Michele L Ochsner v. Michael J Astrue, No. 8:2012cv00186 - Document 15 (C.D. Cal. 2012)

Court Description: MEMORANDUM OPINION AND ORDER AFFIRMING THE COMMISSIONER AND DISMISSING ACTION by Magistrate Judge Jean P Rosenbluth. IT IS ORDERED that judgment be enteredAFFIRMING the decision of the Commissioner and dismissing thisaction with prejudice. IT IS FURTHER ORDERED that the Clerkserve copies of this Order and the Judgment on counsel for bothparties. (twdb)

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1 2 3 4 5 6 UNITED STATES DISTRICT COURT 7 CENTRAL DISTRICT OF CALIFORNIA 8 9 10 MICHELE L. OCHSNER, 11 Plaintiff, 12 v. 13 14 MICHAEL J. ASTRUE, Commissioner of the Social Security Administration, 15 Defendant. 16 17 I. ) ) ) ) ) ) ) ) ) ) ) ) Case No. SACV 12-0186 JPR MEMORANDUM OPINION AND ORDER AFFIRMING THE COMMISSIONER AND DISMISSING ACTION PROCEEDINGS 18 Plaintiff seeks review of the Commissioner s final decision 19 denying her application for Social Security Disability Insurance 20 Benefits ( DIB ). 21 the undersigned U.S. Magistrate Judge pursuant to 28 U.S.C. 22 § 636(c). 23 2012, which the Court has taken under submission without oral 24 argument. 25 decision is affirmed and this action is dismissed. 26 II. 27 28 The parties consented to the jurisdiction of The parties filed a Joint Stipulation on September 27, For the reasons stated below, the Commissioner s BACKGROUND Plaintiff was born on January 12, 1965. Record ( AR ) 124.) (Administrative She earned a bachelor s degree in Health 1 1 Science and received certifications as a medical assistant and 2 laser technician. 3 disability, on March 24, 2009, when she stopped working, 4 Plaintiff worked for two and a half years as a coordinator at a 5 wellness program and as a laser technician and medical assistant 6 for over 10 years before that. 7 (AR 71.) Before the onset of her alleged (AR 71-73, 124, 134.) On February 11, 2010, Plaintiff applied for DIB, alleging 8 that she was unable to work because of sarcoidosis (systemic 9 organ inflammation), fibromyalgia (chronic soft-tissue and joint (AR 124-25; see id. at 181-82.) After 10 pain), and depression. 11 Plaintiff s application was denied, she requested a hearing 12 before an Administrative Law Judge ( ALJ ). 13 held the hearing on April 21, 2011, at which Plaintiff, who was 14 represented by counsel, and a vocational expert ( VE ) testified. 15 (AR 66-67.) 16 not disabled because she could perform her past relevant work. 17 (AR 16-35.) 18 Plaintiff s request for review. 19 III. STANDARD OF REVIEW 20 (AR 99.) The ALJ On July 5, 2011, the ALJ found that Plaintiff was On December 14, 2011, the Appeals Council denied (AR 1-4.) This action followed. Under 42 U.S.C. § 405(g), a district court may review the 21 decision of the Commissioner to deny benefits. The Court may set 22 aside the Commissioner s decision when the ALJ s findings were 23 based on legal error or were not supported by substantial 24 evidence in the record as a whole. 25 F.3d 1033, 1035 (9th Cir. 2001); Smolen v. Chater, 80 F.3d 1273, 26 1279 (9th Cir. 1996). 27 scintilla, but less than a preponderance. 28 157 F.3d 715, 720 (9th Cir. 1998). Aukland v. Massanari, 257 Substantial evidence is more than a 2 Reddick v. Chater, It is relevant evidence 1 which a reasonable person might accept as adequate to support a 2 conclusion. 3 supported a finding, the court must consider the record as a 4 whole, weighing both evidence that supports and evidence that 5 detracts from the [Commissioner s] conclusion. 6 F.3d at 1035 (internal quotation marks omitted). 7 could reasonably support either affirming or reversing that 8 conclusion, a court may not substitute its judgment for that of 9 the Commissioner, and the ALJ s decision must be upheld. Id. To determine whether substantial evidence 10 IV. If the evidence Reddick, 157 F.3d at 720-21. 11 Aukland, 257 12 DISABILITY EVALUATION Claimants are disabled for purposes of receiving Social 13 Security benefits if they are unable to engage in any substantial 14 gainful activity owing to a severe physical or mental impairment 15 that is expected to result in death or which has lasted, or is 16 expected to last, for a continuous period of at least 12 months. 17 42 U.S.C. § 423(d)(1)(A); Drouin v. Sullivan, 966 F.2d 1255, 1257 18 (9th Cir. 1992). 19 A. 20 The Commissioner follows a five-step sequential evaluation The Five-Step Evaluation Process 21 process in assessing whether a claimant is disabled. 22 § 404.1520(a)(4); Lester v. Chater, 81 F.3d 821, 828 n.5 (9th 23 Cir. 1995) (as amended Apr. 9, 1996). 24 Commissioner must determine whether the claimant is currently 25 engaged in substantial gainful activity; if so, the claimant is 26 not disabled and the claim is denied. 27 the claimant is not engaged in substantial gainful activity, the 28 second step requires the Commissioner to determine whether the 3 20 C.F.R. In the first step, the § 404.1520(a)(4)(i). If 1 claimant has a severe impairment or combination of impairments 2 significantly limiting her ability to do basic work activities; 3 if not, a finding of not disabled is made. 4 If the claimant has a severe impairment or combination of 5 impairments, the third step requires the Commissioner to 6 determine whether the impairment or combination of impairments 7 meets or equals an impairment in the Listing of Impairments 8 ( Listing ) set forth at 20 C.F.R., Part 404, Subpart P, 9 Appendix 1; if so, disability is conclusively presumed and § 404.1520(a)(4)(ii). 10 benefits are awarded. § 404.1520(a)(4)(iii). If the claimant s 11 impairment does not meet an impairment in the Listing, the fourth 12 step requires the Commissioner to determine whether the claimant 13 has sufficient residual functional capacity ( RFC )1 to perform 14 her past work; if so, the claimant is not disabled. 15 § 404.1520(a)(4)(iv). 16 that she is unable to perform past relevant work. 17 F.2d at 1257. 18 case of disability is established. 19 the claimant has no past relevant work, the Commissioner then 20 bears the burden of establishing that the claimant is not 21 disabled because she can perform other substantial gainful work 22 available in the national economy. 23 determination comprises the fifth and final step in the 24 sequential analysis. The claimant has the burden of proving Drouin, 966 If the claimant meets that burden, a prima facie Id. If that happens or if § 404.1520(a)(4)(v). That Id.; Lester, 81 F.3d at 828 n.5; Drouin, 25 26 1 27 28 RFC measures what a claimant can still do despite existing exertional and nonexertional limitations. 20 C.F.R. § 404.1545; see Cooper v. Sullivan, 880 F.2d 1152, 1155 n.5 (9th Cir. 1989). 4 1 966 F.2d at 1257. 2 B. The ALJ s Application of the Five-Step Process 3 At step one, the ALJ found that Plaintiff had not engaged in 4 any substantial gainful activity from the onset of her alleged 5 disability, March 24, 2009, through the time of the ALJ s adverse 6 decision, in July 2011. 7 that Plaintiff had severe impairments of mixed connective-tissue 8 disorder including sarcoid-like granulomas, lymphadenopathy 9 (inflammation of lymph nodes), sarcoidosis, and asthma. (AR 21.) At step two, the ALJ found (AR 21- 10 23.) The ALJ concluded, however, that her alleged mental 11 impairment of depression was not severe, a finding Plaintiff does 12 not challenge. 13 Plaintiff s impairments did not meet or equal any of the 14 impairments in the Listing. 15 found that Plaintiff retained the RFC to perform light work,2 16 limited by her (1) inability to perform above-shoulder activities 17 or work in an environment with excess airborne irritants, (2) 18 numbness in hands and feet, (3) nausea, and (4) moderate pain 19 in joints, muscles, head, shoulders, abdomen, and extremities. 20 (Id.) 21 limitations of dizziness, hypothyroidism, fibromyalgia, fatigue, 22 and depression because he found them slight in nature. 23 The ALJ concluded that Plaintiff was capable of performing her 24 past relevant work as a medical assistant and the equivalent of (Id.) At step three, the ALJ determined that (AR 23.) At step four, the ALJ The ALJ did not include Plaintiff s additional asserted (Id.) 25 26 27 28 2 Light work involves lifting no more than 20 pounds at a time with frequent lifting or carrying of objects weighing up to 10 pounds and a good deal of walking or standing or sitting, with some pushing and pulling of arm or leg controls. 20 C.F.R. § 404.1567(b). 5 1 an esthetician and case manager.3 2 at step four that Plaintiff was not disabled and accordingly did 3 not reach step five. 4 V. 5 (AR 31.) The ALJ determined (Id.) DISCUSSION Plaintiff contends that the ALJ improperly (1) discounted 6 the opinion of her treating rheumatologist, Dr. Christine 7 Leehealey, by giving little weight to Dr. Leehealey s RFC 8 assessment (J. Stip. 5-12)4 and (2) found that Plaintiff was not 9 credible as to the severity of her conditions and limitations 10 11 (id. at 14-19). A. Substantial Evidence Supported the ALJ s Rejection of Dr. Leehealey s RFC Assessment 12 1. 13 Applicable law 14 Three types of physicians may offer opinions in social 15 security cases: (1) those who treat the claimant (treating 16 physicians); (2) those who examine but do not treat the claimant 17 (examining physicians); and (3) those who neither examine nor 18 treat the claimant (non-examining physicians). 19 at 830. 20 afforded more weight than those of nontreating physicians because 21 treating physicians are employed to cure and have a greater 22 opportunity to know and observe the claimant. 23 24 25 Lester, 81 F.3d The opinions of treating physicians are generally Smolen, 80 F.3d at 3 The VE testified that no positions existed in the Dictionary of Occupational Titles ( DOT ) equivalent to Plaintiff s past work as a laser technician and wellness program coordinator, and that the closest matches were an esthetician and case manager. (AR 85-86.) 26 4 27 28 In addition to discounting Dr. Leehealey s RFC assessment, the ALJ gave little weight to her letters from August 2010 and March 2011 alleging that Plaintiff could not work. (AR 30-31.) 6 1 1285. The weight given a treating physician s opinion depends on 2 whether it was supported by sufficient medical data and was 3 consistent with other evidence in the record. 4 § 404.1527(c)(2). 5 supported by medically acceptable clinical and laboratory 6 diagnostic techniques and was not inconsistent with other 7 substantial evidence from the record, it should be given 8 controlling weight and should be rejected only for clear and 9 convincing reasons. 20 C.F.R. If a treating physician s opinion was well Lester, 81 F.3d at 830; § 404.1527(c)(2). 10 When a treating physician s opinion conflicts with other medical 11 evidence or was not supported by clinical or laboratory findings, 12 the ALJ must provide only specific and legitimate reasons for 13 discounting that doctor s opinion. 14 632 (9th Cir. 2007). 15 treating physician s opinion include the [l]ength of the 16 treatment relationship and the frequency of examination as well 17 as the [n]ature and extent of the treatment relationship. 18 § 404.1527(c)(2)(i)-(ii). 19 20 2. Orn v. Astrue, 495 F.3d 625, Factors relevant to the evaluation of a Background Plaintiff had a history of abdominal pain, nausea, and 21 vomiting since 2007. (AR 206.) 22 but experienced significant abdominal and lower sternal pain in 23 March 2009, which resulted in two trips to the emergency room and 24 her stopping work. 25 physician, referred her to specialists to ascertain the cause. 26 (AR 348, 353-54, 376.) 27 March and April 2009 and was subsequently diagnosed with 28 lymphadenopathy in the thorax and abdomen by Drs. Syed Naqvi, (Id.) She improved slightly in 2008 Dr. Sheryl Long, her primary care Plaintiff lost about 15 pounds between 7 1 Colin Joyo, Winston Whitney, and Frederick Birnberg. 2 201, 206-09, 217, 222, 322, 437.) 3 however, concluded in late 2009 that compared to Plaintiff s 4 earlier chest scans, her lymph nodes had decreased in size and 5 her mediastinal lymphadenopathy had normalized.5 6 In particular, Dr. Whitney noted in September 2009 that there was 7 [n]o evidence of inflammatory stranding, free fluid, bowel wall 8 thickening or significant lymphadenopathy elsewhere in the 9 abdomen. (AR 217.) (AR 194- Drs. Whitney and Birnberg, (AR 217, 322.) On October 5, 2009, Dr. David Kaufman 10 conducted an esophagogastroduodenoscopy and found that 11 Plaintiff s esophagus, stomach, and duodenum were normal. 12 310.) 13 (AR As to Plaintiff s symptoms, Dr. Jennifer Grossman noted on 14 August 26, 2009, that even though her weight loss had 15 stabilized, she (1) felt nauseated all the time, (2) was weak 16 and fatigued and could not get out of bed to do more than walk 17 to her mailbox each day, and (3) had difficulty running errands, 18 shopping, doing chores, traveling by herself, and gripping and 19 opening things. 20 (AR 221-24.) Plaintiff was referred to Dr. Leehealey, who subsequently 21 diagnosed her with sarcoidosis. (AR 225-27, 376, 655.) In their 22 initial meeting, on August 31, 2009, Dr. Leehealey noted that 23 Plaintiff had severe abdominal pain and diagnosed her with 24 arthralgias in multiple sites and diffuse mediastinal and 25 intraabdominal lymphadenopathy, which was the pathology . . . 26 27 28 5 Likewise, in August 2009, Dr. Leehealey noted that Plaintiff s lymphadenopathy had decreased under steroid treatment but that she still had severe abdominal pain. (AR 562.) 8 1 most consistent with sarcoidosis. (AR 562-64.) Dr. Leehealey 2 indicated that Plaintiff had been taking Prednisone since May but 3 that the dosage had been reduced because of side effects. 4 562.) (AR On September 24, 2009, Dr. Leehealey opined that Plaintiff 5 6 likely had sarcoidosis and noted that she suffered from weight 7 loss, low-grade fever, and abdominal pain. 8 Leehealey prescribed Methotrexate. (AR 566.) Dr. (AR 567.) On October 27, 2009, Plaintiff informed Dr. Leehealey that 9 10 she had not improved and that the Methotrexate nauseated her. 11 (AR 569-70.) 12 symptoms [we]re worsening and prescribed Remicade because it was 13 worth [a] try. Dr. Leehealey found that Plaintiff s systemic (AR 571.) On December 8, 2009, Dr. Leehealey noted mixed results: 14 15 Plaintiff felt overall a little better, including decreased 16 stomach pain, but still had nausea, aching, and weakness. 17 572.) 18 such as her joint pain and arthralgias, were to be expected as 19 she tapered off Prednisone and switched to Remicade. 20 Dr. Leehealey noted that Plaintiff was gaining some weight back 21 and her gastrointestinal symptoms were maybe slightly better. 22 (Id.) 23 (AR Dr. Leehealey stated that some of Plaintiff s symptoms, (AR 573.) On February 9, 2010, Plaintiff complained that everything 24 was severely painful and stiff, including her hands, wrists, 25 forearms, legs, and muscles. 26 however, that other than her joint and muscle pain, Plaintiff was 27 doing better in general on Remicade. 28 (AR 575.) Dr. Leehealey found, (AR 577.) On April 27, 2010, Dr. Leehealey noted that Remicade caused 9 1 nausea and headaches but was helping and that each dosage would 2 remain effective for about six weeks. 3 Plaintiff still had pain in her hands and feet, Dr. Leehealey 4 noted that she had gained a few pounds and continued to improve 5 on many of her [gastrointestinal] symptoms. 6 Leehealey found, however, that Plaintiff s arthralgias and 7 myalgias had worsened and suspected fibromyalgia based on 8 Plaintiff having 14 of 18 tender points.6 (AR 578.) Even though (AR 578-80.) Dr. (AR 579-80.) 9 On June 29, 2010, Dr. Leehealey observed that Plaintiff 10 continued to gain weight (eight pounds) and her stomach pain had 11 improved, although she was still woozy and fatigued and 12 nauseated. 13 suffered from significant arthralgias and fibromyalgia and had 14 18 of 18 tender points; Dr. Leehealey proscribed Plaquenil for 15 treatment. 16 (AR 661.) Dr. Leehealey found that Plaintiff still (AR 661-63.) On August 24, 2010, Dr. Leehealey noted that after taking 17 Plaquenil, Plaintiff felt at least 20% better and not as stiff 18 and achy, though she still had pain in her left ankle and foot. 19 (AR 659.) 20 [Plaquenil] and [Methotrexate] and noted tender points 12 out 21 of 18 improved and that her fibromyalgia was slightly better 22 with the improved arthralgias. 23 Dr. Leehealey found Plaintiff to be stable on (AR 660.) On November 16, 2010, Dr. Leehealey noted that although 24 Plaintiff still had nausea and headaches, she appeared to have 25 more energy. (AR 656.) Further, Dr. Leehealey found Plaintiff 26 27 28 6 The rule of thumb for diagnosing fibromyalgia is that one must have at least 11 of 18 tender points. Rollins v. Massanari, 261 F.3d 853, 855 (9th Cir. 2001). 10 1 to be stable on her current med[ication]s and her pain 2 somewhat controlled such that she [wa]s able to do other things 3 now during the day such as taking classes. 4 Leehealey also noted that Plaintiff no longer took her pain 5 medication (Darvocet) every day, even though it was supposed to 6 be taken three times a day. 7 tender points 12 out of 18 improved. 8 scheduled the next appointment in four months or as needed. 9 (Id.) (AR 656.) (AR 657.) Dr. Dr. Leehealey found (AR 657.) Dr. Leehealey Dr. Leehealey filled out an RFC assessment form on February 10 11 1, 2011. (AR 763.) She described Plaintiff as having 12 sarcoidosis and fibromyalgia with a fair-to-poor prognosis, 13 supported in part by her prior finding of 18 of 18 tender points. 14 (Id.) 15 stiffness, muscle and soft-tissue pain, numbness, nausea, 16 vomiting, weight loss, and severe fatigue. 17 indicated that Plaintiff (1) had pain ranking nine of 10 in 18 severity and fatigue ranking 10 of 10; (2) could sit for only two 19 hours and stand and walk for zero to one hour during a regular 20 work day; (3) could occasionally lift and carry five to 10 21 pounds; and (4) had significant limitations in doing repetitive 22 reaching, handling, fingering, and lifting because of her joint 23 pain and numbness and marked limitations in using her upper 24 extremities. 25 that Plaintiff s pain and fatigue constantly interfered with her 26 attention and concentration and that she was incapable of working She noted that Plaintiff had symptoms of joint pain and (AR 765-67.) (AR 764-65.) She In addition, Dr. Leehealey concluded 27 28 11 1 2 even in a low-stress environment.7 (AR 768.) On March 15, 2011, in her final treatment note on record, 3 Dr. Leehealey found a major flare-up of symptoms, including 4 increased nausea, joint pain, and fatigue, but attributed 5 Plaintiff s worsening conditions to her temporary interruption in 6 medication to fight off a two-week-long infection. 7 Dr. Leehealey noted that Plaintiff had been off Methotrexate for 8 four weeks and had resumed taking it and Plaquenil only since 9 the past week. (Id.) (AR 794.) Noting that Plaintiff was worse off 10 without those medications, Dr. Leehealey found 18 of 18 tender 11 points, a lot of arthralgias, and debilitating pain. 12 794-96.) (AR 13 Dr. Leehealey documented Plaintiff s weight during each 14 visit: 141 pounds on August 31, 2009 (AR 563); 136 pounds on 15 September 24, 2009 (AR 566); 135 pounds on October 27, 2009 (AR 16 569); 137 pounds on December 8, 2009 (AR 572); 137 pounds on 17 February 9, 2010 (AR 575); 140 pounds on April 27, 2010 (AR 578); 18 144 pounds on June 29, 2010 (AR 661); 140 pounds on August 24, 19 2010 (AR 659); and 142 pounds on November 16, 2010 (AR 656).8 20 In contrast to Dr. Leehealey s RFC assessment finding 21 Plaintiff incapable of performing even sedentary work, two 22 doctors from the Department of Social Services ( DSS ) evaluated 23 Plaintiff and found that she was capable of light work. (AR 604, 24 25 26 7 Notably, Dr. Leehealey s RFC assessment prohibited Plaintiff from performing even sedentary work, which involves lifting no more than 10 pounds at a time and primarily sitting with occasional standing and walking. See 20 C.F.R. § 404.1567(a). 27 8 28 Dr. Leehealey s March 15, 2011 report does not indicate Plaintiff s weight. (AR 794-96.) 12 1 624.) 2 examination of Plaintiff based on her complaints of joint pain, 3 headaches, abdominal pain, nausea, and fatigue. 4 Godes diagnosed her with mixed connective-tissue disorder 5 including sarcoid-like granulomas but concluded that she could 6 lift 20 pounds occasionally and 10 pounds frequently and was able 7 to stand or walk for six hours in a workday and to sit for six 8 hours of the day as well. 9 Harris, a medical consultant, concurred with Dr. Godes s finding 10 11 On June 18, 2010, Dr. John Godes conducted a physical (AR 609.) (AR 604.) Dr. On June 29, 2010, Dr. B. that Plaintiff was capable of light work. (AR 624-27.) In addition, Dr. Lorna Carlin from DSS indicated the 12 following regarding Plaintiff s daily activities based on a 13 psychiatric evaluation on June 24, 2010: 14 [Plaintiff] currently lives with a cousin and his 15 family in a house, . . . She takes care of self- 16 dressing, personal 17 transportation, [Plaintiff] drives a car. 18 activities are going to church. 19 goes daily to play with her dog, who is staying at her 20 ex-husband s house, which is only about two miles from 21 where she lives. 22 restaurants to get take out food. 23 jewelry and reading. She is able to pay bills and handle 24 cash appropriately. 25 Relationships with family and friends are good. 26 able to focus attention during the interview. 27 reports that she does not do a lot of household chores. 28 She keeps up her room and does her own laundry. self-bathing and hygiene. For Her outside She visits her son and She says that she sometimes goes to Her hobby is making She is able to go out alone. 13 She is She She can 1 prepare food for herself and can run errands. 2 [Plaintiff] has no difficulty making decisions. 3 On a daily basis, [Plaintiff] says she gets up late 4 in the morning, she may watch television for a couple of 5 hours and take a shower and then she gets something to 6 eat. 7 take-out salad and then she will go to her ex-husband s 8 house and play with her dog. She will then come home and 9 watch television. 10 Sometimes she will go to a restaurant and get a She does go on the computer at times. (AR 614, 616-17.) 3. 11 ALJ s findings The ALJ noted that Dr. Leehealey began treating Plaintiff in 12 13 August 2009 and subsequently diagnosed her with sarcoidosis. (AR 14 28.) 15 2011 RFC assessment, however, because it was too restrictive 16 and not based on objective evidence. 17 contrasted Dr. Leehealey s conclusions underlying the RFC 18 assessment, including that Plaintiff had 18 of 18 tender points 19 and lost weight, with Dr. Leehealey s previous treatment notes 20 showing that Plaintiff had in fact improved. 21 Leehealey s August 24, 2010 note indicated that Plaintiff was 22 doing better with medications and her fibromyalgia was 23 slightly better with the improved arthralgias. 24 Further, Dr. Leehealey observed on November 16, 2010, that in 25 spite of nausea and headaches, Plaintiff had only 12 of 18 26 tender points and more energy, her pain was somewhat 27 controlled, and she could do other things . . . during the 28 day. The ALJ gave little weight to Dr. Leehealey s February (AR 29.) (AR 30.) The ALJ For instance, Dr. (AR 28-29.) The ALJ considered Dr. Leehealey s March 2011 14 1 report indicating increased pain, nausea, and fatigue but 2 reasoned that Plaintiff s conditions worsened at the time only 3 because she had stopped taking her medications in order to fight 4 off an infection. 5 Leehealey s conclusion that Plaintiff continued to lose weight, 6 noting that her weight had no significant changes and remained 7 relatively stable in 2010 and 2011. 8 rejected Dr. Leehealey s RFC assessment. 9 instead the RFC assessment from Drs. Godes and Harris, finding 10 (Id.) The ALJ also disagreed with Dr. (AR 30.) (Id.) The ALJ therefore The ALJ credited that Plaintiff was capable of performing light work. 4. 11 (AR 31.) Analysis 12 Substantial evidence supported the ALJ s specific and 13 legitimate reasons for rejecting Dr. Leehealey s February 2011 14 RFC assessment as embellishing Plaintiff s symptoms. 15 found, Dr. Leehealey s RFC assessment contradicted her previous 16 treatment notes and other objective medical evidence showing that 17 Plaintiff had improved with medication. 18 Leehealey began treating Plaintiff in August 2009, she suffered 19 from autoimmune diseases such as sarcoidosis and lymphadenopathy, 20 which caused severe abdominal pain, and arthralgias, which caused 21 joint and muscle pain. 22 October 2009 that Plaintiff s overall condition was worsening. 23 (AR 571.) 24 medical notes show that Plaintiff gradually began improving, 25 particularly in terms of her abdominal pain and gastrointestinal 26 problems. 27 pain improved and gastrointestinal problems were slightly 28 better ); AR 577-80 (noting that Plaintiff s gastrointestinal (AR 562-64.) As the ALJ In particular, when Dr. Dr. Leehealey noted in After that visit, however, Dr. Leehealey s subsequent (See AR 571-73 (observing that Plaintiff s stomach 15 1 2 problems continued to improve).) Likewise, objective medical evidence corroborates Dr. 3 Leehealey s conclusion that Plaintiff s intestinal pain and 4 inflammation subsided in late 2009: (1) Dr. Birnberg found in 5 August 2009 that compared to Plaintiff s earlier scans, her lymph 6 nodes had decreased in size and her mediastinal lymphadenopathy 7 had normalized (AR 322); (2) Dr. Whitney found in September 2009 8 that there was no evidence of significant lymphadenopathy in the 9 abdomen (AR 217); and (3) Dr. Kaufman observed in October 2009 10 that Plaintiff s esophagus, stomach, and duodenum appeared normal 11 (AR 310). 12 Unlike her intestinal problems, Plaintiff s joint and muscle 13 pain worsened in 2010, culminating in Dr. Leehealey s diagnosis 14 of fibromyalgia in April 2010 and her finding of 18 of 18 tender 15 points in June 2010. 16 proscribed Plaquenil on August 24, 2010, however, Plaintiff s 17 joint and muscle pain improved and her overall condition appears 18 to have stabilized. 19 medical note on November 16, 2010, which was based on her last 20 examination of Plaintiff before her February 2011 RFC assessment, 21 shows that Plaintiff s pain was under control, evidenced by her 22 not having to take her pain medication every day, and that she 23 had more energy, was taking a class, and was stable on her 24 current medications. 25 in all visits that Plaintiff s muscle strength was 5/5, 26 indicating that she had no underlying physical limitations 27 outside of her autoimmune symptoms. 28 (AR 578-80, 661-63.) (AR 659-63.) After Dr. Leehealey Indeed, Dr. Leehealey s (AR 656-57.) Finally, Dr. Leehealey noted (See, e.g., AR 660.) Dr. Leehealey s documentation of Plaintiff s weight also 16 1 coincides with her treatment notes showing that Plaintiff 2 responded to medication and began to improve: Plaintiff dropped 3 to her lowest weight, 135 pounds, on October 27, 2009, but 4 gradually regained it in subsequent visits. 5 575, 578, 656, 659, 661.) 6 weight of 142 pounds on November 16, 2010, was higher than her 7 weight of 141 pounds when she initially saw Dr. Leehealey on 8 August 31, 2009. 9 (See AR 569, 572, In fact, Plaintiff s final documented (AR 562, 656.) Thus, substantial evidence supported the ALJ s rejection of 10 Dr. Leehealey s February 2011 RFC assessment alleging in direct 11 contrast with her past treatment notes that Plaintiff was 12 limited to less than sedentary work and suffered debilitating 13 symptoms from sarcoidosis and fibromyalgia, including extreme 14 pain and fatigue and ongoing weight loss. 15 Massanari, 261 F.3d 853, 856 (9th Cir. 2001) (holding that ALJ 16 did not err in rejecting various statements by treating physician 17 because they were internally inconsistent and unsupported by any 18 objective medical evidence, including findings from same 19 physician). 20 note indicates that Plaintiff suffered a major flare-up in 21 symptoms, the ALJ properly discounted it because (1) the RFC form 22 preceded Plaintiff s March 2011 visit with Dr. Leehealey and 23 therefore could not possibly have accounted for Plaintiff s 24 prospective adverse symptoms and (2) in any event, her conditions 25 worsened because she had not been taking Plaquenil and 26 Methotrexate, which had proved to be effective. 27 contentions that the ALJ ignored Dr. Leehealey s March 2011 note 28 and placed undue emphasis on her previous treatment notes See Rollins v. Even though Dr. Leehealey s March 2011 treatment 17 Plaintiff s 1 therefore fail. (See J. Stip. 10-11.) The ALJ therefore was 2 justified in relying on the RFC assessment from Drs. Godes and 3 Harris and finding that Plaintiff was capable of performing light 4 work in spite of her conditions. 5 Court cannot reverse simply because the medical evidence of 6 record might have supported another interpretation more favorable 7 to Plaintiff. 8 Soc. Sec., 528 F.3d 1194, 1198 (9th Cir. 2008) (holding that if 9 evidence is susceptible to more than one rational (AR 604, 609, 624-27.) This See Reddick, 157 F.3d at 720-21; Ryan v. Comm r of 10 interpretation, the ALJ s decision should be upheld (internal 11 quotation marks omitted)). 12 warranted on this claim. 13 B. Accordingly, reversal is not Substantial Evidence Supported the ALJ s Adverse 14 Credibility Determination 15 1. 16 Applicable law An ALJ s assessment of credibility is entitled to great 17 weight. Weetman v. Sullivan, 877 F.2d 20, 22 (9th Cir. 1989). 18 When the ALJ finds a claimant s subjective complaints not 19 credible, the ALJ must make specific findings that support the 20 conclusion. 21 1991) (en banc); Varney v. Sec y of Health & Human Servs., 846 22 F.2d 581, 584 (9th Cir.), modified on reh g, 859 F.2d 1396 (9th 23 Cir. 1988). 24 must give clear and convincing reasons for rejecting the 25 claimant s testimony. 26 ultimate credibility finding was supported by substantial 27 evidence in the record, the ALJ s decision must be upheld, even 28 if he relied on some improper reasons in support of the finding. Bunnell v. Sullivan, 947 F.2d 341, 345 (9th Cir. Absent affirmative evidence of malingering, the ALJ Lester, 81 F.3d at 834. 18 As long as the 1 Carmickle v. Comm r, Soc. Sec. Admin., 533 F.3d 1155, 1162-63 2 (9th Cir. 2008). 3 by substantial evidence, the reviewing court may not engage in 4 second-guessing. 5 Cir. 2002). 2. 6 7 If the ALJ s credibility finding was supported Thomas v. Barnhart, 278 F.3d 947, 959 (9th Background Plaintiff testified at the April 2011 hearing that despite 8 medications that help[ed], she had pain everywhere, 9 particularly in her arms, wrists, hands, legs, feet, and ankles; 10 she also had numbness in her hands and feet. 11 was fatigued [a]ll the time, and her weekly intake of 12 Methotrexate nauseated her. 13 every day, which lasted [t]he majority of the day. 14 Finally, she suffered from depression, with symptoms of 15 [s]adness and not feeling worthwhile. 16 (AR 75, 79-80.) (AR 74-76.) She She had headaches (AR 80.) (AR 76.) As a result, Plaintiff did not do very much during the day 17 except watch television. 18 the internet but could not use it for very long. 19 The last time she had driven before the hearing was a couple 20 days ago. 21 (Id.) She used the computer to browse (AR 76-77.) (AR 77.) 3. ALJ s findings 22 In denying her claim, the ALJ found that Plaintiff s 23 statements concerning the intensity, persistence and limiting 24 effects of [her] symptoms [we]re not credible to the extent they 25 [we]re inconsistent with the ALJ s finding that she retained the 26 RFC to perform light work. 27 found that Plaintiff s allegations about the extent and disabling 28 effects of nausea, abdominal pain, headaches, muscle and joint (AR 23-24.) 19 In particular, the ALJ 1 pain, fatigue, weakness, fibromyalgia, and depression conflicted 2 with the objective medical evidence and her daily activities. 3 (AR 29.) 4 The ALJ cited the medical reports of Drs. Long, Whitney, 5 Kaufman, and Leehealey in rejecting Plaintiff s testimony. In 6 early 2010, Dr. Long found that (1) Plaintiff s depression 7 improved markedly on Cymbalta and she was feeling better ; 8 (2) most of Plaintiff s chronic problems including her asthma, 9 reflux esophagitis, and hypothyroidism were stable ; (3) her 10 lower back pain was satisfactorily self managing with well 11 controlled or resolved symptoms ; (4) her lymphadenopathy became 12 normalized; (5) she had no abdominal pain, weight loss, or 13 anxiety; and (6) she was managing demands of home and work9 14 [and] play. 15 decrease in the size of Plaintiff s lymph nodes and no evidence 16 of inflammatory stranding, free fluid, bowel-wall thickening, or 17 significant lymphadenopathy elsewhere in the abdomen. 18 Kaufman found in October 2009 that Plaintiff s esophagus, 19 stomach, and duodenum appeared normal. 20 Leehealey s more recent reports showed that Plaintiff had 21 improved overall and become stable with medications, including 22 having more energy and gaining weight. (Id.) In September 2009, Dr. Whitney found a (AR 29-30.) (Id.) Dr. Finally, Dr. (AR 30.) 23 The ALJ also noted that Plaintiff s subjective complaints 24 contradicted her documented activities, such as self-grooming, 25 maintaining hygiene, driving, eating out, attending church, 26 27 28 9 Plaintiff was apparently no longer working in early 2010, so the reference to work was likely either a mistake or simply, in context, a colloquialism. 20 1 visiting her son, playing daily with her dog at her ex-husband s 2 house, paying bills, handling cash, doing laundry, preparing 3 food, and running errands. 4 Plaintiff s contrary testimony not credible. 5 6 4. (Id.) The ALJ therefore found (Id.) Analysis Substantial evidence supported the ALJ s adverse credibility 7 determination. As explained above, objective medical evidence, 8 including reports from Drs. Long and Leehealey, showed that based 9 on treatment and medication, Plaintiff s abdominal pain and 10 inflammation improved in late 2009 and her joint and muscle pain 11 stabilized around 2010. 12 report indicates a flare-up of adverse symptoms because Plaintiff 13 temporarily stopped taking Plaquenil and Methotrexate, those 14 symptoms presumably subsided after she resumed taking the 15 necessary medications. 16 was fatigued [a]ll the time was contradicted by Dr. Long s 17 observation in January 2010 that her fatigue waxe[d] and wane[d] 18 with her autoimmune condition, which had improved under Dr. 19 Leehealey s care. 20 Even though Dr. Leehealey s March 2011 Further, Plaintiff s assertion that she (AR 536.) In addition, Plaintiff overstated the effect of her 21 depression. The record shows that even though Plaintiff had 22 suffered from depression since 1990, which worsened in 2009 23 because her Prozac prescription had become less effi[ca]cious . 24 . . over time and she experienced increased stress with work, 25 her financial condition, and her divorce (AR 353), her depression 26 markedly improved after she started taking Cymbalta in December 27 2009 (AR 534, 536, 542). 28 2010 that as to her depression, the therape[]utic goal had been In fact, Dr. Long noted in February 21 1 achieved and Plaintiff experienced no side effects from 2 taking Cymbalta and Wellbutrin. 3 from DSS corroborated Dr. Long s conclusions: (1) Dr. Carlin 4 found in June 2010 that Plaintiff suffered from depression but 5 had moderate psychosocial stressors and a global assessment of 6 functioning ( GAF ) score of 70, which was also moderate10 (AR 7 614, 619); and (2) Dr. R. Tashjian found in July 2010 that 8 Plaintiff suffered from depression, but the degree of limitation 9 on her daily activities and maintaining social functioning or (AR 542.) Further, two doctors 10 concentration was mild (AR 633-35, 641). 11 Dr. Long and to an extent the DSS doctors, Plaintiff did not seek 12 medical help to treat her depression after March 24, 2009, her 13 alleged disability onset date (see AR 615 (Dr. Carlin noting that 14 Plaintiff had never been hospitalized in a psychiatric 15 hospital, never received outpatient psychiatric treatment other 16 than in 2006, and was not seeing any mental health professional 17 at the time)); the ALJ therefore properly considered that factor 18 in finding her not credible, see Bunnell, 947 F.2d at 346 19 (holding that in assessing credibility, ALJ may properly rely on 20 plaintiff s unexplained failure to request treatment consistent 21 with alleged severity of symptoms). 22 Moreover, other than Moreover, as the ALJ noted, Plaintiff s alleged limitations 23 were inconsistent with her documented activities, which in June 24 2010 consisted of taking care of personal hygiene and bathing, 25 driving by herself to visit her son and play with her dog, 26 27 28 10 A score between 61 to 70 on the GAF scale indicates some mild symptoms or difficulty in social, occupational, or school functioning. 22 1 attending church, getting take-out from restaurants, making 2 jewelry, reading, and paying her bills. 3 could also handle household chores such as maintaining her room, 4 doing laundry, preparing food, and running errands. 5 ALJ therefore properly considered the inconsistencies between 6 Plaintiff s testimony and her documented activities in finding 7 her not credible. 8 F.3d 1190, 1196-97 (9th Cir. 2004) (adverse credibility 9 determination supported in part by conflict between claimant s 10 (AR 616-17.) Plaintiff (Id.) The See Batson v. Comm r of Soc. Sec. Admin., 359 allegation and documented activities). 11 Accordingly, the ALJ s adverse credibility determination 12 regarding the severity of Plaintiff s impairments and limitations 13 was supported by substantial evidence, and reversal is not 14 warranted on this claim. 15 VI. 16 CONCLUSION Consistent with the foregoing and pursuant to sentence four 17 of 42 U.S.C. § 405(g),11 IT IS ORDERED that judgment be entered 18 AFFIRMING the decision of the Commissioner and dismissing this 19 action with prejudice. 20 serve copies of this Order and the Judgment on counsel for both 21 parties. IT IS FURTHER ORDERED that the Clerk 22 23 DATED: October 16, 2012 24 ______________________________ JEAN ROSENBLUTH U.S. Magistrate Judge 25 26 27 28 11 This 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. 23

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