2 FILED IN THE U.S. DISTRICT COURT EASTERN DISTRICT OF WASHINGTON 3 Apr 02, 2026 4 SEAN F. MCAVOY, CLERK 5 UNITED STATES DISTRICT COURT 6 EASTERN DISTRICT OF WASHINGTON 7 BOBBIE A.,1 No. 2:25-CV-00383-RLP 8 Plaintiff,
9 v. ORDER AFFIRMING THE COMMISSIONER’S DECISION 10 FRANK BISIGNANO COMMISSIONER OF SOCIAL 11 SECURITY,
12 Defendant. 13 BEFORE THE COURT is an appeal from an Administrative Law Judge 14 (ALJ) final decision denying disability income benefits under Title XVI of the 15 Social Security Act. ECF No. 10. The Court considered the matter without oral 16 argument. For the reasons discussed below, the Court concludes the ALJ did not 17 commit harmful legal error in evaluating medical opinion evidence or Ms. A.’s 18 symptom testimony, or at step five of the evaluation. Therefore, Ms. A.’s brief, ECF 19 No. 10, is denied and the Commissioner’s brief, ECF No. 12, is granted. 20
1 Plaintiff’s first name and last initial are used to protect her privacy. 1 BACKGROUND 2 The facts of the case are set forth in the administrative hearing and transcript, 3 the ALJ’s decision, and the briefs of Plaintiff and the Commissioner, and therefore 4 require only a brief summary.
5 Ms. A. was born in 1980. Tr. 207. She has a 9th grade education and no past 6 relevant work. Tr. 27, 243. Ms. A. injured her right hand at age 14 when a door 7 slammed on her wrist, severing tendons and causing other injuries. Tr. 317, 323.
8 On July 7, 2021, Ms. A. filed an application for benefits under Title XVI of 9 the Social Security Act, alleging an onset date of September 15, 1994. Tr. 207-213. 10 She claimed that her right hand injury, PTSD, hand fusion, hand 11 numbness/weakness, neuroma in right wrist, chronic pain, limited right hand range
12 of motion, and carpal tunnel syndrome rendered her unable to perform any job. Tr. 13 242. The application was denied initially and upon reconsideration. Tr. 108-117, 14 119-126. Ms. A. thereafter filed a request for a hearing. Tr. 129. A telephonic
15 hearing was held on October 16, 2024. Tr. 39-78. During the hearing, Ms. A. 16 amended her disability onset date to the application date, May 17, 2021. Tr. 17, 19, 17 42. 18 On October 21, 2024, the ALJ issued an unfavorable decision. Tr. 14-33. The
19 Appeals Council denied a request for review. Tr. 1-6. The matter is now before this 20 Court pursuant to 42 U.S.C. § 405(g). 1 STANDARD OF REVIEW 2 This Court’s review of a final decision of the Commissioner of Social Security 3 is governed by 42 U.S.C. § 405(g). The scope of review is limited; the 4 Commissioner’s decision will be disturbed “only if it is not supported by substantial
5 evidence or is based on legal error.” Hill v. Astrue, 698 F.3d 1153, 1158 (9th Cir. 6 2012). If the evidence in the record “is susceptible to more than one 7 rational interpretation, [the Court] must uphold the ALJ’s findings if they are
8 supported by inferences reasonably drawn from the record.” Molina v. Astrue, 674 9 F.3d 1104, 1111 (9th Cir. 2012), superseded on other grounds by 20 C.F.R. §§ 10 404.1502(a), 416.902(a) (citation omitted). 11 Further, a district court “may not reverse an ALJ’s decision on account of an
12 error that is harmless.” Id. An error is harmless “where it is inconsequential to the 13 [ALJ’s] ultimate nondisability determination.” Id. at 1115 (quotation and citation 14 omitted). The party appealing the ALJ’s decision generally bears the burden of
15 establishing that it was harmed. Shinseki v. Sanders, 556 U.S. 396, 409-10, 129 S.Ct. 16 1696 (2009). 17 FIVE-STEP EVALUATION PROCESS 18 A claimant must satisfy two conditions to be considered “disabled” within the
19 meaning of the Social Security Act. First, the claimant must be “unable to engage in 20 any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or 1 can be expected to last for a continuous period of not less than twelve months.” 42 2 U.S.C. §§ 423(d)(1)(A), 1382c(a)(3)(A). Second, the claimant’s impairment must be 3 “of such severity that he is not only unable to do [his or her] previous work[,] but 4 cannot, considering [his or her] age, education, and work experience, engage in any
5 other kind of substantial gainful work which exists in the national economy.” 42 6 U.S.C. §§ 423(d)(2)(A), 1382c(a)(3(B). 7 The Commissioner has established a five-step sequential analysis to determine
8 whether a claimant satisfies the above criteria. See 20 C.F.R. §§ 404.1520(a)(4)(i)- 9 (v), 416.920(a)(4)(i)-(v). At step one, if the claimant is engaged in “substantial 10 gainful activity,” the Commissioner must find that the claimant is not disabled. 20 11 C.F.R. §§ 404.1520(b), 416.920(b). At step two, the Commissioner considers the
12 severity of the claimant’s impairment. 20 C.F.R. §§ 404.1520(a)(4)(ii), 13 416.920(a)(4)(ii). If the claimant suffers from “any impairment or combination of 14 impairments which significantly limits [his or her] physical or mental ability to do
15 basic work activities,” the analysis proceeds to step three. 20 C.F.R. §§ 404.1520(c), 16 416.920(c). At step three, the Commissioner compares the claimant’s impairment to 17 severe impairments recognized by the Commissioner to be so severe as to preclude a 18 person from engaging in substantial gainful activity. 20 C.F.R. §§
19 404.1520(a)(4)(iii), 416.920(a)(4)(iii). 20 1 If the severity of the claimant’s impairment does not meet or exceed the 2 severity of the enumerated impairments, the Commissioner must assess the 3 claimant’s residual functional capacity (RFC), which is the claimant’s ability to 4 perform physical and mental work activities on a sustained basis despite his or her
5 limitations. 20 C.F.R. §§ 404.1545(a)(1), 416.945(a)(1). 6 At step four, the Commissioner considers whether, in view of the claimant’s 7 RFC, the claimant is capable of performing work that he or she has performed in the
8 past (past relevant work). 20 C.F.R. §§ 404.1520(a)(4)(iv), 416.920(a)(4)(iv). If not, 9 the analysis proceeds to step five and the Commissioner considers whether, in view 10 of the claimant’s RFC, the claimant is capable of performing other work in the 11 national economy. 20 C.F.R. §§ 404.1520(a)(4)(v), 416.920(a)(4)(v).
12 The claimant bears the burden of proof at steps one through four above. 13 Tackett v. Apfel, 180 F.3d 1094, 1098 (9th Cir. 1999). If the analysis proceeds to 14 step five, the burden shifts to the Commissioner to establish that (1) the claimant is
15 capable of performing other work; and (2) such work “exists in significant numbers 16 in the national economy.” 20 C.F.R. §§ 404.1560(c)(2), 416.960(c)(2); Beltran v. 17 Astrue, 700 F.3d 386, 389 (9th Cir. 2012). 18 ALJ’S FINDINGS
19 At step one, the ALJ found Ms. A. has not engaged in substantial gainful 20 activity since May 17, 2021, the application date. Tr. 19. At step two, the ALJ found Ms. A. has the following severe impairment: right hand injury. Id. 1 At step three, the ALJ found Ms. A. does not have an impairment or 2 combination of impairments that meets or medically equals the severity of one of the 3 listed impairments. Tr. 21. 4 With respect to the RFC, the ALJ found Ms. A. has the RFC to perform light
5 work with the following exceptions: 6 she is precluded from crawling and climbing ladders, ropes, and scaffolds; she can frequently climb ramps and stairs; she cannot push 7 or pull with the right upper extremity; she can occasionally handle, finger, and feel with the right upper extremity; she is precluded from 8 use of the right upper extremity for forceful gripping (e.g., swinging a hammer or turning a lug wrench); she can have occasional exposure to 9 extreme cold and vibration; and she can have no exposure to hazards (e.g., unprotected heights, moving mechanical parts). 10 Tr. 21-22. 11 At step four, the ALJ found Ms. A. has no past relevant work. Tr. 27. At step 12 five, the ALJ found Ms. A. capable of performing jobs that exist in significant 13 numbers in the national economy, specifically as a dealer accounts investigator, 14 school bus monitor, and router. Tr. 27-29. Based on these adverse findings, the ALJ 15 determined Ms. A. has not been under a disability, as defined in the Social Security 16 Act, since May 17, 2021, the date the application was filed. Tr. 29. 17 ANALYSIS 18 Ms. A.’s assignments of error pertain to the ALJ’s assessment of three 19 medical opinions and her own symptom testimony. These appear to pertain to the 20 ALJ’s analysis of Ms. A.’s RFC. Ms. A. also challenges the ALJ’s evaluation at the 1 A. Medical Opinions 2 Ms. A. contends the ALJ failed to properly evaluate the opinions of her 3 consultative examiners, Dr. Mitchell and Ms. Cowell. ECF No. 10 at 7-14. The 4 regulations provide that an ALJ must consider and evaluate the persuasiveness of all
5 medical opinions or prior administrative medical findings from medical sources. 20 6 C.F.R. §§ 404.1520c, 416.920c. Supportability and consistency are the most 7 important factors in evaluating the persuasiveness of medical opinions and prior
8 administrative findings, and therefore the ALJ is required to explain how both 9 factors were considered. 20 C.F.R. §§ 404.1520c(b)(2), 416.920c(b)(2). The ALJ 10 may, but is not required, to explain how other factors were considered. 20 C.F.R. §§ 11 404.1520c(b)(2), 416.920c(b)(2); see 20 C.F.R. §§ 404.1520c(c)(1)-(5),
12 416.920c(c)(1)-(5). 13 1. Benjamin Mitchell, DO 14 On October 15, 2022, Dr. Mitchell completed a physical evaluation of Ms.
15 A. and diagnosed a right wrist neuroma and carpal tunnel syndrome. Tr. 335-344. 16 As a result of these impairments, Dr. Mitchell concluded that Ms. A. could lift at 17 least 25 pounds occasionally and 20 pounds frequently, carry at least 15 pounds 18 frequently and 20 pounds occasionally, could occasionally reach, handle, grasp,
19 and frequently feel. Tr. 342. Dr. Mitchell also indicated that Ms. A. was limited to 20 four hours sitting, two hours standing, and two hours walking. Tr. 342. The ALJ found this opinion was not persuasive. Tr. 25. The ALJ rejected Dr. Mitchell’s 1 opinion related to Ms. A.’s sitting, standing, and walking limitations, as well as 2 limitations in reaching, handling, feeling, and grasping with the left hand, as 3 unsupported by Dr. Mitchell’s own examination findings and inconsistent with 4 evidence in the record. Tr. 25-26.
5 Dr. Mitchell evaluated Ms. A. again on June 10, 2023. Tr. 354-363. He 6 concluded that Ms. A. had sitting, standing, and walking limitations, the same 7 carrying limitations he found in 2022, an increased lifting capacity, and rare
8 handling, feeling, and grasping with the right arm. Tr. 361. The ALJ found Dr. 9 Mitchell’s 2023 opinion to be partially persuasive. Tr. 23. The ALJ rejected Dr. 10 Mitchell’s finding that handling, feeling, and grasping were limited to “rarely[,]” 11 as his meaning of “rarely” was unclear, not an option on the completed form, and
12 not defined by the agency. Tr. 26, 361. The ALJ determined that to the extent this 13 can be read as an indication that Ms. A. is limited to less than occasional use of the 14 right arm for these tasks, the finding is unsupported by Dr. Mitchell’s own
15 evaluation and inconsistent with the treatment record. Tr. 26. 16 The ALJ determined that, read together, Dr. Mitchell’s evaluations of Ms. A. 17 are not consistent, as she demonstrated more limitation in the 2023 evaluation, but 18 her lifting capacity increased. Tr. 26. The ALJ noted that her sitting capacity
19 decreased, while her standing and walking ability increased, all with no real 20 evidence of limitation in either evaluation. Tr. 26. The ALJ concluded that these facts prevent Dr. Mitchell’s opinion from earning more persuasive value. Tr. 26. 1 Ms. A. argues that the ALJ made little more than a boilerplate finding in 2 rejecting Dr. Mitchell’s disabling opinion restricting her to rarely handling, feeling, 3 and grasping with the dominant right hand. ECF No. 10 at 9-11. She asserts that 4 the ALJ failed to explain the alleged “modest limitations” found upon Dr.
5 Mitchell’s evaluation. Id. at 9-10. Rather, Ms. A. asserts that Dr. Mitchell found 6 severe limitations in strength, sensation, and range of motion of the right hand, 7 with multiple swollen and deformed joints of the hands/wrists. Id. She notes that
8 these findings are consistent with findings of contractures of the dominant right 9 hand, fingers flexing and extending in unison, and significant sensory deficits from 10 another doctor’s evaluation in April 2022. Id.; citing Tr. 324-325. 11 Ms. A. also contends that any “modest loss of functional strength is not
12 relevant, as Ms. A. testified that the weight of items is not her limiting factor. ECF 13 No. 10 at 10. Rather, she notes that she explained she is restricted by pain, fatigue, 14 and loss of sensation. Id.; Tr. 48-57. Further, Ms. A. argues that the ALJ erred by
15 failing to consider the steps Ms. A. must take to alleviate her symptoms, which are 16 consistent with Dr. Mitchell’s assessed limitations. Id. She asserts that a proper 17 assessment of Dr. Mitchell’s opinion shows that she is unable to meet the 18 manipulative requirements of competitive employment. Id. at 11.
19 The Court disagrees that the ALJ discredited Dr. Mitchell’s opinion for 20 improper reasons. First, the ALJ determined Dr. Mitchell’s assessed limitations in 2022 regarding sitting, standing, and walking, as well as limitations in reaching, 1 handling, feeling, and grasping with the left hand, were not well supported by his 2 own examination. Tr. 25-26. This finding is legally sound, see Tommasetti v. 3 Astrue, 533 F.3d 1035, 1041 (9th Cir. 2008) (an ALJ may discount a doctor’s 4 opinion when it is inconsistent with or unsupported by the doctor’s own clinical
5 findings), and substantial evidence supports it, see Tr. 338-39 (Dr. Mitchell’s 2022 6 report noted that gait was normal with “reciprocal gait pattern” and “There appear 7 to be no balance problems[,]” muscle strength normal in legs, ankles, and hips,
8 “Sensory examination was normal to pinprick and light touch throughout lower 9 extremities[,]” able to squat and rise from that position with ease, able to rise from 10 a sitting position without assistance and no difficulty getting up and down from 11 exam table, able to walk on heels and toes, tandem walking was normal, could hop
12 on one foot bilaterally); Tr. 341 (Dr. Mitchell’s 2022 report showed normal range 13 of motion in back, hips, knees, ankles, and great toes). 14 The ALJ determined that Dr. Mitchell’s 2022 evaluation demonstrated no
15 left-hand abnormalities, so limitations in reaching, handling, feeling, and grasping 16 with the left hand have no evidentiary basis. Tr. 25-26; see Tr. 338 (Dr. Mitchell’s 17 2022 report showed normal muscle strength in left wrist flexion, left wrist 18 extension, finger abduction, and hand grip); Tr. 339 (noting “Joint swelling,
19 erythema in bilateral hand IP joints[,]” but “Soft, tender 2 cm mass palpated in 20 volar surface of right wrist”); Tr. 340 (normal range of motion in left shoulder, elbow, wrist, and hand). 1 Second, the ALJ discounted Dr. Mitchell’s 2022 assessed limitations 2 regarding sitting, standing, and walking, as well as limitations in reaching, 3 handling, feeling, and grasping with the left hand, as inconsistent with the medical 4 record. Tr. 25-26. This finding is also legally sound, see Batson v. Comm’r of Soc.
5 Sec. Admin., 359 F.3d 1190, 1195 (9th Cir. 2004) (an ALJ may reasonably reject 6 doctors’ opinions when they are inconsistent with or contradicted by the medical 7 evidence), and substantial evidence supports it, see, e.g., Tr. 323, 325, 328 (April
8 23, 2022 consultative examination with Dr. Crisp: ambulating independently, able 9 to get up and down from exam table without difficulty, tandem walking was 10 performed without difficulty, walking on heels and toes both performed without 11 difficulty, normal gait, assessed no limits on standing or walking); Tr. 254
12 (Function Report dated February 2, 2022: Ms. A. did not report any difficulty with 13 squatting, standing, walking, sitting, or kneeling); Tr. 323-24, 326-27, 329 (April 14 23, 2022 consultative examination with Dr. Crisp indicates “having overuse issues
15 of non-dominant L hand,” but notes had carpal tunnel surgery on the L side; 16 physical exam notes on extremities do not reference left hand except to indicate 17 that Ms. A. uses her left hand to manipulate individual fingers on her right hand 18 into extension; neuromuscular strength exam notes a 4/5 motor power in right
19 functional grip, but otherwise 5/5 strength in extremities; sensory and muscle tone 20 exam notes only discuss right upper extremity deficits; normal range of motion for both left and right shoulder, elbows, wrists, and hands; diagnosed carpal tunnel in 1 her left upper extremity and noted “Reduced sensation in L hand. Reduced 2 dexterity, non-dominant hand.”; can occasionally handle and finger with left hand,2 3 and frequently feel with left hand); Tr. Tr. 358-59 (June 10, 2023 examination with 4 Dr. Mitchell: left hand fist can be made, normal opposition of fingers in left hand,
5 can pinch, grasp, and manipulate small and large objects without difficulty with 6 left hand, but cannot make a fist or approximate pointing finger and thumb – does 7 not specify which hand; normal range of motion normal in left wrist and hand).
8 In his 2023 opinion, Dr. Mitchell indicated Ms. A. was limited to three hours 9 sitting (decreased from four hours sitting in his 2022 opinion), two and a half hours 10 standing (increased from two hours in his 2022 opinion), and two and a half hours 11 walking (increased from two hours in his 2022 opinion). Tr. 361; compared with
12 Tr. 342. He also concluded Ms. A. could rarely handle, grasp, or feel with her right 13 hand (as opposed to his 2022 opinion which found she could occasionally handle 14 and grasp, and frequently feel). Tr. 361; compared with Tr. 342.
15 The ALJ noted that “rarely” was not an option on the completed form, is not 16 defined by the agency, and therefore Dr. Mitchell’s meaning as to “rarely” is 17 unclear. Tr. 26. However, the ALJ determined that to the extent this can be read as 18
19 2 In evaluating Dr. Crisp’s opinion, the ALJ found that limitations in use of 20 Ms. A.’s left hand are not consistent with Dr. Crisp’s evaluation, which does not
show objective abnormalities in use of the left hand. Tr. 25. 1 an indication Ms. A. is limited to less than occasional use of the right arm for 2 handling, feeling, and grasping, it is not supported by the modest limitations found 3 at Dr. Mitchell’s evaluation. Tr. 26. Again, this finding is legally sound, see 4 Tommasetti, 533 F.3d at 1041; see Tr. 357 (Dr. Mitchell’s 2023 report noted
5 normal muscle strength in wrist flexion, wrist extension, finger abduction, and 3/5 6 muscle strength in right hand grip); Tr. 357 (inconsistent sensory examination on 7 right hand); Tr. 358 (exam showed “Hand Can be fully extended[] on right, left
8 pinky cannot fully extend[,] fist cannot be made on right hand completely, left 9 hand fist can be made, fingers cannot be opposed on right hand, normal opposition 10 in left hand, can pinch, grasp, and manipulate small and large objects without 11 difficulty with left hand, but cannot make a fist or approximate pointing finger and
12 thumb – does not specify which hand); Tr. 359 (range of motion normal in left 13 wrist and hand; decreased range of motion in right wrist and hand). 14 The ALJ also determined that to the extent Dr. Mitchell’s 2023 opinion
15 found that Ms. A. is limited to less than occasional use of the right arm for 16 handling, feeling, and grasping, it is inconsistent with treatment record findings 17 showing only modest loss of functional strength and Ms. A.’s demonstrated ability 18 to use her right hand to assist with daily functional activities. Tr. 29. Again, this
19 finding is legally sound, see Batson, 359 F.3d at 1195; see, e.g., Tr. 338-39, 342-43 20 (Dr. Mitchell’s 2022 opinion indicated muscle strength was 4/5 in right upper extremity, except for hand grip which was 3/5; upper extremities showed altered 1 sensation in inconsistent pattern in distal right hand and arm; hand can be fully 2 extended, fist cannot be made with right hand; concern for inconsistent effort at 3 times causing inconsistency on range of motion and strength in right upper 4 extremity); Tr. 323 (Aprill 2022 evaluation by Dr. Crisp noted Ms. A. “is able to
5 groom and perform daily ablutions by herself without assistance. She is also 6 capable of basic household chores such as laundry, cooking, sweeping and 7 vacuuming; uses adaptive behaviors to accomplish tasks; cooking is difficult,
8 limited dexterity/safety with cutting implements. The claimant is able to drive and 9 go shopping for groceries and home essentials.”) 10 The ALJ had an adequate basis for rejecting Dr. Mitchell’s assessed sitting, 11 standing, and walking limitations, as well as his 2022 limitations in reaching,
12 handling, feeling, and grasping with the left hand, and his 2023 limitations in 13 handling, feeling, and grasping with her right hand. 14 2. Angela Cowell, PMHNP3
15 Ms. Cowell completed a consultative psychiatric examination of Ms. A. on 16 May 2, 2023. Tr. 347-53. Ms. Cowell diagnosed PTSD and major depressive 17 disorder with anxious distress, moderate severe, and concluded that Ms. A. was 18 unable to understand, remember, and carry out simple or complex instructions,
19 sustain concentration at a reasonable pace, interact with others, or adapt to usual 20
3 1 workplace stressors. Tr. 351-52. The ALJ found that Ms. Cowell’s opinion was not 2 persuasive. Tr. 26. In rejecting Ms. Cowell’s opinion, the ALJ determined that the 3 substantial limitations she found were not supported by her own examination 4 findings, and were inconsistent with the entirety of the record. Id.
5 Ms. A. argues that the ALJ did not provide any valid reasons for rejecting 6 Ms. Cowell’s opinion and excluding her limitations from his RFC assessment. ECF 7 No. 10 at 12-13. The Court disagrees. The ALJ properly discounted Ms. Cowell’s
8 opinion on the same grounds used to discount the sitting, standing, walking, and 9 manipulative limitations opined by Dr. Mitchell. Tr. 26. 10 First, the ALJ determined Ms. Cowell’s opinion was not strongly supported 11 by her own examination. Tr. 26. As discussed above, this finding is legally sound.
12 See Tommasetti, 533 F.3d at 1041. The ALJ referenced Ms. A.’s “multiple normal 13 findings” on Ms. Cowell’s examination, “including orientation, remote memory, 14 immediate recall, digit span testing, digit span testing,4 fund of knowledge, and
15 following a three-step command[,]” and determined these findings indicate “the 16 substantial limitations found by Cowell overstate her limitations, even when 17 considering just Cowell’s own findings.” Tr. 26. Further, the ALJ specifically 18 noted that despite Ms. Cowell’s narrative conclusion, she determined Ms. A. had
19 fair attention and concentration. Id. 20
4 1 Second, the ALJ discounted Ms. Cowell’s opinion as inconsistent with the 2 entirety of the record. Tr. 26. As discussed above, this finding is also legally sound. 3 See Batson, 359 F.3d at 1195. The ALJ found that a review of the entirety of the 4 record shows Ms. A. has “generally normal findings in memory, concentration,
5 interaction, and adaptation at treatment visits and at Dr. Henry’s evaluation.” Tr. 6 26, see, e.g., (April 11, 2022: psychological diagnostic evaluation by Dr. Henry 7 noted Ms. A. “describes limited mental health history prior to the emotional
8 problems that she has been having since her children were taken from her 9 custody[,]” she was highly distressed on and off throughout the interview, crying, 10 talking in a rapid manner, content focused on the perceived injustice of her 11 children being taken out of her custody; report of anxiety and depression
12 symptoms in the context of significant psychosocial stressors is consistent with an 13 adjustment disorder; “Under the current circumstances” she is focused on not 14 having her children in her custody and endorsing persisting depression and anxiety
15 symptoms which may limit her willingness and/or ability to seek, obtain, and 16 maintain employment; she is also under a significant amount of stress related to 17 pending legal matters; results from the MoCA indicated possible mild cognitive 18 impairment; she exhibited the greatest difficulty with items that involve short-term
19 auditory memory; she demonstrated ability to understand and follow simple 20 multistep instructions; it is possible that symptoms of depression and/or anxiety contributed to observed difficulties on the mental status examination; it is not 1 known whether or not there are other contributing factors and/or other 2 neurocognitive deficits not directly assessed during the current evaluation; she 3 does not exhibit severe cognitive impairment that would be expected to prevent her 4 from being capable of independently managing funds).
5 The ALJ had an adequate basis for rejecting Ms. Cowell’s assessed mental 6 health limitations. 7 B. Symptom Testimony
8 Ms. A. contends that the ALJ improperly discounted her testimony showing 9 that she was unable to work. 10 An ALJ engages in a two-step analysis to determine whether to discount a 11 claimant’s testimony regarding subjective symptoms. SSR 16-3p, 2016 WL
12 1119029, at *2. “First, the ALJ must determine whether there is objective medical 13 evidence of an underlying impairment which could reasonably be expected to 14 produce the pain or other symptoms alleged.” Molina, 674 F.3d at 1112 (quotation
15 marks and citation omitted). Second, “[i]f the claimant meets the first test and there 16 is no evidence of malingering, the ALJ can only reject the claimant’s testimony 17 about the severity of the symptoms if [the ALJ] gives ‘specific, clear and 18 convincing reasons’ for the rejection.” Ghanim v. Colvin, 763 F.3d 1154, 1163 (9th
19 Cir. 2014) (citations omitted). “The clear and convincing [evidence] standard is the 20 most demanding required in Social Security cases.” Garrison v. Colvin, 759 F.3d 1 995, 1015 (9th Cir. 2014) (quoting Moore v. Comm’r of Soc. Sec. Admin., 278 F.3d 2 920, 924 (9th Cir. 2002)). 3 Factors to be considered in evaluating the intensity, persistence, and limiting 4 effects of a claimant’s symptoms include: 1) daily activities; 2) the location,
5 duration, frequency, and intensity of pain or other symptoms; 3) factors that 6 precipitate and aggravate the symptoms; 4) the type, dosage, effectiveness, and 7 side effects of any medication an individual takes or has taken to alleviate pain or
8 other symptoms; 5) treatment, other than medication, an individual receives or has 9 received for relief of pain or other symptoms; 6) any measures other than treatment 10 an individual uses or has used to relieve pain or other symptoms; and 7) any other 11 factors concerning an individual’s functional limitations and restrictions due to
12 pain or other symptoms. SSR 16-3p, 2016 WL 1119029, at *7; 20 C.F.R. § 13 416.929(c). The ALJ is instructed to “consider all of the evidence in an 14 individual’s record,” to “determine how symptoms limit ability to perform work-
15 related activities.” SSR 16-3p, 2016 WL 1119029, at *2. 16 Here, the ALJ found there was objective medical evidence of underlying 17 impairments which could reasonably be expected to produce Ms. A.’s alleged 18 symptoms, but that Ms. A.’s statements concerning the intensity, persistence, and
19 limiting effects of her symptoms were inconsistent with the record. Tr. 22-23. 20 The ALJ offered several reasons to discount Ms. A.’s testimony, which the Court finds well supported. First, the ALJ discounted Ms. A.’s testimony about her 1 physical and mental health impairments as unsupported by the objective medical 2 evidence. Tr. 23. The ALJ cited several medical reports in making his 3 determination that a limitation to a light exertion level with restrictions on postural 4 and manipulation activities would account for Ms. A.’s physical medically
5 determinable impairments. Tr. 23; see, e.g., Tr. 326 (April 2022: consultative 6 examination showed normal hand, thumb, and finger range of motion in both 7 hands and wrists, contrary to her allegations); Tr. 340 (October 2022: orthopedic
8 examination showed near-normal range of motion in the right metacarpophalangeal 9 joints, and otherwise normal hand and wrist range of motion); Tr. 359 (June 2023: 10 consultative physical examination findings demonstrated normal range of motion 11 in the left hand and wrist, with range of motion limitations in the right hand and
12 wrist); Tr. 377 (March 2020: Ms. A.’s hand surgeon indicated she had very good 13 range of motion in the right hand, although there would be permanent long-term 14 deficits); Tr. 378 (March 2020: moderate loss of strength, but only slightly
15 diminished full composite grip strength); Tr. 324 (April 2022: physical 16 examination showed Ms. A. is able to complete functional tasks with the right 17 hand, albeit with difficulty, such as writing and opening a medication bottle). The 18 ALJ determined that, despite allegations to the contrary, the record does not show
19 meaningful evidence of left wrist and hand weakness or fatigability during the 20 relevant period. See, e.g., Tr. 324 (April 2022: motor power 4/5 in right functional grip, otherwise 5/5 strength in extremities); Tr. 338 (October 2022: muscle strength 1 normal in left wrist flexion, left wrist extension, finger abduction, and hand grip); 2 Tr. 357 (June 2023: muscle strength normal in left wrist flexion, left wrist 3 extension, finger abduction, and hand grip). 4 The ALJ also referenced the discussion of the record previously outlined in
5 his decision to find Ms. A.’s allegations of substantial mental impairment not 6 supported by the objective record. Tr. 23. The ALJ determined that although there 7 were some abnormalities at examination, the record does not show evidence of
8 meaningful limitation during treatment examinations and objective findings at 9 consultative examinations are relatively modest. Id.; see, e.g., Tr. 254 (February 10 2022: function report does not indicate difficulties with memory, but does indicate 11 problems with understanding and following instructions); Tr. 317 (April 2022:
12 psychological examination showed scores consistent with mild cognitive 13 impairment); Tr. 324 (April 2022: physical examination noted normal speech, 14 memory, concentration); Tr. 337, 356 (October 2022 and June 2023: memory and
15 concentration were normal); Tr. 350 (May 2023: fair concentration); Tr. 253-54 16 (February 2022: function report shows Ms. A. engages in social activities with 17 others and reported she gets along with others); Tr. 316, 348, 350, 361 (April 2022, 18 May 2023, June 2023: depressed mood); Tr. 337, 356 (October 2022 and June
19 2023: appropriate mood); Tr. 371 (February 2021: mood/affect appropriate for 20 situation, normal); Tr. 378 (March 2020: normal mood); Tr. 254 (February 2022: function report Ms. A. endorsed difficulty with concentration, task completion, and 1 attention span); Tr. 317 (April 2022: psychological evaluation showed limited 2 difficulty with sustained attention; completed serial seven testing without issue); 3 compared with Tr. 351 (May 2023: difficulty with serial three testing); Tr. 255 4 (February 2022: on function report, Ms. A. reported difficulty dealing with stress
5 but indicated she easily handled changes to routine); Tr. 350-51, 378 (insight and 6 judgment are fair or normal).5 The ALJ also noted that the record does not show 7 significant evidence of social anxiety or self-isolation. Tr. 23.
8 Ms. A. argues that the ALJ did little more than engage in a general recitation 9 of the medical evidence, but did not specify any inconsistencies. ECF No. 10 at 15. 10 The Court disagrees with Ms. A.’s characterization of the ALJ’s decision. The ALJ 11 discussed Ms. A’s specific symptom claims, then referenced examination reports
13 5 The ALJ stated that at psychological examination, Ms. A. demonstrated 14 scores consistent with mild cognitive impairment, but noted the record does not 15 show other evidence of memory impairment, including at a psychiatric consultative 16 examination. Tr. 20. However, at the May 2023 psychiatric consultative 17 examination, Ms. Cowell determined that Ms. A. is not able to understand, 18 remember, and carry out simple instructions, citing to errors on serial three 19 subtraction, and delayed three item recall, and she is not able to understand, 20 remember, and carry out complex instructions, citing errors on number repetition
backwards and serial seven subtraction or abstraction. Tr. 350, 352. 1 and assertions on her function report in finding that the objective evidence does not 2 support the level of limitation alleged. Tr. 22-23. 3 Ms. A. also appears to contend that the ALJ discounted her symptom 4 testimony solely because it is not substantiated by objective medical evidence.
5 ECF No. 10 at 15. Again, the Court disagrees with Ms. A.’s characterization of the 6 ALJ’s decision. An ALJ may not discredit a claimant’s pain testimony and deny 7 benefits solely because the degree of pain alleged is not supported by objective
8 medical evidence. Rollins v. Massanari, 261 F.3d 853, 857 (9th Cir. 2001); 9 Bunnell v. Sullivan, 947 F.2d 341, 346-47 (9th Cir. 1991); Fair v. Bowen, 885 F.2d 10 597, 601 (9th Cir. 1989). However, the medical evidence is a relevant factor in 11 determining the severity of a claimant’s pain and its disabling effects. Rollins, 261
12 F.3d at 857. While minimal objective evidence is a factor which may be relied 13 upon in discrediting a claimant’s testimony, it may not be the only factor. See 14 Burch v. Barnhart, 400 F.3d 676, 680 (9th Cir. 2005). As discussed below, the ALJ
15 explicitly relied on several other valid reasons to discount Ms. A.’s symptom 16 testimony. 17 Second, the ALJ found that the course of treatment for Ms. A.’s impairments 18 is nearly nonexistent during the relevant period. Tr. 23. He noted that since the
19 application date in May 2021, Ms. A. has sought treatment exactly one time, for 20 removal of a splinter in her toe. Id., citing Tr. 364. The ALJ noted that the record does not show treatment for her hands or mental health treatment of any kind. Tr. 1 23. He acknowledged that Ms. A.’s hand surgeon did not offer further surgical 2 treatment for her right hand in March 2020, but the ALJ noted this does not mean 3 no non-surgical treatments are available. Tr. 23; citing Tr. 377. The ALJ stated that 4 there is no evidence of pain management treatment from a pain clinic, strength or
5 range of motion treatment at physical therapy, or any other attempts to improve the 6 symptoms she claims to be debilitating. Tr. 23-24. He also noted that there is no 7 follow-up treatment of record on Ms. A.’s left hand after surgery, which was
8 reportedly successful. Tr. 24. The ALJ found that Ms. A.’s allegations of difficulty 9 using both hands and severe pain in both hands, in particular, are inconsistent with 10 the lack of any indication she sought additional treatment for these symptoms 11 during the relevant period. Id.
12 The Court finds the ALJ did not err by citing her lack of treatment as one of 13 the reasons to discredit her symptom testimony. An ALJ may reasonably consider 14 the course and effectiveness of treatment. Social Security Ruling 16-3p;
15 Tommasetti, 533 F.3d at 1039 (an ALJ may properly rely on “unexplained or 16 inadequately explained failure to seek treatment” in discounting subjective 17 symptom testimony). Ms. A. argues that the ALJ failed to adequately consider that 18 her lack of treatment is due to financial limitations, as well as difficulty driving to
19 appointments due to pain and her hand locking up. ECF No. 10 at 16; citing Tr. 59. 20 She also contends that she should not be penalized for difficulty recognizing her need for mental health treatment. ECF No. 10 at 17. However, as to financial 1 limitations, the ALJ stated that Ms. A. indicated she has access to health insurance 2 and is able to get the treatment she feels is needed. Tr. 24; see Tr. 62-63. Thus, the 3 ALJ determined that the lack of treatment demonstrates that Ms. A. does not feel 4 she needs treatment, which is suggestive that she is not as limited as alleged. Tr.
5 24. 6 The ALJ also recognized that Ms. A.’s alleged unavailability of 7 transportation is a barrier to treatment, but upon further questioning she admitted
8 her residence is within 5-7 miles of bus stops, and that she is able to drive short 9 distances. Tr. 24. The ALJ stated that Google Maps shows this testimony was 10 somewhat exaggerated, and Ms. A. is actually located 3.5 miles from a bus stop, 11 and a 15-minute drive from downtown Spokane. Id. Thus, the ALJ adequately
12 considered potential barriers to treatment, but did not find them significant enough 13 to warrant her complete failure to engage in treatment. Id. The ALJ validly 14 discounted Ms. A.’s testimony as inconsistent with her lack of treatment during the
15 relevant period. 16 Third, the ALJ found Ms. A.’s daily activities are not consistent with her 17 allegations. Tr. 24. The ALJ noted that despite Ms. A.’s allegations that she can 18 use her hands only for minimal amounts of time, she is able to engage in activities
19 that require intact hand functioning, such as shopping, cooking, cleaning, doing 20 other chores, driving, bathing, and fishing. Id., citing Tr. 50-55, 59-60, 249-53. The ALJ noted that although she receives assistance in some of these activities, the 1 record shows she is able to use her hands well enough to participate in a significant 2 way. Tr. 24. The ALJ noted that Ms. A. also engages in activities that require 3 considerable use of her hands, such as childcare and pet care. Id.; citing Tr. 54, 59- 4 60, 250.
5 An ALJ may consider “whether the claimant engages in daily activities 6 inconsistent with the alleged symptoms.” Lingenfelter v. Astrue, 504 F.3d 1028, 7 1040 (9th Cir. 2007). Ms. A. contends that her ability to take part in daily activities
8 and use her hands with frequent breaks and assistance does not show that her 9 activity level is inconsistent with her disabling allegations. ECF No. 10 at 18. 10 However, allegations of disabling pain may be discredited if a claimant is able to 11 spend a substantial part of the day engaged in pursuits involving the performance
12 of physical functions that are transferable to a work setting. Fair, 885 F.2d at 603. 13 Even if the claimant experiences some difficulty or pain, his or her daily activities 14 “may be grounds for discrediting the claimant’s testimony to the extent that they
15 contradict claims of a totally debilitating impairment.” Molina, 674 F.3d at 1113. 16 It is not the court’s role to second guess an ALJ’s reasonable interpretation 17 of a claimant’s testimony. Rollins, 261 F.3d at 857; Thomas v. Barnhart, 278 F.3d 18 947, 959 (9th Cir. 2002) (affirming an ALJ’s decision discounting a claimant’s
19 testimony after finding that the claimant “was able to perform various household 20 chores such as cooking, laundry, washing dishes, and shopping”). Here, the ALJ’s 1 determination that Ms. A. engaged in daily activities inconsistent with disabling 2 limitations is reasonably supported by substantial evidence. 3 Next, the ALJ discounted Ms. A.’s symptom testimony due to evidence of 4 poor effort during her consultative examination with Dr. Mitchell in 2022. Tr. 24.
5 The ALJ observed that Dr. Mitchell noted altered sensation in an inconsistent 6 pattern in the right arm, as Ms. A. voiced sensation with touch, but said she was 7 unable to feel it. Id.; citing Tr. 338. Similarly, the ALJ indicated that Dr. Mitchell’s
8 report shows she was inconsistent in that she could not oppose her fingers when 9 asked to, but then was able to pinch a pretend piece of paper at a different time. Tr. 10 24; citing Tr. 342-43. Dr. Mitchell questioned whether effort was consistent during 11 the examination. Id. Thus, it was Dr. Mitchell who questioned Ms. A.’s effort
12 during the examination, and the ALJ reasonably considered his statements in 13 evaluating the record. 14 An ALJ may consider evidence of poor effort by the claimant when
15 evaluating her symptom testimony. Tonapetyan v. Halter, 242 F.3d 1144, 1148 16 (9th Cir. 2001); Thomas, 278 F.3d at 959. The ALJ found that, in addition to 17 rendering the results of the specific examination suspect, the evidence of Ms. A.’s 18 poor effort colors the entirety of the record. Tr. 24. He also noted that the
19 unreliability of any piece of evidence is significant because Ms. A. had so little 20 objective and observational treatment evidence. Id. 1 Finally, the ALJ found Ms. A.’s work history undermines her disability 2 allegations. Tr. 24. An ALJ may use evidence of poor work history in assessing a 3 claimant’s credibility. Thomas, 278 F.3d at 959. The ALJ stated that Ms. A. has 4 worked at substantial gainful activity levels in only one year in her lifetime, 2001.
5 Tr. 24; citing Tr. 223-24. He noted that this was many years before the amended 6 alleged onset and application date, but also many years after Ms. A.’s injury. Tr. 7 24. Therefore, the ALJ found that Ms. A. was able to engage in work activity at a
8 significant level after the initial recovery from her childhood right hand injury, and 9 before any evidence of additional impairments, such as her left carpal tunnel 10 syndrome. Id. He stated the record does not show an intervening event of declining 11 ability until her development of carpal tunnel syndrome. Id.
12 Additionally, the ALJ recognized that Ms. A. testified she was able to work 13 at a modest level using her hands for cleaning. Tr. 24. While Ms. A. argues that her 14 lack of work history is due to the fact that her right upper extremity limitations
15 have existed since the age of 14, thus affecting her ability to work throughout her 16 life, the ALJ determined the totality of this evidence leads to the conclusion that 17 the impetus for her ongoing lack of employment is likely something other than her 18 current medical impairments. ECF No. 10 at 18; Tr. 24. The Court finds the ALJ’s
19 reasoning with respect to Ms. A.’s work history also supports his conclusion. 20 The ALJ did not commit legal error in rejecting Ms. A.’s symptom testimony. 1 C. Final Step 2 Ms. A. appears to argue that the ALJ erred by failing to resolve the 3 vocational expert’s deviation from the Dictionary of Occupational Titles (DOT). 4 Specifically, Ms. A. asserts that the vocational expert’s testimony was equivocal
5 and appeared to contradict the DOT when presented with the ALJ’s assessed 6 restriction to never pushing/pulling with the right upper extremity and occasionally 7 handling, fingering, and feeling with the right upper extremity.6 ECF No. 10 at 19;
8 citing Tr. 70-76. 9 The vocational expert testified that the DOT specifies two of the three 10 identified jobs, investigator/dealer and school bus monitor, as occasionally 11 handling, fingering, and feeling. Tr. 68. The vocational expert testified that for the
12 third job of router, the DOT noted frequent reaching and handling, but explained 13 “that job can be done with the occasional limitation” outlined in the ALJ’s 14 hypothetical. Id. The vocational expert confirmed that her testimony regarding
15 anything not in the DOT, or different from the DOT, is based on her 40 years of 16 experience as a vocational rehabilitation counselor, her training, and her 17 experience. Id. She also testified that the DOT does not break down the use of one 18
20 6 It is unclear what testimony Ms. A. is referring to concerning the restriction
to never pushing/pulling with the right upper extremity. ECF No. 10 at 19. 1 hand versus another, and that is also based on her experience, education, and 2 training. Id. 3 Caselaw within the Ninth Circuit indicates that an ALJ may reasonably rely 4 on a vocational expert’s explanation that is based on the vocational expert’s
5 education, experience, or surveys when identifying jobs that can be performed. See 6 Dennis B. v. Saul, 2020 WL 7264460 at *2 (C.D. Cal. Dec. 10, 2020) (finding 7 “[a]n ALJ may rely on a VE’s experience as a reasonable explanation for deviating
8 from the DOT.”); BucknerLarkin v. Astrue, 450 F. App’x 626, 628-629 (9th Cir. 9 2011) (finding that a conflict between the DOT and vocational expert was 10 appropriately explained where the vocational expert offered testimony based on his 11 own labor market surveys, experience, and research); Morey v. Berryhill, 2018 WL
12 1415160 at *3 (C.D. Cal. Mar. 20, 2018) (finding that the ALJ obtained a 13 reasonable explanation for a conflict where the vocational expert “indicated that 14 his testimony addressing the apparent conflict was based on his individual
15 experience in placing individuals in similar jobs.”); Brian L. v. O’Malley, 2024 16 WL 3223667 at *4-5 (C.D. Cal. Apr. 30, 2024) (finding the ALJ provided 17 sufficient support to justify a deviation from the DOT by indicating the vocational 18 expert’s opinion was based on his education, training, and review of occupational
19 requirement surveys). Accordingly, an ALJ may reasonably rely on a vocational 20 expert’s explanation for deviating from the DOT that is based on the vocational expert’s education, experience, or surveys. 1 The Court finds the ALJ obtained a reasonable explanation for the 2 vocational expert’s variance from the DOT and properly relied on her testimony to 3 determine that jobs exist in significant numbers in the national economy that Ms. 4 A. can perform.
5 Ms. A. next contends that her counsel did not have an opportunity to 6 ask follow-up questions on cross-examination to determine whether the 7 restriction on the right-hand dominant side would affect the ability to
8 perform the full-time jobs identified by the vocational expert and adopted by 9 the ALJ at step five. ECF No. 10 at 19; Tr. 27-29, 77-78. Ms. A. does not 10 explain why counsel “did not have an opportunity” to ask these questions, as 11 the hearing transcript shows that counsel engaged in extensive questioning
12 of the vocational expert, Tr. 70-77, and when the ALJ directly asked her 13 counsel if there was anything else, her counsel responded in the negative. Tr. 14 77.
15 Finally, Ms. A. asserts that the ALJ also erred because the vocational 16 testimony relied on was without evidentiary value as it was provided in response to 17 an incomplete hypothetical. ECF No. 10 at 20. This argument is foreclosed 18 because, as discussed above, the ALJ properly evaluated the medical evidence and
19 reasonably discounted Ms. A.’s testimony. This restatement of Ms. A.’s argument 20 1 || fails to establish error at step five. Stubbs-Danielson v. Astrue, 539 F.3d 1169, 2 || 1175-76 (9th Cir. 2008). 3 The Court finds no error at step five. 4 CONCLUSION 5 Having reviewed the record and the ALJ’s findings, this Court concludes that the ALJ’s decision is supported by substantial evidence and free of harmful legal error. 7 Accordingly, 8 1. Ms. A.’s Brief, ECF No. 10, is DENIED. 9 2. Defendant’s Brief, ECF No. 12, is GRANTED. 10 IT IS SO ORDERED. The District Court Clerk is directed to enter this Order 11 and provide copies to counsel. Judgment shall be entered for Defendant and the file 12 || shall be CLOSED. 13 DATED April 2, 2026. 2 Le se 15 REBECCA L. PENNELL United States District Judge 16 17 18 19 20
ORDER AGEIR MING THE COANMINTSCOTIONER?S NECTOAION * 214