explaining that the ALJ is responsible 15 for resolving conflicts in the medical evidence and resolving ambiguities
How later courts described this case
- explaining that the ALJ is responsible 15 for resolving conflicts in the medical evidence and resolving ambiguities
- “[s]ubstantial evidence is 24 more than a mere scintilla but less than a preponderance”
- “The revised social security regulations are 20 clearly irreconcilable with our caselaw according special deference to the opinions 21 of treating and examining physicians on account of their relationship with the 22 claimant.”
- finding that an ALJ properly discounted a 9 treating physician’s opinion for being “so extreme as to be implausible” and “not 10 supported by any findings” where there was “no indication in the record” as to the 11 basis for the opinion
Written by the judges who cited it.
The opinion
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8 UNITED STATES DISTRICT COURT
9 CENTRAL DISTRICT OF CALIFORNIA
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STEVEN R.,1
11 Case No. 5:22-cv-02173-GJS
Plaintiff
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v.
13 MEMORANDUM OPINION AND
KILOLO KIJAKAJI, Acting ORDER
14 Commissioner of Social Security,
15 Defendant.
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18 I. PROCEDURAL HISTORY
19 Plaintiff Steven R. (“Plaintiff”) filed a complaint seeking review of the
20 decision of the Commissioner of Social Security denying his application for
21 Disability Insurance Benefits (“DIB”). The parties filed consents to proceed before
22 a United States Magistrate Judge [Dkt. 7, 9, and 20] and motions for summary
23 judgment [Dkt. 14 (Pl. Br.), 17 (Def. Br.), and 18 (Response)] addressing disputed
24 issues in the case. The matter is now ready for decision. For the reasons set forth
25 below, the Court finds that this matter should be affirmed.
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27 1 In the interest of privacy, this Order uses only the first name and the last
initial of the non-governmental party.
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1 II. ADMINISTRATIVE DECISION UNDER REVIEW
2 Plaintiff filed an application for DIB on August 24, 2020, alleging disability
3 beginning July 18, 2018. [Dkt. 13, Administrative Record (“AR”) 10, 221-22.]
4 Plaintiff’s application was denied at the initial level of review and on
5 reconsideration. [AR 10, 109-13, 120-32.] A telephone hearing was held before
6 Administrative Law Judge Daniel Benjamin (“the ALJ”) on January 13, 2022. [AR
7 10, 25-69.]
8 On February 14, 2022, the ALJ issued an unfavorable decision applying the
9 five-step sequential evaluation for assessing disability. [AR 10-19]; see 20 C.F.R. §
10 404.1520(b)-(g)(1). At step one, the ALJ determined that Plaintiff engaged in
11 substantial gainful activity from the alleged onset date through December 2018, but
12 did not engage in substantial gainful activity from January 2019 through the date of
13 the ALJ’s decision. [AR 12.] At step two, the ALJ determined that Plaintiff has the
14 following severe impairments: obesity; asthma/chronic obstructive pulmonary
15 disorder; right knee degenerative joint disease; chronic fatigue syndrome;
16 obstructive sleep apnea; gastrointestinal reflux disease (GERD); cervical spine
17 degenerative disc disease; and lumbar spine degenerative disc disease. [AR 13.] At
18 step three, the ALJ determined that Plaintiff does not have an impairment or
19 combination of impairments that meets or medically equals the severity of one of
20 the impairments listed in Appendix I of the Regulations. [AR 14]; see 20 C.F.R. Pt.
21 404, Subpt. P, App. 1. Next, the ALJ found that Plaintiff has the residual functional
22 capacity (“RFC”) to perform light work, as defined in 20 C.F.R. § 404.1567(b),
23 except Plaintiff can occasionally climb ramps and stairs, balance, stoop, kneel
24 crouch, and crawl, frequently push and pull with the right lower extremity, and
25 occasionally be exposed to extremes of cold and heat and pulmonary irritants, but
26 Plaintiff cannot climb ladders, ropes, or scaffolds or be exposed to unprotected
27 heights or hazardous moving machinery parts. [AR 14-15.] At step four, the ALJ
28 determined that Plaintiff is capable of performing his past relevant work as a
1 construction estimator. [AR 18-19.] Therefore, the ALJ concluded that Plaintiff
2 was not under a disability from July 18, 2018, through the date of the decision. [AR
3 19.]
4 The Appeals Council denied review of the ALJ’s decision on October 31,
5 2022. [AR 1-6.] This action followed.
6 Plaintiff raises the following issues challenging the ALJ’s findings and
7 determination of non-disability:
8 1. The ALJ failed to properly evaluate the opinions of Plaintiff’s
9 physicians. [Pl. Br. at 5-11.]
10 2. The ALJ failed to properly evaluate Plaintiff’s RFC. [Pl. Br. at 11-13.]
11 The Commissioner asserts that the ALJ’s decision is supported by substantial
12 evidence and should be affirmed. [Def. Br. at 2-15.]
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14 III. GOVERNING STANDARD
15 Under 42 U.S.C. § 405(g), the Court reviews the Commissioner’s decision to
16 determine if: (1) the Commissioner’s findings are supported by substantial
17 evidence; and (2) the Commissioner used correct legal standards. See Carmickle v.
18 Comm’r Soc. Sec. Admin., 533 F.3d 1155, 1159 (9th Cir. 2008); Brewes v. Comm’r
19 Soc. Sec. Admin., 682 F.3d 1157, 1161 (9th Cir. 2012). “Substantial evidence … is
20 ‘more than a mere scintilla’ … [i]t means – and only means – ‘such relevant
21 evidence as a reasonable mind might accept as adequate to support a conclusion.’”
22 Biestek v. Berryhill, 139 S. Ct. 1148, 1154 (2019) (citations omitted); Gutierrez v.
23 Comm’r of Soc. Sec., 740 F.3d 519, 522 (9th Cir. 2014) (“[s]ubstantial evidence is
24 more than a mere scintilla but less than a preponderance”) (internal quotation marks
25 and citation omitted).
26 The Court will uphold the Commissioner’s decision when “‘the evidence is
27 susceptible to more than one rational interpretation.’” Burch v. Barnhart, 400 F.3d
28 676, 681 (9th Cir. 2005) (quoting Magallanes v. Bowen, 881 F.2d 747, 750 (9th Cir.
1 1989)). However, the Court may review only the reasons stated by the ALJ in the
2 decision “and may not affirm the ALJ on a ground upon which he did not rely.”
3 Orn v. Astrue, 495 F.3d 625, 630 (9th Cir. 2007). The Court will not reverse the
4 Commissioner’s decision if it is based on harmless error, which exists if the error is
5 “inconsequential to the ultimate nondisability determination, or that, despite the
6 error, the agency’s path may reasonably be discerned.” Brown-Hunter v. Colvin,
7 806 F.3d 487, 492 (9th Cir. 2015) (internal quotation marks and citations omitted).
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IV. DISCUSSION
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A. Opinion Evidence
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Plaintiff contends the ALJ improperly evaluated the opinions of his treating
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physicians. For claims filed on or after March 27, 2017, 20 C.F.R. § 404.1520c
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governs how an ALJ must evaluate medical opinion evidence. See Revisions to
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Rules Regarding the Evaluation of Medical Evidence, 82 Fed. Reg. 5844 (Jan. 18,
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2017). Under the new regulations, ALJs articulate how “persuasive” they find the
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medical opinions and prior administrative medical findings to be. 20 C.F.R. §
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404.1520c(a)-(b). The new regulations eliminate the hierarchy of medical opinions
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and state that the agency will not defer to any particular medical opinions, even
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those from treating sources. 20 C.F.R. § 404.1520c(a); see also Woods v. Kijakazi,
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32 F.4th 785, 792 (9th Cir. 2022) (“The revised social security regulations are
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clearly irreconcilable with our caselaw according special deference to the opinions
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of treating and examining physicians on account of their relationship with the
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claimant.”). Under the new regulations, the ALJ primarily considers the
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“supportability” and “consistency” of an opinion in determining whether the opinion
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is persuasive. 20 C.F.R. § 404.1520c(c). “Supportability means the extent to which
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a medical source supports the medical opinion by explaining the ‘relevant ...
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objective medical evidence.’” Woods, 32 F.4th at 791-92 (quoting 20 C.F.R. §
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404.1520c(c)(1)). “Consistency means the extent to which a medical opinion is
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1 ‘consistent ... with the evidence from other medical sources and nonmedical sources
2 in the claim.’” Woods, 32 F.4th at 792 (quoting 20 C.F.R. § 404.1520c(c)(2)).
3 An ALJ may also consider a medical source’s relationship with the claimant
4 by looking to factors such as the length of the treatment relationship, the frequency
5 of the claimant’s examinations, the purpose of the treatment relationship, the extent
6 of the treatment relationship, and whether there is an examining relationship. See 20
7 C.F.R. § 404.1520c(c)(3). An ALJ is not, however, required to explain how these
8 secondary medical factors were considered, unless it is determined that two or more
9 medical opinions about the same issue are equally well-supported and consistent
10 with the record but not identical. See 20 C.F.R. § 404.1520c(b)(2)-(3).
11 Here, in evaluating Plaintiff’s chronic fatigue syndrome, GERD, sleep apnea,
12 and other conditions, the ALJ considered Department of Veterans Affairs (VA)
13 disability questionnaires and other supporting records from Plaintiff’s doctors, as
14 well as an August 2020 VA disability decision.2 [AR 15-17, 201-20, 409-91, 785-
15 93.] Referring to the medical sources collectively as the “Veteran’s Administration
16 doctors,”3 the ALJ determined that the opinions of Plaintiff’s doctors were “partially
17 persuasive.” [AR 17.] While Plaintiff asserts that the ALJ improperly considered
18 “all of the treating physicians together” as a group, Plaintiff specifically challenges
19 the ALJ’s evaluation of only two medical sources, Dr. Eddy Escobar and Dr.
20 Tommy Tiong-Hien Oei. [Pl. Br. at 6-7.]
21 Dr. Escobar became Plaintiff’s primary care physician at Kaiser Permanente
22 in February 2019. [AR 852.] A physical examination of Plaintiff was generally
23 normal, except Plaintiff was obese and positive for a leg rash, blood in the stool, and
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2 The VA disability decision granted Plaintiff’s appeal for Total Disability
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Individual Unemployability benefits and Dependents’ Educational Assistance. [AR
26 201-20.]
27 3 Plaintiff points out that many of the medical sources referred to the as the
“Veteran’s Administration doctors” were associated with Kaiser Permanente. [Pl.
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Br. at 7.]
1 back pain. [AR 523.] On August 28, 2019, Dr. Escobar completed a VA chronic
2 fatigue syndrome disability benefits questionnaire for Plaintiff. [AR 409-11.] Dr.
3 Escobar stated that Plaintiff stopped working full time on July 17, 2018, due to an
4 acute onset of chronic fatigue, and that his symptoms included severe fatigue,
5 pharyngitis, sore throat, post-nasal drip, general malaise, muscle aches or weakness,
6 headaches, joint pain, neuropsychologic symptoms, sleep disturbances, difficulty
7 concentrating, poor attention/focus, and short-term memory loss/forgetfulness. [AR
8 409-11.] Dr. Escobar opined that Plaintiff’s symptoms would restrict routine daily
9 activities 50 to 75 percent of pre-illness levels, result in periods of incapacitation of
10 at least six weeks per year, and prevent him from finding gainful employment. [AR
11 410.]
12 On June 17, 2019, Dr. Oei, a Kaiser Permanente gastroenterologist, diagnosed
13 Plaintiff with GERD. [AR 450, 515.] An endoscopy showed that Plaintiff’s
14 esophagus, stomach, and duodenum were within normal limits. [AR 515.] Dr. Oei
15 recommended that Plaintiff take omeprazole two times a day, try to make lifestyle
16 changes, avoid trigger foods, and sleep with the head of his bed elevated. [AR 453,
17 515.] In a VA esophageal conditions disability benefits questionnaire, Dr. Oei
18 reported that Plaintiff had the following signs or symptoms due to an esophageal
19 condition: persistently recurrent epigastric distress, dysphagia, pyrosis, reflux,
20 substernal arm or shoulder pain, and sleep disturbance. [AR 450-51.]
21 Plaintiff asserts that the ALJ failed to properly consider the supportability and
22 consistency factors in evaluating the medical evidence and failed to articulate valid
23 reasons for discounting his doctors’ opinions. [Pl. Br. at 8-9.] The Court disagrees.
24 The ALJ explained that the opinions of Dr. Escobar, Dr. Oei, and the other
25 medical sources were only partially persuasive, as they were inconsistent with and
26 unsupported by the medical and other evidence in the record. [AR 17.]
27 Significantly, the ALJ noted that Plaintiff’s admitted activities included taking care
28 of his young child at least 40 hours a week while his wife was at work. [AR 15-17,
1 41-42, 47.] Plaintiff also works two to three hours per week for the family business
2 and spends about two hours per week teaching an online course. [AR 15-17, 30-35.]
3 In addition, Plaintiff was in the process of applying to flight school and was “trying
4 to get medical clearance to begin flight school.” [AR 17, 50.] Thus, the ALJ
5 reasonably concluded that Plaintiff’s admitted activities were inconsistent with the
6 medical opinion evidence suggesting that he suffered from debilitating symptoms
7 and limitations. See 20 C.F.R. § 404.1520c(c)(2)); see also Rollins v. Massanari,
8 261 F.3d 853, 856 (9th Cir. 2001) (finding that an ALJ properly discounted a
9 treating physician’s opinion for being “so extreme as to be implausible” and “not
10 supported by any findings” where there was “no indication in the record” as to the
11 basis for the opinion).
12 The ALJ also adequately considered the supportability of the medical source
13 opinions. The ALJ noted that Dr. Escobar’s examination of Plaintiff in February
14 2019 was generally normal and Plaintiff’s later records did not reveal significant
15 concerns about chronic fatigue syndrome. [AR 16-17, 523-24.] As for Dr. Oei’s
16 opinion, the ALJ found that Plaintiff had been treated for GERD with medication
17 and that testing indicated Plaintiff’s stomach, esophagus and duodenum were within
18 normal limits. [AR 16, 515.] The ALJ also noted that the additional medical
19 evidence of record revealed mostly mild findings, as discussed in more detail below.
20 [AR 16-17.] Thus, substantial evidence supports the ALJ’s finding that the medical
21 source opinions were not fully supported by the objective medical evidence. See 20
22 C.F.R. § 404.1520c(c)(1)).
23 Plaintiff further complains that the ALJ inaccurately described Dr. Escobar,
24 Dr. Oei, and Plaintiff’s other doctors as “Veteran’s Administration doctors” and
25 erroneously “devalued” their opinions by “lumping” them together with the VA
26 disability decision. [Pl. Br. at 7-8.] Even if the ALJ erred in referring to Plaintiff’s
27 doctors as VA doctors, Plaintiff has not shown actual harm. Under the new
28 regulations, the ALJ was not even required to address the VA disability decision.
1 See 20 C.F.R. § 404.1504 (stating that the ALJ need not provide “any analysis in our
2 determination or decision about a decision made by any other governmental agency
3 or a nongovernmental entity about whether you are disabled, blind, employable, or
4 entitled to any benefits.”); Diaz v. Comm’r of Soc. Sec., No. 2:19-CV-537-KJN,
5 2020 WL 2732027, at *3 (E.D. Cal. May 26, 2020). The only evidence that the ALJ
6 was required to consider was the evidence underlying the VA’s disability
7 determination [AR 15-17]. See 20 C.F.R. § 404.1504.4 As discussed, the ALJ
8 properly evaluated the medical evidence underlying the VA disability decision (i.e.,
9 the opinions of Dr. Escobar, Dr. Oei, and the other medical sources). Because the
10 ALJ’s evaluation of the persuasiveness of the opinion evidence was supported by
11 substantial evidence, any asserted errors in referring to Plaintiff’s doctors as the
12 “Veteran’s Administration doctors” and addressing their opinions together as a
13 group, were harmless. See Brown-Hunter v. Colvin, 806 F.3d at 492 (explaining
14 that even when the ALJ commits error, the ALJ’s decision must be upheld when
15 “the error is harmless, meaning that it is inconsequential to the ultimate
16 nondisability determination”) (internal quotation marks and citation omitted).
17 B. Plaintiff’s RFC
18 An RFC “is the most [one] can still do despite [his or her] limitations” and it
19 is “based on all the relevant evidence in [the] case record,” rather than a single
20 medical opinion or piece of evidence. 20 C.F.R. § 404.1545(a)(1); see also Vertigan
21 v. Halter, 260 F.3d 1044, 1049 (9th Cir. 2001) (“It is clear that it is the
22 responsibility of the ALJ, not the claimant’s physician, to determine residual
23 functional capacity.”).
24 Plaintiff contends that the ALJ’s RFC assessment for a limited range of light
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26 4 The Court notes that the ALJ correctly determined that the VA rating of
disability did not compel a similar finding on Plaintiff’s claim for DIB [AR 17]. See
27 McCartey v. Massanari, 298 F.3d 1072, 1076 (9th Cir. 2002) (explaining that “a VA
rating of disability does not necessarily compel the SSA to reach an identical
28
result”).
1 work is not supported by substantial evidence. [AR 14-15; Pl. Br. at 11-13.] He
2 argues that none of the treating physicians specifically assessed Plaintiff with an
3 RFC for a range of light work and, while the consultative examiner and state agency
4 medical consultants opined that Plaintiff could perform medium work, the ALJ
5 found their opinions unpersuasive. An ALJ’s RFC determination, however, need
6 not precisely reflect any particular physician’s assessment. See 20 C.F.R. §
7 404.1545(a)(3) (“We will assess your residual functional capacity based on all of the
8 relevant medical and other evidence.”); see also Mills v. Comm’r of Soc. Sec., No.
9 2:13-CV-0899-KJN, 2014 WL 4195012, at *4, n.8 (E.D. Cal. Aug. 22, 2014) (“[I]t
10 is the ALJ’s responsibility to formulate an RFC that is based on the record as a
11 whole, and thus the RFC need not exactly match the opinion or findings of any
12 particular medical source.”) (emphasis in original). It is the ALJ’s responsibility to
13 interpret the evidence of record, including the medical evidence. See Andrews v.
14 Shalala, 53 F.3d 1035, 1039 (9th Cir. 1995) (explaining that the ALJ is responsible
15 for resolving conflicts in the medical evidence and resolving ambiguities).
16 Here, the ALJ carefully analyzed the various medical opinions, treatment
17 records and Plaintiff’s own testimony in formulating the RFC for a limited range of
18 light work. The ALJ explained that the medical evidence of record revealed mostly
19 mild findings and conservative treatment. [AR 16.] As discussed, examination of
20 Plaintiff in February 2019 was “generally normal” and an endoscopy in June 2019
21 revealed his stomach, esophagus, and duodenum were within normal limits. [AR
22 16, 515, 523-24.] The ALJ also noted that Plaintiff was fitted with a continuous
23 positive airway pressure (CPAP) mask for obstructive sleep apnea in August 2019,
24 and he was “doing well” in September 2020. [AR 16-17, 542, 673.] Plaintiff’s
25 asthma and COPD were reported as stable and he was advised to continue taking his
26 medications and using the CPAP machine. [AR 16, 673-74.] In February 2021,
27 when imaging of Plaintiff’s lumbar spine and cervical spine revealed some
28 degenerative changes at L5-S1 and C5-6 and C6-7, Plaintiff’s doctor recommended
1 only conservative treatment, including ibuprofen, ice, and heat. [AR 16, 737-38,
2 761-62.] In December 2021, a pulmonary function test showed no obstruction or
3 restriction consistent with COPD. [AR 16, 794-97.] And, while the ALJ recognized
4 that Plaintiff continued to experience ongoing symptoms from chronic fatigue
5 syndrome and his other conditions, the ALJ discounted Plaintiff’s subjective
6 symptom testimony to the extent it was inconsistent with his admitted activities and
7 other evidence of record.5 [AR 15-17.] Thus, the ALJ reasonably considered the
8 objective medical evidence, along with Plaintiff’s subjective complaints, in
9 formulating the RFC. [AR 14-18.] See 20 C.F.R. § 404.1545(a)(3).
10 Plaintiff asserts that the third-party statement of his wife, Kjersti Richardson,
11 describes functional limitations that are inconsistent with the RFC assessed. [Pl. Br.
12 at 12-13.] The ALJ, however, disregarded Ms. Richardson’s statement, because it
13 was not consistent with the medical and other evidence of record.6 [AR 17-18.] As
14 such, the ALJ did not err in failing to incorporate her statement into the RFC. See
15 Bayliss v. Barnhart, 427 F.3d. 1211, 1217 (9th Cir. 2005) (explaining that the ALJ is
16 only required to consider those limitations for which there was record support in
17 determining RFC).
18 In sum, substantial evidence supports the ALJ’s assessment of Plaintiff’s
19 RFC. While Plaintiff advocates for an alternative interpretation of the evidence, the
20 ALJ’s interpretation was rational and, therefore, must be upheld. See Burch, 400
21 F.3d at 679 (“Where evidence is susceptible to more than one rational
22 interpretation,” the ALJ’s decision should be upheld).
23 / / /
24 / / /
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26 5 Plaintiff does not challenge the ALJ’s consideration of his subjective
symptom testimony. [Pl. Br. at 5, 12.]
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6 Plaintiff does not challenge the ALJ’s consideration of Ms. Richardson’s
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statement. [Pl. Br. at 5; Response at 5.]
1 Vv. CONCLUSION
2 For all of the foregoing reasons, IT IS ORDERED that the decision of the
3 || Commissioner finding Plaintiff not disabled is AFFIRMED.
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5 IT IS SO ORDERED.
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7 || DATED: August 29, 2023 | TT
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° UNITED STATES MAGISTRATE JUDGE
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