Opinion
20cv2049-MSB
09-08-2022
FRANKIE ANITA T.,[1] Plaintiff, v. KILOLO KIJAKAZI, Acting Commissioner of Social Security, Defendant.
ORDER REGARDING JOINT MOTION FOR JUDICIAL REVIEW [ECF NO. 15]
HONORABLE MICHAEL S. EIERG UNITED STATES MAGISTRATE JUDGE
On October 16, 2020, Frankie Anita T. (“Plaintiff”) filed a Complaint pursuant to 42 U.S.C. § 405(g) seeking judicial review of a decision by the Commissioner of Social Security (“Defendant”) denying Plaintiff's application for supplemental security income. (Compl., ECF No. 1.) Now pending before the Court is the parties' Joint Motion for Judicial Review (“Joint Motion”). (J. Mot., ECF No. 15 (“J. Mot.”).) For the reasons set forth below, the Court ORDERS that judgment be entered affirming the decision of the Commissioner pursuant to sentence four of 42 U.S.C. § 405(g).
I. PROCEDURAL BACKGROUND
On March 27, 2018, Plaintiff filed an application for supplemental security income benefits under Title XVI of the Social Security Act, alleging disability beginning January 26, 2018. (Certified Admin. R., 266-68, ECF No. 12 (“AR”).) After her application was denied initially and upon reconsideration, (id. at 120-38, 140-58), Plaintiff requested an administrative hearing before an administrative law judge (“ALJ”), (id. at 180-81). An administrative hearing was held on January 2, 2020. (Id. at 73-103.) Plaintiff appeared at the hearing with counsel, and testimony was taken from her and a vocational expert (“VE”). (Id.)
The ALJ incorrectly listed March 15, 2018 as the date of Plaintiff's application. (See AR at 20, 23.)
As reflected in his January 29, 2020 hearing decision, the ALJ found that Plaintiff had not been under a disability, as defined in the Social Security Act, from March 15, 2018, through the date of the decision. (Id. at 33.) The ALJ's decision became the final decision of the Commissioner on August 18, 2020, when the Appeals Council denied Plaintiff's request for review. (Id. at 1-7.) This timely civil action followed.
II. SUMMARY OF THE ALJ'S FINDINGS
In rendering his decision, the ALJ followed the Commissioner's five-step sequential evaluation process. See 20 C.F.R. § 404.1520. At step one, the ALJ found that Plaintiff had not engaged in substantial gainful activity since the application date. (AR at 23.) At step two, the ALJ found that Plaintiff had the following severe impairments: left foot nodule of plantar fascia, hypertension, chronic anemia, depression, schizoaffective disorder, post-traumatic stress disorder (“PTSD”), and alcohol and methamphetamine use disorder. (Id.) At step three, the ALJ found that Plaintiff did not have an impairment or combination of impairments that met or medically equaled the severity of one of the impairments listed in the Commissioner's Listing of Impairments. (Id. at 24.)
Next, the ALJ determined that Plaintiff had the residual functional capacity (“RFC”) to do the following:
perform medium work as defined in 20 CFR 416.967(c) except the claimant can lift and/or carry 50 pounds occasionally and 25 pounds frequently; the claimant can sit for 6 hours in an 8-hour workday; the claimant can stand and/or walk for 6 hours in an 8-hour workday with normal breaks; the claimant can frequently balance, kneel, stoop, crouch and crawl; the claimant is limited to understanding, remembering, and carrying out simple, routine, repetitive tasks, with breaks every two hours; no interaction with the general public, and to occasional work-related, nonpersonal, non-social interaction with co-workers and supervisors involving no more than a brief exchange of information or hand-off of product; the claimant cannot perform highly time pressured tasks such that the claimant is limited to generally goal-oriented work, not time sensitive strict production quotas (that is, production rate pace work with strict by the minute or by the hour production quotas that are frequently and/or constantly monitored by supervisors or that are fast paced); the claimant can work in a low-stress environment where there are few work place changes (i.e., the claimant would not have to switch from task to task) and the claimant has minimal decision-making capability.(Id. at 26.)
At step four, the ALJ adduced and accepted the VE's testimony that Plaintiff is capable of performing her past relevant work as a kitchen helper. (Id. at 31, 99.)
Alternatively, at step five, based on the VE's testimony, the ALJ found that a hypothetical person with Plaintiff's RFC could perform the requirements of occupations that existed in significant numbers in the national economy, such as cleaner II, laundry laborer, and food mixer. (Id. at 32, 99.) Therefore, the ALJ found that Plaintiff was not disabled. (Id. at 33.)
III. DISPUTED ISSUE
As reflected in the parties' Joint Motion, Plaintiff is raising the following issue as the grounds for reversal and remand-whether the ALJ properly considered the testimony of Plaintiff. (J. Mot. at 4.)
IV. STANDARD OF REVIEW
Section 405(g) of the Social Security Act allows unsuccessful applicants to seek judicial review of the Commissioner's final decision. 42 U.S.C. § 405(g). The scope of judicial review is limited, and the denial of benefits will not be disturbed if it is supported by substantial evidence in the record and contains no legal error. Id.; Buck v. Berryhill, 869 F.3d 1040, 1048 (9th Cir. 2017) (citing Molina v. Astrue, 674 F.3d 1104, 1110 (9th Cir. 2012)).
“Substantial evidence means more than a mere scintilla but less than a preponderance. It means such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.” Revels v. Berryhill, 874 F.3d 648, 654 (9th Cir. 2017) (quoting Desrosiers v. Sec'y Health & Human Servs., 846 F.2d 573, 576 (9th Cir. 1988)); see also Richardson v. Perales, 402 U.S. 389, 401 (1971). Where the evidence is susceptible to more than one rational interpretation, the ALJ's decision must be upheld. Tommasetti v. Astrue, 533 F.3d 1035, 1038 (9th Cir. 2008). This includes deferring to the ALJ's credibility determinations and resolutions of evidentiary conflicts. See Lewis v. Apfel, 236 F.3d 503, 509 (9th Cir. 2001). Even if the reviewing court finds that substantial evidence supports the ALJ's conclusions, the court must set aside the decision if the ALJ failed to apply the proper legal standards in weighing the evidence and reaching his or her decision. See Batson v. Comm'r Soc. Sec. Admin., 359 F.3d 1190, 1193 (9th Cir. 2004).
V. DISCUSSION
The ALJ Provided Specific, Clear, and Convincing Reasons for Discounting Plaintiff's Testimony
Plaintiff argues that the ALJ failed to provide specific, clear, and convincing reasons for rejecting Plaintiff's testimony. (J. Mot. at 5-14.) Plaintiff contends that in his written opinion, the ALJ merely provided boilerplate language, followed by a discussion of medical evidence, and the ALJ did not provide legally sufficient rationale to discount Plaintiff's symptoms. (Id. at 8-10.) Plaintiff further argues that the ALJ failed to link his reasons for rejecting Plaintiff's symptom testimony to Plaintiff's specific statements regarding her symptoms, thereby precluding review of whether the ALJ's decision is supported by substantial evidence. (Id. at 11-12.) Plaintiff argues that the ALJ erred, and asks the Court to reverse the ALJ's decision and award benefits, or, in the alternative, to remand the case for further proceedings. (Id. at 14-15, 21-22.)
The Commissioner contends that the ALJ provided legally sufficient reasons for discounting Plaintiff's symptom testimony. (Id. at 16-21.) The Commissioner alleges that the ALJ properly identified medical evidence that contradicted, or did not corroborate, the degree of limitations that Plaintiff alleged. (Id. at 17-20.) Further, the Commissioner contends that the ALJ properly concluded that Plaintiff's conservative and efficacious treatment undermined her alleged limitations. (Id. at 19-20.) The Commissioner thus asserts that the ALJ's decision is supported by substantial evidence and free of legal error, and should be affirmed. (Id. at 19-20, 22-23.)
1. Applicable law
When evaluating a claimant's allegations regarding subjective symptoms, the ALJ must engage in a two-step analysis. See Smolen v. Chater, 80 F.3d 1273, 1281 (9th Cir. 1996), superseded, in part, on other grounds by 20 C.F.R. §§ 404.1529(c)(3), 416.929(c)(3); see also Social Security Ruling (“SSR”) 16-3p, 2016 WL 1119029 (Mar. 16, 2016). First, the ALJ must determine whether there is objective medical evidence of an underlying impairment that “could reasonably be expected to produce the pain or other symptoms alleged.” Trevizo v. Berryhill, 871 F.3d 664, 678 (9th Cir. 2017) (quoting Garrison v. Colvin, 759 F.3d 995, 1014-15 (9th Cir. 2014)). The claimant is not required to show that an underlying impairment could reasonably be expected to cause the severity of the pain alleged, but only that it could have reasonably caused some degree of the pain. Vasquez v. Astrue, 572 F.3d 586, 591 (9th Cir. 2009) (citing Lingenfelter v. Astrue, 504 F.3d 1028, 1036 (9th Cir. 2007)).
SSR 16-3p, which went into effect before the ALJ's decision, rescinded and superseded SSR 96-7p and the former “credibility” language. The Ninth Circuit noted that the SSR 16-3p “makes clear what [the] precedent already required: that assessments of an individual's testimony by an ALJ are designed to ‘evaluate the intensity and persistence of symptoms' . . . and not to delve into wide-ranging scrutiny of the claimant's character and apparent truthfulness.” Trevizo, 871 F.3d at 678 n.5 (quoting SSR 16-3p).
Second, if the first step has been satisfied and there is no evidence of malingering, then the ALJ may reject the claimant's statements about the severity of their symptoms “only by offering specific, clear and convincing reasons for doing so.” Trevizo, 871 F.3d at 678 (quoting Garrison, 759 F.3d at 1014-15). “The clear and convincing standard is the most demanding required in Social Security cases.” Revels, 874 F.3d at 648 (quoting Garrison, 759 F.3d at 1014-15). General findings are insufficient, and the ALJ must identify which specific symptom statements are being discounted and what evidence undermines those claims. See Lambert v. Saul, 980 F.3d 1266, 1277 (9th Cir. 2020) (citing Treichler v. Comm'r Soc. Sec. Admin., 775 F.3d 1090, 1102 (9th Cir. 2014)); Burch v. Barnhart, 400 F.3d 676, 680 (9th Cir. 2005). An ALJ's failure to identify specific statements and explain why they are not credible precludes meaningful review, because the reviewing court cannot determine if the ALJ's decision was supported by substantial evidence, and constitutes reversible error. Brown-Hunter v. Colvin, 806 F.3d 487, 489 (9th Cir. 2015); see also SSR 16-3p.
“[B]ecause symptoms, such as pain, are subjective and difficult to quantify,” the ALJ considers “all of the evidence presented,” including information about the claimant's prior work record, statements about their symptoms, evidence submitted by their medical sources, and observations by the Agency's employees and other persons. 20 C.F.R. §§ 404.1529(c)(3), 416.929(c)(3); SSR 16-3p. Factors the ALJ may consider, in addition to objective medical evidence, include Plaintiff's daily activities; the location, duration, frequency, and intensity of their pain or other symptoms; precipitating and aggravating factors; the type, dosage, effectiveness, and side effects of any medication taken to alleviate pain; treatment; and any other measures used to relieve pain. See 20 C.F.R. §§ 404.1529(c)(3), 416.929(c)(3); SSR 16-3p. The ALJ may also consider inconsistencies between Plaintiff's statements and the medical evidence. See 20 C.F.R. §§ 404.1529(c)(4), 416.929(c)(4); SSR 16-3p.
2. Plaintiff's testimony during the administrative hearing and medical records
a. Relevant testimony during Plaintiff's administrative hearing
Plaintiff testified that she had worked in a casino kitchen, washing dishes and cleaning, until she “developed a condition with [her] fingers,” whereby “they all became numb,” as well as problems with her hips and back. (AR at 80.) Plaintiff stated that she cannot work because she is depressed, cannot “get out of bed” three or four times a week, experiences sadness, cries all the time, sometimes hears voices, and sleeps with a light on because she sometimes sees shadows at night. (Id. at 83, 88-89.) She feels “so weak and so tired” that she does not “have the strength to get up and face the day.” (Id. at 88.) Plaintiff has pain in her back, legs, hip, chest, and Achilles tendon. (Id. at 80, 83, 89.)
Plaintiff further testified that she has problems with her memory, focus, and concentration. (Id. at 83, 86, 91.) Plaintiff can only walk one block, stand for five minutes, sit for twenty minutes, and lift and carry fifteen pounds. (Id. at 90.) Plaintiff used a cane during the administrative hearing, and testified that her doctor prescribed the cane, and she uses the cane to walk. (Id. at 85, 90.) Plaintiff also uses a hand brace on her right non-dominant hand to help with the numbness and pain. (Id. at 85-86.)
Plaintiff stated that she is receiving treatment for her high blood pressure and diabetes, and plans to start physical therapy for her foot. (Id. at 83.) Plaintiff said that she takes Metformin for diabetes; Seroquel, Zoloft, and “one other medication” for her mental impairments; and Nitroglycerin, Naproxen, and Acetaminophen for pain. (Id. at 87, 89, 93.) Plaintiff also testified she had not used methamphetamine for seven-to-eight months before the administrative hearing. (Id. at 87.)
Lastly, Plaintiff testified that she has PTSD from stabbing and killing her daughters' father in self-defense. (Id. at 91-92.) Her husband passed away from cancer, and this contributes to her depression. (Id. at 92.) Plaintiff stated that her sons help her with chores, and her younger son who lives with her pays the bills. (Id. at 77-78.) b. Medical records
From May of 2017 to August of 2019, Plaintiff was examined and treated at the Family Health Centers of San Diego. (Id. at 391-423, 425-33, 475-80, 497-505, 829-37, 841-43, 846-52.) With respect to physical limitations, Plaintiff reported shoulder pain, (id. at 425, 660); lower back pain, (id. at 398, 402, 412, 475, 497, 501, 660, 836, 841, 850); hip pain, (id. at 398, 497); ankle pain, (id. at 475, 660); radicular pain to the legs, (id. at 841); chest pain, (id. at 391, 836, 846, 850); right foot pain, (id. at 402); pain from a lump on the bottom of her left foot, (id. at 425, 475, 834 (9/10 pain when walking); and numbness in her fingers, (id. at 394). Plaintiff was diagnosed with essential hypertension, (id. at 395, 399, 403, 408, 413, 419, 427, 477, 498, 502, 837, 842, 847, 851); hyperlipidemia, (id. at 392, 399, 413, 418, 427, 832); iron deficiency anemia, (id. at 408, 413, 418, 502); type two diabetes, (id. at 477, 498, 832, 835, 848, 851); plantar fascial fibromatosis, (id. at 832, 835); Achilles tendinitis, right leg, (id. at 477); onychogryphosis, (id. at 835); cardiac murmur, (id. at 413); and vitamin D deficiency, (id. at 399, 413).
Treatment notes indicate that Plaintiff had normal gait, (id. at 406, 497, 661); 5/5 muscle strength, (id. at 399, 498, 661); no muscle atrophy of the hands, (id. at 395); appropriate tone and muscle build, (id. at 661); a negative Tinel's test, (id. at 395); intact sensation, (id.); and that she was not able to squat fully due to pain, (id. at 399, 498). On August 27, 2018, at Plaintiff's request, she was prescribed a cane and temporary back brace. (Id. at 475, 477.) On January 30, 2019, Plaintiff declined a Toradol shot for her back pain. (Id. at 850.) Additionally, Plaintiff reported that she had been diagnosed with an “enlarged heart.” (Id. at 403, 412.)
“[A] Tinel's test ‘is an orthopedic test used to detect irritated nerves. Positive signs of a Tinel's test is upon light tapping over a nerve the patient complains of a tingling sensation.'” Ruby L. T. v. Berryhill, Case No. 5:18-cv-00282-JDE, 2019 WL 185686, at *3 n.4 (C.D. Cal. Jan. 14, 2019) (citation omitted).
With respect to mental limitations, Plaintiff reported a history of depression, (id. at 398, 412); normal appetite, (id. at 412); frequent alcohol consumption, (id. at 394, 398, 406); chronic fatigue, (id. at 394); lack of motivation or energy, (id. at 501); and denied suicidal ideations, (id. at 398, 412, 497, 501). During her exams, Plaintiff was alert and oriented, (id. at 395, 399, 402, 413, 417, 498, 501); cooperative, (id. at 498, 501); pleasant, (id. at 417, 501); with a depressed mood, (id. at 501), and calm, (id. at 498). Plaintiff's physicians noted her history of noncompliance due to missed office visits and not following up with referrals. (Id. at 398, 403, 501.) Plaintiff also forgot to take her medications at times, (id. at 501), but reported that the mental health treatment was helping, (id. at 497). Plaintiff was diagnosed with schizoaffective disorder, (id. at 408); major depressive disorder (“MDD”), (id. at 399, 403, 498, 502, 848); and PTSD, (id. at 848).
ii. Psychiatric evaluations
On July 12, 2017, Dr. Bohy conducted a behavioral health assessment of Plaintiff. (Id. at 562-66.) Plaintiff reported being depressed, always feeling tired, having visual and auditory hallucinations, and problems with memory and sleep. (Id. at 562, 564.) Plaintiff's back and foot pain was a 7/10. (Id. at 563.) Dr. Bohy found that Plaintiff was alert; oriented to person, time, place, and current situation; moderately hygienic; dressed appropriately; cooperative; of normal weight; that Plaintiff had coherent thought processes; appropriate affect; age appropriate vocabulary; depressed mood; normal memory; and age appropriate motor skills, judgment, and insight. (Id. at 56465.) Dr. Bohy diagnosed Plaintiff with schizoaffective disorder, depressive type; alcohol use disorder; and methamphetamine use disorder. (Id. at 565.) Dr. Bohy also filled out a “San Diego County Adult Medi-Cal Mental Health Severity Analysis” questionnaire and assessed moderate “clinical complexity” and “life circumstances,” medium “benefit of integrated care,” and no risk of “suicidal/violent, high risk behavior, catastrophic illness/loss, criminogenic behavior, impulsivity, insight, [and] ego discordance.” (Id. at 565-66.)
“Moderate clinical complexity” finding indicates “schizophrenia, major mood or anxiety disorder- stable on medications, baseline function, sustained recovery; prior history of effective treatment, uncomplicated management; minimal cognitive impairment; no recent hospitalizations; [alcohol or drug disorder] misuse.” Patricia C. v. Saul, Case No.: 19-cv-00636-JM-JLB, 2020 WL 4596757, at *3 n.4 (S.D. Cal. Aug. 10, 2020) (internal citations omitted).
“Moderate life circumstances” finding indicates “intermittent emotional distress as a manifestation of a mental illness which is worsened by life stressors; limited resources [and] support; strained resilience.'” Patricia C., 2020 WL 4596757, at *3 n.5 (internal citations omitted).
From September 2017 to April 2018, Plaintiff was treated by Dr. Smith, a psychiatrist. (Id. at 354-57, 438-44, 553-56.) At the initial psychiatric evaluation on September 28, 2017, Plaintiff alleged that she had been “depressed for years” and “recently things [had] been worse.” (Id. at 354.) She reported that she had “very little energy, [was] sleeping poorly, with poor concentration, [had] increased appetite, anhedonia, guilt and hopelessness,” “sometimes hear[d] a voice calling her name,” “[saw] shadows out of the corner of her eye,” and had “occasional nightmares.” (Id.) Additionally, Plaintiff stated that she felt extremely guilty for stabbing her daughters' father in self-defense, which led to his death. (Id.) Plaintiff stated she consumed alcohol three-to-four nights a week and had used methamphetamine a few months before the examination. (Id.) Dr. Smith diagnosed Plaintiff with PTSD and MDD with psychotic features that occur only during depressive periods. (Id. at 354, 356.) He prescribed Gabapentin and Lexapro. (Id. at 354-55.)
Dr. Smith's treatment note from January 10, 2018, stated that Plaintiff experienced some improvement after taking prescribed medications, and that Plaintiff reduced her alcohol intake to one-to-two nights per week. (Id. at 553.) Plaintiff, nevertheless, continued to drink, despite being advised that alcohol could exacerbate her symptoms. (Id. at 438, 441, 553.) On February 14, 2018, Dr. Smith noted that significant stressors in Plaintiff's life, such as losing her job at the casino, exacerbated her depression and psychotic symptoms. (Id. at 441-42.) Plaintiff continued to have auditory and visual hallucinations. (Id. at 438, 441, 553.)
Dr. Smith repeatedly noted that Plaintiff had speech within normal limits; linear thought processes; normal thought content; restricted mood and affect; and appropriate associations, judgment and insight, fund of knowledge, attention span and concentration, and recent and remote memory. (Id. at 355, 439, 442, 554.) Plaintiff was alert and oriented, cooperative, and articulate. (Id.) Dr. Smith also repeatedly assessed moderate “clinical complexity” and “life circumstances,” medium “benefit of integrated care,” and no risk of “suicidal/violent, high risk behavior, catastrophic illness/loss, criminogenic behavior, impulsivity, insight, [and] ego discordance.” (Id. at 356-57, 440, 443, 555.) Dr. Smith reaffirmed his diagnoses of PTSD and MDD with psychotic features. (Id. at 439, 442.) However, on January 10, 2018, because Plaintiff's auditory hallucinations were the “worst when she was depressed,” Dr. Smith opined that this “may suggest more of a schizoaffective disorder picture instead of MDD with psychotic features.” (Id. at 553-54.) On April 11, 2018, Dr. Smith noted that Plaintiff continued to struggle with depressive symptoms, had “ups and downs,” and was “depressed with low energy and [had] difficulty getting up off the couch” four to five days a week. (Id. at 438.)
On August 10, 2018, Dr. Glassman, a consultative examining psychiatrist, completed a psychiatric evaluation of Plaintiff. (Id. at 462-67.) Dr. Glassman wrote that Plaintiff stopped working because of “problems with her hands, with decreased use of her hands, and also pain in her hip and low back.” (Id. at 463.) Plaintiff reported that she was not able to perform basic work because she could not “remember things,” was “very tired” and depressed, and had “very low energy, interest, or motivation.” (Id. at 464.) Plaintiff further reported that she was anxious most of the time and had intermittent suicidal ideation. (Id. at 464-65.) Plaintiff stated that her depression was at its worst after she lost her husband and after she killed her daughters' father in selfdefense. (Id.) Plaintiff told Dr. Glassman that she consumed alcohol twice a week to improve her mood, and had used methamphetamine three-to-four months before the appointment. (Id. at 464.)
Dr. Glassman noted that Plaintiff had problems with low self-esteem, abusive relationships, feelings of alienation, identity confusion, lack of direction, affective lability, controlling her anger and temper, and managing stress. (Id.) With respect to Plaintiff's activities of daily living, Dr. Glassman wrote the following:
She stated that she does not sleep well. It is hard to get to sleep, because of being worried and anxious. She does not take care of her grooming very well. She can go a week or more without a shower. She only brushes her teeth about once a week. She stated she “tries” to do household chores, but “[i]t is hard . . . [she] get[s] panic attacks, feel[s] the world is closing in!” She stated her son has to do much of the grocery shopping, as she is avoidant of going there.(Id. at 465.)
Dr. Glassman noted that during the examination, Plaintiff was “a bit rumpled and unkempt in her physical presentation.” (Id. at 466.) She was alert and oriented, had socially appropriate behavior, was able to follow directions, and had coherent, relevant, and goal-directed thought processes. (Id.) Plaintiff was “poorly engaged,” “[h]er eye contact was limited,” and she “appeared very depressed,” sobbing intermittently during the evaluation. (Id.)
Dr. Glassman diagnosed Plaintiff with ongoing alcohol and methamphetamine use; dysthymic disorder; borderline personality features; and probable borderline personality disorder. (Id. at 467.) As to Plaintiff's ability to function in a workplace setting, Dr. Glassman found that:
[f]rom a psychiatric perspective, she has moderate impairment in her capacity to get along adequately with others and to behave in a socially-appropriate manner, due to her poor grooming and significant depression. She has mild impairment in her capacity to understand and follow even simple instructions consistently. [She] has moderate impairment in her capacity to maintain concentration, persistence, and pace, and to adapt to changes and stressors in a workplace setting.(Id.) Dr. Glassman further opined that “[a] clean and sober lifestyle and appropriate substance abuse treatment” could decrease Plaintiff's symptoms and improve functioning. (Id.)
On November 1, 2018, Dr. Ariella conducted a behavioral health assessment of Plaintiff. (Id. at 539-43.) Plaintiff reported:
depressed mood, anhedonia, hypersomnia, fatigue, poor appetite, feelings of guilt or worthlessness, trouble concentrating, psychomotor retardation, thoughts of being better off dead. [U]ncontrollable worry and nervousness about multiple issues, trouble relaxing, restlessness, irritability, and feeling afraid something awful might happen. [S]ymptoms of posttraumatic stress disorder 2-3 times a week, including increased arousal, psychological and physiological responses to (and avoidance of) reminders of trauma, feeling of detachment, negative overall view of the world.(Id. at 539.) Plaintiff reported that her pain level was an 8/10. (Id. at 540.) Plaintiff also stated that she had visual and auditory hallucinations. (Id. at 541.)
Dr. Ariella noted that Plaintiff was alert; oriented to person, time, place, and current situation; hygienic; dressed appropriately; cooperative; overweight; had normal speech; coherent thought processes; appropriate affect; average intellect; age appropriate vocabulary; depressed mood; normal memory; slowed motor skills; and age appropriate judgment and insight. (Id.) Dr. Ariella diagnosed Plaintiff with PTSD; MDD, recurrent; and generalized anxiety disorder. (Id. at 542.) Dr. Ariella assessed moderate “clinical complexity” and “life circumstances,” medium “benefit of integrated care,” and no risk of “suicidal/violent, high risk behavior, catastrophic illness/loss, criminogenic behavior, impulsivity, insight, [and] ego discordance.” (Id. at 542-43.) On May 8, 2019, Dr. Ariella closed Plaintiff's case because Plaintiff was “[n]ot engaged in treatment at [that] time.” (Id. at 853.)
Dr. Dobos treated Plaintiff from November 2018 to January 2019. (Id. at 532-38, 775-78, 856-59.) At the initial evaluation, Plaintiff reported that she “had depression for a number of years,” did not have any energy, was “always tired,” had nightmares and flashbacks about the killing of her daughters' father, heard voices, saw shadows, and had “passive thoughts of not caring if she goes on living.” (Id. at 532.) Plaintiff reported consuming alcohol three times a week, and using methamphetamine in March 2018. (Id.) Dr. Dobos diagnosed Plaintiff with MDD, recurrent; other psychotic disorder; PTSD; generalized anxiety disorder; panic disorder; alcohol use disorder; and methamphetamine use disorder. (Id. at 536.)
At subsequent visits, Plaintiff reported improved mood and a reduction in psychotic symptoms after beginning Zoloft, but her auditory and visual hallucinations persisted. (Id. at 775, 856.) Dr. Dobos reaffirmed his initial diagnoses. (Id. at 776, 857.) Dr. Dobos noted that Plaintiff was pleasant and polite, (id. at 536, 776, 857); normally groomed and attired, (id. at 536, 776, 857); alert, (id. at 536, 776); and sad and worried, (id. at 536.)
Dr. Dobos found that Plaintiff had speech within normal limits; coherent and circumstantial thought processes; paranoid ideation; auditory and visual hallucinations; ideas of reference; fair judgment and insight; limited fund of knowledge; fair attention span and concentration; anxious and depressed mood and affect; and appropriate associations. (Id. at 535-36, 775-76, 856-57.) Plaintiff was alert and oriented, cooperative, and articulate. (Id.) Dr. Dobos assessed severe “clinical complexity” and “life circumstances,” medium “benefit of integrated care,” and mild risk of “suicidal/violent, high risk behavior, catastrophic illness/loss, criminogenic behavior, impulsivity, insight, [and] ego discordance.” (Id. at 538, 777-78.)
iii. Physical examinations
On December 1, 2017, Plaintiff saw Dr. Puccinelli because of a painful lump in her left plantar arch and chronic heel pain. (Id. at 347.) Dr. Puccinelli noted that Plaintiff had a palpable firm module approximately 1.5 centimeters in diameter with pain to palpation, and “pain to palpation posterior right heel at insertion site of Achilles tendon.” (Id.) Plaintiff had a decreased range of motion with her knee extended, and her sensation was grossly intact via light touch. (Id.) Dr. Puccinelli noted that Plaintiff was “[o]riented to person, place and time,” and her “[m]ood and affect [were] normal and appropriate to situation.” (Id.) Dr. Puccinelli diagnosed Plaintiff with plantar fascial fibromatosis, Achilles tendonitis, and equinus left and right. (Id.) He advised Plaintiff to wear supportive shoes, stretch daily, and prescribed physical therapy. (Id. at 348.)
Plaintiff was hospitalized on January 14, 2018, due to chest pain and numbness in both of her hands. (Id. at 367-69.) Her neurologic exam was normal, her head CT showed no evidence of acute intracranial abnormalities, and a chest x-ray showed a normal heart size. (Id. at 368, 377.) Plaintiff was alert and oriented, had “5 out of 5 muscle strength throughout,” and her sensation to light touch was intact. (Id. at 370.) She was diagnosed with atypical chest pain, bilateral hand paresthesias, hypertension, dyslipidemia, hypertriglyceridemia, prediabetes, crystal methamphetamine abuse, and obesity, and discharged as stable on January 15, 2018. (Id. at 367-68.)
On August 31, 2018, Dr. Yashruti, a consultative orthopedic examiner, completed an orthopedic evaluation of Plaintiff. (Id. at 468-74.) Plaintiff complained of “[n]eck and low back pain with bilateral hip, right ankle, and foot pain with numbness in the tips of the fingers of both hands.” (Id. at 468.) Plaintiff stated that she had been involved in a motor vehicle accident ten years ago, and in December 2017, or January 2018, she developed numbness in the tips of her fingers of both hands. (Id.) Plaintiff was taking Metformin, Gabapentin, and Abilify, which “helped a little,” and used a cane when she was in pain. (Id.)
Dr. Yashruti noted that Plaintiff “walk[ed] with a mild right-sided limp,” but was able to walk on her heels and toes without the limp, and could partially squat. (Id. at 469.) Plaintiff had normal range of motion of the shoulders, elbows, wrists, fingers, hips, knees, ankles, and feet. (Id. at 470-71.) She had a decreased range of motion of the cervical and lumbar spine. (Id.) Plaintiff had full extension of her fingers, and her Phalen's test was negative. (Id. at 471-72.) She had no muscle weakness in upper or lower extremities, and her straight-leg raising test was negative in both the sitting and supine positions. (Id. at 472.)
“[A] Phalen's test is a maneuver used in the physical diagnosis of carpal tunnel symptoms.” Christopher V. v. Comm'r, Soc. Sec. Admin., No. 3:17-cv-01503-HZ, 2019 WL 93502, at *9 n.3 (D. Or. Jan. 2, 2019) (citation omitted).
Dr. Yashruti opined that Plaintiff had the following functional limitations:
[Plaintiff] is able to sit with no limitations. She is able to stand and walk on level ground six hours a day. She is able to squat, kneel, crouch, and crawl frequently. She is able to lift 50 pounds occasionally and 25 frequently. She is able to reach with the arms and manipulate with the hands with no limitations.(Id. at 473.)
c. Disability determinations
On September 18, 2018, at the initial level of review, Dr. Kalmar reviewed Plaintiff's medical records based on her alleged impairments of depression, anxiety, high blood pressure and cholesterol, arthritis, an enlarged heart, and numbness in the hands. (Id. at 120-38.) Dr. Kalmar found that Plaintiff had the following severe impairments: a disorder of the back, essential hypertension, and substance addiction disorder. (Id. at 129.) Additionally, after finding that Plaintiff had moderate limitations with respect to her ability to understand, remember, or apply information; interact with others; and concentrate, persist, or maintain pace; and a mild limitation as to her ability to adapt or manage herself, Dr. Kalmar concluded that Plaintiff's depression was not severe. (Id.)
Dr. Kalmar opined that Plaintiff could lift or carry fifty pounds occasionally and twenty-five pounds frequently; stand, walk, and sit for six hours in an eight-hour workday; and that Plaintiff had an unlimited ability to push and pull. (Id. at 132.) Dr. Kalmar also found that Plaintiff's limitations ranged from “moderate” to “not significantly limited” with respect to understanding and memory, concentration and persistence, and social interaction. (Id. at 133-35.) Dr. Kalmar noted that Plaintiff's statements regarding her symptoms of pain and weakness were not “substantiated by the medical evidence alone,” and her “statements regarding symptoms considering the total medical and non-medical evidence” were “[p]artially [consistent.” (Id. at 131.) Dr. Kalmar concluded that Plaintiff was capable of performing her past relevant work and was not disabled. (Id. at 136-37.)
On January 5, 2019, at the reconsideration level, Dr. Zukowsky reviewed Plaintiff's records for the same alleged impairments, and an additional claim that Plaintiff was borderline diabetic. (Id. at 140-58.) Dr. Zukowsky found that Plaintiff had the following severe impairments: essential hypertension and substance addiction disorder. (Id. at 149.) Further, after finding that Plaintiff had moderate limitations with respect to her ability to understand, remember, or apply information; interact with others; concentrate, persist or maintain pace; and adapt or manage oneself, Dr. Zukowsky concluded that Plaintiff's depression was not severe. (Id.)
Dr. Zukowsky opined that Plaintiff could lift or carry fifty pounds occasionally and twenty-five pounds frequently; stand, walk, or sit for six hours in an eight-hour workday; and that Plaintiff's ability to push and pull was not restricted. (Id. at 152.) Dr. Zukowsky also found that that Plaintiff's limitations ranged from “moderate” to “not significantly limited” with respect to understanding and memory, concentration and persistence, social interaction, and adaptation. (Id. at 153-55.) Dr. Zukowsky noted that Plaintiff's statements regarding her symptoms of pain and weakness were not “substantiated by the medical evidence alone,” and her “statements regarding symptoms considering the total medical and non-medical evidence” were “[p]artially [c]onsistent.” (Id. at 150-51.) Dr. Zukowsky concluded that Plaintiff was capable of performing her past relevant work and was not disabled. (Id. at 156-57.)
3. Analysis
Neither party contests the ALJ's determination that Plaintiff has the following severe impairments: left foot nodule of plantar fascia, hypertension, chronic anemia, depression, schizoaffective disorder, PTSD, and alcohol and methamphetamine use disorder. (See id. at 23; see also J. Mot.) Because the ALJ found that Plaintiff's “medically determinable impairments could reasonably be expected to cause the alleged symptoms,” a finding that is not contested by the parties, the first prong of the ALJ's inquiry regarding Plaintiff's subjective symptoms is satisfied. (See AR at 27; see also J. Mot.) Further, neither party alleges that the ALJ found that Plaintiff was malingering. (See J. Mot.) As a result, the Court must determine whether the ALJ identified which of Plaintiff's subjective allegations of impartment he discounted, and whether the ALJ provided specific, clear, and convincing reasons for doing so. See Brown-Hunter, 806 F.3d at 489; Trevizo, 871 F.3d at 678; Garrison, 759 F.3d at 1014-15.
In his written opinion, the ALJ noted that Plaintiff alleged in the disability report that she could not work due to “depression, anxiety, high blood pressure, high cholesterol, arthritis, an enlarged heart and numbness in her hands.” (AR at 27.) The ALJ further stated the following with respect to Plaintiff's testimony:
At the hearing, the claimant testified that she lives with her son and he pays all the bills (See Testimony). Her last employment was washing dishes and she was let go as she developed a condition with her fingers and hips, as she could not perform the job. She has medical issues and major depression, somedays she cannot get [out] of bed due to sadness and hearing voices. She further testified she cries all the time, and she limits her exercise due to heart and back pain. Her cane was prescribed about two years ago, and her hand brace helps with the numbness. The claimant stated she no longer uses methamphetamine, and last used [the drug] seven or eight months ago. She further testified she can stand for five minutes and walk a block. She can sit for twenty minutes before changing positions. She can lift and carry five pounds (Id.).(Id.) The ALJ explained his two-step analysis of Plaintiff's symptom testimony as follows:
After careful consideration of the evidence, the undersigned finds that the claimant's medically determinable impairments could reasonably be expected to cause the alleged symptoms; however, the claimant's statements concerning the intensity, persistence and limiting effects of these symptoms are not entirely consistent with the medical evidence and other evidence in the record for the reasons explained in this decision.(Id.) The ALJ then discounted Plaintiff's statements regarding her impairments, citing the following reasons: (1) Plaintiff's statements conflicted with the objective medical evidence; (2) Plaintiff received conservative treatment for her mental health issues; and (3) Plaintiff failed to follow a prescribed course of treatment. (See AR at 28-30.)
When reviewing the ALJ's basis for discounting Plaintiff's testimony, the Court can only assess the reasoning provided by the ALJ in his decision. See Brown-Hunter, 806 F.3d at 495; Garrison, 759 F.3d at 1010. The Court will therefore address the validity of each of the ALJ's stated reasons for discounting Plaintiff's statements.
a. Inconsistencies between Plaintiff's testimony and objective medical evidence
The ALJ's identification of inconsistencies between Plaintiff's testimony and the objective medical evidence is a clear and convincing reason to discount Plaintiff's testimony. See Koch v. Berryhill, 720 Fed.Appx. 361, 364 (9th Cir. 2017) (finding that the “ALJ properly discredited [plaintiff's] testimony because it was inconsistent with objective medical evidence”; reasoning that “although [plaintiff] testified her carpel tunnel syndrome caused significant pain and numbness in her hands, objective findings were unremarkable and relatively mild”); Parra v. Astrue, 481 F.3d 742, 750 (9th Cir. 2007) (finding that inconsistencies between plaintiff's testimony and medical record are proper grounds to discredit plaintiff's testimony); Burch v. Barnhart, 400 F.3d 676, 681 (9th Cir. 2005) (“Although lack of medical evidence cannot form the sole basis for discounting pain testimony, it is a factor that the ALJ can consider in his credibility analysis.”); Raul V. v. Kijakazi, Case No.: 20-cv-2014-BGS, 2022 WL 3567008, at *5 (S.D. Cal. Aug. 18, 2022) (“Inconsistency with objective medical evidence is a clear and convincing reason to discredit claimant testimony.”).
In this case, the ALJ stated in his written decision that “[t]he clinical findings of the examining medical sources fail to corroborate the claimant's allegations of disabling functional limitations,” and “[t]he records since the claimant's alleged onset date show no significant worsening of her symptoms since before her alleged onset date.” (AR at 27.) The ALJ further identified specific inconsistencies between Plaintiff's statements and the objective medical evidence.
First, the ALJ identified Plaintiff's report that she had an “enlarged heart,” which Plaintiff also alleged as an impairment in her disability application. (Id. at 24, 121.) The ALJ reasoned that there were no signs of acute heart failure during Plaintiff's examinations, “no orthopnea, palpitations, shortness of breath or wheezing,” and that Plaintiff's chest x-ray revealed a normal heart size and no other physical abnormalities that would suggest an enlarged heart. (Id.; see also id. at 141, 377, 403, 412.) The medical records the ALJ cited and discussed support his conclusion. (See id.)
Additionally, the ALJ discussed Plaintiff's allegation of numbness in her hands. (Id. at 24, 29-30.) The ALJ pointed out that the record in this case indicates no muscle atrophy in Plaintiff's hands, a negative Tinel's test, intact sensation, and a negative Phalen's test. (See id. at 24, 29-30; see also id. 367-69, 394-95, 468, 472.)
Further, in his subsequent discussion of the medical evidence, the ALJ also detailed Plaintiff's alleged symptoms related to her mental, social, and cognitive functioning, which she reported to various medical care providers. (See id. at 27-29.) The symptoms included low energy, poor sleep and concentration, increased appetite, anhedonia, feelings of guilt and hopelessness, auditory and visual hallucinations, frequent alcohol use, memory problems, constant anxiety, and panic attacks. (Id.) The ALJ noted, however, that Plaintiff's examinations included findings that Plaintiff was cooperative, calm, alert and oriented, articulate, able to follow directions, had socially appropriate behavior, appropriate associations, and had “normal” speech, thought processes, thought content, judgment, insight, attention span, concentration, and memory. (Id; see also AR at 355, 439, 442, 466-67, 535-36, 541, 554, 564-65, 775-76, 856-57.)
Accordingly, the ALJ identified Plaintiff's specific statements regarding her symptoms, and explained why they were inconsistent with the medical record. Such identification constitutes a specific, clear, and convincing reason to discount Plaintiff's symptom testimony. However, this reason cannot be the sole factor to reject Plaintiff's symptom testimony. See Reddick v. Chater, 157 F.3d 715, 722 (9th Cir. 1998); 20 C.F.R. § 404.1529(c)(2); SSR 16-3p, 2017 WL 5180304, at *5. The Court will therefore examine whether the ALJ provided other clear and convincing reasons for rejecting Plaintiff's symptom testimony.
b. Conservative mental health treatment
“[E]vidence of ‘conservative treatment' is sufficient to discount a claimant's testimony regarding severity of an impairment.” Morris v. Astrue, 323 Fed.Appx. 584, 586 (9th Cir. 2009) (quoting Parra, 481 F.3d. at 751). Conservative treatment, nevertheless, “is not a proper basis for rejecting the claimant's credibility where the claimant has a good reason for not seeking more aggressive treatment.” Carmickle v. Comm'r, Soc. Sec. Admin., 533 F.3d 1155, 1162 (9th Cir. 2008) (citation omitted). “Discrediting a [p]laintiff for not receiving inpatient mental health treatment is a position some district courts have rejected or found questionable.” Duarte v. Berryhill, Case No.: 16CV2654 W (BGS), 2018 WL 785819, at *9 (S.D. Cal. Feb. 8, 2018) (citing Mason v. Colvin, No. 1:12-cv-00584 GSA, 2013 WL 5278932, at *6 (E.D. Cal. Sept. 18, 2013) (concluding that treatment with antidepressants and antipsychotic medications was not “conservative”); Odisian v. Colvin, No. CV 12-9521-SP, 2013 WL 5272996, at *8 (C.D. Cal. Sept. 18, 2013) (finding that treatment with psychiatric medications and sessions with a psychologist did not constitute “conservative treatment”); Matthews v. Astrue, No. EDCV 11-01075-JEM, 2012 WL 1144423, at *9 (C.D. Cal. April 4, 2012) (“Claimant does not have to undergo inpatient hospitalization to be disabled”).
In this case, the ALJ stated in his written opinion that Plaintiff received “conservative treatment for her mental health issues, and reported the treatment helped.” (AR at 30; see also id. at 28.) Plaintiff's medical records contain her reports that the mental health treatment she was receiving was helping. (See i.e., Id. at 497, 721 (Dr. Chug's July 13, 2018 note that Plaintiff “[is] currently seeing mental health for her depression” and “feels this is helping”); id. at 468 (Dr. Yashruti's August 31, 2018 note that Plaintiff reported she was treated with medications and “the treatment helped a little”).) Nevertheless, it is not apparent that Plaintiff's mental health treatment consisting of therapy and medication was “conservative.” Without further explanation from the ALJ, Plaintiff's alleged conservative treatment is not a specific, clear, and convincing reason to discredit Plaintiff's testimony. See Duarte, 2018 WL 785819, at *9-10; Odisian, 2013 WL 5272996, at *8; Matthews, 2012 WL 1144423, at *9.
c. Failure to follow a prescribed course of treatment
“An ALJ may discount an allegation of disabling excess pain based on ‘an unexplained, or inadequately explained, failure to seek treatment or follow a prescribed course of treatment.'” Moreno v. Comm'r Soc. Sec., Case No. 1:19-cv-01580-SAB, 2021 WL 84376, at *15 (E.D. Cal. Jan. 11, 2021) (quoting Fair v. Bowen, 885 F.2d 597, 603 (9th Cir. 1989)); see also Rachel G. v. Kijakazi, Case No. 5:20-cv-01594-GJS, 2022 WL 952630, at *4 (C.D. Cal. Mar. 29, 2022) (citation omitted) (“noncompliance with a prescribed course of treatment is [a] clear and convincing reason for finding a claimant's subjective complaints lack credibility”).
In this case, the ALJ noted in his written decision that Plaintiff had not consistently taken her medications, and was repeatedly advised to comply with her prescribed treatment and medications. (AR at 28-29.) The medical record indicates that, at times, Plaintiff did not take her prescribed medications and did not follow the treatment recommended by her doctors. (See i.e., id. at 401-02 (Dr. Chung's October 24, 2017 note that Plaintiff “has not been taking her BP medications as instructed. Takes it some days and does not some days”; and that “much time [was] spent on counseling patient on importance of taking medications as directed”); id. at 501 (Dr. Chung's June 29, 2018 note that Plaintiff “has not followed through with physical therapy” and “[f]orgets to take her medications at times”).) Accordingly, Plaintiff's failure to follow a prescribed course of treatment is an additional specific, clear, and convincing reason provided by the ALJ to discount Plaintiff's symptom testimony. See Rachel G., 2022 WL 952630, at *4.
VI. CONCLUSION AND ORDER
For the foregoing reasons, the Court finds that the ALJ properly identified which of Plaintiff's statements he discounted, and that the ALJ provided specific, clear, and convincing reasons for doing so. The Court therefore ORDERS that judgment be entered affirming the decision of the Commissioner pursuant to sentence four of 42 U.S.C. § 405(g) and dismissing this case.
IT IS SO ORDERED.