Stringer v. Commissioner of Social Security Administration

• Court: District Court, D. Arizona
• Decided: March 28, 2024
• Docket: 4:22-cv-00387
• Status: Unknown

Opinion

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

9 Joni Diane Stringer, No. CV-22-00387-TUC-JCH

10 Plaintiff, ORDER

11 v.

12 Commissioner of Social Security Administration, 13 Defendant. 14 15 Plaintiff Joni Diane Stringer brought this action under 42 U.S.C. §§ 405(g) and 16 1383(c)(3), seeking judicial review of a final decision by the Commissioner of Social 17 Security ("Commissioner"). Doc. 1. This matter was referred to United States Magistrate 18 Judge Lynette C. Kimmins for Report and Recommendation ("R&R"). Doc. 14. On 19 December 18, 2023, Judge Kimmins issued her R&R finding the Administrative Law 20 Judge ("ALJ") did not err and recommending this Court affirm the Commissioner's 21 decision. Doc. 26 at 12. Plaintiff objects to the R&R. Doc. 27. The Court will overrule 22 Plaintiff's objections, adopt the R&R in full, and affirm the Commissioner's decision. 23 I. FACTUAL AND PROCEDURAL HISTORY 24 In February 2019, Plaintiff filed her initial application for Title II Disability 25 Insurance Benefits, alleging disability beginning June 1, 2017. See Administrative Record 26 ("AR") 316–25. Plaintiff's application was denied upon initial review and on 27 reconsideration. AR 105–31. On September 2, 2020, ALJ Kelly Walls found Plaintiff not 28 disabled because she could perform past relevant work. AR 132–47. On February 8, 2021, 1 the Appeals Council vacated the ALJ's decision and remanded the case to the ALJ to 2 resolve conflicts between vocational expert evidence and the Dictionary of Occupational 3 Titles. AR 152–55. On December 22, 2021, the ALJ again found Plaintiff not disabled 4 because she could perform past relevant work and concluded that Plaintiff was not disabled 5 pursuant to the Social Security Act. AR 23–35. 6 To be found disabled and qualified for Disability Insurance Benefits or 7 Supplemental Security Income, a claimant must be unable "to engage in any substantial 8 gainful activity by reason of any medically determinable physical or mental impairment 9 which can be expected to result in death or which has lasted or can be expected to last for 10 a continuous period of not less than 12 months." 42 U.S.C. §§ 423(d)(1)(a) & 11 1382(a)(3)(A). The same five-step sequential evaluation governs eligibility for benefits 12 under both programs. See 20 C.F.R. §§ 404.1520, 404.1571-76, 416.920 & 416.971-76; 13 Bowen v. Yuckert, 482 U.S. 137, 140–142 (1987). The five-step process requires the 14 claimant to show (1) she has not worked since the alleged disability onset date, (2) she has 15 a severe physical or mental impairment, and (3) the impairment meets or equals a listed 16 impairment, or (4) her residual functional capacity ("RFC") precludes her from doing her 17 past work. If at any step the Commissioner determines that a claimant is or is not disabled, 18 the inquiry ends. If the claimant satisfies her burden through step four, the burden shifts to 19 the Commissioner to show at step five that the claimant has the RFC to perform other work 20 that exists in substantial numbers in the national economy. Lester v. Chater, 81 F.3d 821, 21 828 n. 5 (9th Cir. 1995); see also Bowen, 482 U.S. at 146 n. 5 (describing shifting burden 22 at step five). 23 In this case, the ALJ found at step one that Plaintiff had not engaged in substantial 24 gainful activity during the relevant period. AR 26. At step two, the ALJ found Plaintiff had 25 "severe"1 impairments including COPD, asthma, obesity, adjustment disorder with 26 depressed mood and insomnia, and major depressive disorder. AR 26. At step three, the 27 ALJ found that Plaintiff's impairments did not meet or medically equal the severity of one

28 1 An “impairment or combination of impairments” is “severe” if it “significantly limits [the] physical or mental ability to do basic work activities.” 20 C.F.R. § 404.1520(c). 1 of the impairments listed in 20 C.F.R., Part 404, Subpart P, Appendix 1. AR 26–29. 2 Between steps three and four, the ALJ determined Plaintiff had the Residual Functional 3 Capacity2 ("RFC") to perform medium work as defined in 20 CFR 404.1567(c), with 4 postural limitations, restricted exposure to concentrated environmental factors (dust, 5 fumes, gases, odors, and chemicals), and with limited decision-making and social 6 interaction in the workplace. AR 29. At step four, the ALJ found Plaintiff could perform 7 past relevant work as a laundry attendant and that such work does not require activities 8 precluded by Plaintiff's RFC. AR 34. Accordingly, the ALJ concluded Plaintiff was not 9 disabled since June 1, 2017, the date she filed her application. AR 34. Plaintiff requested 10 review before the Appeals Council, which was denied on July 6, 2022, thereby making the 11 ALJ's decision the Commissioner's final decision. AR 1–7. Thereafter, Plaintiff timely filed 12 the instant action. Doc. 1. Plaintiff argues the ALJ erred by (1) improperly rejecting opinion 13 evidence by Dr. Peter Hauser, MD ("Dr. Hauser") and (2) failing to provide clear and 14 convincing reasons for rejecting Plaintiff's symptom testimony. Doc. 20. 15 Judge Kimmins issued an R&R finding that the ALJ did not err in rejecting opinion 16 evidence by Dr. Peter Hauser, MD ("Dr. Hauser") or rejecting Plaintiff's symptom 17 testimony. See Doc. 26. Plaintiff objects.3 Doc. 27. Plaintiff first objects to Judge 18 Kimmins's recommended finding that the ALJ adequately addressed "supportability" with 19 respect to the medical opinions of Dr. Hauser. Doc. 27 at 2–3. Second, Plaintiff objects to 20 the recommendation that any failure by the ALJ to explicitly address both the supportability 21 and consistency of Dr. Hauser's opinions was harmless error. Doc. 27 at 3–6. Third, 22 Plaintiff objects to the recommendation that the ALJ provided clear and convincing reasons 23 for discounting symptom testimony that Plaintiff's Major Depressive Disorder produces 24

25 2 “Between steps three and four of the five-step evaluation, the ALJ must proceed to an intermediate step in which the ALJ assesses the claimant’s residual functional capacity.” Massachi 26 v. Astrue, 486 F.3d 1149, 1151 n.2 (9th Cir. 2007). A plaintiff’s residual functional capacity is what they can do despite existing exertional and nonexertional limitations. Cooper v. Sullivan, 880 27 F.2d 1152, 1155–56 n.5–7 (9th Cir. 1989). 3 Plaintiff did not object to the R&R's factual and procedural summary, or the standard of review 28 (see Doc. 27), therefore the Court adopts those portions in full. Doc. 26 at 1–3. 1 disabling restrictions. Doc. 27 at 7–9. Plaintiff requests this Court sustain Plaintiff's 2 objections, decline to adopt the R&R, and remand the matter for further administrative 3 proceedings including a de novo hearing and a new decision. Doc. 27 at 9. 4 II. STANDARD OF REVIEW 5 A. Review of the Report and Recommendation 6 In reviewing a Magistrate Judge's R&R, "[a] judge of the court shall make a de novo 7 determination of those portions of the report ... to which objection is made." 28 U.S.C. § 8 636(b)(1); see also Fed. R. Civ. P. 72(b); United States v. Remsing, 874 F.2d 614, 617 (9th 9 Cir. 1989). 10 B. Review of the ALJ's Decision 11 An ALJ's decision may be reversed only when it is unsupported by substantial 12 evidence or constitutes harmful legal error. Aukland v. Massanari, 257 F.3d 1033, 1035 13 (9th Cir. 2001). "Substantial evidence means more than a mere scintilla, but less than a 14 preponderance, i.e., such relevant evidence as a reasonable mind might accept as adequate 15 to support a conclusion." Robbins v. Soc. Sec. Admin., 466 F.3d 880, 882 (9th Cir. 2006) 16 (internal quotation and citation omitted). "Under the substantial-evidence standard, a court 17 looks to an existing administrative record and asks whether it contains 'sufficien[t] 18 evidence' to support the agency's factual determinations." Biestek v. Berryhill, 139 S. Ct. 19 1148, 1154 (2019) (quoting Consolidated Edison Co. v. NLRB, 305 U.S. 197, 229 (1938)). 20 While the Court is required to examine the record as a whole, it may neither reweigh 21 the evidence nor substitute its judgment for that of the Commissioner. Thomas v. Barnhart, 22 278 F.3d 947, 954 (9th Cir. 2002). When the evidence is susceptible to more than one 23 rational interpretation, it is the Commissioner's conclusion that must be upheld. Id. 24 III. ANALYSIS 25 A. Supportability 26 Plaintiff argues the ALJ did not address supportability in rejecting opinion evidence 27 from Dr. Hauser and Judge Kimmins's recommendation finding otherwise should be 28 rejected. While the Court conducted a de novo review of the entire Administrative Record, 1 Plaintiff did not object to the accuracy of Judge Kimmins's factual summary of Dr. Hauser's 2 treatment, notes, and conclusions (Doc. 26 at 4:12–6:3), therefore the Court adopts those 3 portions of the R&R in full and will not rehearse those facts here. Notably, the ALJ found 4 several of Dr. Hauser's assertions of "marked limitations" lacked support, which negatively 5 affected the persuasiveness of Dr. Hauser's opinion. See AR 33. 6 ALJs are to consider both supportability4 and consistency5 when evaluating the 7 persuasiveness of a medical opinion. 20 C.F.R. § 404.1520c(b)(2) (supportability and 8 consistency are "the most important factors" for persuasiveness of a medical opinion). 9 ALJs are required to explain how they "considered the supportability and consistency 10 factors for a medical source's medical opinions…" 20 C.F.R. § 404.1520c(b)(2). "[A]n ALJ 11 cannot reject an examining or treating doctor's opinion as unsupported or inconsistent 12 without providing an explanation supported by substantial evidence." Woods v. Kijakazi, 13 32 F.4th 785, 792 (9th Cir. 2022). 14 The Court agrees with the Magistrate Judge's finding that the ALJ adequately 15 addressed supportability in the decision: "There is insufficient evidence to support [Dr. 16 Hauser's] assertion that [Plaintiff] has marked limitations in social functioning, adaptation 17 and self-care, or concentration, persistence and pace." AR 33 (emphasis added). The ALJ 18 first listed several statements from Dr. Hauser's September 18, 2020, opinion before 19 finding his opinion only partially persuasive. AR 33. The ALJ articulates the reason for 20 this determination as discrepancies between Dr. Hauser's opinion and Dr. Hauser's medical 21 records. See AR 30–33. The ALJ reasoned that Dr. Hauser's records contained insufficient 22 or contradictory evidence to support the opinion that Plaintiff has "marked limitations" in 23 three domains of mental functioning. AR 33. The ALJ then notes that Dr. Hauser's records6

24 4 Supportability refers to the connection between (1) objective medical evidence and supporting explanations and (2) the resulting medical opinions. See 20 C.F.R. § 25 404.1520c(c)(1). It is an “internal check” on whether a doctor’s opinions are supported by that doctor’s medical records. See Doc. 27 at 2 n.1. 26 5 Consistency refers to the connection between (1) the medical opinion and (2) other medical and nonmedical sources from the claim. See 20 C.F.R. § 404.1520c(c)(2). In other 27 words, it is an “external check” on whether a particular doctor’s opinion is consistent with evidence from other sources in the claim record. See Doc. 27 at 2 n.1. 28 6 While the ALJ only cites to Dr. Hauser’s records once in the paragraph discussing supportability, the ALJ also refers to discussions “above in the body of [the ALJ’s] 1 detailing Plaintiff's medication compliance, intellectual functioning, and motivation are in 2 contradiction with Dr. Hauser's September 2020 opinion. AR 33. The ALJ considered the 3 supportability of Dr. Hauser's opinion, articulated the reasons for finding the opinion only 4 partially persuasive, and supported those reasons with substantial evidence from the 5 Administrative Record. Thus, the ALJ adequately addressed the supportability of Dr. 6 Hauser's medical opinion. The Court will overrule Plaintiff's objections and fully adopt the 7 Magistrate Judge's recommendation on this point. 8 B. Harmless Error 9 Plaintiff alleges that any legal error is grounds to set aside an ALJ's determination. 10 See Doc. 25 at 5. But the Court "may not reverse an ALJ's decision on account of an error 11 that is harmless." Molina v. Astrue, 674 F.3d 1004, 1111 (9th Cir 2012), superseded by 12 regulation on other grounds. "An error is harmless if it is inconsequential to the ultimate 13 nondisability determination[.]" Treichler v. Comm'r of Soc., Sec. Admin., 775 F.3d 1090, 14 1099 (9th Cir. 2015) (internal quotation and citation omitted). Put differently, "an error is 15 harmless so long as there remains substantial evidence supporting the ALJ's decision and 16 the error does not negate the validity of the ALJ's ultimate conclusion." Molina, 674 F.3d 17 at 1115 (internal quotation marks and citations omitted). 18 Even if the ALJ had not adequately addressed supportability, it would be harmless 19 error because the persuasiveness determination was supported by substantial evidence. The 20 regulations state ALJs must address both supportability and consistency when explaining 21 the persuasiveness of a medical opinion. 20 C.F.R. § 404.1520c(b)(2) (An ALJ "will 22 explain" how it considers supportability and consistency, versus other statutory factors that 23 ALJs simply "may, but are not required to, explain."). But 82 Fed. Reg. at 5854 states "[a] 24 medical opinion without supporting evidence, or one that is inconsistent with evidence 25 from other sources, will not be persuasive regardless of who made the medical opinion." 26 decision”—discussions that thoroughly cite to Dr. Hauser’s records. See AR 30–33. Thus, 27 the Court will infer that the ALJ was referring to Dr. Hauser’s records to evaluate the supportability of Dr. Hauser’s opinion. See Magallanes v. Bowen, 881 F.2d 747, 755 (9th 28 Cir. 1989) (proper for a reviewing court to draw “specific and legitimate inferences from the ALJ’s opinion”). 1 Similarly, in Woods, the Court of Appeals upheld an ALJ's rejection of a medical opinion 2 that only addressed consistency, stating "the decision to discredit any medical opinion, 3 must simply be supported by substantial evidence." 32 F.4th at 787. Other courts have 4 inferred from the Woods decision that an ALJ addressing only supportability or consistency 5 is harmless error, so long as there is substantial evidence to support the finding. See Joseph 6 F. v. Kijakazi, No. ED CV-22-050-DFM, 2022 WL 17903079, at *7 (C.D. Cal. Oct. 11, 7 2022) (collecting cases), appeal dismissed sub nom. Fields v. Kijakazi, No. 22-56187, 2023 8 WL 2572464 (9th Cir. Jan. 26, 2023). The Court agrees with this implication7 and finds 9 that even if the ALJ failed to address supportability, the error is harmless because the ALJ 10 adequately addressed consistency. 11 Following Plaintiff's argument would require a longer path to the same outcome. If 12 the ALJ finds persuasiveness already partially or fully failed based on one factor, remand 13 to address the other factor would not reverse that persuasiveness finding. This is the very 14 sort of error that is "inconsequential to the ultimate nondisability determination." The Court 15 will overrule Plaintiff's objections and fully adopt the Magistrate Judge's explanation on 16 this point. 17 C. Discounting Major Depressive Disorder Symptom Testimony 18 In evaluating symptom testimony, the ALJ must engage in a two-step analysis. First, 19 the ALJ must determine whether the claimant presented objective medical evidence of an 20 impairment that could reasonably be expected to produce the symptoms alleged. See 20 21 C.F.R. §§ 404.1529 & 416.929. If the claimant has presented such evidence, the ALJ 22 proceeds to consider "all of the available evidence, including [the claimant's] history, the 23 signs and laboratory findings, and statements from [the claimant]," her doctors, and other 24 persons to determine the persistence and intensity of these symptoms. See 20 C.F.R § 25 404.1529(c)(1). If there is no evidence of malingering, the ALJ may reject the claimant's 26 7 Plaintiff objects to any recommendation by the Magistrate Judge that the District Court 27 find the Court of Appeals in Woods held “that the ALJ is only required to address one factor or the other … [or] that substantial evidence trumps the need to comply with the 28 regulations.” Doc. 27 at 5. The Magistrate Judge made no such recommendation, and the Court makes no such finding. 1 symptom testimony only by giving specific, clear, and convincing reasons that are 2 supported by substantial evidence. Vasquez v. Astrue, 572 F.3d 586, 591 (9th Cir. 2009). 3 In other words, "[t]he ALJ must specify what testimony is not credible and identify the 4 evidence that undermines the claimant's complaints – general findings are insufficient." 5 Burch v. Barnhart, 400 F.3d 676, 680 (9th Cir. 2005) (internal citation and quotation 6 omitted); see Lambert v. Saul, 980 F.3d 1266, 1277 (9th Cir. 2020) (finding insufficient 7 the ALJ's "boilerplate statement" that the claimant's symptom testimony was "not entirely 8 consistent with the objective medical evidence"). 9 Here, the ALJ found Plaintiff's medically determinable impairments could 10 reasonably be expected to cause her alleged symptoms, but concluded Plaintiff's 11 "statements concerning the intensity, persistence and limiting effects of these symptoms 12 are not entirely consistent with the medical evidence and other evidence in the record for 13 the reasons explained in this decision." AR 30. Plaintiff objects to the ALJ's conclusions 14 related to Plaintiff's mental health symptom testimony. Plaintiff argues that "the ALJ does 15 not point to genuine inconsistencies; rather, she suggests character deficits and implies that 16 Plaintiff's condition is her own fault." Doc. 20 at 18. Plaintiff alleges the ALJ failed to 17 address Plaintiff's testimony "that she is unable to tolerate being around people" and instead 18 improperly chastised Plaintiff for not following her prescribed medication regimen. Doc. 19 25 at 7–8. Further, Plaintiff objects to the Magistrate Judge's recommended finding that 20 "the ALJ's discussion about why Plaintiff ceased working and the fact that she continued 21 to look for work were clear and convincing reasons for the ALJ to discount [Plaintiff's] 22 testimony." Doc. 27 at 7. 23 Plaintiff did not object to the accuracy of the Magistrate Judge's summary of the 24 Administrative Record on this issue. See generally Doc. 27 at 7–9. Though the Court 25 conducted a de novo review of the Administrative Record, the Court will adopt those 26 summary portions of the R&R in full (Doc. 26 at 8:24–11:2, 11:4–15) and will not restate 27 a summary here. 28 The ALJ discounted Plaintiff's symptom testimony and, in support, cited the 1 objective medical evidence and other evidence from the Administrative Record. AR 30– 2 32; see also AR 28. While an ALJ may not discount a claimant's symptom testimony solely 3 because a claimant's symptoms are not substantiated by the medical evidence, the medical 4 evidence is a relevant consideration in evaluating the claimant's symptoms. SSR 16-3p; 5 Rollins v. Massanari, 261 F.3d 853, 857 (9th Cir. 2001) (citing 20 C.F.R. § 6 404.1529(c)(2)). 7 In discounting Plaintiff's symptom testimony, the ALJ cited not only Plaintiff's 8 mental health treatment records, but also statements from Plaintiff that she stopped working 9 to care for her elderly parents, rather than due to disability (AR 527, 603); she continued 10 to seek and engage in work and volunteer activities (AR 503, 575, 670, 674, 715); and she 11 was able to interact with friends and neighbors (AR 95–96, 500, 605, 633, 674), go to 12 church (AR 96–97, 747), and go shopping (AR 95–96)—all during the relevant assessment 13 period where Plaintiff alleged she was "unable to tolerate being around people." Doc. 25 14 at 7–8; see also AR 49–53. The ALJ further noted Plaintiff interacted appropriately with 15 medical personnel of record, as well as with the ALJ at the hearing. AR 28. These citations 16 to the Administrative Record are substantial evidence, clearly and convincingly articulated 17 by the ALJ as the reasons for discounting Plaintiff's symptom testimony. The Court will 18 overrule Plaintiff's objections and fully adopt the Magistrate Judge's recommendation on 19 this point. 20 IV. ORDER 21 IT IS ORDERED OVERRULING Plaintiff's Objections to the Report and 22 Recommendation (Doc. 27). 23 IT IS FURTHER ORDERED ADOPTING IN FULL the Report and 24 Recommendation, (Doc. 26), and AFFIRMING the decision of the Commissioner. 25 /// 26 /// 27 /// 28 /// 1 IT IS FURTHER ORDERED DIRECTING the Clerk of the Court to enter || judgment accordingly and close this case. 3 Dated this 28th day of March, 2024. 4 5 / A . | 7 / / John C. Hinderaker _/United States District Judge 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28

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