United States District Court, D. Arizona
Murray Snow Chief United States District Judge
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.
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).
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
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)
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.
Evaluation of Medical Evidence
“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).
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.
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 ...