(SS) Coronado v. Commissioner of Social Security

• Court: District Court, E.D. California
• Decided: April 9, 2020
• Docket: 1:19-cv-00606
• Status: Unknown

Opinion

1 2 3 4 5 6 7 8 UNITED STATES DISTRICT COURT 9 EASTERN DISTRICT OF CALIFORNIA 10 11 TERESA R. CORONADO, No. 1:19-cv-00606-GSA 12 Plaintiff, 13 v. ORDER DIRECTING ENTRY OF 14 JUDGMENT IN FAVOR OF ANDREW SAUL, Commissioner of Social COMMISSIONER OF SOCIAL SECURITY 15 Security, AND AGAINST PLAINTIFF

16 Defendant. 17 18 19 I. Introduction 20 Plaintiff Teresa R. Coronado (“Plaintiff”) seeks judicial review of the final decision of the 21 Commissioner of Social Security (“Commissioner” or “Defendant”) denying her application for 22 supplemental security income pursuant to Title XVI of the Social Security Act. The matter is 23 currently before the Court on the parties’ briefs which were submitted without oral argument to 24 the Honorable Gary S. Austin, United States Magistrate Judge.1 See Docs. 15 and 16. Having 25 reviewed the record as a whole, the Court finds that the ALJ’s decision is supported by substantial 26 evidence and applicable law. Accordingly, Plaintiff’s appeal is denied. 27 ///

28 1 The parties consented to the jurisdiction of the United States Magistrate Judge. See Docs. 8 and 10. 1 II. Procedural Background 2 On May 6, 2015, Plaintiff filed an application for supplemental security income alleging 3 disability beginning April 30, 2015. AR 15. The Commissioner denied the application initially 4 on August 3, 2015 and following reconsideration on December 16, 2015. AR 15. 5 On January 5, 2016, Plaintiff filed a request for a hearing. AR 15. Administrative Law 6 Judge Joyce Frost-Wolf presided over an administrative hearing on February 2, 2018. AR 28-48. 7 Plaintiff appeared and was represented by an attorney. AR 28. On May 22, 2018, the ALJ denied 8 Plaintiff’s application. AR 15-23. 9 The Appeals Council denied review on March 1, 2019. AR 1-6. On May 6, 2019, 10 Plaintiff filed a complaint in this Court. Doc. 1. 11 III. Factual Background 12 A. Plaintiff’s Testimony 13 Plaintiff (born January 1964) is a high school graduate. AR 33. Although she babysat 14 part time for her grandchildren for several months in 2007, Plaintiff had no substantial gainful 15 activity. AR 34. 16 Because of her knee pain Plaintiff had been using a walker since October 2016. AR 35. 17 Asked about her use of assistive devices before October 2016, Plaintiff explained, “I just found a 18 doctor that would give me the walker, and some wouldn’t cover the insurance.” AR 36. Plaintiff 19 used the walker even when she was performing an activity such as washing dishes because 20 sometimes her legs gave out and she felt that she might fall. AR 36-37. Plaintiff had never 21 actually fallen. AR 40. 22 Other than doing dishes Plaintiff’s husband, who was retired, performed all household 23 chores including vacuuming, cooking and grocery shopping. AR 37. Plaintiff did not leave her 24 home except to visit the doctor. AR 38. 25 Plaintiff experienced side effects from her medications including dizziness and fatigue. 26 AR 38. In addition, she thought her diabetes medication might cause her to sweat more in the 27 summer. AR 38. She treated her leg pain with pain medication and elevation. AR 38. Plaintiff 28 elevated her legs four or five hours daily. AR 39. 1 When Plaintiff walked her knees hurt and she became short of breath. AR 39. She could 2 not climb a flight of stairs. AR 39. Cold and rainy weather aggravated her knee pain. AR 39. 3 Plaintiff could not kneel because she probably would not be able to get back up. AR 39-40. If 4 she dropped an object she could not bend over and pick it up. AR 40. Plaintiff could not squat. 5 AR 40. 6 Plaintiff felt depressed “just about every day,” and experienced anxiety about five out of 7 seven days. AR 41-43. Plaintiff explained her depression by saying that she did not like to be 8 around a lot of people. AR 38, 41. Her memory was poor. AR 43. She also complained of poor 9 appetite, testifying that it had caused her to lose about fifty pounds without trying. AR 42. 10 B. Medical Records 11 Plaintiff was 54 inches tall. AR 232. From the time of her application, her weight ranged 12 from 248 to 258 pounds. AR 232, 238, 245. 13 Plaintiff was treated at Westside Medical Mendota (WMM) from April 2015 through 14 January 2018, for complaints including difficulty sleeping, difficulty swallowing, daytime 15 fatigue, dizziness, rapid heartbeat, shortness of breath and swelling of her lower extremities. AR 16 232-236, 144-57, 287-325. 17 On April 21, 2015, Plaintiff had an appointment for a thyroid check and prescription 18 refills. AR 236. Her treating professionals2 attributed Plaintiff’s dizziness and fatigue to iron 19 deficiency anemia. AR 233. On April 24, 2015, the examiner noted that Plaintiff had a twenty- 20 year history of anemia and hypothyroidism. AR 235. By April 30, 2015, her blood pressure had 21 improved with Lisinopril. AR 234. An April 29, 2015 note reported that Plaintiff was improving 22 and had more energy. AR 225. A treatment note dated October 2015 reported an overcorrection 23 of Plaintiff’s hypothyroid and reduced her medication accordingly. AR 247. By October 2017, 24 Plaintiff’s hypothyroidism was “subclinical.” AR 298. 25 Plaintiff received inhalers for asthma. AR 300. Her allergy tests were consistently 26 negative. AR 222, 256. 27 2 Because each handwritten appointment note includes only an illegible signature, the Court is unable to identify the 28 identity or professional status of the person(s) examining Plaintiff on each visit. 1 In July 2015, Plaintiff reported less frequent dizziness but continued shortness of breath. 2 AR 249. Treatment notes indicated that Plaintiff’s complaints of depression should resolve with 3 continued vitamin D supplementation. AR 249. In September 2015, Plaintiff complained of 4 severe low back pain (ranging from 6/10 to 10/10) and added that her medications were not 5 improving her dizziness and fatigue. AR 248. 8. In October 2015, Plaintiff complained of ankle 6 swelling and pain without any accident or injury. AR 258. 7 In June and October 2015, Plaintiff was treated by cardiologist Bipin Joshi, M.D.. AR 8 258, 269-73. Echocardiogram studies were normal except for trivial mitral valve and tricuspid 9 valve regurgitation. AR 258. Dr. Joshi diagnosed dyspnea (unspecified), essential hypertension 10 and obesity. AR 271. He advised Plaintiff to take her medications; consume a diet low in 11 sodium, cholesterol and fat; exercise thirty to forty minutes daily six days a week; and lose 12 weight. AR 272. 13 From December 2015 through September 2016, Plaintiff missed nine appointments at 14 WMM. AR 310, 312-13. When she came to have forms completed in September 2016, Plaintiff 15 complained of anxiety and continued tiredness. AR 307-09. In October 2016, Nurse Ruth A. 16 Thomas, F.N.P., ordered a walker for Plaintiff. AR 325. Plaintiff missed six appointments in 17 December 2016. AR 304-05. 18 In December 2017 and January 2018, WMM also treated Plaintiff for right knee pain 19 following a fall. AR 288-89, 291-97. Nurse Thomas directed Plaintiff to apply hot and cold 20 compresses for pain relief and referred Plaintiff for magnetic resonance imaging. AR 294 In 21 December 2017, Jeffrey Child, M.D., evaluated x-rays of Plaintiff’s right knee and diagnosed 22 mild bicompartmental osteoarthritis. AR 274. Following magnetic resonance imaging in January 23 2018, however, Dr. Child reported: 24 Severe grade 4 articular cartilage degenerative change in medial compartment as evidenced by total loss of articular cartilage in both 25 femoral and tibial aspect with juxta articular marrow signal change and resultant secondary medial extrusion of the medial meniscus but 26 no meniscal tear. 27 AR 283. 28 /// 1 IV. Standard of Review 2 Pursuant to 42 U.S.C. §405(g), this court has the authority to review a decision by the 3 Commissioner denying a claimant disability benefits. “This court may set aside the 4 Commissioner’s denial of disability insurance benefits when the ALJ’s findings are based on 5 legal error or are not supported by substantial evidence in the record as a whole.” Tackett v. 6 Apfel, 180 F.3d 1094, 1097 (9th Cir. 1999) (citations omitted). Substantial evidence is evidence 7 within the record that could lead a reasonable mind to accept a conclusion regarding disability 8 status. See Richardson v. Perales, 402 U.S. 389, 401 (1971). It is more than a scintilla, but less 9 than a preponderance. See Saelee v. Chater, 94 F.3d 520, 522 (9th Cir. 1996) (internal citation 10 omitted). When performing this analysis, the court must “consider the entire record as a whole 11 and may not affirm simply by isolating a specific quantum of supporting evidence.” Robbins v. 12 Social Security Admin., 466 F.3d 880, 882 (9th Cir. 2006) (citations and internal quotation marks 13 omitted). 14 If the evidence reasonably could support two conclusions, the court “may not substitute its 15 judgment for that of the Commissioner” and must affirm the decision. Jamerson v. Chater, 112 16 F.3d 1064, 1066 (9th Cir. 1997) (citation omitted). “[T]he court will not reverse an ALJ’s 17 decision for harmless error, which exists when it is clear from the record that the ALJ’s error was 18 inconsequential to the ultimate nondisability determination.” Tommasetti v. Astrue, 533 F.3d 19 1035, 1038 (9th Cir. 2008) (citations and internal quotation marks omitted). 20 V. The Disability Standard 21 To qualify for benefits under the Social Security Act, a plaintiff must establish that he or she is unable to engage in substantial gainful 22 activity due to a medically determinable physical or mental impairment that has lasted or can be expected to last for a continuous 23 period of not less than twelve months. 42 U.S.C. § 1382c(a)(3)(A). An individual shall be considered to have a disability only if . . . his 24 physical or mental impairment or impairments are of such severity that he is not only unable to do his previous work, but cannot, 25 considering his age, education, and work experience, engage in any other kind of substantial gainful work which exists in the national 26 economy, regardless of whether such work exists in the immediate area in which he lives, or whether a specific job vacancy exists for 27 him, or whether he would be hired if he applied for work. 28 42 U.S.C. §1382c(a)(3)(B). 1 To achieve uniformity in the decision-making process, the Commissioner has established 2 a sequential five-step process for evaluating a claimant’s alleged disability. 20 C.F.R. §§ 3 416.920(a)-(f). The ALJ proceeds through the steps and stops upon reaching a dispositive finding 4 that the claimant is or is not disabled. 20 C.F.R. §§ 416.927, 416.929. 5 Specifically, the ALJ is required to determine: (1) whether a claimant engaged in 6 substantial gainful activity during the period of alleged disability, (2) whether the claimant had 7 medically determinable “severe impairments,” (3) whether these impairments meet or are 8 medically equivalent to one of the listed impairments set forth in 20 C.F.R. § 404, Subpart P, 9 Appendix 1, (4) whether the claimant retained the residual functional capacity (“RFC”) to 10 perform his past relevant work, and (5) whether the claimant had the ability to perform other jobs 11 existing in significant numbers at the national and regional level. 20 C.F.R. § 416.920(a)-(f). 12 VI. Summary of the ALJ’s Decision 13 The ALJ found that Plaintiff had not engaged in substantial gainful activity since the 14 application date of May 6, 2015. AR 17. Her only severe impairment was degenerative changes 15 of the right knee. AR 17 Plaintiff’s severe impairment did not meet or medically equal one of 16 the listed impairments in 20 C.F.R. Part 404, Subpart P, Appendix 1 (20 C.F.R. §§ 416.920(d), 17 416.925 and 416.926). AR 19. 18 The ALJ concluded that Plaintiff had the residual functional capacity to perform the full 19 range of light work as defined in 20 C.F.R. § 416.967(b). AR 19. Plaintiff had no past relevant 20 work. AR 22. Considering Plaintiff’s age, education, work experience and residual functional 21 capacity, significant numbers of jobs that Plaintiff could perform existed in the national economy. 22 AR 22. Accordingly, the ALJ found that Plaintiff was not disabled at any time from May 6, 23 2015, the application date, through May 22, 2018, the date of the decision. AR 22=23. 24 VII. Sufficient Evidence Supported the Residual Functional Capacity Determination 25 Although Plaintiff does not allege error in determining her severe impairments at step two, 26 Plaintiff contends that the ALJ erred at step four by failing to consider the effect of Plaintiff’s 27 obesity in combination with her sole severe impairment of degenerative changes of the right knee. 28 1 The Commissioner responds that the ALJ appropriately considered the evidence as a whole, 2 including any contributory effect of Plaintiff’s obesity. 3 A. Medical Opinions 4 1. Agency Physicians 5 On initial review, agency physician A. Khong, M.D., wrote: 6 It appears the claimant re-established care with her TS on 4/21/15, just a couple of weeks before filing for disability. She needed a refill 7 of her thyroid medications so it is likely that she had not been compliant with her medications for some time. Labs showed an 8 elevated TSH of 39 and very low T3 and T4 levels consistent with inadequate treatment for hypothyroidism. The hematocrit was 28 % 9 with low RBC indices. Iron studies were also low indicative of iron deficiency anemia. In this age range without any significant GI 10 complaints, dysfunctional uterine bleeding needs to be ruled out as a cause. The claimant is in the menopausal range. Iron supplements 11 have been started and the claimant has been referred for a GI workup. Although she has been referred to cardiology for c/o of dizziness and 12 SOB, these symptoms, along with fatigue can all be explained by the combination of her hypothyroid state and the severe anemia. 13 AR 52. 14 Dr. Khong opined that with proper treatment of anemia and hypothyroidism, Plaintiff’s 15 physical complaints of dizziness and fatigue should resolve in less than one year. AR 52. 16 Noting no new allegations on reconsideration, agency physician Keith M. Quint, M.D., agreed 17 with Dr. Khong that with treatment Plaintiff’s hypothyroid, anemia and insomnia would resolve 18 in less than a year. AR 259-60. After noting Plaintiff’s obesity, Dr. Quint opined that Plaintiff’s 19 physical impairments would have minimal impact on function. AR 260. 20 1 Consultative Examination: Internal Medicine 21 Internist Tomas Rios, M.D., conducted a consultative examination on June 30, 2015. AR 22 237-41. Provided with no medical records, Dr. Rios relied on Plaintiff’s report that she had been 23 diagnosed with hypothyroidism in 2009 and with asthma recently. AR 237. Plaintiff reported 24 that she performed her activities of daily living independently and helped with some household 25 chores. AR 237. 26 /// 27 /// 28 1 Plaintiff’s physical examination was normal in all regards. AR 238-40. Dr. Rios opined 2 that Plaintiff had no functional limitations other than avoidance of chemicals, dust, fumes and 3 gases due to her history of asthma. AR 240-41. The doctor wrote: 4 The claimant has reactive airway disease but no clinical evidence of chronic hypoxic state. She also has a history of hypothyroidism but 5 she is clinically euthyroid. She reports history of anemia but no significant symptoms noted on today’s examination, No orthostatic 6 symptoms provoked. 7 AR 240. 8 2 Nurse Frutes 9 In April 2015, after seeing Plaintiff three times, Lisa Frutes, F.N.P.-P.C., prepared a two- 10 page residual functional capacity questionnaire. AR 219-20. Plaintiff’s symptoms of dizziness, 11 shortness of breath and fatigue, were often severe enough to interfere with the attention and 12 concentration necessary to perform simple work-related tasks. AR 219. Her diagnoses were 13 hypertension, shortness of breath and insomnia. AR 219. Plaintiff took prescription lisinopril, 14 which caused drowsiness. AR 219. Plaintiff reported anemia but no lightheadedness or fainting. 15 AR 237. 16 Plaintiff could walk one-half block without rest or significant pain; sit for thirty minutes at 17 a time and stand or walk for ten minutes at a time. AR 219. In an eight-hour workday Plaintiff 18 could sit three hours and stand or walk for two hours. AR 219. She needed to change positions at 19 will. AR 219. Plaintiff would need an unscheduled break of fifteen to twenty minutes every half 20 hour. AR 219. 21 Plaintiff could lift and carry ten pounds occasionally and less than ten pounds frequently. 22 AR 220. She could reach, perform fine manipulation and grasp, turn or twist objects only twenty 23 percent of the time in an eight-hour workday. AR 220. Plaintiff was likely to be absent from 24 work more than four times monthly. AR 220. 25 3 Nurse Thomas 26 Nurse Thomas completed a medical source statement in September 2016. AR 261-67. 27 Plaintiff’s diagnoses were hypothyroidism, sciatica and obstructive sleep apnea, with symptoms 28 of fatigue, dizziness, pain, “anemia issues,” and shortness of breath.. AR 261. Plaintiff 1 experienced side effects from her prescriptions for Tylenol #3, Soma, Xanax and Lexapro, all of 2 which were sedating. AR 261. Plaintiff’s symptoms were affected by her depression and 3 anxiety. AR 261. 4 Plaintiff was able to sit for twenty minutes at a time and stand for five to ten minutes at a 5 time. AR 262. In an eight-hour workday Plaintiff could sit about two hours and stand or walk for 6 less than two hours. AR 262. She needed to walk for five minutes every twenty minutes and to 7 be able to change positions at will. AR 262. Plaintiff needed to use a walker due to imbalance, 8 pain, weakness, insecurity and dizziness. AR 265. 9 Plaintiff could rarely lift twenty, ten or less than ten pounds and never lift fifty pounds. 10 AR 265. She could never crouch, squat or climb stairs or ladders. AR 265. She could rarely 11 stoop or bend and occasionally twist. AR 265. Plaintiff had significant limitations of her upper 12 extremities and was limited bilaterally to using her hands to grasp, turn and twist objects, and to 13 use her arms to reach overhead, five percent of the workday. AR 265. She could reach forward 14 bilaterally ten percent of the workday. AR 265. 15 Plaintiff was likely to require unscheduled breaks eight to ten times daily for five to ten 16 minutes due to pain/paresthesia, numbness and the adverse effects of medication. AR 262. She 17 needed to keep her legs elevated 80 per cent of the time. AR 262. Plaintiff was likely to miss 18 more than four workdays monthly. AR 263, 266. 19 Evaluating Plaintiff’s mental impairments, Nurse Thomas opined that Plaintiff had no 20 impairment of her ability to understand, remember or carry out very short and simple instructions; 21 ask simple questions or request assistance; and, accept instruction and respond appropriately to 22 criticism from supervisors. AR 264. About five percent of the workday Plaintiff would be 23 unable to remember work-like procedures; sustain an ordinary routine without special 24 supervision; work in coordination with or proximity to others without being unduly distracted; be 25 aware of normal hazards and take appropriate precautions; interact appropriately with the general 26 public; maintain socially appropriate behavior; adhere to basic standards of neatness and 27 cleanliness; travel in an unfamiliar place; and, use public transportation. AR 264, 266. About ten 28 percent of the workday, Plaintiff would be unable to maintain attention for a two-hour segment; 1 perform at a consistent pace without an unreasonable number and length of rest periods; and, get 2 along with co-workers or peers without unduly distracting them or exhibiting behavioral 3 extremes. AR 264. About fifteen percent of the workday Plaintiff would be unable to maintain 4 regular attendance, and be punctual within customary, usually strict tolerances; complete a 5 normal workday or workweek without interruptions from psychologically based symptoms; 6 respond appropriately to changes in a routine work setting; and, deal with normal work stress. 7 AR 264. Plaintiff was likely to be off task five to ten percent of the workday. AR 265. She was 8 only capable of low stress work and would have good days and bad days. AR 265. 9 B. Determining Residual Functional Capacity 10 “Residual functional capacity is an assessment of an individual’s ability to do sustained 11 work-related physical and mental activities in a work setting on a regular and continuing basis.” 12 SSR 96-8p. The residual functional capacity assessment considers only functional limitations and 13 restrictions which result from an individual’s medically determinable impairment or combination 14 of impairments. SSR 96-8p. 15 A determination of residual functional capacity is not a medical opinion, but a legal 16 decision that is expressly reserved for the Commissioner. See 20 C.F.R. §§ 404.1527(d)(2) 17 (residual functional capacity is not a medical opinion), 404.1546(c) (identifying the ALJ as 18 responsible for determining residual functional capacity). “[I]t is the responsibility of the ALJ, not 19 the claimant’s physician, to determine residual functional capacity.” Vertigan v. Halter, 260 F.3d 20 1044, 1049 (9th Cir. 2001). In doing so the ALJ must determine credibility, resolve conflicts in 21 medical testimony and resolve evidentiary ambiguities. Andrews v. Shalala, 53 F.3d 1035, 1039- 22 40 (9th Cir. 1995). 23 “In determining a claimant's [residual functional capacity], an ALJ must consider all 24 relevant evidence in the record such as medical records, lay evidence and the effects of 25 symptoms, including pain, that are reasonably attributed to a medically determinable 26 impairment.” Robbins, 466 F.3d at 883. See also 20 C.F.R. § 404.1545(a)(3) (residual functional 27 capacity determined based on all relevant medical and other evidence). “The ALJ can meet this 28 burden by setting out a detailed and thorough summary of the facts and conflicting evidence, 1 stating his interpretation thereof, and making findings.” Magallanes v, Bowen, 881 F.2d 747, 751 2 (9th Cir. 1989) (quoting Cotton v. Bowen, 799 F.2d 1403, 1408 (9th Cir. 1986)). 3 The opinions of treating physicians, examining physicians, and non-examining physicians 4 are entitled to varying weight in residual functional capacity determinations. Lester v. Chater, 81 5 F.3d 821, 830 (9th Cir. 1995). Ordinarily, more weight is given to the opinion of a treating 6 professional, who has a greater opportunity to know and observe the patient as an individual. Id.; 7 Smolen v. Chater, 80 F.3d 1273, 1285 (9th Cir. 1996). The opinion of an examining physician is, 8 in turn, entitled to greater weight than the opinion of a non-examining physician. Pitzer v. 9 Sullivan, 908 F.2d 502, 506 (9th Cir. 1990). An ALJ may reject an uncontradicted opinion of a 10 treating or examining medical professional only for “clear and convincing” reasons. Lester, 81 11 F.3d at 831. In contrast, a contradicted opinion of a treating professional may be rejected for 12 “specific and legitimate” reasons. Id. at 830. However, the opinions of a treating or examining 13 physician are “not necessarily conclusive as to either the physical condition or the ultimate issue 14 of disability.” Morgan v. Comm'r of Soc. Sec. Admin., 169 F.3d 595, 600 (9th Cir. 1999). 15 Nurse practitioners are not evaluated as if they were physicians. A nurse practitioner is 16 not considered an acceptable medical source under 20 C.F.R. § 416.913.3 Instead, nurse 17 practitioners are considered to be other sources. 20 C.F.R. § 416.913(d)(1) (listing medical 18 sources that are considered other sources, including nurse practitioners, physicians’ assistants, 19 naturopaths, chiropractors, audiologists, and therapists). Unlike the opinions of physicians, the 20 opinions of nurse practitioners are not entitled to special weight. An ALJ may reject the opinions 21 of other sources by giving “reasons germane to each witness for doing so.” Molina v. Astrue, 674 22 F.3d 1104, 1111 (9th Cir. 2012); Turner v. Comm’r of Soc. Sec. Admin., 613 F.3d 1217, 1224 (9th 23 Cir. 2010). Factors used to evaluate a nurse practitioner’s opinion include: (1) examining 24 relationship; (2) length of treatment relationship and frequency of examination; (3) supportability 25 ///

26 3 The Social Security Administration has recently adopted new rules applicable to claims filed after March 27, 2017, which expand the category of acceptable medical providers to include, among others, nurse practitioners. 20 C.F.R. 27 §§ 404.1502(a)(6), (7), (8); 416.902(a)(6), (7), (8) (2017); Revisions to Rules Regarding the Evaluation of Medical Evidence, 82 Fed. Reg. 5844 (Jan. 18, 2017). The revisions do not apply to Plaintiff’s claim, which was filed May 6, 28 2015. 1 of opinion; (4) consistency with the record; (5) specialization; and (6) other factors supporting or 2 contradicting the opinion. 20 C.F.R. § 416.927 (c) and (f)(1). 3 C. The ALJ Properly Analyzed Evidence in the Record as a Whole 4 “[A]n ALJ is responsible for determining credibility and resolving conflicts in medical 5 testimony.” Magallanes, 881 F.2d at 750. An ALJ may choose to give more weight to opinions 6 that are more consistent with the evidence in the record. 20 C.F.R. §§ 404.1527(c)(4) (“the more 7 consistent an opinion is with the record as a whole, the more weight we will give to that 8 opinion”). 9 In the course of her assessment of the medical opinions, here the ALJ found that 10 Plaintiff’s “statements concerning the intensity, persistence and limiting effects of these 11 symptoms are not entirely consistent with the medical evidence and other evidence in the record.” 12 AR 35. The ALJ explained: 13 The claimant reported experiencing some right knee pain, but there is not much evidence of treatment for the condition, In fact, in 14 October 2015, an examination of the musculoskeletal system, showed no evidence of bony tenderness, joint effusion, enlargement, 15 or abnormal motion. There was also no muscle atrophy, muscle weakness, asymmetry or reduced range of motion and she exhibited 16 full motor strength in all muscle groups with a normal gait. An x-ray of right knee taken in December 2017 did show some mild tri- 17 compartmental osteoarthritis and a subsequent magnetic resonance image (MRI) revealed articular cartilage degenerative changes in the 18 medial compartment, but there was no meniscal tear. As for treatment, she reported taking Naproxen for pain and inflammation 19 but there is no evidence of any invasive treatment and she failed to show up for numerous appointments. 20 AR 20 (citations to administrative record omitted). 21 The ALJ again addressed Plaintiff’s credibility at the close of her residual functional 22 capacity analysis: 23 The claimant’s statements and complaints are not fully consistent 24 with the medical and other evidence. For example, she stated she was prescribed a walker to ambulate but no evidence supports this. 25 In fact, Dr. Rios found she had a normal gait and station with a negative Romberg test. The claimant further alleges suffering from 26 significant limitations that prevent her from working, but that is inconsistent with an examination of musculoskeletal system, which 27 showed no evidence of bony tenderness, joint effusion, enlargement, or abnormal motion. In addition, there was also no muscle atrophy, 28 muscle weakness, asymmetry or reduced range of motion and she 1 exhibited full motor strength in all muscle groups with a normal gait. An alleged inability to work is also inconsistent with the claimant’s 2 report that she is capable of helping with some household chores and she is independent with activities of daily living. Finally, her 3 documented failure to show up for numerous medical appointments indicates her conditions are not as severe as alleged. 4 AR 21-22 (citations to administrative record omitted). 5 The ALJ acknowledged the opinions of the agency physicians, Drs. Khong and Quint, 6 who concluded that just after Plaintiff’s application for benefits in 2015, Plaintiff had no severe 7 impairment including her obesity. AR 20. The ALJ noted that consultative examiner, Dr. Rios, 8 also opined that Plaintiff had no exertional, postural or manipulative limitations, but she declined 9 to adopt the environmental limitations to which Dr. Rios opined since the restrictions were not 10 supported by the record as a whole, or Dr. Rios’ own examination of Plaintiff. AR 20. In light of 11 later evidence of the degenerative changes in Plaintiff’s right knee joint, however, the ALJ 12 limited Plaintiff to light work as more consistent with the evidence as a whole. AR 20. The ALJ 13 stated that the limitation to light work “more than adequately accounts for the degenerative 14 changes, especially in light of the lack of consistent treatment, the missed appointments and an 15 examination of the musculoskeletal system showing no evidence of bony tenderness, joint 16 effusion, enlargement, or abnormal motion. AR 20 (citations to administrative record omitted). 17 The ALJ gave little weight to the opinions of Nurses Flores and Thomas, finding both 18 opinions over-restrictive; inconsistent with medical evidence, particularly the mild findings 19 related to Plaintiff’s knee impairment; and also inconsistent with evidence of Plaintiff’s ability to 20 help with household chores and independently perform her activities of daily living. AR 21. 21 “[A]n ALJ is responsible for determining credibility and resolving conflicts in medical 22 testimony.” Magallanes, 881 F.2d at 750. S/he properly determines the weight to be given each 23 medical opinion by considering the evidence in the record, as the ALJ did here. 20 C.F.R. § 24 404.1527(c)(4) (“the more consistent an opinion is with the record as a whole, the more weight 25 we will give to that opinion”). The record must include objective evidence to support the medical 26 opinion of the claimant’s residual functional capacity. Meanel v. Apfel, 172 F.3d 1111, 1113-14 27 (9th Cir. 1999). Inconsistencies with the overall record or with a physician’s own notes are a valid 28 1 basis to reject a medical opinion. Molina, 674 F.3d at 1111-1112 (recognizing that a conflict with 2 treatment notes is a germane reason to reject a treating physician's assistant's opinion); Connett v. 3 Barnhart, 340 F.3d 871, 875 (9th Cir. 2003) (rejecting physician’s opinion when treatment notes 4 provide no basis for the opined functional restrictions); Tommasetti, 533 F.3d at 1041 5 (incongruity between questionnaire responses and the Plaintiff’s medical records is a specific and 6 legitimate reason for rejecting an opinion); Valentine v. Comm'r of Soc. Sec. Admin., 574 F.3d 7 685, 692-693 (9th Cir. 2009) (holding that a conflict with treatment notes is a specific and 8 legitimate reason to reject a treating physician's opinion). 9 Notably, no medical expert opined that Plaintiff’s obesity was a severe impairment. 10 Although Plaintiff now contends that her obesity was capable of exacerbating her right knee pain, 11 no evidence in the record supports her contention. Where the record does not include evidence of 12 a functional limitation due to obesity, or an indication that the claimant’s obesity exacerbated 13 another impairment, the ALJ is not required to consider a claimant’s obesity in combination with 14 other impairments. Burch v. Barnhart, 400 F.3d 676, 682 (9th Cir. 2005). See also Rocha v. 15 Colvin, 633 Fed.Appx. 894, 897 (9th Cir. 2015) (“The ALJ properly considered Rocha’s obesity 16 in making his determinations. The ALJ noted there was little evidence in the record to suggest 17 Rocha was limited by her obesity”); Garcia v. Comm’r of Soc. Sec. Admin., 498 Fed.Appx. 710, 18 712 (9th Cir. 2012) (the ALJ appropriately found that the claimant’s obesity did not impact the 19 residual functional capacity where the Plaintiff “did not provide any evidence of functional 20 limitations due to obesity”); Hoffman v. Astrue, 266 Fed.Appx. 623, 625 (9th Cir. 2008) (“The 21 ALJ’s failure to consider Hoffman’s obesity in relation to his RFC was proper because Hoffman 22 failed to show how his obesity in combination with another impairment increased the severity of 23 his limitations”). 24 The Court is not required to accept Plaintiff’s characterization of her treatment records or 25 her assessment of the medical opinions. The ALJ fully supported her determination based on multiple medical opinions and the evidence of record. Even if this Court were to accept that the 26 record could support Plaintiff’s opinion, the record amply supports the ALJ’s interpretation as 27 /// 28 1 well. When the evidence could arguably support two interpretations, the Court may not substitute 2 its judgment for that of the Commissioner. Jamerson, 112 F.3d at 1066. 3 VIII. Conclusion and Order 4 Based on the foregoing, the Court finds that the ALJ’s decision that Plaintiff is not 5 disabled is supported by substantial evidence in the record as a whole and is based on proper legal 6 standards. Accordingly, this Court DENIES Plaintiff’s appeal from the administrative decision of 7 the Commissioner of Social Security. The Clerk of Court is directed to enter judgment in favor of 8 Defendant Andrew Saul, Commissioner of Social Security, and against Plaintiff Teresa R. 9 Coronado. 10 IT IS SO ORDERED. 11 12 Dated: April 8, 2020 /s/ Gary S. Austin UNITED STATES MAGISTRATE JUDGE 13

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