Guillen-Andringa v. Commissioner of Social Security

Filing 15

ORDER Affirming and Dismissing the Case. The Court AFFIRMS the Commissioner's final decision and DISMISSES the case with prejudice. Signed by Judge John H. Chun. (SB)

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1 2 3 4 5 UNITED STATES DISTRICT COURT WESTERN DISTRICT OF WASHINGTON AT SEATTLE 6 7 8 9 10 11 SHANNON G., Case No. C22-5372 JHC Plaintiff, v. COMMISSIONER OF SOCIAL SECURITY, ORDER AFFIRMING AND DISMISSING THE CASE Defendant. 12 13 Plaintiff seeks review of the denial of her application for Supplemental Security Income. 14 Plaintiff contends the Administrative Law Judge (ALJ) erred by failing to properly evaluate her 15 symptom testimony and the medical opinion evidence. Dkt. 12. As discussed below, the Court 16 AFFIRMS the Commissioner’s final decision and DISMISSES the case with prejudice. 17 I. BACKGROUND 18 19 20 21 22 23 Plaintiff is 48 years old, has at least a high school education, and has no relevant past work. Admin. Record (AR) 22. On February 15, 2019, Plaintiff applied for benefits, alleging disability as of January 1, 2009. AR 15, 79, 91. Plaintiff’s application was denied initially and on reconsideration. AR 15, 88, 100. After the ALJ conducted a hearing on April 6, 2021, the ALJ issued a decision finding Plaintiff not disabled. AR 12–77. ORDER AFFIRMING AND DISMISSING THE CASE - 1 II. THE ALJ’S DECISION 1 2 3 4 5 6 7 8 9 Using the five-step disability evaluation process, 1 the ALJ found: Step one: Plaintiff has not engaged in substantial gainful activity since February 15, 2019, the application date. Step two: Plaintiff has the following severe impairments: attention deficit hyperactivity disorder (ADHD); posttraumatic stress disorder (PTSD); major depressive disorder; and generalized anxiety disorder. Step three: These impairments do not meet or equal the requirements of a listed impairment. 2 Residual Functional Capacity: Plaintiff can perform less than the full range of medium work as defined in 20 C.F.R. § 416.967(c). 10 Step four: Plaintiff has no past relevant work. 11 Step five: As there are jobs that exist in significant numbers in the national economy that Plaintiff can perform, Plaintiff is not disabled. 12 13 14 AR 17–23. The Appeals Council denied Plaintiff’s request for review, making the ALJ’s decision the Commissioner’s final decision. AR 1–6. 3 III. DISCUSSION 15 16 The Court may reverse the ALJ’s decision only if it is legally erroneous or not supported 17 by substantial evidence of record. Ford v. Saul, 950 F.3d 1141, 1154 (9th Cir. 2020). The Court 18 must examine the record but cannot reweigh the evidence or substitute its judgment for the 19 ALJ’s. Thomas v. Barnhart, 278 F.3d 947, 954 (9th Cir. 2002). When evidence is susceptible to 20 more than one interpretation, the Court must uphold the ALJ’s interpretation if rational. Ford, 21 950 F.3d at 1154. Also, the Court “may not reverse an ALJ’s decision on account of an error 22 23 20 C.F.R. § 416.920. 20 C.F.R. Part 404, Subpart P, Appendix 1. 3 The rest of the procedural history is irrelevant to the outcome of the case and is thus omitted. 1 2 ORDER AFFIRMING AND DISMISSING THE CASE - 2 1 that is harmless.” Molina v. Astrue, 674 F.3d 1104, 1111 (9th Cir. 2012). 2 A. 3 Plaintiff contends the ALJ erred in evaluating her symptom testimony. Dkt. 12 at 2–6. 4 At the hearing before the ALJ, Plaintiff testified she cannot work because of mental Plaintiff’s Testimony 5 health impairments, including PTSD, ADHD, and anxiety. AR 43. Plaintiff testified she lives 6 by herself, she goes to the foodbanks “a lot,” and goes shopping once a month. AR 46. She 7 stated she mostly stays at home, and that except for going on walks with her neighbor, she does 8 not go out much because she does not like being around others. AR 46–47. Plaintiff testified 9 she takes medication for her mental health impairments, but they are not always effective, as she 10 experiences periods of severe anxiety and panic attacks that can last several days to a week. AR 11 48–54. Plaintiff testified that when her anxiety worsens, she lays in bed, she cannot go outside to 12 shop for groceries, attend her appointments, go on walks, complete her daily chores, or be 13 around others. AR 55–59. 14 Where, as here, an ALJ determines a claimant has presented objective medical evidence 15 establishing underlying impairments that could cause the symptoms alleged, and there is no 16 affirmative evidence of malingering, the ALJ can only discount the claimant’s testimony about 17 symptom severity by providing “specific, clear, and convincing” reasons supported by 18 substantial evidence. Trevizo v. Berryhill, 871 F.3d 664, 678 (9th Cir. 2017). 19 In this case, the ALJ first rejected Plaintiff’s testimony because of her limited work 20 history. AR 20. A claimant’s extremely poor work history can be a clear and convincing reason 21 an ALJ can give in rejecting a claimant’s testimony, as a claimant who has “shown little 22 propensity to work in her lifetime” can hurt her credibility as to her inability to work. See 23 Thomas, 278 F.3d at 959. Plaintiff’s earnings record from 1990 to 2021 is sparse, with her most ORDER AFFIRMING AND DISMISSING THE CASE - 3 1 recent work taking place in 2007 when she was employed as a caretaker for three months and an 2 assistant manager for her sister-in-law’s construction company. AR 37–41, 185–89. While 3 Plaintiff’s work history is not extensive, the Court cannot say it suggests her “little propensity” to 4 work, especially considering Plaintiff could not work in 2008 because she was in prison, and that 5 as recently as October 2019, she worked as a home caretaker in exchange for housing. AR 42, 6 639. Thus, the Court cannot say the ALJ reasonably rejected her testimony based on her poor 7 work history. 8 The ALJ also rejected Plaintiff’s testimony because it was inconsistent with her activities 9 of daily living. AR 20–21. An ALJ may discount a claimant’s symptom testimony when it 10 conflicts with the claimant’s general activity level. See Molina, 674 F.3d at 1112–13; 11 Lingenfelter v. Astrue, 504 F.3d 1028, 1040 (9th Cir. 2007). Here, in rejecting Plaintiff’s 12 statements, the ALJ cited Plaintiff’s ability to go on walks with her neighbor, go shopping with 13 her cousin, go to the mall and restaurants with her children, live by herself, and take public 14 transportation. AR 20–21. The Court finds the ALJ’s reasoning with regards to most of the 15 activities identified by the ALJ unpersuasive, as Plaintiff did not testify to being unable to 16 perform them—during the hearing, she explained that she was prevented from doing them when 17 her symptoms increase in severity. AR 55–57. Thus, the Court cannot say the ALJ reasonably 18 rejected Plaintiff’s testimony based on her activities of daily living. 19 Finally, the ALJ rejected Plaintiff’s testimony because of its inconsistency with the 20 objective medical evidence. AR 20–21. An ALJ may reject a claimant’s symptom testimony 21 when it is contradicted by the medical evidence. See Carmickle v. Comm’r, Soc. Sec. Admin., 22 533 F.3d 1155, 1161 (9th Cir. 2008) (citing Johnson v. Shalala, 60 F.3d 1428, 1434 (9th 23 Cir.1995)). Here, the ALJ cited treatment notes which show Plaintiff repeatedly reported ORDER AFFIRMING AND DISMISSING THE CASE - 4 1 improvement of her symptoms because of her medications. See AR 446 (“She states [her 2 medications] are working well for her), 454, 637 (“Patient … states that her medication … helps 3 her focus, and also able to finish things that she does”), 639 (“She says that her mood has been 4 ok lately and he finds that the medication is working well. She feels good at this time.”), 641, 5 644 (“She says both medications are working very well for her.”). The record also shows that 6 when under medication, Plaintiff was able to work as a home caretaker and clean and cook 7 throughout the day. See AR 639. Plaintiff argues the ALJ’s citation were selective, as her 8 overall record indicates her symptoms waxed and waned and her improvement was not long 9 term. See Dkt. 12 at 5; Dkt. 14 at 4. Yet the evidence Plaintiff cited mostly supports the ALJ’s 10 finding. They show that Plaintiff reported she is “happy with her care,” her medication helps her 11 anxiety, she had not had panic attacks in months, she is “happy with much of her life in terms of 12 housing and relationship with her children,” and she does not remember bad dreams and 13 nightmares when under medication. See AR 600, 613, 615. Plaintiff also attributed increase of 14 her symptoms to COVID-19, because she was “‘running out of medication,’” or to other external 15 stressors, such as her ex-husband. See AR 594, 600, 606–07, 613, 620. In sum, the ALJ’s 16 assessment of Plaintiff’s record is supported by substantial evidence. Thus, in rejecting 17 Plaintiff’s testimony based on its inconsistency with objective medical evidence, the ALJ did not 18 err. 19 Although the ALJ’s first two reasons for rejecting Plaintiff’s testimony were erroneous, 20 Plaintiff has failed to show the ALJ committed harmful error. See Ludwig v. Astrue, 681 F.3d 21 1047, 1054 (9th Cir. 2012) (holding that the party challenging an administrative decision bears 22 the burden of proving harmful error) (citing Shinseki v. Sanders, 556 U.S. 396, 407–09 (2009)). 23 An error is harmless “where it is ‘inconsequential to the ultimate nondisability determination.’” ORDER AFFIRMING AND DISMISSING THE CASE - 5 1 Molina, 674 F.3d at 1115 (quoting Carmickle, 533 F.3d at 1162). As the ALJ gave at least one 2 valid reason for rejecting Plaintiff’s testimony, his inclusion of erroneous reasons was 3 inconsequential and therefore harmless. See id. (quoting Batson v. Comm’r of Soc. Sec. Admin., 4 359 F.3d 1190, 1197 (9th Cir. 2004)). 5 B. 6 Plaintiff contends the ALJ erred in evaluating the medical opinion evidence provided by Medical Opinion Evidence 7 (1) Dr. Stamschror, (2) Dr. McCaw, and (3) Mr. Cirilo Adao, PA-C. Dkt. 12 at 6–9. 8 Plaintiff submitted her applications after March 27, 2017. AR 15, 79, 91. Under the 9 applicable regulations, ALJs must consider every medical opinion in the record and evaluate 10 each opinion’s persuasiveness, using five factors (supportability, consistency, relationship with 11 claimant, specialization, and other), with supportability and consistency being the two most 12 important factors. Woods v. Kijakazi, 32 F.4th 785, 791 (9th Cir. 2022); 20 C.F.R. § 13 416.920c(a). Supportability means the extent to which a medical source supports the medical 14 opinion by explaining the “relevant ... objective medical evidence.” 20 C.F.R. § 416.920c(c)(1). 15 Consistency means the extent to which a medical opinion is “consistent ... with the evidence 16 from other medical sources and nonmedical sources in the claim.” 20 C.F.R. § 416.920c(c)(2), § 17 404.1520c(c)(2). “An ALJ cannot reject an examining or treating doctor’s opinion as 18 unsupported or inconsistent without providing an explanation supported by substantial 19 evidence.” Woods, 32 F.4th at 792. 20 21 1. Dr. McCaw In January 2020, Dr. W. Kefron McCaw completed a mental evaluation of Plaintiff by 22 conducting a mental status examination and reviewing notes from Plaintiff’s social worker. AR 23 563–68. Dr. McCaw diagnosed her with PTSD “with panic attacks”; “Opioid use disorder, mild ORDER AFFIRMING AND DISMISSING THE CASE - 6 1 to moderate, in reported sustained remission”; and “R/O [rule out] ADHD.” AR 565. Based on 2 Plaintiff’s impairments, Dr. McCaw opined that Plaintiff would be markedly limited in: 3 performing activities within a schedule, maintaining regular attendance, and being punctual 4 within customary tolerances without special supervision; communicating and performing 5 effectively in a work setting; maintaining appropriate behavior in a work setting; and completing 6 a normal work day and work week without interruptions from psychologically based symptoms. 7 AR 565–66. 8 The ALJ first rejected Dr. McCaw’s opinion because it was “based on only one 9 examination.” AR 21. Under the new regulations, the frequency of a claimant’s visits with a 10 medical source is a factor the ALJ can consider, as it “demonstrate[s] whether the medical source 11 has a longitudinal record understanding of [the claimant’s] impairment[s].” See 20 C.F.R. § 12 416.920c(c)(3)(ii). But it is neither the sole nor determinative factor. The regulations make it 13 clear that a medical opinion’s supportability and consistency are the most important factors 14 considered by the ALJ when considering medical opinions. See 20 C.F.R. § 416.920c(b)(1). 15 Thus, that Dr. McCaw has only evaluated Plaintiff once is not by itself a valid reason the ALJ 16 can use to reject the doctor’s opinion. 17 The ALJ also rejected Dr. McCaw’s opinion for its inconsistency with the longitudinal 18 record, finding that Plaintiff’s record “suggest[ed] improvements in mental health symptoms” 19 due to her medication. See AR 21. An ALJ may reasonably reject a doctor’s opinions when they 20 conflict with or are contradicted by the medical evidence. See Batson v. Comm’r of Soc. Sec. 21 Admin., 359 F.3d 1190, 1195 (9th Cir. 2004) (holding that a treating physician’s opinion may 22 properly be rejected where it is contradicted by other medical evidence in the record). In this 23 case, the ALJ’s assessment of Plaintiff’s record is substantially supported. The treatment notes ORDER AFFIRMING AND DISMISSING THE CASE - 7 1 the ALJ identified include Plaintiff’s own reports that she is doing well under her ADHD 2 medication and that she can better focus and concentrate. See AR 647, 652, 660, 666. Plaintiff 3 also reported that, because of her medication, she has not been in a depressed mood, and that she 4 “no longer experiences excessive nervousness, fear, apprehension, and worry” when she 5 complies with her anxiety medication. AR 669. Given that these findings negate Dr. McCaw’s 6 opinion about the effects of Plaintiff’s mental impairments, the ALJ could reasonably find Dr. 7 McCaw’s opinion lacking in persuasiveness. Thus, in rejecting Dr. McCaw’s opinion with its 8 inconsistency with the longitudinal record, the ALJ did not err. 9 As the ALJ has given at least one valid reason, supported by substantial evidence, to 10 reject Dr. McCaw’s opinion, the Court need not further assess the other reasons offered by the 11 ALJ. Even if the ALJ committed error on those grounds, those errors would be harmless. See 12 Carmickle, 533 F.3d at 1162-1163 (inclusion of erroneous reasons is harmless). 13 14 2. Dr. Stamschror Dr. Justin Stamschror completed a psychiatric evaluation in May 2019 by conducting a 15 mental status exam and reviewing Plaintiff’s medical records. AR 433–37. Based on Plaintiff’s 16 performance on her exam, Dr. Stamschror opined that Plaintiff’s ability to perform simple and 17 repetitive tasks is adequate, her ability to perform detailed and complex tasks is “somewhat 18 impaired,” and her ability to perform work activities on a consistent basis without special or 19 additional instructions is “also somewhat impaired.” AR 437. He also opined that Plaintiff’s 20 ability to perform work activities at an adequate pace, maintain regular attendance in the 21 workplace and complete a normal workday, and ability to interact with coworkers and adapt to 22 workplace stressors is “likely poor.” See id. 23 The ALJ found the portion of Dr. Stamschror’s opinion about Plaintiff’s ability to ORDER AFFIRMING AND DISMISSING THE CASE - 8 1 perform simple tasks supported by the evidence, but rejected the rest because of its inconsistency 2 with Plaintiff’s record showing improvement from medication. See AR 20. As stated, an ALJ 3 may reasonably reject a doctor’s opinions when they conflict with or contradicted by the medical 4 evidence. See Batson, 359 F.3d at 1195. Here, the ALJ cited several times when Plaintiff herself 5 found her ADHD medication effective in helping her focus and finish tasks, that hat her mood 6 has been “ok lately,” that she “feels good,” that her PTSD medication has been working well, 7 that her anxiety is better, that she is sleeping better, and that she “is happy with her current 8 regimen.” See AR 637, 639, 641, 644. The record does show Plaintiff experienced increased 9 anxiety and stress, but the ALJ properly pointed out that the record also shows this was caused 10 by external stressors, namely her familial issues. See AR 579, 609. The ALJ also properly 11 pointed out her records show she can live with others, she believes she gets along with others, 12 and she endorsed positive relationships with the couple she was living with, her close friends and 13 neighbors, though she herself seldom socializes. AR 578–81, 588. Based on Plaintiff’s own 14 reports of improvement and ability to form positive relationships with others, and given that the 15 record shows the worsening of Plaintiff’s symptoms is due to external stressors, the ALJ could 16 reasonably find Dr. Stamschror’s opinion lacking in persuasiveness. Thus, in rejecting his 17 opinion because of its inconsistency with the longitudinal record, the ALJ did not err. 18 19 3. Cirilo Adao, PA-C Mr. Adao, one of Plaintiff’s treating sources, completed a mental residual functional 20 capacity assessment prepared by Plaintiff’s counsel in March 2021. AR 684–87. Mr. Adao 21 indicated Plaintiff was markedly limited in her ability to: carry out very short and simple 22 instructions, carry out detailed instructions, interact appropriately with the public, accept 23 instructions and respond appropriately to criticisms from supervisors, and responding changes in ORDER AFFIRMING AND DISMISSING THE CASE - 9 1 the work setting. AR 685–87. When asked how often Plaintiff would need to miss work each 2 month because of her mental impairments, Mr. Adao wrote one to two days per month. AR 687. 3 Finally, when asked if Plaintiff’s impairments would substantially interfere with her ability to 4 work at least 20 percent of the time, Dr. Adao said, “[Y]es.” Id. 5 The ALJ rejected Mr. Adao’s opinion because of its general inconsistency with “the 6 longitudinal record showing that [Plaintiff] had good results with her mental health medication, 7 including improved focus and concentration.” See AR 22. As stated above, an ALJ may 8 reasonably reject a medical opinion when it conflicts with or contradicted by the medical 9 evidence. See Batson, 359 F.3d at 1195. Further, as discussed above, Plaintiff’s record shows 10 she repeatedly reported improvement of her mental health symptoms because of her medications, 11 and that she reported forming positive relationships and even live with others. See AR 578–81, 12 588, 637, 639, 641, 644, 647, 652, 660, 666. As these records largely undermine Mr. Adao’s 13 opinion, the Court cannot say the ALJ unreasonably rejected Mr. Adao’s opinion for its 14 inconsistency with the medical record. Accordingly, the Court finds the ALJ did not err. IV. CONCLUSION 15 16 17 18 19 For the foregoing reasons, the Commissioner’s final decision is AFFIRMED and this case is DISMISSED with prejudice. DATED this 18th day of November, 2022. A 20 21 John H. Chun United States District Judge 22 23 ORDER AFFIRMING AND DISMISSING THE CASE - 10

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