Ledesma v. Commissioner of Social Security Administration

          ORDER

          G. Murray Snow Chief United States District Judge

         Pending before the Court is Claimant Cynthia Ledesma's appeal of the Social Security Administration's (SSA) decision to deny disability insurance benefits and supplemental security income. (Doc. 22). For the following reasons, the Court affirms the denial of benefits.

         BACKGROUND

         Cynthia Ledesma filed for disability benefits on November 4, 2010, alleging a disability onset date of June 11, 2010. (Tr. 557-59). Her claim was denied on April 3, 2013, but that decision was reversed and remanded by the Appeals Council on July 5, 2013. (Tr. 202-26; 220-27). Ms. Ledesma's second unfavorable decision was entered on May 6, 2014, but this decision was also reversed and remanded by the Appeals Council on November 18, 2015. (Tr. 231-52; 253-57). Ms. Ledesma's case was reviewed a third time by an ALJ, with a hearing held on June 2, 2016. The ALJ determined that Ms. Ledesma had the following severe impairments: diabetes mellitus, fibromyalgia, right knee chondramalacia patella, right thoracolumbar facet syndrome, spinal stenosis, small posterior central annular tear and disk protrusion, lumbar radiculopathy, lumbar stenosis, lumbar spondylosis, obesity, hypertension, chronic pain syndrome, carpal tunnel syndrome, and neuropathy. (Tr. 15). The ALJ found that Ms. Ledesma had the residual functional capacity (RFC) to perform light work with certain exertional limitations. (Tr. 19). The ALJ found that, even with these restrictions, Ms. Ledesma could perform her past relevant work, namely working as a companion, car jockey, and check cashier. (Tr. 26). As such, the ALJ determined that Ms. Klick was not disabled under the Social Security Act. Id. The Appeals Council denied the request to review, making the Commissioner's decision final. (Tr. 1-4). Ms. Ledesma now seeks judicial review of this decision pursuant to 42 U.S.C. § 405(g).

         DISCUSSION

         I. Legal Standard

         A reviewing federal court will address only the issues raised by the claimant in the appeal from the ALJ's decision. See Lewis v. Apfel, 236 F.3d 503, 517 n. 13 (9th Cir. 2001). A federal court may set aside a denial of disability benefits when that denial is either unsupported by substantial evidence or based on legal error. Thomas v. Barnhart, 278 F.3d 947, 954 (9th Cir. 2002). Substantial evidence is “more than a scintilla but less than a preponderance.” Id. (quotation omitted). It is “relevant evidence which, considering the record as a whole, a reasonable person might accept as adequate to support a conclusion.” Id. (quotation omitted).

         The ALJ is responsible for resolving conflicts in testimony, determining credibility, and resolving ambiguities. See Andrews v. Shalala, 53 F.3d 1035, 1039 (9th Cir. 1995). When evidence is “subject to more than one rational interpretation, [courts] must defer to the ALJ's conclusion.” Batson v. Comm'r of Soc. Sec. Admin., 359 F.3d 1190, 1198 (9th Cir. 2004). This is so because “[t]he [ALJ] and not the reviewing court must resolve conflicts in evidence, and if the evidence can support either outcome, the court may not substitute its judgment for that of the ALJ.” Matney v. Sullivan, 981, F.2d 1016, 1019 (9th Cir. 1992) (citations omitted).

         II. Analysis

         Claimant alleges that the ALJ erred by (1) improperly weighing the treating physicians' opinions; (2) discounting Claimant's credibility; and (3) improperly weighing a third-party report from Claimant's friend.

         A. Evaluation of Medical Evidence

         A “treating physician” is one who actually treats the claimant. Lester v. Chater, 81 F.3d 821, 830 (9th Cir. 1995). When a treating doctor's opinion is not contradicted by another doctor, it may only be rejected for clear and convincing reasons. Id. If a treating doctor's opinion is contradicted by another doctor, it may only be rejected for “specific and legitimate reasons supported by substantial evidence in the record for so doing.” Id. In general, the opinions of treating physicians are given more weight than examining non-treating physicians, and the opinions of examining physicians are given more weight than non-examining physicians. See 20 C.F.R. § 404.1527(c)(1)-(2). In the case of a treating doctor, the ALJ considers the length of the treatment relationship, and the nature and extent of the treatment relationship. Id. at § 404.1527(c)(2)(i)-(ii). For all medical providers, the ALJ considers factors such as whether the provider supports their opinion with evidence and whether the opinion is consistent with the medical record. Id. at § 404.1527(c)(3)-(6). Where substantial evidence contradicts a treating doctor's opinion, the doctor's opinion is not entitled to controlling weight. See Orn v. Astrue, 495 F.3d 625, 632 (9th Cir. 2007).

         Dr. Kevin Theodorou, one of Claimant's treating physicians, provided multiple evaluations. In July 2011, Dr. Theodorou opined that Claimant could not perform fulltime work due to her severe back pain with radiation to her legs. (Tr. 832-33). Dr. Theodorou assessed that Claimant would only be able to sit for 2 hours, stand or walk for 2 hours, and lift or carry less than 10 pounds. (Tr. 832). He also noted her fatigue and drowsiness due to pain medication. (Tr. 833). Dr. Theodorou assessed similar limitations in July 2012 (Tr. 1678-79) and August 2012 (Tr. 1077-78). The ALJ assigned minimal weight to Dr. Theodorou's opinions, stating that “the extreme restrictions assess by Dr. Theodorou were inconsistent with objective medical and clinical findings discussed throughout this decision and the inconsistencies between the claimant's subjective limitations and available medical evidence of record, addressed above.” (Tr. 24). Claimant argues that the ALJ erred in rejecting Dr. Theodorou's opinion by failing to state precisely what medical evidence was inconsistent and by relying on her own evaluation of the medical evidence. Even if the ALJ did err, it was harmless because the ALJ had extensively discussed such objective evidence in other parts of the opinion. Lewis v. Astrue, 498 F.3d 909, 911 (9th Cir. 2007). ALJs may consider whether physicians' opinions are consistent with the medical records. See Tommasetti v. Astrue, 533 F.3d 1035, 1041-42 (9th Cir. 2008) (affirming the ALJ's consideration of a physician's responses being inconsistent with medical records); Bayliss v. Barnhart, 427 F.3d 1211, 1216 (9th Cir. 2005) (“[W]hen evaluating conflicting medical opinions, an ALJ need not accept the opinion of a doctor if that opinion is brief, conclusory, and inadequately supported by clinical findings.”); 20 C.F.R. § 404.1527(c)(4) (“Generally, the more consistent a medical opinion is with the record as a whole, the more weight we will give to that medical opinion.”). Although the ALJ did not provide a specific citation to the record after that statement, the earlier parts of the ALJ's opinion provide a detailed discussion of the medical record relating to Claimant's back and leg pain. (Tr. 20-23). That discussion indicated inconsistencies with Dr. Theodorou's assessment: Claimant's MRI's showed only mild degenerative disc disease, Claimant was assessed to have a normal gait and normal strength in her lower extremities, Claimant's use of a cane was not medically necessary, Claimant did not appear to regularly take her pain medication, and Claimant was regularly found to not be in acute distress. Id. The ALJ did not err in discounting Dr. Theodorou's opinions.

         Dr. Midhum Malla treated Claimant at a pain management practice. In September 2015, Dr. Malla opined that because of Claimant's fibromyalgia, Claimant could sit, stand, or walk for less than 2 hours, would need to alternate positions every 1-20 minutes and then rest for 5-9 minutes, and would miss over 6 days of work a month. (Tr. 1459- 60). In April 2016, Dr. Malla stated that Claimant's back and knee pain would allow Claimant to sit, stand, or walk for 2 hours, and that Claimant would need to alternate positions ever hour and then rest for over 15 minutes. (Tr. 1676-77). Dr. Malla also noted Claimant's moderately severe headaches and side effects from the prescription Lyrica. Id. The ALJ assigned Dr. Malla's opinions minimal weight because “treatment records from Sun Pain Management indicated that the claimant had very few treatment visits with Dr. Mall[a], ” the “extreme limitations assessed by Dr. Mall[a] were inconsistent with treatment records from Sun Pain Management and inconsistent with examination results, ” and the assessments were “inconsistent with factors assessed above, which included screening tests where the claimant was negative for medication on several occasions, suggesting the claimant was not as limited.” (Tr. 25). Claimant argues that the ALJ erred by failing to detail the inconsistencies. As discussed with Dr. Theodorou, the ALJ's opinion had earlier discussed at great length the inconsistencies in the record. The ALJ did not err by incorporating that discussion by reference in evaluating Dr. Malla's opinions. Moreover, the ALJ also gave less weight to Dr. Malla's opinion because of his limited treatment relationship with ...