1 WO 2 3 4 5 6 IN THE UNITED STATES DISTRICT COURT 7 FOR THE DISTRICT OF ARIZONA
9 Heather Lynn Stein, No. CV-22-00141-PHX-JJT
10 Plaintiff, ORDER
11 v.
12 Commissioner of Social Security Administration, 13 Defendant. 14 15 At issue is the denial of Plaintiff Heather Lynn Stein’s Application for Disability 16 Insurance Benefits (“DIB”) by the Social Security Administration (“SSA”) under the 17 Social Security Act (“the Act”). Plaintiff filed a Complaint (Doc. 1) with this Court seeking 18 judicial review of that denial, and the Court now addresses Plaintiff’s Opening Brief 19 (Doc. 17), Defendant Social Security Administration Commissioner’s Response Brief 20 (Doc. 20), and Plaintiff’s Reply Brief (Doc. 21). The Court has reviewed the briefs, 21 Administrative Record (Doc. 14, “R.”), and the Administrative Law Judge’s (“ALJ”) 22 decision (R. at 13-29) and affirms the ALJ’s decision for the reasons addressed herein. 23 I. BACKGROUND 24 Plaintiff filed an application for DIB on January 20, 2020, alleging disability 25 beginning on October 30, 2018. During her hearing, Plaintiff later amended her disability 26 onset date to December 18, 2018. (R. at 13). Plaintiff’s claims were denied initially on 27 March 23, 2020, and upon reconsideration on May 29, 2020. (Id.) On March 25, 2021, 28 Plaintiff testified before an ALJ in a telephone hearing regarding her claims. (Id.) On 1 April 28, 2021, the ALJ denied her claims. (R. at 13-29). On November 26, 2021, the 2 Appeals Council denied her request for review of the ALJ’s decision. (R. at 1-5). On 3 January 25, 2022, Plaintiff filed this action seeking judicial review. (Doc. 1). 4 The Court has reviewed the medical evidence in its entirety and finds it unnecessary 5 to provide a complete summary here. The pertinent medical evidence will be discussed in 6 addressing the issues raised by the parties. In short, upon consideration of the medical 7 records and opinions, the ALJ evaluated Plaintiff’s alleged disability based on the severe 8 impairments of bilateral hip bursitis, inflammatory arthritis, fibromyalgia, and bipolar 9 affective disorder. (R. at 16). 10 Ultimately, the ALJ evaluated the medical evidence and opinions and concluded 11 that Plaintiff was not disabled. (R. at 29). The ALJ found that Plaintiff did “not have an 12 impairment or combination of impairments that met or medically equaled the severity of 13 one of the listed impairments in 20 CFR Part 404, Subpart P, Appendix 1.” (R. at 17). Next, 14 the ALJ found that Plaintiff had the residual functional capacity (“RFC”) to “perform 15 sedentary work as defined in 20 CFR 404.1567(a)” with certain function limitations and 16 concluded that Plaintiff was “capable of making a successful adjustment to other work that 17 existed in significant numbers in the national economy.” (R. at 20, 29). 18 II. LEGAL STANDARD 19 In determining whether to reverse an ALJ’s decision, the district court reviews only 20 those issues raised by the party challenging the decision. See Lewis v. Apfel, 236 F.3d 503, 21 517 n.13 (9th Cir. 2001). The court may set aside the Commissioner’s disability 22 determination only if the determination is not supported by substantial evidence or is based 23 on legal error. Orn v. Astrue, 495 F.3d 625, 630 (9th Cir. 2007). Substantial evidence is 24 more than a scintilla, but less than a preponderance; it is relevant evidence that a reasonable 25 person might accept as adequate to support a conclusion considering the record as a whole. 26 Id. To determine whether substantial evidence supports a decision, the court must consider 27 the record as a whole and may not affirm simply by isolating a “specific quantum of 28 supporting evidence.” Id. As a general rule, “[w]here the evidence is susceptible to more 1 than one rational interpretation, one of which supports the ALJ’s decision, the ALJ’s 2 conclusion must be upheld.” Thomas v. Barnhart, 278 F.3d 947, 954 (9th Cir. 2002). 3 (citations omitted). 4 To determine whether a claimant is disabled for purposes of the Act, the ALJ 5 follows a five–step process. 20 C.F.R. § 416.920(a). The claimant bears the burden of proof 6 on the first four steps, but the burden shifts to the Commissioner at step five. Tackett v. 7 Apfel, 180 F.3d 1094, 1098 (9th Cir. 1999). At the first step, the ALJ determines whether 8 the claimant is presently engaging in substantial gainful activity. 20 C.F.R. § 416.920(b). 9 If so, the claimant is not disabled, and the inquiry ends. Id. At step two, the ALJ determines 10 whether the claimant has a “severe” medically determinable physical or mental 11 impairment. 20 C.F.R. § 416.920(c). If not, the claimant is not disabled, and the inquiry 12 ends. Id. At step three, the ALJ considers whether the claimant’s impairment or 13 combination of impairments meets or medically equals an impairment listed in Appendix 14 1 to Subpart P of 20 C.F.R. Part 404. 20 C.F.R. § 416.920(d). If so, the claimant is 15 automatically found to be disabled. Id. If not, the ALJ proceeds to step four. Id. At step 16 four, the ALJ assesses the claimant’s RFC and determines whether the claimant is still 17 capable of performing past relevant work. 20 C.F.R. § 416.920(e). If so, the claimant is not 18 disabled, and the inquiry ends. Id. If not, the ALJ proceeds to the fifth and final step, where 19 she determines whether the claimant can perform any other work in the national economy 20 based on the claimant’s RFC, age, education, and work experience. 20 C.F.R. § 416.920(g). 21 If so, the claimant is not disabled. Id. If not, the claimant is disabled. Id. 22 III. ANALYSIS 23 Plaintiff raises two arguments for the Court’s consideration: (1) whether Plaintiff’s 24 symptom testimony was erroneously rejected, and (2) whether the ALJ properly considered 25 the assessment of treating nurse practitioner, Heidi Pence, PsyNP. (Doc. 17 at 1). Plaintiff 26 requests this Court to remand the case for an award of benefits. (Doc. 17 at 25). 27 28 1 A. The ALJ did not err in rejecting Plaintiff’s symptom and pain testimony. 2 Plaintiff argues that the ALJ failed to provide specific, clear, and convincing reasons 3 supported by substantial evidence to reject Plaintiff’s symptom testimony. (Doc. 17 at 4 13-20.) 5 An ALJ performs a two-step analysis to evaluate a claimant’s testimony regarding 6 pain and symptoms. Garrison v. Colvin, 759 F.3d 995, 1014 (9th Cir. 2014). First, the ALJ 7 evaluates whether the claimant has presented objective medical evidence of an impairment 8 “which could reasonably be expected to produce the pain or symptoms alleged.” 9 Lingenfelter v. Astrue, 504 F.3d 1028, 1035–36 (9th Cir. 2007) (quoting Bunnell v. 10 Sullivan, 947 F.2d 341, 344 (9th Cir. 1991) (en banc) (internal quotation marks omitted)). 11 Second, absent evidence of malingering, an ALJ may only discount a claimant’s allegations 12 for reasons that are “specific, clear and convincing” and supported by substantial evidence. 13 Molina v. Astrue, 674 F.3d 1104, 1112 (9th Cir. 2012). “The clear and convincing standard 14 is the most demanding required in Social Security cases.” Garrison, 759 F.3d at 1015. 15 “[T]he ALJ must specifically identify the testimony she or he finds not to be credible 16 and must explain what evidence undermines the testimony.” Holohan v. Massanari, 246 17 F.3d 1195, 1208 (9th Cir. 2001). General findings regarding the Plaintiff’s credibility are 18 insufficient. Id. “Although the ALJ’s analysis need not be extensive, the ALJ must provide 19 some reasoning in order for [the Court] to meaningfully determine whether the ALJ’s 20 conclusions were supported by substantial evidence.” Treichler v. Comm’r of Soc. Sec. 21 Admin., 775 F.3d 1090, 1099 (9th Cir. 2014). However, “an ALJ [is not] required to believe 22 every allegation of disabling pain, or else disability benefits would be available for the 23 asking, a result plainly contrary to 42 U.S.C. § 423(d)(5)(A).” Fair v. Bowen, 885 F.2d 24 597, 603 (9th Cir. 1989). “[T]he ALJ may consider inconsistencies either in the claimant’s 25 testimony or between the testimony and the claimant’s conduct.” Molina, 674 F.3d at 1112. 26 For instance, the ALJ may consider “‘whether the claimant engages in daily activities 27 inconsistent with the alleged symptoms.’” Id. (quoting Lingenfelter, 504 F.3d at 1040). 28 1 The ALJ’s decision accounted for Plaintiff’s impairments encompassing bilateral 2 hip bursitis, inflammatory arthritis, fibromyalgia, and bipolar affective disorder. (R. at 16). 3 Plaintiff testified that she has been unable to work because of severe depression, anxiety, 4 and panic attacks, along with physical issues that include pain with her hip, hands, and feet. 5 (R. at 50). Plaintiff asserted that she can only walk for five to ten minutes at a slow pace 6 and would occasionally have to take a break. (R. at 50-51). Plaintiff stated that she 7 experienced constant aching pain with occasional sharpness in her hands and hips. (R. at 8 53). Plaintiff further stated that walking, sitting for too long, and standing for ten minutes 9 “aggravates” her pain and she needs to lay down for two hours every day. (R. at 53-55). 10 With regards to Plaintiff’s mental limitations, she testified that her anxiety and panic 11 attacks are triggered when having to be around people and she suffered from a panic attack 12 once every four months that lasts for ten to fifteen minutes. (R. at 56-58). Plaintiff claimed 13 that she cried every other day due to her depression and it caused her to experience brain 14 fog, which affected her short-term memory. (R. at 58). 15 The ALJ considered the level of Plaintiff’s medical issues and found that her 16 “impairments could reasonably be expected to cause the alleged symptoms; however, the 17 claimant’s statements concerning the intensity, persistence and limiting effects of these 18 symptoms are not entirely consistent with the medical evidence and other evidence in the 19 record...” (R. at 23). The ALJ then cited to specific examples in the record to support her 20 findings. Plaintiff, however, argues that the ALJ failed to provide specific, clear, and 21 convincing reasons to reject Plaintiff’s symptom testimony. (Doc. 17 at 13-20). The Court 22 does not agree with Plaintiff’s arguments. The ALJ appropriately relied on medical 23 evidence that did not corroborate the Plaintiff’s allegations as only one reason to discount 24 her testimony. Although this could not be the ALJ’s sole consideration, it is a permissible 25 one. Burch v. Barnhart, 400 F.3d 676, 680 (9th Cir. 2005). The ALJ also pointed to 26 Plaintiff’s conservative treatment as an additional reason for discrediting Plaintiff’s 27 symptom testimony. (R. at 22-24). 28 1 Plaintiff’s first argument implies that the ALJ relied on the severity of the symptoms 2 to reject her symptom testimony. (Doc. 17 at 14). Plaintiff’s argument is misplaced. The 3 ALJ did not require proof of the severity of Plaintiff’s symptoms; however, the ALJ is also 4 not required to believe every allegation of pain made by the Plaintiff. “The Court does not 5 read the ALJ's ‘not entirely consistent’ statement . . . as requiring Plaintiff to fully 6 corroborate her symptom testimony with objective medical evidence. Instead, the ALJ's 7 statement merely notes that the record contains conflicting evidence.” McPherson v. 8 Comm’r of Soc. Sec. Admin., No. CV-20-08202-PCT-JAT, 2021 WL 3709845, at *7 (D. 9 Ariz. Aug. 20, 2021). 10 With regard to Plaintiff’s mental impairments, the limited argument suggests that 11 the ALJ failed to explain how normal examination findings in the record diminished 12 Plaintiff’s testimony of anxiety, concentration deficiency or mood cycling during severe 13 depression. (Doc. 17 at 19). From the outset, the ALJ found that Plaintiff’s alleged anxiety 14 and depressive disorders were not impairments because “the record contains no medical 15 evidence to substantiate these impairments resulted from psychological abnormalities, 16 which were demonstrable by medically acceptable clinical and laboratory diagnostic 17 techniques as described in the Act.” (R. at 17). “Although [a] lack of medical evidence 18 cannot form the sole basis for discounting pain [or symptom] testimony, it is a factor that 19 the ALJ can consider in his credibility analysis.” Burch, 400 F.3d at 681. Additionally, the 20 ALJ’s discussion cited to treatment notes that documented Plaintiff had logical and intact 21 thought processes; normal mood and affect; clear speech, and an alert, calm and pleasant 22 appearance. (R. at 19, 23, 418, 421-22, 426, 432, 436, 442, 446, 497, 502, 509-10, 519, 23 523, 550, 552, 556, 560, 675, 678, 685, 692, 743, 765, 804, 856, 878, 913-14, 918, 923, 24 928, 932). The ALJ’s findings also deemed Plaintiff’s bipolar disorder as severe and cited 25 to instances in the record where Plaintiff experienced mood lability, sleep disturbances, 26 anxiety, low energy, hopelessness, racing thoughts, and difficulty controlling her emotions. 27 (R. at 23, 467, 470, 472-75, 756, 770, 888). However, the ALJ determined that the majority 28 of the examination records demonstrated Plaintiff had intact thought content, processes, 1 and perceptions. (R. at 23, 464-76, 754-58, 885-88, 904-05). Clearly, the record exposes 2 conflicting evidence between the Plaintiff’s testimony and the treatment notes, but it is the 3 ALJ’s responsibility “‘for determining credibility, resolving conflicts in medical 4 testimony, and for resolving ambiguities.’” Ford v. Saul, 950 F.3d 1141, 1149 (9th Cir. 5 2020) (quoting Andrews v. Shalala, 53 F.3d 1035, 1039 (9th Cir. 1995)). The Court finds 6 the ALJ has met her burden in providing sufficient explanations to support her decision. 7 The ALJ’s discussion regarding Plaintiff’s physical impairments focused on her 8 bilateral hip bursitis, inflammatory arthritis, and fibromyalgia. (R. at 22-23). The ALJ 9 noted that physical examinations in the record revealed Plaintiff experienced tenderness to 10 palpation over the trochanteric bursa and multiple fibromyalgia tender points. (R. at 23). 11 Nevertheless, many treatment notes also contradicted this evidence and demonstrated that 12 Plaintiff exhibited nonantalgic gait, intact ability to stand on her tiptoes/heels, no joint 13 effusions, no erythema, no synovitis, normal range of motion to include her hands, intact 14 strength, no edema, and normal coordination, reflexes and movement of all extremities. 15 (R. at 23, 418, 421-22, 426, 432, 436, 442, 446, 497, 502, 509-10, 519, 523, 552, 556, 560, 16 675, 678, 685, 691-92, 742-43, 765, 803-04, 856, 878, 912-14, 918, 923, 928, 932). 17 Plaintiff argues that the ALJ made no effort to connect the discussion of the medical 18 evidence to a finding that any specific part of Plaintiff’s testimony lacked credibility. 19 (Doc. 17 at 14). The Court is not persuaded by Plaintiff’s argument. The ALJ unmistakably 20 set forth a summary of Plaintiff’s testimony that illustrated her physical impairments. 21 (R. at 22). The ALJ then discussed the objective medical evidence from the record and 22 used specific evidence from the record to render her findings. (R. at 22-23). The Court 23 finds the ALJ’s reasoning is discernible and is clearly supported by the medical evidence. 24 If an ALJ’s decision is made “with less than ideal clarity, a reviewing court will not upset 25 the decision on that account if [his] path may reasonably be discerned.” Alaska Dept. of 26 Edvtl. Conservation v. E.P.A., 540 U.S. 461, 497 (2004); See Brown-Hunter v. Colvin, 806 27 F.3d 487, 492 (9th Cir. 2015) (applying this standard to social security). 28 1 The medical record further indicates that despite claims of pain, Plaintiff exhibited 2 normal range of motion to include the hands, normal coordination, normal reflexes, normal 3 movement of extremities, and nonantalgic gait. (R. at 24, 418, 421-22, 426, 432, 436, 442, 4 446, 497, 502, 509-10, 519, 523, 552, 556, 560, 675, 678, 685, 691-92, 742-43, 765, 803- 5 04, 856, 878, 912-14, 918, 923, 928, 932). The ALJ also noted that nothing in the record 6 indicated that Plaintiff required an assistive device to ambulate, and Plaintiff experienced 7 some benefits with her treatment regimen. (R. at 23-24). Plaintiff additionally argues that 8 the ALJ did not explain how examinations with normal findings were inconsistent with 9 Plaintiff’s testimony regarding the effects of her pain and other symptoms on her inability 10 to sustain full-time work. (Doc. 17 at 15). The ALJ is not required to mechanically specify 11 each allegation that every piece of medical evidence undermined. Grouping the medical 12 evidence with the allegations they undermined was sufficient. See Brown-Hunter, 806 F.3d 13 at 492. Plaintiff’s arguments only seek to offer alternative interpretations of the evidence, 14 which the Court does not support. See Burch, 400 F.3d at 679. 15 The ALJ also considered the conservative course of treatment as a factor in the non- 16 disability determination. (R. at 40). This was a proper consideration by the ALJ. See Parra 17 v. Astrue, 481 F.3d 742, 750-51 (9th Cir. 2007) (indicating that if a claimant has only 18 received conservative treatment, this is a proper reason for the ALJ to discount his 19 symptom testimony). Plaintiff contends that the injections and medical trials she underwent 20 do not qualify as conservative medical treatment. (Doc. 17 at 18). However, the ALJ may 21 consider “whether the claimant takes medication or undergoes other treatment for the 22 symptoms.” Lingenfelter, 504 F.3d at 1040; see 20 C.F.R. § 404.1529(c)(3). “Impairments 23 that can be controlled effectively with medication are not disabling.” Warre v. Comm’r of 24 Soc. Sec. Admin., 439 F.3d 1001, 1006 (9th Cir. 2006). The ALJ noted that Plaintiff 25 received bilateral hip injections and medication for treatment of her pain. (R. at 22-23, 26 413-63, 517-28, 550, 739-52, 802-67, 889-903, 906-33). Plaintiff reported experiencing a 27 benefit from her treatment regimen. (R. at 23, 416, 422, 424, 426, 432, 546, 802, 804, 912, 28 916). Plaintiff pointed out that she received 30% to 50% and upwards of 70% improvement 1 with her medications and injections. (Doc. 17 at 16) (citing R. at 416, 741, 918, 926, 930). 2 Plaintiff argues that the medical evidence the ALJ cited to does not show Plaintiff was 3 provided with lasting relief to allow her to work or to invalidate her symptom testimony. 4 (Doc. 17 at 17). However, based upon the medical evidence, the record clearly shows that 5 Plaintiff exhibited vast improvement with her prescribed treatment plans and received 6 significant pain relief from her impairments. Plaintiff further argues that she experienced 7 issues with sedation between July 2019 and October 2019 stemming as a side effect from 8 her medication. (Doc. 17 at 17). Nevertheless, it appears to have been a limited matter as 9 the ALJ noted the Plaintiff denied problems with sedation at the remainder of her medical 10 appointments during the relevant period of her disability claim. (R. at 23, 414, 417, 421, 11 425, 431, 435, 441, 446, 742, 913, 917, 923, 927). 12 In consideration of Plaintiff’s daily living activities, the ALJ analyzed the extent of 13 Plaintiff’s activity level against the functional limitations required to meet the listed 14 impairments, specifically Listing 1.18, 12.04, 14.09 and SSR 12-2p. (R. at 17). The ALJ 15 found Plaintiff did not meet any of the criteria and cited Plaintiff’s daily activities as one 16 example to reach this conclusion. Plaintiff’s activity level included preparation of simple 17 meals, use of a computer, performance of household chores that included laundry and 18 washing dishes, the ability to drive without medical restrictions, the capability to go 19 shopping, paying bills, and visiting with her family in-person (pre-Covid) and on video 20 chat (during Covid). (R. at 18-20, 46, 51-52, 60). Although Plaintiff alleged pain during 21 some of her activities, “[e]ven where those [daily] activities suggest some difficulty 22 functioning, they may be grounds for discrediting the claimant’s testimony to the extent 23 that they contradict claims of a totally debilitating impairment,” Molina, 674 F.3d at 1113. 24 Given the scope of the record, the ALJ properly relied upon the objective medical 25 evidence to find Plaintiff’s allegations were inconsistent with the record. There is sufficient 26 evidence present to enable this Court to reasonably discern the ALJ’s path to conclude that 27 her decision is supported by substantial evidence. As stated previously, “[w]here the 28 evidence is susceptible to more than one rational interpretation, one of which supports the 1 ALJ’s decision, the ALJ’s conclusion must be upheld.” Thomas, 278 F.3d at 954. 2 Therefore, the Court finds the ALJ did not err in rejecting Plaintiff’s pain and symptom 3 testimony. The ALJ provided specific, clear, and convincing reasons to dismiss Plaintiff’s 4 claims and those reasons were supported by substantial evidence. 5 B. The ALJ properly considered the medical opinion evidence. 6 Plaintiff argues that the ALJ erred in her assessment of psychiatric nurse 7 practitioner, Heidi Pence, PsyNP, by failing to explain the supportability and consistency 8 factors required to be supported by substantial evidence. (Doc. 17 at 1). 9 Plaintiff applied for disability benefits after March 27, 2017, and is subject to the 10 new set of regulations for evaluating evidence from medical providers. See 20 C.F.R. 11 § 416.920c. The new regulations eliminate the previous hierarchy of medical opinions, and 12 the ALJ is not allowed to defer to or give specific weight to any medical opinions. The new 13 regulations state: 14 We will not defer or give any specific evidentiary weight, including controlling weight, to any medical opinion(s) or prior 15 administrative medical finding(s), including those from your 16 medical sources . . . The most important factors we consider when we evaluate the persuasiveness of medical opinions and 17 prior administrative medical findings are supportability 18 (paragraph (c)(1) of this section) and consistency (paragraph (c)(2) of this section). We will articulate how we considered 19 the medical opinions and prior administrative medical findings 20 in your claim according to paragraph (b) of this section. 21 20 C.F.R. § 416.920c.1 22 Recently, the Ninth Circuit confirmed that the “recent changes to the Social Security 23 Administration’s regulations displace our longstanding case law requiring an ALJ to 24 provide ‘specific and legitimate’ reasons for rejecting an examining doctor’s opinion.” 25 Woods v. Kijakazi, 32 F.4th 785, 787 (9th Cir. 2022). Thus, “the former hierarchy of 26 medical opinions—in which we assign presumptive weight based on the extent of the
27 1 Other factors that may be considered by the ALJ in addition to supportability and consistency include the provider’s relationship with the claimant, the length of the 28 treatment relationship, frequency of examinations, purpose and extent of the treatment relationship, and the specialization of the provider. 20 C.F.R. § 416.920c. 1 doctor's relationship with the claimant—no longer applies. Now, an ALJ’s decision, 2 including the decision to discredit any medical opinion, must simply be supported by 3 substantial evidence.” Id. With that said, “[e]ven under the new regulations, an ALJ cannot 4 reject an examining or treating doctor’s opinion as unsupported or inconsistent without 5 providing an explanation supported by substantial evidence. The agency must articulate 6 how persuasive it finds all of the medical opinions from each doctor or other source and 7 explain how it considered the supportability and consistency factors in reaching these 8 findings.” Id. at 792. 9 In the present case, NP Pence submitted two separate check-box medical 10 questionnaires in February 2020 and February 2021. (R. at 668-69, 934-35). NP Pence 11 opined that Plaintiff experienced moderately-severe to severe impairments in various areas 12 of functioning that affected her ability to work an eight-hour workday. (R. at 668-69, 934- 13 35). NP Pence also noted that Plaintiff experienced moderately severe sedation as a side 14 effect from her medication. (R. at 668-69, 934-35). The ALJ found NP Pence’s opinions 15 unpersuasive. (R. at 26). The check-box questionnaires lacked supporting explanations and 16 documentation to support NP Pence’s opinions. “We have held that the ALJ may 17 ‘permissibly reject []…check-off reports that [do] not contain any explanation of the bases 18 of their conclusions.’” Molina, 674 F.3d at 1111-12 (citations omitted). The ALJ found NP 19 Pence’s opinion lacked supportability because treatment notes from NP Pence’s own 20 examinations of Plaintiff suggest other findings contrary to what was submitted in the 21 forms. For instance, NP Pence documented sedation as a side effect from Plaintiff’s 22 medication, but the ALJ pointed out that NP Pence’s treatment records consistently 23 indicated that Plaintiff did not experience any side effects from her prescribed medications, 24 aside from a few months in 2019. (R. at 26, 414, 417, 421, 425, 431, 435, 441, 446, 742, 25 913, 917, 923, 927). While Plaintiff again argues that sedation was not properly considered 26 by the ALJ (Doc. 17 at 22), the record indicates that the ALJ did take this side effect into 27 consideration and found it was not supported by the treatment records. (R. at 26). An ALJ 28 need not adopt wholesale any physician’s opinion regarding a claimant’s limitations. See 1 Carmickle v. Comm’r of Soc. Sec., 533 F.3d 1155, 1164 (9th Cir. 2008). The ALJ also 2 found that the limitations proffered by NP Pence were not supported by her own mental 3 status examinations, which found some abnormalities in the record, but overall, indicated 4 Plaintiff displayed intact thought content, thought processes, and perceptions. (R. at 26, 5 464-76, 754-58, 885-88, 904-05). 6 Moreover, the ALJ found NP Pence’s limitations were not consistent with Plaintiff’s 7 treatment course, which was routine and conservative. (R. at 26). The ALJ found NP Pence 8 did not require Plaintiff to attend any inpatient psychiatric hospitalizations, intensive 9 outpatient programs, or crisis interventions during her course of treatment. (R. at 24). The 10 ALJ also found that NP Pence’s limitations were not consistent with the examination 11 findings in the record by Plaintiff’s other medical providers. (R. at 26). Other providers’ 12 treatment notes indicated Plaintiff had “an alert/calm/pleasant appearance with normal 13 mood, normal affect, normal behavior, logical/goal-directed thought processes, clear 14 speech, and intact thought content.” (R. at 26, 418, 421-22, 426, 432, 436, 442, 446, 497, 15 502, 509-10, 519, 523, 552, 556, 560, 675, 678, 685, 691-92, 742-43, 765, 803-04, 856, 16 878, 912-14, 918, 923, 928, 932). Again, Plaintiff argues the ALJ failed to “clearly explain” 17 the supportability and consistency of NP Pence’s assessed limitations submitted via the 18 check-box forms. (Doc. 17 at 22-23). The ALJ met her burden of discussing the Listings 19 limitations and the “paragraph B” criteria as required for mental impairments. (R. at 17- 20 20). The regulations specifically state that, “it is not administratively feasible for us to 21 articulate in each determination or decision how we considered all of the factors for all of 22 the medical opinions and prior administrative medical findings in your case record… We 23 are not required to articulate how we considered each medical opinion or prior 24 administrative medical finding from one medical source individually.” 20 C.F.R. 25 § 416.920c(b)(1). The regulations illustrate that an ALJ does not need to convey their 26 consideration behind every limitation finding in a medical opinion. 27 Plaintiff’s final argument again asserts that since NP Pence was a treating provider, 28 the ALJ should have been more detailed in her analysis as to why nonexamining physician 1 || opinions were more persuasive than a treating provider. (Doc. 17 at 23-24). However, as 2|| stated above, the new regulations no longer afford any deference to one treating source || over another. The two most important factors for an ALJ to consider are consistency and 4|| supportability. The ALJ clearly discussed how persuasive she found each medical opinion 5 || and articulated sufficient reasons based upon the consistency and supportability factors to 6|| validate her nondisability finding. Ultimately, Plaintiff takes issue with the ALJ’s interpretation of the evidence and asserts that her interpretation of the evidence is a better || alternative. But “[w]here the evidence is susceptible to more than one rational 9|| interpretation, one of which supports the ALJ’s decision, the ALJ’s conclusion must be upheld.” Thomas, 278 F.3d at 954. The Court finds the ALJ provided substantial evidence 11 || to sufficiently support her decision. IV. CONCLUSION 13 The Court finds that substantial evidence supports the Commissioner’s nondisability determination. The ALJ properly discounted Plaintiff's symptom testimony 15 || by providing specific, clear, and convincing reasons supported by substantial evidence, and 16 || properly considered the medical opinion evidence of record. Therefore, the Court finds that 17 || the ALJ did not err in her decision, which is based on substantial evidence. The Court need 18 || not reach the merits of Plaintiff's request to remand for an award of benefits since the Court || finds a remand is unwarranted. 20 IT IS HEREBY ORDERED that the decision of the Commissioner 1s || AFFIRMED. The Clerk of Court is directed to enter judgment accordingly and dismiss □□ this action. 23 Dated this 11th day of July, 2023. o™ 24 “wok: 25 wefhlee— 26 United StatesDistrict Judge 27 28
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