Crystal A. v. Frank Bisignano, Commissioner of Social Security

1 U.S. FDILISETDR IINC TT HCEO URT EASTERN DISTRICT OF WASHINGTON Jan 23, 2026 — 2 — SEAN F. MCAVOY, CLERK — 3 — — 4 — 5 UNITED STATES DISTRICT COURT 6 EASTERN DISTRICT OF WASHINGTON 7 CRYSTAL A.,1 No. 2:24-CV-00399-MKD 8 Plaintiff, ORDER AFFIRMING THE COMMISSIONER’S DECISION 9 v. ECF Nos. 11, 13 10 FRANK BISIGNANO, COMMISSIONER OF SOCIAL 11 SECURITY, 12 Defendant. 13 Before the Court are the parties’ briefs. ECF Nos. 11, 13. Chad Hatfield 14 represents Plaintiff. Special Assistant United States Attorneys L. Jamala Edwards 15 and David Burdett represent Defendant. The Court, having reviewed the 16 administrative record and the parties’ briefing, is fully informed. For the reasons 17 discussed below, the Court affirms the Commissioner’s decision. — 18 — 19 1 To protect the privacy of plaintiffs in social security cases, the Court identifies 20 them by only their first names and the initial of their last names. See LCivR 5.2(c). — 21 — 1 JURISDICTION 2 Plaintiff filed an application for Title XVI supplemental security income 3 benefits on August 8, 2019, alleging disability beginning January 1, 2019. Tr. 15, 4 75, 208-23. The application was denied initially and upon reconsideration. Tr. 965 104, 108-114. An Administrative Law Judge (ALJ) held a hearing on September 6 30, 2021, Tr. 37-57, and issued an unfavorable decision on October 27, 2021. Tr. 7 13-34. The Appeals Council denied review on August 16, 2022. Tr. 1-6. This 8 Court remanded the matter on April 24, 2023. Tr. 794-96. The ALJ held a second 9 hearing on September 5, 2024, Tr. 735-49, and issued an unfavorable decision on 10 September 27, 2024. Tr. 711-34. Per 20 C.F.R. § 416.1484 , the ALJ’s decision 11 following this Court’s prior remand became the Commissioner’s final decision for 12 purposes of judicial review. Plaintiff appealed this final decision on November 27, 13 2024. ECF No. 1. 14 The Court has jurisdiction over this case pursuant to 42 U.S.C. § 1383 (c)(3). 15 STANDARD OF REVIEW 16 A district court’s review of a final decision of the Commissioner of Social 17 Security is governed by 42 U.S.C. § 405 (g). The scope of review under § 405(g) is 18 limited; the Commissioner’s decision will be disturbed “only if it is not supported 19 by substantial evidence or is based on legal error.” Hill v. Astrue, 698 F.3d 1153 , 20 1158 (9th Cir. 2012) (citations omitted). “Substantial evidence” means “relevant — 21 — 1 evidence [that] a reasonable mind might accept as adequate to support a 2 conclusion.” Id. at 1159 (quotation marks and citation omitted). Stated 3 differently, substantial evidence equates to “more than a mere scintilla[,] but less 4 than a preponderance.” Id. (quotation marks and citation omitted). In determining 5 whether the standard has been satisfied, a reviewing court must consider the entire 6 record as a whole rather than searching for supporting evidence in isolation. Id. 7 In reviewing a denial of benefits, a district court may not substitute its 8 judgment for that of the Commissioner. Edlund v. Massanari, 253 F.3d 1152 , 9 1156 (9th Cir. 2001), as amended on reh’g (Aug. 9, 2001). If the evidence in the 10 record “is susceptible to more than one rational interpretation, [the court] must 11 uphold the ALJ’s findings if they are supported by inferences reasonably drawn 12 from the record.” Molina v. Astrue, 674 F.3d 1104, 1111 (9th Cir. 2012), 13 superseded on other grounds by 20 C.F.R. §§ 404.1502 (a), 416.902(a) (citation 14 omitted). Further, a district court “may not reverse an ALJ’s decision on account 15 of an error that is harmless.” Id. (citation omitted). An error is harmless “where it 16 is inconsequential to the [ALJ’s] ultimate nondisability determination.” Id. at 1115 17 (quotation marks and citation omitted). The party appealing the ALJ’s decision 18 generally bears the burden of establishing that it was harmed. Shinseki v. Sanders, — 19 — 556 U.S. 396, 409-10 (2009). — 20 — — 21 — 1 FIVE-STEP EVALUATION PROCESS 2 A claimant must satisfy two conditions to be considered “disabled” within 3 the meaning of the Social Security Act. First, the claimant must be “unable to 4 engage in any substantial gainful activity by reason of any medically determinable 5 physical or mental impairment which can be expected to result in death or which 6 has lasted or can be expected to last for a continuous period of not less than twelve 7 months.” 42 U.S.C. § 1382c(a)(3)(A). Second, the claimant’s impairment must be 8 “of such severity that he is not only unable to do his previous work[,] but cannot, 9 considering his age, education, and work experience, engage in any other kind of 10 substantial gainful work which exists in the national economy.” 42 U.S.C. § 11 1382c(a)(3)(B). 12 The Commissioner has established a five-step sequential analysis to 13 determine whether a claimant satisfies the above criteria. See 20 C.F.R. § 14 416.920(a)(4)(i)-(v). At step one, the Commissioner considers the claimant’s work 15 activity. 20 C.F.R. § 416.920 (a)(4)(i). If the claimant is engaged in “substantial 16 gainful activity,” the Commissioner must find that the claimant is not disabled. 20 17 C.F.R. § 416.920 (b). 18 If the claimant is not engaged in substantial gainful activity, the analysis 19 proceeds to step two. At this step, the Commissioner considers the severity of the 20 claimant’s impairment. 20 C.F.R. § 416.920 (a)(4)(ii). If the claimant suffers from — 21 — 1 “any impairment or combination of impairments which significantly limits [his or 2 her] physical or mental ability to do basic work activities,” the analysis proceeds to 3 step three. 20 C.F.R. § 416.920 (c). If the claimant’s impairment does not satisfy 4 this severity threshold, however, the Commissioner must find that the claimant is 5 not disabled. Id. 6 At step three, the Commissioner compares the claimant’s impairment to 7 severe impairments recognized by the Commissioner to be so severe as to preclude 8 a person from engaging in substantial gainful activity. 20 C.F.R. § 9 416.920(a)(4)(iii). If the impairment is as severe or more severe than one of the 10 enumerated impairments, the Commissioner must find the claimant disabled and 11 award benefits. 20 C.F.R. § 416.920 (d). 12 If the severity of the claimant’s impairment does not meet or exceed the 13 severity of the enumerated impairments, the Commissioner must pause to assess 14 the claimant’s “residual functional capacity.” Residual functional capacity (RFC), 15 defined generally as the claimant’s ability to perform physical and mental work 16 activities on a sustained basis despite his or her limitations, 20 C.F.R. § 17 416.945(a)(1), is relevant to both the fourth and fifth steps of the analysis. 18 At step four, the Commissioner considers whether, in view of the claimant’s 19 RFC, the claimant is capable of performing work that he or she has performed in 20 the past (past relevant work). 20 C.F.R. § 416.920 (a)(4)(iv). If the claimant is — 21 — 1 capable of performing past relevant work, the Commissioner must find that the 2 claimant is not disabled. 20 C.F.R. § 416.920 (f). If the claimant is incapable of 3 performing such work, the analysis proceeds to step five. 4 At step five, the Commissioner considers whether, in view of the claimant’s 5 RFC, the claimant is capable of performing other work in the national economy. — 6 — 20 C.F.R. § 416.920 (a)(4)(v). In making this determination, the Commissioner 7 must also consider vocational factors such as the claimant’s age, education and 8 past work experience. Id. If the claimant is capable of adjusting to other work, the 9 Commissioner must find that the claimant is not disabled. 20 C.F.R. § 10 416.920(g)(1). If the claimant is not capable of adjusting to other work, the 11 analysis concludes with a finding that the claimant is disabled and is therefore 12 entitled to benefits. Id. 13 The claimant bears the burden of proof at steps one through four above. 14 Tackett v. Apfel, 180 F.3d 1094, 1098 (9th Cir. 1999). If the analysis proceeds to 15 step five, the burden shifts to the Commissioner to establish that (1) the claimant is 16 capable of performing other work; and (2) such work “exists in significant 17 numbers in the national economy.” 20 C.F.R. § 416.960 (c)(2); Beltran v. Astrue, — 18 — 700 F.3d 386, 389 (9th Cir. 2012). — 19 — — 20 — — 21 — 1 ALJ’S FINDINGS 2 At step one, the ALJ found Plaintiff had not engaged in substantial gainful 3 activity since August 8, 2019, the amened alleged onset date. Tr. 717. 4 At step two, the ALJ found that Plaintiff has the following severe 5 impairments: posttraumatic stress disorder (PTSD); anxiety disorder; depressive 6 disorder; and polysubstance abuse disorders (amphetamine, opioid, cannabis, 7 alcohol). Tr. 717. 8 At step three, the ALJ found Plaintiff does not have an impairment or 9 combination of impairments that meets or medically equals the severity of a listed 10 impairment. Tr. 718. 11 The ALJ then concluded that Plaintiff has the RFC to perform a full range of 12 work with the following non-exertional limitations: 13 [Plaintiff] is able to understand, remember, and carry out simple routine tasks and instructions. [Plaintiff] can 14 maintain concentration, persistence, and pace for two-hour intervals between regularly scheduled breaks. [Plaintiff] 15 is limited to occasional and superficial interaction with the public and coworkers. — 16 — Tr. 720. — 17 — At step four, the ALJ found Plaintiff is unable to perform any past relevant — 18 — work. Tr. 725. At step five, the ALJ found that, considering Plaintiff’s age, — 19 — education, work experience, RFC, and testimony from the vocational expert, there — 20 — are jobs that existed in significant numbers in the national economy that Plaintiff — 21 — 1 could perform, to include dishwasher, hospital cleaner, and lab equipment cleaner. 2 Tr. 725-26. 3 Therefore, the ALJ concluded Plaintiff was not under a disability, as defined 4 in the Social Security Act, from the amended alleged onset date of August 8, 2019, 5 through the date of the decision. Tr. 726-27. 6 ISSUES 7 Plaintiff seeks judicial review of the Commissioner’s final decision denying 8 her supplemental security income benefits under Title XVI of the Social Security 9 Act. Plaintiff raises the following issues for review: 10 1. Whether the ALJ properly evaluated the medical opinion evidence; 11 2. Whether the ALJ properly evaluated Plaintiff’s symptom claims; 12 3. Whether the ALJ erred at step two; and 13 4. Whether the ALJ erred at step five. 14 ECF No. 11 at 4. 15 DISCUSSION 16 A. Medical Opinion Evidence 17 For claims filed on or after March 27, 2017, new regulations apply that 18 change the framework for how an ALJ must evaluate medical opinion evidence. 19 Revisions to Rules Regarding the Evaluation of Medical Evidence, 2017 WL 20 168819, 82 Fed. Reg. 5844 -01 (Jan. 18, 2017); 20 C.F.R. §§ 404 .1520c, 416.920c. — 21 — 1 The new regulations provide that the ALJ will no longer “give any specific 2 evidentiary weight . . . to any medical opinion(s) . . . .” Revisions to Rules, 2017 3 WL 168819 , 82 Fed. Reg. 5844 , at 5867-68; see also 20 C.F.R. §§ 404 .1520c(a), 4 416.920c(a). Instead, an ALJ must consider and evaluate the persuasiveness of all 5 medical opinions or prior administrative medical findings from medical sources. — 6 — 20 C.F.R. §§ 404 .1520c(a)-(b), 416.920c(a)-(b). 7 The factors for evaluating the persuasiveness of medical opinions and prior 8 administrative medical findings include supportability, consistency, relationship 9 with the claimant (including length of the treatment, frequency of examinations, 10 purpose of the treatment, extent of the treatment, and the existence of an 11 examination), specialization, and “other factors that tend to support or contradict a 12 medical opinion or prior administrative medical finding” (including, but not 13 limited to, “evidence showing a medical source has familiarity with the other 14 evidence in the claim or an understanding of our disability program’s policies and 15 evidentiary requirements”). 20 C.F.R. §§ 404 .1520c(c)(1)-(5), 416.920c(c)(1)-(5). 16 Supportability and consistency are the most important factors, and therefore the 17 ALJ is required to explain how both factors were considered. 20 C.F.R. §§ 18 404.1520c(b)(2), 416.920c(b)(2). Supportability and consistency are explained in 19 the regulations: 20 Supportability. The more relevant the objective medical evidence and supporting explanations presented by a — 21 — 1 medical source are to support his or her medical opinion(s) or prior administrative medical finding(s), the more 2 persuasive the medical opinions or prior administrative medical finding(s) will be. — 3 — Consistency. The more consistent a medical opinion(s) or 4 prior administrative medical finding(s) is with the evidence from other medical sources and nonmedical 5 sources in the claim, the more persuasive the medical opinion(s) or prior administrative medical finding(s) will 6 be. — 7 — 20 C.F.R. §§ 404 .1520c(c)(1)-(2), 416.920c(c)(1)-(2) (emphases added). The ALJ 8 may, but is not required to, explain how the other factors were considered. 20 9 C.F.R. §§ 404 .1520c(b)(2), 416.920c(b)(2). However, when two or more medical 10 opinions or prior administrative findings “about the same issue are both equally 11 well-supported . . . and consistent with the record . . . but are not exactly the same,” 12 the ALJ is required to explain how “the other most persuasive factors in paragraphs 13 (c)(3) through (c)(5)” were considered. 20 C.F.R. §§ 404 .1520c(b)(3), 14 416.920c(b)(3). 15 The Ninth Circuit addressed the issue of whether the changes to the 16 regulations displace the longstanding case law requiring an ALJ to provide specific 17 and legitimate reasons to reject an examining provider’s opinion. Woods v. 18 Kijakazi, 32 F.4th 785, 787 (9th Cir. 2022). The Court held that the new 19 regulations eliminate any hierarchy of medical opinions, and the specific and 20 legitimate standard no longer applies. Id. The Court reasoned the “relationship — 21 — 1 factors” remain relevant under the new regulations, and thus the ALJ can still 2 consider the length and purpose of the treatment relationship, the frequency of 3 examinations, the kinds and extent of examinations that the medical source has 4 performed or ordered from specialists, and whether the medical source has 5 examined the claimant or merely reviewed the claimant’s records. Id. at 792 . 6 However, the ALJ is not required to make specific findings regarding the 7 relationship factors. Id. Even under the new regulations, an ALJ must provide an 8 explanation supported by substantial evidence when rejecting an examining or 9 treating doctor’s opinion as unsupported or inconsistent. Id. 10 Plaintiff argues the ALJ improperly discounted three medical opinions. ECF 11 No. 11 at 7-17. 12 1. Dr. Arnold (2019) 13 Dr. Arnold examined Plaintiff on May 28, 2019, and opined Plaintiff had, 14 among other things, a series of severe and marked impairments and an overall 15 severity rating of “marked.” Tr. 369, 372. Dr. Arnold assessed Plaintiff would be 16 severely limited in maintaining appropriate behavior in a work setting. Tr. 372. 17 The ALJ found Dr. Arnold’s opinion not persuasive. Tr. 723. 18 The ALJ first discounted Dr. Arnold’s opinion as “inconsistent with the 19 record,” noting “the totality of the record shows normal findings at least as often as 20 abnormalities, inconsistent with the level of limitation assigned.” Tr. 723. This — 21 — 1 finding is legally sound, see Batson v. Comm’r of Soc. Sec. Admin., 359 F.3d 1190 , 2 1195 (9th Cir. 2004) (an ALJ may reasonably reject doctors’ opinions when they 3 are inconsistent with or contradicted by the medical evidence), and substantial 4 evidence supports it, see, e.g., Tr. 314 (April 23, 2019, treatment note indicating 5 “good judgment” and “happy/content, and normal activity level”); Tr. 350 (July 6 30, 2018, mental status examination indicating largely unremarkable and within 7 normal limits results); Tr. 425-26 (April 10, 2019, mental status examination 8 indicating normal thought process and thought control, fair judgment, orientation 9 to person/time/place, normal memory, and normal language); Tr. 433-34 (January 10 17, 2019, mental status examination indicating same); Tr. 579 (February 10, 2021, 11 mental status examination indicating cooperative attitude, normal speech, normal 12 thought process and thought control, orientation to person/time/place, good fund of 13 knowledge, and normal memory). 14 The ALJ also discounted Dr. Arnold’s opinion as “not supported by his own 15 evaluation,” noting Plaintiff’s “examination was within normal limits with respect 16 to observational and objective evidence.” Tr. 723. This finding is legally sound, 17 see Tommasetti v. Astrue, 533 F.3d 1035, 1041 (9th Cir. 2008) (an ALJ may 18 discount a doctor’s opinion when it is inconsistent with or unsupported by the 19 doctor’s own clinical findings), and substantial evidence supports it, see Tr. 371 20 (noting “Rey: 15/15: [within normal limits]”); Tr. 373 (“Generally logical and — 21 — 1 progressive [speech] for the most part.”); Tr. 374 (assessing orientation, 2 perception, fund of knowledge, concentration, abstract thought, insight and 3 judgment as within normal limits). 4 2. Dr. Arnold (2020) 5 Dr. Arnold again examined Plaintiff on September 3, 2020, and opined, 6 among other things, Plaintiff would have up to moderate difficulty understanding 7 and performing simple and less physically demanding work tasks and basic 8 instructions, marked difficulty making judgements, marked or greater difficulty 9 interacting with others, and marked or greater difficulty maintaining employment 10 for long periods. Tr. 530. The ALJ found this opinion not persuasive. Tr. 723. 11 The ALJ discounted the opinion on the same grounds used to discount Dr. 12 Arnold’s prior opinion, as discussed above. Tr. 723. For the reasons discussed 13 above, the ALJ did not err by discounting the opinion on these grounds. See Tr. 14 529 (Dr. Arnold’s 2020 mental status examination reflecting orientation to 15 person/place/time, generally logical and progressive thought, engaged behavior, a 16 judgment within normal limits). 17 3. Dr. Genthe 18 Dr. Genthe examined Plaintiff on January 5, 2024, and opined, among other 19 things, Plaintiff had a series of marked limitations and an overall severity level of 20 marked. Tr. 985. The ALJ found the opinion not persuasive. Tr. 725. — 21 — 1 The ALJ first discounted the opinion on the same grounds used to discount 2 Dr. Arnold’s two opinions, as discussed above. Tr. 725. For the reasons discussed 3 above, the ALJ did not err by discounting the opinion on these grounds. See Tr. 4 987-88 (Dr. Genthe’s mental status examination reflecting normal speech and 5 “fairly clear[] articulation,” cooperative behavior, coherent “with no evidence of 6 abnormal or delusional thought content or cognitive disturbance,” orientation 7 within normal limits, and perception within normal limits). The ALJ also noted 8 that Dr. Genthe “did not review any records,” finding that “[t]he records available 9 show [Plaintiff’s] abnormal findings are interspersed with normal findings, more 10 suggestive of moderate limitations than those found by Dr. Genthe.” Tr. 725. On 11 this record, as detailed above, this was reasonable. See C.F.R. § 404.1520c(c)(3) 12 (stating that the length, purpose, and extent of a medical source’s relationship with 13 the claimant “may help demonstrate whether the medical source has a longitudinal 14 understanding” and appropriate “level of knowledge” about the claimant’s 15 impairments). 16 B. Plaintiff’s Testimony 17 Plaintiff faults the ALJ for failing to rely on reasons that were clear and 18 convincing in discrediting her symptom claims. ECF No. 11 at 18-21. An ALJ 19 engages in a two-step analysis to determine whether to discount a claimant’s 20 testimony regarding subjective symptoms. SSR 16-3p, 2016 WL 1119029 , at *2 — 21 — 1 (Mar. 16, 2016). “First, the ALJ must determine whether there is objective 2 medical evidence of an underlying impairment which could reasonably be 3 expected to produce the pain or other symptoms alleged.” Molina, 674 F.3d at 4 1112 (quotation marks and citation omitted). “The claimant is not required to 5 show that [the claimant’s] impairment could reasonably be expected to cause the 6 severity of the symptom [the claimant] has alleged; [the claimant] need only show 7 that it could reasonably have caused some degree of the symptom.” Vasquez v. 8 Astrue, 572 F.3d 586, 591 (9th Cir. 2009) (quotation marks and citation omitted). 9 Second, “[i]f the claimant meets the first test and there is no evidence of 10 malingering, the ALJ can only reject the claimant’s testimony about the severity of 11 the symptoms if [the ALJ] gives ‘specific, clear and convincing reasons’ for the 12 rejection.” Ghanim v. Colvin, 763 F.3d 1154, 1163 (9th Cir. 2014) (citation and 13 footnote omitted). General findings are insufficient; rather, the ALJ must identify 14 what symptom claims are being discounted and what evidence undermines these 15 claims. Id. (quoting Lester v. Chater, 81 F.3d 821, 834 (9th Cir. 1995), as 16 amended (Apr. 9, 1996)); Thomas v. Barnhart, 278 F.3d 947, 958 (9th Cir. 2002) 17 (requiring the ALJ to sufficiently explain why it discounted claimant’s symptom 18 claims). “The clear and convincing [evidence] standard is the most demanding 19 required in Social Security cases.” Garrison v. Colvin, 759 F.3d 995, 1015 (9th — 20 — — 21 — 1 Cir. 2014) (quoting Moore v. Comm’r of Soc. Sec. Admin., 278 F.3d 920, 924 (9th 2 Cir. 2002)). 3 Factors to be considered in evaluating the intensity, persistence, and limiting 4 effects of a claimant’s symptoms include: (1) daily activities; (2) the location, 5 duration, frequency, and intensity of pain or other symptoms; (3) factors that 6 precipitate and aggravate the symptoms; (4) the type, dosage, effectiveness, and 7 side effects of any medication an individual takes or has taken to alleviate pain or 8 other symptoms; (5) treatment, other than medication, an individual receives or has 9 received for relief of pain or other symptoms; (6) any measures other than 10 treatment an individual uses or has used to relieve pain or other symptoms; and (7) 11 any other factors concerning an individual’s functional limitations and restrictions 12 due to pain or other symptoms. SSR 16-3p, 2016 WL 1119029 , at *7; 20 C.F.R. § 13 416.929(c). The ALJ is instructed to “consider all of the evidence in an 14 individual’s record,” to “determine how symptoms limit ability to perform work15 related activities.” SSR 16-3p, 2016 WL 1119029 , at *2. 16 The ALJ found that Plaintiff’s medically determinable impairments could 17 reasonably be expected to cause some of the alleged symptoms, but that Plaintiff’s 18 statements concerning the intensity, persistence, and limiting effects of her 19 symptoms were not entirely consistent with the evidence. Tr. 721-22. — 20 — — 21 — 1 The ALJ offered numerous reasons to discount Plaintiff’s testimony, at least 2 three of which the Court finds well supported. First, the ALJ discounted Plaintiff’s 3 testimony as inconsistent with the objective medical evidence, to include mental 4 status examinations. Tr. 721. “Contradiction with the medical record is a 5 sufficient basis for rejecting the claimant’s subjective testimony.” Carmickle v. 6 Comm’r, Soc. Sec. Admin., 533 F.3d 1155, 1161 (9th Cir. 2008) (citing Johnson v. 7 Shalala, 60 F.3d 1428, 1434 (9th Cir. 1995)). The ALJ did not err and relied on 8 substantial evidence—including, as discussed above, a series of mental status 9 examinations and treatment notes—by discounting Plaintiff’s testimony on this 10 ground. 11 Next, the ALJ discounted Plaintiff’s testimony as inconsistent with 12 Plaintiff’s improvement with and course of treatment. Tr. 721-22. “[E]vidence of 13 medical treatment successfully relieving symptoms can undermine a claim of 14 disability.” Wellington v. Berryhill, 878 F.3d 867, 876 (9th Cir. 2017) (citing 20 15 C.F.R. §§ 404 .1520a(c)(1), 416.920a(c)(1)). Substantial evidence supports this 16 ground. See, e.g., Tr. 317 (“medication very helpful”); Tr. 580 (“She is responding 17 very well to [new medication]. Her mood is good. She is sleeping well. It is 18 working for her.”). The ALJ thus reasonably relied on this ground to discount 19 Plaintiff’s testimony. — 20 — — 21 — 1 The ALJ also discounted Plaintiff’s testimony as inconsistent with Plaintiff’s 2 noncompliance with treatment. Tr. 722. “An unexplained, or inadequately 3 explained, failure to seek treatment or follow a prescribed course of treatment may 4 be considered when evaluating the claimant’s subjective symptoms.” Jeanette R. 5 v. Kijakazi, 620 F. Supp. 3d 1127 , 1138 (E.D. Wash. 2022) (citing Orn v. Astrue, — 6 — 495 F.3d 625, 638 (9th Cir. 2007)). Substantial evidence supports this ground. 7 See, e.g., Tr. 974 (treatment note indicating Plaintiff refused to take GAD-7 and 8 PHQ-2/PHQ-9 mental health assessments); Tr. 1059 (same); Tr. 584 (treatment 9 note indicating noncompliance with medication usage); Tr. 573 (treatment note 10 indicating Plaintiff discontinued medication usage and “doesn’t want any” 11 medication). The ALJ thus reasonably relied on this ground to discount Plaintiff’s 12 testimony. 13 Because the ALJ gave at least three valid reasons for discounting Plaintiff’s 14 testimony, the Court need not address the balance of the ALJ’s stated reasons for 15 discounting Plaintiff’s testimony. Any inclusion of erroneous reasons was 16 inconsequential and therefore harmless. See Carmickle, 533 F.3d at 1162 . 17 C. Step Two 18 Plaintiff argues the ALJ erred at step two by “rejecting [her] bilateral lower 19 extremity edema as groundless.” ECF No. 11 at 17. However, in determining 20 Plaintiff’s RFC, the ALJ addressed Plaintiff’s physical impairments and — 21 — 1 complaints. Tr. 723 (discussing Dr. Smiley’s “thorough examination” of Plaintiff, 2 to include physical impairments and complaints). Because the ALJ discussed and 3 rejected Plaintiff’s physical impairments and complaints as disabling in 4 determining Plaintiff’s RFC, any error at step two was harmless. See Lewis v. 5 Astrue, 498 F.3d 909, 911 (9th Cir. 2007). 6 D. Step Five 7 Plaintiff argues “the vocational testimony relied on by the ALJ at step five 8 was without evidentiary value because it was provided in response to an 9 incomplete hypothetical.” ECF No. 11 at 21. This argument is foreclosed because, 10 as discussed above, the ALJ properly evaluated the medical evidence and 11 reasonably discounted Plaintiff’s testimony. This restatement of Plaintiff’s 12 argument fails to establish error at step five. Stubbs-Danielson v. Astrue, 539 F.3d 13 1169, 1175-76 (9th Cir. 2008). 14 CONCLUSION 15 Having reviewed the record and the ALJ’s findings, the Court concludes the 16 ALJ’s decision is supported by substantial evidence and free of harmful legal error. 17 Accordingly, IT IS HEREBY ORDERED: 18 1. Plaintiff’s Brief, ECF No. 11, is DENIED. 19 2. Defendant’s Brief, ECF No. 13, is GRANTED. 20 3. The Clerk’s Office shall enter JUDGMENT in favor of Defendant. — 21 — 1 The District Court Executive is directed to file this Order, provide copies to 2 counsel, and CLOSE THE FILE. 3 DATED January 23, 2026. 4 s/Mary K. Dimke MARY K. DIMKE 5 UNITED STATES DISTRICT JUDGE — 6 — — 7 — — 8 — — 9 — — 10 — — 11 — — 12 — — 13 — — 14 — — 15 — — 16 — — 17 — — 18 — — 19 — — 20 — — 21 —