Garcia v. Commissioner of Social Security Administration

• Court: District Court, D. Arizona
• Decided: May 11, 2023
• Docket: 4:22-cv-00065
• Status: Unknown

Opinion

1 WO 2 3 4 5 6 IN THE UNITED STATES DISTRICT COURT 7 FOR THE DISTRICT OF ARIZONA

9 Aaron Garcia, No. CV-22-00065-TUC-MSA

10 Plaintiff, ORDER

11 v.

12 Commissioner of Social Security Administration, 13 Defendant. 14 15 Plaintiff Aaron Garcia seeks judicial review of an unfavorable decision issued by 16 the Commissioner of Social Security Administration. The matter has been fully briefed. 17 For the following reasons, the Commissioner’s decision will be affirmed. 18 Background 19 Plaintiff is 30 years old. (See AR 194.) He has a GED. (AR 225.) He has experience 20 working in restaurants taking orders, waiting on customers, preparing food, and cleaning. 21 (AR 248–53.) He alleges that he is disabled because of various mental disorders, including 22 posttraumatic stress disorder, depression, and anxiety. (AR 28, 224, 236.) According to 23 Plaintiff, these conditions affect his memory and ability to socialize, understand, and 24 concentrate. (AR 241.) He testified that he has about ten “bad days” per month, during 25 which he cannot focus on anything besides his fear, flashbacks, and nightmares. (AR 31.) 26 He reported that his conditions also cause him to neglect his personal hygiene. (AR 236.) 27 In 2019, Plaintiff filed applications for disability insurance benefits and 28 supplemental security income. (AR 194, 201.) The applications were denied initially and 1 on reconsideration. (AR 35, 45, 91–92.) Plaintiff requested a hearing before an 2 administrative law judge (ALJ), and a hearing was held in November 2020. (AR 26–34, 3 119.) 4 After the hearing, the ALJ issued a written decision following the five-step process 5 for determining whether a claimant is disabled. 20 C.F.R. §§ 404.1520, 416.920.1 At step 6 one, the ALJ found that Plaintiff had not engaged in substantial gainful activity since his 7 alleged onset date. (AR 15.) At step two, the ALJ found that Plaintiff had three medically 8 determinable impairments: posttraumatic stress disorder, anxiety disorder, and bipolar 9 disorder. (AR 15.) However, the ALJ found that those impairments were not severe, either 10 alone or in combination. (AR 15.) The ALJ therefore concluded that Plaintiff was not 11 disabled. (AR 19.) 12 The Appeals Council denied review, making the ALJ’s decision the final decision 13 of the Commissioner. (AR 1–3.) This lawsuit followed. 14 Legal Standard 15 The Commissioner’s decision will be affirmed if it is supported by substantial 16 evidence and free of legal error. White v. Kijakazi, 44 F.4th 828, 833 (9th Cir. 2022) 17 (quoting Smolen v. Chater, 80 F.3d 1273, 1279 (9th Cir. 1996)). “Substantial evidence . . . 18 is such relevant evidence as a reasonable mind might accept as adequate to support a 19 conclusion.” Smartt v. Kijakazi, 53 F.4th 489, 494 (9th Cir. 2022) (alteration in original) 20 (quoting Vasquez v. Astrue, 572 F.3d 586, 591 (9th Cir. 2009)). 21 Discussion 22 Plaintiff challenges the ALJ’s decision on two grounds. He argues that the ALJ erred 23 in finding he does not have a severe impairment or combination of impairments. He also 24 argues that the ALJ erred in rejecting his symptom testimony. Plaintiff’s symptoms are 25 relevant to whether his impairments are severe, 20 C.F.R. § 404.1529(d)(1), so these 26 arguments will be addressed in reverse. As discussed below, neither argument has merit. 27 1 The regulations for disability insurance benefits are similar in substance to the 28 regulations for supplemental security income. For ease of reference, further citations will be only to the former. 1 I. Symptom Testimony 2 Plaintiff reported that he had a poor memory, neglected his personal hygiene, had 3 difficulty socializing, concentrating, and understanding, and had about ten “bad days” per 4 month where he was consumed by fear, flashbacks, and nightmares. The parties agree that 5 the ALJ could discount these reports only for “specific, clear and convincing reasons.” 6 Smith v. Kijakazi, 14 F.4th 1108, 1112 (9th Cir. 2021) (quoting Garrison v. Colvin, 759 7 F.3d 995, 1014–15 (9th Cir. 2014)). This standard is satisfied so long as “the ALJ’s 8 rationale is clear enough that it has the power to convince,” even if it is not particularly 9 convincing to the Court. Smartt v. Kijakazi, 53 F.4th 489, 499 (9th Cir. 2022). 10 An ALJ may discount testimony on the ground that it is inconsistent with the 11 objective medical evidence. Id. at 498. Here, the ALJ identified inconsistencies between 12 Plaintiff’s testimony and (1) his treatment records and (2) the medical-opinion evidence. 13 See id. at 497–98 (holding the ALJ properly relied on inconsistencies between the 14 claimant’s testimony and treatment records); Moncada v. Chater, 60 F.3d 521, 524 (9th 15 Cir. 1995) (per curiam) (holding the ALJ properly relied on an inconsistency between the 16 claimant’s testimony and a medical opinion). Those inconsistencies are a clear and 17 convincing reason for discounting Plaintiff’s testimony. 18 First, the treatment records. The ALJ observed that, in August 2018 (when 19 Plaintiff’s records begin), Plaintiff’s psychological presentation was appropriate and 20 pleasant, and he was alert and oriented. (AR 17, 298.) The ALJ found, with supporting 21 citations, that Plaintiff presented similarly at later appointments. (AR 17.) For instance, the 22 ALJ cited an April 2019 treatment note indicating that Plaintiff had denied anxiety and 23 depression. (AR 17, 355.) At the same appointment, Plaintiff was alert and oriented and 24 had a PHQ-2 score of 0, indicating that he was not depressed. (AR 355–56.) 25 The ALJ found that while Plaintiff was observed with symptoms in July 2019, he 26 remained cooperative and engaged in treatment. (AR 17.) On July 24, Plaintiff reported a 27 history of depression and difficulty socializing, keeping a job, and maintaining his hygiene. 28 (AR 362.) Even so, as the ALJ noted, Plaintiff had an appropriate mood and affect, and he 1 maintained good eye contact. (AR 17, 362, 365.) Plaintiff also denied anxiety and 2 depression during that appointment. (AR 365.) On July 31, Plaintiff presented with poor 3 hygiene, poor memory, and a suspicious and defensive demeanor. (AR 371.) He also had 4 a PHQ-9 score of 9, indicating moderate depression, and a GAD-7 score of 7, indicating 5 mild anxiety. (AR 376–77.) The ALJ noted that Plaintiff was nevertheless cooperative, 6 polite, and engaged with good eye contact. (AR 17, 371.) 7 The ALJ found that, after July 2019, Plaintiff’s mental status was “benign” for more 8 than one year. (AR 17.) This was a rational interpretation of the record. See Burch v. 9 Barnhart, 400 F.3d 676, 679 (9th Cir. 2005) (“Where evidence is susceptible to more than 10 one rational interpretation, it is the ALJ’s conclusion that must be upheld.”). In August and 11 September, Plaintiff reported struggling with depression, anxiety, anger, antisocial 12 behavior, and hygiene concerns, but he generally presented with no symptoms or mild 13 symptoms, and he was always attentive, alert, and engaged. (AR 382 (on August 5, Plaintiff 14 had a flat mood but was attentive, alert, and engaged); AR 383, 385 (on August 12, Plaintiff 15 had a calm demeanor and was attentive, alert, talkative, and engaged with good eye 16 contact); AR 386 (on August 19, Plaintiff appeared worried but was attentive, alert, and 17 engaged with good eye contact); AR 388 (on September 6, Plaintiff had a relaxed posture, 18 smiled and laughed appropriately, and was attentive, alert, and engaged); AR 389 (on 19 September 16, Plaintiff had a somber expression and slumped posture but was attentive, 20 alert, talkative, and engaged); AR 390 (on September 23, Plaintiff reported doing well, had 21 a relaxed posture, and was attentive, alert, and talkative).) 22 Plaintiff presented similarly in early October. (AR 395–96 (on October 3, Plaintiff 23 had an unremarkable mental status examination and had a PHQ-9 score of 1, indicating 24 minimal depression); AR 397 (on October 7, Plaintiff had a slumped posture and low tone 25 of voice, but he reported doing well and was attentive, alert, talkative, and engaged).) In 26 mid-October, Plaintiff appeared upset and reported he had had a bad week. (AR 398.) 27 Nevertheless, he knew that his emotional state was temporary, and he was talkative and 28 willing to listen. (AR 398.) Plaintiff reported improvement during the remainder of 1 October. (AR 399 (on October 21, Plaintiff reported doing better, had good posture, and 2 was attentive, alert, talkative, and engaged); AR 400 (on October 30, Plaintiff reported 3 feeling well, reported stable symptoms, and was engaged).) 4 In early November, Plaintiff reported being sad for half a day because of recent 5 nightmares and a lack of sleep, but he was willing and engaged during his appointment. 6 (AR 401.) Over the next few weeks, he reported improvement in his mood. (AR 402 (on 7 November 14, despite appearing tired and having a slumped posture, Plaintiff reported 8 feeling better, reported a desire to socialize more, and was attentive, alert, and engaged); 9 AR 403 (on November 18, Plaintiff reported feeling very well and was attentive, alert, and 10 engaged with good eye contact).) On November 23, Plaintiff went to the emergency room 11 because of a severe panic attack, and, a few days later, he appeared anxious during an 12 appointment. (AR 301, 404.) Nevertheless, he was attentive, alert, and engaged, and he 13 reported a decrease in depression. (AR 404–05.) 14 In December, Plaintiff’s presentation was largely unremarkable. (AR 406 (on 15 December 2, Plaintiff reported doing well despite continued issues with sleeping, and he 16 was attentive, alert, talkative, and engaged); AR 407 (on December 9, Plaintiff reported 17 feeling well because he had been sleeping better, had a relaxed posture, and was attentive, 18 alert, talkative, and engaged with good eye contact); AR 414–15 (on December 19, Plaintiff 19 reported that therapy was helping a lot, and that he was improving at coping with his 20 anxiety); AR 499 (on December 20, Plaintiff was stressed because of his in-laws but felt at 21 ease knowing the stress was temporary, and he was attentive, alert, talkative, and engaged 22 with good eye contact); AR 500 (on December 26, Plaintiff reported being well, reported 23 stable symptoms, and was engaged); AR 501 (on December 27, Plaintiff reported being 24 well, had a relaxed posture, and was attentive, alert, talkative, and engaged with good eye 25 contact); AR 502 (on December 30, Plaintiff reported having a stable mood despite external 26 stressors, had a relaxed posture, and was attentive, alert, talkative, and engaged with good 27 eye contact).) 28 In early January 2020, Plaintiff reported that he had slept only 14 hours over the 1 past three days because of nightmares and flashbacks, and he appeared tired with a slumped 2 posture. (AR 507.) The following day, he had a PHQ-9 score of 13, indicating moderate 3 depression. (AR 509.) Even so, he reported feeling less hatred towards himself, he was 4 cooperative and attentive, and his judgment and insight were only minimally impaired. 5 (AR 507, 510.) 6 Over the next several months, although Plaintiff continued to report symptoms, he 7 consistently presented with no symptoms or mild symptoms. (AR 527 (on January 21, 8 Plaintiff reported being well, had a relaxed posture, and was attentive, alert, talkative, and 9 engaged); AR 524, 526 (on January 27, Plaintiff reported a clearer mind, less anxiety, and 10 fewer nightmares and flashbacks, and he was attentive, alert, talkative, and engaged with 11 good eye contact); AR 521–22 (on January 30, Plaintiff denied anxiety and depression and 12 had a PHQ-2 score of 0, indicating no depression); AR 519 (on February 3, Plaintiff 13 reported doing very well, reported less anxiety and depression, and was attentive, alert, 14 talkative, and engaged with good eye contact); AR 518 (on February 12, Plaintiff reported 15 doing well with his medications and coping skills, had a relaxed posture, and was attentive, 16 alert, talkative, and engaged); AR 517 (on February 18, Plaintiff reported being well 17 despite having received bad news, agreed to attend therapy less often due to his good 18 progress, and was attentive, alert, talkative, and engaged with good eye contact); AR 591 19 (on March 5, Plaintiff was anxious and had a PHQ-9 score of 6, indicating mild depression, 20 but he was cooperative and had only minimally impaired judgment and insight); AR 549 21 (on March 24, Plaintiff reported he was very happy with his progress on his anxiety); 22 AR 582–83 (on May 13, Plaintiff denied anxiety and depression and was alert and 23 oriented).) 24 As the ALJ noted, Plaintiff’s presentation did not become worse until late 2020. 25 (AR 17.) In August 2020 (ten months after his date last insured), he had a PHQ-9 score of 26 22, indicating severe depression. (AR 576.) He had a flat affect and appeared anxious, 27 depressed, withdrawn, irritable, and sad. (AR 576, 579.) Still, he had logical and coherent 28 thought content, intact thought processes, good attention and concentration, and only 1 minimally impaired judgment and insight. (AR 579.) In late October, Plaintiff reported 2 severe anxiety and depression, and his judgment and insight were moderately to severely 3 impaired. (AR 587–88.) Even so, he was cooperative and had good attention and 4 concentration. (AR 588.) Plaintiff’s treatment records end in December 2020. At that time, 5 he presented as anxious and irritable with moderately to severely impaired judgment and 6 insight. (AR 563–64.) Nevertheless, he was cooperative and had fair attention and 7 concentration. (AR 563.) 8 The ALJ also found that the record was inconsistent with Plaintiff’s testimony that 9 he neglected his hygiene. (AR 17.) That finding is supported by substantial evidence. As 10 the ALJ observed, Plaintiff presented with poor hygiene only rarely. (AR 371 (on July 31, 11 2019, Plaintiff “appeared to be with poor hygiene”).)2 At most of his appointments, he was 12 observed as “well groomed,” “appropriately groomed,” or “casually” dressed. (AR 346 13 (August 9, 2018); AR 351 (December 14); AR 360 (May 30, 2019); AR 386 (August 19); 14 AR 387 (August 26); AR 388 (September 6); AR 389 (September 16); AR 390 (September 15 23); AR 392 (September 30); AR 396 (October 3); AR 397 (October 7); AR 399 (October 16 21); AR 402 (November 14); AR 403 (November 18); AR 404 (November 25); AR 406 17 (December 2); AR 407 (December 9); AR 499 (December 20); AR 500 (December 26); 18 AR 501 (December 27); AR 505 (December 30); AR 507 (January 6, 2020); AR 510 19 (January 7); AR 530 (January 14); AR 528 (January 21); AR 524 (January 27); AR 519 20 (February 3); AR 518 (February 12); AR 517 (February 18); AR 591 (March 5); AR 567 21 (March 10); AR 582 (May 13); AR 572 (July 8); AR 579 (August 26); AR 563 (December 22 14).) Similarly, Plaintiff appears to have been assessed for poor memory only once. 23 (AR 371 (July 31, 2019).) The other assessments were normal. (AR 323 (September 5, 24 2019); AR 306 (December 4).) 25 The ALJ chronicled Plaintiff’s course of treatment and, with citation to 26 representative examples, rationally concluded that Plaintiff’s treatment records were 27 inconsistent with his reports of severe and pervasive symptoms. Plaintiff argues that the

28 2 From the Court’s review of the record, this appears to be the only occasion where a provider observed Plaintiff with poor hygiene. 1 ALJ’s analysis is flawed because it ignores that mental impairments are characterized by 2 symptoms that wax and wane. See Garrison, 759 F.3d at 1017. It is true that “it is error for 3 an ALJ to pick out a few isolated instances of improvement over a period of months or 4 years and to treat them as a basis for concluding a claimant is capable of working.” Id. The 5 ALJ here, however, did not rely on a few isolated instances of improvement. Instead, the 6 ALJ found that Plaintiff rarely had more than mild limitations. That finding was rational. 7 It must be upheld even if Plaintiff’s interpretation of the evidence is also rational. Burch, 8 400 F.3d at 679. 9 Second, the medical-opinion evidence. The state-agency physicians opined that 10 Plaintiff did not have a severe impairment or combination of impairments. (AR 41, 64, 75, 11 86.) The ALJ found those opinions persuasive because they were “well supported with 12 citations to objective evidence in the record.” (AR 18; see AR 73–76.) As explained above, 13 the ALJ reasonably found the record to be inconsistent with Plaintiff’s alleged symptoms. 14 Clearly, it was rational for the ALJ to rely on trained physicians who reached the same 15 conclusion about the same evidence. 16 Plaintiff disputes that the ALJ relied on the agency opinions. He says that because 17 unfavorable agency opinions are present in “virtually every case and an ALJ is required . . 18 . to discuss them, absent language specifically tying these opinions to claimant testimony, 19 their presence as an object of discussion in an Unfavorable Decision can hardly be seen as 20 analysis specifically intended to undermine symptom testimony.” The Court disagrees. The 21 ALJ’s decision must be read in its full context. See Smartt, 53 F.4th at 498. The ALJ found 22 that the longitudinal record showed Plaintiff rarely experienced more than mild limitations. 23 The ALJ then found the opinions “consistent with” that understanding of the evidence, and 24 thus “persuasive.” It is reasonable to infer that the ALJ’s treatment of Plaintiff’s testimony 25 was based in part on those relevant, consistent, and persuasive opinions. See Magallanes 26 v. Bowen, 881 F.2d 747, 755 (9th Cir. 1989) (noting federal courts may make reasonable 27 inferences about an ALJ’s reasoning). 28 Plaintiff also argues that the ALJ could not reject his symptom testimony without 1 considering other evidence, namely, that he consistently reported the same symptoms over 2 the course of his treatment. The Commissioner attacks this reasoning as “circular,” saying 3 that the Court should not accept Plaintiff’s symptom testimony as true simply because it is 4 consistent with statements he has made in the past. The consistency of the claimant’s self- 5 reports is a relevant factor. SSR 16-3p, 2017 WL 5180304, at *6 (Oct. 25, 2017). Still, as 6 the Commissioner points out, ALJs are not “‘required to believe every allegation of 7 disabling [symptoms], or else disability benefits would be available for the asking, a result 8 plainly contrary to’ the Social Security Act.” Smartt, 53 F.4th at 499 (quoting Molina v. 9 Astrue, 674 F.3d 1104, 1112 (9th Cir. 2012)). Here, the ALJ was not required to accept 10 Plaintiff’s self-reports, as those reports were inconsistent with the longitudinal evidence. 11 The Court rejects Plaintiff’s claim of error. 12 II. Severity of Impairments 13 “[T]he step-two inquiry is a de minimis screening device [used] to dispose of 14 groundless claims.” Smolen v. Chater, 80 F.3d 1273, 1290 (9th Cir. 1996) (citing Bowen 15 v. Yuckert, 482 U.S. 137, 153–54 (1987)). To pass step two, the claimant must have at least 16 one severe impairment. 20 C.F.R. § 404.1520(c). “An impairment or combination of 17 impairments can be found ‘not severe’ only if the evidence establishes a slight abnormality 18 that has ‘no more than a minimal effect on an individual[’]s ability to work.’” Smolen, 80 19 F.3d at 1290 (quoting SSR 85-28, 1985 WL 56856, at *3 (Jan. 1, 1985)). “[A]n ALJ may 20 find that a claimant lacks a medically severe impairment or combination of impairments 21 only when his conclusion is ‘clearly established by medical evidence.’” Webb v. Barnhart, 22 433 F.3d 683, 687 (9th Cir. 2005) (quoting SSR 85-28, 1985 WL 56856, at *3). 23 The ALJ must follow a “special technique” when evaluating the severity of a mental 24 impairment. 20 C.F.R. § 404.1520a. Using a five-point scale—none, mild, moderate, 25 marked, and extreme—the ALJ must rate the degree to which the impairment limits the 26 claimant’s ability to (1) “understand, remember, or apply information,” (2) “interact with 27 others,” (3) “concentrate, persist, or maintain pace,” and (4) “adapt or manage” himself. 28 Id. § 404.1520a(c). When the claimant has either no limitations or mild limitations in these || four areas, the ALJ “will generally conclude that [his] impairment(s) is not severe, unless the evidence otherwise indicates that there is more than a minimal limitation in [his] ability 3|| to do basic work activities.” Jd. § 404.1520a(d)(1). 4 Here, the ALJ rationally found that Plaintiff had a mild limitation in each functional || area. (AR 18.) That finding is supported by the longitudinal record, which, as discussed in || the preceding section, indicates that Plaintiff generally presented with no symptoms or mild symptoms. He was attentive, alert, and engaged; he was cooperative; he was well groomed; 8 || he had intact and logical thought processes; he learned and successfully implemented 9|| coping skills; not infrequently, he denied anxiety and depression and reported improvement in his mental condition; and, even when he presented with symptoms, his judgment and 11 |} insight were only minimally impaired. Given Plaintiff's mild limitations, the ALJ could rationally find that Plaintiff's impairments were non-severe. 20 C.F.R § 404.1520a(d)(1). 13 The finding is also supported by the state-agency physicians’ opinions that Plaintiff lacked a severe mental impairment. See Chaudhry v. Astrue, 688 F.3d 661, 670 (9th Cir. 2012) (affirming the ALJ’s reliance on opinion evidence to find the claimant’s mental disorder non-severe). Notably, Plaintiff fails to challenge the ALJ’s evaluation of the 17 || opinion evidence, and there is no contrary medical opinion in the record. Cf. Schink v. 18 || Comm’r of Soc. Sec., 935 F.3d 1245, 1265 (11th Cir. 2019) (per curiam) (reversing the 19|| ALJ’s non-severe finding where “[e]very doctor who saw Schink diagnosed him with || bipolar disorder or a comparable personality disorder and opined that it significantly affected his mood, affect, and ability to interact with others,” and “[n]o state doctor disputed this diagnosis”). The Court rejects Plaintiff's claim of error. 23 IT IS ORDERED that the Commissioner's decision is affirmed. The Clerk of 24 || Court is directed to enter judgment accordingly and close this case. 25 Dated this 11th day of May, 2023. a ere 27 United States Mavs ae □□□□ 28

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