Opinion
CV-21-00191-PHX-JJT
10-26-2022
Leandro Garcia, Jr., Plaintiff, v. Commissioner of Social Security Administration, Defendant.
ORDER
Honorable John J. Tuchi, United States District Judge
At issue is the denial of Plaintiff Leandro Garcia, Jr.'s Application for Supplemental Security Income (“SSI”) by the Social Security Administration (“SSA”) under the Social Security Act (“the Act”). Plaintiff filed a Complaint (Doc. 1) with this Court seeking judicial review of that denial, and the Court now addresses Plaintiff's Opening Brief (Doc. 19), Defendant Social Security Administration Commissioner's Response Brief (Doc. 20), and Plaintiff's Reply Brief (Doc. 21). The Court has reviewed the briefs, Administrative Record (Doc. 18, “R.”), and the Administrative Law Judge's (“ALJ”) decision (R. at 10-26) and affirms the ALJ's decision for the reasons addressed herein.
I. BACKGROUND
Plaintiff protectively filed an application for SSI on December 7, 2017, for a period of disability beginning on December 31, 2016. (R. at 13). Plaintiff's claims were denied initially on April 30, 2018, and upon reconsideration on December 14, 2018. (Id.) Plaintiff testified before an ALJ in a hearing regarding his claims on June 10, 2020. (Id.) The ALJ denied his claims on July 1, 2020. (R. at 10-26). On December 11, 2020, the Appeals Council denied his request for review of the ALJ's decision. (R. at 1-5). On February 3, 2021, Plaintiff filed this action seeking judicial review. (Doc. 1).
The Court has reviewed the medical evidence in its entirety and finds it unnecessary to provide a complete summary here. The pertinent medical evidence will be discussed in addressing the issues raised by the parties. In short, upon consideration of the medical records and opinions, the ALJ evaluated Plaintiff's alleged disability based on the severe impairments of traumatic brain injury, schizophrenia, personality disorder, and substance abuse disorder. (R. at 15-16).
Ultimately, the ALJ evaluated the medical evidence and opinions and concluded that Plaintiff was not disabled. (R. at 22). The ALJ found that Plaintiff did “not have an impairment or combination of impairments that meets or medically equals the severity of one of the listed impairments in 20 CFR Part 404, Subpart P, Appendix 1.” (R. at 16). Next, the ALJ found that Plaintiff had the residual functional capacity (“RFC”) to “perform medium work as defined in 20 CFR 416.967(c)” with certain function limitations and concluded that “there are jobs that exist in significant numbers in the national economy that the [Plaintiff] can perform.” (R. at 17, 21).
II. LEGAL STANDARD
In determining whether to reverse an ALJ's decision, the district court reviews only those issues raised by the party challenging the decision. See Lewis v. Apfel, 236 F.3d 503, 517 n.13 (9th Cir. 2001). The court may set aside the Commissioner's disability determination only if the determination is not supported by substantial evidence or is based on legal error. Orn v. Astrue, 495 F.3d 625, 630 (9th Cir. 2007). Substantial evidence is more than a scintilla, but less than a preponderance; it is relevant evidence that a reasonable person might accept as adequate to support a conclusion considering the record as a whole. Id. To determine whether substantial evidence supports a decision, the court must consider the record as a whole and may not affirm simply by isolating a “specific quantum of supporting evidence.” Id. As a general rule, “[w]here the evidence is susceptible to more than one rational interpretation, one of which supports the ALJ's decision, the ALJ's conclusion must be upheld.” Thomas v. Barnhart, 278 F.3d 947, 954 (9th Cir. 2002). (citations omitted).
To determine whether a claimant is disabled for purposes of the Act, the ALJ follows a five-step process. 20 C.F.R. § 416.920(a). The claimant bears the burden of proof on the first four steps, but the burden shifts to the Commissioner at step five. Tackett v. Apfel, 180 F.3d 1094, 1098 (9th Cir. 1999). At the first step, the ALJ determines whether the claimant is presently engaging in substantial gainful activity. 20 C.F.R. § 416.920(b). If so, the claimant is not disabled, and the inquiry ends. Id. At step two, the ALJ determines whether the claimant has a “severe” medically determinable physical or mental impairment. 20 C.F.R. § 416.920(c). If not, the claimant is not disabled, and the inquiry ends. Id. At step three, the ALJ considers whether the claimant's impairment or combination of impairments meets or medically equals an impairment listed in Appendix 1 to Subpart P of 20 C.F.R. Part 404. 20 C.F.R. § 416.920(d). If so, the claimant is automatically found to be disabled. Id. If not, the ALJ proceeds to step four. Id. At step four, the ALJ assesses the claimant's RFC and determines whether the claimant is still capable of performing past relevant work. 20 C.F.R. § 416.920(e). If so, the claimant is not disabled, and the inquiry ends. Id. If not, the ALJ proceeds to the fifth and final step, where she determines whether the claimant can perform any other work in the national economy based on the claimant's RFC, age, education, and work experience. 20 C.F.R. § 416.920(g). If so, the claimant is not disabled. Id. If not, the claimant is disabled. Id.
III. ANALYSIS
Plaintiff raises two arguments for the Court's consideration: (1) whether the ALJ erroneously rejected Plaintiff's symptom testimony; and (2) whether the ALJ properly considered the assessment of treating practitioner, DNP Luis Fong. (Doc. 19 at 3). Plaintiff also requests this Court to remand the case for an award of benefits. (Id. at 9-11).
A. The ALJ did not err in rejecting Plaintiff's symptom and pain testimony.
Plaintiff argues that the ALJ failed to provide clear and convincing reasons to reject Plaintiff's symptom testimony. (Doc. 19 at 7-9.)
An ALJ performs a two-step analysis to evaluate a claimant's testimony regarding pain and symptoms. Garrison v. Colvin, 759 F.3d 995, 1014 (9th Cir. 2014). First, the ALJ evaluates whether the claimant has presented objective medical evidence of an impairment “which could reasonably be expected to produce the pain or symptoms alleged.” Lingenfelter v. Astrue, 504 F.3d 1028, 1035-36 (9th Cir. 2007) (quoting Bunnell v. Sullivan, 947 F.2d 341, 344 (9th Cir. 1991) (en banc) (internal quotation marks omitted)). Second, absent evidence of malingering, an ALJ may only discount a claimant's allegations for reasons that are “specific, clear and convincing” and supported by substantial evidence. Molina v. Astrue, 674 F.3d 1104, 1112 (9th Cir. 2012). “The clear and convincing standard is the most demanding required in Social Security cases.” Garrison, 759 F.3d at 1015.
“[T]he ALJ must specifically identify the testimony she or he finds not to be credible and must explain what evidence undermines the testimony.” Holohan v. Massanari, 246 F.3d 1195, 1208 (9th Cir. 2001). General findings regarding the Plaintiff's credibility are insufficient. Id. “Although the ALJ's analysis need not be extensive, the ALJ must provide some reasoning in order for [the Court] to meaningfully determine whether the ALJ's conclusions were supported by substantial evidence.” Treichler v. Comm'r of Soc. Sec. Admin., 775 F.3d 1090, 1099 (9th Cir. 2014). However, “an ALJ [is not] required to believe every allegation of disabling pain, or else disability benefits would be available for the asking, a result plainly contrary to 42 U.S.C. § 423(d)(5)(A).” Fair v. Bowen, 885 F.2d 597, 603 (9th Cir. 1989). “[T]he ALJ may consider inconsistencies either in the claimant's testimony or between the testimony and the claimant's conduct.” Molina, 674 F.3d at 1112. For instance, the ALJ may consider “‘whether the claimant engages in daily activities inconsistent with the alleged symptoms.'” Id. (quoting Lingenfelter, 504 F.3d at 1040). Additionally, “[a]lthough [a] lack of medical evidence cannot form the sole basis for discounting pain [or symptom] testimony, it is a factor that the ALJ can consider in his credibility analysis.” Burch v. Barnhart, 400 F.3d 676, 681 (9th Cir. 2005).
In the present case, Plaintiff argues the ALJ failed to present specific reasons from the medical record that were inconsistent with Plaintiff's symptom testimony. (Doc. 19 at 8-9). Plaintiff takes issue with the ALJ's decision “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...” (R. at 18.) Plaintiff believes that this statement failed to elucidate how the objective findings undermine any specific statements of Plaintiff's testimony. (Id.) The Court does not agree. It is apparent from the record as a whole that the ALJ used a multitude of specific reasons that are supported by substantial evidence to discount the Plaintiff's symptom testimony.
The ALJ appropriately relied on medical evidence that did not corroborate the Plaintiff's allegations as only one reason to discount his testimony. Although this could not be the ALJ's sole consideration, it is a permissible one. Burch, 400 F.3d at 680. The ALJ's decision accounts for the Plaintiff's impairments encompassing traumatic brain injury, schizophrenia, personality disorder, and substance abuse disorder. Plaintiff fails to argue with any specificity as to which particular ailments Plaintiff believes the ALJ did not correctly consider when discounting the symptom testimony. In reviewing the ALJ's decision, the Court does not find a lack of evidence to substantiate the ALJ's conclusions and finds it was supported by the record.
The ALJ noted that Plaintiff alleged issues with his memory, needing assistance with remembering and completing tasks, and he needed reminders with medications, appointments, and personal care. (R. at 16). However, the ALJ found that the record indicated the Plaintiff's memory appeared to be normal with sporadic deficits in mental status exams. (Id.) Upon review of the record, many of Plaintiff's mental status exams support the ALJ's finding of a moderate limitation regarding Plaintiff's memory. (R. 655, 701, 714, 718, 725, 1362-63, 1368, 1446, 1492, 1535, 1541, 1573). The ALJ equally found a moderate limitation in Plaintiff's interaction with others. (R. at 16). The ALJ identified that while Plaintiff may not take part in many social gatherings or activities outside of his own family, there was no indication that Plaintiff does not get along with others, no history of issues with authority figures, and no suggestion of negative interactions with medical providers or staff. (Id.) Treatment notes indicated that Plaintiff maintained a happy mood, engaged in therapy, was calm, and exhibited good cooperation. (R. at 1506-1508, 1873). There are also examples that Plaintiff took part in numerous family social activities. (R. at 703, 733, 1501, 1529).
The ALJ found that Plaintiff had a moderate limitation in the areas of concentrating, persisting, or maintaining pace. (R. at 16-17). The ALJ specifically cited that Plaintiff claimed he could only pay attention for 1-3 minutes and does not finish what he starts; however, treatment notes showed that with the use of medication, Plaintiff exhibited no impairments with attention or concentration, and medication has helped him to stay on a schedule. (R. at 701, 712). A family member that testified at the hearing is also quoted in treatment notes as stating that Plaintiff is “able to make a plan and follow through with it” and when Plaintiff “does something he does it right.” (R. at 730, 704). The ALJ further discussed that his daily activities included shopping for groceries, housework, the ability to complete tasks independently, and watching television. (R. at 16-17). Additional treatment notes indicated that Plaintiff takes care of yard work and landscaping, fixes plumbing leaks and performs general maintenance. (R. at 700, 703, 1491-1493). While Plaintiff does not have a car, he stated that he is able to get around using a bike or a bus, and the same family member is quoted as stating, “This man can ride his bicycle for miles!” (R. at 703). Plaintiff's family member also cited further evidence of Plaintiff's capabilities by indicating that he hung Christmas lights for her mother and found a window for his own mother's car. (Id.)
The final area of consideration by the ALJ included a finding of moderate limitations in adapting or managing oneself. (R. at 17). Plaintiff stated he needed help taking care of his hygiene, meals and grooming and has issues with stress that lead to substance abuse. (Id.) However, the ALJ found the record does not indicate a need for such assistance as evidenced by the Plaintiff's various abilities like riding a bus and his bicycle unaccompanied or performing household chores and maintenance like landscaping work or shopping for groceries, as discussed above. “Even where those [daily] activities suggest some difficulty functioning, they may be grounds for discrediting the claimant's testimony to the extent that they contradict claims of a totally debilitating impairment,” Molina, 674 F.3d at 1113, or where they suggest that “later claims about the severity of [the] limitations were exaggerated,” Valentine v. Astrue, 574 F.3d 685, 690 (9th Cir. 2009). Moreover, if an ALJ's decision is made “with less than ideal clarity, a reviewing court will not upset the decision on that account if [his] path may reasonably be discerned.” Alaska Dept. of Edvtl. Conservation v. E.P.A., 540 U.S. 461, 497 (2004); See Brown-Hunter, 806 F.3d at 492 (applying this standard to social security).
Given the scope of the record, the ALJ properly relied upon objective medical evidence, and the Plaintiff's daily activities to discount Plaintiff's symptom testimony. There is sufficient evidence present to enable this Court to reasonably discern the ALJ's conclusory path that the reports in the medical record did not support Plaintiff's claims of disabling limitations. Consequently, the ALJ properly found that the subjective symptom testimony was not consistent with the medical evidence or Plaintiff's daily activities. “Where the evidence is susceptible to more than one rational interpretation, one of which supports the ALJ's decision, the ALJ's conclusion must be upheld.” Thomas, 278 F.3d at 954. Therefore, the Court finds the ALJ did not err in rejecting Plaintiff's pain and symptom testimony. The ALJ provided specific, clear and convincing reasons for rejecting Plaintiff's claims and those reasons were supported by substantial evidence.
B. The ALJ properly considered the medical opinion evidence of DNP Luis Fong.
Plaintiff's next argument suggests the ALJ erred in his assessment of DNP Luis Fong's opinion. Plaintiff applied for disability benefits after March 27, 2017, and is subject to the new set of regulations for evaluating evidence from medical providers. See 20 C.F.R. § 416.920c. The new regulations eliminate the previous hierarchy of medical opinions, and the ALJ is not allowed to defer to or give specific weight to any medical opinions. The new regulations state:
We will not defer or give any specific evidentiary weight, including controlling weight, to any medical opinion(s) or prior administrative medical finding(s), including those from your medical sources . . . The most important factors we consider when we evaluate the persuasiveness of medical opinions and prior administrative medical findings are supportability (paragraph (c)(1) of this section) and consistency (paragraph (c)(2) of this section). We will articulate how we considered the medical opinions and prior administrative medical findings in your claim according to paragraph (b) of this section.20 C.F.R. § 416.920c.
Other factors that may be considered by the ALJ in addition to supportability and consistency include the provider's relationship with the claimant, the length of the treatment relationship, frequency of examinations, purpose and extent of the treatment relationship, and the specialization of the provider. 20 C.F.R. § 416.920c.
The regulations define “medical opinion” as “a statement from a medical source about what you can still do despite your impairment(s) and whether you have one or more impairment-related limitations or restrictions.” 20 C.F.R. § 416.913(a)(2). All “other medical evidence” that an ALJ considers as part of the Administrative Record is defined as “evidence from a medical source that is not objective medical evidence or a medical opinion, including judgments about the nature and severity of your impairments, your medical history, clinical findings, diagnosis, treatment prescribed with response, or prognosis.” 20 C.F.R. § 416.913(a)(3).
The new regulations also expand the definition of acceptable medical sources. “Medical source means an individual who is licensed as a healthcare worker by a State and working within the scope of practice permitted under State or Federal law.” 20 C.F.R. § 404.1502 (d). Specifically, a “Licensed Advanced Practice Registered Nurse, or other licensed advanced practice nurse with another title,” and a “Licensed Physician Assistant” are considered acceptable medical sources “for impairments within his or her licensed scope of practice.” Id. at (a). The regulations require an ALJ to articulate how persuasive they find all the medical opinions and prior administrative medical findings and set forth specific “articulation requirements” for the ALJ's evaluation of the medical opinion evidence. 20 C.F.R. §§ 404.1520c(b), 416.920(b).
Recently, the Ninth Circuit confirmed that the “recent changes to the Social Security Administration's regulations displace our longstanding case law requiring an ALJ to provide ‘specific and legitimate' reasons for rejecting an examining doctor's opinion.” Woods v. Kijakazi, 32 F.4th 785, 787 (9th Cir. 2022). Thus, “the former hierarchy of medical opinions-in which we assign presumptive weight based on the extent of the doctor's relationship with the claimant-no longer applies. Now, an ALJ's decision, including the decision to discredit any medical opinion, must simply be supported by substantial evidence.” Id. With that said, “[e]ven under the new regulations, an ALJ cannot reject an examining or treating doctor's opinion as unsupported or inconsistent without providing an explanation supported by substantial evidence. The agency must articulate how persuasive it finds all of the medical opinions from each doctor or other source and explain how it considered the supportability and consistency factors in reaching these findings.” Id. at 792.
In the present case, DNP Fong, Plaintiff's treating Doctor of Nursing practitioner, submitted a check-box questionnaire of Plaintiff's limitations. (R. at 1316-18). DNP Fong opined that Plaintiff would be off-task for more than 15% of an eight-hour workday in all areas of functioning and would be off-task 30% or more due to environmental factors. (R. at 20). DNP Fong also concluded that Plaintiff would be absent from work five or more days a month. (Id.) The ALJ found these limitations to be unpersuasive and inconsistent with the record. (Id.) The ALJ also found the opinion was offered with little explanation and lacked a discussion of the specific evidence used by DNP Fong to support a debilitating opinion. (Id.)
Multiple treatment notes of DNP Fong's own mental status examinations of Plaintiff suggest other findings contrary to what was submitted on DNP Fong's checklist form. In mental status exams from August and October 2019, DNP Fong found the Plaintiff was doing well and exhibited a typical, unremarkable thought process, was fully oriented, both recent and remote memory was typical and intact, maintained typical attention and concentration, was cooperative and showed normal grooming and hygiene. (R. at 1446, 1608). An exam with DNP Fong in December 2019 showed similar overall typical to fair findings. (R. at 1535). In a February 2020 exam, DNP Fong found Plaintiff was responding well to the medical treatment plan and showed improved energy and less over-sedation and found Plaintiff's prognosis to be “Good.” (R. at 1542). In an April 2020 exam, Plaintiff reported to DNP Fong that “Things have been good” and Plaintiff was doing landscaping and cleaning the yard to help with the house. (R. at 1563). This same exam revealed that although Plaintiff had atypical remote and recent memory, in all other areas, DNP Fong found that Plaintiff presented with normal and typical displays. (R. at 1566-67). Considering the above factors, the ALJ found that DNP Fong's opinion lacked support in the record and was unpersuasive.
It is clear to the Court that the ALJ cited to specific examples in the medical record that were inconsistent with DNP Fong's opinion of Plaintiff's limitations. The ALJ fully articulated how persuasive he found all the medical opinions from each source. It is apparent from the record that the ALJ provided substantial evidence to sufficiently support his decision. Plaintiff's arguments only seek to offer alternative interpretations of the evidence, which the Court does not support. See Burch, 400 F.3d at 679 (“Where evidence is susceptible to more than one rational interpretation, it is the ALJ's conclusion that must be upheld.”).
IV. CONCLUSION
The Court finds that substantial evidence supports the ALJ's nondisability determination. The ALJ properly discounted Plaintiff's symptom testimony by providing specific, clear, and convincing reasons supported by substantial evidence and properly considered the medical opinion evidence of record. Therefore, the Court finds that the ALJ did not err in his decision, which is based on substantial evidence. The Court need not reach the merits of Plaintiff's request to remand for an award of benefits since the Court finds a remand is unwarranted.
IT IS HEREBY ORDERED that the decision of the ALJ is AFFIRMED. The Clerk of Court is directed to enter judgment accordingly and dismiss this action.