4:25-cv-00519•Pinesett v. Commissioner of Social Security Administration
Testo completo
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 WO IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF ARIZONA Sudie Pinesett, Plaintiff, vs. Commissioner of Social Security Administration, Defendant. ) ) ) ) ) ) ) ) ) ) ) ) No. CV 25-00519-TUC-AMM (MAA) REPORT AND RECOMMENDATION The plaintiff, Sudie Pinesett, filed this action for review of the final decision of the Commissioner of Social Security pursuant to 42 U.S.C. § 405(g). Doc. 1, p. 1. The case has been referred to the United States Magistrate Judge for report and recommendation pursuant to the Rules of Practice of this court. Doc. 8. The Magistrate Judge recommends that the District Court, after its independent review, affirm the final decision of the Commissioner. The ALJ properly evaluated the medical opinion evidence. The ALJ properly evaluated the claimant’s subjective symptom testimony. PROCEDURAL HISTORY Pinesett filed applications for disability insurance benefits (Title II) and supplemental security income (Title XVI) on July 3, 2023. Administrative Record, AR 17. She alleged disability beginning on June 27, 2023 due to “stage one cancer in lung.” AR 17, 300. The onset date is the date of Pinesett’s surgery to remove the cancer. AR 42. Case 4:25-cv-00519-AMM-MAA Document 21 Filed 06/03/26 Page 1 of 15
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 - 2 - Pinesett’s applications were denied initially and upon reconsideration. AR 17. She requested review and appeared with counsel at a hearing before Administrative Law Judge (ALJ) Laura Speck Havens on January 30, 2025. AR 17, 38. Prior to the hearing, Pinesett filed a Case Summary explaining that she suffers from “History of pulmonary adenocarcinoma; Depression; Anxiety; Right shoulder degenerative joint disease; Cervical spondylosis; and Hypertension.” AR 403. The ALJ issued a decision denying benefits on February 14, 2025. AR 31. The Appeals Council denied Pinesett’s request for review on July 17, 2025, making the decision of the ALJ the final decision of the Commissioner. AR 1. Pinesett subsequently filed this action for review of that final decision. Doc. 1. Hearing Testimony Pinesett explained that she had surgery to remove her lung cancer and she is now in remission. AR 41. Previously, she worked at the Dollar Tree and at Handmaker washing dishes. AR 42. She did not have to lift more than 20 pounds. AR 42. She explained why she stopped working as a dishwasher as follows: “I was doing mostly the job by myself, I was doing it a lot by myself, so I had to walk out because it was too much on me. It was, and I had, it was like depression. So, I was working mostly by myself. Some people sat around. They talked. They didn’t want to help me, so I just like well this is not for me any more, so I walked out.” AR 50. Pinesett currently lives with her niece. AR 43. She does chores around the house. AR 44. She cooks and washes dishes. AR 44. She can mop or sweep, shop for groceries, and do her own laundry. AR 44. She does not do yard work or gardening. AR 44. She can take the bus; she does not drive. AR 45. Since her son passed away, Pinesett has been receiving mental health treatment. AR 47. She has pain in her legs and back, and she has arthritis in her hands, arms, and legs. AR 49. On a scale of one to ten, she stated her pain with medications is “[p]robably a ten, and Case 4:25-cv-00519-AMM-MAA Document 21 Filed 06/03/26 Page 2 of 15
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 - 3 - sometimes a nine.” AR 49. The ALJ explained that if her pain were a ten, she would be in the emergency room. AR 50. She then stated, “I know. Sometimes it’s between an eight and nine.” AR 50. Pinesett stated that if she had a job, she would miss work three or four days out of the week due to headaches. AR 51. The ALJ took testimony from vocational expert Linda Pearl Tolley. AR 54. Tolley characterized Pinesett’s past work as follows: “dishwasher, DOT [Dictionary of Occupational Titles] code 318.687-010, SVP [Specific Vocational Preparation]: 2, medium, light as performed.” AR 54. The ALJ asked Tolley to consider a hypothetical claimant with Pinesett’s age, education and past work, who “can sit six hours out of an eight-hour day, can stand six hours out of an eight-hour day, can walk six hours out of an eight-hour day,” can lift and carry 50 pounds occasionally and 25 pounds frequently, “[c]an occasionally climb, balance, stoop, kneel, crouch, and crawl . . . [c]an reach overhead with the right upper extremity on a frequent basis only . . . [c]an have only occasional exposure to heights and moving machinery . . . [i]n addition . . . is able to understand, remember, and carry out simple job[] instructions . . . with only occasional interaction with coworkers, the public and supervisors, and can perform tasks that do not involve a specific production rate pace, such as assembly line work or an hourly production quota.” AR 55. Tolley testified that such a person could perform Pinesett’s past work as a dishwasher. AR 55-56. Also, she could work as a janitor, hand packager, or laundry worker II. Id. Tolley further testified that a worker must not be off-task more than 10 percent of the time or miss two or more days of work per month. AR 57. CLAIM EVALUATION To qualify for disability benefits, the claimant must demonstrate, through medically acceptable clinical or laboratory standards, an inability to engage in substantial gainful activity due to a physical or mental impairment that can be expected to last for a continuous period of Case 4:25-cv-00519-AMM-MAA Document 21 Filed 06/03/26 Page 3 of 15
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 1 The citation is for a Title II claim (disability insurance benefits). The regulations for evaluating a Title XVI claim (supplemental security income) are substantively identical and appear in the code beginning at 20 C.F.R. § 416.901. Ford v. Saul, 950 F.3d 1141, 1148, n. 1 (9th Cir. 2020). - 4 - at least twelve months. 42 U.S.C. § 423(d)(1)(A); 42 U.S.C. § 1382c(a)(3)(A). “An individual shall be determined to be under a disability only if [her] physical or mental impairment or impairments are of such severity that [she] is not only unable to do [her] previous work but cannot, considering [her] age, education, and work experience, engage in any other kind of substantial gainful work which exists in the national economy, regardless of whether such work exists in the immediate area in which [she] lives, or whether a specific job vacancy exists for [her] or whether [she] would be hired if [she] applied for work.” 42 U.S.C. § 423(d)(2)(A); 42 U.S.C. § 1382c(a)(3)(B). “To determine whether an individual is disabled within the meaning of the Social Security Act, and therefore eligible for benefits, an ALJ follows a five-step sequential evaluation.” Ford v. Saul, 950 F.3d 1141, 1148 (9th Cir. 2020) (citing 20 C.F.R. § 404.1520).1 The first step requires a determination of whether the claimant is engaged in substantial gainful activity. 20 C.F.R. § 404.1520(a)(4). If so, then the claimant is not disabled and benefits are denied. Id. If the claimant is not engaged in substantial gainful activity, the ALJ proceeds to step two, which requires a determination of whether the claimant has a “severe” impairment or combination of impairments. 20 C.F.R. § 404.1520(a)(4). In making a determination at step two, the ALJ uses medical evidence to evaluate whether the claimant has an impairment that significantly limits or restricts his or her physical or mental ability to do basic work activities. Id. If the ALJ concludes there is no severe impairment, the claim is denied. Id. Upon a finding of severity, the ALJ proceeds to step three, which requires a determination of whether the impairment meets or equals one of several listed impairments that are so limiting as to preclude substantial gainful activity. 20 C.F.R. § 404.1520(a)(4); 20 C.F.R. Case 4:25-cv-00519-AMM-MAA Document 21 Filed 06/03/26 Page 4 of 15
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 2 Residual functional capacity is defined as that which an individual can still do despite his or her limitations. 20 C.F.R. § 404.1545. - 5 - Pt. 404, Subpt. P, App.1. If the claimant’s impairment does not meet or equal a listed impairment, evaluation proceeds to the next step. The fourth step requires the ALJ to consider whether the claimant has sufficient residual functional capacity (RFC)2 to perform past relevant work. 20 C.F.R. § 404.1520(a)(4). If yes, then the claim is denied. Id. If the claimant cannot perform any past relevant work, then the ALJ must move to the fifth step, which requires consideration of the claimant’s RFC to perform other substantial gainful work in the national economy in view of the claimant’s age, education, and work experience. 20 C.F.R. § 404.1520(a)(4). “To meet this burden, the ALJ may rely on the Medical-Vocational Guidelines found at 20 C.F.R. Pt. 404 Subpt. P, App. 2 or on the testimony of a vocational expert.” Ford v. Saul, 950 F.3d 1141, 1149 (9th Cir. 2020). “Given its inherent reliability, a qualified vocational expert’s testimony as to the number of jobs existing in the national economy that a claimant can perform is ordinarily sufficient by itself to support an ALJ’s step-five finding.” Id. at 1160. The ALJ’s Findings At step one of the disability analysis, the ALJ found that “[t]he claimant has not engaged in substantial gainful activity since June 27, 2023, the alleged onset date . . . .” AR 20. At step two, she found that “[t]he claimant has the following severe impairments: right shoulder degenerative joint disease, depression, anxiety, and neurocognitive disorder . . . .” AR 20. At step three, the ALJ found that “[t]he claimant does not have an impairment or combination of impairments that meets or medically equals the severity of one of the listed impairments in 20 CFR Part 404, Subpart P, Appendix 1 . . . .” AR 22. The ALJ then analyzed the claimant’s residual functional capacity (RFC). She found that “the claimant has the residual functional capacity to perform medium work as defined in 20 CFR § 404.1567(c) and § 416.967(c) except she can occasionally climb, balance, stoop, kneel, Case 4:25-cv-00519-AMM-MAA Document 21 Filed 06/03/26 Page 5 of 15
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 - 6 - crouch, and crawl, frequently reach overhead with the right upper extremity, and occasionally be exposed to heights and moving machinery. The claimant can do work with simple instructions only and can perform tasks that do not involve a specific production rate pace, such assembly line work or an hourly production quota. She can have occasional interaction with the public, coworkers, and supervisors.” AR 24. At step four, the ALJ found that “[t]he claimant is capable of performing past relevant work as a dishwasher.” AR. 29. At step five, the ALJ found in the alternative, relying on testimony from the vocational expert, that Pinesett can work as a janitor, hand packager, or laundry worker 2. AR 30-31. Accordingly, the ALJ found that Pinesett is not disabled. AR 31. STANDARD OF REVIEW The findings of the Commissioner are meant to be conclusive. 42 U.S.C. §§ 405(g), 1383(c)(3). The court “will disturb the [ALJ’s] denial of benefits only if the decision contains legal error or is not supported by substantial evidence.” Ford v. Saul, 950 F.3d 1141, 1154 (9th Cir. 2020) (punctuation modified). “Substantial evidence is more than a mere scintilla, and means only such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.” Id. “If the evidence is susceptible to more than one rational interpretation, it is the ALJ’s conclusion that must be upheld.” Id. Moreover, the court “may affirm the ALJ’s decision even if the ALJ made an error, so long as the error was harmless, meaning it was inconsequential to the ultimate nondisability determination.” Id. Discussion: Medical Opinion Evidence Pinesett asserts first that the ALJ failed to properly evaluate the opinions of her treating providers Cynthia Lee, DNP, PMHNP-BC, and Monica Leverette, DNP, PMHNP-B. Doc. 15, p. 8. Lee and Leverette opined that Pinesett’s mental impairments resulted in “marked” limitations. AR 29. Case 4:25-cv-00519-AMM-MAA Document 21 Filed 06/03/26 Page 6 of 15
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 - 7 - In accordance with the regulations regarding the evaluation of mental impairments, the ALJ considered the “paragraph B” criteria. AR 23. These are “four broad functional areas,” which are designed to help the ALJ analyze the claimant’s level of functional limitation: “Understand, remember, or apply information; interact with others; concentrate, persist, or maintain pace; and adapt or manage oneself.” 20 C.F.R. § 404.1520a(c)(3). The claimant’s level of limitation is rated using a “five-point scale: None, mild, moderate, marked, and extreme.” 20 C.F.R. § 404.1520a(c)(4). “The last point on the scale represents a degree of limitation that is incompatible with the ability to do any gainful activity.” Id. If the claimant’s limitation is rated “none” or “mild,” the ALJ “will generally conclude that [the claimant’s] impairment(s) is not severe, unless the evidence otherwise indicates that there is more than a minimal limitation in [the claimant’s] ability to do basic work activities. . . .” 20 C.F.R. § 404.1520a(d)(1). In the first area of “understand, remember, or apply information,” the ALJ found that the claimant has “moderate” limitation. AR 23. She explained that “current treatment notes do not show problems with attention, concentration, cognition, thought process, or memory (Exhibits B11F & B12F/13, 46, 53, 57, 61, 65, 83).” AR 23. “The record also reflects no further concerns for deficits in the claimant’s abilities to comprehend or use learned information.” AR 23. In the area of “interacting with others,” the ALJ found that the claimant has “moderate” limitation. AR 23. The ALJ noted that “[t]he claimant does not endorse problems getting along with others but does not socialize as she used to (Exhibits B4E & B7E).” AR 23. “Mental health treatment notes show that the claimant is cooperative and do not show problems maintaining appropriate eye contact (Exhibits B11F & B12F/13, 46, 53, 57, 61, 65, 83).” AR 23. “Additionally, in her function report, the claimant admits she can engage in activities that take her out into the community, such as shopping and using public transportation (Exhibits B4E & B7E).” AR 23. “With regard to concentration, persisting, or maintaining pace,” the ALJ found that the claimant’s functional limitation is “moderate.” AR 23. The ALJ noted that “current treatment Case 4:25-cv-00519-AMM-MAA Document 21 Filed 06/03/26 Page 7 of 15
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 - 8 - notes do not show problems with attention, concentration, cognition, or thought process (Exhibits B11F & B12F/13, 46, 53, 57, 61, 65, 83).” AR 23. “Additionally, the claimant’s description of her activities reflects some ability to sustain focus and attention and see a task through to completion.” AR 23. “For example, she reports she can do household chores, shop, and manage her own finances (Exhibits B4E & B7E).” AR 23. Finally the ALJ considered the area of “adapting or managing oneself.” AR 23. She found that the claimant has “moderate” limitation. AR 23. The ALJ explained as follows: “The claimant contends that she does not handle stress very well but can handle changes in routine if they are within reason (Exhibits B4E & B7E).” AR 23. “Treatment records show one notation of poor insight (Exhibit B12F/61).” AR 23. “Otherwise, the claimant demonstrated appropriate judgment and insight, cooperative behavior, and no abnormalities of dress or grooming (Exhibits B11F & B12F/13, 46, 53, 57, 61, 65, 83).” AR 23-24. “Lastly, for the period under adjudication, the claimant has not required intensive or structured mental health care.” AR 24. The ALJ also considered the medical opinion evidence, particularly as it relates to the “paragraph B” criteria. She considered the medical opinions of psychologist Andres Kerns as follows: The undersigned also considered the reports of State Agency reviewing psychologist Andres Kerns, Ph.D., who noted treatment records show benign mental status exams and that testing from the 2014 psychological consultative examination showed low WAIS [Wechsler Adult Intelligence Scale] scores. [Kerns] opined that due to the mental health impairments, the claimant has a moderate limitation in the ability to understand, remember, or apply information, a mild limitation in the ability to interact with others, a moderate limitation in the ability to concentrate, persist, or maintain pace, and a moderate limitation in the ability to adapt or manage oneself. Dr. Kerns opined the claimant can remember basic workplace locations and procedures, remember and understand simple (one to two-step) instructions, carry out simple (one to two-step) instructions, follow simple work-like procedures, and make simple work-related decisions, and carry out simple tasks in situations where a supervisor or co-worker is occasionally present to explain tasks and give directions. The claimant has adequate ability to perform at a consistent pace if engaged in a simple task and can complete tasks that do not require more than daily planning or independent prioritization of tasks. He opined the claimant can adapt to a routine environment and appears capable of simple one and two-step tasks in a routine and predictable environment where changes are easily explained, and interaction with others is superficial and occasional (Exhibits B3A & B5A). Regarding the B criteria, the opinion is somewhat persuasive as some support was given. Case 4:25-cv-00519-AMM-MAA Document 21 Filed 06/03/26 Page 8 of 15
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 - 9 - AR 28 (emphasis added). The ALJ also considered the medical opinions of the claimant’s treating providers, Lee and Leverette, who believed that Pinesett’s mental impairments are more limiting. The ALJ noted as follows: Cynthia Lee, DNP, PMHNP-BC, and Monica Leverette, DNP, PMHNP-BC opined the claimant has a marked limitation in the ability to understand, remember, or apply information, a marked limitation in the ability to interact with others, a marked limitation in the ability to concentrate, persist, or maintain pace, and a marked limitation in the ability to adapt or manage oneself. They noted the claimant endorsed depressed mood and struggles with concentration and following instructions. [Lee] noted the claimant tends to avoid others if she senses conflict. [AR 877] They noted the claimant lack[s] insight into her mental health symptoms. They opined the claimant would miss work two days or more each month, noting she continues to struggle with depressive symptoms and find[ing] housing. They noted the opinions are based on their direct observations and treatment of the claimant (Exhibits B14F & B15F) [AR 868-882]. Though somewhat supported, the opinions are not persuasive as they are inconsistent with the medical evidence of record, which shows conservative treatment and good mental function on examination, as discussed earlier in the decision. AR 29 (emphasis added). Pinesett argues that the ALJ’s analysis of Lee and Leverette’s opinions is error. The court does not agree. Under the new regulations, “[t]he 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.” Woods v. Kijakazi, 32 F.4th 785, 792 (9th Cir. 2022) (punctuation modified). “The more relevant the objective medical evidence and supporting explanations presented and the more consistent with evidence from other sources, the more persuasive a medical opinion or prior finding.” Machelle H. v. Kijakazi, 2021 WL 4342313, at *7 (D. Idaho Sept. 22, 2021) (punctuation modified). “In sum, the [ALJ] must explain [her] reasoning and specifically address how [she] considered the supportability and consistency of the opinion, and [her] reasoning must be free from legal error and supported by substantial evidence.” Id. Here, the ALJ considered the opinions of Lee and Leverette and found them “not persuasive” because, while they are “somewhat supported,” they are “inconsistent with the medical evidence of record, which shows conservative treatment and good mental function on Case 4:25-cv-00519-AMM-MAA Document 21 Filed 06/03/26 Page 9 of 15
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 - 10 - examination, as discussed earlier in the decision.” AR 29. Lee and Leverette opined that Pinesett’s “paragraph B” limitations were “marked.” AR 29. The ALJ, however, found them to be only “moderate” after considering the treatment notes, Pinesett’s function report, and her report of daily activities. AR 23-24. The ALJ explained that Pinesett’s treatment has been conservative in so far as it “has not required intensive or structured mental health care.” AR 24. The ALJ noted that the State Agency reviewing psychologist Andres Kerns found that Pinesett’s functional limitations are only “moderate” or “mild.” The ALJ found Lee and Leverette’s opinions to be “somewhat supported” but inconsistent with Kerns’s opinions, inconsistent with the medical record, and inconsistent with Pinesett’s record of daily activities. The ALJ considered the “supportability and consistency” of the treating providers’ opinions as required by the new regulations. Pinesett maintains that the ALJ’s analysis if flawed because she “made no more than [] boilerplate conclusion[s]” and “failed to cite specific evidence.” Doc. 15, p. 9. The court does not agree. The ALJ cited to specific places in the medical record that support her “paragraph B” analysis that Pinesett’s mental impairments are less limiting that Lee and Leverette believe. AR 23 (citing Exhibits B4E, B7E, B11F, B12F). She cited to specific places in the record where Pinesett discussed her activities of daily living. AR 25 (citing Exhibits B4E & B7E and “Hearing Testimony”). She also cited the contrary opinions of Andres Kerns. AR 28 (citing Exhibits B3A & B5A). The court finds that the ALJ’s analysis was not limited to “boilerplate conclusions.” Pinesett asserts that the ALJ should have specifically recognized that the opinions of Lee and Leverette were consistent with each other and “opined identical limitations.” Doc. 15, p. 11. The court agrees that the ALJ did not explicitly discuss the fact that the two opinions were nearly identical. She did, however, present their opinions together indicating that they were substantively identical. She recognized, for example, that they both “noted the claimant endorsed depressed mood and struggles with concentration and following instructions.” AR 29. Where one of the providers made an important comment, the ALJ correctly stated that the comment came from only one of the providers, not both. AR 29 (Only one of the providers, Case 4:25-cv-00519-AMM-MAA Document 21 Filed 06/03/26 Page 10 of 15
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 - 11 - Lee, noted that “the claimant tends to avoid others if she senses conflict.”). The court finds that the ALJ did recognize that the two opinions were nearly identical and did consider this factor in her analysis. Pinesett further argues that “the ALJ’s characterization of the record is false and suggests improper picking and choosing.” Doc. 15, p. 10; Doc. 20, p. 3. Pinesett directs the court to places in the medical record “related to [her] anxiety and depression symptoms.” Doc. 15, p. 10; Doc. 20, p. 3. She explains that she “sought therapy and counseling services in August 2023 in connection with external stressors, including the death of her son and housing situation.” Doc. 15, p. 10; Doc. 20, p. 3. She was assessed with “poor insight and judgment and anxious and depressed mood.” Doc. 15, p. 10. “PHQ-9 [Patient Health Questionnaire-9] screening was consistent with moderate depression.” Doc. 20, p. 3 (citing AR 536). “At a follow-up evaluation in December 2023, Ms. Pinesett reported worsening symptoms that included decreased mood, energy, and motivation, and increased worrying and feelings of guilt and worthlessness.” Doc. 20, p. 3. Moreover, the record indicates that she “received special education courses in high school and had to quit her most recent employment due to increased feelings of stress, depression, and anxiety.” Doc. 15, p. 11. The court agrees that there is evidence in the record that could support a finding of more significant limitation. Reasonable minds could differ. Pinesett’s argument, however, overlooks this court’s standard of review. It does not matter if the evidence would support a different result. The court only decides whether the ALJ’s decision is free from legal error and is supported by substantial evidence. The court concludes that it is. See also Ford v. Saul, 950 F.3d 1141, 1154 (9th Cir. 2020) (“If the evidence is susceptible to more than one rational interpretation, it is the ALJ’s conclusion that must be upheld.”) (punctuation modified). Discussion: Subjective Symptom Testimony Pinesett further argues that the ALJ failed to properly evaluate her subjective symptom testimony. Doc. 15, p. 12. She confines her arguments to the ALJ’s evaluation of her Case 4:25-cv-00519-AMM-MAA Document 21 Filed 06/03/26 Page 11 of 15
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 - 12 - depression and anxiety, and the court will cabin its analysis accordingly. Doc. 15, p. 13. The regulations explain as follows: When the medical signs or laboratory findings show that you have a medically determinable impairment(s) that could reasonably be expected to produce your symptoms, such as pain, we must then evaluate the intensity and persistence of your symptoms so that we can determine how your symptoms limit your capacity for work. In evaluating the intensity and persistence of your symptoms, we consider all of the available evidence from your medical sources and nonmedical sources about how your symptoms affect you. 20 C.F.R. § 404.1529(c)(1). “When a claimant presents objective medical evidence establishing an impairment that could reasonably produce the symptoms of which she complains [and there is no evidence of malingering], an adverse credibility finding must be based on clear and convincing reasons.” Smartt v. Kijakazi, 53 F.4th 489, 497 (9th Cir. 2022). In this case, the ALJ found that Pinesett has medically determinable mental impairments: depression, anxiety, and neurocognitive disorder. AR 20. The ALJ found, however, that Pinesett’s “statements concerning the intensity, persistence, and limiting effects of these symptoms are not entirely consistent with the medical evidence and other evidence in the record for the reasons explained in this decision.” AR 26. The ALJ wrote as follows: Regarding depression and anxiety, the medical evidence of record does not support the claimant’s symptoms and limitations to the extent alleged. First, though the claimant’s symptoms are longstanding, she has demonstrated good function on examination despite those symptoms. Treatment records show only a few clinical findings, most of which were notations of depressed and/or anxious mood, and only one notation of poor insight. [AR 711, 730, 800] Otherwise, the claimant demonstrated good function on examination. At exams in December 2023, January, March, April, June, and September 2024, the claimant was alert and fully oriented and had appropriate appearance, cooperative behavior, normal speech, linear thought process, normal thought content and perception, and normal judgment (Exhibits B11F & B12F/13, 46, 53, 57, 65, 83) [AR 712, 730, 763, 770, 774, 782, 800]. In February 2024, she was alert and fully oriented and had appropriate appearance, cooperative behavior, normal speech, linear thought process, and normal thought content and perception (Exhibit B12F/61) [AR 778]. Second, the medical evidence of record does not include hospitalizations or similarly intensive mental health treatment during the period under adjudication. Treatment has consisted of medication and supportive therapy. AR 27; see also Doc. 19, p. 7. Case 4:25-cv-00519-AMM-MAA Document 21 Filed 06/03/26 Page 12 of 15
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 - 13 - The ALJ recognized that Pinesett has medically determinable mental impairments such as depression and anxiety. Nevertheless, she concluded that these impairments are not as limiting as Pinesett alleges based on “demonstrated good function on examination,” “[t]reatment records [that] show only a few clinical findings,” and a lack of hospitalization or intensive mental treatment. AR 27. The ALJ previously noted that Pinesett’s activities of daily living support only moderate limitation in her “paragraph B” functional areas. AR 23-24. Moreover, the State Agency reviewing psychologist Andres Kerns, Ph.D., opined that Pinesett’s mental impairments result in only moderate or mild limitations. AR 28. “The standard [of review] isn’t whether our court is convinced, but instead whether the ALJ’s rationale is clear enough that it has the power to convince.” Smartt v. Kijakazi, 53 F.4th 489, 499 (9th Cir. 2022). And here, it is. See, e.g., Smartt, 53 F.4th at 496–97 (“The ALJ properly discounted Smartt’s subjective pain testimony and self-reported limitations because (1) the objective medical evidence was inconsistent with those limitations, (2) Smartt acknowledged that she routinely performed several daily activities, notwithstanding her caveats, and (3) generally her treatment had been conservative.”). The ALJ provided “clear and convincing reasons” for discounting Pinesett’s subject symptom testimony. See also Smartt, 53 F.4th at 499 (“[A]n ALJ is not required to believe every allegation of disabling pain, or else disability benefits would be available for the asking . . . .”) (punctuation modified). Pinesett takes issue with the ALJ’s statements that she displayed “good function on examination” such as “appropriate appearance, cooperative behavior, normal speech, linear though process, normal thought content and perception, and normal judgment.” Doc. 15, pp. 13-14. She argues that “the ALJ failed to explain how these ‘normal’ findings [are] inconsistent with [her] complaints of anxiety and depression.” Doc. 15, pp. 13-14; Doc. 20, p. 6. The ALJ, however, did not state that these “normal” findings are inconsistent with Pinesett’s “complaints of anxiety and depression.” She stated that these “normal” findings are inconsistent with Pinesett’s “symptoms and limitations to the extent alleged.” AR 26. ALJ does not dispute the fact that Pinesett has “severe” mental impairments such as anxiety and depression. She does not dispute the fact that these mental impairments limit her Case 4:25-cv-00519-AMM-MAA Document 21 Filed 06/03/26 Page 13 of 15
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 - 14 - ability to perform work-related tasks. She evaluated these limitations and incorporated them into her assessment of Pinesett’s RFC. She concluded that Pinesett “can do work with simple instructions only and can perform tasks that do not involve a specific production rate pace, such as assembly line work or an hourly production quota . . . [and] can have [only] occasional interaction with the public, coworkers, and supervisors.” AR 24. The ALJ does dispute Pinesett’s implication that these mental impairments are so limiting that she is unable to perform any substantial gainful activity. See also Rounds v. Comm’r Soc. Sec. Admin., 807 F.3d 996, 1006 (9th Cir. 2015) (“[T]he ALJ is responsible for translating and incorporating clinical findings into a succinct RFC.”). And these “normal” findings support her conclusion that Pinesett’s “statements concerning the intensity, persistence, and limiting effects of these symptoms are not entirely consistent with the medical evidence and other evidence in the record.” AR 26; see also Smartt v. Kijakazi, 53 F.4th 489, 499 (9th Cir. 2022) (“Ultimately, the clear and convincing standard requires an ALJ to show [her] work . . . .”) (punctuation modified). RECOMMENDATION For the foregoing reasons, the Magistrate Judge recommends that the District Court, after its independent review, affirm the final decision of the Commissioner. The ALJ properly evaluated the medical opinion evidence. The ALJ properly evaluated the claimant’s subjective symptom testimony. Pursuant to 28 U.S.C. § 636(b), any party may file and serve written objections within 14 days after being served with a copy of this Report and Recommendation. If objections are not timely filed, the party’s right to de novo review may be waived. The Local Rules permit the filing of a response to an objection. They do not permit the filing of a reply to a response without leave of the District Court. DATED this 3rd day of June, 2026. Case 4:25-cv-00519-AMM-MAA Document 21 Filed 06/03/26 Page 14 of 15
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Case 4:25-cv-00519-AMM-MAA Document 21 Filed 06/03/26 Page 1 of 15 WO IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF ARIZONA Sudie Pinesett, Plaintiff, ) ) ) ) VS. Commissioner of Social Security) Administration, Defendant. ) ) ) ) ) ) No. CV 25-00519-TUC-AMM (MAA) REPORT AND RECOMMENDATION The plaintiff, Sudie Pinesett, filed this action for review of the final decision of the Commissioner of Social Security pursuant to 42 U.S.C. § 405(g). Doc. 1, p. 1. The case has been referred to the United States Magistrate Judge for report and recommendation pursuant to the Rules of Practice of this court. Doc. 8. The Magistrate Judge recommends that the District Court, after its independent review, affirm the final decision of the Commissioner. The ALJ properly evaluated the medical opinion evidence. The ALJ properly evaluated the claimant's subjective symptom testimony. PROCEDURAL HISTORY Pinesett filed applications for disability insurance benefits (Title II) and supplemental security income (Title XVI) on July 3, 2023. Administrative Record, AR 17. She alleged disability beginning on June 27, 2023 due to "stage one cancer in lung." AR 17, 300. The onset date is the date of Pinesett's surgery to remove the cancer. AR 42. AUTHENTICATED U.S. GOVERNMENT INFORMATION / GPO ID 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 - 2 - Pinesett’s applications were denied initially and upon reconsideration. AR 17. She requested review and appeared with counsel at a hearing before Administrative Law Judge (ALJ) Laura Speck Havens on January 30, 2025. AR 17, 38. Prior to the hearing, Pinesett filed a Case Summary explaining that she suffers from “History of pulmonary adenocarcinoma; Depression; Anxiety; Right shoulder degenerative joint disease; Cervical spondylosis; and Hypertension.” AR 403. The ALJ issued a decision denying benefits on February 14, 2025. AR 31. The Appeals Council denied Pinesett’s request for review on July 17, 2025, making the decision of the ALJ the final decision of the Commissioner. AR 1. Pinesett subsequently filed this action for review of that final decision. Doc. 1. Hearing Testimony Pinesett explained that she had surgery to remove her lung cancer and she is now in remission. AR 41. Previously, she worked at the Dollar Tree and at Handmaker washing dishes. AR 42. She did not have to lift more than 20 pounds. AR 42. She explained why she stopped working as a dishwasher as follows: “I was doing mostly the job by myself, I was doing it a lot by myself, so I had to walk out because it was too much on me. It was, and I had, it was like depression. So, I was working mostly by myself. Some people sat around. They talked. They didn’t want to help me, so I just like well this is not for me any more, so I walked out.” AR 50. Pinesett currently lives with her niece. AR 43. She does chores around the house. AR 44. She cooks and washes dishes. AR 44. She can mop or sweep, shop for groceries, and do her own laundry. AR 44. She does not do yard work or gardening. AR 44. She can take the bus; she does not drive. AR 45. Since her son passed away, Pinesett has been receiving mental health treatment. AR 47. She has pain in her legs and back, and she has arthritis in her hands, arms, and legs. AR 49. On a scale of one to ten, she stated her pain with medications is “[p]robably a ten, and Case 4:25-cv-00519-AMM-MAA Document 21 Filed 06/03/26 Page 2 of 15 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 - 3 - sometimes a nine.” AR 49. The ALJ explained that if her pain were a ten, she would be in the emergency room. AR 50. She then stated, “I know. Sometimes it’s between an eight and nine.” AR 50. Pinesett stated that if she had a job, she would miss work three or four days out of the week due to headaches. AR 51. The ALJ took testimony from vocational expert Linda Pearl Tolley. AR 54. Tolley characterized Pinesett’s past work as follows: “dishwasher, DOT [Dictionary of Occupational Titles] code 318.687-010, SVP [Specific Vocational Preparation]: 2, medium, light as performed.” AR 54. The ALJ asked Tolley to consider a hypothetical claimant with Pinesett’s age, education and past work, who “can sit six hours out of an eight-hour day, can stand six hours out of an eight-hour day, can walk six hours out of an eight-hour day,” can lift and carry 50 pounds occasionally and 25 pounds frequently, “[c]an occasionally climb, balance, stoop, kneel, crouch, and crawl . . . [c]an reach overhead with the right upper extremity on a frequent basis only . . . [c]an have only occasional exposure to heights and moving machinery . . . [i]n addition . . . is able to understand, remember, and carry out simple job[] instructions . . . with only occasional interaction with coworkers, the public and supervisors, and can perform tasks that do not involve a specific production rate pace, such as assembly line work or an hourly production quota.” AR 55. Tolley testified that such a person could perform Pinesett’s past work as a dishwasher. AR 55-56. Also, she could work as a janitor, hand packager, or laundry worker II. Id. Tolley further testified that a worker must not be off-task more than 10 percent of the time or miss two or more days of work per month. AR 57. CLAIM EVALUATION To qualify for disability benefits, the claimant must demonstrate, through medically acceptable clinical or laboratory standards, an inability to engage in substantial gainful activity due to a physical or mental impairment that can be expected to last for a continuous period of Case 4:25-cv-00519-AMM-MAA Document 21 Filed 06/03/26 Page 3 of 15 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 1 The citation is for a Title II claim (disability insurance benefits). The regulations for evaluating a Title XVI claim (supplemental security income) are substantively identical and appear in the code beginning at 20 C.F.R. § 416.901. Ford v. Saul, 950 F.3d 1141, 1148, n. 1 (9th Cir. 2020). - 4 - at least twelve months. 42 U.S.C. § 423(d)(1)(A); 42 U.S.C. § 1382c(a)(3)(A). “An individual shall be determined to be under a disability only if [her] physical or mental impairment or impairments are of such severity that [she] is not only unable to do [her] previous work but cannot, considering [her] age, education, and work experience, engage in any other kind of substantial gainful work which exists in the national economy, regardless of whether such work exists in the immediate area in which [she] lives, or whether a specific job vacancy exists for [her] or whether [she] would be hired if [she] applied for work.” 42 U.S.C. § 423(d)(2)(A); 42 U.S.C. § 1382c(a)(3)(B). “To determine whether an individual is disabled within the meaning of the Social Security Act, and therefore eligible for benefits, an ALJ follows a five-step sequential evaluation.” Ford v. Saul, 950 F.3d 1141, 1148 (9th Cir. 2020) (citing 20 C.F.R. § 404.1520).1 The first step requires a determination of whether the claimant is engaged in substantial gainful activity. 20 C.F.R. § 404.1520(a)(4). If so, then the claimant is not disabled and benefits are denied. Id. If the claimant is not engaged in substantial gainful activity, the ALJ proceeds to step two, which requires a determination of whether the claimant has a “severe” impairment or combination of impairments. 20 C.F.R. § 404.1520(a)(4). In making a determination at step two, the ALJ uses medical evidence to evaluate whether the claimant has an impairment that significantly limits or restricts his or her physical or mental ability to do basic work activities. Id. If the ALJ concludes there is no severe impairment, the claim is denied. Id. Upon a finding of severity, the ALJ proceeds to step three, which requires a determination of whether the impairment meets or equals one of several listed impairments that are so limiting as to preclude substantial gainful activity. 20 C.F.R. § 404.1520(a)(4); 20 C.F.R. Case 4:25-cv-00519-AMM-MAA Document 21 Filed 06/03/26 Page 4 of 15 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 2 Residual functional capacity is defined as that which an individual can still do despite his or her limitations. 20 C.F.R. § 404.1545. - 5 - Pt. 404, Subpt. P, App.1. If the claimant’s impairment does not meet or equal a listed impairment, evaluation proceeds to the next step. The fourth step requires the ALJ to consider whether the claimant has sufficient residual functional capacity (RFC)2 to perform past relevant work. 20 C.F.R. § 404.1520(a)(4). If yes, then the claim is denied. Id. If the claimant cannot perform any past relevant work, then the ALJ must move to the fifth step, which requires consideration of the claimant’s RFC to perform other substantial gainful work in the national economy in view of the claimant’s age, education, and work experience. 20 C.F.R. § 404.1520(a)(4). “To meet this burden, the ALJ may rely on the Medical-Vocational Guidelines found at 20 C.F.R. Pt. 404 Subpt. P, App. 2 or on the testimony of a vocational expert.” Ford v. Saul, 950 F.3d 1141, 1149 (9th Cir. 2020). “Given its inherent reliability, a qualified vocational expert’s testimony as to the number of jobs existing in the national economy that a claimant can perform is ordinarily sufficient by itself to support an ALJ’s step-five finding.” Id. at 1160. The ALJ’s Findings At step one of the disability analysis, the ALJ found that “[t]he claimant has not engaged in substantial gainful activity since June 27, 2023, the alleged onset date . . . .” AR 20. At step two, she found that “[t]he claimant has the following severe impairments: right shoulder degenerative joint disease, depression, anxiety, and neurocognitive disorder . . . .” AR 20. At step three, the ALJ found that “[t]he claimant does not have an impairment or combination of impairments that meets or medically equals the severity of one of the listed impairments in 20 CFR Part 404, Subpart P, Appendix 1 . . . .” AR 22. The ALJ then analyzed the claimant’s residual functional capacity (RFC). She found that “the claimant has the residual functional capacity to perform medium work as defined in 20 CFR § 404.1567(c) and § 416.967(c) except she can occasionally climb, balance, stoop, kneel, Case 4:25-cv-00519-AMM-MAA Document 21 Filed 06/03/26 Page 5 of 15 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 - 6 - crouch, and crawl, frequently reach overhead with the right upper extremity, and occasionally be exposed to heights and moving machinery. The claimant can do work with simple instructions only and can perform tasks that do not involve a specific production rate pace, such assembly line work or an hourly production quota. She can have occasional interaction with the public, coworkers, and supervisors.” AR 24. At step four, the ALJ found that “[t]he claimant is capable of performing past relevant work as a dishwasher.” AR. 29. At step five, the ALJ found in the alternative, relying on testimony from the vocational expert, that Pinesett can work as a janitor, hand packager, or laundry worker 2. AR 30-31. Accordingly, the ALJ found that Pinesett is not disabled. AR 31. STANDARD OF REVIEW The findings of the Commissioner are meant to be conclusive. 42 U.S.C. §§ 405(g), 1383(c)(3). The court “will disturb the [ALJ’s] denial of benefits only if the decision contains legal error or is not supported by substantial evidence.” Ford v. Saul, 950 F.3d 1141, 1154 (9th Cir. 2020) (punctuation modified). “Substantial evidence is more than a mere scintilla, and means only such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.” Id. “If the evidence is susceptible to more than one rational interpretation, it is the ALJ’s conclusion that must be upheld.” Id. Moreover, the court “may affirm the ALJ’s decision even if the ALJ made an error, so long as the error was harmless, meaning it was inconsequential to the ultimate nondisability determination.” Id. Discussion: Medical Opinion Evidence Pinesett asserts first that the ALJ failed to properly evaluate the opinions of her treating providers Cynthia Lee, DNP, PMHNP-BC, and Monica Leverette, DNP, PMHNP-B. Doc. 15, p. 8. Lee and Leverette opined that Pinesett’s mental impairments resulted in “marked” limitations. AR 29. Case 4:25-cv-00519-AMM-MAA Document 21 Filed 06/03/26 Page 6 of 15 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 - 7 - In accordance with the regulations regarding the evaluation of mental impairments, the ALJ considered the “paragraph B” criteria. AR 23. These are “four broad functional areas,” which are designed to help the ALJ analyze the claimant’s level of functional limitation: “Understand, remember, or apply information; interact with others; concentrate, persist, or maintain pace; and adapt or manage oneself.” 20 C.F.R. § 404.1520a(c)(3). The claimant’s level of limitation is rated using a “five-point scale: None, mild, moderate, marked, and extreme.” 20 C.F.R. § 404.1520a(c)(4). “The last point on the scale represents a degree of limitation that is incompatible with the ability to do any gainful activity.” Id. If the claimant’s limitation is rated “none” or “mild,” the ALJ “will generally conclude that [the claimant’s] impairment(s) is not severe, unless the evidence otherwise indicates that there is more than a minimal limitation in [the claimant’s] ability to do basic work activities. . . .” 20 C.F.R. § 404.1520a(d)(1). In the first area of “understand, remember, or apply information,” the ALJ found that the claimant has “moderate” limitation. AR 23. She explained that “current treatment notes do not show problems with attention, concentration, cognition, thought process, or memory (Exhibits B11F & B12F/13, 46, 53, 57, 61, 65, 83).” AR 23. “The record also reflects no further concerns for deficits in the claimant’s abilities to comprehend or use learned information.” AR 23. In the area of “interacting with others,” the ALJ found that the claimant has “moderate” limitation. AR 23. The ALJ noted that “[t]he claimant does not endorse problems getting along with others but does not socialize as she used to (Exhibits B4E & B7E).” AR 23. “Mental health treatment notes show that the claimant is cooperative and do not show problems maintaining appropriate eye contact (Exhibits B11F & B12F/13, 46, 53, 57, 61, 65, 83).” AR 23. “Additionally, in her function report, the claimant admits she can engage in activities that take her out into the community, such as shopping and using public transportation (Exhibits B4E & B7E).” AR 23. “With regard to concentration, persisting, or maintaining pace,” the ALJ found that the claimant’s functional limitation is “moderate.” AR 23. The ALJ noted that “current treatment Case 4:25-cv-00519-AMM-MAA Document 21 Filed 06/03/26 Page 7 of 15 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 - 8 - notes do not show problems with attention, concentration, cognition, or thought process (Exhibits B11F & B12F/13, 46, 53, 57, 61, 65, 83).” AR 23. “Additionally, the claimant’s description of her activities reflects some ability to sustain focus and attention and see a task through to completion.” AR 23. “For example, she reports she can do household chores, shop, and manage her own finances (Exhibits B4E & B7E).” AR 23. Finally the ALJ considered the area of “adapting or managing oneself.” AR 23. She found that the claimant has “moderate” limitation. AR 23. The ALJ explained as follows: “The claimant contends that she does not handle stress very well but can handle changes in routine if they are within reason (Exhibits B4E & B7E).” AR 23. “Treatment records show one notation of poor insight (Exhibit B12F/61).” AR 23. “Otherwise, the claimant demonstrated appropriate judgment and insight, cooperative behavior, and no abnormalities of dress or grooming (Exhibits B11F & B12F/13, 46, 53, 57, 61, 65, 83).” AR 23-24. “Lastly, for the period under adjudication, the claimant has not required intensive or structured mental health care.” AR 24. The ALJ also considered the medical opinion evidence, particularly as it relates to the “paragraph B” criteria. She considered the medical opinions of psychologist Andres Kerns as follows: The undersigned also considered the reports of State Agency reviewing psychologist Andres Kerns, Ph.D., who noted treatment records show benign mental status exams and that testing from the 2014 psychological consultative examination showed low WAIS [Wechsler Adult Intelligence Scale] scores. [Kerns] opined that due to the mental health impairments, the claimant has a moderate limitation in the ability to understand, remember, or apply information, a mild limitation in the ability to interact with others, a moderate limitation in the ability to concentrate, persist, or maintain pace, and a moderate limitation in the ability to adapt or manage oneself. Dr. Kerns opined the claimant can remember basic workplace locations and procedures, remember and understand simple (one to two-step) instructions, carry out simple (one to two-step) instructions, follow simple work-like procedures, and make simple work-related decisions, and carry out simple tasks in situations where a supervisor or co-worker is occasionally present to explain tasks and give directions. The claimant has adequate ability to perform at a consistent pace if engaged in a simple task and can complete tasks that do not require more than daily planning or independent prioritization of tasks. He opined the claimant can adapt to a routine environment and appears capable of simple one and two-step tasks in a routine and predictable environment where changes are easily explained, and interaction with others is superficial and occasional (Exhibits B3A & B5A). Regarding the B criteria, the opinion is somewhat persuasive as some support was given. Case 4:25-cv-00519-AMM-MAA Document 21 Filed 06/03/26 Page 8 of 15 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 - 9 - AR 28 (emphasis added). The ALJ also considered the medical opinions of the claimant’s treating providers, Lee and Leverette, who believed that Pinesett’s mental impairments are more limiting. The ALJ noted as follows: Cynthia Lee, DNP, PMHNP-BC, and Monica Leverette, DNP, PMHNP-BC opined the claimant has a marked limitation in the ability to understand, remember, or apply information, a marked limitation in the ability to interact with others, a marked limitation in the ability to concentrate, persist, or maintain pace, and a marked limitation in the ability to adapt or manage oneself. They noted the claimant endorsed depressed mood and struggles with concentration and following instructions. [Lee] noted the claimant tends to avoid others if she senses conflict. [AR 877] They noted the claimant lack[s] insight into her mental health symptoms. They opined the claimant would miss work two days or more each month, noting she continues to struggle with depressive symptoms and find[ing] housing. They noted the opinions are based on their direct observations and treatment of the claimant (Exhibits B14F & B15F) [AR 868-882]. Though somewhat supported, the opinions are not persuasive as they are inconsistent with the medical evidence of record, which shows conservative treatment and good mental function on examination, as discussed earlier in the decision. AR 29 (emphasis added). Pinesett argues that the ALJ’s analysis of Lee and Leverette’s opinions is error. The court does not agree. Under the new regulations, “[t]he 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.” Woods v. Kijakazi, 32 F.4th 785, 792 (9th Cir. 2022) (punctuation modified). “The more relevant the objective medical evidence and supporting explanations presented and the more consistent with evidence from other sources, the more persuasive a medical opinion or prior finding.” Machelle H. v. Kijakazi, 2021 WL 4342313, at *7 (D. Idaho Sept. 22, 2021) (punctuation modified). “In sum, the [ALJ] must explain [her] reasoning and specifically address how [she] considered the supportability and consistency of the opinion, and [her] reasoning must be free from legal error and supported by substantial evidence.” Id. Here, the ALJ considered the opinions of Lee and Leverette and found them “not persuasive” because, while they are “somewhat supported,” they are “inconsistent with the medical evidence of record, which shows conservative treatment and good mental function on Case 4:25-cv-00519-AMM-MAA Document 21 Filed 06/03/26 Page 9 of 15 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 - 10 - examination, as discussed earlier in the decision.” AR 29. Lee and Leverette opined that Pinesett’s “paragraph B” limitations were “marked.” AR 29. The ALJ, however, found them to be only “moderate” after considering the treatment notes, Pinesett’s function report, and her report of daily activities. AR 23-24. The ALJ explained that Pinesett’s treatment has been conservative in so far as it “has not required intensive or structured mental health care.” AR 24. The ALJ noted that the State Agency reviewing psychologist Andres Kerns found that Pinesett’s functional limitations are only “moderate” or “mild.” The ALJ found Lee and Leverette’s opinions to be “somewhat supported” but inconsistent with Kerns’s opinions, inconsistent with the medical record, and inconsistent with Pinesett’s record of daily activities. The ALJ considered the “supportability and consistency” of the treating providers’ opinions as required by the new regulations. Pinesett maintains that the ALJ’s analysis if flawed because she “made no more than [] boilerplate conclusion[s]” and “failed to cite specific evidence.” Doc. 15, p. 9. The court does not agree. The ALJ cited to specific places in the medical record that support her “paragraph B” analysis that Pinesett’s mental impairments are less limiting that Lee and Leverette believe. AR 23 (citing Exhibits B4E, B7E, B11F, B12F). She cited to specific places in the record where Pinesett discussed her activities of daily living. AR 25 (citing Exhibits B4E & B7E and “Hearing Testimony”). She also cited the contrary opinions of Andres Kerns. AR 28 (citing Exhibits B3A & B5A). The court finds that the ALJ’s analysis was not limited to “boilerplate conclusions.” Pinesett asserts that the ALJ should have specifically recognized that the opinions of Lee and Leverette were consistent with each other and “opined identical limitations.” Doc. 15, p. 11. The court agrees that the ALJ did not explicitly discuss the fact that the two opinions were nearly identical. She did, however, present their opinions together indicating that they were substantively identical. She recognized, for example, that they both “noted the claimant endorsed depressed mood and struggles with concentration and following instructions.” AR 29. Where one of the providers made an important comment, the ALJ correctly stated that the comment came from only one of the providers, not both. AR 29 (Only one of the providers, Case 4:25-cv-00519-AMM-MAA Document 21 Filed 06/03/26 Page 10 of 15 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 - 11 - Lee, noted that “the claimant tends to avoid others if she senses conflict.”). The court finds that the ALJ did recognize that the two opinions were nearly identical and did consider this factor in her analysis. Pinesett further argues that “the ALJ’s characterization of the record is false and suggests improper picking and choosing.” Doc. 15, p. 10; Doc. 20, p. 3. Pinesett directs the court to places in the medical record “related to [her] anxiety and depression symptoms.” Doc. 15, p. 10; Doc. 20, p. 3. She explains that she “sought therapy and counseling services in August 2023 in connection with external stressors, including the death of her son and housing situation.” Doc. 15, p. 10; Doc. 20, p. 3. She was assessed with “poor insight and judgment and anxious and depressed mood.” Doc. 15, p. 10. “PHQ-9 [Patient Health Questionnaire-9] screening was consistent with moderate depression.” Doc. 20, p. 3 (citing AR 536). “At a follow-up evaluation in December 2023, Ms. Pinesett reported worsening symptoms that included decreased mood, energy, and motivation, and increased worrying and feelings of guilt and worthlessness.” Doc. 20, p. 3. Moreover, the record indicates that she “received special education courses in high school and had to quit her most recent employment due to increased feelings of stress, depression, and anxiety.” Doc. 15, p. 11. The court agrees that there is evidence in the record that could support a finding of more significant limitation. Reasonable minds could differ. Pinesett’s argument, however, overlooks this court’s standard of review. It does not matter if the evidence would support a different result. The court only decides whether the ALJ’s decision is free from legal error and is supported by substantial evidence. The court concludes that it is. See also Ford v. Saul, 950 F.3d 1141, 1154 (9th Cir. 2020) (“If the evidence is susceptible to more than one rational interpretation, it is the ALJ’s conclusion that must be upheld.”) (punctuation modified). Discussion: Subjective Symptom Testimony Pinesett further argues that the ALJ failed to properly evaluate her subjective symptom testimony. Doc. 15, p. 12. She confines her arguments to the ALJ’s evaluation of her Case 4:25-cv-00519-AMM-MAA Document 21 Filed 06/03/26 Page 11 of 15 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 - 12 - depression and anxiety, and the court will cabin its analysis accordingly. Doc. 15, p. 13. The regulations explain as follows: When the medical signs or laboratory findings show that you have a medically determinable impairment(s) that could reasonably be expected to produce your symptoms, such as pain, we must then evaluate the intensity and persistence of your symptoms so that we can determine how your symptoms limit your capacity for work. In evaluating the intensity and persistence of your symptoms, we consider all of the available evidence from your medical sources and nonmedical sources about how your symptoms affect you. 20 C.F.R. § 404.1529(c)(1). “When a claimant presents objective medical evidence establishing an impairment that could reasonably produce the symptoms of which she complains [and there is no evidence of malingering], an adverse credibility finding must be based on clear and convincing reasons.” Smartt v. Kijakazi, 53 F.4th 489, 497 (9th Cir. 2022). In this case, the ALJ found that Pinesett has medically determinable mental impairments: depression, anxiety, and neurocognitive disorder. AR 20. The ALJ found, however, that Pinesett’s “statements concerning the intensity, persistence, and limiting effects of these symptoms are not entirely consistent with the medical evidence and other evidence in the record for the reasons explained in this decision.” AR 26. The ALJ wrote as follows: Regarding depression and anxiety, the medical evidence of record does not support the claimant’s symptoms and limitations to the extent alleged. First, though the claimant’s symptoms are longstanding, she has demonstrated good function on examination despite those symptoms. Treatment records show only a few clinical findings, most of which were notations of depressed and/or anxious mood, and only one notation of poor insight. [AR 711, 730, 800] Otherwise, the claimant demonstrated good function on examination. At exams in December 2023, January, March, April, June, and September 2024, the claimant was alert and fully oriented and had appropriate appearance, cooperative behavior, normal speech, linear thought process, normal thought content and perception, and normal judgment (Exhibits B11F & B12F/13, 46, 53, 57, 65, 83) [AR 712, 730, 763, 770, 774, 782, 800]. In February 2024, she was alert and fully oriented and had appropriate appearance, cooperative behavior, normal speech, linear thought process, and normal thought content and perception (Exhibit B12F/61) [AR 778]. Second, the medical evidence of record does not include hospitalizations or similarly intensive mental health treatment during the period under adjudication. Treatment has consisted of medication and supportive therapy. AR 27; see also Doc. 19, p. 7. Case 4:25-cv-00519-AMM-MAA Document 21 Filed 06/03/26 Page 12 of 15 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 - 13 - The ALJ recognized that Pinesett has medically determinable mental impairments such as depression and anxiety. Nevertheless, she concluded that these impairments are not as limiting as Pinesett alleges based on “demonstrated good function on examination,” “[t]reatment records [that] show only a few clinical findings,” and a lack of hospitalization or intensive mental treatment. AR 27. The ALJ previously noted that Pinesett’s activities of daily living support only moderate limitation in her “paragraph B” functional areas. AR 23-24. Moreover, the State Agency reviewing psychologist Andres Kerns, Ph.D., opined that Pinesett’s mental impairments result in only moderate or mild limitations. AR 28. “The standard [of review] isn’t whether our court is convinced, but instead whether the ALJ’s rationale is clear enough that it has the power to convince.” Smartt v. Kijakazi, 53 F.4th 489, 499 (9th Cir. 2022). And here, it is. See, e.g., Smartt, 53 F.4th at 496–97 (“The ALJ properly discounted Smartt’s subjective pain testimony and self-reported limitations because (1) the objective medical evidence was inconsistent with those limitations, (2) Smartt acknowledged that she routinely performed several daily activities, notwithstanding her caveats, and (3) generally her treatment had been conservative.”). The ALJ provided “clear and convincing reasons” for discounting Pinesett’s subject symptom testimony. See also Smartt, 53 F.4th at 499 (“[A]n ALJ is not required to believe every allegation of disabling pain, or else disability benefits would be available for the asking . . . .”) (punctuation modified). Pinesett takes issue with the ALJ’s statements that she displayed “good function on examination” such as “appropriate appearance, cooperative behavior, normal speech, linear though process, normal thought content and perception, and normal judgment.” Doc. 15, pp. 13-14. She argues that “the ALJ failed to explain how these ‘normal’ findings [are] inconsistent with [her] complaints of anxiety and depression.” Doc. 15, pp. 13-14; Doc. 20, p. 6. The ALJ, however, did not state that these “normal” findings are inconsistent with Pinesett’s “complaints of anxiety and depression.” She stated that these “normal” findings are inconsistent with Pinesett’s “symptoms and limitations to the extent alleged.” AR 26. ALJ does not dispute the fact that Pinesett has “severe” mental impairments such as anxiety and depression. She does not dispute the fact that these mental impairments limit her Case 4:25-cv-00519-AMM-MAA Document 21 Filed 06/03/26 Page 13 of 15 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 - 14 - ability to perform work-related tasks. She evaluated these limitations and incorporated them into her assessment of Pinesett’s RFC. She concluded that Pinesett “can do work with simple instructions only and can perform tasks that do not involve a specific production rate pace, such as assembly line work or an hourly production quota . . . [and] can have [only] occasional interaction with the public, coworkers, and supervisors.” AR 24. The ALJ does dispute Pinesett’s implication that these mental impairments are so limiting that she is unable to perform any substantial gainful activity. See also Rounds v. Comm’r Soc. Sec. Admin., 807 F.3d 996, 1006 (9th Cir. 2015) (“[T]he ALJ is responsible for translating and incorporating clinical findings into a succinct RFC.”). And these “normal” findings support her conclusion that Pinesett’s “statements concerning the intensity, persistence, and limiting effects of these symptoms are not entirely consistent with the medical evidence and other evidence in the record.” AR 26; see also Smartt v. Kijakazi, 53 F.4th 489, 499 (9th Cir. 2022) (“Ultimately, the clear and convincing standard requires an ALJ to show [her] work . . . .”) (punctuation modified). RECOMMENDATION For the foregoing reasons, the Magistrate Judge recommends that the District Court, after its independent review, affirm the final decision of the Commissioner. The ALJ properly evaluated the medical opinion evidence. The ALJ properly evaluated the claimant’s subjective symptom testimony. Pursuant to 28 U.S.C. § 636(b), any party may file and serve written objections within 14 days after being served with a copy of this Report and Recommendation. If objections are not timely filed, the party’s right to de novo review may be waived. The Local Rules permit the filing of a response to an objection. They do not permit the filing of a reply to a response without leave of the District Court. DATED this 3rd day of June, 2026. Case 4:25-cv-00519-AMM-MAA Document 21 Filed 06/03/26 Page 14 of 15 Case 4:25-cv-00519-AMM-MAA Document 21 Filed 06/03/26 Page 15 of 15 4 Honorable Michael A. Ambri United States Magistrate Judge - 15 - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
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