(SS) Igasan v. Commissioner of Social Security ( 2024 )

1 2 3 4 5 6 7 UNITED STATES DISTRICT COURT 8 EASTERN DISTRICT OF CALIFORNIA 9 10 CYNTHIA MARIE IGASAN, Case No. 1:23-cv-00031-SAB 11 Plaintiff, ORDER DENYING PLAINTIFF’S MOTION FOR SUMMARY JUDGMENT; DIRECTING 12 v. CLERK OF THE COURT TO ENTER JUDGMENT IN FAVOR OF DEFENDANT 13 COMMISSIONER OF SOCIAL COMMISSIONER OF SOCIAL SECURITY0 SECURITY, AND AGAINST PLAINTIFF CYNTHIA 14 MARIE IGASAN AND TO CLOSE THIS Defendant. ACTION 15 (ECF Nos. 15, 16, 18) 16 17 I. 18 INTRODUCTION 19 Cynthia Marie Igasan (“Plaintiff”) seeks judicial review of a final decision of the 20 Commissioner of Social Security (“Commissioner” or “Defendant”) denying her application for 21 disability benefits pursuant to the Social Security Act. The matter is currently before the Court on 22 the parties’ briefs, which were submitted, without oral argument, to Magistrate Judge Stanley A. 23 Boone.1 24 Plaintiff requests the decision of the Commissioner be vacated and the case be remanded for 25 further proceedings, arguing the Administrative Law Judge improperly discounted the opinion of Dr. 26 Nooshin Maolemi, and the decision is not supported by substantial evidence and free of legal error. 27 1 The parties have consented to the jurisdiction of the United States Magistrate Judge and this action has been assigned 1 For the reasons explained herein, Plaintiff’s Social Security appeal shall be denied. 2 II. 3 BACKGROUND 4 A. Procedural History 5 Plaintiff protectively filed an application for a period of disability and disability insurance 6 benefits on September 21, 2017. (AR 128.) Plaintiff’s application was initially denied on January 7 17, 2018, and denied upon reconsideration on April 16, 2018. (AR 109-127, 129-146.) Plaintiff 8 requested and received a hearing before Administrative Law Judge Erin Justice (“the ALJ”). 9 Plaintiff appeared for a telephonic hearing on January 29, 2020. (AR 82-108.) On February 12, 10 2020, the ALJ issued a decision finding that Plaintiff was not disabled. (AR 148-64.) On 11 September 29, 2020, the appeals counsel sent this matter back to the ALJ to evaluate Plaintiff’s 12 claim from October 19, 2016 through September 30, 2019, the date last insured; evaluate Plaintiff’s 13 carpal tunnel syndrome at Step 2; give further consideration to Plaintiff’s maximum residual 14 functional capacity and provide appropriate rational with specific references to evidence in the 15 record in support of the assessed limitations; and obtain supplemental evidence from a vocational 16 expert to clarify the effect of the assessed limitations on Plaintiff’s occupational base. (AR 171- 17 75.) 18 Following remand, Plaintiff appeared for a telephonic hearing on July 8, 2021, before ALJ 19 Shiva Bozarth. (AR 40-81.) On September 15, 2021, the ALJ issued a decision finding that 20 Plaintiff was not disabled. (AR 16-31.) On September 19, 2022, the Appeals Council denied 21 Plaintiff’s request for review. (AR 5-7.) 22 B. The ALJ’s Findings of Fact and Conclusions of Law 23 The ALJ made the following findings of fact and conclusions of law as of the date of the 24 decision, September 5, 2021: 25 1. Plaintiff last met the insured status requirements of the Social Security Act on September 26 30, 2019. 27 2. Plaintiff did not engage in substantial gainful activity during the period from her alleged 1 3. Through the date last insured, Plaintiff had the following severe impairments: 2 degenerative disc disease of the cervical, lumbar, and thoracic spines; degenerative joint 3 disease; essential tremor; rheumatoid arthritis; carpal tunnel syndrome; small fiber 4 neuropathy; fibromyalgia; and obesity. 5 4. Through the date last insured, Plaintiff did not have an impairment or combination of 6 impairments that met or medically equaled the severity of one of the listed impairments. 7 5. After careful consideration of the entire record, the ALJ found that through the date last 8 insured, Plaintiff had the residual functional capacity to perform a reduced range of light 9 work as defined in 20 CFR § 404.1567(b). Specifically, Plaintiff can lift and carry 20 10 pounds occasionally and 10 pounds frequently. She can sit, stand, and walk for 6 hours 11 in an 8-hour day. Plaintiff can never climb ladders, ropes, or scaffolds; but can 12 occasionally climb ramps and stairs. She can occasionally stoop, kneel, crouch, or crawl. 13 In addition, she can never work at unprotected heights or around fast-moving machinery. 14 Plaintiff can never reach with the non-dominant upper extremity; but can frequently reach 15 with the dominant upper extremity. Further, Plaintiff can frequently handle, finger, or 16 feel with the bilateral upper extremity. 17 6. Through the date last insured, Plaintiff was capable of performing past relevant work as 18 an eligibility worker, caseworker, salesclerk, furniture salesperson, and jewelry 19 salesperson. This work did not require the performance of work-related activities 20 precluded by Plaintiffs residual functional capacity. 21 7. Plaintiff was not under a disability, as defined in the Social Security Act, at any time 22 from October 19, 2016, the alleged onset date, through September 30, 2019, the date last 23 insured. 24 (AR 21-30.) 25 III. 26 LEGAL STANDARD 27 A. The Disability Standard 1 show she is unable “to engage in any substantial gainful activity by reason of any medically 2 determinable physical or mental impairment2 which can be expected to result in death or which has 3 lasted or can be expected to last for a continuous period of not less than 12 months.” 42 U.S.C. § 4 423(d)(1)(A). The Social Security Regulations set out a five-step sequential evaluation process to 5 be used in determining if a claimant is disabled. 20 C.F.R. § 404.1520;3 Batson v. Comm’r of Soc. 6 Sec. Admin., 359 F.3d 1190, 1194 (9th Cir. 2004). The five steps in the sequential evaluation in 7 assessing whether the claimant is disabled are: 8 Step one: Is the claimant presently engaged in substantial gainful activity? If so, the claimant is not disabled. If not, proceed to step two. 9 Step two: Is the claimant’s alleged impairment sufficiently severe to limit his or her 10 ability to work? If so, proceed to step three. If not, the claimant is not disabled. 11 Step three: Does the claimant’s impairment, or combination of impairments, meet or equal an impairment listed in 20 C.F.R., pt. 404, subpt. P, app. 1? If so, the claimant 12 is disabled. If not, proceed to step four. 13 Step four: Does the claimant possess the residual functional capacity (“RFC”) to perform his or her past relevant work? If so, the claimant is not disabled. If not, 14 proceed to step five. 15 Step five: Does the claimant’s RFC, when considered with the claimant’s age, education, and work experience, allow him or her to adjust to other work that exists in 16 significant numbers in the national economy? If so, the claimant is not disabled. If not, the claimant is disabled. 17 18 Stout v. Comm’r, Soc. Sec. Admin., 454 F.3d 1050, 1052 (9th Cir. 2006). The burden of proof is 19 on the claimant at steps one through four. Ford v. Saul, 950 F.3d 1141, 1148 (9th Cir. 2020). A 20 claimant establishes a prima facie case of qualifying disability once she has carried the burden of 21 proof from step one through step four. 22 Before making the step four determination, the ALJ first must determine the claimant’s 23 RFC. 20 C.F.R. § 416.920(e); Nowden v. Berryhill, No. EDCV 17-00584-JEM, 2018 WL 1155971, 24 25 2 A “physical or mental impairment” is one resulting from anatomical, physiological, or psychological abnormalities that are demonstrable by medically acceptable clinical and laboratory diagnostic techniques. 42 U.S.C. § 423(d)(3). 26 3 The regulations which apply to disability insurance benefits, 20 C.F.R. §§ 404.1501 et seq., and the regulations which apply to SSI benefits, 20 C.F.R. §§ 416.901 et seq., are generally the same for both types of benefits. 27 Accordingly, while Plaintiff seeks disability insurance benefits in this case, to the extent cases cited herein may reference one or both sets of regulations, the Court notes these cases and regulations are applicable to the instant 1 at *2 (C.D. Cal. Mar. 2, 2018). The RFC is “the most [one] can still do despite [her] limitations” 2 and represents an assessment “based on all the relevant evidence.” 20 C.F.R. §§ 404.1545(a)(1); 3 416.945(a)(1). The RFC must consider all of the claimant’s impairments, including those that are 4 not severe. 20 C.F.R. §§ 416.920(e); 416.945(a)(2); Social Security Ruling (“SSR”) 96-8p, 5 available at 1996 WL 374184 (Jul. 2, 1996).4 A determination of RFC is not a medical opinion, 6 but a legal decision that is expressly reserved for the Commissioner. See 20 C.F.R. §§ 7 404.1527(d)(2) (RFC is not a medical opinion); 404.1546(c) (identifying the ALJ as responsible for 8 determining RFC). “[I]t is the responsibility of the ALJ, not the claimant’s physician, to determine 9 residual functional capacity.” Vertigan v. Halter, 260 F.3d 1044, 1049 (9th Cir. 2001). 10 At step five, the burden shifts to the Commissioner, who must then show that there are a 11 significant number of jobs in the national economy that the claimant can perform given her RFC, 12 age, education, and work experience. 20 C.F.R. § 416.912(g); Lounsburry v. Barnhart, 468 F.3d 13 1111, 1114 (9th Cir. 2006). To do this, the ALJ can use either the Medical Vocational Guidelines 14 (“grids”) or rely upon the testimony of a VE. See 20 C.F.R. § 404 Subpt. P, App. 2; Lounsburry, 15 468 F.3d at 1114; Osenbrock v. Apfel, 240 F.3d 1157, 1162 (9th Cir. 2001). “Throughout the five- 16 step evaluation, the ALJ is responsible for determining credibility, resolving conflicts in medical 17 testimony, and for resolving ambiguities.’ ” Ford, 950 F.3d at 1149 (quoting Andrews v. Shalala, 18 53 F.3d 1035, 1039 (9th Cir. 1995)). 19 B. Standard of Review 20 Congress has provided that an individual may obtain judicial review of any final decision 21 of the Commissioner of Social Security regarding entitlement to benefits. 42 U.S.C. § 405(g). In 22 determining whether to reverse an ALJ’s decision, the Court reviews only those issues raised by 23 the party challenging the decision. See Lewis v. Apfel, 236 F.3d 503, 517 n.13 (9th Cir. 2001). 24 Further, the Court’s review of the Commissioner’s decision is a limited one; the Court must find 25 the Commissioner’s decision conclusive if it is supported by substantial evidence. 42 U.S.C. § 26 4 SSRs are “final opinions and orders and statements of policy and interpretations” issued by the Commissioner. 20 27 C.F.R. § 402.35(b)(1). While SSRs do not have the force of law, the Court gives the rulings deference “unless they are plainly erroneous or inconsistent with the Act or regulations.” Han v. Bowen, 882 F.2d 1453, 1457 (9th Cir. 1 405(g); Biestek v. Berryhill, 139 S. Ct. 1148, 1153 (2019). “Substantial evidence is relevant 2 evidence which, considering the record as a whole, a reasonable person might accept as adequate 3 to support a conclusion.” Thomas v. Barnhart (Thomas), 278 F.3d 947, 954 (9th Cir. 2002) (quoting 4 Flaten v. Sec’y of Health & Human Servs., 44 F.3d 1453, 1457 (9th Cir. 1995)); see also Dickinson 5 v. Zurko, 527 U.S. 150, 153 (1999) (comparing the substantial-evidence standard to the deferential 6 clearly erroneous standard). “[T]he threshold for such evidentiary sufficiency is not high.” Biestek, 7 139 S. Ct. at 1154. Rather, “[s]ubstantial evidence means more than a scintilla, but less than a 8 preponderance; it is an extremely deferential standard.” Thomas v. CalPortland Co. (CalPortland), 9 993 F.3d 1204, 1208 (9th Cir. 2021) (internal quotations and citations omitted); see also Smolen v. 10 Chater, 80 F.3d 1273, 1279 (9th Cir. 1996). Even if the ALJ has erred, the Court may not reverse 11 the ALJ’s decision where the error is harmless. Stout, 454 F.3d at 1055–56. Moreover, the burden 12 of showing that an error is not harmless “normally falls upon the party attacking the agency’s 13 determination.” Shinseki v. Sanders, 556 U.S. 396, 409 (2009). 14 Finally, “a reviewing court must consider the entire record as a whole and may not affirm 15 simply by isolating a specific quantum of supporting evidence.” Hill v. Astrue, 698 F.3d 1153, 16 1159 (9th Cir. 2012) (quoting Robbins v. Soc. Sec. Admin., 466 F.3d 880, 882 (9th Cir. 2006)). 17 Nor may the Court affirm the ALJ on a ground upon which he did not rely; rather, the Court may 18 review only the reasons stated by the ALJ in his decision. Orn v. Astrue, 495 F.3d 625, 630 (9th 19 Cir. 2007); see also Connett v. Barnhart, 340 F.3d 871, 874 (9th Cir. 2003). Nonetheless, it is not 20 this Court’s function to second guess the ALJ’s conclusions and substitute the Court’s judgment 21 for the ALJ’s; rather, if the evidence “is susceptible to more than one rational interpretation, it is 22 the ALJ’s conclusion that must be upheld.” Ford, 950 F.3d at 1154 (quoting Burch v. Barnhart, 23 400 F.3d 676, 679 (9th Cir. 2005)). 24 IV. 25 DISCUSSION AND ANALYSIS 26 Plaintiff contends that the ALJ erred by failing to properly consider the opinion of Dr. 27 Nooshin Maolemi and the rationale provided to reject his imposed restrictions is legally insufficient 1 that the restrictions imposed by Dr. Maolemi were not accommodated in the RFC and the ALJ did 2 not provide adequate rationale for finding his opinion to be unpersuasive and the analysis contains 3 inadequacies that frustrate meaningful review. (Mot. 25.) Further, Plaintiff contends that the ALJ’s 4 failure to discuss significant probative evidence that was contrary to the findings is a 5 mischaracterization of the evidence. (Mot. 25.) Plaintiff asserts that the ALJ focused on benign 6 findings in the record and the actual record presents a more serious picture. (Mot. 26.) Specifically, 7 Plaintiff alleges that the ALJ cited solely normal findings and ignored a plethora of objective 8 imaging and physical examinations that document abnormal findings. (AR 26.) Plaintiff argues 9 that the ALJ engaged in lay interpretation of the raw medical evidence and the error is harmful 10 because it would have consequence in the ultimate non-disability determination. (Mot. 29.) 11 Plaintiff requests that this action be remanded for further proceedings. (Mot. 30.) 12 Defendant counters that the ALJ considered a variety of medical opinions and prior 13 administrative findings and determined that several were persuasive including the opinion of Dr. 14 Damania who opined that Plaintiff was capable of medium work, but the ALJ assessed additional 15 limitations due to abnormal examination findings related to Plaintiff’s cervical spine, hip pain, mild 16 tremor of the hand and face, and decreased sensation of the lower extremity. (Def.’s Responsive 17 Brief (“Opp.”) 5, ECF No. 17.) Defendant contends that substantial evidence supports the ALJ’s 18 analysis of Dr. Moalemi’s questionnaire. (Opp. 7.) Defendant asserts that the ALJ found Dr. 19 Moalemi’s opinion was not supported by a detailed explanation or objective evidence in the record. 20 (Opp. 7.) Defendant also argues that Dr. Moalemi cautioned that his response that Plaintiff was 21 only capable of low stress work was based on Plaintiff’s subjective complaints and Dr. Moalemi 22 did not have training in occupational or disability medicine. (Opp. 7.) Defendant contends that Dr. 23 Moalemi’s deference to Plaintiff’s subjective assessment of her abilities disqualified the 24 questionnaire from the definition of a medical opinion. (Opp. 7.) Defendant argues that the ALJ 25 accurately discussed the imaging studies of Plaintiff’s lumbar, thoracic, and cervical spines, as well 26 as her hip pain. (Opp. 11.) Further, Defendant asserts that the ALJ discussed evidence that was 27 inconsistent with Dr. Moalemi’s opinion. (Opp. 11.) Defendant contends that in compliance with 1 only those examination findings that tended to show Plaintiff was not more limited. (Opp. 11.) 2 Defendant states that the ALJ reasonably found Dr. Moalemi’s questionnaire was not supported 3 and the extreme limitations assessed were inconsistent with other evidence. (Opp. 12.) Defendant 4 requests that the ALJ’s opinion be affirmed. (Opp. 12.) 5 Plaintiff replies that the ALJ did not accommodate the restrictions assessed by Dr. Maolemi 6 and did not provide an adequate rationale for finding his opinion to be unpersuasive. (Reply 2, ECF 7 No. 18.) Plaintiff argues that Defendant is attempting to cure the deficiencies in the ALJ’s decision 8 by raising issues not cited by the ALJ and this is nothing more than post-hoc rationalization that is 9 not allowed. (Reply 3.) Further, Plaintiff contends that the fact that Dr. Maolemi’s opinion was on 10 a check box form is not a reason to reject the opinion because he identified clinical findings and 11 objective signs that support his assessed limitations. (Reply 3.) Finally, Plaintiff asserts that 12 Defendant ignores that factual findings must be supported by substantial evidence and were reached 13 by application of the correct legal standard. (Reply 4.) Plaintiff contends that the ALJ made legal 14 errors and this matter should be remanded. (Reply 5.) 15 A. Weighing Medical Opinions and Prior Administrative Medical Findings 16 Where, as here, a claim is filed after March 27, 2017, the revised Social Security 17 Administration regulations apply to the ALJ’s consideration of the medical evidence. See 18 Revisions to Rules Regarding the Evaluation of Medical Evidence (Revisions), 82 Fed. Reg. 5844- 19 01, 2017 WL 168819, at *5844 (Jan. 18, 2017); 20 C.F.R. § 404.1520c. Under the updated 20 regulations, the agency “will not defer or give any specific evidentiary weight, including controlling 21 weight, to any medical opinion(s) or prior administrative medical finding(s), including those from 22 [the claimant’s own] medical sources.” 20 C.F.R. §§ 404.1520c(a); 416.920c(a). Thus, the new 23 regulations require an ALJ to apply the same factors to all medical sources when considering 24 medical opinions, and no longer mandate particularized procedures that the ALJ must follow in 25 considering opinions from treating sources. See 20 C.F.R. § 404.1520c(b) (the ALJ “is not required 26 to articulate how [he] considered each medical opinion or prior administrative medical finding from 27 one medical source individually.”); Trevizo v. Berryhill, 871 F.3d 664, 675 (9th Cir. 2017). As 1 abrogate prior precedents requiring an ALJ to provide “clear and convincing reasons” to reject the 2 opinion of a treating physician where uncontradicted by other evidence, or otherwise to provide 3 “specific and legitimate reasons supported by substantial evidence in the record,” where 4 contradictory evidence is present. Woods v. Kijakazi, 32 F.4th 785, 788–92 (9th Cir. 2022). 5 Instead, “[w]hen a medical source provides one or more medical opinions or prior 6 administrative medical findings, [the ALJ] will consider those medical opinions or prior 7 administrative medical findings from that medical source together using” the following factors: (1) 8 supportability; (2) consistency; (3) relationship with the claimant; (4) specialization; [and] (5) other 9 factors that “tend to support or contradict a medical opinion or prior administrative medical 10 finding.” 20 C.F.R. §§ 404.1520c(a), (c)(1)–(5). The most important factors to be applied in 11 evaluating the persuasiveness of medical opinions and prior administrative medical findings are 12 supportability and consistency. Woods, 32 F.4th at 791 (citing 20 C.F.R. §§ 404.1520c(a), (b)(2)). 13 Regarding the supportability factor, the regulation provides that the “more relevant the objective 14 medical evidence and supporting explanations presented by a medical source are to support his or 15 her medical opinion(s), the more persuasive the medical opinions … will be.” 20 C.F.R. § 16 404.1520c(c)(1). Regarding the consistency factor, the “more consistent a medical opinion(s) is 17 with the evidence from other medical sources and nonmedical sources in the claim, the more 18 persuasive the medical opinion(s) … will be.” 20 C.F.R. § 404.1520c(c)(2). 19 Accordingly, the ALJ must explain in his decision how persuasive he finds a medical opinion 20 and/or a prior administrative medical finding based on these two factors. 20 C.F.R. § 21 404.1520c(b)(2). The ALJ “may, but [is] not required to, explain how he considered the [other 22 remaining factors],” except when deciding among differing yet equally persuasive opinions or 23 findings on the same issue. 20 C.F.R. §§ 404.1520c(b)(2)–(3). Further, the ALJ is “not required 24 to articulate how he considered evidence from nonmedical sources.” 20 C.F.R. § 404.1520c(d). 25 Nonetheless, even under the new regulatory framework, the Court still must determine whether the 26 ALJ adequately explained how he considered the supportability and consistency factors relative to 27 medical opinions and whether the reasons were free from legal error and supported by substantial 1 14, 2021). 2 B. ALJ’s Opinion 3 The ALJ considered that on January 21, 2017, imaging of Plaintiff’s lumbar spine was taken 4 and revealed disc bulge at L4-5, L5-S1 anterolisthesis, arthropathy, and ligamentum flavum 5 hypertrophy. (AR 26, 588, 592-93, 691-92.) Thereafter in mid-2017, it is noted that imaging of 6 Plaintiff’s right hip noted a possible labral tear. (AR 26, 582.) Treatment notes show that medical 7 personnel advised Plaintiff that she may need to undergo a hip arthroscopy. (AR 26, 582.) In June 8 2017, imaging of Plaintiff’s cervical and thoracic spine were also taken and noted degenerative 9 changes. (AR 26, 594, 595.) On November 29, 2016, the record shows that medical personnel 10 within neurosurgery were consulted about her hip and advised no surgical intervention was needed, 11 but physical therapy was recommended. (AR 26, 616.) 12 On August 31, 2017, additional imaging of Plaintiff’s cervical spine was taken and noted 13 anterior ligament calcification with minimal spondylosis and no acute process seen.5 (AR 26, 682.) 14 Imaging of her thoracic spine noted minimal disc bulges and anterolisthesis, and no canal stenosis 15 or foraminal narrowing. (AR 26, 684.) The ALJ noted that treatment notes on May 2, 2017, show 16 that Plaintiff also complained of generalized tenderness.6 (AR 26, 1160.) 17 At times, Plaintiff’s examinations noted bilateral cervical trigger points, decreased cervical 18 range of motion, an antalgic gait, positive straight leg raises, decreased range of motion and 19 strength, trigger points, edema and joint hypertrophy, painful hip range of motion, right hip tender 20 to palpation, paraspinal tenderness, decreased spinal range of motion, mild tremor of hand and face, 21 and lower extremity decreased sensation. (AR 27, 566, 582, 645, 1132, 1145, 1150, 1153, 1160, 22 23 5 The ALJ also cited to a July 27, 2017 MRI of Plaintiff’s cervical spine without detailing the findings. The MRI showed a small left paracentral disc extrusion at C3-C4 with mild cord impingement and mild cord edema; small 24 disc protrusions at C5-C6, C6-C7, C7-TJ with minimal cord impingement and without cord edema; no gross demyelinating cord lesions; and nonspecific mildly enlarged bilateral cervical nodes which may be reactive. (AR 25 685.) 6 At this visit, Plaintiff complained of lower back pain with the pain radiating to her bilateral hips and down to her 26 lower extremities. (AR 1159.) She also complained of localized neck pain and mild back pain. (AR 1159.) She described the intensity as severe in her lower back, neck mid back, and hips and legs. (AR 1159.) She described 27 constant, burning, aches, radiates, sharp and stabbing, comes and goes, worse in the a.m., worse in the p.m. Worse since it began. (AR 1159.) However, the ALJ considered the examination findings in discussing the abnormal 1 1262, 1462, 1579, 1639, 1860, 1873, 2857, 2877, 3107-08.) 2 However, Plaintiff’s examinations also noted a normal gait; full cervical range of motion; no 3 cervical tenderness; negative straight leg raises; no clubbing, cyanosis, or edema; normal range of 4 motion; normal strength in the upper and lower extremities; no hip instability, swelling or 5 deformity; normal muscle tone; no swelling or deformity of joints; intact sensation; and normal grip 6 strength. (AR 27, 582, 587, 589, 636, 650, 653, 676, 697, 901, 1125, 1279, 1420-21, 1873, 1885, 7 2423-24, 2444-45, 2721, 2733, 2877.) The ALJ considered that at the hearing, Plaintiff testified 8 that she continued to experience tremors and pain in her hands, back, and hip. She explained that 9 she had difficulty grasping items and could not sit, stand, or walk for prolonged periods. 10 Additionally, Plaintiff testified that she could not lift half a gallon of milk, and cold temperatures 11 caused pain and swelling in her hands and joints. She described her pain as an 8 on a 10-point scale 12 and noted that she only had one to two good days a week. The ALJ accommodated Plaintiff’s 13 symptoms and impairments by limiting her to light work, along with the postural, reaching, 14 manipulative, and environmental limitations detailed in the residual functional capacity. (AR 27.) 15 The ALJ found that the record reflects that Plaintiff testified that she continued to experience 16 significant pain and limitations stemming from her impairments, but as discussed above, her 17 examinations generally noted normal findings. (AR 28, 582, 589, 636, 645, 653, 676, 697, 901, 18 961, 1135, 1279, 1421, 1873, 1885, 2423, 2444, 2721, 2733, 2877.) The ALJ found the medical 19 evidence concerning her impairment provides only limited support for Plaintiff’s allegations, and 20 suggests that her symptoms are not as severe, persistent, or limiting as she has alleged. Further, the 21 ALJ found that her most recent treatment notes continue to reflect a disparity between her alleged 22 limitations and clinical findings. (AR 28, 2423, 2444, 2588, 2721, 2731.) 23 The ALJ considered the medical opinions and prior administrative medical findings. He 24 found that the opinions of the State agency medical consultants, Laurence Ligon, M.D., and Julie 25 Chu, M.D., were partially persuasive. (AR 28.) The ALJ found the opinion of Dr. Ligon at the 26 initial level (AR 122-25) was unpersuasive because the assessed limitations were not supported by 27 the evidence that was available at the time of the assessment. Namely, exams noting full cervical 1 instability or deformity, normal spinal range of motion, and intact sensation. (AR 28, 582, 587, 2 589, 636, 645, 653, 676, 697, 901, 962.) Further, the ALJ found that the assessed limitations were 3 not consistent with the record as a whole, which continued to note the same. (AR 28, 1135-1136, 4 1279, 1421, 1873, 1885, 2423, 2444, 2721, 2733, 2877.) The ALJ also found that subsequent 5 treatment notes revealing normal respiratory exams, decreased sensation, and hand tremors support 6 the finding of less environmental limitations and more manipulative and postural limitations. (AR 7 28, 1160, 1583, 2423-24, 2877.) 8 The ALJ found that the opinion of Dr. Chu at the reconsideration level was more persuasive. 9 (AR 28, 141-44.) The opinion was supported by the evidence that was available at the time of the 10 assessment. Dr. Chu assessed limitations based upon Plaintiff’s largely normal exams, while still 11 accounting for exams noting an antalgic gait, decreased range of motion, positive straight leg raises, 12 decreased strength and painful range of motion. (AR 28, 567, 582, 645.) The ALJ found the 13 opinion to be consistent with the record as a whole which continued to note the same. However, 14 the ALJ found that the record as a whole, including Plaintiff’s subjective complaints and exams 15 noting hand tremors, decreased sensation, edema, and joint hypertrophy, support the finding that 16 she has more postural and manipulative limitations than those assessed. (AR 28, 1160, 2857, and 17 hearing testimony.) 18 The ALJ considered that Plaintiff underwent a physical examination with Dr. Damania in 19 June of 2019, and found the opinion to be persuasive. (AR 29, 1132-42). The opinion is supported 20 by a detailed explanation and Dr. Damania’s objective findings. Dr. Damania assessed limitations 21 based largely upon Plaintiff’s subjective complaints and the opinion was found to be generally 22 consistent with the record as a whole. However, the ALJ assessed additional limitations to account 23 for Plaintiff’s examinations noting bilateral cervical trigger points, decreased cervical range of 24 motion, an antalgic gait, positive straight leg raises, decreased range of motion and strength, trigger 25 points, edema and joint hypertrophy, painful hip range of motion, right hip tender to palpation, 26 paraspinal tenderness, decreased spinal range of motion, mild tremor of hand and face, and lower 27 extremity decreased sensation. (AR 29, 567, 582, 645, 1135, 1145, 1150, 1160, 1263, 1462, 1583, 1 The ALJ also considered that in November of 2017, Dr. Moalemi provided functional 2 limitations which he found to be unpersuasive. (AR 29, 1451-53.) The ALJ found the opinion was 3 not supported by a detailed explanation or objective findings and additionally, the extreme 4 limitations assessed were not consistent with the record as a whole which largely noted a normal 5 gait; full cervical range of motion; no cervical tenderness; negative straight leg raises; no clubbing, 6 cyanosis, or edema; normal range of motion; normal strength in the upper and lower extremities; 7 no hip instability, swelling or deformity; normal muscle tone; no swelling or deformity of joints; 8 intact sensation; and normal grip strength. (AR 29, 582, 587, 589, 636, 645, 653, 676, 697, 901, 9 961, 1135, 1279, 1421, 1873, 1885, 2423, 2444, 2721, 2733, 2877.) 10 C. Medical Record 11 The medical record the ALJ addressed in the opinion is as follows. 12 Plaintiff was seen for a neurosurgery consult by Dr. Taggard on October 20, 2016, 13 complaining of continued back, flank, and hip pain. (AR 900.) Examination notes bilateral upper 14 extremities have 5/5 motor strength and sensory is intact to light touch. Sensory in the bilateral 15 lower extremities was intact to light touch. There was pain into the back with proximal movement. 16 Hip flex was 4/5, knee extension and flex were 4+/5; dorsiflex, plantarflex and EHL were 5/5 17 bilaterally. MRI of the spine showed lumbar facet joint effusions. (AR 901.) The lumbar joint 18 effusions were found to be nonspecific and most likely chronic, degenerative changes and 19 inflammation. No surgical intervention was required. (AR 902.) 20 On November 10, 2016, Plaintiff was seen for an initial physical therapy assessment 21 reporting that she has 10/10 back and groin pain since October 15, 2016. She is noted to show 22 severe limitations in range of motion, strength, and functional mobility to perform walking, 23 standing, sitting, transfer to a car, and lay supine. Authorization was requested for a walker and 24 tens unit to assist with pain relief and mobility. (AR 566.) 25 Plaintiff was seen for a consultation with Dr. Ma on February 9, 2017. (AR 695.) 26 Examination of the neck showed no tenderness and no decrease in suppleness. Musculoskeletal 27 exam noted normal appearance of the fingers. Gait and stance were normal. (AR 697.) She was 1 Plaintiff was seen by Dr. Maolemi on January 27, 2017, for severe low back pain and 2 requested disability paperwork be filled out. She had an MRI of the lumbar spine which showed 3 L4-5 and L5-S1 joint effusion. Neurosurgery was consulted and they advised no surgical 4 intervention. She also had an MRI of the right hip that showed a questionable labral tear. She 5 stated her pain was 7 out of 10 and she was ambulatory. Examination notes that her back was tender 6 to palpation over the lumbar-sacral spine and straight leg raising test was positive bilaterally. She 7 had a normal gait; sensory exam was intact, and she had normal motor strength to the lower 8 extremities. (AR 636.) 9 On May 2, 2017, Plaintiff was seen for chronic pain management by Dr. Grandhe. (AR 588- 10 90, 1159-61.) She complained of lower back pain radiating into the bilateral hips and down to her 11 lower left extremity as well as localized neck pain and mid back pain. (AR 1159.) Musculoskeletal 12 examination notes upper and lower extremity range of motion was within normal limits. 13 Tenderness was present in the cervical spine. Mild paraspinal tenderness was present with rigidity 14 and guarding. Tenderness was present in the thoracic spine. Paraspinal tenderness was present with 15 rigidity and guarding. Tenderness was present in the lumbar spine with rigidity and guarding. 16 Trigger points were present with taut bands and jump signs present. Facet joint tenderness was 17 present bilaterally, more severe on the right compared to the left. Twisting, turning, extension, and 18 flexion were painful. Radiculopathy of bilateral lower extremities. Sacroiliac joint tenderness was 19 present bilaterally. Gaenslen’s and Patrick’s signs were positive. Neurological exam showed 20 cranial nerves were intact. Sensation in the left lower extremity was decreased. Power in the upper 21 and lower extremities was 5/5 bilaterally. (AR 1160.) Straight leg raise was positive on the left. 22 (AR 1160-61.) Reflexes were 0+ in the lower extremities and 1+ in the upper extremities. Plaintiff 23 was given a back brace to reduce pain by restricting mobility of the truck and to support weak spinal 24 muscles. (AR 1161.) 25 On May 15, 2017, Plaintiff was seen by Dr. Moalemi complaining of tremors in her head 26 and hands for the past two months. Examination noted back tender to palpation over lumbar-sacral 27 spine; straight leg testing positive bilaterally; right hip tender to palpation; normal gait and motor 1 extremities when holding them out, and cranial nerves 2-12 grossly intact. (AR 645.) 2 Plaintiff was seen by Dr. Maolemi on May 31, 2017, complaining that her tremors had 3 worsened since her last visit. She had not been taking Flexeril. (AR 649.) She had normal motor 4 strength in the upper and lower extremities, normal strength and tone, and cranial nerves 2-12 were 5 grossly intact. (AR 650.) 6 On June 15, 2017, Plaintiff saw Dr. Mai reporting right groin and hip pain. (AR 581.) 7 Examination noted right hip with groin pain on exam, some pain with range of motion in the hips 8 with no LLD or instability, no swelling or deformity. An MRI of the right hip showed a possible 9 labral tear and she was advised that she might need a right hip arthroscopy. (AR 582.) 10 On June 21, 2017, Plaintiff was seen by Dr. Moalemi for MRI results due to the worsening 11 of her hand and head tremors. She complained of some weakness which she attributed to her right 12 hip pain and lumbar stenosis. Examination notes normal gait and motor strength in the upper and 13 lower extremities. Sensory exam was intact. Tremor was present in the upper extremities when 14 holding them out. Cranial nerves 2-12 were grossly intact. (AR 653.) 15 On September 1, 2017, Plaintiff saw Dr. Grandhe reporting relief for one- or two-days 16 following trigger point injections on July 14, 2017. Examination notes that the cervical spine was 17 tender with rigidity and guarding present. Paraspinal tenderness was present with bilateral radicular 18 pain. Suprascapular area tenderness was present. Occipital area and lumbar tenderness were 19 present with rigidity and guarding and bilateral radicular pain. (AR 587.) 20 Plaintiff was seen at Indian Health on September 19, 2017, complaining of dizziness that had 21 started four days prior. She also reported muffled ear sounds on the left knee and numbness of the 22 right jaw. (AR 675.) Examination was unremarkable with back exam showing full range of motion 23 with a normal exam of the spine. (AR 675-76.) Musculoskeletal exam noted normal cervical spine 24 with full range of motion. Extremity exam noted good capillary refill in nail beds with no clubbing, 25 cyanosis or edema. (AR 676.) 26 Plaintiff saw Dr. Maurice-Diya on October 24, 2017, complaining of radicular neck pain to 27 her right shoulder and lower back that radiates to her right hip area and is rated at 10/10. 1 tenderness was present. Cervical trigger points were present with jump signs and taut bands. Right 2 suprascapular tenderness was present. Lumbar tenderness was present with rigidity and guarding. 3 Paraspinal tenderness was present. Right trochanteric tenderness was present with trigger points 4 with jump signs and taut bands positive. (AR 1152.) 5 On November 6, 2017, Dr. Moalemi completed the physical medical source statement that 6 is at issue in this appeal. (AR 1451-53.) 7 On January 31, 2018, Plaintiff was seen in the emergency room complaining of a respiratory 8 cough. (AR 1418.) Neck examination notes normal range of motion with a supple neck. 9 Musculoskeletal examination notes normal range of motion, with no edema, tenderness, or 10 deformity. (AR 1420.) Coordination and muscle tone were normal. (AR 1421.) 11 On March 5, 2018, Plaintiff was seen by Dr. Kumar and stated her main concern was chronic 12 low back pain with bilateral radiculopathy and chronic neck pain secondary to degenerative joint 13 disease. (AR 1262.) Examination of the neck and shoulders reports positive tenderness of the 14 paraspinal muscles in the C-spine with stiffness and decreased range of motion in flexion and 15 extension. Plaintiff had mild enlargement and stiffness of her trapezius muscles bilaterally. 16 Examination of the back reports decreased range of motion, no costovertebral angle tenderness, 17 tender to palpation over the lumbar-sacral spine and paraspinal muscles left more than right. She 18 had positive single leg raising on the left side but no “e/o fnds”. Range of motion was painful at 19 the lower spine. (AR 1263.) 20 Plaintiff was seen by Physicians Assistant Brown on March 28, 2018, for a neuro evaluation 21 after an MRI of the cervical spine showed herniated disks. Plaintiff complained of tremors in her 22 face and arms for years and intermittent numbness in her bilateral upper extremities and weakness 23 in her bilateral hands. (AR 1278.) Upper extremity examination showed sensory was intact to light 24 touch and motor of 5/5 bilaterally. Strength was 5/5 and there was negative Hoffman’s bilaterally. 25 Lower extremity examination shows sensory was intact to light touch and motor was 5/5 bilaterally. 26 Strength was 5/5 bilaterally. (AR 1279.) Clonus was negative. No surgical intervention was 27 planned. (AR 1280.) 1 trigger point injections. Examination of the cervical spine showed tenderness present at palpation. 2 Trigger points with taut bands and jump signs are present with paraspinal muscle tenderness. The 3 right suprascapular nerve was tender. Lumbar spine examination showed tenderness present with 4 palpation. The paraspinal muscles were tender. Trigger points with taut bands and jump signs were 5 present. Bilateral sacroiliac joints were tender. Gaenslen’s signs and Patrick’s signs were positive. 6 (AR 1150.) 7 On July 26, 2018, Plaintiff was seen by Dr. Maurice-Diya after having cervical, lumbar and 8 thoracic trigger point injections on July 3, 2018. Examination notes cervical spine tenderness is 9 present. Bilateral trigger points are present with taut bands and jump signs. Bilateral radicular 10 symptoms are present. Facet joints are tender. Shoulder exam showed bilateral acromioclavicular 11 joint tenderness with pain on the right worse than the left. Right suprascapular tenderness was 12 present. Range of motion was normal. Lumbar area tenderness was present. Paraspinal tenderness, 13 rigidity, and guarding are present. Bilateral radicular symptoms are present. Facet joints are tender. 14 Left sacroiliac joint tenderness was present with positive Gaenslen’s and Patrik’s signs. Twisting, 15 turning, extension, and flexion were painful. (AR 1145.) 16 On November 26, 2018, Plaintiff was seen by Dr. Kadel for a follow up. Examination notes 17 show an unremarkable examination, other than an antalgic gait is noted. (AR 1639.) 18 Plaintiff saw Dr. Rasmussen on March 1, 2019, reporting that her tremors are consistent, not 19 better and not worse. She reported weakness in her hands as well as numbness and tingling in her 20 hands and arms. (AR 1579.) Neurologic exam notes cranial nerves 2 through 12 were grossly 21 intact. She had a mild tremor of face and bilateral hands. There were diminished reflexes bilaterally 22 in the upper and lower extremities. (AR 1583.) 23 Plaintiff was seen by Physicians Assistant Esters on March 7, 2019, for her lumbar pain. 24 (AR 1883.) Examination notes that thoracolumbar spine range of motion was abnormal at 45 25 degrees true flexion, 10 degrees extension, 15 degrees right lateral flexion, 20 degrees left lateral 26 flexion, 10 degrees right rotation, 10 degrees left rotation. (AR 1884.) Reverse Thomas test and 27 Patrik’s test were positive bilaterally. Sitting straight leg raising was negative bilaterally. Sitting 1 Babinski signs were negative bilaterally. Neurological examination of the ankles and knees were 2 2+ bilaterally. Sensation in the dermatomes was normal bilaterally. Hip adduction was 5/5 3 bilaterally, hip abduction was 4/5 bilaterally. Hip extension, hip flexion, knee extension, knee 4 flexion, and ankle plantar flexion were 5/5 bilaterally. Ankle dorsiflexion was 4/5 bilaterally. 5 Palpation over the lumbar facet joints noted pain bilaterally. Ulnar stretch test, median stretch test, 6 Adson test, and Spurling test were all negative. (AR 1885.) 7 On March 8, 2019, Plaintiff was seen Nurse Practitioner Villegas. (AR 1461.) 8 Musculoskeletal examination showed normal range of motion with normal strength and tone. (AR 9 1462.) 10 On June 25, 2019, Plaintiff had an internal medicine evaluation by Dr. Damania. (AR 1132- 11 36.) Back examination notes some tenderness to left lumbar muscles with straight leg raising 12 negative at 90 degrees. Laseques’s sign was negative. There were no muscle spasms. She stated 13 it was too painful to do range of motion testing. Examination of the extremities notes she declined 14 to do range of motion testing for her right shoulder, all other range of motion is within normal 15 limits. Her right hip was slightly tender on palpation. (AR 1135.) Cranial nerves 2 through 12 were 16 grossly intact, motor strength was 5/5 in all extremities with good tone bilaterally and good active 17 range of motion. Sensation was grossly intact throughout. Reflexes were normal and symmetric 18 bilaterally at 2+ with no clonus. When she was told to extend her head there were some tremors 19 and Dr. Damania noticed shaking of her head once. Her gait was within normal limits, and she did 20 not use an assistive device. She did appear to be in pain toward the end of the examination. (AR 21 1136.) 22 On July 12, 2019, and December 17, 2019, Plaintiff saw Physician’s Assistant Esters who 23 noted that gait and station were within normal limits. Range of motion for the cervical spine was 24 abnormal at 20 degrees of flexion, 10 degrees of extension, 65 degrees of right rotation, 60 degrees 25 of left rotation, 40 degrees of right lateral flexion and 30 degrees of left lateral flexion. Plaintiff 26 had pain with cervical spine range of motion testing. Upper extremity neurological examination 27 notes 5/5 motor to the elbow, hands, and wrists bilaterally. Sensation was normal. Reflexes were 1 clonus. There was no tenderness to palpation over the biceps tendon, supraspinatus tendon, or AC 2 joint. There was tenderness to palpation over the cervical paraspinals and the trapezius. Ulnar 3 stretch test, median stretch test, Adson test, and Spurling test were all negative. Thoracolumbar 4 spine range of motion was abnormal at 45 degrees true flexion, 10 degrees extension, 15 degrees 5 right lateral flexion, 20 degrees left lateral flexion, 10 degrees right rotation, 10 degrees left rotation, 6 and there was pain with lumbar spine range of motion testing. Sitting straight leg raising was 7 negative bilaterally. Sitting straight leg in the supine position showed 90 degrees negative 8 bilaterally. Reverse Thomas test and Patrik’s test were positive bilaterally. There was no clonus. 9 Babinski signs were negative bilaterally. Neurological examination of the ankles and knees note 10 2+ bilaterally. Sensation in the dermatomes was normal bilaterally. Hip adduction was 5/5 11 bilaterally, hip abduction was 4/5 bilaterally. Hip extension, hip flexion, knee extension, knee 12 flexion, and ankle plantar flexion were 5/5 bilaterally. Ankle dorsiflexion was 4/5 bilaterally. 13 Palpation over the lumbar facet joints noted pain bilaterally. (AR 1860, 1873.) 14 Plaintiff was seen by Dr. Parveez on March 4, 2020, and June 4, 2020, for a follow up on her 15 abnormality of globulin. (AR 2588, 2731.) Examination findings show the neck is supple with no 16 cervical masses present. Trachea is midline and there is no thyromegaly. Extremity examination 17 records no edema, no digital clubbing, no cyanosis, and no discoloration. There is normal range of 18 motion, strength, and tone on musculoskeletal examination. (AR 2588, 2733.) 19 On August 14, 2020, and September 16, 2020, Plaintiff was seen by Physician’s Assistant 20 Esters complaining of neck pain going down to her lower back. (AR 2441 3105.) On examination, 21 gait and station are noted to be within normal limits. Range of motion for the cervical spine was 22 abnormal at 20 degrees of flexion, 10 degrees of extension, 65 degrees of right rotation, 60 degrees 23 of left rotation, 40 degrees of right lateral flexion and 30 degrees of left lateral flexion. Plaintiff 24 had pain with cervical spine range of motion testing. (AR 2444, 3107.) Upper extremity 25 neurological examination notes 5/5 motor to the elbow, hand and wrists bilaterally. (AR 2444, 26 3107-08.) Sensation was normal. Reflexes are 1+ or 2+ bilaterally, Babinski and Hoffman’s signs 27 are negative bilaterally and there is no clonus. There is no tenderness to palpation over the biceps 1 paraspinals and the trapezius. Ulnar stretch test, median stretch test, Adson test, and Spurling test 2 are all negative. Sitting straight leg raising was negative bilaterally. Sitting straight leg in the supine 3 position showed 90 degrees negative bilaterally on August 14 and 60 degrees on the left, 45 degrees 4 on the right and was negative bilaterally on September 16. Reverse Thomas test and Patrik’s test 5 were positive bilaterally. On September 16 slump test was negative. There was no clonus. 6 Babinski signs were negative bilaterally. Neurological examination of the ankles and knees were 7 2+ bilaterally. Sensation in the dermatomes was normal bilaterally. Hip adduction was 5/5 8 bilaterally, hip abduction was 4/5 bilaterally. (AR 2445, 3108.) Hip extension, hip flexion, knee 9 extension, knee flexion, and ankle plantar flexion were 5/5 bilaterally. Ankle dorsiflexion was 4/5 10 bilaterally. Palpation over the lumbar facet joints noted pain bilaterally. (AR 2445, 3108.) 11 On October 29, 2020, Plaintiff was seen by Dr. Parveez for a follow up on her abnormality 12 of globulin. (AR 2719.) Physical examination notes neck is supple with no cervical masses present. 13 Trachea is midline and there is no thyromegaly. Extremity exam shows no edema, no cyanosis, no 14 digital clubbing, and no discoloration. Musculoskeletal examination shows normal range of 15 motion, strength, and tone are normal. (AR 2721.) 16 Plaintiff was seen on November 6, 2020, for her annual examination. (AR 2875.) 17 Musculoskeletal examination shows no swelling or deformity of any joints or extremities. 18 Extremity examination noted no clubbing, cyanosis, or edema with full range of motion. 19 Neurologic examination noted cranial nerves 2-12 were grossly intact, gait was normal, motor 20 strength was normal to the upper and lower extremities, there was no rigidity and no tremor. There 21 was decreased sensation to the inner right thigh “OTW silt.” (AR 2876.) 22 On December 3, 2020, Plaintiff was seen by Physician’s Assistant Esters complaining of 23 neck pain going down to her lower back. (AR 2420.) On examination, gait and station are noted 24 to be within normal limits. Range of motion for the cervical spine was abnormal at 20 degrees of 25 flexion, 10 degrees of extension, 65 degrees of right rotation, 60 degrees of left rotation, 40 degrees 26 of right lateral flexion and 30 degrees of left lateral flexion. Plaintiff had pain with cervical spine 27 range of motion testing. Upper extremity neurological examination notes 5/5 motor to the elbow, 1 Hoffman’s signs are negative bilaterally and there is no clonus. There is no tenderness to palpation 2 over the biceps tendon, supraspinatus tendon, or AC joint. There is tenderness to palpation over 3 the cervical paraspinals and the trapezius. Ulnar stretch test, median stretch test, Adson test, and 4 Spurling test are all negative. Sitting straight leg raising in the supine position was 60 degrees on 5 the left, 30 degrees on the right and negative bilaterally. Sitting straight leg raising was negative 6 bilaterally. Slump test was negative and Patrik’s test was positive bilaterally. There was no clonus. 7 Babinski signs were negative bilaterally. Neurological examination of the ankles and knees were 8 2+ bilaterally. Sensation in the dermatomes was normal bilaterally. Hip adduction was 5/5 9 bilaterally, hip abduction was 4/5 bilaterally. (AR 2423.) Hip extension, hip flexion, knee 10 extension, knee flexion, and ankle plantar flexion were 5/5 bilaterally. Ankle dorsiflexion was 4/5 11 bilaterally. Palpation over the lumbar facet joints noted pain bilaterally. (AR 2424.) 12 Plaintiff was seen on May 3, 2021, for a follow up on her diabetes myelitis. (AR 2856.) 13 Musculoskeletal examination notes slightly decreased range of motion with tightness, especially in 14 her back. Extremity examination noted no clubbing, cyanosis, positive edema, and joint 15 hypertrophy. Neurological examination notes the cranial nerves 2-12 are grossly intact with no 16 rigidity and no tremor. (AR 2857.) 17 D. Whether the ALJ’s Opinion is Supported by Substantial Evidence and Free of Error 18 19 1. The ALJ did not err by ignoring significant object evidence 20 The Court first considers Plaintiff’s argument that the ALJ focused on benign findings while 21 ignoring evidence that demonstrates she has more functional limitations. The ALJ would err by 22 ignoring significant objective evidence from other medical and nonmedical sources in the record 23 that are consistent with the medical opinion rejected. Thompson v. Comm’r of Soc. Sec., No. 2:20- 24 CV-3-KJN, 2021 WL 1907488, at *6 (E.D. Cal. May 12, 2021); see also Ghanim v. Colvin, 763 25 F.3d 1154, 1161-62 (9th Cir. 2014) (some period of improvement does not mean the impairment 26 no longer serious affects the claimant’s ability to work; the medical record must be read in context 27 of the overall diagnostic picture the provider draws); Garrison v. Colvin, 759 F.3d 995, 1018 (9th 1 of impairment). 2 Plaintiff points to specific evidence that she contends the ALJ ignored that shows her 3 impairments are more serious than found by the ALJ. First, Plaintiff cites an MRI of the lumbar 4 spine on January 21, 2017 that documented findings “at T12-L1 there is a trace broad bilobed 5 posterior disc bulge with trace flattening of the ventral CSF space; at L4-5 there is exuberant facet 6 arthropathy and ligamentum flavum hypertrophy; there are small bilateral facet joint effusions seen, 7 right greater than left; this is in conjunction with a mild annular disc bulge; there may be some new 8 trace 1-2 mm anterolisthesis of L4 relative to L5; mild spinal stenosis due to facet arthropathy and 9 ligamentum flavum hypertrophy in conjunction with the annular disc bulge visually appears similar; 10 there is some mild bilateral inferior foraminal narrowing; at L5-S1 marked facet arthropathy and 11 ligamentum flavum hypertrophy left greater than right; asymmetric left sided ligamentum flavum 12 hypertrophy indents into the left dorsal CSF space, narrows the left lateral recess, and abuts the 13 central the central left S1 nerve root; and minimal inferior bilateral foraminal narrowing left greater 14 than right.” (Mot. 27 (AR 691-692).) 15 However, the ALJ did acknowledge these findings in his opinion. This MRI was specifically 16 referenced in the finding, “on January 21, 2017, imaging of Plaintiff’s lumbar spine was taken and 17 revealed disc bulge at L4-5, L5-S1 anterolisthesis, arthropathy, and ligamentum flavum 18 hypertrophy. (AR 26, 588, 592-93, 691-92.) The ALJ did not neglect to cite or consider this MRI. 19 Similarly, Plaintiff argues that the ALJ ignored the MRI of her hip on April 28, 2017, an 20 MRI of the thoracic spine on July 28, 2017, and an MRI of the cervical spine on July 27, 2017. 21 (Mot. 27.) In his opinion, the ALJ did find that in mid-2017 it was noted that imaging of her hip 22 showed a possible labral tear, and she might need to undergo a hip arthroplasty. (AR 26, 582.) 23 Further, the ALJ did cite to and consider these MRIs in referencing that additional imaging of 24 Plaintiff’s cervical spine was taken and noted anterior ligament calcification with minimal 25 spondylosis and no acute process seen. (AR 26, 682, 685.) The ALJ also considered the MRI of 26 the thoracic spine noted minimal disc bulges and anterolisthesis, and no canal stenosis or foraminal 27 narrowing. (AR 26, 684.) The ALJ did not neglect to cite or consider the MRIs of Plaintiff’s hip 1 Lastly, Plaintiff argues that a physical therapy note, dated January 9, 2018, documents that 2 she continued to have low back and bilateral hip pain, and examination findings document deficits 3 in her range of motion, positive leg raising, positive testing and increased pain to palpation on her 4 spine. (Mot. 28.) The ALJ did note that on November 10, 2016, Plaintiff was seen for an initial 5 physical therapy assessment reporting that she has 10/10 back and groin pain since October 15, 6 2016. She is noted to show severe limitations in range of motion, strength, and functional mobility 7 to perform walking, standing, sitting, transfer to a car, and lay supine. (AR 566.) Plaintiff asserts 8 error due to the failure to consider and reference a recertification note on January 9, 2018. This 9 note states, 10 Ms IGASAN continues to demonstrate slow but steady improvement with range of motion, pain, and strength due to physical therapy. She is able to tolerate mild 11 strengthening activities and is able to tolerate weight bearing activities longer without aggravating her symptoms. She continues to be limited in prolonged ambulation and 12 sitting, decreased active/passive range of motion secondary to increased low back pains, and pain to palpation along the low back and piriformis/glut musculature. She 13 will continue to benefit from physical therapy to continue to increase AROM, strength, decrease pain, and increase function without aggravation of her symptoms. 14 (AR 1049.) 15 In his opinion, the ALJ noted numerous records containing similar findings of decreased 16 range of motion, positive testing, positive straight leg raising, and pain to palpation. (See AR 27, 17 582, 587, 645, 636, 1135-36, 1145, 1150, 1152, 1160-61, 1263, 1860, 1873, 1884-85, 2423-24, 18 2444-45, 3107-08.) The Court cannot find that the failure to comment on this physical therapy note 19 would be a misrepresentation of the record given the ALJ’s recognition of the similar findings of 20 numerous other providers in the record. The Court finds that the ALJ did not err by ignoring 21 significant objective evidence from other medical and nonmedical sources in the record that are 22 consistent with the medical opinion rejected. Thompson, 2021 WL 1907488, at *6. 23 Plaintiff’s argument that there is a plethora of evidence to support Dr. Maolemi’s opinion is 24 seeking for this Court to review the evidence and come to an alternate conclusion. It is not this 25 Court’s function to second guess the ALJ’s conclusions and substitute the Court’s judgment for the 26 ALJ’s; rather, if the evidence “is susceptible to more than one rational interpretation, it is the ALJ’s 27 conclusion that must be upheld.” Ford, 950 F.3d at 1154 (quoting Burch, 400 F.3d at 679. 1 2. The ALJ properly considered the opinion of Dr. Maolemi 2 The Court next considers Plaintiff’s argument that the ALJ erred by ignoring evidence that 3 supports Dr. Maolemi’s opined limitations. 4 On November 6, 2017, Dr. Moalemi completed a physical medical source statement. (AR 5 1451-53.) He stated he had been seeing Plaintiff since July 2, 2015, and she has been diagnosed 6 with tremor, right hip bursitis, and lumber stenosis. Her prognosis is fair. She has a tremor, right 7 hip pain due to a labral tear, and leg weakness. The clinical findings and objective signs identified 8 essential tremor, doctor’s examinations, and right hip tenderness. He noted that Plaintiff is currently 9 being evaluated by neurology, received steroid injections for hip pain, medication that can cause 10 dizziness, physical therapy, and interventional pain management. Her impairments have or can be 11 expected to last 12 months and emotional factors contribute to the severity of her symptoms and 12 functional limitations. (AR 1451.) 13 Dr. Moalemi opined that Plaintiff can walk one half block without rest or severe pain, can sit 14 10 minutes before having to get up and stand 5 minutes before having to sit down or walk around. 15 She can sit, stand/walk less than 2 hours in an 8-hour day. She would require a job that permits 16 shifting positions from sitting, standing, walking. (AR 1451.) She would need a job that permits 17 walking around during an 8-hour workday. She must walk for 10 minutes every 10 minutes. She 18 would require six twenty-minute unscheduled breaks during a workday due to muscle weakness, 19 chronic fatigue, and pain/paresthesia/numbness. She requires her legs to be elevated to waist level 20 with prolonged sitting. Her legs would need to be elevated seventy five percent of the time if she 21 were to have a sedentary job. She requires the use of a cane or other assistive device for occasional 22 standing or walking due to imbalance, insecurity, pain, and weakness. (AR 1452.) 23 Dr. Moalemi opined that Plaintiff can rarely lift and carry less than ten pounds. She can 24 rarely twist and can never stoop, bend, crouch, squat, climb stairs, or climb ladders. (AR 1452.) 25 She has no limitations in reaching, handling, or fingering. Contrarily, Dr. Moalemi stated that 26 Plaintiff can grasp, turn and twist objects with her hands 10 percent of an 8-hour workday; can do 27 fine manipulation with her fingers 20 percent of an 8-hour workday; can reach in front of her body 1 workday. (AR 1452.) 2 He opined that Plaintiff would likely be off task more than 25 percent of the day due to 3 symptoms interfering with concentration and attention. She is capable of low stress work based on 4 her answers. She is likely to have good and bad days. If she was trying to work fulltime, she would 5 likely be absent from work more than five days per month due to her impairments or treatment. Dr. 6 Moalemi noted that “[t]hese answers are mostly based on patient’s subjective answers as I do not 7 have any training in occupational/disability medicine.” (AR 1453.) 8 As stated above, the most important factors to be applied in evaluating the persuasiveness of 9 medical opinions and prior administrative medical findings are supportability and consistency. 10 Woods, 32 F.4th at 791 (citing 20 C.F.R. §§ 404.1520c(a), (b)(2)). Here, the ALJ found that Dr. 11 Moalemi’s opinion was not supported by a detailed explanation or the objective findings. (AR 29.) 12 Dr. Moalemi’s opinion itself states that the answers are mostly based on Plaintiff’s subjective 13 complaints providing substantial support for the ALJ’s findings. (AR 1453.) Additionally, the ALJ 14 pointed to Dr. Moalemi’s examinations of Plaintiff which, despite finding tenderness in her spine, 15 noted a normal gait, normal motor strength in the upper and lower extremities, and an intact sensory 16 examination. (AR 636, 645, 653.) Similarly, notes from the clinic record similar findings with 17 normal range of motion in the back and cervical spine (AR 676), gait and station within normal 18 limits and generally normal strength in the lower extremities and sensation despite pain upon 19 palpation and some limitations in range of motion in the spine (AR 1873, 1884-85, 2423-24, 2444- 20 45), and normal gait with full range of motion to all extremities and normal motor strength to the 21 upper and lower extremities (AR 2877). 22 Additionally, the ALJ found that Dr. Moalemi’s opinion was not consistent with the record 23 as a whole which largely noted a normal gait; full cervical range of motion; no cervical tenderness; 24 negative straight leg raises; no clubbing, cyanosis, or edema; normal range of motion; normal 25 strength in the upper and lower extremities; no hip instability, swelling or deformity; normal muscle 26 tone; no swelling or deformity of joints; intact sensation; and normal grip strength. (AR 29.) The 27 ALJ pointed to examinations finding no hip instability despite her hip pain (AR 582); no findings 1 lower extremities despite findings of tenderness, rigidity and guarding (AR 589, 1135-36); normal 2 gait and stance (AR 697, 962); sensory intact to light touch and motor of 4 to 5/5 bilateral to the 3 upper and lower extremities (901, 1279); normal muscle tone and coordination (AR 1421); and 4 normal range of motion, strength, and tone (AR 2721, 2733). 5 The Court finds that the ALJ properly considered Dr. Moalemi’s opinion consistent with 20 6 C.F.R. §§ 404.1520c(a), (c)(1)–(5), and that the ALJ’s reasoning for rejecting the limitations opined 7 by Dr. Maolemi are supported by substantial evidence in the record. Accordingly, Plaintiff’s 8 motion for summary judgment on this ground shall be denied. 9 3. The ALJ did not engage in interpretation of raw medical evidence 10 Finally, Plaintiff argues that the ALJ erred by rejecting to some extent every medical opinion 11 in the record and engaged in his own interpretation of the raw medical evidence. Here, the ALJ 12 found several medical opinions and prior administrative medical findings to be persuasive but 13 included additional limitations to account for Plaintiff’s subjective complaints and the findings 14 during medical examination as discussed below. 15 The ALJ found that the opinions of the State agency medical consultants, Laurence Ligon, 16 M.D., and Julie Chu, M.D., were partially persuasive. (AR 28.) The ALJ found the opinion of Dr. 17 Ligon at the initial level (AR 122-25) was unpersuasive because the assessed limitations were not 18 supported by the evidence that was available at the time of the assessment. (AR 28.) The ALJ 19 found that the opinion of Dr. Chu at the reconsideration level was more persuasive. (AR 28, 141- 20 44.) Dr. Chu opined that Plaintiff was able to occasionally lift and carry 20 pounds and frequently 21 lift and carry 20 pounds; could stand and or walk 6 hours in an 8-hour day; could sit 6 hours in an 22 8-hour day; and was unlimited in push and or pull other than the lift and carry limits. (AR 142-43.) 23 Plaintiff could occasionally climb ramps/stairs, stoop, kneel, crouch, and crawl; never climb 24 ladders/ropes/scaffolds; and balancing was unlimited. Plaintiff had no manipulative, visual, or 25 communicative limitations. (AR 143.) Plaintiff should avoid concentrated exposure to working at 26 unprotected heights, working around dangerous machinery, and walking on uneven terrain. (AR 27 144.) 1 including Plaintiff’s subjective complaints and exams noting hand tremors, decreased sensation, 2 edema, and joint hypertrophy support the finding that she has more postural and manipulative 3 limitations than those assessed. (AR 28, 1160, 2857, and hearing testimony.) 4 The ALJ considered that Plaintiff underwent a physical examination with Dr. Damania in 5 June of 2019, and found the opinion to be persuasive. (AR 29, 1132-42). Dr. Damania opined that 6 Plaintiff was able to lift and carry 20 pounds frequently and 50 pounds occasionally and could sit, 7 stand, and walk 8 hours in an 8-hour workday. (AR 1137.) Plaintiff did not need a cane to ambulate. 8 (AR 1138.) She could never reach with her right hand due to right shoulder pain, but could 9 frequently handle, finger, feel, and push/pull with the right hand. She could frequently reach, 10 handle, finger, feel, and push/pull with her left hand. Plaintiff is lefthanded. Plaintiff can frequently 11 operate foot controls. (AR 1139.) She can never climb ladders or scaffolds; occasionally climb 12 ramps and stairs; and frequently balance, stoop, kneel, crouch, and crawl. She has no impairment 13 of hearing or vision. (AR 1140.) She could frequently tolerate moving mechanical parts; operating 14 a motor vehicle; humidity and wetness; dust, odors, fumes and pulmonary irritants; extreme cold 15 and heat; vibrations; and loud noise; but can never tolerate exposure to unprotected heights. (AR 16 41.) 17 The ALJ assessed additional limitations to account for Plaintiff’s examinations noting 18 bilateral cervical trigger points, decreased cervical range of motion, an antalgic gait, positive 19 straight leg raises, decreased range of motion and strength, trigger points, edema and joint 20 hypertrophy, painful hip range of motion, right hip tender to palpation, paraspinal tenderness, 21 decreased spinal range of motion, mild tremor of hand and face, and lower extremity decreased 22 sensation. (AR 29, 567, 582, 645, 1135, 1145, 1150, 1160, 1263, 1462, 1583, 1639, 1860, 1873, 23 2857, 2877, 3107.) 24 An ALJ is capable at some level “of independently reviewing and forming conclusions about 25 medical evidence to discharge their statutory duty to determine whether a claimant is disabled and 26 cannot work.” Farlow v. Kijakazi, 53 F.4th 485, 488 (9th Cir. 2022). It is the responsibility of the 27 ALJ to translate and incorporate clinical findings into a succinct RFC. Rounds v. Comm’r Soc. 1 1169, 1174 (9th Cir.2008)). Even when reviewing new medical evidence that ALJ need not seek 2 the opinion of a medical expert to make an RFC determination. Bufkin v. Saul, 836 F. App’x 578, 3 579 (9th Cir. 2021). 4 Plaintiff cites to Pilgreen v. Berryhill, 757 F. App’x 618 (9th Cir. 2019), to argue, “An ALJ may 5 not substitute her own lay opinion for the judgment of medical professionals.” (Mot. 29.) In Pilgreen, 6 the ALJ rejected a physician’s conclusions finding they were “not fully supported by her own findings.” 7 Pilgreen, 757 F. App’x at 619. The Ninth Circuit found that the substance of the ALJ’s criticism 8 concerned the extent of the physician’s testing and her interpretation of the results. Id. They held the 9 ALJ’s assessment of a physician’s methodology and interpretation was not supported by any medical 10 evidence, and the ALJ was not free to substitute his own lay opinion. Id. 11 However, here, the ALJ did not reject the opinions of the physicians that he found to be 12 persuasive, rather he selected limitations from each opinion and imposed additional limitations to 13 account for Plaintiff’s complaints of pain and the medical findings in the record. The ALJ adopted Dr. 14 Chu’s postural limitations in full except that he found that Plaintiff could only lift 10 pounds frequently 15 rather than the 20 pounds opined by Dr. Chu. The ALJ adopted the postural and manipulative 16 limitations opined by Dr. Damania. Accordingly, the only additional limitation included in the RFC is 17 that Plaintiff can only lift 10 pounds frequently rather than the 20 pounds opined by Drs. Chu and 18 Damania. The ALJ did not err by interpreting raw medical data in developing Plaintiff’s RFC. 19 Further, even had there been error, Plaintiff has not shown how she was prejudiced by the ALJ 20 imposing a limitation of lifting and carrying 10 pounds frequently rather than the 20 pounds opined by 21 the physicians. The Court finds that the ALJ’s opinion is supported by substantial evidence and free of 22 legal error. Accordingly, Plaintiff’s motion for summary judgment shall be denied. 23 V. 24 CONCLUSION AND ORDER 25 In conclusion, the Court denies Plaintiff’s Social Security appeal and finds no harmful error 26 warranting remand of this action. 27 Accordingly, IT IS HEREBY ORDERED that Plaintiff’s appeal from the decision of the 1 | entered in favor of Defendant Commissioner of Social Security and against Plaintiff Cynthia Marie 2 |Igasan. The Clerk of the Court is directed to CLOSE this action. 3 4 IS SO ORDERED. FA. ee 5 Dated: _ March 15, 2024 ‘ UNITED STATES MAGISTRATE JUDGE 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28