Metzgar v. Commissioner of Social Security Administration

• Court: District Court, D. Arizona
• Decided: May 5, 2025
• Docket: 2:24-cv-02410
• Status: Unknown

Opinion

1 WO 2 3 4 5 6 IN THE UNITED STATES DISTRICT COURT 7 FOR THE DISTRICT OF ARIZONA

9 Leticia Metzgar, No. CV-24-02410-PHX-KML

10 Plaintiff, ORDER

11 v.

12 Commissioner of Social Security Administration, 13 Defendant. 14 15 Plaintiff Leticia Metzgar seeks review of the Social Security Commissioner’s final 16 decision denying her disability insurance benefits. Because the Administrative Law 17 Judge’s (“ALJ’s”) decision is supported by substantial evidence and is not based on 18 harmful legal error, it is affirmed. 19 I. Background 20 Metzgar applied for disability insurance benefits on September 27, 2019, alleging a 21 disability onset date of September 24, 2019. (Administrative Record (“AR”) 43.) Her claim 22 was denied initially and on reconsideration. (AR 43.) Metzgar then presented her case to 23 an ALJ who found she was not disabled. (AR 43–55.) The Appeals Council denied her 24 request for review (AR 12), and she then appealed to this court. 25 II. Legal Standard 26 The court may set aside the Commissioner’s disability determination only if it is not 27 supported by substantial evidence or is based on legal error. Orn v. Astrue, 495 F.3d 625, 28 630 (9th Cir. 2007). “Substantial evidence is more than a mere scintilla but less than a 1 preponderance” of evidence and is such that “a reasonable mind might accept as adequate 2 to support a conclusion.” Id. (quoting Burch v. Barnhart, 400 F.3d 676, 679 (9th Cir. 3 2005)). The court reviews only those issues raised by the party challenging the decision. 4 See Lewis v. Apfel, 236 F.3d 503, 517 n.13 (9th Cir. 2001). 5 III. Discussion 6 Metzgar argues the ALJ committed two materially-harmful legal errors in analyzing 7 her claim: (1) finding Dr. Gregory L. Umphrey’s medical opinion partially unpersuasive 8 and (2) rejecting Metzgar’s symptom testimony without adequate justification. She seeks 9 a remand for further administrative proceedings. 10 A. The ALJ’s Five-Step Disability Evaluation Process 11 Under the Social Security Act, a claimant for disability insurance benefits must 12 establish disability prior to the date last insured. 42 U.S.C. § 423(c); 20 C.F.R. § 404.131. 13 A claimant is disabled under the Act if she cannot engage in substantial gainful activity 14 because of a medically-determinable physical or mental impairment that has lasted, or can 15 be expected to last, for a continuous period of twelve months or more. 42 U.S.C. 16 §§ 423(d)(1)(A); 1382c(a)(3)(A). 17 Whether a claimant is disabled is determined by a five-step sequential process. See 18 Woods v. Kijakazi, 32 F.4th 785, 787 n.1 (9th Cir. 2022) (summarizing 20 C.F.R. 19 § 404.1520(a)(4)). The claimant bears the burden of proof on the first four steps, but the 20 burden shifts to the Commissioner at step five. Tackett v. Apfel, 180 F.3d 1094, 1098 (9th 21 Cir. 1999). At step three, the claimant must show that her impairment or combination of 22 impairments meets or equals the severity of an impairment listed in Appendix 1 to Subpart 23 P of 20 C.F.R. Part 404. 20 C.F.R. § 404.1520(a)(4)(iii). At step four, the claimant must 24 show her residual functional capacity (“RFC”)—the most she can do with her 25 impairments—precludes her from performing her past work. Id. If the claimant meets her 26 burden at step three, she is presumed disabled and the analysis ends. If the inquiry proceeds 27 and the claimant meets her burden at step four, then at step five the Commissioner must 28 determine if the claimant is able to perform other work that “exists in significant numbers 1 in the national economy” given the claimant’s RFC, age, education, and work experience. 2 Id. at § 404.1520(a)(4)(v). If so, the claimant is not disabled. Id. 3 The ALJ found Metzgar had “not engaged in substantial gainful activity” since her 4 disability onset date and that she had a severe impairment1 for a continuous period of 5 twelve months, satisfying her burden at steps one and two. Id. § 404.1520(a)(4)(i)–(ii). (AR 6 46.) At step three, the ALJ determined Metzgar’s impairments or combination of 7 impairments did not meet or medically equal the severity of a listed impairment and at step 8 four, that Metzgar had the RFC to perform light work with some additional limitations. 9 (AR 47, 49.) In evaluating Metzgar’s RFC, the ALJ discounted part of Dr. Umphrey’s 10 medical opinion because he found it inconsistent with and unsupported by the medical 11 record. (AR 53.) The ALJ also partially discounted Metzgar’s symptom testimony because 12 it was inconsistent with the medical evidence and other evidence in the record. (AR 49.) 13 The ALJ used Metzgar’s RFC to conclude at step five2 that “there were jobs that 14 existed in significant numbers in the national economy that [she] could have performed,” 15 so she was not disabled. (AR 53–55.) Specifically, the ALJ found Metzgar could work as 16 a housekeeping cleaner, production assembler, and office helper as those jobs are defined 17 in the Dictionary of Occupational Titles. (AR 54.) 18 B. The ALJ’s Evaluation of Dr. Umphrey’s Medical Opinion and Metzgar’s 19 Symptom Testimony 20 The ALJ deemed Dr. Umphrey’s medical opinion “partially persuasive” (AR 53) 21 and found Metzgar’s impairments could cause her symptoms, but not to the severity she 22 alleged in her testimony (AR 49). Metzgar challenges both conclusions on largely the same 23 grounds. (See Doc. 12 at 22 (noting “the reasons [the ALJ] provided” for discounting Dr. 24 Umphrey’s medical opinion and Metzgar’s symptom testimony “are the same” and “largely 25 mirror[ ]” each other).) She correctly points out the ALJ must meet a higher standard to 26

27 1 The ALJ found Metzgar had the following severe impairments: degenerative disc disease, carpal tunnel syndrome, and anxiety. (AR 46.) 28 2 The ALJ did not analyze at step four if Metzgar could perform her past relevant work because she had no past relevant work. (AR 53.) 1 reject subjective symptom testimony than to reject a medical opinion,3 but that distinction 2 does not change the analysis here because the ALJ met both standards. The ALJ’s rationale 3 for partially rejecting Dr. Umphrey’s medical opinion and Metzgar’s symptom testimony 4 will therefore be evaluated together. 5 Dr. Umphrey opined that Metzgar’s ailments—including right carpal tunnel 6 syndrome, low back pain, joint dysfunction, degenerative disc disease, cervical spondylosis 7 without myelopathy, liver hemangioma, bilateral sciatica, lumbar spasm, and bilateral 8 rotator cuff impingement syndrome (AR 1416)—would severely limit her ability to sit or 9 stand and lift or carry, and interfere with her ability to sustain full time work. (AR 1439– 10 40.) The ALJ found Dr. Umphrey’s conclusion that Metzgar’s shoulder symptoms had 11 improved persuasive and credited the lift-and-carry limits he imposed, but found the 12 “remainder of the limitations” he assessed “not persuasive and not consistent with” or 13 supported by the medical record. (AR 53.) 14 The ALJ likewise discounted Metzgar’s symptom testimony because it was 15 inconsistent with the medical evidence, which did not support the loss of function she 16 described. (AR 49.) Metzgar testified she had difficulty driving due to her disabilities, had 17 tingling and weakness on her right side, recently had pain in her foot due to a callus, and 18 struggled with concentration which caused issues with her organization and memory. (See 19 AR 49.) 20 Metzgar’s objections to the ALJ’s discounting of her symptom testimony and Dr. 21 Umphrey’s medical opinion fall into three buckets. She challenges: (1) the ALJ’s reliance 22 on irrelevant evidence such as her gait and strength and the fact she had been a student; (2) 23 the ALJ’s reliance on her improvement from treatment; and (3) the ALJ’s reliance on her 24 daily activities. 25 26 3 An ALJ’s decision to discredit a medical opinion “must simply be supported by 27 substantial evidence.” Woods, 32 F.4th at 787. In contrast, because the ALJ did not find Metzgar was malingering, he could only discredit her symptom testimony by providing 28 “specific, clear and convincing” reasons for doing so. Revels v. Berryhill, 874 F.3d 648, 655 (9th Cir. 2017). 1 1. The ALJ’s Reliance on Purportedly Irrelevant Findings 2 The ALJ noted Metzgar had a normal gait, denied gait abnormalities, and had 3 normal strength. (AR 51.) Metzgar argues these findings were irrelevant because she did 4 not allege gait or strength issues. (Doc. 12 at 18, 24.) The Commissioner, however, points 5 out these findings “directly contradict [Metzgar’s] claims of tingling and weakness on her 6 right side, as well as claims of stiffness, arthritis, and tendonitis, and undermine her claim 7 that she is more limited than assessed in her RFC.” (Doc. 16 at 10 (citing AR 49).) And 8 they showed that “despite her claimed pain, [she] did not display signs of compensating 9 for it.” (Doc. 16 at 10.) Metzgar argues the Commissioner, who is not a medical 10 professional, is providing post hoc rationalizations for the ALJ’s conclusions. (Doc. 17 at 11 4–5.) But even if the ALJ had not considered findings related to Metzgar’s gait and 12 strength, his decision to discount her symptom testimony and Dr. Umphrey’s medical 13 opinion would still be supported by substantial evidence because he cited a range of other 14 supportive medical records (see AR 49–53). See Orn, 495 F.3d at 630 (“Substantial 15 evidence is more than a mere scintilla but less than a preponderance . . . .”) (quoting Burch, 16 400 F.3d at 679). Those records included the opinions of medical professionals—the state 17 agency medical consultants—who indicated Metzgar had fewer restrictions because her 18 physical impairments improved with treatment, her carpal tunnel symptoms stabilized with 19 injections, she responded well to lumbar radiofrequency ablation, and she had normal gait 20 and strength. (AR 52–53.) The ALJ’s decision was therefore supported by substantial 21 evidence. See Lenord D. v. O’Malley, 758 F. Supp. 3d 1266, 1277 (E.D. Wash. 2024) (“It 22 is the ALJ’s duty to resolve conflicts and ambiguity in the medical and non-medical 23 evidence.”); Norris v. Colvin, 160 F. Supp. 3d 1251, 1273 (E.D. Wash. 2016) (“[I]t is the 24 ALJ’s responsib[ility] to resolve conflicts and inconsistencies between medical 25 opinions.”). 26 The same analysis applies to the ALJ’s reference to Metzgar’s status as a student as 27 a basis for discounting Dr. Umphrey’s medical opinion. (AR 53.) Metzgar testified she was 28 trying to get her GED at Central Arizona College but was unable to complete her studies 1 due to her divorce and her health. (AR 314.) The ALJ noted that Metzgar’s status as a 2 student “indicat[ed] she was not as limited as alleged.” (AR 53.) The Commissioner posits 3 her status as a student, even if short lived, was relevant because Dr. Umphrey “explicitly 4 opined that [Metzgar] would have lapses in concentration and memory on a regular basis.” 5 (Doc. 16 at 16 (citing AR 1440).) But even if his reliance on Metzgar’s status as a student 6 was an error, it was harmless because it was “irrelevant to the [ALJ’s] ultimate disability 7 conclusion when considering the record as a whole.” Rogers v. Colvin, 970 F. Supp. 2d 8 1147, 1153 (W.D. Wash. 2013). That is, the ALJ’s decision to discount Dr. Umphrey’s 9 medical opinion was still supported by the substantial evidence described above even 10 without considering Metzgar’s status as a student. (See AR 49–53.) 11 2. The ALJ’s Reliance on Symptom Improvement from Treatment 12 The ALJ cited Metzgar’s improvement with treatment as a reason to discount her 13 symptom testimony and Dr. Umphrey’s medical opinion. (AR 51, 53.) He also remarked 14 that the “majority of her treatment was routine with conservative measures.” (AR 51, 53.) 15 Metzgar disputes both assertions, contending her treatment was not conservative and the 16 ALJ overstated her level of improvement. (Doc. 12 at 13, 15, 17.) 17 As to whether her treatment was conservative, Metzgar quibbles over whether the 18 steroid injections she received qualify as a conservative treatment method under Ninth 19 Circuit precedent. (Doc. 12 at 17 (quoting Garrison v. Colvin, 759 F.3d at 995, 1015 n.20 20 (9th Cir. 2014)).) But it is not clear the ALJ was referring to the steroid injections alone as 21 conservative treatment, as opposed to Metzgar’s entire course of treatment (which the ALJ 22 elsewhere described). (See AR 51.) 23 Even if he was specifically describing steroid injections as conservative, the Ninth 24 Circuit has rejected a claimant’s argument “that the ALJ erred in characterizing her 25 treatment as conservative, particularly regarding her injection.” Fry v. Berryhill, 749 F. 26 App’x 659, 660 (9th Cir. 2019). In Fry, the court explained Garrison—the case Metzgar 27 cites for her contention that her injections were not conservative treatment—“did not base 28 its holding on whether the claimant’s treatment was conservative or not.” Id. (citing 1 Garrison, 759 F.3d at 1015). Instead, the ALJ in Garrison committed a different error 2 regarding the claimant’s testimony which was one of the bases for the court’s reversal of 3 the ALJ’s denial of benefits. Id. (citing Garrison, 759 F.3d at 1015). Garrison therefore 4 has no bearing on the issue of whether injections are conservative treatment. 5 More importantly, regardless of whether the injections were permissibly classified 6 as conservative treatment, “the evidence shows it was effective in treating [Metzgar’s] 7 conditions, which contradicts her allegations of disabling symptoms.” (Doc. 16 at 9.) The 8 ALJ appropriately relied on the effectiveness of treatment—which Dr. Umphrey’s opinion 9 itself described (AR 1416) and the state agency physicians corroborated (AR 52–53)—as 10 not supporting the limitations either Dr. Umphrey or Metzgar described. And indeed, it is 11 the ALJ’s responsibility to “determin[e] credibility, resolv[e] conflicts in medical 12 testimony, and . . . resolv[e] ambiguities.” Andrews v. Shalala, 53 F.3d 1035, 1039 (9th 13 Cir. 1995) (citation omitted). For these reasons, it was not error for the ALJ to rely on 14 Metzgar’s symptom improvement from her injections. See Floe v. O’Malley, No. 23- 15 35589, 2024 WL 4601594, at *1 (9th Cir. Oct. 29, 2024) (noting improvement with 16 treatment is a valid reason to discount a claimant’s symptom testimony). 17 Metzgar also contends the ALJ overstated her improvement in symptoms, arguing 18 some improvement “does not equate to the ability to perform competitive employment.” 19 (Doc. 12 at 13.) But as the Commissioner notes (Doc. 16 at 15), an ALJ “cannot be required 20 to believe every allegation of disabling pain, or else disability benefits would be available 21 for the asking.” Fair v. Bowen, 885 F.2d 597, 603 (9th Cir. 1989), superseded on other 22 grounds by 20 C.F.R. § 404.1502(a). This principle “holds true even where the claimant 23 introduces medical evidence showing that [s]he has an ailment reasonably expected to 24 produce some pain; many medical conditions produce pain not severe enough to preclude 25 gainful employment.” Id. Metzgar does not argue the treatments cited by the ALJ were 26 ineffective (nor would the medical records support such a claim), only that they were not 27 as effective as the ALJ suggested. (Doc. 12 at 13.) But the ALJ merely stated she “had 28 improvement” from treatment, that her symptoms were “effectively treated,” and that she 1 had a “good response” to treatment. (AR 51.) That finding tracks the opinions of Dr. 2 Umphrey and the state agency physicians. (See AR 52–53.) 3 Metzgar cites no authority suggesting it is legal error for an ALJ to over-rely on a 4 claimant’s responsiveness to treatment and she has not shown the ALJ did so here. 5 Improvement with treatment is a valid, specific, clear, and convincing reason to discount a 6 claimant’s symptom testimony. See Floe, 2024 WL 4601594, at *1. For these reasons, the 7 ALJ did not err in his consideration of Metzgar’s responsiveness to treatment. 8 3. The ALJ’s Reliance on Metzgar’s Daily Activities 9 The ALJ also referenced Metzgar’s daily activities as a reason for discounting her 10 symptom testimony. (See AR 50.) Inconsistencies between a claimant’s symptom 11 testimony and her daily activities provide a valid ground for discounting that testimony. 12 See Molina v. Astrue, 674 F.3d 1104, 1113 (9th Cir. 2012), superseded on other grounds 13 by 20 C.F.R. § 404.1502(a) (“Even where [daily] activities suggest some difficulty 14 functioning, they may be grounds for discrediting the claimant’s testimony to the extent 15 that they contradict claims of a totally debilitating impairment”). 16 The ALJ noted Metzgar “joined a boxing gym with her children” and reported being 17 busy caring for her grandchildren. (AR 50 (citing AR 2939, 2949).) Metzgar argues these 18 references were merely part of the ALJ’s factual summary and the Commissioner is 19 improperly trying to retroactively tie them to the ALJ’s credibility determination. (Doc. 17 20 at 7–8.) But the record indicates the ALJ did rely on these activities as reasons to discount 21 Metzgar’s symptom testimony. (See AR 49–50.) Metzgar’s argument is therefore without 22 merit, and the ALJ did not err by relying on her daily activities as a reason to discount her 23 symptom testimony. 24 4. Harmlessness 25 Even assuming the ALJ erred in one or more of the ways Metzgar claims, any such 26 error would be harmless because the ALJ’s decision to discount the opinion of Dr. 27 Umphrey and to discount Metzgar’s symptom testimony was otherwise supported by 28 substantial evidence. The ALJ cited ample medical records supporting his nondisability findings (see AR 51), including the evaluations of state agency medical consultants (AR 52-53). As such, the ALJ’s potential errors would be inconsequential to the ALJ’s ultimate || nondisability determination and would not provide a reason to reverse the ALJ’s decision. 4|| See Marsh v. Colvin, 792 F.3d 1170, 1173 (9th Cir. 2015) (simplified) (an ALJ’s errors are 5 || harmless if they are “inconsequential to the ultimate nondisability determination.”’). 6|| IV. Conclusion 7 The ALJ’s partial discounting of Dr. Umphrey’s medical opinion was supported by 8 || substantial evidence and his partial discounting of Metzgar’s symptom testimony was supported by specific, clear, and convincing reasons. Even if some of the ALJ’s rationales || were flawed, those errors would be harmless because they did not affect the ALJ’s 11 |} nondisability determination. As a result, the ALJ’s decision that Metzgar is not disabled is affirmed. 13 Accordingly, 14 IT IS ORDERED affirming the December 19, 2022, decision of the ALJ. 15 IT IS FURTHER ORDERED directing the Clerk to enter final judgment 16 || consistent with this Order and close this case. 17 Dated this 5th day of May, 2025. 18

20 en Honorable Krissa M. Lanham 21 United States District Judge 22 23 24 25 26 27 28

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