1 2 3 4 5 6 7 8 UNITED STATES DISTRICT COURT 9 SOUTHERN DISTRICT OF CALIFORNIA 10 11 SHANAZ K., Case No.: 22-cv-1610-DDL Plaintiff, 12 ORDER AFFIRMING DECISION v. 13 OF THE COMMISSIONER OF MARTIN O’MALLEY, SOCIAL SECURITY and 14 Commissioner of Social Security, ENTERING JUDGMENT IN 15 DEFENDANT’S FAVOR Defendant.
17 Plaintiff Shanaz K. seeks judicial review of the Social Security 18 Commissioner’s denial of her application for disability benefits. See Dkt. No. 1. 19 The parties have consented to the undersigned’s jurisdiction. Dkt. No. 5. Plaintiff 20 moves the Court to remand her application to the Social Security Administration 21 for an award of benefits or, alternatively, for further proceedings. See generally 22 Dkt. No. 13. For the reasons stated below, the Court finds the Commissioner’s 23 decision is free of legal error and supported by substantial evidence and 24 accordingly the motion to reverse and remand is DENIED. The Commissioner’s 25 decision is AFFIRMED. 26 / / / 27 / / / 28 / / / 1 I. 2 BACKGROUND 3 A. Plaintiff’s Application for Disability Benefits 4 Plaintiff is a former pediatrician who suffers from various eye diseases and 5 conditions, including glaucoma,1 staphyloma,2 and myopia. On December 5, 6 2016, Plaintiff filed an application for disability insurance benefits under Title II of 7 the Social Security Act (the “Act”), alleging that these conditions rendered her 8 unable to work as of December 1, 2014. See AR at 187.3 After the Commissioner 9 denied her application on May 23, 2019, Plaintiff appealed on August 31, 2020. 10 Id. at 511-20. However, Plaintiff and the Commissioner jointly moved to remand 11 the matter, which was granted. Id. at 433-48. Further proceedings were 12 conducted, including a hearing before ALJ Deborah J. Van Vleck, at which Plaintiff 13 appeared with counsel and gave testimony. Id. at 464-507. In an opinion dated 14 July 6, 2022, the ALJ concluded Plaintiff was not disabled within the meaning of 15 the Act “at any time from . . . the alleged onset date through . . . the last date 16 insured.” Id. at 441-56. The ALJ’s decision became the final decision of the 17 Commissioner by operation of 42 U.S.C. § 405(h). 18 / / / 19
20 1 Glaucoma develops when the optic nerve is damaged and can cause blind 21 spots. The damage to the optic nerve is usually the result of increased pressure 22 in the eye. See Mayo Clinic, “Glaucoma,” https://www.mayoclinic.org/diseases- conditions/glaucoma/symptoms-causes/syc-20372839 (last accessed March 4, 23 2024). 24 2 “A staphyloma is an abnormal protrusion of the uveal tissue through a weak 25 point in the eyeball. In the posterior segment of the eye,” a staphyloma “result[s] in progressive myopia (nearsightedness).” Certified Administrative Record (“AR”) 26 [Dkt. No. 9] at 74. 27 3 The Court uses the parties’ pagination of the AR. All other docket citations 28 are to the page numbers generated by the Court’s CM/ECF system. 1 B. Summary of the ALJ’s Findings 2 A person is considered “disabled” within the meaning of the Act if they suffer 3 from a medically determinable physical or mental impairment which is expected to 4 last at least a year and is of such severity that they cannot work, considering their 5 age, education, and work experience. See 42 U.S.C. § 423(d). The Administration 6 employs a sequential five-step evaluation to make this determination.4 7 The ALJ followed this five-step process in adjudicating Plaintiff’s disability 8 claim. See generally AR at 441-456. At step one, the ALJ found Plaintiff did not 9 engage in substantial gainful activity from the alleged date of the onset of Plaintiff’s 10 disability through her last date insured.5 Id. at 444. At step two, the ALJ found 11 Plaintiff suffered from “a visual impairment diagnosed to include chronic open 12 angle glaucoma, vitreous degeneration and detachment, posterior staphyloma, 13 and degenerative malignant myopia,” which significantly limited Plaintiff’s ability to 14 perform basic work activities. AR at 445. At step three, the ALJ found Plaintiff did 15
16 4 See 20 C.F.R. § 404.1520. First, the ALJ must determine whether the 17 claimant is engaged in substantial gainful activity. Second, the ALJ must determine 18 whether the claimant suffers from a severe impairment within the meaning of the regulations. Third, if the claimant suffers from a severe impairment, the ALJ must 19 determine whether the impairment meets or is medically equal to one of the 20 impairments identified in the Listing of Impairments. Fourth, if the impairment does not meet or equal a listing, the ALJ must determine the claimant’s residual 21 functional capacity (“RFC”) based on all impairments (including those that are not 22 severe) and whether, given the RFC, the claimant can perform his or her past relevant work. At the fifth and final step, the ALJ must determine whether the 23 claimant can make an adjustment to other work based on his or her RFC. 24 5 Plaintiff last met the insured status requirements of the Act on December 31, 25 2016 (the “last date insured”). See AR at 442. Therefore, to be eligible for benefits, Plaintiff must have been disabled on or before that date. See id.; accord 42 U.S.C. 26 § 416(i)(2) and (3) (defining “period of disability” and eligibility requirements). The 27 ALJ referred to the period between the alleged onset date (December 1, 2014) and the last date insured (December 31, 2016) as the “period at issue,” and the Court 28 1 not have an impairment or combination of impairments that met or medically 2 equaled one of the impairments listed in the Listing of Impairments through the 3 date last insured. Id. 4 Before proceeding to step four, the ALJ determined that through the date last 5 insured, Plaintiff could: 6 perform light work as defined in 20 CFR [§] 404.1567(b)6 except that while [she] could frequently climb ramps or stairs, . . . she could never 7 climb ladders, ropes or scaffolds. The claimant could frequently 8 balance, and could occasionally stoop, kneel and crouch, but she could never crawl. [Plaintiff] could no more than occasionally read ordinary 9 newspaper or book print, but could avoid ordinary hazards in the 10 workplace. [Plaintiff] could never work in the presence of unprotected heights or hazardous machinery, and could not be required to operate 11 a motor vehicle as part of her job duties. 12 13 See AR at 445-46. 14 In formulating this RFC, the ALJ considered Plaintiff’s subjective testimony 15 regarding her limitations. Id. at 446-48. The ALJ noted Plaintiff’s statement she 16 was unable to work “due to poor vision related to a visual impairment she described 17 as glaucoma, staphyloma, malignant myopia and problems with her retinas,” and 18 Plaintiff’s hearing testimony she could not run or jump, could lift only 5 or 10 19 pounds, suffered from blurred vision and sensitivity to bright light, and must avoid 20 “fast head movements.” Id. at 446-49. Evaluating these allegations in conjunction 21 with the objective medical evidence of record, the ALJ concluded that although the 22 23 24 6 “Light work” is defined as work that “involves lifting no more than 20 pounds 25 at a time with frequent lifting or carrying of objects weighing up to 10 pounds,” and may require “a good deal of walking or standing, or . . . sitting most of the time with 26 some pushing and pulling of arm or leg controls.” 20 C.F.R. § 404.1567(b).
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1 2 3 4 5 6 7 8 UNITED STATES DISTRICT COURT 9 SOUTHERN DISTRICT OF CALIFORNIA 10 11 SHANAZ K., Case No.: 22-cv-1610-DDL Plaintiff, 12 ORDER AFFIRMING DECISION v. 13 OF THE COMMISSIONER OF MARTIN O’MALLEY, SOCIAL SECURITY and 14 Commissioner of Social Security, ENTERING JUDGMENT IN 15 DEFENDANT’S FAVOR Defendant.
17 Plaintiff Shanaz K. seeks judicial review of the Social Security 18 Commissioner’s denial of her application for disability benefits. See Dkt. No. 1. 19 The parties have consented to the undersigned’s jurisdiction. Dkt. No. 5. Plaintiff 20 moves the Court to remand her application to the Social Security Administration 21 for an award of benefits or, alternatively, for further proceedings. See generally 22 Dkt. No. 13. For the reasons stated below, the Court finds the Commissioner’s 23 decision is free of legal error and supported by substantial evidence and 24 accordingly the motion to reverse and remand is DENIED. The Commissioner’s 25 decision is AFFIRMED. 26 / / / 27 / / / 28 / / / 1 I. 2 BACKGROUND 3 A. Plaintiff’s Application for Disability Benefits 4 Plaintiff is a former pediatrician who suffers from various eye diseases and 5 conditions, including glaucoma,1 staphyloma,2 and myopia. On December 5, 6 2016, Plaintiff filed an application for disability insurance benefits under Title II of 7 the Social Security Act (the “Act”), alleging that these conditions rendered her 8 unable to work as of December 1, 2014. See AR at 187.3 After the Commissioner 9 denied her application on May 23, 2019, Plaintiff appealed on August 31, 2020. 10 Id. at 511-20. However, Plaintiff and the Commissioner jointly moved to remand 11 the matter, which was granted. Id. at 433-48. Further proceedings were 12 conducted, including a hearing before ALJ Deborah J. Van Vleck, at which Plaintiff 13 appeared with counsel and gave testimony. Id. at 464-507. In an opinion dated 14 July 6, 2022, the ALJ concluded Plaintiff was not disabled within the meaning of 15 the Act “at any time from . . . the alleged onset date through . . . the last date 16 insured.” Id. at 441-56. The ALJ’s decision became the final decision of the 17 Commissioner by operation of 42 U.S.C. § 405(h). 18 / / / 19
20 1 Glaucoma develops when the optic nerve is damaged and can cause blind 21 spots. The damage to the optic nerve is usually the result of increased pressure 22 in the eye. See Mayo Clinic, “Glaucoma,” https://www.mayoclinic.org/diseases- conditions/glaucoma/symptoms-causes/syc-20372839 (last accessed March 4, 23 2024). 24 2 “A staphyloma is an abnormal protrusion of the uveal tissue through a weak 25 point in the eyeball. In the posterior segment of the eye,” a staphyloma “result[s] in progressive myopia (nearsightedness).” Certified Administrative Record (“AR”) 26 [Dkt. No. 9] at 74. 27 3 The Court uses the parties’ pagination of the AR. All other docket citations 28 are to the page numbers generated by the Court’s CM/ECF system. 1 B. Summary of the ALJ’s Findings 2 A person is considered “disabled” within the meaning of the Act if they suffer 3 from a medically determinable physical or mental impairment which is expected to 4 last at least a year and is of such severity that they cannot work, considering their 5 age, education, and work experience. See 42 U.S.C. § 423(d). The Administration 6 employs a sequential five-step evaluation to make this determination.4 7 The ALJ followed this five-step process in adjudicating Plaintiff’s disability 8 claim. See generally AR at 441-456. At step one, the ALJ found Plaintiff did not 9 engage in substantial gainful activity from the alleged date of the onset of Plaintiff’s 10 disability through her last date insured.5 Id. at 444. At step two, the ALJ found 11 Plaintiff suffered from “a visual impairment diagnosed to include chronic open 12 angle glaucoma, vitreous degeneration and detachment, posterior staphyloma, 13 and degenerative malignant myopia,” which significantly limited Plaintiff’s ability to 14 perform basic work activities. AR at 445. At step three, the ALJ found Plaintiff did 15
16 4 See 20 C.F.R. § 404.1520. First, the ALJ must determine whether the 17 claimant is engaged in substantial gainful activity. Second, the ALJ must determine 18 whether the claimant suffers from a severe impairment within the meaning of the regulations. Third, if the claimant suffers from a severe impairment, the ALJ must 19 determine whether the impairment meets or is medically equal to one of the 20 impairments identified in the Listing of Impairments. Fourth, if the impairment does not meet or equal a listing, the ALJ must determine the claimant’s residual 21 functional capacity (“RFC”) based on all impairments (including those that are not 22 severe) and whether, given the RFC, the claimant can perform his or her past relevant work. At the fifth and final step, the ALJ must determine whether the 23 claimant can make an adjustment to other work based on his or her RFC. 24 5 Plaintiff last met the insured status requirements of the Act on December 31, 25 2016 (the “last date insured”). See AR at 442. Therefore, to be eligible for benefits, Plaintiff must have been disabled on or before that date. See id.; accord 42 U.S.C. 26 § 416(i)(2) and (3) (defining “period of disability” and eligibility requirements). The 27 ALJ referred to the period between the alleged onset date (December 1, 2014) and the last date insured (December 31, 2016) as the “period at issue,” and the Court 28 1 not have an impairment or combination of impairments that met or medically 2 equaled one of the impairments listed in the Listing of Impairments through the 3 date last insured. Id. 4 Before proceeding to step four, the ALJ determined that through the date last 5 insured, Plaintiff could: 6 perform light work as defined in 20 CFR [§] 404.1567(b)6 except that while [she] could frequently climb ramps or stairs, . . . she could never 7 climb ladders, ropes or scaffolds. The claimant could frequently 8 balance, and could occasionally stoop, kneel and crouch, but she could never crawl. [Plaintiff] could no more than occasionally read ordinary 9 newspaper or book print, but could avoid ordinary hazards in the 10 workplace. [Plaintiff] could never work in the presence of unprotected heights or hazardous machinery, and could not be required to operate 11 a motor vehicle as part of her job duties. 12 13 See AR at 445-46. 14 In formulating this RFC, the ALJ considered Plaintiff’s subjective testimony 15 regarding her limitations. Id. at 446-48. The ALJ noted Plaintiff’s statement she 16 was unable to work “due to poor vision related to a visual impairment she described 17 as glaucoma, staphyloma, malignant myopia and problems with her retinas,” and 18 Plaintiff’s hearing testimony she could not run or jump, could lift only 5 or 10 19 pounds, suffered from blurred vision and sensitivity to bright light, and must avoid 20 “fast head movements.” Id. at 446-49. Evaluating these allegations in conjunction 21 with the objective medical evidence of record, the ALJ concluded that although the 22 23 24 6 “Light work” is defined as work that “involves lifting no more than 20 pounds 25 at a time with frequent lifting or carrying of objects weighing up to 10 pounds,” and may require “a good deal of walking or standing, or . . . sitting most of the time with 26 some pushing and pulling of arm or leg controls.” 20 C.F.R. § 404.1567(b). A 27 person who is capable of light work is also considered capable of sedentary work, “unless there are additional limiting factors such as loss of fine dexterity or inability 28 1 totality of the evidence supported the existence of an impairment that limited 2 Plaintiff’s work activities, but that Plaintiff’s limitations were not as great as she 3 subjectively alleged and she “retained the ability to perform work at the light 4 exertional level through the last date insured.” Id. at 449; see also id. at 446-47 5 (noting Plaintiff’s “allegations represent a high degree of limitation that would 6 substantially interfere with the performance of work-related tasks” that was “not . . 7 . supported by the evidence of record during the period at issue”). 8 The ALJ also considered the opinion evidence and prior administrative 9 medical findings in the record. AR at 449. The ALJ afforded “partial weight” to the 10 findings of state agency medical consultants R. Masters, M.D. and S. Lee, M.D. 11 Id. The ALJ observed Dr. Masters’ findings did not account for additional medical 12 evidence submitted on reconsideration and thus concluded they were 13 “insufficiently restrictive.” Id. at 450. While Dr. Lee considered the additional 14 evidence, his “total lack of any proposed exertional or postural limitations” was also 15 “insufficiently restrictive” in light of the medical evidence in the record. Id. The ALJ 16 incorporated certain of Dr. Lee’s recommendations, such as limitations against 17 exposure to hazards and driving, but “decline[d] to adopt Dr. Lee’s findings in their 18 entirety.” Id. 19 The ALJ afforded “little weight” to the opinions of Sam Nikou, M.D., Plaintiff’s 20 treating ophthalmologist. AR at 450. After describing Dr. Nikou’s various medical 21 source statements and the proposed work restrictions proposed therein, the ALJ 22 observed a “significant degree of variation” in those limitations that did “not 23 correspond[] to any commensurate changes in the claimant’s underlying 24 condition.” Id. at 452. The ALJ likewise found Dr. Nikou’s exertional, postural and 25 visual limitations inconsistent with the objective medical evidence, noting, for 26 example, that “there [was] no evidentiary basis for a total restriction against reading 27 regular print.” Id. at 452-53. The ALJ further found some of Dr. Nikou’s proposed 28 limitations, such as allowing for frequent breaks during the workday, did not bear 1 any “rational connection” to the identified elevated risk of retinal detachment. Id. at 2 452. The ALJ also explained that Dr. Nikou’s recommendations for “prophylactic 3 measure[s] against future disease progression” were “of limited probative value” 4 given the remoteness of Plaintiff’s alleged onset date and last date insured. Id. 5 The inconsistencies with the objective evidence and the lack of any apparent 6 relationship between the recommended limitations and Plaintiff’s conditions 7 “undermined [Dr. Nikou’s] opinions” and the ALJ accordingly “declined to adopt 8 any of his varied opinions as to [Plaintiff’s] functional capacity.” Id. at 453. 9 Finally, the ALJ considered a Third Party Function Report completed by 10 Plaintiff’s mother. Id. The ALJ noted Plaintiff’s mother was not a medical source, 11 and that she completed her report more than two years after the last date insured, 12 “calling into question the degree to which her statements are applicable 13 . . . to the period at issue.” Id. The ALJ also found the mother’s report found “little 14 support” in the objective medical record, and therefore carried “little weight.” Id. 15 Having considered the totality of the evidence, the ALJ concluded: 16 the evidence of record clearly documents the presence of eye 17 conditions throughout the period at issue here, giving rise to a reduction in the claimant’s visual acuity, but [Plaintiff] appears to have 18 retained at least fair vision through her date last insured, with little 19 evidence of material disease progression until several years after the expiration of her period of insured status. 20 21 AR at 448. Accordingly, the ALJ determined during the period of her alleged 22 disability, Plaintiff “retained the capacity to perform light work,” subject to 23 “additional postural, environmental, and visual limitations” as described above. Id. 24 at 453. Based on this RFC, the ALJ found at step four Plaintiff could not perform 25 her past relevant work as a pediatrician. Id. at 453-54. 26 At step five, the ALJ found “there were jobs that existed in significant 27 numbers in the national economy that [Plaintiff] could have performed,” based on 28 / / / 1 the vocational expert’s testimony regarding jobs which could be performed by 2 someone with Plaintiff’s RFC. AR at 454, 456. 3 Based on the foregoing five-step analysis, the ALJ concluded Plaintiff had 4 not been under a disability within the meaning of the Act between the alleged onset 5 of her disability and her last date insured. Id. at 456. 6 II. 7 DISPUTED ISSUES 8 Plaintiff’s single claim of error is that the ALJ failed to articulate specific and 9 legitimate reasons, supported by substantial evidence, for rejecting Dr. Nikou’s 10 treating medical opinion. See Dkt. No. 13 at 4. In opposition, the Commissioner’s 11 argues “[t]he ALJ reasonably gave less weight to Dr. Nikou’s opinions based on 12 [the] myriad of inconsistencies” in them. Dkt. No. 15 at 4. 13 III. 14 STANDARD OF REVIEW 15 The Court’s review of the Commissioner’s final decision is “highly 16 deferential.” Kitchen v. Kijakazi, 82 F. 4th 732, 738 (9th Cir. 2023).7 The Court 17 “will disturb the denial of benefits only if the decision contains legal error or is not 18 supported by substantial evidence.” Id. “Substantial evidence is such relevant 19 evidence that a reasonable mind might accept as adequate to support a 20 conclusion, and must be more than a mere scintilla, but may be less than a 21 preponderance.” Id. This Court must review the entire record and consider 22 adverse as well as supporting evidence. See Ahearn v. Saul, 988 F.3d 1111, 1115 23 (9th Cir. 2021). The Court “may not reweigh the evidence or substitute [its] 24 judgment for that of the ALJ.” Id. Moreover, “[t]he ALJ is responsible for 25 determining credibility, resolving conflicts in medical testimony, and for resolving 26 27 7 All citations, internal quotation marks, and subsequent history are omitted 28 1 ambiguities.” Id. If the evidence is susceptible of more than one rational 2 interpretation, the ALJ’s decision must be upheld. See id. at 1115-16. However, 3 the Court cannot affirm “on a ground upon which [the ALJ] did not rely.” Garrison 4 v. Colvin, 759 F.3d 995, 1010 (9th Cir. 2014). Where the ALJ commits legal error, 5 the Court may affirm the decision if the error is harmless, meaning “it is 6 inconsequential to the ultimate nondisability determination, or that, despite the 7 legal error, the agency’s path may reasonably be discerned, even if the agency 8 explains its decision with less than ideal clarity.” Brown-Hunter v. Colvin, 806 F.3d 9 487, 492 (9th Cir. 2015). 10 IV. 11 DISCUSSION 12 A. The ALJ Did Not Err in Weighing Dr. Nikou’s Opinion 13 An ALJ must consider all evidence, including medical opinions, in 14 determining whether the claimant is disabled. See 20 C.F.R. § 416.920(a)(3). As 15 Plaintiff correctly points out, because her application for benefits was filed before 16 March 27, 2017, the operative regulatory framework required special consideration 17 of Dr. Nikou’s opinion as her treating physician. Dkt. No. 13 at 7; see also Dkt. No. 18 15 at 2. Pursuant to the then-operative regulations, “[a] treating or examining 19 physician’s medical opinion was afforded greater deference due to his or her 20 relationship to the claimant.” Cross v. O’Malley, 89 F.4th 1211, 1214 (9th Cir. 21 2024).8 To disregard a treating provider’s opinion under these regulations, the ALJ 22 must give “ʻspecific and legitimate’ reasons for doing so, based upon substantial 23 evidence in the record.” Id. The ALJ satisfies this requirement “by setting out a 24 detailed and thorough summary of the facts and conflicting clinical evidence, 25 stating his [or her] interpretation thereof, and making findings.” Magellanes v. 26 27 8 The regulations no longer require the ALJ to give greater weight to a treating 28 1 Bowen, 881 F.2d 747, 751 (9th Cir. 1989). Furthermore, although a treating 2 provider’s opinion is afforded relatively greater weight than the opinion of an 3 examining or non-examining physician under these regulations, the opinion is “‘not 4 binding on an ALJ with respect to the existence of an impairment or the ultimate 5 determination of disability,” which remains the province of the ALJ. See Batson v. 6 Comm’r of Soc. Sec. Admin., 359 F.3d 1190, 1195 (9th Cir. 2004). 7 Plaintiff argues the ALJ failed to articulate specific and legitimate reasons for 8 affording Dr. Nikou’s opinion little weight, stating the ALJ’s reasons for doing so 9 are “internally inconsistent,” not supported by the evidence, and not legitimate. 10 See Dkt. No. 13 at 5-10. The Court disagrees.9 The ALJ declined to adopt Dr. 11 Nikou’s opinions because the “significant degree of variation” among them 12 undermined their supportability. AR at 452; Dkt. No. 13 at 7. That conclusion 13 follows a lengthy cataloging of Dr. Nikou’s assessment of Plaintiff’s ability to work 14 between 2010 and 2019, revealing numerous inconsistencies in Dr. Nikou’s 15 opinions. AR at 450-52. 16 For example, the ALJ observed the following diverse recommendations and 17 assessments by Dr. Nikou: 18 • Driving. Dr. Nikou variously stated Plaintiff was prohibited only from “night driving” (August 2012, June 2013, March 2014, April 2017, April 19 2018, April 2019 and June 2021); could drive “rarely” (April 2016); 20 could not drive or operate machinery whatsoever (May 2019); and was restricted only from “distance driving” (April 2022). AR at 450-51 (citing 21 id. at 215-16, 416-17, 428-31, 435, 853-54, 798, 801, 811, 829, 843, 22 and 847). 23
24 25 9 Plaintiff’s arguments regarding the ALJ’s “implicit” or unspoken findings are not persuasive. See Dkt. No. 13 at 6 (“To the extent the ALJ used the reviewing 26 opinions to reject the opinions of Dr. Nikou . . .”); 7 (“To the extent the ALJ may 27 have thought . . .”); 9 (“The ALJ implicitly admitted . . .”). The ALJ’s opinion is straightforward and plainly written, and the Court does not find it necessary to 28 1 • Bending, squatting and stooping. Dr. Nikou likewise conflictingly stated Plaintiff could “frequently” twist, crouch, squat, and climb 2 ladders or stairs (April 2010 or 2011); could “never” stoop or bend and 3 “rarely” crouch or squat (April 2016); could “rarely” stoop or bend and “occasionally” crouch or squat (April 2019), and could not be required 4 to do any bending or lifting (May 2019). Id. (citing id. at 216, 358-59, 5 416, and 435). 6 • Visual limitations. Dr. Nikou’s recommended visual restrictions were at times “unspecified,” but when specified were in conflict, with 7 competing statements that Plaintiff could “occasionally” work with small 8 objects or could not work with them at all (April 2016 and April 2019, respectively); either “rarely” or “occasionally” use color vision (same); 9 use tools and small parts but had impaired attention to detail (April 10 2016 and April 2022, respectively). Id. (citing id. at 215-16, 358-59, 416, and 853-54). 11 12 By identifying these conflicting statements in Dr. Nikou’s various opinions, 13 the ALJ provided a specific and legitimate reason for discounting this opinion 14 evidence. See Ford, 950 F.3d at 1154 (finding no error where ALJ rejected treating 15 provider’s opinion as “inconsistent with medical evidence, including previous 16 medical opinions contained in his own notes”). Furthermore, although Plaintiff’s 17 counsel characterized these discrepancies as an opinion that had “evolved,” AR 18 at 472, the ALJ correctly observed that the changes in Dr. Nikou’s 19 recommendations did not correlate with any change in Plaintiff’s condition, which 20 remained relatively unchanged during the period at issue. Id. at 452. This was a 21 further specific and legitimate reason for discounting Dr. Nikou’s opinion. See 22 Batson, 359 F.3d at 1195 (“[A]n ALJ may discredit treating physicians’ opinions 23 that are conclusory, brief, and unsupported by the record as a whole . . . or by 24 objective medical findings.”). 25 The ALJ also found Dr. Nikou’s recommendations were “largely inconsistent 26 with the evidence of record,” including his own treatment notes. AR at 452. For 27 example, although Dr. Nikou recommended Plaintiff be restricted to working “in 28 dim light,” there were no references to Plaintiff’s alleged photophobia in Dr. Nikou’s 1 treatment records. Id. Dr. Nikou’s recommendations regarding Plaintiff’s alleged 2 visual field defect were directly contradicted by evidence that throughout the period 3 at issue and even thereafter, Plaintiff’s visual field remained “full to confrontation.” 4 Id. A treating provider’s opinion is properly rejected where the provider’s own 5 “treatment notes provide no basis for the functional restrictions” proposed. Connett 6 v. Barnhart, 340 F.3d 871, 875 (9th Cir. 2003); accord Jeanette R. v. Kijakazi, 620 7 F. Supp. 3d 1127, 1143 (E.D. Wash. 2022) (“[A]n ALJ is not obliged to credit 8 medical opinions that are unsupported by the medical source’s own data . . ..”). 9 The ALJ relatedly found several of Dr. Nikou’s recommendations lacked 10 evidentiary support (such as the total prohibition on reading regular print) or were 11 simply untethered to Plaintiff’s documented impairments and the corresponding 12 risk of retinal detachment (such as the purported need for unscheduled breaks 13 during the workday). AR at 452. These findings and observations are further 14 specific and legitimate reasons in support of the ALJ’s weighing of Dr. Nikou’s 15 opinions. See Coleman v. Saul, 979 F.3d 751, 757 (9th Cir. 2020) (finding ALJ 16 “did not err in concluding that the opinions assessing severe limitations were 17 unsupported by the record, thus furnishing a specific and legitimate reason to 18 discount [them]”). 19 Even under the then-existing opinion hierarchy, the ALJ was not required to 20 “take [Dr. Nikou’s] opinions at face value.” Ford, 950 F.3d at 1155; see also Cross, 21 89 F.4th at 1213 (same). For the reasons stated above, the Court finds the ALJ’s 22 conclusion that the “inconsistency and poor supportability” of Dr. Nikou’s opinions 23 “significantly undermine[d]” them, AR at 453, is adequate reason to afford those 24 opinions little weight. The Court further finds the ALJ’s reasons were well- 25 supported by reference to the objective medical record. Accordingly, the Court 26 finds the ALJ did not err in weighing Dr. Nikou’s opinions, and the ALJ’s resulting 27 determination that Plaintiff was not disabled between December 1, 2014 and 28 December 31, 2016 was not the product of legal error. 1 B. The ALJ’s Nondisability Determination Is Supported by Substantial 2 Evidence 3 Having found the ALJ’s analysis free of legal error, the Court turns to the 4 question of whether the ALJ’s decision is supported by substantial evidence. The 5 Court has independently “assess[ed] the entire record, weighing the evidence both 6 supporting and detracting from the [ALJ’s] conclusion,” see Ahearn, 988 F.3d at 7 1115, and finds substantial evidence supports the ALJ’s nondisability 8 determination. A summary of that evidence follows. 9 The record confirms Dr. Nikou diagnosed Plaintiff with myopia, retinal 10 degeneration and staphyloma as early as 2003 and that these conditions persisted 11 through the period at issue and afterwards. See, e.g., AR at 392, 397, 408, 790- 12 91. By 2009, Dr. Nikou suspected Plaintiff had glaucoma and his diagnosis of 13 chronic open angle glaucoma was confirmed as of 2012. See id. at 393, 407. 14 Plaintiff began complaining of “flashes and floaters” in 2014, and Dr. Nikou 15 diagnosed her with vitreous opacities. Id. at 382. 16 Dr. Nikou’s office notes demonstrate Plaintiff’s bilateral visual acuity 17 remained consistently in the range of 20/30 to 20/40 before, during and after the 18 period at issue. See, e.g., AR at 374, 377, 379-382, 400-401, 403, 407, 804-05, 19 813-15. Records of Plaintiff’s treatment at Shiley Eye Center during this 20 timeframe, although limited, confirm these visual acuity findings. See id. at 368- 21 70. Dr. Nikou’s examination findings dated between 2009 and 2017 also document 22 Plaintiff’s visual field was full to confrontation in both eyes. See, e.g., id at 374, 23 377, 379-382, 400-401, 403, 407, 804-05, 813-15. During this period, Plaintiff 24 complained of floaters, flashes, foreign body sensation, itching, and decreased or 25 blurry vision, but did not complain of sensitivity to light. See id. 26 Although they post-date the period at issue by several years, the Court also 27 observes Plaintiff’s most recent treatment records from Shiley Eye Institute 28 document several visits in 2020 and 2021 at which Plaintiff reported she had “no 1 visual complaints or discomfort” other than dissatisfaction with her corrective 2 lenses. See, e.g., AR at 761, 762, 768, 771. Plaintiff did not report any sensitivity 3 to light during these visits. See id. Her visual acuity continued to remain 4 approximately 20/40 bilaterally and there is no indication of a visual field defect. 5 See id. at 763, 769. 6 State agency consultant Dr. Masters noted in an initial disability evaluation 7 dated April 19, 2017 that there were no visual field tests in the record, “perhaps 8 because the principal [diagnoses] (bilateral posterior staphylomas, mild glaucoma, 9 and malignant myopia) do not usually produce v[isual] f[ield] impairment.” AR at 10 74. At the reconsideration level, state agency consultant Dr. Lee noted on June 8, 11 2017, that Plaintiff’s “recent vision evaluations have been mostly w[ithin] n[ormal] 12 l[imits].” Id. at 84. 13 At the hearing on June 13, 2022, Plaintiff testified she lives alone (although 14 she was living with her mother during the period at issue) and as long as she does 15 not lift anything heavy and stays out of bright light, she has no difficulty managing 16 herself. See AR at 479-80. She is – and was during the period at issue – able to 17 walk, stand and sit without limitation. Id. at 489-90. Plaintiff was, and remains, 18 able to perform self-care and to dress herself, including fine motor manipulations 19 such as buttoning buttons, without difficulty. Id. at 490-91. During the day she 20 drives short distances, runs errands, buys groceries and does light housework. Id. 21 at 492-94. She can read emails and operate her cell phone. Id. at 495. She 22 testified she can read documents in 14-point font, albeit slowly and only “if the light 23 is right.” Id. at 496. Plaintiff’s testimony is consistent with her mother’s 2019 report 24 that Plaintiff takes “short daily trips” to the grocery store, bank, post office and 25 doctor’s office, reads news or emails on her computer, and does light chores such 26 as vacuuming. See AR at 321-46. 27 The Court finds the foregoing is relevant and substantial evidence adequate 28 to support the ALJ’s assessment of Plaintiff’s RFC and subsequent determination 1 Plaintiff was not disabled during the period at issue. See Kitchen, 82 F. 4th at 2 ||738; see also 42 U.S.C.A. § 405(g) (providing that “[t]he findings of the 3 ||Commissioner of Social Security as to any fact, if supported by substantial 4 |levidence, shall be conclusive”). Accordingly, the ALJ’s decision will not be 5 disturbed. See Ahearn, 988 F.3d at 1115 (“If substantial evidence in the record 6 ||Supports the ALJ’s decision we must defer to the ALJ.”). 7 V. 8 CONCLUSION 9 For the foregoing reasons, the Court concludes that the ALJ’s decision was 10 ||not legally erroneous and was supported by substantial evidence. Plaintiffs 11 ||request for reversal and remand is therefore DENIED. The final decision of the 12 Commissioner of Social Security is AFFIRMED. The Clerk of the Court shall enter 13 ||judgment accordingly and terminate the case. 14 |/IT IS SO ORDERED. 15 || Dated: March 4, 2024 ait Ctl edb 17 ‘Hon. □□□□□□□□□□□□□□□□□□□□□□ 18 United States Magistrate Judge 19 20 21 22 23 24 25 26 27 28