Opinion
For Maria De Santiago, Plaintiff: Irene Ruzin, LEAD ATTORNEY, Law Offices of Irene Ruzin, Encino, CA.
For Carolyn W. Colvin, Acting Commissioner of Social Security, Defendant: Assistant U.S. Attorney LA-CV, LEAD ATTORNEY, Office of U.S. Attorney, Civil Division, Los Angeles, CA; Assistant U.S. Attorney LA-SSA, LEAD ATTORNEY, Office of the General Counsel for Social Security Adm., San Francisco, CA; Kevin Gregory Gill, LEAD ATTORNEY, Social Security Administration, Office of the General Counsel - Region IX, San Francisco, CA.
ORDER AFFIRMING DECISION OF ADMINISTRATIVE LAW JUDGE
HON. MICHAEL R. WILNER, UNITED STATES MAGISTRATE JUDGE.
I. SUMMARY OF RULING
Plaintiff challenges the denial of her application for disability insurance benefits. The Administrative Law Judge (ALJ) found that Plaintiff was capable of performing her past relevant work, and denied benefits.
On appeal, Plaintiff challenges the ALJ's rejection of (a) the opinion of a treating physician and (b) her own credibility regarding her symptoms. However, the Court concludes that the ALJ identified lawful reasons for disbelieving this evidence. As a result, the Court affirms the ALJ's decision.
II. PLAINTIFF'S CONDITIONS AND PROCEEDINGS BELOW
Plaintiff applied for benefits based on various physical and mental conditions. Following an administrative hearing, the ALJ found that several of Plaintiff's conditions (including her back and neck problems and obesity) constituted " severe impairments" as that term is used under the federal regulations. (AR 19.)
The ALJ determined that Plaintiff had the residual functional capacity (RFC) to perform medium work with additional limitations. (AR 20-21.) In establishing the RFC, the ALJ expressly rejected the more restrictive limitations that a treating physician recommended. The ALJ also explained that she disbelieved Plaintiff's pain and symptom testimony. (AR 23-25.)
A vocational expert testified that that an individual with Plaintiff's RFC could perform her past job as a kitchen assistant. (AR 59.) From this, the ALJ concluded that Plaintiff was not disabled and denied benefits. (AR 26.)
III. STANDARD OF REVIEW
Under 42 U.S.C. § 405(g), a district court may review the Commissioner's decision to deny benefits. The ALJ's findings and decision must be upheld if they are supported by substantial evidence and are free of legal error. Hill v. Astrue, 698 F.3d 1153, 1158 (9th Cir. 2012). A court must uphold the ALJ's conclusion even if the evidence in the record " is susceptible to more than one rational interpretation." Ludwig v. Astrue, 681 F.3d 1047, 1052 (9th Cir. 2012) (quotation omitted). A reviewing court must consider " the entire record as a whole and may not affirm simply by isolating a specific quantum of supporting evidence." Hill, 698 F.3d at 1159 (quotation omitted).
A reviewing court " leave[s] it to the ALJ to determine credibility, resolve conflicts in the testimony, and resolve ambiguities in the record." Treichler v. Comm'r of Soc. Sec. Admin., 775 F.3d 1090, 1099 (9th Cir. 2014). If the evidence " can reasonably support either affirming or reversing the decision, " this Court " may not substitute [its] judgment for that of the Commissioner" or the ALJ. Parra v. Astrue, 481 F.3d 742, 746 (9th Cir. 2007).
IV. DISCUSSION
A. Rejection of Treating Physician's Opinion (Issue 1)
Plaintiff contends that the ALJ improperly rejected the opinion and limitations recommended by her treating physician (Dr. Opoku). (Docket #17 at 3.)
1. Facts and Decision Below
Dr. Opaku treated Plaintiff on a monthly basis after she sustained injuries. In connection with Plaintiff's disability application, Dr. Opaku filled out a functional capacity questionnaire. (AR 330-334.) The osteopath opined that Plaintiff was severely limited in her ability to work.
Specifically, he checked the entry on the form stating that Plaintiff could " never" carry less than 10 pounds. (AR 332.) Because the form offered no lesser weight restriction, the meaning of this limitation was apparently that Plaintiff could never carry anything. Dr. Opaku also recommended strict limits on Plaintiff's ability to stand or walk, and opined that she could never reach, handle, or finger anything at all. (AR 332-33.)
The ALJ determined that Dr. Opaku's " extreme assessments" of Plaintiff's limitations were " deserving of little probative weight." (AR 25.) The ALJ noted that the physician's limitations were " not even supported by the claimant's statements, " as Plaintiff testified that she was able to lift " seven to ten pounds." (AR 55.) The ALJ acknowledged the treating physician's conclusion that Plaintiff was entitled to some limitations in her RFC. As a result, the ALJ added additional limits to the general medium work RFC that a non-examining consultant (Dr. Bailey) recommended. (AR 22-24, 301.)
2. Relevant Law
" In determining a claimant's RFC, an ALJ must consider all relevant evidence in the record." Robbins v. SSA, 466 F.3d 880, 883 (9th Cir. 2006) (quotations omitted). In addition, an ALJ's findings " must be supported by specific, cogent reasons." Reddick v. Chater, 157 F.3d 715, 722 (9th Cir. 1998). " The ALJ must set out in the record his reasoning and the evidentiary support for his interpretation of the medical evidence." Tackett v. Apfel, 180 F.3d 1094, 1098 (9th Cir. 1999).
An ALJ generally gives the most weight to medical evidence from a claimant's treating physician, and progressively less weight to the opinions of examining and nonexamining physicians. Under agency regulations, a treating physician's opinion as to the nature and severity of an impairment will be given controlling weight if it is " well-supported by medically acceptable clinical and laboratory diagnostic techniques and is not inconsistent with the other substantial evidence in [the] case record." Orn v. Astrue, 495 F.3d 625, 631 (9th Cir. 2007) (quoting 20 C.F.R. § 404.1527).
When a treating physician's opinion is contradicted by another doctor's evaluation, the ALJ " must provide specific and legitimate reasons supported by substantial evidence" for rejecting the treating physician's opinion. Lester v. Chater, 81 F.3d 821, 830 (9th Cir. 1995) (quotation marks omitted). The ALJ satisfies this burden by detailing and summarizing the facts and conflicting medical evidence and stating the ALJ's interpretations and findings. Tommasetti v. Astrue, 533 F.3d 1035, 1041 (9th Cir. 2008). The ALJ may also satisfy this burden by pointing to inconsistencies between the treating physician's opinion and Plaintiff's own testimony. Morgan v. Commissioner of the SSA, 169 F.3d 595, 603 (9th Cir. 1999) (" the ALJ cited to testimony from [claimant] that conflicted with" opinions of physicians); Ryan-Werry v. Colvin, F.App'x, 2015 WL 3728969 at *1 (9th Cir. 2015) (" The ALJ properly discredited Dr. Daniel's opinion because his conclusions were inconsistent with Ryan-Werry's own testimony.").
3. Analysis
The ALJ rejected a treating physician's opinion regarding Plaintiff's limitations. Because that opinion was contradicted by the opinion of another practitioner, the ALJ was required to identify a specific and legitimate reason supported by substantial evidence to reject the opinion. Lester, 81 F.3d at 830.
The ALJ did so here. The ALJ stated a clear and legitimate reason in the written decision. Dr. Opaku opined that Plaintiff could never lift any weight under 10 pounds. (AR 332.) That extreme limitation would have prevented Plaintiff from lifting any item ever, be it a gallon of milk or a single piece of paper. Yet, Plaintiff herself attested to a greater lifting ability. Plaintiff testified that, although she had limitations related to her conditions, she could certainly lift light objects. (AR 55.)
Plaintiff grossly misreads the medical form in her assertion that Dr. Opaku's opinion " would limit her to lifting/carrying less than 10 pounds." (Docket # 17 at 8.) The plain text of the form (which may have originated with Plaintiff's lawyer, as frequently occurs in disability litigation) as Dr. Opaku filled it out read that Plaintiff could " never" lift such a weight. Further, to the extent that the form was ambiguous, the ALJ's interpretation of it is entitled to deference on appellate review. Ludwig, 681 F.3d at 1052.
The ALJ concluded that Plaintiff's testimony contradicted the dire limitation that her doctor recommended. That statement in the decision provided a specific and acceptable basis for rejecting Dr. Opaku's opinion and proposed RFC. Morgan, 169 F.3d at 603. Moreover, that determination was certainly supported by substantial evidence. Hill, 698 F.3d at 1158. Further, the Court observes that the ALJ included aspects of Dr. Opaku's recommendation (particularly regarding postural and non-exertional limitations) when establishing Plaintiff's RFC. The Court affirms the ALJ's determination regarding the treating physician's opinion.
B. Adverse Credibility Determination (Claim 3)
Plaintiff argues that the ALJ improperly rejected her testimony regarding her symptoms and limitations. (Docket # 17 at 25.)
1. Facts and Decision Below
Plaintiff testified at the hearing that her back and neck pain were unbearable and prevented her working. (AR 50.)
The ALJ did not believe her. In support of that determination, the ALJ noted the findings of a treating physician (Dr. Haronian). (AR 23.) That doctor observed that Plaintiff was " doing well with the conservative regimen" in lieu of surgery. (AR 340.) Additionally, the ALJ noted that Plaintiff applied for disability benefits based on mental health issues, yet had not received treatment from any mental health specialist. (AR 23-24.) The ALJ also noted that Plaintiff failed to take medications for her diagnosed hypertension condition for several months. (AR 23.) The ALJ then described Plaintiff's generally normal test results and evaluations from consulting practitioners. From this, the ALJ concluded that Plaintiff's conservative care and failure to comply with her doctors' recommendations " suggest[ ] that her symptoms were not as serious as she alleged." (AR24.)
2. Relevant Law
Certain disability decisions require an evaluation of a claimant's subjective symptomatic complaints. An ALJ may not " arbitrarily discredit a claimant's testimony." Thomas v. Barnhart, 278 F.3d 947, 958 (9th Cir. 2002). If an ALJ determines that there is objective medical evidence of an underlying impairment that reasonably could cause the alleged pain or symptoms, the ALJ may disregard the individual's statements regarding the severity of those symptoms if, in the absence of evidence that the claimant is malingering, the ALJ provides " specific, clear and convincing reasons" for rejecting the claimant's testimony. Burrell v. Colvin, 775 F.3d 1133, 1136 (9th Cir. 2014) (citation omitted).
An ALJ may consider a variety of factors in weighing a claimant's believability, including ordinary techniques of credibility evaluation (including testimony by the claimant that " appears less than candid"), " unexplained or inadequately explained failure to seek treatment or to follow a prescribed course of treatment, " and the claimant's daily activities. Ghanim v. Colvin, 763 F.3d 1154, 1163 (9th Cir. 2014) (quotations omitted). An ALJ may specifically consider inconsistencies either in [claimant's] testimony or between [her] testimony and [her] conduct" and statements to others. Thomas, 278 F.3d at 958-59 (brackets in original).
An ALJ may determine that a claimant lacks credibility based on evidence of conservative treatment. Parra, 481 F.3d at 750-51. A claimant's favorable response to conservative treatment can undermine the claimant's testimony and reports of disabling pain. Tommasetti, 533 F.3d at 1040. An ALJ may also discredit a claimant's testimony for " lack of consistent treatment" or because the claimant " did not seek any treatment or evaluation" for the condition. Burch, 400 F.3d at 681.
An ALJ may consider whether there is a lack of objective medical evidence supporting a claimant's allegations. However, this factor " cannot form the sole basis for discounting" subjective symptom testimony. Burch, 400 F.3d at 681.
3. Analysis
To reject Plaintiff's subjective pain testimony, the ALJ was required to identify at least one clear and convincing reason to do so that was supported by substantial evidence. Burrell, 775 F.3d at 1136. The ALJ provided several such reasons that were amply supported.
One reason that the ALJ gave for disbelieving Plaintiff's testimony about her pain and symptoms was her favorable response to a " conservative regimen" of care. That wasn't the ALJ's description of her treatment; those words came from a treating physician. Her doctor's candid observation that Plaintiff was doing well as a result of noninvasive or lesser care was a legitimate basis for the ALJ to doubt her candor. Tommasetti, 533 F.3d at 1040; Parra, 481 F.3d at 750-51.
Similarly, as an " ordinary technique" of credibility assessment, the ALJ was entitled to disbelieve Plaintiff based on her allegations regarding the severity of her mental health conditions. The ALJ convincingly explained that she didn't think Plaintiff was a truthful person by applying for disability benefits for conditions that were not serious enough for her to seek specialized treatment from a psychiatrist, psychologist, or a mental hospital. Ghanim, 763 F.3d at 1163; Thomas, 278 F.3d at 958-59.
Finally, the ALJ was entitled to doubt Plaintiff's believability based on her admitted failure to take medication for her high blood pressure condition. Burch, 400 F.3d at 681. Plaintiff correctly observes that this treatment was unrelated to Plaintiff's testimony regarding her back and neck pain. (Docket # 17 at 37.) Yet, again, the ALJ was required to justify a finding that Plaintiff was not a truth-telling person when she talked about the severity of her symptoms. The ALJ did not err in concluding that her non-compliance with prescribed treatment in another area of her health - unless triggered by other reasons such as loss of insurance or other dire circumstances - caused the ALJ to doubt the overall legitimacy of her testimony. Ghanim, 763 F.3d at 1163; cL Strickler v. Colvin, No. SA CV 14-1936 MRW, (C.D. Cal. 2015) (Docket # 15 at 9) (claimant did not appear for agency-ordered consultation on mental health claim, but cooperated with consultation regarding physical injury; ALJ entitled to find that mental health claim abandoned, but failed to identify convincing reason to doubt credibility).
With these conclusions, the ALJ did not err in making reference to the lack of objective medical evidence regarding Plaintiff's pain and limitation claims. Burch, 400 F.3d at 681. The ALJ specifically noted Plaintiff's relatively unexceptional diagnostic tests, her performance during consultative exams, and the overall level of treatment she receive for her various ailments. (AR 23-24.) On appeal, Plaintiff properly emphasizes the regular treatment she received from her physicians. However, it was within the ALJ's purview to interpret this conflicting evidence; this Court will not reweigh it on appeal. Treichler, 775 F.3d at 1099. The ALJ was entitled to view the evidence of Plaintiff's benign test results and consultative exams as additional support for the conclusion that she was not truthful in describing her allegedly disabling symptoms.
C. Remaining Claims
Plaintiff's remaining claims do not articulate a basis for reversing the ALJ's determination. Plaintiff contends at Ground Two that " the ALJ failed to properly assess the extent of Plaintiff's obesity and the impact of obesity [ ] on her ability to perform work-related activities." (Docket # 17 at 19.) But, the ALJ was clearly aware of Plaintiff's obesity - designating it as a " severe impairment" at step two of the sequential analysis - and referred to it elsewhere in the written decision. (AR 19, 22.)
And, as the government cogently notes, Plaintiff fails to explain how she would have been entitled to a different set of RFC limitations as a result of a differently articulated discussion of her weight. (Docket # 17 at 22.) This is particularly true in light of the many additional limits that the ALJ added to the medium work RFC. Even assuming the ALJ erred in the analysis of Plaintiff's obesity, Plaintiff failed to demonstrate actual prejudice resulting from that error. The burden is " on the party attacking the agency's determination to show that prejudice resulted from the error." McLeod v. Astrue, 640 F.3d 881, 887 (9th Cir. 2011) (applying harmless error test under Ludwig).
Finally, Plaintiff's fourth ground (error regarding vocational expert's analysis) is derivative of her claim regarding the ALJ's determination of the RFC. If the ALJ didn't commit error in disregarding the treating doctor's evaluation - which is the Court's conclusion - then Plaintiff cannot obtain relief on this version of the same claim.
V. CONCLUSION
The ALJ's denial of Plaintiff's application for Social Security benefits was supported by substantial evidence in the record and contained no legal error. Therefore, the Court AFFIRMS the decision
IT IS SO ORDERED.
JUDGMENT
It is the judgment of this Court that the decision of the Administrative Law Judge is AFFIRMED. Judgment is hereby entered in favor of Defendant.