St Helen v. Commissioner of Social Security

1 2 3 4 5 UNITED STATES DISTRICT COURT 6 WESTERN DISTRICT OF WASHINGTON AT SEATTLE 7 JOLIETTE S.H. ex rel. I.Z.S.H., 8 Plaintiff, CASE NO. C25-1171-BAT 9 v. ORDER AFFIRMING THE 10 COMMISSIONER’S DECISION AND COMMISSIONER OF SOCIAL SECURITY, DISMISSING THE CASE WITH 11 PREJUDICE Defendant. 12 13 On behalf of her minor child, plaintiff appeals the denial of I.Z.S.H.’s application for 14 Supplemental Security Income. She contends the ALJ erred by (1) failing to explain how 15 I.Z.S.H. was assessed with less than a marked limitation in the ability to attend and complete 16 tasks; and (2) improperly discounting the consulting examinations by Dr. Shirley Deem and Dr. 17 David Widlan that support a marked limitation in the ability to attend and complete tasks. Dkts. 18 12, 17. As discussed below, the Court AFFIRMS the Commissioner’s final decision and 19 DISMISSES the case with prejudice. 20 BACKGROUND 21 I.Z.S.H. is currently under 18 years old and her application for benefits was protectively 22 filed on her behalf in July 2022, with an alleged disability onset date from the date of her birth in 23 March 2011. Tr. 240–49. Her claim was denied initially and on reconsideration in 2022. The 1 ALJ conducted a March 2024 telephone hearing at which I.Z.S.H. and her mother both testified. 2 Tr. 36–67. The ALJ conducted a supplemental hearing in July 2024, at which plaintiff’s counsel 3 cross-examined impartial medical expert (“ME”) Dr. Bradley John Bradford. Tr. 68–85. 4 An ALJ employs a three-step sequential evaluation process to determine whether a 5 claimant under age 18 is disabled: (1) Is the claimant engaging in substantial gainful activity 6 (“SGA”)? (2) Does the claimant have an impairment or combination of impairments that is 7 severe? (3) Does the claimant’s impairment or combination of impairments meet, medically 8 equal, or functionally equal a listed impairment? 20 C.F.R. § 416.924(a). In an August 2024 9 decision, the ALJ found that I.Z.S.H. had not engaged in substantial gainful activity. Tr. 18–19. 10 At step two, the ALJ found I.Z.S.H. has the following severe impairments: borderline intellectual 11 functioning; and specific learning disorders in reading, math, and written language. Tr. 19. At 12 step three, the ALJ first determined that I.Z.S.H. does not have an impairment or combination of 13 impairments that meets or medically equals a listing, including Listing 112.11 14 (neurodevelopmental disorders for children between 3 and 18 years). Tr. 19. The ALJ then 15 proceeded to determine whether I.Z.S.H. has an impairment or combination of impairments that 16 functionally equals a listing by evaluating the whole child with respect to six domains. 20 C.F.R. 17 § 416.926a; SSR 09-1p; SSR 09-2p. To functionally equal the listings, an impairment or 18 combination of impairments must result in “marked” limitations in two domains of functioning 19 or an “extreme” limitation in one domain. 20 C.F.R. §§ 416.924(d), 416.926(a), 416.926a(a). 20 The ALJ found that I.Z.S.H. has: (1) a marked limitation in acquiring and using information; 21 (2) less than a marked limitation in attending and completing tasks; (3) no limitation in 22 interacting and relating with others; (4) no limitation in moving about and manipulating objects; 23 (5) less than a marked limitation in the ability to care for herself; and (6) less than a marked 1 limitation in health and physical well-being. Tr. 20–30. The ALJ found I.Z.S.H. does not have an 2 impairment or combination of impairments that functionally equals a listing because she does not 3 have either “marked” limitations in two domains of functioning or “extreme” limitation in one 4 domain of functioning. Tr. 30. The ALJ therefore found I.Z.S.H. to be not disabled. Id. As the 5 Appeals Council denied plaintiff’s request for review, the ALJ’s decision is the Commissioner’s 6 final decision. Tr. 1–3. 7 DISCUSSION 8 Plaintiff contends the ALJ erred by failing to consider adequately (1) evidence I.Z.S.H. 9 had marked limitations in attending and completing tasks; and (2) the opinions of Drs. Deem and 10 Widlan that would support marked limitations in attending and completing tasks. Plaintiff argues 11 these errors were harmful because if I.Z.S.H. were found to have marked limitations in two 12 domains, she would have impairments functionally equivalent to a listing. The Court finds the 13 ALJ’s decision was supported by substantial evidence and not marred by harmful, legal error. 14 Molina v. Astrue, 674 F.3d 1104, 1110–11 (9th Cir. 2012). 15 1. Limitation in Attending and Completing Tasks 16 Plaintiff argues the ALJ’s decision failed to meaningfully analyze the functional domains 17 in that the ALJ’s general summary of the evidence “did not address I.Z.S.H.’s comprehensive 18 amount of help and adaptations as to her ability to function or compare her functioning with her 19 same-aged peers that do not need extra help and adaptations or have any impairments.” Dkt. 12, 20 at 5. Plaintiff contends had the ALJ done so, he would have determined I.Z.S.H. had a marked 21 limitation in attending and completing tasks, just as she had a marked limitation in acquiring and 22 using information. This contention is unpersuasive because plaintiff proffers at best an 23 alternative interpretation of the evidence that does not demonstrate the unreasonableness of the 1 ALJ’s reconciliation of conflicting evidence. See Thomas v. Barnhart, 278 F.3d 947, 954 (9th 2 Cir. 2002) (where the evidence is susceptible to more than one rational interpretation, a 3 reviewing court must uphold the Commissioner’s interpretation). 4 The ALJ sent interrogatories to impartial medical expert Dr. Bradford. Tr. 639–46. In his 5 response, Dr. Bradford considered and rejected I.Z.S.H. met or medically equaled a listing, 6 specifically referring to Listings 112.02 (neurocognitive disorders for children ages 3 to 18) and 7 12.05 (intellectual disorders). Tr. 641. In examining the six domains relevant to evaluating the 8 functional equivalent of a listing, Dr. Bradford opined while I.Z.S.H. had a marked limitation on 9 acquiring and using information, she had a “less than marked” limitation on attending and 10 completing tasks. Tr. 644. Dr. Bradford explained this functional limitation by citing Dr. Deem’s 11 September 2024 pediatric physical exam that noted “emotional issues and difficulty follow[ing] 12 directions.” Tr. 644. On questioning by plaintiff’s counsel at the supplemental hearing, Dr. 13 Bradford explained he opined less than marked limitation in attending and completing tasks 14 because there was no formal diagnosis of ADHD, no medication targeting ADHD, no ADHD 15 evaluation, and I.Z.S.H’s special education targeted only the learning disability. Tr. 79. 16 Moreover, Dr. Bradford noted although he generally found teacher’s evaluations to be 17 trustworthy, he opined more limitations than did I.Z.S.H.’s teacher regarding acquiring and using 18 information and attending and completing tasks due to Dr. Deem’s and Dr. Widlan’s 19 examinations. Tr. 76–82. I.Z.S.H.’s special education teacher, who taught reading and writing to 20 I.Z.S.H. for three-quarters of the year for an hour per day, opined not only that I.Z.S.H. had no 21 problems in acquiring and using information, but also that I.Z.S.H. had no problems in attending 22 and completing tasks and that her functioning in this domain appeared age-appropriate. Tr. 420– 23 21. 1 The ALJ found Dr. Bradford’s expert opinion to be persuasive and reconciled conflicting 2 information about I.Z.S.H.’s limitation on attending and completing tasks. Tr. 28. For example, 3 the ALJ noted while I.Z.S.H.’s mother referred to her daughter having difficulty in emotionally 4 regulating herself, IEP records did not suggest this problem and teacher questionnaires noted 5 I.Z.S.H.’s independence. Tr. 28–29. To the extent I.Z.S.H. had greater than no limitation on 6 attending and completing tasks, the ALJ cited as persuasive Dr. Deem’s observation that I.Z.S.H. 7 was unable to perform all of the tasks because she did not follow instructions. Tr. 30. The ALJ 8 noted while in 2024, I.Z.S.H.’s special education teacher suggested no limitation on her ability to 9 attend and complete tasks, Dr. Bradford’s opinion of less than marked limitation on attending 10 and completing tasks appeared to be more reflective of the record. Tr. 28; see, e.g., Tr. 24 (noting 11 that in 2022, I.Z.S.H.’s special education teacher referred to her having only “slight” problems in 12 attending and completing tasks with respect to carrying out multi-step instructions, organizing 13 her own things or school materials, and working without distracting herself and others) (citing 14 Tr. 346). 15 Although plaintiff argues the ALJ did not consider the extent to which I.Z.S.H. lagged 16 behind her peers, the ALJ did not harmfully err by relying upon expert medical testimony as well 17 as teacher evaluations that explicitly stated I.Z.S.H.’s functioning appeared age-appropriate and 18 showed anywhere from “slight” limitation on the ability to attend and complete tasks to “no” 19 limitation to attend and complete tasks. See Tr. 346, 421. Plaintiff appears to suggest I.Z.S.H.’s 20 enrollment in special education itself is sufficient to show that she has a marked limitation in 21 attending and completing tasks. Dr. Bradford explained, however, that I.Z.S.H.’s learning 22 disability led to opining a marked limitation in acquiring and completing tasks. Tr. 79, 644. 23 Similarly, in 2022, I.Z.S.H.’s special education teacher noted that I.Z.S.H. had serious problems 1 with certain aspects of acquiring and using information but only slight problems with certain 2 aspects of attending and completing tasks. Tr. 345–46. 3 Plaintiff also argues, prior to examining functional equivalency to a listing, the ALJ 4 failed to adequately explain why I.Z.S.H. did not meet or equal Listing 112.11 for 5 neurodevelopmental disorder in children ages 3 to 18. Dkt. 12, at 9–10. Plaintiff cannot show the 6 ALJ’s evaluation of Listing 112.11 was erroneous or harmful. Listing 112.11 provides, in 7 addition to demonstrating that a child demonstrates significant difficulties learning and using 8 academic skills, the child must have an extreme limitation of one, or marked limitation of two, of 9 four areas of mental functioning: understanding, remembering, or applying information; 10 interacting with others; concentrating, persisting, or maintaining pace; and adapting or managing 11 oneself. Plaintiff cites to educational notes that refer to I.Z.S.H. being distractable and not 12 completing an assignment, but it was not unreasonable for the ALJ or ME Dr. Bradford to have 13 interpreted such notes as referring primarily to a marked limitation on understanding, 14 remembering, or applying information while referring to some difficulty below a marked level 15 with respect to concentrating, persisting, or maintaining pace. The cited notes show few 16 references to the domain of concentration, persistence, and pace, instead focusing on I.Z.S.H.’s 17 learning difficulties. Tr. 430–31, 433, 437, 490, 492–93, 494, 495. Moreover, though the ALJ 18 found that I.Z.S.H.’s impairments did not meet or equal Listing 112.11, he proceeded to examine 19 extensively whether her impairments functionally equaled a listing, rendering harmless any error 20 in evaluating Listing 112.11. 21 The ALJ supported with substantial evidence the determination that I.Z.S.H. had less than 22 a marked limitation on attending and completing tasks. The ALJ therefore did not harmfully err 23 1 in determining that I.Z.S.H.’s impairments or combination of impairments did not meet, 2 medically equal, or functionally equal a listed impairment. 3 2. Opinions of Drs. Deem and Widlan 4 Plaintiff contends the ALJ failed to reconcile conflicts between his attending and 5 completing tasks domain finding and the opinions of Drs. Deem and Widlan, which harmfully 6 resulted in an RFC assessment that is not supported by substantial evidence and prevents 7 meaningful review. This contention is unpersuasive. 8 The ALJ considers the persuasiveness of medical opinions using five factors 9 (supportability, consistency, relationship with claimant, specialization, and other), but 10 supportability and consistency are the two most important factors. 20 C.F.R. §§ 404.1520c(b)(2), 11 416.920c(b)(2), (c) (2017). The ALJ must explain in the decision how persuasive he or she finds 12 a medical opinion(s) and/or a prior administrative medical finding(s) based on these two factors. 13 20 C.F.R. §§ 404.1520c(b), 416.920c(b) (2017). The ALJ may, but is not required to, explain 14 how he or she considered the other remaining factors, unless the ALJ finds that two or more 15 medical opinions or prior administrative medical findings about the same issue are both equally 16 well-supported and consistent with the record, but not identical. 20 C.F.R. §§ 404.1520c(b)(3), 17 416.920c(b)(3) (2017). Nevertheless, an ALJ cannot reject a doctor’s opinion as unsupported or 18 inconsistent without providing an explanation supported by substantial 19 evidence. Woods v. Kijakazi, 32 F.4th 785, 792 (9th Cir. 2022). 20 a. Dr. Deem 21 In February 2024, physician Dr. Deem examined I.Z.S.H. and offered her medical 22 evaluation. Dr. Deem opined, “Attending and completing tasks: She was not able to perform all 23 of the tasks because she did not follow instructions” and “Acquiring and using information: She 1 was not following instructions.” Tr. 611. The ALJ found Dr. Deem’s opinion on these points 2 generally persuasive because “[i]t is supported by Dr. Deem’s observation and findings and is 3 generally consistent with the claimant’s IQ scores and learning disabilities.” Tr. 30. That is, the 4 ALJ found Dr. Deem’s opinion to be supported by her clinical examination and consistent with 5 evidence that I.Z.S.H. had a marked limitation on acquiring and using information, as well as 6 less than a marked limitation on attending and completing tasks. 7 Plaintiff contends that the only proper way to read Dr. Deem’s opinion is to determine 8 that Dr. Deem opined I.Z.S.H. was markedly limited in attending and completing tasks. The 9 Court disagrees. A marked limitation is defined as follows: 10 We will find that you have a “marked” limitation in a domain when your impairment(s) interferes seriously with your ability to 11 independently initiate, sustain, or complete activities. Your day-to- day functioning may be seriously limited when your impairment(s) 12 limits only one activity or when the interactive and cumulative effects of your impairment(s) limit several activities. “Marked” 13 limitation also means a limitation that is “more than moderate” but “less than extreme.” It is the equivalent of the functioning we 14 would expect to find on standardized testing with scores that are at least two, but less than three, standard deviations below the mean. 15 20 C.F.R. § 416.926a(e)(2)(i). In finding ME Dr. Bradford’s opinion to be persuasive, the ALJ 16 found Dr. Deem’s opinion to be more persuasive than, and inconsistent with, the most recent 17 evaluation by I.Z.S.H.’s special education teacher, who stated I.Z.S.H. had no limitation in either 18 domain. Tr. 28, 30. That is, in assessing a less than marked limitation in attending and 19 completing tasks, the ALJ concluded I.Z.S.H. has as much as a moderate limitation in that 20 domain, in contradiction to the 2024 teacher assessment of no limitation and the 2022 teacher 21 assessment of a “slight” limitation in certain aspects of that domain. See Tr. 346, 421. This 22 conclusion was supported by substantial evidence and plaintiff has not demonstrated this 23 interpretation of the evidence was unreasonable. 1 b. Dr. Widlan 2 In January 2024, psychologist Dr. Widlan examined I.Z.S.H. and offered an evaluation. 3 As plaintiff notes, Dr. Widlan opined limitations related to attending and completing tasks that 4 could be interpreted to be marked. Tr. 567–79. As the ALJ accurately summarized, Dr. Widlan 5 opined I.Z.S.H. could perform a designated task or function but would have noticeable difficulty 6 more than 20% of the workday/work week (4 on a 5-point scale) with respect to carrying out 7 detailed instructions; maintaining attention and concentration for extended periods of time; 8 sustaining an ordinary routine without special supervision; and accepting instructions and 9 responding appropriately to criticism from supervisors. Tr. 28–29; see Tr. 576. Dr. Widlan also 10 opined I.Z.S.H. would have a more moderate limitation of having noticeable difficulty from 11 11 to 20 percent of the workday/work week (3 on a 5-point scale) in seven other domains of 12 sustained concentration and persistence. Tr. 29; see Tr. 576. The ALJ determined Dr. Widlan’s 13 opinion was supported by his IQ testing and I.Z.S.H.’s need for IEPs but found it to be largely 14 unpersuasive as inconsistent with other record evidence. Tr. 29. 15 For example, while the claimant’s mother reported that the claimant cries and yells on a daily basis, she is receiving no 16 treatment for any such complaints, and such reported difficulty with emotional regulation is not noted in the IEPs or teacher 17 questionnaires. Additionally, the claimant was not observed to have difficulty interacting and relating with others, and does not 18 have a behavior intervention plan at school. Moreover, as to the claimant’s purported difficulty adapting, she as noted to be “very 19 independent” at school and problems were noted neither by the teachers nor in the IEP reports. 20 Tr. 29. 21 Plaintiff argues the ALJ did not adequately explain why Dr. Widlan’s opinion supported 22 less than marked rather than a marked limitation on attending and completing tasks. Dkt. 12, at 23 13–14. The Court disagrees. Tasked with reconciling conflicting evidence, the ALJ determined 1 that Dr. Widlan’s opinion was supported by his own examination but was inconsistent with other 2 aspects of the record that suggested either no limitation or some limitation less than marked. 3 Plaintiff offers a plausible, alternative interpretation of the evidence that, on review, is 4 insufficient to demonstrate harmful error. 5 CONCLUSION 6 For the foregoing reasons, the Commissioner’s final decision is AFFIRMED, and this 7 case is DISMISSED with prejudice. 8 9 DATED this 3rd day of April, 2026. 10 A 11 BRIAN A. TSUCHIDA 12 United States Magistrate Judge 13 14 15 16 17 18 19 20 21 22 23