UNITED STATES DISTRICT COURT CENTRAL DISTRICT OF CALIFORNIA EASTERN DIVISION
October 4, 2010
FITZGERALD FIELDS SR., PLAINTIFF,
MICHAEL J. ASTRUE, COMMISSIONER, SOCIAL SECURITY ADMINISTRATION, DEFENDANT.
The opinion of the court was delivered by: Carla M. Woehrle United States Magistrate Judge
DECISION AND ORDER
The parties have consented, under 28 U.S.C. § 636(c), to the jurisdiction of the undersigned magistrate judge. Plaintiff seeks review of the denial of supplemental security income. The court finds that judgment should be granted in favor of defendant, affirming the Commissioner's decision.
Plaintiff Fitzgerald Fields Sr. was born on April 15, 1964, and was forty-five years old at the time of his administrative hearing. [Administrative Record ("AR") 154.] He has a high school education and past relevant work as a construction laborer. [AR 39-40, 175.]
Plaintiff alleges disability on the basis of sleep apnea, problems with his knee and hip, and seizures. [AR 169.]
II. PROCEEDINGS IN THIS COURT
Plaintiff's complaint was lodged on October 1, 2009, and filed on October 8, 2009. On April 16, 2010, Defendant filed an answer and the Administrative Record. On June 15, 2010, the parties filed their Joint Stipulation ("JS") identifying matters not in dispute, issues in dispute, the positions of the parties, and the relief sought by each party. This matter has been taken under submission without oral argument.
III. PRIOR ADMINISTRATIVE PROCEEDINGS
Plaintiff applied for supplemental security income on January 17, 2008, alleging disability since August 1, 2004.*fn1 [AR 154.] After the application was denied initially and upon reconsideration, Plaintiff requested an administrative hearing, which was held on April 1, 2009, before Administrative Law Judge Robert A. Evans ("ALJ"). [AR 36-55, 61-65, 67-71.] Plaintiff appeared with counsel and gave testimony. [AR 36-55.] The ALJ denied benefits in a decision issued on June 19, 2009. [AR 28-35.] When the Appeals Council denied review on August 27, 2009, the ALJ's decision became the Commissioner's final decision. [AR 2-4.]
IV. STANDARD OF REVIEW
Under 42 U.S.C. § 405(g), a district court may review the Commissioner's decision to deny benefits. The Commissioner's (or ALJ's) findings and decision should be upheld if they are free of legal error and supported by substantial evidence. However, if the court determines that a finding is based on legal error or is not supported by substantial evidence in the record, the court may reject the finding and set aside the decision to deny benefits. See Aukland v. Massanari, 257 F.3d 1033, 1035 (9th Cir. 2001); Tonapetyan v. Halter, 242 F.3d 1144, 1147 (9th Cir. 2001); Osenbrock v. Apfel, 240 F.3d 1157, 1162 (9th Cir. 2001); Tackett v. Apfel, 180 F.3d 1094, 1097 (9th Cir. 1999); Reddick v. Chater, 157 F.3d 715, 720 (9th Cir. 1998); Smolen v. Chater, 80 F.3d 1273, 1279 (9th Cir. 1996); Moncada v. Chater, 60 F.3d 521, 523 (9th Cir. 1995) (per curiam).
"Substantial evidence is more than a scintilla, but less than a preponderance." Reddick, 157 F.3d at 720. It is "relevant evidence which a reasonable person might accept as adequate to support a conclusion." Id. To determine whether substantial evidence supports a finding, a court must review the administrative record as a whole, "weighing both the evidence that supports and the evidence that detracts from the Commissioner's conclusion." Id. "If the evidence can reasonably support either affirming or reversing," the reviewing court "may not substitute its judgment" for that of the Commissioner. Id. at 720-21; see also Osenbrock, 240 F.3d at 1162.
A. THE FIVE-STEP EVALUATION
To be eligible for disability benefits a claimant must demonstrate a medically determinable impairment which prevents the claimant from engaging in substantial gainful activity and which is expected to result in death or to last for a continuous period of at least twelve months. Tackett, 180 F.3d at 1098; Reddick, 157 F.3d at 721; 42 U.S.C. § 423(d)(1)(A).
Disability claims are evaluated using a five-step test:
Step one: Is the claimant engaging in substantial gainful activity? If so, the claimant is found not disabled. If not, proceed to step two.
Step two: Does the claimant have a "severe" impairment? If so, proceed to step three. If not, then a finding of not disabled is appropriate.
Step three: Does the claimant's impairment or combination of impairments meet or equal an impairment listed in 20 C.F.R., Part 404, Subpart P, Appendix 1? If so, the claimant is automatically determined disabled. If not, proceed to step four.
Step four: Is the claimant capable of performing his past work? If so, the claimant is not disabled. If not, proceed to step five.
Step five: Does the claimant have the residual functional capacity to perform any other work? If so, the claimant is not disabled. If not, the claimant is disabled.
Lester v. Chater, 81 F.3d 821, 828 n.5 (9th Cir. 1995, as amended April 9, 1996); see also Bowen v. Yuckert, 482 U.S. 137, 140-142, 107 S.Ct. 2287, 96 L.Ed. 2d 119 (1987); Tackett, 180 F.3d at 1098-99; 20 C.F.R. § 416.920. If a claimant is found "disabled" or "not disabled" at any step, there is no need to complete further steps. Tackett, 180 F.3d 1098; 20 C.F.R. § 416.920.
Claimants have the burden of proof at steps one through four, subject to the presumption that Social Security hearings are non-adversarial, and to the Commissioner's affirmative duty to assist claimants in fully developing the record even if they are represented by counsel. Tackett, 180 F.3d at 1098 and n.3; Smolen, 80 F.3d at 1288. If this burden is met, a prima facie case of disability is made, and the burden shifts to the Commissioner (at step five) to prove that, considering residual functional capacity ("RFC")*fn2, age, education, and work experience, a claimant can perform other work which is available in significant numbers. Tackett, 180 F.3d at 1099-1100; Reddick, 157 F.3d at 721; 20 C.F.R. § 416.920.
B. THE ALJ'S EVALUATION IN PLAINTIFF'S CASE
Here, the ALJ found that Plaintiff had not engaged in substantial gainful activity since January 31, 2008, the protective filing date of Plaintiff's application (step one); that Plaintiff had the "severe" impairments of seizure disorder v. asystole and status post left knee surgery (step two); and that Plaintiff did not have an impairment or combination of impairments that met or equaled a "listing" (step three). [AR 30.] The ALJ determined that Plaintiff had the RFC to lift and carry fifty pounds occasionally and twenty-five pounds frequently, stand/walk six hours in an eight-hour workday provided he can sit every two hours as needed for alleged right hip or right knee pain, and sit six hours in an eight-hour workday. [Id.] Plaintiff was restricted from working at heights or near hazardous machinery. [Id.] Plaintiff was unable to perform his past relevant work (step four). [AR 33.] Based on testimony from the vocational expert, the ALJ determined that Plaintiff could perform certain jobs existing in significant numbers in the national economy, including janitor (step five). [AR 33-34.] Accordingly, Plaintiff was found not "disabled" as defined by the Social Security Act. [AR 34.]
C. ISSUES IN DISPUTE
The parties' Joint Stipulation identifies the following disputed issues:
1. Whether the ALJ properly held that Plaintiff can perform the job of janitor;
2. Whether the ALJ's finding that Plaintiff is limited to standing and/or walking for six hours out of an eight-hour workday provided he can sit for two hours as needed for right hip or right knee pain is consistent with the ALJ's finding that Plaintiff is capable of performing the exertional demands of medium work as a janitor;
3. Whether the ALJ properly considered if Plaintiff meets or equals listing 11.02B*fn3; and
4. Whether the ALJ properly considered Plaintiff's testimony and made proper credibility findings.
D. ISSUES ONE AND TWO: STEP FIVE FINDING
Plaintiff alleges that he experienced episodes of seizures from 2004-2008. [AR 41.] According to Plaintiff, in 2004, Dr. Richard Kay, a treating internist, diagnosed Plaintiff with a seizure disorder and prescribed seizure medication. [Id.]
On April 2, 2008, Dr. Barry Gordon Gwartz, a consultative examiner, concluded that Plaintiff was capable of lifting and/or carrying fifty pounds occasionally and twenty-five pounds frequently, standing and/or walking for six hours out of an eight-hour workday provided he can sit every two hours as needed, and sit for six hours out of an eight-hour workday. [AR 254-59.] Dr. Gwartz imposed no other limitations except to preclude Plaintiff from working at heights or near hazardous machinery "because of his history of alleged seizure disorder." [AR 259.] Dr. Gwartz did not diagnose Plaintiff with a seizure disorder. Rather, he noted that Plaintiff had a normal neurological examination, but that Plaintiff reported a history of nighttime seizure disorder. [AR 258.] Dr. Elliot L. Gilpeer, a State Agency review physician, agreed with Dr. Gwartz's exertional limitations. [AR 263.]
In November 2008, Plaintiff checked into USC University Hospital ("USC") for an epilepsy study. [AR 50-51, 365-67.] While monitoring Plaintiff, USC doctors learned that Plaintiff was actually experiencing periods of syncope*fn4 and asystole*fn5 and recommended a pacemaker. [AR 368-70.] Dr. Laura Ann Kalayjian, a treating neurologist at USC, verified that Plaintiff was not experiencing seizures. [AR 298.] On November 13, 2008, doctors implanted a pacemaker in Plaintiff. [AR 353-54.] On November 14, 2008, Dr. Kalayjian wrote that Plaintiff was likely misdiagnosed with a seizure disorder. [AR 314.] Dr. Kalayjian explained that Plaintiff had syncope, which caused the loss of consciousness. [Id.] Dr. Kalayjian explained that due to the implantation of a pacemaker, Plaintiff should no longer experience any syncopal episodes. [Id.] Dr. Kalayjian discontinued Plaintiff's seizure medications. [Id.]
Plaintiff stopped experiencing seizures or episodes when he lost consciousness, whether synocopal or seizure-related, after the procedure and was informed the previous seizure diagnosis was incorrect. [AR 51, 458.]
At the April 1, 2009, administrative hearing, the ALJ asked the vocational expert whether a person with Plaintiff's limitations, including the need to sit every two hours and preclusion from working around heights and around dangerous machinery, could perform any range of medium exertion jobs in the national economy. [AR 53-54.] The vocational expert responded that the person could perform the job of a janitor (Dictionary of Occupational Titles ("DOT") code 381.687-018). [AR 54.] The ALJ adopted the vocational expert's testimony to find that Plaintiff was not disabled. [AR 33-34.]
Plaintiff argues that the ALJ erred in finding that he can perform the job of janitor because the job is inconsistent with his RFC. [JS 3-6, 11-13.] First, Plaintiff asserts that the job of janitor would require him to work around hazardous machinery. [AR 3-6.] Second, Plaintiff argues that the job of janitor would require him to stand or walk "for a total of approximately [six] hours in an [eight]-hour workday," which does not meet the requirement that he can sit every two hours as needed. [AR 11-13.] Accordingly, Plaintiff argues that the ALJ's decision at step five was based on reversible error. [AR 6, 13.]
Because these arguments both concern the step five analysis and inconsistency with Plaintiff's RFC, the Court will address them together.
At step five of the sequential evaluation, the burden of proof shifts to the Commissioner to identify specific jobs existing in substantial numbers in the national economy that claimant can perform despite his identified limitations. Johnson v. Shalala, 60 F.3d 1428, 1432 (9th Cir. 1995). One method of demonstrating the existence of these jobs is through the testimony of a vocational expert, who can assess the effect of any limitation on the range of work at issue, identify jobs which are within the RFC, if they exist, and provide a statement of the incidence of such jobs in the region where the claimant lives or in several regions of the country. Social Security Ruling ("SSR") 83-12, 1983 WL 31253 at *3.
Pursuant to SSR 00-4p, 2000 WL 1898704 at *4, when a vocational expert provides evidence about the requirements of a job or occupation, the ALJ has "an affirmative responsibility to ask about any possible conflict" between that testimony and the Dictionary of Occupational Titles ("DOT") and to obtain a reasonable explanation for any conflict. In light of the requirements of SSR 00-4p, the Ninth Circuit has held that an ALJ may not rely on a vocational expert's testimony without first inquiring whether the testimony conflicts with the DOT. Massachi v. Astrue, 486 F.3d 1149, 1152-53 (9th Cir. 2007). The failure to expressly follow this procedural error can be harmless when there is no conflict or if the vocational expert "provided sufficient support for her conclusion." Id. at 1154, n.19; Burch v. Barnhart, 400 F.3d 676, 679 (9th Cir. 2005) ("A decision of the ALJ will not be reversed for errors that are harmless.").
The Court finds that the ALJ committed a procedural error when he failed to expressly ask the vocational expert if her testimony was consistent with the DOT*fn6, but that the error is harmless for multiple reasons.
First, there is sufficient support for the vocational expert's conclusion. See Massachi, 486 F.3d at 1154, n.19. The ALJ expressly incorporated both restrictions -- the need to sit every two hours and preclusion from working around heights and hazardous machinery -- in his hypothetical to the vocational expert. [AR 53-54.] The vocational expert responded to the ALJ's hypothetical and determined that in spite of those limitations, there were medium work*fn7 jobs that Plaintiff could perform. [AR 54.] In addition, the vocational expert expressly explained that a janitor would be given a ten to fifteen-minute break every two hours. [Id.]
Second, the ALJ's actions amount to harmless error because there is no conflict between the vocational expert's testimony and the DOT description. Massachi, 486 F.3d at 1154, n.19 (stating that the failure to ask if there is a conflict can be harmless when there is no conflict). A DOT description lists duties that may be required of a janitor but this does not mean that every listed duty is mandatory to the position. See Johnson, 60 F.3d at 1435 (stating that the DOT "provides only occupational information on jobs as they have been found to occur, but they do not coincide in every respect with the contents of jobs as performed in particular establishments or at certain localities") (citation omitted). While some janitors may work with incinerators, lawnmowers, handtrucks, or industrial trucks, others do not.*fn8 Thus, the ALJ's finding and the vocational expert's testimony do not deviate from the DOT job description or conflict with Plaintiff's RFC.
Third, Plaintiff's RFC was based upon a misdiagnosis. [AR 51, 314.] When the consultative examiner and State Agency review physician offered their opinions as to Plaintiff's RFC, they restricted him from working at heights or near hazardous machinery due to his "history of alleged seizure disorder." [AR 259.] Neither the consultative examiner nor State Agency review physician diagnosed Plaintiff with a seizure disorder or verified the diagnosis with Plaintiff's medical records, but rather relied on Plaintiff's own reporting. [AR 258.] Given the subsequent discovery that Plaintiff was incorrectly diagnosed with a seizure disorder and no longer suffers from any syncopal episodes, the limitations restricting him from working around heights and dangerous machinery are inappropriate and should not have been included in the RFC. Substantial evidence supports the finding that there is no medical basis for including these limitations in any future RFC determination. [AR 458.]
Finally, even if the job of janitor conflicted with Plaintiff's RFC limitations, there are other jobs that he can perform. The ALJ concluded that Plaintiff can perform medium work, which includes light and sedentary work. [AR 30.] 20 C.F.R. § 416.967(c). Sedentary work involves sitting and requires only occasional walking and standing.
20 C.F.R. § 416.967(a). There are few unskilled sedentary jobs which require work around hazardous machinery. SSR 96-9p, 1996 WL 374185 at *9. Sedentary work should accommodate Plaintiff's limitations. Accordingly, the ALJ did not commit reversible error when he failed to expressly ask the vocational expert as to whether her testimony conflicted with the DOT description.
E. ISSUE THREE: STEP THREE FINDING
At step three of the sequential evaluation, plaintiff has the burden to show that his impairment, or combination of impairments, meets or equals a listing. Lester, 81 F.3d at 828, n.5; Tackett, 180 F.3d at 1098. In order to meet a listing, the impairment must meet all of the specified medical criteria in the listing. Tackett, 180 F.3d at 1099. In order to equal a listing, a plaintiff must establish "symptoms, signs and laboratory findings 'at least equal in severity and duration' to the characteristics of a relevant listed impairment." Id. (quoting 20 C.F.R. § 404.1526).
Plaintiff argues that the ALJ failed to properly consider whether he met or equaled listing 11.02B. [JS 15-18.] Listing 11.02B provides, in relevant part:
Epilepsy - convulsive epilepsy, (grand mal or psychomotor), documented by detailed description of a typical seizure pattern, including all associated phenomena; occurring more frequently than once a month, in spite of at least 3 months of prescribed treatment. With:
B. Nocturnal episodes manifesting residuals which interfere significantly with activity during the day.
20 C.F.R. Part 404, Subpart P, Appendix 1, Listing 11.02.
The ALJ properly found that Plaintiff did not meet or equal listing 11.02B. As the ALJ discussed, the record does not adequately support Plaintiff's contention that he has a seizure disorder. [AR 32.] Although prior to 2008, Plaintiff was diagnosed with a seizure disorder, Plaintiff was informed in November 2008 that he had been previously misdiagnosed and actually suffered from asystole and syncope. [AR 32, 51, 314.] After surgery to implant a pacemaker in Plaintiff, doctors discontinued Plaintiff's anti-seizure medication. [AR 314.] On February 4, 2009, Plaintiff reported to his doctor during a routine follow-up of his pacemaker that he had no further syncopal episodes. [AR 458.] Despite Plaintiff's acknowledgment of his misdiagnosis during the hearing, he fails to mention it in his argument. [AR 51.]
Even if Plaintiff did have a seizure disorder, the ALJ adequately explained in his decision why Plaintiff did not meet or equal a listing. The listing requires a "detailed description of a typical seizure pattern" by a reporting physician or testimony of persons other than the claimant. 20 C.F.R. Part 404, Subpart P, Appendix 1, Listing 11.00A. The ALJ noted that the record is bereft of any such description as it contains no records of doctor's visits, emergency room visits or hospitalization documenting the alleged seizure activity. [AR 32.] Dr. Kay, the doctor who diagnosed Plaintiff with a seizure disorder, simply indicates in his treatment notes that Plaintiff has a seizure disorder. [AR 231-48.] Plaintiff alleges that his wife and others have witnessed these seizures but none have provided any testimony or statements as required when no physician has provided a description of the seizure activity. [AR 179.] Indeed, the doctors at USC who were studying Plaintiff for an epilepsy study concluded that he had syncope and not a seizure disorder. [AR 32, 314.] Moreover, the listing also requires that an individual "follow prescribed antiepileptic treatment." 20 C.F.R. Part 404, Subpart P, Appendix 1, Listing 11.00A. The ALJ noted that Plaintiff was not fully compliant with his treatment plan. [AR 33, 228-30.] Accordingly, the ALJ correctly concluded that Plaintiff's impairment did not meet Listing 11.02B.
The ALJ also correctly found that Plaintiff's impairment, or combination of impairments, did not equal listing 11.02B. Plaintiff cites his Seizure Questionnaire, where he describes his seizures, as an example of how he meets or equals listing 11.02B. [AR 177-179.] Plaintiff, however, fails to even mention his subsequent diagnosis of syncope, treatment for syncope, and the lack of further episodes of syncope after treatment. Unless Plaintiff presents evidence of an equivalence or offers a theory which includes discussion of the subsequent diagnosis and lack of symptoms, the ALJ was not required to explain his finding and discuss the combined effects of the impairments. See Lewis v. Apfel, 236 F.3d 503, 514 (9th Cir. 2001) (rejecting claimant's argument that the ALJ failed to adequately explain his finding that his impairments did not equal a listing because claimant failed to offer a theory as to how the impairments equaled a listing). As such, Plaintiff failed to satisfy listing 11.02B and no remand is required.
F. ISSUE FOUR: CREDIBILITY
During the hearing, Plaintiff testified that his seizures prevented him from working. [AR 41.] Plaintiff testified that he took anti-seizure medication from 2004 through 2008. [Id.] Plaintiff explained that in November 2008, doctors at USC who were monitoring him told him that he was not having any seizures but rather had congestive heart failure and required a pacemaker. [Id.] Plaintiff testified that the doctors explained to him that he was misdiagnosed with seizures. [AR 51.]
The ALJ found that Plaintiff's statements "concerning the intensity, persistence and limiting effects of [his] symptoms are not credible to the extent that they are inconsistent with" his RFC. [AR 33.] With regard to Plaintiff's knee and hip problems, the ALJ determined that there was no evidence of disuse muscle trophy that would be compatible with Plaintiff's alleged level of inactivity. [Id.] As for Plaintiff's complaint and limitations regarding his seizures, the ALJ concluded that they were inconsistent with the treatment he received. [Id.] The record contained no evidence of doctor's visits, emergency room visits, or hospitalizations for seizures. [Id.] Further, contrary to Plaintiff's contentions, the record showed that Plaintiff was not fully compliant with his medication protocol. [Id.] The ALJ also noted that Plaintiff takes care of his two children and disabled wife. [Id.] Plaintiff asserts that the ALJ did not provide clear and convincing reasons for discrediting his testimony and "failed to specifically explain which parts of [his] statements" were credible and which were not. [JS 21-25.]
Questions of credibility and resolution of conflicts in the testimony are functions solely for the ALJ. Parra v. Astrue, 481 F.3d 742, 750 (9th Cir. 2007) (citing Sample v. Schweiker, 694 F.2d 639, 642 (9th Cir. 1982)). To determine whether a claimant's subjective symptom testimony is credible, the ALJ must engage in a two-step analysis. Lingenfelter v. Astrue, 504 F.3d 1028, 1035-36 (9th Cir. 2007). First, the ALJ must determine whether the claimant has presented objective medical evidence of an underlying impairment "'which could reasonably be expected to produce the pain or other symptoms alleged.'" Id. at 1036 (quoting Bunnell v. Sullivan, 947 F.2d 341, 344 (9th Cir. 1991)). Second, if the claimant meets this first test, and there is no evidence of malingering, "the ALJ can reject the claimant's testimony about the severity of her symptoms only by offering specific, clear and convincing reasons for doing so." Id. (quoting Smolen, 80 F.3d at 1281); see also Parra, 481 F.3d at 750; Holohan v. Massanari, 246 F.3d 1195, 1208 (9th Cir. 2001). An ALJ must "specifically identify" the testimony found not credible, the ALJ must explain what evidence undermines the testimony, and the evidence on which the ALJ relies must be "substantial." Parra, 481 F.3d at 750; Tonapetyan, 242 F.3d at 1148 ("The ALJ must give specific, convincing reasons for rejecting the claimant's subjective statements."); Light v. Soc. Sec. Admin., 119 F.3d 789, 792 (9th Cir. 1997).
Plaintiff's contention that the ALJ failed to specify which parts of his testimony were not credible and provide clear and convincing reasons for rejecting them is without merit. Although the ALJ did not expressly specify at the outset of each paragraph which reason applied to which impairment and its symptoms, it is clear from the decision to which he is referring.
Contrary to Plaintiff's argument, a review of the record indicates that the ALJ provided clear and convincing reasons under the Ninth Circuit standard. An ALJ "may rely on ordinary techniques of credibility evaluation," including a plaintiff's reputation for truthfulness and inconsistencies between a plaintiff's testimony and conduct. See Tommasetti v. Astrue, 533 F.3d 1035, 1040 (9th Cir. 2008); Thomas v. Barnhart, 278 F.3d 947, 958-59 (9th Cir. 2002). First, the ALJ noted that the objective medical evidence did not support Plaintiff's alleged symptoms. [AR 31.] Although the lack of objective medicine cannot be the sole basis for rejecting a plaintiff's credibility, "it is a factor that the ALJ can consider in his credibility analysis." Burch, 400 F.3d at 681. Here, in addition to the lack of objective medical evidence, the ALJ noted additional reasons for finding Plaintiff less than credible. First, the ALJ noted that the level of care for Plaintiff's seizures was inconsistent with Plaintiff's complaints. [AR 33.] Plaintiff alleged that he had seven to eight seizures a month, where he would foam at the mouth, urinate on himself, have spasms, stiffen up, and become nauseous and lightheaded. [AR 44-46.] Yet, Plaintiff never sought treatment any sort of emergency treatment. [AR 33.] His medical records show that he made only about fourteen visits to his doctor over a four-year period and these visits were not directly seizure-related. [AR 33, 231-48.] Rather, Plaintiff primarily visited Dr. Kay to have "paperwork" filled out. [AR 231-48.] See Burch, 400 F.3d at 681 (stating that the "ALJ is permitted to consider lack of treatment in his credibility determination"). Second, contrary to Plaintiff's contention that he takes his medication as prescribed, the record shows that Plaintiff is not always fully compliant. [AR 33, 45, 228-30.] See Montalvo v. Astrue, 237 Fed. Appx. 259, 262 (9th Cir. 2007) (finding that plaintiff's failure to comply with certain aspects of her treatment plan was a clear and convincing reason to reject her testimony); Fair v. Bowen, 885 F.2d 597, 603 (9th Cir. 1989) (noting that the failure to follow a prescribed treatment plan without good reason can cast doubt on credibility). The ALJ reasonably concluded that if Plaintiff's symptoms were as alleged, both he would have required more aggressive treatment and been more compliant with his medication. See Parra, 481 F.3d at 751 (noting that conservative treatment is a clear and convincing reason for finding a plaintiff not credible).
Accordingly, this issue is without merit.
Accordingly, IT IS ORDERED that:
1. The decision of the Commissioner is AFFIRMED.
2. This action is DISMISSED WITH PREJUDICE.
3. The Clerk of the Court shall serve this Decision and Order and the Judgment herein on all parties or counsel.