Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-2_11-cv-00956/USCOURTS-azd-2_11-cv-00956-0/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 

Todd Van Dam, 

Plaintiff, 

vs. 

Michael J. Astrue, Commissioner of Social 

Security, 

Defendant.

No. CV11-0956-PHX-DGC

ORDER 

 Plaintiff filed an application for supplemental security income (SSI) on April 29, 

2008, claiming a disability onset date of April 1, 2011 due to mental impairments. 

TR 19. The application was denied initially on July 30, 2008 and again on October 8, 

2008. Id. A hearing before an administrative law judge (ALJ) was held on December 9, 

2009. Id. The administrative law judge (ALJ) issued a decision on February 19, 2010, 

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

TR 16-32. This decision became Defendant’s final decision when the Appeals Council 

denied review. TR 1-3. Plaintiff commenced this action for judicial review pursuant to 

42 U.S.C. § 405(g). For the reasons that follow, the Court will affirm Defendant’s 

decision. 

II. Standard of Review.

 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 

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scintilla, but less than a preponderance, i.e., such relevant evidence as a reasonable mind 

might accept as adequate to support a conclusion.” Id. To determine whether substantial 

evidence supports Defendant’s decision, the Court must review the administrative 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 Defendant’s determination, the Court cannot substitute its 

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

III. Analysis. 

 Plaintiff claims that (1) the ALJ’s determination that Plaintiff is unable to sustain 

work on a regular and continuous basis due to substance abuse is not based on substantial 

evidence; (2) the ALJ did not accord adequate weight to the opinions of Plaintiff’s 

treating physicians in conformity with 20 C.F.R. § 404.1527; and (3) the ALJ should 

have considered Plaintiff’s borderline personality as a severe and disabling condition. 

Doc. 10. 

A. Substance Abuse as a Material Contributing Factor. 

 Whether a claimant is disabled is determined using a five-step sequential 

evaluation process. The claimant bears the burden in steps one through four. To 

establish disability the claimant must show (1) he is not currently working, (2) he has a 

severe medically determinable 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. 20 C.F.R. § 416.920(a). At step five, the 

Commissioner bears the burden of showing that the claimant has the RFC to perform 

other work that exists in substantial numbers in the national economy. Id.

 The ALJ found that Plaintiff suffers severe impairments of schizoaffective 

disorder, depressive disorder, and substance abuse. TR 22. The ALJ found that these 

impairments do not individually or in combination meet the criteria for severity listed in 

20 C.F.R. § 416.920(d). Considering Plaintiff’s age, education, work experience, and 

RFC impaired by substance abuse, the ALJ determined that there are no jobs that exist in 

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significant numbers in the national economy that Plaintiff can perform. TR 28. “With 

substance abuse, [Plaintiff] is unable to meet the basic mental demands of competitive 

unskilled work on a sustained basis.” TR 29. 

 Notwithstanding this initial disability determination, the ALJ was required to 

perform an additional analysis in light of Plaintiff’s medical record of substance abuse. 

The Commissioner “must determine whether [a claimant’s] drug addiction or alcoholism 

is a contributing factor material to the determination of disability . . . .” 20 C.F.R. 

§ 416.935(a). The key factor is whether the Commissioner would still find the claimant 

disabled if he stopped using drugs or alcohol. 20 C.F.R. § 416.935(b). An individual is 

not considered “disabled” for the purposes of receiving SSI “if alcoholism or drug 

addiction would . . . be a contributing factor material to the Commissioner’s 

determination that the individual is disabled.” 42 U.S.C. § 1382c(3)(J). 

 Plaintiff did not meet his burden of showing that his substance abuse was not 

material. See Parra v. Astrue, 481 F.3d 742, 748-50 (9th Cir. 2007). Plaintiff’s medical 

records are replete with diagnoses and his own admissions of alcohol dependence. 

TR 22-23, 223, 226-27, 278, 320. The medical evidence, as well as Plaintiff’s own 

reports and hearing testimony, indicate that Plaintiff has not complied with the medical 

regimens prescribed by his physicians. Plaintiff self-discontinued anti-psychotic 

medication, declined substance abuse treatment, and declined inpatient care. TR 223, 

301-02, 305. Plaintiff notes that he did not consume alcohol while incarcerated and 

“continued to have difficulties dealing with stress, self-mutilated, reported seeing bugs, 

expressed anger, and was described as pessimistic,” and argues that this evidence 

supports a finding of disability independent of substance abuse. Doc. 10, at 4. However, 

it is insufficient to show that limitations exist independent of substance abuse. Plaintiff 

must prove that these remaining limitations are disabling. See 20 C.F.R. § 416.935(b) 

(“If we determine that your remaining limitations would not be disabling, we will find 

that your drug addiction or alcoholism is a contributing factor material to the 

determination of disability.”) (emphasis added). 

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 The ALJ properly considered the entire record in analyzing which limitations 

would remain if the substance abuse stopped and whether they would be disabling. The 

ALJ considered medical evidence that Plaintiff may have mild-to-moderate difficulty 

interacting appropriately with the public and moderate difficulty responding to 

supervisory criticism, getting along with co-workers, and sustaining concentration. 

TR 29. The ALJ also considered that Plaintiff would not have problems with personal 

care, preparing simple meals, and performing household chores. TR 144-51, 281-84. 

Plaintiff is able to pay his bills, count change, and handle a checking account. TR 144-

51. The ALJ determined that if Plaintiff stopped his substance abuse, his mental health 

symptoms would not prevent him from maintaining unskilled work and that his 

remaining limitations would not be disabling. TR 29-31. 

 This determination meets the substantial evidence standard. “Where the evidence 

is susceptible to more than one rational interpretation, one of which supports the ALJ’s 

decision, the ALJ’s conclusion must be upheld.” Thomas v. Barnhart, 278 F.3d 947, 954 

(9th Cir. 2002). Because substantial evidence supports the ALJ’s determination that 

substance abuse is a contributing factor material to the disability determination, the Court 

must uphold the ALJ’s decision that Plaintiff is not disabled within the meaning of the 

Social Security Act and is ineligible for SSI. 42 U.S.C. § 1382c(3)(J). 

 B. Weight Accorded to Treating Physicians. 

 Regarding the weight that an ALJ should give to a particular medical opinion, the 

Ninth Circuit distinguishes between the opinions of treating physicians, examining 

physicians, and non-examining physicians. See Lester v. Chater, 81 F.3d 821, 830 

(9th Cir. 1996). Generally, an ALJ should give greatest weight to a treating physician’s 

opinion and more weight to the opinion of an examining physician than to one of a nonexamining physician. See Andrews v. Shalala, 53 F.3d 1035, 1040-41 (9th Cir. 1995); 

20 C.F.R. § 416.927(d)(1), (2). 

 If a treating physician’s opinion is controverted by a non-treating physician’s 

opinion, the ALJ must make findings setting forth “‘specific, legitimate reasons’ 

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supported by substantial evidence in the record” for rejecting it. Murray v. Heckler, 

722 F.2d 499, 502 (9th Cir. 1983). “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.’” Thomas, 278 F.3d at 957 (quoting 

Magallanes v. Bowen, 881 F.2d 747, 751 (9th Cir. 1989)). 

 Practitioner Lusk was Plaintiff’s treating provider.1

 Among the diagnoses she 

provided in Plaintiff’s Supplemental Questionnaire were marked limitations with 

understanding and remembering short, simple instructions and extreme limitations with 

responding appropriately to work pressures in a usual work setting. TR 303-04. The 

ALJ gave some weight to Practitioner Lusk’s opinion, but found that she did not 

adequately address Plaintiff’s substance abuse and that her notes did not comport with the 

Plaintiff’s overall treatment record. TR 27. The Court finds these to be specific reasons 

for giving less weight to Practitioner Lusk’s opinions, and that the ALJ’s reasons are both 

legitimate and supported by substantial evidence. As the ALJ noted, Drs. Vaughan, 

Rabara, and Nagella all diagnosed Plaintiff with alcohol dependence. TR 22-23. The 

ALJ also noted the following additional information from the medical records. In a July 

2008 exam by Dr. Rabara, Plaintiff reported that he had 10 driving under the influence 

offenses and that he last consumed alcohol “last night. I had a bunch.” Id. at 23. 

Plaintiff reported that he drinks “every other day,” and admitted to recreational use of 

marijuana. Id. Treatment notes from November of 2008 show that Plaintiff was “not 

really” taking his medications, that he was still drinking, and that he smelled of alcohol 

during the exam. TR 23. Practitioner Lusk’s notes from June of 2009 indicate that 

Plaintiff reported he drinks beer every other day, as much as he can; that he declined 

inpatient treatment and detoxification; and that he declined medications. Id. In October 

of 2009, Practitioner Lusk noted that Plaintiff reported drinking one day and being hung 

1

 The Court does find it necessary to address the distinction between “acceptable medical sources” and “other sources” because the ALJ properly weighed Practitioner Lusk’s findings, and her status as a nurse practitioner would not alter the outcome. See

Doc. 11, at 9-10; 20 C.F.R. § 415.913(a). 

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over the next, that he usually drinks 15 beers at a time, and that he had not obtained his 

medication for months. Id. at 23-24. Practitioner Lusk provided a check-the-box 

summary of Plaintiff’s limitations on October 27, 2009, as well as this brief finding: 

Plaintiff “has auditory hallucinations daily, at times constantly which interfere with his 

functioning.” TR 303. Despite the substantial information in the medical record 

regarding Plaintiff’s substance abuse and her own diagnoses of Plaintiff’s alcohol 

dependence (TR 306, 311), Practitioner Lusk’s brief medical findings made no mention 

of alcohol dependence (TR 303-304). The Court finds the ALJ’s reasons for according 

her opinion less weight to be specific, legitimate, and supported by substantial evidence. 

 An ALJ need not accept such a treating physician’s opinion if it is brief, 

conclusory, and unsupported by clinical findings. See Thomas, 278 F.3d at 956-57 

(citing Matney v. Sullivan, 981 F.2d 1016, 1019 (9th Cir. 1992)). The ALJ found that Dr. 

Vaughan’s assessments were not accompanied by appropriate clinical signs or findings, 

and that he “simply ticked a box agreeing with the claimant’s statement of his 

impairment.” TR 27. Dr. Vaughan marked a box indicating that Plaintiff had 

schizophrenia based on Plaintiff’s statement of his impairment. TR 219. Rather than 

relying solely on this conclusory finding, the ALJ properly considered Dr. Vaughan’s 

entire assessment. As the ALJ notes in his decision, Dr. Vaughan indicated that Plaintiff 

admitted to poor compliance with medication, stating “[n]othing ever helps much. Beer 

helps the best, but I don’t want to go there.” TR 22, 223. The ALJ concluded that 

Plaintiff’s “noncompliance does not support the alleged intensity and duration of his 

subjective complaints and limitations.” TR 26. The Court finds this to be a specific, 

legitimate reason for giving less weight to Dr. Vaughan’s opinion and that this reason is 

supported by substantial evidence of Plaintiff’s alcohol abuse in the record. See TR 22-

23. 

 The ALJ is responsible for determining credibility, resolving conflicts in medical 

testimony, and resolving ambiguities. Andrews, 53 F.3d at 1039. Some of the medical 

reports opine that Plaintiff could not perform substantially gainful employment. TR 219, 

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304. Others indicate that Plaintiff would be able to carry out simple instructions, adhere 

to a schedule, and adapt adequately. TR 283. Each of the medical reports cites 

Plaintiff’s substance abuse. TR 223, 227, 278, 302, 305-318. To the extent that the 

reports were ambiguous, e.g., Dr. Nagella’s report (“Todd is unable to seek gainful 

employment and would not succeed in any employment setting due to his mental illness 

as well as his history of substance abuse.”) (TR 302) (emphasis added), the ALJ acted 

well within his power to weigh the evidence before him and make the determination that 

Plaintiff’s substance abuse was a contributing factor material to his disability. The Court 

does not find error in the ALJ’s analysis of the treating physician opinions. The Court 

finds that the ALJ provided specific, legitimate reasons, supported by substantial 

evidence in the record, for his assessment of the medical providers’ opinions. 

C. Procedure for Evaluating Mental Impairments. 

Plaintiff alleges that the ALJ failed to use appropriate procedures for evaluating 

his borderline personality as a severe impairment. The ALJ applied the requisite fivestep process. TR 21-29. He included borderline traits in his analysis of the severity of 

Plaintiff’s impairments. TR 22; see 20 C.F.R. § 416.920(a)(3) (“We will consider all 

evidence in your case record when we make a determination or decision whether you are 

disabled.”); 20 C.F.R. § 416.920(a)(4)(ii) (“At the second step, we consider the medical 

severity of your impairment(s).”) The Court finds that the ALJ sufficiently considered 

Plaintiff’s borderline personality diagnosis in the five-step evaluation of his overall 

mental impairments. 

 IT IS ORDERED: 

1. Defendant’s administrative decision denying benefits is affirmed. 

 2. The Clerk is directed to terminate this action. 

 Dated this 20th day of October, 2011. 

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