Unreported / Non-Citable
Background
Sara F. applied for Supplemental Security Income (SSI) — the federal disability program for low-income individuals — alleging disability beginning in September 2018 from back pain caused by a car accident. At a hearing in August 2024 she testified that she could stand only a few hours, felt numbness when sitting, refused to lift heavy items, could not pick up more than 10 pounds, did light household chores for short periods, and used heat patches. She acknowledged she had never received pain injections or medications for her back pain.
The administrative law judge (ALJ) partially discredited her testimony, finding her allegations were not entirely consistent with the medical evidence and the course of treatment. Sara F. sought judicial review under 42 U.S.C. § 405(g), challenging only the ALJ’s symptom-testimony analysis.
The Court’s Holding
The court affirmed the denial of benefits and dismissed the action with prejudice. It applied the Ninth Circuit’s “most demanding” clear-and-convincing standard for ALJ rejections of subjective symptom testimony but found two specific, supported rationales:
First, the ALJ identified a striking inconsistency between the claimant’s testimony and the medical record. The submitted records showed treatment at Venice Urgent Care for a cold and COVID in 2022, a urinary tract infection in November 2022, and additional UTI and acute vaginitis treatment in mid-2023 — but contained no mention of the alleged 2018 car accident or any treatment for back or shoulder pain. The court noted that, like the ALJ, it could not find any reference in the records to the principal complaints driving the disability claim. The only medical providers to whom Sara F. reported the alleged disabling symptoms were the consultative examiners hired by the State agency to evaluate her disability claim. Even those consultative examinations (with Dr. Chuang in January 2023 and again in January 2024) showed mostly normal findings.
Second, the ALJ properly considered Sara F.’s “lack of pursuit of medical treatment” for the allegedly disabling conditions, noting she had not been sent for imaging, prescribed pain medication, attended physical therapy, or been seen by orthopedic or neurosurgical specialists. Under Tommasetti v. Astrue, an unexplained or inadequately explained failure to seek treatment can weigh against a claimant’s credibility. Here the contrast between Sara F.’s use of urgent care for relatively minor conditions and her lack of treatment for the allegedly disabling back and shoulder pain reinforced the ALJ’s adverse credibility finding.
The court rejected Sara F.’s argument that the absence of pre-2022 records was a “straw-man rationale,” noting that the ALJ also independently relied on the absence of post-2022 treatment for the allegedly disabling conditions. With the ALJ’s reasoning supported by substantial evidence, the court declined to “second-guess” the symptom-testimony assessment.
Key Takeaways
- An ALJ may rely on inconsistency between a claimant’s alleged disabling symptoms and a medical record that contains no documentation of those symptoms — especially where the claimant did seek treatment for unrelated conditions during the same period.
- Reporting allegedly disabling symptoms only to consultative examiners hired to evaluate the disability claim, rather than to treating providers, undercuts credibility.
- Under Tommasetti v. Astrue, unexplained failure to pursue treatment (imaging, pain medication, physical therapy, specialist visits) for the allegedly disabling condition can support an adverse symptom-testimony finding.
- The Ninth Circuit’s clear-and-convincing standard does not require the reviewing court to be convinced; it asks whether the ALJ’s rationale has the “power to convince.”
- Routine use of urgent care for unrelated conditions but no treatment for the disabling condition is a recurring fact pattern courts treat as undermining symptom credibility.
Why It Matters
This decision is a useful illustration of when an ALJ’s symptom-testimony analysis will withstand judicial review. The contrast between Sara F. v. Bisignano and other recent Central District orders (such as Tobias M.P. v. Bisignano, where the court reversed) shows that the clear-and-convincing standard is not insurmountable when the ALJ identifies specific record gaps and ties them to particular elements of testimony.
For claimants and their counsel, the practical takeaway is that gaps in treatment for the very conditions said to be disabling are extraordinarily damaging to the case — even more so when the claimant is actively seeking medical care for unrelated conditions during the same period. For ALJs, the order endorses a specific approach: identify the contradiction, point to specific examples, and address the alleged disabling condition rather than the medical record as a whole.