The court “must consider the entire record as a 17 whole, weighing both the evidence that supports and the evidence that 18 detracts from the Commissioner's conclusion,” not simply the evidence 19 20 cited by the ALJ or the parties.
How later courts described this case
- The court “must consider the entire record as a 17 whole, weighing both the evidence that supports and the evidence that 18 detracts from the Commissioner's conclusion,” not simply the evidence 19 20 cited by the ALJ or the parties.
- “An ALJ’s failure to cite specific evidence does 22 not indicate that such evidence was not considered[.]”
Written by the judges who cited it.
The opinion
1 Jul 09, 2025
2 SEAN F. MCAVOY, CLERK
3
4
UNITED STATES DISTRICT COURT
EASTERN DISTRICT OF WASHINGTON
5
6
VITTORIA P.,1 No. 2:25-cv-00010-EFS
7
Plaintiff,
8
ORDER AFFIRMING THE
9 v. ALJ’S DENIAL OF BENEFITS
10 FRANK BISIGNANO,
Commissioner of Social Security,
11
Defendant.
12
13
14
Due to bipolar disorder, depression, anxiety, obsessive compulsive
15
16 disorder (OCD), panic attacks, and migraine headaches, Plaintiff
17 Vittoria P. claims that she is unable to work fulltime and applied for
18 disability benefits and supplemental security income benefits. She
19
20
21 1 For privacy reasons, Plaintiff is referred to by first name and last
22
initial or as “Plaintiff.” See LCivR 5.2(c).
23
1 appeals the denial of benefits by the Administrative Law Judge (ALJ)
2 on the grounds that the ALJ improperly analyzed the opinions of
3
treating source Shannon Rowland, PMHNP, and failed to resolve
4
conflicts between the vocational expert testimony and the Dictionary of
5
Occupational Titles at step five. As is explained below, Plaintiff has
6
not established any consequential error. The ALJ’s denial of benefits is
7
8 affirmed.
9 I. Background
10
In November 2021, Plaintiff filed applications for benefits under
11
Title 2 and Title 16, claiming disability beginning August 21, 2021,
12
based on the physical and mental impairments noted above.2 Plaintiff’s
13
claims were denied at the initial and reconsideration levels.3
14
15 After the agency denied Plaintiff benefits, ALJ Marie Palachuk
16 held a telephone hearing in August 2023, at which Plaintiff appeared
17
18
19
20
21 2 AR 310-311, 364.
22
3 AR 107, 112, 119, 122.
23
1 with her representative.4 Plaintiff, a medical expert, and a vocational
2 expert testified.5
3
After the hearing, the ALJ issued a decision denying benefits.6
4
Plaintiff appealed ALJ Palachuk’s decision to the Appeals Council, and
5
the Appeals Council denied her request for review.7 Plaintiff filed suit
6
in this Court and on January 2, 2024, this Court remanded the case for
7
8 further proceedings on stipulation of the parties.8 Pursuant to the
9 Court’s order the Appeals Council remanded the case to ALJ
10
Palachuk.9
11
On September 19, 2024, ALJ Palachuk held a second hearing,
12
which Plaintiff attended with her representative.10 Plaintiff and a
13
14
15
4 AR 41-68.
16
5 Id.
17
6 AR 14-40, 1623-1649.
18
7 AR 1-6, 1650-1655.
19
20 8 AR 1656-1662.
21 9 AR 1663-1668.
22
10 AR 1605-1622.
23
1 vocational expert testified.11 On October 11, 2024, ALJ issued a second
2 decision denying benefits.12
3
The ALJ found Plaintiff’s alleged symptoms were not entirely
4
consistent with the medical evidence and the other evidence.13 As to
5
medical opinions, the ALJ found:
6
• The opinions of medical expert Laura Hopper, PhD, to be
7
8 very persuasive.
9 • The opinions of state agency evaluators Jonathan Anderson,
10
PhD, and Vincent Gollogly, PhD, to be partially persuasive.
11
• The opinions of consultative examiner Rebecca Alexander,
12
PhD, to be not persuasive.
13
14 • The opinions of state agency evaluators Mark Magdaleno,
15 MD, and Glenn Gade, MD, to be not persuasive.
16
17
18
11 Id.
19
20 12 AR 1565-1595. Per 20 C.F.R. §§ 404.1520(a)-(g); 416.920(a)–(g), a
21 five-step evaluation determines whether a claimant is disabled.
22
13 AR 1576-1580.
23
1 • The opinions of treating source Shannon Rowland, PMHNP,
2 to be not persuasive.14
3
The ALJ also considered the third-party statement of Plaintiff’s brother
4
and found that it was inconsistent with Plaintiff’s own accounts of her
5
activities of daily living.15 As to the sequential disability analysis, the
6
ALJ found:
7
8 • Step one: Plaintiff meets the insured status requirements
9 through March 31, 2026, and had not engaged in
10
substantial gainful activity since August 21, 2021, the
11
amended alleged onset date.
12
• Step two: Plaintiff had the following medically determinable
13
severe impairments: bipolar vs depressive disorder, anxiety,
14
15 and migraines.
16 • Step three: Plaintiff did not have an impairment or
17
combination of impairments that met or medically equaled
18
the severity of one of the listed impairments.
19
20
21 14 AR 1580-1583.
22
15 AR 1582.
23
1 • RFC: Plaintiff had the RFC to perform a full range of work
2 at all exertional levels with the following exceptions:
3
Due to migraine headaches, she needs to avoid more
4 than moderate exposure to industrial noise, industrial
vibration, very bright lights (defined as lights brighter
5 than standard fluorescent office lighting) and hazards,
such as unprotected heights and dangerous moving
6
machinery. She is able to understand, remember, and
carry out simple routine tasks and maintain
7
concentration, persistence, and pace on simple routine
8 tasks for two-hour intervals between regularly
scheduled breaks. She needs a predictable environment
9 with no assembly-line pace or similarly fast paced work.
She should have no public contact, no crowds and
10
occasional interaction with coworkers and supervisors.
11 She should be dealing with things rather than people.
12 • Step four: Plaintiff is unable to perform her past relevant
13
work as an administrative clerk.
14
• Step five: considering Plaintiff’s RFC, age, education, and
15
work history, Plaintiff could perform work that existed in
16
significant numbers in the national economy, such as a
17
18 change house attendant (DOT 358.687-010), marker (DOT
19
20
21
22
23
1 209.587-034), and small products assembler (DOT
2 706.684.022 ).16
3
Plaintiff timely filed suit in this Court.17
4
II. Standard of Review
5
The ALJ’s decision is reversed “only if it is not supported by
6
substantial evidence or is based on legal error,”18 and such error
7
8 impacted the nondisability determination.19 Substantial evidence is
9 “more than a mere scintilla but less than a preponderance; it is such
10
11
12
13
14 16 AR 1570-1585.
15
17 ECF No. 1.
16
18 Hill v. Astrue, 698 F.3d 1153, 1158 (9th Cir. 2012). See 42 U.S.C. §
17
405(g).
18
19 Molina v. Astrue, 674 F.3d 1104, 1115 (9th Cir. 2012), superseded on
19
20 other grounds by 20 C.F.R. § 416.920(a) (recognizing that the court may
21 not reverse an ALJ decision due to a harmless error—one that “is
22
inconsequential to the ultimate nondisability determination”).
23
1 relevant evidence as a reasonable mind might accept as adequate to
2 support a conclusion.”20
3
III. Analysis
4
Plaintiff seeks relief from the denial of disability on two grounds.
5
She argues the ALJ erred when evaluating the medical opinions and
6
when evaluating Plaintiff’s subjective complaints regarding her mental
7
8 impairments. As is explained below, the Court concludes that Plaintiff
9 fails to establish the ALJ erred in her evaluation of the medical opinion
10
evidence, the listings, or Plaintiff’s symptom reports.
11
12
13
14 20 Hill, 698 F.3d at 1159 (quoting Sandgathe v. Chater, 108 F.3d 978,
15
980 (9th Cir. 1997)). See also Lingenfelter v. Astrue, 504 F.3d 1028,
16
1035 (9th Cir. 2007) (The court “must consider the entire record as a
17
whole, weighing both the evidence that supports and the evidence that
18
detracts from the Commissioner's conclusion,” not simply the evidence
19
20 cited by the ALJ or the parties.) (cleaned up); Black v. Apfel, 143 F.3d
21 383, 386 (8th Cir. 1998) (“An ALJ’s failure to cite specific evidence does
22
not indicate that such evidence was not considered[.]”).
23
1 A. Medical Opinion: Plaintiff fails to establish consequential
2 error.
3
Plaintiff argues the ALJ erred in her evaluation of the medical
4
opinion of PMHNP Rowland.21 Specifically, Plaintiff argues that the
5
ALJ erred in reasoning that the extreme degree of limitation described
6
by PMHNP Rowland was inconsistent with the predominantly normal
7
8 mental status findings in the record and also erred both in considering
9 PMHNP Rowland’s relatively short treatment history and that her own
10
treatment notes reflected that Plaintiff’s condition was well-
11
controlled.22 Plaintiff argues that the ALJ cherry-picked relatively
12
normal findings while ignoring notes of an anxious or depressed affect
13
and reports of ongoing panic attacks.23 The Commissioner counter-
14
15
16
21 An ALJ must consider and articulate how persuasive she found each
17
medical opinion, including whether the medical opinion was consistent
18
with and supported by the record. 20 C.F.R. §§ 416.920c(a)–(c); Woods
19
20 v. Kijakazi, 32 F.4th 785, 792 (9th Cir. 2022).
21 22 ECF No. 8.
22
23 Id.
23
1 argues that the ALJ considered the record in its entirety and properly
2 considered both the supportability and consistency factors.24
3
1. Standard
4
The ALJ was required to consider and evaluate the
5
persuasiveness of the medical opinions and prior administrative
6
7 medical findings.25 The factors for evaluating the persuasiveness of
8 medical opinions and prior administrative medical findings include,
9
but are not limited to, supportability, consistency, relationship with the
10
claimant, and specialization.26 Supportability and consistency are the
11
most important factors,27 and the ALJ must explain how she
12
considered the supportability and consistency factors when reviewing
13
14 the medical opinions and support her explanation with substantial
15
16
17
18
24 ECF No. 9.
19
20 25 20 C.F.R. §§ 404.1520c(a), (b); 416.920c(a), (b).
21 26 20 C.F.R. §§ 404.1520c(c)(1)-(5); 416.920c(c)(1)–(5).
22
27 Id. §§ 404.1520c(b)(2); 416.920c(b)(2).
23
1 evidence.28 The ALJ may consider, but is not required to discuss the
2 following additional factors: the source’s relationship to Plaintiff such
3
as length of the treatment, purpose of the treatment relation and
4
whether the source examined Plaintiff, as well as whether the source
5
had advanced training or experience to specialize in the area of
6
medicine in which the opinion was being given.29 When considering the
7
8 ALJ’s findings, the Court is constrained to the reasons and supporting
9 explanation offered by the ALJ.30 An ALJ is not required to articulate
10
11
12
13
14 28 Id. §§ 404.1520c(b)(2); 416.920c(b)(2); Woods v. Kijakazi, 32 F.4th a
15
at 785 (“The agency must articulate . . . how persuasive it finds all of
16
the medical opinions from each doctor or other source and explain how
17
it considered the supportability and consistency factors in reaching
18
these findings.”) (cleaned up).
19
20 29 Id.
21 30 See Burrell v. Colvin, 775 F.3d 1133, 1138 (9th Cir. 2014)
22
(recognizing court review is constrained to the reasons the ALJ gave).
23
1 how they considered evidence from nonmedical sources using the
2 requirements in paragraphs (a) through (c).31
3
2. PMHNP Rowland’s Opinions
4
On August 27, 2024, PMHNP Rowland completed a medical
5
source statement.32 She said that she had been seeing Plaintiff on a
6
7 monthly or bi-monthly basis and that she had bipolar disorder,
8 generalized anxiety disorder and obsessive-compulsive disorder.33 She
9
opined that Plaintiff has a poor prognosis and that Plaintiff has had
10
improvement with medication but may struggle for her life and that
11
she had reported auditory hallucinations on several occasions, and
12
struggles with paranoia and intrusive thoughts.34
13
14 PMHNP Rowland wrote that Plaintiff’s symptoms included
15 anhedonia, decreased energy, feelings of guilt, generalized anxiety,
16
mood disturbance, intrusive thoughts, paranoia, obsessions, emotional
17
18
31 20 C.F.R. §§ 404.1520c(d); 416.920c(d)
19
20 32 AR 2579-2584.
21 33 AR 2579.
22
34 Id.
23
1 withdrawal, episodes of mania or depression, unstable relationships,
2 hallucinations, easy distractibility, and sleep disturbance.35
3
PMHNP Rowland opined that Plaintiff would be seriously limited
4
in the following abilities: remember work-like procedures, understand
5
and remember short and simple instructions, carry out short and
6
simple instructions, sustain a routine without supervision, work in
7
8 coordination with others, make simple work-like decisions, ask simple
9 questions, accept instructions from supervisors, be aware of hazards,
10
understand and remember detailed instructions, set realistic goals,
11
travel in unfamiliar places and use public transportation.36
12
PMHNP Rowland opined that Plaintiff would be unable to meet
13
competitive standards in the following abilities: maintain attention for
14
15 a two-hour segment, maintain regular attendance and punctuality,
16 complete a normal workday or workweek without interruption, perform
17
at a consistent pace, get along with co-workers, deal with normal work
18
19
20
21 35 AR 2580.
22
36 AR 2581-2582.
23
1 stress, carry out detailed instructions, and deal with the stress of
2 skilled or semiskilled work.37
3
PMHNP Rowland wrote:
4
I believe that [Plaintiff] due to her anxiety, history of
5 trauma, and paranoia would be overwhelmed in a working
environment. She would have increased distractibility,
6
attentional lapses, and poor concentration. The anxiety will
limit her working memory which will make it harder to
7
perform goal-directed tasks. Her anxiety would inhibit her
8 executive functioning ability and ability to retain
information, reduces flexibility in thinking, error detection,
9 impairs working memory and causes brain fog.38
10
She wrote that Plaintiff did not have a low IQ and that she
11
suffered from migraine headaches that would cause fatigue, nausea,
12
and frequent absences.39 PMHNP Rowland further opined that
13
Plaintiff would be expected to be absent for more than four days a
14
15 month, and that her condition had lasted or would last for more than
16 12 months.40 PMHNP Rowland wrote that stress would cause Plaintiff’
17
18
37 Id.
19
20 38 AR 2582.
21 39 Id.
22
40 AR 2583.
23
1 to suffer from frequent migraines, and added that she suffered sleep
2 apnea that also caused headaches, fatigue, impaired memory, and poor
3
immune function.41 PMHNP Rowland also opined that Plaintiff’s
4
impairments were not the result of alcohol or substance abuse.42
5
3. Relevant Medical Records
6
7 On September 16, 2021, Plaintiff was admitted to St. Joseph
8 Regional Medical Center after presenting to the emergency department
9
with “rapidly cycling panic attacks”.43 Plaintiff reported that after
10
starting Topamax for headaches she lost 70 pounds and began having
11
racking thoughts.44 Plaintiff was grandiose and had poor insight and
12
judgment, and reported rapidly cycling panic attacks for the last 2
13
14
15
16
17
18
41 Id.
19
20 42 AR 2584.
21 43 AR 519.
22
44 Id.
23
1 months.45 Plaintiff was discharged on September 21, 2021, after
2 increase in her medication stabilized her condition.46
3
On September 29, 2021, Plaintiff presented to Melissa Park, MD,
4
for follow-up for anxiety and depression.47 She reported that her
5
anxiety and depression were interfering with her relationships,
6
household activities, and work but had a good prognosis if she took her
7
8 medication.48 On mental status examination, she had good judgment,
9 normal affect and mood, was alert and active, was oriented, and had
10
normal recent and remote memory.49 Dr. Park assessed bipolar
11
disorder, chronic depression, and anxiety.50
12
13
14
15
16
45 Id.
17
46 AR 519-520.
18
47 AR 647.
19
20 48 Id.
21 49 AR 648.
22
50 Id.
23
1 On August 15, 2023, Plaintiff first met with Shannon Rowland,
2 PMHNP, for consult.51 Plaintiff reported that she had been seeing
3
another provider but the provider did not support her disability
4
application.52 Plaintiff reported she last had a manic episode in 2022
5
before she started her current medication and that she had been
6
hospitalized in March/April 2023 for suicidal thoughts.53 Plaintiff
7
8 reported social anxiety, panic attacks once or twice a week, and
9 symptoms of OCD.54 Plaintiff’s mental status examination was normal
10
other than an anxious affect and reports that she hears bells chiming.55
11
PMHNP Rowland noted the following:
12
Pt reported she primarily would like to see a new medication
13
manager to manage her medication’s. She reported she likes
the medications she is currently on, however, she would like
14
to transfer care from her current provider due to "feeling
15 afraid of her" and feeling she "doesn't trust her." Pt reports
overall feeling "stable" however, currently is experiencing
16
17
51 AR 2527.
18
52 AR 2532.
19
20 53 Id.
21 54 Id.
22
55 AR 2534.
23
1 anxiety due to current life stressors. Pt reported she has a
history of panic attacks, however, with her current
2 medications she has them "pretty infrequent" any more. Pt
reports having a disability hearing next week, which is
3
increasing her feelings of anxiety. In addition, pt would like
4 to see a therapist.56
5 At an August 23, 2023 appointment with ARNP Jennifer
6
Anderson, Plaintiff had normal mood, affect, behavior, judgment, and
7
thought content and reported that she was “doing well,” sleeping well
8
and had an appointment scheduled for September 11, 2023, with a
9
behavioral specialist.57
10
11 On September 11, 2023, Plaintiff presented to Katherine
12 Johnson, LMSW, for a treatment assessment.58 She reported that with
13
her new medication she felt like herself.59 Her mental status
14
15
16
17
18
56 AR 2550.
19
20 57 AR 2525.
21 58 AR 2500.
22
59 AR 2505.
23
1 examination was normal, and she reported that her symptoms had a
2 moderate impact on her daily functioning.60
3
On September 12, 2023, Plaintiff reported she was anxious about
4
her disability claim but was doing well and denied irritability but
5
reported she almost had a panic attack the week prior.61 On mental
6
status exam, Plaintiff reported a “sleepy” mood and said she heard
7
8 bells chiming.62 On September 18, 2023, Plaintiff reported she was
9 “doing well,” and her mental status exam was normal.63 At her October
10
9, 2023 appointment, Plaintiff reported she was completing her daily
11
activities despite feeling low motivation.64 Her mental status
12
examination was normal.65
13
14
15
16
60 AR 2507-2508.
17
61 AR 2495.
18
62 Id.
19
20 63 AR 2483-2484.
21 64 AR 2438.
22
65 Id.
23
1 At her October 30, 2023 appointment, Plaintiff reported that she
2 had organized a haunted hayride event for her family and successfully
3
dealt with the stress, although she had one panic attack.66 Her mental
4
status examination was normal.67
5
At her November 14, 2023 appointment, Plaintiff reported that
6
she was under stress because her dog had cancer and she did not get
7
8 her state assistance, but that her mood was stable.68 Her mental status
9 examination was again unremarkable.69
10
At her November 30, 2023 appointment, Plaintiff appeared and
11
reported stress due to situational reasons when her state assistance
12
was placed on hold.70 PMHNP Rowland noted:
13
Today in session Vittoria reflected on the past week and the
14
current stressors she is experiencing. Vittoria was
15 extremely overwhelmed and tearful during todays
appointment. It appears that Vittoria has been
16
17
66 AR 2399.
18
67 Id.
19
20 68 AR 2373.
21 69 AR 2383.
22
70 AR 2347.
23
1 catastrophizing over the past week about several stressors.
She was able to speak through some recent health issues,
2 her financial and living situation, and some family stressors
she is taking on. We talked about how things seem "very out
3
of control" and we spoke about focusing on one thing at a
4 time. We spoke about setting a timer to pick up her home
for 10 minutes and she feels that is doable. She reported she
5 has a selfcare journal her CSAP advocate gave her and she
would like to work a little in it, we spoke about doing a little
6
at a time, to not be so overwhelming. We spoke about
showering more frequently as she has not showered in 5
7
days and we spoke about what an attainable goal would be.
8 She was able to get things out and was able to then focus on
solutions and steps to take towards the end of session.
9 Vittoria reported "feeling much better" at the end of the
appointment.71
10
11 Plaintiff’s affect was sullen, flat, and tearful and she had racing
12 thought at the beginning of the appointment but by the end of the
13
appointment her racing thoughts were improved.72
14
At her December 13, 2023 appointment, Plaintiff reported that
15
she was doing well and had handled the stress of moving recently.73 On
16
December 28, 2023, Plaintiff also reported to PMHNP Rowland that
17
18
19
20 71 Id.
21 72 AR 2348.
22
73 AR 2317.
23
1 she was handling the stress of the holidays well.74 Her mental status
2 examination findings were unremarkable.75
3
At her January 8, 2024 appointment, with PMHNP Rowland,
4
Plaintiff’s mental status examination was largely normal. PMHNP
5
Rowland found the following:
6
Appearance: well-groomed, clean, and normal station.
7
Behavior: cooperative and calm. Eye Contact within normal
8 limits. Motor Activity: within normal limits. Features of
Speech: fluent, clear, reciprocal, and normal volume. Mood:
9 patient's stated mood "mostly good". Affect: full-range and
congruent to mood. Perception / Hallucinations none.
10
Cognition: oriented to situation, time, place, and person and
11 alert and memory grossly intact. Thought Processes: linear
and goal-directed. Thought Content: unremarkable.
12 Attention/Concentration: sustained and appropriate for age.
Language Skills expressive language within normal limits
13
and receptive language within normal limits. Insight:
grossly intact. Judgment: grossly intact.76
14
15 When seen in February 2024, Plaintiff’s mental status
16 examination was unremarkable.77 Plaintiff reported that she was doing
17
18
74 AR 2308.
19
20 75 AR 2304.
21 76 AR 2283.
22
77 AR 2214-2215, 2223, 2232-2233.
23
1 well and working on quitting smoking.78 In March 2024, Plaintiff
2 reported that she was happy where she was at and had not been
3
hospitalized for a year.79 Her mental status examination was normal.80
4
PMHNP Rowland noted:
5
Today in session Vittoria reflected on the past week and
6
getting her mom moved, and her apartment cleaned. Pt
reported her motivation is "better" and that she has been
7
pretty active over the past week. She reported she did
8 accomplish things she has been wanting to do. She reported
she is getting some crafts made which has been good as
9 well. Today we spoke about stress management while
getting her mom moved and how to motivate her family to
10
help.81 Earlier in March Plaintiff had reported good
11 motivation and that she had read 3 books and completed
creative projects.82
12
At her May 20, 2024 appointment, it was noted that Plaintiff’s
13
mental status examination was unremarkable she had not had a self-
14
15
16
17
78 AR 2232.
18
79 AR 2165.
19
20 80 AR 2165-2166.
21 81 AR 2196.
22
82 AR 2205.
23
1 harm thought in a “significant time.”83 At her June 17, 2024
2 appointment, Plaintiff reported her anxiety and depression have been
3
maintained.84 Her mental status examination findings were
4
unremarkable.85
5
On July 1, 2024, Plaintiff’s mental status examination findings
6
were as follows:
7
8 Appearance: well-groomed, clean, and normal station.
Behavior: cooperative and calm. Eye Contact within normal
9 limits. Motor Activity: within normal limits. Features of
Speech: fluent, clear, reciprocal, and normal volume. Mood:
10
euthymic and patient's stated mood "--". Affect: full-range
11 and congruent to mood. Perception / Hallucinations none.
Cognition: oriented to situation, time, place, and person and
12 alert and memory grossly intact. Thought Processes: linear
and goal-directed. Thought Content: unremarkable.
13
Attention/Concentration: sustained and appropriate for age.
Language Skills expressive language within normal limits
14
and receptive language within normal limits. Insight:
15 grossly intact. Judgment: grossly intact.86
16
17
18
83 AR 2085.
19
20 84 AR 2052.
21 85 Id.
22
86 AR 2032.
23
1 On July 24, 2024, Plaintiff was seen by PMHMP Rowland in a
2 telehealth visit.87 Plaintiff reported excessive worry, irritability,
3
depressed mood, and anergy.88 Ms. Rowland noted:
4
Vittoria is a 42-year-old female with the diagnoses of
5 chronic depression, anxiety, bipolar disorder, OCD, and
insomnia. Vittoria is here for a follow-up appointment for
6
medication management. She states that things aren't going
to bad. She has been feeling pretty steady. She feels the
7
same since increasing the lithium. She will be going in to
8 complete a new lithium level due to the increase. She has
been sleeping pretty good. She is getting the normal amount
9 for her. She is going to be getting a CPAP. She will also be
having surgery on her nose because it is narrow and
10
collapses. She denies SI or HI. She denies paranoia or
11 hallucinations. She had COVID last month but she is okay.
It was more like a bad cold. She denies manic behaviors.89
12
Mental status examination findings were: “Appearance: well-groomed,
13
clean, and normal station. Behavior: cooperative and calm. Eye Contact
14
15 within normal limits. Motor Activity: within normal limits. Features of
16 Speech: fluent, clear, reciprocal, and normal volume. Mood: patient's
17
stated mood "Steady". Affect: full-range and congruent to mood.
18
19
20 87 AR 1998.
21 88 AR 2003.
22
89 AR 2004.
23
1 Perception / Hallucinations none. Cognition: oriented to situation, time,
2 place, and person and alert and memory grossly intact. Thought
3
Processes: linear and goal-directed. Thought Content: unremarkable.
4
Attention/Concentration: sustained and appropriate for age. Language
5
Skills expressive language within normal limits and receptive language
6
within normal limits. Insight: grossly intact. Judgment: grossly
7
8 intact.”90
9 Ms. Rowland made the following findings: “Generalized anxiety
10
disorder - Generalized Anxiety Disorder F41.1 evidenced by her
11
excessive anxiety and worrying occurring for over 6 months about
12
multiple different events of activities and difficulty controlling the
13
worry with restlessness or feeling keyed up/on edge, easily fatigued,
14
15 difficulty concentrating or mind going blank, she struggles with
16 irritability and take trazodone to help with her sleep disturbance.
17
These symptoms are causing significant distress and impairment in:
18
social, occupational and other important areas of functioning. She is
19
not able to work and has applied for disability. F41.1: Generalized
20
21
22
90 Id.
23
1 anxiety disorder 3. Bipolar I disorder - Her last manic episode was
2 2022 before she was on her current medication. She still struggles with
3
depression. She states that when she has a manic episode she becomes
4
hyper and confrontational, and she has reckless behavior towards
5
herself and other. She will have an inflated self-esteem. When she
6
becomes manic, her anxiety goes through the roof. F31.9: Bipolar
7
8 disorder, unspecified.”91
9
4. Analysis
10
a. The ALJ’s consideration of the opinions of Dr. Brooks
11
The ALJ gave the following reasoning as to her consideration of
12
PMHNP Rowland’s opinions:
13
14 The Medical Source Statement provided by provider
Shannon Rowland, PMHNP, dated August 27, 2024, is not
15 persuasive. (Ex. 24F). This provider reports that she has
seen the claimant since August 15, 2023, on a monthly or
16
bimonthly basis for medication management. Ms. Rowland
identifies a variety of symptoms, all consistent with the
17
claimant’s severe impairments, and opines the claimant is
18 seriously limited, defined as having noticeable difficulty for
11 to 20% of the workday or workweek, in the abilities to
19 remember work-like procedures; understand and remember
very short and simple instructions; carry out very short and
20
simple instructions; sustain an ordinary routine without
21
22
91 AR 2005.
23
1 special supervision, work in coordination with or proximity
to others; make simple work-related decisions; ask simple
2 questions or request assistance; accept instructions and
respond appropriately to criticism; and be aware of normal
3
hazards and take appropriate precautions. (Ex. 24F/3). She
4 opines the claimant is unable to meet competitive standards
defined as having noticeable difficulty from 21 to 40% of the
5 workday or workweek, in the ability to maintain attention
for two hour segments; maintain regular attendance and be
6
punctual within customary, usually strict tolerances;
complete a normal workday or workweek without
7
interruptions from psychologically based symptoms;
8 perform at a consistent pace without an unreasonable
number and length of rest periods; get along with coworkers
9 or peers without unduly distracting them or exhibiting
behavioral extremes; responding appropriately to changes
10
in a routine work setting; and dealing with normal work
11 stress. (Ex. 24F/3). She reports that the claimant’s anxiety,
history of trauma, and paranoia, would cause the claimant
12 to be overwhelmed in a working environment. (Ex. 24F/4).
She reports the claimant would have increased
13
distractibility, lapses in attention, and poor concentration,
and anxiety would limit her working memory. (Ex. 24F/4).
14
She additionally reports excessive absenteeism (more than
15 four days per month), problems with executive functioning,
information retention, and brain fog. (Ex. 24F/4). This
16 degree of limitation is not only inconsistent with evidence of
predominantly normal memory function, cognition,
17
behavior, insight, and mood, but is unsupported by the
18 short amount of time Ms. Rowland has treated the claimant.
Ms. Rowland reports that she began caring for the claimant
19 on August 15, 2023, but the claimant has alleged disability
since August of 2021. There is a significant amount of time
20
this provider cannot personally form an opinion on. Ms.
Rowland typically states the claimant’s conditions are well-
21
managed (Ex. 23F/17) and she reports objective findings
22 that are normal, and not consistent with her significant
limitations. (Ex. 23F/26, 38, 54, 64, 74, 98, 107). Nor are
23
1 these limitations consistent with moderate findings made by
Dr. Alexander or Dr. Hopper.92
2
Plaintiff argues that the ALJ erred in reasoning that PMHNP
3
4 Rowland was not able to make a reasoned opinion as to the period prior
5 to her treating Plaintiff and that both the ALJ’s consistency and
6
supportability analysis are flawed.
7
The Court agrees with Plaintiff that a qualified medical expert is
8
not limited in rendering an opinion as to a patient’s opined limitations
9
to the period for which the medical source has personally treated the
10
11 patient. The Court agrees with the Commissioner, however, that the
12 ALJ properly considered the consistency and supportability factors.
13
The Court thus concludes that Plaintiff failed to establish
14
consequential error in the ALJ’s consideration of PMHNP Rowland’s
15
testimony.
16
b. The ALJ’s consideration of the time period in which
17
18 PMHNP Rowland treated Plaintiff
19
20
21
22
92 AR 1583.
23
1 As noted above, the ALJ erred in her reasoning that because the
2 alleged disability onset date preceded the date that PHMNP Rowland
3
first treated Plaintiff she was unable to “personally form an opinion.”93
4
There is no precedent for the ALJ’s reasoning. While the Court is
5
aware of cases in which it has been difficult to obtain a medical source
6
opinion for periods of time for Plaintiff had no treatment records, this
7
8 is not the case here. There were records in evidence and in PMHNP
9 Rowland’s treatment record reflecting treatment at St. Joseph’s
10
Medical Center in both 2021 and 2022. The Commissioner offers no
11
reason that PMHNP Rowland would not have been able to review those
12
records and form an opinion based upon those records.
13
The ALJ found that the opinions of Dr. Hopper, who never
14
15 treated Plaintiff were very persuasive and also found the opinions of
16 state agency consultants Dr. Anderson and Dr. Gollogly to be partially
17
persuasive and they also never treated or personally examined
18
Plaintiff.
19
20
21
22
93 Id.
23
1 c. The ALJ’s consideration of the supportability and
2 consistency factors
3
Plaintiff argues that the ALJ erred in her supportability and
4
consistency analysis regarding PMHNP Rowland’s opinions. She
5
asserts that the ALJ erred in focusing on normal findings not relevant
6
to the limitations endorsed, and by ignoring other findings such as
7
8 anxious or depressed affect and reports of panic attacks. The Court
9 has reviewed the record as a whole and finds that this argument is not
10
well-supported.
11
While there are instances in the record in which it was noted that
12
Plaintiff had an inappropriate affect,94 those treatment notes indicated
13
that Plaintiff reported that even with situational stressors in her life
14
15 her medication had made her panic attacks “infrequent” and the rest of
16 her mental status examination was normal, with normal mood,
17
behavior, judgment, and thought content.95 The ALJ did not “cherry-
18
pick” normal mental status findings, as Plaintiff alleges, because
19
20
21 94 AR 2534.
22
95 Id.
23
1 PMHNP Rowland’s finding on mental status examinations were
2 predominantly within normal limits and unremarkable, as detailed
3
above.
4
Moreover, it was Plaintiff’s statement when she first initiated
5
treatment with PMHNP Rowland that she was seeking a new medical
6
source because her prior psychiatrist did not support her application
7
8 for disability.96
9 In September 2021, Plaintiff was assessed by Dr. Park as having
10
good judgment, normal affect and mood, being alert and active, being
11
fully-oriented and having normal recent and remote memory.97 In
12
August 2023, when seen by ARNP Anderson, Plaintiff had normal
13
mood, affect, behavior, judgment, and thought content and reported
14
15 that she was “doing well.”98 In September 2023, LMSW Johnson noted
16 that Plaintiff’s mental status examination was normal and she
17
reported that her symptoms had only a moderate impact on her daily
18
19
20 96 AR 3532.
21 97 AR 648.
22
98 AR 2525.
23
1 functioning.99 In the fall of 2023, Plaintiff reported that she was
2 successfully dealing with stress despite multiple situational stressors,
3
and she had normal findings on mental status examinations.100
4
When read in context, the ALJ gave a detailed statement as to
5
findings in the medical record which she felt were inconsistent with
6
PMHNP Rowland’s opinion. Viewed in that context, the Court does not
7
8 find the ALJ’s reasoning to be deficient.
9
5. Summary
10
Because the ALJ committed no error in her consideration of the
11
opinions of PMHNP Rowland, the Court finds that no consequential
12
error occurred and a remand is not warranted as to this issue.
13
14 B. Step Five: Plaintiff fails to establish consequential error
15 Plaintiff argues the ALJ’s step five finding is flawed because the
16
ALJ failed to properly perform a function-by-function analysis of
17
Plaintiff’s RFC. She argues that the ALJ erred in finding that she was
18
19
20
21 99 AR 2507-2508.
22
100 AR 2482, 2399.
23
1 able to perform three jobs cited by the VE because she did not question
2 or resolve conflicts between the specific jobs cited and the RFC.
3
1. Standard
4
At step five, the ALJ has the burden to identify specific jobs
5
existing in substantial numbers in the national economy that claimant
6
7 can perform despite their identified limitations.101 At an administrative
8 hearing, an ALJ may solicit vocational expert testimony as to the
9
availability of jobs in the national economy.102 A vocational expert’s
10
testimony may constitute substantial evidence of the number of jobs
11
that exist in the national economy.103 The ALJ’s decision regarding the
12
number of alternative occupations must be supported by substantial
13
14 evidence.104
15
16
101 Johnson v. Shalala, 50 F.3d 1428, 1432 (9th Cir. 1995). See 20
17
C.F.R. § 404.1520(g).
18
102 Tackett v. Apfel, 180 F.3d 1094, 1100 (9th Cir. 2011).
19
20 103 Bayliss v. Barnhart, 427 F.3d 1211, 1218 (9th Cir. 2005).
21 104Farias v. Colvin, 519 F. App’x 439, 440 (9th Cir. 2013) (unpublished).
22
See Hill v. Astrue, 698 F.3d 1153, 1158 (9th Cir. 2012).
23
1 At step five, the ALJ considers the claimant’s background and
2 RFC, along with the testimony of the vocational expert, to decide
3
whether the claimant can perform available jobs notwithstanding his
4
functional limitations.105 If the vocational expert’s “opinion that the
5
applicant is able to work conflicts with, or seems to conflict with, the
6
requirements listed in the Dictionary, then the ALJ must ask the
7
8 expert to reconcile the conflict before relying on the expert to decide if
9 the claimant is disabled”:106
10
For a difference between an expert’s testimony and
11 the Dictionary’s listings to be fairly characterized as a
conflict, it must be obvious or apparent. This means that the
12 testimony must be at odds with the Dictionary’s listing of
job requirements that are essential, integral, or expected.
13
This is not to say that ALJs are free to disregard
the Dictionary’s definitions or take them with a grain of
14
salt—they aren't. But tasks that aren’t essential, integral,
15 or expected parts of a job are less likely to qualify as
apparent conflicts that the ALJ must ask about. Likewise,
16
17
18
19
20 105 20 C.F.R. §§ 404.1520(g), 404.1560(c); Tackett v. Apfel, 180 F.3d
21 1094, 1100 (9th Cir. 1999); Hill, 698 F.3d at 1161.
22
106 Gutierrez v. Colvin, 844 F.3d 804, 807 (9th Cir. 2016).
23
1 where the job itself is a familiar one—like cashiering—less
scrutiny by the ALJ is required.107
2
The ALJ—and the reviewing court—are to consider not only the
3
4 Dictionary and SCO, but also common experience, to determine
5 whether there is an apparent conflict.108
6
2. The Vocational Expert’s Testimony
7
The following exchange took place on the record between the
8
vocational expert (VE) and the ALJ:
9
BY ADMINISTRATIVE DAW JUDGE:
10
Q: So, Mr. Harrington, we don’t need to go through that
11 then. We’ll just move directly to a hypothetical. Please
assume an individual with the same age, education, and
12 work experience as the claimant. Having been born in 1981,
13
14 107 Id. at 808; see also SSR 00-4p (“When a [vocational expert] . . .
15
provides evidence about the requirements of a job or occupation, the
16
adjudicator has an affirmative responsibility to ask about any possible
17
conflict between that [vocational expert] . . . evidence and information
18
provided in the [Dictionary].”).
19
20 108 Lamear v. Berryhill, 865 F.3d 1201, 1205–06 (9th Cir. 2017); see also
21 SSR 00-4p (requiring the ALJ to consider the Dictionary and SCO);
22
SSR 83-14 (referencing the Dictionary and SCO)
23
1 she falls within the younger regulatory category and with
her GED, she would fall in the high school and above
2 educational category. The individual would have the
following functional Limitations. There would be no
3
exertional limitations, However, due to migraine headaches,
4 the individual would need to avoid more than moderate
exposure to industrial noise, vibration, hazards such as
5 unprotected heights and dangerous moving machinery and
very bright lights. And I define very bright lights as lights
6
which are brighter than standard fluorescent office lighting.
The individual is able to understand, remember, and carry
7
out simple, routine, tasks. Can maintain concentration,
8 persistence and pace for the two-hour intervals between
regularly scheduled breaks. Needs a predictable
9 environment, there should be no assembly line pace or
similarly fast paced work. There should be no public. Only
10
occasional interaction with coworkers and supervisors. No
11 crowds. The individual should be dealing with things rather
than people. Would such an individual be able to perform
12 the claimant’s past work as an admin clerk?
13
A: No, I would rule that job out given the public, simple
routine, and there was another one you mentioned, Your
14
Honor, but for those two reasons at least, I would rule out
15 the past work.
16 Q: Are there other jobs that exist in the national economy
that such an individual could perform?
17
18 A: Yes. let me give you some examples. At the medium level
of unskilled work, one example is a janitor, DOT code is
19 358.687-010, medium, unskilled, with an SVP of 2. This
specific DOT estimate is 63,000. At the light level of
20
unskilled work -- let me see -~- one would be a price marker,
DOT code is 209,587-034, Light, unskilled with an SVP of 2.
21
The DOT estimate is 165,000, And a third example at the
22 Light level is -- or second example at the Light Level, but
third example, would be a small products I assembler. DOT
23
1 code is 706.684-022, light, unskilled with an SVP of 2. DOT
estimate is 20,300.
2
Q: And Mr. Harrington, I know that many of the items that
3
I included in my hypothetical are not specifically delineated
4 in the Dictionary of Occupational Titles, things like very
bright lights, the degree of social interaction, whether an
5 environment is predictable or not, whether people -- there’s
crowds. So from where do you get your knowledge that these
6
jobs would fit all of my hypothetical limitations even those
that are not specifically delineated within the DOT?
7
8 A: It’s based on my training, knowledge, and experience and
that would be in the capacity of analyzing the same or
9 similar Jobs or while working with employees in a
placement capacity.109
10
11 3. The ALJ’s Findings
12 The ALJ reasoned as follows:
13
The claimant’s ability to perform work at all exertional
14 levels has been compromised by nonexertional limitations.
To determine the extent to which these limitations erode
15 the occupational base of unskilled work at all exertional
levels, the Administrative Law Judge asked the vocational
16
expert whether jobs exist in the national economy for an
individual with the claimant’s age, education, work
17
experience, and residual functional capacity. The vocational
18 expert testified that given all of these factors the individual
would be able to perform the requirements of representative
19 occupations such as (1) Change-house attendant (DOT
358.687- 010), considered medium work according to the
20
Dictionary of Occupational Titles, with a specific vocational
21
22
109 AR 1618-1621.
23
1 preparation of 2, with approximately 63,000 jobs available
nationally; (2) Marker (DOT 209.587-034) considered light
2 work according to the Dictionary of Occupational Titles,
with a specific vocational preparation of 2, with 165,000 jobs
3
available nationally; and (3) Assembler, small products I
4 (DOT 706.684-022), considered light work according to the
Dictionary of Occupational Titles, with a specific vocational
5 preparation of 2, with approximately 20,000 jobs available
nationally.
6
Although the vocational expert’s testimony is inconsistent
with the information contained in the Dictionary of
7
Occupational Titles, there is a reasonable explanation for
8 the discrepancy. The vocational expert explained, in
testimony, the basis for his knowledge that the above
9 identified jobs fit the hypothetical limitations that are not
discussed in the DOT based on his 35 years of work
10
experience as a vocational rehabilitation counselor, his
11 training, his performing job analyses and actually placing
individuals in these jobs.110
12
4. Analysis
13
14 Plaintiff argues the following:
15 At Step Five, the Commissioner bears the burden to
demonstrate that the claimant can perform other work that
16
exists in significant numbers in the national economy, given
the claimant’s RFC, age, education, and work experience.
17
20 C.F.R. §§ 404.1560(c)(2). This determination typically
18 involves testimony from a VE in response to a hypothetical
mirroring the claimant’s RFC. Importantly, the ALJ must
19 ensure that the VE’s testimony is reliable and consistent
with the DOT, SSR 00-4p, 2000WL 1898704. Under 00-4p,
20
the ALJ has an “affirmative responsibility” to inquire about
21
22
110 AR 1584-1585.
23
1 and resolve any apparent conflicts between the VE’s
testimony and the DOT job information. If an apparent
2 conflict exists (even if not flagged by the VE or claimant’s
attorney), the ALJ must as the VE to explain it, and then
3
determine whether to accept the VE’s explanation.111
4
5 Plaintiff then goes on to assert that the three jobs identified by
6
the VE have unresolved discrepancies.112 As the first job identified,
7
that of “charge-house attendant” Plaintiff asserts that the ALJ never
8
asked the VE whether there were crowds to be expected in the
9
workplace.
10
11 The Court concludes on the basis of the hearing transcript that
12 Plaintiff errs. The ALJ specifically questioned the VE as to whether
13
the jobs would require Plaintiff to work in the presence of a crowd and
14
the VE stated that in his experience the jobs did not require that.113
15
Plaintiff offers no conflicting VE testimony or proof other than her own
16
17
18
111 ECF No. 8, pg. 12.
19
20 112 Id. at 14-15.
21 113 AR 1621.
22
23
1 non-expert assertion that the position “appears” to require that the
2 individual work in crowds. Here, the ALJ specifically queried the VE
3
as to the issue and accepted his testimony that based on his years of
4
experience the job would fit within the hypothetical given by the ALJ.
5
Plaintiff next asserts that the job of “marker” is a “production-
6
type” job and that it therefore would not fit within the hypothetical
7
8 which limited Plaintiff from “assembly-line pace” or “fast-paced work.”
9 The Court notes that again, Plaintiff does not specify any actual
10
information contained in the DOT that indicates the position is a
11
production rate job, nor again does she offer any conflicting opinion
12
from a qualified vocational expert. Instead, Plaintiff relies upon the
13
vague assertion that many such positions “have a certain number of
14
15 items to be tagged per hour – which could be considered production-
16 paced.”114
17
The Court concludes that without evidence or a conflicting
18
professional opinion that the ALJ erred in relying upon the VE’s
19
testimony the Court cannot find the ALJ to have committed error in
20
21
22
114 ECF No. 8.
23
1 doing so based solely on Plaintiff’s non-expert assertions. The simple
2 fact that a job is a “production-type” job does not necessarily lead to the
3
conclusion that it is “fast-paced.” There is nothing in the DOT that
4
indicates that the position of marker is “fast-paced.”
5
With regard to the last of the three jobs identified, that of a small
6
products assembler, Plaintiff argues that because the job is to be
7
8 performed on an assembly line it is inherently to be performed at an
9 “assembly-line pace.” But the DOT is not as clear as Plaintiff asserts.
10
The position is one performed “as part of an assembly group.”
11
The Court agrees with the Commissioner that even if the third
12
position identified is performed on an assembly-line and the Court
13
were to accept Plaintiff’s argument that it is thus performed at
14
15 “assembly-line pace” this is not consequential error, because the two
16 prior positions identified constitute a substantial number of jobs
17
available in the national economy, with a total of 228,000 for the two
18
jobs.
19
In this instance, the Court concludes that the ALJ properly
20
considered the VE testimony and found that there were a substantial
21
22
23
1 number of jobs available in the national economy that fit within
2 Plaintiff’s RFC.
3
The Court declines to remand as to this issue.
4
5. Summary
5
It is the ALJ’s responsibility to review and evaluate the
6
7 conflicting evidence.115 The ALJ queried the VE as to any potential
8 conflict between his testimony and the DOT and meaningfully
9
explained why she accepted the VE’s testimony that he resolved the
10
conflicts on the basis of his professional experience and judgment.
11
IV. Conclusion
12
Accordingly, IT IS HEREBY ORDERED:
13
14 1. The ALJ’s nondisability decision is AFFIRMED.
15 2. The Clerk’s Office shall TERM the parties’ briefs, ECF
16
Nos. 8 and 9, enter JUDGMENT in favor of Defendant,
17
and CLOSE the case.
18
IT IS SO ORDERED. The Clerk’s Office is directed to file this
19
order and provide copies to all counsel.
20
21
22
115 Tackett v. Apfel, 180 F.3d 1094, 1102 (9th Cir. 1999).
23
1 DATED this 9** day of July 2025.
Mred The
° EDWARD F.SHEA
4 Senior United States District Judge
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DISPOSITIVE ORDER, - 44