1 WO 2 3 4 5 6 IN THE UNITED STATES DISTRICT COURT 7 FOR THE DISTRICT OF ARIZONA
9 Tammy Leann Winton, No. CV-21-00872-PHX-JAT
10 Plaintiff, ORDER
11 v.
12 Commissioner of Social Security Administration, 13 Defendant. 14 15 Pending before the Court is Plaintiff Tammy Leann Winton’s appeal from the 16 Commissioner of the Social Security Administration’s (“SSA”) final decision denying 17 social security disability benefits. (Doc. 1). The appeal is fully briefed (Doc. 18, Doc. 19, 18 Doc. 20), and the Court now rules. 19 I. BACKGROUND 20 The issues presented in this appeal are whether the ALJ committed legal error in 21 determining Plaintiff was not disabled under Section 1614(a)(3)(A) of the Social Security 22 Act and whether substantial evidence of record supports this determination. (Doc. 18 at 1, 23 8). 24 a. Factual Overview 25 Plaintiff was 52 years old on her alleged disability onset date of December 2, 2016. 26 (Doc. 18 at 3, 1). She had an 11th grade education and past relevant work as a short order 27 cook, peddler, and vegetable vendor. (Id. at 3). On June 20, 2018, Plaintiff filed an 28 application for social security disability benefits. (Id. at 1). As relevant here, Plaintiff 1 suffered from obesity, degenerative disc disease and facet arthropathy, chronic kidney 2 disease - stage III, nephropathy, systemic ANCA vasculitis, and renal vasculitis. (Doc. 14- 3 3 at 21). Plaintiff’s claim was denied initially on December 28, 2018, and upon 4 reconsideration on May 22, 2019. (Id. at 19). Plaintiff filed a request for a hearing before 5 an ALJ, which occurred via telephone on October 21, 2020. (Id.) The ALJ issued a decision 6 on December 4, 2020, finding that based on the June 20, 2018, social security benefit 7 application, Plaintiff was not disabled under Section 1614(a)(3)(A) of the Social Security 8 Act. (Id. at 32). The SSA Appeals Council denied Plaintiff’s request for review of the ALJ’s 9 decision and adopted this as the agency’s final decision. (Doc. 1 at 5). 10 a. The SSA’s Five-Step Evaluation Process 11 To qualify for social security disability insurance benefits, a claimant must show 12 that she “is under a disability.” 42 U.S.C. § 423(a)(1)(E). To be “under a disability,” the 13 claimant must be unable to engage in “substantial gainful activity” due to any medically 14 determinable physical or mental impairment. Id. § 423(d)(1). The impairment must be of 15 such severity that the claimant cannot do her previous work or any other substantial gainful 16 work within the national economy. Id. § 423(d)(2). The SSA has created a five-step 17 sequential evaluation process for determining whether an individual is disabled. See 20 18 C.F.R. § 404.1520(a)(1). The steps are followed in order, and each step is potentially 19 dispositive. See id. § 404.1520(a)(4). 20 At step one, the ALJ determines whether the claimant is engaging in “substantial 21 gainful activity.” Id. § 404.1520(a)(4)(i). “Substantial gainful activity” is work activity that 22 is (1) “substantial,” i.e., doing “significant physical or mental activities;” and (2) “gainful,” 23 i.e., usually done “for pay or profit.” 20 C.F.R. § 416.972(a)-(b). If the claimant is engaging 24 in substantial gainful work activity, the ALJ will find the claimant is not disabled. Id. § 25 404.1520(a)(4)(i). 26 At step two, the ALJ determines whether the claimant has “a severe medically 27 determinable physical or mental impairment” or severe “combination of impairments.” Id. 28 § 404.1520(a)(4)(ii). To be “severe,” the claimant’s impairment must “significantly limit” 1 the claimant’s “physical or mental ability to do basic work activities.” Id. § 404.1520(c). 2 If the claimant does not have a severe impairment or combination of impairments, the ALJ 3 will find the claimant is not disabled. Id. § 404.1520(a)(4)(ii). 4 At step three, the ALJ determines whether the claimant’s impairment(s) “meets or 5 equals” an impairment listed in Appendix 1 to Subpart P of 20 C.F.R. Part 404. Id. § 6 404.1520(a)(4)(iii). If so, the ALJ will find the claimant is disabled, but if not, the ALJ 7 must assess the claimant’s “residual functional capacity” (“RFC”) before proceeding to 8 step four. Id. §§ 404.1520(a)(4)(iii), 404.1520(e). The claimant’s RFC is her ability to do 9 physical and mental work activities “despite [her] limitations,” based on all relevant 10 evidence in the case record. Id. § 404.1545(a)(1). To determine RFC, the ALJ must 11 consider all the claimant’s impairments, including those that are not “severe,” and any 12 related symptoms that “affect what [the claimant] can do in a work setting.” Id. §§ 13 404.1545(a)(1)-(2). 14 At step four, the ALJ determines whether the claimant has the RFC to perform the 15 physical and mental demands of “[her] past relevant work.” Id. §§ 404.1520(a)(4)(iv), 16 404.1520(e). “Past relevant work” is work the claimant has “done within the past 15 years, 17 that was substantial gainful activity.” Id. § 404.1560(b)(1). If the claimant has the RFC to 18 perform her past relevant work, the ALJ will find the claimant is not disabled. Id. § 19 404.1520(a)(4)(iv). If the claimant cannot perform her past relevant work, the ALJ will 20 proceed to step five in the sequential evaluation process. 21 At step five, the last in the sequence, the ALJ considers whether the claimant “can 22 make an adjustment to other work,” considering her RFC, age, education, and work 23 experience. Id. § 404.1520(a)(v). If so, the ALJ will find the claimant not disabled. Id. If 24 the claimant cannot make this adjustment, the ALJ will find the opposite. Id. 25 b. The ALJ’s Application of the Factors 26 Here, at step one, the ALJ concluded that Plaintiff had “not engaged in substantial 27 gainful activity since June 20, 2018, the application date.” (Doc. 14-3 at 21). 28 At step two, the ALJ determined that the following impairments were “severe”: 1 obesity, degenerative disc disease and facet arthropathy, chronic kidney disease - stage III, 2 nephropathy, systemic ANCA vasculitis, and renal vasculitis. (Id. at 21). The ALJ found 3 that Plaintiff’s remaining physical and mental impairments did “not cause more than a 4 minimal restriction in [Plaintiff’s] ability to work” and were therefore “not severe.” (Id.) 5 At step three, the ALJ concluded that Plaintiff does not have an impairment or 6 combination of impairments that meet or equal the severity of any impairment listed in 20 7 C.F.R. Part 404, Subpart P, Appendix 1. (Id. at 25). The ALJ determined that Plaintiff has 8 the RFC to perform light work as defined in 20 C.F.R. § 416.967(b) “except she can 9 frequently balance, and occasionally stoop, kneel, crouch, crawl, and climb ramps and 10 stairs.” (Id. at 26). The ALJ also determined that Plaintiff “can never climb ladders, ropes, 11 or scaffolds, and can tolerate frequent exposure to extreme heat and unprotected heights.” 12 (Id.) 13 At step four, the ALJ determined that Plaintiff can perform past relevant work as a 14 short order cook, reasoning that this work does not require “work-related activities 15 precluded by [Plaintiff’s] residual functional capacity.” (Id. at 31). Accordingly, the ALJ 16 did not proceed to step five of the evaluation and found that Plaintiff has not been under a 17 disability since June 20, 2018, the date Plaintiff filed her disability benefits application.
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1 WO 2 3 4 5 6 IN THE UNITED STATES DISTRICT COURT 7 FOR THE DISTRICT OF ARIZONA
9 Tammy Leann Winton, No. CV-21-00872-PHX-JAT
10 Plaintiff, ORDER
11 v.
12 Commissioner of Social Security Administration, 13 Defendant. 14 15 Pending before the Court is Plaintiff Tammy Leann Winton’s appeal from the 16 Commissioner of the Social Security Administration’s (“SSA”) final decision denying 17 social security disability benefits. (Doc. 1). The appeal is fully briefed (Doc. 18, Doc. 19, 18 Doc. 20), and the Court now rules. 19 I. BACKGROUND 20 The issues presented in this appeal are whether the ALJ committed legal error in 21 determining Plaintiff was not disabled under Section 1614(a)(3)(A) of the Social Security 22 Act and whether substantial evidence of record supports this determination. (Doc. 18 at 1, 23 8). 24 a. Factual Overview 25 Plaintiff was 52 years old on her alleged disability onset date of December 2, 2016. 26 (Doc. 18 at 3, 1). She had an 11th grade education and past relevant work as a short order 27 cook, peddler, and vegetable vendor. (Id. at 3). On June 20, 2018, Plaintiff filed an 28 application for social security disability benefits. (Id. at 1). As relevant here, Plaintiff 1 suffered from obesity, degenerative disc disease and facet arthropathy, chronic kidney 2 disease - stage III, nephropathy, systemic ANCA vasculitis, and renal vasculitis. (Doc. 14- 3 3 at 21). Plaintiff’s claim was denied initially on December 28, 2018, and upon 4 reconsideration on May 22, 2019. (Id. at 19). Plaintiff filed a request for a hearing before 5 an ALJ, which occurred via telephone on October 21, 2020. (Id.) The ALJ issued a decision 6 on December 4, 2020, finding that based on the June 20, 2018, social security benefit 7 application, Plaintiff was not disabled under Section 1614(a)(3)(A) of the Social Security 8 Act. (Id. at 32). The SSA Appeals Council denied Plaintiff’s request for review of the ALJ’s 9 decision and adopted this as the agency’s final decision. (Doc. 1 at 5). 10 a. The SSA’s Five-Step Evaluation Process 11 To qualify for social security disability insurance benefits, a claimant must show 12 that she “is under a disability.” 42 U.S.C. § 423(a)(1)(E). To be “under a disability,” the 13 claimant must be unable to engage in “substantial gainful activity” due to any medically 14 determinable physical or mental impairment. Id. § 423(d)(1). The impairment must be of 15 such severity that the claimant cannot do her previous work or any other substantial gainful 16 work within the national economy. Id. § 423(d)(2). The SSA has created a five-step 17 sequential evaluation process for determining whether an individual is disabled. See 20 18 C.F.R. § 404.1520(a)(1). The steps are followed in order, and each step is potentially 19 dispositive. See id. § 404.1520(a)(4). 20 At step one, the ALJ determines whether the claimant is engaging in “substantial 21 gainful activity.” Id. § 404.1520(a)(4)(i). “Substantial gainful activity” is work activity that 22 is (1) “substantial,” i.e., doing “significant physical or mental activities;” and (2) “gainful,” 23 i.e., usually done “for pay or profit.” 20 C.F.R. § 416.972(a)-(b). If the claimant is engaging 24 in substantial gainful work activity, the ALJ will find the claimant is not disabled. Id. § 25 404.1520(a)(4)(i). 26 At step two, the ALJ determines whether the claimant has “a severe medically 27 determinable physical or mental impairment” or severe “combination of impairments.” Id. 28 § 404.1520(a)(4)(ii). To be “severe,” the claimant’s impairment must “significantly limit” 1 the claimant’s “physical or mental ability to do basic work activities.” Id. § 404.1520(c). 2 If the claimant does not have a severe impairment or combination of impairments, the ALJ 3 will find the claimant is not disabled. Id. § 404.1520(a)(4)(ii). 4 At step three, the ALJ determines whether the claimant’s impairment(s) “meets or 5 equals” an impairment listed in Appendix 1 to Subpart P of 20 C.F.R. Part 404. Id. § 6 404.1520(a)(4)(iii). If so, the ALJ will find the claimant is disabled, but if not, the ALJ 7 must assess the claimant’s “residual functional capacity” (“RFC”) before proceeding to 8 step four. Id. §§ 404.1520(a)(4)(iii), 404.1520(e). The claimant’s RFC is her ability to do 9 physical and mental work activities “despite [her] limitations,” based on all relevant 10 evidence in the case record. Id. § 404.1545(a)(1). To determine RFC, the ALJ must 11 consider all the claimant’s impairments, including those that are not “severe,” and any 12 related symptoms that “affect what [the claimant] can do in a work setting.” Id. §§ 13 404.1545(a)(1)-(2). 14 At step four, the ALJ determines whether the claimant has the RFC to perform the 15 physical and mental demands of “[her] past relevant work.” Id. §§ 404.1520(a)(4)(iv), 16 404.1520(e). “Past relevant work” is work the claimant has “done within the past 15 years, 17 that was substantial gainful activity.” Id. § 404.1560(b)(1). If the claimant has the RFC to 18 perform her past relevant work, the ALJ will find the claimant is not disabled. Id. § 19 404.1520(a)(4)(iv). If the claimant cannot perform her past relevant work, the ALJ will 20 proceed to step five in the sequential evaluation process. 21 At step five, the last in the sequence, the ALJ considers whether the claimant “can 22 make an adjustment to other work,” considering her RFC, age, education, and work 23 experience. Id. § 404.1520(a)(v). If so, the ALJ will find the claimant not disabled. Id. If 24 the claimant cannot make this adjustment, the ALJ will find the opposite. Id. 25 b. The ALJ’s Application of the Factors 26 Here, at step one, the ALJ concluded that Plaintiff had “not engaged in substantial 27 gainful activity since June 20, 2018, the application date.” (Doc. 14-3 at 21). 28 At step two, the ALJ determined that the following impairments were “severe”: 1 obesity, degenerative disc disease and facet arthropathy, chronic kidney disease - stage III, 2 nephropathy, systemic ANCA vasculitis, and renal vasculitis. (Id. at 21). The ALJ found 3 that Plaintiff’s remaining physical and mental impairments did “not cause more than a 4 minimal restriction in [Plaintiff’s] ability to work” and were therefore “not severe.” (Id.) 5 At step three, the ALJ concluded that Plaintiff does not have an impairment or 6 combination of impairments that meet or equal the severity of any impairment listed in 20 7 C.F.R. Part 404, Subpart P, Appendix 1. (Id. at 25). The ALJ determined that Plaintiff has 8 the RFC to perform light work as defined in 20 C.F.R. § 416.967(b) “except she can 9 frequently balance, and occasionally stoop, kneel, crouch, crawl, and climb ramps and 10 stairs.” (Id. at 26). The ALJ also determined that Plaintiff “can never climb ladders, ropes, 11 or scaffolds, and can tolerate frequent exposure to extreme heat and unprotected heights.” 12 (Id.) 13 At step four, the ALJ determined that Plaintiff can perform past relevant work as a 14 short order cook, reasoning that this work does not require “work-related activities 15 precluded by [Plaintiff’s] residual functional capacity.” (Id. at 31). Accordingly, the ALJ 16 did not proceed to step five of the evaluation and found that Plaintiff has not been under a 17 disability since June 20, 2018, the date Plaintiff filed her disability benefits application. 18 (Id. at 32). 19 II. LEGAL STANDARD 20 This Court may not set aside a final denial of disability benefits unless the ALJ 21 decision is “based on legal error or not supported by substantial evidence in the record.” 22 Revels v. Berryhill, 874 F.3d 648, 654 (9th Cir. 2017) (quoting Benton ex rel. Benton v. 23 Barnhart, 331 F.3d 1030, 1035 (9th Cir. 2003)). Substantial evidence refers to “such 24 relevant evidence as a reasonable mind might accept as adequate to support a conclusion.” 25 Id. (quoting Desrosiers v. Sec’y of Health & Human Servs., 846 F.2d 573, 576 (9th Cir. 26 1988)). The Court, in its review, must consider the record in its entirety, “weighing both 27 the evidence that supports and evidence that detracts from the [ALJ’s] conclusion.” Id. 28 (quoting Garrison v. Colvin, 759 F.3d 995, 1009 (9th Cir. 2007)). 1 The ALJ—not this Court—is responsible for resolving ambiguities, resolving 2 conflicts in medical testimony, determining credibility, and drawing logical inferences 3 from the medical record. See Andrews v. Shalala, 53 F.3d 1035, 1039 (9th Cir. 1995) (citing 4 Magallanes v. Bowen, 881 F.2d 747, 750 (9th Cir. 1989); Gallant v. Heckler, 753 F.2d 5 1450, 1453 (9th Cir. 1984)). Therefore, when the evidence of record could result in more 6 than one rational interpretation, “the ALJ’s decision should be upheld.” Orn v. Astrue, 495 7 F.3d 625, 630 (9th Cir. 2007). Further, this Court may only review the reasons the ALJ 8 provides in the disability determination; it “may not affirm the ALJ on a ground upon which 9 he did not rely.” Garrison, 759 F.3d at 1010. 10 III. DISCUSSION 11 Plaintiff raises two claims of error in the ALJ’s analysis: (1) the ALJ did not afford 12 sufficient weight to the medical opinion of treating rheumatologist, Dr. Ravi Bhalla; and 13 (2) no substantial evidence supports the ALJ’s determination of Plaintiff’s RFC, because 14 the ALJ did not correctly apply the regulatory standards of 20 C.F.R. § 416.920c in 15 considering Dr. Bhalla’s opinion. 16 a. Medical Opinion 17 Plaintiff argues that the ALJ erred in failing to afford adequate weight to Dr. 18 Bhalla’s medical opinion. (Doc. 18 at 1, 8). Dr. Bhalla began treating Plaintiff on October 19 26, 2018, and Plaintiff had six appointments with Dr. Bhalla over approximately one year. 20 (Id. at 12–13). Though not always citing to the record using Dr. Bhalla’s name, the ALJ 21 cites to Dr. Bhalla’s treatment records eight times in his discussion of Plaintiff’s medical 22 evidence. (Doc. 14-3 at 29, 30). For example, the ALJ refers to several of the Plaintiff’s 23 appointments with Dr. Bhalla by noting that in “every visit … through September 2019, 24 [Plaintiff] demonstrated unremarkable physical examinations without any swelling, despite 25 allegations of increased hip and back joint pain.” (Doc. 14-3 at 11, citing Doc. 14-10 at 26 136, 140, 143, 147). 27 As the ALJ noted, in September 2019, Dr. Bhalla completed an assessment form in 28 which he indicated that Plaintiff could occasionally lift and carry less than ten pounds, 1 stand and/or walk for 15 minutes, and sit for 30 minutes in an eight-hour workday. (Doc. 2 14-3 at 31). In the assessment form, Dr. Bhalla also indicated that Plaintiff’s impairments 3 were severe enough to “constantly” interfere with her concentration and attention; 4 Plaintiff’s abilities to grasp, turn, twist, reach, and finely manipulate were limited; and 5 Plaintiff’s impairments or treatments would cause her to miss more than four workdays 6 monthly. (Id. at 31). 7 The ALJ addressed Dr. Bhalla’s opinion as follows: The undersigned … concludes that this opinion is 8 unpersuasive, as it is overly restrictive and unsupported by the 9 mental status examinations, physical examinations, and reports to her [medical] providers. The claimant admitted she shopped 10 in stores, did the laundry, prepared simple meals, had no 11 problem with her personal care, and left her house every day. [(Doc. 14-7 at 12, 15; Doc. 14-9 at 122)]. Furthermore, as 12 recent as July 2020, the claimant’s balance remains normal, 13 and she had a normal gait and her attention and thought process were unimpaired. [(Doc. 14-10 at 104)]. Although she 14 experienced intermittent fatigue [(Doc. 14-12 at 22; Doc. 14- 15 15 at 39)], she was able to independently attend to personal care without a problem and alleged she could stand for 15 16 minutes before needing a rest [(Doc. 14-7 at 48)]. Accordingly, 17 this opinion is not supported by the evidence, and therefore, unpersuasive. 18 (Doc. 14-3 at 31). 19 Further, the ALJ considered the medical opinion of State Agency Medical 20 Consultant, Dr. M. Gleason (Id. at 30). Dr. Gleason opined that Plaintiff has exertional and 21 postural limitations as follows: 22 [Plaintiff] could lift and carry 20 pounds occasionally and 10 23 pounds frequently, stand and/or walk 6 hours in an 8-hour 24 workday, and sit for 6 hours in an 8-hour workday. She can occasionally climb ramps and stairs, stoop, kneel, crouch and 25 crawl, and can frequently balance. [Plaintiff] can never climb 26 ladders, ropes or scaffolds, should avoid concentrated exposure to extreme head and hazards. 27
28 (Id.) The ALJ found that Dr. Gleason’s opinion was persuasive, “as the physical 1 examinations, observations of providers and claimant’s allegations corroborate” Dr. 2 Gleason’s opinion. (Id.) 3 Courts in this circuit previously distinguished among treating physicians, examining 4 physicians, and non-examining physicians, generally giving the greatest weight to the 5 opinions of treating physicians. See Lester v. Chater, 81 F.3d 821, 830 (9th Cir. 1995). 6 This distinction was referred to as the “treating physician rule.” See Regula v. Delta 7 Family-Care Survivorship Plan, 266 F.3d 1130, 1139 (9th Cir. 2001), cert. granted, 8 vacated sub nom. Regula v. Delta Family-Care Disability & Survivorship Plan, 539 U.S. 9 901 (2003). However, “in March of 2017, the [SSA] amended their regulations to abrogate 10 the treating physician rule, among other changes.” Alonzo v. Comm’r of Soc. Sec. Admin., 11 No. CV-18-08317-PCT-JZB, 2020 WL 1000024, at *3 (D. Ariz. Mar. 2, 2020) (citing 12 Revisions to Rules Regarding the Evaluation of Medical Evidence, 82 Fed. Reg. 5844-01, 13 2017 WL 168819, at *5852–57 (Jan. 18, 2017)). The amended regulations stipulate that 14 the ALJ “will not defer or give any specific evidentiary weight, including controlling 15 weight, to any medical opinion(s) or prior administrative medical finding(s), including 16 those from … medical sources.” 20 C.F.R. §§ 404.1520c, 416.920c. Claims filed on or 17 after March 27, 2017, must adhere to the amended regulations. (Id.) 18 As discussed above, the ALJ, not the reviewing court, is responsible for resolving 19 ambiguities and conflicts in medical testimony and the medical record. See Andrews, 53 20 F.3d at 1039. Therefore, when the evidence of record could result in more than one rational 21 interpretation, “the ALJ’s decision should be upheld.” Orn, 495 F.3d at 630. 22 Given the amended SSA regulations regarding treating physician opinions, Dr. 23 Bhalla’s medical opinion is of equal weight to non-treating physician opinions. Here, to 24 find the ALJ improperly relied on Dr. Gleason’s opinion instead of Dr. Bhalla’s, this Court 25 must find that the ALJ’s determination that Dr. Gleason’s opinion is persuasive and Dr. 26 Bhalla’s opinion is unpersuasive is unsupported by substantial evidence on record or that 27 the ALJ opinion contains a harmful legal error in its analysis. This Court finds no materially 28 harmful error in the ALJ’s decision to reject Dr. Bhalla’s opinion and further finds that the 1 ALJ’s opinion is supported by substantial evidence in the record. 2 Substantial evidence supports the ALJ’s finding that the medical evidence on record 3 corroborates and is consistent with Dr. Gleason’s medical opinion. (Doc. 14-3 at 12); see 4 Trevizo v. Berryhill, 871 F.3d 664, 675 (9th Cir. 2017) (“The ALJ can meet his burden by 5 setting out a detailed and thorough summary of the facts and conflicting clinical evidence, 6 stating his interpretation thereof, and making findings.”) (quotations omitted). In 7 evaluating the medical opinions in the record, the ALJ used the standard stated in 20 C.F.R. 8 § 404.1520c, considering the supportability and consistency factors laid out therein. (Doc. 9 14-3 at 12-13); see 20 C.F.R. § 404.1520c(c). For example, the ALJ stated Dr. Gleason’s 10 opinion regarding Plaintiff’s exertional and postural limitations was persuasive because the 11 record supports it. (Doc. 14-3 at 30). To show this, the ALJ highlighted diagnostic imaging 12 results from a March 2018 MRI showing “multilevel facet hypertrophy,” “disc osteophyte 13 complex,” and “mild disc bulge” with “significant nerve compression,” which “supported 14 [Dr. Gleason’s opined] exertional limits.” (Id.) As another example, ALJ noted that during 15 a medical examination in November 2018, Plaintiff “maintained a normal station and gait 16 and motor strength of 5/5 throughout,” consistent with Dr. Gleason’s opinion that Plaintiff 17 can “stand and/or walk 6 hours in an 8-hour workday.” (Id.) 18 In contrast, the ALJ found that Dr. Bhalla’s opinion was unpersuasive, because it 19 was “overly restrictive” compared to other “mental status examinations, physical 20 examinations and [Plaintiff’s] reports to her [medical] providers.” (Doc. 14-3 at 31). For 21 example, the ALJ noted that as recently as July 2020, Plaintiff’s “attention and thought 22 process were unimpaired.” (Id.) This was inconsistent with Dr. Bhalla’s assertion that 23 Plaintiff’s impairments were severe enough to “constantly” interfere with her attention and 24 concentration. (Id.) The ALJ also notes that Plaintiff indicated “she shopped in stores, did 25 the laundry, prepared simple meals, had no problem with her personal care, and left her 26 house every day,” and that, despite “intermittent fatigue,” she was able to “stand for 15 27 minutes before needing a rest,” and as recent as July 2020, she had a normal gait and 28 balance. (Id.) This documented evidence from the medical record is inconsistent with Dr. 1 Bhalla’s opinion that Plaintiff could stand or walk for only “15 minutes in an 8-hour 2 workday” and sit for only “30 minutes in an 8-hour workday.” (Id.) It is also inconsistent 3 with Dr. Bhalla’s opinion that Plaintiff was “limited” in her ability to “grasp, turn, twist, 4 and perform fine manipulation or reaching.” (Id.) 5 Accordingly, this Court finds that the ALJ did not commit materially harmful legal 6 error in relying on Dr. Gleason’s opinion instead of Dr. Bhalla’s opinion, as the ALJ 7 reasonably determined that Dr. Gleason’s medical findings were supported by and 8 consistent with the medical record and Dr. Bhalla’s findings were not. See Andrews, 53 9 F.3d at 1039-40. (“The ALJ is responsible for determining credibility, resolving conflicts 10 in medical testimony, and for resolving ambiguities. We must uphold the ALJ’s decision 11 where the evidence is susceptible to more than one rational interpretation.”) (citations 12 omitted). 13 b. Supportability and Consistency Factors 14 Plaintiff argues that no substantial evidence supports the ALJ’s determination of 15 Plaintiff’s RFC. (Doc. 18 at 8). Plaintiff contends that this is because the ALJ incorrectly 16 applied the regulatory standards of 20 C.F.R. § 416.920c by failing to explain the rejection 17 of Dr. Bhalla’s opinion based on the factors of supportability and consistency. (Id. at 1, 8, 18 10–11). The Court disagrees. 19 In addition to the abrogation of the “treating physician rule,” as of March 2017, the 20 amended SSA regulations stipulate that the ALJ must “consider all medical opinions 21 according to several enumerated factors, including whether the opinion is supported by 22 objective medical evidence and whether the opinion is consistent with the evidence from 23 other sources.” Alonzo, 2020 WL 1000024, at *3. Supportability and consistency are the 24 “most important factors,” and the ALJ must explain how he considered these two factors 25 for a medical source’s opinions. 20 C.F.R § 404.1520c(b)(3). 26 Based on this standard, as discussed above, the ALJ adequately described how he 27 considered the supportability and consistency factors for Dr. Bhalla’s opinion. For 28 example, the ALJ indicated that Dr. Bhalla’s medical opinion was not persuasive because 1 “mental status examinations, physical examinations and [Plaintiff’s] reports to her 2 [medical] providers” did not support it. (Doc. 14-3 at 31). To demonstrate this, as outlined 3 above, the ALJ subsequently gave examples of examination results and Plaintiff’s reports 4 to medical providers showing a lack of support for and inconsistency with Dr. Bhalla’s 5 opinion. (Id.) For example, the ALJ cited a self-report that Plaintiff completed in February 6 2017, in which Plaintiff “admitted she shopped in stores, did the laundry, [and] prepared 7 simple meals.” (Id.) This contradicts Dr. Bhalla’s opinion that Plaintiff could carry and lift 8 “less than 10 pounds on an occasional basis” and that her ability to “grasp … and perform 9 fine manipulation or reaching” was “limited.” (Id.) The ALJ also cited a psychological 10 evaluation from November 2018 in which Plaintiff indicated she “left her house every 11 day.” (Id.) This is inconsistent with Dr. Bhalla’s assertation that Plaintiff could stand or 12 walk only “15 minutes in an 8-hour workday.” (Id.) 13 Further, the ALJ indicated that he determined Plaintiff’s RFC after “careful 14 consideration of the entire record.” (Id.) To wit, for several pages prior to discussing Dr. 15 Bhalla’s opinion, though not always specifically labeling as such, the ALJ recounts specific 16 consistent and inconsistent record evidence that both supports and undermines all the 17 medical source’s medical opinions, including Dr. Bhalla’s. (Doc. 19-3 at 26–31); Labine 18 v. Comm’r of Soc. Sec. Admin., No. CV-19-04528-PHX-JZB, 2020 WL 6707822, at *4 19 (“the Commissioner’s regulations specifically direct the ALJ to assess [Plaintiff’s RFC] 20 based on all of the relevant medical and other evidence … and to evaluate medical opinion 21 evidence according to certain factors, which include the degree of support the opinion has 22 from objective medical evidence … as well as its consistency with the record as a whole.”) 23 (citations and internal quotation marks omitted). As an example, the ALJ noted Dr. 24 Gordon’s November 2018 internal medicine evaluation, in which Plaintiff, upon physical 25 examination, “sat in the chair comfortably,” “had a normal gait and station,” “did not use 26 any assistive devices,” and denied pain with “movement of the joints.” (Doc. 14-3 at 28). 27 This directly contradicts Dr. Bhalla’s assessment that Plaintiff could sit only “30 minutes 28 in an 8-hour workday” and walk only “15 minutes in an 8-hour workday.” (Id.) 1 Thus, the Court disagrees with Plaintiff’s contention that the ALJ “never compared 2 Dr. Bhalla’s findings or explanations with anything or made a discussion of such.” (Doc. 3 18 at 10). See Kennedy v. Colvin, 738 F.3d 1172, 1178 (9th Cir. 2013) (stating that the ALJ 4 is only required to discuss and evaluate the evidence that supports his conclusion; he is not 5 required to do so in a specific location within the decision); Labine, 2020 WL 6707822, at 6 *4 (“The Court reads the ALJ’s decision as a whole, and not just one sentence of it in a 7 vacuum. Thus, based on the ALJ’s earlier analysis … the Court can ‘reasonably discern’ 8 what evidence the ALJ is referring to when stating that [the evidence is unsupportive].”). 9 Plaintiff makes additional arguments that the ALJ erred in failing to provide a valid 10 explanation for rejecting Dr. Bhalla’s opinion based on the factor of consistency. (Doc. 18 11 at 12). Specifically, Plaintiff contends that the ALJ’s explanation did not accurately 12 describe Plaintiff’s function report from February 2017, nor a pain management report 13 from July 2020. (Id. at 11). Plaintiff argues that this is because when the ALJ cited 14 information from these reports to support his explanation, he omitted information from the 15 same reports that substantiated Dr. Bhalla’s opinion. (Id. at 11–12). Even if these 16 arguments reflect error on the part of the ALJ, the Court concludes any such error is 17 harmless. See Treichler v. Comm’r of Soc. Sec., 775 F.3d 1090, 1099 (9th Cir. 2014). (“An 18 error is harmless … if the agency’s path may reasonably be discerned, even if the agency 19 explains its decision with less than ideal clarity.”) (citations and internal quotation marks 20 omitted). Plaintiff contends the allegedly omitted information contained in the reports in 21 question is consistent with Dr. Bhalla’s opinion. (Doc. 18 at 11-12). However, the ALJ 22 found Dr. Bhalla’s opinion unpersuasive, and substantial evidence supports the ALJ’s 23 finding, as discussed above. (Doc. 14-3 at 31). Thus, the allegedly omitted information 24 simply corroborates Dr. Bhalla’s appropriately rejected medical opinion. 25 Plaintiff also argues that the ALJ further erred in failing to “consider the supporting 26 treatment regarding [Plaintiff’s] kidney disease.” (Doc 18 at 12). Plaintiff contends that 27 this was compounded by the ALJ’s improper rejection of the medical opinion of Dr. 28 William R. Huffman, whose opinion Plaintiff claims was consistent with Dr. Bhalla’s. (Id. 1 at 14). The Court does not find that either argument has merit. 2 First, contrary to Plaintiff’s assertion, prior to discussing Dr. Huffman’s and Dr. 3 Bhalla’s opinions, the ALJ concluded that Dr. Sapin’s opinion regarding Plaintiff’s 4 “nonsevere” impairments was “unpersuasive, as it is inconsistent with [Plaintiff’s] chronic 5 kidney disease and associated treatment.” (Id. at 30). Second, Plaintiff states that the ALJ 6 rejected Dr. Huffman’s opinion in part because “he focused on range of motion and 7 strength … but this misses the point of Plaintiff’s condition: she alleges fatigue and lack of 8 stamina due to chronic kidney disease.” (Id. at 14). However, it is not the Court’s 9 responsibility to judge the ALJ’s interpretation of the evidence of record where it is 10 supported by substantial evidence and free from legal error. See Andrews, 53 F.3d at 1039 11 (stating that it is the ALJ’s responsibility to resolve ambiguities and conflicts in, determine 12 the credibility of, and draw logical inferences from the medical record). Here, the Court 13 finds that the ALJ’s rejection of Dr. Huffman’s opinion and Dr. Sapin’s opinion, in view 14 of Plaintiff’s kidney disease treatment, does not constitute reversible error. Further, as 15 discussed previously, even when the evidence of record could result in more than one 16 rational interpretation, “the ALJ’s decision should be upheld.” Orn, 495 F.3d at 630. 17 In sum, substantial evidence supports the ALJ’s findings, and they are free from 18 legal error, as the ALJ sufficiently describes how Dr. Bhalla’s opinion lacks support from 19 and is inconsistent with the medical evidence on record, in accordance with the relevant 20 SSA regulations. Thus, the Court affirms the ALJ’s decision. 21 c. Further Proceedings 22 Plaintiff asks this Court to vacate the ALJ’s decision and remand for further 23 administrative proceedings. (Doc. 18 at 15). However, because the Court is affirming the 24 ALJ’s decision, the Court denies Plaintiff’s request. 25 IV. CONCLUSION 26 For the foregoing reasons, 27 IT IS ORDERED that the ALJ’s decision is AFFIRMED. 28 IT IS FURTHER ORDERED that the Clerk of court shall enter judgment accordingly. 2 Dated this 23rd day of June, 2022. 3 '
= James A. CO S Senior United States District Judge 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
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