Kapp 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 Kelly R. Kapp, No. CV-18-04565-PHX-SMB 10 Plaintiff, ORDER 11 v. 12 Commissioner of Social Security Administration, 13 Defendant. 14 15 16 At issue is the denial of Plaintiff Kelly R. Kapp’s Application for Disability 17 Insurance Benefits by the Social Security Administration (SSA) under the Social Security 18 Act. Plaintiff filed a Complaint (Doc. 1) with this Court seeking judicial review of that 19 denial, and the Court now addresses Plaintiff’s Opening Brief (Doc. 13, “Pl. Br.”) and 20 Defendant SSA Commissioner’s Response Brief (Doc. 14, “Def. Br.”). Plaintiff did not 21 file a Reply Brief. The Court has reviewed the briefs and Administrative Record (Doc. 9, 22 “R.”) and now affirms the Administrative Law Judge’s decision (R. at 17–37) as upheld by 23 the Appeals Council (R. at 1–3). 24 I. BACKGROUND 25 Plaintiff filed an Application for Disability Insurance benefits on January 15, 2015, 26 for a period of disability beginning on September 1, 2014 (amended). (R. at 17.) Her claim 27 was denied initially on April 9, 2015, and upon reconsideration on August 24, 2015. (R. at 28 17.) Plaintiff appeared before the ALJ for a hearing regarding her claim on May 5, 2017, 1 which the ALJ denied on October 23, 2017. (R. at 37, 51.) On October 11, 2018, the 2 Appeals Council denied Plaintiff’s Request for Review and adopted the ALJ’s decision as 3 the agency’s final decision. (R. at 1–3.) 4 The Court has reviewed the medical evidence in its entirety and will discuss the 5 pertinent medical evidence in addressing the issues raised by the parties. Upon considering 6 the medical records and opinions, the ALJ evaluated Plaintiff’s disability based on the 7 following severe impairments: degenerative disc disease of the cervical and lumbar spine, 8 status/post anterior cruciate ligament (“ACL”) reconstruction, chondromalacia, 9 fibromyalgia, Ehlers-Danlos Syndrome (“EDS”), autonomic nervous system disorder, 10 chronic pain syndrome, status/post left shoulder arthroscopy and labrum repair. (R. at 19.) 11 Ultimately, the ALJ evaluated the medical evidence and testimony and concluded 12 that Plaintiff was not disabled from the alleged disability onset-date through the date of the 13 decision. (R. at 36.) The ALJ found that Plaintiff “did not have an impairment or 14 combination of impairments that met or medically equaled the severity of one of the listed 15 impairments in 20 CFR Part 404, Subpart P, Appendix 1.” (R. at 28.) Next, the ALJ 16 calculated Plaintiff’s residual functional capacity (“RFC”): 17 [Plaintiff] has the [RFC] to perform light work as defined in 20 CFR 404.1567(b) with the following exceptions: stand and 18 walk for a total of three hours in an eight-hour workday; occasionally climb ramps and stairs; never climb ladders, 19 ropes, or scaffolding; occasionally balance, kneel, crouch, and crawl; frequently stop; avoid concentrated exposure to extreme 20 cold, extreme heat, wetness, vibration, fumes, odors, gases, and poor ventilation; no exposure to hazards, such as moving 21 machinery or unprotected heights; frequently, not constantly, handle and finger. 22 23 (R. at 28.) Accordingly, the ALJ found that Plaintiff could perform past relevant work as 24 an administrative assistant. (R. at 34.) 25 II. LEGAL STANDARD 26 In determining whether to reverse an ALJ’s decision, the district court reviews only 27 those issues raised by the party challenging the decision. See Lewis v. Apfel, 236 F.3d 503, 28 517 n.13 (9th Cir. 2001). The Court may set aside the Commissioner’s disability 1 determination only if it is not supported by substantial evidence or is based on legal error. 2 Orn v. Astrue, 495 F.3d 625, 630 (9th Cir. 2007). Substantial evidence is relevant evidence 3 that a reasonable person might accept as adequate to support a conclusion considering the 4 record as a whole. Id. To determine whether substantial evidence supports a decision, the 5 Court must consider the record as a whole and may not affirm simply by isolating a 6 “specific quantum of supporting evidence.” Id. Generally, “[w]here the evidence is 7 susceptible to more than one rational interpretation, one of which supports the ALJ’s 8 decision, the ALJ’s conclusion must be upheld.” Thomas v. Barnhart, 278 F.3d 947, 954 9 (9th Cir. 2002) (citations omitted). 10 To determine whether a claimant is disabled for purposes of the Act, the ALJ 11 follows a five-step process. 20 C.F.R. § 404.1520(a). The claimant bears the burden of 12 proof on the first four steps, but the burden shifts to the Commissioner at step five. Tackett 13 v. Apfel, 180 F.3d 1094, 1098 (9th Cir. 1999). At the first step, the ALJ determines whether 14 the claimant is presently engaging in substantial gainful activity. 20 C.F.R. 15 § 404.1520(a)(4)(i). At step two, the ALJ determines whether the claimant has a “severe” 16 medically determinable physical or mental impairment. 20 C.F.R. § 404.1520(a)(4)(ii). At 17 step three, the ALJ considers whether the claimant’s impairment or combination of 18 impairments meets or medically equals an impairment listed in Appendix 1 to Subpart P 19 of 20 C.F.R. Part 404. 20 C.F.R. § 404.1520(a)(4)(iii). If so, the claimant is automatically 20 found to be disabled. Id. At step four, the ALJ assesses the claimant’s RFC and determines 21 whether the claimant is still capable of performing past relevant work. 20 C.F.R. 22 § 404.1520(a)(4)(iv). If not, the ALJ proceeds to the fifth and final step, where she 23 determines whether the claimant can perform any other work in the national economy 24 based on the claimant’s RFC, age, education, and work experience. 20 C.F.R. 25 § 404.1520(a)(4)(v). If not, the claimant is disabled. Id. 26 III. ANAYSIS 27 First, Plaintiff argues the ALJ erred in assigning little weight to the opinions of Dr. 28 David S. Saperstein and Dr. Jordan S. Ross and in assigning minimal weight to her physical 1 therapists (“PT”), massage therapist (“MT”), and the vocational expert (“VE”). (Pl. Br. at 2 6–18.) Second, Plaintiff argues the ALJ erred in rejecting Plaintiff symptom testimony 3 because the ALJ provided insufficient reasons for rejecting the testimony. (Pl. Br. at 23– 4 26.) 5 The Court finds the ALJ did not err in assigning weight to medical opinions and in 6 rejecting Plaintiff’s symptom testimony. First, the ALJ explained that Drs. Saperstein and 7 Ross’s medical opinions were contradictory which is why she afforded them little weight. 8 (R. at 6–19.) Second, the ALJ provided germane reasons supported by substantial evidence 9 in assigning minimal weight to PT Richard S. Randall, PT Larry A. Gruver, MT Alisha 10 Felten, and VE David A. Janus. PT Randall and PT Gruver found Plaintiff could not sit for 11 longer than 20 minutes, but in the same year, Plainitff traveled by airplane to California, 12 which the ALJ found was inconsistent. MT Felten provided an opinion unsupported by 13 documented notes and outside the scope of her expertise as a massage therapist. VE Janus 14 based his opinion on whether Plaintiff was disabled under the Arizona Revised Statutes 15 and Arizona State Retirement System, which have different standards than the Social 16 Security Act. Finally, the ALJ opined that Plaintiffs ADLs and the medical evidence do 17 not support Plaintiff’s symptom testimony. For the following reasons, the Court affirms. 18 A. The ALJ did not err in evaluating the medical opinions. 19 Plaintiff argues the ALJ erred by rejecting the medical opinions of two treating 20 physicians, Drs. Saperstein and Ross. (Pl. Br. at 5.) While “[t]he ALJ must consider all 21 medical opinion evidence,” there is a hierarchy among the sources of medical opinions. 22 Tommasetti v. Astrue, 533 F.3d 1035, 1041 (9th Cir. 2008). Those who have treated a 23 claimant are treating physicians, those who examined but did not treat the claimant are 24 examining physicians, and those who neither examined nor treated the claimant are 25 nonexamining physicians. Lester v. Chater, 81 F.3d 821, 830 (9th Cir. 1995). “As a general 26 rule, more weight should be given to the opinion of a treating source than to the opinion of 27 doctors who did not treat the claimant.” Id. This is so because treating physicians have the 28 advantage of in-person interaction and typically a longer history of treatment than a 1 claimant’s other doctors, and their “subjective judgments . . . are important, and properly 2 play a part in their medical evaluations.” Embrey v. Bowen, 849 F.2d 418, 422 (9th Cir. 3 1988). 4 An ALJ “may only reject a treating or examining physician’s uncontradicted 5 medical opinion based on ‘clear and convincing reasons.’” Carmickle v. Comm’r of Soc. 6 Sec., 533 F.3d 1155, 1164 (9th Cir. 2008) (citing Lester, 81 F.3d at 830–31). “Where such 7 an opinion is contradicted, however, it may be rejected for specific and legitimate reasons 8 that are supported by substantial evidence in the record.” Id. An ALJ meets this standard 9 by “setting out a detailed and thorough summary of the facts and conflicting medical 10 evidence, stating his interpretation thereof, and making findings.” Magallanes v. Bowen, 11 881 F.2d 747, 751 (9th Cir. 1989). 12 1. The ALJ did not err in assigning little weight to Dr. Saperstein’s medical opinions. 13 Plaintiff argues the ALJ erred in giving little weight to Dr. Saperstein’s medical 14 opinions. (Pl. Br. at 6–18.) The ALJ afforded “less than full weight” to the letters and 15 medical source statements from Dr. Saperstein because they appeared to be narratives 16 written to support Plaintiff’s application for long-term disability insurance through the 17 state. (R. at 31–32, 639–44, 1393–97, 1793–99, 2113.) 18 Plaintiff argues that the ALJ did not explain why she rejected Dr. Saperstein’s 19 opinions, but the ALJ made clear in her opinion that Dr. Saperstein’s objective and clinical 20 observations did not support the extreme limitations he described. (R. at 32; Pl. Br. at 8.) 21 Specifically, the ALJ identified that Dr. Saperstein’s initial physical examination in May 22 2014 was largely normal. (R. at 32, 693–96.) Dr. Saperstein noted in this examination that 23 Plaintiff was in no acute distress, had no sensory deficits, and had normal muscle tone, 24 bulk, strength, and gait (R. at 32, 695). At the next examination in May 2015, Dr. 25 Saperstein’s nurse practitioner found Plaintiff was in no acute distress, had no 26 abnormalities, had normal muscle tone and bulk, had full strength throughout, and had 27 normal gait and hypermobility. (R. at 32, 1486–87.) In June 2015, Dr. Saperstein also 28 examined Plaintiff’s knee because of Plaintiff’s concerns about complex regional pain 1 syndrome, but he found no warmth or temperature difference. (R. at 32, 1482–84.) In 2 August 2015, Dr. Saperstein examined Plaintiff’s left shoulder and found it was normal. 3 (R. at 32, 1820–22.) In August 2016, Dr. Saperstein observed significant tenderness to 4 palpation. (R. at 32, 1877–80.) In November 2016, Dr. Saperstein observed Plaintiff had 5 full strength and had normal coordination and gait. (R. at 32, 1870–72.) Because of these 6 examination results, the ALJ found that Dr. Saperstein’s opinions were inconsistent with 7 his records of Plaintiff’s limitations and symptoms. The inconsistencies the ALJ found 8 between Dr. Saperstein’s medical examinations and his reports of Plaintiff’s symptoms and 9 limitations are a specific and legitimate reason for giving little weight to Dr. Saperstein’s 10 opinion and are supported by substantial evidence. 11 Plaintiff contends that because her diseases are diagnosed based on self-reports, the 12 ALJ erred in finding Dr. Saperstein’s opinions should be given little weight because they 13 were largely based on Plaintiff’s self-reports. (Pl. Br. at 8–9.) Plaintiff’s opening brief 14 spends much time explaining that Plaintiff was actually diagnosed with EDS, complex 15 regional pain syndrome, and fibromyalgia but misses the issue here. The ALJ does not 16 refute that Plaintiff has these diseases, only that the diseases do not inhibit her from 17 working. Further, the ALJ makes clear that her reasoning behind rejecting Dr. Saperstein’s 18 opinions were inconsistencies between his medical examinations and his opinions of 19 Plaintiff’s degree of limitations. These inconsistencies are not a result of the nature of 20 Plaintiff’s diseases or their heavy reliance on self-reports for diagnoses and treatment. Had 21 Dr. Saperstein indicated in his medical examination reports more severe limitations based 22 on Plaintiff’s self-reports and his examination findings, perhaps these discrepancies would 23 not exist. 24 Plaintiff also argues the ALJ gave little weight to Dr. Saperstein’s opinions because 25 he incorrectly assessed Plaintiff’s mental limitations regarding her frequent interruption of 26 ability to maintain attention, concentration, persistence, and pace. (Pl. Br. at 17; R. at 26– 27 27, 643, 1396.) But the ALJ made clear that Dr. Saperstein’s opinions regarding Plaintiff’s 28 alleged mental limitations did not tie into any of his assessments to anxiety or depression 1 and that his treatment notes were “unpersuasive regarding the functional effect of potential 2 anxiety or depression.” (R. at 28, 639–44, 1393–97, 1793–99, 2113.) This was a specific 3 and legitimate reason to give little weight to Dr. Saperstein’s opinions. 4 Finally, Plaintiff argues the ALJ erred in rejecting Dr. Saperstein’s opinion because 5 Plaintiff changed her disability onset date from October 2013 to September 2014. (Pl. Br. 6 at 17, R. at 32.) Plaintiff changed the disability onset date due to her receipt of 7 unemployment benefits during that time period, and Dr. Saperstein, apparently, amended 8 his opinion of the disability onset date to reflect Plaintiff’s change. (Pl. Br. at 17.) While 9 the ALJ does mention Dr. Saperstein’s lack of explanation for changing the disability onset 10 date, it is clear from the ALJ’s analysis that she relied on the inconsistencies in Dr. 11 Saperstein’s medical opinions to make her decision to give little weight to Dr. Saperstein’s 12 medical opinions. 13 2. The ALJ did not err in giving little weight to Dr. Ross’s medical opinions. 14 Plaintiff argues the ALJ made many of the same mistakes with Dr. Ross’s opinions 15 as she did with Dr. Saperstein’s opinions by determining that Dr. Ross’s opinions were 16 based largely on Plaintiff’s self-reports. (Pl. Br. at 18–19.) Dr. Ross wrote a letter 17 concluding that Plaintiff had severe limitations in her functional capacity, she could not 18 work an occupation, she had difficulty maintain body position, and that she was unable to 19 do repetitive tasks. (R. at 33, 2111–12, 2114–15.) However, the ALJ found that Dr. Ross’s 20 records did not reveal any weakness. (R. at 33, 1586.) The ALJ also found that Dr. Ross’s 21 letter detailing Plaintiff’s alleged severe limitations contradicted Dr. Ross’s previous 22 medical findings. Additionally, the ALJ found that Dr. Ross encouraged Plaintiff to 23 exercise and do aquatic therapy, which the ALJ found is contrary to the severe limitations 24 Dr. Ross described in his letter. (R. at 33.) The ALJ provided substantial evidence in giving 25 little weight to Dr. Ross’s opinions because the medical opinions were contradictory. 26 Plaintiff also contends that the ALJ erroneously rejected Dr. Ross’s opinions 27 regarding Plaintiff’s mental limitations because they were not directly tied to anxiety or 28 depression. (R. at 28, Pl. Br. at 19.) Similar to the ALJ’s reasoning for giving little weight 1 to Dr. Saperstein’s opinions, the ALJ made clear that Dr. Ross’s opinions regarding 2 Plaintiff’s alleged mental limitations did not tie into any of his assessments to anxiety or 3 depression and that his treatment notes were “unpersuasive regarding the functional effect 4 of potential anxiety or depression.” (R. at 28.) The Court finds the inconsistencies between 5 Dr. Ross’s reports of Plaintiff’s symptoms and her alleged limitations were a specific and 6 legitimate reason supported by substantial evidence for giving little weight to Dr. Ross’s 7 opinion. 8 3. The ALJ did not err in evaluating the opinions of PT Randall, PT Gruver, MT Felten, and VE Janus. 9 The ALJ assigned minimal weight to the opinions of PT Randall, PT Gruver, MT 10 Felten, and VE Janus because they all found Plaintiff could not sustain full time work for 11 similar reasons to Drs. Saperstein and Ross. (R. at 33–34, 314–15, 335–37, 523–26, 2124, 12 2134–42, 2184–94, 2195–96.) An ALJ must give germane reasons that have evidentiary 13 support to reject lay witness testimony. Molina v. Astrue, 674 F.3d 1104, 1111 (9th Cir. 14 2012). 15 The ALJ assigned minimal weight to PT Randall and PT Gruver because they 16 opined that Plaintiff was only able to sit for 20 minute intervals in the February 2015 17 evaluation, but in May and September of 2015, Plaintiff took trips to California where she 18 would have to sit longer than 20 minutes at a time. (R. at 33, 2184–94.) Thus the ALJ 19 assigned minimal weight to their opinions that Plaintiff was unable to work for those 20 reason. (R. at 33, 523–26, 2195–96.) Additionally, the ALJ found PT Gruver’s opinions 21 too severe and unpersuasive. (R. at 33.) PT Gruver found Plaintiff could not stand, walk, 22 or sit for longer than five minutes. (R. at 33, 2196.) The ALJ provided germane reasons 23 supported by substantial evidence for rejecting the opinions of PT Randall and PT Gruver. 24 The ALJ also found MT Felten’s March 2017 letter should be given little weight. 25 (R. at 34.) In the letter, MT Felton opined that Plaintiff could not stand for long periods 26 without pain, fatigue, and occasional dizziness. (R. at 34, 2124.) MT Felten also noted 27 extreme limitations in Plaintiff’s left shoulder abduction and flexion and spasms with other 28 muscles. (R. at 34, 2124.) The ALJ found this letter offered conclusory opinions that were 1 beyond the scope of MT Felton’s scope of practice and that they were not at all supported 2 by treatment notes. (R. at 34.) The Court finds this was a germane reason supported by 3 substantial evidence for giving little weight to MT Felten’s opinions. 4 Finally, the ALJ gave minimal weight to VE Janus’s opinions. (R. at 34.) In October 5 2014 and June 2015, VE Janus reviewed Dr. Saperstein’s report and found it described 6 physical functioning that would meet the definition of disability defined under the Arizona 7 Revised Statutes and Arizona State Retirement System. (R. at 34, 76F, 20E, 335-37, 2134- 8 42.) The ALJ found the criteria set forth in these statutes is not necessarily consistent with 9 the criteria set forth to establish disability under the Social Security Act. (R. at 34.) See 20 10 C.F.R. § 404.1504 (“Because a decision by any other governmental agency or a 11 nongovernmental entity about whether you are disabled . . . is based on its rules, it is not 12 binding on us and is not our decision about whether you are disabled . . . under our rules.”). 13 The ALJ provided germane reasons supported by substantial evidence for giving minimal 14 weight to VE Janus’s opinion. 15 B. The ALJ did not err in rejecting Plaintiff’s symptom testimony. 16 Plaintiff contends the ALJ erred in rejecting her symptom testimony. (Pl. Br. at 23– 17 26.) An ALJ performs a two-step analysis to evaluate a claimant’s testimony regarding 18 pain and symptoms. Garrison v. Colvin, 759 F.3d 995, 1014 (9th Cir. 2014). First, the ALJ 19 evaluates whether the claimant has presented objective medical evidence of an impairment 20 “which could reasonably be expected to produce the pain or symptoms alleged.” 21 Lingenfelter v. Astrue, 504 F.3d 1028, 1035–36 (9th Cir. 2007) (quoting Bunnell v. 22 Sullivan, 947 F.2d 341, 344 (9th Cir. 1991) (en banc) (internal quotation marks omitted)). 23 Second, absent evidence of malingering, an ALJ may only discount a claimant’s allegations 24 for reasons that are “specific, clear and convincing” and supported by substantial evidence. 25 Molina, 674 F.3d at 1112. 26 “[T]he ALJ must specifically identify the testimony she or he finds not to be credible 27 and must explain what evidence undermines the testimony.” Holohan v. Massanari, 246 28 F.3d 1195, 1208 (9th Cir. 2001). General findings are insufficient. Id. “Although the ALJ’s 1 analysis need not be extensive, the ALJ must provide some reasoning in order for [the 2 Court] to meaningfully determine whether the ALJ’s conclusions were supported by 3 substantial evidence.” Treichler v. Comm’r of Soc. Sec. Admin., 775 F.3d 1090, 1099 (9th 4 Cir. 2014). “[T]he ALJ may consider inconsistencies either in the claimant’s testimony or 5 between the testimony and the claimant’s conduct.” Molina, 674 F.3d at 1112. For 6 instance, the ALJ may consider “‘whether the claimant engages in daily activities 7 inconsistent with the alleged symptoms.’” Id. (quoting Lingenfelter, 504 F.3d at 1040). 8 “Even where those activities suggest some difficulty functioning, they may be grounds for 9 discrediting the claimant’s testimony to the extent that they contradict claims of a totally 10 debilitating impairment,” id. at 1113, or where they suggest that “later claims about the 11 severity of [the] limitations were exaggerated,” Valentine v. Astrue, 574 F.3d 685, 694 (9th 12 Cir. 2009). Additionally, the ALJ may consider “whether the claimant takes medication or 13 undergoes other treatment for the symptoms.” Lingenfelter, 504 F.3d at 1040; see 20 14 C.F.R. § 404.1529(c)(3). “Impairments that can be controlled effectively with medication 15 are not disabling.” Warre v. Comm’r of Soc. Sec. Admin., 439 F.3d 1001, 1006 (9th Cir. 16 2006). Finally, “[a]lthough [a] lack of medical evidence cannot form the sole basis for 17 discounting pain [or symptom] testimony, it is a factor that the ALJ can consider in his 18 credibility analysis.” Burch v. Barnhart, 400 F.3d 676, 681 (9th Cir. 2005). 19 Here, the ALJ found “that [Plaintiff’s] medically determinable impairments could 20 reasonably be expected to cause the alleged symptoms. However, [Plaintiff] and her 21 husband’s, father’s, and friends’ statements concerning the intensity, persistence, and 22 limiting effects of these symptoms are not entirely consistent with the medical evidence 23 and other evidence in the record for the reasons explained in this decision.” (R. at 29.) The 24 ALJ provided “specific, clear and convincing” reasons supported by substantial evidence 25 in rejecting Plaintiff’s symptom testimony based on Plaintiff’s activities of daily living 26 (“ADLs”) and the objective medical evidence. See Molina, 674 F.3d at 1112. 27 First, the ALJ did not err in rejecting Plaintiff’s symptom testimony based on 28 Plaintiff’s ADLs. Plaintiff argues the ALJ omitted substantial evidence of daily limitations, 1 but the ALJ’s opinion considers Plaintiff’s daily limitations. (R. at 28–29; Pl. Br. at 25.) 2 The ALJ goes into detail describing Plaintiff’s allegations of her symptoms. (R. at 19–21.) 3 The ALJ explains that Plaintiff reported she has difficulties, walking, sitting, lifting, and 4 carrying. (R. at 20.) The ALJ notes Plaintiff described issues with chronic pain, muscles 5 spams, and constant joint pain in her beck, ribs, mid back, low back, hips, knees, left ankle, 6 and wrists. (R. at 20.) The ALJ notes Plaintiff’s history with colonic or bowel spasms 7 causing constipation, reflux, and heartburn, as well as her lightheadedness due to her 8 body’s inability to regulate her heart rate or blood pressure. (R. at 20.) The ALJ also 9 included that Plaintiff estimated she would be able to sit for 15 to 20 minutes as one time 10 for a total or two hours in an eight-hour workday, stand 10 minutes at one time for a total 11 of one hour, walk for 10 minutes at one time for a total of one hour, and lift five to eight 12 pounds at one time. (R. at 20, 30.) Regardless, Plaintiff was still able to pursue activities 13 that were not consistent with the limitations she alleged. For example, Plaintiff said she 14 could drive a car and completed one to two activities per day. (R. at 20, 27, 1502.) 15 Defendant also points out that after Plaintiff stopped working, she got married, adopted a 16 puppy, and joined a support group. (R. at 27, 30, 1753, 1760, 1763.) Plaintiff was also able 17 to sit on an airplane long enough to fly to California twice in 2015 for vacation, which the 18 ALJ noted called into question Plaintiff’s claim that she could not sit for more than a few 19 minutes at a time. (R. at 31, 1753.) Plaintiff also attended physical therapy and took part in 20 aquatic therapy indicating her ability to move and exercise. (R. at 30, 2240, 2242.) Plaintiff 21 also noted that Dr. Saperstein said Plaintiff could not live independently, but as explained 22 previously, the ALJ appropriately gave little weight to Dr. Saperstein’s opinion. (R. at 23 1796; Pl. Br. at 25.) The ALJ appropriately focused on the discrepancies between 24 Plaintiff’s allegations and her ADLs. 25 Second, the ALJ thoroughly explained how Plaintiff’s medical evidence did not 26 support her symptom allegations. The ALJ explained that Plaintiff’s examinations from 27 her providers did not reveal significant deficits in line with Plaintiff’s reports of her 28 functional limitations. (R. at 30.) The ALJ explained that Plaintiff’s medical examinations 1 largely revealed normal findings and occasionally reflected tenderness to palpation and 2 joint hyperextensibility. (R. at 30.) The ALJ acknowledged that diagnostic testing revealed 3 mild degeneration, which in combination with Plaintiff’s EDS, resulted in some limitations 4 caused by tenderness at various parts of her body, but explained that despite this, Plaintiff 5 had a lack of neurological or significant musculoskeletal deficits over many examinations. 6 (R. at 30, 693–96, 750, 1487, 1945, 1959, 2133.) Plaintiff also had similarly normal 7 examinations from her knee specialist Dr. Chhabra, pain specialist Dr. Zakas, neurologist 8 Dr. Kapoor, spinal specialist Dr. Crandall, and orthopedic surgeon Dr. Burgess. (R. at 30, 9 722–23, 749–51, 754–55, 1933–34.) In addition to the normal findings from Plaintiff’s 10 doctors, the ALJ found that Plaintiff’s symptoms were managed with conservative 11 treatment including physical therapy and exercise. (R. at 31, 722–841, 1505, 1507, 1577– 12 79.) 13 Plaintiff specifically argues that the ALJ erred in finding Plaintiff did not need an 14 assistive device. (Pl. Br. at 24.) Plaintiff explains she was prescribed or recommended by 15 treating sources that she needed an assistive device including knee braces, a back brace, 16 wrist braces, an SI belt, and a power scooter. (R. at 495, 746, 1371, 1578, 1777, 1814, 17 1934, 1939; Pl. Br. at 24.) The ALJ found, however, that Plaintiff’s primary care physician 18 submitted a request for a scooter at Plaintiff’s request, and the scooter was denied by 19 insurance twice. (R. at 30, 85.) The ALJ also points out the record indicates none of 20 Plaintiff’s doctors prescribed her use of a wheelchair or that they thought it was needed. 21 (R. at 30.) Though Plaintiff was recommended by treating sources that she wears braces 22 for her knees or wrists are various times, Plaintiff was never prescribed a power scooter, 23 thus the ALJ did not err in finding Plaintiff did not need one. 24 Additionally, Plaintiff argues the ALJ erred in finding that Plaintiff’s symptoms 25 were managed with conservative treatment because this is not a valid reason for diseases 26 with no cure. (R. at 31; Pl. Br. at 26.) Defendant correctly points out that even if Plaintiff’s 27 diagnosed conditions do not have a cure, “it does not follow that the nature of treatment is 28 irrelevant.” (Def. Br. at 10.) Defendant explains that “[u]nder Plaintiff’s theory, course of 1 || treatment for any congenital, genetic, or autoimmune disorder would be irrelevant to the 2|| consistency analysis, and that argument has no support in the regulations. The question is 3 || not whether Plaintiff has specific diagnoses, but the extent to which her impairments result in functional limitations.” (Def. Br. at 10.) The Court agrees. Plaintiff is incorrect in 5 || arguing that because her diseases are not curable, that the ALJ’s finding well-managed 6 || conservative treatment is not a valid reason for discounting her symptom testimony. Even 7|| more, the ALJ noted that Plaintiff often adjusted, never took, or stopped taking her 8 || prescribed medications on her own. (R. at 21, 25-26, 1482, 1761, 1811, 1874-80, 2127- 29.) The ALJ provided specific, clear, and convincing reasons supported by substantial || evidence in rejecting Plaintiff's symptom testimony including contradictions with 11} Plaintiff's ADLs and symptoms, contradictions with medical evidence, and □□□□□□□□□□□ 12 || noncompliance with treatment, as well as her well-managed conservative treatment. 13) IV. CONCLUSION 14 Substantial evidence supports the ALJ’s nondisability determination. The ALJ 15 || provided sufficient reasons supported by substantial evidence in considering the medical opinions and in rejecting Plaintiff's symptom testimony. 17 IT IS THEREFORE ORDERED affirming the October 23, 2017 decision of the 18 |} Administrative Law Judge (R. at 17-37), as upheld by the Appeals Council on October 11, 2018 (R. at 1-3). 20 IT IS FURTHER ORDERED directing the Clerk to enter final judgment 21 || consistent with this Order and close this case. 22 Dated this 13th day of January, 2021. 23 —_—_— 24 S JS fe 25 Aionorable Susan M. Brnovich □□ 46 United States District Judge 27 28 -13-