgment.
Entered for the Court
Scott M. Matheson, Jr.
Circuit Judge
First, on remand the ALJ “should consider the impact of the new evidence” that
Claimant’s mother submitted to the Appeals Council after the ALJ’s 2009 decision
“on the determination of disability.” Krauser, 638 F.3d at 1329. Second, because
determining functional equivalence accounts for “the interactive and cumulative
effects” of the child’s impairments, a revised severity rating on remand in one
domain may affect the ALJ’s rating(s) in other domain(s). SSR 09-1p, 2009 WL
396031, *2; see also 20 C.F.R. § 416.926a(c) (“Any given activity may involve the
integrated use of many abilities and skills; therefore, any single limitation may be the
result of the interactive and cumulative effects of one or more impairments. And any
given impairment may have effects in more than one domain . . . .”).
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