Ahumada v. Commissioner Social Security Administration

UNITED STATES DISTRICT COURT

DISTRICT OF OREGON

EUGENE DIVISION

ELISA A.,1

Plaintiff,

Case. No. 6:23-cv-00727-YY

v.

OPINION AND ORDER

COMMISSIONER OF THE SOCIAL

SECURITY ADMINISTRATION,

Defendant.

YOU, Magistrate Judge.

Plaintiff Elisa A. seeks judicial review of the final decision by the Social Security

Commissioner (“Commissioner”) denying her application for Disability Insurance Benefits

(“DIB”) under Title II of the Social Security Act (“SSA”), 42 U.S.C. §§ 401–33. This Court

has jurisdiction to review the Commissioner’s decision pursuant to 42 U.S.C. § 405(g) and

§ 1383(c)(3). For the reasons set forth below, the Commissioner’s decision is AFFIRMED.

PROCEDURAL HISTORY

Plaintiff protectively filed an application for disability insurance benefits on June 17,

2020, alleging a disability onset date of June 20, 2013. Tr. 13. The Commissioner denied

1 In the interest of privacy, the court uses only plaintiff’s first name and the first initial of

the last name.

plaintiff’s claim on September 3, 2020, and again upon reconsideration on July 2, 2021. Id.

Plaintiff filed a written request for a hearing on July 23, 2021, and hearings were held

before Administrative Law Judge Richard Geib on January 6, 2022, and April 19, 2022. Tr.

41–73, 76–105. The ALJ issued a decision, finding plaintiff not disabled within the

meaning of the Act. Tr. 13–31. The Appeals Council denied plaintiff’s request for review

on March 20, 2023. Tr. 1–6. Thus, the ALJ’s decision is the Commissioner’s final decision

and subject to review by this court. 42 U.S.C. § 405(g); 20 C.F.R. § 422.210.

STANDARD OF REVIEW

The reviewing court must affirm the Commissioner’s decision if it is based on proper

legal standards and the findings are supported by substantial evidence in the record. 42

U.S.C. § 405(g); Lewis v. Astrue, 498 F.3d 909, 911 (9th Cir. 2007). This court must weigh

the evidence that supports and detracts from the ALJ’s conclusion and “‘may not affirm

simply by isolating a specific quantum of supporting evidence.’” Garrison v. Colvin, 759

F.3d 995, 1009–10 (9th Cir. 2014) (quoting Lingenfelter v. Astrue, 504 F.3d 1028, 1035 (9th

Cir. 2007)). This court may not substitute its judgment for that of the Commissioner when

the evidence can reasonably support either affirming or reversing the decision. Parra v.

Astrue, 481 F.3d 742, 746 (9th Cir. 2007). Instead, where the evidence is susceptible to

more than one rational interpretation, the Commissioner’s decision must be upheld if it is

“supported by inferences reasonably drawn from the record.” Tommasetti v. Astrue, 533

F.3d 1035, 1038 (9th Cir. 2008) (citation omitted); see also Lingenfelter, 504 F.3d at 1035.

SEQUENTIAL ANALYSIS AND ALJ FINDINGS

Disability is the “inability to engage in any substantial gainful activity by reason of

any medically determinable physical or mental impairment which can be expected to result

in death or 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)(1)(A). The ALJ engages in a five-step sequential

inquiry to determine whether a claimant is disabled within the meaning of the Act. 20

C.F.R. § 404.1520; Lounsburry v. Barnhart, 468 F.3d 1111, 1114 (9th Cir. 2006)

(discussing Tackett v. Apfel, 180 F.3d 1094, 1098–99 (9th Cir. 1999)).

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

activity since her alleged onset date of June 20, 2013, through her date last insured of

September 30, 2016. Tr. 17. At step two, the ALJ determined plaintiff suffered from the

following severe impairments: undifferentiated connective tissue disorder versus

inflammatory arthritis, cervical, lumbar and sacroiliac disorders, and Sjogren’s syndrome.

Id.

At step three, the ALJ found plaintiff did not have an impairment or combination of

impairments that met or medically equaled a listed impairment. Tr. 20. The ALJ next

assessed plaintiff’s residual functional capacity (“RFC”) and determined she could perform

light work as defined in 20 C.F.C. § 404.1567(b), except “she could sit for four hours at a

time, could stand up to two hours at a time, could walk up to two hours at a time, could sit

for six hours total, could stand for four hours total, could walk for four hours total; could

push/pull frequently and as much as she can lift and carry; could frequently use the feet to

operate foot controls; she could occasionally climb ramps and stairs and never climb

ladders, ropes, scaffolds, could occasionally balance, stoop, kneel, crouch, crawl; she could

occasionally reach overhead bilaterally, could frequently reach in other directions, could

frequently handle, handle, and feel; she could have frequent exposure to humidity and

wetness, could never have exposure to extreme cold, could have frequent exposure to

extreme heat; could have occasional exposure to vibration.” Tr. 21-22.

At step four, the ALJ found plaintiff is unable to perform any past relevant work. Tr.

29.

At step five, the ALJ found that considering plaintiff’s age, education, work

experience, and residual functional capacity, there are jobs that exist in significant numbers

in the national economy that the claimant can perform, including electronics worker, small

products assembler II, and marker. Tr. 30. Thus, the ALJ concluded plaintiff was not

disabled at any time from June 20, 2013, the alleged onset date, through September 30,

2016, the date last insured. Tr. 31.

DISCUSSION

Plaintiff argues that the ALJ (1) failed to give clear and convincing reasons

supported by substantial evidence to reject her subjective symptom testimony, and (2) erred

in evaluating her impairments at step three. Pl. Br. 2, ECF 17.

I. Subjective Symptom Testimony

When a claimant has medically documented impairments that could reasonably be

expected to produce some degree of the symptoms alleged, and the record contains no

affirmative evidence of malingering, “the ALJ can reject the claimant’s testimony about the

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) (citation omitted). A general

assertion that 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). The ALJ need not “perform a line-by-line exegesis of the

claimant’s testimony” or “draft dissertations when denying benefits.” Lambert v.

Saul, 980 F.3d 1266, 1277 (9th Cir. 2020). But Ninth Circuit law “plainly requires” that an

ALJ do more than “offer[ ] non-specific conclusions that [the claimant’s] testimony [is]

inconsistent with [certain evidence].” Id. (citations omitted). If the “ALJ’s credibility

finding is supported by substantial evidence in the record, [the court] may not engage in

second-guessing.” Thomas v. Barnhart, 278 F.3d 947, 959 (9th Cir. 2002) (citation

omitted).

In evaluating a claimant’s subjective symptom testimony, an ALJ may consider

whether it is consistent with objective medical evidence. 20 C.F.R. §§ 404.1529(c)(1)-(3),

416.929(c)(1)-(3); SSR 16-3p, available at 2017 WL 5180304, at *7-8. The lack of

objective medical evidence may not form the sole basis for discounting a claimant’s

testimony. 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. Chater, 157 F.3d 715, 722 (9th

Cir. 1998) (“[T]he Commissioner may not discredit [a] claimant’s testimony as to the

severity of symptoms merely because they are unsupported by objective medical

evidence.”)). However, “[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).

Effective March 28, 2016, the Commissioner superseded Social Security Ruling

(“SSR”) 96-7p, governing the assessment of a claimant’s “credibility,” and replaced it with

SSR 16-3p. See SSR 16-3p, available at 2016 WL 1119029. SSR 16-3p eliminates the

reference to “credibility,” clarifies that “subjective symptom evaluation is not an

examination of an individual’s character,” and requires the ALJ to consider all the evidence

in an individual’s record when evaluating the intensity and persistence of symptoms. Id. at

*1-2. The ALJ must examine “the entire case record, including the objective medical

evidence; an individual’s statements about the intensity, persistence, and limiting effects of

symptoms; statements and other information provided by medical sources and other persons;

and any other relevant evidence in the individual’s case record.” Id. at *4.

Here, the ALJ provided three distinct rationales for discounting plaintiff’s symptom

testimony. First, the ALJ found that the symptoms were inconsistent with the objective

medical evidence; next, the ALJ noted that plaintiff symptoms were managed with treatment

and a routine course of pain management; and finally, the ALJ determined that plaintiff’s

symptom complaints conflicted with her daily activities. Tr. 23–25.

A. Inconsistency with Objective Medical Evidence

The ALJ acknowledged that plaintiff complained of a wide range of signs and

symptoms, including:

[S]he could not keep up with her work as a caregiver due to

joint pain and fatigue. She testified that she had constant pain

in her feet, back, fingers, and wrist. She testified that she had

difficulty lifting and her symptoms were worse with movement.

She testified that she could not get through the day without

resting due to fatigue.

Tr. 22 (internal citations omitted). However, the ALJ noted that throughout the relevant

period, many of plaintiff’s physical examinations with her rheumatologist “rarely showed

signs of pain behavior, fatigue, or muscle weakness.” Tr. 24 (citing Tr. 2169–2188). The

ALJ also observed that despite plaintiff’s complaints:

[s]he was sometimes noted to have swelling in the joints of the

fingers and tenderness in the joints and spine, but at other times

she showed no signs of active inflammation. For example,

synovitis in the left wrist was noted in an August 2013

appointment, but it was not observed when she saw a provider

in August 2014. No signs of active inflammation were noted in

April 2015, October 2015, June 2016, September 2016,

appointments. Although swelling and tenderness and the fingers

were noted in some appointments, the claimant rarely

complained of significant dysfunction with using her hands for

activities and she was rarely observed to show signs of

significant dysfunction in the use of the hands. X-rays of the

hands, wrists, and knees showed no signs of erosion or other

abnormalities associated with autoimmune disorders. She also

did not report significant issues with dry eyes a common

Sjogren’s symptom. Moreover, her healthcare providers rarely

observed her to have difficulty walking and was not observed to

have significant or persistent muscle weakness or atrophy,

which suggest her symptoms would not prevent her from

performing light work with reduced standing and walking, as

accounted for in the above residual functional capacity.

Id. (citing Tr. 2361, 2390, 2171, 2175, 2188, 2346–47, 2169–2188 2341–89, 529, 1898–99,

2385, 2388, 1151, 1156, 1161, 1176, 1632, 1670, 1681, 1685, 1692, 1774).

The treatment notes and other objective evidence cited by the ALJ support the ALJ’s

conclusions, namely, that:

the limited observations of pain behavior and fatigue, the

observations of no active inflammation in some appointments,

the limited reports and observations of hand dysfunction, the x-

rays showing no signs of inflammatory arthritis, the limited

reports of dry eyes, and observations of mostly normal gait and

strength, it strongly suggests that the claimant’s autoimmune

disorders (i.e. connective tissue disease, inflammatory arthritis,

Sjogren’s syndrome) would not cause greater limitations than

are accounted for in the [] residual functional capacity.

Tr. 24.

In response, plaintiff cites to portions of the medical record to show that, in her view,

the ALJs “recounting was not an accurate reflection of the record.” Pl. Br. 28, ECF 17.

Plaintiff argues that “[t]here are many, many reports of [her] pain symptoms in the record

that were never questioned by her doctors” and that “[t]here are many reports of significant

fatigue with various medication regimens. Her doctors had no reason not to believe her.”

Id. Thus, plaintiff argues, the ALJ’s rejection of her complaints regarding pain and fatigue

was not a clear and convincing reason and supported by substantial evidence. Id.

However, it was reasonable for the ALJ to consider plaintiff’s normal x-ray results

alongside numerous treatment notes showing that she had no active inflammation or muscle

weakness to undermine her allegations of completely disabling symptoms. Tr. 25. “Where

evidence is susceptible to more than one rational interpretation, the ALJ’s decision should

be upheld.” Trevizo v. Berryhill, 871 F.3d 664, 674–75 (citing Orn v. Astrue, 495 F.3d 625,

630 (9th Cir. 2007)). Accordingly, the ALJ’s first rationale for discrediting plaintiff’s

symptom allegations—that they were inconsistent with the objective medical evidence—

meets the clear-and-convincing threshold.

B. Improvement with Treatment

The ALJ also discredited plaintiff’s symptoms because her autoimmune disorder

medication management regimen suggests her symptoms were adequately managed and had

improved. Tr. 23. A claimant’s improvement with treatment is “an important indicator of

the intensity and persistence of . . . symptoms.” 20 C.F.R. §§ 404.1529(c)(3),

416.929(c)(3). “[E]vidence of medical treatment successfully relieving symptoms can

undermine a claim of disability.” Wellington v. Berryhill, 878 F.3d 867, 876 (9th Cir.

2017); see also Warre v. Comm’r of Soc. Sec. Admin., 439 F.3d 1001, 1006 (9th Cir. 2006)

(“Impairments that can be controlled effectively with medication are not disabling for the

purpose of determining eligibility for SSI benefits.”).

The ALJ observed that plaintiff’s providers placed her on Simponi in 2013 to address

her rheumatoid arthritis and “she reported a 50 percent improvement in stiffness and joint

pain.” Tr. 23 (citing Tr. 2392). She also reported a “20 percent improvement in symptoms”

with methotrexate. Id. (citing Tr. 2389). In 2014, plaintiff reported to her rheumatologist

that her “joint pain did not ‘affect her quality of life,’” which the ALJ concluded was “very

inconsistent with the claimant’s testimony of disabling symptoms during the period at

issue.” Id. (citing Tr. 2361). The ALJ noted that plaintiff changed medications over the

years due to various infections, but in 2016 she responded positively to Orencia and only

had “residual pain in the knees, feet, and fingers.” Tr. 23–24 (citing Tr. 2169–2175). The

ALJ also noted that plaintiff was not regularly prescribed opioid medications and treated

with Tylenol. Tr. 24. The ALJ concluded that plaintiff’s “improvements in symptoms with

autoimmune treatments and routine pain management strongly suggest her symptoms before

the date last insured were not as limiting as alleged.” Tr. 24. An ALJ may discount a

claimant’s testimony regarding the severity of an impairment where the claimant has

received conservative treatment. Parra, 481 F.3d at 751 (finding the ALJ properly

discredited testimony of disabling pain that was “treated with an over-the-counter pain

medication”).

Plaintiff highlights various parts of the medical record to argue against the ALJ’s

characterization of her pain management regimen as “routine.” Pl. Reply Br. 3, ECF 24.

Plaintiff contends that she “was taking Percocet for pain along with Tylenol but neither

fully addressed the pain she was experiencing.” Id. (citing Tr. 2105). Medical records from

2014 show that plaintiff’s “prior prescription for Percocet . . . was given to her for an

unrelated condition,” i.e., a “dental issue,” and she took it only “on occasion” for pain

associated with rheumatoid arthritis. Tr. 2105. The records further show that her doctor

“explained that opiates would be associated with increased risk for somnolence which she

already seems to have had with muscle relaxers in the past” and that “chronic use of opiates

would require to have her on a pain contract and that she would need to submit to random

urine drug testing.” Id. “After discussing this[,] [plaintiff] decided that for now she would

stay with Tylenol.” Id. Considering the circumstances relating to plaintiff’s Percocet

prescription, the ALJ did not err in concluding that plaintiff’s medication regimen was

conservative.

In sum, the ALJ’s conclusions are supported by substantial evidence, and this court

may not reweigh the evidence. Garrison, 759 F.3d at 1010 (“Where the evidence can

reasonably support either affirming or reversing a decision, we may not substitute our

judgment for that of the ALJ.”) (internal quotation marks and citation omitted). The ALJ’s

second rationale meets the exacting clear-and-convincing legal standard. Because the ALJ

provided at least one valid reason for rejecting plaintiff’s subjective symptom testimony, it

is unnecessary to reach the third reason.

II. Step-Three Evaluation

At step three, the ALJ considers whether a claimant’s impairment or combination of

impairments meets or equals the criteria for a listed impairment in 20 C.F.R. Part 404,

Subpart P, Appendix 1. If so, the impairment is per se disabling and the ALJ must award

benefits.

Plaintiff contends that her impairments met or equaled Listing 14.09D for

inflammatory arthritis. Pl. Br. 28, ECF 17. Listing 14.09D requires:

Repeated manifestations of inflammatory arthritis, with at least

two constitutional symptoms or signs (severe fatigue, fever,

malaise, or involuntary weight loss) and one of the following at

the marked level:

1. Limitation of activities of daily living,

2. Limitation in maintaining social functioning.

3. Limitation in completing tasks in a timely manner due to

deficiencies in concentration, persistence, and pace.

20 C.F.R. Pt. 404, Subpt. P, App. 1, § 14.09D. A “marked” limitation “means that the signs

and symptoms of your immune system disorder interfere seriously with your ability to

function.” Id., § 14.00I.5. Although it is not necessary to use a scale, “marked” “would be

the fourth point on a five-point scale consisting of no limitation, mild limitation, moderate

limitation, marked limitation, and extreme limitation.” Id. A marked limitation may exist

“when several activities or functions are impaired, or even when only one is impaired.” Id.

Also, it is not necessary to be “totally precluded from performing an activity to have a

marked limitation, as long as the degree of limitation seriously interferes with [the

claimant’s] ability to function independently, appropriately, and effectively. The term

‘marked’ does not imply that you must be confined to bed, hospitalized, or in a nursing

home.” Id.

A claimant has “marked” limitation in activities of daily living, such as doing

household chores, maintaining grooming and hygiene, using a post office, taking public

transportation, or paying bills, if the claimant has “a serious limitation in [the] ability to

maintain a household or take public transportation because of symptoms, such as pain,

severe fatigue, anxiety, or difficulty concentrating, caused by [the claimant’s] immune

system disorder (including manifestations of the disorder) or its treatment, even if [the

claimant] is able to perform some self-care activities.” Id., § 14.00I.6.

Completing tasks in a timely manner “involves the ability to sustain concentration,

persistence, or pace to permit timely completion of tasks commonly found in work settings.”

Id., § 14.00I.8. A claimant has a “marked” limitation in completing tasks if the claimant has

“a serious limitation in [the] ability to sustain concentration or pace adequate to complete

work-related tasks because of symptoms, such as pain, severe fatigue, anxiety, or difficulty

concentrating, caused by [the claimant’s] immune system disorder (including manifestations

of the disorder) or its treatment, even if [the claimant] is able to do some routine activities

of daily living.” Id.

In concluding that plaintiff’s rheumatoid arthritis did not meet a listing, the ALJ

stated:

Listing 14.09 was considered in evaluating [plaintiff]’s

inflammatory arthritis, but the evidence does not show that this

condition has resulted in an inability to ambulate effectively or

to perform fine and gross movements effectively; or repeated

manifestations of inflammatory arthritis with at least two o[f]

the constitutional symptoms or signs (severe fatigue, fever,

malaise, or involuntary weight loss) and one of the following at

the marked level: limitation of activities of daily living;

limitation in maintaining social functioning; or limitation in

completing tasks in a timely manner due to deficiencies in

concentration, persistence or pace.

Tr. 21.

Plaintiff argues that her “condition clearly meets the requirements of the Listings.

She suffers from severe fatigue, she has constitutional symptoms in her joints due to

[rheumatoid arthritis] and she is markedly limited in her ability to perform her daily

activities.” Id. The Commissioner responds that “[plaintiff] lists evidence in the record that

the ALJ also discussed, and she baldly claims she met the requirements of 14.09. She does

not explain with any specificity, however, how the evidence supports such a finding.” Def.

Br. 7, ECF 20 (internal citations omitted). Indeed, as the Commissioner argues, “[a]

generalized assertion of functional problems is not enough to establish disability at step

three.” Id. (citing Tackett, 180 F.3d at 1100). Moreover, as the ALJ observed, plaintiff has

failed to point to evidence showing “repeated manifestations of inflammatory arthritis with

at least two o[f] the constitutional symptoms or signs (severe fatigue, fever, malaise, or

involuntary weight loss).” Tr. 21 (citing 20 C.F.R. Pt. 404, Subpt. P, App. 1, §§ 14.00I,

14.09D). The only “constitutional symptom or sign” plaintiff points to is severe fatigue,

and absent evidence of accompanying fever, malaise, or involuntary weight loss, the ALJ

did not err in finding that she did not meet the requirements of Listing 14.09. Accordingly,

the ALJ’s ruling on step three will not be disturbed by this court.

ORDER

The Commissioner’s decision is AFFIRMED.

DATED June 4, 2024.

/s/ Youlee Yim You

Youlee Yim You

United States Magistrate Judge