Malone v. Commissioner of Social Security Administration

• Court: District Court, D. Arizona
• Decided: September 13, 2022
• Docket: 4:21-cv-00214
• Status: Unknown

Opinion

Case 4:21-cv-00214-DCB-BGM Document 25 Filed 09/13/22 Page 1 of 40

1 WO 2 3 4 5 6 IN THE UNITED STATES DISTRICT COURT 7 FOR THE DISTRICT OF ARIZONA 8 9 Resana Malone, No. CV-21-00214-TUC-DCB (BGM) 10 Plaintiff, 11 v. ORDER 12 Kilolo Kijakazi, Acting Commissioner of Social Security, 13 Defendant. 14 15 Currently pending before the Court is Plaintiff Resana Malone’s Opening Brief 16 (Doc. 21). Defendant filed her Answering Brief (“Response”) (Doc. 22), and Plaintiff 17 replied (“Reply”) (Doc. 23). Plaintiff brings this cause of action for review of the final 18 decision of the Commissioner for Social Security pursuant to 42 U.S.C. §§ 405(g) and 19 1383(c)(3). Compl. (Doc. 1). The Court will deny Plaintiff’s Opening Brief (Doc. 21) and 20 affirm the Commissioner’s decision. 21 I. BACKGROUND 22 A. Procedural History 23 On February 11, 2019, Plaintiff protectively filed a Title II application for Social 24 Security Disability Insurance Benefits (“DIB”), as well as a Title XVI application for 25 Supplemental Security Income (“SSI”), alleging disability as of December 1, 2017, due to 26 valley fever, depression, anxiety, neuropathy, asthma, severe sciatica, carpal tunnel, spinal 27 stenosis, chronic pain, and lower back pain.1 See Administrative Record (“AR”) at 19, 42– 28 1 Plaintiff filed a prior application under Title II on January 24, 2018. See Case 4:21-cv-00214-DCB-BGM Document 25 Filed 09/13/22 Page 2 of 40

1 45, 73, 75, 77–78, 80–81, 91–92, 94–96, 105, 107, 109–10, 114–15, 126–27, 131–33, 259, 2 263, 275, 285, 324, 347, 354. The Social Security Administration (“SSA”) denied these 3 applications on April 2, 2019. Id. at 19, 73–104, 151–55. On May 8, 2019, Plaintiff filed 4 a request for reconsideration, and on July 24, 2019, SSA denied Plaintiff’s application upon 5 reconsideration. Id. at 19, 105–42, 156–75. On August 22, 2019, Plaintiff filed her request 6 for hearing. Id. at 19, 176–77, 352. On August 28, 2020, a telephonic hearing was held 7 before Administrative Law Judge (“ALJ”) Charles Davis. AR at 19, 39–59. On October 8 9, 2020, the ALJ issued an unfavorable decision. Id. at 13–33. On December 8, 2020, 9 Plaintiff requested review of the ALJ’s decision by the Appeals Council, and on April 15, 10 2021, review was denied. Id. at 1–6, 221–24, 367–69. On May 21, 2021, Plaintiff filed 11 this cause of action. Compl. (Doc. 1). 12 B. Factual History 13 Plaintiff was fifty (50) years old at the time of the alleged onset of her disability and 14 fifty-three (53) years old at the time of the administrative hearing. AR at 19, 39, 73, 75, 15 77–78, 80–81, 91–92, 94–96, 105, 107, 109–10, 114–15, 126–27, 131–33, 216, 225, 227, 16 259, 285, 324, 354. Plaintiff is a high school graduate and two (2) years of college. Id. at 17 42, 73, 75, 105, 107, 264, 276. Prior to her alleged disability, Plaintiff worked as a hospital 18 billing clerk, receptionist, customer service representative, day care provider, and 19 administrative assistant. Id. at 32, 50–51, 264, 288–93, 308–315. 20 1. Plaintiff’s Testimony 21 a. Administrative Hearing 22 At the administrative hearing, Plaintiff confirmed that she was fifty-three (53) years 23 old and had attended some college. AR at 42. Plaintiff testified that she last worked on 24 December 1, 2017, at Banner University Medical Center as a patient and customer service 25 26 Administrative Record (“AR”) at 19, 225–26. On April 18, 2018, SSA denied this application on initial review. Id. at 19, 60–72, 143–46. The Administrative Law Judge 27 (“ALJ”) observed that “[a]s the prior final denial can potentially be reopened for any 28 reason, the undersigned is deciding the claimant’s disability status since December 1, 2017, anew.” Id. at 19.

-2- Case 4:21-cv-00214-DCB-BGM Document 25 Filed 09/13/22 Page 3 of 40

1 representative. Id. Plaintiff described the position as obtaining physicians’ orders and 2 coordinating preauthorization with the insurance company. Id. Plaintiff indicated that she 3 left the position after she contracted Valley Fever. Id. at 42–44. Plaintiff further testified 4 that her Valley Fever is currently controlled, but she has COPD—shortness of breath and 5 coughing—as a result of the infection. Id. at 44. 6 Plaintiff testified that she remains unable to return to work due to prior carpal tunnel 7 surgeries, as well as lower back surgery. AR at 44. Plaintiff indicated that she was still 8 dealing with therapy for her hands due to the surgery, and she just had lower back surgery 9 and remains unable to sit or stand for any length of time. Id. Plaintiff also noted that she 10 was going to need another back surgery for her left side. Id. Plaintiff further testified that 11 after her Valley Fever resolved, she had a breast cancer recurrence. Id. Plaintiff stated that 12 all of these things, one after another, resulted in her inability to return to work. Id. 13 Plaintiff testified that she lives alone in an apartment. AR at 44–45. Plaintiff 14 explained that her son had lived with her, but had recently passed away, so her nephew was 15 coming from New York to care for her. Id. at 44–45. Plaintiff also indicated that her next 16 door neighbor helped her when she did not have family in town. Id. at 45. Plaintiff 17 confirmed that she could drive, but indicated she had not been out to do her own grocery 18 shopping because she cannot carry them. Id. 19 Plaintiff testified that she did not have another back surgery scheduled, because the 20 insurance company required her to do physical therapy first. Id. Plaintiff reported that she 21 had begun aquatic physical therapy the previous day. AR at 45–46. Plaintiff further 22 explained that until she has some type of physical therapy, her insurance would not approve 23 Magnetic Resonance Imaging (“MRI”) either. Id. at 46. Plaintiff clarified that her doctor 24 told her that if the therapy is too painful, to contact him and they could tell the insurer. Id. 25 at 46–47. Plaintiff confirmed that she had post-surgical MRIs, but the doctors could not 26 figure out what was wrong with her left side. Id. at 49. Her original surgery was because 27 of pain radiating down her right leg, but the pain on her left side developed after surgery. 28 Id. at 49–50. Plaintiff explained that the post-surgical MRI caused her to surpass her annual

-3- Case 4:21-cv-00214-DCB-BGM Document 25 Filed 09/13/22 Page 4 of 40

1 quota, which is why the insurance company requires physical therapy prior to further 2 imaging studies. AR at 49. 3 Plaintiff estimated that she could walk for five (5) to seven (7) minutes before 4 feeling “serious” pain and weakness. Id. at 47. Plaintiff further testified that “laying down 5 is just the worst.” Id. Plaintiff explained that she alternates sitting, standing, and walking 6 in an attempt to keep the pain to a minimum. Id. Plaintiff noted that for appointments, her 7 family drops her off at the entrance to minimize the distance she needs to walk. Id. Plaintiff 8 also testified that she had been sleeping on her right side, which she had recently had 9 surgery on and despite instructions against it, because laying on her left side is so painful. 10 AR at 47. Plaintiff estimated that she can lift and carry between three (3) and five (5) 11 pounds. Id. Plaintiff testified that using a computer has been difficult due to her hand 12 surgery, and indicated that she “can peck on a keyboard” but cannot type for any length of 13 time. Id. at 47–48. Plaintiff further testified that she had trigger release surgery in 14 December of 2018, and a trigger release surgery on her right thumb and index finger, as 15 well as carpal tunnel surgery on the left in May of 2019. Id. at 48–49. Plaintiff confirmed 16 that the trigger release of her right thumb and index finger was a success; however, opined 17 that the trigger release on the left was not. Id. at 50. Plaintiff testified that her surgeon 18 “wants [her] in physical therapy, but I can’t do two[,] [a]nd right now my back is more 19 important to me than the hand right now.” AR at 50. 20 In describing what would be the most difficult part of the pre-authorizations and 21 billing position at Banner University Medical Center, Plaintiff testified as follows: 22 That job, sitting for long periods of time and keyboarding. A lot of keyboarding, lot of repetitive work. And that’s the work that I can’t do 23 anymore as far as my hands. I wouldn’t want to put myself in a keyboarding 24 position, because – although he just did carpal tunnel surgery, I’ve done work and I’ve been in this career, administrative career, over 17 years in higher 25 education at Cornell University. And I’ve had carpal tunnel releases before. 26 So[,] with this last one, I know that it’s, like, I’m using – my hands 27 are not as strong and I’m not able to use them like I was before. Because, again, this is the second time on both hands to have surgery. So it’s just the 28 repetitive typing, the sitting for long periods of time, I just – I can’t do that.

-4- Case 4:21-cv-00214-DCB-BGM Document 25 Filed 09/13/22 Page 5 of 40

1 Id. at 50–51. Plaintiff described all of her past work involving “a lot of keyboarding, 2 typing, repetitive work, a lot of sitting.” Id. at 51. Plaintiff estimated that even in a more 3 comfortable type of office chair, she would only be able to sit for approximately ten (10) 4 minutes before needing to get up and move around. Id. Plaintiff further testified that she 5 is unable to sit in the car long enough to travel out of Tucson. Id. at 52–53. 6 b. Administrative Forms 7 i. Exertional Daily Activities Questionnaire 8 In March 12, 2018, Plaintiff completed an Exertional Daily Activities 9 Questionnaire. AR at 270–73. Plaintiff reported that she lived alone in an apartment. Id. 10 at 270. Plaintiff described her average day as follows: 11 Shower, dress myself, make my bed, fix my meals, let my dog in and out to a gated backyard, lots of naps, sit with feet and legs elevated, walk approx. 12 100 ft., to mailbox (not daily), take medicine on time, and I lay down a lot. 13 Id. at 270. Plaintiff indicated that due to the severity of the pain in her left hip, she takes 14 medication that causes “tiredness and fatigue,” as well as anti-fungal medication that 15 causes a rash and raw, itchy skin. Id. Plaintiff noted that after brief activity she experiences 16 shortness of breath and coughing. Id. Plaintiff reported that she has bouts of nausea and 17 her appetite is affected, as well as edema in her feet and legs which require elevation. AR 18 at 270. 19 Plaintiff estimated that she walks approximately 100 feet to her mailbox, and to go 20 there and back takes her approximately eight (8) minutes. Id. Plaintiff indicated that she 21 can lift and carry a gallon of milk, her purse, sixty-four (64) ounces of laundry detergent, 22 and a ten (10) pound bag of dog food. Id. at 271. Plaintiff reported that she does do her 23 own grocery shopping, but “only if I need to grab something[,]” her son and his girlfriend 24 do “actual grocery shopping.” Id. Plaintiff further reported that she does her own 25 household chores, including cooking and preparing her own meals, laundry, vacuuming, 26 and mopping. Id. Plaintiff indicated that she has difficulty cleaning the bathtub and 27 “[p]utting on bottoms, socks, and shoes[.]” AR at 271. Plaintiff further indicated that she 28 drives to her doctor’s appointments, the labs, and grocery store, “all within a 10 mile radius

-5- Case 4:21-cv-00214-DCB-BGM Document 25 Filed 09/13/22 Page 6 of 40

1 of [her] home.” Id. Plaintiff noted that she does these activities at least once per week. Id. 2 Plaintiff described being able to complete chores, go on walks, and go to the mall prior to 3 her illness. Id. Plaintiff indicated that now she becomes short of breath, body aches, 4 swelling of her feet and legs, and severe hip pain. Id. 5 Plaintiff estimated sleeping approximately six (6) hours per night and including 6 naps. AR at 271. Plaintiff indicated that she rests for at least an hour, once or twice per 7 day. Id. Plaintiff’s medications included acetaminophen, benzonatate, cetirizine, codeine- 8 guaifenesin, fluconazole, ibuprofen, lidocaine topical, magnesium aspartate, tramadol, and 9 trazodone. Id. at 272. Plaintiff reported that she wears glasses to correct her near- 10 sightedness. Id. at 273. Plaintiff concluded her function report, as follows: 11 Every day is different. I have some good days and some bad days. Taking it 1-day at a time, but my joint and hips hurt all the time. I’m learning how 12 to deal with the pain and trying to be more active by trying to do things on 13 my own. 14 Id. 15 ii. Work History Reports 16 Plaintiff completed an undated Work History Report. AR at 288–98. Plaintiff listed 17 her past work to include administrative assistant, customer service representative, day care 18 provider, patient financial services representative, and receptionist. Id. at 288. Plaintiff 19 described each position as full time and reported her pay rate; however, she did not provide 20 any additional information. Id. at 289–93. 21 On March 13, 2019, Plaintiff completed a second Work History Report. Id. at 308– 22 315. Plaintiff listed her prior work to include administrative assistant, telemarketer, 23 cashier, day care provider, executive administrative assistant, receptionist, customer 24 service representative II, and patient service representative. Id. at 308. Plaintiff described 25 the position of administrative assistant as fulltime—eight (8) or more hours per day, five 26 (5) days per week—and included providing administrative and secretarial support to the 27 Director and Associate Director of Multicultural Affairs, assisting in the preparation, 28 monitoring, and reconciliation of the departmental and programming budgets, assimilating

-6- Case 4:21-cv-00214-DCB-BGM Document 25 Filed 09/13/22 Page 7 of 40

1 data and preparing reports, preparing correspondence, coordinating and ensuring 2 appropriate administrative support, and maintaining files. AR at 309. Plaintiff reported 3 that the job required her to use machines, tools, or equipment; technical knowledge or 4 skills; and to write, complete reports, or perform similar duties. Id. Plaintiff further 5 reported that while working, she wrote, typed, or handled small objects for approximately 6 forty (40) percent of her time or three (3) hours per day; sat for approximately sixty (60) 7 percent of her time or four and one half (4 1/2) hours per day; and walked or stood for 8 approximately twenty (20) percent of her time or two and one half (2 1/2) hours per day. 9 Id. Plaintiff also reported that while working she would frequently lift ten (10) pounds, 10 and fifty (50) pounds was the heaviest weight she lifted. Id. Plaintiff noted she would lift 11 and carry items such as supplies and copier paper. Id. Plaintiff did not supervise others 12 and was not a lead worker. AR at 309. 13 Plaintiff described the telemarketer position as fulltime—eight (8) hours per day, 14 five (5) days per week—and included making calls to specific groups regarding research 15 questionnaires. Id. at 310. Plaintiff reported that the position required her to use machine, 16 tools, or equipment, as well as technical knowledge or skills, she did not write, complete 17 reports, perform similar duties. Id. Plaintiff further reported that while working she sat for 18 seven and one half (7 1/2) hours per day; wrote, typed, or handled small objects for three 19 (3) hours per day; and walked or stood for one (1) hour per day. Id. Plaintiff also reported 20 that she would frequently lift less than ten (10) pounds, and noted this was also the heaviest 21 weight she lifted. Id. Plaintiff indicated that she did not supervise other people, was not a 22 lead worker, and did not hire or fire employees. AR at 310. 23 Plaintiff described the position of cashier as parttime—four (4) to five (5) hours per 24 day, four (4) days per week—and included efficiently and accurately completing sales and 25 service transactions at a front counter, keeping dining area clean, and supplies stocked. Id. 26 at 311. Plaintiff reported using machines, tools, or equipment, but did not use technical 27 knowledge or skills or write, complete reports, or perform similar duties in this position. 28 Id. Plaintiff further reported that she stood for four (4) hours per day; wrote, typed, or

-7- Case 4:21-cv-00214-DCB-BGM Document 25 Filed 09/13/22 Page 8 of 40

1 handled small objects for three (3) hours per day; and walked for two (2) hours per day. 2 Id. Plaintiff also reported that she frequently lifted ten (10) pounds, and this was also the 3 heaviest weight that she lifted. Id. Plaintiff noted that the items she carried included 4 supplies for restocking and bulk sized food prep bags. AR at 311. Plaintiff indicated that 5 she was not a supervisor or a lead worker. Id. 6 Plaintiff described the position of daycare provider as fulltime—six (6) hours per 7 day, five (5) days per week—and included providing supervision to one (1) infant and two 8 (2) toddlers. Id. at 312. Plaintiff reported using machines, tools, or equipment, but did not 9 use technical knowledge or skills or write, complete reports, or perform similar duties in 10 this position. Id. Plaintiff further reported that she walked for five (5) hours per day; stood 11 for three (3) hours per day; sat, kneeled, and crouched for two (2) hours per day; and wrote, 12 typed, or handled small objects for one (1) hour per day. Id. Plaintiff also reported that 13 she frequently lifted twenty-five (25) pounds, and this was also the heaviest weight that 14 she lifted.2 AR at 312. Plaintiff noted that she lifted and carried children. Id. Plaintiff 15 indicated that she was a supervisor and a lead worker, but did not hire and fire employees. 16 Id. 17 Plaintiff described the position of executive administrative assistant as fulltime— 18 eight (8) hours per day, five (5) days per week—and included handling accounts payable, 19 maintaining a calendar, making appointments, travel arrangements, answering phone, 20 maintaining files, compiling and composing reports and correspondence, reconciling 21 checking accounts, and answering inquiries from external organizations and vendors. Id. 22 at 313. Plaintiff reported using machines, tools, or equipment, technical knowledge or 23 skills, and writing, completing reports, or performing similar duties in this position. Id. 24 Plaintiff further reported that she sat and wrote, typed, or handled small objects for seven 25 (7) hours per day; stood for three (3) hours per day; walked for two (2) hours per day; and 26 crouched for one (1) hour per day. AR at 313. Plaintiff also reported that she frequently 27 2 28 Plaintiff checked the line indicating twenty (20) pounds was the heaviest weight lifted, which conflicts with the check indicating she lifted twenty-five pounds frequently.

-8- Case 4:21-cv-00214-DCB-BGM Document 25 Filed 09/13/22 Page 9 of 40

1 lifted less than (10) pounds, and the heaviest weight that she lifted was twenty (20) pounds. 2 Id. Plaintiff noted that she lifted and carried office supplies and copy paper. Id. Plaintiff 3 indicated that she was neither a supervisor nor a lead worker. Id. 4 Plaintiff described the position of receptionist as fulltime—eight (8) hours per day, 5 five (5) days per week—and included responsibility for all incoming calls; greeting 6 customers, visitors, and vendors; maintaining office supplies, files, packing slips, and paid 7 invoices; mailing statements; handling inquiries and requests; and maintaining customer 8 accounts. Id. at 314. Plaintiff reported using machines, tools, or equipment, technical 9 knowledge or skills, and writing, completing reports, or performing similar duties in this 10 position. AR at 314. Plaintiff further reported that she sat, wrote, typed, or handled small 11 objects for seven (7) hours per day; walked for two (2) hours per day; and stood for one (1) 12 hour per day. Id. Plaintiff also reported that she frequently lifted less than ten (10) pounds, 13 and the heaviest weight that she lifted was twenty (20) pounds. Id. Plaintiff noted that she 14 lifted and carried office supplies, copier paper, and electrical parts and supplies. Id. 15 Plaintiff indicated that she was not a supervisor or a lead worker. Id. 16 Plaintiff described the position of customer service representative II as fulltime— 17 eight (8) hours per day, five (5) days per week—and included handling inbound telephone 18 calls; assisting customers with refills, status updates, and insurance issues; and assisting 19 members in benefits, eligibility, and account management. AR at 315. Plaintiff reported 20 using machines, tools, or equipment, as well as technical knowledge or skills, but did not 21 write, complete reports, or perform similar duties in this position. Id. Plaintiff further 22 reported that she sat and wrote, typed, or handled small objects for seven (7) hours per day; 23 and walked for two (2) hours per day. Id. Plaintiff also reported that she did not perform 24 any lifting or supervising, and was not a lead worker. Id. 25 Plaintiff described the position of patient service representative as fulltime—eight 26 (8) hours per day, five (5) days per week—and included handling large volumes of calls 27 from insurance companies, patients, and providers regarding billing and payment issues. 28 Id. Plaintiff reported that she sat for eight (8) hours per day; wrote, typed, or handled small

-9- Case 4:21-cv-00214-DCB-BGM Document 25 Filed 09/13/22 Page 10 of 40

1 objects for seven and a half (7 1/2) hours per day; and walked for two (2) hours per day. 2 AR at 315. Plaintiff also reported that she did not lift anything and was not a supervisor or 3 a lead worker. Id. 4 iii. Function Report—Adult 5 On March 12, 2019, Plaintiff completed a Function Report—Adult. AR at 299– 6 307. Plaintiff reported that she lived alone in an apartment. Id. at 299. Plaintiff outlined 7 the limitations of her medical conditions as follows: 8 Due to lower back and hip pain, my activities are very limited. I experience shortness of breath even with walking. I am always fatigued and don’t get 9 much sleep. I’m also left-handed and due to severe carpal tunnel and my 10 recent trigger finger surgery, this makes things more complicated. My depression and anxiety have also gotten much worse, with more frequent 11 episodes. 12 Id. Plaintiff described her usual day to include showering, getting dressed, making her bed, 13 preparing breakfast, and letting her dog in and out during the day. Id. at 300. Plaintiff 14 indicated that her average day also includes taking her medications on time, walking 15 approximately 100 feet to the mailbox, taking frequent naps throughout the day, and 16 driving herself to doctors’ appointments. Id. Plaintiff reported that she does not care for 17 any other people, but does take care of her small dog. AR at 300. Plaintiff further reported 18 that she is able to give her dog food and water, as well as let it in and out of the backyard, 19 without assistance. Id. 20 Plaintiff stated that prior to the onset of her condition she was able to work and 21 complete chores without pain, anxiety, and fatigue. Id. Plaintiff indicated that lower back 22 pain, pain in her left arm and hand, and anxiety affect her sleep. Id. Plaintiff reported that 23 her condition affects her ability to bend to put on bottoms, socks, and shoes. Id. at 301. 24 Plaintiff further indicated that she showers instead of bathing in a tub due to mobility 25 issues; has difficulty keeping her arms raised over her head to care for her hair; has hair 26 loss; and she avoids preparing meals that require a lot of standing. AR at 301. Plaintiff 27 noted that she does not require reminders for personal care or taking medications. Id. 28 Plaintiff reported that she prepares her own meals every day, and these include frozen

- 10 - Case 4:21-cv-00214-DCB-BGM Document 25 Filed 09/13/22 Page 11 of 40

1 meals, sandwiches, salads, and slow cooker meals. Id. Plaintiff explained that she usually 2 prepares meals that do not require a lot of preparation time, attention, or standing. Id. 3 Plaintiff described her current household chores to include preparing her own meals, doing 4 laundry, sweeping and mopping the floors, and vacuuming her throw rugs. Id. Plaintiff 5 estimated that she performed these tasks for less than two hours each day. AR at 302. 6 Plaintiff reported that she does not need help or encouragement to do these tasks, and noted 7 that she is not responsible for the area outside of her apartment. Id. 8 Plaintiff indicated that she goes out daily, is able to go out alone, and can drive a 9 car. Id. Plaintiff noted that she avoids driving if it is contraindicated by her medication. 10 Id. Plaintiff reported that she shops in stores, “mostly [for] staples and small items.” Id. 11 Plaintiff estimated that she shops twice per month for less than a half hour. AR at 302. 12 Plaintiff confirmed that she is able to pay bills, count change, handle a savings account, 13 and use a checkbook/money orders.3 Id. at 303. Plaintiff listed her hobbies as reading, 14 watching television, and taking scenic short drives. Id. Plaintiff noted that she reads and 15 watches television daily, but takes drives and has anxiety episodes weekly. Id. Plaintiff 16 reported that prior to the onset of her conditions she “was never a couch potato, or 17 experienced daily anxiety episodes.” Id. Plaintiff confirmed that she spends time with 18 others, and described these interactions to include watching movies or sitting and visiting. 19 AR at 303. Plaintiff indicated that these visits occur once per week. Id. Plaintiff further 20 reported that she attends church every Sunday and does not need reminding or 21 accompaniment. Id. Plaintiff explained that her anxiety and pain sometimes cause her to 22 lash out, which results in difficulty getting along with others. Id. at 304. 23 Plaintiff noted that her conditions affect her ability to lift, squat, bend, stand, walk, 24 sit, kneel, climb stairs, complete tasks, use her hands, and get along with others. Id. 25 Plaintiff reported that she can walk for approximately ten (10) minutes before needing to 26 stop and rest, and her recovery time varies. AR at 304. Plaintiff reported that she is able 27 to pay attention for an hour, but does not finish what she starts. Id. Plaintiff further 28 3 Plaintiff noted that paying bills is difficult due to her current financial situation.

- 11 - Case 4:21-cv-00214-DCB-BGM Document 25 Filed 09/13/22 Page 12 of 40

1 reported that she is able to follow written and spoken instructions. Id. Plaintiff indicated 2 that she is able to get along with authority figures and has never lost a job because of an 3 inability to get along with others. Id. Plaintiff also reported that she does not handle stress 4 or changes in routine well. Id. Plaintiff expressed a fear of being homeless and ill. AR at 5 305. Plaintiff further indicated that she uses a cane, brace/splint and glasses, all of which 6 have been prescribed. Id. Plaintiff’s current medications included tramadol and 7 gabapentin. Id. at 306. 8 On May 23, 2019, Plaintiff completed a second Function Report—Adult. Id. at 9 335–43. Plaintiff indicated that she lived alone in an apartment. Id. at 335. Plaintiff 10 described the limitations of her medical conditions as follows: 11 Carpal tunnel in both hands and trigger in both hands make it difficult to 12 grasp, carry, and hold objects. Back pain makes it difficult to sit and stand for extended periods of time. 13 14 AR at 335. Plaintiff described her usual day to include showering, getting dressed, 15 napping, watching television, attending appointments, eating, and walking to and from the 16 mailbox. Id. at 336. Plaintiff denied caring for any other people, but reported caring for a 17 pet whom she feeds, waters, and lets outside. Id. Plaintiff indicated that she does not have 18 assistance caring for her pet. Id. Plaintiff reported that prior to her conditions, she “could 19 do everything–work, social activities, hobbies, and interests.” Id. Plaintiff noted that her 20 conditions cause difficulty sleeping due to back pain. AR at 336. 21 Plaintiff reported difficulties with personal care including bending over to put on 22 and tying her shoes; pulling herself out of the bath due to back pain; washing her hair due 23 to carpal tunnel and trigger finger; holding a razor after hand surgery; and holding utensils 24 due to trigger finger and carpal tunnel. Id. at 337. Plaintiff indicated that she did not need 25 reminders to take care of her personal hygiene; however, she uses a medicine container 26 with an alarm to remind her to take her medications. Id. 27 Plaintiff confirmed that she prepares simple meals, such as microwave meals, every 28 day, and it takes her fifteen (15) minutes or less. Id. Plaintiff observed that she “used to

- 12 - Case 4:21-cv-00214-DCB-BGM Document 25 Filed 09/13/22 Page 13 of 40

1 make full-course meals.” Id. Plaintiff reported that she vacuums with a light cordless 2 vacuum for approximately ten (10) minutes a few times per week. AR at 338. Plaintiff 3 denies being able to do other chores, noting that her cousin does the dishes, sweeps, mops, 4 and takes out the garbage. Id. 5 Plaintiff reported that she goes out once a week for appointments and can drive a 6 car without accompaniment. Id. Plaintiff further reported that she shops in stores for food 7 and personal supplies. Id. Plaintiff noted that her family helps with groceries, and that she 8 shops once per month, using an app, and it takes her approximately thirty (30) minutes. Id. 9 Plaintiff confirmed that she is able to pay bills, count change, handle a savings account, 10 and use a checkbook/money orders. AR at 339. 11 Plaintiff listed reading, sewing, and drives in the country as her hobbies. Id. 12 Plaintiff noted that she takes drives once a month on the weekends, reads daily, and does 13 not sew at all anymore. Id. Plaintiff described herself as an outdoor lover, who went hiking 14 and driving up the mountains, prior to her conditions. Id. Plaintiff confirmed that she 15 spends time with others on the telephone or visiting in person. Id. Plaintiff reported talking 16 to friends on the telephone daily, and visiting in person a few times per week. AR at 339. 17 Plaintiff also reported going to church every Sunday, but noted that she needs reminders to 18 go places and someone to accompany her. Id. Plaintiff indicated that it was difficult to go 19 out with friends. Id. at 340. 20 Plaintiff described her conditions as affecting her ability to lift, squat, bend, stand, 21 reach, walk, sit, kneel, and use her hands. Id. Plaintiff reported that she could walk for 22 between ten (10) and fifteen (15) minutes before need to stop and rest. Id. Plaintiff 23 estimated that after five (5) to ten (10) minutes of resting, she would be able to resume 24 walking. AR at 340. Plaintiff denied having any problems paying attention, confirmed 25 that she is able to finish what she starts, and indicated that she is able to follow written and 26 spoken instructions. Id. Plaintiff noted that she does not have interactions with authority 27 figures, and has never lost a job because of an inability to get along with others. Id. at 341. 28 Plaintiff reported that she handles stress well, but does not handle changes in routine well

- 13 - Case 4:21-cv-00214-DCB-BGM Document 25 Filed 09/13/22 Page 14 of 40

1 because it causes anxiety. Id. Plaintiff further reported that she does not want to be around 2 people anymore. Id. 3 Plaintiff also reported that she uses a cane, a brace/splint, and eyeglasses, all of 4 which were prescribed. AR at 341. Plaintiff described using the cane for her “unsteady 5 gait,” sleeping with her wrist braces, as well as using them during the day while driving, 6 and wearing glasses to correct her vision. Id. Plaintiff listed medications that included 7 duloxetine for drowsiness and “combination” for nausea. Id. at 342. The remarks section 8 indicated that her attorney’s assistant completed the form with her because she was unable 9 to use the pen to write, and she does not have someone to complete the Third Party Function 10 Report. Id. 11 2. Plaintiff’s Medical Records 12 a. Treatment records4 13 On March 2, 2018, Plaintiff saw Michael S. Dahip, M.D. for an urgent visit 14 regarding coughing, fevers, and left hip pain. AR at 648–52. Plaintiff described her hip 15 pain as “feel[ing] like I dislocated my hip.” Id. at 648. Plaintiff reported that the pain was 16 consistent throughout the day and aggravated by movement, weight bearing, and external 17 rotation or flexion at the hip.” Id. Regarding Plaintiff’s hip pain, Dr. Dahip noted “[n]o 18 known inciting event or trauma but [Plaintiff was] unable to perform straight leg test due 19 to pain.” Id. at 650. Dr. Dahip began Plaintiff on a trial of Tramadol. Id. 20 On June 13, 2018, Plaintiff was seen at Body Central Physical Therapy for low back 21 and hip pain. AR at 768–75. Plaintiff complained of low back and hip pain radiating to 22 the groin with walking, standing, transitional movement and sitting. Id. at 770. Plaintiff 23 further reported that her left hip was worse than her right, and she has leg weakness. Id. 24 Plaintiff “present[ed] with limited lumbar and hip mobility, weakness of the core, glutes 25 and quads, decreased flexibility, impaired balance and gait and as a result decreased 26 27 4 Although the Court has reviewed the entirety of Plaintiff’s medical records, its 28 summary is generally limited to records regarding Plaintiff’s degenerative disc disease and carpal tunnel treatment.

- 14 - Case 4:21-cv-00214-DCB-BGM Document 25 Filed 09/13/22 Page 15 of 40

1 function.” Id. at 774. On June 21, 2018, Plaintiff reported to her physical therapist that 2 she had a lot of hip and back pain the previous day, and although the pain was decreased, 3 she was having weakness. Id. at 766. Treatment records indicate significant tension in 4 Plaintiff’s left hip adductors proximally, iliotibial band, glutes, and piriformis. AR at 766. 5 Plaintiff could only tolerate gentle treatment. Id. On June 25, 2018, Plaintiff reported to 6 her physical therapist that she had fallen the previous day walking her dog. Id. at 764. 7 Plaintiff showed increased pain and weakness, and had difficulty completing her exercises. 8 Id. On June 28, 2018, Plaintiff reported soreness, without significant change in her groin 9 pain to her physical therapist. Id. at 762. Treatment records indicated some decreased 10 restrictions and increased strength in her legs and hips, but continued restriction and 11 tenderness in her left hip adductors. AR at 762. 12 On July 11, 2018, Plaintiff reported to her physical therapist that she had been sick 13 the previous week, but reported an overall reduction in her pain levels. Id. at 760. 14 Treatment records indicated Plaintiff showed improved left hip mobility and increased 15 strength in her “glutes and quad.” Id. On July 13, 2018, Plaintiff returned to physical 16 therapy, and “report[ed] that she is overall feeling better since starting [physical therapy] 17 but [] has been having [low back pain] with transitional movement.” Id. at 738. Treatment 18 records indicated that Plaintiff “tolerated manual [traction] and [dry needling] without 19 exacerbation of [symptoms].” Id. Treatment records further indication limitations due to 20 weakness and a limited range of motion. Id. On July 18, 2018, Plaintiff again returned to 21 physical therapy. AR at 740. Plaintiff reported lower pain levels and showed improved 22 hip mobility and “increased strength of the glutes and quad.” Id. Treatment notes indicate 23 that despite compliance with point of care and home exercise program, Plaintiff continued 24 to show weakness and hip pain. Id. At her July 20, 2018, physical therapy appointment, 25 Plaintiff reported “her symptoms are off an[d] on.” Id. at 736. Treatment records indicated 26 that Plaintiff “presented with increased restrictions along right lumbosacral musculature[,]” 27 but did not have any adverse reactions to treatment. Id. On July 27, 2018, Plaintiff reported 28

- 15 - Case 4:21-cv-00214-DCB-BGM Document 25 Filed 09/13/22 Page 16 of 40

1 “continued pain in left low back/hip but also has pain groin on the right” to her physical 2 therapist. AR at 734. Records indicate that she tolerated exercise well. Id. 3 On August 1, 2018, Plaintiff reported to her physical therapist that “she ha[d] been 4 rolling the inside of her thighs and so the groin has been feeling better[,] . . . [but] continues 5 to have pain in left low back and hip.” Id. at 732. Treatment records that “[s]he tolerated 6 exercises well without increase in symptoms.” Id. On August 8, 2018, Plaintiff expressed 7 concern that she had broken her big toe after a chair fell on her, but reported her hip was 8 feeling better overall. Id. at 730. Plaintiff “tolerated manual [traction] and [dry needling] 9 well and without pain.” AR at 730. Treatment records also reflected that “[s]he tolerated 10 exercises well and overall present[ed] with improved glute and core strength.” Id. On 11 August 15, 2018, Plaintiff reported doing better overall but experienced increased soreness 12 and tightness in her back after running for shelter the previous week. Id. at 753, 757. 13 Treatment records indicate that her imaging came back negative. Id. Records further 14 reflected overall improvement since the start of physical therapy. Id. at 755, 757. On 15 August 22, 2018, Plaintiff reported that her low back felt better, but her left hip and buttock 16 were sore. AR at 751. Treatment records indicated tightness with radiating symptoms on 17 the left piriformis, but Plaintiff tolerated manual traction and dry needling well and was 18 able to complete exercises afterwards without exacerbating her symptoms. Id. 19 On September 5, 2018, Plaintiff reported being “really sore today after going up to 20 [M]ount Lemmon and d[oing] some hiking.” Id. at 749. Physical therapy records indicate 21 that Plaintiff tolerated treatment well and showed improved hip mobility, as well as core 22 and glute strength, but complained of limitations due to pain. Id. On September 17, 2018, 23 Plaintiff reported to her physical therapist that her left hip and low back “continue[d] to 24 hurt but overall her [symptoms] are lower since starting [physical therapy].” Id. at 743. 25 Plaintiff further reported seeing a neurologist. AR at 743. Treatment records indicated 26 that Plaintiff tolerated exercises well, and posited her pain, weakness, and increased 27 tightness of her lumbosacral spine may be due to her Valley Fever. Id. On September 18, 28 2018, Plaintiff saw Elizabeth Connick, M.D. for a follow up regarding her Valley Fever.

- 16 - Case 4:21-cv-00214-DCB-BGM Document 25 Filed 09/13/22 Page 17 of 40

1 Id. at 592–94. Dr. Connick noted that Plaintiff developed hip pain in January 2018, “but 2 imaging did not reveal lesions to suggest cocci involvement” and no cause was determined. 3 Id. at 592. Dr. Connick opined that “the joint pains that she is experiencing in her index 4 fingers . . . do not represent active disease but the sequelae of disease.” Id. at 593. 5 On October 15, 2018, Plaintiff underwent magnetic resonance imaging (“MRI”) of 6 her spine. AR at 487–88, 505–506. Blair A. Winegar, M.D. reported “[s]evere bilateral 7 L5-S1 facet arthrosis with associated grade 1 anterolisthesis of L5 on S1 contributing to 8 mild spinal canal stenosis, severe bilateral subarticular recess narrowing, and severe 9 bilateral neural foraminal narrowing[;] . . . bilateral L5-S1 facet joint effusions[;] . . . [and] 10 [n]o abnormal contrast enhancement or marrow signal abnormality to suggest metastatic 11 disease or infection[.]” Id. at 487, 506. Dr. Winegar’s findings indicated that “[t]here 12 [wa]s severe bilateral L5-S1 facet arthrosis with associated joint effusions and a grade 1 13 anterolisthesis of L5 on S1[,]” but were otherwise unremarkable. Id. at 488, 505. 14 On December 4, 2018, Plaintiff returned to Dr. Connick for a follow up regarding 15 her Valley Fever. Id. at 589–91. Dr. Connick noted that Plaintiff “is greatly improved, 16 particularly in terms of her fatigue, and feels that she could go back to work now.” Id. at 17 590. Dr. Connick opined that this “would be good for her.” AR at 590. Dr. Connick also 18 noted Plaintiff’s “ongoing pulmonary issues, back pain, and nausea and vomiting of 19 unclear etiology” that were being evaluated by Plaintiff’s other physicians. Id. On 20 December 18, 2018, Gregory L. DeSilva, M.D. performed a trigger finger release and mass 21 excision of Plaintiff’s left thumb. Id. at 614–15. The surgery was unremarkable and mass 22 benign. Id. 23 On January 16, 2019, Plaintiff saw Helen Chan, M.D. at the Pain Institute of 24 Southern Arizona to establish care. Id. at 445–52, 461–68, 471–75. Plaintiff reported pain 25 in her “lower back and radiates down hips, and legs bilaterally (side)” that had been present 26 for seven (7) to nine (9) months. AR at 445, 461, 471. Dr. Chan reviewed Plaintiff’s 27 history. Id. at 445–47, 461–63. Dr. Chan’s review of Plaintiff’s systems noted fatigue, 28 achiness, fever, chills, cold feeling, muscle weakness, back pain, arthralgias, tingling,

- 17 - Case 4:21-cv-00214-DCB-BGM Document 25 Filed 09/13/22 Page 18 of 40

1 numbness, and muscle tenderness. Id. at 447, 463. Dr. Chan’s physical examination 2 reported no acute distress, normal gait and station, but pain with palpation with bilateral 3 L5-S1 lumbar facets and lumbar intervertebral spaces; pain in the lumbar spine in 4 extension, as well as left and right lateral rotation; mild pain with palpation of the bilateral 5 sacroiliac joints, with negative Patrick’s test, bilateral piriformis muscles, and trochanteric 6 bursae; and positive straight leg raising at 70 degrees bilaterally. Id. at 448, 464, 472. Dr. 7 Chan assessed that Plaintiff’s “pain is likely secondary to bilateral L5 radiculopathy, spinal 8 stenosis, spondylosis and degenerative disc disease and myofascial pain.” Id. at 450, 466, 9 473. Dr. Chan discussed possible steroid injections, after clearance from her infectious 10 disease provider, prior to which she increased Plaintiff’s gabapentin dosage and prescribed 11 a muscle relaxant for breakthrough pain. AR at 450, 466, 473. Plaintiff was also directed 12 to continue a home exercise plan. Id. at 450, 466, 474. 13 On January 24, 2019, Plaintiff underwent an electrodiagnostic consultation 14 regarding bilateral hand numbness and carpal tunnel syndrome. Id. at 586–88. Plaintiff’s 15 nerve conduction velocity (“NCV”) study demonstrated “[a]bnormal left median sensory 16 and motor NCVs due to prolonged distal latencies.” Id. at 586. Electromyography 17 (“EMG”) produced normal results in both arms. Id. at 586–87. Micah Etter, M.D. and 18 Colin R. Bamford, M.D. concluded Plaintiff’s results suggested moderate left carpal tunnel 19 syndrome. AR at 587. 20 On February 13, 2019, Plaintiff was seen by Anthony M. Witten, D.O. for a follow- 21 up regarding her carpal tunnel and tumor removal surgeries, as well as her spinal canal 22 stenosis. Id. at 617–20. Dr. Witten reviewed Plaintiff’s October 2018 MRI results and 23 assessed that “[b]ilateral L5-S1 facet joint effusions and may be the result of abnormal 24 motion or active inflammation in the setting of facet arthrosis.” Id. at 618. Dr. Witten did 25 not find any abnormalities suggestive of metastatic disease or infection. Id. Dr. Witten 26 also noted the small benign tumor that was removed, as well as Plaintiff’s MRI results for 27 her lower back and hip, and that Plaintiff was being followed by Orthopedic surgery and 28 pain management. AR at 618–19. Dr. Witten reviewed Plaintiff’s NCV and EMG

- 18 - Case 4:21-cv-00214-DCB-BGM Document 25 Filed 09/13/22 Page 19 of 40

1 summaries, and indicated that she was being followed by Neurology. Id. at 619. Dr. Witten 2 continued Plaintiff’s Gabapentin prescription, increased her Tramadol, and directed that 3 she continue physical therapy. Id. 4 On March 20, 2019, Plaintiff saw Dr. Dahip for a follow-up. Id. at 623–27. Dr. 5 Dahip’s review of Plaintiff’s systems was positive for night sweats, fatigue, malaise, 6 intermittent cough (stable), numbness, tingling, anxiety, and depression. Id. at 623. Dr. 7 Dahip’s physical examination was generally unremarkable, except for decreased grip 8 strength in Plaintiff’s hands, with her left worse than her right. AR at 623–24. Dr. Dahip 9 did not change any of Plaintiff’s pain medication as her “[c]urrent pain regimen [was] 10 working best for her.” Id. at 625. 11 On May 9, 2019, Plaintiff underwent left carpal tunnel release surgery and a trigger 12 release of the right thumb and index fingers. Id. at 612–13. Dr. DeSilva performed the 13 surgery, which was uneventful. Id. On May 30, 2019, Plaintiff returned to Dr. Dahip 14 because she was concerned that her hands were not healing properly. Id. at 628–34. Dr. 15 Dahip noted that Plaintiff had a significant amount of pain after hand surgery, which was 16 complicated by a soft tissue infection. AR at 628. Plaintiff indicated that she had followed 17 up with hand surgery and was put on Bactrim. Id. Plaintiff reported that her fingers are 18 swollen but feel broken, and she is having difficulty opening jars. Id. Dr. Dahip indicated 19 that radiographs showed no acute fractures, but that Plaintiff’s fingers were swollen. Id. 20 Dr. Dahip’s review of Plaintiff’s systems was unremarkable except for poor sleep, 21 shortness of breath, and hand pain with drainage. Id. Dr. Dahip’s physical examination of 22 Plaintiff was similarly unremarkable, but he noted her “[r]ight hand with 2nd digit more 23 edematous in comparison to left hand[;] [t]wo hyperkeratotic lesions on the palmar surface 24 that appear to be healing[;] [l]eft hand palmar surface median tendon sheath site with 25 hyperkeratotic lesion and minor fluctuance, no visible drainage at this time.” AR at 629. 26 Dr. Dahip directed Plaintiff to follow up with hand surgery again for post wound check, 27 and if cleared to begin hand occupational therapy. Id. 28

- 19 - Case 4:21-cv-00214-DCB-BGM Document 25 Filed 09/13/22 Page 20 of 40

1 On July 24, 2019, Plaintiff saw Dr. DeSilva for a follow-up regarding her surgeries. 2 Id. at 686–87. Plaintiff “continue[d] to endorse severe pain over her left carpal tunnel 3 incision and left thenar eminence[,] . . . [and] endorses triggering of her right index finger 4 [distal interphalangeal] joint.” Id. at 686. Plaintiff reported that her primary care physician 5 expressed concern that something was wrong. Id. Dr. DeSilva’s examination of Plaintiff’s 6 right hand demonstrated well healed incisions over the A1 pulley of her index and thumb, 7 without signs of infection. Id. Plaintiff was “able to flex/extend thumb and index finger 8 without any triggering or catching.” Id. Dr. DeSilva’s examination of Plaintiff’s left hand 9 showed a well-healed incision over her carpal tunnel without signs of infection. AR at 686. 10 Dr. DeSilva noted that Plaintiff was “extremely tender to light palpation over incision and 11 thenar eminence[,] [was] [a]ble to make a fist, but very weak[,] sensation intact to light 12 touch over [median/ulnar/radial] distribution.” Id. Plaintiff rated her pain at an eight (8). 13 Id. Dr. DeSilva opined that Plaintiff’s incisions looked “fantastic” without noticeable 14 triggering or catching. AR at 687. Dr. DeSilva reassured Plaintiff that “her course [wa]s 15 progressing as expected in terms of pain and numbness[,]” and referred her to hand therapy 16 for desensitization therapy for her continuing left hand pain. Id. 17 On August 19, 2019, Plaintiff saw Rita Wadeea, M.D. for her annual physical 18 examination. Id. at 678–80. Plaintiff reported that she was still having pain at the site of 19 her left carpal tunnel surgery and some swelling and weakness. Id. at 678. Dr. Wadeea 20 noted that Plaintiff wore her splint but never worked with physical or occupational therapy. 21 Id. Dr. Wadeea’s review of Plaintiff’s systems was unremarkable. AR at 678. Dr. 22 Wadeea’s physical examination was similarly unremarkable, but noted “left wrist 23 tenderness at the site of carpal tunnel surgery, with slight weakness, motor 4/5, [and] lower 24 spine tenderness.” Id. at 679. Dr. Wadeea recommended that Plaintiff continue to wear 25 the splint, begin working with physical or occupational therapy, and consider a follow-up 26 with hand surgery if she did not see any improvement in two (2) weeks after physical 27 therapy. Id. 28

- 20 - Case 4:21-cv-00214-DCB-BGM Document 25 Filed 09/13/22 Page 21 of 40

1 On September 25, 2019, Plaintiff returned to Dr. DeSilva for a follow-up. Id. at 2 684–85. Plaintiff reported that she had been working with a hand therapist, but continued 3 to complain of left-hand pain. Id. at 684. Dr. DeSilva noted that “on further questioning 4 she says that the carpal tunnel deep achiness has gotten better[,] . . . [and] is working with 5 a hand therapist to improve sensation.” AR at 684. Plaintiff reported difficulty grabbing 6 things with the left hand, as well as low back pain. Id. Dr. DeSilva further noted that 7 Plaintiff had an elastic stockinette on the left hand, when this was removed the carpal tunnel 8 incision appeared well healed. Id. Dr. DeSilva reported that “[t]here is no erythema[,] . . 9 . no fluctuance[,] . . . [Plaintiff] is tender with any motion of the thumb and withdraws the 10 hand[,] [s]he is tender all over so [Dr. DeSilva] cannot tell if there is distinct pillar pain[,] 11 [Plaintiff] has good digital range of motion[,] [n]o intrinsic wasting[,] . . . [n]o 12 fasciculations are noted in the thenar area[,] [and] [t]he hand is pink warm and well 13 perfused.” Id. Dr. DeSilva opined that he had “tried to provide a lot of confidence and 14 reassurance that [he] ha[s] been able to help with some but not all of her symptoms and 15 that she is the most important person for looking at the positive outlook and adapting and 16 finding what needs with her chronic pain issues.” Id. Plaintiff “seem[ed] pleased that the 17 carpal tunnel release has helped much of her symptoms.” AR at 684. 18 On November 18, 2019, Plaintiff had a new patient consult with Kurt A. Schroeder, 19 M.D. regarding her low back pain which radiated down her right leg. Id. at 708–709. Dr. 20 Schroeder reviewed Plaintiff’s MRI from October 2018 that showed “she ha[d] a slip of 21 L5 on S1.” Id. at 708. Dr. Schroeder noted that “[t]he radiologist called it severe foraminal 22 disease; I might call it moderate foraminal disease, but one can still see that the 5 roots still 23 maintain their round shape and are not particularly flattened as you would see in severe 24 stenosis, but [Plaintiff] has pain with sitting that goes down the right lower extremity, 25 buttock, a little bit in the calf, though really not much beyond that.” Id. Dr. Schroeder’s 26 physical examination was generally unremarkable, but indicated Plaintiff had pain when 27 he pushed on the right sacroiliac joint. Id. Dr. Schroeder also noted that Plaintiff had gone 28

- 21 - Case 4:21-cv-00214-DCB-BGM Document 25 Filed 09/13/22 Page 22 of 40

1 off of her fluconazole, which was treating her Valley Fever, without telling her infectious 2 disease specialist. AR at 708. 3 On December 2, 2019, Plaintiff underwent nerve conduction studies for her back 4 and right leg pain. Id. at 710–12. Adam Reynolds, M.D. reported that her nerve conduction 5 studies were within normal limits; however, “[t]he needle exam of the right lower extremity 6 shows motor unit abnormalities in the tibialis anterior and extensor hallucis longus.” Id. at 7 710. Dr. Reynolds interpreted these results as “compatible with possible mild, chronic, 8 right L5 radiculopathy.” Id. 9 On February 26, 2020, Plaintiff underwent an MRI of her lumbar spine. Id. at 721– 10 22. Nicholas Fraley, M.D. reported “[s]evere L5-S1 facet degeneration with L5 11 degenerative anterolisthesis and disc bulge[,] . . . [and] an increasing right paracentral 12 protrusion causing right lateral recess stenosis and some mass effect on descending right 13 L5 nerve root[,] [c]orrelate with right L5 radiculopathy.” AR at 722. Dr. Fraley further 14 reported “[m]ild to moderate right sided dominant spinal stenosis[,] [and] [m]oderate 15 bilateral foraminal stenosis.” Id. Dr. Fraley indicated that Plaintiff exhibited “[m]ild spinal 16 stenosis at L4-5 mostly due to posterior element degenerative changes and overgrowth[,] 17 [but] [n]o evidence of spinal infection.” Id. 18 On March 4, 2020, Plaintiff returned to Dr. DeSilva regarding continued pain after 19 surgery and concern that the procedure was not done correctly. Id. at 681–82. Plaintiff 20 reported that her hand will tremor on occasion, and she is unable to hold objects, often 21 dropping them due to weakness. Id. at 681. Dr. DeSilva noted “[t]enderness to palpation 22 of the right index PIP joint[,] [m]ild swelling[,] [w]eak fist, [u]nable to touch her index 23 finger to the [metacarpophalangeal] joint[,] [d]istal pulses 2+ radial bilaterally[,] [c]ap refill 24 regular in the rest of patient’s right hand as well as h[er] left hand[,] . . . no evidence of 25 triggering[,] . . . [n]o masses are palpable in the right index finger[,] . . . no abnormal 26 swelling[,] [flexor digitorum superficialis] and [flexor digitorum profundus] function intact 27 to right index finger.” AR at 681. Dr. DeSilva referred Plaintiff “to hand therapy for hand 28 sensation and biofeedback.” Id. Dr. DeSilva opined that her finger looked good without

- 22 - Case 4:21-cv-00214-DCB-BGM Document 25 Filed 09/13/22 Page 23 of 40

1 evidence of triggering, and further surgical intervention was not required. Id. at 682. On 2 March 20, 2020, Plaintiff returned to physical therapy for low back pain and right lower 3 extremity radicular symptoms. Id. at 797–803. Treatment records indicate “decreased 4 lumbar [active range of motion], dermatome changes in a non-dermatome pattern, 5 decreased [bilateral lower extremity] strength, myotome changes mostly with [right] 6 dorsiflexion and big toe extension, [positive] slump test on right, [positive straight leg 7 raise] test on right starting at 20 degrees, pain with OP to L5 and S1, and increased 8 paraspinal tightness especially on L.” Id. at 797, 799, 802. On March 30, 2020, Plaintiff 9 underwent physical therapy and reported that she had been hurting for a few days. AR at 10 795. Treatment records indicate that Plaintiff had “[g]ood tolerance to initial treatment 11 session.” Id. She also exhibited increased overall soreness, but no exacerbation was noted 12 during manual therapy techniques and therapeutic exercises. Id. 13 On April 3, 2020, Plaintiff returned to physical therapy complaining of severe leg 14 pain. Id. at 793–94. Treatment records noted that “[m]annual therapy [was] provided to 15 centralize symptoms, decrease muscle spasms followed by ther[apeutic] ex[ercises] to 16 improve core stabilization, decrease nerve pain.” Id. at 793. On April 7, 2020, Plaintiff 17 underwent imaging of her lumbar spine. AR at 723. Rajul Shah, M.D. reported that x-rays 18 showed “[d]egenerative grade 2 anterolisthesis L5 on S1[,] [with] [n]o significant 19 translation with weightbearing.” Id. On April 8, 2020, Plaintiff returned to physical 20 therapy. Id. at 791–92. Treatment records indicated that Plaintiff underwent therapeutic 21 exercises, as well as manual therapy techniques. Id. at 791. Plaintiff also had “[g]ood 22 tolerance with initial dry needling session . . . and [g]entle progression of core 23 stabilization[.]” Id. Two days later, Plaintiff had another physical therapy appointment, 24 and showed “[g]ood tolerance to initial trial of cupping[.]” AR at 789. She again received 25 therapeutic exercises and manual therapy techniques, and reported feeling better. Id. at 26 789. On April 13, 2020, Plaintiff saw was seen by Kurt A. Schroeder, M.D. regarding her 27 MRI. Id. at 706–707. Dr. Schroeder reported that Plaintiff had “a grade 2 slip of 5 on 1 28 that is nonmobile” and treated with one lumbar epidural steroid injection, as well as “some

- 23 - Case 4:21-cv-00214-DCB-BGM Document 25 Filed 09/13/22 Page 24 of 40

1 localized blocks without any improvement in her back and lower extremity pain.” Id. at 2 706. Dr. Schroeder further noted that on a follow-up MRI, Plaintiff had “a right 5-1 3 [herniated nucleus pulposus] that is severely narrowing her canal on that right-hand side 4 secondary to the disc rupture.” Id. Dr. Schroeder also noted that Plaintiff had “a little bit 5 of foraminal disease[.]” AR at 706. Dr. Schroeder’s physical examination of Plaintiff was 6 unremarkable except for positive straight leg raising on right. Id. Dr. Schroeder and 7 Plaintiff agreed that she would go forward with a right L5-S1 microdiscectomy. Id. On 8 April 15, 2020, Plaintiff returned to physical therapy and performed therapeutic exercises 9 followed by manual intervention. Id. at 787. Plaintiff also received instructions for a home 10 exercise program. Id. On April 17, 2020, Plaintiff had another physical therapy session. 11 AR at 785–86. Plaintiff reported “feeling much better since last session and addition of 12 towel roll stretch/self-mob.” Id. at 785. Plaintiff further reported continued mild to 13 moderate pain mainly in the right buttock. Id. Plaintiff performed therapeutic exercises 14 and received manual intervention. Id. Treatment records indicate that Plaintiff “[a]dded 15 bridges today with good tolerance[,]” which was “a big improvement” as she had been 16 unable to do bridges previously. Id. Records further indicated that Plaintiff did not have 17 any pain during exercises. AR at 785. On April 22, 2020, Plaintiff returned to physical 18 therapy and reported “minimal pain and numbness[.]” Id. at 783–84. Treatment records 19 indicated that Plaintiff performed therapeutic exercises and received manual intervention, 20 with her “[p]ain and tenderness still mainly in [her] [right] buttock.” Id. at 783. Two days 21 later, Plaintiff again reported “minimal pain and numbness” at physical therapy. Id. at 781. 22 Treatment records indicate that Plaintiff was able to tolerate the bike “without increased 23 pain reported.” Id. On April 27, 2020, Plaintiff was seen by Dr. Schroeder regarding her 24 right leg pain. AR at 704–705. Dr. Schroeder noted Plaintiff had “good strength and absent 25 right ankle jerk[,] [and] [s]traight leg raising [wa]s positive on the right.” Id. at 704. 26 Plaintiff confirmed that she wanted to proceed with surgery. Id. Dr. Schroeder further 27 noted that Plaintiff had “a grade 2 slip on 5 on 1 but she has, interestingly enough, not 28 much foraminal disease on the right, a lot more on the left where she does not have any

- 24 - Case 4:21-cv-00214-DCB-BGM Document 25 Filed 09/13/22 Page 25 of 40

1 pain so a simple microdiscectomy is contemplated and is what she has elected to do.” Id. 2 Dr. Schroeder’s review of Plaintiff’s systems was unremarkable. Id. On April 29, 2020, 3 Plaintiff returned to physical therapy and indicated that she was sore. AR at 779–80. 4 Plaintiff performed therapeutic exercises and underwent manual therapy. Id. at 779. 5 Treatment records indicated “[d]ecreased pain after towel roll exercise.” Id. 6 On May 1, 2020, Plaintiff was discharged from physical therapy to have surgery. 7 Id. at 776. On May 6, 2020, Plaintiff underwent a right-sided L5-S1 microdiscectomy and 8 dissection of the S1 root from hypertrophied soft tissue. Id. at 716–17. The surgery was 9 unremarkable. AR at 716–17. On May 18, 2020, Plaintiff saw Dr. Schroeder for a follow- 10 up one (1) week after her right L5-S1 resection of a herniated nucleus pulposus. Id. at 702– 11 703. Plaintiff reported that her “right leg [wa]s doing great but she has had a lot of . . . 12 excruciating left leg pain.” Id. at 702. Plaintiff reported that even Percocet did not manage 13 the pain. Id. Dr. Schroeder noted that Plaintiff had “good strength on both sides[,] 14 [s]traight leg raising [wa]s positive on the left, negative on the right[,] [s]he c[ould] toe 15 walk and heel walk[,] [and] [h]er incision look[ed] good.” Id. Dr. Schroeder opined that 16 Plaintiff “look[ed] like someone who maybe has ruptured a disc opposite the side of her 17 surgery.” AR at 702. Dr. Schroeder ordered an MRI of Plaintiff’s lumbar spine and added 18 an anti-inflammatory medication. Id. Dr. Schroeder’s review of Plaintiff’s symptoms was 19 unremarkable. Id. On May 13, 2020, Plaintiff underwent imaging of her lumbar spine. Id. 20 at 724–26. Plaintiff’s post-operative MRI showed a residual disc bulge with “mixed signal 21 intensity material in the right lateral recess which is largely enhancing but with a small 22 focus of central non-enhancement on the axial enhanced T1 sequences[,] . . . correlate with 23 any right S1 radiculopathy.” Id. at 725. Dr. Fraley observed that “[o]n the left, the findings 24 have slightly progressed from recent prior and the far lateral herniation is intimate with the 25 exiting left L5 nerve root[,] [c]orrelate with left L5 radiculopathy.” AR at 725. Dr. Fraley 26 indicated that this was a subtle change. Id. On x-ray, Dr. Fraley noted “[s]table 1.2 cm L5 27 anterolisthesis with associated advanced facet arthrosis and L5-S1 degenerative disc 28 disease.” Id. at 726. On May 15, 2020, Plaintiff underwent venous duplex imaging of her

- 25 - Case 4:21-cv-00214-DCB-BGM Document 25 Filed 09/13/22 Page 26 of 40

1 left lower extremity. Id. Matthew Namanny, D.O. found “no evidence of acute deep or 2 superficial vein thrombosis in [Plaintiff’s] left lower extremity.” Id. Dr. Namanny noted 3 that this was a limited study due to Plaintiff’s inability to tolerate probe pressure. AR at 4 727. On May 18, 2020, Plaintiff was seen by Kurt A. Schroeder, M.D. for an incision 5 check. Id. at 700–701. Plaintiff reported her right leg pain was “totally gone.” Id. at 700. 6 Dr. Schroeder indicated that Plaintiff later developed left leg pain. Id. Dr. Schroeder 7 reported Plaintiff deep vein thrombosis study (“DVT”) “was clean” and her MRI looked 8 “pretty clean.” Id. Dr. Schroeder described Plaintiff’s left leg pain as “down the whole 9 leg” and “very positional.” AR at 700. Dr. Schroeder noted that they had put Plaintiff on 10 steroids, and after “three days, she started to have some drainage.” Id. Dr. Schroeder 11 stopped the steroids and started her on an antibiotic. Id. On May 20, 2020, Plaintiff 12 returned to Dr. Schroeder for a post-operative follow-up. Id. at 698–99. Dr. Schroeder 13 reported that Plaintiff’s DVT study “was clean” and her post-operative MRI looked 14 “good.” Id. at 698. Dr. Schroeder further noted that Plaintiff still “has that anterolisthesis 15 of 5 on 1.” AR at 698. Dr. Schroeder also reported Plaintiff had good strength, negative 16 straight leg raising, and that she could sit. Id. Dr. Schroeder described Plaintiff as smiling 17 and joking a bit, although not completely back to normal. Id. Plaintiff indicated “that now 18 it is not so much the pain, but she notices numbness in the lateral aspect of her left foot.” 19 Id. Dr. Schroeder noted that Plaintiff’s reflexes were “2+ at the knees and 2+ at both ankles 20 with downgoing toes.” Id. Dr. Schroeder’s review of Plaintiff’s systems was 21 unremarkable. AR at 698. On May 27, 2020, Plaintiff returned to Dr. Schroeder for a post- 22 operative follow-up. Id. at 696–97. Dr. Schroeder reported that Plaintiff had a skin staph 23 infection that was sensitive to the Bactrim, “[h]er incision looks good[,] [t]here is no 24 drainage[,] [t]he scab looks good[,] [s]he has normal strength, symmetric 2+ and even ankle 25 jerks are 2+[,] [s]he had good strength in the dorsiflexors and plantar flexors[,] [s]traight 26 leg raising is negative.” Id. at 696. Dr. Schroeder described Plaintiff as smiling and joking. 27 Id. Dr. Schroeder further noted that “[t]he excruciating pain on the left side is gone[.]” Id. 28 Dr. Schroeder instructed Plaintiff to “walk, walk, walk” and she indicated that she is out

- 26 - Case 4:21-cv-00214-DCB-BGM Document 25 Filed 09/13/22 Page 27 of 40

1 taking car trips. AR at 696. Dr. Schroeder’s review of Plaintiff’s systems was 2 unremarkable. Id. 3 On June 5, 2020, Plaintiff saw Dr. Schroeder for a follow-up regarding her 4 continued left leg pain. Id. at 694–95. Dr. Schroeder reported that after the operation for 5 Plaintiff’s right leg pain, it did not return; however, “she developed left leg pain and also 6 she was on Bactrim for some skin staph that was growing there.” Id. at 694. Plaintiff 7 reported increased pain down her left leg, which never gets to the top or bottom of the foot, 8 although her whole foot felt numb. Id. Dr. Schroeder’s physical examination of Plaintiff 9 showed “normal strength in the left leg with only rachety, giveway, nonphysiologic 10 weakness, [s]traight leg raising is theatrically positive at 5 degrees[,] [t]he reflexes are 11 preserved at the knees at 2+ and 2+ at both ankles[,] [and] [t]he incision looks good.” AR 12 at 694. Dr. Schroeder’s review of Plaintiff’s systems was unremarkable. Id. On June 9, 13 2020, Plaintiff underwent nerve conduction studies for her left leg pain. Id. at 713–15. Dr. 14 Reynolds observed that her nerve conduction studies in the left lower extremity were within 15 normal limits, but the needle exam showed abnormalities. Id. at 713. Dr. Reynolds found 16 it was an “[a]bnormal study with mild distal neurogenic changes[,] [and] [could not] 17 exclude left L5/S1 radiculopathy.” Id. 18 On July 17, 2020, Plaintiff was seen by Kurt A. Schroeder, M.D. for a follow-up. 19 AR at 692. Dr. Schroeder reported that Plaintiff had a “total resolution” of the right leg 20 pain post-surgery. Id. Dr. Schroeder indicated that she began having left leg pain 21 approximately four (4) days postop. Id. Dr. Schroeder further reported that at her visit at 22 the end of May 2020, Plaintiff looked good, but then at the beginning of June, she was 23 having more left hip pain. Id. Dr. Schroeder reported that an EMG showed L5 24 radiculopathy without “much pressure on the 5 root.” Id. Dr. Schroeder noted that “[h]er 25 incision looks perfect[,] [s]traight leg raising is negative[,] [s]he has good strength[,] [s]he 26 can toe walk and all of her L5 muscles are normally strong.” AR at 692. Dr. Schroeder 27 further noted that insurance denied an additionally MRI and he recommended pool therapy. 28 Id. Dr. Schroeder opined that Plaintiff looked a lot better, and reported feeling better than

- 27 - Case 4:21-cv-00214-DCB-BGM Document 25 Filed 09/13/22 Page 28 of 40

1 on her previous visit. Id. Dr. Schroeder’s review of Plaintiff’s systems was unremarkable. 2 Id. 3 b. Examining physician records—Justin S. Phelps, Ed.D. 4 On July 13, 2019, Plaintiff was seen by Justin S. Phelps, Ed.D. for a psychological 5 evaluation upon referral from the Arizona Department of Economic Security (“AZDES”). 6 AR at 662–66. Dr. Phelps reviewed Plaintiff’s medical records and history. Id. at 662. 7 Plaintiff reported that her “hand injury makes everything really hard.” Id. at 663. Plaintiff 8 indicated that she “used to be very productive” and no longer does “much of anything” in 9 terms of socializing or entertainment. Id. Plaintiff further indicated that she was not 10 working “[m]ostly because of Valley Fever . . . it got really bad.” Id. (ellipses in original). 11 Dr. Phelps noted Plaintiff’s medical conditions included neuropathy, asthma, severe 12 sciatica, Valley Fever, carpal tunnel, spinal stenosis, chronic pain, and lower back pain. 13 AR at 663. 14 Dr. Phelps administered the Folstein Mini-Mental Status Examination. Id. at 664. 15 Plaintiff achieved a score of 29 out of a possible 30 on the exam. Id. Dr. Phelps’s 16 observations were generally unremarkable, but noted Plaintiff had a poor grip and indicated 17 decreased sleep. Id. at 664–66. Dr. Phelps observed that Plaintiff’s “[d]epression appears 18 to be mild to moderate in nature and chronic[,] . . . [and] amenable to therapy.” Id. at 666. 19 Dr. Phelps further opined that Plaintiff’s “[a]nxiety levels are situational and not 20 diagnosable[,] . . . [and] [n]o other mood or thought disorders were present.” AR at 666. 21 Dr. Phelps completed a Psychological/Psychiatric Medical Source Statement 22 regarding Plaintiff. Id. at 667–68. Dr. Phelps opined that although there was a current 23 diagnosis, he did not expect it to last for twelve (12) continuous months. Id. at 667. Dr. 24 Phelps further opined that Plaintiff was generally unlimited in the areas of understanding 25 and memory; sustained concentration and persistence; social interaction; and adapting to 26 change. Id. at 667–68. Dr. Phelps noted mild limitations in Plaintiff’s overall abilities in 27 work/life procedures; maintaining regular attendance; working with co-workers; and 28 socialization. Id. at 667.

- 28 - Case 4:21-cv-00214-DCB-BGM Document 25 Filed 09/13/22 Page 29 of 40

1 3. Vocational Expert Gretchen A. Bakkenson’s Testimony 2 Ms. Bakkenson testified as a vocational expert at the administrative hearing. AR at 3 19, 53–58. Ms. Bakkenson described Plaintiff’s past relevant work in hospital billing, 4 Dictionary of Occupational Titles (“DOT”) number 214.482-010, as semi-skilled, having 5 a Specific Vocational Preparation (“SVP”) of 4, and exertional level of sedentary. Id. at 6 53. Ms. Bakkenson described the job of customer service representative, DOT number 7 219.387-014, as semi-skilled, having an SVP of 4, and sedentary exertional level.5 Id. at 8 54–55. Ms. Bakkenson also described the receptionist position, DOT 237.367-038, semi- 9 skilled, with an SVP of 4, and sedentary exertional level. Id. at 53. Ms. Bakkenson 10 observed that Plaintiff described the receptionist position as sedentary to light. Id. Ms. 11 Bakkenson also noted that Plaintiff worked as an administrative assistant, but did not meet 12 an SVP. AR at 54. 13 The ALJ asked Ms. Bakkenson to consider a hypothetical individual of Plaintiff’s 14 age, education, and work history, and who retains the residual functional capacity to 15 perform a range of up to light work, but is limited to the occasional climbing of ramps and 16 stairs; no ladders, ropes, or scaffolds; frequent balancing; and occasional stooping, 17 kneeling, crouching, and crawling. Id. at 55. Ms. Bakkenson opined that such an 18 individual could perform all the jobs that she had described. Id. 19 The ALJ then asked about a second hypothetical individual of Plaintiff’s age, 20 education, and work history, and who is limited to a full range of sedentary work. Id. Ms. 21 Bakkenson opined that such an individual would be able to perform all of the jobs that she 22 had previously described. Id. The ALJ then added additional limitations to the second 23 hypothetical individual, including that they could only sit for twenty (20) minutes before 24 they would need to go from sitting to standing. AR at 55–56. Ms. Bakkenson opined that 25 there would be no work for such an individual, because the individual would end up being 26 off-task more than allowed. Id. at 56. Ms. Bakkenson further opined that if the individual 27 28 5 Ms. Bakkenson initially described this position as telemarketing, but corrected it upon clarification by the Plaintiff. AR at 53–55.

- 29 - Case 4:21-cv-00214-DCB-BGM Document 25 Filed 09/13/22 Page 30 of 40

1 could sit for thirty (30) minutes before needing to stand up and stretch for a couple of 2 minutes, then they would be able to maintain employment. Id. Ms. Bakkenson explained 3 that the off-task limitation was no more than ten (10) percent. Id. at 56–57. Ms. Bakkenson 4 confirmed that her knowledge regarding the sit/stand limitations was not from the DOT, 5 but her own experience and her testimony was otherwise consistent with the DOT and 6 Standard Occupational Classification (“SCO”). Id. at 57–58. 7 Upon questioning by Plaintiff’s counsel, Ms. Bakkenson opined that Plaintiff’s 8 previous work involved frequent handling and fingering. AR at 57. Plaintiff’s counsel 9 further inquired about the second hypothetical individual, who could stand and walk for no 10 more than ten (10) to fifteen (15) minutes at a time for a total of four (4) hours in the day 11 or sit no more than ten (10) to fifteen (15) minutes at a time for a total of four (4) hours of 12 the day; lift ten (10) pounds occasionally, and less than ten pounds frequently. Id. Ms. 13 Bakkenson reiterated her opinion regarding the amount of time such an individual would 14 be off-task and how that would preclude employment. Id. Plaintiff’s counsel also asked 15 about work availability for a hypothetical person at a full range of sedentary work with 16 occasional handling and fingering. Id. Ms. Bakkenson opined that such an individual 17 would not be able to perform Plaintiff’s past work, and that there would not be any 18 transferrable skills. Id. at 58. 19 4. Lay Witness Testimony—Meredith Reams 20 On March 14, 2019, Plaintiff’s cousin, Meredith Reams, completed a Function 21 Report—Adult—Third Party. AR at 316–23. Ms. Reams reported that she has known 22 Plaintiff for eight (8) years and spends all between thirty (30) and 180 minutes a day, up to 23 five (5) days per week helping with household chores. Id. at 316. Ms. Reams described 24 Plaintiff’s living situation as alone in an apartment. Id. Ms. Reams observed that Plaintiff 25 is usually in a lot of pain and not feeling well when she visits. Id. Ms. Reams further 26 reported that Plaintiff is often laying down resting, although she will push through her pain 27 to do what she can. Id. Ms. Reams indicated that Plaintiff has a dog that she feeds and 28 cares for. AR at 317. Ms. Reams described Plaintiff prior to her illness as someone who

- 30 - Case 4:21-cv-00214-DCB-BGM Document 25 Filed 09/13/22 Page 31 of 40

1 worked and lived a normal self-supporting life. Id. Ms. Reams recalled that Plaintiff 2 occasionally mentioned that she had not slept due to pain. Id. Ms. Reams noted that she 3 will either ask or remind Plaintiff about her medication to ensure that she has taken it. Id. 4 at 318. 5 Ms. Reams confirmed that Plaintiff can prepare her own meals, which include 6 frozen meals, salads, microwavable vegetables, or other easily prepared meals. Id. Ms. 7 Reams indicated that Plaintiff prepares meals daily, and it takes her approximately ten (10) 8 to twenty (20) minutes. AR at 318. Ms. Reams observed that Plaintiff has to choose how 9 and what she cooks because she cannot stand for long. Id. Ms. Reams reported that 10 Plaintiff struggles to maintain her apartment, but does the dishes, floor, bathroom, and 11 laundry. Id. Ms. Reams indicated that Plaintiff goes out daily depending on the weather. 12 Id. at 319. Ms. Reams further reported that Plaintiff can drive a car and goes out alone. Id. 13 Ms. Reams confirmed that Plaintiff can shop in stores for food, household 14 items/necessities, and dog food, and does so every other week. AR at 319. Ms. Reams 15 reported that Plaintiff can count change, handle a savings account, and use a 16 checkbook/money orders, but cannot pay bills because she had not been able to work. Id. 17 Ms. Reams listed Plaintiff’s hobbies as watching television. Id. at 320. Ms. Reams 18 indicated that she tries to take Plaintiff for a ride at least once per week. Id. Ms. Reams 19 stated that prior to Plaintiff’s illness they would travel, hike, and do other outdoor activities 20 together. Id. Ms. Reams reported that Plaintiff spends time with others and visits daily 21 with friends and family. AR at 320. Ms. Reams also reported that Plaintiff attends church 22 once a week and doctor’s appointments regularly. Id. Ms. Reams noted that Plaintiff does 23 not need reminders or someone to accompany her. Id. Ms. Reams confirmed Plaintiff’s 24 ability to get along with others, but indicated that she does not go out as much because 25 environmental stressors “make her sicker.” Id. at 321. 26 Ms. Reams reported that Plaintiff’s illness impacted her ability to lift, squat, bend, 27 stand, walk, and climb stairs. Id. Ms. Reams further noted that Plaintiff is unable to lift 28 any heavy items and is tired and out of breath after walking or climbing stairs. AR at 321.

- 31 - Case 4:21-cv-00214-DCB-BGM Document 25 Filed 09/13/22 Page 32 of 40

1 Ms. Reams indicated that Plaintiff could walk for five (5) minutes before requiring five (5) 2 minutes of rest before resuming. Id. Ms. Ream confirmed that Plaintiff is capable of 3 finishing what she starts and is able to follow written and spoken directions. Id. Ms. Reams 4 denied that Plaintiff had ever lost a job due to problems getting along with others. Id. at 5 322. Ms. Reams noted that Plaintiff had difficulty dealing with stress, but had not given 6 up. Id. Ms. Reams reported that Plaintiff used a cane, brace/splint, and glasses regularly 7 and all were prescribed. AR at 322. 8 II. STANDARD OF REVIEW 9 The factual findings of the Commissioner shall be conclusive so long as they are 10 based upon substantial evidence and there is no legal error. 42 U.S.C. §§ 405(g), 11 1383(c)(3); Tommasetti v. Astrue, 533 F.3d 1035, 1038 (9th Cir. 2008). This Court may 12 “set aside the Commissioner’s denial of disability insurance benefits when the ALJ’s 13 findings are based on legal error or are not supported by substantial evidence in the record 14 as a whole.” Tackett v. Apfel, 180 F.3d 1094, 1097 (9th Cir. 1999) (citations omitted); see 15 also Treichler v. Comm’r of Soc. Sec. Admin., 775 F.3d 1090, 1098 (9th Cir. 2014). 16 Substantial evidence is “‘more than a mere scintilla[,] but not necessarily a 17 preponderance.’” Tommasetti, 533 F.3d at 1038 (quoting Connett v. Barnhart, 340 F.3d 18 871, 873 (9th Cir. 2003)); see also Garrison v. Colvin, 759 F.3d 995, 1009 (9th Cir. 2014). 19 Further, substantial evidence is “such relevant evidence as a reasonable mind might accept 20 as adequate to support a conclusion.” Parra v. Astrue, 481 F.3d 742, 746 (9th Cir. 2007). 21 Where “the evidence can support either outcome, the court may not substitute its judgment 22 for that of the ALJ.” Tackett, 180 F.3d at 1098 (citing Matney v. Sullivan, 981 F.2d 1016, 23 1019 (9th Cir. 1992)); see also Massachi v. Astrue, 486 F.3d 1149, 1152 (9th Cir. 2007). 24 Moreover, the court may not focus on an isolated piece of supporting evidence, rather it 25 must consider the entirety of the record weighing both evidence that supports as well as 26 that which detracts from the Secretary’s conclusion. Tackett, 180 F.3d at 1098 (citations 27 omitted). 28

- 32 - Case 4:21-cv-00214-DCB-BGM Document 25 Filed 09/13/22 Page 33 of 40

1 III. ANALYSIS 2 A. The Five-Step Evaluation 3 The Commissioner follows a five-step sequential evaluation process to assess 4 whether a claimant is disabled. 20 C.F.R. § 404.1520(a)(4). This process is defined as 5 follows: Step One asks is the claimant “doing substantial gainful activity[?]” 20 C.F.R. § 6 404.1520(a)(4)(i). If yes, the claimant is not disabled. Step Two considers if the claimant 7 has a “severe medically determinable physical or mental impairment[.]” 20 C.F.R. § 8 404.1520(a)(4)(ii). If not, the claimant is not disabled. Step Three determines whether the 9 claimant’s impairments or combination thereof meet or equal an impairment listed in 20 10 C.F.R. Pt. 404, Subpt. P, App.1. 20 C.F.R. § 404.1520(a)(4)(iii). If not, the claimant is 11 not disabled. Step Four considers the claimant’s residual functional capacity and past 12 relevant work. 20 C.F.R. § 404.1520(a)(4)(iv). If claimant can still do past relevant work, 13 then he or she is not disabled. Step Five assesses the claimant’s residual functional 14 capacity, age, education, and work experience. 20 C.F.R. § 404.1520(a)(4)(v). If it is 15 determined that the claimant can make an adjustment to other work, then he or she is not 16 disabled. Id. 17 In the instant case, the ALJ found that Plaintiff had not engaged in substantial 18 gainful activity since her alleged onset date of December 1, 2017. AR at 22. At step two 19 of the sequential evaluation, the ALJ found that “[t]he claimant has the following severe 20 impairments: degenerative disc disease; peripheral neuropathy, asthma, status post carpal 21 tunnel release (20 CFR 404.1520(c) and 416.920(c)).” Id. at 22. At step three, the ALJ 22 further found that “[t]he claimant does not have an impairment or combination of 23 impairments that meets or medically equals the severity of one of the listed impairments in 24 20 CFR Part 404, Subpart P, Appendix 1 (20 CFR 404.1520(d), 404.1525, 404.1526, 25 416.920(d), 416.925 and 416.926).” Id. at 27. Prior to step four and “[a]fter careful 26 consideration of the entire record,” the ALJ determined that “the claimant has the residual 27 functional capacity to perform light work as defined in 20 CFR 404.1567(b) and 416.967(b) 28 except she can only occasionally climb ramps and stairs, never climb ladders, ropes, and

- 33 - Case 4:21-cv-00214-DCB-BGM Document 25 Filed 09/13/22 Page 34 of 40

1 scaffolds, frequently balance, and occasionally stoop, kneel, crawl, and crouch.” Id. at 27. 2 At step four, the ALJ found that “[t]he claimant is capable of performing past relevant work 3 as a hospital billing clerk, receptionist, and customer service representative.” Id. at 32. 4 Accordingly, the ALJ determined that Plaintiff was not disabled. Id. 5 B. Plaintiff’s Symptoms 6 Plaintiff asserts that the ALJ failed to set forth “clear and convincing” reasons for 7 discounting her symptom testimony. Opening Br. (Doc. 21) at 6. Defendant counters that 8 “[t]he ALJ properly evaluated Plaintiff’s subjective symptom testimony along with the 9 other record evidence in assessing her RFC, and substantial evidence supports the ALJ’s 10 findings[.]” Response (Doc. 22) at 4 (citations omitted). The Court agrees with Respondent 11 and finds the ALJ provided clear and convincing reasons for discounting Plaintiff’s 12 testimony, and remand is inappropriate. 13 1. Legal Standard 14 An ALJ must engage in a two-step analysis to evaluate a claimant’s subjective 15 symptom testimony. Lingenfelter v. Astrue, 504 F.3d 1028, 1035–36 (9th Cir. 2007). First, 16 “a claimant who alleges disability based on subjective symptoms ‘must produce objective 17 medical evidence of an underlying impairment which could reasonably be expected to 18 produce the pain or other symptoms alleged[.]’” Smolen v. Chater, 80 F.3d 1273, 1281– 19 82 (9th Cir. 1996) (quoting Bunnell v. Sullivan, 947 F.2d 341, 344 (9th Cir. 1991) (en banc) 20 (internal quotations omitted)); see also Ghanim v. Colvin, 763 F.3d 1154, 1163 (9th Cir. 21 2014). Further, “the claimant need not show that her impairment could reasonably be 22 expected to cause the severity of the symptom she has alleged; she need only show that it 23 could reasonably have caused some degree of the symptom.” Smolen, 80 F.3d at 1282 24 (citations omitted); see also Trevizo v. Berryhill, 871 F.3d 664, 678 (9th Cir. 2017). “Nor 25 must a claimant produce ‘objective medical evidence of the pain or fatigue itself, or the 26 severity thereof.’” Garrison v. Colvin, 759 F.3d 995, 1014 (9th Cir. 2014) (quoting 27 Smolen, 80 F.3d at 1282). “[I]f the claimant meets this first test, and there is no evidence 28 of malingering, ‘the ALJ can reject the claimant’s testimony about the severity of her

- 34 - Case 4:21-cv-00214-DCB-BGM Document 25 Filed 09/13/22 Page 35 of 40

1 symptoms only by offering specific, clear and convincing reasons for doing so.’” 2 Lingenfelter, 504 F.3d at 1036 (quoting Smolen, 80 F.3d at 1281); see also Burrell v. 3 Colvin, 775 F.3d 1133, 1137 (9th Cir. 2014) (rejecting the contention that the “clear and 4 convincing” requirement had been excised by prior Ninth Circuit case law). “This is not 5 an easy requirement to meet: ‘The clear and convincing standard is the most demanding 6 required in Social Security cases.’” Garrison, 759 F.3d at 1015 (quoting Moore v. Comm’r 7 of Soc. Sec. Admin., 278 F.3d 920, 924 (9th Cir. 2002)). 8 2. Analysis 9 The ALJ acknowledged the two-step process for assessing Plaintiff’s symptom 10 testimony. AR at 27. The ALJ remarked that “[a]fter careful consideration of the evidence 11 . . . the claimant’s medically determinable impairments could reasonably be expected to 12 cause at least the bulk of the basic alleged symptoms; however, the claimant’s statements 13 concerning the intensity, persistence and limiting effects of these symptoms are not entirely 14 consistent with the medical evidence and other evidence in the record for the reasons 15 explained in this decision.” Id. The ALJ went on to review the medical records, weigh the 16 opinion testimony of certain medical professionals, and considered Plaintiff’s own 17 statements. See id. at 27–32. 18 SSR 16-3p6 states, in relevant part: 19 We will not evaluate an individual’s symptoms based solely on objective medical evidence unless that objective medical evidence supports a finding 20 that the individual is disabled. We will evaluate an individual’s symptoms 21 based on the evidence in an individual’s record as described below; however, not all of the types of evidence described below will be available or relevant 22 in every case. 23 *** 24 In evaluating an individual’s symptoms, it is not sufficient for our adjudicators to make a single, conclusory statement that “the individual’s 25 statements about his or her symptoms have been considered” or that “the 26 statements about the individual’s symptoms are (or are not) supported or 27 6 Social Security Rulings are “binding on all components of the Social Security 28 Administration.” 20 C.F.R. §§ 402.35(b)(1) and (2); Heckler v. Edwards, 465 U.S. 873 n.3, 104 S. Ct. 1532, 79 L. Ed. 2d 878 (1984).

- 35 - Case 4:21-cv-00214-DCB-BGM Document 25 Filed 09/13/22 Page 36 of 40

1 consistent.” It is also not enough for our adjudicators simply to recite the 2 factors described in the regulations for evaluating symptoms. The determination or decision must contain specific reasons for the weight given 3 to the individual’s symptoms, be consistent with and supported by the evidence, and be clearly articulated so the individual and any subsequent 4 reviewer can assess how the adjudicator evaluated the individual’s 5 symptoms. 6 SSR 16-3p, available at 2017 WL 5180304, at *5, 10 (October 25, 2017). “[T]he ALJ is 7 not ‘required to believe every allegation of disabling pain, or else disability benefits would 8 be available for the asking, a result plainly contrary to 42 U.S.C. § 423(d)(5)(A).’” Molina 9 v. Astrue, 674 F.3d 1104, 1112 (9th Cir. 2012), superseded by regulation on other grounds 10 (quoting Fair v. Bowen, 885 F.2d 597, 603 (9th Cir. 1989)). Plaintiff “bears the burden of 11 proving that an impairment is disabling.” Miller v. Heckler, 779 F.2d 845, 849 (9th Cir. 12 1985) (citations omitted). 13 a. 12-month durational requirement 14 The ALJ “d[id] not find any 12-month period establishing manipulative limitations 15 or any related exertional limitations precluding light work due [to] the history of carpal 16 tunnel syndrome or any other condition of either upper extremity.” AR at 28. The ALJ 17 provided a detailed review of the Plaintiff’s medical records regarding her carpal tunnel 18 syndrome. Id. at 28–29. On January 24, 2019, Plaintiff underwent an electrodiagnostic 19 consultation, the results of which suggested moderate left carpal tunnel syndrome. Id. at 20 586–87. On May 9, 2019, Plaintiff underwent left carpal tunnel release surgery and a 21 trigger release of the right thumb and index fingers. Id. at 612–13. As detailed by the ALJ, 22 Plaintiff continued to follow-up with Dr. DeSilva through September 25, 2019. Id. at 28– 23 29, 684–87. Plaintiff indicated that she had been working with a hand therapist, and that 24 “the carpal tunnel release ha[d] helped much of her symptoms.” Id. at 684. Six months 25 elapsed without further treatment regarding her carpal tunnel, when Plaintiff returned to 26 Dr. DeSilva on March 4, 2020. AR at 681–82. Dr. Silva opined that Plaintiff’s finger 27 looked good without evidence of triggering, and referred her to hand therapy. Id. The 28

- 36 - Case 4:21-cv-00214-DCB-BGM Document 25 Filed 09/13/22 Page 37 of 40

1 ALJ’s finding that Plaintiff did not establish a 12-month period of manipulative limitations 2 is supported by substantial evidence. 3 b. Dr. DeSilva’s notes 4 The ALJ provided a rational interpretation of the objective medical evidence and 5 notes of treatment providers, which were inconsistent with Plaintiff’s subjective 6 complaints. See Mitchell v. Saul, 2021 WL 3032667, at *8 (D. Nev. July 16, 2021) (ALJ 7 is allowed to consider whether a “claimant’s statements concerning the intensity, 8 persistence and limiting effects of [her] symptoms are not entirely consistent with the 9 medical evidence and other evidence in the record.”). After a detailed review with citations 10 to the administrative record, the ALJ concluded that “repeated examinations have shown 11 good results from the surgeries[,] [and] [t]he claimant has made contemporaneous 12 statements of improvement.” Id. at 29. 13 Plaintiff asserts that “[t]he ALJ’s reliance on Dr. DeSilva’s dismissive notes is not 14 supported by substantial evidence, and is not a clear and convincing reason to discount Ms. 15 Malone’s symptom testimony regarding her hand pain and weakness with handling and 16 fine fingering.” Pl.’s Opening Br. (Doc. 21) at 9. Where “the evidence can support either 17 outcome, the court may not substitute its judgment for that of the ALJ.” Tackett, 180 F.3d 18 at 1098 (citing Matney v. Sullivan, 981 F.2d 1016, 1019 (9th Cir. 1992)); see also Massachi 19 v. Astrue, 486 F.3d 1149, 1152 (9th Cir. 2007). The Court finds that the ALJ’s reliance on 20 Dr. DeSilva’s treatment records was appropriate. 21 c. Ability to drive 22 The ALJ noted that “Dr. DeSilva’s repeated examinations and comments and the 23 fact the claimant drove to the psychological examination” weighed against the consultative 24 psychologist’s observation that “claimant demonstrated very poor grip and could not grip 25 a pen to write.” AR at 29. Plaintiff asserts that because Plaintiff “testified that she is unable 26 to spend more than a few minutes seated in a car . . . [s]ubstantial evidence does not support 27 a finding that objective evidence showing significant impairment in handling and fingering 28 is overshadowed by the ability to drive.” Plaintiff’s contention is without merit. As an

- 37 - Case 4:21-cv-00214-DCB-BGM Document 25 Filed 09/13/22 Page 38 of 40

1 initial matter, an ALJ is entitled to consider “whether the claimant engages in daily 2 activities inconsistent with the alleged symptoms.” Lingenfelter v. Astrue, 504 F.3d 1028, 3 1040 (9th Cir. 2007). The ALJ is also allowed to consider whether a “claimant’s statements 4 concerning the intensity, persistence and limiting effects of [her] symptoms are not entirely 5 consistent with the medical evidence and other evidence in the record.” Mitchell, 2021 6 WL 3032667, at *8 (alteration in original). Here, Plaintiff testified that she is able to drive, 7 and does so. See AR at 45, 271, 302, 338. Plaintiff’s testimony, as well as Dr. Silva 8 treatment records, were inconsistent with the observation of Dr. Phelps. Furthermore, the 9 ALJ’s discussion in this regard was limited to Plaintiff’s ability to use her upper 10 extremities. See id. at 28–29. The ALJ properly weighed the evidence as it was his 11 responsibility to do. 12 d. Improvement in Hand Symptoms 13 Plaintiff asserts that the ALJ’s finding that Plaintiff “made contemporaneous 14 statements of improvement with respect to her hand . . . is an exaggeration of the record.” 15 Pl.’s Opening Br. (Doc. 21) at 10. The Court will not reweigh the evidence. Where “the 16 evidence can support either outcome, the court may not substitute its judgment for that of 17 the ALJ.” Tackett, 180 F.3d at 1098 (citing Matney v. Sullivan, 981 F.2d 1016, 1019 (9th 18 Cir. 1992)); see also Massachi v. Astrue, 486 F.3d 1149, 1152 (9th Cir. 2007). The Court 19 finds that the ALJ’s findings regarding Plaintiff’s contemporaneous statements well 20 supported by the record. 21 e. Physical therapy 22 Plaintiff concedes that “the medical evidence of record does not contain notes of 23 hand-related physical therapy,” but notes the reference to such therapy occurring. Pl.’s 24 Opening Br. (Doc. 21) at 11 (citation omitted). Plaintiff asserts that “the ALJ did not 25 explain why he rejected the explanation that physical therapists and/or insurers will only 26 engage in physical therapy for one body part at a time.” Id. “A claimant’s subjective 27 symptom testimony may be undermined by ‘an unexplained, or inadequately explained, 28 failure to . . . follow a prescribed course of treatment. While there are any number of good

- 38 - Case 4:21-cv-00214-DCB-BGM Document 25 Filed 09/13/22 Page 39 of 40

1 reasons for not doing so, a claimant's failure to assert one, or a finding by the ALJ that the 2 profferred [sic] reason is not believable, can cast doubt on the sincerity of the claimant’s 3 pain testimony.’” Trevizo v. Berryhill, 871 F.3d 664, 679 (9th Cir. 2017) (alteration in 4 original) (quoting Fair v. Bowen, 885 F.2d 597, 603 (9th Cir. 1989)). In discounting 5 Plaintiff’s symptom testimony, the ALJ observed that Plaintiff “has not had any related 6 physical therapy, as one might expect, notwithstanding her current focus on her back.” AR 7 at 29. The ALJ’s observation is correct. Moreover, Dr. DeSilva referred Plaintiff “to hand 8 therapy for hand sensation and biofeedback” on March 4, 2020. Id. at 618. Furthermore, 9 Plaintiff did not return to Dr. DeSilva or otherwise notify him that she was unable to 10 proceed with the recommended therapy. The ALJ did not commit any error in discounting 11 her testimony. See Chaudhry v. Astrue, 688 F.3d 661, 672 (9th Cir. 2012) (quoting Orn v. 12 Astrue, 495 F.3d 625, 638 (9th Cir. 2007) (“[I]f a claimant complains about disabling pain 13 but fails to seek treatment, or fails to follow prescribed treatment, for the pain, an ALJ may 14 use such failure as a basis for finding the complaint unjustified or exaggerated[.]”) 15 f. Reliance on the experience of others 16 Plaintiff asserts that the ALJ misstated the record because he “was under the 17 impression that Ms. Malone somehow based her allegations of pain off experiences of 18 others.” Pl.’s Opening Br. (Doc. 21) at 11. The ALJ did misunderstand Plaintiff’s 19 statement regarding not wanting to put herself in a keyboarding position; however, this 20 misinterpretation was harmless. See Molina v. Astrue, 674 F.3d 1104, 1111 (9th Cir. 2012) 21 (“[W]e may not reverse an ALJ's decision on account of an error that is harmless.”). The 22 ALJ articulated other clear and convincing reasons for discounting Plaintiff’s symptom 23 testimony, and any error in interpretation with this statement does not negate those reasons. 24 g. Neurological findings 25 Plaintiff asserts that the ALJ’s reliance on Dr. Schroeder’s findings was misplaced 26 because “[t]here [wa]s no indication that Dr. Schroeder believed that Ms. Malone’s pain or 27 other symptoms were less than genuine[.]” Pl.’s Opening Br. (Doc. 21) at 12. The ALJ 28 provided a thorough and rational interpretation of the objective medical evidence and notes

- 39 - Case 4:21-cv-00214-DCB-BGM Document 25 Filed 09/13/22 Page 40 of 40

1 of treatment providers. See Mitchell, 2021 WL 3032667, at *8. The ALJ pointed to 2 continued “negative straight [leg] raising, save for when described as ‘theatrically 3 positive,’ as well as [] normal neurological findings except when their reliability is 4 questioned.” AR at 31. “The ALJ is the final arbiter with respect to resolving ambiguities 5 in the medical evidence.” Tommasetti v. Astrue, 533 F.3d 1035, 1041–42 (9th Cir. 2008). 6 Furthermore, given Dr. Schroeder’s descriptions, it is reasonable to infer that Dr. Schroeder 7 questioned the veracity of Plaintiff’s complaints. The Court finds that the ALJ provided 8 specific, clear and convincing reasons for discounting Plaintiff’s testimony which is 9 supported by substantial evidence in the record. See Lingenfelter, 504 F.3d at 1036; 10 Tommasetti v. Astrue, 533 F.3d 1035, 1040 (9th Cir. 2008). 11 IV. CONCLUSION 12 Based on the foregoing, the Court finds the ALJ properly assessed Plaintiff’s 13 symptom testimony. For the reasons delineated above, IT IS HEREBY ORDERED that: 14 1) Plaintiff’s Opening Brief (Doc. 21) is DENIED; 15 2) The Commissioner’s decision is AFFIRMED; and 16 3) The Clerk of the Court shall enter judgment and close its file in this case. 17 Dated this 13th day of September, 2022. 18 19 20 21 22 23 24 25 26 27 28

- 40 -