Minnifield v. Commissioner of Social Security Administration ( 2021 )

1 WO 2 3 4 5 6 IN THE UNITED STATES DISTRICT COURT 7 FOR THE DISTRICT OF ARIZONA 8 9 Cathy Cook Minnifield, No. CV-20-00913-PHX-MTL 10 Plaintiff, ORDER 11 v. 12 Commissioner of Social Security Administration, 13 Defendant. 14 15 At issue is the denial of Plaintiff Cathy Minnifield’s Application for Disability 16 Insurance benefits by the Social Security Administration. Plaintiff filed a Complaint 17 (Doc. 1) with this Court seeking judicial review of that denial. The Court now addresses 18 Plaintiff’s Opening Brief (Doc. 10, Pl. Br.), Defendant Social Security Administration 19 Commissioner’s Answering Brief (Doc. 11, Def. Br.), and Plaintiff’s Reply Brief (Doc. 20 12, Reply). The Court has reviewed the briefs and Administrative Record (Doc. 8), and 21 now affirms the Administrative Law Judge’s (“ALJ”) decision. 22 I. BACKGROUND 23 Plaintiff filed her Application for Disability Insurance benefits in January 2017, 24 alleging disability beginning July 25, 2016. (R. at 74.) Plaintiff’s claim was denied 25 initially on April 12, 2017, and upon reconsideration on August 23, 2017. (Id. at 98–101, 26 104–07.) On April 8, 2019, Plaintiff appeared before the ALJ for a hearing on her claim. 27 (Id. at 10–36.) On May 15, 2019, the ALJ denied Plaintiff’s claim. (Id. at 71–97.) The 28 Appeals Council denied Plaintiff’s Request for Review of the ALJ’s decision on March 1 23, 2020. (Id. at 1–6.) Plaintiff now seeks judicial review of the Commissioner’s decision 2 pursuant to 42 U.S.C. § 405(g). 3 The Court has reviewed the medical evidence and will discuss the pertinent 4 evidence in addressing the issues raised by the parties. Upon considering the medical 5 evidence and opinions, the ALJ evaluated Plaintiff’s disability based on the following 6 severe impairments: right ankle fusion; right knee replacement; obesity; degenerative disc 7 disease of the cervical spine status post fusion; asthma; and chronic kidney disease. (Id. at 8 77.) 9 Ultimately, the ALJ evaluated the medical evidence and testimony and concluded 10 that Plaintiff was not disabled from the alleged disability onset-date through the date of 11 the decision. (Id. at 89.) The ALJ found that Plaintiff “does not have an impairment or 12 combination of impairments that meets or medically equals the severity of one of the 13 listed impairments in 20 CFR Part 404, Subpart P, Appendix 1.” (Id. at 80.) Next, the 14 ALJ calculated Plaintiff’s residual functional capacity (“RFC”): 15 [Plaintiff] has the [RFC] to perform sedentary work as defined in 20 CFR 404.1567(a) except she can frequently 16 push and pull with the upper extremities, and never operate 17 foot controls with the right lower extremity. She can never climb ladders, ropes or scaffolds, and occasionally climb 18 ramps or stairs. She can never crawl. She can occasionally 19 balance, stoop, crouch and kneel. She is limited to occasional bilateral overhead reaching. She can frequently handle, finger 20 and feel bilaterally. She can have occasional exposure to 21 nonweather-related extreme cold, extreme heat, excessive vibration and pulmonary irritants, such as fumes, odors, dusts, 22 gases and poorly ventilated areas. She can have no exposure 23 to dangerous machinery or unprotected heights. She requires a hand held assistive device at all times when standing. 24 (Id. at 81.) Accordingly, the ALJ found that Plaintiff “is capable of performing past 25 relevant work as a customer service representative.” (Id. at 88.) 26 II. LEGAL STANDARDS 27 In determining whether to reverse an ALJ’s decision, the district court reviews 28 only those issues raised by the party challenging the decision. See Lewis v. Apfel, 236 1 F.3d 503, 517 n.13 (9th Cir. 2001). The Court may set aside the Commissioner’s 2 disability determination only if it is not supported by substantial evidence or is based on 3 legal error. Orn v. Astrue, 495 F.3d 625, 630 (9th Cir. 2007). Substantial evidence is 4 relevant evidence that a reasonable person might accept as adequate to support a 5 conclusion considering the record as a whole. Id. To determine whether substantial 6 evidence supports a decision, the Court must consider the record as a whole and may not 7 affirm simply by isolating a “specific quantum of supporting evidence.” Id. Generally, 8 “[w]here the evidence is susceptible to more than one rational interpretation, one of 9 which supports the ALJ’s decision, the ALJ’s conclusion must be upheld.” Thomas v. 10 Barnhart, 278 F.3d 947, 954 (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, 13 but the burden shifts to the Commissioner at step five. Tackett v. Apfel, 180 F.3d 1094, 14 1098 (9th Cir. 1999). At the first step, the ALJ determines whether the claimant is 15 presently engaging in substantial gainful activity. 20 C.F.R. § 404.1520(a)(4)(i). At step 16 two, the ALJ determines whether the claimant has a “severe” medically determinable 17 physical or mental impairment. 20 C.F.R. § 404.1520(a)(4)(ii). At step three, the ALJ 18 considers whether the claimant’s impairment or combination of impairments meets or 19 medically equals an impairment listed in Appendix 1 to Subpart P of 20 C.F.R. Part 404. 20 20 C.F.R. § 404.1520(a)(4)(iii). If so, the claimant is automatically found to be disabled. 21 Id. At step four, the ALJ assesses the claimant’s RFC and determines whether the 22 claimant is still capable of performing past relevant work. 20 C.F.R. § 404.1520(a)(4)(iv). 23 If not, the ALJ proceeds to the fifth and final step, where she determines whether the 24 claimant can perform any other work in the national economy based on the claimant’s 25 RFC, age, education, and work experience. 20 C.F.R. § 404.1520(a)(4)(v). If not, the 26 claimant is disabled. Id. 27 III. ANALYSIS 28 Plaintiff raises two arguments in challenging the ALJ’s nondisability finding. 1 First, Plaintiff argues that the ALJ erred by rejecting opinions offered by Plaintiff’s 2 treating physicians—Dr. Wanda Figueroa-Cruz and Dr. Lawrence Kutz. (Pl. Br. at 1.) 3 Second, Plaintiff argues that the ALJ erroneously rejected her symptom testimony 4 without sufficient justification. (Id. at 2.) For the following reasons, the Court rejects 5 Plaintiff’s arguments and finds that the ALJ’s determination is supported by substantial 6 evidence. 7 A. Medical Opinion Evidence 8 Plaintiff’s treating physicians Drs. Kutz and Figueroa-Cruz offered opinions 9 regarding Plaintiff’s functional limitations, which Plaintiff claims “preclude the ability to 10 sustain work.” (Pl. Br. at 16; R. at 1795–96, 1802–03.) The ALJ rejected both opinions 11 as “overly restrictive given [Plaintiff]’s positive response to surgical interventions and 12 other treatment modalities, such as injection therapy and medication management.” (R. at 13 88.) 14 While “[t]he ALJ must consider all medical opinion evidence,” there is a hierarchy 15 among the sources of medical opinions. Tommasetti v. Astrue, 533 F.3d 1035, 1041 (9th 16 Cir. 2008). Those who have treated a claimant are treating physicians, those who examined 17 but did not treat the claimant are examining physicians, and those who neither examined 18 nor treated the claimant are nonexamining physicians. Lester v. Chater, 81 F.3d 821, 830 19 (9th Cir. 1995). If a treating physician’s opinion is not given controlling weight, then the 20 ALJ must consider the relevant factors listed in 20 C.F.R. § 404.1527(c)(1)–(6) and 21 determine the appropriate weight to give the opinion. Orn, 495 F.3d at 632. If a treating 22 physician’s opinion is contradicted by another doctor’s opinion, the ALJ cannot reject the 23 treating physician’s opinion unless he provides specific and legitimate reasons that are 24 based on substantial evidence in the record.” Bayliss v. Barnhart, 427 F.3d 1211, 1216 25 (9th Cir. 2005). 26 Here, the ALJ provided a specific and legitimate reason—Plaintiff’s improvement 27 with treatment—for rejecting Drs. Kutz and Figueroa-Cruz’s opinions and that reason is 28 supported by substantial evidence. The record indicates that Plaintiff had three significant 1 surgeries during the relevant period—cervical spine surgery in July 2017; right total knee 2 arthroplasty surgery in May 2018; and right ankle surgery in December 2018. (R. at 3 1784–85, 2479–80, 4443–44.) The ALJ acknowledged these surgical interventions but 4 discounted the treating physicians’ opinions because of documented improvement with 5 treatment after each surgery. (Id. at 86–88.) This was a permissible basis to discount the 6 opinions. See Berry v. Astrue, 622 F.3d 1228, 1236 (9th Cir. 2010) (finding that the ALJ 7 used medical records that specifically supported his conclusion that plaintiff’s 8 impairments had improved and were well controlled by the prescribed treatment, 9 resulting in minimal limitations). Further, the ALJ’s finding was supported by substantial 10 evidence since the ALJ identified specific records that demonstrate Plaintiff reported 11 improvement, diminished pain, and increased functionality following each surgery. (R. at 12 82–88, 2286, 2323, 2349, 2359–63, 4410, 4429, 4671, 4674.) 13 Plaintiff argues that the ALJ’s analysis is flawed, but her arguments are 14 unpersuasive. Initially, Plaintiff argues that the ALJ generally cited over 1,000 medical 15 records rather than identifying specific records that undermine the doctors’ opinions. (Pl. 16 Br. at 13–14.) Plaintiff’s argument misses the mark. Although the ALJ cited thousands of 17 records in the paragraph directly analyzing the treating physicians’ opinions, she cited 18 specific records elsewhere in her opinion. (R. at 82–88.) Reading the ALJ’s opinion as a 19 cohesive whole, it is clear the ALJ’s detailed discussion of Plaintiff’s medical treatment 20 and improvement earlier in her opinion applies with equal force to her analysis of the 21 treating physicians’ opinions. The ALJ is not required to repeat each citation to the record 22 after she has previously done so in detailed fashion. See Howard ex rel. Wolff v. 23 Barnhart, 341 F.3d 1006, 1012 (9th Cir. 2003); Magallanes v. Bowen, 881 F.2d 747, 755 24 (9th Cir. 1989). Accordingly, the ALJ did not err by citing generally to the records she 25 relied on specifically elsewhere in her analysis. 26 Plaintiff’s next argument is that the ALJ identified only isolated records of 27 improvement in discounting the treating physicians’ opinions. (Pl. Br. at 14–15.) This 28 argument is also unpersuasive. Plaintiff is correct that the record discloses that Plaintiff 1 had continued symptoms even after each of her surgeries. (R. at 2286, 2323, 2359–63, 2 4414, 4681.) Nevertheless, the ALJ identified many medical records that document 3 Plaintiff’s improvement with treatment, which, in the ALJ’s opinion, undermine the 4 treating physicians’ opinions regarding the extent of Plaintiff’s limitations. (Id. at 82–88, 5 2286, 2323, 2349, 2359–63, 4410, 4429, 4671, 4674.) Ultimately, the evidence on this 6 issue points in either direction. Because substantial evidence is a relatively low 7 evidentiary threshold and highly deferential, Valentine v. Astrue, 574 F.3d 685, 690 (9th 8 Cir. 2009), the ALJ’s interpretation of the evidence was reasonable. The ALJ did not err 9 in concluding that Plaintiff’s improvement, despite her remaining symptoms, undermined 10 the physicians’ opinions. See Thomas, 278 F.3d at 954; see also Batson v. Comm’r of 11 Soc. Sec. Admin., 359 F.3d 1190, 1194 (9th Cir. 2004) (declaring that when competing 12 rational inferences can be drawn from the record, the ALJ’s decision should be upheld). 13 Plaintiff’s final argument on this issue is that “the ALJ, as a layperson and 14 administrative adjudicator, was unqualified to determine whether the limitations assessed 15 by Drs. Kutz and Figueroa-Cruz were ‘overly restrictive.’” (Pl. Br. at 15.) Though 16 Plaintiff is correct that the ALJ is not qualified to make independent medical findings, 17 she is incorrect that the ALJ is unqualified to determine whether the medical opinions are 18 adequately supported. It is the ALJ’s duty to evaluate the medical evidence, resolve 19 conflicts and ambiguities in the record and determine a claimant’s RFC. See Tommasetti, 20 533 F.3d at 1041. Further, the RFC need not match any particular medical source opinion 21 since it is a legal determination. 20 C.F.R. §§ 404.1527(d)(2), 404.1545, 404.1546(c). 22 Thus, the ALJ must navigate between potentially competing medical opinions and 23 evidence and determine a claimant’s RFC. That is precisely what the ALJ did here. Even 24 the opinions she credited—from Dr. Neil Sapin and Dr. Nadine Keer—she partially 25 rejected because aspects of the opinions were inconsistent with the remaining record. (R. 26 at 86–87.) This was not error because the ALJ must compute the claimant’s RFC by 27 considering all the evidence and evaluating the extent to which the medical opinions are 28 consistent with the remaining evidence. But this does not mean the ALJ was herself 1 offering a medical opinion. 2 Accordingly, the ALJ provided a specific and legitimate reason—Plaintiff’s 3 improvement with treatment—for rejecting the opinions offered by Plaintiff’s treating 4 physicians. The ALJ did not err since substantial evidence supported the ALJ’s finding 5 that Plaintiff’s improvement undermined the medical opinions. 6 B. Symptom Testimony 7 At her hearing, Plaintiff testified that pain in her neck, arms, shoulder, knee and 8 ankle prevent her from working on a regular basis. (R. at 19.) She also testified that 9 treatment helps but she still has continuous pain and “pretty much do[es]n’t do anything” 10 during the day. (Id.) The ALJ discounted Plaintiff’s testimony because Plaintiff’s 11 improvement undermined her allegations of disabling symptoms. (Id. at 82–86.) Further, 12 the ALJ also found that Plaintiff’s allegation that she requires an assistive device to walk 13 was unsupported by the record; however, the ALJ also included a restriction that Plaintiff 14 requires an assistive device in her RFC. (Id. at 81, 85.) 15 An ALJ performs a two-step analysis to evaluate a claimant’s testimony regarding 16 pain and symptoms. Garrison v. Colvin, 759 F.3d 995, 1014 (9th Cir. 2014). First, the 17 ALJ evaluates whether the claimant has presented objective medical evidence of an 18 impairment “which could reasonably be expected to produce the pain or symptoms 19 alleged.” Lingenfelter v. Astrue, 504 F.3d 1028, 1035–36 (9th Cir. 2007) (quoting 20 Bunnell v. Sullivan, 947 F.2d 341, 344 (9th Cir. 1991) (en banc) (internal quotation 21 marks omitted)). If the claimant presents such evidence then “the ALJ can reject the 22 claimant’s testimony about the severity of her symptoms only by offering specific, clear 23 and convincing reasons for doing so.” Garrison, 759 F.3d at 1014–15 (citing Smolen v. 24 Chater, 80 F.3d 1273, 1281 (9th Cir. 1996)). This is the most demanding standard in 25 Social Security cases. Id. at 1015. “In evaluating the credibility of pain testimony after a 26 claimant produces objective medical evidence of an underlying impairment, an ALJ may 27 not reject a claimant’s subjective complaints based solely on a lack of medical evidence 28 1 to fully corroborate the alleged severity of pain.” Burch v. Barnhart, 400 F.3d 676, 682 2 (9th Cir. 2005). 3 Here, the ALJ considered Plaintiff’s symptom testimony and found that her 4 medically determinable impairments could reasonably be expected to cause her alleged 5 symptoms. (R. at 81–82.) Plaintiff, therefore, satisfied the first step of the analysis. At 6 step two, however, the ALJ determined Plaintiff’s statements concerning the intensity, 7 persistence, and limiting effects of her symptoms were not entirely consistent with the 8 record. (Id.) To support this finding, the ALJ listed several reasons, such as inconsistent 9 evidence and improvement with treatment. The ALJ’s finding that Plaintiff improved 10 with treatment and that this improvement undermines Plaintiff’s allegations is supported 11 by substantial evidence. Significantly, the ALJ identified many records that specifically 12 documented Plaintiff’s improvement with treatment following surgery and other 13 treatments. (R. at 82–88, 2286, 2323, 2349, 2359–63, 4410, 4429, 4671, 4674.) Plaintiff’s 14 documented improvement was a specific, clear, and convincing basis for discounting her 15 allegations of disabling symptoms. See Tommasetti, 533 F.3d at 1040. 16 Plaintiff argues that the ALJ failed to connect Plaintiff’s improvement to any 17 specific testimony that warranted rejection. (Pl. Br. at 18.) Further, Plaintiff again argues 18 that the ALJ overlooked the continued existence of symptoms despite Plaintiff’s 19 improvement. (Id. at 19.) The Court rejects Plaintiff’s arguments. In analyzing the 20 medical evidence and Plaintiff’s improvement, the ALJ repeatedly references Plaintiff’s 21 specific allegations that are undermined by the record. (R. at 83–85.) Specifically, the 22 ALJ found that Plaintiff’s improvement “weaken[s] her allegations of disabling right 23 knee impairment. . . . disabling cervical symptoms. . . . disabling chronic pain. . . . [and] 24 her allegations of disabling symptoms.” (Id.) Thus, Plaintiff’s argument that the ALJ’s 25 analysis “[w]as without any effort to connect the discussion of the medical evidence to a 26 finding that any specific part of the symptom testimony lacked credibility,” is incorrect. 27 (Pl. Br. at 18.) Next, as similarly discussed in relation to the ALJ’s analysis of the 28 medical opinions, the ALJ did not err by finding Plaintiff’s improvement undermines her || allegations. Though some records that indicate Plaintiff had residual symptoms despite 2|| improvement, the ALJ’s interpretation of the evidence undermines her allegation was still 3|| a reasonable one. Substantial evidence supports the ALJ’s conclusion that Plaintiffs 4|| improvement undermines her allegations, even if some symptoms persisted. Because this 5 || interpretation is reasonable, the Court defers to it, even if alternative interpretations of the 6 || evidence are also permissible. 7 Finally, even if the ALJ erred, as Plaintiff argues, by discrediting □□□□□□□□□□□ 8 || allegations that she requires an assistive device, such error would be harmless. (PI. Br. at 19-20.) The ALJ included an assistive device requirement in Plaintiff's RFC so any 10 || potential error is inconsequential since the ALJ gave Plaintiff the benefit of the doubt || regarding her use of an assistive device. (R. at 80.) Plaintiff's arguments do not persuade 12 || the Court that the ALJ improperly rejected her symptom testimony. IV. CONCLUSION 14 Accordingly, 15 IT IS ORDERED affirming the May 15, 2019 decision of the Administrative 16 || Law Judge (R. at 71-97). 17 IT IS FURTHER ORDERED directing the Clerk to enter final judgment 18 |} consistent with this Order and close this case. 19 Dated this 11th day of January, 2021. 20 Michal T. Shure 22 Michael T. Liburdi 23 United States District Judge 24 25 26 27 28 -9-