Lisa Jean Hughes v. Andrew Saul

• Court: District Court, C.D. California
• Decided: June 30, 2020
• Docket: 2:19-cv-07462
• Status: Unknown

Opinion

1 2 3 4 5 6 7 8 UNITED STATES DISTRICT COURT 9 CENTRAL DISTRICT OF CALIFORNIA 10 11 LISA J. H.,1 Case No. CV 19-07462-RAO 12 Plaintiff, 13 v. MEMORANDUM OPINION AND 14 ORDER ANDREW SAUL, Commissioner of 15 Social Security, 16 Defendant. 17 18 I. INTRODUCTION 19 Plaintiff Lisa J. H. (“Plaintiff”) challenges the Commissioner’s denial of her 20 application for a period of disability and disability insurance benefits (“DIB”). For 21 the reasons stated below, the decision of the Commissioner is AFFIRMED. 22 II. PROCEEDINGS BELOW 23 On or about March 29, 2013, Plaintiff filed a Title II application for a period 24 of disability and DIB alleging disability beginning January 15, 2013. (Administrative 25 Record (“AR”) 135-36.) Her application was denied initially on August 16, 2013, 26 27 1 Partially redacted in compliance with 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 and upon reconsideration on January 3, 2014. (AR 87-90, 94-98.) Plaintiff filed a 2 request for a hearing, and a hearing was held on September 14, 2015. (AR 33-53, 3 100.) Represented by counsel, Plaintiff appeared and testified, along with an 4 impartial vocational expert. (AR 33-53.) On October 9, 2015, the Administrative 5 Law Judge (“ALJ”) found that Plaintiff had not been under a disability, pursuant to 6 the Social Security Act, from March 28, 2013 through December 31, 2014, the date 7 last insured. (AR 25-26.) The ALJ’s decision became the Commissioner’s final 8 decision when the Appeals Council denied Plaintiff’s request for review. (AR 1-4.) 9 Plaintiff filed her first action in this Court on May 10, 2017. (AR 930-32.) 10 The action resulted in reversal and remand of the ALJ’s decision. (AR 939, 940-47.) 11 On May 14, 2019, a supplemental hearing was held. (AR 877-95.) 12 Represented by counsel, Plaintiff appeared and testified, along with an impartial 13 vocational expert. (Id.) On June 28, 2019, the ALJ rendered an unfavorable decision. 14 (AR 867.) The ALJ’s decision became the Commissioner’s final decision.2 Plaintiff 15 filed this action on August 28, 2019. (Dkt. No. 1.) 16 The ALJ followed a five-step sequential evaluation process to assess whether 17 Plaintiff was disabled under the Social Security Act. See Lester v. Chater, 81 F.3d 18 821, 828 n.5 (9th Cir. 1995). At step one, the ALJ found that Plaintiff did not engage 19 in substantial gainful activity since her alleged onset date through her date last 20 insured. (AR 860.) At step two, the ALJ found that Plaintiff had the following 21 severe impairments: multilevel cervical and lumbar disc degeneration. (Id.) At step 22 three, the ALJ found that Plaintiff “did not have an impairment or combination of 23

24 2 “[W]hen a case is remanded by a Federal court for further consideration, the 25 decision of the administrative law judge will become the final decision of the Commissioner after remand on your case unless the Appeals Council assumes 26 jurisdiction of the case.” 20 C.F.R. § 404.984 (a). Upon review of the record, the 27 Court finds that the Appeals Council did not assume jurisdiction over the case and as such the ALJ’s decision is the Commissioner’s final decision subject to this Court’s 28 review. 1 impairments that met or medically equaled the severity of one of the listed 2 impairments in 20 CFR Part 404, Subpart P, Appendix 1.” (AR 861.) 3 Before proceeding to step four, the ALJ found Plaintiff had the residual 4 functional capacity (“RFC”) to: 5 [P]erform light work . . . except [Plaintiff] is limited to occasional 6 climbing, balancing, stooping, kneeling, crouching, and crawling. [Plaintiff] cannot work around unprotected heights or operate 7 hazardous machinery. [Plaintiff] is limited to occasional neck rotation, 8 flexion, and extension while at the workstation. [Plaintiff] is limited to predictable, routine changes in the work setting. [Plaintiff] is limited 9 to standing one minute out of every 30 minutes while at the workstation. 10 [Plaintiff] is limited to frequent reaching, handling, and fingering. 11 (AR 861.) 12 At step four, the ALJ found that Plaintiff was capable of performing past 13 relevant work as an accounting controller and a scheduler. (AR 867.) Accordingly, 14 the ALJ determined that, as to Plaintiff’s claim for period of disability and DIB, 15 Plaintiff had not been under a disability from January 15, 2013, through December 16 31, 2014, the date last insured. (Id.) 17 III. STANDARD OF REVIEW 18 Under 42 U.S.C. § 405(g), a district court may review the Commissioner’s 19 decision to deny benefits. A court must affirm an ALJ’s findings of fact if they are 20 supported by substantial evidence and if the proper legal standards were applied. 21 Mayes v. Massanari, 276 F.3d 453, 458-59 (9th Cir. 2001). “Substantial evidence . 22 . . is ‘more than a mere scintilla[,]’ . . . [which] means--and means only--‘such 23 relevant evidence as a reasonable mind might accept as adequate to support a 24 conclusion.’” Biestek v. Berryhill, —U.S. —, 139 S. Ct. 1148, 1154, 203 L. Ed. 2d 25 504 (2019) (citations omitted); Revels v. Berryhill, 874 F.3d 648, 654 (9th Cir. 2017). 26 An ALJ can satisfy the substantial evidence requirement “by setting out a detailed 27 and thorough summary of the facts and conflicting clinical evidence, stating his 28 1 interpretation thereof, and making findings.” Reddick v. Chater, 157 F.3d 715, 725 2 (9thCir. 1998) (citation omitted). 3 “[T]he Commissioner’s decision cannot be affirmed simply by isolating a 4 specific quantum of supporting evidence. Rather, a court must consider the record 5 as a whole, weighing both evidence that supports and evidence that detracts from the 6 Secretary’s conclusion.” Aukland v. Massanari, 257 F.3d 1033, 1035 (9th Cir. 2001) 7 (citations and internal quotation marks omitted). “‘Where evidence is susceptible to 8 more than one rational interpretation,’ the ALJ’s decision should be upheld.” Ryan 9 v. Comm’r of Soc. Sec., 528 F.3d 1194, 1198 (9th Cir. 2008) (citing Burch v. 10 Barnhart, 400 F.3d 676, 679 (9th Cir. 2005)); see Robbins, 466 F.3d at 882 (“If the 11 evidence can support either affirming or reversing the ALJ’s conclusion, we may not 12 substitute our judgment for that of the ALJ.”). The Court may review only “the 13 reasons provided by the ALJ in the disability determination and may not affirm the 14 ALJ on a ground upon which he did not rely.” Orn v. Astrue, 495 F.3d 625, 630 (9th 15 Cir. 2007) (citing Connett v. Barnhart, 340 F.3d 871, 874 (9th Cir. 2003)). 16 IV. DISCUSSION 17 Plaintiff raises a single issue for review – whether the ALJ properly considered 18 the treating opinion of Moustapha Abou-Samra, M.D. (See Joint Stipulation (“JS”) 19 4.) Plaintiff contends that “the ALJ once again impermissibly rejected Dr. Abou- 20 Samra’s opinion.” (JS 9; see JS 9-14, 20-22.) The Commissioner contends that “the 21 ALJ provided several specific reasons for discounting Dr. Abou-Samra’s opinions.” 22 (JS 16; see JS 14-20.) 23 A. Dr. Abou-Samra’s Opinions3 24 On October 14, 2013, Dr. Abou-Samra saw Plaintiff for a neurosurgical 25 consultation. (AR 852-53.) Plaintiff presented with chronic neck pain which was 26 27 3 Dr. Abou-Samra’s opinions are found within a series of letters to referring physician, Laura Harman, M.D. (See AR 852.) The Court previously found that 28 these records were proper medical opinions. (See AR 946.) 1 noted to have started about twenty years ago. (AR 852.) Plaintiff’s condition “has 2 fluctuated and always recovered with physical therapy.” (Id.) Beginning in March, 3 Plaintiff “started having rather significant pain, which did not respond to physical 4 therapy.” (Id.) Plaintiff’s pain was “localizing to both shoulders, right more than 5 left, with some tingling in the upper extremities. The tingling is in the medial aspect 6 of the hand on the left side only.” (Id.) 7 Dr. Abou-Samra reviewed an MRI and observed “evidence of straightening of 8 the lordotic curve and degenerative abnormalities at the C4-5, C5-6, and C6-7 levels. 9 The 4-5 and 6-7 abnormalities are mild; 5-6 seems to be moderately severe with right- 10 sided localization.” (AR 852.) He engaged in a review of Plaintiff’s symptoms and 11 past history. (Id.) Dr. Abou-Samra found Plaintiff’s thoracic and brain MRI scans 12 were entirely normal. (AR 853.) Plaintiff’s lumbar MRI scan showed very mild 13 abnormality at the L4-5 level. (Id.) Dr. Abou-Samra found Plaintiff’s review of 14 systems and past history was “otherwise not remarkable.” (Id.) 15 Dr. Abou-Samra conducted a physical examination of Plaintiff. (AR 853.) He 16 observed Plaintiff was normocephalic, with equal and reactive pupils. (Id.) Plaintiff 17 had normal strength and normal funduscopic examination. (Id.) He noted Plaintiff’s 18 neck movements were “limited in extension where she reports dizziness. Rotation 19 seems to be free and flexion seems to be okay.” (Id.) Plaintiff was noted to be 20 “slightly hyperactive throughout[,] but there is no clonus, Hoffman, or upgoing toes.” 21 (Id.) Her sensory examination was normal, and she did not have a sensory level. 22 (Id.) 23 Dr. Abou-Samra explained that Plaintiff “should complete her vasculitis 24 workup as well as therapy and [she] actually wants to wait until July before deciding 25 on surgery.” (AR 853.) Dr. Abou-Samra noted that Plaintiff had “exhausted 26 conservative therapy, that is physical therapy over a multitude of time, as well as 27 prednisone.” (Id.) He explained that he “did not see any point of giving her epidural 28 injections.” (Id.) Dr. Abou-Samra found that “[s]ince [Plaintiff] does not have any 1 motor weakness, she can choose to live with the symptoms but if she gets to a point 2 where she cannot live with the symptoms surgery will be indicated.” (Id.) However, 3 he opined that he would “be inclined to restrict surgery to the C5-6 level where [he] 4 think[s] the bulk of the symptoms [are].” (Id.) Dr. Abou-Samra also ordered 5 additional x-rays. (Id.) 6 On January 13, 2014, Dr. Abou-Samra saw Plaintiff for a neurosurgical 7 follow-up. (AR 850-51.) Plaintiff’s neck symptoms were documented as being the 8 same, but her left sided trapezius and shoulder pain were noted to be “getting worse.” 9 (AR 850.) Dr. Abou-Samra reviewed Plaintiff’s cervical x-rays and opined that “the 10 C5-6 level is significantly degenerated and there is compromise of the neural 11 foramen. There are some abnormalities at 4-5 and 6-7 and there is slight motion at 12 C4-5 level.” (Id.) He noted that Plaintiff’s ocular vasculitis had worsened and 13 resulted in “increasing her prednisone” and prescribing methotrexate. (Id.) Dr. 14 Abou-Samra opined that, because Plaintiff did not have any motor dysfunction, 15 “treating her cervical spine at this junction is not the most optimal thing we can do 16 given the fact that she is on steroids and methotrexate.” (Id.) He explained that 17 surgery could be considered if she had a motor deficit, but that Plaintiff would be 18 managed symptomatically. (Id.) He noted that Plaintiff’s conditions “makes doing 19 definitive surgical therapy for her cervical spine difficult.” (AR 850-51.) Dr. Abou- 20 Samra opined that “it is unlikely that this patient can work at her usual job sitting at 21 a desk and dealing with computers.” (Id.) Accordingly, he opined that Plaintiff “is 22 totally disabled for the time being.” (AR 851.) 23 On March 20, 2014, Dr. Abou-Samra saw Plaintiff in a neurosurgical follow- 24 up. (AR 848.) Dr. Abou-Samra observed that Plaintiff’s vasculitis is “still quite 25 symptomatic” and had not improved. (Id.) He explained that Plaintiff was on 26 prednisone, but she could not tolerate methotrexate and was being referred to a trial 27 to use Humira. (Id.) He noted that Plaintiff was “quite distraught” about the cost of 28 the trial. (Id.) Plaintiff presented for the follow-up because she was experiencing 1 clumsiness but did not exhibit weakness in the upper extremities. (Id.) Plaintiff was 2 “having intense tingling in the upper extremities and it is of concern to her.” (Id.) 3 Dr. Abou-Samra examined Plaintiff and did not detect any weakness in her 4 upper extremities or upper motor neuron findings, but found subtle hyperreflexia. 5 (AR 848.) He explained that there was no clonus, no upgoing toes, and no Hoffman. 6 (Id.) He “indicated that it is necessary to pursue the vasculitis treatment and to stop 7 smoking.” (Id.) Plaintiff was instructed to contact Dr. Abou-Samra if her condition 8 deteriorated “in which case [he] will repeat her cervical MRI scan.” (Id.) 9 On April 20, 2015, Dr. Abou-Samra saw Plaintiff again for a neurosurgical 10 follow-up. (AR 844.) Dr. Abou-Samra noted that Plaintiff had undergone a cervical 11 MRI scan, which documented unchanged abnormalities, including “significant at C5- 12 6, moderately severe at 4-5, and less significant at C6-7 level.” (Id.) He noted that 13 Plaintiff had not stopped smoking. (Id.) Plaintiff reported that she was thinking of 14 having surgery once she returns from visiting family out-of-state and would follow 15 up with Dr. Abou-Samra. (Id.) Dr. Abou-Samra explained that smoke cessation was 16 essential, and that Plaintiff was “being withdrawn from steroids.” (Id.) Dr. Abou- 17 Samra explained that once Plaintiff “decided on the time of surgery, a bone density 18 study should be obtained.” (Id.) 19 Dr. Abou-Samra saw Plaintiff for another follow-up on March 19, 2015. (AR 20 846.) He explained that Plaintiff “continues to have symptoms of neck pain, bilateral 21 shoulder and arm pain, which is quite intense on occasion.” (Id.) He noted that 22 Plaintiff was “eager to consider surgical treatment on her cervical spine; however, 23 she [was] not ready” because she was still on her steroid therapy and still smokes. 24 (Id.) Dr. Abou-Samra noted that Plaintiff was exploring options to stop smoking. 25 (Id.) Additionally, he explained that since more than two years had passed since 26 there were “any anatomical studies of her cervical spine,” it would be appropriate to 27 obtain new cervical x-rays and cervical MRI scan, and the results would dictate the 28 speed with which to “move after the stoppage of steroids and smoking.” (Id.) 1 B. Applicable Legal Standards 2 The ALJ is responsible for assessing a claimant’s RFC “based on all of the 3 relevant medical and other evidence.” 20 C.F.R. § 404.1545(a)(3), 404.1546(c); see 4 Robbins, 466 F.3d at 883 (citing SSR 96-8p, 1996 WL 374184, at *5 (July 2, 1996)). 5 In doing so, the ALJ may consider any statements provided by medical sources, 6 including statements that are not based on formal medical examinations. See 20 7 C.F.R. § 404.1513(a), 404.1545(a)(3). An ALJ’s determination of a claimant’s RFC 8 must be affirmed “if the ALJ applied the proper legal standard and his decision is 9 supported by substantial evidence.” Bayliss v. Barnhart, 427 F.3d 1211, 1217 (9th 10 Cir. 2005); accord Morgan v. Comm’r of Soc. Sec. Admin., 169 F.3d 595, 599 (9th 11 Cir. 1999). 12 Courts give varying degrees of deference to medical opinions based on the 13 provider: (1) treating physicians who examine and treat; (2) examining physicians 14 who examine, but do not treat; and (3) non-examining physicians who do not examine 15 or treat. Valentine v. Comm’r, Soc. Sec. Admin., 574 F.3d 685, 692 (9th Cir. 2009). 16 Most often, the opinion of a treating physician is given greater weight than the 17 opinion of a non-treating physician, and the opinion of an examining physician is 18 given greater weight than the opinion of a non-examining physician. See Garrison 19 v. Colvin, 759 F.3d 995, 1012 (9th Cir. 2014). 20 The ALJ must provide “clear and convincing” reasons to reject the ultimate 21 conclusions of a treating or examining physician. Embrey v. Bowen, 849 F.2d 418, 22 422 (9th Cir. 1988); Lester, 81 F.3d at 830-31. When a treating or examining 23 physician’s opinion is contradicted by another opinion, the ALJ may reject it only by 24 providing specific and legitimate reasons supported by substantial evidence in the 25 record. Orn, 495 F.3d at 633; Lester, 81 F.3d at 830; Carmickle v. Comm’r, Soc. Sec. 26 Admin., 533 F.3d 1155, 1164 (9th Cir. 2008). “An ALJ can satisfy the ‘substantial 27 evidence’ requirement by ‘setting out a detailed and thorough summary of the facts 28 1 and conflicting evidence, stating his interpretation thereof, and making findings.’” 2 Garrison, 759 F.3d at 1012 (citation omitted). 3 C. Discussion 4 After summarizing Dr. Abou-Samra’s treatment records, the ALJ gave Dr. 5 Abou-Samra’s assessment that Plaintiff “was temporarily disabled pending cervical 6 surgery . . . less probative weight for several reasons.” (AR 865.) The ALJ reasoned 7 as follows: 8 First, Dr. Abou-Samra is the only medical source that assessed 9 functional limitations other than the state agency medical consultants. His conclusion that [Plaintiff] was temporarily disabled pending spinal 10 surgery was inconsistent with the weight of the medical evidence. The 11 other medical sources did not assess any functional limitations or advise surgery. [Plaintiff] was treated conservatively for her alleged spinal 12 pain and the records indicate, including an admission by the claimant, 13 that her spinal pain was substantially reduced by these conservative measures. Further, the examining eye physicians all stated that her 14 ocular vasculitis was controlled and she had 20/20 or 20/25 vision 15 bilaterally. Finally, the treatment records from Dr. Abou-Samra and the other medical sources did not reveal significant physical findings 16 upon examination or diagnostic testing. The finding of moderate 17 cervical disc disease at several levels and mild lumbar disc disease at one level did not warrant a finding of total temporary disability. 18 (Id.) 19 20 Plaintiff contends that the ALJ erred in assessing Dr. Abou-Samra’s 21 opinions.4 (See JS 9-14, 20-22.) The Commissioner contends that the ALJ 22 23 4 Plaintiff also argues that the ALJ failed to discuss Dr. Abou-Samra’s opinion that it was unlikely Plaintiff would be able to work at her usual job sitting at a desk and 24 dealing with computers. (JS 13; see JS 21-22.) Plaintiff contends that the ALJ failed 25 “to adhere to the directive of this Court” by not “specifically consider[ing] Dr. Abou- Samra’s opinion.” (JS 21, citing AR 946.) However, the Court did not mandate or 26 direct the ALJ to specifically consider this statement, but rather offered this statement 27 as evidence that Dr. Abou-Samra had provided proper medical opinions. (See AR 946.) The Court did not direct the ALJ to consider this opinion beyond what the ALJ 28 has done here. (See id.) In summarizing Dr. Abou-Samra’s treatment and opinions, 1 discounted Dr. Abou-Samra’s opinions because: the opinions were inconsistent with 2 the medical evidence, including Dr. Abou-Samra’s own treatment records; the 3 opinions were “inconsistent with evidence from other providers who also treated 4 Plaintiff for cervical pain”; “none of the many other physicians who treated Plaintiff 5 offered any opinion assessing her functional limitations, and none of them advised 6 cervical surgery”; Plaintiff received only conservative treatment; and “the objective 7 medical evidence, specifically imaging reports showing moderate cervical disc 8 disease and mild lumbar disc disease ‘did not warrant a finding of total temporary 9 disability’ as Dr. Abou-Samra opined.” (AR 16-20.) 10 The Court’s review of the ALJ’s decision finds that in giving little weight to 11 Dr. Abou-Samra’s opinion, the ALJ relied on three reasons. Specifically, Dr. Abou- 12 Samra’s opinion was (1) inconsistent with the weight of the medical evidence; (2) 13 inconsistent with Plaintiff’s conservative treatment; and (3) treatment records did 14 not reveal significant physical findings upon examination or diagnostic testing. 15 1. Reason No. 1: Inconsistent with the Weight of the Medical 16 Evidence 17 An ALJ may reasonably rely on inconsistencies with the medical record to 18 discount a treating physician’s opinion. Tommasetti v. Astrue, 533 F.3d 1035, 1041 19 (9th Cir. 2008); Corral v. Saul, 797 F. App’x 380 (9th Cir. 2020) (holding an ALJ 20 may give “less weight to the opinions . . . that are otherwise inconsistent with credited 21 medical evidence”). 22 Here, the ALJ reasoned that Dr. Abou-Samra’s assessment that Plaintiff was 23 temporarily disabled pending spinal surgery was entitled to little probative weight 24 25 the ALJ noted that Dr. Abou-Samra found Plaintiff “could not return to her past sedentary work and she was totally disabled ‘for the time being’ until she underwent 26 cervical surgery.” (AR 865, citing AR 850-51.) Dr. Abou-Samra relied on Plaintiff’s 27 inability to return to her sedentary work in opining that she was “totally disabled for the time being.” (AR 850-51.) The ALJ then went on to give little probative weight 28 to Dr. Abou-Samra’s opinions of Plaintiff’s total disability. (AR 865.) 1 because the assessment was inconsistent with the weight of the medical evidence. 2 (AR 865.) Specifically, the ALJ relied on the fact that Dr. Abou-Samra was “the 3 only medical source that assessed functional limitations other than the state agency 4 medical consultants” and “other medical sources did not assess any functional 5 limitations or advise surgery.” (Id.) Notably, the only opinions discussed by the ALJ 6 are those of the state agency medical consultants. (See AR 865-66.) The ALJ gave 7 the opinions of the state agency medical consultants partial probative weight, but did 8 not explain why the opinions were entitled to more weight than Dr. Abou-Samra’s 9 opinions. (See AR 866.) An opinion that contradicts the opinion of a treating 10 physician cannot alone constitute a specific, legitimate reason for discounting the 11 opinion of a treating physician. See Tonapetyan, 242 F.3d at 1149; see also Heather 12 V. v. Comm’r of Soc. Sec., No. 2:18-CV-00163-MKD, 2019 WL 1643647, at *6 (E.D. 13 Wash. Apr. 16, 2019) (“[C]ase law requires not only an opinion from the consulting 14 physician but also substantial evidence (more than a mere scintilla but less than a 15 preponderance), independent of that opinion which supports the rejection of contrary 16 conclusions by examining or treating physicians.”) (citing Andrews v. Shalala, 53 17 F.3d 1035, 1041 (9th Cir. 1995)). 18 Although an ALJ need not recite “magic words” to reject a treating physician’s 19 opinion, he must–in addition to merely summarizing the facts–interpret the evidence 20 and make findings. See Magallanes v. Bowen, 881 F.2d 747, 755 (9th Cir. 1989). 21 Merely stating that Dr. Abou-Samra’s opinion was inconsistent with the weight of 22 the evidence, without relating that evidence to specific rejected opinions and 23 findings, is inadequate. See Embrey, 849 F.2d at 421; see also Garrison, 759 F.3d at 24 1012-13 (“[A]n ALJ errs when he rejects a medical opinion or assigns it little weight 25 while doing nothing more than ignoring it, asserting without explanation that another 26 medical opinion is more persuasive, or criticizing it with boilerplate language that 27 fails to offer a substantive basis for his conclusion.”); Carmona v. Berryhill, No. 28 EDCV 16-01376-AJW, 2017 WL 3614425, at *4 (C.D. Cal. Aug. 22, 2017) (“Saying 1 that a medical opinion is ‘inconsistent with the substantial evidence’ is not a specific 2 reason for rejecting the opinion; it is nothing more than boilerplate.”). 3 Accordingly, this was not a specific, legitimate reason supported by substantial 4 evidence for discounting Dr. Abou-Samra’s opinions. 5 2. Reason No. 2: Inconsistent with Plaintiff’s Conservative 6 Treatment 7 An ALJ may reject the opinion of a treating physician who prescribed 8 conservative treatment, yet opines that a claimant suffers disabling conditions. See 9 Rollins v. Massanari, 261 F.3d 853, 856 (9th Cir. 2001). The ALJ reasoned that 10 Plaintiff “was treated conservatively for her alleged spinal pain and the records 11 indicate, including an admission by the claimant, that her spinal pain was 12 substantially reduced by these conservative measures.” (AR 865.) 13 Plaintiff contends that the ALJ erred because although Plaintiff wanted 14 “surgical intervention and Dr. Abou-Samra wanted to proceed with surgery but for 15 the steroid use and the fact that [Plaintiff] was still in the process of smoking 16 cessation.” (JS 11, citing AR 567.) Additionally, Plaintiff contends that the ALJ 17 erred by failing to point to or indicate which additional treatments were more 18 appropriate. (Id.) Courts have held that an ALJ’s reliance on a claimant’s 19 conservative treatment history is misplaced when there is no indication that more 20 aggressive treatment options are available. See Juan C. P. v. Saul, No. ED CV 19- 21 427-PLA, 2019 WL 6039944, at *9 (C.D. Cal. Nov. 14, 2019) (finding ALJ erred 22 where “the ALJ points to no evidence in the record that any treatment other than the 23 treatment [claimant] was receiving or had been recommended to receive . . . is a 24 standard method for treating individuals with [claimant’s] impairments and the type 25 of pain caused by [claimant’s] physical impairments.”); see also Lapeirre-Gutt v. 26 Astrue, 382 F. App’x 662, 664 (9th Cir. 2010) (“[T]he record does not reflect that 27 more aggressive treatment options are appropriate or available. A claimant cannot be 28 [faulted] for failing to pursue non-conservative treatment options where none 1 exist.”); Cindy F. v. Berryhill, 367 F. Supp. 3d 1195, 1210 (D. Or. 2019) (“Because 2 the ALJ did not specify what ‘more aggressive treatment options [were] appropriate 3 or available,’ it would be illogical to discredit Plaintiff ‘for failing to pursue non- 4 conservative treatment options where none exist.’”) (citation omitted). 5 Here, the ALJ observed that Dr. Abou-Samra opined on multiple occasions 6 that Plaintiff required surgery, but that such surgery was not advisable because 7 Plaintiff was undergoing steroid therapy for ocular vasculitis and continued smoking. 8 (SeeAR 865.) Further, the ALJ noted that Plaintiff’s ocular vasculitis was controlled, 9 and she had 20/20 or 20/25 vision bilaterally. (Id.) Because Plaintiff’s treatment for 10 her ocular vasculitis was one of the reasons Dr. Abou-Samra proposed withholding 11 surgery, the fact that Plaintiff’s condition was controlled suggests that Dr. Abou- 12 Samra could have insisted on surgery if it was necessary. (See id.) While the ALJ 13 did not explicitly state that a more aggressive treatment was available, i.e. surgery, 14 the ALJ’s discussion makes it clear that he discounted Dr. Abou-Samra’s opinion 15 because Dr. Abou-Samra did not pursue the more aggressive treatment that was 16 available. See Magallanes, 881 F.2d at 755 (“As a reviewing court, we are not 17 deprived of our faculties for drawing specific and legitimate inferences from the 18 ALJ's opinion.”). 19 Accordingly, this was a specific, legitimate reason supported by substantial 20 evidence for discounting Dr. Abou-Samra’s opinions. 21 3. Reason No. 3: Treatment Records Did Not Reveal Significant 22 Physical Findings Upon Examination or Diagnostic Testing 23 An ALJ can reasonably discount a treating physician’s opinion that is 24 inadequately supported by clinical findings. Bray v. Comm’r of Soc. Sec. Admin., 25 554 F.3d 1219, 1228 (9th Cir. 2009). Here, the ALJ reasoned that “treatment records 26 from Dr. Abou-Samra and the other medical sources did not reveal significant 27 physical findings upon examination or diagnostic testing.” (AR 865.) In support the 28 ALJ observed that “[t]he finding of moderate cervical disc disease at several levels 1 and mild lumbar disc disease at one level did not warrant a finding of total temporary 2 disability.” (Id.) 3 Plaintiff contends that “[t]his is just another way of saying Dr. Abou-Samra’s 4 opinion is inconsistent with the weight of the medical evidence. The ALJ’s 5 continuation of this claim without demonstrating how or why is nothing more than a 6 factually challenged legally flawed conclusion.” (JS 12.) However, “[a]n ALJ 7 properly may discount a treating physician’s opinions that are in conflict with 8 treatment records or are unsupported by objective clinical findings.” Bokhari v. 9 Berryhill, No. CV 17-1668-E, 2017 WL 3600379, at *3 (C.D. Cal. Aug. 18, 2017) 10 (emphasis added) (citing Bayliss, 427 F.3d at 1216; Batson v. Commissioner, 359 11 F.3d 1190, 1195 (9th Cir. 2004)). 12 Additionally, Plaintiff contends that “[t]he ALJ does not demonstrate how the 13 presence of moderate to severe bilateral neural foraminal narrowing at C5-C6, that a 14 neurosurgeon believes merits surgery, is inconsistent with the evidence when the 15 only opinion contrary to that conclusion is her own lay opinion.” (JS 10 (internal 16 citations omitted).) However, where, as here, the evidence might be susceptible to 17 more than one rational interpretation, the ALJ’s decision should be upheld. SeeRyan 18 v. Comm’r of Soc. Sec., 528 F.3d 1194, 1198 (9th Cir. 2008) (citing Burch v. 19 Barnhart, 400 F.3d 676, 679 (9th Cir. 2005)); see Robbins, 466 F.3d at 882 (“If the 20 evidence can support either affirming or reversing the ALJ’s conclusion, we may not 21 substitute our judgment for that of the ALJ.”). The ALJ was allowed to rely on 22 normal medical examinations and mild diagnostic findings in discounting the 23 opinions of Dr. Abou-Samra. See Kelle A.B. v. Berryhill, No. ED CV 16-1693-SP, 24 2018 WL 6832089, at *4 (C.D. Cal. Dec. 28, 2018) (finding ALJ did not err in 25 discounting treating physician’s opinion, in part, where ALJ relied on normal 26 examination results and mild findings); Yang v. Saul, No. 1:18-CV-00759-BAM, 27 2019 WL 4392417, at *6 (E.D. Cal. Sept. 13, 2019) (finding ALJ properly discounted 28 treating physician’s opinion where “he noted ‘substantially normal examination 1 || findings’ and [claimant’s] diagnostic imaging had essentially mild findings.”). 2 Accordingly, this was a specific, legitimate reason supported by substantial 3 || evidence for discounting Dr. Abou-Samra’s opinions. 4 D. Conclusion 5 In sum, the ALJ did not err in assessing the opinion of Plaintiff’s treating 6 || physician. Because the ALJ has provided specific and legitimate reasons for 7 || discounting Dr. Abou-Samra’s opinions, “[a]ny error in relying on additional reasons 8 || to reyect [a physician’s] opinion was harmless.” See Barney v. Berryhill, 769 F. 9 || App’x 465, 466 (9th Cir. 2019). 10 | V. CONCLUSION 11 IT IS ORDERED that Judgment shall be entered AFFIRMING the decision of 12 || the Commissioner denying benefits. 13 IT IS FURTHER ORDERED that the Clerk of the Court serve copies of this 14 || Order and the Judgment on counsel for both parties. 15 □□ O C □ 16 || DATED: June 30, 2020 Raytin □ OC ROZELLA A. OLIVER UNITED STATES MAGISTRATE JUDGE 18 19 20 NOTICE 21 THIS DECISION IS NOT INTENDED FOR PUBLICATION IN WESTLAW, 99 || LEXIS/NEXIS, OR ANY OTHER LEGAL DATABASE. 23 24 25 26 27 28 15