Court Opinion

ID: 9950752
Source: CourtListenerOpinion
Date Created: 2024-03-14 19:01:20.051025+00
Date Added: 2024-06-11T14:36:38.023951
License: Public Domain

FOR PUBLICATION

   UNITED STATES COURT OF APPEALS
        FOR THE NINTH CIRCUIT

DANNY RAY FERGUSON,                       No. 21-35412

              Plaintiff-Appellant,       D.C. No. 2:19-cv-
                                            01845-MC
 v.

MARTIN J. O’MALLEY,                         OPINION
Commissioner of Social Security,

              Defendant-Appellee.

      Appeal from the United States District Court
                for the District of Oregon
      Michael J. McShane, District Judge, Presiding

          Argued and Submitted April 21, 2023
                   Portland, Oregon

                  Filed March 14, 2024

Before: Johnnie B. Rawlinson, Carlos T. Bea, and Jennifer
                 Sung, Circuit Judges.

               Opinion by Judge Sung;
              Dissent by Judge Rawlinson
2                     FERGUSON V. O’MALLEY

                          SUMMARY *

                         Social Security

    The panel reversed the district court’s judgment
affirming the Commissioner of Social Security’s denial of
claimant’s application for disability benefits, and remanded
to the district court with instructions to remand to the
administrative law judge (“ALJ”) to reconsider the
credibility of claimant’s headache symptom testimony.
    The panel held that the ALJ failed to provide clear and
convincing reasons for rejecting claimant’s symptom
testimony regarding the severity of his headaches.
    The ALJ impliedly found that claimant’s medically
determinable impairments could reasonably be expected to
cause his headaches. However, in evaluating the medical
evidence, the ALJ failed to specify which of claimant’s
symptoms were, in the ALJ’s view, inconsistent with the
record evidence. The panel rejected the Commissioner’s
argument, not asserted by the ALJ, that a claimant must
provide independent medical evidence to establish the
severity of headaches.
    The ALJ’s reference to the purported inconsistency
between claimant’s headache testimony and his daily
activities was not a specific, clear, and convincing reason to
discount claimant’s headache testimony because there was
no such inconsistency.

*
 This summary constitutes no part of the opinion of the court. It has
been prepared by court staff for the convenience of the reader.
                    FERGUSON V. O’MALLEY                     3

    Because the ALJ did not consider Ferguson’s
conservative treatment when it discounted his subjective
symptom testimony, the district court erred when it affirmed
the ALJ’s decision on that ground.
    Judge Rawlinson dissented because the majority opinion
fails to apply the substantial evidence standard of review in
evaluating the ALJ’s decision, rewrites the facts, and fails to
properly credit the evidence that supports the ALJ’s
decision.

                         COUNSEL

Alyson R. Young (argued) and Kevin Kerr, Kerr Robichaux
& Carroll, Portland, Oregon, for Plaintiff-Appellant.
Daniel P. Talbert (argued), Special Assistant United States
Attorney, Social Security Administration, Office of the
General Counsel, San Francisco, California; Frederick D.
Fripps, Special Assistant United States Attorney; Willy Le,
Acting Regional Chief Counsel, Seattle Region X; Renata
Gowie, Civil Division Chief; Scott E. Asphaug, Acting
United States Attorney; Social Security Administration,
Office of the General Counsel, Seattle, Washington; Kevin
C. Danielson, Assistant United States Attorney, United
States Department of Justice, United States Attorney’s
Office, Portland, Oregon; for Defendant-Appellee.
4                   FERGUSON V. O’MALLEY

                         OPINION

SUNG, Circuit Judge:

    Danny Ray Ferguson seeks judicial review of a denial of
Social Security benefits. The district court affirmed the
denial of benefits, and Ferguson timely filed this appeal. We
have jurisdiction under 28 U.S.C. § 1291. We review de
novo the district court’s order. Smartt v. Kijakazi, 53 F.4th
489, 494 (9th Cir. 2022) (citation omitted). The only issue
presented is whether the Administrative Law Judge (“ALJ”)
erred in rejecting Ferguson’s testimony regarding the
severity of his headaches. “When an ALJ determines that a
claimant for Social Security benefits is not malingering and
has provided objective medical evidence of an underlying
impairment which might reasonably produce the pain or
other symptoms [he] alleges, the ALJ may reject the
claimant’s testimony about the severity of those symptoms
only by providing specific, clear, and convincing reasons for
doing so.” Brown-Hunter v. Colvin, 806. F.3d 487, 488–89
(9th Cir. 2015). Here, the ALJ failed to provide clear and
convincing reasons for rejecting Ferguson’s symptom
testimony regarding his headaches. Further, the district court
erred by affirming for reasons other than those asserted by
the ALJ. Accordingly, we reverse and remand.
                      I. Background
    To determine whether a claimant is disabled, the ALJ
follows a five-step process. 20 C.F.R. § 416.920(a)(4). At
step two of the disability analysis, the ALJ must determine
whether the claimant has any “severe medically
determinable” impairments. 20 C.F.R. § 416.920(a)(4)(ii). A
“severe impairment” is one that significantly limits a
claimant’s ability to perform basic work activities. 20 C.F.R.
                    FERGUSON V. O’MALLEY                    5

§ 416.920(c). After reviewing Ferguson’s testimony and the
medical record, the ALJ determined that Ferguson has
multiple severe medically determinable impairments,
including a history of epilepsy, Arnold-Chiari malformation
type I, headaches, a depressive disorder, borderline
intellectual functioning, a specified learning disorder with
impairment in reading and math, and a mild neurocognitive
disorder. The Arnold-Chiari malformation diagnosis means
that part of Ferguson’s brain bulges into his vertebral canal.
In 2015, Ferguson underwent surgery to treat the
malformation.
    At his hearing before the ALJ, Ferguson presented
medical records that demonstrate he has experienced
headaches since he was a child, including prolonged weekly
headaches that could last up to a day or two. Ferguson also
testified about the symptoms he experienced before and after
his 2015 surgery. Before the surgery, he experienced
seizures, passing out, and “incredible” pressure in both the
front and back of his head. After the surgery, Ferguson
enjoyed relief from those symptoms for about two to three
months. But then, in his words, “it all rushed back.”
Ferguson testified that he currently experiences headaches
that last up to two days, two or three times a week, and that
the headaches cause pressure so intense that he cannot leave
his room. In the past, his headaches were triggered by
physical labor, but now, there is no identifiable trigger.
    A claimant’s subjective symptoms, if credited, are
relevant to the determination of a claimant’s residual
function capacity (“RFC”), which is “the most [one] can still
do despite [one’s] limitations.” 20 C.F.R. § 416.945(a)(1).
The RFC is used at step four to determine if a claimant can
do past relevant work and at step five to determine if a
claimant can adjust to other work. 20 C.F.R. § 416.920(e).
6                      FERGUSON V. O’MALLEY

In this case, the ALJ discounted Ferguson’s testimony
regarding the severity and frequency of his headaches when
assessing his RFC. 1 In turn, based on that RFC, the ALJ
determined at step five that there were sufficient jobs in the
national economy that Ferguson could perform and,
therefore, that Ferguson was not disabled under the Social
Security Act. The district court affirmed. For the reasons
stated below, we conclude that the ALJ erred by improperly
discounting Ferguson’s headache symptom testimony.
                     II. Standard of Review
    We review de novo a district court’s order that upholds
the denial of social security benefits. Lingenfelter v. Astrue,
504 F.3d 1028, 1035 (9th Cir. 2007). We may set aside an
ALJ’s decision to deny benefits “only if it is not supported
by substantial evidence or is based on legal error.” Id.

1
  The ALJ did not specifically state that Ferguson’s testimony regarding
the severity and frequency of his headaches lacked credibility. However,
the ALJ found that Ferguson’s statements “concerning the intensity,
persistence and limiting effects of [his] symptoms are not entirely
consistent with the medical evidence and other evidence in the record,”
and the ALJ stated that, when determining Ferguson’s RFC, it
considered “the extent to which [Ferguson’s] symptoms can reasonably
be accepted as consistent with the objective medical evidence and other
evidence.” Further, the RFC indisputably does not include any
limitations that account for headaches of the severity and frequency
attested to by Ferguson. Thus, Ferguson correctly contends, and the
Commissioner acknowledges, that the ALJ impliedly discounted
Ferguson’s headache symptom testimony. See Swenson v. Sullivan, 876
F.2d 683, 688 (9th Cir. 1989) (concluding the ALJ had rejected a
claimant’s symptom testimony where the ALJ found the claimant
credible but determined that he “felt himself more limited than medical
evidence established that he was” (cleaned up)). We therefore cannot
agree with our dissenting colleague, who reasons the ALJ “accepted
Ferguson’s [subjective symptom] testimony” because he never explicitly
said he had rejected it. Diss. Op. 20–21.
                     FERGUSON V. O’MALLEY                      7

(quoting Robbins v. Soc. Sec. Admin., 466 F.3d 880, 882 (9th
Cir. 2006)). “‘Substantial evidence’ means more than a mere
scintilla, but less than a preponderance; it is such relevant
evidence as a reasonable person might accept as adequate to
support a conclusion.” Id. If the evidence can reasonably
support either affirming or reversing a decision, we may not
substitute our judgment for that of the ALJ. Batson v.
Comm’r of Soc. Sec. Admin., 359 F.3d 1190, 1196 (9th Cir.
2004).
     However, substantial evidence does not support an
ALJ’s RFC assessment if “the ALJ improperly rejected [the
claimant’s] testimony as to the severity of his pain and
symptoms.” Lingenfelter, 504 F.3d at 1035. To determine
whether a claimant’s subjective symptom testimony is
credible, the ALJ must engage in a two-step analysis: “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.” Garrison v. Colvin, 759 F.3d 995,
1014 (9th Cir. 2014) (citation omitted). In this analysis, the
claimant is “not required to show that [their] impairment
could reasonably be expected to cause the severity of the
symptom [they have] alleged; [they] need only show that it
could reasonably have caused some degree of the symptom.”
Id. (emphasis omitted) (citation omitted). Further, the
claimant is not required to produce “objective medical
evidence of the pain or fatigue itself, or the severity thereof.”
Id. (citation omitted).
    “If the claimant satisfies the first step of this analysis,
and there is no evidence of malingering, the ALJ can reject
the claimant’s testimony about the severity of [their]
symptoms only by offering specific, clear and convincing
reasons for doing so.” Id. at 1014–15 (citation omitted). “The
8                   FERGUSON V. O’MALLEY

clear and convincing standard is the most demanding
required in Social Security cases.” Id. (citation omitted).
“Ultimately, the ‘clear and convincing’ standard requires an
ALJ to show [their] work[.]” Smartt, 53 F.4th at 499. If the
ALJ fails to provide specific, clear, and convincing reasons
for discounting the claimant’s subjective symptom
testimony, then the ALJ’s determination is not supported by
substantial evidence. Lingenfelter, 504 F.3d at 1040
(“Because the ALJ did not provide clear and convincing
reasons for excluding Lingenfelter’s pain and symptoms
from his assessment of Lingenfelter’s RFC, substantial
evidence does not support the assessment.”).
                       III. Discussion
    In this case, at step one of the ALJ’s symptom testimony
analysis, the ALJ broadly stated that Ferguson’s “medically
determinable impairments could reasonably be expected to
cause some of the alleged symptoms.” Although Ferguson
testified about multiple symptoms, including but not limited
to headaches, the ALJ did not specify which symptoms his
medically determinable impairments could reasonably be
expected to cause. Id. However, after considering the ALJ’s
decision in its entirety, we conclude that the ALJ impliedly
found that Ferguson’s medically determinable impairments
could reasonably be expected to cause his headaches.
Headaches can be both an impairment and a symptom. See
SSR 19-4p: Titles II and XVI: Evaluating Cases Involving
Primary Headache Disorders, 84 Fed. Reg. 44,667 (Aug. 26,
2019). Here, the ALJ had already found that there was
objective medical evidence of Ferguson’s headaches
sufficient to establish them as a severe impairment at step
two of the five-step disability analysis. Presumably, then, the
ALJ also found that Ferguson’s severe impairment of
headaches can reasonably be expected to cause the symptom
                   FERGUSON V. O’MALLEY                   9

of headaches. Further, the ALJ did not identify any evidence
of malingering. Thus, the ALJ was required to move to step
two of the symptom analysis. Garrison, 759 F.3d at 1014.
    At step two of the symptom analysis, the ALJ broadly
stated that Ferguson’s statements “concerning the intensity,
persistence and limiting effects of these symptoms are not
entirely consistent with the medical evidence and other
evidence in the record for the reasons explained in this
decision.” Again, the ALJ failed to specify which of
Ferguson’s many symptoms were, in the ALJ’s view,
inconsistent with the record evidence.
                  1. Medical Evidence
    Although an ALJ may use “inconsistent objective
medical evidence in the record to discount subjective
symptom testimony,” the ALJ “cannot effectively render a
claimant’s subjective symptom testimony superfluous by
demanding positive objective medical evidence fully
corroborating every allegation within the subjective
testimony.” Smartt, 53 F.4th at 498 (emphasis added)
(cleaned up); see Coleman v. Saul, 979 F.3d 751, 756 (9th
Cir. 2020) (“An ALJ, however, may not discredit the
claimant’s subjective complaints solely because the
objective evidence fails to fully corroborate the degree of
pain alleged.”). Thus, to satisfy the substantial evidence
standard, the ALJ must provide specific, clear, and
convincing reasons which explain why the medical evidence
is inconsistent with the claimant’s subjective symptom
testimony. See Lingenfelter, 504 F.3d at 1035–38, 1040.
    Here, the ALJ never expressly and specifically stated
that Ferguson’s headache symptom testimony was
inconsistent with any particular record evidence, as it was
required to do. In the symptom-testimony discussion, the
10                 FERGUSON V. O’MALLEY

ALJ specifically mentioned Ferguson’s headaches only
once: The ALJ stated, “upon exam in September 2017,
despite continued reports of headaches, the claimant had no
neurological deficits with full strength throughout, as well
as, a normal mood and affect.” We infer from that statement
that the ALJ found Ferguson’s headache symptom testimony
to be inconsistent with the results of his September 2017
exam. But an exam showing “no neurological defects” and a
“normal mood,” at best, provides a reason to discount
Ferguson’s testimony about his neurological deficits and
mood. The ALJ did not explain, and we do not see, how the
absence of neurological defects and a normal mood during a
medical exam are inconsistent with Ferguson’s testimony
about the severity and frequency of his headaches. For
example, the ALJ did not identify any evidence indicating
that Ferguson cannot experience severe and frequent
headaches in the absence of neurological defects. See
Glanden v. Kijakazi, 86 F.4th 838, 847 (9th Cir. 2023) (“[A]s
we have recognized, subjective pain is not always verifiable
through a physical examination.”); 84 Fed. Reg 44,667
(explaining the difference between primary headaches and
secondary headaches, the former of which “occur
independently and are not caused by another medical
condition”). And as we have repeatedly held, at step two of
the symptom analysis, the ALJ cannot rely on an absence of
positive medical evidence to discredit a claimant’s
subjective symptom testimony. See Smartt, 53 F.4th at 498.
     The ALJ also discussed the fact that Ferguson underwent
“posterior fossa decompression” surgery to treat his Arnold-
Chiari type 1 malformation. However, the ALJ did not
expressly state that the fact that Ferguson underwent surgery
is inconsistent with his headache testimony. Nor did the ALJ
identify any reason for finding such an inconsistency, and
                   FERGUSON V. O’MALLEY                   11

we see none. Ferguson testified that, after the surgery, his
headaches went away for a short period of time but then
returned. But the ALJ did not identify any evidence
indicating that the posterior fossa decompression surgery
was guaranteed to eliminate Ferguson’s headaches, or that
his headaches could not return after the surgery. To the
contrary, Ferguson’s surgeon warned him that the “risks” of
the “spinal neurosurgery” included “recurrence, failure to
improve, [and] need for further surgery,” and that there were
no guarantees.
    The ALJ also noted that post-surgery neurological-
function exams “indicated some signs of diminished
functioning, but not progressive worsening.” Those exam
results might be inconsistent with Ferguson’s testimony
“that his memory and stumbling [had] progressively
worsened.” But the ALJ failed to explain, and we do not see,
how such neurological-function exam results are
inconsistent with Ferguson’s headache testimony.
    Finally, as the dissent notes, the ALJ stated that it
considered the notes of Dr. Rowh and Dr. Lin, both
consulting physicians, who reported that “[e]xertion
typically worsens Ferguson’s headache symptoms” and
documented specific incidents when physical labor
“exacerbate[d] the severity of the headache” or
“significantly elevated” his pain. Diss. Op. at 19. But
evidence that physical labor exacerbates Ferguson’s
headaches has no bearing on the credibility of his testimony
that he experiences headaches—which last for up to two
days and are so severe that he cannot leave his room—
12                     FERGUSON V. O’MALLEY

without any identifiable triggers. 2 And again, the ALJ failed
to explain, and we do not see, how the evidence that
Ferguson’s headaches worsen with physical labor is
inconsistent with his testimony that he experiences
headaches when he is not engaged in physical labor. 3

2
  The ALJ stated it “accounted for [Ferguson’s] reports of worsening
headaches with physical work labor” in the RFC, but the ALJ did not
account for the underlying headache symptoms that Ferguson
experiences even without physical labor.
3
  The dissent reasons that we improperly engage in de novo review of
the medical evidence the ALJ considered when it discounted Ferguson’s
symptom testimony. Diss. Op. at 18–19. Not so. We express no view as
to whether, on remand, the medical evidence could provide substantial
evidence to discount Ferguson’s subjective symptom testimony. We
merely reaffirm the principle that, to discount a claimant’s subjective
symptom testimony at step two of the symptom analysis, the substantial
evidence standard requires an ALJ to provide specific, clear, and
convincing reasons for doing so that comport with this Circuit’s
precedents. See Lingenfelter, 504 F.3d at 1035, 1040; see also Garrison,
759 F.3d at 1015 (noting this standard “is not an easy requirement to
meet” and is “the most demanding required in Social Security cases”
(citation and internal quotation omitted)). That is precisely how we have
long reviewed ALJ decisions with respect to this issue under the
substantial evidence standard. See, e.g., Robbins, 466 F.3d at 884
(holding an ALJ improperly discounted subjective symptom testimony
that it found inconsistent with the medical evidence in part because the
ALJ did not “make clear . . . the weight the adjudicator gave to the
individual’s statements and the reasons for that weight, as he is required
to do” (internal quotation and citation omitted)); Light v. Soc. Sec.
Admin., 119 F.3d 789, 792–93 (9th Cir. 1997) (remanding because “the
ALJ failed to articulate an acceptable reason either for disbelieving
Light’s testimony in general or for discrediting his pain testimony
specifically”); Glanden, 86 F.4th at 846–48 (holding an ALJ improperly
discounted symptom testimony because it did so based on medical
evidence that “did not fully substantiate Glanden’s pain reports,” in
                       FERGUSON V. O’MALLEY                         13

    On appeal, the Commissioner argues that we should
affirm for another reason that the ALJ did not assert: The
Commissioner argues that under 20 C.F.R. § 416.929(b) and
Britton v. Colvin, 787 F.3d 1011 (9th Cir. 2015) (per
curiam), “a claimant must present ‘independent medical
evidence’ to establish the existence and severity of his
alleged headaches, and cannot rely only on his own
subjective statements.” Even assuming we can consider this
argument, we conclude that it does not provide an alternate
basis for affirming the ALJ’s decision.
    The cited regulation, 20 C.F.R. § 416.929(b), provides
that a claimant’s “symptoms, such as pain, fatigue, shortness
of breath, weakness, or nervousness, will not be found to
affect [the claimant’s] ability to do basic work activities
unless medical signs or laboratory findings show that a
medically determinable impairment(s) is present.” That
regulation, however, has no bearing on this case, because the
ALJ determined that Ferguson has multiple severe,
medically determinable impairments—including headaches.
    The Commissioner also significantly overstates the
holding of Britton. In that case, a medical expert testified that
Britton experienced migraines three to four days a month,
lasting two to four hours each. Britton, 787 F.3d at 1013–14.
The ALJ gave no weight to the expert’s testimony about the
severity and frequency of Britton’s migraines because the
expert relied exclusively on Britton’s own testimony, which
the ALJ had deemed not credible as to the severity or
frequency of her migraines. Id. at 1014. In that case, unlike

contravention of the rule that an ALJ cannot require positive medical
evidence). As noted, here, the ALJ did not provide any specific, clear,
and convincing reasons as to why the medical evidence was inconsistent
with Ferguson’s headache testimony specifically.
14                 FERGUSON V. O’MALLEY

here, Britton did not contend that the ALJ erred by deeming
her underlying migraine testimony not credible. Because the
expert relied exclusively on symptom testimony that the ALJ
had properly deemed not credible, and there was “no
independent medical evidence” establishing the severity or
frequency of Britton’s migraines, we concluded that the ALJ
did not err by disregarding the expert’s testimony. Id. at
1013–14. We did not hold, as the Commissioner asserts, that
a claimant always must provide independent medical
evidence to establish the severity of their headaches and can
never rely on their own symptom testimony—even when the
ALJ fails to identify any specific, clear, and convincing
reason to discount that testimony.
    Neither the regulation nor Britton establish the
Commissioner’s        purported    rule.   Moreover,      the
Commissioner’s purported rule (that a claimant must
provide independent medical evidence to establish the
severity of headaches) conflicts with the longstanding and
well-established rules that a claimant is “not required to
show ‘that [their medically determinable] impairment could
reasonably be expected to cause the severity of the symptom
[they have] alleged,’” and is not required to “produce
‘objective medical evidence of the pain or fatigue itself, or
the severity thereof.’” Garrison, 759 F.3d at 1014 (emphasis
in original) (quoting Smolen v. Chater, 80 F.3d 1273, 1282
(9th Cir. 1996)).
                    2. Daily Activities
    “Only if the level of activity [is] inconsistent with
Claimant’s claimed limitations” do daily “activities have any
bearing on Claimant’s credibility.” Reddick v. Chater, 157
F.3d 715, 722 (9th Cir. 1998). “We have repeatedly warned
that ALJs must be especially cautious in concluding that
                   FERGUSON V. O’MALLEY                   15

daily activities are inconsistent with testimony about pain,
because impairments that would unquestionably preclude
work and all the pressures of a workplace environment will
often be consistent with doing more than merely resting in
bed all day.” Garrison, 759 F.3d at 1016.
    The ALJ stated, “Activities the claimant has performed
during the period at issue further supports finding that in
spite of his symptoms he remained capable of some degree
of sedentary, simple work.” The ALJ noted that Ferguson’s
daily activities include “watching television and playing
video games,” “help[ing] care for his mother’s wild cats,”
“prepar[ing] simple meals,” “going out to his shop to work
on projects” (such as a model house), and “walk[ing] every
now and then.” The ALJ also noted that some reports
indicated that Ferguson “attended to basic self-care and
remained capable of driving a vehicle.” But, the ALJ did not
explain how, in his view, Ferguson’s testimony about those
daily activities is inconsistent with his testimony about the
severity and frequency of his headaches. And we see no
reasonable inference that such an inconsistency exists.
Ferguson testified that he experiences headaches two or
three times a week, and that sometimes, the headache lasts
“a day or two.” Further, Ferguson testified that when he
experiences headaches, he does not “get out of [his] room,”
and he does “nothing.” Ferguson can both do nothing when
he has severe headaches and engage in his daily activities
when he does not. See Garrison, 759 F.3d at 1015–16
(reversing and remanding for an award of benefits in part
because the ALJ improperly relied upon claimant’s daily
activities—talking on the phone, preparing meals, cleaning
her room, and caring for her daughter—to discredit her
testimony regarding “near-constant, intense pain” because
those activities are not inconsistent with those symptoms).
16                  FERGUSON V. O’MALLEY

Ferguson need not “vegetate in a dark room” to qualify for
disability. See Cooper v. Bowen, 815 F.2d 557, 561 (9th Cir.
1987) (quoting Smith v. Califano, 637 F.2d 968, 971 (3d
Cir.1981)).
    Because there is no inconsistency between Ferguson’s
headache testimony and his daily activities, the ALJ’s
reference to that purported inconsistency is not a specific,
clear, and convincing reason to discount Ferguson’s
headache testimony.
                3. Conservative Treatment
    The district court also reasoned that Ferguson “has had
minimal treatment” for headaches and that “conservative
treatment supports the ALJ’s finding that his symptoms are
not as severe as alleged.” Putting aside the question of
whether the district court’s characterization of Ferguson’s
treatment is accurate, the district court erred by affirming the
ALJ’s determination for a reason that the ALJ did not assert.
“[W]e can affirm the agency’s decision to deny benefits only
on the grounds invoked by the agency.” Brown-Hunter, 806
F.3d at 492. This means that courts can consider only “the
reasons the ALJ asserts.” Id. (citing Connett v. Barnhart, 340
F.3d 871, 874 (9th Cir. 2003)).
    Thus, because the ALJ did not consider Ferguson’s
conservative treatment when it discounted his subjective
symptom testimony, the district court erred when it affirmed
the ALJ’s decision on that ground. See Brown-Hunter, 806
F.3d at 492.
                       IV. Conclusion
   In sum, substantial evidence does not support the ALJ’s
RFC assessment because the ALJ did not articulate any
specific, clear, and convincing reasons for discounting
                       FERGUSON V. O’MALLEY                         17

Ferguson’s headache symptom testimony. See Lingenfelter,
504 F.3d at 1035, 1040. The district court also erred by
affirming the ALJ’s decision based on reasons the ALJ did
not discuss. See Brown-Hunter, 806 F.3d at 492. The
Commissioner does not contend that the ALJ’s error was
harmless. Consequently, we reverse the judgment of the
district court with instructions to remand to the ALJ to
reconsider the credibility of Ferguson’s headache symptom
testimony in a manner consistent with this opinion. See
Connett, 340 F.3d at 876.
    REVERSED AND REMANDED. 4

RAWLINSON, Circuit Judge, dissenting:
    I respectfully dissent from the majority opinion for the
following three reasons:

    1. The majority opinion fails to apply the governing
standard of review.
    2. The majority opinion rewrites the facts of the case.
    3. The majority opinion fails to properly credit the
evidence that supports the decision of the Administrative
Law Judge (ALJ).

    I will address each in turn.

4
 Defendant-Appellee shall bear all costs of appeal. See Fed. R. App. P.
39(a)(3).
18                  FERGUSON V. O’MALLEY

     1. The majority opinion fails to apply the governing
        standard of review.
    When reviewing decisions of an ALJ, we apply the
substantial evidence standard of review. See Ahearn v. Saul,
988 F.3d 1111, 1115 (9th Cir. 2021). This is a deferential
standard of review. See Smith v. Califano, 637 F.2d 968, 970
(9th Cir. 1981). “Substantial evidence means such relevant
evidence as a reasonable mind might accept as adequate to
support a conclusion. The evidence must be more than a
mere scintilla but may be less than a preponderance. . . .”
Ahearn, 988 F.3d at 1115 (citation omitted). This standard
“is not high.” Biestek v. Berryhill, 139 S. Ct. 1148, 1154
(2019). The United States Supreme Court has compared the
substantial evidence standard to that of clear error. See id.
And we have described this standard as “modest.” Smith v.
Kijakazi, 14 F.4th 1108, 1111 (9th Cir. 2021).
    In applying the substantial evidence standard of review,
“if evidence exists to support more than one rational
interpretation, we must defer to the [ALJ’s] decision.”
Batson v. Comm’r, 359 F.3d 1190, 1193 & n.1 (9th Cir.
2004) (citation omitted).
    The majority opinion cites the substantial evidence
standard of review but fails to apply it in evaluating the
decision of the ALJ. The majority opinion gives absolutely
no deference to the decision of the ALJ. Rather, it is
apparent that the majority opinion applies a de novo standard
of review. The majority evaluates the evidence of
Ferguson’s symptom testimony independently.               See
Majority Opinion, pp. 9-12 (analyzing Ferguson’s symptom
testimony and medical records and discounting the opinions
of the consulting physicians); see also, p. 12 (observing that
the majority “do[es] not see how such neurological-function
                   FERGUSON V. O’MALLEY                   19

exam results are inconsistent with Ferguson’s headache
testimony.” This de novo review flouts the applicable
substantial evidence standard of review. See Garrison v.
Colvin, 759 F.3d 995, 1010 (9th Cir. 2014) (cautioning that
“[w]here the evidence can reasonably support either
affirming or reversing a decision, we may not substitute our
judgment for that of the ALJ”) (citation, alteration, and
internal quotation marks omitted). The ALJ based his
decision on the opinions from the medical providers. See
ALJ Decision, pp. 18-21. In particular, the ALJ referenced
the treatment notes from Dr. Rowh indicating that
Ferguson’s headaches worsened with exertion. However,
Dr. Rowh did not find that the headaches affected
Ferguson’s cranial nerves, cognition, or cerebellar function.
After reviewing the medical records that contained
observations similar to that of Dr. Rowh, the consulting
physicians opined that despite severe medical impairments,
including the headaches, Ferguson was not disabled, but
could perform sedentary work that avoided exposure to
noise. The majority’s de novo analysis that contradicts the
expert opinions on which the ALJ relied conflicts completely
with our precedent. See id.
   2. The majority opinion rewrites the facts of the case.
    It is clear from his decision that the ALJ did not reject
Ferguson’s symptom testimony. Rather, the ALJ noted that
Ferguson’s “statements concerning the intensity, persistence
and limiting effects of these symptoms are not entirely
consistent with the medical evidence and other evidence in
the record.” In short, although the ALJ accepted Ferguson’s
testimony that his headaches constituted a severe medical
impairment, he relied on the opinions from the consulting
physicians that the headaches did not prevent Ferguson from
working. The ALJ incorporated those opinions into his
20                     FERGUSON V. O’MALLEY

determination of Ferguson’s ability to perform sedentary
work by avoiding the exertion that exacerbated his
headaches, and “concentrated exposure to noise” that might
trigger his headaches. 1
    Despite the clear record of the ALJ’s acceptance of
Ferguson’s symptom testimony, the majority nevertheless
maintains that the ALJ rejected Ferguson’s testimony. See
Majority Opinion, p. 4. The majority relies on Swenson v.
Sullivan, 876 F.2d 683 (9th Cir. 1989), to support its
contention that the ALJ rejected Ferguson’s symptom
testimony. See Majority Opinion, p. 6, n.1. However, that
case does not support the majority’s claim that the ALJ
rejected Ferguson’s symptom testimony. As an initial
matter, in Swenson we determined that the ALJ found the
claimant credible, not that the ALJ rejected the claimant’s
testimony. See Swenson, 876 F.2d at 688. Nevertheless, in
Swenson, we found error because the ALJ’s conclusion was
contradicted by the medical evidence, including that of “the
only expert to give an opinion of Swenson’s functional
ability.” Id. That is not the case before us. Here, the ALJ
found that Ferguson’s testimony concerning “the limiting
effects of [his] symptoms [is] not entirely consistent with the
medical evidence.” The ALJ’s conclusion regarding the
severity of Ferguson’s symptoms was not contradicted by
the medical evidence. Rather, it was consistent with that of

1
  The majority opinion concludes that the ALJ erred by failing to account
for the claimant’s testimony regarding headaches when he was not
engaged in physical exertion. See Majority Opinion, p. 12. However the
ALJ relied on the medical evidence that there was “no clinical sign to
suggest intracranial pressure” and that Ferguson “had a negative CT scan
of the brain,” as well as Ferguson’s testimony that he spent “75% of [his]
time . . . on [his] phone” playing games and “looking through Facebook,”
which would be inconsistent with debilitating headaches.
                    FERGUSON V. O’MALLEY                   21

the two experts “to give an opinion of [Ferguson’s]
functional ability.” Id.; see also Rounds v. Comm’r, 807
F.3d 996, 1006 (9th Cir. 2015), as amended (discerning no
error in the ALJ’s discounting of claimant’s testimony that
was not consistent with the opinions of two medical experts
“regarding [the claimant’s] functional capabilities”).
    The majority continues to insist that the ALJ failed to
give “specific, clear, and convincing reasons” for
discounting Ferguson’s symptom testimony. Majority
Opinion, p. 12 n.3. But our precedent has regularly upheld
the discounting of symptom testimony that conflicts with
expert medical opinion and/or is inconsistent with the
claimant’s daily activities. See Kitchen v. Kijakazi, 82 F.4th
732, 739 (9th Cir. 2023) (concluding that the ALJ properly
discounted the claimant’s testimony that was not supported
by the medical experts’ “mild or moderate, rather than
disabling” assessments of impairment) (citation, alteration,
and internal quotation marks omitted); see also Smartt v.
Kijakazi, 53 F.4th 489, 496-97 (9th Cir. 2022) (holding that
the ALJ properly discounted the claimant’s “subjective pain
testimony” that was inconsistent with “the objective medical
evidence” and the claimant’s daily activities); Ahearn, 988
F.3d at 1116-17 (determining that “[s]ubstantial evidence
support[ed] the ALJ’s conclusion that the medical record
was inconsistent with the severity of the limitations [the
claimant] described in his testimony”); Bray v. Comm’r, 554
F.3d 1219, 1227 (9th Cir. 2009) (reasoning that the ALJ’s
discounting of the claimant’s testimony was proper because
the claimant’s “statements at her hearing [did] not comport
with objective evidence in her medical record”); Crane v.
Shalala, 76 F.3d 251, 254 (9th Cir. 1996) (affirming ALJ’s
rejection of the claimant’s testimony as inconsistent with
daily activities and the medical record).
22                  FERGUSON V. O’MALLEY

     3. The majority opinion fails to properly credit the
        evidence that supports the decision of the ALJ.
    In reviewing the ALJ decision, we must consider all the
evidence, including the evidence that supports the ALJ’s
decision. See Garrison, 759 F.3d at 1010. But the majority
ignores the evidence supporting the ALJ’s decision. In
addition to the evidence from the consulting physicians
discussed above that supported the ALJ’s decision, the ALJ
also referenced Ferguson’s activities that were inconsistent
with the headaches being disabling. For example, the ALJ
pointed to Ferguson’s report that his daily activities included
watching television, playing video games, helping to care for
his mother’s wild cats, preparing simple meals, working on
projects in his shop (such as a model house), and attending
to his self-care. He was also “capable of driving a vehicle.”
We have upheld reliance on similar daily activities to
support a determination that a claimant was not disabled.
See Smartt, 53 F.4th at 499-500 (explaining that “[e]ven if
the claimant experiences some difficulty or pain, [his] daily
activities may be grounds for discrediting the claimant’s
testimony to the extent that they contradict claims of a totally
debilitating impairment,” and concluding that the claimant’s
daily activities of cooking, cleaning, “doing crafts,” and
“completing various chores, albeit in short increments due to
pain,” supported the ALJ’s decision) (citation and internal
quotation marks omitted); Ahearn, 988 F.3d at 1117
(determining that the claimant’s “daily activities provide[d]
substantial evidence to support the ALJ’s decision” because
the claimant “had the ability to play video games and watch
television for sustained periods, to use a library computer a
few times a week for two hours at a time (the maximum time
permitted by the library), to use public transportation, to
shop at stores, to perform personal care, to prepare meals, to
                    FERGUSON V. O’MALLEY                    23

socialize with friends, and to perform household chores”);
Berry v. Astrue, 622 F.3d 1228, 1235 (9th Cir. 2010)
(concluding that the ALJ’s decision was supported by
substantial evidence based in part on claimant’s “self-
reported activities” that he “drove his car and did crossword
puzzles, computer work, pet care, cooking, laundry and other
house-keeping”). The ALJ’s reliance on these daily
activities was also consistent with the opinion of the
consulting physicians that Ferguson’s headaches were not
disabling.
     The majority does not credit this evidence as sufficiently
substantial to support the ALJ’s decision. However, as
noted, the substantial evidence standard “is not high.”
Biestek, 139 S. Ct. at 1154. Rather, it is a “modest” one.
Smith, 14 F.4th at 1111. And “if evidence exists to support
more than one rational interpretation, we must defer to the
[ALJ’s] decision.” Batson, 359 F.3d at 1193 & n.1 (citation
omitted). Even if the majority’s de novo interpretation of the
record is a rational one, so is the interpretation of the ALJ,
as it is supported by the opinions of the consulting physicians
that Ferguson’s headaches were not disabling, and by the
evidence of Ferguson’s daily activities.            Under our
precedent, these facts required deference to the ALJ’s
decision, see id., which the majority fails to afford it. See
Garrison, 759 F.3d at 1010 (“The ALJ is responsible for
determining credibility”. . .) (citation omitted).
    In sum, because the majority fails to apply the applicable
standard of review, rewrites the facts, and fails to properly
credit evidence that supports the ALJ’s decision, I
respectfully dissent.