Puljarga v. Commissioner of Social Security Administration ( 2023 )

1 WO 2 3 4 5 6 IN THE UNITED STATES DISTRICT COURT 7 FOR THE DISTRICT OF ARIZONA 8 9 Enesa Puljarga, No. CV-22-00383-PHX-MTL 10 Plaintiff, ORDER 11 v. 12 Commissioner of Social Security Administration, 13 Defendant. 14 15 At issue is the denial of Plaintiff Enesa Puljarga’s Application for Social Security 16 Disability benefits. Puljarga filed a Complaint (Doc. 1) seeking judicial review of that 17 denial. The Court has reviewed the briefs and Administrative Record (Doc. 11) and now 18 affirms the Administrative Law Judge’s decision. 19 I. BACKGROUND 20 Puljarga filed an application for Social Security Disability Insurance benefits on 21 June 20, 2019, based on an alleged disability with an onset date of April 4, 2019. (Doc. 14 22 at 2.) After the Social Security Administration’s initial and reconsideration denials, the 23 Administrative Law Judge (“ALJ”) issued an unfavorable decision on October 18, 2021, 24 which became the final agency decision when the Social Security Administration Appeals 25 Council denied a request for review. (Id.) The present appeal followed. 26 II. LEGAL STANDARD 27 In determining whether to reverse an ALJ’s decision, the district court reviews only 28 those issues raised by the party challenging the decision. See Lewis v. Apfel, 236 F.3d 503, 1 517 n.13 (9th Cir. 2001). The Court may set aside the Commissioner’s disability 2 determination only if it is not supported by substantial evidence or is based on legal error. 3 Orn v. Astrue, 495 F.3d 625, 630 (9th Cir. 2007). Substantial evidence is relevant evidence 4 that a reasonable person might accept as adequate to support a conclusion considering the 5 record as a whole. Id. To determine whether substantial evidence supports a decision, the 6 Court must consider the record as a whole and may not affirm simply by isolating a 7 “specific quantum of supporting evidence.” Id. Generally, “[w]here the evidence is 8 susceptible to more than one rational interpretation, one of which supports the ALJ’s 9 decision, the ALJ’s conclusion must be upheld.” Thomas v. Barnhart, 278 F.3d 947, 954 10 (9th Cir. 2002) (citations omitted). 11 To determine whether a claimant is disabled, the ALJ follows a five-step process. 12 20 C.F.R. § 404.1520(a). The claimant bears the burden of proof on the first four steps, but 13 the burden shifts to the Commissioner at step five. Tackett v. Apfel, 180 F.3d 1094, 1098 14 (9th Cir. 1999). At the first step, the ALJ determines whether the claimant is presently 15 engaging in substantial gainful activity. 20 C.F.R. § 404.1520(a)(4)(i). If so, the claimant 16 is not disabled, and the inquiry ends. Id. At step two, the ALJ determines whether the 17 claimant has a “severe” medically determinable physical or mental impairment. 20 C.F.R. 18 § 404.1520(a)(4)(ii). If not, the claimant is not disabled, and the inquiry ends. Id. At step 19 three, the ALJ considers whether the claimant’s impairment or combination of impairments 20 meets or medically equals an impairment listed in Appendix 1 to Subpart P of 20 C.F.R. 21 Part 404. 20 C.F.R. § 404.1520(a)(4)(iii). If so, the claimant is automatically found to be 22 disabled. Id. At step four, the ALJ assesses the claimant’s RFC and determines whether the 23 claimant is still capable of performing past relevant work. 20 C.F.R. 24 § 404.1520(a)(4)(iv). If so, the claimant is not disabled, and the inquiry ends. Id. If not, the 25 ALJ proceeds to the fifth and final step, where the ALJ determines whether the claimant 26 can perform any other work in the national economy based on the claimant’s RFC, age, 27 education, and work experience. 20 C.F.R. § 404.1520(a)(4)(v). If not, the claimant is 28 disabled. Id. 1 III. ANALYSIS 2 Puljarga makes two primary two arguments against the ALJ’s decision. First, 3 Puljarga argues that the ALJ erred by rejecting her symptom testimony without providing 4 substantial evidence. (Doc. 14 at 18.) Second, Puljarga argues that the ALJ erred by 5 rejecting the assessments from treating psychiatric nurse practitioner, Daniel Chafetz, 6 without providing substantial evidence. (Id. at 12.) 7 A. The ALJ did not err by rejecting Puljarga’s symptom testimony. 8 Puljarga argues that the ALJ erred by rejecting her symptom testimony without 9 providing substantial evidence. (Id. at 18.) The Commissioner responds by arguing that 10 substantial evidence supported the ALJ’s decision. (Doc. 17 at 4-7.) Specifically, the 11 Commissioner claims Puljarga’s activities were inconsistent with her allegations, objective 12 evidence contradicted Puljarga’s allegations, and Puljarga was satisfied with her 13 medication management. (Id.) 14 The ALJ engages in a two-step analysis when evaluating a claimant’s symptom 15 testimony. Garrison v. Colvin, 759 F.3d 995, 2014 (9th Cir. 2014). First, the ALJ must 16 determine whether the claimant has produced objective medical evidence of an underlying 17 impairment. Id. Second, unless there is evidence that the claimant is malingering, the ALJ 18 must provide specific, clear, and convincing reasons for rejecting symptom testimony 19 associated with the underlying impairment. Burch v. Barnhart, 400 F.3d 676, 680 (9th Cir. 20 2005). This is the most demanding standard in Social Security cases. Moore v. Comm’r of 21 Soc. Sec. Admin., 278 F.3d 920, 924 (9th Cir. 2002). Here, the ALJ found an underlying 22 impairment and cited no evidence of malingering. (Doc. 11-3 at 14-26.) Accordingly, the 23 ALJ needed to provide specific, clear and convincing reasons to discount Plaintiff’s 24 symptom testimony. 25 In making credibility determinations, an ALJ may consider a variety of factors in 26 evaluating symptom testimony including, “[the claimant’s] reputation for truthfulness, 27 inconsistencies either in [her] testimony or between [her] testimony and [her] conduct, 28 [her] daily activities, [her] work record, and testimony from physicians and third parties 1 concerning the nature, severity, and effect of the symptoms of which [she] complains.” 2 Light v. Soc. Sec. Admin., Comm’r, 119 F.3d 789, 792 (9th Cir. 1997). Here, the ALJ 3 presented three bases for discounting Puljarga’s testimony: (1) the objective medical 4 evidence is inconsistent with Puljarga’s allegations; (2) Puljarga’s activities were 5 inconsistent with her claimed limitations; and (3) Puljarga was satisfied with her 6 medication management and declined more advanced treatment. 7 In discounting Puljarga’s symptom testimony, the ALJ properly relied on the 8 objective medical evidence in the record. Before explaining why it was rejected, the ALJ 9 explicitly recited Puljarga’s symptom testimony regarding difficulty with lifting, squatting, 10 bending, walking, kneeling, stair climbing, following instructions, memory and 11 concentration. (Doc. 11-3 at 20.) The ALJ concluded that Puljarga’s testimony concerning 12 the intensity, persistence and limiting effects of her symptoms was not entirely consistent 13 with the evidence in the record. (Id. at 21.) In making these credibility determinations, the 14 ALJ pointed to multiple inconsistent examination results. For example, in March 2019, 15 Puljarga complained of chest pain around the ribs and thoracic spine, but medical imaging 16 showed only mild degenerative changes of the thoracic spine and no radiographic 17 abnormality or fracture of her ribs. (Id.) Similarly, in September 2019, Puljarga complained 18 of chronic pain, arthritis, and left leg numbness, but she was able to walk to the exam room, 19 sit comfortably, lay down, get up without difficulty, walk on toes and heels, had good 20 dexterity of her hands, and performed rapid alternating movements with her hands. (Id.) 21 The ALJ also properly relied on the medical opinion testimony of state agency medical 22 consultants N. Keer, D.O., and Deborah Wafer, M.D., who the ALJ found generally 23 persuasive. (Id. at 23.) These consultants assessed that Puljarga could perform a range of 24 light work with additional limitations, and the ALJ found that their assessments were 25 consistent with the evidence as a whole. (Id.) 26 The Court finds that the ALJ’s explanations detailing the inconsistencies between 27 Puljarga’s testimony, and the objective medical evidence provided specific, clear, and 28 convincing reasons supported by substantial evidence to reject Puljarga’s symptom 1 testimony. Thus, the ALJ did not err in rejecting Puljarga’s symptom testimony. 2 The Court need not discuss the ALJ’s use of Puljarga’s daily activities and 3 satisfaction with medication management to discount her symptom testimony since any 4 other error in assessing Puljarga’s subjective complaints is harmless so long as a valid 5 reason for rejecting them remains. Carmickle v. Comm’r of Soc. Sec. Admin., 533 F.3d 6 1155, 1162 (9th Cir. 2008). 7 B. The ALJ did not err by rejecting P.N.P Daniel Chafetz’s assessments. 8 Puljarga argues that the ALJ erred by rejecting P.N.P Daniel Chafetz’s assessments 9 without providing substantial evidence. (Doc. 14 at 12.) The Commissioner responds that 10 substantial evidence supported the ALJ’s rejection of Chafetz’s assessment. (Doc. 17 at 9- 11 13.) Specifically, the Commissioner argues that Chafetz’s opinions were not supported by 12 his own treatment records and were inconsistent with other evidence in the record. 13 In 2017, the Social Security Administration amended the regulations for evaluating 14 medical evidence. See Revisions to Rules Regarding Evaluation of Medical Evidence, 82 15 Fed. Reg. 5844, 5844 (Jan. 18, 2017). The new regulations apply to claims filed on or after 16 March 27, 2017. Id. Here, Puljarga filed her application after the effective date. (Doc. 14 17 at 2.) The Ninth Circuit has addressed the effect of the new regulations, so the Court begins 18 with this issue. See Woods v. Kijakazi, 32 F.4th 785 (9th Cir. 2022). 19 Under the old regulations, “[t]he law in the Ninth Circuit [was] that, although the 20 ALJ must consider all medical opinion evidence, there is a hierarchy among the sources of 21 medical opinions. Those who have treated a claimant are treating physicians, those who 22 examined but did not treat the claimant are examining physicians, and those who neither 23 examined nor treated the claimant are nonexamining physicians.” Latahotchee v. Comm’r 24 of Soc. Sec. Admin., No. CV-19-05668-PHX-DWL, 2021 WL 267909, at *4 (D. Ariz. 25 2021) (citation omitted). Based on this hierarchy, the Ninth Circuit consistently ruled that 26 an ALJ may only reject an examining physician’s opinion by providing “specific and 27 legitimate reasons that are support by substantial evidence in the record.” Lester v. Chater, 28 81 F.3d 821, 830-31 (9th Cir. 1995). 1 The 2017 regulations provide that “[ALJs] will not defer or give any specific 2 evidentiary weight, including controlling weight, to any medical opinion . . . The most 3 important factors [an ALJ will] consider when [evaluating] the persuasiveness of medical 4 opinions . . . are supportability . . . and consistency.” 20 C.F.R. § 404.1520c(a). Other 5 factors, which an ALJ “may, but [is] not required to . . . explain” when evaluating the 6 persuasiveness of a medical opinion, are the medical source’s “relationship with the 7 claimant,” “specialization,” “familiarity with the other evidence in the claim,” and 8 “understanding of our disability program’s policies and evidentiary requirements.” Id. 9 § 404.1520c(b)(2), (c). 10 In Woods, the Ninth Circuit held that these revised regulations clearly intended to 11 abrogate its precedent requiring ALJs to provide “specific and legitimate reasons” for 12 rejecting a treating or examining doctor’s opinion. See Woods, 32 F.4th at 792. 13 Nonetheless, in so holding, the Ninth Circuit stressed that an ALJ “must ‘articulate . . . how 14 persuasive’ it finds ‘all of the medical opinions’ from each doctor or other source, and 15 ‘explain how it considered the supportability and consistency factors’ in reaching these 16 findings.” Id. (citing 20 C.F.R. §§ 404.1520c(b), 404.1520(b)(2)). 17 Here, the ALJ met the revised regulations’ articulation standards in finding 18 Chafetz’s opinions to be unpersuasive. First, the ALJ explained that Chafetz’s opinions 19 regarding Puljarga’s limitations lacked supportability because they were not supported by 20 his own treatment records. (Doc. 11-3 at 25.) To illustrate this, the ALJ found that Chafetz’s 21 September 2020 report where he indicated that Puljarga was cooperative, had good 22 judgment, a logical thought process, and an average fund of knowledge was inconsistent 23 with his later claims that Puljarga was severely impaired in performing even simple tasks 24 around that same time. (Id.). Second, the ALJ sufficiently explained why he believed 25 Chafetz’s opinions lacked consistency. The ALJ found that Chafetz’s opinions regarding 26 Puljarga’s limitations were inconsistent with other evidence in the record. (Id.) Namely, 27 the ALJ highlighted a consultative examination where Puljarga was able to understand, 28 remember, carry out simple instructions, and maintain attention. (Id.) The ALJ found that || these demonstrated abilities were inconsistent with Chafetz’s opinion of Puljarga’s 2|| limitations. Ud.) The ALJ also found Chafetz’s opinion to be inconsistent with Puljarga’s 3 || reports where she stated she could do basic chores around the house and participate in 4|| activities such as reading, going shopping, swimming, and visiting her family. (/d.) The Court finds the ALJ properly explained how he considered the supportability and || consistency factors and provided substantial evidence to support his conclusion. As a 7\| result, the ALJ did not err in finding P.N.P Chafetz’s opinions to be unpersuasive. 8 As remand is not appropriate here, the Court need not address the credit-as-true 9|| analysis. 10] IV. CONCLUSION 11 Accordingly, 12 IT IS ORDERED affirming the October 18, 2021 decision of the Administrative 13 || Law Judge (Doc. 11-3 at 26), as upheld by the Appeals Council on January 18, 2022. (Doc. 11-3 at 2). 15 IT IS FURTHER ORDERED directing the Clerk of Court to enter judgment 16 || consistent with this Order and close this case. 17 Dated this 15th day of March, 2023. 18 Michal T. Hbhurdle Michael T. Liburdi 21 United States District Judge 22 23 24 25 26 27 28 -7-