Helen K. v. Kijakazi, Case No. 2:21-cv-09711-KES (C.D. Ca. Jan. 24, 2023)

• Joint Stipulation
• Memorandum Opinion and Order 

Topics addressed:

• Specific impairments - stroke

• Specific impairments - cognitive limitations

• RFC - failure to include credited opinions

• Medical opinions (new law) - persuasiveness

• RFC - relationship with PRTF findings

• RFC - need for special supervision

• RFC - lay evidence

• Subjective complaints - failure to take medications

• Subjective complaints - daily activities
  

Rulings addressed:

• Social Security Ruling 96-8p

• Social Security Ruling 16-3p

• Social Security Ruling 18-3p

Issues Briefed:

1)  Whether the ALJ properly considered the evidence from Dr. Williamson, whose opinions the ALJ found “persuasive.”

2)  Whether the ALJ’s mental RFC assessment is supported by substantial evidence.

3) Whether the ALJ properly considered the lay evidence of record in assessing Plaintiff’s RFC.

4) Whether the ALJ properly evaluated Plaintiff’s subjective complaints.

Court decision:

The court held that the “ALJ failed to give legally sufficient reasons for discrediting the lay witnesses’ statements.” Slip op. at 10. In so holding, the court reviewed the three reasons given by the ALJ for rejecting the statements of the two lay witnesses. Id. at 5. First, the court agreed that ALJs “cannot disregard a lay witness’s testimony simply because it was not provided under oath,” noting that SSA’s Function Report form for lay witness statements “does not include an attestation under penalty of perjury.” Id. at 6. Second, the court agreed that:  

ALJs cannot disregard a lay witness’s observations of symptoms and activities simply because the witness is not a medical source. (JS at 37-38.) The lay witnesses’ statements here, such as that Plaintiff cannot remember where she put her purse, has forgotten to turn off the stove, cannot complete chores without prompts, and does not go out alone for fear of getting lost, are neither medical opinions nor diagnoses. 

Id. Thus, this reason is “not a valid basis for discounting the lay witnesses’ statements.” Id.

The third reason cited by the ALJ was that the lay evidence was duplicative of the complaints made by Plaintiff. Id. The Commissioner relied on Valentine v. Astrue, 574 F.3d 685, 694 (9th Cir. 2009), in arguing if “an ALJ gives legally sufficient reasons for discounting a claimant’s symptom testimony and the lay witnesses describe the same symptoms, then the ALJ’s reasons are also legally sufficient to discredit the lay witnesses’ statements.” Id. at 6-7. However, the court held that this doctrine could not be critically applied in this case as:

[i]t is far from clear that the reasons on which the ALJ relied to discount Plaintiff’s testimony would apply equally to the lay witnesses. Plaintiff suffered a serious brain injury with resulting cognitive dysfunction.  Her medical records repeatedly state that she could not reliably describe her own symptoms and functional limitations. . . . In this unique context, the observations of Plaintiff’s friends – who do not suffer from similar cognitive deficits – cannot be considered unreliable for the same reasons that Plaintiff’s own testimony could.

Id. at 7.

Finally, the court held that the ALJ had overstated Plaintiff’s mental abilities in claiming that upon discharge from the rehabilitation facility at Solutions in August 2018, “the claimant was safe and independent in her self-care, with better organization and planning. She regularly participated in lunch preparation and baking activities in the rehabilitation facility, and was able to follow simple written recipe with minimal assistance.” Id. at 7-8 (bolding in original).  As the court explained:

As for self-care, when Plaintiff first came to Solutions, she could not shower independently and needed cues to use utensils to feed herself. AR 1014, 1060. When she started to shower alone, she would forget to bring a towel and change of clothes to the bathroom, and staff helped her put items in a caddy as a strategy to overcome this memory deficit. AR 1047. By the date of discharge, she was able to bathe and dress herself independently. AR 1055. Thus, the “better organization and planning” appears to refer to Plaintiff’s ability to use the caddy system devised by Solutions staff – not to Plaintiff’s own ability to solve problems by organizing or planning.

Far from considering Plaintiff “safe and independent” in her other activities of daily living upon discharge, Solutions noted that she was still generally disoriented as to the date, would confabulate, and needed cues to refer to memory prompts like a calendar. AR 1025, 1052. Solutions recommended that she only walk outside with a companion because she required “close supervision . . . due to impaired orientation.” AR 1033-34. In addition, Solutions “highly recommended” that after discharge she continue to have 24/7 supervision (AR 1057) and provided caregiver training to two friends (AR 1026).

Id. at 8-9.

Regarding meal preparation, by July 12, 2018, “she could successfully follow one- and two-step instructions given orally,” but “could not remember her own address and would lose her train of thought or forget the topics in conversation lasting longer than one minute.” Id. at 9. Plaintiff could only grocery shop with staff, but “could not find items in the store, even when standing right by them” and by August 31, 2018, “needed ‘cues to attend to tasks, read and follow a specific list.’” Id. And while she was eventually able to “‘follow a simple written recipe with minimal assistance” Solutions “‘recommended she not do any hot meal preparation at home alone.’” Id.

The court found that the descriptions of Plaintiff’s abilities and activities were “quite consistent with the lay witnesses’ observations.” Id. at 9. Given the lack of “medical sources with clinical notes focused on Plaintiff’s mental health” after her discharge from the rehabilitation facility, the lay evidence “provides uniquely useful evidence . . . .” Id. at 9-10. Thus, the court held that the “ALJ failed to give legally sufficient reasons for discrediting the lay witnesses’ statements” and remanded for further proceedings. Id. at 10.

Finally, the court observed that on remand:

Defendant may wish to consider Plaintiff’s other claims of error. In particular, are Plaintiff’s memory and pace deficits sufficiently accounted for by the current RFC determination? Is Plaintiff able to persist at simple, full-time work without special supervision or more- than-normal time spent off-task? If Plaintiff would sometimes need cues to remember and/or complete her job duties, would that erode the number of available positions? Do any of the job duties described [cited by he ALJ] exceed Plaintiff’s mental RFC? Are there any additional post-stroke mental health records available . . .? 

Id.