(SS) Kephart v. Commissioner of Social Security ( 2023 )

2 3 4 5 6 7 8 UNITED STATES DISTRICT COURT 9 EASTERN DISTRICT OF CALIFORNIA 10 11 12 SANDRA L. KEPHART, Case No. 1:22-cv-00945-EPG 13 Plaintiff, FINAL JUDGMENT AND ORDER REGARDING PLAINTIFF’S SOCIAL 14 v. SECURITY COMPLAINT 15 COMMISSIONER OF SOCIAL SECURITY, (ECF Nos. 1, 25). 16 Defendant. 17 This matter is before the Court on Plaintiff’s complaint for judicial review of an 18 unfavorable decision by the Commissioner of the Social Security Administration regarding her 19 application for disability benefits. The parties have consented to entry of final judgment by the 20 United States Magistrate Judge under the provisions of 28 U.S.C. § 636(c) with any appeal to the 21 Court of Appeals for the Ninth Circuit. (ECF No. 11). 22 Plaintiff presents the following issues: 23 1. The ALJ did not properly evaluate the evidence of mental impairments, or 24 even account for her own findings of mental limitations, when assessing Ms. Kephart’s RFC. 25 2. The ALJ did not sustainably find that Ms. Kephart could perform her past relevant semi-skilled work. 26 3. The ALJ failed to comply with the remand orders issued in this case when 27 evaluating the opinion evidence from Dr. Coombs. 28 (ECF No. 15-1, p. 5) (alterations to capitalization). 2 applicable law, the Court finds as follows: 3 I. ANALYSIS 4 A. Step 2 Finding and RFC 5 Plaintiff’s first issue argues that the (1) ALJ’s decision at Step 2—that Plaintiff did not 6 have a severe mental impairment relating to her mood disorder—is not based on substantial 7 evidence and (2) even if the Plaintiff did not have a severe mental impairment, the ALJ erred by 8 failing to address her mental limitations when formulating the RFC. 9 1. Step 2 10 Plaintiff argues that the ALJ’s conclusion that her mood disorder was not a severe mental 11 impairment is not supported by substantial evidence because (1) evidence contradicted the ALJ’s 12 findings that medication controlled her symptoms and (2) the ALJ failed to account for all the 13 findings of psychological consultative examiner Dr. Stenbeck, whose opinion the ALJ deemed 14 persuasive. (ECF No. 15-1, p. 18-21). Defendant counters that (1) the ALJ provided other 15 reasons, which Plaintiff does not challenge, that show she had no severe mental impairment; (2) 16 the evidence supports the ALJ’s conclusion that medication controlled her symptoms, and (3) the 17 ALJ properly accounted for Dr. Stenbeck’s opinion, which ultimately concluded that Plaintiff had 18 only mild mental limitations. (ECF No. 17, pp. 7-11). 19 If a claimant has a medically determinable impairment (MDI), the ALJ must determine 20 “whether [the] impairment(s) is severe,” which is referred to as Step Two. 20 C.F.R. § 404.1521. 21 A “severe” impairment is “any impairment or combination of impairments which significantly 22 limits [a claimant’s] physical or mental ability to do basic work activities.” 20 C.F.R. 23 § 404.1520(c). The “ability to do basic work activities,” in turn, is defined as “the abilities and 24 aptitudes necessary to do most jobs.” 20 C.F.R. § 404.1522(b). In evaluating mental impairments, 25 the ALJ considers four broad function areas: “Understand, remember, or apply information; 26 interact with others; concentrate, persist, or maintain pace; and adapt or manage oneself.” 20 27 C.F.R. § 404.1520a(c)(3). 28 The Ninth Circuit has provided the following guidance regarding whether medically 2 An impairment or combination of impairments may be found “not severe only if the evidence establishes a slight abnormality that has no more than a minimal 3 effect on an individual’s ability to work.” [Smolen v. Chater, 80 F.3d 1273, 1290 (9th Cir. 1996)] (internal quotation marks omitted) (emphasis added); see Yuckert 4 v. Bowen, 841 F.2d 303, 306 (9th Cir. 1988). The Commissioner has stated that 5 “[i]f an adjudicator is unable to determine clearly the effect of an impairment or combination of impairments on the individual’s ability to do basic work activities, 6 the sequential evaluation should not end with the not severe evaluation step.” 7 S.S.R. No. 85–28 (1985). Webb v. Barnhart, 433 F.3d 683, 686-87 (9th Cir. 2005). A Step 2 finding must be supported by 8 substantial evidence, which “is such relevant evidence as a reasonable mind might accept as 9 adequate to support a conclusion.” Id. at 686. 10 Regarding Plaintiff’s mood disorder, the ALJ provided the following reasoning for 11 concluding that it was not a severe impairment: 12 The first functional area is understanding, remembering, or applying information. 13 The claimant alleged low energy, motivation and mood (Ex. 9F/2). At times, the 14 claimant presented as anxious or depressed in the setting of chronic spinal symptoms (e.g., Ex. 9F/5). At other times, the claimant reported a good mood 15 despite her chronic back pain (e.g., Exs. 4F/6 and 27F/6/30). Overall, her mental status examinations were unremarkable and documented normal affect, normal 16 thought contact and intact cognition (Exs. 4F/15/47/52, 8F/3, 9F/2, 12F/13, 15F/3 17 and 27F/34). The claimant’s treatment records showed no evidence of significantly impaired memory, understanding or cognition. During the internal medicine 18 consultative examination, the claimant recalled 3/3 words immediately and 2/3 words in five minutes (Ex. 8F/4). During the psychological examination, the 19 claimant demonstrated intact intelligence, adequate fund of knowledge, intact 20 abstract thinking, and intact, linear and logical thought processes (Ex. 9F/5). Further, the claimant’s mental symptoms improved with psychotropic medication 21 management, such as fluoxetine (e.g., Ex. 12F/6). Based on the claimant’s generally normal memory and intact cognition, I find the claimant has a mild 22 limitation in this area of mental functioning. 23 The next functional area is interacting with others. The claimant reported getting 24 anxious in public places and becoming easily flustered and upset (Ex. 9F/2). At times, the claimant presented as anxious or depressed in the setting of chronic 25 spinal symptoms (e.g., Ex. 9F/5). At other times, the claimant reported a good mood despite persistent pain symptoms (e.g., Exs. 4F/6 and 27F/6/30). Her mental 26 status examinations generally documented normal affect, normal speech, 27 cooperative behavior and calm demeanor (Exs. 4F/15/47/52, 8F/3, 9F/2, 12F/13, 15F/3 and 27F/34). During the psychological examination, the claimant presented 28 in a friendly manner and exhibited good eye contact, normal facial expression and improved with psychotropic medication management, such as fluoxetine (e.g., Ex. 2 12F/6). Based on the claimant’s generally cooperative behavior, normal affect and calm demeanor, I find the claimant has a mild limitation in this area of mental 3 functioning. 4 The third functional area is concentrating, persisting, or maintaining pace. The claimant alleged low energy, motivation and mood (Ex. 9F/2). At times, the 5 claimant presented as anxious or depressed in the setting of chronic spinal 6 symptoms (e.g., Ex. 9F/5). At other times, the claimant reported a good mood despite her chronic back pain (e.g., Exs. 4F/6 and 27F/6/30). Her mental status 7 examinations generally documented normal affect, normal speech, full orientation and normal thought processes (Exs. 4F/15/47/52, 8F/3, 9F/2, 12F/13, 15F/3 and 8 27F/34). There was no evidence of significantly impaired concentration and/or 9 attention. During the psychological examination, the claimant exhibited adequate attention, good concentration, and intact, linear and logical thought processes (Ex. 10 9F/5). Based on the claimant’s adequate attention and good concentration, I find the claimant has a mild limitation in this area of mental functioning. 11 The fourth functional area is adapting or managing oneself. The claimant alleged 12 low energy, motivation and mood (Ex. 9F/2). At times, the claimant presented as anxious or depressed in the setting of chronic spinal symptoms (e.g., Ex. 9F/5). At 13 other times, the claimant reported a good mood despite her chronic back pain (e.g., 14 Exs. 4F/6 and 27F/6/30). Her mental status examinations generally documented normal affect, normal speech, cooperative behavior, good grooming, calm 15 demeanor and normal thought processes (Exs. 4F/15/47/52, 8F/3, 9F/2, 12F/13, 15F/3 and 27F/34). During the psychological examination, the claimant presented 16 in a friendly manner and exhibited good eye contact, normal facial expression, 17 intact judgment, intact insight and unremarkable thought content (Ex. 9F/5). Based on the claimant’s lack of significant adaptive deficits, I find the claimant has a 18 mild limitation in this area of mental functioning. 19 (A.R. 1793-94). 20 Additionally, the ALJ relied on the findings of three physicians—including Dr. 21 Stenbeck—to conclude that Plaintiff’s mood disorder causes no more than mild limitation in any 22 of the functional areas and the evidence does not otherwise indicate that there is more than a 23 minimal limitation in the claimant’s ability to do basic work activities; thus, it was nonsevere. 24 (A.R. 1794) (citing 20 C.F.R. § 404.1520a(d)(1), which provides as follows: “If we rate the 25 degrees of your limitation as ‘none’ or ‘mild,’ we will generally conclude that your impairment(s) 26 is not severe, unless the evidence otherwise indicates that there is more than a minimal limitation 27 in your ability to do basic work activities (see § 404.1522).”). 28 2 Plaintiff does not address the bulk of the ALJ’s reasons for deeming her mood disorder 3 nonsevere. (ECF No. 17, p. 9). The Court agrees. Importantly, even if Plaintiff established that 4 some of the ALJ’s reasons were not supported by substantial evidence, such error would be 5 “harmless so long as there remains substantial evidence supporting the ALJ’s decision and the 6 error does not negate the validity of the ALJ’s ultimate conclusion.” Molina v. Astrue, 674 F.3d 7 1104, 1115 (9th Cir. 2012) (internal citation and quotation marks omitted). Here, the ALJ’s 8 reliance on (1) unremarkable mental health examinations; (2) the lack of supporting evidence of 9 mental limitations; and (3) doctors who found Plaintiff’s mental impairments nonsevere provide 10 substantial evidence for the Step 2 decision. 11 Additionally, Plaintiff’s challenge to the ALJ’s other reasons fails. First, Plaintiff argues 12 that, contrary to the ALJ’s determination, her medication did not control her symptoms, citing a 13 medical record where Plaintiff reported that her “fluoxetine at 20mg daily is not holding her” and 14 Plaintiff appeared to be “under a lot more anxiety with a court appearance coming.” (ECF No. 15- 15 1, p. 19) (citing A.R. 2098). Under the substantial evidence standard, the Court must “uphold the 16 ALJ’s conclusion when the evidence is susceptible to more than one rational interpretation” and 17 draw reasonable inferences in support of the ALJ’s findings. Tommasetti v. Astrue, 533 F.3d 18 1035, 1038 (9th Cir. 2008). Here, a rational interpretation of the record supports the ALJ’s 19 decision. Notably, Plaintiff’s treatment provider did not take her off the medication, but simply 20 increased the dosage to see if it would be more effective. (A.R. 2098). And, as the ALJ noted, 21 another record indicated that this medication helped Plaintiff, at least at times. (A.R. 1793) (citing 22 A.R. 530 - “The patient feels that she is better, less anxious and seems a little more hopeful that 23 fluoxetine has been added.”). Moreover, the record indicates that Plaintiff’s upcoming court 24 appearance placed her “under a lot more anxiety,” meaning that her medication was likely less 25 effective at this particularly stressful time as opposed to ineffective most of the time. 26 Plaintiff next argues that the ALJ did not properly evaluate Dr. Stenbeck’s opinion. (ECF 27 No. 15-1, p. 20). Specifically, Plaintiff argues that, despite finding Dr. Stenbeck’s opinion 28 persuasive, the ALJ failed to consider certain portions of the opinion—most notably, that Plaintiff 2 Defendant points out, despite this notation, Dr. Stenbeck assessed Plaintiff as being only “mildly 3 limited due to mood symptoms and limited coping abilities.” (A.R. 511). Moreover, all of Dr. 4 Stenbeck’s findings regarding Plaintiff’s various work-related abilities concluded that she was 5 either “not significantly limited” or only “mildly limited.” (A.R. 510-11). Thus, there is nothing 6 to show that any of Dr. Stenbeck’s additional commentary—like Plaintiff’s symptoms being 7 exacerbated in a stressful environment—made her more than mildly limited in any functional 8 area. 9 Because the record rationally supports the ALJ’s decision that Plaintiff’s mood disorder is 10 nonsevere, it must be upheld. 11 2. RFC 12 Plaintiff next argues that, even if there was no error at Step 2, the ALJ improperly failed to 13 account for her mental limitations in formulating the RFC because the ALJ failed to address her 14 limitations in any meaningfully way. (ECF No. 15-1, p. 21). Because this argument ties in with 15 Plaintiff’s next issue—that the ALJ’s failure to include mental limitations in the RFC renders the 16 ALJ’s finding that Plaintiff could perform her past work as a telephone solicitor unsupported by 17 substantial evidence—the Court considers both issues together. (Id. at 32). Defendant argues that 18 the ALJ reasonably chose not to include mental limitations in the RFC and that Plaintiff fails to 19 specify what limitations should have been included so as to establish harmful error. (ECF No. 17, 20 pp. 12-13). 21 A claimant’s RFC is “the most [a claimant] can still do despite [her] limitations.” 20 22 C.F.R. §§ 404.1545(a), 416.945(a); see also 20 C.F.R. Part 404, Subpart P, Appendix 2, 23 § 200.00(c) (defining an RFC as the “maximum degree to which the individual retains the 24 capacity for sustained performance of the physical-mental requirements of jobs”). “In 25 determining a claimant’s RFC, an ALJ must consider all relevant evidence in the record, 26 including, inter alia, medical records, lay evidence, and the effects of symptoms, including pain, 27 that are reasonably attributed to a medically determinable impairment.” Robbins v. Soc. Sec. 28 Admin., 466 F.3d 880, 883 (9th Cir. 2006) (internal quotation marks and citations omitted). An 2 F.3d 1211, 1217 (9th Cir. 2005). 3 “Once the ALJ determines the claimant’s RFC, he then compares these limitations with 4 the job duties of the claimants previous work.” Sazo v. Colvin, No. EDCV 15-01078 SS, 2016 5 WL 447797, at *5 (C.D. Cal. Feb. 4, 2016). If the ALJ’s RFC is incomplete, the subsequent 6 ALJ’s determination that a plaintiff could perform past relevant work based on the RFC may be 7 unsupported by substantial evidence. See id. at 6 (“The ALJ’s step four determination that 8 Plaintiff can perform her past relevant work is based on an incomplete RFC that failed to consider 9 Plaintiff's visual impairments and therefore is unsupported by substantial evidence.”). 10 As for the differences between Step 2 and the RFC finding, the Ninth Circuit has 11 observed: 12 Step two is merely a threshold determination meant to screen out weak claims. Bowen v. Yuckert, 482 U.S. 137, 146–47, 107 S.Ct. 2287, 96 L.Ed.2d 119 (1987). 13 It is not meant to identify the impairments that should be taken into account when determining the RFC. In fact, “[i]n assessing RFC, the adjudicator must consider 14 limitations and restrictions imposed by all of an individual’s impairments, even 15 those that are not ‘severe.’” Titles II & XVI: Assessing Residual Functional Capacity in Initial Claims, Social Security Ruling (“SSR”) 96-8p, 1996 WL 16 374184, at *5 (S.S.A. July 2, 1996). The RFC therefore should be exactly the same 17 regardless of whether certain impairments are considered “severe” or not. Buck v. Berryhill, 869 F.3d 1040, 1048-49 (9th Cir. 2017). 18 Here, the ALJ formulated the following RFC for Plaintiff: 19 I find that the claimant has the residual functional capacity to perform sedentary 20 work as defined in 20 CFR 404.1567(a) except she can stand or walk two hours in 21 an eight-hour workday and sit more than six hours in an eight-hour workday. She can occasionally climb ramps and stairs, but cannot climb ladders, ropes or 22 scaffolds. She can occasionally balance, stoop, kneel, crouch or crawl. She can occasionally reach overhead. She can have no exposure to unprotected heights or 23 dangerous moving machinery. She can use a cane as needed for standing or 24 walking. 25 (A.R. 1795-96). 26 Plaintiff argues that “the ALJ actually failed to meaningfully address [her] mental 27 limitations during the residual functional capacity assessment.” (ECF No. 15-1, p. 21). Pointing to 28 the ALJ’s discussion from Step 2, Defendant argues that “the ALJ reasonably did not include any 2 that the evidence suggests any particular mental limitations that the ALJ did not consider” so as to 3 establish harmful error. (ECF No. 17, p. 12). 4 Ultimately, because the Court concludes that any error here would be harmless, it need not 5 address whether the ALJ failed to adequately address Plaintiff’s mental limitations apart from the 6 Step 2 discussion in formulating the RFC. As the Ninth Circuit has concluded, “harmless error 7 applies in the Social Security context,” Stout v. Comm’r, Soc. Sec. Admin., 454 F.3d 1050, 1054 8 (9th Cir. 2006), with the burden of showing error falling on Plaintiff here, see Molina, 674 F.3d at 9 1111. 10 Here, although the ALJ did not address mental limitations in connection with the RFC, the 11 ALJ’s discussion in connection with Step 2 provides a reasonable understanding of the ALJ’s 12 opinion regarding those limitations. See Brown-Hunter v. Colvin, 806 F.3d 487, 492 (9th Cir. 13 2015) (noting that an ALJ decision will be upheld where the underlying reasoning can reasonably 14 be discerned). As discussed above, the ALJ found mostly normally mental status examinations 15 and deemed persuasive the findings of medical professionals finding only mild limitations. 16 Notably, Plaintiff does not argue that any specific additional limitations would follow from such 17 reasoning. 18 Moreover, while Plaintiff generally indicates that mental limitations should have been 19 included in the RFC, she does not specify what those specific limitations should have been, why 20 they should have been included based on the record evidence, and how such limitations would 21 have precluded her from her past work. While Plaintiff at one point states that “the vocational 22 witness at the first hearing testified that the job at issue could not be performed if Ms. Kephart 23 was limited to simple, repetitive tasks,” the ALJ did not make any findings in its Step 2 analysis 24 that would support such limitations. Moreover, the medical opinions relied on in the ALJ’s Step 2 25 analysis of mental impairments also did not limit Plaintiff to simple, repetitive tasks. 26 For these reasons, the Court cannot find harmful error in the ALJ’s RFC formulation or 27 determination that Plaintiff is capable of performing her past work as a telephone solicitor. See 28 Alexander v. Saul, No. 1:19-CV-01208-SKO, 2021 WL 929615, at *11 (E.D. Cal. Mar. 11, 2021) 2 should have credited or what additional limitations should have been included in her mental RFC, 3 nor [did] she explain how the ALJ’s mental RFC determination is inconsistent with her 4 testimony”). 5 B. Compliance with the Remand Order 6 Some brief background is needed before addressing Plaintiff’s remaining issue. This is 7 Plaintiff’s second complaint regarding the denial of benefits. Her first complaint was filed in 8 1:20-cv-516-BAM, which resulted in the presiding Judge approving the parties’ voluntary 9 stipulation to remand the case under Sentence Four of 42 U.S.C. § 405(g). (ECF No. 21 of 1:20- 10 cv-516-BAM). The remand order reflected the parties’ agreement that the Commissioner would 11 conduct necessary further proceedings and issue a new decision on remand. 12 On remand, the Appeals Council vacated the ALJ’s decision and remanded with 13 instructions to address certain issues. Pertinent here, the order directed the ALJ to properly 14 evaluate the supportability and consistency factors, after considering certain evidence, in 15 evaluating the opinion of Dr. Jack Coombs. (A.R. 1866); 20 C.F.R. §§ 404.1520c(b)(2) (listing 16 supportability and consistency factors for evaluating medical opinions for claims filed on or after 17 March 27, 2017). 18 With respect to supportability, the Administrative Law Judge concluded that there were inaccuracies regarding Dr. Coombs’s conclusions that the claimant 19 experiences impaired appetite and weight change and that the claimant can only sit for five minutes at a time without interruption or changing positions (Decision, 20 page 11). However, the Administrative Law Judge did not consider the factor of 21 supportability with respect to the remainder of Dr. Coombs’s opinion. For example, Dr. Coombs also opined that the claimant has significant limitations with 22 regard to her ability to lift and carry, stand and walk, perform postural activities, 23 manipulate, tolerate environmental conditions, and sustain work without time off- task or absenteeism (Exhibit 10F, pages 2-3). Further, the Administrative Law 24 Judge reasoned that the extreme limitations contained in Dr. Coombs’s opinion lack explanation as to why the claimant is so limited (Decision, page 11). 25 However, Dr. Coombs indicated that he relied on positive clinical signs in 26 rendering his opinion, including reduced range of motion, abnormal gait, muscle spasm, swelling, tenderness, and impaired sleep (Exhibit 10F, page 2). The 27 Administrative Law Judge did not consider these findings in evaluating the supportability of Dr. Coombs's opinion. 28 limitations set forth in Dr. Coombs’s opinion are not supported by the overall 2 evidence (Decision, page 11). However, the Administrative Law Judge did not provide any further rationale or citation to the record in support of this conclusion. 3 Notably, treatment notes reflect that Dr. Coombs observed marked limited motion laterally to the neck and straight leg raising referring pain to the low back 4 bilaterally (Exhibits 4F, page 10; and 11F, page 5). Dr. Coombs further observed 5 that the claimant was uncomfortable sitting and moved to alleviate her pain, walked flexed over due to pain, and looked a little bit unstable getting up from a 6 seated position (Exhibits 4F, page 15; 11F, page 9; and 15F, page 3). Further, in December 2018, Dr. Coombs observed that the claimant “is now needing a walker 7 to get around” (Exhibit 15F, page 53). Other medical records reveal positive 8 clinical abnormalities, including tenderness, positive straight leg raise tests, atrophy, limited range of motion, decreased sensation, limping gait, and an 9 inability to do heel and toe walking (Exhibits 1F, pages 3 and 5; 4F, pages 44, 130, 10 and 136; and 8F, page 4). However, the Administrative Law Judge did not consider this evidence in evaluating the consistency of Dr. Coombs’s opinion. 11 Further evaluation of the medical source opinions and prior administrative medical findings is therefore warranted. 12 (A.R. 1867). 13 After the instant adverse decision, Plaintiff appealed, alleging, among other things, that 14 the ALJ did not comply with these instructions. (A.R. 1778). However, the Appeals Council 15 rejected this argument. 16 Now before this Court, Plaintiff argues that the ALJ did not fully comply with the Appeals 17 Council’s remand order and argues that such constitutes reversible error. (ECF No. 15-1, p. 22). 18 Defendant argues that ALJ complied with the remand order. (ECF No. 17, p. 13). Accordingly, 19 the Court now considers the ALJ’s discussion of Dr. Coombs’s opinion: 20 Jack Coombs, M.D., the claimant’s treating physician, submitted a medical source 21 statement dated August 2018 (Ex. 10F). Dr. Coombs opined the claimant can lift/carry up to five pounds occasionally, stand/walk up to ten minutes at one time 22 for a total of one hour in an eight-hour workday, and sit for five minutes at one 23 time for a total of two hours in an eight-hour workday (Id.). Dr. Coombs further opined the claimant must change positions every five minutes (Id.). He opined the 24 claimant can never bend, climb, balance, stoop, crouch, kneel, crawl or finger, and occasionally reach, handle, feel, push, pull, flex her neck/head forward, tilt her 25 head back, and turn neck/head from side-to-side (Id.). He opined the claimant is 26 limited in her ability to work around heights, temperature extremes and humidity (Id.). Dr. Coombs opined the claimant needs one-hour breaks after every 30 27 minutes (Id.). Dr. Coombs opined the claimant can maintain attention and concentration more than 50% of the time due to pain and will be absent more than 28 relied on the claimant’s diagnoses of spinal stenosis of the lumbar spine and 2 degenerative disc disease of the cervical spine (Id.). He also noted clinical signs, including reduced range of motion, abnormal gait, muscle spasm, weight change, 3 swelling, tenderness, impaired sleep and impaired appetite (Id.). In an updated medical source statement dated July 2021, Dr. Coombs confirmed his prior 4 medical opinion (Ex. 28F). In supporting this opinion, Dr. Coombs relied on the 5 claimant’s self reports of constant neuropathic pain and stinging in her feet as well as the claimant’s weight gain of 50 pounds due to inactivity (Id.). For the same 6 reasons discussed regarding Dr. Williams’ prior administrative finding, I find Dr. Coombs’ medical opinion inconsistent. Further, Dr. Coombs’ opinion is 7 inconsistent with his own clinical observations. For example, while the claimant 8 had positive straight leg raises, she also had good strength and showed no evidence of swelling (e.g., Exs. 4F/10 and 5F). Dr. Coombs’ opinions did not consider the 9 claimant’s positive response to medication management and lumbar surgery, 10 which are clearly documented in his own treatment records (e.g., Exs. 26F and 27F). Finally, Dr. Coombs’ opinion dated July 2021 relies on the claimant’s self- 11 reports of neuropathic pain; however, clinical examinations documented infrequently decreased sensation in the left lower extremity and the claimant 12 engaged in activities of daily living inconsistent with a disabling level of 13 neuropathic pain in her feet, such as driving a car and being independent with her activities of daily living (Id.). Based on the foregoing, I find Dr. Coombs’ medical 14 opinion unpersuasive. 15 (A.R. 1801-02). Elsewhere, in the decision, the ALJ further discussed evidence relating to 16 Plaintiff’s treatment with Dr. Coombs. 17 Upon review, the Court does not conclude that the ALJ failed to comply with the Appeals 18 Council’s remand order. Importantly, that order directed the ALJ to consider certain findings in 19 conjunction with evaluating the opinion for supportability and consistency—the order did not 20 direct the ALJ to reach any conclusion as to the persuasiveness of the opinion. Here, the ALJ 21 sufficiently considered Dr. Coombs opinion as directed, e.g., the ALJ recognized that Dr. Coombs 22 relied on clinical signs, including reduced range of motion, abnormal gait, muscle spasm, weight 23 change, swelling, tenderness, impaired sleep and impaired appetite. 24 Moreover, even if the ALJ did not comply in all respects with the remand order, that does 25 not necessarily warrant reversal as “[t]he ALJ’s errors are relevant only as they affect that 26 analysis on the merits” because “[a] claimant is not entitled to benefits under the statute unless the 27 claimant is, in fact, disabled, no matter how egregious the ALJ’s errors may be.” Strauss v. 28 Comm'r of the Soc. Sec. Admin., 635 F.3d 1135, 1138 (9th Cir. 2011). On this point, Plaintiff 1 | argues that the ALJ should have found Dr. Coombs’s opinion persuasive. However, the ALJ’s 2 || rejection of the opinion is sufficiently supported by substantial evidence, e.g., the ALJ’s citation 3 | to normal examination findings, positive response to treatment, and Plaintiff's daily activities. 4 | Moreover, in formulating the RFC for Plaintiffs physical limitations, the ALJ relied on three 5 || other doctors, adopting less restrictive limitations than Dr. Coombs’s opined based on their 6 | recommendations. (A.R. 1800-01). While Plaintiff argues that the record could support a different 7 | conclusion as to the evidence, this at most amounts to another “rational interpretation,” meaning 8 | that “the decision of the ALJ must be upheld. Orteza v. Shalala, 50 F.3d 748, 749 (9th Cir. 1995). 9 Accordingly, the Court concludes that the ALJ complied with the Appeals Council’s 10 || remand order and the ALJ’s review of Dr. Coomb’s opinion was supported by substantial 11 | evidence after consideration of the supportability and consistency factors. 12 | IL CONCLUSION AND ORDER 13 Based on the above reasons, the decision of the Commissioner of Social Security is 14 | affirmed. And the Clerk of the Court is directed to close this case. 15 16 IT IS SO ORDERED. 71 Dated: _May 16, 2023 [Je hey — 18 UNITED STATES MAGISTRATE JUDGE 19 20 21 22 23 24 25 26 27 28 12