“A physician’s disability opinion may be disregarded if it is premised 10 upon the claimant’s subjective symptoms and limitations that were properly 11 discredited.”
How later courts described this case
- “A physician’s disability opinion may be disregarded if it is premised 10 upon the claimant’s subjective symptoms and limitations that were properly 11 discredited.”
- finding no error where ALJ rejected opinion “based almost entirely 8 on the claimant's self-reporting”
- “Impairments that can be controlled effectively 27 with medication are not disabling for the purposes of determining eligibility for 28 [disability] benefits.”
- finding 22 no error where ALJ limited claimant to “simple tasks” to accommodate limitations 23 related to concentration, persistence or pace
Written by the judges who cited it.
The opinion
1
2
3
4
5
6
7
8 UNITED STATES DISTRICT COURT
9 SOUTHERN DISTRICT OF CALIFORNIA
10
11 CHRISTINA S. C., Case No.: 24-cv-84-CAB-DDL
12 Plaintiff,
REPORT AND RECOMMENDATION
13 v. FOR ORDER AFFIRMING
COMMISSIONER OF SOCIAL COMMISSIONER’S DECISION AND
14
SECURITY, ENTERING JUDGMENT IN
15 COMMISSIONER’S FAVOR
Defendant.
16
17 The undersigned respectfully submits this Report and Recommendation to
18 United States District Judge Cathy Ann Bencivengo pursuant to 28 U.S.C. § 636(b)
19 and Civil Local Rule 72.1.c. Plaintiff Christina S. C. appeals the Commissioner’s
20 denial of her application for disability benefits pursuant to 42 U.S.C. § 405(g) and
21 requests remand to the Social Security Administration for further proceedings. See
22 Plaintiff’s Opening Brief (“Op. Br.”), Dkt. No. 12. For the reasons stated below, the
23 Court RECOMMENDS the District Judge AFFIRM the Commissioner’s decision.
24 I.
25 BACKGROUND
26 A. Plaintiff’s Application for Disability Benefits
27 On January 5, 2021, Plaintiff applied for disability insurance benefits under
28 Title II of the Social Security Act (“Act”) and for supplemental security income
1 under Title XVI of the Act. See Certified Administrative Record (“AR”) [Dkt. No.
2 9] at 73-75.1 Plaintiff alleged she had been unable to work since June 16, 2019 due
3 to various mental and physical impairments. Id. After her application was denied
4 at the initial stage and upon reconsideration, Plaintiff requested a hearing before
5 an administrative law judge (“ALJ”), which took place on January 18, 2023 before
6 ALJ Kim Field. Id. at 50-72. Plaintiff appeared with counsel and gave testimony.
7 Id. The ALJ issued an unfavorable decision on February 1, 2023, having concluded
8 Plaintiff “has not been under a disability, as defined in [the Act], from June 16,
9 2019, through the date of [the] decision.” Id. at 30, 41. On November 21, 2023, the
10 Appeals Council denied review, and the ALJ’s decision became final. See id. at 1-
11 3. This appeal timely followed.
12 B. Summary of ALJ’s Findings
13 A person is considered “disabled” within the meaning of the Act if they
14 suffer from a medically determinable physical or mental impairment which is
15 expected to last at least a year and is of such severity that they cannot work,
16 considering their age, education, and work experience. See 42 U.S.C. § 423(d). The
17 ALJ followed the sequential five-step evaluation set forth in the regulations in
18 adjudicating Plaintiff’s disability claim.2 See generally AR at 29-42.
19
20
1 The Court uses the parties’ pagination of the AR. All other docket citations
21
are to the CM/ECF page numbers.
22
2 The five-step sequential evaluation is the same for both disability insurance
23
benefits and supplemental security income. See 20 C.F.R. § 404.1520; id. § 416.920.
24 The ALJ must determine the following: at step one, whether the claimant is
25 engaged in substantial gainful activity; at step two, whether the claimant suffers
from a severe impairment within the meaning of the regulations; at step three,
26
whether the impairment meets or is medically equal to an impairment identified
27
in the Listing of Impairments; at step four, the claimant’s residual functional
28
1 At step one, the ALJ found Plaintiff had not engaged in substantial gainful
2 activity after August 3, 2019. Id. at 31. Although Plaintiff alleged a disability onset
3 date of June 16, 2019, the record demonstrated she worked full-time work through
4 August 3, 2019 and that her earnings which met the threshold for substantial
5 gainful activity.3 Id. at 32.
6 At step two, the ALJ found Plaintiff had the following severe impairments:
7 depression and anxiety.4 Id.
8 At step three, the ALJ found Plaintiff’s impairments did not meet or
9 medically equal a listed impairment. Id. at 33-34. In making this finding, the ALJ
10 assessed Plaintiff’s functioning in the four “Paragraph B” categories.5 Based on
11 the evidence in the record, the ALJ determined Plaintiff had a moderate limitation
12 in understanding, remembering or applying information; a moderate limitation in
13
14
their past relevant work; at step five, whether the claimant can make an
15
adjustment to other work. If the claimant is found not disabled at any step, the
16 analysis does not proceed to the next step.
17
3 Plaintiff also worked at McDonald’s in 2022 (during her period of alleged
18 disability), but her earnings were “not at the substantial gainful activity level.” Id.
19 at 32.
20 4 The ALJ found Plaintiff’s alleged physical impairments (high blood
pressure, brain aneurysm, sleep apnea, knee and leg “problems,” congestive heart
21
failure, sleep apnea and “bladder issues”) were not severe. AR at 32. Plaintiff does
22
not challenge these findings.
23
5 In addition to the five-step sequential evaluation, where a claimant alleges a
24 mental impairment, the ALJ must also rate the claimant’s degree of limitation in
25 four functional areas (understand, remember, or apply information; interact with
others; concentrate, persist, or maintain pace; and adapt or manage oneself), using
26
a five-point scale (none, mild, moderate, marked, and extreme). See 20 C.F.R.
27
§ 404.1520a; id. at § 416.920a. This analysis is interchangeably referred to as the
28
1 interacting with others; a moderate limitation in concentrating, persisting or
2 maintaining pace; and a moderate limitation in adapting or managing herself. See
3 AR at 33-34. The ALJ concluded the Paragraph B criteria were not satisfied
4 because Plaintiff did not have at least two “marked” limitations or one “extreme”
5 limitation. Id. at 34.
6 Proceeding to step four, the ALJ determined Plaintiff could:
7
perform a full range of work at all exertional levels but with the
8 following nonexertional limitations: she is able to perform simple,
9 routine tasks and make simple work-related decisions[;] . . .
occasionally interact with supervisors, coworkers and the public[;]
10
[and] . . . occasionally deal with changes in a work setting.
11
12 AR at 35. The ALJ stated the foregoing RFC “reflect[ed] the degree of limitation
13 . . . found in the ‘Paragraph B’ mental function analysis.” Id.
14 In addition to the Paragraph B results, the ALJ also considered Plaintiff’s
15 subjective testimony regarding her limitations in formulating the RFC. AR at 35-
16 39. Having reviewed the medical records and Plaintiff’s statements regarding her
17 daily activities, the ALJ found although Plaintiff’s medically determinable
18 impairments could reasonably be expected to cause her alleged symptoms,
19 Plaintiff’s allegations regarding the intensity, persistence and limiting effects of
20 her symptoms was “not entirely consistent with the medical evidence and other
21 evidence in the record.” Id. at 36.
22 The ALJ also reviewed the medical opinions in the record. AR at 37, 39. The
23 ALJ found the opinions of two state agency psychological consultants were
24 partially persuasive. Id. at 39. The ALJ found these opinions “well supported and
25 consistent with other evidence,” and supported the RFC and the ultimate finding
26 that Plaintiff was not disabled; however, the ALJ also noted the record contained
27 evidence the consultants did not have available at the time of their respective
28 / / /
1 reviews. Id. The ALJ found the medical opinion of A. Morin, APRN6 was not
2 persuasive, as it was neither supported by objective findings nor consistent with
3 other evidence in the record. Id. at 37. The ALJ also noted Morin’s opinion
4 “rel[ied] on complete acceptance of the claimant’s allegations” as to the limiting
5 effects of her impairments, which the ALJ had already discounted. Id.
6 At step four, the ALJ concluded Plaintiff was unable to perform any of her
7 past relevant work as a nurse aide, fast food worker and hospital cleaner. AR at
8 40. At step five, the ALJ determined an individual of Plaintiff’s age, education,
9 work experience, and RFC would be able to perform jobs which exist in significant
10 numbers in the national economy. Id. Accordingly, the ALJ concluded Plaintiff
11 was “not disabled” within the meaning of the Act. Id. at 41.
12 II.
13 ISSUES PRESENTED
14 Plaintiff raises two issues on appeal:
15 1) Whether the ALJ erred by failing to reconcile her mental findings in
16 the “B” criteria at steps two and three of the sequential evaluation
process with the limitations she assessed in the RFC determination;
17
and
18
2) Whether the ALJ’s RFC determination is legally erroneous and
19
unsupported by substantial evidence, because the ALJ failed to
20 properly evaluate the opinion of treating source Amy Morin,
21 APRN.
22 See Op. Br. at 9.
23
24
25 6 An Advanced Practice Registered Nurse is an acceptable medical source “for
impairments within his or her licensed scope of practice.” See 20 C.F.R.
26
§ 420.1502(a)(7); id. at § 416.902(a)(7). The Court assumes Morin’s scope of practice
27
is mental health, given her additional certification as a Psychiatric-Mental Health
28
1 III.
2 STANDARD OF REVIEW
3 The Court’s review of the Commissioner’s final decision is “highly
4 deferential.” Kitchen v. Kijakazi, 82 F.4th 732, 738 (9th Cir. 2023).7 The Court “will
5 disturb the denial of benefits only if the decision contains legal error or is not
6 supported by substantial evidence.” Id. “Substantial evidence is such relevant
7 evidence that a reasonable mind might accept as adequate to support a conclusion,
8 and must be more than a mere scintilla, but may be less than a preponderance.”
9 Id. This Court must review the entire record and consider adverse as well as
10 supporting evidence. See Ahearn v. Saul, 988 F.3d 1111, 1115 (9th Cir. 2021). The
11 Court “may not reweigh the evidence or substitute [its] judgment for that of the
12 ALJ.” Id. Moreover, “[t]he ALJ is responsible for determining credibility,
13 resolving conflicts in medical testimony, and for resolving ambiguities.” Id. If the
14 evidence is susceptible of more than one rational interpretation, the ALJ’s decision
15 must be upheld. See id. at 1115-16. However, the Court cannot affirm “on a ground
16 upon which [the ALJ] did not rely.” Garrison v. Colvin, 759 F.3d 995, 1010 (9th Cir.
17 2014). Where the ALJ commits legal error, the Court may affirm the decision if the
18 error is harmless, meaning “it is inconsequential to the ultimate nondisability
19 determination, or that, despite the legal error, the agency’s path may reasonably
20 be discerned, even if the agency explains its decision with less than ideal clarity.”
21 Brown-Hunter v. Colvin, 806 F.3d 487, 492 (9th Cir. 2015). “[T]he burden of showing
22 that an error is harmful normally falls upon the party attacking the agency’s
23 determination.” Molina v. Astrue, 674 F.3d 1104, 1111 (9th Cir. 2012), superseded on
24 other grounds by 20 C.F.R. § 404.1502(a).
25 / / /
26
27
7 Unless otherwise noted, internal quotation marks, ellipses, brackets,
28
1 IV.
2 DISCUSSION
3 A. The ALJ’s Residual Functional Capacity Determination Appropriately
Reflects the Paragraph B Findings
4
5 As a first charge of reversible error, Plaintiff asserts the ALJ “fail[ed] to
6 reconcile her mental findings in the [Paragraph] ‘B’ criteria . . . with the limitations
7 she assessed in the RFC determination.” Op. Br. at 10. Plaintiff further argues “the
8 RFC adopted by the ALJ failed to properly account for the moderate limitations in
9 maintaining concentration, persistence and pace, which the ALJ adopted in her
10 P[sychiatric] R[eview] T[echnique] findings, and the failure to explain this
11 discrepancy is error.” Id. at 11. The Court disagrees.
12 A claimant’s “residual functional capacity is the most [the claimant] can still
13 do despite [their] limitations,” and is assessed “based on all the relevant evidence
14 in [the] record.” 20 C.F.R. § 404.1545(a); id. § 416.945(a). The ALJ’s task is to
15 “translate” the claimant’s limitations into “concrete restrictions.” Stubbs-Danielson
16 v. Astrue, 539 F. 3d 1169, 1174 (9th Cir. 2008). “Moderate limitations [in the
17 Paragraph B categories] do not have to be exactly mirrored in the RFC
18 determination.” Phillips v. Colvin, 61 F. Supp. 3d 925, 939 (N.D. Cal. 2014). Instead,
19 the Ninth Circuit holds that “an ALJ’s assessment of a claimant adequately
20 captures [those] restrictions . . . where the assessment is consistent with restrictions
21 identified in the medical testimony.” Stubbs-Danielson, 539 F.3d at 1174 (finding
22 no error where ALJ limited claimant to “simple tasks” to accommodate limitations
23 related to concentration, persistence or pace).
24 The medical testimony in the record amply supports the restrictions the ALJ
25 incorporated into the RFC. See Phillips, 61 F. Supp. 3d at 940 (“The relevant inquiry
26 is whether the medical evidence supports a particular RFC finding.”). On initial
27 review, state agency consultant M. Tashner, Ed.D., noted Plaintiff had “difficulties
28 with memory, concentration” and “authority,” and did not “handle stress or
1 change well,” but could “follow written instructions” and was able to “manage”
2 personal care, medications, chores, driving and shopping. See AR at 80. Dr.
3 Tashner opined Plaintiff was “[c]apable of understanding instructions at least 2-3
4 steps,” noting Plaintiff’s abilities with regard to concentration, persistence and
5 pace “varie[d] with motivation and interest, but capable of 1-2 steps.” Id. Due to
6 her “[d]ifficulties socially,” Dr. Tashner further opined Plaintiff “would do better
7 in low stress environment with limited social interactions.” Id. On reconsideration
8 review, state agency consultant M. Becker, Ph.D., concurred with these findings
9 and recommendations. Id. at 99. Dr. Becker found the initial assessment
10 “consistent with the objective evidence and supported by other information in the
11 file,” and found additional evidence submitted after the initial review “d[id] not
12 change the previous decision,” which remained “appropriate and supported by”
13 the medical evidence in the record. Id.
14 The ALJ’s RFC limited Plaintiff to “simple, routine tasks” and making
15 “simple work-related decisions.” AR at 35. Plaintiff was also limited to only
16 occasional contact with the public, coworkers and supervisors, and only
17 occasional changes in her work setting. See id. These limitations appropriately
18 “track” the consultants’ testimony. See Kitchen, 82 F.4th at 740. Plaintiff has not
19 persuaded the Court that the ALJ’s Paragraph B findings “were not adopted into
20 – or adequately accommodated by – the RFC she adopted.” Op. Br. at 12. As in
21 Stubbs-Danielson, the ALJ incorporated “the only concrete restrictions available.”
22 Stubbs-Danielson, 539 F.3d at 1174.8 Plaintiff complains of an “inconsistency”
23
24
25 8 See also Knealy P. v. Kijakazi, No. 20-CV-0984-AJB-BGS, 2022 WL 563237, at
*25 (S.D. Cal. Feb. 24, 2022), report and recommendation adopted, 2022 WL 827119
26
(S.D. Cal. Mar. 18, 2022) (noting Stubbs-Danielson “makes clear the ALJ is permitted
27
to translate a claimant’s limitations in concentration, persistence, or pace into
28
1 between the Paragraph B findings and the RFC but has not identified any other
2 concrete limitations recommended by any other medical source, nor has she cited
3 any other information in the record which supports different or further work
4 restrictions to accommodate her moderate mental limitations. See Israel v. Astrue,
5 494 F. App’x 794, 796 (9th Cir. 2012) (unpublished) (“reject[ing]” identical
6 argument that ALJ “disregarded his step-3 findings about moderate limitations”
7 where ALJ relied on medical testimony and claimant had “not shown” the ALJ
8 “failed to consider all of the evidence in the record”); see also Sandra S. v. Kijakazi,
9 No. 21CV1248-AJB-MDD, 2022 WL 3355803, at *6 (S.D. Cal. Aug. 12, 2022), report
10 and recommendation adopted, 2022 WL 4180973 (S.D. Cal. Sept. 12, 2022)
11 (recommending affirmance where, “[l]ike in Stubbs-Danielson,” the ALJ
12 “appropriately translated Plaintiff’s limitations with concentration and pace into .
13 . . the restrictions articulated by the State agency psychological consultants”).
14 For the foregoing reasons, the Court finds Plaintiff has not established
15 harmful error with respect to whether the RFC sufficiently reflects the ALJ’s
16 finding that Plaintiff had moderate limitations in concentration, persistence and
17 maintaining pace.
18 B. The ALJ Properly Assessed APRN Morin’s Opinion
19 As a second charge of reversible error, Plaintiff asserts the ALJ’s assessment
20 of Morin’s opinion was “cursory and conclusory” and therefore “legally
21 insufficient.” Op. Br. at 16. Plaintiff further contends the ALJ’s “failure to provide
22 the requisite explanation robs both Plaintiff and the reviewing Court of the ability
23 to ascertain the foundation” for her rejection of the opinion. See id. Again, the
24 Court disagrees.
25
26
medical testimony that is adequate to support RFC restrictions — an opinion that
27
identifies the concentration, persistence, and pace limitations and . . . provides the
28
1 It is well established in this Circuit that the ALJ “need not take every medical
2 opinion at face value.” Cross v. O’Malley, 89 F.4th 1211, 1213 (9th Cir. 2024).
3 “Rather, the ALJ must scrutinize the various – often conflicting – medical opinions
4 to determine how much weight to afford each opinion.” Id. at 1213-14. The “most
5 important factors” the ALJ must consider in doing so are supportability and
6 consistency. 20 C.F.R. § 404.1520c(a); id. § 416.920c(a). “Supportability means the
7 extent to which a medical source supports the medical opinion by explaining the
8 relevant objective medical evidence.” Woods v. Kijakazi, 32 F.4th 785, 791-92 (9th
9 Cir. 2022) (citing 20 C.F.R. § 404.1520c(c)(1)). “Consistency means the extent to
10 which a medical opinion is consistent with the evidence from other medical
11 sources and nonmedical sources in the claim.” Id. at 792 (citing 20 C.F.R.
12 § 404.1520c(c)(2)). In assessing a medical opinion’s persuasive value, the “ALJ
13 need only provide an explanation supported by substantial evidence.” Kitchen, 82
14 F.4th at 740.
15 The medical opinion at issue is a three-page check-the-box form titled
16 “Mental Capacity Assessment” signed by Morin on February 9, 2021. AR at 1051-
17 53. Morin assessed Plaintiff as having “mild” limitations in all areas of
18 understanding, remembering and applying information; “mild,” “moderate,” or
19 “marked” limitations in areas concerning concentration, persistence, and
20 maintaining pace; “moderate” or “marked” limitations in areas concerning
21 adapting or managing oneself; and “marked” limitations in all areas concerning
22 interacting with others. See id. The form instructs the opinion writer their
23 assessments must be “based on [their] examination” of the claimant, and although
24 the form prompts the provider to “describe the . . . findings that support [their]
25 assessment[s],” Morin did not do so. See id.
26 The ALJ “was unable to attribute much persuasiveness to [Morin’s]
27 opinion.” AR at 37-38. First, the ALJ found the opinion was not supported by
28 signs and findings consistent with the degree of limitation alleged. Id. at 37. The
1 governing regulations provide “[t]he more relevant the objective medical evidence
2 and supporting explanations presented by a medical source are to support his or
3 her medical opinion[,]the more persuasive the medical opinion[]will be.” 20 C.F.R.
4 § 404.1520c(c)(1); id. § 416.920c(c)(1). Here, however, Morin did not cite any
5 clinical findings, test results or other objective medical evidence in support of her
6 opinion. AR at 1501-03. Because Morin’s opinion is “wholly unexplained” by any
7 reference to medical evidence, the ALJ “reasonably rejected” it. Woods, 32 F.4th at
8 793; see also Kitchen, 82 F.4th at 740-41 (“we have accepted the discounting of a
9 medical opinion set forth in a checkbox form with little to no explanation”); Ford
10 v. Saul, 950 F.3d 1141, 1155 (9th Cir. 2020) (the ALJ “may permissibly reject check-
11 off reports that do not contain any explanation of the bases of their conclusions”).
12 Second, the ALJ found Morin’s opinion was inconsistent with her own
13 treatment record, citing mental health progress notes from Morin and others in her
14 practice group. AR at 37. The ALJ specifically identified Morin’s progress notes
15 dated December 2020 and January 2021 (i.e., shortly before issuing her opinion),
16 which documented Plaintiff’s “pleasant and cooperative” demeanor and
17 statement she “ha[d] friends she could rely on.” AR at 37 (citing id. at 1020-1049).
18 This evidence undermined Morin’s opinion that Plaintiff was “greatly functionally
19 limited,” especially in the areas of interacting with others, managing herself, and
20 “sustaining an ordinary routine and regular attendance at work.” Id. A medical
21 opinion is properly found unpersuasive where the provider assesses limitations
22 that are “contradicted [by] his own treatment records.” Stiffler v. O’Malley, 102
23 F.4th 1102, 1107 (9th Cir. 2024); see also Jeanette R. v. Kijakazi, 620 F. Supp. 3d 1127,
24 1143 (E.D. Wash. 2022) (noting the ALJ “is not obliged to credit medical opinions
25 that are unsupported by the medical source’s own data . . .”).
26 Third, the ALJ found Morin’s opinion relied “on complete acceptance” of
27 Plaintiff’s subjective allegations regarding her limitations, AR at 37, which the ALJ
28 had determined were not supported by the record. See id. at 36 (finding the record
1 “fail[ed] to support allegations of a debilitating . . . impairment” because the
2 objective medical evidence “indicate[d] at best, ailments that appear troublesome,
3 but do not impose limitations of such significance as to preclude sustained
4 competitive employment”). The ALJ could reasonably discount Morin’s opinion
5 for its overreliance on Plaintiff’s self-reported limitations, having found those
6 allegations unsupported. See, e.g., Turner v. Comm’r of Soc. Sec., 613 F.3d 1217, 1223
7 (9th Cir. 2010) (finding no error where ALJ rejected opinion “based almost entirely
8 on the claimant's self-reporting”); Evenhus v. Astrue, 815 F. Supp. 2d 1154, 1160 (D.
9 Or. 2011) (“A physician’s disability opinion may be disregarded if it is premised
10 upon the claimant’s subjective symptoms and limitations that were properly
11 discredited.”).
12 Fourth, the ALJ found Morin’s opinion was inconsistent with other evidence
13 in the record, including “inconsistencies” in the evidence Morin “[did] not appear
14 to have been aware of.” AR at 38. This statement is followed by a lengthy
15 description of the evidence the ALJ found inconsistent with both Morin’s opinion
16 and Plaintiff’s subjective assessment of her limitations. See id. at 38-39. The ALJ
17 cited progress notes from the several-month period after Morin issued her opinion
18 documenting largely “normal” findings on mental status examinations. Id. at 38-
19 39 (citing id. at 1085, 1090, 1138-40, 1147, 1178-82, 1908, 1912, 1919). Although
20 Plaintiff was “tearful” or “agitated” during some visits, she was largely noted to
21 be alert, oriented, and cooperative, with no disturbances in sleep or appetite. Id.
22 (citing id. at 1085, 1138-40, 1178-82, 1908). Plaintiff was able to travel and engage
23 in activities of daily living. Id. (citing id. at 1085, 1090, 1912). The ALJ also cited
24 indications in the record that Plaintiff’s mental symptoms abated with medication
25 “when used appropriately.” Id. (citing id. at 1090, 1908, 1919). See Warre v. Comm’r,
26 439 F.3d 1001, 1006 (9th Cir. 2006) (“Impairments that can be controlled effectively
27 with medication are not disabling for the purposes of determining eligibility for
28 [disability] benefits.”).
1 In sum, the ALJ found Morin’s opinions regarding Plaintiff’s limitations
2 were not persuasive because they were not “consistent with the evidence from
3 other medical sources and nonmedical sources in the claim.” 20 C.F.R.
4 § 404.1520c(c)(2). The ALJ’s discussion of the “inconsistencies” undermining
5 Morin’s opinion is thorough and detailed. Although that discussion is somewhat
6 intertwined with the ALJ’s analysis of Plaintiff’s subjective testimony, given
7 Morin’s reliance on Plaintiff’s self-reported limitations, this does not obscure the
8 ALJ’s reasoning. Despite Plaintiff’s protestations that the ALJ “rob[bed] . . . the
9 Court of the ability to ascertain the foundation for” rejecting Morin’s opinion, Op.
10 Br. at 19, the Court finds the ALJ’s reasoning both clear and legally sound. See
11 Stiffler, 102 F.4th at 1107 (finding ALJ did not err in rejecting “extreme limitations”
12 contradicted by the record).
13 For the foregoing reasons, the Court finds Plaintiff has not established
14 harmful error with respect to the ALJ’s evaluation of Morin’s medical opinion.
15 C. Substantial Evidence Supports the ALJ’s Conclusions
16 Having found the ALJ’s evaluation of Plaintiff’s subjective testimony is free
17 of harmful error, the Court turns to the question of whether the ALJ’s conclusion
18 is supported by substantial evidence. The Court has independently “assess[ed]
19 the entire record, weighing the evidence both supporting and detracting from the
20 [ALJ’s] conclusion.” See Ahearn, 988 F.3d at 1115. Based on this review, the Court
21 finds substantial evidence supports the ALJ’s decision, as summarized below.
22 Plaintiff’s treatment records dated between 2018 and 2022 confirm Plaintiff’s
23 diagnoses of recurrent depression and generalized anxiety disorder, with
24 associated symptoms including sadness, hopelessness, low self-esteem and
25 agitation. AR at 981, 993, 996, 1013, 1038, 1154, 1173, 1908. Notwithstanding
26 Plaintiff’s sad, anxious or tearful presentation at several visits, however, mental
27 status examinations were largely normal during this period, including findings
28 regarding memory, judgment, insight and concentration. See, e.g., id. at 645, 669,
1 983, 999, 1018, 1024, 1031, 1036, 1047, 1082, 1139, 1162, 1182, 1933. By both
2 subjective report and provider observation, Plaintiff’s symptoms improved with
3 medication and therapy. Id. at 744, 984, 989, 1016, 1090, 1162, 1911-12, 1937.
4 Results of an October 2022 neurology consult for Plaintiff’s complaints of memory
5 loss demonstrated “no obvious genitive deficits.” Id. at 1917-1921.
6 Plaintiff was hospitalized for suicidal ideation on March 3, 2020 after having
7 voluntarily discontinued all her medications. Id. at 588-93. She was discharged
8 three days later, on March 6, 2020, after resuming her medications (or starting new
9 ones) and reporting a “significant improvement in mood and resolution of [her]
10 suicidal ideation.” Id. at 609-12; see also id. at 1018 (progress note dated March 9,
11 2020 indicating Plaintiff “state[d] the medications that she was started on at the
12 hospital appeared to be helping her”).
13 On initial review, state agency consultant Dr. Tashner noted Plaintiff had
14 been diagnosed with adjustment disorder with mixed anxiety and depression as
15 early as 2018. AR at 80. Plaintiff’s treatment records reflected “intact” mental
16 status examinations, with “grossly intact” memory, concentration, and attention,
17 and Dr. Tashner noted Plaintiff improved with therapy and medication. Id. Dr.
18 Tashner assessed Plaintiff as capable of understanding simple instructions, and
19 recommended she work in a low-stress environment with limited social
20 interactions. Id. Dr. Tashner also identified a “TSS” completed by Plaintiff’s
21 ARNP who “cited significant difficulties not supported by objective evidence,”
22 specifically noting the provider had seen Plaintiff and had “not documented” the
23 “significant” issues reported in the TSS.9 Id. On reconsideration review, state
24
25
9 The Court understands “TSS” refers to a trauma symptom scale (or trauma
26
symptom checklist), a questionnaire to identify potential symptoms of trauma and
27
its effect on a patient’s daily functioning. The Court further understands Dr.
28
1 |}agency consultant Dr. Becker noted Plaintiff “had returned for more treatment for
2 mental condition and [was] receiving therapy” since the initial review. Id. at
3 1199. Dr. Becker concluded the additional, more recent medical records did not
4 ||change Dr. Tashner’s initial assessment and recommendations, which remained
5 || consistent with the objective medical evidence. Id.
6 The Court finds the foregoing is substantial evidence to support the AL]’s
7 \|RFC, the conclusion that Morin’s opinion was not persuasive, and the
8 || determination that Plaintiff was not disabled.
9 V.
10 CONCLUSION
11 For the foregoing reasons, the Court concludes the ALJ’s decision is free of
12 ||/legal error and supported by substantial evidence in the record. The undersigned
13 |}accordingly RECOMMENDS that the District Judge issue an order: (1) approving
14 adopting this Report and Recommendation in its entirety; (2) affirming the
15 ||decision of the Commissioner; and (3) directing that judgment be entered in the
16 ||Commissioner’s favor.
17 IT IS HEREBY ORDERED that any objections to this Report and
18 ||Recommendation must be filed by not later than December 16, 2024. Any
19 ||response to a party’s objections must be filed by not later than December 23, 2024.
20 || Failure to timely file objections may waive the right to raise those objections on
21 ||appeal. See Robbins v. Carey, 481 F.3d 1143, 1146-47 (9th Cir. 2007).
22 ||IT Is SO ORDERED.
23 || Dated: December 2, 2024 _— ZL
24 Tb hho wa
29 ‘Hon.DavidD.Leshner
26 United States Magistrate Judge
27
28