MEMORANDUM *
Plaintiff Michael Nygren appeals the district courts order affirming the Commissioner of Social Securitys decision denying Nygrens application for Supplemental Security Income. We review de novo and set aside a denial of benefits if it is unsupported by substantial evidence or the administrative law judge (“ALJ”) committed legal error. Ford v. Saul, 950 F.3d 1141, 1153–54 (9th Cir. 2020). We have jurisdiction pursuant to 28 U.S.C. § 1291 and we reverse and remand. Because the parties are familiar with the facts, we recount them only as necessary to resolve the arguments on appeal.
Nygren contends that the ALJ failed to properly evaluate the medical evidence. First, Nygren argues the ALJ committed reversible error in failing to discuss the opinion of Dr. Erum Quadeer, his treating physician, regarding the limitations triggered by his ankle injury. If an ALJ overlooks a medical opinion, we must consider whether this error was harmless. Marsh v. Colvin, 792 F.3d 1170, 1172 (9th Cir. 2015). Although Dr. Quadeer initially opined that Nygren has a set of specific limitations, she explicitly opined that those limitations would last for approximately four months. Because a disabling impairment must last or be expected to last at least twelve months, the Commissioner argues that the ALJs failure to discuss Dr. Quadeers opinion was harmless. We disagree. Although Dr. Quadeer initially limited Nygren to four months of modified work duty, she subsequently diagnosed Nygren with synovitis, degenerative joint disease, nerve entrapment, tasrsal tunnel syndrome, and tendonitis. “[A]n ALJ cannot in its decision totally ignore a treating doctor and his or her notes, without even mentioning them.” Id. at 1172–73. Because the ALJ did so here, we cannot “confidently conclude” that the ALJs error was harmless. Id. at 1173 (citation omitted).
Next, Nygren argues that the ALJ improperly rejected the opinion of Dr. Michael Dujela, a treating podiatrist. The ALJ in some respects gave “little weight” to Dr. Dujelas statements because “[h]is assessment of [Nygrens] functioning is inconsistent with the objective medical evidence in this case.” An ALJ may reject a treating physicians opinion only “by providing specific and legitimate reasons that are supported by substantial evidence.” Ryan v. Commr of Soc. Sec., 528 F.3d 1194, 1198 (9th Cir. 2008) (citation omitted). The ALJ explained that while “some of [Dr. Dujelas] outlined limitations are accommodated in the residual functional capacity above, other [sic] are clearly inconsistent with the medical record, including restrictions on fine and gross manipulation, which fall outside Dr. Dujelas medical expertise as a podiatrist.” The ALJ highlighted specific contrary medical evidence, such as nerve conduction studies and a normal EMG of Nygrens lower extremities that led other physicians to conclude that Nygrens diagnosis of “complex regional pain syndrome was not supported.” These are “specific and legitimate reasons” to discount Dr. Dujelas opinions. Ryan, 528 F.3d at 1198 (citation omitted).
What is more, Dr. Dujelas limitations were for the most part accounted for in the ALJs residual functional capacity (“RFC”) finding. Dr. Dujela indicated that Nygren could stand and walk between one to three hours each workday and that he could sit throughout the workday. The ALJs RFC finding largely reflected Dr. Dujelas opinion, indicating that Nygren could “stand and/or walk up to two hours in an eight-hour workday, and sit about six hours in an eight-hour workday.” Any error was thus harmless because Dr. Dujelas primary limitations were accounted for in the RFC. See Molina v. Astrue, 674 F.3d 1104, 1115 (9th Cir. 2012) (holding that an error is harmless if it is “inconsequential to the ultimate nondisability determination”) (internal quotation marks and citation omitted).
Nygren also argues that the ALJ failed to properly evaluate the opinion of Dr. Amir Atabeygi, a treating physician. Nygren contends that the “ALJ does not acknowledge Dr. Atabeygis discussion of why he prescribed a four-wheel walker to Nygren.” But the ALJ did discuss the prescription of a four-wheel walker, finding that it did not reflect Nygrens true limitations. In any event, an ALJ need not address every single note or observation about a claimants condition. Howard ex rel. Wolff v. Barnhart, 341 F.3d 1006, 1012 (9th Cir. 2003).
However, the ALJ did not discuss Dr. Atabeygis clinical findings on Nygrens severe hip pain, including Nygrens diagnoses of bursitis of the right hip and IT band syndrome. Dr. Atabeygi also indicated agreement with Dr. Dujelas complex regional pain syndrome (“CRPS”) diagnosis, based on Dr. Atabeygis reading of Nygrens bone scan. It appears that the ALJ entirely ignored these opinions, which is reversible error. Marsh, 792 F.3d at 1172–73. The dissent would hold that this error was harmless. We respectfully disagree, because “an ALJ cannot in its decision totally ignore a treating doctor and his or her notes, without even mentioning them.” Id. So even though the ALJ discussed Nygrens four-wheel walker prescription, we cannot “confidently conclude” that the ALJs failure to mention Dr. Atabeygis clinical findings was harmless. Id. at 1173 (citation omitted).
Finally, Nygren argues that the ALJ improperly rejected Dr. William Wilkinsons opinion. Dr. Wilkinson diagnosed Nygren in 2017 with major recurrent depression and unspecified anxiety disorder. Dr. Wilkinson described Nygren as having various mild to moderate limitations, but he also opined that Nygren would have marked limitations in performing activities within a schedule, in adapting to changes and maintaining appropriate behavior in a work setting, and in completing a normal workday or workweek without interruption.
The ALJ gave “some weight” to Dr. Wilkinsons opinion and explained that it is “generally consistent with the longitudinal treatment record and the claimants limited treatment history,” but stated that Nygrens “presentation to Dr. Wilkinson was not consistent with his presentation throughout the record” and that Dr. Wilkinsons opinions that Nygren had marked limitations “appear to be largely based on [Nygrens] self-report of symptoms, which are not wholly consistent with the evidence of record.”
To the extent that the ALJ discredited Dr. Wilkinsons opinion because it was based on Nygrens self-report, that is a reversible error.
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We have made clear that, in the context of mental health evidence, a clinical interview and mental health evaluation “are objective measures and cannot be discounted as a ‘self-report.’ ” Buck v. Berryhill, 869 F.3d 1040, 1049 (9th Cir. 2017). “Diagnoses will always depend in part on the patients self-report, as well as on the clinicians observations of the patient. But such is the nature of psychiatry.” Id. In the context of mental health evaluations, a physicians reliance on self-reported symptoms is thus not a legitimate reason to reject a physicians opinion. Id.
The ALJ noted that Nygrens “presentation to Dr. Wilkinson was not consistent with his presentation throughout the record,” but failed to specify other instances in the record that undermined Dr. Wilkinsons conclusions. The Commissioner points to the ALJs decision to give “great weight” to Dr. Rogerss psychological evaluation, which the ALJ discussed in the preceding paragraph before the discussion about Dr. Wilkinsons findings. “If a treating or examining doctors opinion is contradicted by another doctors opinion, an ALJ may only reject it by providing specific and legitimate reasons that are supported by substantial evidence.” Ryan, 528 F.3d at 1198 (citation omitted). Although the dissent is correct that Nygren reported to Dr. Loyer that he had experienced some improvement in his mood, the ALJ did not mention Dr. Loyer and failed to provide specific reasons for discounting Dr. Wilkinsons opinion. “This can be done by setting out a detailed and thorough summary of the facts and conflicting clinical evidence, stating [the ALJs] interpretation thereof, and making findings.” Reddick v. Chater, 157 F.3d 715, 725 (9th Cir. 1998). On remand, the ALJ must specifically consider conflicting opinions together with any other relevant evidence, and, if the ALJ continues to give the opinion only “some weight,” must provide “specific and legitimate” reasons for doing so. Id.
The ALJs rejection of Nygrens subjective symptom testimony and of his fiancées supporting testimony rested in large part on the ALJs evaluation of the medical evidence. As we find that evaluation inadequate, we do not address the credibility findings independently.
We reverse and remand to the district court with instructions to remand this case to the ALJ for further findings consistent with this decision. Specifically, the ALJ should consider the opinions of Dr. Quadeer and Dr. Atabeygi, reevaluate whether Dr. Wilkinsons opinions should be assigned greater weight, and revisit the credibility issues in light of any revisions in the evaluation of the medical evidence. See Marsh, 792 F.3d at 1173.
REVERSED and REMANDED.
I agree with the result reached by the majority, but I write separately to address two points on which I disagree.
1. I would hold that the ALJs failure to specifically mention Dr. Atabeygis diagnosis of complex regional pain syndrome (CRPS) was harmless error. The ALJ considered whether the medical evidence supported the CRPS diagnosis, noted that Drs. Mark Holmes, Alfred Blue, and Terry Felts all agreed that Nygren did not have CRPS, and acknowledged that “there is[ ] a dispute in the record between physicians as to whether the claimant has complex regional pain syndrome.” Dr. Atabeygis diagnosis of hip pain and IT band syndrome was adequately accounted for by the RFC, which stated that Nygren can “sit about six hours in an eight hour work day” and is “unable to operate foot controls with the left lower extremity.” The majority concludes the ALJs failure to specifically discuss each limitation noted by Dr. Dujela is harmless error because “the ALJs RFC finding largely reflected Dr. Dujelas opinion.” Maj. Memo. at 875. I would reach the same conclusion with respect to Dr. Atabeygis clinical findings.
2. I would also hold that the ALJs evaluation of Dr. Wilkinsons opinion was not error. The majority relies on Buck v. Berryhill, 869 F.3d 1040, 1049 (9th Cir. 2017), to conclude that the ALJ improperly discounted Dr. Wilkinsons opinion because it relied on Nygrens self report. Maj. Memo at 876. In Buck, we held that a clinical interview and mental health evaluation “are objective measures and cannot be discounted as a ‘self-report’ ” because mental health diagnoses will always depend in part on the patients self-report. Id. The ALJ gave “some weight” to Dr. Wilkinsons opinion but concluded “the claimants presentation to Dr. Wilkinson was not consistent with [Nygrens] presentation throughout the record.” In other words, Nygrens own self reports were inconsistent, and the ALJ discounted Dr. Wilkinsons testimony because Nygren described his symptoms differently to Dr. Wilkinson than he had to other care providers.
The majority concludes that the ALJ “failed to specify other instances in the record that undermined Dr. Wilkinsons conclusions.” Maj. Memo. at 876. But as the ALJ noted, the evidence strongly suggests “[Nygrens] mental health impairments are not as severe as he has alleged.” Nygrens own testimony at the hearing established that he felt his depression and anxiety were well controlled by medication. This testimony was supported by record evidence from a mental health evaluation with Dr. Loyer in September 2017, a month after Nygren saw Dr. Wilkinson. Nygren reported to Dr. Loyer that he had experienced a significant improvement in his mental health after a change in his pain medication. Dr. Loyers assessment after one session was that Nygren “[h]as had a great time with his children and wife this past couple weeks and is very happy about that and appreciative. Gaining insight.”
In all other respects, I agree with the majority.
FOOTNOTES
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. The dissent would instead read the ALJs conclusion on Dr. Wilkinson to mean that Nygrens own self-reports throughout the record were inconsistent. We respectfully disagree with this interpretation.
Partial Dissent by Judge CHRISTEN