Hannah Leigh Jones v. Andrew Saul

• Court: District Court, C.D. California
• Decided: March 23, 2021
• Docket: 2:19-cv-08183
• Status: Unknown

Opinion

1 2 3 4 5 6 7 8 UNITED STATES DISTRICT COURT 9 CENTRAL DISTRICT OF CALIFORNIA 10 HANNAH LEIGH J.,1 ) Case No. CV 19-8183-JPR 11 ) Plaintiff, ) 12 ) MEMORANDUM DECISION AND ORDER v. ) AFFIRMING COMMISSIONER 13 ) ANDREW SAUL, Commissioner ) 14 of Social Security, ) ) 15 Defendant. ) ) 16 17 I. PROCEEDINGS 18 Plaintiff seeks review of the Commissioner’s final decision 19 denying her application for Social Security supplemental security 20 income benefits (“SSI”). The matter is before the Court on the 21 parties’ Joint Stipulation, filed August 31, 2020, which the 22 Court has taken under submission without oral argument. For the 23 reasons discussed below, the Commissioner’s decision is affirmed. 24 25 26 1 Plaintiff’s name is partially redacted in line with 27 Federal Rule of Civil Procedure 5.2(c)(2)(B) and the recommendation of the Committee on Court Administration and Case 28 Management of the Judicial Conference of the United States. 1 1 II. BACKGROUND 2 Plaintiff was born in 1997. (Administrative Record (“AR”) 3 161.) She completed high school and worked part time as a baker, 4 receptionist, and warehouse worker, although her most recent jobs 5 were in customer service. (AR 34, 175-76, 190.) On November 12, 6 2015, she applied for SSI, alleging that she had been unable to 7 work since February 15 of that year because of major depression, 8 chronic post-traumatic stress disorder, borderline personality 9 disorder, and generalized anxiety. (AR 15, 189.) After her 10 application was denied (AR 74-78), she requested a hearing before 11 an Administrative Law Judge (AR 85-90). One was held on April 12 17, 2018, at which Plaintiff, who was represented by counsel, 13 testified, as did a vocational expert. (See AR 28-55.) In a 14 written decision issued July 25, 2018, the ALJ found her not 15 disabled. (AR 15-23.) She sought Appeals Council review (AR 16 158, 227-29), which was denied on July 18, 2019 (AR 1-6). This 17 action followed. 18 III. STANDARD OF REVIEW 19 Under 42 U.S.C. § 405(g), a district court may review the 20 Commissioner’s decision to deny benefits. The ALJ’s findings and 21 decision should be upheld if they are free of legal error and 22 supported by substantial evidence based on the record as a whole. 23 See Richardson v. Perales, 402 U.S. 389, 401 (1971); Parra v. 24 Astrue, 481 F.3d 742, 746 (9th Cir. 2007). Substantial evidence 25 means such evidence as a reasonable person might accept as 26 adequate to support a conclusion. Richardson, 402 U.S. at 401; 27 Lingenfelter v. Astrue, 504 F.3d 1028, 1035 (9th Cir. 2007). It 28 is “more than a mere scintilla, but less than a preponderance.” 2 1 Lingenfelter, 504 F.3d at 1035 (citing Robbins v. Soc. Sec. 2 Admin., 466 F.3d 880, 882 (9th Cir. 2006)). “[W]hatever the 3 meaning of ‘substantial’ in other contexts, the threshold for 4 such evidentiary sufficiency is not high.” Biestek v. Berryhill, 5 139 S. Ct. 1148, 1154 (2019). To determine whether substantial 6 evidence supports a finding, the reviewing court “must review the 7 administrative record as a whole, weighing both the evidence that 8 supports and the evidence that detracts from the Commissioner’s 9 conclusion.” Reddick v. Chater, 157 F.3d 715, 720 (9th Cir. 10 1998). “If the evidence can reasonably support either affirming 11 or reversing,” the reviewing court “may not substitute its 12 judgment” for the Commissioner’s. Id. at 720-21. 13 IV. THE EVALUATION OF DISABILITY 14 People are “disabled” for Social Security purposes if they 15 are unable to engage in any substantial gainful activity owing to 16 a physical or mental impairment that is expected to result in 17 death or has lasted, or is expected to last, for a continuous 18 period of at least 12 months. 42 U.S.C. § 423(d)(1)(A); Drouin 19 v. Sullivan, 966 F.2d 1255, 1257 (9th Cir. 1992). 20 A. The Five-Step Evaluation Process 21 An ALJ follows a five-step sequential evaluation process to 22 assess whether someone is disabled. 20 C.F.R. § 416.920(a)(4); 23 Lester v. Chater, 81 F.3d 821, 828 n.5 (9th Cir. 1995) (as 24 amended Apr. 9, 1996). In the first step, the Commissioner must 25 determine whether the claimant is currently engaged in 26 substantial gainful activity; if so, the claimant is not disabled 27 and the claim must be denied. § 416.920(a)(4)(i). 28 If the claimant is not engaged in substantial gainful 3 1 activity, the second step requires the Commissioner to determine 2 whether the claimant has a “severe” impairment or combination of 3 impairments significantly limiting her ability to do basic work 4 activities; if not, a finding of not disabled is made and the 5 claim must be denied. § 416.920(a)(4)(ii) & (c). 6 If the claimant has a “severe” impairment or combination of 7 impairments, the third step requires the Commissioner to 8 determine whether the impairment or combination of impairments 9 meets or equals an impairment in the Listing of Impairments 10 (“Listing”) set forth at 20 C.F.R., part 404, subpart P, appendix 11 1; if so, disability is conclusively presumed and benefits are 12 awarded. § 416.920(a)(4)(iii) & (d). If the claimant’s 13 impairment or combination of impairments does not meet or equal 14 one in the Listing, the fourth step requires the Commissioner to 15 determine whether the claimant has sufficient residual functional 16 capacity (“RFC”)2 to perform her past work; if so, she is not 17 disabled and the claim must be denied. § 416.920(a)(4)(iv). The 18 claimant has the burden of proving she is unable to perform past 19 relevant work. Drouin, 966 F.2d at 1257. If the claimant meets 20 that burden, a prima facie case of disability is established. 21 Id. 22 If that happens or if the claimant has no past relevant 23 work, the Commissioner bears the burden of establishing that the 24 25 2 RFC is what a claimant can do despite existing exertional 26 and nonexertional limitations. § 416.945(a)(1); see Cooper v. Sullivan, 880 F.2d 1152, 1155 n.5 (9th Cir. 1989). The 27 Commissioner assesses the claimant’s RFC between steps three and four. Laborin v. Berryhill, 867 F.3d 1151, 1153 (9th Cir. 2017) 28 (citing § 416.920(a)(4)). 4 1 claimant is not disabled because she can perform other 2 substantial gainful work available in the national economy, the 3 fifth and final step of the sequential analysis. 4 § 416.920(a)(4)(v), 416.960(b). 5 B. The ALJ’s Application of the Five-Step Process 6 At step one, the ALJ found that Plaintiff had not engaged in 7 substantial gainful activity since November 12, 2015, the 8 application date. (AR 17.) At step two, he determined that she 9 had severe impairments of anxiety, depression, and personality 10 disorder.3 (Id.) 11 At step three, he found that Plaintiff’s impairments did not 12 meet or equal any of the impairments in the Listing. (AR 18.) 13 At step four, he determined that she had the RFC to perform a 14 full range of work at all exertional levels with the following 15 nonexertional limitations: “no more than simple, routine, 16 repetitive tasks; no more than incidental contact with 17 supervisors; no more than occasional and superficial contact with 18 coworkers; and no contact with the public.” (AR 18.) 19 The ALJ found that Plaintiff had no past relevant work (AR 20 22), but she could work as a cleaner II, scrap sorter, or machine 21 22 3 The ALJ did not include PTSD as a severe impairment 23 despite several doctors’ diagnosis of it but included a discussion of her symptoms and treatment for it in the medical 24 summary. (See AR 17, 19-22.) And as explained in section V.A.4.a., he reasonably accommodated those symptoms by limiting 25 Plaintiff’s contact with supervisors, coworkers, and the public. 26 Therefore, any error was harmless. See Lewis v. Astrue, 498 F.3d 909, 911 (9th Cir. 2007) (failure to address particular 27 impairment at step two harmless if ALJ fully evaluated claimant’s medical condition in later steps of sequential evaluation 28 process). 5 1 feeder, positions that “exist[ed] in significant numbers in the 2 national economy” (AR 22-23). Accordingly, he found her not 3 disabled. (AR 23.) 4 V. DISCUSSION 5 Plaintiff alleges that the ALJ erred in evaluating the 6 medical evidence and opinions, assessing her symptom statements, 7 and determining her RFC. (See J. Stip. at 3-17, 21-31, 35-39, 8 40-41.) For the reasons discussed below, remand is not 9 warranted. 10 A. The ALJ Properly Evaluated the Medical Opinions and 11 Evidence 12 1. Relevant background 13 a. Samuel Byungsung Lee 14 On February 12, 2015, Plaintiff reported to psychiatrist 15 Samuel Byungsung Lee that she had been having nightmares about 16 her father, who she alleged had physically abused her, for 17 approximately four weeks. (AR 239.) The nightmares started 18 when she was four years old, soon after the abuse allegedly 19 began. (Id.) She started experiencing social anxiety, not 20 wanting to go to school, and becoming “scared of things such as 21 jackets” or “anything out of place.” (Id.) Recently, she “ha[d] 22 been feeling that certain objects may be moving throughout the 23 house, which ma[de] her feel scared.” (Id.) She reported 24 feeling when in public “that someone [wa]s going to shoot her.” 25 (Id.) She was scared at restaurants and would hide in the 26 restroom or leave early. (Id.) “She constantly look[ed] around 27 at people because she believe[d] they might hurt her, especially 28 men.” (AR 239-40.) She also reported “feeling depressed for the 6 1 past month,” isolating socially, losing her energy, missing 2 school a lot, losing her appetite, and becoming emotionally 3 unresponsive. (AR 240.) She had “passive suicidal thoughts” as 4 recently as the previous night; had deleted all social media and 5 put her phone into airplane mode because she “d[idn’t] want to 6 look at anybody”; and “[f]elt hopeless, stuck,” and like there 7 was “nothing” she could do to “feel better.” (Id.) She reported 8 a history of cutting, stating that she “[did] it when [she was] 9 angry” and had last done it three months prior. (Id.) She 10 “cut[] not to hurt [her]self, but to feel something because she’s 11 angry.” (Id.) She denied any “active suicidal ideation, intent 12 or plan.” (Id.) She reported that her anxiety came “in waves” 13 and that several situations, especially movie theaters, triggered 14 severe panic attacks, with shortness of breath, sweating, and 15 palpitations. (Id.) But at the time of the examination, she 16 denied symptoms of PTSD, obsessive compulsive disorder, social 17 anxiety, any specific phobia, or a history of manic symptoms. 18 (Id.) Dr. Lee noted that she did not have audio or visual 19 hallucinations or paranoid ideation. (Id.) 20 Dr. Lee diagnosed PTSD; “MDD,” or major depressive disorder, 21 “severe, recurrent with psychotic features”; and “history of 22 abuse/trauma.” (AR 242.) He prescribed Lexapro4 and Ativan.5 23 24 4 Lexapro is name-brand escitalopram oxalate, which is used to treat depression and anxiety. See Lexapro, WebMD, https:// 25 www.webmd.com/drugs/2/drug-63990/lexapro-oral/details (last 26 visited Mar. 22, 2021). 27 5 Ativan is name-brand lorazepam, a benzodiazepine medication used to treat anxiety. See Ativan, WebMD, https:// 28 (continued...) 7 1 Plaintiff reported on March 13, 2015, that she was doing 2 “ok,” had “low energy,” “fe[lt] tired all the time,” and still 3 had “spontaneous onset anxiety.” (AR 247.) But she had a “lot 4 less tearfulness” and anxiety in both “frequency and intensity,” 5 rated her anxiety as “much better,” had had no nightmares since 6 her last visit, was going to school and not isolating as much, 7 made a few new friends, had no suicidal ideation or urges to cut, 8 and had had no intrusive thoughts about her father since her last 9 appointment. (Id.) 10 Dr. Lee noted that Plaintiff was cooperative and pleasant; 11 had normal rate, volume, and prosody6 of speech; exhibited no 12 apparent motor abnormalities; and displayed euthymic mood, full 13 affect, goal-directed and linear thought process, and good 14 insight and judgment. (AR 248.) She had no suicidal, homicidal, 15 or paranoid ideation or audio hallucinations. (Id.) She was 16 alert and oriented; her memory was intact to immediate, 17 intermediate, and remote recall. (Id.) Dr. Lee encouraged her 18 to participate in “behavioral activation/yoga” and to return in 19 two months. (AR 249.) 20 On June 26, 2015, Plaintiff reported “feel[ing] better” and 21 less anxious, with no panic attacks or sadness for two to three 22 weeks; she was sleeping well and hiking more, but her appetite 23 24 5 (...continued) www.webmd.com/drugs/2/drug-6685/ativan-oral/details (last visited 25 Mar. 22, 2021). 26 6 Prosody is the rhythm, stress, and intonation of speech; 27 it provides clues about attitude or affective state. Prosody in Speech and Song, Am. Psych. Ass’n, https://www.apa.org/pubs/ 28 highlights/peeps/issue-29 (last visited Mar. 22, 2021). 8 1 had decreased. (AR 254.) She had reduced her Lexapro dosage 2 because it was making her very tired. (Id.) Her mental-status 3 examination was unchanged. (AR 255.) Dr. Lee decreased her 4 Lexapro dosage and instructed her to follow up by telephone 5 because she would be in Pennsylvania all summer. (AR 256.) 6 Plaintiff saw Dr. Lee again on February 26, 2016, after 7 moving out of her grandfather’s house in Pennsylvania, and 8 reported that he had been inappropriate with her. (AR 467.) But 9 she had been doing “really good” since moving back, her mood had 10 been “stable,” she was seeing a therapist weekly, and she had 11 gotten a job at a crafts store. (AR 467-68.) She continued to 12 have “occasional flashbacks/nightmares” from her history of abuse 13 and was sleeping too much, but she was no longer having “social 14 avoidance” and denied any suicidal ideation, intent, or plan. 15 (AR 468.) Dr. Lee noted no “current psychosis.” (Id.) She was 16 compliant with her medications and “f[elt] possible [side 17 effects] of fatigue[] and low energy.” (Id.) Her mental-status 18 examination revealed normal findings. (AR 468-69.) Dr. Lee 19 noted that her depression, anxiety, and PTSD symptoms were 20 controlled and adjusted her Zoloft7 dosage. (AR 469.) 21 b. West LA Medical Center 22 On April 12, 2015, Plaintiff’s mother took her to the West 23 LA Medical Center emergency department after she found her 24 cutting herself. (AR 259, 261.) Plaintiff reported feeling 25 26 7 Zoloft treats depression, panic attacks, and social- 27 anxiety disorder. See Zoloft, WebMD, https://www.webmd.com/ drugs/2/drug-35-8095/zoloft-oral/sertraline-oral/details (last 28 visited Mar. 22, 2021). 9 1 “increasingly depressed [and] hopeless,” having “passing thoughts 2 of suicide,” and feeling more depressed “due to a romantic 3 interest rejecting” her. (AR 261.) She had “had suicidal 4 thoughts over the weekend” but no clear plan. (AR 268.) She cut 5 herself “to make [her]self feel better.” (Id.) She continued to 6 have “passive suicidal ideation” at the hospital and described 7 her mood as “miserable” but exhibited no “psychotic [symptoms] or 8 mania.” (Id.) She was placed on a psychiatric hold (AR 259-60, 9 268) and transferred to Northridge Hospital Medical Center the 10 next day for further treatment of her depression and suicidal 11 ideation (AR 492, 499). 12 On July 28, 2016, Plaintiff went to the urgent-care clinic, 13 complaining of suicidal ideation. (AR 814.) Her memory and 14 judgment were normal; her affect was not blunt, labile, or 15 inappropriate; she was not agitated or apathetic; and she did not 16 exhibit a depressed mood. (AR 815.) She was transported to the 17 emergency department for psychiatric consultation and 18 observation. (AR 814, 816.) 19 At the emergency department, Plaintiff reported to 20 psychiatrist Daniel Son that she had been “feeling like nothing 21 is real” for one week and had “thoughts of hurting herself.” (AR 22 829; see AR 833-34.) She had been missing work because of these 23 feelings and was getting in trouble and experiencing stress. 24 (AR 829.) She claimed to have a plan to cut herself with a 25 razor, but she denied any recent attempt. (Id.) She was 26 “crying, tearful” on examination. (AR 831.) She had recently 27 been experiencing more “out of body” experiences, “fe[lt] crazy,” 28 had “increased irritability” with customers, and was having 10 1 “paranoid thoughts of the government being after her” and 2 customers “hav[ing] a gun and want[ing] to kill her.” (AR 835.) 3 But she denied any current suicidal thoughts, requested to be 4 discharged to pursue outpatient mental-health resources, and 5 asked for a note for time off work. (Id.) Dr. Son diagnosed her 6 with “mood disorder, unspecified” and identified the possible 7 type as “borderline personality disorder,” “bipolar disorder,” 8 “MDD with psychotic” features, or “psychotic disorders.” (AR 9 837.) She was observed for several hours, after which Dr. Son 10 discharged her. (AR 834.) 11 On September 25, 2016, Plaintiff went to the emergency 12 department complaining of “suicidal thoughts” for one day that 13 had been worsening. (AR 923.) She was not nervous or anxious, 14 and examination findings were negative. (AR 924.) She was 15 placed on a psychiatric hold (AR 929-30) and transferred to Del 16 Amo Hospital8 (AR 948). 17 c. Northridge Hospital Medical Center 18 After being transferred from West LA Medical Center to the 19 Northridge Hospital psychiatric unit on April 13, 2015, 20 Plaintiff’s Lexapro dosage was increased. (AR 501.) During her 21 hospitalization, she remained depressed but repeatedly denied any 22 current suicidal ideation or plan (AR 548, 625, 629, 635, 640-42, 23 717) and exhibited no audiovisual hallucinations (AR 503). She 24 participated in group therapy and activities (AR 625) and was 25 discharged on April 16, 2015 (AR 548). 26 27 28 8 No records from Del Amo Hospital appear in the record. 11 1 d. Penn State Hershey Medical Center 2 On August 21, 2015, Plaintiff went to Penn State Hershey 3 Medical Center complaining of anxiety and depression. (AR 371.) 4 She said she was fearful of men but was pleasant and cooperative, 5 appeared to be at ease, and made good eye contact with the male 6 doctor who examined her. (AR 373.) Her psychomotor activity was 7 normal. (Id.) Her speech was clear, coherent, and not 8 pressured. (Id.) She was conversant and interactive, and her 9 thought process was coherent and goal directed. (Id.) She 10 described her mood as anxious, but she denied any current 11 thoughts of suicide and stated that she would not harm herself. 12 (Id.) Her affect was restricted sometimes, but she also laughed 13 and “appeared bright.” (Id.) She had violent dreams of killing 14 her father, but she had no actual homicidal thoughts toward 15 anyone. (Id.) She had a distrust of men, feared they might harm 16 her, worried that inanimate objects would move toward her, and 17 was afraid to turn around in the shower for “fear of seeing a 18 demon.” (Id.) But she had no “hallucinations in the [five] 19 senses.” (Id.) She had intermittent suicidal ideation and 20 thoughts of cutting or hanging herself and running away and 21 “starving herself in the woods.” (Id.) But she stated that she 22 would not do those things because she was motivated by her 23 relationship with family and could reach out for help. (AR 373- 24 74.) Therefore, her risk of suicide was rated low, and she was 25 deemed safe for outpatient care. (AR 374.) She was diagnosed 26 with major depressive disorder, anxiety, borderline personality 27 traits, and obsessive-compulsive personality traits. (AR 373.) 28 She elected to continue partial hospitalization with intensive 12 1 outpatient treatment and was switched from Lexapro to Zoloft. 2 (AR 374.) 3 She reported to psychiatrist Tjiauw Tan on August 24, 2015, 4 that she was having difficulty initiating and maintaining sleep. 5 (AR 367.) Her grandfather had allegedly made a “few sexually 6 inappropriate comments and some sexual advances towards her,” and 7 her step-grandmother was jealous. (Id.) She did not feel safe 8 at her grandfather’s house and was upset by the constant 9 arguments between her grandfather and step-grandmother. (Id.) 10 She reported that she had urges to cut herself but stated that 11 she would use “distraction” techniques to avoid acting on the 12 urge, and she had no suicidal or homicidal ideation. (Id.) Dr. 13 Tan noted that she was friendly and pleasant during her 14 examination; her speech was coherent, relevant, and normal in 15 rate, tone, and volume. (AR 368.) Her psychomotor activity was 16 normal; she was depressed and her affect was dysphoric and 17 anxious, but her thought process was linear, organized, and goal 18 directed. (Id.) No “circumstantiality,” “tangentiality,” or 19 perceptual disturbances were noted. (Id.) Her cognitive 20 functioning and memory were grossly intact, and her insight and 21 judgment were fair. (Id.) Dr. Tan found that she did not meet 22 the criteria for inpatient hospitalization and continued her in 23 the partial hospitalization program, which included family, 24 individual, and group therapy. (Id.) 25 On August 27, 2015, Plaintiff described her mood as happy; 26 her affect was euthymic, and her mood was congruent, reactive, 27 and appropriate. (AR 365.) She exhibited linear, organized, and 28 goal-directed thought process. (Id.) She strongly denied any 13 1 urge to injure herself or any suicidal or homicidal ideation. 2 (Id.) No perceptual disturbances were noted, and her insight and 3 judgment were fair. (Id.) 4 Plaintiff reported on September 1, 2015, that the day before 5 she had had thoughts of hurting herself and strong urges to cut 6 herself. (AR 363.) She felt her anxiety was getting worse and 7 recently got upset when her grandfather asked her to start 8 working. (Id.) A family session was held, and Plaintiff 9 appeared anxious and dysphoric during it; she stated that she did 10 not feel ready to start working. (AR 363-64.) But she was 11 pleasant and cooperative during her mental-status examination, 12 and the examination findings were unchanged. (Id.) 13 On September 2, 2015, Plaintiff reported that she spoke to 14 her grandfather after the family session and was now considering 15 starting to work part time. (AR 361.) She was getting along 16 with her grandparents, and her anxiety, depression, and 17 anhedonia9 were getting better. (Id.) She was more positive and 18 looked forward to working, going to college, and accomplishing 19 her long-term life goals. (Id.) 20 Plaintiff stated on September 8, 2015, that her mood and 21 anxiety symptoms had “significant[ly] improve[d].” (AR 359.) 22 She continued to take Zoloft with no adverse affects and looked 23 forward to starting work. (Id.) She was getting along well with 24 her grandparents, and her grandfather intended to take her to 25 26 9 Anhedonia is “a psychological condition characterized by 27 inability to experience pleasure in normally pleasurable acts.” Anhedonia, Merriam-Webster, http://www.merriam-webster.com (last 28 visited Mar. 22, 2021). 14 1 Canada for a vacation in October. (Id.) She actively completed 2 chores at home and socialized during the weekend. (Id.) She 3 agreed to be discharged the next day. (Id.) 4 On September 9, 2015, Plaintiff called the on-call resident 5 and reported a strong urge to cut herself but denied any suicidal 6 or homicidal ideation. (AR 357.) She had had an argument with 7 her grandfather, who yelled at her and made some “homophobic and 8 racial comments.” (Id.) She then texted her mother and reported 9 that she would have “done [her]self” if her mom had not called or 10 texted back within 20 minutes. (Id.) Her mother called her back 11 and asked her to take a taxi to the partial-hospitalization 12 program. (Id.) She was sad and depressed, had vague thoughts of 13 not living, and felt that life was not worth it. (AR 355.) She 14 did not want to return to her grandfather’s house and did not 15 feel safe; she was taken to the emergency department, from which 16 she was sent to inpatient psychiatric hospitalization. (AR 357.) 17 At the emergency department, Plaintiff stated that she spent 18 the night at her grandfather’s house after the argument, but she 19 began wandering the streets the next morning after he would not 20 drive her to her outpatient appointment. (AR 350.) She found an 21 abandoned farmhouse, where she began formulating a plan to hang 22 herself. (Id.) She stated that she “would likely take her own 23 life if released.” (Id.) An examination revealed good insight, 24 poor judgment, fair impulsivity, depressed mood, and congruent 25 affect. (AR 347.) On September 10, 2015, she was transferred to 26 Philhaven Center for inpatient treatment. (AR 271.) 27 On October 2, 2015, Plaintiff reported to psychiatrist 28 Gagandeep Dhillon that following her inpatient treatment, her 15 1 mood was “neutral.” (AR 292.) She was compliant with her 2 medications and had no side effects. (Id.) She feared 3 paranormal activity, such as inanimate objects moving, but denied 4 any suicidal or homicidal ideation, delusions, or perceptual 5 disturbances. (Id.) She continued to live with her 6 grandparents. (Id.) 7 Plaintiff reported to psychiatrist Sanjay Yadav on November 8 6, 2015, that she had had “bad lows” in her mood in the last two 9 weeks. (AR 287.) She was having a lot of stress from 10 relationship issues with her grandfather’s wife. (Id.) She had 11 “a lot of suicidal thoughts and urges to cut herself in the last 12 [two to three] weeks,” but her mood was “a lot better” when she 13 was away from home, and she denied anhedonia or current suicidal 14 thoughts. (Id.) She denied any panic attacks when not at home 15 or side effects from Zoloft. (Id.) 16 On November 13, 2015, Plaintiff reported to psychiatrist 17 Aditya Joshi that her mood was “okay”; she had normal energy and 18 concentration, no appetite or sleep problems, and no suicidal or 19 homicidal ideation, intent, or plan. (AR 326.) She had taken 20 medication for anxiety after her last visit, and she became 21 extremely dizzy. (Id.) She had recently cut herself on her leg 22 because she was upset that her grandfather was pushing her to 23 apply for SSI. (Id.) She was compliant with medications, had 24 been attending individual therapy, and was going to start 25 dialectical behavioral therapy, or DBT. (Id.) She denied any 26 anxiety except around her grandfather’s wife and denied any panic 27 attacks. (Id.) She was pleasant, calm, and cooperative. (AR 28 16 1 327.) She had moderate affective dysregulation10 that was normal 2 in range, her thought process was goal directed, she was not 3 delusional and denied any perceptual disturbances, and no 4 obsessions or compulsions were noted. (Id.) Her insight and 5 judgment were fair, and her impulse control and memory were 6 intact. (Id.) The dosages of her Zoloft and Vistaril11 were 7 adjusted, and she was instructed to continue with DBT therapy for 8 “provisional borderline personality disorder.” (Id.) 9 On January 28, 2016, Plaintiff went to the emergency 10 department, complaining of depression and “[p]assive” suicidal 11 ideation “without [a] plan.” (AR 329.) She had enrolled in DBT, 12 was “kicked out” of the group after having missed an appointment 13 while in Los Angeles visiting her mother, and was having trouble 14 getting in to see her psychiatrist. (Id.) She had recently told 15 her mother and the rest of her family that her grandfather had 16 abused her while she was living with him, and she was now living 17 with friends in their basement. (Id.) She spoke with a social 18 worker about getting into counseling and reporting her abuse, 19 felt “ok to go home,” and was discharged. (AR 331.) 20 21 10 Affective dysregulation is “an excessive reactivity to 22 negative emotional stimuli with an affective (anger) and a behavioral component (aggression).” Affective Dysregulation in 23 Childhood — Optimizing Prevention and Treatment: Protocol of Three Randomized Controlled Trials in the ADOPT Study, BMC 24 Psychiatry, https://bmcpsychiatry.biomedcentral.com/articles/ 10.1186/s12888-019-2239-8 (last visited Mar. 22, 2021). 25 26 11 Vistaril, or hydroxyzine, is used to relieve itching caused by allergies, control nausea and vomiting caused by 27 various conditions, and treat anxiety. Hydroxyzine, MedlinePlus, http://www.nlm.nih.gov/medlineplus/druginfo/meds/a682866.html 28 (last visited Mar. 22, 2021). 17 1 e. Philhaven Center 2 On September 10, 2015, Plaintiff was transferred to 3 Philhaven Center for inpatient psychiatric treatment. (AR 271.) 4 On examination she was calm and had a depressed mood, congruent 5 affect, coherent thought processes, good insight, fair judgment, 6 and no psychotic symptoms. (AR 272.) Her Zoloft dosage was 7 adjusted, and she was assigned to therapeutic groups and 8 activities and individual therapy. (Id.) She participated in a 9 lengthy family session with her grandfather, at which they 10 discussed ways they could communicate more effectively and ways 11 Plaintiff could use grounding skills. (Id.) Her grandfather 12 committed to helping her get back on her feet, by getting her own 13 apartment or going to college. (Id.) She completed home-safety 14 and relapse-prevention plans and reported that her mood was 15 improved and she was looking forward to discharge and beginning a 16 new job. (Id.) She was discharged on September 14, 2015, and 17 was scheduled for outpatient treatment. (Id.) 18 f. Giulianna Nguyen 19 On February 26, 2016, Plaintiff saw Dr. Giulianna Nguyen12 20 to establish care and for an annual physical. (AR 446.) 21 Plaintiff reported that she had switched from Lexapro to Zoloft 22 and that she had experienced chronic fatigue and anhedonia since 23 the onset of depression. (Id.) But her depression was 24 “improved,” and she described her anxiety as “only situational.” 25 26 12 Dr. Nguyen primarily practices internal medicine. See Cal. Dep’t Consumer Aff. License Search, https:// 27 search.dca.ca.gov (search for “Giulianna” with “Nguyen” under “License Type,” “Physicians and Surgeons”) (last visited Mar. 22, 28 2021). 18 1 (Id.) 2 g. Thaworn Rathana-Nakintara 3 Consulting psychiatrist Thaworn Rathana-Nakintara performed 4 a complete psychiatric evaluation of Plaintiff on May 18, 2016. 5 (AR 484-89.) She told Dr. Rathana-Nakintara that she “had a lot 6 of trauma . . . growing up” and that her “father beat up” her and 7 her mother. (AR 484.) She reported having anxiety that made her 8 ill at times, panic attacks, “major depression,” “bipolar 9 disorder,” paranoia while at school, irrational thinking, and “an 10 urge to hurt [her]self.” (Id.) Her father was banned from 11 seeing her when she was 11 years old. (AR 484-85.) When she 12 graduated high school, she stayed with her grandfather in 13 Pennsylvania, but she said he abused her sexually. (AR 485.) 14 She felt “much better now by taking Zoloft.” (Id.) 15 Dr. Rathana-Nakintara diagnosed her with mood disorder and 16 cannabis abuse and assigned a GAF score of 95.13 (AR 487.) She 17 18 13 GAF scores assess a person’s overall psychological functioning on a scale of 1 to 100. See Diagnostic and 19 Statistical Manual of Mental Disorders 32 (revised 4th ed. 2000). A GAF score between 91 and 100 indicates “[s]uperior functioning 20 in a wide range of activities,” such that “life’s problems never seem to get out of hand”; a person with that score “is sought out 21 by others because of his or her many positive qualities” and 22 suffers “[n]o symptoms.” DSM-IV 34. The Commissioner has declined to endorse GAF scores, Revised Medical Criteria for 23 Evaluating Mental Disorders and Traumatic Brain Injury, 65 Fed. Reg. 50764-65 (Aug. 21, 2000) (codified at 20 C.F.R. pt. 404) 24 (GAF score “does not have a direct correlation to the severity requirements in our mental disorders listings”), and the most 25 recent edition of the DSM “dropped” the GAF scale, citing its 26 lack of conceptual clarity and questionable psychological measurements in practice, DSM-V 16 (5th ed. 2013). Because GAF 27 scores continue to be included in claimant medical records, however, the Social Security Administration has clarified that 28 (continued...) 19 1 was cooperative, maintained good eye contact, had normal 2 psychomotor activity, and demonstrated fluent speech, with normal 3 prosody, rate, and rhythm; her affect was appropriate and 4 reactive, and her mood was responsive and “not depressed or 5 anxious.” (AR 486.) Her thought processes were linear and goal- 6 oriented, and she exhibited normal memory, concentration, 7 abstract thinking, insight, and judgment. (AR 486-87.) She 8 denied current suicidal or homicidal ideation, plans, or intent. 9 (AR 486.) Further, she exhibited “no difficulty interacting with 10 the clinic staff” or Dr. Rathana-Nakintara; “maintaining 11 composure,” “even temperament,” and “social functioning”; or 12 “focusing and maintaining attention.” (AR 488.) She had “no 13 difficulties in concentration, persistence and pace.” (Id.) Her 14 “level of personal independence [was] adequate,” and she was 15 “intellectually and psychologically capable of performing 16 activities of daily living.” (Id.) 17 Dr. Rathana-Nakintara opined that she “would have no 18 limitations performing simple and repetitive tasks and no 19 limitations performing detailed and complex tasks.” (Id.) She 20 “would have no difficulties . . . perform[ing] work activities on 21 a consistent basis without special or additional supervision”; 22 “no limitations completing a normal workday or workweek due to 23 [her] mental condition” or “accepting instructions from 24 supervisor[s] and interacting with coworkers and with the 25 26 13 (...continued) 27 they are “medical opinion evidence . . . if they come from an acceptable medical source.” Wellington v. Berryhill, 878 F.3d 28 867, 871 n.1 (9th Cir. 2017) (citation omitted). 20 1 public”; and “no difficulties . . . handl[ing] the usual 2 stresses, changes and demands of gainful employment.” (Id.) 3 h. Celine Payne-Gair 4 On July 4, 2016, Celine Payne-Gair, a state-agency reviewing 5 psychologist,14 evaluated portions of Plaintiff’s medical 6 records, including Dr. Rathana-Nakintara’s examination report and 7 some of the treatment records from Philhaven and Penn State 8 Hershey Hospital. (AR 64-65.) 9 Dr. Payne-Gair opined that Plaintiff had no limitations in 10 understanding and memory. (AR 68.) She was not significantly 11 limited in the ability to carry out very short and simple or 12 detailed instructions, perform activities within a schedule, 13 maintain regular attendance, be punctual within customary 14 tolerances, sustain an ordinary routine without special 15 supervision, work in coordination with or in proximity to others 16 without being distracted by them, make simple work-related 17 decisions, ask simple questions or request assistance, accept 18 instructions and respond appropriately to criticism from 19 supervisors, get along with coworkers or peers without 20 distracting them or exhibiting behavioral extremes, maintain 21 socially appropriate behaviors and adhere to basic standards of 22 neatness and cleanliness, be aware of normal hazards and take 23 appropriate precautions, travel in unfamiliar places or use 24 public transportation, or set realistic goals or make plans 25 26 14 Dr. Payne-Gair used a medical specialty code of 38 (AR 27 73), indicating psychology, see Soc. Sec. Admin., Program Operations Manual System (POMS) DI 24501.004, https:// 28 secure.ssa.gov/apps10/poms.nsf/lnx/0424501004 (May 5, 2015). 21 1 independently of others. (AR 68-69.) 2 She was moderately limited in the ability to maintain 3 attention and concentration for extended periods, complete a 4 normal workday and workweek without interruptions from 5 psychologically based symptoms, perform at a consistent pace 6 without an unreasonable number and length of rest periods, 7 interact appropriately with the general public, and respond 8 appropriately to changes in the work setting. (Id.) 9 She could complete simple and detailed tasks, maintain 10 attention and concentration for periods of at least two hours, 11 complete a normal workday and workweek without significant 12 psychologically related interruptions, perform at a consistent 13 pace, and adapt to routine changes in the workplace. (AR 69.) 14 i. Aurora Charter Oak Hospital 15 On September 27, 2017, Plaintiff was brought to Aurora 16 Charter Oak Hospital by the Los Angeles Police Department 17 following a verbal altercation with her roommate; she complained 18 of “feeling suicidal” and was placed on a psychiatric hold. (AR 19 735.) She exhibited depressed mood; flat affect; and poor 20 insight, social judgment, and coping skills. (Id.) She was 21 using illicit drugs like marijuana “off and on,” and her urine 22 toxicology was positive for THC. (Id.) But she denied 23 hallucinations or delusions. (Id.) She was admitted for 24 inpatient treatment; was prescribed medication for depression; 25 and participated in group, individual, milieu,15 and family 26 27 15 Milieu therapy treats mental-health conditions by “using a person’s surroundings to encourage healthier ways of thinking 28 (continued...) 22 1 therapy. (AR 735-36.) On October 3, 2017, she was less 2 dysphoric, her insight and social judgment had improved, and she 3 was discharged. (AR 736.) 4 2. Applicable law 5 Three types of physicians may offer opinions in Social 6 Security cases: those who directly treated the plaintiff, those 7 who examined but did not treat the plaintiff, and those who did 8 neither. See Lester, 81 F.3d at 830. A treating physician’s 9 opinion is generally entitled to more weight than an examining 10 physician’s, and an examining physician’s opinion is generally 11 entitled to more weight than a nonexamining physician’s. Id.; 12 see § 416.927(c)(1)-(2).16 But “the findings of a nontreating, 13 nonexamining physician can amount to substantial evidence, so 14 long as other evidence in the record supports those findings.” 15 Saelee v. Chater, 94 F.3d 520, 522 (9th Cir. 1996) (per curiam) 16 (as amended). 17 The ALJ may discount a physician’s opinion regardless of 18 whether it is contradicted. Magallanes v. Bowen, 881 F.2d 747, 19 751 (9th Cir. 1989); see also Carmickle v. Comm’r, Soc. Sec. 20 Admin., 533 F.3d 1155, 1164 (9th Cir. 2008). When a doctor’s 21 opinion is not contradicted by other medical-opinion evidence, 22 23 15 (...continued) and behaving.” What is Milieu Therapy?, Healthline, https:// 24 www.healthline.com/health/mental-health/milieu-therapy (last visited Mar. 22, 2021). 25 26 16 For claims filed on or after March 27, 2017, the rules in § 416.920c (not § 416.927) apply. See § 416.920c (evaluating 27 opinion evidence for claims filed on or after Mar. 27, 2017). Plaintiff’s claims were filed before March 27, 2017, however, and 28 the Court therefore analyzes them under former § 416.927. 23 1 however, it may be rejected only for a “clear and convincing” 2 reason. Magallanes, 881 F.2d at 751 (citations omitted); 3 Carmickle, 533 F.3d at 1164 (citing Lester, 81 F.3d at 830-31). 4 When it is contradicted, the ALJ need provide only a “specific 5 and legitimate” reason for discounting it. Carmickle, 533 F.3d 6 at 1164 (citing Lester, 81 F.3d at 830-31). The weight given a 7 doctor’s opinion, moreover, depends on whether it is consistent 8 with the record and accompanied by adequate explanation, among 9 other things. See § 416.927(c); see also Orn v. Astrue, 495 F.3d 10 625, 631 (9th Cir. 2007) (factors in assessing physician’s 11 opinion include length of treatment relationship, frequency of 12 examination, and nature and extent of treatment relationship). 13 3. The ALJ’s assessment of the doctors’ opinions 14 The ALJ found Dr. Rathana-Nakintara’s opinion assessing no 15 limitations “somewhat persuasive because [he] had the opportunity 16 to examine [Plaintiff] personally.” (AR 22.) He found the 17 opinion of psychologist Payne-Gair, who assessed some moderate 18 limitations, more persuasive, however, “in light of the totality 19 of the objective medical evidence and [Plaintiff’s] testimony.” 20 (Id.) 21 The ALJ found Dr. Payne-Gair’s opinion persuasive 22 because it [was] supported by the objective medical 23 evidence, which shows a history of complaints of anxious 24 depressive, and psychotic symptoms, as well as a 25 depressed and anxious mood and some problems with 26 insight, judgment, and impulse control, but otherwise 27 mostly normal cognitive, expressive, receptive, and 28 social functioning and improvement in [Plaintiff’s] 24 1 condition with treatment. Dr. Payne-Gair had the 2 opportunity to review and consider [Plaintiff’s] medical 3 records, which lends her opinion additional support. 4 (AR 21.) 5 In light of Plaintiff’s testimony regarding the effects of 6 her symptoms on her ability to interact with others, however, the 7 ALJ limited her to work that requires no more than incidental 8 contact with supervisors, no more than occasional and superficial 9 contact with coworkers, and no contact with the public. (AR 21- 10 22.) 11 Although the ALJ stated that he had “considered statements 12 from treating . . . physicians” (AR 21), he did not discuss them 13 by name or assign any particular weight to them. He did, 14 however, fully summarize the medical evidence of record. (See AR 15 19-22.) 16 4. Analysis 17 Plaintiff argues that the ALJ failed to properly consider 18 the medical evidence of record and erred in affording “greater 19 weight” to the opinions of Drs. Rathana-Nakintara and Payne-Gair. 20 (J. Stip. at 3-4, 16.) 21 a. Physician opinions 22 Plaintiff fails to cite any physician opinion, treating or 23 nontreating, that contradicted those of Drs. Rathana-Nakintara 24 and Payne-Gair. Indeed, no such opinions appear in the record. 25 No physician assigned Plaintiff any work-related limitations, 26 much less any greater than those opined by Drs. Rathana-Nakintara 27 and Payne-Gair. Thus, contrary to Plaintiff’s contention (J. 28 Stip. at 6), the ALJ did not simply “ignore” medical opinions 25 1 that did not support his conclusions. See Ford v. Saul, 950 F.3d 2 1141, 1156 (9th Cir. 2020) (ALJ reasonably concluded that 3 doctor’s statements that did not discuss degree of plaintiff’s 4 limitations were not useful for determining RFC). 5 As the ALJ noted, Dr. Payne-Gair had the opportunity to 6 review and consider many of Plaintiff’s medical records, 7 including the opinion of Dr. Rathana-Nakintara. Further, the ALJ 8 gave Plaintiff the benefit of the doubt by assigning additional 9 limitations based on her testimony regarding the effects of her 10 symptoms on her ability to interact with others. 11 And although Dr. Payne-Gair’s July 2016 assessment was 12 somewhat early in the claims process and did not consider later 13 emergency-room treatment and hospitalization, Plaintiff’s mental 14 conditions responded similarly during that later treatment and 15 did not significantly deteriorate: she was admitted to Aurora 16 Charter Oak Hospital on September 27, 2017, “feeling suicidal” 17 following a verbal altercation with her roommate. (AR 735.) She 18 was prescribed medication for depression and participated in 19 group, individual, milieu, and family therapy. (AR 735-36.) A 20 few days later, on October 3, she was less dysphoric, her insight 21 and social judgment had improved, and she was discharged. (AR 22 736.) As Plaintiff acknowledges, her symptoms “waxed and waned” 23 somewhat throughout the relevant period (J. Stip. at 4) but 24 overall remained relatively stable. See Miller v. Berryhill, 732 25 F. App’x 526, 528-29 (9th Cir. 2018) (no error in declining to 26 remand case to ALJ to consider later surgical procedure because 27 there was no evidence of significant change in functional 28 limitations). 26 1 Plaintiff cites various treatment notes in which a physician 2 observed that she had trouble holding jobs, was often absent from 3 them, and left jobs because she could not handle criticism at 4 work and the stress made her want to cut herself. (See J. Stip. 5 at 15-16 (citing AR 320, 735, 829).) But the treatment notes 6 were not physician opinions regarding Plaintiff’s work 7 limitations. Rather, they were nothing more than the recording 8 of Plaintiff’s own subjective complaints and opinions about her 9 limitations. (AR 320, 735, 829); see Thomas v. Barnhart, 278 10 F.3d 947, 960 (9th Cir. 2002) (finding that ALJ properly rejected 11 Plaintiff’s symptom statements when only evidence of symptoms was 12 her statements to doctor and her testimony at hearing). 13 Moreover, almost all her jobs involved heavy customer interaction 14 (see AR 34-35, 320, 735, 829, 835), which even Plaintiff 15 acknowledged was the main trigger for her symptoms (AR 36). By 16 limiting her to no contact with the public, the ALJ fully 17 accommodated that limitation. See Barney v. Berryhill, 769 F. 18 App’x 465, 466 (9th Cir. 2019) (“The ALJ’s RFC determination 19 limiting [plaintiff] to simple unskilled work with no public 20 contact reasonably accommodated any limitations . . . as to 21 cognitive and social interaction impairments.”). Finally, as 22 discussed in section V.A.4.b. below, the medical evidence did not 23 support any work limitations beyond those assigned by the ALJ. 24 b. Medical evidence 25 Plaintiff contends that the ALJ’s assessment of the medical 26 evidence “failed to adequately address treating physician records 27 and opinions which indicate greater functional limitations than 28 those found by the ALJ.” (J. Stip. at 3-4.) But the ALJ 27 1 considered all of the record medical evidence, and as noted, 2 assigned limitations greater than those in any medical opinion. 3 The ALJ’s analysis of the medical evidence detailed the 4 occasional deterioration of Plaintiff’s condition, including 5 psychiatric hospitalizations in April 2015, July and September 6 2016, and September 2017. (AR 19-20.) The medical record as a 7 whole demonstrated few work limitations, however, as the ALJ 8 explained. 9 He also correctly noted that although Plaintiff’s treatment 10 providers noted her anxious and depressed mood and her sometimes 11 restricted affect, they also routinely observed a cooperative and 12 pleasant attitude, full orientation, clear and coherent speech, 13 normal psychomotor activity, linear and goal-directed thought 14 process, intact memory, and fair insight and judgment. (AR 20 15 (citing AR 276, 283, 309, 311-12, 314, 321, 334, 405, 411, 434, 16 469, 837).) 17 Her relative functional stability was likely because, as the 18 ALJ noted (AR 21), Plaintiff’s course of treatment was largely 19 successful. She was prescribed psychotropic medications such as 20 Lexapro, Ativan, and Zoloft. She also participated in 21 individual, group, and family therapy. Her argument that her 22 mental conditions were not controlled with her medication (J. 23 Stip. at 4) is not well taken. Instead, the record demonstrates 24 that her symptoms were generally controlled when she took her 25 medication as prescribed. In March 2015, just one month after 26 Dr. Lee prescribed her psychotropic medication, she had a “lot 27 less tearfulness” and anxiety in both “frequency and intensity,” 28 rated her anxiety as “much better,” had had no nightmares since 28 1 her last visit, was going to school and not isolating as much, 2 made a few new friends, had no suicidal ideation or urges to cut, 3 and had had no intrusive thoughts about her father since her last 4 appointment. (AR 247.) In June 2015, she reported “feel[ing] 5 better” and less anxious, with no panic attacks and no sadness 6 for two to three weeks; she was sleeping well and hiking more. 7 (AR 254.) In February 2016, she reported that she had switched 8 from Lexapro to Zoloft, her depression was “improved,” and her 9 anxiety was “only situational.” (AR 446.) Later that month, she 10 told Dr. Lee that she no longer experienced “social avoidance.” 11 (AR 468.) In May 2016, she told Dr. Rathana-Nakintara that she 12 felt “much better now by taking Zoloft” (AR 484), and Dr. 13 Rathana-Nakinara noted that she was “adhering and responding well 14 to treatment” (AR 488). 15 On the other hand, Plaintiff experienced setbacks when she 16 was not compliant with her medication. When she was hospitalized 17 following an altercation with her roommate in September 2017, she 18 reported that she had not taken her medication for one week. (AR 19 737.) Once she became compliant, her symptoms quickly improved. 20 (AR 742-46.) 21 Plaintiff correctly notes that a few instances of 22 improvement of symptoms is not a proper basis for concluding that 23 she is capable of working. See Garrison v. Colvin, 759 F.3d 995, 24 1017 (9th Cir. 2014) (“Cycles of improvement and debilitating 25 symptoms are a common occurrence, and in such circumstances it is 26 error for an ALJ to pick out a few isolated instances of 27 improvement over a period of months or years and to treat them as 28 a basis for concluding a claimant is capable of working.”); 29 1 Holohan v. Massanari, 246 F.3d 1195, 1205 (9th Cir. 2001) (noting 2 that doctor’s statements of improvement must be read in context 3 of overall diagnostic picture). The isolated instances here are 4 of deterioration, however, not improvement. As the ALJ 5 documented, Plaintiff’s four brief hospitalizations of a few days 6 each were separated by months and sometimes more than a year of 7 medication compliance, improved symptoms, and relatively normal 8 functioning. (See AR 19-22 (citing 247, 254, 276, 283, 309, 311- 9 12, 314, 321, 334, 405, 411, 434, 446, 468-69, 488, 742-46, 10 837).) At most, the records cited by Plaintiff establish that 11 the medical evidence was susceptible of more than one rational 12 interpretation, which is insufficient to warrant reversal. See 13 Molina v. Astrue, 674 F.3d 1104, 1111 (9th Cir. 2012); Tommasetti 14 v. Astrue, 533 F.3d 1035, 1041 (9th Cir. 2008) (ALJ is “final 15 arbiter with respect to resolving ambiguities in the medical 16 evidence”). Remand is not warranted. 17 B. The ALJ Properly Assessed Plaintiff’s Symptom 18 Statements 19 1. Applicable law 20 An ALJ’s assessment of a claimant’s allegations concerning 21 the severity of her symptoms is entitled to “great weight.” 22 Weetman v. Sullivan, 877 F.2d 20, 22 (9th Cir. 1989) (as amended) 23 (citation omitted); Nyman v. Heckler, 779 F.2d 528, 531 (9th Cir. 24 1985) (as amended Feb. 24, 1986). “[T]he ALJ is not ‘required to 25 believe every allegation of disabling pain, or else disability 26 benefits would be available for the asking, a result plainly 27 contrary to 42 U.S.C. § 423(d)(5)(A).’” Molina, 674 F.3d at 1112 28 (quoting Fair v. Bowen, 885 F.2d 597, 603 (9th Cir. 1989)). 30 1 In evaluating a claimant’s subjective symptom testimony, the 2 ALJ engages in a two-step analysis. See Lingenfelter, 504 F.3d 3 at 1035-36; see also SSR 16-3p, 2016 WL 1119029, at *3 (Mar. 16, 4 2016). “First, the ALJ must determine whether the claimant has 5 presented objective medical evidence of an underlying impairment 6 ‘[that] could reasonably be expected to produce the pain or other 7 symptoms alleged.’” Lingenfelter, 504 F.3d at 1036 (citation 8 omitted). If such objective medical evidence exists, the ALJ may 9 not reject a claimant’s testimony “simply because there is no 10 showing that the impairment can reasonably produce the degree of 11 symptom alleged.” Id. (citation omitted; emphasis in original). 12 If the claimant meets the first test, the ALJ may discount 13 the claimant’s subjective symptom testimony only if she makes 14 specific findings that support the conclusion. See Berry v. 15 Astrue, 622 F.3d 1228, 1234 (9th Cir. 2010). Absent a finding or 16 affirmative evidence of malingering, the ALJ must provide a 17 “clear and convincing” reason for rejecting the claimant’s 18 testimony. Brown-Hunter v. Colvin, 806 F.3d 487, 493 (9th Cir. 19 2015) (as amended) (citing Lingenfelter, 504 F.3d at 1036); 20 Treichler v. Comm’r of Soc. Sec. Admin., 775 F.3d 1090, 1102 (9th 21 Cir. 2014). The ALJ may consider, among other factors, the 22 claimant’s (1) reputation for truthfulness, prior inconsistent 23 statements, and other testimony that appears less than candid; 24 (2) unexplained or inadequately explained failure to seek 25 treatment or to follow a prescribed course of treatment; (3) 26 daily activities; (4) work record; and (5) physicians’ and third 27 parties’ statements. Rounds v. Comm’r Soc. Sec. Admin., 807 F.3d 28 996, 1006 (9th Cir. 2015) (as amended); Thomas, 278 F.3d at 958- 31 1 59 (citation omitted). If the ALJ’s evaluation of a plaintiff’s 2 alleged symptoms is supported by substantial evidence in the 3 record, the reviewing court “may not engage in second-guessing.” 4 Thomas, 278 F.3d at 959. 5 2. Plaintiff’s symptom statements and testimony 6 In a January 25, 2015 Function Report, Plaintiff stated that 7 she frequently experienced “random, severe panic attacks in 8 public [and] social situations,” “PTSD flashbacks” stemming from 9 abuse by her father, “major fear being around men,” anxiety that 10 made her feel “physically ill,” “run away” thoughts, irrational 11 “self-injurious thinking,” “p[s]ychosis episodes,” emotional 12 instability, lack of trust of others, and hypervigilance. (AR 13 177.) In an undated Disability Report, she stated that her 14 ability to work was limited by “major depression,” “chronic 15 PTSD,” “borderline personality disorder,” and “generalized 16 anxiety.” (AR 189.) 17 At the April 17, 2018 hearing, Plaintiff testified that she 18 last worked about a week before the hearing. (AR 34.) She 19 worked between 15 and 20 hours a week as a sales associate and 20 cashier at a pet store. (Id.) She testified that she was 21 precluded from working full time by her “anxiety and panic 22 attacks that she [had] during work[].” (AR 35-36.) She had 23 gotten “very physically hot and sweaty and nauseous” when 24 “assist[ing] customers” at the pet store, “triggered with 25 interactions,” “especially [with] male individuals.” (AR 36.) 26 She had had “flashbacks at work that cause[d] her to . . . 27 abandon [her] tasks.” (Id.) Depression and “suicidal ideation” 28 also limited her ability to work. (AR 38-39.) She had “often 32 1 cut [her]self,” behavior that was “still going on” at the time of 2 the hearing. (AR 39.) She last cut herself five days before the 3 hearing. (AR 47-48.) She left the home where she was staying 4 with the intention of committing suicide but returned and cut 5 herself because she had missed her shift at the pet store. (AR 6 48.) She had missed three days since she started working at the 7 pet store five weeks earlier. (Id.) The family with whom she 8 was staying had asked her to leave. (Id.) 9 She “d[id] not smoke marijuana” but had used cannabis in the 10 past to help her sleep. (AR 40.) She had experienced headaches 11 when she was taking Lexapro and Lorazepam for anxiety, but she 12 was no longer taking them. (AR 43.) At the time of the hearing, 13 she was attending therapy once a week. (AR 43-44.) She usually 14 walked to get around, but she took the bus on longer trips. (AR 15 44.) She did not drive and did not have a license. (Id.) She 16 had been fired or agreed to leave jobs several times because of 17 poor attendance. (AR 46-47.) It usually took her “a couple of 18 days to complete” a “task . . . such as laundry,” she did not 19 cook for herself, and she got “overwhelmed with . . . self- 20 hygiene.” (AR 49.) 21 3. The ALJ’s decision 22 The ALJ reviewed Plaintiff’s claimed limitations and found 23 that her “medically determinable impairments could reasonably be 24 expected to cause the alleged symptoms; however, [her] statements 25 concerning the intensity, persistence, and limiting effects of 26 these symptoms [were] not entirely consistent with the medical 27 evidence and other evidence in the record[.]” (AR 19.) The ALJ 28 discounted Plaintiff’s subjective symptom statements because they 33 1 were inconsistent with the objective medical evidence (AR 20) and 2 her work history (AR 21) and because they were controlled when 3 she was compliant with medication and treatment (id.). 4 4. Analysis 5 Plaintiff asserts that the ALJ failed to properly assess her 6 subjective symptom statements. (J. Stip. at 24-31, 35-37.) For 7 the reasons discussed below, the ALJ did not err. 8 a. Medical and other evidence 9 To start, the ALJ properly concluded that Plaintiff’s 10 subjective symptom statements were inconsistent with the 11 objective medical evidence in the record. Morgan v. Comm’r of 12 Soc. Sec. Admin., 169 F.3d 595, 600 (9th Cir. 1999) (finding 13 “conflict” with “objective medical evidence in the record” to be 14 “specific and substantial reason” undermining plaintiff’s 15 allegations). Among other things, the ALJ noted that although 16 Plaintiff claimed she could not work because of major depression, 17 chronic PTSD, borderline personality disorder, and anxiety (see 18 AR 19 (citing AR 189)), she was often noted to be cooperative and 19 pleasant, with full orientation, clear and coherent speech, 20 normal psychomotor activity, linear and goal-directed thought 21 processes, intact memory, and fair insight and judgment (AR 20 22 (citing AR 276, 283, 309, 311-12, 314, 321, 334, 405, 411, 434, 23 469, 837)). The ALJ also correctly noted that although she told 24 Dr. Rathana-Nakintara that she felt “emotionally unstable,” Dr. 25 Rathana-Nakintara observed a cooperative attitude; good eye 26 contact; normal psychomotor activity; fluent speech; appropriate 27 and reactive affect; a responsive mood; linear and goal-directed 28 thought processes; intact memory, concentration, and abstract 34 1 thinking; commonsense understanding; and no abnormal thought 2 content or perceptions. (AR 20 (citing AR 484-87).) No doctor 3 assessed functional limitations greater than the RFC. As noted 4 previously, the records cited by Plaintiff at most establish that 5 the medical evidence was susceptible of more than one rational 6 interpretation, which is insufficient to warrant reversal. See 7 Molina, 674 F.3d at 1111; Tommasetti, 533 F.3d at 1041. 8 b. Effective treatment 9 The ALJ also discounted Plaintiff’s subjective symptom 10 statements because they were inconsistent with evidence 11 demonstrating that her symptoms improved and were relatively 12 controlled when she complied with her prescribed treatment and 13 medication. (AR 21; see AR 247 (Plaintiff reporting one month 14 after Dr. Lee prescribed psychotropic medication that she had 15 “lot less tearfulness” and anxiety in both “frequency and 16 intensity”; her anxiety was “much better”; she had no nightmares 17 since last visit; she was going to school, not isolating as much, 18 and had made new friends; and she had no suicidal ideation, urges 19 to cut, or intrusive thoughts about her father since her last 20 appointment), 254 (Plaintiff reporting “feel[ing] better” and 21 less anxious, with no panic attacks or sadness for two to three 22 weeks, sleeping well, and hiking more), 446 (Plaintiff stating 23 that she had switched from Lexapro to Zoloft, her depression was 24 “improved,” and her anxiety was “only situational”), 468 25 (Plaintiff telling Dr. Lee that she no longer experienced “social 26 avoidance”), 484 (Plaintiff reporting that she felt “much better 27 now by taking Zoloft”), 488 (Dr. Rathana-Nakinara noting that 28 Plaintiff was “adhering and responding well to treatment”).) 35 1 Plaintiff argues that her hospitalizations demonstrate that 2 her treatment was not effective. But that she occasionally 3 needed more aggressive treatment, especially when she had not 4 been compliant with her medication, does not diminish the 5 numerous times when she acknowledged that her treatment and 6 medication was working. This is at most another record gray 7 area, the final arbiter of which was the ALJ. See Molina, 674 8 F.3d at 1111; Tommasetti, 533 F.3d at 1041. The ALJ properly 9 considered the evidence that Plaintiff’s treatment was effective 10 in discounting her symptom statements. 11 c. Plaintiff’s employment 12 Finally, the ALJ properly discounted Plaintiff’s subjective 13 symptom statements because her “earnings records and testimony 14 showed [she] worked several part-time jobs between 2016 and 2017” 15 and because she stated in her disability report that she was 16 “‘currently working’ when she filed the application” (AR 21 17 (citing AR 189)). See Presley-Carrillo v. Berryhill, 692 F. 18 App’x 941, 945 (9th Cir. 2017) (ALJ reasonably discounted 19 Plaintiff’s testimony based on daily activities, “particularly 20 given that she already worked part-time”); Hollen v. Comm’r of 21 Soc. Sec., No. 3:15-cv-2357-GPC-DHB, 2017 WL 1075194, at *13 22 (C.D. Cal. Mar. 22, 2017) (“Plaintiff’s certification to the 23 unemployment office that she was ready, willing, and able to 24 work, combined with the finding she worked part-time in 2014, 25 provides further clear and convincing reasons for the ALJ to 26 discount her testimony.”). 27 Plaintiff contends that she had attendance issues with those 28 jobs and was unable to sustain even part-time employment for more 36 1 than brief periods. (J. Stip. at 30-31.) But assuming 2 Plaintiff’s apparent history of attendance issues at those 3 customer-service jobs was probative of her ability to sustain 4 employment in them, the ALJ did not find that she could perform 5 those jobs on a full-time basis. The ALJ limited her to “no more 6 than simple, routine, repetitive tasks; no more than incidental 7 contact with supervisors; no more than occasional and superficial 8 contact with coworkers; and no contact with the public.” (AR 9 18.) Moreover, “[e]ven where [a plaintiff’s] activities suggest 10 some difficulty functioning, they may be grounds for discrediting 11 [her] testimony to the extent that they contradict claims of a 12 totally debilitating impairment,” Molina, 674 F.3d at 1113 13 (citations omitted), or “suggest” that her “claims about the 14 severity of [her] limitations were exaggerated,” Valentine v. 15 Comm’r Soc. Sec. Admin., 574 F.3d 685, 693 (9th Cir. 2009). 16 Plaintiff’s work activity demonstrated that she was functional. 17 She was able to go to work, at least on a part-time basis, and 18 deal to some degree with supervisors and the public. Without the 19 additional stress that contact entailed, she likely would be able 20 to do even more; therefore, the ALJ’s RFC reasonably accommodated 21 this limitation. See Barney, 769 F. App’x at 466. The ALJ 22 properly considered this evidence in assessing Plaintiff’s 23 symptom statements. 24 Substantial evidence supported the ALJ’s discounting of 25 Plaintiff’s subjective symptom statements. Remand is not 26 warranted on this basis. 27 C. The RFC Is Supported by Substantial Evidence 28 Plaintiff claims that the RFC is not supported by 37 1 substantial evidence in that it failed to include a limitation 2 for her attendance issues. (J. Stip. at 37-39, 40-41.) Although 3 she points to her own statements in medical records that she had 4 a poor work-attendance record, she offers no evidence that any 5 doctor assigned any such limitation. To the extent she did have 6 attendance issues, nothing indicates she would still have them in 7 the jobs the ALJ identified, which involved very limited 8 interaction with other people, her main trigger. Moreover, as 9 discussed in sections V.A. and V.B., the ALJ considered the 10 medical evidence and opinions and properly discounted Plaintiff’s 11 subjective symptom statements. Based on the record and 12 Plaintiff’s failure to identify any flaw in the ALJ’s reasoning, 13 he properly omitted any such limitation from the RFC. See 14 Bayliss v. Barnhart, 427 F.3d 1211, 1217 (9th Cir. 2005) (ALJ not 15 required to include in RFC limitations based on plaintiff’s 16 properly discounted subjective complaints); Figueroa v. Colvin, 17 No. CV 12-06742-OP., 2013 WL 1859073, at *9 (C.D. Cal. May 2, 18 2013) (no error in failing to include limitations in RFC when ALJ 19 properly rejected plaintiff’s subjective complaints of 20 impairment). This issue does not warrant remand. 21 VI. CONCLUSION 22 Consistent with the foregoing and under sentence four of 42 23 U.S.C. § 405(g),17 IT IS ORDERED that judgment be entered 24 25 26 17 That sentence provides: “The [district] court shall have power to enter, upon the pleadings and transcript of the record, 27 a judgment affirming, modifying, or reversing the decision of the Commissioner of Social Security, with or without remanding the 28 cause for a rehearing.” 38 1 || AFFIRMING the Commissioner’s decision, DENYING Plaintiff’s request for remand, and DISMISSING this action with prejudice. fe hrehlatlr paTED: March 23, 2021 JEAN ROSENBLUTH 5 U.S. Magistrate Judge 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 39