Garcia v. Commissioner of Social Security Administration ( 2021 )

1 2 WO 3 4 5 6 7 IN THE UNITED STATES DISTRICT COURT 8 FOR THE DISTRICT OF ARIZONA 9 10 Debra Ann Garcia, No. CV-20-00689-PHX-DLR 11 Plaintiff, ORDER 12 v. 13 Commissioner of Social Security Administration, 14 Defendant. 15 16 17 At issue is the denial of Plaintiff Debra Garcia’s Applications for Disability 18 Insurance benefits and Supplemental Security Income benefits by the Social Security 19 Administration (“SSA”) under the Social Security Act (“the Act”). Plaintiff filed a 20 Complaint (Doc. 1) with this Court seeking judicial review of that denial, and the Court 21 now addresses Plaintiff’s Opening Brief (Doc. 19, “Pl. Br.”), Defendant SSA 22 Commissioner’s Answering Brief (Doc. 20, “Def. Br.”), and Plaintiff’s Reply (Doc. 24, 23 “Reply”). The Court has reviewed the briefs and Administrative Record (Doc. 14, “R.”) 24 and now affirms the Administrative Law Judge’s (“ALJ”) decision (R. at 120–40). 25 I. BACKGROUND 26 On June 2, 2015, Plaintiff filed an application for Disability Insurance benefits 27 alleging disability beginning October 10, 2014. (Id. at 123.) On June 3, 2015, Plaintiff filed 28 an application for Supplemental Security Income benefits also alleging disability beginning 1 October 10, 2014. (Id.) Plaintiff’s claims were denied initially on November 6, 2015, and 2 on reconsideration on November 16, 2016. (Id.) Plaintiff appeared before the ALJ for a 3 hearing on her claims on October 22, 2018. (Id.) On February 27, 2019, the ALJ denied 4 Plaintiff’s claims and on February 7, 2020, the Appeals Council denied Plaintiff’s Request 5 for Review (Id. at 1–7, 134.) 6 The Court has reviewed the medical evidence and will discuss the pertinent 7 evidence in addressing the issues raised by the parties. Upon considering the medical 8 evidence and opinions, the ALJ evaluated Plaintiff’s disability based on the following 9 severe impairments: fibromyalgia; cervical and lumbar spine degenerative disc disease; 10 osteoarthritis of the bilateral hands; mild osteoarthritis of the bilateral knees; and mild 11 rotator cuff tendinosis of the bilateral shoulders. (Id. at 125–26.) 12 Ultimately, the ALJ evaluated the medical evidence and testimony and concluded 13 that Plaintiff was not disabled from October 10, 2014, through the date of the decision. (Id. 14 at 133.) The ALJ found that Plaintiff “does not have an impairment or combination of 15 impairments that meets or medically equals the severity of one of the listed impairments in 16 20 CFR Part 404, Subpart P, Appendix 1.” (Id. at 128.) Next, the ALJ calculated Plaintiff’s 17 residual functional capacity (“RFC”), finding Plaintiff “has the [RFC] to perform the full 18 range of light work.” (Id. at 129.) Accordingly, the ALJ found Plaintiff “is capable of 19 performing past relevant work as a receptionist, data entry operator, customer service 20 representative, and mortgage loan processor.” (Id. at 132.) 21 II. LEGAL STANDARDS 22 In determining whether to reverse an ALJ’s decision, the district court reviews only 23 those issues raised by the party challenging the decision. See Lewis v. Apfel, 236 F.3d 503, 24 517 n.13 (9th Cir. 2001). The Court may set aside the Commissioner’s disability 25 determination only if it is not supported by substantial evidence or is based on legal error. 26 Orn v. Astrue, 495 F.3d 625, 630 (9th Cir. 2007). Substantial evidence is relevant evidence 27 that a reasonable person might accept as adequate to support a conclusion considering the 28 record as a whole. Id. To determine whether substantial evidence supports a decision, the 1 Court must consider the record as a whole and may not affirm simply by isolating a 2 “specific quantum of supporting evidence.” Id. Generally, “[w]here the evidence is 3 susceptible to more than one rational interpretation, one of which supports the ALJ’s 4 decision, the ALJ’s conclusion must be upheld.” Thomas v. Barnhart, 278 F.3d 947, 954 5 (9th Cir. 2002) (citations omitted). 6 To determine whether a claimant is disabled for purposes of the Act, the ALJ 7 typically follows a five-step process. 20 C.F.R. § 404.1520(a). The claimant bears the 8 burden of proof on the first four steps, but the burden shifts to the Commissioner at step 9 five. Tackett v. Apfel, 180 F.3d 1094, 1098 (9th Cir. 1999). At the first step, the ALJ 10 determines whether the claimant is presently engaging in substantial gainful activity. 11 20 C.F.R. § 404.1520(a)(4)(i). At step two, the ALJ determines whether the claimant has a 12 “severe” medically determinable physical or mental impairment. 20 C.F.R. § 13 404.1520(a)(4)(ii). At step three, the ALJ considers whether the claimant’s impairment or 14 combination of impairments meets or medically equals an impairment listed in Appendix 15 1 to Subpart P of 20 C.F.R. Part 404. 20 C.F.R. § 404.1520(a)(4)(iii). If so, the claimant is 16 automatically found to be disabled. Id. At step four, the ALJ assesses the claimant’s RFC 17 and determines whether the claimant is still capable of performing past relevant work. 18 20 C.F.R. § 404.1520(a)(4)(iv). If not, the ALJ proceeds to the fifth and final step, where 19 she determines whether the claimant can perform any other work in the national economy 20 based on the claimant’s RFC, age, education, and work experience. 20 C.F.R. 21 § 404.1520(a)(4)(v). If not, the claimant is disabled. Id. 22 III. ANALYSIS 23 Plaintiff raises two issues for the Court’s consideration. First, Plaintiff argues that 24 the ALJ failed to provide sufficient reasoning for rejecting the medical opinions of 25 Plaintiff’s treating physician. (Pl. Br. at 13–20.) Second, Plaintiff argues that the ALJ erred 26 by rejecting her symptom testimony. (Id. 20–23.) 27 For the reasons that follow, the Court rejects Plaintiff’s arguments and finds that 28 substantial evidence supports the ALJ’s nondisability determination. The Court finds that 1 the ALJ provided specific and legitimate reasons for rejecting the opinions of Plaintiff’s 2 treating physician, Dr. Vikram Kapur. The ALJ reasonably determined that the doctor’s 3 opinions were inconsistent with the objective medical evidence and Plaintiff’s conservative 4 treatment. Further, the ALJ provided specific, clear, and convincing reasons supported by 5 substantial evidence for rejecting Plaintiff’s symptom testimony. Again, the ALJ 6 reasonably determined Plaintiff’s symptom testimony was inconsistent with the objective 7 medical evidence and Plaintiff’s conservative treatment. 8 A. The ALJ correctly rejected Dr. Kapur’s opinions based on their inconsistency with the objective medical evidence and Plaintiff’s 9 conservative treatment. 10 11 Dr. Kapur completed two checkbox opinions regarding Plaintiff’s functional 12 limitations. On April 7, 2017, he offered opinions indicating that Plaintiff “could not 13 perform exertional requirements for even sedentary work on a sustained basis.” (Pl. Br. at 14 11; R. at 819–21.) Dr. Kapur also completed a Fatigue Questionnaire where he opined that 15 Plaintiff’s fatigue-related limitations would cause marked limitations in several areas, 16 including: “[the] ability to understand and remember short, simple instructions . . . [the] 17 ability to carry out short, simple instruction . . . [and the] ability to understand and 18 remember detailed instructions.” (R. at 818.) The ALJ rejected these opinions for two 19 reasons. First, the ALJ found that “there are no objective findings in [Dr. Kapur’s] reports 20 to support either moderate to marked mental limitations or limitations to sitting, standing 21 or walking.” (Id. at 132.) Second, the ALJ found that Plaintiff’s “treatment is mostly 22 maintenance of her conditions.” (Id.) 23 When evaluating medical opinion evidence, “[t]he ALJ must consider all medical 24 opinion evidence,” and there is a hierarchy among the sources of medical opinions. 25 Tommasetti v. Astrue, 533 F.3d 1035, 1041 (9th Cir. 2008). Those who have treated a 26 claimant are treating physicians, those who examined but did not treat the claimant are 27 examining physicians, and those who neither examined nor treated the claimant are 28 nonexamining physicians. Lester v. Chater, 81 F.3d 821, 830 (9th Cir. 1995). If a treating 1 physician’s opinion is not given controlling weight, then the ALJ must consider the relevant 2 factors listed in 20 C.F.R. § 404.1527(c)(1)–(6) and determine the appropriate weight to 3 give the opinion. Orn, 495 F.3d at 632. If a treating physician’s opinion is contradicted by 4 another doctor’s opinion, the ALJ cannot reject the treating physician’s opinion unless he 5 provides specific and legitimate reasons that are based on substantial evidence in the 6 record.” Bayliss v. Barnhart, 427 F.3d 1211, 1216 (9th Cir. 2005). 7 The Court finds that the ALJ reasonably rejected Dr. Kapur’s opinions based on 8 their inconsistency with the objective medical evidence and Plaintiff’s conservative 9 treatment. The ALJ reasonably concluded that Dr. Kapur’s medical records largely do not 10 corroborate the significant mental and physical limitations he opined to. (R. at 132.) As the 11 ALJ noted, Dr. Kapur’s treatment records routinely disclose that Plaintiff’s physical 12 examinations were largely normal, despite the presence of some positive findings. (Id. at 13 132, 747, 779, 788, 1220, 1243, 1260.) The ALJ also reasonably relied on the reviewing 14 physicians’ opinions that diagnostic imaging showed only mild findings. (Id. at 131.) 15 Further, the ALJ reasonably determined that the opined-to mental limitations were 16 unsupported by the objective medical evidence since Dr. Kapur’s treatment records do not 17 disclose mental limitations consistent with his opinions. (Id.) The ALJ was permitted to 18 discount Dr. Kapur’s opinions based on the lack of corroborative objective medical 19 evidence. See 20 C.F.R. § 404.1527(c)(4); see also Rollins v. Massanari, 261 F.3d 853, 20 856 (9th Cir. 2005). 21 Additionally, the ALJ reasonably determined that Dr. Kapur’s opinions were 22 inconsistent with Plaintiff’s conservative treatment. Many of Dr. Kapur’s treatment records 23 indicate that Plaintiff saw him only for routine follow-up appointments and medication 24 refills. (R. at 710, 716, 722, 728, 734, 740, 1205, 1207, 1211, 1217, 1223, 1229, 1235, 25 1258.) At several appointments Plaintiff’s chief complaint was unrelated to her allegedly 26 disabling impairments. (Id. at 728, 1211, 1235, 1275, 1281.) Ultimately, the ALJ’s 27 conclusion that Plaintiff’s treatment was conservative is a reasonable one and is entitled to 28 deference. And the ALJ was permitted to discount Dr. Kapur’s opinions for this reason. 1 Plaintiff makes several arguments regarding the ALJ’s rejection of Dr. Kapur’s 2 opinions, which the Court rejects.1 Plaintiff argues the ALJ failed to account for Plaintiff’s 3 fatigue due to fibromyalgia. (Pl. Br. at 15.) Plaintiff argues that Dr. Kapur opined to 4 limitations from fatigue but not from mental impairments. (Id.) First, the ALJ expressly 5 considered Plaintiff’s fatigue and Dr. Kapur’s opinions regarding her fatigue. (R. at 129, 6 131.) Next, the ALJ reasonably concluded that Dr. Kapur opined to mental limitations even 7 if they did not stem from mental impairments. And the ALJ correctly rejected Dr. Kapur’s 8 opinions regarding those mental limitations because they were uncorroborated by the 9 evidence. The ALJ correctly relied on the lack of corroborating evidence for the opined-to 10 limitations, including an examining physician’s opinion that Plaintiff did not have any 11 limitations in memory, understanding, or concentration. (Id. at 127, 132.) The ALJ 12 reasonably determined this lack of findings was incongruent with Dr. Kapur’s opinion that 13 Plaintiff’s fatigue-related limitations would cause marked limitations in several areas, 14 including: “[the] ability to understand and remember short, simple instructions . . . [the] 15 ability to carry out short, simple instruction . . . [and the] ability to understand and 16 remember detailed instructions.” (Id. at 818.) Plaintiff also argues the ALJ singled out 17 unfavorable evidence and impermissibly opined regarding Plaintiff’s diagnostic findings. 18 (Pl. Br. at 18.) The Court disagrees. The ALJ correctly relied on other medical opinions 19 that found Plaintiff’s diagnostic imaging is inconsistent with disabling limitations and 20 substantial evidence supports the ALJ’s weighing of the evidence despite some findings 21 favorable to Plaintiff. (R. at 131.) Finally, Plaintiff argues that the ALJ’s finding that 22 Plaintiff’s treatment was conservative was insufficiently specific to reject Dr. Kapur’s 23 opinion. (Pl. Br. at 18–19.) Again, the Court disagrees. The ALJ cited many records, as 24 25 1 In a footnote, Plaintiff appears to argue that the ALJ erred by giving greater weight to the reviewing physicians’ opinions because those physicians had not reviewed the entire 26 record before rendering their opinions. (Pl. Br. at 19–20.) But as Defendant correctly points out, the ALJ reasonably determined that the reviewing physicians’ opinions were more 27 consistent with the record than Dr. Kapur’s opinions, and Plaintiff does not indicate any compelling evidence that would undermine the reviewing physicians’ findings, despite the 28 fact that they did not, and could not have, review all the most recent evidence in the record. (Def. Br. at 12.) 1 Plaintiff aptly identifies, but such citation was appropriate since these records largely 2 corroborate the ALJ’s finding that Plaintiff’s treatment was conservative. (R. at 132.) 3 B. The ALJ reasonably discounted Plaintiff’s symptom testimony based on its inconsistency with the objective medical evidence and her 4 conservative treatment. 5 6 At her hearing before the ALJ, Plaintiff testified that she cannot sustain work 7 because of pain in her back, neck, knees, shoulders, arms, and hands. (Pl. Br. at 12; R. at 8 39–40.) Plaintiff also testified that she experiences considerable fatigue, which requires her 9 to lie down each day, twice a day, and for two hours at a time. (R. at 48–49.) The ALJ 10 discounted Plaintiff’s symptom testimony for the same reasons he discounted Dr. Kapur’s 11 opinion. The ALJ found that Plaintiff’s testimony was uncorroborated by the objective 12 medical evidence and inconsistent with her conservative treatment.2 (Id. at 129–31.) 13 An ALJ performs a two-step analysis to evaluate a claimant’s testimony regarding 14 pain and symptoms. Garrison v. Colvin, 759 F.3d 995, 1014 (9th Cir. 2014). First, the ALJ 15 evaluates whether the claimant has presented objective medical evidence of an impairment 16 “which could reasonably be expected to produce the pain or symptoms alleged.” 17 Lingenfelter v. Astrue, 504 F.3d 1028, 1035–36 (9th Cir. 2007) (quoting Bunnell v. 18 Sullivan, 947 F.2d 341, 344 (9th Cir. 1991) (en banc) (internal quotation marks omitted)). 19 If the claimant presents such evidence then “the ALJ can reject the claimant’s testimony 20 about the severity of her symptoms only by offering specific, clear and convincing reasons 21 for doing so.” Garrison, 759 F.3d at 1014–15 (citing Smolen v. Chater, 80 F.3d 1273, 1281 22 (9th Cir. 1996)). This is the most demanding standard in Social Security cases. Id. at 1015. 23 “In evaluating the credibility of pain testimony after a claimant produces objective medical 24 evidence of an underlying impairment, an ALJ may not reject a claimant’s subjective 25 26 2 Defendant argues that the ALJ also cited Plaintiff’s activities of daily living and 27 improvement with treatment as bases for rejecting Plaintiff’s symptom testimony. (Def. Br. at 18–19.) The Court disagrees and does not find that the ALJ relied on these reasons 28 to reject Plaintiff’s testimony. Nevertheless, the ALJ provided sufficient reasons for discounting Plaintiff’s allegations. 1 complaints based solely on a lack of medical evidence to fully corroborate the alleged 2 severity of pain.” Burch v. Barnhart, 400 F.3d 676, 682 (9th Cir. 2005). 3 Here, the ALJ provided specific, clear, and convincing reasons for rejecting 4 Plaintiff’s symptom testimony. Though the ALJ could not, and did not, rely solely on a 5 lack of corroborating objective evidence for Plaintiff’s allegations, substantial evidence 6 supports the ALJ’s consideration of the medical evidence. The ALJ noted that an 7 examination of Plaintiff revealed normal findings, including the absence of swelling, 8 normal range of motion, and no difficulty standing or walking. (R. at 129–30.) The ALJ 9 also noted that diagnostics including x-rays and an MRI revealed only mild to moderate 10 findings. (Id. at 130.) Other medical records support the ALJ’s finding that, despite the 11 presence of some symptoms, Plaintiff’s allegations are uncorroborated by the objective 12 medical evidence. Plaintiff’s medical records consistently document that she regularly 13 reported fatigue and pain, but that she was not in acute distress. (Id. at 710, 716, 722, 728, 14 734, 740, 1205, 1207, 1211, 1217, 1235, 1258, 1275, 1293.) The ALJ reasonably 15 determined that these records do not corroborate the magnitude of her allegations. Plaintiff 16 argues that the findings cited by the ALJ do not undermine her complaints related to 17 fibromyalgia and fatigue. (Pl. Br. at 22) But the Court disagrees and finds that the ALJ 18 reasonably concluded that the minimal corroboration of Plaintiff’s allegations in her 19 medical records undermined her testimony. Though this basis could not be the ALJ’s sole 20 reason for discounting Plaintiff’s symptom testimony, the ALJ reasonably relied in part on 21 the lack of corroborating evidence for discounting Plaintiff’s allegations. 22 The ALJ also properly discounted Plaintiff’s symptom testimony based on her 23 conservative treatment. This was a permissible basis for the ALJ to reject Plaintiff’s 24 symptom testimony. See Parra v. Astrue, 481 F.3d 742, 750-51 (9th Cir. 2007) (finding 25 that evidence of conservative treatment is a sufficient reason to discount a claimant’s 26 symptom testimony). Here, substantial evidence supports the ALJ’s conclusion that 27 Plaintiff’s treatment was routine and conservative. The medical evidence reveals that many 28 of Plaintiff’s medical appointments were for medication refills. (R. at 710, 716, 722, 728, 1|| 734, 740, 1205, 1207, 1211, 1217, 1223, 1229, 1235, 1258.) Plaintiff argues that her 2|| treatment was not actually conservative.* (Reply at 9.) The Court disagrees and finds the 3|| ALJ reasonably concluded Plaintiff's treatment was, in fact, conservative based on her 4|| treatment records. Because the ALJ’s conclusion is reasonable, it is entitled to deference. 5 Finally, the Court rejects Plaintiff's argument that the ALJ did not identify any 6 || specific testimony that was undermined by the medical evidence. (Pl. Br. at 22.) The ALJ is not required to identify every isolated allegation that is undermined by the evidence, and 8 || the ALJ’s opinion makes clear that Plaintiff's testimony as a whole was undermined by a 9|| lack of corroborating evidence and treatment. 10] IV. CONCLUSION 11 Substantial evidence supports the ALJ’s nondisability determination. The ALJ || correctly rejected Dr. Kapur’s treating physician opinions because they were inconsistent 13} with the objective medical evidence and Plaintiff's conservative treatment. The ALJ also □□ reasonably discounted Plaintiff's symptom testimony for the same reasons. Substantial 15} evidence supports the ALJ’s conclusions that Plaintiffs symptom testimony was 16 || inconsistent with the objective medical evidence and her conservative treatment. 17 IT IS THEREFORE ORDERED affirming the decision of the Administrative 18 || Law Judge (R. at 120-40). 19 IT IS FURTHER ORDERED directing the Clerk of Court to enter judgment || accordingly and close this matter. 21 Dated this 7th day of May, 2021. 22 - 23 J LS (2, ee 24 Do . Rayes 35 United States District Judge 26 27 28 > Plaintiff argues this point while discussing the ALJ’s analysis of Dr. Kapur’s opinion but it applies with equal force to the ALJ’s analysis of her symptom testimony. -9-