Flamme v. Saul ( 2021 )

1 2 3 4 5 6 7 8 ° UNITED STATES DISTRICT COURT 10 ul SOUTHERN DISTRICT OF CALIFORNIA 12 || JULIE FLAMME, Case No.: 3:20-CV-01050-WVG 8 Plaintiff, 4 DIRECT ORDER ON PLAINTIFF’S is MOTION FOR SUMMARY 16 | ANDREW SAUL JUDGMENT AND DEFENDANT’S , CROSS-MOTION FOR SUMMARY '7 Commissioner of Social Security, JUDGMENT 8 Defendant 19 20 111. INTRODUCTION 71 Pending before the Court is Julie Flamme’s (“Plaintiff”) Motion for Summa Judgment and Commissioner of Social Security Andrew Saul’s (“Defendant” o °° “Commissioner’”) Cross-Motion for Summary Judgment. (Doc. Nos. 11-1, 12. ** |) Plaintiff alleges she suffers from severe disabilities that preclude her from workin °° and filed for disability insurance benefits under the Social Security Act (“SSA”) The Commissioner denied Plaintiff's application for such benefits. (AR 864. Plaintiff sought administrative relief from the Commissioner’s decision but wa ! llunsuccessful. (AR 884.) After convening a hearing on the merits of Plaintiff? 2 |lapplication, the Administrative Law Judge affirmed the Commissioner’s decisio 3 ||(“ALJ”). (AR 363.) This litigation followed. Now, Plaintiff brings a Motion fo ‘ Summary Judgment, alleging the ALJ’s rejection of Plaintiffs treating physicians’ > || medical opinions was not based on specific, legitimate reasons supported b ° substantial evidence. Plaintiff requests this Court reverse the ALJ’s decision an order payment of benefits, or, in the alternative, remand. Defendant has filed a Cross Motion for Summary Judgment, arguing the ALJ properly weighed the evidence 1 making his determinations. Defendant also argues the appropriate remedy, if th Court should find for Plaintiff, is not payment of benefits, but remand. Havin reviewed and considered the Parties’ submissions and the entirety of th B administrative record, the Court GRANTS Defendant’s motion and DENIE 14 || Plaintiffs motion. 15 BACKGROUND 16 A. Procedural History 7 Plaintiff protectively filed an application for disability insurance benefits i ig |;}October 2016, alleging disability since April 30, 2013. (AR 946-949). Th 19 ||Commissioner denied the claims twice, first on December 27, 2016, and second, o 20 || April 18, 2017 upon reconsideration. (AR 884-87). Plaintiff then requested a hearin 21 ||before an ALJ on June 16, 2017. (AR 896-97). On May 28, 2019, the ALJ issued hi 22 || decision that was unfavorable to Plaintiff (351-69). The ALJ found Plaintiff was no 23 1! disabled and was capable of performing work that exists in substantial numbers i *4 l/the national economy. As such, Plaintiff was not entitled to disability benefits °> |! Plaintiff requested review of the ALJ’s decision by the Appeals Council, but wa *° |! denied on April 20, 2020. (AR 1-7). Plaintiff commenced this action on June 9, 2020. (Doc. No. 1.) 28 B. Medical Overview In January 2012, Plaintiff underwent an orthopedic evaluation for reporte 3 back pain radiating into the left leg. (AR 1261). Dr. William Eves performe * || the evaluation. (/d.) Plaintiff's physical exam showed tenderness to palpation ove > |! the left paraspinal muscles, decreased range of motion, and positive straight leg rais ° on the left side. (AR 1262). An x-ray of the lumbar spine showed mild degenerativ disc disease. (AR 1263). Dr. Eves diagnosed Plaintiff with lumbosacral spin degenerative disc disease. (AR 1263). A magnetic resonance imaging (“MRI”) sca of the lumbosacral spine taken days later showed small L5-S1 disc herniation an mild L4-L5 annular bulging. (AR 1264). In July 2014, Plaintiff stated she had low energy, but her physical an B neurological examinations were within normal limits. (AR 1207-08). In Decembe 14 |{2014, Dr. Terry Carrilio assessed Plaintiff after Plaintiff reported a history of stress 15 |/nervous breakdowns, anxiety, and depression. (AR 1197). After Plaintiff's menta 16 ||Status exam, which showed an obsessive and scattered thought process, Dr. Carrili 17 ||diagnosed Plaintiff with mixed personality disorder and suspected undisclose ig ||history of psychosis or other personality disorder. (AR 1197-98). 19 In May 2015, Plaintiff complained of depression and was prescribe 20 ||Citalopram by her primary care doctor, Eric Leute. (AR 1179). In June 2015 21 |)Plaintiff's therapist, Dr. Carrilio, stated Plaintiff appeared to be improving wit 22 |lantidepressant medication and therapy. (AR 1169). During this same visit, Dr 23 1/Carrilio described Plaintiff as “more organized” and “more focused” and reporte *4 || Plaintiff seemed to be accomplishing tasks, and had begun to manage conflict wit Wa “positive, problem solving approach.” (AR 1169-70). Plaintiff also reported he °° || medication was helping, and she felt more focused and less anxious, had a goo appetite, and was sleeping well and exercising regularly. (AR 1173). In August 2015 28 ! Carrilio noted Plaintiff seemed to be less depressed and anxious, but appeare |lmore disheveled than usual; Plaintiff also appeared to be more focused and les > distracted. (AR 1159). In November 2015, Plaintiff denied taking psychiatri ‘ medication, and her mental status exam was within normal limits. (AR 1143). I > |! December 201 5, Plaintiff reported therapy was “going well” and her depression an ° anxiety had improved. (AR 1134). During a therapy session with Dr. Carrilio in July 2016, Plaintiff received phone call from a friend cancelling their plans for the evening. (AR 1101). Thi caused Plaintiff to become flustered, disorganized, and almost incoherent whe attempting to explain the situation to Dr. Carrilio. (AR 1101). In August 2016, Dr Carrilio again noted Plaintiff presented as disheveled and distracted. (AR 1096) B Plaintiff recounted vague, transient thoughts of self-harm, but “nothing serious.’ 14 1096). Plaintiff spoke in broken sentences and failed to complete her thoughts is. 1096). 16 In early October 2016, Plaintiff met with Dr. Kelley De Leeuw an 17 |}complained of depression and anxiety. (AR 1086). Plaintiff reported having take ig ||St. John’s Wort for most of the last year, which kept her stable. (AR 1086). Plaintifi 19 ||presented a mild dysphoric affect, but her mental examination was within norma 20 limits. (AR 1087). She was prescribed Bupropion. (AR 1087). A week later, durin 21 next session with Dr. Carrilio, Plaintiff appeared less disheveled and mor 22 || focused. (AR 1084). 23 On October 11, 2016, Dr. Carrilio authored a mental impairment residua *4 functional capacity questionnaire. (AR 1230). Dr. Carrilio reported treating Plaintif biweekly since December 2014 and diagnosing Plaintiff with depression and anxiety. *° (AR 1239). Dr. Carrilio also reported Plaintiff improved with medication but ha become disorganized. (AR 1230). In determining Plaintiff's ability to perform work 28 ! Ilrelated activities on a daily basis in a regular work setting, Dr. Carrilio opine ? ||Plaintiff was unable to meet competitive standards, including: maintaining regula 3 attendance and being punctual within customary, usual strict tolerances; sustainin * lan ordinary routine without special supervision; making simple work-relate ° decisions; performing at a consistent pace without an unreasonable number an ° length of rest periods; and responding appropriately to changes in a routine wor setting. (AR 1232-33). Dr. Carrilio also noted Plaintiff's extreme difficult maintaining concentration, persistence or pace. (AR 1234). Plaintiff's difficult managing simple logistics was also noted in Dr. Carrilio’s report, as was her abilit to get to places as scheduled, modified by her tendency to be derailed by unrelate distractors. (AR 1232-33). Finally, Dr. Carrilio noted Plaintiff become B overwhelmed and frustrated by minor performance demands and exhibits dramati 14 |{teactions to minor physical symptoms like fatigue or illness. (AR 1233, 1235). 1s By November 2016, Plaintiff reported improvements in her depression an 16 || concentration with medication, and her mental status examination was within norma 17 ||limits. (AR 18-19). Plaintiff also reported she “still [felt] down sometimes,” but “1 ig nowhere to the degree” that it had been. (AR 1253). Plaintiff further stated 1 19 ||she had “known an antidepressant would be so helpful, I would have started a yea 20 |jago.” (AR 1253). In March 2017, R. Waranch, Ph.D., reviewed Plaintiff's medica 21 |\files and opined Plaintiff would have difficulty with detailed and comple 22 |linstructions. (AR 874-77). 23 In October 2017, Dr. De Leeuw again examined Plaintiff and diagnosed he *4 delusional disorder. (AR 1260). Plaintiff presented with a restricted affec during this visit. (AR 1260), expressed thoughts that she was being watched by he °° |! former employer, and became tearful while explaining that she was bein manipulated and controlled. (AR 1258). Dr. De Leeuw reported that delusions ar 28 ! || generally refractory to antipsychotic medications and can self-resolve. (AR 1260) ? Plaintiff made it clear she was not open to a diagnosis of delusional disorder, and Dr > Leeuw did not feel that it would be “therapeutic” at this time to challenge her * 1260). ° In December 2018, Dr. De Leeuw reported Plaintiff's condition was “fairl ° refractory” to treatment, and opined that she could no longer meet the requirement of a competitive work environment. (AR 1310). Dr. De Leeuw authored a menta impairment residual functional capacity questionnaire in February 2019, where sh diagnosed Plaintiff with delusional disorder and generalized anxiety disorder. (A 1342). Plaintiff reportedly responded well to mindfulness and motivationa interviewing and was adherent to her medication, though this did not help gai B insight into her delusions. (AR 1342). Dr. De Leeuw noted Plaintiff becomes easil 14 Stressed when trying to complete simply tasks and is derailed by others easily. (A 15 || 1345). Dr. De Leeuw opined Plaintiff was mentally unable to meet competitiv 16 ||Standards in several areas of work-related functioning required for unskilled 17 ||Semiskilled, and skilled work, including maintaining regular attendance and bein ig |;punctual within customary tolerances; understanding and remembering short an 19 |}simple instructions; maintaining attention for two-hour segments; and sustaining a 20 |}ordinary routine without special supervision. (AR 1347). In Dr. De Leeuw’s opinion 21 ||Plaintiff's daily paranoia, not based in reality, would make her unable to mee 22 ||competitive standards at work. (AR 1347). Plaintiff had little insight into he 23 |) paranoia at the time of the report. (AR 1344). 24 In March 2019, Plaintiff continued to express paranoia about her new cel phone and being spied on. (AR 750). She also claimed that she had recently seen a °° || FBI surveillance van. (AR 750). Dr. De Leeuw noted Plaintiff had a linear, logica thought process, but exhibited slight anxiety and emotional restriction. (AR 751) 28 ! Plaintiff's thought content was consistent with persecutory delusions and paranoia 751). Five days later, Plaintiff presented as disheveled with a scattered though 3 process. (AR 748). ‘ On March 29, 2019, Plaintiff underwent a consultative examination with Dr ° Gregory Nicholson for disability determination purposes. (AR 1349). Plaintifi ° presented with no psychomotor agitation or retardation and appeared genuine an truthful with no indications of manipulation. (AR 1351). Plaintiff stated she wa feeling paranoid, anxious, and depressed, and had auditory hallucinations, but sh did not appear to be responding to internal stimuli. (AR 1350-52). Plaintiff als reported having seen a doctor and was prescribed Wellbutrin and Abilify. (AR 1350). Plaintiff was living alone and cooking her own meals and had no difficulty dressing B bathing, and caring for her hygiene. (AR 1351). The mental status exam showed 14 ||depressed mood and dysphoric affect during the exam, though Plaintiff presente 15 || with good eye contact and interpersonal contact. (AR 1351-52). Plaintiff was able t 16 ||recall one item after five minutes with hints and perform serial threes, but sh 17 |}answered a simple math problem incorrectly. (AR 1352). Additionally, Plaintifi ig ||believed the year was 2018, but was otherwise oriented to place, person, and purpose. 19 ||(AR 1352). 20 At the end of the examination, Dr. Nicholson assessed an unspecifie 21 ||psychotic disorder and major depressive disorder. (AR 1353). He noted Plaintiff’ 22 ||reported anxiety was accounted for in a diagnosis of psychosis and did not require 23 |!separate diagnosis of an anxiety disorder. (AR 1353). Dr. Nicholson also observe the mental status exam showed some cognitive deficits, opined Plaintiff may have cognitive disorder, and believed that neuropsychological testing may provide mor |linformation about Plaintiff's cognitive functioning. (AR 1353). Dr. Nicholso expected Plaintiff's condition to improve over the next year with active treatment 28 ! 1353). Finally, Dr. Nicholson opined Plaintiff retains mild limitations in he ? || ability to interact with coworkers and the public, maintain concentration persistenc 3 pace, accept instructions from supervisors, maintain regular attendance, an ‘ perform work activities without special supervision. (AR 1354). ° In April 2019, Plaintiff reported feeling extremely fatigued and underwent ° stress test as a result. (AR 744). She presented as alert and oriented, but dishevele with a scattered thought process, tangential, hyperverbal, and labile. (AR 744). I early May, Plaintiff continued to be cautious about her former boss having access t her phone. (AR 742). Her provider again described her as disheveled with a scattere thought process, tangential and hyperverbal, but also alert and oriented. (AR 742) In June 2019, Plaintiff was voluntarily admitted to Sharp Mesa Vista Hospital afte B disclosing she had been contemplating overdosing on her medication in previou 14 ||days. (AR 22). She reported feeling hopeless and having recurrent suicidal ideation 15 occasionally expressed paranoid delusions that someone was following her. (A 16 ||23). Plaintiff stabilized and was discharged five days later. (AR 20). 17 C. Plaintiff’'s Testimony 18 At the hearing before the ALJ, Plaintiff testified that, although she possesse 19 driver’s license, she has not driven in two years because she has too much anxiety 20 837). Plaintiff reported taking various medications, including Abilify for he 21 |)mental state, Wellbutrin for depression, and inhalers for mild but persistent asthma 22 839). When asked why she believed she was unable to work, Plaintiff testifie 23 was very stressed, overwhelmed, and had major anxiety, and did not have th *4 |! mental, emotional, or physical strength to work. (AR 844). Plaintiff reported hearin “gibberish” voices sometimes and felt they could be real. (AR 846). Plaintiff als °° told the ALJ about her sciatica, which she reported suffering from since 2003. (A 27 28 ! 11850). Plaintiff told the ALJ if she were to work again, she knew that she would mis ? Ila lot of work. (AR 852). 3 Additionally, Plaintiff mentioned reading when she can concentrate, but sh * tired all the time. (AR 847). Plaintiff reported getting a little bit of exercise, whic > \lmade her feel better. (AR 847). Plaintiff also mentioned knowing her phone wa ° been tapped by her former boss and had bought her third phone in the last tw |Imonths. (AR 849). D. Vocational Expert’s Testimony A vocational expert also testified at the hearing. The ALJ asked the vocationa expert whether a person with Plaintiff's age, education, and prior work experience > well as job restrictions, could find work. (AR 850-51). The vocational expe B responded that the hypothetical individual could work as a Hand Packager, a Kitche i4 || Helper, or a Food Service Worker. (AR 851). The ALJ then gave the expert the sam 15 ||Set of facts, with an additional restriction: this person would be off task at least 2 16 ||percent of the time, due to psychological-based symptoms or fatigue. (AR 851). Th 17 ||expert responded that there would be no work for this individual. (AR 851). 18 E. ALJ’s Findings 19 At step one of the analysis, the ALJ found Plaintiff has not engaged i 20 ||substantial gainful activity since April 30, 2013. (AR 356). At step two, the AL 21 |}found Plaintiff had the following severe impairments: degenerative disc disease o 22 lumbar spine, major depressive disorder, and psychotic disorder. (AR 356). 23 At step three, the ALJ found Plaintiff did not have an impairment o *4 || combination of impairments that meets or medically equals the severity of one o °> IIthe listed impairments. (AR 357). In making this determination, the ALJ firs *° || considered the “paragraph B” criteria, where the mental impairment must result 1 at least one extreme or two marked limitations in a broad area of functioning. (A 28 ! 11357). The ALJ assessed Plaintiff had a mild limitation in understanding |lremembering, or applying information and adapting or managing oneself. (AR 357) ALJ found the Plaintiff had a moderate limitation in interacting with others an ‘ concentrating, persisting, or maintaining pace. (AR 357). The paragraph B criteri > \lwere thus not satisfied, because the Plaintiff's mental impairment did not cause a ° least two marked limitations or one extreme limitation. (AR 357). The AL also considered whether “paragraph C” criteria, which require the Plaintiff's menta disorders to be “serious and persistent,’ were satisfied. (AR 357). The AL concluded that the medical evidence failed to establish the claimant achieved onl marginal adjustment, and that changes or increased demands on Plaintiff would hav led to exacerbation of her signs and symptoms, and to deterioration in her menta B functioning. (AR 357). 4 Prior to step four, the ALJ found Plaintiff has the Residual Functiona 15 ||Capacity (“RFC”) to perform medium work, but that she was limited to no work o 16 unprotected heights or dangerous machinery; requires a clean air environment; n 17 |/temperature extremes; routine, noncomplex tasks; and no sustained intens ig |}interaction with the public, coworkers, or supervisors, but incidental or brief socia 19 ||conversation is not precluded. (AR 358). 20 At step five, the ALJ found that there were jobs that exist in significan 21 ||numbers in the national economy that Plaintiff could perform. (AR 362). These job 22 |!included Hand Packager, Kitchen Helper, and Food Service Worker. (AR 362). A 23 !/such, the ALJ found Plaintiff not disabled. (AR 362). = STANDARD OF REVIEW A district court will only disturb the Commissioner’s decision if it constitute *° legal error or is not supported by substantial evidence. Smolen v. Chater, 80 F.3 1273, 1279 (9th Cir. 1996) (citing Fair v. Bowen, 885 F.2d 587, 601 (9th Cir. 1989)) 28 10 ! ||“Substantial evidence” is less than a preponderance, but more than a scintilla, and i |levidence that a reasonable person would consider sufficient to support a conclusion > The ALJ is responsible for weighing and determining credibility, settlin * conflicts in medical testimony, and resolving ambiguities. Andrews v. Shalala, 53 > 1035, 1039 (9th Cir. 1995). The ALJ’s decision must be upheld if the evidenc ° is subject to more than one rational interpretation. Burch v. Barnhart, 400 F.3d 676 "11679 (9th Cir, 2005). IV. LEGAL STANDARD A. Overview of Social Security Claim Proceedings Under the Social Security Act (“the Act’), the Social Security Administratio (“SSA”) administers the supplemental security income (“SSI”) benefits program. 4 B U.S.C. § 901. The Act allows the SSA to create a process to determine eligibility fo 4 benefits and, in the case of an unsuccessful claimant, the circumstances under whic 15 ||those adverse decisions may be reviewed. Jd. §§ 423 et seq. Defendant, as Actin 16 Commissioner of the SSA, is responsible for administration of the Act. Id. § 17 |{902(a)(4), (b)(4). 18 B. The SSA’s Sequential Five-Step Process 19 The SSA uses a five-step sequential process to determine a claimant’ 20 eligibility for benefits. 20 C.F.R. §§ 416.920, 404.1520. To be eligible under the Act 21 claimant must establish two criteria. First, the claimant must show he or she suffer. 22 a medically determinable physical or mental impairment, which “results fro 23 |/anatomical, physiological, or psychological abnormalities” and is shown throug |l“medically acceptable clinical and laboratory diagnostic techniques.” 42 U.S.C. § 423(d)(3). Second, the claimant must show he or she is incapable of performin 7° |! work previously performed or any other substantially gainful employment due to th || impairment. See 42 U.S.C. §§ 423(d)(1)(A), (2)(A); 1382(c)(3)(A). 28 Wl In addition to meeting both of these criteria, the claimant must prove he or sh ||“either was permanently disabled or subject to a condition which became so sever 3 to create a disability prior to the date upon which [his or] her disability insure * || status expired.” Johnson v. Shalala, 60 F.3d 1428, 1432 (9th Cir. 1995). A > \ladministrative law judge (“ALJ”) will use the five-step evaluation to determin ° eligibility. See Barnhart v. Thomas, 540 U.S. 20, 24-25 (2003) (explaining the five step process). If the ALJ finds that a claimant is or is not disabled at any of the fiv steps, the evaluation ends at that step. Corrao v. Shalala, 20 F.3d 943, 946 (9th Cir 1994). 10 The first step in the process considers a claimant’s “work activity, if any.” 2 C.F.R. § 404.1520(a)(4)(1). If the claimant is found to be engaged in “substantia B gainful activity,” the ALJ will end the evaluation here. /d. §§ 404.1520(b) 14 |[416-920(6). 1s The analysis proceeds to the second step if the claimant cannot show gainfu 16 || work activity. At step two, the ALJ will use the “severity regulation” to determin 17 |}whether the claimant has a medically severe impairment or combination o ig |}impairments. Jd. §§ 404.1520(c), 416.920(c); see also Bowen v. Yuckert, 482 U.S 19 140-41 (1987). This analysis asks whether the claimant suffers from a sever 20 ||impairment or combination of impairments that significantly limit the claimant’ 21 ||physical or mental ability to accomplish “basic work activities.” 20 C.F.R. § 22 |1404.1520(c). This refers to the claimant’s “abilities and aptitudes necessary to d 23 jobs.” Id. §§ 404.1521(b), 416.921(b). If the ALJ does not find the claiman *4 || suffers from such an impairment or combination of impairments that renders him o °> unable to fulfill these obligations, the evaluation will end. *° However, if the ALJ does find a severe impairment, the evaluation proceed to the third step. At this step, the ALJ will compare the impairment to several liste 28 ! |}impairments that the SSA has acknowledged are so severe that they preclud ? || substantial gainful activity. Jd. §§ 404.1520(d), 416.920(d). If the impairment meet 3 || or is equivalent to one of the listed impairments, the ALJ will presume the claiman * || disabled. Id. § 404.1520(d). ° The ALJ must establish the claimant’s RFC before proceeding to the fourt ° step. Id. §§ 404.1520(e), 404.1545(a). The RFC refers to the claimant’s ability t perform physical and mental work activities on a regular basis despite limitation due to his or her impairments. Jd. §§ 404.945(a)(1), 404.1545(a)(1). The RF analysis asks “whether [the claimant’s] impairment(s), and any related symptoms such as pain, may cause physical and mental limitations that affect what [th claimant] can do in a work setting.” Jd. §§ 404.1545(a)(1), 416. 945(a)(1). The AL 13 |{ must consider the claimant’s impairments, including those considered non-severe 14 well as relevant evidence in determining the claimant’s RFC. Id. §§ 15. |[404.1545(a)(3), (e). The evaluation will proceed to step four if, at step three, the AL 16 ||does not determine a claimant’s impairment, or combination of impairments, 1 17 disabling. 18 At the fourth step, the ALJ will determine whether the claimant can perfor 19 requirements of his or her past relevant work, using the claimant’s RFC. Id. § 20 ||404.1520(f). If the claimant has the RFC to carry out his or her past relevant work 21 claimant is not disabled. /d. § 404.1560(b)(3). If, however, the claimant does no 22 ||have any past relevant work or cannot perform that work, the analysis proceeds t ?3 fifth and final step. 24 At step five, the ALJ must determine whether the claimant is able to do an || other work in light of his or her RFC, age, education, and work experience. Id. § *6 404.1520(g). If the claimant is unable to do other work and meets the duratio requirement, the claimant is disabled. /d. Conversely, if the claimant can perfor 28 1B ! |lother work, the claimant is not considered disabled. Jd. The claimant generall ||continues to bear the burden of proving disability at this step, but a limited burde 3 || of moving forward shifts to the SSA. Here, the SSA must provide evidence showin * other work that the claimant can perform actually exists in significant number > Tin the national economy, and the ALH must consider the claimant’s RFC, age ° education, and work experience in doing so. Jd. §§ 404.1520, 1560(c), 416.920 "||404.1512(f). C. SSA Hearings and Appeals Process The Office of Disability Adjudication and Review administers a nationwid hearings and appeals program. SSA regulations set forth a four-step process fo administrative review of a claimant’s application for disability benefits. See id. §§ B 416.1400, 404.900. After the SSA makes an initial determination, three more level 14 |{Of appeal are available: (1) reconsideration, (2) a hearing before an ALJ, and (3 15 |[review by the Appeals Council. See id. §§ 416.1400, 404.900. The claimant wil 16 || have 60 days to seek administrating review if he or she wishes to appeal a decision 17 ||See id. §§ 404.933, 416.1433. The decision becomes the SSA’s—and henc is ||Defendant’s—binding and final decree if the claimant does not request review. Se 19 404.905, 416.1405. 20 Various SSA field offices and state disability determination services proces 21 |}initial applications for disability benefits. This initial review begins when a claiman 22 |!completes an application, as well as an adult disability report, and submits bot 3 documents to an SSA field office. If the SSA denies the claim, the claimant is the *4 entitled to a hearing before an ALJ in the SSA’s Office of Disability Adjudicatio °> \land Review. Id. §§ 404.929, 416.1429. An ALJ hearing is informal and non °° || adversarial. Id. § 404.900(b). 27 28 14 If the ALJ’s decision is unfavorable to the claimant, the claimant can reques 2 |lreview by the Appeals Council. Jd. §§ 404.967, 416.1467. The Appeals Council wil > grant, deny, dismiss, or remand the claimant’s request for review. Jd. 416.1479 * ||404.979. If the Appeals Council declines review of the claim or the claiman ° disagrees with the Appeals Council’s decision, the claimant can seek the distric ° court’s review. See id. §§ 404.981, 416.1481. If the district court remands the claim the claim is sent back to the Appeals Council for a decision or referral to anothe ALJ. Id. § 404.983. V. DISCUSSION Plaintiff challenges the ALJ’s unfavorable decision on the grounds that th ALJ failed to provide specific, legitimate reasons supported by substantial evidenc B for rejecting Drs. Carrilio and De Leeuw’s opinions. More specifically, Plaintifi 14 |{attacks the ALJ’s reason for rejecting the medical opinions: the medical record 15 ||indicated improvement in Plaintiff's mental symptoms with medication and therapy 16 Plaintiff uses Garrison to argue it is improper “for an ALJ to pick out a few isolate 17 |}instances of improvement over a period of months or years and to treat them as ig for concluding a claimant is capable of working.” 759 F.3d at 1017 (citin 19 Holohan v. Massanari, 246 F.3d 1195, 1205 (9th Cir. 2001)). Plaintiff also notes th 20 and material evidence presented to the Appeals Council after the ALJ’s decisio 21 which Plaintiff believes supports the opinions of Drs. Carrilio and De Leeu 22 further demonstrate Plaintiff's mental condition. Plaintiff alleges this, take 3 |/together, resulted in an improper rejection of the treating physicians’ medica *4 opinions. Defendant counters by asserting the ALJ’s conclusion must be uphel |lwhere the evidence is supported by more than one rational interpretation. Here °° || Defendant argues this is the case because the ALJ found that the evidence supporte limitations on mental functioning, yet also supported a higher degree of residua 28 15 ! || functioning. Defendant argues Plaintiff is relying on isolated instances, for example |lappearing disheveled, while ignoring “normal findings” of improvement. 3 A. The ALJ’s Treatment of Dr. Carrilio’s and Dr. De Leeuw’s Medica ‘ Opinions. ° In his decision, the ALJ gave “partial weight” to the medical opinions of Dr: ° Carrilio, Plaintiff's treating psychologist, and Dr. De Leeuw, Plaintiffs treatin psychiatrist. (AR 361). The ALJ gave “great weight” to their opinions of “sever mental conditions and moderate mental functional limitations,” and gave “les weight” to their opinions of “marked and extreme mental functional limitations.’ (AR 361). In doing so, the ALJ found some objective findings of depression an reported paranoia did exist, but other mental health records indicated improvemen in Plaintiff's mental symptoms with medication and therapy. (AR 361). In Plaintiff? 14 |{continued therapy sessions with Dr. Carrilio in 2015, Plaintiff appeared to b is |/improving with medication and therapy, presented as less disheveled, and seeme 16 || less stressed as she continued with “therapeutic recommendations.” (AR 1159, 1169 17 ||1175). By contrast, the ALJ gave “great weight” to the opinion of the DDS stat ig |}agency mental consultant, who assessed severe depression. (AR 360). The AL 19 ||reasoned this medical opinion was consistent with the mental status exams in th 20 ||record showing a depressed mood, some difficulty with concentration tasks, an 21 ||Plaintiff’s self-reported depression. (AR 360). 22 Plaintiff argues the ALJ did not properly reject the opinions of Drs. Carrili De Leeuw because the ALJ did not give specific, legitimate reasons for doin I! so. (Doc. No. 11-1, 6:25-7:2). Plaintiff argues the ALJ’s sole reason for rejecting th opinions violates Garrison, which held it is improper for an ALJ to deny a claimant’ °° benefits due to isolated incidents, because the claimant’s symptoms can wax an wane during treatment. 759 F.3d at 1017. Plaintiff claims she continued to suffe 28 16 ! |lsymptoms despite ongoing treatment—she appeared more disheveled than usual i ? || August 2015, presented as disheveled and distracted in August 2016, and spoke i 3 |!broken sentences without completing her thoughts. (AR 1096, 1159). Plaintiff als * Ilrelies on the new and material evidence submitted to the Appeals Council, whic > |Ishe argues provides further support for these two medical opinions. (Doc. No. 11-1 ° 8:12-14). This evidence explains Plaintiff's ongoing paranoia about her cell phon being tapped and continuing to present as scattered and disheveled during variou visits. (AR 742, 744, 748, 750). Plaintiff claims this new evidence “demonstrate[s] significant, ongoing problems with [Plaintiff's] mental stability.” (Doc. No. 11-1 9:9-10). Plaintiff reported feeling hopeless, having suicidal ideations, an experiencing paranoid delusions. (AR 23). Plaintiff's ultimate position is the ALJ’ B focus on her instances of improvement do not constitute a specific, legitimate reaso 14 ||Supported by substantial evidence that justify rejecting the opinions of Drs. Carrili 15 De Leeuw. (Doc. No. 11-1, 9:20-23). 16 Defendant contends Plaintiff has not established reversible error becaus 17 Plaintiff failed to address the ALJ’s reliance on various “normal medical findings’ ig ||that supported the ALJ’s decision. (Doc. No. 12, 6:21-7:3). Moreover, Defendan 19 |}argues the ALJ did provide specific, legitimate reasons that explain why th 20 |)evidence supported the Plaintiff's RFC. (Doc. No. 12, 5:1-4). Defendant points t 21 |}multiple mental status examinations that show depressed mood, restricted affect, an 22 paranoia to describe the ALJ’s findings of Plaintiffs limitations. (Doc. No. 12, 5:9 1113). However, the ALJ also found instances where Plaintiff had a normal mood, wa |! described by her physicians as alert and oriented, and her mental status examination °> entirely normal. (Doc. No. 12, 5:14-20). As such, Defendant argues the AL *6 “reasonably found that the weight of the medical findings” were consistent wit Plaintiff's RFC. (Doc. No. 12, 5:21-23). Additionally, Defendant refutes Plaintiff’ 28 ! |lcontention that the ALJ relied on isolated instances of improvement, becaus ? ||Plaintiff ignored the ALJ’s consideration of findings throughout the entire disabilit 3 ||period. (Doc. No. 12, 7:10-13). Finally, Defendant argues even if the Court were t * || find this reversible error, the proper remedy would not be payment of benefits, a > |! Plaintiff requests, but a remand for further proceedings. (Doc. No. 12, 8:11-16). ° B. The ALJ Gave Proper Weight to the Medical Opinions of Drs. Carrili and De Leeuw. In the present case, the ALJ’s decision to give partial weight to the treatin physicians’ medical opinions rests on specific, legitimate reasons supported b substantial evidence. The ALJ cites to specific medical records where Plaintifi reported improvement with antidepressants and following through with therapeuti B recommendations, and presented as more organized as she continued wit 14 |{antidepressants and therapy. (AR 1159, 1169). During one of Plaintiff’s session is Dr. Carrilio, Plaintiff appeared less distressed and Dr. Carrilio noted tha 16 Plaintiff appeared to be improving with the use of antidepressant medication an 17 ||therapy. (AR 1169). In a later session, Dr. Carrilio assessed that Plaintiff seemed t is feeling less depressed, less anxious, and less stressed. (AR 1159). Plaintif 19 ||developed coping skills, such as making lists and managing conflict with positivit 20 a problem-solving approach. (AR 1169). Plaintiff argues her continue 21 ||“symptoms consistent with the severity of impairment,” (Doc. No. 11-1, 7:119-21 22 |lincluding appearing disheveled, disorganized, and paranoid thoughts (AR 1101 111159, 1258) should govern here. However, the Court finds Defendant’s argumen |) more persuasive: the ALJ did not find that Plaintiff's symptoms disappeared entirel with treatment—rather, the ALJ accounted for Plaintiff's ongoing symptoms in hi *6 determinations. (Doc. No. 12, 7:5-7, 20-22). As such, the Court looks to thi 27 28 18 ! || evidence in finding that there is more than one reasonable interpretation. Under thes ? || circumstances, the Court is required to leave the ALJ’s decision undisturbed. 3 Additionally, Plaintiff believed her medications were helping her: she fel * || more focused, less anxious, was sleeping well, had a good appetite, and wa ° exercising regularly. (AR 1173). Plaintiff's physical exam in June 2015 assesse ° depression, but noted Plaintiff appeared more focused and less disheveled, an presented with an alert mental status. (AR 1173-74). She also described gettin together more often with friends while on her medication, and continued to appea to Dr. Carrilio as less disheveled and distressed (AR 1175). Nowhere in Plaintiff Motion for Summary Judgment are these improvements addressed—trather, Plaintifi focuses only on her ongoing symptoms that continued despite treatment. B By Plaintiff's own admission in 2016, if she had known antidepressant 14 || would be so helpful, [she] would have started a year ago.” (AR 1253). While sh 15 |/initially reported trouble sleeping with some of her medications, it appeared t 16 ||resolve. (AR 1253). When Celexa resulted in migraines and Plaintiff did not believ 17 ||Prozac would help her, she stopped taking those medications, but continued in th ig ||Bupropin and reported it had helped her. (AR 1253). There is no mention of thes 19 ||improvements in Plaintiff's Motion for Summary Judgment, though it does refer t 20 ||“the ALJ’s mere reference to [Plaintiff's] purported improvement.” (Doc. No. 11-1 21 |)9:20-21). Plaintiff also expressed her therapy sessions with Dr. Carrilio were als 22 || going well, which Plaintiff does not address in her Motion for Summary Judgment 23 11(AR 1253). 24 Plaintiff also argues records dated after the ALJ’s decision demonstrat ° “significant, ongoing problems with [Plaintiff's] mental stability, and specificall *° || mentions her hospitalization in June 2019. (Doc. No. 11-1, 9:9-10). But this evidenc is no different from evidence submitted prior to the ALJ’s decision, which support 28 19 ! |\findings of paranoia and scattered thought processes (AR 357, 359, 361). A ? Defendant argues, Plaintiff ignores findings in later submitted evidence that suppo 3 ALJ’s findings. (Doc. No. 12, 8:28-9:1). Plaintiffs hospital records from Jun * 12019 also indicate good grooming and hygiene, linear and coherent speech, and a ° alert and oriented demeanor. (AR 23, 32, 34, 39). Plaintiff does not provide an ° grounds to disturb the ALJ’s decision based on this evidence. Further, the evidence here is open to more than one rational interpretation The Disability Determination Services (“DDS”) state agency mental consultan examined Plaintiff in March 2017, and although Plaintiff argues that the opinion o a treating physician should be afforded greater weight than one of a physician wh examined the Plaintiff one time, (Doc. 11-1, 10:24-26), the consultant’s finding 13 supported by objective findings from both Dr. Carrilio and Dr. De Leeuw. (A 14 |{876). For example, the consultant noted most of Plaintiff's medical progress note 15 ||from October and November 2016, just a few months prior, reported improvemen 16 |{in Plaintiff's symptoms. (AR 875). This is a reasonable interpretation: Plaintif 17 ||reported therapy was going well, and she noted she wished she had starte ig |;antidepressants earlier. (AR 1253). Based on this information, it is rational t 19 ||conclude that with continued medication and therapy, Plaintiff's conditions woul 20 improved, as she reported they had in the past. This rational explanatio 21 |)requires the Court to give deference to the ALJ’s decision. Burch v. Barnhart, 40 22 676, 679 (9th Cir. 2005); Andrews v. Shalala, 53 F.3d 1035, 1040-41 (9th Cir 111995); Magallanes v. Bowen, 881 F.2d 747, 750 (9th Cir. 1989). Accordingly, th *4 l/Court finds there is no factual or legal basis that supports disturbing the ALJ’ *> decision. 28 20 1 CONCLUSION For the foregoing reasons, Defendant’s Cross-Motion for Summary Judgmen ||(Doc. No. 12) is GRANTED and Plaintiff’s Motion for Summary Judgment (Doc * 11-1) is DENIED. ° IT IS SO ORDERED. 6 , Dated: April 20, 2021 : Se Hon. William V. Gallo 9 United States Magistrate Judge 10 1 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 21