Cole v. Commissioner Social Security Administration

IN THE UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF OREGON

SAVANNAH C.,1 No. 1:21-cv-1310-MO

Plaintiff, OPINION & ORDER

v.

COMMISSIONER, SOCIAL

SECURITY ADMINISTRATION,

Defendant.

MOSMAN, District Judge:

This matter comes before me on Plaintiff Savannah C.’s Complaint [ECF 1] against

Defendant Commissioner of the Social Security Administration. For the reasons given below, I

AFFIRM the Commissioner’s decision and DISMISS this case.

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.

PROCEDURAL BACKGROUND

On March 26, 2019, Plaintiff applied for Child’s Insurance Benefits (“CIB”) and

Supplemental Security Income (“SSI”) under Titles II and XVI of the Social Security Act,

alleging disability beginning July 15, 2018. Tr. 167-71, 172-81. The Social Security

Administration (“SSA”) denied her claim initially and upon reconsideration. Tr. 55-76, 79-102.

Plaintiff appeared and testified at a hearing held on April 7, 2021, before Administrative Law

Judge (ALJ) Mark Triplett. Tr. 31-52. On April 28, 2021, the ALJ issued a decision finding that

Plaintiff had not been under a disability at any time from the alleged onset date through the date

of the decision. Tr. 10-27. Plaintiff filed an appeal, and the Appeals Council denied review. Tr.

1-6.

THE ALJ’S FINDINGS

At step one, the ALJ found that Plaintiff had not engaged in substantial gainful activity

(SGA) since July 15, 2018, the alleged onset date. Tr. 16. At step two, the ALJ determined that

Plaintiff had the following severe impairments: a depressive disorder; an anxiety disorder; a

post-traumatic stress disorder (PTSD); a borderline personality disorder; and a cannabis use

disorder. Tr. 16. At step three, the ALJ found no impairment that met or equaled the severity of

any impairment listed in 20 C.F.R. Part 404, Subpart P, Appendix 1. Tr. 16. The ALJ assessed

Plaintiff’s residual functional capacity (“RFC”) to:

perform a full range of work at all exertional levels but with the following

nonexertional limitations: she can perform only simple, routine tasks that can be

learned in 30 days or less. She can tolerate occasional public interaction. She can

tolerate frequent, incidental coworker contact, but cannot engage in team-based or

collaborative work. She cannot engage in work involving strict time constraints,

such as assembly line work or work involving timed production quotas.

Tr. 17-18.

At step four, the ALJ determined that Plaintiff was unable to perform any past relevant

work. Tr. 21. At step five, the ALJ determined that there are jobs that exist in significant

numbers in the national economy that the claimant can perform such as hand packager, laborer,

and meat clerk. Tr. 22. The ALJ therefore found Plaintiff not disabled. Tr. 22.

LEGAL STANDARD

Courts must uphold the ALJ’s decision if it “was supported by substantial evidence and

based on proper legal standards.” Lewis v. Astrue, 498 F.3d 909, 911 (9th Cir. 2007). 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, 139 S. Ct. 1148,

1150 (2019) (internal quotation marks omitted). When “evidence is susceptible of more than one

rational interpretation ... the ALJ’s conclusion ... must be upheld.” Burch v. Barnhart, 400 F.3d

676, 679 (9th Cir. 2005). Errors in the ALJ’s decision do not warrant reversal if they are

harmless. Stout v. Comm’r Soc. Sec. Admin., 454 F.3d 1050, 1054 (9th Cir. 2006).

DISCUSSION

Plaintiff raises four issues with the ALJ’s decision. Plaintiff argues the ALJ erred by (1)

erroneously discounting her symptom testimony, (2) erroneously discounting lay witness

testimony, (3) improperly rejecting relevant medical opinions, and (4) failing to incorporate

relevant limitations into the RFC, which yielded incomplete hypotheticals to the vocational

expert (VE) at step five. I address these issues in turn.

I. Subjective Symptom Testimony

The ALJ is responsible for evaluating symptom testimony. SSR 16-3p, 2017 WL

5180304, at *1 (Oct. 25, 2017). The ALJ engages in a two-step analysis for subjective symptom

evaluation. Molina v. Astrue, 674 F.3d 114, 1112 (9th Cir. 2012) (superseded on other grounds).

First, the ALJ determines whether there is “objective medical evidence of an underlying

impairment which could reasonably be expected to produce the pain or other symptoms alleged.”

Id. (internal quotations omitted). Second, “if the claimant has presented such evidence, and there

is no evidence of malingering, then the ALJ must give specific, clear and convincing reasons in

order to reject the claimant’s testimony about the severity of the symptoms.” Id.

When evaluating subjective symptom testimony, “[g]eneral findings are insufficient.”

Reddick v. Chater, 157 F.3d 715, 722 (9th Cir. 1998). “An ALJ does not provide specific, clear,

and convincing reasons for rejecting a claimant’s testimony by simply reciting the medical

evidence in support of his or her residual functional capacity determination.” Brown-Hunter v.

Colvin, 806 F.3d 487, 489 (9th Cir. 2015). Instead, “the ALJ must specifically identify the

testimony she or he finds not to be credible and must explain what evidence undermines the

testimony.” Holohan v. Massanari, 246 F.3d 1195 (9th Cir. 2001); see also Orteza v. Shalala, 50

F.3d 748, 750 (9th Cir. 1995) (The reasons proffered must be “sufficiently specific to permit the

reviewing court to conclude that the ALJ did not arbitrarily discount the claimant’s testimony.”).

At the hearing, Plaintiff testified that she does not leave the house without her husband

because of her anxiety. Tr. 38. When her husband has to work a night shift, Plaintiff goes to stay

with her father because her anxiety is too severe for her to stay alone. Tr. 41. Plaintiff explained

that her fear and anxiety have caused her to quit many jobs because she gets overwhelmed, feels

trapped, and has to leave. She has had conflicts with coworkers and supervisors over this issue in

the past. Tr. 44-45. She has had crying spells at work, and does not go out or run errands alone.

Tr. 45.

The ALJ found Plaintiff’s medically determinable impairments could reasonably be

expected to cause the alleged symptoms and did not identify evidence of malingering. Tr. 18.

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. 18. Specifically, the ALJ found Plaintiff’s symptom allegations

were inconsistent with objective medical evidence, her conservative treatment history, and that

Plaintiff’s daily activities conflicted with her symptom allegations. Tr. 18-20.

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).

Concerning Plaintiff’s testimony about her anxiety and depression, the ALJ reasonably

discounted these allegations as inconsistent with the record. Conflict with objective medical

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 depression

and anxiety inhibit her cognition, rendering her totally unable to work. Tr. 38-45. The ALJ

juxtaposed this allegation of total disability with, for example, Plaintiff’s mental status

examinations that showed full alertness, orientation, cooperative behavior, and grossly intact

cognition, even when Plaintiff presented as tearful, anxious, and/or depressed. Tr. 19 (citing, e.g.,

303, 308-09, 316-17, 477, 491, 683, 701, 710-11). The ALJ also cited psychologist Douglas A.

Smyth’s observation that Plaintiff was “cooperative throughout the session” and that her

interpersonal skills were “intact though colored by emotionality and self-focused content” as

contradicting her testimony that she had difficulty with coworkers and supervisors. Tr. 19 (citing

Tr. 495). The ALJ also relied on Dr. Smyth’s observation of Plaintiff’s intact memory, average

attention and concentration, grossly intact cognition, congruent affect, and no unusual deficits in

persistence or pace upon examination. Tr. 19 (citing Tr. 496). Taken together, these

countervailing symptom reports amount to substantial evidence supporting the ALJ’s decision to

discount Plaintiff’s testimony about anxiety and depression because it conflicted with the record

evidence.

Plaintiff argues the ALJ was not sufficiently specific about which testimony she was

discounting for this Court to meaningfully review the ALJ’s decision. Pl. Br, ECF No. 13 at 10

(citing Brown-Hunter v. Colvin, 806 F.3d 487, 494 (9th Cir. 2015)). Plaintiff argues that because

the ALJ “failed to identify specific aspects of the medical record which were inconsistent with

any particular aspects of Plaintiff’s testimony,” his stated rationale for discounting Plaintiff’s

testimony is too vague. Id. Plaintiff misreads the record on this point. The ALJ explicitly cited

Plaintiff’s testimony, and contrasted it with Plaintiff’s medical history and “reported activities.”

Tr. 23, 24. The Ninth Circuit does not require an ALJ to “perform a line-by-line exegesis of the

claimant’s testimony.” Lambert v. Saul, 980 F.3d 1266, 1277 (9th Cir. 2020) (citation omitted).

And the Court “will not fault the agency merely for explaining its decision with ‘less than ideal

clarity.’ ” Brown-Hunter, 806 F.3d at 492 (quoting Treichler v. Comm’r of Soc. Sec. Admin., 775

F.3d 1090, 1099 (9th Cir. 2014)). Since the ALJ’s discussion of objective medical evidence was

sufficient to “allow[ ] for meaningful review, ” id, the Court rejects Plaintiff’s contention the

ALJ failed to articulate his reason for rejecting Plaintiff's testimony.

B. Conservative Treatment

The ALJ also found Plaintiff’s symptom testimony was inconsistent with a history of

conservative treatment, and her failure to follow treatment recommendations. Tr. 19. “[I]n order

to get benefits, an individual must follow treatment prescribed by his or her physician if the

treatment can restore the ability to work, unless the individual has an acceptable reason for

failing to follow the prescribed treatment.” Orn v. Astrue, 495 F.3d 625, 636-37 (9th Cir. 2007).

An ALJ may reject a claimant’s testimony when the severity of symptoms alleged is inconsistent

with the level or frequency of treatment. See Molina, 674 F.3d at 1113 (quoting Social Security

Ruling (“SSR”) 96–7p, 1996 WL 374186, at *7 (July 2, 1996); Burch v. Barnhart, 400 F.3d

1111, 1114 (9th Cir. 2005).

The ALJ reasonably considered Plaintiff’s conservative treatment when discounting her

testimony about the extent of her mental health symptoms. Here, Plaintiff alleged

“overwhelming anxiety” and depression (Tr. 18, 244, 246), but did not take any medications for

these symptoms. Tr. 19 (citing Tr. 402-86, 503-720). The ALJ specifically highlighted that

medications are routinely used to treat symptoms of anxiety and depression, and that Plaintiff’s

provider expressly encouraged her to obtain a “medication evaluation from psychiatric

prescriber” and to “explore medication issues in depth with PCP.” Tr. 18-19, 318. Plaintiff did

not. See id. Instead, her treatment consisted only of outpatient psychotherapy, which the ALJ

concluded undermined a claim of total disability. Tr. 19 (citing Tr. 402-86, 503-720). Though

Plaintiff argues that the ALJ “is not a doctor or a mental health specialist, and is not qualified to

determine whether medications may have been warranted for [her] conditions,” Pl. Br. at 7, the

ALJ reasonably relied on a generally conservative course of treatment to undermine the extent of

Plaintiff’s testimony about her anxiety and depression. Particularly because a medical provider

recommended that Plaintiff pursue medication to treat her mental health issues, and Plaintiff

declined, it was reasonable for the ALJ to discount Plaintiff’s testimony on this basis.

C. Daily Activities

The ALJ also discounted Plaintiff’s subjective symptom testimony because it was

inconsistent with her daily activities. Tr. 20. Activities of daily living can form the basis for an

ALJ to discount a claimant’s testimony in two ways: (1) as evidence a claimant can work if the

activities “meet the threshold for transferable work skills,” or (2) where the activities “contradict

[a claimant’s] testimony.” Orn v. Astrue, 495 F.3d 625, 639 (9th Cir. 2007). The relevant

regulations require an ALJ to consider a claimant’s daily activities when evaluating subjective

symptom statements. 20 C.F.R. §§ 404.1529(c)(3)(i), 416.929(c)(3)(i). The Ninth Circuit has

even found such routine activities as playing video games, using public transportation, and

preparing meals to undercut a claimant’s testimony of disabling limitations. Ahearn v. Saul, 988

F.3d 1111, 1117 (9th Cir. 2021).

The ALJ reasonably concluded that several of Plaintiff’s daily activities conflicted with

her testimony about anxiety and depression. To discount a Plaintiff’s testimony, and ALJ must

cite daily activities that “meet the threshold for transferable work skills” or “contradict [a

claimant’s] testimony.” Orn, 495 F.3d at 639. The ALJ contrasted Plaintiff’s ability to “do

laundry, vacuum, clean, shop in stores for groceries with her boyfriend,” among other activities,

with her testimony about otherwise extreme mental deficits including difficulty with

concentration, motivation, and anxiety. Tr. 18, 20 (citing Tr. 244, 246-49). The ALJ made

specific references to the record when identify these activities, which all suggested Plaintiff

could function at a higher level, and perform more complex tasks than she alleged. Tr. 20.

Although Plaintiff argues the ALJ singled out a “few periods of temporary well-being from a

sustained period of impairment,” Pl. Br. at 9, the ALJ identified activities that Plaintiff did on a

regular basis, and viewed them in the context of evidence that both supported and detracted from

Plaintiff’s allegations. Tr. 19-20, 247-48. In sum, this was another clear and convincing reason

for the ALJ to rely upon to discount Plaintiff’s testimony about the extent of her mental health

issues.

II. Lay Witness Testimony

“Lay testimony as to a claimant’s symptoms is competent evidence that the Secretary

must take into account.” Nguyen v. Chater, 100 F.3d 1462, 1467 (9th Cir. 1996) (citation

omitted); 20 C.F.R. §§ 404.1529(c)(1), 416.929(c)(1) (“In evaluating the intensity and

persistence of your symptoms, we consider all of the available evidence from your medical

sources and nonmedical sources about how your symptoms affect you.”). Under the 2017

regulations, the ALJ is not “required to articulate how [they] considered evidence from

nonmedical sources” using the same criteria required for the evaluation of medical sources. 20

C.F.R. §§ 404.1520c(d), 416.920c(d).

The ALJ must give reasons “germane to the witness” when discounting the testimony of

lay witnesses. Valentine, 574 F.3d at 694. But the ALJ is not required “to discuss every witness’s

testimony on an individualized, witness-by-witness basis.” Molina, 674 F.3d at 1114, superseded

on other grounds by 20 C.F.R. § 404.1502(a). If the ALJ gives valid germane reasons for

rejecting testimony from one witness, the ALJ may refer only to those reasons when rejecting

similar testimony by a different witness. Id. Additionally, where “lay witness testimony does not

describe any limitations not already described by the claimant, and the ALJ’s well-supported

reasons for rejecting the claimant’s testimony apply equally well to the lay witness testimony,”

any error by the ALJ in failing to discuss the lay testimony is harmless. Id. at 1117, 1122

Plaintiff’s friend completed a questionnaire describing Plaintiff’s limitations. She noted

Plaintiff has anxiety and is unable to go out by herself or talk to others on the phone because of

panic attacks. She has quit every job she has tried because of these difficulties with social

interaction. Tr. 198. Plaintiff often has nightmares from anxiety. She does not eat very often and

barely manages her personal hygiene. Tr. 199. Plaintiff does not go out alone because she will

get irritable and have a panic attack. Tr. 201. Plaintiff has angry outbursts and uncontrollable

crying as a result of her anxiety. Tr. 202. The witness checked memory, completing tasks,

concentration, understanding, following instructions, and getting along with others as abilities

affected by Plaintiff’s conditions. She noted Plaintiff does not follow spoken instructions well.

She has had angry outbursts towards a manager at work in the past. Tr. 203. Plaintiff does not

handle stress well and fears social interaction. Tr. 204.

The ALJ failed to analyze the lay witness testimony, but any error in failing to do so was

harmless. Plaintiff’s friend alleged similar limitations regarding Plaintiff’s anxiety and overall

mental health. Compare Tr. 38-45 (Plaintiff’s testimony) with Tr. 198-204 (lay witness

testimony). As discussed above, the ALJ provided legally sufficient reasons for concluding that

Plaintiff’s testimony was unpersuasive. These reasons apply with equal force to the lay witness

testimony. Any error in rejecting the lay witness testimony was therefore harmless. Molina, 674

F.3d at 1117, 1122.

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. §

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 well-

supported 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.”).

A. LPC Shannon Modjeski

On January 16, 2020, Licensed Professional Counselor (LPC) Shannon Modjeski

evaluated Plaintiff. LPC Modjeski noted Plaintiff had a history of angry outbursts over small

things, anxiety, and depression. Tr. 421. Plaintiff could not leave the house without her

boyfriend. She had frequent nightmares. LPC Modjeski noted Plaintiff did use cannabis, which

could be exacerbating her anxiety, but had already had significant mental health concerns prior

to using cannabis. Tr. 422. Plaintiff had been sexually abused in childhood and placed in foster

care for a short time (with the relative who had abused her) because of her parents’ substance

abuse. Plaintiff had a history of self-harm behavior including cutting herself. Tr. 424. LPC

Modjeski diagnosed Plaintiff with generalized anxiety disorder and borderline personality

disorder, and with cannabis use listed as a “rule out” possibility. Tr. 426. On January 21, 2020,

LPC Modjeski noted Plaintiff’s symptoms had not improved and were unstable. Plaintiff had

observable anxiety and frustration. Tr. 432. LPC Modjeski continued to treat Plaintiff with

Dialectical Behavior Therapy (DBT). Tr. 435. LPC Modjeski noted Plaintiff’s excessive worry

and anxiety did not appear to be improving with therapy. Tr. 445. Plaintiff continued to engage

in self-harm. Tr. 448. Plaintiff continued to avoid certain situations due to her anxiety. Tr. 455.

Plaintiff had ongoing problems with nightmares, ruminating thoughts, and poor sleep. Tr. 467.

On April 22, 2020, after treating Plaintiff for several months, LPC Modjeski completed a

statement in which she opined Plaintiff had generalized anxiety disorder, borderline personality

disorder, and PTSD. Tr. 487. She opined Plaintiff had only slightly responded to treatment with

weekly therapy and a weekly group skills class. Plaintiff had panic attacks as well. Tr. 487. LPC

Modjeski opined Plaintiff’s anxiety resulted in a complete inability to function independently

outside of her home. Tr. 487. Plaintiff had lost numerous jobs due to her anxiety. LPC Modjeski

opined Plaintiff would miss more than 4 days or work each month. LPC Modjeski opined

Plaintiff would be markedly limited in her ability to sustain an ordinary routine without special

supervision, interact appropriately with the general public, ask simple questions or request

assistance, accept instructions and respond appropriately to criticism from supervisors, maintain

socially appropriate behavior and adhere to basic standards of neatness and cleanliness, travel in

unfamiliar places or use public transportation, and set realistic goals or make plans independently

of others. Tr. 488-89.

The ALJ found LPC Modjeski’s opinion unpersuasive. Tr. 20. He rejected her opinion as

inconsistent with Plaintiff’s level of treatment, internally inconsistent, and lacking support

because it did not describe Plaintiff’s substance use. Tr. 20.

Regarding supportability, the ALJ adequately discussed the strength of the evidence

underlying LPC Modjeski’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

LPC Modjeski’s opinion lacked support from the record because it was internally inconsistent

and left out Plaintiff’s substance abuse. As to its internal inconsistency, the ALJ noted that Dr.

Modjeski opined that Plaintiff would not have significant limitations in her ability to concentrate

for extended periods of time or perform simple tasks, but that somehow Plaintiff would have

marked limitations in her ability to sustain an ordinary routine. Tr. 20 (citing Tr. 488). The ALJ

also found it inconsistent that, despite the extreme limitations LPC Modjeski assessed (Tr. 487-

89), her prognosis for Plaintiff was “good” if she continued treatment. Tr. 487. The ALJ further

discounted LPC Modjeski’s assessment because she indicated in her treatment notes that

Plaintiff‘s cannabis use may be exacerbating her anxiety, but did not mention Plaintiff’s

substance use in her opinion. Tr. 20 (citing Tr. 679). The ALJ adequately considered the

supportability of LPC Modjeski’s opinion by examining the bases for her conclusions, and

discounting them for their inconsistency and lack of thoroughness.

The ALJ also adequately addressed the consistency of LPC Modjeski’s opinion when

finding it unpersuasive. The consistency factor requires the ALJ to assess medical opinions’

alignment with “evidence from other medical sources and nonmedical sources in the claim.” 20

C.F.R. § 404.1520c(c)(2). The ALJ reasoned that the opinion was “not consistent with

[Plaintiff’s] level of treatment, including the lack of treatment with medications.” Tr. 20.

Although LPC Modjeski assessed various marked mental limitations (Tr. 488-89) and believed

that Plaintiff had a “complete inability to function independently” outside the area of her home

due to an anxiety-related disorder (Tr. 487), Plaintiff took no medication for her anxiety or

depressive symptoms .Tr. 19, 402-86, 503-720. The ALJ, in turn, reasonably inferred that

Plaintiff’s lack of treatment with medication undermined the extreme limitations LPC Modjeski

assessed. Tr. 20. As he did with Plaintiff’s symptom testimony, the ALJ contrasted Plaintiff’s

conservative treatment with the more significant limitations suggested in LPC Modjeski’s

opinion. LPC Modjeski was also the only provider who opined that Plaintiff would have

debilitating mental limitations. Tr. 487-89. By contrast, the ALJ noted that the state agency

psychological consultants opined that Plaintiff could perform simple work with limited public

contact (Tr. 61-62, 72-73, 88-89, 100-01); and Dr. Smyth opined that Plaintiff would have

moderate social limitations, variable pace, but no limitations in her ability to understand,

remember, or carry out instructions. Tr. 499-500. The Court finds that the ALJ sufficiently

address the consistency and supportability factors, and supported her decision to discount LPC

Modjeski’s opinion with substantial evidence.

IV. Step Five

Plaintiff also argues the ALJ committed an independent error at step five by failing to

include relevant limitations in his hypotheticals to the vocational expert (VE), stemming from

erroneously leaving those limitations out of the RFC. Pl. Br., ECF No. 13 at 12-14. The RFC is

the most a person can do, despite the person's physical or mental impairments. 20 C.F.R. §§

404.1545, 416.945. In formulating an RFC, the ALJ must consider all medically determinable

impairments, including those that are not “severe,” and evaluate “all of the relevant medical and

other evidence,” including the claimant's testimony. Id.; SSR 96-8p, available at 1996 WL

374184. In determining a claimant’s RFC, the ALJ is responsible for resolving conflicts in the

medical testimony and translating the claimant's impairments into concrete functional limitations

in the RFC. Stubbs-Danielson v. Astrue, 539 F.3d 1169, 1174 (9th Cir. 2008). Only limitations

supported by substantial evidence must be incorporated into the RFC and, by extension, the

dispositive hypothetical question posed to the vocational expert. Osenbrock v. Apfel, 240 F.3d

1157, 1163-65 (9th Cir. 2001). An ALJ is only required to identify specific, supported, and

credible limitations in the RFC; “[p]reparing a function-by-function analysis for medical

conditions or impairments that the ALJ found neither credible nor supported by the record is

unnecessary.” Bayliss, 427 F.3d at 1217. The ALJ must include all relevant limitations from the

RFC in his VE hypotheticals. See Ford, 950 F.3d at 1159.

In determining Plaintiff’s RFC, the ALJ considered persuasive opinions from the state

agency medical consultants who opined, in relevant part, that Plaintiff could perform short and

simple instructions but not more detailed instructions, “so tasks should be broken down into

simple task sequences.” Tr. 61, 72, 88, 100. The ALJ found these opinions persuasive, and he

limited Plaintiff to simple, routine tasks in the RFC. Tr. 17, 20. The vocational expert, in turn,

testified that an individual limited to simple, routine tasks could perform jobs requiring a level

two reasoning. Tr. 47-48. Plaintiff argues that the state agency consultants’ limitation to “not

more detailed instructions” was inconsistent with the RFC and the VE’s resultant conclusion that

she could perform jobs with a level two reasoning, which involves an ability to “carry out

detailed but uninvolved written or oral instructions.” Pl. Br. ECF No. 13 at 12.

The ALJ did not err because his RFC was a reasonable interpretation of the state agency

doctors’ opinions, and the VE’s conclusion that Plaintiff could perform level two reasoning

based on the RFC is likewise consistent with those opinions. An ALJ is not compelled to adopt,

word-for-word, the limitations set forth by a medical source opinion the ALJ has found

persuasive, so long as the RFC is “consistent with restrictions identified in the medical

testimony.” Stubbs-Danielson, 539 F.3d at 1174; c.f. Thomas v. Saul, 796 Fed. App’x 923, 926

(9th Cir. 2019) (noting no apparent conflict between a psychologist’s assessment that claimant

could not handle “detailed instructions” and level two reasoning). Here, the ALJ reasonably

adapted the state agency psychologists’ limitation that Plaintiff could perform short and simple

instructions “but not more detailed instructions” by limiting Plaintiff to simple, routine tasks in

the RFC. Tr. 17, 20. Omitting the phrase “but not more detailed instructions” from the RFC and

from hypotheticals posed to the VE was not error, since the RFC captured that limitation, but just

in different terms. See, e.g., Cortez v. Comm’r. Soc. Sec. Admin., 2018 WL 1173423, at *4 (D.

Or. Mar. 3, 2018) (upholding an RFC’s interpretation of “detailed but uninvolved” instructions to

mean instructions, which “may consist of a number of steps, none of which are complex.”). What

is more, there is nothing inconsistent between the state agency psychologists’ limitation to “short

and simple instructions but not more detailed instructions,” with reasoning level two’s

requirement of an ability to “carry out detailed but uninvolved written or oral instructions.” U.S.

Dep’t of Labor, Dictionary of Occupational Titles (DOT), App. C (4th ed. 1991) (emphasis

added). Here, the ALJ reasonably crafted an RFC and VE hypotheticals that interpreted the state

agency medical consultants’ opinions to mean that Plaintiff could perform simple, routine work,

sometimes involving detailed but uninvolved instructions. Since this did not conflict with the

persuasive medical opinions the ALJ relied upon, and the ALJ’s step five determination was

otherwise supported by substantial evidence, the ALJ did not err at step five.

CONCLUSION

For the reasons given above, I AFFIRM the Commissioner’s decision and DISMISS this

case.

IT IS SO ORDERED.

DATED: _2/8/2024

MICHAEL W. MOSMAN

United States District Judge

17 — OPINION & ORDER