JEAN ROSENBLUTH, United States Magistrate Judge.
Plaintiff seeks review of the Commissioner's final decision denying her application for Social Security Supplemental Security Income ("SSI"). The parties consented to the jurisdiction of the undersigned U.S. Magistrate Judge pursuant to 28 U.S.C. § 636(c). This matter is before the Court on the parties' Joint Stipulation, filed October 15, 2012, which the Court has taken under submission without oral argument. For the reasons stated below, the Commissioner's decision is affirmed and this action is dismissed.
Plaintiff was born on April 30, 1967. (Administrative Record ("AR") 80.) She has a seventh-grade education and is able to communicate in English. (AR 90, 97.) Plaintiff has not worked since 1991, although she earned a small amount of income in 1993. (AR 85, 91.) On June 29, 2007, Plaintiff filed an application for SSI, alleging a disability onset date of June 1, 1998. (AR 80.) The application was denied on September 27, 2007. (AR 36-38.) Plaintiff filed a request for reconsideration, which was denied on September 9, 2008. (AR 41-45.)
After Plaintiff's application was denied, she requested a hearing before an Administrative Law Judge ("ALJ"). (AR 48.) An initial hearing was held on May 6, 2010, at which Plaintiff, who was represented by counsel, appeared and testified on her own behalf. (AR 479-508.) In a written decision issued on June 7, 2010, the ALJ determined that Plaintiff was not disabled. (AR 22-33.) Plaintiff then requested review of the ALJ's decision, and on October 29, 2010, the Appeals Council reversed and remanded the matter for further proceedings. (AR 65-67.) On June 7, 2011, another hearing was held, at which Plaintiff again testified on her own behalf. (AR 455-78.) On June 17, 2011, the ALJ issued a written decision again determining that Plaintiff was not disabled. (AR 12-21.) Plaintiff requested review of the ALJ's decision. (AR 11.) On December 2, 2011, the Appeals Council denied Plaintiff's request for review. (AR 5-7.) This action followed.
Pursuant to 42 U.S.C. § 405(g), a district court may review the Commissioner's
People are "disabled" for purposes of receiving Social Security benefits if they are unable to engage in any substantial gainful activity owing to a physical or mental impairment that is expected to result in death or which has lasted, or is expected to last, for a continuous period of at least 12 months. 42 U.S.C. § 423(d)(1)(A); Drouin v. Sullivan, 966 F.2d 1255, 1257 (9th Cir.1992).
The ALJ follows a five-step sequential evaluation process in assessing whether a claimant is disabled. 20 C.F.R. § 416.920(a)(4); Lester v. Chater, 81 F.3d 821, 828 n. 5 (9th Cir.1995) (as amended Apr. 9, 1996). In the first step, the Commissioner must determine whether the claimant is currently engaged in substantial gainful activity; if so, the claimant is not disabled and the claim must be denied. § 416.920(a)(4)(i). If the claimant is not engaged in substantial gainful activity, the second step requires the Commissioner to determine whether the claimant has a "severe" impairment or combination of impairments significantly limiting his ability to do basic work activities; if not, a finding of not disabled is made and the claim must be denied. § 416.920(a)(4)(ii). If the claimant has a "severe" impairment or combination of impairments, the third step requires the Commissioner to determine whether the impairment or combination of impairments meets or equals an impairment in the Listing of Impairments ("Listing") set forth at 20 C.F.R., Part 404, Subpart P, Appendix 1; if so, disability is conclusively presumed and benefits are awarded. § 416.920(a)(4)(iii). If the claimant's impairment or combination of impairments does not meet or equal an impairment in the Listing, the fourth step requires the Commissioner to determine whether the claimant has sufficient residual functional capacity ("RFC")
At step one, the ALJ found that Plaintiff had not engaged in any substantial gainful activity since June 29, 2007, the date of her SSI application. (AR 17.) At step two, the ALJ concluded that Plaintiff had the severe impairments of "obesity, degenerative disc disease of the neck and back, bilateral carpal tunnel syndrome, status post left carpal tunnel surgical release, history of left knee arthroscopy, diabetes, and asthma." (Id.) He also found that Plaintiff's "medically determinable mental impairment of depression does not cause more than minimal limitation in the claimant's ability to perform basic mental work activities and is therefore non-severe." (Id.) At step three, the ALJ determined that Plaintiff's impairments did not meet or equal any of the impairments in the Listing. (AR 18.) At step four, the ALJ found that Plaintiff retained the RFC to perform "light work"
(Id.) At step five, the ALJ found that jobs existed in significant numbers in the national economy that Plaintiff could perform. (AR 20-21.) Accordingly, the ALJ determined that Plaintiff was not disabled. (AR 21.)
Plaintiff alleges that the ALJ erred in (1) finding her subjective symptom testimony not credible and (2) evaluating the opinions of her treating physician. (J. Stip. at 3.)
Plaintiff argues that the ALJ failed to articulate clear and convincing reasons for discounting her subjective symptom testimony. (J. Stip. at 3-6, 16-17.) Reversal is not warranted on this basis, however, because the ALJ made specific, clear findings as to Plaintiff's credibility that were consistent with the medical evidence of record.
An ALJ's assessment of pain severity and claimant credibility is entitled
In connection with her SSI application, Plaintiff alleged that she suffered from the following conditions:
(AR 91.) She claimed that her conditions limited her ability to work in the following ways:
(Id.) Her application also stated, "I do not need help in personal care, hygiene or upkeep of a home." (AR 81.)
At the hearing, Plaintiff testified that she had "problems" with her knees, back, arms, and hands for which she received
In his written opinion, the ALJ found, "[a]fter careful consideration of the evidence," that Plaintiff's "medically determinable impairments could reasonably be expected to cause the alleged symptoms; however, the claimant's statements concerning the intensity, persistence and limiting effects of these symptoms are not credible to the extent they are inconsistent with" the ALJ's RFC assessment. (AR 19.) He noted that Plaintiff "acknowledges pain relief and sleeping well at night" and that despite her "alleged symptoms and limitations," she "continues to cook, perform household chores, and shop for groceries." (Id.) He further noted that "[p]ain management progress notes indicate the claimant experiences pain relief because of medication and injections," and "a review of the laboratory findings shows the consultative examiners were justified in their functional assessments [that Plaintiff could perform medium work]." (Id.) He gave "some weight" to Plaintiff's "treatment for chronic pain" but found that the "severity of the pain" that Plaintiff alleged was "disproportionate to the signs and laboratory findings." (Id.) He further noted that Plaintiff "acknowledges she still cooks, performs household chores, and shops for groceries" and "performs activities of daily living and sleeps well," and thus it was unreasonable to conclude that she was not capable of performing even sedentary work. (AR 20.) He noted that "[a]lthough the claimant's alleged symptoms and limitations are not entirely supported by the objective medical evidence, the undersigned has considered them," and he concluded that "[t]here is no justification for deviating from the [RFC] assessment noted in the [June 2010] decision." (Id.)
Reversal is not warranted based on the ALJ's alleged failure to make proper credibility findings or properly consider Plaintiff's subjective symptoms. Contrary to Plaintiff's arguments, the ALJ provided specific reasons for rejecting Plaintiff's credibility: medical evidence showed that
The ALJ correctly found that Plaintiff's testimony was inconsistent with the objective medical evidence. Tests of Plaintiff's knee in December 2006 showed only "very slight lateral subluxation," no fracture, and "[t]iny suprapatellar joint effusion." (AR 143.) X-rays taken after Plaintiff underwent knee surgery in March 2008 (AR 212) revealed a "normal left knee" with "no evidence of a fracture or osseous injury" (AR 362). Nerve conduction studies performed in January 2008, after Plaintiff's May 2007 carpal tunnel surgery (AR 233), revealed "mild[] improve[ment]" to Plaintiff's left wrist since the surgery (AR 159). The same study showed new "[c]hronic cervical radiculopathy," but another study performed later, in April 2010, showed "[n]o evidence of cervical radiculopathy," indicating that Plaintiff's condition had improved with treatment. (AR 268.) An examining doctor also noted in July 2008 that "[s]ince her surgery [Plaintiff] has improved carpal tunnel syndrome on the left." (AR 414.) In September 2010, Dr. Navdeep Loomba, the pain-management specialist to whom Plaintiff was referred by her primary physician, noted that Plaintiff "has good range of motion of the bilateral upper extremities," her motor strength was "5/5 in the bilateral upper extremities," "[s]ensory is grossly normal, bilateral equal and intact to pinprick sensation," and "[d]eep tendon reflexes are normal." (AR 432.) Dr. Loomba also noted in March 2011 that Plaintiff's "pain is relieved by medications, rest, position change," "[t]he pain medications are helping," and injections relieved her pain by "50-60%." (AR 441.) An MRI of Plaintiff's cervical spine performed in February 2008 showed only "mild" loss of lordosis, "mild" disc space narrowing and disc dessication, "minimal" and "mild" disc bulge, and "slight" narrowing of the central canal. (AR 191-93.) Tests of Plaintiff's lumbar spine in December 2006 showed "[v]ery minimal degenerative change." (AR 143.) An x-ray of Plaintiff's lumbar spine taken in June 2008 showed "[e]xtenuated lordosis" and "moderate spurring of the anterior endplates of L1, L2, L4, and L5" but "normal" disc space heights and facet joints and "no obvious pars defects." (AR 342.) Another x-ray of Plaintiff's lumbar spine, taken in October 2009, showed "narrowing of the L5-S1 interspace consistent with discogenic disease" but "no evidence of fracture or osseous injury," "no evidence of spondylolysis or spondylolisthesis," "normal" "sacroiliac joints," and "mild" osteoarthritis changes. (AR 360.)
In September 2007, consulting examiner Dr. Jeff Altman, a specialist in physical medicine and rehabilitation (AR 171), found that Plaintiff had only minimal impairments and that she had a normal gait, did not appear to be in acute distress, had good range of motion in her extremities and only mildly reduced range of motion in the thoracolumbar spine with no tenderness upon palpation, had intact strength
Because Plaintiff's testimony conflicted with the evidence that her medical conditions only minimally affected her ability to work and that her pain, diabetes, and asthma were well-controlled with medication and other treatments, the ALJ properly discounted it. See, e.g., 20 C.F.R. § 416.929(c)(4)(iv) (ALJ may consider effectiveness of medication in evaluating severity and limiting effects of an impairment); SSR 96-7p, 1996 WL 374186, at *6 ("medical signs and laboratory findings that ... demonstrate worsening or improvement of the underlying medical condition may also help an adjudicator to draw appropriate inferences about the credibility of an individual's statements"); Johnson v. Shalala, 60 F.3d 1428, 1434 (9th Cir.1995) (holding that "contradictions between claimant's testimony and the relevant medical evidence" provided clear and convincing reason for ALJ to reject plaintiff's subjective symptom testimony); Tonapetyan v. Halter, 242 F.3d 1144, 1148 (9th Cir.2001) (credibility determination based on, among other things, plaintiff's "tendency to exaggerate" proper when supported by "substantial evidence").
The ALJ's finding that Plaintiff's testimony conflicted with her daily activities was also proper. Although it is true that "one does not need to be `utterly incapacitated' in order to be disabled," Vertigan v. Halter, 260 F.3d 1044, 1050 (9th Cir.2001), the extent of Plaintiff's activities here supports the ALJ's finding that Plaintiff's reports of her impairment were not fully credible. See Bray v. Comm'r of Soc. Sec. Admin., 554 F.3d 1219, 1227 (9th Cir. 2009); Curry v. Sullivan, 925 F.2d 1127, 1130 (9th Cir.1990) (finding that claimant's ability to "take care of her personal needs, prepare easy meals, do light housework and shop for some groceries ... may be seen as inconsistent with the presence of a condition which would preclude all work activity") (citing Fair v. Bowen, 885 F.2d 597,
The ALJ provided legally sufficient reasons for rejecting Plaintiff's testimony and specific examples of how Plaintiff's testimony was contradicted by the record. In fact, he appears to have given Plaintiff the benefit of the doubt with respect to the severity of her restrictions, as most of the consultative physicians found that she was capable of medium work (see AR 171, 173-77, 254-58) but the ALJ's RFC finding limited her to light work with some additional restrictions (AR 18). He thus did not materially err in assessing Plaintiff's credibility, and reversal is not warranted on this basis.
Plaintiff contends that the ALJ did not properly evaluate the opinions of her treating physician, Dr. Arthur Jimenez. (J. Stip. at 18-20, 25-27.) Reversal is not warranted on this basis because the ALJ gave specific and legitimate reasons for rejecting Dr. Jimenez's opinions, and the ALJ's evaluation of the medical evidence was consistent with substantial evidence in the record.
Three types of physicians may offer opinions in social security cases: "(1) those who treat[ed] the claimant (treating physicians); (2) those who examine[d] but d[id] not treat the claimant (examining physicians); and (3) those who neither examine[d] nor treat[ed] the claimant (non-examining physicians)." Lester, 81 F.3d at 830. A treating physician's opinion is generally entitled to more weight than the opinion of a doctor who examined but did not treat the claimant, and an examining physician's opinion is generally entitled to more weight than that of a nonexamining physician. Id.
The opinions of treating physicians are generally afforded more weight than the opinions of nontreating physicians because treating physicians are employed to cure and have a greater opportunity to know and observe the claimant. Smolen, 80 F.3d at 1285. The weight given a treating physician's opinion depends on whether it was supported by sufficient medical data and was consistent with other evidence in the record. See 20 C.F.R. § 416.927(c)(2). If a treating physician's opinion was well supported by medically acceptable clinical and laboratory diagnostic techniques and is not inconsistent with the other substantial evidence in the record, it should be given controlling weight and rejected only for "clear and convincing" reasons. See Lester, 81 F.3d at 830; § 416.927(c)(2). When a treating physician's opinion conflicts with other medical evidence or was not supported by clinical or laboratory findings, the ALJ must provide only "specific and legitimate reasons" for discounting that doctor's opinion. Orn v. Astrue, 495 F.3d 625, 632 (9th Cir.2007). Indeed, the ALJ may discredit treating-doctor opinions that are conclusory, brief, and unsupported by the record as a whole or by objective medical findings. See Batson v. Comm'r of Soc. Sec. Admin., 359 F.3d 1190, 1195 (9th Cir.2004); Thomas, 278 F.3d at 957. Other factors relevant to the evaluation of a treating physician's opinion include the "[l]ength of the treatment relationship and the frequency of
Plaintiff began seeing Dr. Jimenez as her primary care physician in 2001 for her "diabetes, asthma, high blood pressure, cholesterol problems, ... thyroid, depression, knee injury, and ... back/neck problems." (AR 94.) She testified that she saw Dr. Jimenez "at least once a month," "[m]ostly" for the pain in her knees, back, arms, and hands. (AR 460.) In April 2010, Dr. Jimenez filled out a check-box form stating that, in an eight-hour workday, Plaintiff could not lift even 10 pounds; she could stand, walk, and sit for less than two hours a workday; she could sit 15 minutes and stand 20 minutes before needing to change position; she must walk for 20 minutes every 20 minutes; she could only occasionally twist and climb stairs and could never stoop, crouch, or climb ladders; she must avoid concentrated exposure to humidity and all exposure to extreme temperatures, airborne irritants, and heights; and she would likely be absent from work more than three times a month. (AR 379-81.) He stated that Plaintiff's "lumbar narrowing" and "carpal tunnel syndrome" supported his conclusions. (AR 380.) In September 2010 he filled out an RFC Questionnaire noting substantially similar limitations. (AR 434-38.)
(AR 20.)
As discussed above, evidence in the record supported the ALJ's finding that Plaintiff was capable of performing light work with some restrictions. (See AR 43, 159, 169-71, 173-77, 191-93, 198-200, 254-58, 268, 318, 342, 357, 360, 362, 414, 432, 441.) Dr. Jimenez's two RFC forms were in check-box form, were conclusory, and conflicted with substantial other evidence in the record; the ALJ was entitled to reject them on that basis. See Batson, 359 F.3d at 1195 ("The ALJ need not accept the opinion of any physician, including a treating physician, if that opinion is brief, conclusory, and inadequately supported by clinical findings."). Dr. Jimenez noted that Plaintiff had complained of pain in her back, neck, legs, and arms and that she had been diagnosed with asthma, degenerative conditions in her spine and knee, and carpal tunnel syndrome (AR 380, 464), but he did not explain how these diagnoses led to his findings that she was incapable of even sedentary work, particularly given the ample evidence in the record, including results from tests and consultations ordered
The ALJ was also entitled to reject Dr. Jimenez's opinions to the extent they imposed a highly restrictive RFC that was inconsistent with Plaintiff's daily activities. Plaintiff acknowledged that she daily kept house for herself and four minors and that she "[did] not need help" in doing so (AR 81, 458-59), and yet Dr. Jimenez found that she would have to miss more than three days of work a month. His finding was inconsistent with the reality of Plaintiff's daily activities. See Rollins v. Massanari, 261 F.3d 853, 856 (9th Cir.2001) (ALJ's finding that doctor's "restrictions appear to be inconsistent with the level of activity that [plaintiff] engaged in by maintaining a household and raising two young children, with no significant assistance from her ex husband," was specific and legitimate reason for discounting opinion); Morgan v. Comm'r of Soc. Sec. Admin., 169 F.3d 595, 601-02 (9th Cir.1999) (ALJ permissibly rejected treating physician's opinion when it conflicted with plaintiff's activities); see also Fisher v. Astrue, 429 Fed.Appx. 649, 652 (9th Cir.2011) (conflict between doctor's opinion and claimant's daily activities was specific and legitimate reason to discount opinion).
Plaintiff argues that under Orn, 495 F.3d at 632, even if the laboratory test results and other independent evidence in the record "did not fully corroborate Dr. Jimenez's opinions," in rejecting those opinions the ALJ was still required to articulate "specific and legitimate reasons based on substantial evidence in the record." (J. Stip. at 25-26.) As discussed above, that is precisely what the ALJ did. The ALJ properly found that Dr. Jimenez's opinions were inconsistent with the laboratory findings and other medical evidence in the record and his RFC assessment was inconsistent with Plaintiff's daily activities. (AR 19-20.) These were specific and legitimate reasons for rejecting Dr. Jimenez's opinions, and they were supported by substantial evidence in the record. The ALJ's rejection of Dr. Jimenez's opinions was therefore proper. See Orn, 495 F.3d at 632-33.
The Court must consider the ALJ's decision in the context of "the entire record as a whole," and if the "evidence is susceptible to more than one rational interpretation, the ALJ's decision should be upheld." Ryan v. Comm'r of Soc. Sec., 528 F.3d 1194, 1198 (9th Cir.2008) (internal quotation marks omitted). Although Plaintiff points to various pieces of evidence in the record that could support a more restrictive RFC finding if interpreted differently than by the ALJ, read in the context of the record as a whole, Plaintiff's symptoms were not as severe as she alleged and were well-controlled with medication and other
Consistent with the foregoing, and pursuant to sentence four of 42 U.S.C. § 405(g),
