Leslie Woods v. Kilolo Kijakazi

FOR PUBLICATION

UNITED STATES COURT OF APPEALS

FOR THE NINTH CIRCUIT

LESLIE WOODS, No. 21-35458

Plaintiff-Appellant,

D.C. No.

v. 3:20-cv-00805-

BR

KILOLO KIJAKAZI, Acting

Commissioner of Social Security,

Defendant-Appellee. OPINION

Appeal from the United States District Court

for the District of Oregon

Anna J. Brown, District Judge, Presiding

Submitted March 8, 2022 *

Seattle, Washington

Filed April 22, 2022

Before: Jacqueline H. Nguyen, Eric D. Miller, and

Patrick J. Bumatay, Circuit Judges.

Opinion by Judge Nguyen

*

The panel unanimously concludes this case is suitable for decision

without oral argument. See Fed. R. App. P. 34(a)(2).

2 WOODS V. KIJAKAZI

SUMMARY **

Social Security

The panel affirmed the district court’s decision affirming

the Commissioner of Social Security’s denial of claimant’s

application for benefits under the Social Security Act based

on various physical and mental impairments.

As a threshold matter, the panel held that recent changes

to the Social Security Administration’s regulations displaced

longstanding case law requiring an administrative law judge

(“ALJ”) to provide “specific and legitimate” reasons for

rejecting an examining doctor’s opinion. For claims filed on

or after March 27, 2017, that are subject to the new

regulations, the former hierarchy of medical opinions – in

which the court assigned presumptive weight based on the

extent of the doctor’s relationship with the claimant – no

longer applies. While the panel agreed with the government

that the “specific and legitimate” standard was clearly

irreconcilable with the 2017 regulations, the panel held that

the extent of the claimant’s relationship with the medical

provider – the “relationship factors” – remained relevant

under the new regulations. An ALJ can still consider the

length and purpose of the treatment relationship, the

frequency of examinations, the kinds and extent of

examinations that the medical source has performed or

ordered from specialists, and whether the medical source has

examined the claimant or merely reviewed the claimant’s

records. However, the ALJ no longer needs to make specific

findings regarding those relationship factors. Even under the

**

This summary constitutes no part of the opinion of the court. It

has been prepared by court staff for the convenience of the reader.

WOODS V. KIJAKAZI 3

new regulations, an ALJ cannot reject an examining or

treating doctor’s opinion as unsupported or inconsistent

without providing an explanation supported by substantial

evidence.

Here, the ALJ acknowledged Dr. Causeya’s opinion that

the claimant had marked and extreme limitations in various

cognitive areas, including memory and concentration; but

the ALJ found this opinion unpersuasive because it was

inconsistent with the overall treating notes and mental status

exams in the record. The panel held that substantial

evidence supported the ALJ’s inconsistency finding.

The panel rejected claimant’s contention that the ALJ

failed to consider all her physical and mental limitations that

are supported by the record. Because substantial evidence

supported the ALJ’s decision here, the panel affirmed.

COUNSEL

George Joseph Wall, Law Offices of George J. Wall,

Portland, Oregon, for Plaintiff-Appellant.

Willy Le, Acting Regional Chief Counsel, Seattle Region X;

Jeffrey E. Staples, Assistant Regional Counsel; Office of

General Counsel, Social Security Administration, Seattle,

Washington; Scott Erik Asphaug, United States Attorney;

Renata Gowie, Civil Division Chief; United States

Attorney’s Office, Portland, Oregon; for Defendant-

Appellee.

4 WOODS V. KIJAKAZI

OPINION

NGUYEN, Circuit Judge:

Leslie Woods seeks benefits under the Social Security

Act based on various physical and mental impairments. An

administrative law judge (“ALJ”) found that she was not

disabled and denied her claim. The district court affirmed.

As a threshold matter, we must decide whether recent

changes to the Social Security Administration’s regulations

displace our longstanding case law requiring an ALJ to

provide “specific and legitimate” reasons for rejecting an

examining doctor’s opinion. We conclude that they do. For

claims subject to the new regulations, the former hierarchy

of medical opinions—in which we assign presumptive

weight based on the extent of the doctor’s relationship with

the claimant—no longer applies. Now, an ALJ’s decision,

including the decision to discredit any medical opinion, must

simply be supported by substantial evidence. Because

substantial evidence supports the ALJ’s decision here, we

affirm.

I.

Woods applied for disability insurance benefits and

supplemental security income in July 2017. See 42 U.S.C.

§§ 423, 1381a, 1395i-2a. The agency denied her claim

initially and on reconsideration. Following a hearing on

Woods’s administrative appeal, the ALJ determined that she

was not disabled.

WOODS V. KIJAKAZI 5

At step two of the analysis, 1 the ALJ concluded that

Woods had two severe impairments: cervical degenerative

disc disease and osteoarthritis involving the hip and knees.

The ALJ concluded that Woods’s other reported

impairments—including small fiber neuropathy, anterior

tibialis tendonitis of the right leg, venous insufficiency,

carpal tunnel syndrome, obesity, hypertension, depression,

and anxiety—were not severe. In reaching this conclusion,

the ALJ rejected the opinion of Dr. Karla Rae Causeya, a

psychologist who examined Woods and assessed her ability

to work. Dr. Causeya evaluated Woods to have “marked and

extreme limitations in a number of areas of understanding,

remembering or applying information, interacting with

1

The recent changes to the Social Security regulations did not affect

the familiar “five-step sequential evaluation process.” 20 C.F.R.

§ 404.1520(a)(1) (disability insurance benefits); see also id.

§ 416.920(a)(4) (same standard for supplemental security income). This

process ends when the ALJ can make a finding that the claimant is or is

not disabled. Id. § 404.1520(a)(4). At the first step, a claimant “doing

substantial gainful [work] activity” is not disabled. Id.

§ 404.1520(a)(4)(i). At the second step, a claimant is not disabled unless

she has a “medically determinable physical or mental impairment” or

combination of impairments that is severe and either lasts at least a year

or can be expected to result in death. Id. § 404.1520(a)(4)(ii); see also

42 U.S.C. §§ 423(d)(1), 1382c(a)(3)(C)(i). At the third step, a claimant

is disabled if the severity of her impairments meets or equals one of

various impairments listed by the Commissioner of Social Security,

20 C.F.R. pt. 404, subpt. P, app. 1. See 20 C.F.R. § 404.1520(a)(4)(iii).

At the fourth step, a claimant is not disabled if her residual functional

capacity allows her to perform her past relevant work. Id.

§ 404.1520(a)(4)(iv). At the fifth step, a claimant is disabled if, given

her residual functional capacity, age, education, and work experience,

she cannot make an adjustment to other work that “exists in significant

numbers in the national economy,” id. § 404.1560(c)(2). See id.

§ 404.1520(a)(4)(v).

6 WOODS V. KIJAKAZI

others, concentrating, persisting and maintaining pace, and

adaptation.”

At step four of the analysis, the ALJ concluded that

Woods had the residual functional capacity to perform “light

work” with minor limitations. Based on this finding, the

ALJ found that Woods could perform her past relevant work

as a cosmetologist and hairstylist.

The Appeals Council denied review of the ALJ’s

decision. Woods then sought judicial review. The district

court, reviewing the ALJ’s decision, affirmed the agency’s

denial of benefits.

II.

We have jurisdiction under 28 U.S.C. § 1291. We

review the district court’s order affirming the ALJ’s denial

of social security benefits de novo, and we will not overturn

the Commissioner’s decision “unless it is either not

supported by substantial evidence or is based upon legal

error.” Luther v. Berryhill, 891 F.3d 872, 875 (9th Cir.

2018). Under the substantial-evidence standard, we look to

the existing administrative record and ask “whether it

contains ‘sufficient evidence’ to support the agency’s factual

determinations.” Biestek v. Berryhill, 139 S. Ct. 1148, 1154

(2019) (cleaned up) (quoting Consol. Edison Co. of N.Y. v.

NLRB, 305 U.S. 197, 229 (1938)). “Substantial” means

“more than a mere scintilla” but only “such relevant

evidence as a reasonable mind might accept as adequate to

support a conclusion.” Id. (quoting Consol. Edison,

305 U.S. at 229). “Where evidence is susceptible to more

than one rational interpretation, it is the ALJ’s conclusion

that must be upheld.” Burch v. Barnhart, 400 F.3d 676, 679

(9th Cir. 2005).

WOODS V. KIJAKAZI 7

III.

Woods contends that the ALJ improperly rejected the

opinion of her examining physician, Dr. Causeya, that she

has memory and concentration impairments. The ALJ found

that Dr. Causeya’s opinion conflicted with evidence from

other medical sources. But before turning to the merits of

this claim, we must first resolve the parties’ dispute over the

applicable legal standard.

Woods argues that the ALJ erred in rejecting

Dr. Causeya’s opinion by failing to provide “specific and

legitimate reasons that are supported by substantial evidence

in the record.” Lester v. Chater, 81 F.3d 821, 830–31 (9th

Cir. 1996). The government counters that changes to the

Social Security regulations in 2017 “eliminate any

semblance of a hierarchy of medical opinions and state that

the agency does not defer to any medical opinions, even

those from treating sources.” We agree with the

government.

A.

For nearly 40 years, we have weighed medical opinions

based on the extent of the doctor’s relationship with the

claimant. 2 We categorized these relationships in a three-

2

Although we refer to doctors for convenience, our discussion

applies to evidence from any “acceptable medical source,” which

includes medical professionals other than physicians, such as

psychologists and certain advanced practice nurses and physician

assistants. See 20 C.F.R. § 404.1502(a)(2), (7), (8); see also id.

§ 404.1527(a)(1) (former regulation defining “medical opinions” as

“statements from acceptable medical sources that reflect judgments

about the nature and severity of [a claimant’s] impairment(s)”); id.

§ 404.1521 (current regulation requiring “objective medical evidence

from an acceptable medical source”).

8 WOODS V. KIJAKAZI

tiered hierarchy. See Smith v. Kijakazi, 14 F.4th 1108, 1114

(9th Cir. 2021). At the top are treating physicians. These

medical sources treat or evaluate the claimant and have an

ongoing treatment relationship with her. See 20 C.F.R.

§ 404.1527(a)(2); Benton ex rel. Benton v. Barnhart,

331 F.3d 1030, 1036–38 (9th Cir. 2003).

A treating physician’s opinion is entitled to “substantial

weight,” Ford v. Saul, 950 F.3d 1141, 1154 (9th Cir. 2020)

(quoting Embrey v. Bowen, 849 F.2d 418, 422 (9th Cir.

1988)), and we generally give it “more weight . . . than . . .

the opinion of doctors who do not treat the claimant,” Lester,

81 F.3d at 830. This deference “is based not only on the fact

that [a treating physician] is employed to cure but also on

[the physician’s] greater opportunity to observe and know

the patient as an individual.” Murray v. Heckler, 722 F.2d

499, 502 (9th Cir. 1983) (quoting Bowman v. Heckler,

706 F.2d 564, 568 (5th Cir. 1983)); see also 20 C.F.R.

§ 404.1527(c)(2) (“[Y]our treating sources . . . are likely to

be the medical professionals most able to provide a detailed,

longitudinal picture of your medical impairment(s) and may

bring a unique perspective to the medical evidence that

cannot be obtained from the objective medical findings alone

or from reports of individual examinations . . . .”).

In the middle tier are doctors who examine the claimant

but do not have an ongoing relationship with her. “The

opinion of an examining physician is . . . entitled to greater

weight than the opinion of a nonexamining physician.”

Ford, 950 F.3d at 1155 (quoting Lester, 81 F.3d at 830); see

20 C.F.R. § 404.1527(c)(1).

To reject either a treating or an examining physician’s

opinion, an ALJ must provide “clear and convincing

reasons,” if the opinion is uncontradicted by other evidence,

or “specific and legitimate reasons” otherwise, and the

WOODS V. KIJAKAZI 9

reasons must be supported by substantial evidence. Revels

v. Berryhill, 874 F.3d 648, 654 (9th Cir. 2017) (quoting Ryan

v. Comm’r of Soc. Sec., 528 F.3d 1194, 1198 (9th Cir.

2008)).

The lowest-weighted tier comprises “physicians who

only review the record.” Benton, 331 F.3d at 1036. “The

opinion of a nonexamining physician cannot by itself

constitute substantial evidence that justifies the rejection of

the opinion of either an examining physician or a treating

physician.” Lester, 81 F.3d at 831.

B.

The new regulations apply to Woods because she filed

her claim on or after March 27, 2017. See Revisions to Rules

Regarding the Evaluation of Medical Evidence, 82 Fed. Reg.

5844, 5844 (Jan. 18, 2017) (codified at 20 C.F.R. pts. 404 &

416). We must therefore decide whether, as Woods argues,

“the ‘specific and legitimate’ standard still applies under the

new rules.”

Our precedent controls unless its “reasoning or theory

. . . is clearly irreconcilable with the reasoning or theory of

intervening higher authority,” which in this case is the

agency’s updated regulations. Lambert v. Saul, 980 F.3d

1266, 1274 (9th Cir. 2020) (quoting Miller v. Gammie,

335 F.3d 889, 893 (9th Cir. 2003) (en banc)). While we

agree with the government that the “specific and legitimate”

standard is clearly irreconcilable with the 2017 regulations,

the extent of the claimant’s relationship with the medical

provider—what we will refer to as “relationship factors”—

remains relevant under the new regulations.

10 WOODS V. KIJAKAZI

1.

The Social Security Act provides no guidance as to how

the agency should evaluate medical evidence. It merely

directs the Commissioner of Social Security “to make

findings of fact” and discuss “the evidence . . . and the

reason or reasons upon which [any unfavorable decision] is

based.” 42 U.S.C. §§ 405(b)(1), 1383(c)(1)(A). And it

provides that the Commissioner’s “findings . . . as to any fact

. . . shall be conclusive” on judicial review “if supported by

substantial evidence.” Id. § 405(g).

The Commissioner has wide latitude “to make rules and

regulations and to establish procedures . . . to carry out [the

statutory] provisions,” in particular regulations governing

“the nature and extent of the proofs and evidence . . . to

establish the right to benefits.” Id. § 405(a); see Bowen v.

Yuckert, 482 U.S. 137, 145 (1987) (observing that the

agency has “exceptionally broad authority” to promulgate

evidentiary rules, which therefore may be set aside only if

they exceed the agency’s statutory authority or are arbitrary

and capricious). 3 The statute directs the claimant to furnish

whatever “medical and other evidence of [disability]” the

Commissioner “may require,” and it directs the

Commissioner to consider “[o]bjective medical evidence of

3

In this case, the issue is one of adherence to our own precedent

rather than deference to the agency. Woods does not argue that the 2017

regulations exceed the agency’s statutory authority or are arbitrary and

capricious. See Yuckert, 482 U.S. at 145. Whether our caselaw is clearly

irreconcilable with the 2017 regulations is not a question entrusted to the

agency’s expertise. See Acosta v. Gonzales, 439 F.3d 550, 553 n.4 (9th

Cir. 2006) (“[A]n agency is not owed deference when the issue is the

interpretation of Circuit law rather than the statute.”), overruled on other

grounds by Garfias-Rodriguez v. Holder, 702 F.3d 504, 514 (9th Cir.

2012) (en banc).

WOODS V. KIJAKAZI 11

pain or other symptoms established by medically acceptable

clinical or laboratory techniques.” 42 U.S.C.

§ 423(d)(5)(A). Beyond that, how to evaluate the evidence

is up to the agency.

The agency formalized the prior rule emphasizing

relationship factors in 1991, see Standards for Consultative

Examinations and Existing Medical Evidence, 56 Fed. Reg.

36,932 (Aug. 1, 1991), but the rule’s genesis was a series of

court decisions. See id. at 36,934 (“[T]he majority of the

circuit courts generally agree on two basic principles. First

. . . [,] treating source evidence tends to have a special

intrinsic value . . . . Second . . . [,] if the [Commissioner]

decides to reject such an opinion, he should provide the

claimant with good reasons for doing so. We have been

guided by these principles in our development of the final

rule.”); see also Revisions to Rules Regarding the

Evaluation of Medical Evidence, 81 Fed. Reg. 62,560,

62,572 (Sept. 9, 2016) (explaining that the agency

promulgated the 1991 rule “to create a uniform national

policy about how to consider medical opinions from treating

physicians”).

One of those decisions was Murray, where we joined the

Second, Fifth, and Sixth Circuits “in giving greater weight

to the opinions of treating physicians.” Murray, 722 F.2d

at 501 (citing Bowman, 706 F.2d at 568 & n.3; Allen v.

Califano, 613 F.2d 139, 145 (6th Cir. 1980); McLaughlin v.

Sec’y of Health, Educ. & Welfare, 612 F.2d 701, 705 (2d Cir.

1980)). In accordance with that principle, Murry established

the “specific and legitimate” standard: “If the ALJ wishes to

disregard the opinion of the treating physician, he or she

must make findings setting forth specific, legitimate reasons

for doing so that are based on substantial evidence in the

record.” Id. at 502.

12 WOODS V. KIJAKAZI

Under the 1991 rule, an ALJ gives “more weight to the

medical opinion of a source who has examined [the

claimant] than to the medical opinion of a medical source

who has not examined [her].” 20 C.F.R. § 404.1527(c)(1).

In addition, the ALJ gives “more weight to medical opinions

from [the claimant’s] treating sources, since these sources

are likely to be the medical professionals most able to

provide a detailed, longitudinal picture of [her] medical

impairment(s).” Id. § 404.1527(c)(2).

2.

The agency revised the rules for evaluating medical

evidence in 2017 to resolve several “adjudicative issues.”

Revisions to Rules Regarding the Evaluation of Medical

Evidence, 81 Fed. Reg. at 62,572. To begin with, ALJs often

needed “to make a large number of findings” to avoid a

remand for “failure to weigh properly one of the many

medical opinions in a record.” Id. Courts sometimes

“focused more on whether [the agency] sufficiently

articulated the weight [it] gave treating source opinions

rather than on whether substantial evidence supports the

Commissioner’s final decision.” Id. The agency also had

concerns that “the treating physician rule’s built-in

evidentiary bias in favor of treating physicians may

influence treating sources to favor a finding of disabled.” Id.

at 62,572–73 (citing Black & Decker Disability Plan v.

Nord, 538 U.S. 822, 832 (2003)).

In addition, the agency disagreed with our practice of

“combin[ing] the treating physician rule with [our] credit-as-

true rule” whereby we sometimes remanded with an order to

award benefits if the ALJ provided insufficient reasons for

rejecting a treating source opinion. Id. at 62,573. This

practice “prevent[ed] [the agency] from reconsidering the

WOODS V. KIJAKAZI 13

evidence in the record as a whole and correcting any errors.”

Id.

Lastly, the agency expressed doubts about “the

presumption that a claimant’s sole treating physician

generally has the longitudinal knowledge and a unique

perspective about his or her patient’s impairments that

objective medical evidence alone cannot provide.” Id. The

agency found this presumption “less persuasive” than it had

been 25 years earlier due to “changes in the national

healthcare workforce and in the manner in which many

people now receive primary medical care.” Id.

Under the revised regulations, “there is not an inherent

persuasiveness to evidence from [government consultants]

over [a claimant’s] own medical source(s), and vice versa.”

Revisions to Rules Regarding the Evaluation of Medical

Evidence, 82 Fed. Reg. at 5844. “The most important

factors” that the agency considers when evaluating the

persuasiveness of medical opinions are “supportability” and

“consistency.” 20 C.F.R. § 404.1520c(a). Supportability

means the extent to which a medical source supports the

medical opinion by explaining the “relevant . . . objective

medical evidence.” Id. § 404.1520c(c)(1). Consistency

means the extent to which a medical opinion is “consistent

. . . with the evidence from other medical sources and

nonmedical sources in the claim.” Id. § 404.1520c(c)(2).

The revised regulations recognize that a medical

source’s relationship with the claimant is still relevant when

assessing the persuasiveness of the source’s opinion. See id.

§ 404.1520c(c)(3). Thus, an ALJ can still consider the

length and purpose of the treatment relationship, the

frequency of examinations, the kinds and extent of

examinations that the medical source has performed or

ordered from specialists, and whether the medical source has

14 WOODS V. KIJAKAZI

examined the claimant or merely reviewed the claimant’s

records. Id. § 404.1520c(c)(3)(i)–(v). However, the ALJ no

longer needs to make specific findings regarding these

relationship factors:

[W]e will explain how we considered the

supportability and consistency factors for a

medical source’s medical opinions . . . in

your determination or decision. We may, but

are not required to, explain how we

considered the [relationship] factors . . .

when we articulate how we consider medical

opinions . . . in your case record.

Id. § 404.1520c(b)(2) (emphasis added).

A discussion of relationship factors may be appropriate

when “two or more medical opinions . . . about the same

issue are . . . equally well-supported . . . and consistent with

the record . . . but are not exactly the same.” Id.

§ 404.1520c(b)(3). In that case, the ALJ “will articulate how

[the agency] considered the other most persuasive factors.”

Id. Other factors include relationship factors, id.

§ 404.1520c(c)(3), whether the medical source’s opinion

concerns “medical issues related to his or her area of

specialty,” id. § 404.1520c(c)(4), and any “other factors that

tend to support or contradict [the] medical opinion,” id.

§ 404.1520c(c)(5).

3.

The revised social security regulations are clearly

irreconcilable with our caselaw according special deference

to the opinions of treating and examining physicians on

account of their relationship with the claimant. See

20 C.F.R. § 404.1520c(a) (“We will not defer or give any

WOODS V. KIJAKAZI 15

specific evidentiary weight, including controlling weight, to

any medical opinion(s) . . . , including those from your

medical sources.”). Our requirement that ALJs provide

“specific and legitimate reasons” for rejecting a treating or

examining doctor’s opinion, which stems from the special

weight given to such opinions, see Murray, 722 F.2d at 501–

02, is likewise incompatible with the revised regulations.

Insisting that ALJs provide a more robust explanation when

discrediting evidence from certain sources necessarily

favors the evidence from those sources—contrary to the

revised regulations.

Even under the new regulations, an ALJ cannot reject an

examining or treating doctor’s opinion as unsupported or

inconsistent without providing an explanation supported by

substantial evidence. The agency must “articulate . . . how

persuasive” it finds “all of the medical opinions” from each

doctor or other source, 20 C.F.R. § 404.1520c(b), and

“explain how [it] considered the supportability and

consistency factors” in reaching these findings, id.

§ 404.1520c(b)(2).

C.

Here, the ALJ acknowledged Dr. Causeya’s opinion that

Woods has marked and extreme limitations in various

cognitive areas, including memory and concentration. The

ALJ found this opinion unpersuasive because it was

inconsistent with the overall treating notes and mental status

exams in the record. 4 Substantial evidence supports the

ALJ’s inconsistency finding.

4

The ALJ described Dr. Causeya’s opinion as “not supported by”

the record, but the ALJ plainly did not intend to make a supportability

16 WOODS V. KIJAKAZI

The ALJ pointed to Dr. Mischelle McMillan’s February

2018 observation that Woods’s “[c]ognition and memory are

normal.” The ALJ also noted the inconsistency between Dr.

Causeya’s opinion that Woods cannot obtain or maintain

gainful employment and “the fact that [Woods’s] income has

not significantly declined since her alleged onset date”

despite her having “the additional duties of caring for . . . a

[13-year-old] and dealing with her [80-year-old] mother’s

medical issues.”

The evidence on which Woods relies does not show that

she has severe difficulties in attention, concentration, or

memory. For example, on five occasions in 2018, Nurse

Practitioner Anne Pollock assessed Woods to have good or

fair attention and concentration and normal memory.

Most of the psychological evidence that Woods cites is

treatment notes from Licensed Professional Counselor Heidi

Bermeosolo. These treatment notes do not discuss Woods’s

attention, concentration, or memory at all. Rather, they

concern, as the ALJ summarized, “situational stressors that

cause [Woods] distress,” such as Woods’s “fight[s] with

[the] granddaughter” whom Woods was raising and

Woods’s “mother’s health.” Although Bermeosolo checked

a box on a letter to Woods’s attorney indicating that she

concurred with Dr. Causeya’s psychological assessment,

Bermeosolo’s concurring opinion is wholly unexplained and

finding. Dr. Causeya supported her opinion with “relevant . . . objective

medical evidence and supporting explanations,” 20 C.F.R.

§ 404.1520c(c)(1), and the ALJ did not suggest otherwise. Rather, the

ALJ meant only that Dr. Causeya’s opinion was inconsistent with other

record evidence. Although the ALJ’s meaning here is clear from context,

to avoid confusion in future cases, ALJs should endeavor to use these

two terms of art—“consistent” and “supported”—with precision.

WOODS V. KIJAKAZI 17

thus unsupported. The ALJ reasonably rejected it. See Ford,

950 F.3d at 1155.

IV.

Woods also contends that the ALJ failed to consider all

her physical and mental limitations that are supported by the

record. In assessing Woods’s residual functional capacity,

the ALJ was required to “consider all of [her known]

medically determinable impairments . . . , including [those]

that are not ‘severe.’” 20 C.F.R. § 404.1545(a)(2).

A.

The ALJ found that Woods can perform “light work”

with frequent balancing, stooping, crouching, crawling, and

reaching overhead, but only occasional climbing. In general,

light work “requires a good deal of walking or standing” and

“frequent lifting or carrying of objects weighing up to

10 pounds” but “no more than 20 pounds at a time.”

20 C.F.R. § 404.1567(b).

Woods asserts that the ALJ “[did] not consider the

evidence that prolonged standing exacerbates the pain and

swelling in [her] legs and feet.” To the contrary, the ALJ

acknowledged her testimony that “if she works too much one

day, she is down for . . . 3 or 4 days” as well as her statement

to a family nurse practitioner that she “had to space . . . out”

her three daily clients. The ALJ reasonably discounted

Woods’s “statements concerning the intensity, persistence

and limiting effects” of her pain and swelling as “not entirely

consistent with the medical evidence and other evidence in

the record.”

Nor did the ALJ limit his consideration, as Woods

suggests, to her own subjective statements about her

18 WOODS V. KIJAKAZI

physical impairments. For example, the ALJ addressed the

opinion of Certified Nurse Practitioner Lindsay McGinnis

that Woods should not stand or walk for more than four

hours in a workday and needs to sit for 30 minutes every two

hours. McGinnis expressed these limitations on a fill-in-the-

blank questionnaire from Woods’s attorney. The ALJ found

McGinnis’s opinion “not persuasive because it is not

supported by any explanation” or “pertinent exam findings.”

The ALJ also found McGinnis’s opinion “inconsistent

with the objective treating record, exam findings and

imaging,” as well as Woods’s “work activities combined

with her parenting and other activities.” In particular, the

ALJ cited the “fairly benign” results of an MRI examining

Woods’s cervical spine and the “very conservative[]”

treatment of her symptoms—“mostly with medication alone

until she received a left knee injection in December of

2018.” Substantial record evidence supports these findings.

B.

Woods faults the ALJ for including no mental limitations

in her residual functional capacity because, she asserts, her

psycho-diagnostic evaluation and two years of mental health

treatment records document problems with mood, anxiety,

memory, and concentration. The ALJ was required to

“assess the nature and extent of [her] mental limitations and

restrictions” and whether they “reduce [her] ability to do past

work and other work.” 20 C.F.R. § 404.1545(c).

The ALJ considered Woods’s mental health records and

assessed her mental functioning in four broad areas known

as the “paragraph B” criteria. See 20 C.F.R. pt. 404, subpt.

P, app. 1 § 12.00.A.2.b. The ALJ found that Woods had

“mild limitation[s]” in two of the criteria—“understanding,

remembering, or applying information” and “concentrating,

WOODS V. KIJAKAZI 19

persisting, or maintaining pace.” The ALJ found that Woods

had “no limitation[s]” in the other two paragraph B

criteria—“interacting with others” and “adapting or

managing oneself.” The ALJ’s assessment of her residual

functional capacity expressly reflected these limitations.

Woods does not identify any particular evidence that the

ALJ failed to consider or explain why the record does not

support the ALJ’s findings regarding her mental functioning.

The ALJ considered and reasonably rejected the more severe

limitations prescribed by Dr. Causeya. As for Woods’s

remaining treatment record, the ALJ characterized it as “not

reflect[ing] any significant complaints of mental health

symptoms.” This characterization is well supported by the

record.

AFFIRMED.