Kamphaus v. O'Malley

Opinion

FILED IN THE U.S. DISTRICT COURT EASTERN DISTRICT OF WASHINGTON Jan 03, 2024

SEAN F. MCAVOY, CLERK EASTERN DISTRICT OF WASHINGTON

ROBBIN K.,1 No. 2:23-cv-00199-EFS

Plaintiff, ORDER AFFIRMING THE ALJ’S v. DENIAL OF BENEFITS

MARTIN O’MALLEY, Commissioner of Social Security,2 Defendant. Due to social anxiety, agoraphobia, anxiety, difficulty sleeping, nausea, irritability, fatigue, racing thoughts, depression, and trouble losing weight,

1 For privacy reasons, Plaintiff is referred to by first name and last initial or as “Plaintiff.” See LCivR 5.2(c). 2 Martin O’Malley became the Commissioner of Social Security on December 20, 2023. Pursuant to Rule 25(d) of the Federal Rules of Civil Procedure, and section 205(g) of the Social Security Act, 42 U.S.C. § 405(g), he is hereby substituted for Kilolo Kijakazi as the defendant. Plaintiff Robbin K. claims she is unable to work full-time and applied for social- security benefits. She appeals the denial of benefits by the Administrative Law Judge (ALJ) on the grounds that the ALJ improperly analyzed the credibility of

Plaintiff’s subjective complaints, and the ALJ’s evaluation of the medical expert opinions was flawed. Although the record reflects that Plaintiff’s impairments limit her mentally, the Administrative Law Judge’s (ALJ) nondisability finding is adequately explained and supported by substantial evidence. For the reasons that follow, the ALJ’s decision is affirmed. I. Background

In January 2018, Plaintiff filed an application for benefits under Title 2, claiming disability beginning June 1, 2017, based on the mental and physical impairments noted above.3 After the agency denied Plaintiff benefits, ALJ Michael Blanton held a telephone hearing in February 2020, but did not issue a decision before taking administrative leave.4 On June 13, 2022, ALJ Deborah Van Vleck (the ALJ) held a hearing via telephone, at which Plaintiff and a vocational expert testified.5 After

3 AR 267, 305. 4 AR 38-64. 5 AR 65-104. the hearing, the ALJ issued a decision denying benefits.6 The ALJ found Plaintiff’s alleged symptoms were not entirely consistent with the medical evidence and the other evidence.7 As to medical opinions, the ALJ found:

• The opinions of state agency evaluator Michael Regets, PhD, to be persuasive. • The opinions of state agency evaluator John Robinson, PhD, not subject to consideration because he was not an acceptable medical source. • The opinions of consultative examiner Catherine MacLennan, PhD, to

be unpersuasive. As to the sequential disability analysis, the ALJ found: • Plaintiff met the insured status requirements of the Social Security Act through December 31, 2024. • Step one: Plaintiff had not engaged in substantial gainful activity since June 1, 2017, the alleged onset date. • Step two: Plaintiff had the following medically determinable severe

impairments: a mental impairment diagnosed to include depression

6 AR 12-37. Per 20 C.F.R. §§ 404.1520(a)–(g), a five-step evaluation determines whether a claimant is disabled. 7 AR 25-27. and anxiety disorder, bipolar II disorder, and post-traumatic stress disorder. • Also at step two, the ALJ found the following conditions to be non-

severe: obesity and gastrointestinal problems/irritable bowel syndrome. • Step three: Plaintiff did not have an impairment or combination of impairments that met or medically equaled the severity of one of the listed impairments. • RFC: Plaintiff had the RFC to perform a full range of work at all

exertional levels with the following exceptions: [Plaintiff] can perform simple, routine, and repetitive tasks that are not production rate pace (i.e. – assembly line work); [Plaintiff] can use judgment and deal with changes that are consistent with simple, routine, and repetitive tasks that are not production rate paced; with occasional interaction with supervisors and coworkers. [Plaintiff] can never work with the public.

• Step four: Plaintiff was unable to perform her past relevant work as a mail clerk, stockroom clerk, department supervisor, and social worker. • Step five: Plaintiff was able to perform jobs available in the national economy in substantial numbers as a floor cleaner (DOT 381.687-034), a janitor (DOT 381.687-018), and a hand launderer (DOT 361.684- 010).8

8 AR 19-30. Plaintiff timely requested review of the ALJ’s decision by the Appeals Council and now this Court.9 II. Standard of Review

The ALJ’s decision is reversed “only if it is not supported by substantial evidence or is based on legal error,”10 and such error impacted the nondisability determination.11 Substantial evidence is “more than a mere scintilla but less than a preponderance; it is such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.”12

9 AR 264. 10 Hill v. Astrue, 698 F.3d 1153, 1158 (9th Cir. 2012). See 42 U.S.C. § 405(g). 11 Molina v. Astrue, 674 F.3d 1104, 1115 (9th Cir. 2012) ), superseded on other grounds by 20 C.F.R. § 416.920(a) (recognizing that the court may not reverse an ALJ decision due to a harmless error—one that “is inconsequential to the ultimate nondisability determination”). 12 Hill, 698 F.3d at 1159 (quoting Sandgathe v. Chater, 108 F.3d 978, 980 (9th Cir. 1997)). See also Lingenfelter v. Astrue, 504 F.3d 1028, 1035 (9th Cir. 2007) (The court “must consider the entire record as a whole, weighing both the evidence that supports and the evidence that detracts from the Commissioner's conclusion,” not simply the evidence cited by the ALJ or the parties.) (cleaned up); Black v. Apfel, 143 F.3d 383, 386 (8th Cir. 1998) (“An ALJ’s failure to cite specific evidence does not indicate that such evidence was not considered[.]”). III. Analysis Plaintiff seeks relief from the denial of disability on two grounds. She argues the ALJ erred when evaluating Plaintiff’s subjective complaints and erred

when evaluating the medical opinion of Dr. MacLennan. The Commissioner argues there was no error because the ALJ reasonably discounted Plaintiff’s allegations of disabling impairments during the relevant period and reasonably assessed the medical opinions. As is explained below, the Court agrees with the Commissioner and affirms the ALJ’s nondisability finding. A. Symptom Reports: Plaintiff fails to establish consequential error

Plaintiff argues the ALJ failed to properly assess her subjective complaints regarding problems with mental impairments and social interactions. 1. Standard When examining a claimant’s symptoms, the ALJ utilizes a two-step inquiry. “First, the ALJ must determine whether there is objective medical evidence of an underlying impairment which could reasonably be expected to produce the pain or other symptoms alleged.”13 Second, “[i]f the claimant meets the first test and there

is no evidence of malingering, the ALJ can only reject the claimant’s testimony about the severity of the symptoms if [the ALJ] gives ‘specific, clear and convincing

13 Molina, 674 F.3d at 1112. reasons’ for the rejection.”14 General findings are insufficient; rather, the ALJ must identify what symptom claims are being discounted and what evidence undermines these claims.15 “The clear and convincing standard is the most demanding required

in Social Security cases.”16 Therefore, if an ALJ does not articulate specific, clear, and convincing reasons to reject a claimant’s symptoms, the corresponding limitations must be included in the RFC.17

14 Ghanim v. Colvin, 763 F.3d 1154, 1163 (9th Cir. 2014) (quoting Lingenfelter, 504 F.3d at 1036). 15 Id. (quoting Lester v. Chater, 81 F.3d 821, 834 (9th Cir. 1995), and Thomas v. Barnhart, 278 F.3d 947, 958 (9th Cir. 2002) (requiring the ALJ to sufficiently explain why he discounted claimant’s symptom claims)). 16 Garrison v. Colvin, 759 F.3d 995, 1015 (9th Cir. 2014) (quoting Moore v. Comm’r of Soc. Sec. Admin., 278 F.3d 920, 924 (9th Cir. 2002)). 17 Lingenfelter, 504 F.3d at 1035 (“[T]he ALJ failed to provide clear and convincing reasons for finding Lingenfelter’s alleged pain and symptoms not credible, and therefore was required to include these limitations in his assessment of Lingenfelter’s RFC.”). 2. Plaintiff’s Testimony On February 10, 2020, Plaintiff appeared with her attorney by video before ALJ Michael Blanton.18 A vocational expert, Michael Swanson, also testified.19

Plaintiff testified that she was 32 years old and had a bachelor’s degree.20 She said that she had completed all but one year of courses at a community college when she was young and just went for a year.21 She attended Shoreline Community College periodically from 2017 to 2018 and then Central Washington [University] from 2018 to 2019.22 She dropped from full-time to part-time for two quarters because of physical symptoms caused by stress.23 She said her coursework at Central

Washington College was online and she almost did not graduate due to excessive absences.24 Plaintiff said that in 2016, she left her job for a new one because of family obligations and she wanted to work closer to home, but was stressed with the new

18 AR 38-64. 19 Id. 20 AR 44. 21 Id. 22 AR 45. 23 Id. 24 AR 46. job and decided to return to school instead of working.25 She was scared of leaving her house and she worried that something might happen but had no specific fear.26 When she is very anxious, she will not complete tasks and will go and be alone.27 She

said she has bad days and that on those days she is irritable and will isolate herself.28 She said that she worried she was not mentally ready to work when she finished school.29 She said that she called in sick for half of the time.30 Plaintiff said that medication helped with her depression but did not help with her anxiety long-term.31 She went back to work in January 2020, and missed eight to ten days since she started.32

Plaintiff testified that in 2010 and 2011 when working at Walmart she was a cashier and a customer service supervisor.33 Plaintiff said she worked for the Chelan Public Hospital as a material supply purchasing and stocking employee

25 AR 47. 26 AR 48. 27 AR 49. 28 AR 50. 29 AR 51. 30 Id. 31 AR 52. 32 AR 53-54. 33 AR 54. and that she delivered and stocked items and did the job for three years.34 She left the stock clerk job because of anxiety, it was a long commute, and her boss behaved inappropriately and harassed her.35 She reported the harassment, but it was not

stopped.36 She said she also worked in a seasonal position at a resort.37 Plaintiff said she cannot work due to a combination of mostly mental health and gastric issues caused by anxiety.38 She said she was taking four medications for her mental health issues: citalopram, clonazepam, Lamictal, and Wellbutrin.39 She said that for her gastric issues she takes nortriptyline.40 The VE testified that Plaintiff’s past work was as a cashier, a floor manager,

and a stock clerk.41 Plaintiff testified that when she was a stock clerk she had contact with coworkers.42 The ALJ posed a hypothetical of an individual who could not work with the public or in tandem with co-workers and the VE testified that

34 AR 55. 35 AR 55-56. 36 AR 56. 37 Id. 38 AR 56-57. 39 AR 56-57. 40 AR 58. 41 AR 60-61. 42 AR 61. they could not perform past work but could work as a warehouse worker, a laundry worker, a mailroom clerk, or a routing clerk.43 When asked if the identified jobs could be performed if the individual were limited to simple, routine tasks the VE

said they could.44 The VE testified that the tolerance for absences was 1 day per month.45 On June 13, 2022, Plaintiff and her attorney appeared for a hearing before ALJ Deborah Van Vleck.46 Plaintiff testified and a vocational expert, Kent Granat, testified.47 Plaintiff waived her right to a video or in-person hearing and agreed to have her hearing by telephone.48 Plaintiff testified that she was 34 years old, had

been married for nine years, and had two children aged 15 and 9.49 She said she weighed 245 and that her weight had fluctuated between 210 and 280 after she had surgery for endometriosis.50 She said she is right-handed, has a driver’s

43 AR 60-62. 44 AR 62. 45 Id. 46 AR 65-104. 47 Id. 48 AR 70. 49 AR 75. 50 AR 76. license, and has a bachelor’s degree in social work.51 She said she obtained an associate’s degree from Shoreline Community College in 2018, and then transferred to Central Washington University and earned a bachelor’s degree in

2019.52 She also later took classes in medical billing but stopped due to stress.53 Plaintiff said she lived in a home for the last six years and has no physical issues but mentally has difficulty leaving home.54 She said she had that issue for years and that all her recent college classes were online.55 She said she received unemployment benefits until July 2020.56 She said she is covered by her husband’s insurance.57 Plaintiff testified that she was hired by the post office in May 2020,

and worked for a month as a clerk and left because she was offered a job with Okanogan Behavioral Health.58 Plaintiff said that while working at the post office she had difficulty interacting with customers but did not miss any workdays during

51 AR 76-77. 52 AR 77. 53 Id. 54 AR 79. 55 Id. 56 AR 80. 57 AR 81. 58 Id. the time she was working there.59 She said she began working for Okanogan Behavioral Health in December 2019, and last worked there in June 2021.60 She said that in June 2021, she gave two-weeks notice on the advice of her husband.61

She had two jobs when there.62 Plaintiff said that as a mental health case manager from December 2019 to May 2020, she met students, evaluated them, and offered counseling until they saw a therapist.63 She said that from June 2020 to June 2021 she worked as a crisis case manager and hospital liaison.64 As a crisis manager, she was evaluating crisis clients and contacting their families to plan a safe place for them after hospital discharge.65 Plaintiff said that from 2014 to 2017 she worked at

Chelan Public Hospital as a supply material and supply tech and that she both ordered products and delivered them to doctors and nurses, and that she delivered for 80 percent of time and ordered for 20 percent of the time.66 She said she left

59 AR 82. 60 AR 82-83. 61 AR 83. 62 Id. 63 Id. 64 AR 83-84. 65 AR 84. 66 AR 84-85. that job because it was stressful and she wanted to pursue a college degree.67 Plaintiff said that at Walmart she was a customer service supervisor and that she left the job when she sent on maternity leave and did not return.68

When asked if she could return to her jobs as a stockroom clerk or a department supervisor, Plaintiff testified that she could not because just the thought of leaving home would make her sick due to anxiety.69 When asked why she picked a socially demanding job, Plaintiff said she did not consider how demanding it would be.70 She was asked why she did not want to work a job remotely and she responded that when she worked from home during Covid, she

occasionally had to do zoom meetings and thought that most remote jobs would require occasional zoom meetings.71 She said she gets anxious at the thought of having interactions with anyone at all.72 Plaintiff said she had only mental impairments, and no physical ones.73 She said she was treating with a nurse

67 AR 85. 68 AR 86. 69 AR 86-87. 70 AR 87. 71 AR 88. 72 Id. 73 AR 88-89. practitioner and currently taking clonazepam, Abilify, and nortriptyline, none of which gave her side effects.74 She felt that the medication helped most days.75 Plaintiff said she has no limitations in standing, walking, sitting, lifting,

carrying, or using her hands, and can bathe and dress without help.76 She said that four of seven days she does not want to get out of bed.77 Plaintiff said she has not been assigned a counselor because she lives in a rural place and she does not want to get therapy from someone she worked with in the past.78 She said her husband goes everywhere with her and she does not go out alone or attend her children’s events.79 She said she does not do chores and they go undone and that she has no

friends.80 She said her hobbies are reading and baking.81 She flew to California to her grandfather’s funeral for four days the prior January.82 She said she has two

74 Id. 75 AR 90. 76 Id. 77 Id. 78 AR 91. 79 AR 92. 80 AR 93. 81 AR 94. 82 Id. cats and a dog and that she and her husband care for them.83 She went to one or two movies from 2017 to 2020 and none thereafter because they were all on TV.84 She gets up every day and gets her kids ready for school and her estranged

husband picks them up and brings them to school.85 She waits for them to return and sometimes makes meals.86 Plaintiff said that before she was laid off during Covid her mental health was declining.87 She said that before Covid she missed one or two days of work in each two-week pay period.88 If Covid had not happened she would not have been able to keep her job.89 She was taking time off due to anxiety and depression, which

was severe then.90 She said her main symptom is anxiety and that she gets fidgety and becomes panicked.91 When she has people coming over she will get ill with

83 AR 95. 84 Id. 85 AR 96. 86 Id. 87 AR 97. 88 AR 97. 89 Id. 90 AR 98. 91 AR 99. nausea and diarrhea.92 She said that the depression makes her have suicidal ideations.93 The VE testified that Plaintiff’s past work was mail clerk, social service aide,

a stockroom clerk, and a department supervisor.94 The VE testified that the position of Social Worker was sedentary and skilled with an SVP of 7.95 Given a hypothetical of an individual who could perform simple, routine, and repetitive tasks that are not production paced, have occasional interaction with supervisors and co-workers and never work with the public, the VE stated that past work was precluded.96 The VE said the individual could perform work as a

floor cleaner, a janitor, a hand launderer, a copy machine operator, or a copy examiner.97 The VE said the tolerance for absences would be 1 or 2 days a month and the tolerance for being off-task would be 15 percent.98 The VE said there were no unskilled jobs that allowed working from home in substantial numbers.99

92 Id. 93 AR 100. 94 AR 82, 84, 85,86. 95 AR 87. 96 AR 101-102. 97 AR 102. 98 AR 103. 99 AR 104. 3. The Medical Record On October 5, 2020, Plaintiff presented to PA-C Nancy Espelin with concerns regarding anxiety.100 Plaintiff reported that she had been hospitalized at

Foothills Psychiatric in August and had been given gabapentin, clonazepam, and Latuda for bipolar but had stopped the medication because it made her aggressive.101 She said she had been on clonazepam and intermittently taken another drug but her clinic was closing and she would need to find a new provider to replace PA-C Victoria Lopez.102 Plaintiff said she was working from home and was hesitant to go to therapy because people talk but that she was going through a

divorce, had broken her foot and her daughter had moved out so she was having trouble sleeping.103 On mental status examination, she was calm and cooperative with normal speech, no hallucinations, normal attention and concentration, normal intelligence, happy mood and affect, intact insight and thought process and normal thought content.104 PA Espelin referred Plaintiff to ARNP Katherine Kirner for psychiatry.105

100 AR 887. 101 AR 889. 102 Id. 103 Id. 104 Id. 105 AR 892. On November 24, 2020, Plaintiff had a follow-up appointment for medication management with PA-C Roy Huffstetler.106 Plaintiff reported that she had no difficulty filling out medical forms, caring for herself, or paying for basics like food

and housing.107 She said her stress level was low and that she was not in crisis but wanted to reestablish care.108 He noted that she had an appointment with behavioral health in 3 weeks and with a psychiatric nurse practitioner in six weeks.109 On December 4, 2020, Plaintiff presented to PA Huffstetler.110 Plaintiff reported that she had started taking clonazepam and gabapentin a week prior and

that it had reduced her anxiety and helped her sleep but she was still having depressive symptoms.111 On December 15, 2020, Plaintiff returned to PA Huffstetler and asked for a change in medication.112 Her olanzapine was increased

106 AR 895. 107 AR 896. 108 AR 896-897. 109 AR 898. 110 AR 900. 111 AR 902. 112 AR 905-906. from 5mg to 10mg daily.113 On December 17, 2020, Plaintiff advised PA Huffstetler that she was stressed due to an upcoming custody hearing.114 On December 29, 2020, Plaintiff presented to ARNP Katherine Kirner.115

Plaintiff reported that she experienced depression as a teen when her parents divorced and that in August her boss had helped her get admitted for a short inpatient stay at a psychiatric hospital in August when she had an affair and was having racing thoughts.116 Presently, Plaintiff was stressed due to a medical diagnosis of endometriosis, a filing for bankruptcy, and a pending divorce.117 On examination, Plaintiff was pleasant and cooperative, oriented, had normal speech,

had no hallucinations and had normal attention and concentration.118 Plaintiff had a euthymic mood and happy affect, as well as average intelligence, intact judgment, normal thought content and motor activity, and impaired insight.119 At a

113 AR 907. 114 AR 911. 115 AR 912. 116 AR 914. 117 Id. 118 AR 915. 119 Id. December 30, 2020, appointment with PA Huffstetler he noted that on examination Plaintiff was cooperative with normal speech and normal concentration.120 On January 7, 2021, Plaintiff was seen by LMHC Kelcie Eddy.121 On

examination LMHC Eddy noted that Plaintiff was well-groomed and cooperative; had normal speech and no hallucinations; was oriented; had normal attention and concentration; had average intelligence and intact memory; had a euthymic mood and an affect congruent to mood and anxiousness; had intact insight, judgment, and thought processes; and had normal thought content.122 Plaintiff endorsed hopeless and helpless thoughts and of being better off dead in the context of severe

anxiety but had no suicidal plan or intent.123 Plaintiff reported severe depression, difficulty concentrating, excess worry, high irritability, muscle tension, headaches, and restlessness.124 On January 19, 2021, Plaintiff presented to ARNP Kirner.125 Plaintiff reported anxiety and depression in the context of major life stressors and family

120 AR 922. 121 AR 924. 122 AR 926. 123 Id. 124 Id. 125 AR 929. problems.126 She reported that she had days she had anxiety about work but had not missed any days.127 On examination, her appearance behavior and speech were normal; she had no hallucinations, concentration was normal and memory was

intact; mood was euthymic and affect was pleasant and congruent; insight was impaired; and judgment, thought process, thought content, and motor activity were intact.128 At a February 9, 2021 follow-up with ARNP Kirner, Plaintiff reported a worse mood that interfered with household activities, sleep, and work.129 On examination, Plaintiff was well-groomed and appeared fatigued; had pleasant behavior, normal speech, normal perception, and normal attention and

concentration; and had intact memory.130 Plaintiff’s mood was sad, and her affect was congruent; her insight was impaired; and her thought content, thought process, and judgment were intact.131 Plaintiff reported suicidal ideations but denied any intent.132

126 AR 931. 127 Id. 128 Id. 129 AR 945. 130 Id. 131 Id. 132 Id. On May 6, 2021, Plaintiff presented to ARNP Kirner for follow-up for PTSD and bipolar disorder.133 Plaintiff reported anxiety due to a return to work and stated that she was looking for other positions.134 On examination, Plaintiff was in

no acute distress, Plaintiff was pleasant with normal eye contact, speech, attention, concentration, and memory.135 Her affect was congruent to mood, her insight was impaired, judgment was intact, and thought content and thought process were normal.136 On June 8, 2021, Plaintiff presented to ARNP Kirner for follow-up for PTSD and bipolar disorder.137 Plaintiff reported that she was dealing with major life

stressors and relationship issues.138 On examination, Plaintiff was in no acute distress, Plaintiff was pleasant with normal eye contact, speech, attention, concentration, and memory.139 Her affect was congruent to mood, her insight was

133 AR 1356. 134 AR 1359. 135 Id. 136 Id. 137 AR 1350. 138 AR 1353. 139 Id. impaired, judgment was intact, and thought content and thought process were normal.140 On July 6, 2021, Plaintiff presented to ARNP Kirner.141 Plaintiff was

maintaining functioning but was having trouble with sleep and decreased energy.142 On examination, Plaintiff was in no acute distress, Plaintiff was pleasant with normal eye contact, speech, attention, concentration, and memory.143 Her affect was congruent to mood, her insight was impaired, judgment was intact, and thought content and thought process were normal.144 On August 3, 2021, Plaintiff presented to ARNP Kirner.145 She was

functioning well but had low energy.146 On examination, Plaintiff was in no acute distress, Plaintiff was pleasant with normal eye contact, speech, attention, concentration, and memory.147 Her affect was congruent to mood, her insight was

140 Id. 141 AR 1345. 142 AR 1348. 143 Id. 144 Id. 145 AR 1341. 146 AR 1343. 147 AR 1344. impaired, judgment was intact, and thought content and thought process were normal.148 On October 26, 2021, Plaintiff presented to ARNP Kirner for follow-up for

PTSD and bipolar disorder.149 On examination, Plaintiff was in no acute distress, Plaintiff was pleasant with normal eye contact, speech, attention, concentration, and memory.150 Her mood was apathetic, her affect was tearful, her insight was impaired, judgment, was intact, and thought content and thought process were normal.151 On November 17, 2021, Plaintiff presented to ARNP Kirmer.152 Plaintiff

reported she felt more anxious and stressed and was struggling with a decision to return to school.153 On examination, Plaintiff was in no acute distress, Plaintiff was pleasant with normal eye contact, speech, attention, concentration, and memory.154 Her mood was apathetic, her affect was tearful, her insight was impaired,

148 Id. 149 AR 1331. 150 AR 1334. 151 Id. 152 AR 1326. 153 AR 1328. 154 AR 1329. judgment was intact, and thought content and thought process were normal.155 She did not want to return to counseling.156 ARNP Kirner noted that her SSRI had been stopped in August and she thought Plaintiff was becoming depressive.157

On December 2, 2021, Plaintiff presented to ARNP Kirner for follow-up for PTSD, and bipolar disorder.158 On examination, Plaintiff was in no acute distress, Plaintiff was pleasant with normal eye contact, speech, attention, concentration, and memory.159 Her mood was apathetic, her insight was impaired, judgment was intact, and thought content and thought process were normal.160 On December 23, 2021, Plaintiff presented to ARNP Kirner for follow-up for

PTSD and bipolar disorder.161 On examination, Plaintiff was in no acute distress, Plaintiff was pleasant with normal eye contact, speech, attention, concentration,

155 Id. 156 Id. 157 Id. 158 AR 1321. 159 AR 1324. 160 Id. 161 AR 1316. and memory.162 Her mood was apathetic, her insight was impaired, judgment was intact, and thought content and thought process were normal.163 On February 2, 2022, Plaintiff presented to ARNP Kirner for follow-up for

PTSD and bipolar disorder.164 On examination, Plaintiff was in no acute distress, Plaintiff was pleasant with normal eye contact, speech, attention, concentration, and memory.165 She had a happy mood and affect, intact thought content and thought process, and no suicidal ideations.166 On March 17, 2022, Plaintiff presented to ARNP Kirner for follow up for generalized anxiety disorder.167 Plaintiff was worried that she would fail a college

course.168 On examination, Plaintiff was in no acute distress, Plaintiff was pleasant with normal eye contact, speech, attention, concentration, and memory.169 She had a happy mood and affect, intact thought content and thought process, and no

162 AR1319. 163 Id. 164 AR 1301. 165 AR 1304. 166 Id. 167 AR 1295. 168 AR 1298. 169 Id. suicidal ideations.170 Plaintiff was worried about school and not being able to keep an A grade.171 On April 14, 2022, Plaintiff presented to ARNP Katherine Kirner for follow-

up for PTSD and bipolar disorder.172 On mental status examination, Plaintiff was pleasant with normal eye contact, speech, attention, concentration, and memory.173 She had a happy mood and affect, intact thought content and thought process, and no suicidal ideations.174 ARNP Kirner noted that Plaintiff’s symptoms were relatively well-controlled with mild to moderate symptoms despite situational stressors.175 ARNP Kirner noted that Plaintiff was ambivalent about counseling

and declined to engage with Behavioral Health Services.176 4. The ALJ’s Findings The ALJ found Plaintiff’s statements concerning the intensity, persistence, and limiting effects of the symptoms of her medically determinable impairments

170 Id. 171 AR 1304. 172 AR 1290. 173 AR 1293. 174 Id. 175 Id. 176 AR 1294. not entirely consistent with the medical evidence and other evidence in the record.177 With regard to Plaintiff’s issues with her mental health, the ALJ articulated

her reasoning as follows: Regarding the claimant’s mental health impairment, the record indicates the claimant complained of depression, anxiety, panic attacks, social anxiety, high irritability, major life stressors, intermittent suicidal ideations, decreased energy, poor concentration, decreased effectiveness/productivity, and insomnia (Exs. 1F/20, 25, 44; 2F/11, 44, 71; 12F/4, 9, 39). However, despite these allegations, the claimant was generally noted on mental status examination to have a normal mood and affect with some instances of anxiousness (Exs. 1F/22, 27, 35, 55; 2F/11, 35, 63, 78; 3F/4; 11F/5; 12F/4, 9, 74). She also had normal speech, full orientation, adequate fund of knowledge, average intelligence, logical and organized thought processes, unremarkable thought content, grossly intact memory, good attention and concentration, and fair/intact insight and judgment (Exs. 1F/22, 27; 2F/11, 63, 78; 3F/9; 5F/80, 84, 90, 134; 9F/22; 11F/5, 10; 12F/4, 9, 55, 70). The claimant was prescribed medication, with improvement in her symptoms (Exs. 1F/20, 21, 23, 26, 31; 2F/17, 50, 61, 71; 3F/7, 14; 9F/22, 23). The claimant had one self-admitted inpatient psychiatric admission in August 2020 for suicidal thoughts, but she left against medical advice after one week due to feeling things were unstable at home (Exs. 6F/5; 9F/17, 34). She actively denied psychological symptoms on the record, including delusions, visual/auditory hallucinations, and suicidal ideation or homicidal ideations (Exs. 1F/22; 5F/47, 80; 12F/4, 15, 30, 45, 55). In addition, more recent records showed the claimant reported a big improvement in her overall mood and stability and her symptoms were relatively well controlled with medication (Ex. 12F/4, 15).178 The ALJ went on reason further that:

177 AR 25. 178 AR 25. As for the claimant’s statements about the intensity, persistence, and limiting effects of his or her symptoms, they are inconsistent because the claimant reported her symptoms improved and were relatively well controlled with medications (Ex. 11F/4, 15, 34). Throughout the relevant period the claimant was able to attend school online, obtain two degrees, and work a detailed job full-time, all facts that supporting the finding she possesses the capacity to perform simple work. In 2017 the claimant reported she was taking classes full-time and working full- time (Ex. 1F/38, 44). She reported doing well when she was taking college classes (Ex. 1F/20). In 2018, she received her associates degree in General Studies at Shoreline Community College (Testimony). Thereafter, in June 2019 she received a bachelor’s degree in Social Work from Central Washington University (Testimony). The claimant worked socially demanding and detailed oriented task jobs at Okanogan Behavioral Healthcare (Testimony). She also took classes for medical coding and billing for at least six months and reported doing well (Ex. 12F/34, 39, 45; Testimony). She reported searching for jobs, going through interviews, and that she believed she could perform an office position, supporting the conclusion she has possessed to the ability to sustain the mental demands of work despite her mental health symptoms (Ex. 12F/35, 45, particularly if she were to select employment within the residual functional capacity assessed. In addition, the claimant was generally able to perform activities of daily living without significant difficulty.179

4. Analysis The ALJ’s reasoning describes three instances in which she found Plaintiff’s subjective allegations to be at odds with the record: that Plaintiff was able to engage in activities of daily living and work in stressful and demanding jobs during the relevant time period, that Plaintiff’s medical record indicates that she had predominantly benign findings on examination in the relevant time period, and that the medical record indicates that even Plaintiff’s moderate symptoms appear

179 AR 26. to have been successfully treated with medication during the latter part of the relevant period. Throughout her brief, Plaintiff argues that the ALJ’s reasoning fails to take into account that Plaintiff suffered from anxiety when she left home.

a. Plaintiff’s activities The ALJ considered that Plaintiff’s activities and abilities were inconsistent with her symptom reports.180 If a claimant can spend a substantial part of the day engaged in pursuits involving the performance of work-related functions, the ALJ may find these activities inconsistent with the reported disabling symptoms.181 Here, the ALJ highlighted that Plaintiff’s activities included attending school

online, obtaining two degrees, working at a detailed job full-time, and attending job interviews.182 The ALJ highlighted that Plaintiff believed that she could perform an office position, and that this supports the conclusion that she could perform simple work.183 The Court finds no error in the ALJ’s reasoning regarding Plaintiff’s ability to work during the relevant period in several socially demanding jobs. It was the testimony of Plaintiff that she voluntarily left her job in 2016 when she decided to

180 AR 26-27. 181 Molina v. Astrue, 674 F.3d 1104, 1113 (9th Cir. 2012) (superseded in part on other grounds by statute). 182 AR 26. 183 Id. return to school full-time.184 Between 2017 and 2019, Plaintiff attended Shoreline Community College and then transferred to Central Washington University, where she obtained her bachelor’s in social work.185 While Plaintiff asserts that she was

forced to take part-time classes due to stress and almost did not graduate, the record belies that assertion. Plaintiff completed a four-year degree in less than four years and her reports to her medical providers during that time was that she was stressed because she wanted to keep an A average.186 Even if the Court credits Plaintiff’s testimony as true that for one semester she was stressed and needed to take fewer classes, she made up for that by later taking more classes, or made up

for that in some other way because she graduated on schedule, if not ahead of it. Similarly, the record does not support Plaintiff’s assertions that her difficulty with performing the jobs she held as a postal employee, mental health case worker, or crisis case manager is indicative of an inability to engage in the simple, routine, repetitive work provided for by the ALJ’s formulated RFC. Plaintiff described her position as a postal worker as requiring her to have frequent to constant contact with the public and despite her assertions that she had

184 AR 47. 185 AR 45. 186 AR 1304. difficulty with that contact she also testified that he did not miss any time from that job while she performed it and left it because she was offered a better job.187 From June 2020 through June 2021, Plaintiff worked as a mental health

case manager and a crisis case manager, and the ALJ classified the positions as social worker (DOT 195.107-010).188 Pursuant to the Dictionary of Occupational titles, the firth digit in a DOT code is for the amount of and nature of interaction with “people” and ranges from a high of 0 to a low of 8. The higher the number, the more frequent and intensive interaction would be. A fifth digit people code of “0” denotes the highest degree of contact with others and is described as follows:

“Mentoring: Dealing with individuals in terms of their total personality in order to advise, counsel, and/or guide them with regard to problems that may be resolved by legal, scientific, clinical, spiritual, and/or other professional principals.”189 At her January 19, 2021 appointment with ARNP Kirner, Plaintiff stated that she had not missed any time from that job.190 While Plaintiff avers that she was unable to continue in such a highly stressful position and to endure public contact, she was not fired for cause nor was

she advised by any health care provider to cease performing that job. In January

187 AR 81-82. 188 AR 87. 189 190 AR 931. 2021, when she had been performing the job for seven months, she told ARNP Kerner that she had missed no time. She testified that she left the job because she consulted her husband and they decided that she should take classes in medical

billing.191 Given Plaintiff’s ability to work for more than a month as a postal counter worker with constant interaction with the public without taking time off, and her ability to work in a highly stressful position for one year that required frequent contact with individuals in crisis, the ALJ’s reasoning that Plaintiff was capable of performing simple, routine work requiring only occasional contact with co-workers and no contact with the public is supported by the record.

b. Objective mental-health findings The ALJ found that the objective mental status findings in the record are also not consistent with chronic debilitating symptoms.192 Objective medical evidence—signs, laboratory findings, or both—is a relevant factor for the ALJ to consider when assessing a claimant’s symptoms.193 Here, the medical record also supports the ALJ’s reasoning. The treatment notes from Family Health Centers, where Plaintiff was treated from 2020 through 2022, show primarily benign

findings on mental status examinations. While there was a brief period during

191 AR 83. 192 AR 25. 193 20 C.F.R. § 416.902(k); 3 Soc. Sec. Law & Prac. § 36:26, Consideration of objective medical evidence (2019). which Plaintiff presented with suicidal ideation, she did not have intent and her symptoms quickly improved with medication. When she was assessed by PA Huffstetler, Plaintiff did not have difficulty

filling out medical forms and reported that she had no difficulty caring for herself.194 Throughout her treatment, Plaintiff presented with normal speech, no hallucinations, normal intelligence, and normal thought content.195 At several appointments, Plaintiff reported symptoms to her medical providers which were inconsistent with the objective findings. For example, on January 7, 2021, Plaintiff reported to LMHC Kelsie that she was experiencing severe depression and

irritability, but on examination she was cooperative and had a euthymic mood.196 Moreover, Plaintiff’s treating source, ARNP Kirner, opined that even during a period of significant situational stress, Plaintiff’s symptoms were mild to moderate and were well-controlled with medication.197 c. Improvement with treatment The ALJ also reasoned that Plaintiff more recently reported a “big improvement” in her overall mood and stability and that her symptoms were

194 AR 896. 195 AR 889, 915, 922, 926, 931, 945, 1304, 1329, 1353, 1345, 1348, 1334, 1344, 1359. 196 AR 923. 197 AR 1293. relatively well-controlled with medication.198 A claimant's improvement with treatment is “an important indicator of the intensity and persistence of . . . symptoms.”199 Symptom improvement, however, must be weighed within the

context of an “overall diagnostic picture,” particularly for mental-disorder symptoms which often wax and wane.200 If treatment relieves symptoms to an extent that allows the claimant to return to a level of function she had before she developed mental-disorder symptoms, such treatment can undermine a claim of disability.201 Plaintiff argues that an exhibit cited by the ALJ was incorrect and it appears that the ALJ cited a wrong exhibit number. But that error is harmless

because the medical records as a whole support the ALJ’s finding. Here, Plaintiff’s symptoms were relieved to the extent that her treating source, ARNP Kirner,

198 AR 25. 199 20 C.F.R. § 404.1529(c)(3). See Warre v. Comm'r of Soc. Sec. Admin., 439 F.3d 1001, 1006 (9th Cir. 2006) (“Impairments that can be controlled effectively with medication are not disabling for the purpose of determining eligibility for SSI benefits.”). 200 Holohan v. Massanari, 246 F.3d1195, 1205 (9th Cir. 2001); see also Lester v. Chater, 81 F.3d 821, 833 (9th Cir. 1995) (“Occasional symptom-free periods ... are not inconsistent with disability.”). 201 See 20 C.F.R. § 404.1520a(c)(1). opined that her condition was well-controlled on medication with only mild to moderate symptoms even in periods when significant stressors were present.202 Overall, the ALJ’s reasoning that Plaintiff’s symptoms improved with

medication is supported by the medical record as discussed above. Notably, the only inpatient hospitalization mentioned in the record is one in which Plaintiff voluntarily asked for admission and then left early, which would indicate that psychiatric staff felt no reason to admit her involuntarily. While the medical record might be interpreted in a different manner, it is not the duty of the Court to reweigh the evidence, but instead to determine

whether substantial evidence supports the ALJ’s decision. The Court concludes that the ALJ adequately explained her reasoning. The Court declines to remand as to this issue. B. Medical Opinions: Plaintiff fails to establish consequential error. Plaintiff argues the ALJ erred by finding that the opinion of the consultative examiner, Dr. MacLennan, was not persuasive because it was too restrictive. Plaintiff argues that the ALJ failed to consider the effect that anxiety in the

workplace would cause, erred by finding Dr. MacLennan’s opinions inconsistent with Plaintiff’s ability to work, erred in considering that Dr. MacLennan was not a treating source and did not have a longitudinal relationship, and erred in considering that Dr. MacLennan’s opinion was inconsistent with reports of

202 AR 1293. improvement in Plaintiff’s symptoms with medication. The Commissioner responds that the ALJ properly assessed Dr. MacLennan’s opinion. First, the Commissioner asserts that by failing to raise an argument as to the supportability

factor, Plaintiff has waived it. He then argues that Dr. MacLennan’s examination findings were inconsistent with her opinions, that the ALJ’s reasoning was sound that Plaintiff performed socially demanding jobs during the relevant period, and that the record showed benign findings and improvement with treatment. The Commissioner also argues that the ALJ’s consideration that Dr. MacLennan was not a treating source was only a part of her reasoning.

The Court addresses each of these arguments. As is explained below, the ALJ reasonably found that Dr. MacLennan’s opinions were not sufficiently explained or supported by the record. 1. Standard An ALJ must consider and articulate how persuasive she found each medical opinion, including whether the medical opinion was consistent with and supported by the record.203 The factors for evaluating the persuasiveness of medical opinions

include, but are not limited to, supportability, consistency, relationship with the claimant, and specialization.204 Supportability and consistency are the most

203 20 C.F.R. § 440.1520c(a)–(c); Woods v. Kijakazi, 32 F.4th 785, 792 (9th Cir. 2022). 204 20 C.F.R. § 404.1520c(c)(1)–(5). important factors.205 When considering the ALJ’s findings, the Court is constrained to the reasons and supporting explanation offered by the ALJ.206 2. Dr. MacLennan’s opinion

Dr. MacLennan examined Plaintiff at Plaintiff’s request on March 8, 2021.207 Dr. MacLennan noted that she had reviewed the following medical records: a referral from Family Health Center, noting a diagnosis of Bipolar Disorder; treatment records from April 1, 2020, to February 8, 2021; and progress notes from Frontier Behavioral Health from August 11, 2020, through August 15, 2020.208 On examination, Plaintiff was well-groomed and cooperative.209 Plaintiff reported that

her mood was “alright” and that she had a lot on her plate and was anxious, and her affect was congruent.210 She had no delusions or hallucinations, had normal speech, no suicidal or homicidal ideation, normal thought process, and normal recent and remote memory.211 Dr. MacLennan opined that Plaintiff had average intelligence and that she repeated five digits forward twice and three digits

205 Id. § 404.1520c(b)(2). 206 See Burrell v. Colvin, 775 F.3d 1133, 1138 (9th Cir. 2014). 207 AR 765-779. 208 AR 765. 209 AR 768. 210 AR 768-769. 211 AR 769. backwards and that “otherwise, her mental status examination was entirely normal.”212 Plaintiff reported the following major stressors in the past year: changes in her job due to the Covid pandemic, a bankruptcy filing, filing for

divorce, major surgery in July 2020, fracturing her foot in August 2020, checking into a psychiatric hospital in August 2020 but leaving early due to lack of childcare, her child’s father filing an unsuccessful challenge for custody of her child and an online boyfriend who wanted to marry.213 Dr. MacLennan noted that her finding and Plaintiff’s endorsement of restless sleep, memory problems, forgetfulness, poor concentration, irritability, fear

of losing control, excessive hand washing, and unusual eating habits, supported her diagnosis.214 Plaintiff also endorsed sleep difficulty, fatigue, decreased libido, being withdrawn, suicidal thoughts, hopelessness, nightmares, panic, anxiety, confusion, and having gained 10 pounds.215 Dr. MacLennan diagnosed bipolar disorder, complex PTSD, mood disorder, and rule out learning disorder mathematics.216 Dr. MacLennan opined that Plaintiff performed well in part

212 Id. 213 AR 770. 214 AR 771-772. 215 Id. 216 AR 772. because she had not been under stress from working for several months.217 Plaintiff’s mental status examination score was 30 of 30.218 Dr. MacLennan assessed Plaintiff with marked limitations in her ability to

carry out detailed instructions; maintain concentration persistence and pace, maintain a schedule; sustain an ordinary routine; interact appropriately with others; accept instructions; respond appropriately to changes; and set realistic goals.219 She also assessed severe limitations in Plaintiff’s ability to work in coordination with or proximity to others and to maintain attendance.220 Overall, Dr. MacLennan assessed an extreme limitation in Plaintiff’s social

functioning and a marked limitation in concentration, persistence, and pace.221 She also opined that Plaintiff would be off-task over 30% of the time and would miss 3 days of work per month.222

217 Id. 218 AR 775. 219 AR 777-778. 220 Id. 221 AR 779. 222 Id. 3. The ALJ’s findings When evaluating Dr. MacLennan’s opinion, the ALJ gave several reasons for concluding that it was not persuasive.223 First, the ALJ found that Plaintiff’s

examination was inconsistent with the opinion, stating: Dr. MacLennan’s examination showed the claimant arrived on time for her Zoom appointment and there were no concerns about her appearance. There was no psychomotor hyperactivity, retardation, or agitation. She was noted to be open, cooperative, and likable. She reported her mood was alright and her affect was congruent but her mood for the last week had been anxious. There were no indications of perceptual disturbances or speech problems. Her thinking was linear, clear, and goal oriented. She was able to respond to questions, and there were no concerns as to recent or remote memory. She had low range immediate memory, but she was able to perform basic mathematics. Despite her report of test accommodations for her anxiety, her intelligence was found to be average.224 The ALJ considered further that Dr. MacLennan did not have a longitudinal relationship with Plaintiff, stating: Further, Dr. MacLennan is not the claimant’s treating psychologist, did not have a longitudinal treating relationship with the claimant, and only examined the claimant for the evaluation at the direction of her representative, suggesting her opinion regarding the claimant’s mental limitations are largely based on the claimant’s subjective complaints.225

223 AR 27-28. 224 AR 28. 225 Id. The ALJ then went on to consider that Dr. MacLennan had not had an opportunity to review the complete medical record and was not aware that subsequent records indicated improvement with medication and treatment.226

4. Relevant medical records In its prior finding, the Court cited the medical records of ARNP Kirner and Family Health Centers. Those records are incorporated herein, by reference. 5. Analysis First, the Court concludes that the Commissioner is correct in his assertions that because Plaintiff did not argue that the ALJ’s analysis regarding

supportability was flawed, she has waived the argument. Thus, the Court will accept and credit that the ALJ did not err when reasoning that Dr. MacLennan’s findings on mental status examination were inconsistent with her opined limitations and Dr. MacLennan’s opinions fail regarding the supportability factor. Additionally, the Court finds that Plaintiff took the ALJ’s language with regard to the fact Dr. MacLennan was not a treating source out of context. It would appear from the ALJ’s language that the ALJ considered that

Dr. MacLennan examined Plaintiff at the request of her attorney and found the opinion to be less than impartial.227 The Court finds that the ALJ did not act improperly in considering the partiality of Dr. MacLennan’s opinion. Moreover,

226 Id. 227 AR 28. this was only one of several reasons that the ALJ found Dr. MacLennan’s opinion not persuasive.228 Then turning to the consistency factor, the Court concludes that the ALJ

correctly found that Dr. MacLennan’s opinions were at odds with the record as a whole. The ALJ appropriately considered Dr. MacLennan’s and Dr. Reget’s opinions by themselves and against each other and to the remaining record, including the treatment notes and mental-status screenings with primary care treating and counseling providers.229 For example, as discussed above, PA Huffstedler’s, ARNP Kirner’s, and LMHC Eddy’s notes indicate that they

typically observed normal mood and affect.230 Moreover, as a one-time examiner, Dr. MacLennan appears to have relied heavily on Plaintiff’s subjective complaints, which the ALJ found not entirely credible. This is a record with evidence that is susceptible to more than one rational interpretation,231 and the ALJ’s finding that Dr. Reget’s opinion is supported by and consistent with the record more than

228 Id. 229 20 C.F.R. § 404.1520c(c)(1) (comparing the medical opinion in question to “evidence from other medical sources and nonmedical sources). 230 AR 889, 915, 922, 926, 931, 945, 1304, 1329, 1353, 1345, 1348, 1334, 1344, 1359 231 Magallanes v. Bowen, 881 F.2d 747, 750 (9th Cir. 1989) (“We must uphold the ALJ’s decision where the evidence is susceptible to more than one rational interpretation.”). Dr. MacLennan’s opinion is a rational interpretation of the record. The ALJ’s findings in this regard are upheld. 6. Summary It is the ALJ’s responsibility to review and evaluate the conflicting evidence medical opinions.2°2 The ALJ meaningfully explained why she evaluated the mental-health-related medical opinions as she did, and these reasons are supported by substantial evidence. IV. Conclusion Accordingly, IT IS HEREBY ORDERED: 1. The ALJ’s nondisability decision is AFFIRMED. 2. The Clerk’s Office shall TERM the parties’ briefs, ECF Nos. 8 and 13, enter JUDGMENT in favor of the Commissioner, and CLOSE the case. IT IS SO ORDERED. The Clerk’s Office is directed to file this order and provide copies to all counsel. DATED this 3rd day of January, 2024. " awd Shaw. Senior United States District Judge 232 Tackett v. Apfel, 180 F.3d 1094, 1102 (9th Cir. 1999).

DISPOSITIVE ORDER - 45