Lynne A Devoe v. Nancy A. Berryhill, No. 5:2017cv00299 - Document 23 (C.D. Cal. 2018)

Court Description: MEMORANDUM DECISION AND ORDER AFFIRMING COMMISSIONER by Magistrate Judge Jean P. Rosenbluth. IT IS ORDERED that judgment be entered AFFIRMING the Commissioners decision, DENYING Plaintiff's request for remand, and DISMISSING this action with prejudice. (See Order for details) (bem)

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Lynne A Devoe v. Nancy A. Berryhill Doc. 23 1 2 3 4 5 6 7 8 UNITED STATES DISTRICT COURT 9 CENTRAL DISTRICT OF CALIFORNIA 10 11 LYNNE A. DEVOE, Plaintiff, 12 13 v. 14 15 NANCY A. BERRYHILL, Acting Commissioner of Social Security, 16 Defendant. ) Case No. EDCV 17-0299-JPR ) ) ) MEMORANDUM DECISION AND ORDER ) AFFIRMING COMMISSIONER ) ) ) ) ) ) ) 17 18 I. PROCEEDINGS 19 Plaintiff seeks review of the Commissioner’s final decision 20 denying her application for Social Security disability insurance 21 benefits (“DIB”). 22 the undersigned U.S. Magistrate Judge under 28 U.S.C. § 636(c). 23 The matter is before the Court on the parties’ Joint Stipulation, 24 filed October 30, 2017, which the Court has taken under 25 submission without oral argument. 26 the Commissioner’s decision is affirmed. The parties consented to the jurisdiction of For the reasons stated below, 27 28 1 Dockets.Justia.com 1 2 II. BACKGROUND Plaintiff was born in 1974. (Administrative Record (“AR”) 3 85, 100.) 4 construction and as a restaurant server (see AR 54, 66, 217). 5 She completed 12th grade (AR 217) and last worked in In November 2012, Plaintiff filed an application for DIB, 6 alleging that she had been disabled since July 21, 2011, because 7 of scoliosis; a herniated disk; spinal stenosis; fibromyalgia; 8 numbness in her right neck, shoulder, and arm; headaches; 9 insomnia; anxiety; and depression. (See AR 85, 100, 196.) After 10 her application was denied initially (AR 114-17) and on 11 reconsideration (AR 119-23), she requested a hearing before an 12 Administrative Law Judge (AR 126-27). 13 for June 3, 2015, but Plaintiff did not appear. 14 also AR 135-46 (Apr. 15, 2015 notice of June 3 hearing), 147-48 15 (May 2, 2015 acknowledgment of receipt of notice of hearing), 149 16 (May 20, 2015 reminder of hearing), 151-53 (June 5, 2015 request 17 to show cause for failure to appear at hearing), 154-55 18 (Plaintiff’s June 18, 2015 response).) 19 A hearing was scheduled A hearing was held on October 26, 2015. (See AR 20; see (AR 72-84.) 20 Plaintiff this time appeared but was not represented by an 21 attorney or other acceptable representative. 22 The ALJ continued the hearing so that Plaintiff could obtain 23 representation. 24 held on January 28, 2016, at which Plaintiff, who was now 25 represented by counsel, testified, as did a vocational expert. 26 (AR 40-71.) 27 ALJ found Plaintiff not disabled. 28 requested review from the Appeals Council (AR 14), and on January (See AR 171.) (See AR 76-77.) A supplemental hearing was then In a written decision issued February 18, 2016, the 2 (AR 20-39.) Plaintiff 1 17, 2017, it denied review (AR 1-6). 2 III. STANDARD OF REVIEW 3 This action followed. Under 42 U.S.C. § 405(g), a district court may review the 4 Commissioner’s decision to deny benefits. The ALJ’s findings and 5 decision should be upheld if they are free of legal error and 6 supported by substantial evidence based on the record as a whole. 7 See id.; Richardson v. Perales, 402 U.S. 389, 401 (1971); Parra 8 v. Astrue, 481 F.3d 742, 746 (9th Cir. 2007). 9 evidence means such evidence as a reasonable person might accept Substantial 10 as adequate to support a conclusion. 11 401; Lingenfelter v. Astrue, 504 F.3d 1028, 1035 (9th Cir. 2007). 12 It is more than a scintilla but less than a preponderance. 13 Lingenfelter, 504 F.3d at 1035 (citing Robbins v. Soc. Sec. 14 Admin., 466 F.3d 880, 882 (9th Cir. 2006)). 15 substantial evidence supports a finding, the reviewing court 16 “must review the administrative record as a whole, weighing both 17 the evidence that supports and the evidence that detracts from 18 the Commissioner’s conclusion.” 19 720 (9th Cir. 1998). 20 either affirming or reversing,” the reviewing court “may not 21 substitute its judgment” for the Commissioner’s. 22 IV. Richardson, 402 U.S. at To determine whether Reddick v. Chater, 157 F.3d 715, “If the evidence can reasonably support Id. at 720-21. THE EVALUATION OF DISABILITY 23 People are “disabled” for purposes of receiving Social 24 Security benefits if they are unable to engage in any substantial 25 gainful activity owing to a physical or mental impairment that is 26 expected to result in death or has lasted, or is expected to 27 last, for a continuous period of at least 12 months. 28 § 423(d)(1)(A); Drouin v. Sullivan, 966 F.2d 1255, 1257 (9th Cir. 3 42 U.S.C. 1 1992). 2 A. The Five-Step Evaluation Process 3 The ALJ follows a five-step sequential evaluation process to 4 assess whether a claimant is disabled. 5 § 404.1520(a)(4); Lester v. Chater, 81 F.3d 821, 828 n.5 (9th 6 Cir. 1995) (as amended Apr. 9, 1996). 7 Commissioner must determine whether the claimant is currently 8 engaged in substantial gainful activity; if so, the claimant is 9 not disabled and the claim must be denied. 20 C.F.R. In the first step, the § 404.1520(a)(4)(i). 10 If the claimant is not engaged in substantial gainful 11 activity, the second step requires the Commissioner to determine 12 whether the claimant has a “severe” impairment or combination of 13 impairments significantly limiting her ability to do basic work 14 activities; if not, the claimant is not disabled and her claim 15 must be denied. 16 § 404.1520(a)(4)(ii). If the claimant has a “severe” impairment or combination of 17 impairments, the third step requires the Commissioner to 18 determine whether the impairment or combination of impairments 19 meets or equals an impairment in the Listing of Impairments set 20 forth at 20 C.F.R. part 404, subpart P, appendix 1; if so, 21 disability is conclusively presumed. § 404.1520(a)(4)(iii). 22 If the claimant’s impairment or combination of impairments 23 does not meet or equal an impairment in the Listing, the fourth 24 step requires the Commissioner to determine whether the claimant 25 has sufficient residual functional capacity (“RFC”)1 to perform 26 27 28 1 RFC is what a claimant can do despite existing exertional and nonexertional limitations. § 404.1545; see Cooper v. Sullivan, 880 F.2d 1152, 1155 n.5 (9th Cir. 1989). The 4 1 her past work; if so, she is not disabled and the claim must be 2 denied. 3 proving she is unable to perform past relevant work. 4 F.2d at 1257. 5 case of disability is established. § 404.1520(a)(4)(iv). The claimant has the burden of Drouin, 966 If the claimant meets that burden, a prima facie Id. 6 If that happens or if the claimant has no past relevant 7 work, the Commissioner then bears the burden of establishing that 8 the claimant is not disabled because she can perform other 9 substantial gainful work available in the national economy. 10 § 404.1520(a)(4)(v); Drouin, 966 F.2d at 1257. 11 determination comprises the fifth and final step in the 12 sequential analysis. 13 n.5; Drouin, 966 F.2d at 1257. That § 404.1520(a)(4)(v); Lester, 81 F.3d at 828 14 B. 15 At step one, the ALJ found that Plaintiff had not engaged in The ALJ’s Application of the Five-Step Process 16 substantial gainful activity since July 21, 2011, the alleged 17 disability-onset date. 18 she had one severe impairment: degenerative disc disease of the 19 lumbar spine. 20 have an impairment or combination of impairments falling under a 21 Listing. 22 (Id.) (AR 23.) At step two, he concluded that At step three, he found that she did not (AR 27.) At step four, the ALJ found that Plaintiff had the RFC to 23 perform medium work. 24 concluded that Plaintiff could perform her past relevant work as 25 a server. (AR 32.) (Id.) Based on the VE’s testimony, the ALJ Thus, the ALJ found Plaintiff not disabled. 26 27 28 Commissioner assesses the claimant’s RFC between steps three and four. Laborin v. Berryhill, 867 F.3d 1151, 1153 (9th Cir. 2017) (citing § 416.920(a)(4)). 5 1 (Id.) 2 V. 3 DISCUSSION Plaintiff argues that the ALJ erred in finding that she had 4 no severe mental impairment (J. Stip. at 4-10, 15-18), evaluating 5 her physical impairments (id. at 18-21, 24-26), and rejecting her 6 subjective symptom testimony (id. at 26-27, 31-33). 7 also raises several challenges to the ALJ’s evaluation of the 8 medical-opinion evidence. 9 24-26.) Plaintiff (See id. at 5-7, 8-10, 15-18, 20-21, For efficiency, the Court addresses Plaintiff’s 10 arguments in an order different from that followed by the 11 parties. 12 not warranted. 13 A. 14 As discussed below, the ALJ did not err and remand is The ALJ Properly Evaluated Plaintiff’s Subjective Symptom Testimony 15 The ALJ found Plaintiff’s allegations “less than fully” 16 credible. 17 Stip. at 26) and specifically challenges the ALJ’s reliance on 18 her supposedly “minimal activities of daily living” (id. at 27) 19 and “lack of treatment that [was] more aggressive” (id. at 26). 20 The ALJ did not err in either regard, however, and offered an 21 additional reason unchallenged by Plaintiff: her subjective 22 symptom statements were unsupported by the medical evidence. 23 29.) 24 25 (AR 29.) She contends that that was in error (J. (AR Accordingly, remand is unwarranted on this ground. 1. Applicable law An ALJ’s assessment of the credibility of a claimant’s 26 allegations concerning the severity of her symptoms is entitled 27 to “great weight.” 28 Cir. 1989) (as amended); Nyman v. Heckler, 779 F.2d 528, 531 (9th See Weetman v. Sullivan, 877 F.2d 20, 22 (9th 6 1 Cir. 1985) (as amended Feb. 24, 1986). 2 ‘required to believe every allegation of disabling pain, or else 3 disability benefits would be available for the asking, a result 4 plainly contrary to 42 U.S.C. § 423(d)(5)(A).’” 5 Astrue, 674 F.3d 1104, 1112 (9th Cir. 2012) (quoting Fair v. 6 Bowen, 885 F.2d 597, 603 (9th Cir. 1989)). 7 “[T]he ALJ is not Molina v. In evaluating a claimant’s subjective symptom testimony, the 8 ALJ engages in a two-step analysis. 9 at 1035-36; see also SSR 96-7p, 1996 WL 374186 (July 2, 1996).2 See Lingenfelter, 504 F.3d 10 “First, the ALJ must determine whether the claimant has presented 11 objective medical evidence of an underlying impairment [that] 12 could reasonably be expected to produce the pain or other 13 symptoms alleged.” 14 objective medical evidence exists, the ALJ may not reject a 15 claimant’s testimony “simply because there is no showing that the 16 impairment can reasonably produce the degree of symptom alleged.” 17 Smolen v. Chater, 80 F.3d 1273, 1282 (9th Cir. 1996) (emphasis in 18 original). Lingenfelter, 504 F.3d at 1036. If such 19 20 21 22 23 24 25 26 27 28 2 Social Security Ruling 16-3p, 2016 WL 1119029, effective March 16, 2016, rescinded SSR 96-7p, which provided the framework for assessing the credibility of a claimant’s statements. SSR 16-3p was not in effect at the time of the ALJ’s decision in this case, however, and therefore does not apply. Still, the Ninth Circuit has clarified that SSR 16-3p “makes clear what our precedent already required: that assessments of an individual’s testimony by an ALJ are designed to ‘evaluate the intensity and persistence of symptoms after [the ALJ] find[s] that the individual has a medically determinable impairment(s) that could reasonably be expected to produce those symptoms,’ and not to delve into wide-ranging scrutiny of the claimant’s character and apparent truthfulness.” Trevizo v. Berryhill, 871 F.3d 664, 678 n.5 (9th Cir. 2017) (as amended) (alterations in original) (quoting SSR 16-3p). 7 1 If the claimant meets the first test, the ALJ may discredit 2 the claimant’s subjective symptom testimony only if he makes 3 specific findings that support the conclusion. 4 Astrue, 622 F.3d 1228, 1234 (9th Cir. 2010). 5 affirmative evidence of malingering, the ALJ must provide “clear 6 and convincing” reasons for rejecting the claimant’s testimony. 7 Brown-Hunter v. Colvin, 806 F.3d 487, 493 (9th Cir. 2015) (as 8 amended); Treichler v. Comm’r of Soc. Sec. Admin., 775 F.3d 1090, 9 1102 (9th Cir. 2014). See Berry v. Absent a finding or The ALJ may consider, among other factors, 10 (1) ordinary techniques of credibility evaluation, such as the 11 claimant’s reputation for lying, prior inconsistent statements, 12 and other testimony by the claimant that appears less than 13 candid; (2) unexplained or inadequately explained failure to seek 14 treatment or to follow a prescribed course of treatment; (3) the 15 claimant’s daily activities; (4) the claimant’s work record; and 16 (5) testimony from physicians and third parties. 17 Comm’r Soc. Sec. Admin., 807 F.3d 996, 1006 (9th Cir. 2015) (as 18 amended); Thomas v. Barnhart, 278 F.3d 947, 958-59 (9th Cir. 19 2002). 20 substantial evidence in the record, the reviewing court “may not 21 engage in second-guessing.” 22 If the ALJ’s credibility finding is supported by 2. Thomas, 278 F.3d at 959. Relevant background a. 23 Rounds v. Plaintiff’s Allegations Plaintiff completed an Adult Function Report on April 30, 24 25 2013. (AR 226-37.) She alleged being unable to work because of 26 “excruciating” pain that inhibited her ability to lift, stand, 27 walk, or bend over; the pain was located in her lower back, legs, 28 buttocks, knees, feet, shoulders, arms, fingers, toes, neck, and 8 1 head. (AR 226, 236.) She could do such things as dress and 2 bathe only “as pain allow[ed]” and had trouble sleeping. 3 227.) 4 sons, cat, and dog. 5 daily with help from her family (AR 228), doing “small” household 6 chores (id.; see also AR 236 (“folding laundry, light dusting, 7 wiping down counter[,] and . . . cooking”)), going outside “a 8 lot” to sit on the grass (AR 229), driving a car (id.), going out 9 alone (id.), shopping in stores using an electric cart and with (AR She nonetheless took care of her disabled husband, two (Id.) She reported preparing her own meals 10 the help of family (AR 229, 236), and being able to pay bills, 11 count change, handle a savings account, and use a checkbook or 12 money order (AR 229). 13 She alleged having problems being “around people” and 14 claimed to be able to pay attention for only “6 seconds.” 15 231.) 16 (AR 230.) 17 father “once in a while,” talked with her mother on the phone 18 three times a week, and “text[ed] [her] friends to see how they 19 [we]re.” 20 week, though she would stay in the car, and she didn’t “need 21 someone to accompany [her].” 22 (AR She reported, however, that she spent time with others. She stayed home with her family, saw her mother and (Id.) She also took her son to soccer practice once a (AR 230, 236.) At her January 28, 2016 hearing, Plaintiff testified that 23 she stopped working in July 2011 because she “couldn’t walk.” 24 (AR 52.) 25 her left leg (AR 53) and later had surgery for her back (AR 56- 26 57). 27 but she then “lost all feeling in [her] feet.” 28 testified that “most of the feeling” had “come back,” however. At that time she experienced “shooting nerve pain” in The surgery “got rid of a . . . lot of pain,” she stated, 9 (AR 57.) She 1 (Id.) 2 Plaintiff also couldn’t “use [her] right hand” (AR 57-58), 3 experienced “migraine headaches” caused by pain shooting from her 4 arm up to her neck and “across [her] face” (AR 59), and had 5 problems with her knees (AR 58). 6 worse than the other, she stated that “it used to be the right 7 but it’s now the left.” 8 impairments, she testified, she could sit for only “five minutes 9 without shifting,” stand for only “10-15 minutes” without sitting When asked if one knee was (AR 58-59.) Because of her physical 10 down or changing position, and walk only “about three blocks” 11 before having to rest for a “few minutes.” 12 could also lift only a gallon of milk.3 13 (AR 60-61.) She (AR 62.) Plaintiff had problems with her memory as well. (Id.) She 14 had “little spaces” that she didn’t remember, would be “told 15 stuff that [she didn’t] remember being told,” and could not read 16 a book and remember what she had read. 17 little television because she couldn’t focus, and she stayed away 18 from friends. 19 husband and two kids, who were 22 and 16. 20 (AR 63.) (AR 62-63.) She watched She was married and lived with her (Id.) When asked about chores, Plaintiff stated that she could 21 “cook small meals” and drive. (AR 64.) She did not vacuum, 22 however, and laundry was brought to her and she would “hold it.” 23 (Id.) Chores, she stated, were a “group effort.” (Id.) 24 25 26 27 28 3 A gallon of milk weighs approximately eight and a half pounds. Hernandez v. Colvin, No. 1:12-CV-00330-SMS, 2013 WL 4041862, at *9 n.4 (E.D. Cal. Aug. 8, 2013). 10 1 b. Plaintiff’s Statements to Medical 2 Professionals 3 In April 2013, Plaintiff’s mental condition was evaluated by 4 a consulting examiner. (AR 333-38.) She drove to the 5 appointment “by herself” and was “on time.” 6 reported living with four family members. 7 take care of “self-dressing, self-bathing, and personal hygiene”; 8 drive a car; pay bills and handle cash appropriately; go out 9 alone; and “focus [her] attention.” (AR 333.) (AR 335.) (Id.) She She could She had “excellent or 10 good” relationships with “family and friends” and had “no 11 difficulty completing household tasks” or “making her decisions.” 12 (Id.) 13 do light household chores”; manage money; eat breakfast and make 14 coffee; go grocery shopping and run errands; organize her home; 15 eat lunch; watch television; do chores around the house; go 16 outside and “sit with the dogs”; and “shower before going to 17 bed.” 18 On a daily basis, she could “dress, bathe, cook, clean and (Id.) In May 2015, she reported to one of her own doctors that she 19 was “able to manage her own medication,” “remember[ed] 20 appointments,” “manage[d] finances,” and “pa[id] bills without 21 problem.” 22 and independent in all activities of daily living.” 23 “dr[ove] a car.” 24 week” and “follo[wed] a routine of weight training and 25 cardiovascular exercise.” 26 assistance,” and “[h]er gait was fluid.” 27 hear and read instructions.” 28 (AR 486.) She was noted as being “fully ambulatory (AR 487.) (Id.) She She “visit[ed] the gym 3 times a (Id.) She “walked without (Id.) She “was able to (AR 488.) In October and November 2015, she reported to another of her 11 1 doctors that she had “Power of Attorney over her mother and [was] 2 trying to help her with legal issues regarding her home.” 3 531, 539, 542, 681.) 4 and still live[d] at home,” and she was “trying to get him 5 appropriate medical care.” 6 in 2009 during active duty,” had a “cognitive disorder,” and was 7 “not able to drive,” and Plaintiff was “his caretaker.” 8 He was on disability. 9 mother, her brother, her husband, and herself.” (AR Her oldest son had “mental health problems (AR 532.) (AR 541.) Her husband was “injured (Id.) She reported helping “her (AR 536.) She 10 also said that she and her youngest son traveled to San Diego to 11 find her grandmother’s grave. 12 whole family . . . rallied to care for each other.” 13 Plaintiff denied any suicide plans or attempts. 14 (AR 682.) She reported that “the (AR 683.) (AR 530.)4 Plaintiff’s reports of taking care of her husband appear 15 throughout the record. 16 reporting “tak[ing] care of her husband who suffer[ed] from PTSD” 17 and that she “ha[d] additional stress [from] taking care of 18 him”), 486 (May 2015: “Her husband suffered a back injury while 19 in the military and is disabled.”), 532 (Oct. 2015: stating that 20 she was “caregiver” for disabled husband).) 21 indicated that her “[h]usband got [a] large stipend for her to be 22 caregiver.” 23 she read books (see, e.g., AR 499 (reading ADD book, which became 24 “[her] new Bible”), 502 (stating that she had questions for her (See, e.g., AR 328 (Dec. 2012: Plaintiff (AR 510 (Feb. 2014).) And she at one point She also often reported that 25 26 27 28 4 That same month, however, during one of her aborted hearings, when the ALJ expressed frustration that Plaintiff had not yet gotten a proper representative and declined her request that he “be gentle” with her, she threatened, “I could leave the room and kill myself, okay?” (AR 82.) 12 1 psychiatrist regarding “meds and [a] book she[ was] reading”), 2 540 (reading “books about multiple personality”), 633 (discussing 3 ADHD book and stating that she “derive[d] some benefit from 4 that”)) and was exercising (see, e.g., AR 629 (Mar. 2015: 5 “exercising 3 times a week”), 487 (May 2015: “visits the gym 3 6 times a week and follows a routine of weight training and 7 cardiovascular exercise”)). 8 c. Physical-Health Medical Evidence 9 Near the start of the relevant period, in September 2011, 10 Plaintiff complained of pain in her back and left hip and leg. 11 (AR 424.) 12 evidence of acute fractures, subluxation or significant disc 13 space narrowing.” 14 “frustrated that [the] xray was normal” and continued to have 15 “mild” lower back pain but “severe” pain in her leg. 16 On examination she demonstrated “no abnormality” in her back, 17 normal extension, negative straight-leg raising, and “intact” 18 balance and gait. 19 posterior tenderness and “left tenderness from L2 to L5” with 20 palpation. 21 identical to prior notes/encounters”).) 22 A lumbar-spine x-ray at that time revealed “[n]o (AR 373.) (AR 422.) In October, she reported being (AR 421.) She was “positive,” however, for (Id.; see also AR 418-20 (Nov. 2011: “L spine exam On November 14, 2011, Plaintiff began seeing orthopedic 23 surgeon Amir David Tahernia for her back and left-leg pain. 24 370-71; see also AR 554.) 25 after she “overdid it” with “some vigorous activity” while 26 “vacationing with her family in August” of that year. 27 370.) 28 back, but her range of motion was “[l]imited in all planes” and (AR She reported that she experienced pain (See AR On examination, Dr. Tahernia found no tenderness in her 13 1 she had “4/5 hip flexion, knee extension, and weakness on the 2 left.” 3 spine (AR 372), which was completed later that month (AR 466-68). 4 The MRI revealed that at the “L4-5” disc level she had “mild 5 decreased disc height loss,” “partial disc desiccation,” “disc 6 bulge with . . . mild bilateral ligamentum flavum buckling and 7 facet arthropathy that contribute[d] to moderate to severe 8 bilateral subarticular zone stenosis abutting/compressing the 9 bilateral descending L5 nerve roots and to mild bilateral neural (AR 371.) Dr. Tahernia ordered an MRI of her lumbar 10 foraminal narrowing,” and “[m]ild bilateral reactive facet 11 arthropathy.” 12 bilateral ligamentum flavum buckling and facet arthropathy” at 13 the “L5-S1” disc level, which contributed to “mild bilateral 14 subarticular zone stenosis encroaching upon the bilateral 15 descending S1 nerve roots.” 16 results with Plaintiff and recommended her for a “left L5 17 transforaminal epidural steroid injection.” 18 (AR 467.) She also had a disc bulge with “mild (Id.) Dr. Tahernia reviewed the (AR 368.) The injection was administered on December 7, 2011. (AR 19 366-67.) 20 reported that the injection was “helpful,” “[o]verall she . . . 21 improved,” and she was “slowly getting back to the gym” and 22 exercising. 23 pain,” however, and Dr. Tahernia recommended her for more 24 injections. 25 30, 2012. 26 doctor that it “did not help as much” as the first injection. 27 (AR 415.) 28 At her follow-up appointment a month later, Plaintiff (AR 365.) (Id.) She still had “some intermittent low back She received one later that month, on January (AR 363-64.) She reported in February to another Plaintiff next saw Dr. Tahernia in May 2012, complaining of 14 1 back, left-leg, and neck pain as well as bilateral upper- 2 extremity paresthesias. 3 that point she had “undergone a full course of left L5” steroid 4 injections, which were “therapeutic and diagnostic,” but she 5 nonetheless “developed some recurrent back and lower left leg 6 pain.” 7 physical exam, finding “no specific tenderness to palpation in 8 [her] lumbar spine” but “decreased” sensation along the lateral 9 aspect of her left leg. (Id.) (AR 361.) Dr. Tahernia noted that by He reviewed Plaintiff’s MRI again and conducted a (Id.) He found her to be “a candidate” 10 for “microdecompression L4-5, left-sided” surgery. 11 Plaintiff wanted to “consider options” (id.) and did not receive 12 that surgery until May 2014 (AR 554-55; see also AR 359 (June 13 2013: “unable to undergo surgery at this time due to family 14 issues”)). 15 (AR 362.) During the rest of 2012, Plaintiff complained of abdominal 16 pain, various muscle pains on the right side of her body, 17 “tingling” in her right arm, neck pain, and headaches. 18 413-14 (July 2012), 293-94 (Sept. 2012), 297-98 (Sept. 2012).) 19 In October, she underwent an “EMG” nerve-conduction study, which 20 revealed “mild ulnar neuropathy” in her right elbow. (AR 299- 21 300.) (AR 321- 22 31.) 23 in her shoulders, no swelling or tenderness in her elbows or 24 wrists, no pain in her hips with rotation, full range of motion 25 in her knees, and no swelling or tenderness in her ankles. In December, she visited an arthritis clinic. (See AR On examination, she demonstrated “normal range of motion” 26 27 28 15 (AR She was noted as already taking Vicodin,5 among other 1 330.) 2 medications (AR 325), and was “restart[ed]” on Effexor6 to 3 “control[] her stress level.” 4 spine was also conducted that month and revealed no evidence of 5 “stenosis or disc herniation.” (AR 331.) An MRI of her cervical (AR 464-65.) 6 In May 2013, Plaintiff was evaluated by consulting examiner 7 Sean To, who specialized in internal medicine, and complained of 8 neck and back pain and fibromyalgia. 9 “appear[ed] to be normal” and exhibited “no tenderness to (AR 340-47.) Her abdomen 10 palpation.” 11 upper-extremity joints and “mild tenderness to palpation” in her 12 shoulders, elbows, and trapezius muscles. 13 “normal” range of motion in her lower-extremity joints, “mild 14 tenderness to palpation” in her knees and ankles, and “moderate 15 tenderness to palpation” in her left hip. 16 showed “mild tenderness to palpation” and a range of motion, with 17 “no discernible limitation in any plane.” 18 straight-leg-raising test results were “negative,” and her hands 19 and feet revealed “no significant deformities.” 20 was able to manipulate the use of a pen “with ease,” did not 21 “restrict the use of either hand during the examination,” could (AR 343.) She had “normal” range of motion in her (Id.) (Id.) She had Her spine (AR 343-44.) Her (AR 344.) She 22 5 23 24 25 26 27 28 Vicodin is a name-brand version of a narcotic hydrocodoneacetaminophen product used to relieve moderate to severe pain. Hydrocodone Combination Products, MedlinePlus, https:// medlineplus.gov/druginfo/meds/a601006.html (last updated Jan. 15, 2018). 6 Effexor is the name-brand version of venlafaxine, a selective serotonin and norepinephrine reuptake inhibitor used to treat depression. See Venlafaxine, MedlinePlus, https:// medlineplus.gov/druginfo/meds/a694020.html (last updated Dec. 15, 2017). 16 1 make a fist bilaterally “without difficult[y],” and adequately 2 achieved “[p]inch positioning.” 3 strength (id.) and a “normal gait” (AR 345). 4 that Plaintiff could lift and carry “50 pounds occasionally and 5 25 pounds frequently” and stand and walk for up to “6 hours in a 6 normal 8-hour workday” but otherwise had no limitations or 7 restrictions. 8 9 (Id.) She had “5/5” muscle Dr. To concluded (AR 345-46.) In 2013, she continued to complain of pain in her back, leg, neck, and arm even though she had apparently attended physical 10 therapy for two months that year and had epidural injections in 11 January and May 2013 — all of which provided “no sense of 12 relief.” 13 showed an “essentially normal-looking cervical and lumbar spine.” 14 (AR 360.) 15 to palpation in her back, pain when extending or rotating her 16 back, painful but good range of motion in her shoulders, and 17 normal strength in her upper extremities. 18 MRI of her thoracic spine showed no evidence of stenosis, neural 19 foraminal narrowing, or disc herniation. 20 (See, e.g., AR 358-59 (June 2013).) A June 2013 x-ray That same month, however, she demonstrated tenderness (AR 356.) In July, an (AR 461-63.) In August 2013, Plaintiff also began to complain of pain in 21 her right knee and noted “concerns about disability, which she 22 [wanted] addressed.” 23 tenderness to palpation of her back and painful back extension 24 and rotation, but she had “5/5” muscle strength and negative 25 straight-leg raises bilaterally. 26 attending orthopedic physician, Hazmer Cassim, there was no 27 “clear-cut evidence of fibromyalgia,” and Plaintiff’s “many 28 subjective complaints of pain exceed[ed] objective findings.” (AR 352.) On examination, she had some 17 (AR 353.) According to the 1 (Id.) Dr. Cassim also examined her knees that month, following a 2 complaint that her left knee began to hurt as much as the right; 3 he noted that a “[f]ourteen-point review of systems” was 4 “unremarkable,” she had full range of motion in both knees, and 5 she had “mild palpable tenderness” in her right knee but no 6 tenderness in her left. 7 conducted at that time showed “some very slight patellofemoral 8 degenerative joint disease bilaterally” and a “small effusion on 9 [her] right knee” but was “otherwise unremarkable.” (AR 349-51.) An x-ray of her knees (AR 350; see 10 also AR 460 (Oct. 2013 MRI of left knee showing “subcentimeter 11 focus of superficial chondral fissure formation and fibrillation 12 overlying the median eminence of the patella” but “[o]therwise 13 normal” results).) 14 “[p]atellofemoral syndrome bilaterally[,] right greater [than] 15 left.” 16 In November 2013, she was diagnosed with (AR 582-83.) Plaintiff’s physical-health medical records from 2014 17 primarily concern her decompression surgery in May 2014. 18 554-55.) 19 better” and was “increasing her activities.” 20 continued on antiinflammatory medication, Flexeril,7 and Vicodin. 21 (Id.) 22 “no evidence for spinal canal stenosis or disc herniation”; mild 23 bilateral foraminal narrowing at the L4-L5 level, “consistent for 24 lumbar spine decompression surgery”; and “reactive changes” at 25 the “L2-L3, L3-L4, and L4-L5” levels, which “could represent (AR Following the procedure, Plaintiff reported “doing much (AR 646.) She was An MRI of her lumbar spine completed in August 2014 showed 26 27 28 7 Flexeril is a name-brand version of cylcobenzaprine, a skeletal muscle relaxant used to relieve pain. Cyclobenzaprine, MedlinePlus, https://medlineplus.gov/druginfo/meds/a682514.html (last updated Feb. 15, 2017). 18 1 specific pain generators in the appropriate clinical setting.” 2 (AR 569-71.) 3 She was next seen in June 2015 for pain and numbness in her 4 left leg and foot and right knee. (AR 575-76, 642-43.) She 5 demonstrated “decreased sensation” over her foot on examination; 6 based on a CT scan apparently conducted in March 2015, there was 7 no evidence of nerve compression in her right or left knee. 8 642-43.) 9 well as “[l]eft leg radicular pain and neuropathy.” (AR She was assessed with a “possible” left-toe cyst as (Id.; see 10 also AR 580-81 (assessing Plaintiff with “[s]oft tissue mass [on 11 the] plantar aspect of [left] toe”).) 12 2015 for “multi-site pain,” and on examination she demonstrated 13 some tenderness to palpation of her low back, pain while 14 extending and rotating her back, “greater than 3/5” functional 15 strength, and “[n]ormal” gait. 16 no “clear-cut etiology for her symptoms.” 17 She was seen again in July (AR 577-79, 644-45.) There was (AR 645.) In October 2015, Plaintiff received a neurosurgical 18 consultation. 19 “paresthesias in the left lateral foot and right ulnar 20 distribution” but “equal and symmetrical” deep tendon reflexes, 21 no pathological reflexes, and “symmetrical” gait. 22 Plaintiff’s August 2014 lumbar-spine MRI was also reviewed, which 23 showed no significant stenosis and “mild” disc bulges. 24 The bulges “d[id] not represent [a] severe enough problem to be 25 causing [Plaintiff’s] current symptoms” and were “somewhat more 26 eccentric to the right at L4-5” even though her “symptoms [were] 27 on the left.” 28 “potentially benefit” from “sciatic nerve decompression at the (AR 647-48.) (Id.) She was noted as having (AR 648.) (Id.) She was nonetheless informed that she would 19 1 pelvic outlet” and “perineal nerve decompression at the fibular 2 head.” 3 (Id.) In December 2015, Plaintiff was seen by Dr. A. Nabet for 4 pain in her right arm and shoulder. 5 demonstrated no tenderness in her neck, spine, shoulders, elbows, 6 or wrists and “intact” range of motion in her extremities. 7 660.) 8 completed in January 2016 (AR 650-51). It indicated “mild 9 findings” for bursitis and tendinosis. (AR 651.) (AR 658-61.) She (AR An MRI of her right shoulder was ordered (AR 661) and was Upon review of 10 the MRI results and on examination, during which Plaintiff 11 demonstrated pain and tenderness in her shoulders and right 12 elbow, she was assessed with peripheral nerve-entrapment syndrome 13 in her right elbow and lower left leg. 14 demonstrated no tenderness in her neck, spine, or abdomen, 15 however. 16 RFC questionnaire and assessed that Plaintiff “constantly” 17 experienced pain “severe enough to interfere with attention and 18 concentration” and was “incapable of even ‘low stress’ jobs,” 19 among other limitations. 20 (Id.) (AR 655.) She That same month, Dr. Nabet completed a physical (AR 663; see generally AR 662-66.) At Plaintiff’s January 2016 hearing, orthopedic surgeon Eric 21 Schmitter testified as a medical expert. 22 reviewing the record, he found that there was no “significant 23 orthopaedic pathology of note” (AR 44) and concluded that 24 Plaintiff did not have less than a “medium” RFC (AR 45). 25 support of his findings, he testified that a lumbar-spine MRI 26 from August 2014 “showed no evidence of stenosis,” a right- 27 shoulder MRI from January 2016 “showed mild bursitis and 28 tendinitis,” “[e]lectrodiagnostic studies showed some mild ulnar 20 (See AR 43-52.) After In 1 changes at the right elbow but nothing of great significance,” 2 and an April 2013 internal-medicine exam “had no objective spine 3 findings.” 4 right elbow” was a “common finding,” and another examination 5 indicated “normal nerve[s].” 6 “there [was] no evidence that there [was] significant sensory or 7 motor deficit” (id.) and there were no records finding “any 8 neurological deficits at all on . . . physical examin[ation]” (AR 9 51). 10 (AR 44.) Moreover, the “mild ulnar s[h]owing at the (AR 46 (citing AR 637-46).) Thus, When asked about fibromyalgia, which Dr. Schmitter opined 11 was the “probable cause of all of her symptoms,” he testified 12 that there was no “documentation to substantiate” that diagnosis. 13 (AR 44-45 (finding no record with requisite pressure points).) 14 When asked about a lumbar-spine MRI referenced by Dr. Tahernia in 15 May 2012 (see AR 49 (citing AR 362)), Dr. Schmitter stated that 16 there was no “examination evidence that there[ was] a L5 17 deficit,” such as “muscle weakness or dermatomal sensory loss” 18 (id.). 19 problems” without “evidence that there [was] a neurologic 20 deficit.” 21 Plaintiff’s lumbar spine, Dr. Schmitter stated that it was “as 22 normal as you can get.” 23 attorney noted that the MRI found some “compression in the 24 bilateral descending L5 nerve root,” and Dr. Schmitter responded 25 that that was only a “potential problem.” 26 467.) 27 nerve root on the left, there should be corresponding examination 28 findings resulting in L5 motor weakness . . . [a]nd that’s not Impressions of stenosis and radiculopathy were “potential (AR 50.) When asked about a November 2011 MRI of (AR 50-51 (citing AR 466).) Plaintiff’s (AR 51; see also AR He testified that “[i]f there were pressure on the L5 21 1 evident anywhere in the records.” 2 asked about the decompression surgery that Plaintiff underwent in 3 May 2014. 4 record to support that surgery. (Id.) 5 d. 6 7 (Id.) Dr. Schmitter was also He indicated that there was no basis in the (AR 52.) Mental-Health Medical Evidence i. Dr. Bassanelli Plaintiff began seeing psychiatrist Anthony Bassanelli on 8 January 15, 2014. 9 she appeared “anxious,” but she was oriented and stable and (AR 512-19; see also AR 548.) At that time, 10 exhibited “[a]bove [a]verage” intelligence and “good” memory. 11 (AR 517.) 12 involved loose associations, her thought content was logical and 13 reality based. 14 “ADHD” (AR 518), assigned her a Global Assessment of Functioning 15 score of 55 (AR 519),9 and prescribed Effexor (id.). Though her thought forms were circumstantial and (AR 517-18.) He assessed her with “PTSD”8 and She had 16 17 18 19 20 21 22 23 24 25 26 27 28 8 Plaintiff’s posttraumatic stress disorder was noted by one psychologist as being “due to multiple factors,” including “the death of her father” from cancer in 2013. (AR 684; see also AR 681-82 (“It was very traumatic [and] ‘brutal’ for [Plaintiff] to watch her father . . . die[.]”), 683-84 (describing Plaintiff’s “trauma history”).) 9 A GAF score of 51 to 60 indicates moderate symptoms in one area or difficulty in social, occupational, or school functioning. See Diagnostic and Statistical Manual of Mental Disorders 32 (revised 4th ed. 2000). The Commissioner has declined to endorse GAF scores, Revised Medical Criteria for Evaluating Mental Disorders and Traumatic Brain Injury, 65 Fed. Reg. 50764-65 (Aug. 21, 2000) (codified at 20 C.F.R. pt. 404) (GAF score “does not have a direct correlation to the severity requirements in our mental disorders listings”), and the most recent edition of the DSM “dropped” the GAF scale, citing its lack of conceptual clarity and questionable psychological measurements in practice, Diagnostic and Statistical Manual of Mental Disorders 16 (5th ed. 2012). Because GAF scores continue to be included in claimant medical records, however, the Social Security Administration has clarified that they are “medical 22 1 been using Effexor previously and stated that it “helped[,] even 2 [with] whole body pain.” 3 (AR 513.) Plaintiff followed up with Dr. Bassanelli in February 2014. 4 (AR 510.) She stated that her “[h]usband got [a] large stipend 5 for her to be caregiver” and that she was “feeling a little 6 better,” though “sleep remain[ed] a big problem,” and she was 7 noted as being “pleasant,” “animated,” “calmer,” and “more 8 focused.” 9 Bassanelli made no change because “she like[d] how she [was] (Id.) She was compliant with her medication, and Dr. 10 feeling [and] want[ed] to remain at this dose for now.” 11 The following month, however, Plaintiff reported being frustrated 12 because her “current dose of Effexor [was] not as effective” and 13 her “response to meds” decreased. 14 noted no change in her health and started her on Adderall.10 15 (Id.) 16 17 (AR 509.) (Id.) Dr. Bassanelli By April 2014, Plaintiff had stopped using Effexor because it caused “blurry vision.” (AR 507; see also AR 508.) She 18 19 20 21 22 23 24 25 opinion evidence under 20 C.F.R. §§ 404.1527(a)(2) and 416.927(a)(2) if they come from an acceptable medical source.” Wellington v. Berryhill, 878 F.3d 867, 871 n.1 (9th Cir. 2017) (citing Richard C. Ruskell, Social Security Disability Claims Handbook § 2:15 n.40 (2017)). As with other medical-opinion evidence, the reliability of a GAF score depends on whether it is “consistent with the other evidence, the rater’s familiarity with the claimant, and the credentials of the rater”; GAF scores “should not be considered in isolation.” Ruskell, supra, § 2:15 n.40 (citing internal Social Security Administrative Message number 13066, which became effective July 22, 2013, and was revised on Oct. 14, 2014). 10 26 27 28 Adderall is the name-brand version of a dextroamphetamine and amphetamine combination product, a central-nervous-system stimulant used to control the symptoms of ADHD. See Dextroamphetamine and Amphetamine, MedlinePlus, https:// medlineplus.gov/druginfo/meds/a601234.html (last updated Sept. 15, 2017). 23 1 reported being compliant with Adderall and said “she was able to 2 be much more productive” on it. 3 that there were “too many side effects” from it, as she felt too 4 “wired” and “speeded [sic] up.” 5 her on Vyvanse.11 6 reported feeling “horrible,” so Dr. Bassanelli discontinued it 7 and prescribed her Diazepam “as needed for now.”12 8 9 (Id.) (AR 507.) (Id.) She stated, however, Dr. Bassanelli started A few weeks later, however, Plaintiff (See AR 506.) In June 2014, Plaintiff reported being “anxious but managing,” and Dr. Bassanelli noted that she was “pleasant” and 10 “not racing or pressured.” 11 [and] retry [Effexor]” and was cautioned about its blurred-vision 12 side effect. 13 Diazepam, which had “fair” efficacy, and was restarted on 14 Effexor. 15 away” but her sleeping was “still awful.” 16 however, she was “frustrated” with her medications and began 17 using “natural supplements.” 18 2014: “continuing to manage as ‘naturally’ as possible”).) 19 her November 2014 visit, Plaintiff continued to remain off 20 psychiatric medication, and she reported to Dr. Bassanelli that 21 she was reading an “ADD book” he had recommended to her, which 22 became “[her] new Bible.” (Id.) (Id.) (AR 505.) She requested “to go back She was noted as being compliant with She reported that her “zombie” behavior “went (AR 504.) By July, (AR 501; see also AR 500 (Aug. (AR 499.) At They discussed the book 23 24 25 26 27 28 11 Vyvanse is the name-brand version of lisdexamfetamine, a central-nervous-system stimulant used to control symptoms of ADHD. Lisdexamfetamine, MedlinePlus, https://medlineplus.gov/ druginfo/meds/a607047.html (last updated Aug. 15, 2016). 12 Diazepam is used to relieve anxiety, muscle spasms, and seizures. See Diazepam, MedlinePlus, https://medlineplus.gov/ druginfo/meds/a682047.html (last updated Apr. 15, 2017). 24 1 again in January 2015, and she reported “deriv[ing] some benefit 2 from that.” (AR 633.) 3 Throughout 2015, Dr. Bassanelli frequently noted that 4 Plaintiff’s cognition and recent and remote memory were “intact” 5 and her thoughts were “goal-directed, logical and reality based” 6 despite some observations of “poor concentration” or “anxious” 7 mood. 8 (same), 623 (Apr. 2015), 619 (May 2015), 615 (same), 608 (Aug. 9 2015), 604 (Sept. 2015), 600 (same).) (See, e.g., AR 635 (Jan. 2015), 631 (Mar. 2015), 627 Dr. Bassanelli referred 10 Plaintiff for neuropsychological testing regarding her alleged 11 problems with memory and learning (see AR 619-20; see also AR 606 12 (“[Plaintiff] is very focused on getting validation there is a 13 real problem with [her] memory.”), and that testing was completed 14 in May 2015 by psychologist Anita Chatigny. 15 (AR 484-96.) Dr. Chatigny subjected Plaintiff to a variety of 16 psychological tests (see AR 488-91) and found that she had an 17 overall “[n]ormal” neuropsychological profile with the “capacity 18 for full independence across all arenas of cognition as well as 19 capacity for memory and new learning.” 20 “broad integrity of brain function and intellectual/cognitive 21 abilities that are commensurate with the majority of others of 22 similar age.” 23 Plaintiff’s “cognitive aptitude [was] higher than these scores 24 would suggest.” 25 of “diminished attention/concentration,” which was “congruent 26 with [a] diagnosis of Attention Deficit Disorder.” 27 493.) 28 (AR 488, 492.) (AR 488.) (AR 492.) She also had Indeed, Dr. Chatigny noted that There was, however, some indication (AR 491, Dr. Bassanelli completed a mental RFC questionnaire in 25 1 December 2015. (See AR 543-50.) He opined that Plaintiff was 2 “not capable of any type of employment due to her” mental-health 3 issues, which included PTSD, “panic and anxiety,” and “severe 4 lack of attention and focus.” 5 ability” regarding “[m]aintain[ing] attention for two hour 6 segment[s]” and “[d]eal[ing] with normal work stress” and was 7 unable to “meet competitive standards” for “[r]emember[ing] work- 8 like procedures,” “[u]nderstand[ing] and remember[ing] very short 9 and simple instructions,” and “[m]aintain[ing] regular (AR 550.) She had no “useful 10 attendance,” among other things. (AR 545-46.) But she had the 11 limited but satisfactory ability to “[c]arry out very short and 12 simple instructions,” “[m]ake simple work-related decisions,” 13 “[a]sk simple questions or request assistance,” “[u]nderstand and 14 remember detailed instructions,” “[c]arry out detailed 15 instructions,” “[i]nteract appropriately with the general 16 public,” and “[m]aintain socially appropriate behavior.” 17 She was also “[u]nlimited or [v]ery [g]ood” in her ability to 18 “[b]e aware of normal hazards and take appropriate precautions,” 19 “[a]dhere to basic standards of neatness and cleanliness,” 20 “[t]ravel in unfamiliar place[s],” and “[u]se public 21 transportation.” (Id.) (Id.) 22 He noted that Plaintiff “carrie[d] notes and her appointment 23 book with her to remain organized” and “always [came] on time for 24 her appointments” (AR 549; cf. AR 545 (noting in same report that 25 she had “[d]ifficulty coming on time for appointments”)), but she 26 tended to be “very anxious” and “irritable” and “struggle[d] in 27 her interpersonal relationships.” 28 noted her prognosis as “[f]air.” 26 (AR 549-50.) (AR 543.) Overall, he 1 2 ii. Dr. Monahan Plaintiff began seeing psychologist Rosalind Monahan for 3 psychotherapy in October 2015, on referral from Dr. Bassanelli. 4 (AR 529-33, 541-42.) 5 Plaintiff’s mental-health history and prior therapists; Dr. 6 Monahan noted that she had some memory impairment — but no lack 7 of concentration — and diagnosed her with PTSD. 8 their next visit a week later, they reviewed a homework 9 assignment completed by Plaintiff, and Plaintiff “shared At their first visit, they discussed (AR 541-42.) At 10 info[rmation] re[garding] books about multiple personality . . . 11 that she [had] read.”13 12 impairment and no lack of concentration at that time. 13 following day, they met again, Plaintiff shared poetry that she 14 used to write, and she reported that she had power of attorney 15 over her mother, who “[was] almost homeless.” 16 Monahan noted no memory impairment or lack of concentration at 17 this or their next meeting. 18 memory impairment but no lack of concentration at each of their 19 following sessions, however. 20 4, 2015), 535 (Nov. 11, 2015), 534 (Nov. 18, 2015).) 21 (AR 540.) Dr. Monahan noted no memory (Id.; AR 538.) (Id.) (AR 539.) The Dr. Dr. Monahan noted (AR 537 (Oct. 28, 2015), 536 (Nov. In January 2016, Dr. Monahan completed a mental-disorder 22 evaluation form (AR 668-86), noting that Plaintiff had 23 “significant memory impairments,” “disorganized thinking,” and 24 “paranoia dissociation,” among other symptoms (AR 668-69). 25 Monahan assessed that she had limited but satisfactory ability to Dr. 26 27 28 13 At her hearing a few months later, Plaintiff claimed to be unable to “read a book and remember what [she’d] read.” (AR 63.) 27 1 carry out “very short and simple instructions” and make “simple 2 work-related decisions” and was unlimited or very good in her 3 ability to be aware of normal hazards, take appropriate 4 precautions, and adhere to basic standards of neatness and 5 cleanliness. 6 limited, was unable to meet competitive standards, or had no 7 useful functional ability in all other aspects of mental 8 aptitude. 9 standard tests [were] conducted” to support her findings, (AR 672-73.) (See AR 672-73.) But she otherwise was seriously Dr. Monahan indicated that “no 10 however. 11 performed.”).) 12 questionnaire, Dr. Monahan opined that based on a total of nine 13 therapy sessions together (AR 675), Plaintiff had “Dissociative 14 Identity Disorder with at least one other personality” (AR 684- 15 87). 16 determine if an individual has DID” and that this could be 17 “explored further in future sessions.” (AR 669; see also AR 673 (“No specific tests In a narrative report attached to the Dr. Monahan indicated that there was “no exact test to 18 19 (AR 686.) iii. Dr. Cross In April 2013, Plaintiff was evaluated by consulting 20 psychologist Kara Cross. 21 anxiety and depression. 22 found that her thought processes were coherent and organized; her 23 thought content was relevant, nondelusional, and not in response 24 to “internal stimuli during the interview”; her mood and affect 25 were “stable” but “somewhat anxious”; and she was alert and 26 oriented. 27 to repeat four digits forward and backward,” “recall three items 28 (House, Ball, Chair) immediately and . . . after five minutes,” (AR 336.) (AR 333-38.) (AR 333.) Plaintiff complained of On examination, Dr. Cross Regarding her memory, Plaintiff was “able 28 1 and “recall who George Washington was and a school day attended 2 as a child.” 3 “perform serial threes and serial sevens,” knew that “4 dollars 4 plus 5 dollars is 9 dollars,” could “do alpha numeric reasoning,” 5 and followed the conversation “well.” 6 her with a GAF score of 60 and deemed her condition “good.” 7 337.) 8 or two-step job instructions” and “detailed and complex 9 instructions” and was otherwise “unimpaired” with regard to such (Id.) Regarding her concentration, Plaintiff could (Id.) Dr. Cross assessed (AR She could understand, remember, and carry out “simple one 10 things as interacting with co-workers and the public, maintaining 11 concentration and attention, and maintaining regular attendance. 12 (AR 337-38 (emphasis in original).) 13 14 3. Analysis Plaintiff argues that the ALJ improperly discounted her 15 subjective symptom testimony by basing his analysis on her 16 activities of daily living and an apparent “lack of treatment 17 that [was] more aggressive.” 18 As discussed below, the ALJ erred as to the latter reason but did 19 not otherwise err in his credibility analysis, offering two clear 20 and convincing reasons for discounting her testimony: 21 inconsistency with “activities of daily living” and lack of 22 “support” in the objective medical evidence.14 (J. Stip. at 26-27 (citing AR 29).) (See AR 29.) 23 14 24 25 26 27 28 The ALJ provided an additional reason for discounting Plaintiff’s testimony, that there was “no evidence of [muscle] atrophy.” (AR 29.) But the validity of that reason is “open to question.” See Johnson v. Colvin, No. ED CV 15-1992-E, 2016 WL 1532227, at *4 (C.D. Cal. Apr. 15, 2016); see also Lapeirre-Gutt v. Astrue, 382 F. App’x 662, 665 (9th Cir. 2010) (rejecting “lack of muscle atrophy” as valid justification for discounting plaintiff’s testimony because “no medical evidence suggests that high inactivity levels necessarily lead to muscle atrophy”); 29 1 a. 2 Daily Activities An ALJ may properly discount the credibility of a 3 plaintiff’s subjective symptom statements when they are 4 inconsistent with her daily activities. 5 1112. 6 difficulty functioning, they may be grounds for discrediting the 7 claimant’s testimony to the extent that they contradict claims of 8 a totally debilitating impairment.” 9 found that Plaintiff “ha[d] engaged in a somewhat normal level of See Molina, 674 F.3d at “Even where those [daily] activities suggest some Id. at 1113. The ALJ here 10 daily activity and interaction” and that her “ability to 11 participate in such activities diminishe[d] the credibility of 12 her allegations of functional limitations.” 13 Reddick, 157 F.3d at 722 (ALJ may discount subjective symptom 14 statements when “level of activity [is] inconsistent with 15 Claimant’s claimed limitations”). 16 (AR 29); see Indeed, with regard to her alleged physical impairments, 17 Plaintiff averred that she was unable to fully stand, walk, lift, 18 or bend over (AR 226) or use her right hand or sit for very long 19 (AR 57-58, 60-61). 20 activities as “preparing simple meals, driving, [and] shopping in 21 stores” (AR 29), and those findings were supported by substantial But the ALJ noted that she engaged in such 22 23 24 25 26 27 28 Valenzuela v. Astrue, 247 F. App’x 927, 929 (9th Cir. 2007) (ALJ erred in determining that “absence of evidence of muscular atrophy indicated that [plaintiff’s] carpal tunnel syndrome was not as severe as [he] claimed” because “the record was devoid of any medical testimony to support that finding”). Here, Dr. Schmitter testified that one would expect “motor” or “muscle weakness” in someone with Plaintiff’s complaints (AR 46, 49), lending medical support to the ALJ’s reasoning. But because neither party has challenged or defended the ALJ’s reasoning in this regard, the Court does not address it. 30 1 evidence in the record. 2 that she prepared her own meals (AR 228), “cook[ed]” (AR 64; see 3 also AR 236, 335), and made breakfast, coffee, and lunch daily 4 (see AR 335). 5 64, 229, 333, 335, 487.) 6 went out alone, and regularly went outside to sit on the grass 7 with her dogs. 8 during the relevant period traveled to San Diego with only her 9 16-year-old son. 10 Plaintiff herself reported and testified She could and did drive a car by herself. (See AR And she shopped in stores, ran errands, (See AR 229, 236, 335.) She also at one point (AR 682.) One examining doctor observed that she was “fully ambulatory 11 and independent in all activities of daily living” (AR 486), and 12 she was noted on more than one occasion to be exercising multiple 13 times a week and engaging in “weight training and cardiovascular” 14 activity at a gym (AR 487, 629; see also AR 646 (reporting that 15 she was “increasing her activities” in May 2014)). 16 daily activities also involved taking care of her disabled 17 husband, two children, and mother, over whom she had power of 18 attorney. 19 542, 681.) 20 husband, who was receiving disability, got a “stipend” for 21 Plaintiff to act as his “caretaker.” 22 function report, in which she described how she couldn’t 23 independently cook or do household chores, was completed in April 24 2013 (see AR 228 (“family helps” with cooking and “does most of 25 [the chores]”), the same month she reported to Dr. Cross that she 26 had “no difficulty completing household tasks” and could cook and 27 “take care of self-dressing, self-bathing, and personal hygiene” 28 (see AR 335). Plaintiff’s (See, e.g., AR 227, 328, 486, 510, 531-32, 536, 539, The record even reflects that Plaintiff and her (AR 510.) Moreover, her Thus, the ALJ properly found that such extensive 31 1 activities of daily living undermined the credibility of 2 Plaintiff’s subjective symptom statements. 3 Colvin, No. CV 14-6702 JC, 2015 WL 5768348, at *7 (C.D. Cal. 4 Sept. 30, 2015) (ALJ properly discounted plaintiff’s credibility 5 “because the alleged severity of his impairment was not 6 consistent with [his] admitted level of activity,” which included 7 walking around the block, watching television, preparing meals, 8 driving a car, shopping in stores, and “exercis[ing] 20 minutes 5 9 days per week at a moderate or strenuous level”); Thomas v. See Ronquillo v. 10 Colvin, No. CV 12-09915-VBK, 2013 WL 4517872, at *2 (C.D. Cal. 11 Aug. 23, 2013) (ALJ properly discounted pain testimony given that 12 plaintiff “was able to drive, and drove her father and helped him 13 to prepare his meals; she engaged in physical therapy exercises 14 every morning; she volunteered at her church and served breakfast 15 or worked in a day care center checking the children; [and] she 16 watched her grandchildren”). 17 Regarding her mental impairments, Plaintiff alleged that she 18 had problems with her memory, concentrating, and being around 19 people. 20 “pa[id] bills, handl[ed] the finances, t[ook] her son to soccer 21 practices, and spen[t] time with her family.” 22 AR 229 (reporting that she could pay bills, count change, handle 23 savings account, and use checkbook or money order), 230 24 (reporting that she spent time with others, stayed home with 25 family, saw her mother and father “once in a while,” talked with 26 her mother on phone three times a week, texted her “friends” to 27 see how they were, and drove her son to soccer practice once a 28 week).) (AR 62-63, 231.) The ALJ found, however, that she (AR 29; see also Substantial evidence in the record supported those 32 1 findings. (Compare AR 231 (reporting in Apr. 2013 that she had 2 problems “getting along with . . . others”), with AR 335 3 (reporting that same month to examining psychologist that she 4 managed money and had “excellent or good” relationships with 5 “family and friends”), and AR 486 (reporting in Apr. 2015 to 6 examining psychologist that she “manage[d] finances,” “pa[id] 7 bills without problem,” and “remember[ed] appointments”), and AR 8 549 (treating psychiatrist noting in Oct. 2015 that she always 9 “carrie[d] notes and her appointment book with her to remain 10 organized”).) 11 family, but she also had the mental capacity for helping her 12 mother with “legal issues regarding her home” (AR 531) and 13 endeavoring to get her son “medical care” for his own “mental 14 health problems” (AR 532). 15 Moreover, not only did she spend time with her And despite Plaintiff’s testimony that she was unable to 16 read or remember what she had read for more than “6 seconds” 17 because of her alleged cognitive impairments (see AR 63, 231), 18 she was noted throughout the record as reading books on mental- 19 health issues, such as ADD and “multiple personality” (AR 499 20 (book was “[her] new Bible”), 502, 540, 633; see also AR 488 21 (examining psychologist noting that she “was able to hear and 22 read instructions”)), and being able to keep appointments and 23 manage her medications by herself (see, e.g., AR 486; see also AR 24 335 (Plaintiff reporting that she could “focus [her] attention” 25 and had “no difficulty making her decisions”)). 26 therefore properly discounted Plaintiff’s testimony based on her 27 extensive activities of daily living, and his determination was 28 supported by substantial evidence in the record. 33 The ALJ See Womeldorf 1 v. Berryhill, 685 F. App’x 620, 621 (9th Cir. 2017) (upholding 2 ALJ’s discounting of plaintiff’s credibility in part because his 3 activities of daily living “were not entirely consistent with his 4 claimed inability to engage in social interactions”); Lopez v. 5 Colvin, No. 1:13-cv-00741-SKO, 2014 WL 3362250, at *16 (E.D. Cal. 6 July 8, 2014) (ALJ did not err in discounting plaintiff’s 7 testimony because he “could sustain the concentration and memory 8 to read, watch two to three hours of television, manage his 9 personal finances, perform household chores, and prepare meals”). 10 b. Objective Medical Evidence 11 Contradiction with evidence in the medical record is a 12 “sufficient basis” for rejecting a claimant’s subjective symptom 13 testimony. 14 1161 (9th Cir. 2008); see Morgan v. Comm’r of Soc. Sec. Admin., 15 169 F.3d 595, 600 (9th Cir. 1999) (upholding “conflict between 16 [plaintiff’s] testimony of subjective complaints and the 17 objective medical evidence in the record” as “specific and 18 substantial” reason undermining credibility). 19 medical evidence “cannot form the sole basis for discounting pain 20 testimony, it is a factor that the ALJ can consider in his 21 credibility analysis.” 22 Cir. 2005); Rollins v. Massanari, 261 F.3d 853, 857 (9th Cir. 23 2001) (citing § 404.1529(c)(2)). 24 Carmickle v. Comm’r, Soc. Sec. Admin., 533 F.3d 1155, Although a lack of Burch v. Barnhart, 400 F.3d 676, 681 (9th In addition to the clear and convincing reason discussed 25 above, the ALJ found that Plaintiff’s subjective symptom 26 statements were unsupported by the medical evidence. 27 Specifically, despite allegations of pain in her lower back that 28 allegedly prevented her from working (see AR 56-57, 236), 34 (AR 29.) 1 Plaintiff had “only mild findings with regard to her back issues” 2 (AR 29). 3 throughout the record indicated that Plaintiff’s back presented 4 as either “normal” or “mild[ly]” afflicted. 5 AR 373 (Sept. 2011 lumbar-spine x-ray showing “[n]o evidence of 6 acute fractures, subluxation or significant disc narrowing”), 7 466-68 (Nov. 2011 MRI of lumbar spine showing “mild” findings at 8 L4-L5 and L5-S1 disc levels), 464-65 (December 2012 MRI of 9 cervical spine showing no evidence of “stenosis or disc For example, as the ALJ noted, medical imaging (See id.; see also 10 herniation”), 461-63 (July 2013 MRI of thoracic spine showing no 11 evidence of stenosis, neural foraminal narrowing, or disc 12 herniation).) 13 tenderness to palpation of the back (see, e.g., AR 353, 356, 422, 14 645), they were also “normal,” “mild,” or showed negative 15 straight-leg raises (see AR 29; see also, e.g., AR 422 (Oct. 16 2011: “no abnormality”), 370-71 (Nov. 2011: no tenderness), 361 17 (May 2012: “no specific tenderness”), 343-44 (May 2013: “mild 18 tenderness to palpation” and negative straight-leg raises), 353 19 (Aug. 2013: negative straight-leg raises)). 20 was frequently noted as “normal.” 21 2011), 345 (May 2013), 486-87 (May 2015: “fully ambulatory” and 22 “fluid” gait).) While findings on examination at times indicated Moreover, her gait (See, e.g., AR 422 (Oct. 23 One orthopedic physician observed that Plaintiff’s 24 “subjective complaints of pain exceed[ed] objective findings” 25 upon examination (AR 353), and during a neurosurgical 26 consultation, Plaintiff’s lumbar-spine disc bulges were found 27 “not . . . severe enough . . . to be causing [her] current 28 symptoms,” especially given that her symptoms were on her left 35 1 side and the bulges were “more eccentric to the right” (AR 648). 2 Thus, the ALJ’s discounting of Plaintiff’s complaints of back 3 pain based on a dearth of supporting evidence in the record was 4 premised on substantial evidence. 5 8177 RNB, 2010 WL 2998887, at *1 (C.D. Cal. July 30, 2010) 6 (“ALJ’s adverse credibility determination was proper because it 7 was supported by substantial evidence and was sufficiently 8 specific to permit the Court to conclude that the ALJ did not 9 arbitrarily discredit plaintiff’s subjective testimony.”). Pierce v. Astrue, No. CV 09- Even 10 if alternative interpretations of the medical evidence exist, the 11 Court will not “second guess” the ALJ’s reasonable 12 interpretation. 13 808020, at *9 (C.D. Cal. Feb. 28, 2014) (“[T]he ALJ properly 14 discounted plaintiff’s credibility in part because plaintiff’s 15 pain allegations were not fully corroborated by the objective 16 medical evidence.”); see also Thomas, 278 F.3d at 959. 17 18 Huntsman v. Colvin, No. EDCV 13-1300 JC, 2014 WL c. Lack of Aggressive Treatment As Plaintiff argues (see J. Stip. at 26-27), the ALJ may 19 have erred in his characterization of the medical record as 20 demonstrating a “lack of treatment that [was] more aggressive or 21 [required] additional surgical intervention” (AR 29). 22 received epidural steroid injections (see AR 358-59, 363-64, 366- 23 67), was prescribed the narcotic Vicodin (see, e.g. AR 325, 646), 24 and underwent spinal decompression surgery (see AR 554-55). 25 treatment is aggressive. 26 App’x 662, 664 (9th Cir. 2010) (treatment with narcotic pain 27 medication, occipital nerve blocks, trigger-point injections, and 28 cervical-fusion surgery not conservative); Samaniego v. Astrue, Plaintiff Such See Lapeirre-Gutt v. Astrue, 382 F. 36 1 No. EDCV 11-865 JC, 2012 WL 254030, at *4 (C.D. Cal. Jan. 27, 2 2012) (treatment not conservative when claimant was treated “on a 3 continuing basis” with steroid and anesthetic “trigger point 4 injections,” occasional epidural injections, narcotic medication, 5 and doctor recommended surgery). 6 expert opined that there appeared to be no medical basis for 7 Plaintiff’s decompression surgery (AR 52), nor did the medical 8 record support the severity of her alleged symptoms warranting 9 such aggressive treatment, as discussed above (see AR 353 On the other hand, the medical 10 (Plaintiff’s “many subjective complaints of pain exceed[ed] 11 objective findings”), 648 (lumbar-spine disc bulges “d[id] not 12 represent severe enough problem to be causing [Plaintiff’s] 13 current symptoms”)). 14 Though the ALJ may have erred as to this reason, he provided 15 at least two other clear and convincing reasons for discounting 16 Plaintiff’s subjective symptom testimony, inconsistency with 17 daily activities and lack of support in the objective medical 18 evidence, and thus any error was harmless. 19 Colvin, 674 F. App’x 632, 633 (9th Cir. 2017) (citing Batson v. 20 Comm’r of Soc. Sec. Admin., 359 F.3d 1190, 1197 (9th Cir. 2004)). 21 Remand is therefore unwarranted on this ground. See Larkins v. 22 B. 23 Embedded in her arguments regarding the ALJ’s physical- and The ALJ Properly Evaluated the Medical-Opinion Evidence 24 mental-impairment severity determinations, Plaintiff includes 25 challenges to the ALJ’s evaluation of the medical-opinion 26 evidence. 27 that the ALJ erred in rejecting the opinion of Dr. Nabet (see id. 28 at 20) and accepting the opinions of Drs. Schmitter and To (see (See generally J. Stip.) 37 She specifically contends 1 id. at 21) with regard to her physical impairments, and in 2 rejecting the opinions of Drs. Bassanelli and Monahan (see id. at 3 8-10) and accepting the opinion of Dr. Cross (see id. at 15-17) 4 as to her mental impairments. 5 6 1. Applicable law Three types of physicians may offer opinions in Social 7 Security cases: those who directly treated the plaintiff, those 8 who examined but did not treat the plaintiff, and those who did 9 neither. Lester, 81 F.3d at 830. A treating physician’s opinion 10 is generally entitled to more weight than an examining 11 physician’s, and an examining physician’s opinion is generally 12 entitled to more weight than a nonexamining physician’s. 13 see § 404.1527(c)(1).15 14 are employed to cure and have a greater opportunity to know and 15 observe the claimant. 16 findings of a nontreating, nonexamining physician can amount to 17 substantial evidence, so long as other evidence in the record 18 supports those findings.” Id.; This is so because treating physicians Smolen, 80 F.3d at 1285. But “the Saelee v. Chater, 94 F.3d 520, 522 19 20 21 22 23 24 25 26 27 28 15 Social Security regulations regarding the evaluation of opinion evidence were amended effective March 27, 2017. When, as here, the ALJ’s decision is the final decision of the Commissioner, the reviewing court generally applies the law in effect at the time of the ALJ’s decision. See Lowry v. Astrue, 474 F. App’x 801, 804 n.2 (2d Cir. 2012) (applying version of regulation in effect at time of ALJ’s decision despite subsequent amendment); Garrett ex rel. Moore v. Barnhart, 366 F.3d 643, 647 (8th Cir. 2004) (“We apply the rules that were in effect at the time the Commissioner’s decision became final.”); Spencer v. Colvin, No. 3:15-CV-05925-DWC, 2016 WL 7046848, at *9 n.4 (W.D. Wash. Dec. 1, 2016) (“42 U.S.C. § 405 does not contain any express authorization from Congress allowing the Commissioner to engage in retroactive rulemaking.”). Accordingly, citations to 20 C.F.R. § 404.1527 are to the version in effect from August 24, 2012, to March 26, 2017. 38 1 (9th Cir. 1996) (per curiam) (as amended). 2 testifying medical expert is subject to cross-examination, his 3 opinion may be given greater weight. 4 1035, 1042 (9th Cir. 1995). 5 Moreover, because a Andrews v. Shalala, 53 F.3d The ALJ may disregard a physician’s opinion regardless of 6 whether it is contradicted. 7 751 (9th Cir. 1989); see Carmickle, 533 F.3d at 1164. 8 doctor’s opinion is not contradicted by other medical-opinion 9 evidence, however, it may be rejected only for “clear and Magallanes v. Bowen, 881 F.2d 747, When a 10 convincing” reasons. 11 F.3d at 1164 (citing Lester, 81 F.3d at 830-31). 12 contradicted, the ALJ must provide only “specific and legitimate 13 reasons” for discounting it. 14 Lester, 81 F.3d at 830-31). 15 examining physician’s opinion, moreover, depends on whether it is 16 consistent with the record and accompanied by adequate 17 explanation, among other things. 18 factors also determine the weight afforded the opinions of 19 nonexamining physicians. 20 findings by state-agency medical consultants and experts as 21 opinion evidence. 22 Magallanes, 881 F.2d at 751; Carmickle, 533 When it is Carmickle, 533 F.3d at 1164 (citing The weight given a treating or § 404.1527(c)(3)-(6). § 404.1527(e). Those The ALJ considers Id. Furthermore, “[t]he ALJ need not accept the opinion of any 23 physician . . . if that opinion is brief, conclusory, and 24 inadequately supported by clinical findings.” 25 at 957; accord Batson, 359 F.3d at 1195. 26 “magic words” to reject a physician’s opinion or a portion of it; 27 the court may draw “specific and legitimate inferences” from the 28 ALJ’s opinion. An ALJ need not recite Magallanes, 881 F.2d at 755. 39 Thomas, 278 F.3d “[I]n interpreting 1 the evidence and developing the record, the ALJ does not need to 2 ‘discuss every piece of evidence.’” 3 Barnhart, 341 F.3d 1006, 1012 (9th Cir. 2003) (quoting Black v. 4 Apfel, 143 F.3d 383, 386 (8th Cir. 1998)). 5 Howard ex rel. Wolff v. The Court must consider the ALJ’s decision in the context of 6 “the entire record as a whole,” and if the “‘evidence is 7 susceptible to more than one rational interpretation,’ the ALJ’s 8 decision should be upheld.” 9 F.3d 1194, 1198 (9th Cir. 2008) (citation omitted). 10 11 2. Ryan v. Comm’r of Soc. Sec., 528 Analysis The ALJ afforded “great weight” to the opinions of Drs. 12 Schmitter, To, and Cross (AR 26, 31) and “little weight” to Drs. 13 Nabet’s, Bassanelli’s, and Monahan’s (AR 26, 31-32). 14 parties apparently concede (J. Stip. at 8, 20), the ALJ was 15 required to provide only a “specific and legitimate reason” for 16 rejecting the latter, see Carmickle, 533 F.3d at 1164. 17 18 a. As both He did. Drs. Nabet, Schmitter, and To Dr. Nabet opined that Plaintiff “was limited to a narrow 19 range of sedentary work” (AR 31; see also AR 662-66), while Drs. 20 Schmitter and To opined that she was instead capable of 21 performing “medium work” (AR 31; see also AR 45, 340-47). 22 ALJ rejected Dr. Nabet’s opinion, explaining that it was 23 inconsistent with Plaintiff’s “x-ray examination of the lumbar 24 spine, which showed normal findings,” and “records reflecting 25 that [her] strength was normal in the lower extremities[] and her 26 straight leg raise test was negative.” 27 opinion, by comparison, was consistent with the same evidence 28 (see AR 31), and similarly Dr. Schmitter’s opinion was 40 (AR 31-32.) The Dr. To’s 1 “consistent with the objective medical evidence” — specifically, 2 an “MRI examination of the lumbar spine, which revealed mild 3 findings,” and “records reflecting that [Plaintiff] exhibited no 4 lumbar spine tenderness.” 5 more weight than Dr. Nabet’s. (Id.) The ALJ afforded those opinions (See id.) 6 Plaintiff contends that the ALJ erred in his analysis 7 because Dr. Nabet’s opinion was “in agreement” with the medical 8 record while the opinions of Drs. Schmitter and To were not. 9 Stip. at 20-21.) (J. The ALJ, Plaintiff argues, “cherry-picked” 10 evidence from the record to support his decision. 11 The ALJ, however, did not err, and his evaluation of their 12 opinions was supported by substantial evidence in the record. 13 See Lester, 81 F.3d at 831 (ALJ may reject medical-source opinion 14 in favor of conflicting physician’s opinion as long as that 15 determination is “supported by substantial record evidence” 16 (emphasis in original) (citation omitted)). 17 (Id. at 20.) Dr. Nabet saw Plaintiff in December 2015 and completed her 18 opinion just a month later.16 19 see also Orn v. Astrue, 495 F.3d 625, 631 (9th Cir. 2007) 20 (factors in assessing physician’s opinion include length of 21 treatment relationship, frequency of examination, and nature and 22 extent of treatment relationship); accord § 404.1527(c)(2). 23 Though she assessed Plaintiff with a severely limited, sedentary 24 RFC, she saw her only for arm and shoulder pain. 25 66.) 26 findings” of bursitis and tendinosis, and she found some pain and (Compare AR 658-61, with 662-66); (See AR 658- A right-shoulder MRI she ordered at the time showed “mild 27 16 28 Although Dr. Nabet stated that she began seeing Plaintiff in October 2014 (AR 662), no earlier records support that. 41 1 tenderness in her shoulders and right elbow. (AR 650-51, 655.) 2 She found no tenderness in her neck, spine, or abdomen, however 3 (AR 655, 660), and observed that she had “no difficulty walking” 4 (AR 652). 5 Despite those findings, she nonetheless concluded that 6 Plaintiff could not perform “even ‘low stress’ jobs” or “sit and 7 stand/walk” for more than two hours in an eight-hour workday. 8 (See AR 663-64.) 9 treatment notes throughout the record — including her own, as But that opinion was inconsistent with 10 pointed out above — demonstrating mild or normal findings (see AR 11 31; see also AR 373 (Sept. 2011 x-ray revealing “[n]o evidence of 12 acute fractures, subluxation or significant disc space narrowing” 13 in lumbar spine), 466-68 (Nov. 2011 MRI revealing “mild decreased 14 disc height loss,” “partial disc desiccation,” “disc bulge with 15 . . . mild bilateral ligamentum flavum buckling,” and “[m]ild 16 bilateral reactive facet arthropathy” in lumbar spine), 299-300 17 (Oct. 2012 EMG nerve-conduction study revealing “mild ulnar 18 neuropathy”), 464-65 (Dec. 2012 MRI revealing no “stenosis or 19 disc herniation” in cervical spine), 360 (June 2013 x-ray 20 revealing “essentially normal-looking cervical and lumbar 21 spine”), 461-63 (July 2013 MRI revealing “no evidence [of] 22 stenosis, neural foraminal narrowing, or disc herniation” in 23 thoracic spine), 571 (Aug. 2014 MRI revealing “[m]ild bilateral 24 foraminal narrowing” and “no evidence” of stenosis in lumbar 25 spine), 650-51 (Jan. 2016 MRI revealing “mild” bursitis and 26 tendinosis in right shoulder)); Ruckdashel v. Colvin, 672 F. 27 App’x 745, 745-46 (9th Cir. 2017) (as amended) (finding that ALJ 28 “provided specific and legitimate reasons, supported by 42 1 substantial evidence, for rejecting” treating physician’s 2 opinion, including that it was “conclusory” and “contradicted by 3 the objective medical evidence”); Clay v. Astrue, No. CV 12-1881 4 RNB, 2013 WL 550494, at *3 (C.D. Cal. Feb. 11, 2013) (“[T]he ALJ 5 noted that [treating physician’s] conclusions were not adequately 6 supported by clinical data and diagnostic findings, including 7 [his] own treatment notes[.]”). 8 9 Indeed, as identified by the ALJ, Plaintiff was frequently found to have normal strength in her lower extremities and 10 negative straight-leg raises. 11 (Oct. 2011), 418-20 (Nov. 2011), 297 (Sept. 2012), 313 (Jan. 12 2013), 344 (May 2013), 356 (June 2013), 353 (Aug. 2013), 582 13 (Nov. 2013), 645 (July 2015).) 14 rejected Dr. Nabet’s opinion as inconsistent with the medical 15 evidence. 16 Cir. 2017) (upholding inconsistency with medical evidence as 17 specific and legitimate reason for rejecting medical opinion 18 (citing Tommasetti v. Astrue, 533 F.3d 1035, 1041 (9th Cir. 19 2008))); Bailey v. Colvin, 659 F. App’x 413, 415 (9th Cir. 2016) 20 (inconsistency with “own treatment records” and objective medical 21 evidence constitutes “specific and legitimate” reason for 22 rejecting treating physician’s opinion). 23 (See AR 32; see, e.g., AR 422 The ALJ therefore properly See Kohansby v. Berryhill, 697 F. App’x 516, 517 (9th Dr. To examined Plaintiff in May 2013 and assessed her with 24 a medium RFC. (See AR 340-47.) 25 she had “5/5” muscle strength in her upper and lower extremities 26 (AR 344), “normal” gait (AR 345), and “negative” straight-leg 27 raises (AR 344). 28 evidence of record, as laid out above, and thus the ALJ did not On examination, he found that Those findings were consistent with the medical 43 1 err in his evaluation of Dr. To’s opinion. 2 Dr. Schmitter reviewed Plaintiff’s medical record and 3 testified at her January 2016 hearing, finding no “significant 4 orthopaedic pathology” or support in the record for an RFC that 5 was less than medium. 6 opinions were “reasonable and consistent with the objective 7 medical evidence.” 8 Plaintiff’s August 2014 MRI “revealed mild findings” (id.; see 9 also, e.g., AR 373 (Sept. 2011), 466-68 (Nov. 2011), 299-300 (AR 43-52.) (AR 31.) As discussed by the ALJ, his For example, the ALJ identified how 10 (Oct. 2012), 464-65 (Dec. 2012), 360 (June 2013), 461-63 (July 11 2013), 569-71 (Aug. 2014), 650-51 (Jan. 2016)), and her treatment 12 records frequently demonstrated “mild” or no lumbar-spine 13 tenderness (AR 31; see also, e.g., AR 422 (Oct. 2011), 371 (Nov. 14 2011), 361 (May 2012), 330 (Dec. 2012), 343 (May 2013), 353 (Aug. 15 2013), 645 (July 2015), 660 (Dec. 2015), 655 (Jan. 2016)). 16 Plaintiff argues, however, that Dr. Schmitter “completely 17 ignored” an MRI of her spine indicating facet arthropathy, a disc 18 bulge, and “moderate to severe” stenosis at the L4-5 disc level 19 (see AR 466-68 (Nov. 2011)) and an MRI of her spine identifying 20 “reactive changes” that “could represent specific pain 21 generators” (see AR 569-71 (Aug. 2014)). 22 AR 361, 467, 570-71).) 23 reviewed that evidence (see AR 43 (testifying that he read 24 exhibits “1 through 26-F,” or AR 281 through 661)) and addressed 25 those specific medical-image findings at the hearing (see AR 47- 26 52). 27 28 (J. Stip. at 18 (citing But Plaintiff is mistaken; Dr. Schmitter For instance, Dr. Schmitter explicitly mentioned Plaintiff’s August 2014 MRI in justifying his opinion, stating that it 44 1 “showed no evidence of stenosis” (AR 44), and discussed the 2 November 2011 MRI in response to questioning from Plaintiff’s 3 counsel (AR 50-51). 4 “normal” findings. 5 you can get”).) 6 “compression in the bilateral descending L5 nerve root” and 7 explained that without corroborating evidence of “neurological 8 deficits,” it was only a “potential problem.” (Id.) 9 were pressure on the L5 nerve root on the left,” he stated, He testified that that MRI contained (AR 51 (stating that they were “as normal as Moreover, he discussed its note regarding “If there 10 “there should be corresponding examination findings resulting in 11 L5 motor weakness,” but he “could find” none. 12 discussed by the ALJ (AR 31), Dr. Schmitter’s opinion was 13 consistent with medical evidence throughout the record 14 demonstrating normal muscle strength (see e.g., AR 422, 418-20, 15 297, 313, 344, 356, 353, 582, 645), lack of or mild spinal 16 tenderness (see, e.g., AR 422, 371, 361, 330, 343-44, 353, 645, 17 660, 655), and “mild” imaging results (see, e.g., AR 373, 466-68, 18 299-300, 464-65, 360, 461-63, 569-71, 650-51). 19 entitled to rely on the doctor’s opinion. 20 (Id.) Indeed, as The ALJ was Plaintiff points to a June 2015 treatment note indicating 21 that she had “decreased sensation to light touch and pinprick 22 over [her left] foot” and argues that Dr. Schmitter also 23 “ignored” this evidence. 24 Plaintiff’s argument is misplaced. 25 specifically mention the treatment note at the hearing, he 26 nonetheless indicated that he reviewed the entire record, which 27 included it. 28 The attending physician who observed Plaintiff’s apparent (See J. Stip. at 18; AR 643.) But Though Dr. Schmitter did not Moreover, the note’s significance is questionable. 45 1 “decreased sensation” also found that she had a “negative Tinel 2 sign”17 and “no evidence of compression of her [peroneal] nerve” 3 according to a recent CT scan. 4 believe her nerve [was] being compressed” or that “she would 5 benefit from any decompression” surgery. 6 Plaintiff was seen again, demonstrated “greater than 3/5” 7 strength in her lower extremities and “normal” gait, and was 8 assessed as having no “clear-cut etiology” for her pain symptoms. 9 (AR 645.) 10 (AR 643.) The doctor “did not (Id.) A month later, Plaintiff also points to an October 2015 neurosurgical 11 consultant’s “recommendation” for nerve-decompression surgery, 12 which Dr. Schmitter allegedly also ignored. 13 AR 647-49.) 14 recommendation at the hearing, but as discussed above, he 15 indicated that he reviewed the entire record, which included the 16 neurosurgical consultation. 17 again questionable. 18 Plaintiff’s August 2014 MRI, which he noted as showing no 19 “significant stenosis” and only “mild” disc bulges. 20 He opined that those bulges “d[id] not represent [a] severe 21 enough problem to be causing [her] symptoms” and were “more 22 eccentric to the right at L4-5” even though her “symptoms [were] 23 on the left.” 24 leg [to be] peripheral in origin,” he stated that she “would (See J. Stip. at 19; Dr. Schmitter did not specifically mention that (Id.) The significance of the evidence is That examining physician reviewed (AR 648.) Believing her “entire pathology in the left 25 26 27 28 17 The Tinel’s sign test indicates that a nerve is irritated; a positive Tinel’s sign occurs when light tapping over the nerve elicits a tingling sensation. Medical Definition of Tinel’s Sign, MedinceNet.com, https://www.medicinenet.com/ script/main/art.asp?articlekey=16687 (last updated May 13, 2016). 46 1 potentially benefit” from pelvic and perineal-nerve decompression 2 surgeries. 3 surgical treatment[s].” 4 “recommend” surgery. 5 (Id.) He also “advised her of [other] potential (AR 648-49.) He did not in fact Thus, the ALJ’s reliance on Dr. Schmitter’s opinion was 6 reasonable and supported by substantial evidence in the record. 7 The ALJ therefore did not err in his evaluation of the opinions 8 of Drs. Nabet, To, and Schmitter. 9 b. Drs. Cross, Bassanelli, and Monahan 10 Drs. Bassanelli and Monahan completed mental-evaluation 11 forms indicating that Plaintiff had “severe lack of attention and 12 focus” and “significant memory impairments” and could not perform 13 even low-stress jobs (AR 543-50, 668-86), while Dr. Cross opined 14 that she could understand, remember, and carry out simple as well 15 as complex instructions and was otherwise “unimpaired” (AR 333- 16 38). 17 Monahan because they were inconsistent with “records reflecting 18 that the claimant’s cognition and memory were intact,” “her 19 insight and judgment were appropriate,” and her “memory and 20 impulse control were good, affect was stable, and insight and 21 judgment were fair.” 22 opinion was afforded more weight because it was consistent with 23 the same evidence as well as evidence of her daily activities, 24 which included “preparing simple meals, driving, shopping in 25 stores, paying bills, handling the finances, taking her son to 26 soccer practices, and spending time with her family.” The ALJ rejected the opinions of Drs. Bassanelli and (AR 26-27.) By contrast, Dr. Cross’s (AR 26.) 27 Plaintiff argues that the ALJ erred because Drs. Bassanelli 28 and Monahan had “long-standing treatment relationships” with her 47 1 and their opinions were supported by the “evidence as a whole.” 2 (J. Stip. at 8-9.) 3 inconsistent with the medical evidence (id. at 17), “did not have 4 the benefit of over two years of treatment records” (id. at 16), 5 did not involve “detailed psychological testing” (id.), and was 6 “internally inconsistent” (id.). 7 and his evaluation of their opinions was supported by substantial 8 evidence in the record. 9 Dr. Cross’s opinion, moreover, was allegedly The ALJ, however, did not err, See Lester, 81 F.3d at 831. As discussed above, inconsistency with objective medical 10 evidence is a specific and legitimate reason for discounting a 11 treating physician’s opinion, Batson, 359 F.3d at 1195; Kohansby, 12 697 F. App’x at 517, and the ALJ here properly rejected the 13 opinions of Drs. Bassanelli and Monahan — and credited Dr. 14 Cross’s — for this reason. 15 frequently noted — often by Drs. Bassanelli and Monahan 16 themselves — as being “intact” or “good” (see, e.g., AR 391 (Aug. 17 2013), 517 (Jan. 2014), 635 (Jan. 2015), 631 (Mar. 2015), 627 18 (same), 623 (Apr. 2015), 619 (May 2015), 615 (same), 608 (Aug. 19 2015), 604 (Sept. 2015), 600 (same), 538-40 (Oct. 2015)) and her 20 insight and judgment as “appropriate,” “fair,” “intact,” 21 “preserved,” “adequate,” or “normal” (see, e.g., AR 337 (Apr. 22 2013), 635 (Jan. 2015), 627 (Mar. 2015), 631 (same), 623 (Apr. 23 2015), 615 (May 2015), 619 (same), 608 (Aug. 2015), 600 (Sept. 24 2015), 604 (same)). 25 435 (9th Cir. 2017) (inconsistency with own treatment notes and 26 other medical evidence constitutes “specific and legitimate” 27 reason for discounting treating physician’s opinion). 28 Plaintiff’s cognition and memory were See Woodmass v. Berryhill, 707 F. App’x 432, Indeed, in 2015, following a series of psychological tests 48 1 administered by Dr. Chatigny, Plaintiff was found to have a 2 normal neuropsychological profile, with the “capacity for full 3 independence across all arenas of cognition,” the “capacity for 4 memory and new learning,” and “broad integrity of brain function 5 and intellectual/cognitive abilities that [were] commensurate 6 with the majority of others of similar age.” 7 Specifically with regard to memory, though inconsistences were 8 noted, Plaintiff’s performance on “complex tasks of visual and 9 auditory memory” was “[a]verage” and her acquisition of a “14- (AR 488, 492.) 10 item unrelated word-pair list” was “[a]verage,” with “good 11 learning noted across four learning trials.” 12 immediate and delayed recall of “abstract visual designs” was 13 “[a]verage.” 14 9 of 10 blocks and accurately note the location of 8 blocks.” 15 (Id.) 16 scores” and “Immediate and Delayed Memory scores” were within the 17 “[a]verage” range. 18 (Id.) (AR 490.) Her In a visual learning task, she could “recall And her “Auditory and Visual Memory composite index (Id.) Plaintiff contrasts her 2015 psychological testing with that 19 completed by Dr. Cross, which she argues was “perfunctory,” not 20 “detailed,” and without “the benefit of over two years of 21 treatment records.” 22 completed several tests (see AR 333 (“Testing Administered: 23 Complete Mental Evaluation”); see also AR 335-37 (tests completed 24 for memory, fund of knowledge, concentration and calculation, 25 judgment and reasoning, and similarities and differences)), and 26 the results of Dr. Cross’s and Dr. Chatigny’s testing were 27 consistent with each other, regardless of their different 28 approaches. (See J. Stip. at 16-17.) But Dr. Cross (Compare AR 337 (Dr. Cross concluding that 49 1 Plaintiff’s condition was “good”), with AR 492 (Dr. Chatigny 2 concluding that Plaintiff’s neuropsychological profile was 3 “[n]ormal”).) 4 opinion and provided a legitimate basis for the ALJ’s discounting 5 of Plaintiff’s treating physicians, see Batson, 359 F.3d at 1195 6 (ALJ properly discounted treating physician’s opinion in part 7 because it conflicted with “consultative medical evaluation” 8 completed by examining physician, who determined that plaintiff 9 was “objectively able to work”), and it thus is irrelevant that Dr. Cross’s examination findings supported her 10 she completed fewer tests than Dr. Chatigny18 or that she was 11 only an examining rather than a treating physician, as Plaintiff 12 argues, see Thomas, 278 F.3d at 957 (“Although the treating 13 physician’s opinion is given deference, the ALJ may reject the 14 opinion of a treating physician in favor of a conflicting opinion 15 of an examining physician if the ALJ makes ‘findings setting 16 forth specific, legitimate reasons for doing so that are based on 17 substantial evidence in the record.’” (citing Magallanes, 881 18 F.2d at 751)). 19 Moreover, Dr. Cross’s opinion was not internally 20 inconsistent simply because the GAF score of 60 she assigned 21 Plaintiff denotes “moderate symptoms” whereas she assessed only 22 mild limitations. (See J. Stip. at 16.) GAF scores do not have 23 24 25 26 27 28 18 Dr. Monahan apparently conducted no testing (see AR 52942, 668-86; see also AR 669 (“no standard tests conducted” on “intellectual functioning”), 673 (“no specific tests performed”), 686 (Dr. Monahan acknowledging that she did not employ known “screening tools” to test Plaintiff for Dissociative Identity Disorder but still diagnosed it)) but Plaintiff nonetheless argues that her opinion should have been given substantial weight (J. Stip. at 9). 50 1 a “direct correlation” to Social Security severity requirements, 2 Revised Medical Criteria for Evaluating Mental Disorders and 3 Traumatic Brain Injury, 65 Fed. Reg. 50764-65 (Aug. 21, 2000) 4 (codified at 20 C.F.R. pt. 404), and “should not be considered in 5 isolation.” 6 Claims Handbook § 2:15 n.40 (2017). 7 one point higher, 61, would indicate “mild” symptoms or “some” 8 difficulty in social, occupational, or school functioning but 9 that Plaintiff was “generally functioning pretty well,” with Richard C. Ruskell, Social Security Disability Moreover, a score of just 10 “some meaningful interpersonal relationships.” See Diagnostic and 11 Statistical Manual of Mental Disorders 32 (revised 4th ed. 2000). 12 As discussed above, Dr. Cross’s findings were supported by both 13 the record and her own examination findings, undermining 14 Plaintiff’s argument that the alleged inconsistency constituted 15 reversible error. 16 Finally, the ALJ discussed Plaintiff’s daily activities (AR 17 26), which was another specific and legitimate reason for 18 favoring Dr. Cross’s opinion over those of Drs. Bassanelli and 19 Monahan. 20 2014); Morgan, 169 F.3d at 600-02; Fisher v. Astrue, 429 F. App’x 21 649, 652 (9th Cir. 2011). 22 could manage her finances (see AR 229), spend time with family 23 and friends (see AR 230), and shop in stores (see AR 229). 24 activities were corroborated by similar statements made to her 25 physicians, who noted that she managed her finances (see, e.g. AR 26 335, 486), had “excellent or good” relationships with “family and 27 friends” (see, e.g., AR 335, 683 (“[The] whole family . . . 28 rallied to care for each other.”)), had power of attorney over See Ghanim v. Colvin, 763 F.3d 1154, 1162 (9th Cir. Plaintiff herself reported that she 51 Such 1 her mother and helped with “legal issues” (see, e.g., AR 531, 2 536, 539, 542, 681), was paid to care for her disabled husband 3 (see, e.g., AR 328, 486, 532, 536), cared for her adult son with 4 mental issues (see, e.g., AR 532), and read books (see, e.g., AR 5 499, 502, 540, 633). 6 1189-90 (W.D. Wash. 2013) (finding that ALJ’s rejection of 7 consulting examiner’s opinion as inconsistent with daily 8 activities was properly supported by ALJ’s citation to 9 plaintiff’s self-reported activities and her report of “similar See Hunt v. Colvin, 954 F. Supp. 2d 1181, 10 tasks during a consultative examination”). 11 challenged the ALJ’s reasoning in this regard (see generally J. 12 Stip.), and these activities stand in sharp contrast to the 13 doctors’ opinions that Plaintiff was incapable of performing even 14 low-stress jobs. 15 Plaintiff has not Plaintiff contends that Dr. Cross’s opinion should not have 16 been “construed as substantial evidence” because she was not 17 provided with any of Plaintiff’s medical records (see J. Stip. at 18 15-16 (citing § 404.1517 and Alcazar v. Comm’r of Soc. Sec., No. 19 2:15-cv-2203-KJN, 2017 WL 1275293, at *4 (E.D. Cal. Apr. 4, 20 2017))), but that argument is unavailing. 21 requires only that a consulting examiner be given “necessary 22 background information” about a claimant’s condition. 23 Colvin, No. 1:13-cv-1210 BAM, 2015 WL 351438, at *6 (E.D. Cal. 24 Jan. 26, 2015) (“Social Security regulations do not require that 25 a consulting physician review all of the claimant’s background 26 records.”). 27 mental-health records from the relevant period up to that point 28 existed, and few such records existed at all. Section 404.1517 See Uy v. In April 2013, when Plaintiff met with Dr. Cross, no 52 (See, e.g., AR 1 441-42 (Aug. 2010: earliest record concerning mental health, 2 physician’s assistant noting that Plaintiff’s “anxiety seems 3 better today than in the past”), 398-401 (May 2013: earliest 4 record from relevant period concerning mental health, noting 5 Plaintiff’s report to family-medicine practitioner of “chronic 6 anxiety” over her father being “in hospice w[ith] sudden liver 7 disease”).) 8 Plaintiff’s psychiatric history with her, and she recounted never 9 having been hospitalized for mental-health reasons and that she Moreover, during the examination, Dr. Cross reviewed 10 had had “counseling services off and on since the age of 4.” 11 334.) 12 not contrary to law. 13 BAM, 2013 WL 5375490, at *6 (E.D. Cal. Sept. 24, 2013) (no error 14 when consulting examiner did not review records that were 15 “irrelevant” or did not “shed much light on the claimant’s levels 16 of function as of [the onset date]”); Guerrero v. Colvin, No. 17 1:12-cv-1100 GSA, 2013 WL 4517915, at *6 (E.D. Cal. Aug. 26, 18 2013) (finding that ALJ properly relied on consulting examiner 19 who had “legitimate basis for her opinion” despite having 20 reviewed “no medical records” because she took plaintiff’s 21 medical history and conducted evaluation, and plaintiff “fail[ed] 22 to identify which relevant records [she] should have reviewed and 23 how the purported failure to review particular records prejudiced 24 [the] consultative examination”). 25 (AR Thus, Dr. Cross’s failure to review medical records was See Cisneros v. Colvin, No. 1:12-cv-0931- Viewed another way, “the failure to provide prior records 26 . . . may be harmless when the record as a whole is considered.” 27 Alcazar, 2017 WL 1275293, at *4. 28 Cross’s opinion, though not based on a review of Plaintiff’s 53 As already discussed, Dr. 1 records, was nonetheless consistent with the results of her own 2 psychological testing and the objective medical evidence as a 3 whole. 4 2009) (ALJ did not err in relying on consulting examiner’s 5 assessment, which “rested on his own independent examination of 6 [plaintiff] and was consistent with the record as a whole”); 7 Brown v. Colvin, No. 2:15-cv-0293-KJN, 2016 WL 362232, at *5 8 (E.D. Cal. Jan. 29, 2016) (finding that ALJ properly relied on 9 consulting examiner’s opinion because it was supported by “his See Castaneda v. Astrue, 344 F. App’x 396, 398 (9th Cir. 10 own clinical findings,” other medical-opinion evidence, and 11 “medical record as a whole”); Moreno v. Colvin, No. EDCV 12-0747 12 RNB, 2013 WL 1661566, at *3 (C.D. Cal. Apr. 16, 2013) (reversal 13 not warranted because consulting examiner “conducted a thorough 14 examination resulting in independent clinical findings and 15 reached an opinion about plaintiff’s functional limitations that 16 was generally consistent with plaintiff’s medical record”). 17 Thus, any error was harmless, and Dr. Cross’s opinion was 18 properly considered substantial evidence. 19 No. 2:11-cv-3121-KJN, 2012 WL 6555074, at *6 (E.D. Cal. Dec. 14, 20 2012) (“[A]ny failure to provide plaintiff’s prior treatment 21 records to [consulting examiner] was harmless error, because 22 [treating physician’s] records contain minimal clinical findings 23 concerning plaintiff’s mental impairments, and . . . [other 24 mental-health] records document findings that are generally 25 consistent with those of [the consulting examiner].”) 26 See Perry v. Astrue, Accordingly, remand is unwarranted on this ground. 27 28 54 1 C. 2 3 The ALJ Properly Evaluated the Severity of Plaintiff’s Alleged Impairments Plaintiff argues that the ALJ erred in finding her 4 peripheral nerve-entrapment syndrome “non-severe” (J. Stip. at 5 19) and in finding no severe mental impairment (id. at 4-8). 6 the reasons discussed below, the ALJ did not err in either 7 regard. 8 9 1. For Applicable law The step-two inquiry is “a de minimis screening device to 10 dispose of groundless claims.” 11 claimant has the burden to show that she has one or more “severe” 12 medically determinable impairments that can be expected to result 13 in death or last for a continuous period of at least 12 months, 14 as demonstrated by evidence in the form of signs, symptoms, or 15 laboratory findings. 16 v. Barnhart, 420 F.3d 1002, 1004-05 (9th Cir. 2005); Bowen v. 17 Yuckert, 482 U.S. 137, 146 n.5 (1987). 18 impairment is “severe” if it “significantly limits [the 19 claimant’s] physical or mental ability to do basic work 20 activities.”19 21 impairment or combination of impairments may be found ‘not severe 22 only if the evidence establishes a slight abnormality that has no 23 more than a minimal effect on an individual’s ability to work.’” 24 Webb v. Barnhart, 433 F.3d 683, 686 (9th Cir. 2005) (quoting Smolen, 80 F.3d at 1290. The See §§ 404.1505, 404.1520(a)(4)(ii); Ukolov A medically determinable § 404.1520(c); see also § 404.1521(a). “An 25 26 27 28 19 “Basic work activities” include, among other things, “[p]hysical functions such as walking, standing, sitting, lifting, pushing, pulling, reaching, carrying, or handling” and “[c]apacities for seeing, hearing, and speaking.” § 404.1521(b); accord Yuckert, 482 U.S. at 141. 55 1 Smolen, 80 F.3d at 1290 (emphasis in original)). 2 determine whether substantial evidence in the record supported 3 the ALJ’s finding that a particular impairment was not severe. 4 Davenport v. Colvin, 608 F. App’x 480, 481 (9th Cir. 2015) 5 (citing Webb, 433 F.3d at 687); see also Kent v. Astrue, 335 F. 6 App’x 673, 674 (9th Cir. 2009) (same). 7 2. 8 Analysis a. 9 A court must Peripheral Nerve-Entrapment Syndrome The ALJ found that Plaintiff’s “peripheral nerve entrapment 10 syndrome cause[d] only a slight abnormality that would have no 11 more than a minimal effect on her ability to work.” 12 The ALJ reasoned that “no objective medical evidence” showed that 13 the condition lasted or would last for a “continuous period of 14 not less than 12 months”; further, the condition was “managed 15 medically” and “[n]o aggressive treatment was recommended” for 16 it. 17 (AR 24.) (Id.) Plaintiff argues that “the medical evidence and [her] 18 testimony” supported a finding of severity, specifically 19 identifying three medical records: a September 2012 diagnosis of 20 “ulnar neuropathy versus cervical radiculopathy on the right 21 side” (see AR 297-98); an October 2012 electrodiagnostic study 22 showing “mild ulnar neuropathy” (see AR 299-300); and a January 23 2013 treatment note indicating a “positive” Tinel’s sign on the 24 right ulnar nerve (see AR 313). 25 testimony, she stated at her January 2016 hearing that she “had 26 difficulty using her right arm and hand and experienced burning 27 pain in her elbow area when writing or typing.” 28 (citing AR 57-58).) (J. Stip. at 19-20.) 56 As to her (Id. at 20 1 The ALJ, however, correctly found that the objective medical 2 evidence did not support a finding of severity. 3 for peripheral nerve-entrapment syndrome was made in January 2016 4 by Dr. Nabet. 5 by the ALJ, as discussed above; indeed, just a month before that 6 diagnosis Plaintiff was observed as having no tenderness in her 7 elbows and “intact” range of motion in her extremities (see AR 8 660). 9 in late 2012 and early 2013, Dr. Schmitter, whose opinion the ALJ (See AR 655.) Her diagnosis Her opinion was properly discounted Moreover, despite the evidence of “mild ulnar neuropathy” 10 properly afforded great weight, noted that such a finding was 11 “common.” 12 nerve examination” in June 2015).) 13 Plaintiff’s December 2012 examination at an arthritis clinic 14 revealed that she had “normal range of motion” in her upper 15 extremities and no swelling or tenderness in her elbows or 16 wrists. 17 that examination was a prescription for Effexor to control her 18 “stress level.” 19 Tinel’s sign in January 2013, nothing in the record indicates 20 that the nerve irritation lasted for the requisite 12 months, as 21 the ALJ concluded (AR 24). (AR 46 (also indicating that Plaintiff had “normal (AR 330.) Around that same time, The only treatment she received following (AR 331.) Even if Plaintiff had a positive 22 Though Plaintiff also points to her testimony of difficulty 23 using her right hand, the ALJ properly discounted her subjective 24 symptom testimony, as discussed above. 25 examination in May 2013, she was shown to have grip strength 26 “commensurate with [normal] motor strength.” 27 “no significant deformities” in her hands, could “manipulate the 28 use of a pen with ease,” did “not restrict the use of either hand 57 And at a consultative (AR 344.) She had 1 during the examination,” could “approximate fingers and make a 2 fist without difficulties bilaterally,” and achieved adequate 3 “[p]inch positioning” bilaterally. 4 her activities of daily living included many things requiring the 5 use of her hands, such as driving a car (AR 64, 229, 333, 335, 6 487) and weight-lifting (AR 487 (May 2015)). 7 (Id.) And as already noted, Substantial evidence therefore supported the ALJ’s severity 8 determination as to Plaintiff’s alleged peripheral nerve- 9 entrapment syndrome. See Delanoy v. Berryhill, 697 F. App’x 917, 10 919 (9th Cir. 2017) (“The ALJ properly relied on the absence of 11 record medical evidence sufficient to support a determination 12 that [plaintiff’s] migraines did not cause more than minimal 13 limitation in [his] ability to perform basic work activities.”); 14 accord Neeley v. Berryhill, 693 F. App’x 641, 642 (9th Cir. 15 2017). 16 17 b. Mental Impairments The ALJ found that Plaintiff had the “medically determinable 18 mental impairments of anxiety and depression” but that they did 19 “not cause more than minimal limitation in [her] ability to 20 perform basic mental work activities and [were] therefore 21 nonsevere.” 22 rejected the opinions of Drs. Bassanelli and Monahan to support 23 his analysis here (see J. Stip. at 8-10), but as discussed above, 24 the ALJ properly discounted their opinions and correctly afforded 25 Dr. Cross’s opinion “great weight.” 26 Sec. Admin., No. CV-16-04048-PHX-GMS, 2017 WL 3188418, at *4 (D. 27 Ariz. July 27, 2017) (“The inconsistencies between the objective 28 medical evidence and [physician’s] treating records and his (AR 24.) Plaintiff argues that the ALJ improperly 58 See Frantz v. Comm’r of Soc. 1 ultimate opinion as well as the contradictions between his 2 opinion and the findings of the other physicians ‘provides 3 substantial evidence to find that the medical evidence clearly 4 established the claimant’s lack of a medically severe impairment 5 or combination of impairments.’” (citing Webb, 433 F.3d at 688) 6 (alterations omitted)). 7 Plaintiff further argues that the ALJ “mischaracterized” the 8 medical evidence in making his mental severity determination, but 9 substantial evidence in the record demonstrates that despite her 10 alleged mental impairments, she had “intact” or “good” cognition 11 and memory (see, e.g., AR 391 (Aug. 2013), 517 (Jan. 2014), 635 12 (Jan. 2015), 631 (Mar. 2015), 627 (same), 623 (Apr. 2015), 619 13 (May 2015), 615 (same), 608 (Aug. 2015), 604 (Sept. 2015), 600 14 (same), 538-40 (Oct. 2015)) and “appropriate,” “fair,” “intact,” 15 “preserved,” or “normal” insight and judgment (see, e.g., AR 337 16 (Apr. 2013), 635 (Jan. 2015), 627 (Mar. 2015), 631 (same), 623 17 (Apr. 2015), 615 (May 2015), 619 (same), 608 (Aug. 2015), 600 18 (Sept. 2015), 604 (same)). 19 (see AR 229, 335, 486); spent time with family and friends 20 (see AR 230, 335); had power of attorney over her mother, whom 21 she helped with “legal issues” (see, e.g., AR 531, 536, 539, 542, 22 681); was paid to care for her disabled husband (see, e.g., AR 23 328, 486, 532, 536); cared for her adult son with mental issues 24 (see, e.g., AR 532); and read books (see, e.g., AR 499, 502, 540, 25 633). 26 limitations in her activities of daily living, social 27 functioning, and concentration, persistence, and pace and had 28 never experienced an episode of decompensation. She also managed her own finances As the ALJ found, Plaintiff experienced only “mild” 59 (AR 25); see 1 Cosgrove v. Berryhill, No. EDCV 16-2551 JC, 2017 WL 5054658, at 2 *3 (C.D. Cal. Oct. 31, 2017) (finding that “substantial evidence 3 support[ed] the ALJ’s step two determination” because plaintiff’s 4 daily activities, social functioning, and concentration, 5 persistence, and pace were at most “mild[ly]” limited and she had 6 no episodes of decompensation). 7 Accordingly, the ALJ did not err in his severity 8 determination and remand is unwarranted on this ground. 9 VI. 10 CONCLUSION Consistent with the foregoing and under sentence four of 42 11 U.S.C. § 405(g),20 IT IS ORDERED that judgment be entered 12 AFFIRMING the Commissioner’s decision, DENYING Plaintiff’s 13 request for remand, and DISMISSING this action with prejudice. 14 15 DATED: March 29, 2018 16 ______________________________ JEAN ROSENBLUTH U.S. Magistrate Judge 17 18 19 20 21 22 23 24 25 26 27 28 20 That sentence provides: “The [district] court shall have power to enter, upon the pleadings and transcript of the record, a judgment affirming, modifying, or reversing the decision of the Commissioner of Social Security, with or without remanding the cause for a rehearing.” 60

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