Irby v. Commissioner Social Security Administration

Filing 15

OPINION & ORDER: The Commissioner's decision is Affirmed and this case is Dismissed. Signed on 6/3/24 by Magistrate Judge Jolie A. Russo. (gm)

IN THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF OREGON

VELVET I., 1

No. 6:22-cv-1338-JR
Plaintiff,

OPINION & ORDER

v.
COMMISSIONER, SOCIAL
SECURITY ADMINISTRATION,
Defendant.

RUSSO, Magistrate Judge:
Plaintiff Velvet I. brings this action for judicial review of the final decision of the
Commissioner of Social Security (“Commissioner”) denying her application for Title II
Disability Insurance Benefits under the Social Security Act (“the Act”). All parties have
consented to allow a Magistrate Judge to enter final orders and judgement in this case in

1

In the interest of privacy, this opinion uses only the first name and the initial of the last name of
the nongovernmental party in this case.
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accordance with Fed. R. Civ. P. 73 and 28 U.S.C. § 636(c). ECF No. 13. For the reasons set forth
below, the Commissioner’s decision is AFFIRMED, and this case is DISMISSED.
PROCEDURAL BACKGROUND
Born in October 1973, plaintiff alleges disability beginning September 1, 2017, due to
diabetes, left shoulder pain, hand and finger numbness, essential tremors, neck and back issues,
asthma, nerve pain in her feet, anxiety, PTSD, bee allergy, her “legs give out randomly,” and
fibromyalgia. Tr. 262, 266. Her application was denied initially and upon reconsideration. Tr.
158-62, 167-71. On March 25, 2021, plaintiff appeared at an administrative hearing before
Administrative Law Judge (“ALJ”) Steven De Monbreum. Tr. 51-93. On July 30, 2021, the ALJ
issued a decision finding plaintiff not disabled. Tr. 27-50. After the Appeals Council denied her
request for review, plaintiff filed a complaint in this Court. Tr. 1-6.
THE ALJ’S FINDINGS
At step one of the five step sequential evaluation process, the ALJ found plaintiff did not
engage in substantial gainful activity from her alleged onset date of September 1, 2017 through
her date last insured of June 30, 2020. Tr. 33. At step two, the ALJ determined the following
impairments were medically determinable and severe: “spine disorders status post surgery, hx of
radiculopathy, dysfunction of joints, diabetes, fibromyalgia, asthma/chronic obstructive
pulmonary disease (COPD), history of essential tremor; posttraumatic stress disorder (PTSD),
and depression.” Tr. 34. At step three, the ALJ found plaintiff’s impairments, either singly or in
combination, did not meet or equal the requirements of a listed impairment. Tr. 34.
Because plaintiff did not establish presumptive disability at step three, the ALJ continued
to evaluate how plaintiff’s impairments affected her ability to work. The ALJ resolved that

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plaintiff had the residual function capacity (“RFC”) to perform light work as defined in 20
C.F.R. § 404.1567(b) except that she:
can occasionally climb ramps and stairs, but never climb ladders, ropes, or
scaffolds. She can occasionally stoop, kneel, and crouch. She cannot crawl. She
can occasionally reach overhead bilaterally, and frequently handle and finger
bilaterally. She should have no exposure to vibrations or hazards. She should have
no more than occasional exposure to pulmonary irritants, such as dusts, fumes,
odors, gases, and poor ventilation consistent with an indoor office-like
environment. She can perform simple, routine tasks consistent with a DOT GED
Reasoning Level of 2, or less. She can have occasional interaction with coworkers
and the public.
Tr. 36.
At step four, the ALJ determined plaintiff was unable to perform any past relevant work.
Tr. 44. At step five, the ALJ found plaintiff had the ability to perform jobs that exist in
significant numbers in the national economy, specifically as a router, small products assembler,
and hotel housekeeper. Tr. 44-45.
DISCUSSION
Plaintiff argues the ALJ erred by (1) discrediting her subjective symptom statements
without clear and convincing reasons for doing so; (2) failing to provide germane reasons to
reject competent lay witness statements; and (3) erroneously finding the medical opinion of
Aimee Hansen, FNP, unpersuasive.
I.

Symptom Testimony
Plaintiff contends the ALJ erred by discrediting her testimony that her shoulder and spine

issues, neuropathy, diabetes and fibromyalgia pain limit her ability to work. Pl.’s Br., ECF No. 8
at 10-12. When a claimant has medically documented impairments that could reasonably be
expected to produce some degree of the symptoms complained of, and the record contains no
affirmative evidence of malingering, “the ALJ can reject the claimant’s testimony about the

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severity of ... symptoms only by offering specific, clear and convincing reasons for doing so.”
Smolen v. Chater, 80 F.3d 1273, 1281 (9th Cir. 1996) (internal citation omitted). A general
assertion the claimant is not credible is insufficient; the ALJ must “state which ... testimony is
not credible and what evidence suggests the complaints are not credible.” Dodrill v. Shalala, 12
F.3d 915, 918 (9th Cir. 1993). The reasons proffered must be “sufficiently specific to permit the
reviewing court to conclude that the ALJ did not arbitrarily discredit the claimant’s testimony.”
Orteza v. Shalala, 50 F.3d 748, 750 (9th Cir. 1995) (internal citation omitted). In other words,
the “clear and convincing” standard requires an ALJ to “show [their] work.” Smartt v. Kijakazi,
53 F.4th 489, 499 (9th Cir. 2022).
Thus, in formulating the RFC, the ALJ is not tasked with “examining an individual’s
character” or propensity for truthfulness, and instead assesses whether the claimant’s subjective
symptom statements are consistent with the record as a whole. SSR 16-3p, available at 2017 WL
5180304. If the ALJ’s finding regarding the claimant’s subjective symptom testimony is
“supported by substantial evidence in the record, [the court] may not engage in secondguessing.” Thomas v. Barnhart, 278 F.3d 947, 959 (9th Cir. 2002) (internal citation omitted).
The question is not whether the ALJ’s rationale convinces the court, but whether the ALJ’s
rationale “is clear enough that it has the power to convince.” Smartt, 53 F.4th at 499
At the hearing, plaintiff testified to right shoulder pain that had progressively worsened
over time, and which sometimes impacted her grip strength. Tr. 58, 60-61. She had surgery on
her left shoulder in 2018 but remained limited in the amount of weight she could lift. Tr. 59. She
experienced pain when lifting her left arm above her head and reaching behind her body. Tr. 60.
She had problems reaching in front of her body and “doing everything” with her right, dominant
arm. Tr. 63-64. She also experienced neuropathy in her feet and foot pain with standing and

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walking. Tr. 64. She again reported that her husband handled most of the household chores. Tr.
64. Her diabetes was not well controlled; her A1c was down from 12.0 to 10.0, and her blood
sugars had been in the 300s despite insulin and oral medication. Tr. 66. There were days when
she would “fall asleep all the time” because of her blood sugars. Tr. 66. She had trouble
remembering things and processing information. Tr. 67, 71-72. She spent most of her days in a
reclined position, with her legs slightly elevated. Tr. 72- 73. She experienced tremors in her
hands. Tr. 92.
In a written submission, plaintiff reported an inability to sit or stand for long periods due
to pain. Tr. 291. She described a stutter and tremors. Tr. 291. Her husband typically cared for
their pets. Tr. 292. He also did the household chores. Tr. 294. Plaintiff relied on alarms or other
reminders to take her medications. Tr. 293. She stayed home most days. Tr. 296. She typically
spent her time watching television alone due to pain. Tr. 295, 296. Her impairments impacted her
ability to lift, squat, bend, stand, reach, walk, sit, kneel, talk, climb stairs, see, remember things,
complete tasks, concentrate, understand, and use her hands. Tr. 296. She could pay attention for
about twenty minutes. Tr. 296. She could not “retain information” to follow spoken instructions.
Tr. 296.
The ALJ found plaintiff’s medically determinable impairments could reasonably be
expected to cause the alleged symptoms and did not discuss any evidence of malingering. Tr. 37.
However, the ALJ concluded that plaintiff’s statements concerning the intensity, persistence and
limiting effects of her symptoms were not entirely consistent with the medical evidence and
other evidence in the record. Tr. 37. Specifically, the ALJ found plaintiff’s symptom allegations
were inconsistent with objective medical evidence, and that plaintiff’s improvement with

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treatment and a conservative course of treatment conflicted with her symptom allegations. Tr.
37-38.
A. Objective Medical Evidence
The ALJ is instructed to evaluate objective evidence in considering a claimant’s symptom
allegations. 20 C.F.R. § 416.929(c)(2) (“Objective medical evidence ... is a useful indicator to
assist us in making reasonable conclusions about the intensity and persistence of your
symptoms[.]”). Indeed, “[w]hen objective medical evidence in the record is inconsistent with the
claimant’s subjective testimony, the ALJ may indeed weigh it as undercutting such testimony.”
Smartt v. Kijakazi, 53 F.4th 489, 498 (9th Cir. 2022) (emphasis in original); see also Connett v.
Barnhart, 340 F.3d 871, 874 (9th Cir. 2003) (affirming the ALJ’s credibility finding when the
plaintiff’s testimony of weight fluctuation was inconsistent with the medical record). A
claimant’s failure to report symptoms to providers is another valid basis to find a claimant’s
symptom allegations unreliable. Greger v. Barnhart, 464 F.3d 968, 972-73 (9th Cir. 2006). The
lack of objective medical evidence is insufficient, by itself, to justify discounting a claimant’s
testimony. See, e.g., Tammy S. v. Comm’r Soc. Sec. Admin., No. 6:17-cv-01562-HZ, 2018 WL
5924505, at *4 (D. Or. Nov. 10, 2018) (citing Reddick v. Chafer, 157 F.3d 715, 722 (9th Cir.
1998) (“the Commissioner may not discredit [a] claimant’s testimony as to the severity of
symptoms merely because they are unsupported by objective medical evidence.”). When coupled
with other permissible reasons, however, lack of objective medical evidence to support a
claimant’s allegations may be used to discount a claimant’s testimony. Batson, 359 F.3d at
1197–98.
The ALJ reasonably discounted plaintiff’s allegations about spinal issues, neuropathy,
shoulder pain, and diabetes as inconsistent with the record. Conflict with objective medical

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evidence is a sufficient basis for discounting a claimant’s testimony. Smartt, 53 F.4th at 498; 20
C.F.R. §§ 404.1529(c)(2), 416.929(c)(2). At the hearing, plaintiff testified that her back and
shoulder pain limited how much she could lift, her range of motion, and grip strength. Tr. 60-63.
She further testified that her neuropathy left her with no feeling in her left foot, and that her
“right foot is always on fire, pins and needles,” making it difficult to stand and walk. Tr. 64. The
ALJ compared these allegations to medical imaging and nerve conduction testing performed
during the relevant period, noting that any abnormalities were generally classified as “mild” or
“minimal.” Tr. 37 (citing Tr. 503-04, 662, 667, 848, 937). The ALJ likewise highlighted physical
examinations where plaintiff presented with normal gait, “5/5 strength in all examined major
muscle groups,” and symmetric reflexes except for her left and right hamstrings. Tr. 38 (citing,
e.g., Tr. 505-06, 508-09, 845-47). The ALJ reasonably referenced these relatively mild indicators
in the objective medical evidence when discounting plaintiff’s testimony about her physical
limitations. Tr. 37-38. Concerning diabetes, plaintiff testified at the hearing that some days she
would “fall asleep all the time” because her blood sugar was not well controlled. Tr. 66. The ALJ
acknowledged that plaintiff’s blood sugar levels were “variable,” but overall found that the
evidence “do[es] not objectively show . . . symptoms or limitations [from diabetes] that would be
disabling.” Tr. 40. The ALJ relied upon diabetic foot examination findings, and medical records
showing plaintiff’s diabetes was “stable on current medications” to support this inference. Tr.
40-41 (citing Tr. 590-91, 1024). The ALJ supported his decision to discount these aspects of
plaintiff’s symptom testimony with substantial evidence, and this was a clear and convincing
reason for the ALJ to rely upon.
The objective medical evidence the ALJ cited is not a clear and convincing reason to
discount plaintiff’s testimony about fibromyalgia, however, because the evidence the ALJ relied

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upon does not conflict with how fibromyalgia typically presents. As plaintiff rightly points out,
fibromyalgia is distinctive because an individual can have “muscle strength, sensory functions,
and reflexes [that] are normal,” but still experience significant pain. Revels v. Berryhill, 874 F.3d
648, 656, 663, 666 (9th Cir. 2017). Unlike plaintiff’s neuropathy, and spinal and shoulder issues,
a“diagnosis of fibromyalgia does not rely on X-rays or MRIs,” and is difficult to pin down with
objective medical evidence. Id. at 657; See, e.g., Nunn v. Berryhill, 2018 WL 2244705, at *10
(D. Or. May 16, 2018) (rejecting a lack of objective medical evidence as a valid factor in
considering a fibromyalgia claimant’s testimony); Bair v. Comm'r of Soc. Sec. Admin., 2018 WL
2120274, at *5 (D. Or. May 8, 2018) (holding the same). The objective medical evidence the
ALJ cited here conflicts with some of plaintiff’s diagnoses, but does not meaningfully conflict
with plaintiff’s fibromyalgia, or the likelihood that her fibromyalgia causes the symptoms she
alleged at the hearing. The records the ALJ cited do not actually conflict with plaintiff’s
testimony, and the ALJ failed to support the decision to discount plaintiff’s testimony with
substantial evidence. 2
B. Conservative treatment & improvement with treatment
An ALJ may reject a claimant’s symptom testimony if that testimony is contradicted by
evidence in the medical record. Carmickle v. Comm'r of Soc. Sec. Admin., 533 F.3d 1155, 1161
(9th Cir. 2008). If the record shows a claimant’s symptoms have improved with treatment, that
improvement is “an important indicator of the intensity and persistence of ... symptoms.” 20
C.F.R. §§ 404.1529(c)(3), 416.929(c)(3). The Ninth Circuit holds that “evidence of medical

2

This error was harmless, however, because the ALJ relied on another clear and
convincing reason, supported by substantial evidence, to discount plaintiff’s testimony
concerning fibromyalgia. See Carmickle v. Comm'r, Soc. Sec. Admin., 533 F.3d 1155, 1162 (9th
Cir. 2008) (including an erroneous reason among other reasons is at most harmless error where
an ALJ provides other reasons that are supported by substantial evidence).
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treatment successfully relieving symptoms can undermine a claim of disability.” Wellington v.
Berryhill, 878 F.3d 867, 876 (9th Cir. 2017). Additionally, an ALJ may consider a claimant’s
unexplained or inadequately explained failure to follow a prescribed course of treatment.
Tommasetti v. Astrue, 533 F.3d 1035, 1039 (9th Cir. 2008).
Conservative treatment can also be sufficient to discount a claimant's subjective
testimony regarding the limitations caused by an impairment. Parra v. Astrue, 481 F.3d 742,
750-51 (9th Cir. 2007). Not seeking an “aggressive treatment program” permits the inference
that symptoms were not as all-disabling as the claimant reported. Tommasetti v. Astrue, 533 F.3d
1035, 1039 (9th Cir. 2008). The amount of treatment is “an important indicator of the intensity
and persistence of [a claimant’s] symptoms.” 20 C.F.R. § 416.929(c)(3). If, however, the
claimant has a good reason for not seeking more aggressive treatment, conservative treatment is
not a proper basis for rejecting the claimant's subjective symptoms. Carmickle v. Comm'r, Soc.
Sec. Admin., 533 F.3d 1155, 1162 (9th Cir. 2008).
The ALJ reasonably concluded that plaintiff’s conservative course of medication and
positive response to treatment further undermined her hearing testimony. Although plaintiff
complained that pain associated with her fibromyalgia, shoulder and spine issues, and
neuropathy impacted her ability to work, tr. 60-72, the ALJ noted that plaintiff addressed these
symptoms with an effective course of medications. Tr. 39, 42. The ALJ specifically noted that
plaintiff told providers her pain symptoms were “stable,” and that she “doesn’t check her blood
sugars often, but she feels that they’ve been fine.” Tr. 38. The ALJ also noted plaintiff’s
reflection that she “feels that her pain medications are helping her to feel functional,” and that
her course of medication was generally successful at treating her pain. Tr. 40 (citing Tr. 549,
531, 621, 1040 ). The ALJ further relied on the fact that plaintiff’s doctors found she was not a

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surgical candidate and that she should instead pursue “conservative measures and pain
management.” Tr. 39, 848. The ALJ’s decision also reasonably relies on plaintiff’s failure to
pursue more significant treatment options. Specifically, the ALJ notes plaintiff was twice
referred to physical therapists, but never followed through on these recommendations. See Tr.
39, 506. This is another clear and convincing reason, supported by substantial evidence to
discount plaintiff’s symptom testimony.
II.

Lay Witness Testimony
In determining whether a claimant is disabled, an ALJ must consider “lay witness

testimony concerning a claimant’s ability to work.” Stout v. Comm'r, Soc. Sec. Admin., 454 F.3d
1050, 1053 (9th Cir. 2006). Lay witness testimony regarding a claimant’s symptoms or how an
impairment affects her ability to work is competent evidence that cannot be rejected without
comment, and requires germane reasons, explained individually or in the aggregate. Id. An
ALJ’s failure to provide germane reasons for rejecting lay witness evidence is harmless where an
ALJ properly rejects a claimant’s testimony and the lay witness evidence describes the same
limitations. Molina, 674 F.3d at 1122.
Plaintiff’s husband reported that pain affected her ability to sleep, and that she needed
reminders to take her insulin and to check her blood pressure. Tr. 302, 303. She did not prepare
her own meals. Tr. 303. She was able to do laundry, but she needed reminders to do it. Tr. 303.
She did not go outside often. Tr. 303. She was able to drive and go out alone, but she usually had
someone accompany her. Tr. 304. She watched television “all the time.” Tr. 305. She did not
spend time with other people and no longer had a social life. Tr. 305. She had problems getting
along with other people because of anxiety. Tr. 305. Her conditions affected her ability to lift,
squat, bend, stand, reach, walk, sit, kneel, talk, climb stairs, see, remember, complete tasks,

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concentrate, understand, follow instructions, and use her hands. Tr. 306. She was able to walk
two blocks before needing to stop and rest for ten minutes. Tr. 306. She was “horribly bad” at
following written instructions. Tr. 306. She could not handle stress or changes in routine. Tr.
307. She experienced tremors and stuttering and was afraid of what people might think of her.
Tr. 307.
The ALJ provided specific, germane reasons to discount the lay witness testimony, which
mirrored plaintiff’s own. Where lay witness testimony does not describe limitations beyond
those described by the claimant, “the ALJ’s well-supported reasons for rejecting the claimant’s
testimony apply equally well to the lay witness testimony.” Molina, 674 F.3d at 1122. Here, the
ALJ repeated the clear and convincing reasons for discounting plaintiff’s self-reports, discussed
above, when considering the similar statements from plaintiff’s husband. Tr. 38-40. These were
sufficiently specific, germane reasons for discounting this testimony, and the ALJ’s decision to
do so was supported by substantial evidence in the record.
III.

Medical Opinion Evidence
For disability claims filed on or after March 27, 2017, the ALJ no longer “weighs”

medical opinions but instead determines which are most “persuasive.” 20 C.F.R. §§
404.1520c(a). The 2017 regulations eliminated the hierarchy of medical opinions and state that
the agency does not defer to any particular medical opinions, even those from treating sources.
Id.; see also Woods v. Kijakazi, 32 F.4th 785, 792 (9th Cir. 2022) (“The revised social security
regulations are clearly irreconcilable with our caselaw according special deference to the
opinions of treating and examining physicians on account of their relationship with the
claimant.”). Under the 2017 regulations, the ALJ primarily considers the “supportability” and
“consistency” of the opinions in determining whether an opinion is persuasive. 20 C.F.R. §

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404.1520c(c). Supportability is determined by whether the medical source presents explanations
and objective medical evidence to support their opinions. Id. § 404.1520c(c)(1). Consistency is
determined by how consistent the opinion is with evidence from other medical and nonmedical
sources. Id. § 404.1520c(c)(2).
An ALJ may also consider a medical source’s relationship with the claimant by looking
at factors such as the length, purpose, or extent of the treatment relationship, the frequency of the
claimant’s examinations, and whether there is an examining relationship. Id. § 404.1520c(c)(3).
An ALJ is not, however, required to explain how she considered those secondary medical factors
unless she finds that two or more medical opinions about the same issue are equally wellsupported and consistent with the record but not identical. Id. § 404.1520c(b)(2-3).
The regulations require ALJs to “articulate . . . how persuasive [they] find all of the
medical opinions” and “explain how [they] considered the supportability and consistency
factors.” Id. § 404.1520c(b). The court must, moreover, continue to consider whether the ALJ’s
analysis has the support of substantial evidence. See 42 U.S.C. § 405(g); Woods, 32 F.4th at 792
(“Even under the new regulations, an ALJ cannot reject an examining or treating doctor’s
opinion as unsupported or inconsistent without providing an explanation supported by substantial
evidence.”).
Aimee Hansen, FNP
In February 2021, FNP Hansen reported in a written statement that she had been treating
plaintiff for more than ten years, and they currently met once every month or two. Tr. 1062. FNP
Hansen reported that plaintiff’s diagnoses included type 2 diabetes mellitus, tremors, dorsalgia,
fibromyalgia, radiculopathy, and spinal stenosis. Tr. 1062. All of her conditions were chronic
and lifelong. Tr. 1062. Her symptoms included increased pain, tremors, decreased balance,

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chronic fatigue, memory difficulties, and radiating pain. Tr. 1063. Relevant clinical findings
included MRI results and visible tremor that worsened with pain and stress. Tr. 1063. Treatment
had included pain medication, diabetic medication, and follow up with orthopedics. Tr. 1064.
FNP Hansen noted that plaintiff’s pain medication could cause fatigue and grogginess and could
affect her ability to function completely. Tr. 1064.
FNP Hansen opined that plaintiff needed to lie down and rest frequently throughout the
day for about thirty minutes at a time. Tr. 1063. She was able to sit for thirty minutes at a time
and two hours total in an eight-hour workday. Tr. 1064. She could stand/walk for fifteen minutes
at a time and two hours total in an eight-hour workday. Tr. 1064. She required opportunities to
shift positions at will from sitting, standing, and walking. Tr. 1064. She would need to take four
unscheduled, fifteen-minute breaks in an eight-hour workday. Tr. 1065. She could lift/carry ten
pounds occasionally, and never more. Tr. 1065. She would need to periodically elevate her legs
during a physical eight-hour period. Tr. 1065. She would miss more than four workdays per
month. Tr. 1066. FNP Hansen noted that the limitations she assessed had been present since she
first began treating plaintiff. Tr. 1066.
The ALJ found FNP Hansen’s opinion unpersuasive. Tr. 43. The ALJ found the “extreme
limitations [FNP Hansen] proffered are out of portion [sic] to her own treatment notes and her
objective clinical observations and course of treatment documented therein (see, for example,
[Tr. 953]).” Tr. 43. Plaintiff argues the ALJ did not adequately assess the strength of the
evidence underlying FNP Hansen’s opinions, or take into account “fibromyalgia’s unique
characteristics, including that it is diagnosed based on a patient’s self-reported symptoms and
that outwardly normal physical examinations are to be expected.” Pl. Br. at 15-16 (citing Swales
v. Saul, 852 F. App’x 253, 255 (9th Cir. 2021)).

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Regarding supportability, the ALJ adequately discussed the strength of the evidence
underlying FNP Hansen’s opinion when finding it unpersuasive. The supportability factor
requires ALJs to consider the persuasiveness of a medical opinion based on how “relevant the
objective medical evidence and supporting explanations presented by a medical source are to
support his or her medical opinion.” 20 C.F.R. § 404.1520c(c)(1). The ALJ reasonably found the
opinion lacked supportability because FNP Hansen’s own treatment notes and plaintiff’s course
of treatment did not match up to the extreme limitations she proffered in the treating source
statement issued in support of plaintiff’s disability application. Tr. 43. Instead, FNP Hansen’s
treatment notes from 2017-19 contained largely “benign objective observations,” and reflect a
conservative course of treatment, which kept pain symptoms “stable” Tr. 38. The ALJ further
observed that FNP Hansen’s clinical notes contain “very little objective clinical evidence.” Tr.
39. Thus, the ALJ reasonably concluded that the opinion lacked support, i.e., an adequate
explanation of how specific functional limitations are linked to objective medical evidence and
supporting explanations from medical sources in the record. See 20 C.F.R. § 404.1520c(c)(1);
see also 20 C.F.R. § 404.1513(a)(2)(ii). The ALJ adequately considered the supportability of
FNP Hansen’s opinion by examining the bases for her conclusions and discounting those bases
for lack of support and lack of explanation. 3
The ALJ also adequately addressed the consistency of FNP Hansen’s opinion when
finding it unpersuasive. The consistency factor requires the ALJ to assess medical opinions’

3

Plaintiff renews her argument that the ALJ failed to consider the peculiar characteristics
of fibromyalgia when analyzing the supportability of FNP Hansen’s opinion. Pl. Br. at 9. As
indicated above, however, the ALJ relied on substantial evidence in the record, including
plaintiff’s numerous reports that medications improved her pain, to conclude that plaintiff’s
fibromyalgia was not as limiting as FNP Hansen opined. Tr. 39, 42 (citing Tr. 549, 531, 621,
1040).
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alignment with “evidence from other medical sources and nonmedical sources in the claim.” 20
C.F.R. § 404.1520c(c)(2). The ALJ reasonably contrasted FNP Hansen’s opinion with two
opinions provided by doctors Ramona Bates, M.D., and L. Cylus, M.D., which contradicted FNP
Hansen’s extreme limitations. Tr. 42-43. The ALJ reasoned that Doctors Bates and Cylus’s
opinions were better aligned with the longitudinal record and other medical evidence in the
record. Tr. 43 132-33, 152-56. Again, the ALJ emphasized that the medical record reveals a
patient who treated her pain and neuropathy symptoms conservatively and successfully, with
largely unremarkable findings as documented by Dr. Boggs, Dr. Kokkino, and Dr. Herring, and
that plaintiff failed to follow through on recommendations for physical therapy. Tr. 37-39 (citing
Tr. 503-04, 505-06, 508-09, 532, 662, 667, 845-47, 848, 918-27, 937, 949-57, 1042). Plaintiff
urges a different interpretation of the medical evidence, which she argues better supports FNP
Hansen’s February 2021 opinion. Pl. Br. at 16-17. But these arguments are an effort to have this
Court re-weigh the evidence, which is beyond the scope of review. Ahearn v. Saul, 988 F.3d
1111, 1115 (9th Cir. 2021) (“We may not reweigh the evidence or substitute our judgment for
that of the ALJ.”). Even when there are two reasonable interpretations—plaintiff’s and the
ALJ’s—the ALJ’s interpretation must prevail. Burch v. Barnhart, 400 F.3d 676, 679 (9th Cir.
2005) (“Where evidence is susceptible to more than one rational interpretation, it is the
[Commissioner’s] conclusion that must be upheld.”). The Court finds the ALJ sufficiently
addressed the consistency and supportability factors and supported his decision to discount FNP
Hansen’s opinion with substantial evidence.

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CONCLUSION
For the reasons above, I AFFIRM the Commissioner’s decision and DISMISS this case.
IT IS SO ORDERED.
Dated this 3rd day of June, 2024.

__________________________________
/s/ Jolie A. Russo
Jolie A. Russo
United States Magistrate Judge

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