Opinion
Civ. No. 6:18-cv-00500-MK
02-14-2019
REBECCA L., Plaintiff, v. NANCY A. BERRYHILL, Acting Commissioner, Social Security Administration, Defendant.
OPINION AND ORDER :
Plaintiff Rebecca L. brings this action pursuant to 42 U.S.C. §§ 405(g) and 1383(c) seeking judicial review of a final decision of the Commissioner of Social Security ("Commissioner") denying her application for Disability Insurance Benefits ("DIB") and Supplemental Security Income ("SSI") under the Social Security Act ("Act"). All parties have consented to allow a Magistrate Judge to enter final orders and judgment in this case in accordance with Fed. R. Civ. P. 73 and 28 U.S.C § 636(c). For the reasons that follow, the Commissioner's decision is AFFIRMED.
PROCEDURAL BACKGROUND
On October 6, 2015, Plaintiff filed an application for DIB and SSI alleging disability as of December 18, 2014. Tr. 208-09, 210-15. The Commissioner denied Plaintiff's application initially, and upon reconsideration, after which Plaintiff requested a hearing before an Administrative Law Judge ("ALJ"). Tr. 139-47, 156-57. The hearing was held on October 25, 2017 via video conference. Tr. 15. Plaintiff testified, as did an impartial vocational expert ("VE"). Tr. 15. The ALJ determined Plaintiff was not disabled and issued a decision on November 15, 2017 denying her claim. Tr. 12-24. On February 7, 2018, the Appeals Council denied Plaintiff's request for review, making the ALJ's decision the final decision of the Commissioner. Tr. 1-11. Plaintiff timely filed this complaint for review of the Commissioner's final decision.
"Tr." Refers to the Transcript of Social Security Administrative record provided by the Commissioner.
STANDARD OF REVIEW
This Court must affirm the Commissioner's decision if it is based on proper legal standards and the findings are supported by substantial evidence in the record. Hammock v. Bowen, 879 F.2d 498, 501 (9th Cir. 1989). Substantial evidence is "more than a mere scintilla; it means such relevant evidence as a reasonable mind might accept as adequate to support a conclusion." Richardson v. Perales, 402 U.S. 389, 401 (1971) (citation and internal quotations omitted). This Court must weigh "both the evidence that supports and detracts from the [Commissioner's] conclusions." Martinez v. Heckler, 807 F.2d 771, 772 (9th Cir. 1986). "Where the evidence as a whole can support either a grant or a denial, [this Court] may not substitute [its] judgment for the ALJ's." Massachi v. Astrue, 486 F.3d 1149, 1152 (9th Cir. 2007) (citation omitted).
Disability Analysis
The ALJ engages in a five-step sequential inquiry to determine whether a claimant is disabled within the meaning of the Act. 20 C.F.R. §§ 404.1520(a), 416.920(a). The five-step sequential inquiry is summarized below, as described in Tackett v. Apfel, 180 F.3d 1094, 1098-99 (9th Cir. 1999).
Step One: The Commissioner determines whether the claimant is engaged in substantial gainful activity. A claimant who is engaged in such activity is not disabled. If the claimant is not engaged in substantial gainful activity, the Commissioner proceeds to evaluate the claimant's case under step two. 20 C.F.R. §§ 404.1520(b), 416.920(b).
Step Two: The Commissioner determines whether the claimant has one or more severe impairments. A claimant who does not have any such impairment is not disabled. If the claimant has one or more severe impairment(s), the Commissioner proceeds to evaluate the claimant's case under step three. 20 C.F.R. §§ 404.1520(c), 416.920(c).
Step Three: Disability cannot be based solely on a severe impairment; therefore, the Commissioner next determines whether the claimant's impairment "meets or equals" one of the presumptively disabling impairments listed in the Social Security Administration ("SSA") regulations, 20 C.F.R. Part 404, Subpart P, Appendix 1. A claimant who has an impairment that meets a listing is presumed disabled under the Act. If the claimant's impairment does not meet or equal an impairment in the listings, the Commissioner's evaluation of the claimant's case proceeds under step four. 20 C.F.R. §§ 404.1520(d), 416.920(d).
Step Four: The Commissioner determines whether the claimant is able to perform work he or she has done in the past. A claimant who can perform past relevant work is not disabled. If the claimant demonstrates he or she cannot do past relevant work, the Commissioner's evaluation of claimant's case proceeds under step five. 20 C.F.R. §§ 404.1520(e), 404.1520(f), 416.920(e), 416.920(f).
Step Five: The Commissioner determines whether the claimant is able to do any other work. A claimant who cannot perform other work is disabled. If the Commissioner finds claimant is able to do other work, the Commissioner must show that a significant number of jobs exist in the national economy that claimant is able to do. The Commissioner may satisfy this burden through the testimony of a vocational expert ("VE"), or by reference to the Medical-Vocational Guidelines, 20 C.F.R. Part 404, Subpart P, Appendix 2. If the Commissioner demonstrates that a significant number of jobs exist in the national economy that the claimant is able to perform, the claimant is not disabled. If the Commissioner does not meet the burden, the claimant is disabled. 20 C.F.R. §§ 404.1520(g), 416.920(g).
At steps one through four of the sequential inquiry, the burden of proof is on the claimant. Tackett, 180 F.3d at 1098. If the claimant satisfies her burden with respect to the first four steps, the burden then shifts to the Commissioner regarding step five. 20 C.F.R. §§ 404.1520(g), 416.920(g). At step five, the Commissioner's burden is to demonstrate that the claimant can make an adjustment to other work after considering the claimant's residual functional capacity ("RFC"), age, education, and work experience. Id.
The ALJ's Findings
At step one, the ALJ found that Plaintiff had engaged in substantial gainful activity in 2014 and part of 2015 but stopped this activity in the third quarter of 2015. Tr. 18. Nonetheless, Plaintiff did experience a twelve-month period during her claimed time of disability where she did not engage in substantial gainful activity, allowing for further analysis. Id.
At step two, the ALJ found that Plaintiff had the following severe impairments: history of left shoulder bursitis/rotator cuff tear, status post 2014 surgical repair; complex regional pain syndrome involving the left upper extremity; degenerative disc disease of the cervical spine, status post September 2017 surgery; and mild-to-moderate bilateral carpal tunnel syndrome. Id. The ALJ found that Plaintiff's left knee problems, adjustment disorder, and post-traumatic stress disorder ("PTSD") were not severe, medically determinable impairments. Tr. 19.
At step three, the ALJ found that Plaintiff's impairments or combination of impairments did not meet or medically equal the severity of one of the listed impairments in 20 C.F.R. Part 404, Subpart P, Appendix 1. Tr. 19.
Prior to step four, the ALJ determined Plaintiff's residual functional capacity allowed her to perform light work as defined in 20 C.F.R. 404.1567(b) and 416.967(b) except she can occasionally climb ramps and stairs, but must avoid climbing ladders, ropes, or scaffolds. Tr. 19. She can frequently reach overhead with the left upper extremity, frequently grip, twist or grasp with the left hand, and her right-hand gross manipulative capacity is not limited. Id. Because of chronic pain and medication side effects, the ALJ limited Plaintiff to simple routine, repetitive tasks and determined that she must avoid all exposure to workplace hazards. Id.
At step four, the ALJ found that Plaintiff could not perform her past relevant work as a materials handler, production assembler, or caregiver. Tr. 22.
At step five, the ALJ concluded that based upon the VE's testimony and considering the Plaintiff's age, education, work experience, and RFC, Plaintiff would be capable of making a successful adjustment to other work that exists in significant numbers in the national economy. Tr. 22. Specifically, the ALJ found Plaintiff could perform work as an usher or as a parking lot attendant. Tr. 23. Therefore, the ALJ found Plaintiff was "not disabled." Id.
DISCUSSION
Plaintiff argues that the ALJ erred by: (1) failing to find Plaintiff's mental impairments to be severe; (2) improperly rejecting medical opinions; and (3) improperly rejecting Plaintiff's testimony.
Plaintiff's fourth claim alleging the ALJ's five-step analysis is not supported by substantial evidence is derivative of Plaintiff's other claims and not itself an independent basis for this Court's review.
1. Plaintiff's Mental Impairments
Plaintiff argues the ALJ erred by failing to recognize her alleged mental impairments of borderline personality disorder; PTSD; depression; bipolar disorder; and anxiety as severe at step two of the sequential analysis.
A medically determinable impairment or combination of impairments is severe if it significantly limits an individual's physical or mental ability to do basic work activities. 20 C.F.R. §§ 404.1520, 416.920. Basic work activities "mean the abilities and aptitudes necessary to do most jobs," such as walking, standing, sitting, pushing, pulling, reaching, carrying, handling, understanding and carrying out simple instructions, dealing with changes in a routine work setting, and responding appropriately to supervision, co-workers, and typical work situations. 20 C.F.R. §§ 404.1522(b), 416.922(b). Slight abnormalities that cause no more than minimal limitation to the individual's ability to function are not severe. SSR 96-3p, 1996 WL 374181. The existence of a medically determinable impairment "must be established by objective medical evidence from an acceptable medical source." 20 C.F.R. §§ 404.1521, 416.921. This is shown through "medically acceptable clinical and laboratory diagnostic techniques." Id. In this case, the ALJ determined that, although the record included mention of bipolar disorder, adjustment disorder, and PTSD, these conditions were not "established by an acceptable medical source as required by the regulations." Tr. 19., see C.F.R. §§ 404.1521, 416.921.
Plaintiff argues that her condition was established by acceptable medical sources through the reports of state agency evaluating psychologists Joshua Boyd, Psy.D. and Ben Kessler, Psy.D. Dr. Boyd opined that Plaintiff had medically determinable impairments of affective disorder and anxiety but that those conditions caused only mild restrictions in activities of daily living, maintaining social functioning, and moderate difficulties maintaining concentration, persistence and pace for a period beginning September 1, 2015 through the date of Dr. Boyd's assessment on April 1, 2016. Tr. 62-63. In assessing Plaintiff's mental RFC, Dr. Boyd opined that Plaintiff was moderately limited in her ability to carry out detailed instructions, and moderately limited in her ability to be aware of normal hazards and take appropriate precautions. Tr. 68. Dr. Kessler reached an identical conclusion in July 2016. Tr. 103-04, 108-10.
Notably, Dr. Boyd found Plaintiff had only mild difficulties maintaining concentration, persistence and pace from December 18, 2014 through August 31, 2015. Tr. 63-64.
In sum, the agency psychologists' reports describe some level of mental impairment, but they also explain that Plaintiff's mental conditions were not severe for a large portion of the time for which she alleged disability. Tr. 62-63, 102-03. Furthermore, neither evaluating psychologist found Plaintiff suffered mental impairments comparable to the level of severity described in the letter from Plaintiff's mental health provider, Trish Shannon. See Id., Tr. 506.
Assuming without deciding that a plaintiff could establish a severe mental impairment based upon the opinion of nonexamining state agency psychologists, the doctors' opinions were not supported by objective clinical evidence, as required to establish a severe impairment at step two. 20 C.F.R. §§ 404.1521, 416.921; See Bayliss v. Barnhart, 427 F.3d 1211, 1217 (9th Cir. 2005) (An ALJ may reject a psychological opinion that is "not supported by clinical evidence.").
Here, the record does not include evidence of the kind of objective testing usually relied upon to establish a mental impairment. Plaintiff's mental health treatment was performed exclusively by nurse practitioners and at the time Plaintiff filed her complaint, nurse practitioners were not "acceptable medical sources" for purposes of establishing a severe impairment at step two. 20 C.F.R. §§ 404.1502(a)(7), 416.902(a)(7). Therefore, Plaintiff's lacks the clinical or diagnostic evidence necessary to establish a severe mental impairment at step two, and substantial evidence supports the ALJ's decision not finding such impairments based on the agency psychologists' evaluations.
"Psychiatric signs are medically demonstrable phenomena that indicate specific psychological abnormalities, e.g., abnormalities of behavior, mood, thought, memory, orientation, development, or perception and must also be shown by observable facts that can be medically described and evaluated." 20 C.F.R. §§ 404.1502(g), 416.902(l).
For claims filed on or after March 27, 2017, licensed advanced practice registered nurses, and licensed physician assistants are acceptable medical sources. 20 C.F.R. §§ 404.1502(a), 416.902(a).
Notwithstanding this finding, the ALJ accounted for the cognitive impact of chronic pain symptoms and medication side effects. Tr. 19. The ALJ found that this would impose "moderate difficulty in [Plaintiff's] capacity to understand, remember, or apply information, and to concentrate, persist, or maintain pace." Id. The ALJ limited Plaintiff to simple routine, repetitive tasks. Id.
Because the ALJ included these mental limitations in the RFC formulation and the record does not support greater limitations such as those claimed by Plaintiff here, any error at step two is harmless.
2. Medical and Other Source Opinion Evidence
Plaintiff next asserts that the ALJ erred by improperly rejecting the medical opinions of Dr. Boyd and Dr. Kessler, and "other source" opinions of Trish Shannon, QMHP and Jason Hayes, FNP.
A. Medical Opinion Evidence
Medical opinions are "distinguished by three types of physicians: (1) those who treat the claimant (treating physicians); (2) those who examine but do not treat the claimant (examining physicians); and (3) those who neither examine nor treat the claimant (nonexamining physicians)." Lester v. Chater, 81 F.3d 821, 830 (9th Cir. 1995). As a general rule, more weight should be given to the opinion of a treating source than to the opinion of doctors who do not treat the claimant. Lester (citing Winans v. Bowen, 853 F.2d 643, 647 (9th Cir. 1987)).
(a) Dr. Boyd and Dr. Kessler
Plaintiff argues that the ALJ erred by failing to fully adopt the opinions of Dr. Boyd and Dr. Kessler. Specifically, Plaintiff points to a recommendation in the opinions that she should be limited to simple one or two step tasks, which Plaintiff notes would support level-one reasoning under the Dictionary of Occupational Titles ("DOT"). Level-one reasoning differs from the requirements of the jobs of usher or parking lot attendant; both of which require level-two reasoning.
Beginning with the issue of Dr. Boyd and Dr. Kessler's recommendations, both psychologists are nonexamining physicians. The opinions of Dr. Boyd and Dr. Kessler are based on evaluations of the available documentation regarding Plaintiff's treatment and alleged impairments, but neither doctor personally treated or examined Plaintiff. Nevertheless, the ALJ did adopt much of the doctors' findings, even though she did not rely on the recommendation limiting Plaintiff to simple one or two step tasks. The ALJ utilized the same sustained concentration and persistence limitations within each of the psychologists' reports. The ALJ assessed Plaintiff's RFC to include limitations for "moderate difficulty in her capacity to understand, remember, or apply information, and to concentrate, persist, or maintain pace." Tr. 19. This assessment is consistent with the specific findings in both Dr. Boyd and Dr. Kessler's evaluations. Tr. 62-64, 85-86, 103-04, 109-10. Beyond that, it is ultimately the ALJ's decision to determine Plaintiff's RFC limitations, which are drawn from numerous medical opinions and other available evidence. No other evidence in the record supports limiting Plaintiff to simple one or two step tasks as required for level-one reasoning.
Second, while a conflict among reasoning levels assigned in the RFC and job recommendations would require the ALJ to discuss such an issue, see Rounds v. Commissioner Social Sec. Admin., 807 F.3d 996 (9th Cir. 2015), no such issue occurred here. The ALJ limited Plaintiff to simple routine, repetitive tasks. Tr. 19. Simple routing, repetitive tasks aligns most closely with level-two reasoning under the DOT. See Zavalin v. Colvin, 778 F.3d 842, 846 (9th Cir. 2015). Because Plaintiff's RFC and VE recommendations both require the same level-two reasoning, there is not a conflict with the Commissioner's recommended jobs adopted by the ALJ.
Therefore, the ALJ did not err in the amount of weight given to the simple one or two step task recommendation listed in the opinions of the state agency psychologists. As such, the jobs of usher and parking lot attendant that were assigned by the VE and adopted by the ALJ properly align with Plaintiff's RFC.
B. Other Source Opinion Evidence
Social Security Rule ("SSR") 06-03p, in effect at the time Plaintiff filed her claim, defined "acceptable medical sources" as licensed physicians, licensed or certified psychologists, licensed optometrists, licensed podiatrists, and qualified speech pathologists. Only evidence from an "acceptable medical source" may be considered to establish the existence of a medically determinable impairment. SSR 06-03p at *2, 2016 WL 2329939. Healthcare providers who are not "acceptable medical sources," such as "nurse practitioners, physician's assistants, chiropractors, audiologists, and therapists," are considered "other sources" under the regulations, and the ALJ can consider other medical source opinions to determine the "severity of [the individual's] impairment(s) and how it affects [the individual's] ability to work." 20 C.F.R. §§ 404.1513(d), 416.913(d); SSR 06-03p at *2.
An ALJ may not reject the competent testimony of "other" medical sources without comment. Stout v. Comm'r, 454 F.3d 1050, 1053 (9th Cir. 2006). To reject the competent testimony of "other" medical sources, the ALJ need only give "reasons germane to each witness for doing so." Molina v. Astrue, 674 F.3d 1104, 1111 (9th Cir. 2012) (quoting Turner v. Comm'r of Soc. Sec., 613 F.3d 1217, 1224 (9th Cir. 2010)). In rejecting such testimony, the ALJ need not "discuss every witness's testimony on an individualized, witness-by-witness basis. Rather, if the ALJ gives germane reasons for rejecting testimony by one witness, the ALJ need only point to those reasons when rejecting similar testimony by a different witness." Id. at 1114.
Trish Shannon is a qualified mental health professional (QMHP) and is treated as an "other" medical source. C.F.R. §§ 404.1513(d), 416.913(d).
Ms. Shannon opined that Plaintiff was unable to concentrate or focus, suffered confusion, and had anxiety. Tr. 506. She also opined that due to these disorders Plaintiff would be "unable to retain employment." Id. The administrative record comprises a single medical record for Plaintiff's treatment with Trish Shannon and it appears she only treated Plaintiff on a single occasion. Tr. 525. Her opinion rests on Plaintiff's subjective statements without any objective assessment or findings. Id. During that session, Ms. Shannon noted that Plaintiff suffered from multiple psychological disorders including major depressive disorder, PTSD, and borderline personality disorder, although the source of these diagnoses is unclear. Id. The purpose of the visit appears to have been to revise Plaintiff's treatment plan. Id. In Ms. Shannon's subsequent letter describing Plaintiff's impairments, she states that Nicole Desiderati provided Plaintiff's ongoing mental health treatment. Tr. 506.
The ALJ rejected Ms. Shannon's opinion, finding that it conflicted with observations made by Plaintiff's treating physician Lance Cheung, M.D., and that the opinion was not substantiated by the record. See Tr. 507-24. Dr. Cheung reported that Plaintiff exhibited "normal orientation, mood, affect, judgement, insight and memory." Tr. 509, 524. Conflicting observations made by a treating medical source is a germane reason to reject other source opinion evidence. Molina, 674 F.3d at 111-12. Accordingly, the ALJ did not err when she rejected Ms. Shannon's opinion.
Family Nurse Practitioner Hayes is an "other" medical source. C.F.R. §§ 404.1513(d), 416.913(d).
The ALJ gave only partial weight to the opinion of FNP Hayes. Plaintiff argues that the ALJ should have credited FNP Hayes's assessment that Plaintiff could not lift or carry more than ten pounds, sit or stand for more than two hours at a time, and that Plaintiff would likely miss more than four days per month of work as a result of her impairments. Tr. 561-62. The ALJ discounted the weight of FNP Hayes's opinion because it was inconsistent with other contemporaneous evidence in the record and was largely based upon Plaintiff's subjective complaints. Tr. 21-22, 561-62.
The ALJ mistakenly characterized FNP Hayes as a medical doctor. However, this does not affect the analysis of the ALJ's opinion. --------
Contrary to the opinion of FNP Hayes, objective testing by Southern Oregon Neurosurgical & Spine Associates demonstrated that Plaintiff had normal muscle functioning with full or almost full strength in all muscle groups. Tr. 585. Additionally, Mr. Hayes's opinion that Plaintiff had difficulty standing or walking was contradicted by objective testing that demonstrated Plaintiff had a normal gait and did not suffer difficulty walking. Tr. 584. Based on this reasoning, the ALJ satisfied her requirement to provide reasons germane for her decision to limit the weight of FNP Hayes's opinion.
3. Plaintiff's Testimony
Plaintiff argues that the ALJ erred by improperly rejecting her subjective symptom testimony.
A. Analytical Framework
There is a two-step process for evaluating a claimant's testimony about the severity and limiting effect of the claimant's symptoms. Vasquez v. Astrue, 572 F.3d 586, 591 (9th Cir. 2009). "First, the ALJ must determine whether the claimant has presented objective medical evidence of an underlying impairment 'which could reasonably be expected to produce the pain or other symptoms alleged.'" Lingenfelter v. Astrue, 504 F.3d 1028, 1036 (9th Cir. 2007) (quoting Bunnell v. Sullivan, 947 F.2d 341, 344 (9th Cir. 1991) (en banc)). When doing so, "the claimant need not show that her impairment could reasonably be expected to cause the severity of the symptom she has alleged; she need only show that it could reasonably have caused some degree of the symptom." Smolen v. Chater, 80 F.3d 1273, 1282 (9th Cir. 1996).
"Second, if the claimant meets this first test, and there is no evidence of malingering, 'the ALJ can reject the claimant's testimony about the severity of her symptoms only by offering specific, clear and convincing reasons for doing so.'" Lingenfelter, 504 F.3d at 1036 (quoting Smolen, 80 F.3d at 1281). It is "not sufficient for the ALJ to make only general findings; [the ALJ] must state which pain testimony is not credible and what evidence suggests the complaints are not credible." Dodrill v. Shalala, 12 F.3d 915, 918 (9th Cir. 1993). Those reasons must be "sufficiently specific to permit the reviewing court to conclude that the ALJ did not arbitrarily discredit the claimant's testimony." Orteza v. Shalala, 50 F.3d 748, 750 (9th Cir. 1995) (citing Bunnell, 947 F.2d at 345-46).
Effective March 16, 2016, the Commissioner superseded Social Security Rule 96-7p governing the assessment of a claimant's "credibility" and replaced it with a new rule, SSR 16-3p. See SSR 16-3p, available at 2016 WL 1119029. SSR 16-3p eliminates the reference to "credibility," clarifies that "subjective symptom evaluation is not an examination of an individual's character," and requires the ALJ to consider all the evidence in an individual's record when evaluating the intensity and persistence of symptoms. Id. at *1-2.
The Commissioner recommends that the ALJ examine "the entire case record, including the objective medical evidence; an individual's statements about the intensity, persistence, and limiting effects of symptoms; statements and other information provided by medical sources and other persons; and any other relevant evidence in the individual's case record." Id. at *4. The Commissioner recommends assessing: (1) the claimant's statements made to the Commissioner, medical providers, and others regarding the claimant's location, frequency and duration of symptoms, the impact of the symptoms on daily living activities, factors that precipitate and aggravate symptoms, medications and treatments used, and other methods used to alleviate symptoms; (2) medical source opinions, statements, and medical reports regarding the claimant's history, treatment, responses to treatment, prior work record, efforts to work, daily activities, and other information concerning the intensity, persistence, and limiting effects of an individual's symptoms; and (3) non-medical source statements, considering how consistent those statements are with the claimant's statements about his or her symptoms and other evidence in the file. See Id. at *6-7.
The ALJ's credibility decision may be upheld overall even if not all of the ALJ's reasons for rejecting the claimant's testimony are upheld. See Batson v. Comm'r of Soc. Sec. Admin., 359 F.3d 1190, 1197 (9th Cir. 2004). The ALJ may not, however, make a negative credibility finding "solely because" the claimant's symptom testimony "is not substantiated affirmatively by objective medical evidence." Robbins v. Soc. Sec. Admin., 466 F.3d 880, 883 (9th Cir. 2006).
B. Analysis
The ALJ found that Plaintiff's medically determinable impairments could reasonably be expected to cause the alleged symptoms, but that Plaintiff's statements concerning the intensity, persistence, and limiting effects of these symptoms were not consistent with the evidence. Tr. 20. Plaintiff testified that she suffered pain while lifting anything over ten pounds on a regular basis, and that she experienced poor sleep, inability to sit or stand for longer than two hours per day, difficulty walking and bending, and poor concentration. Tr. 40-45.
Activities of daily living ("ADLs") that are inconsistent with a plaintiff's impairment allegations are a clear and convincing reason to discredit a plaintiff's symptom testimony. Thomas v. Barnhart, 278 F.3d 947 (9th Cir. 2002); 20 C.F.R. § 416.929. Here, the ALJ noted that Plaintiff was able to manage her own personal care, prepare simple meals, wash laundry, drive a car, and was able to take occasional walks on the beach. Tr. 20. The ALJ could reasonably conclude that these ADLs conflicted with Plaintiff's claims of debilitating pain.
Additionally, the ALJ found that imaging and physical exam findings showed only mild to moderate impairments. Tr. 21. Imaging of Plaintiff's left shoulder revealed some degenerative changes at the AC joint, but no rotator cuff tear and cervical imaging revealed some disc space narrowing. Tr. 21, 495-96. The ALJ could reasonably conclude that the objective medical evidence and treatment record did not support Plaintiff's claims. See Lingenfelter, 504 F.3d at 1036.
As to Plaintiff's claims regarding her inability to concentrate due to pain, the ALJ noted inconsistencies between the impact of Plaintiff's reported pain symptoms "sometimes so severe that it was difficult for her to maintain attention," and other statements such as her feeling "OK" after written and spoken instruction. Tr. 20, 243. Moreover, the ALJ noted that Plaintiff reported having "no problems" preparing simple meals, driving a car, going shopping, and that she still enjoyed reading, all of which require some level of concentration inconsistent with Plaintiff's claims.
In sum, the ALJ provided clear and convincing reasons - Plaintiff's inconsistent claims, ADLs that conflicted with her alleged limitations, and mild to moderate clinical findings - to discredit Plaintiff's subjective symptom testimony. / / / / / / / / /
CONCLUSION
For the reasons set forth above, the ALJ's opinion is free of harmful legal error and supported by substantial evidence in the record. Accordingly, the Commissioner's decision is AFFIRMED.
Dated this 14th day of February 2019.
/s/Mustafa T. Kasubhai
Mustafa T. Kasubhai
United States Magistrate Judge