Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-2_12-cv-00738/USCOURTS-azd-2_12-cv-00738-0/pdf.json

Nature of Suit Code: 863
Nature of Suit: Social Security - DIWC/DIWW (405(g))
Cause of Action: 42:405 Review of HHS Decision (SSID)

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WO 

IN THE UNITED STATES DISTRICT COURT 

FOR THE DISTRICT OF ARIZONA 

Tiffany C. Lamb, 

Plaintiff, 

v. 

Michael J. Astrue, Commissioner of the 

Social Security Administration, 

Defendant.

No. CV-12-00738-PHX-DGC

ORDER 

 On September 28, 2012, Tiffany Lamb (“Plaintiff” or “the claimant”) filed an 

opening brief challenging the Commissioner’s denial of her application for Social 

Security benefits. Doc. 13. The Commissioner filed a response on November 14, 2012. 

Doc. 16. Plaintiff filed a reply on December 3, 2012. Doc. 17. For the reasons that 

follow, the Court will grant Plaintiff’s appeal of the Commissioner’s determination and 

remand the case for an award of benefits. 

I. Factual Background. 

Plaintiff filed an application for disability insurance benefits and supplemental 

security income on November 9, 2007, alleging a disability onset date of May 1, 2006. 

Tr. at 24. Her claims were initially denied on April 8, 2008, and again after 

reconsideration on October 7, 2008. Tr. at 24. A hearing was held on February 23, 2010, 

at which Plaintiff amended the alleged onset date to November 4, 2007. Tr. at 24. The 

Administrative Law Judge (“ALJ”) denied Plaintiff’s application, and the ALJ’s decision 

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became the final agency decision when the Social Security Administration Appeals 

Council denied a request for review. Tr. at 1-5. 

II. Legal Standard. 

 Defendant=s decision to deny benefits will be vacated “only if it is not supported 

by substantial evidence or is based on legal error.” 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, i.e., such relevant evidence as a reasonable mind might accept 

as adequate to support a conclusion.” Id. In determining whether the decision is 

supported by substantial evidence, the Court must consider the record as a whole, 

weighing both the evidence that supports the decision and the evidence that detracts from 

it. Reddick v. Charter, 157 F.3d 715, 720 (9th Cir. 1998). If there is sufficient evidence 

to support the Commissioner’s determination, the Court cannot substitute its own 

determination. See Young v. Sullivan, 911 F.2d 180, 184 (9th Cir. 1990). 

III. Analysis. 

 For purposes of Social Security benefits determinations, a disability is 

the inability to do any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted 

or can be expected to last for a continuous period of not less than 12 months. 

20 C.F.R. § 404.1505. 

 Determining whether a claimant is disabled involves a five-step evaluation. The 

claimant must show (1) he is not currently engaged in substantial gainful employment, 

(2) he has a severe physical or mental impairment, and (3) the impairment meets or 

equals a listed impairment or (4) his residual functional capacity (“RFC”) precludes him 

from performing his past work. If at any step the Commission determines that a claimant 

is or is not disabled, the analysis ends; otherwise it proceeds to the next step. If the 

claimant establishes his burden through step four, the Commissioner bears the burden at 

step five of showing that the claimant has the RFC to perform other work that exists in 

substantial numbers in the national economy. See 20 C.F.R. § 404.1520(a)(4)(i)-(v). 

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 The ALJ found that Plaintiff has not engaged in substantial gainful employment 

since the disability onset date of November 4, 2007, and that she suffers from 

“fibromyalgia, with aches and pain through her muscles and joints, fatigue, and major 

depression.” Tr. at 26. The ALJ found the combination of these impairments to be 

severe, satisfying step two. Id. At step three the ALJ considered the medical evidence 

and concluded that the claimant does not have an impairment or combination of 

impairments that meets or equals the severity of one of the impairments listed in the 

regulations. Tr. at 27. The ALJ then considered the medical evidence and relevant 

statements and testimony and concluded that Plaintiff had the RFC to perform light work 

as defined in 20 C.F.R. § 404.1567(b) and § 416.967(b). Tr. at 28. Plaintiff was limited, 

however, to “unskilled work involving simple operations, with no crawling, crouching, 

climbing, squatting or kneeling, no use of her legs or feet for pushing or pulling leg 

controls and no reaching above shoulder level.” Id. At step five, the ALJ considered the 

testimony of the vocational expert and concluded that Plaintiff could not perform her past 

relevant work as a clerk typist or a stocker, but that she could perform other jobs that 

exist in significant numbers in the national economy. Tr. at 32-33. Therefore, the ALJ 

concluded that the Plaintiff was not disabled within the meaning the Social Security Act. 

Tr. at 34. 

 Plaintiff’s brief raises several challenges to the ALJ’s findings. She argues that 

the ALJ erred by rejecting the assessment of the treating rheumatologist and Plaintiff’s 

symptom testimony. She also argues that it was error for the ALJ to determine work 

capacities “based on a standardized assessment, without any basis in the record[.]” 

Doc. 13 at 1. The last argument is presented with an acknowledgment that it has been 

rejected by this Court and is raised merely to preserve the issue for further appeal. 

Doc. 13 at 20-21, n. 13. Because the Court finds that the ALJ improperly discounted the 

treating physician’s testimony and that the testimony is sufficient to remand for an award 

of benefits, it need not address the additional arguments. 

 

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 A. Testimony of Treating Rheumatologist. 

 Where the treating physician=s opinion is not contradicted by another physician, 

the ALJ’s reasons for rejecting the opinion must be “clear and convincing.” Thomas v. 

Barnhart, 278 F.3d 947, 957 (9th Cir. 2002) (citation omitted); see also Lewis v. Apfel, 

236 F.3d 503, 517 (9th Cir. 2001) (“[A]n ALJ may reject a treating doctor’s medical 

opinion, if no other doctor has contradicted it, only for ‘clear and convincing’ reasons 

supported by substantial evidence.”) (citing Reddick, 157 F.3d at 725). If the opinion of a 

treating physician conflicts with the opinion of an examining physician, the ALJ may 

discount the treating physician’s opinion if he “makes findings setting forth specific, 

legitimate reasons for doing so that are based on substantial evidence in the record.” 

Thomas, 278 F.3d at 957 (citation omitted). “The ALJ can meet this burden by setting 

out a detailed and thorough summary of the facts and conflicting clinical evidence, 

stating his interpretation thereof, and making findings.” Id (quotation marks omitted).

Additionally, “[t]he ALJ need not accept the opinion of any physician, including a 

treating physician, if that opinion is brief, conclusory, and inadequately supported by 

clinical findings.” Id. 

 Dr. Vijayabhanu Mahadevan, M.D., was Plaintiff’s treating rheumatologist. In a 

Fibromyalgia Residual Functional Capacity Questionnaire, completed on December 9, 

2011, Dr. Mahadevan opined that Plaintiff’s fibromyalgia and depression caused her 

“moderately severe pain,” and that Plaintiff has “moderately severe fatigue which 

interferes with her attention and concentration on a frequent basis.” Tr. at 213-215. He 

also checked the box indicating that Plaintiff would not be able to sustain work on a 

regular and continuing basis (8 hours a day, 5 days a week). Tr. at 215. 

 The ALJ stated that he gave “little weight” to Dr. Mahadevan’s opinion because it 

was “inconsistent with the record as a whole” and was “based entirely upon the 

claimant’s subjective allegations and . . . unsupported by the medical evidence, which 

includes finding [sic] by other physicians [.]” Tr. at 32. Plaintiff argues that the ALJ did 

not point out any inconsistences with the record, and that the other medical evidence did 

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not contradict Dr. Mahadevan’s assessment. Furthermore, she argues that mere reliance 

on a patient’s subjective reporting of symptoms is not sufficient evidence to undermine 

the opinion of a treating physician. 

 The ALJ specifically cites to several exhibits containing Dr. Mahadevan’s and the 

physician’s assistant’s treatment notes at Valley Arthritis Care (Exs. 4F, 10F, 18F 

corresponding with Tr. at 316-327, 375-389, 492, 516). He characterizes the physical 

exam notes as normal except for a left shoulder problem unrelated to fibromyalgia, but 

the notes contain “other findings” in the “Physical Findings” section that indicate 

Plaintiff was “positive” at multiple trigger points. Tr. at 318, 379, 382, 385, 388, 493, 

495, 497, 500, 503, 506, 508, 510. Multiple tender points are common symptoms of 

fibromyalgia. Benecke v. Barnhart, 379 F.3d 587, 590 (9th Cir. 2004) (“Common 

symptoms . . . include chronic pain throughout the body, multiple tender points, fatigue, 

stiffness, and a pattern of sleep disturbance that can exacerbate the cycle of pain and 

fatigue associated with this disease.”). Although the ALJ cites many pages containing 

these positive trigger point observations, he never mentions them or explains how they 

are consistent with his characterization of the physical exam findings as normal. 

 The ALJ cites opinions from a podiatrist, a gynecologist, and a physical therapist, 

each of whom examined or treated Plaintiff. Tr. at 30. The podiatrist’s opinion concerns 

pain in the big toe of the right foot. Tr. at 549. The ALJ does not explain how this 

opinion contradicts Dr. Mahadevan’s fibromyalgia diagnosis or his findings about 

Plaintiff’s limitations. Tr. at 30. The gynecologist testified that the results of 

gynecological exams in 2008 and 2009 were normal (Tr. at 391, 542), but the ALJ does 

not explain how these exams are related to the treating physician’s fibromyalgia 

diagnosis. The physical therapist’s treatment for back pain from January 25 through 

March 3, 2010, is relevant to the underlying fibromyalgia diagnosis to the extent that it 

addresses the severity of the Plaintiff’s pain. The ALJ noted that the physical therapist’s 

examinations “remained essentially the same” and that the condition was gradually 

improving. Tr. at 30. While this evidence demonstrates some improvement in Plaintiff’s 

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back pain in early 2010, it does not contradict Dr. Mahadevan’s fibromyalgia diagnosis 

or provide clear and convincing evidence for discounting his 2011 opinion regarding 

Plaintiff’s overall condition throughout the disability period. Thomas, 278 F.3d at 957; 

Tr. at 217. 

 The ALJ also appears to have relied on the opinion of a nurse practitioner in 

discounting the opinion of Dr. Mahadevan. He observed that because Dr. Mahadevan 

prescribed a low grade exercise program and stretching to relieve some of the symptoms 

of fibromyalgia, nurse practitioner Patricia Timlick refused to indicate that Plaintiff 

would be disabled for “more than one year” or to fill out an application for a disabled 

license plate. Tr. at 30. Her refusal was also based on her own physical examinations. 

Tr. at 534-35. Timlick also noted that Plaintiff’s condition had improved somewhat as a 

result of medication. Tr. at 392. A nurse practitioner, however, is not an “acceptable 

medical source,” and her opinions cannot be used to contradict the opinion of a treating 

physician. Gomez v. Chater, 74 F.3d 967, 970-71 (9th Cir. 1996); 20 C.F.R. §§ 

404.1513(a) and (d); Thomas, 278 F.3d at 957. The ALJ fails to articulate how a light 

exercise regimen and some improvement with medication provide clear and convincing 

evidence that Dr. Mahadevan’s underlying diagnosis was wrong or that the prescribed 

physical limitations were overstated. 

 Finally, the ALJ discounts Dr. Mahadevan’s opinion because it is “based entirely 

on the claimant’s subjective allegations and is unsupported by the medical evidence.” 

Tr. at 32. While Dr. Mahadevan’s treatment notes contain a record of Plaintiff’s 

subjective complaints, they also note positive trigger points indicative of fibromyalgia. 

“[A]n ALJ does not provide clear and convincing reasons for rejecting an examining 

physician’s opinion by questioning the credibility of the patient’s complaints where the 

doctor does not discredit those complaints and supports his ultimate opinion with his own 

observations.” Ryan v. Commissioner of Social Sec. 528 F.3d 1194, 1199 (9th Cir. 2008) 

(citation omitted). 

 

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B. Award of Benefits. 

 The decision to remand for further development of the record or for an award 

benefits is within the discretion of the Court. 42 U.S.C. § 405(g); see Harman v. Apfel, 

211 F.3d 1172, 1173-74 (9th Cir. 2000). This Circuit has held, however, that an action 

should be remanded for an award of benefits where three conditions are met: the ALJ has 

failed to provide legally sufficient reasons for rejecting evidence, no outstanding issue 

remains that must be resolved before a determination of disability can be made, and it is 

clear from the record that the ALJ would be required to find the claimant disabled were 

the rejected evidence credited as true. 

 The Court has found that the ALJ failed to give legally-sufficient reasons for 

discrediting the opinion of Plaintiff’s treating physician, Dr. Mahadevan. As a result, his 

opinion must be credited as true. See Varney v. Secretary of Health and Human Services, 

859 F.2d 1396 (9th Cir. 1988) (“if grounds for [discrediting a claimant’s testimony] exist, 

it is both reasonable and desirable to require the ALJ to articulate them in the original 

decision.”); Lester v. Chater, 81 F.3d 821, 834 (9th Cir. 1995) (“Where the 

Commissioner fails to provide adequate reasons for rejecting the opinion of a treating or 

examining physician, we credit that opinion ‘as a matter of law.’” (citing Hammock v. 

Bowen, 879 F.2d 498, 502 (9th Cir.1989)); Harman v. Apfel, 211 F.3d 1172, 1178 (9th 

Cir.2000) (same); Benecke v. Barnhart, 379 F.3d 587 (9th Cir.2007) (“Because the ALJ 

failed to provide legally sufficient reasons for rejecting Benecke’s testimony and her 

treating physicians’ opinions, we credit the evidence as true.”). 

 When presented with Dr. Mahadevan’s opinion regarding Plaintiff’s limitations, 

the vocational expert stated the limitations “would preclude work[.]” Tr. at 65. Because 

Dr. Mahadevan’s limitations opinion is credited as true, and the vocational expert has 

already testified that such limitations would preclude all work, there are no outstanding 

issues to be resolved. Accordingly, the Court will remand for an award of benefits. 

IT IS ORDERED: 

 1. Defendant’s decision denying benefits is reversed. 

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 2. The claim is remanded for an award of benefits. 

Dated this 8th day of February, 2013. 

 

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