Crunk v. Commissioner Social Security Administration

Filing 17

Opinion and Order. For the reasons set forth in this Opinion and Order, the Commissioner's decision is affirmed. Please access entire text by document number hyperlink. Signed on 03/10/2025 by Magistrate Judge Mark D. Clarke. (rsm)

IN THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF OREGON

NIEESHAC. 1
Plaintiff,

Civ. No. 3:24-cv-00428-CL

v.

OPINION AND ORDER

COMMISSIONER OF SOCIAL SECURITY
ADMINISTRATION,
Defendant.

MARK D. CLARKE, Magistrate Judge.
PlaintiffNieesha C. ("Plaintiff') seeks judicial review of the final decision of the
Commissioner of the Social Security Administration denying her claims for supplemental
security income benefits. This courthasjurisdiction under42 U.S.C. §§ 405(g) and 1383(c)(3),
and all parties have consented to jurisdiction by magistrate judge under Federal Rule of Civil
Procedure 73 and 28 U.S.C. § 636(c) For the reasons provided below, the Commissioner's
decision is AFFIRMED.

PROCEDURAL BACKGROUND
On November 25, 2020, Plaintiff protectively filed an application for supplemental
security income, alleging disability beginning on November 10, 2011. Tr. 50. The claim was

1

In the interest of privacy, this Opinion and Order uses only the first name and the initial
of the last name of the non-governmental party or parties in this case.

denied initially and on reconsideration. Tr. 58, 69. Plaintiff requested a hearing before an
administrative law judge and appeared before ALJ Richard Geib on November 15, 2022. Tr. 3148. Plaintiff, represented by her attorney, and a vocational expert testified at the hearing. Tr. 3148. The ALJ found Plaintiff not disabled in a written decision issued December 23, 2022. Tr. 1525. The Appeals Council denied review on January 2, 2024, making the ALJ's decision the final
agency decision. Tr. 1-6. Plaintiffs timely appeal followed.
FACTUAL BACKGROUND

Plaintiff was 12 years of age on her alleged onset date and has a limited education. Tr. 24,
50. She has no past relevant work. Tr. 23. She alleges disability due to depression, ADHD, and
rheumatoid arthritis. Tr. 50.
DISABILITY ANALYSIS

A claimant is disabled if he or she is unable to "engage in any substantial gainful activity
by reason of any medically determinable physical or mental impairment which ... has lasted or
can be expected to last for a continuous period of not less than 12 months[.]" 42 U.S.C.
§ 423(d)(l)(A). "Social Security Regulations set out a five-step sequential process for
determining whether an applicant is disabled within the meaning of the Social Security Act."
Keyser v. Comm 'r. Soc. Sec. Admin., 648 F .3d 721, 724 (9th Cir. 2011 ). Each step is potentially

dispositive. 20 C.F.R. §§ 404.1520(a)(4), 416.920(a)(4). The five-step sequential process asks
the following series of questions:

1.

Is the claimant performing "substantial gainful activity"? 20 C.F .R. §
416.920(a)(4)(i). This activity is work involving significant mental or
physical duties done or intended to be done for pay or profit. 20 C.F .R. §
416.910. lfthe claimant is performing such work, she is not disabled within
the meaning of the Act. 20 C.F.R. § 416.920(a)(4)(i). If the claimant is not
performing substantial gainful activity, the analysis proceeds to step two.

2.

Is the claimant's impairment "severe" under the Commissioner's regulations? 20
C.F.R. § 416.920(a)(4)(ii). Unless expected to result in death, an impairment is
"severe" if it significantly limits the claimant's physical or mental ability to do
basic work activities. 20 C.F.R. § 416.921(a). This impairment must have lasted
or must be expected to last for a continuous period of at least 12 months. 20
C.F.R. § 416.909. If the claimant does not have a severe impairment, the analysis
ends. 20 C.F.R. § 416.920(a)(4)(ii). If the claimant has a severe impairment, the
analysis proceeds to step three.

3.

Does the claimant's severe impairment "meet or equal" one or more of the
impairments listed in 20 C.F .R. Part 404, Subpart P, Appendix 1? If so, then
the claimant is disabled. 20 C.F.R. § 416.920(a)(4)(iii). If the impairment
does not meet or equal one or more of the listed impairments, the analysis
proceeds to the "residual functional capacity" ("RFC") assessment.
a. The ALJ must evaluate medical and other relevant evidence to assess
and determine the claimant's RFC. This is an assessment of workrelated activities that the claimant may still perform on a regular and
continuing basis, despite any limitations imposed by his or her
impairments. 20 C.F.R. §§ 416.920(e); 416.945(b)-(c). After the ALJ
determines the claimant's RFC, the analysis proceeds to step four.

4.

Can the claimant perform his or her "past relevant work" with this RFC
assessment? If so, then the claimant is not disabled. 20 C.F .R. §
416.920(a)(4)(iv). If the claimant cannot perform his or her past relevant
work, the analysis proceeds to step five.

5.

Considering the claimant's RFC and age, education, and work experience,
is the claimant able to make an adjustment to other work that exists in
significant numbers in the national economy? If so, then the claimant is not
disabled. 20 C.F.R. §§ 416.920(a)(4)(v); 416.960(c). If the claimant cannot
perform such work, he or she is disabled.

See also Bustamante v. Massanari, 262 F.3d 949, 954-55 (9th Cir. 2001).

The claimant bears the burden of proof at steps one through four. Id. at 954. The
Commissioner bears the burden of proof at step five. Id. at 953-54. At step five, the
Commissioner must show that the claimant can perform other work that exists in significant
numbers in the national economy, "taking into consideration the claimant's residual functional
capacity, age, education, and work experience." Tackett v. Apfel, 180 F.3d 1094, 1100 (9th Cir.
1999) (internal citations omitted); see also 20 C.F.R. §§ 404.1566; 416.966 (describing "work

which exists in the national economy"). If the Commissioner fails to meet this burden, the
claimant is disabled. 20 C.F.R. § 416.920(a)(4)(v). If, however, the Commissioner proves that
the claimant is able to perform other work existing in significant numbers in the national
economy, the claimant is not disabled. Bustamante, 262 F.3d at 954-55; Tackett, 180 F.3d at
1099.

THE ALJ'S FINDINGS
At step one, the ALJ found that Plaintiff had not engaged in substantial gainful activity
since November 25, 2020, the date of her application. Tr. 17. At step two, the ALJ found that
Plaintiff had the following severe impairments: "rheumatoid arthritis, obesity, and attention
deficit hyperactivity disorder (ADHD)." Id. At step three, the ALJ found that Plaintiff did not
have an impairment or combination thereof that met or medically equaled the severity of a listed
impairment. Tr. 18. The ALJ found that Plaintiff had the RFC to perform light work with the
following additional limitations:
[she] can occasionally climb ramps, stairs, and ladders up to ten
feet and never climb ropes or scaffolds; can frequently stoop,
kneel, crouch, and crawl; can frequently handle and finger
bilaterally; and can carry out simple instructions.
Tr. 19. At step four, the ALJ determined that Plaintiff has no past relevant work. Tr. 23. At step
five, the ALJ found, in light of Plaintiff's age, education, work experience, and RFC, a
significant number of jobs existed in the national economy such that Plaintiff could sustain
employment despite her impairments, including such representative occupations as: production
assembler, electrical accessories assembler, routing clerk, and housekeeping cleaner. Tr. 24. The
ALJ thus found Plaintiff was not disabled within the meaning of the Act. Tr. 25.

STANDARD OF REVIEW
The reviewing court must affirm the Commissioner's decision if it is based on the proper
legal standards and the legal findings are supported by substantial evidence in the record. 42
U.S.C. § 405(g); Batson v. Comm 'r Soc. Sec. Admin., 359 F.3d 1190, 1193 (9th Cir. 2004); see
also Hammock v. Bowen, 879 F.2d 498, 501 (9th Cir. 1989). Substantial evidence is "more than a
mere scintilla," and means only "such relevant evidence as a reasonable mind might accept as
adequate to support a conclusion." Biestek v. Berryhill, 587 U.S. 97, 103 (2019) (internal
quotation marks omitted). In reviewing the Commissioner's alleged errors, this Court must
weigh "both the evidence that supports and detracts from the [Commissioner's] conclusions."
Martinez v. Heckler, 807 F.2d 771, 772 (9th Cir. 1986). Variable interpretations of the evidence
are insignificant if the Commissioner's interpretation is rational. Burch v. Barnhart, 400 F.3d
676, 679 (9th Cir. 2005).
If the decision of the Appeals Council is the final decision of the Commissioner, this
Court must review the decision of the Appeals Council to determine whether that decision is
supported by substantial evidence. Howard v. Heckler, 782 F.2d 1484 (9th Cir. 1986). Where the
evidence before the ALJ or Appeals Council is subject to more than one rational interpretation,
the Commissioner's conclusion must be upheld. Batson, 359 F .3d at 1198 (citing Andrews, 53
F.3d at 1041). "However, a reviewing court must consider the entire record as a whole and may
not affirm simply by isolating a 'specific quantum of supporting evidence."' Robbins v. Soc. Sec.
Admin., 466 F.3d 880, 882 (9th Cir. 2006) (quoting Hammock, 879 F.2d at 501). Additionally, a
reviewing court "cannot affirm the [Commissioner's] decision on a ground that the
[Administration] did not invoke in making its decision." Stout v. Comm 'r Soc. Sec. Admin., 454
F.3d 1050, 1054 (9th Cir. 2006) (citations omitted). Finally, a court may not reverse the

Commissioner's decision on account of an error that is harmless. Id. at 1055-56. "[T]he burden
of showing that an error is harmful normally falls upon the party attacking the agency's
determination." Shinseki v. Sanders, 556 U.S. 396,409 (2009).
Even where findings are supported by substantial evidence, "the decision should be set
aside if the proper legal standards were not applied in weighing the evidence and making the
decision." Flake v. Gardner, 399 F.2d 532, 540 (9th Cir. 1968). Under sentence four of 42
U.S.C. § 405(g), the reviewing court has the power to enter, upon the pleadings and transcript
record, a judgment affirming, modifying, or reversing the decision of the Commissioner, with or
without remanding the case for a rehearing.
DISCUSSION
Plaintiff argues that remand is warranted because the ALJ improperly rejected the
medical opinions of Beth Paraskeva, an advanced nurse practitioner (ANP), and Benjamin
Houser, M.D., her primary care physician. Pl. 's Br. 4, ECF 9. For the reasons that follow, the
Court concludes that the ALJ did not err in their assessment, and the Commissioner's decision is
affirmed.
Under prior Social Security regulations, a hierarchy of medical opinions dictated the
weight that must be given by an ALJ: treating doctors were generally given the most weight and
non-examining doctors were generally given the least weight. See 20 C.F.R. §§ 404.1527,
416.927 (1991); 56 Fed. Reg. 36,932 (Aug. 1, 1991). For applications filed on or after March 27,
2017, the new regulations eliminate the old hierarchy of medical opinions. 20 C.F.R. §§
404.1520c(a), 416.920c(a) (2017). Plaintiff filed an application for disability insurance benefits
on March 2, 2018. Thus, the Commissioner's new regulations apply to the ALJ's assessment of

this opinion. See 20 C.F.R. § 404.1520c; 82 Fed. Reg. 5844 (Jan. 18, 2017); see also 82 Fed.
Reg. 15,132 (Mar. 27, 2017) (correcting technical errors).
The new rules no longer provide for any inherent weight: "We [the SSA] will not defer or
give any specific evidentiary weight, including controlling weight, to any medical opinion(s) or
prior administrative medical finding(s) including those from your medical sources." 20 C.F.R. §§
404.1520c(a), 416.920c(a). The SSA "considers" various medical opinions for claims filed on or
after March 27, 2017, and determines which medical opinions are most persuasive. 20 C.F.R. §§
404.1520c(a), 416.920c(a). In evaluating which opinions are most persuasive, the ALJ considers
several factors. The two most important factors are supportability & consistency. Id. Secondary
factors include the relationship with the claimant, specialization, and other factors. Id. at
404.1520c(c), 416.920c(c). Supportability means the extent to which a medical source supports
the medical opinion by explaining the "relevant ... objective medical evidence." Woods v.
Kijakazi, 32 F.4th 785, 791-92 (9th Cir. 2022) (citing 20 C.F.R. § 404.1520c(c)(l)). Consistency
means the extent to which a medical opinion is "consistent ... with the evidence from other
medical sources and nonmedical sources in the claim." Id (citing 20 C.F.R § 404.1520c(c)(2)).

A. Beth Paraskeva, ANP
Paraskeva conducted a consultative examination on April 2, 2022, assessing Plaintiffs
workplace limitations based on her impairments. Tr. 1440-50. In her opinion, Paraskeva stated
that Plaintiff can sit from six to eight hours, stand and walk for up to two hours, occasionally
bend, squat, handle, feel, and grasp, frequently reach, and can lift and carry at least 10 pounds
frequently, and lift 20 pounds occasionally. Tr. 1447. Plaintiff also scored a 27/30 on the minimental state examination. Tr. 1448. Paraskeva also noted that Plaintiff had appropriate speech
and mood, her memory and concentration were normal, her sensory exam was normal, and that

despite swollen hands and fingers, Plaintiff was able to lift, carry and handle light objects, dress
and undress adequately, could fully extend her hand, make a fist, oppose her fingers, and pinch,
grasp, and manipulate small and large objects without difficulty. Tr. 1442-44. Paraskeva further
noted that Plaintiff could rise from a sitting position without assistance, had no difficulty getting
up and down from the exam table, was able to walk on heels and toes, had normal tandem
walking, and could only hop on one foot on her right foot. Tr. 1444. The ALJ determined that
Paraskeva' s medical opinion was unpersuasive because it was internally inconsistent with the
observed clinical signs, as well as inconsistent with other evidence in the record, such as
Plaintiffs lack of treatment, work activity, and reports that Plaintiff did not believe her
symptoms were severe enough for greater treatment. Tr. 23.
Plaintiff contends that the ALJ failed to provide substantial evidence to support their
interpretation of Paraskeva's medical opinion, that Plaintiffs work history does not contradict
the medical findings, that Plaintiffs lack of treatment should not be held against her because of
her ADHD, and that the ALJ failed to take into account whether Plaintiff was limited from
seeking treatment. Pl.'s Br. 5-9, ECF 9. Plaintiff, however, is incorrect.
The ALJ noted that Paraskeva's limitations were internally inconsistent with the results
of her conducted examination. Tr. 23. For example, Plaintiff was limited to occasional handling,
feeling, and grasping, yet testing showed that while Plaintiff had 4/5 grip strength and swelling
in her hands and fingers, she had no difficulty lifting, carrying, and handling light objects, could
fully extend her hand, make a fist, and oppose her fingers, as well as pinch, grasp and manipulate
small and large objects without difficulty. Tr. 1443-44. Plaintiff further argues that in not
following the limitations assessed by Paraskeva, the ALJ is "substituting her own interpretation
of CE Paraskeva's findings," and is therefore substituting her own judgment in place of the

medical expert's. Pl.'s Br. 6, ECF 9. However, Plaintiff is mistaken. Not only is an internal
inconsistency a valid reason to reject a medical opinion, as it is here, an ALJ is "at some level,
capable of independently reviewing and forming conclusions about medical evidence to
discharge their statutory duty to determine whether a claimant is disabled and cannot work."
Farlow v. Kijakazi, 53 F.4th 485,488 (9th Cir. 2022); see see also Rounds v. Comm'r, Soc. Sec.,
807 F.3d 996, 1006 (9th Cir. 2015) ("[T]he ALJ is responsible for translating and incorporating
clinical findings into a succinct RFC."). Furthermore, an ALJ is not strictly beholden to the
limitations assessed in a medical opinion, rather medical opinions are considered along with the
entirety of the evidence ofrecord. See 20 C.F.R. § 416.920c(a).
Next, Plaintiff argues that her work activity is not a valid basis upon which to reject
Paraskeva's medical opinion, noting that while she did work, she worked only part-time at 12
hours a week in three-hour shifts and that was "about as long as she could manage," while also
being "quite painful." Pl.'s Br. 7, ECF 9 (citing Tr.41,1135). Plaintiff, however, is misinformed.
Any work activity may be considered when determining whether a claimant is disabled. See
Ford v. Saul, 950 F.3d 1141, 1156 (9th Cir. 2020). Notably, while Plaintiff reported the walking
as "quite painful," and her doctor believed the walking involved was "as long as she can manage
with her arthritis," he also noted that she was using a treadmill at home which helped. Tr. 1135
Furthermore, while she was taking Naproxen for pain, which was mostly in her hands and wrists
rather than her legs, she had only just reestablished care for her arthritis the day before the above
report after declining rheumatoid arthritis treatment for the five months prior. Tr. 706-07, 1135,
1152. As such, Plaintiffs work activity was a valid reason to discount Paraskeva's medical
opinion.

Plaintiffs last arguments, that her lack of treatment was due to her ADHD and an
inability to seek treatment, are also without merit. First, Plaintiff was not limited in her ability to
seek treatment at any point in the record. In fact, Plaintiff fails to cite any evidence to
substantiate such an argument, rather citing to evidence of her obtaining ongoing treatment
during COVID instead of showing how it was a hindrance. See Pl.' s Br. 9, ECF 9 (citing Tr.
1149, 1153, 1207-08, 1328). As for whether her ADHD was a contributing factor in why she
chose not to pursue treatment, based on the record before this Court, Plaintiff actively denied
treatment two months prior to her amended alleged onset date of November 20, 2020, because
she believed her symptoms were not severe enough despite stating that her symptoms had been
getting worse since 2019. Tr. 706, 1147. In fact, despite how much worse her symptoms were
getting, she only chose to reestablish treatment in February 2021, five months later, with her
expected to improve with treatment, only for her to consistently miss appointments because she
was out of town. Tr. 1152, 1326, 1400, 1468. Plaintiff did not reestablish care again until
February 2022. Tr. 1467. Furthermore, given the lack of ambiguity, the ALJ was not required to
inquire about any such difficulties related to Plaintiffs ability to acquire treatment. Therefore,
Plaintiffs denial of treatment was a valid reason to reject Paraskeva's opinion.
Given the above, the ALJ did not err in rejecting Paraskeva's medical opinion because
inconsistency with medical records and inadequate support by clinical findings serve as specific,
legitimate reasons for rejecting a physician's opinion. Bray v. Comm 'r ofSoc. Sec. Admin., 554
F.3d 1219, 1228 (9th Cir. 2009); Tommasetti v. Astrue, 533 F.3d 1035, 1041 (9th Cir. 2008);
Andrews v. Shala/a, 53 F.3d 1035, 1042-43 (9th Cir. 1995). In light of this evidence, the Court
concludes that the ALJ' s interpretation of the record was reasonable, and the Court will not
second guess the ALJ's findings. See Carmickle v. Comm 'r, Soc. Sec. Admin., 533 F.3d 1155,

1161 (9th Cir. 2008) ("[W]e conclude [that the ALJ's] interpretation of the evidence is
reasonable and we will not second-guess it.") (citation omitted).

B. Benjamin Houser, M.D.
Dr. Houser provided a medical opinion on May 17, 2021, in which he stated that Plaintiff
could return to light duty immediately but only for four-hour shifts as her functional assessment
made it clear that was all she could physically tolerate. Tr. 1340. The ALJ rejected Dr. Rouser's
opinion because it referenced a functional assessment that is not in the record and was
inconsistent with Dr. Rouser's own treatment records and Plaintiffs lack of treatment. Tr. 2223.
Plaintiff contends that while the referenced functional assessment may not be in the
records, Dr. Houser was aware of her treatment and those treatment notes support his opinion.
Pl.'s Br. 9-10, ECF 9. Plaintiffs argument, however, is unavailing.
First, it is questionable as to whether Dr. Rouser's two sentence statement even qualifies
as a medical opinion, as a medical opinion must state what a claimant can still do despite their
limitations. See 20 C.F.R. § 416.913(a)(2). Assuming it does, however, neither the ALJ nor this
Court can provide any weight to an assessment that it cannot review. Plaintiff argues that other
treatment notes provide the context for Dr. Rouser's opinion, but Plaintiff is incorrect. An
occupational therapist saw the referenced functional assessment and noted that Plaintiff should
be referred to a physical therapist in order to maximize her functional abilities and manage her
rheumatoid arthritis, but there is no indication she ever followed through. Tr. 1361-62. Prior to
providing his medical opinion, Dr. Houser noted that Plaintiff declined rheumatoid arthritis
treatment in September 2020 because her' symptoms were "not so bad," only seeking to
reestablish care five months later, in February 2021. Tr. 706, 1152. During Plaintiffs

reenrollment in arthritic care, her rheumatologist, Dr. Davies, reported on May 5, 2021, that with
appropriate treatment she did "not anticipate ongoing disability," despite finding a host of
physical limitations, such as an inability to make a fist, decreased grip strength, swollen hands,
right knee tenderness, both knees hyperextending with pain, and discomfort with ankle
movement Tr. 1326, 1329, 1364. This note was made 12 days prior to Dr. Houser issuing his
opinion. Plaintiff, however, never followed through with appropriate treatment and was released
from the program following missed appointments, appointments missed because she was out of
town. See Tr. 1468. She then waited nine months to reestablish care. Id.
Therefore, the ALJ did not err in rejecting Dr. Rouser's medical opinion for
inconsistency and inadequate support. While Plaintiff may wish for a different reading of the
record, as stated above, this Court will not disturb a reasonable interpretation of the evidence.

CONCLUSION

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For the reasons set forth above, the Commissioner's
It is so ORDERED and DATED this

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