Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-cand-5_08-cv-01968/USCOURTS-cand-5_08-cv-01968-0/pdf.json

Nature of Suit Code: 864
Nature of Suit: Social Security - SSID Title XVI
Cause of Action: 42:405 Review of HHS Decision (SSID)

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United States District Court

For the Northern District of California

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1

 Plaintiff’s Motion for Summary Judgment or Remand, hereafter, “Motion,” Docket Item

No. 11; Defendant’s Cross-Motion for Summary Judgment and Opposition to Plaintiff’s Motion for

Summary Judgment, hereafter, “Cross-Motion,” Docket Item No. 14.)

United States District Court

For the Northern District of California

IN THE UNITED STATES DISTRICT COURT

FOR THE NORTHERN DISTRICT OF CALIFORNIA

SAN JOSE DIVISION

Lisa Craig,

Plaintiff,

 v.

Michael J. Astrue, Commissioner of Social

Security,

Defendant. /

NO. C 08-01968 JW 

AMENDED ORDER GRANTING IN PART

AND DENYING IN PART PLAINTIFF’S

MOTION FOR SUMMARY JUDGMENT;

DENYING DEFENDANT’S CROSSMOTION FOR SUMMARY JUDGMENT;

REMANDING CASE FOR FURTHER

CONSIDERATION

I. INTRODUCTION

Lisa Craig (“Plaintiff”) brings this action pursuant to 42 U.S.C. § 405(g) for judicial review

of a final decision of the Commissioner of Social Security (“Defendant”) denying her disability

benefits. Presently before the Court are the parties’ Cross-Motions for Summary Judgment.1

 The

matter was submitted on the papers without oral argument. See Civ. L.R. 16-5. Based on the papers

submitted to date, the Court GRANTS in part and DENIES in part Plaintiff’s Motion for Summary

Judgment and DENIES Defendant’s Cross-Motion for Summary Judgment. 

II. BACKGROUND

Plaintiff is a forty-year-old individual with a background as a financial administrator, office

manager and bookkeeper. (Transcript at 82, 341, hereafter, “TR.”) On April 15, 2005, Plaintiff

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filed a Title XVI application for supplemental security income, based on disability Plaintiff claimed

began on August 14, 2004. (TR at 19.) In her initial application, Plaintiff complained of

gastrointestinal and mood disorders. (TR at 43-44.) On June 21, 2005, Plaintiff’s claim was

initially denied, and on December 15, 2005, it was denied a second time on rehearing. (Id.) On

January 10, 2006, Plaintiff filed a written request for rehearing, and Plaintiff appeared for a hearing

on March 2, 2007. (Id.) 

At the March 2, 2007 hearing, Plaintiff testified as follows:

In August 2004, Plaintiff had surgery for a hiatal hernia. (TR at 342.) Following

the surgery, she began complaining of stomach problems, which included severe pain,

bloating, diarrhea, and cramping. (TR at 342-43.) These problems manifested themselves

after eating, and generally lasted for three to four hours every time Plaintiff ate. (TR at

344-45.) Plaintiff lost over fifty pounds as a result of these problems. (TR at 345.) 

Plaintiff also suffered incontinence and became unable to engage in recreational activities. 

(TR at 348.) After a battery of medical testing, doctors determined that Plaintiff had

suffered permanent nerve damage in her stomach, which prevents her stomach from

expanding. (TR at 347.) 

After considering Plaintiff’s testimony and the evidence of Plaintiff’s medical condition in

the record, the Administrative Law Judge (“ALJ”) found that Plaintiff was disabled within the

meaning of the Social Security Act from August 14, 2004 through September 14, 2005. (TR at 19.) 

In particular, the ALJ found the following with respect to Plaintiff’s disability during the disability

period: Plaintiff was limited to standing or walking no more than two hours in an eight-hour

workday, and overall suffered severe limits on her range of physical mobility. (TR at 23.) Plaintiff

required the opportunity to take unscheduled breaks totaling more than two hours throughout an

eight-hour workday, resulting from chronic abdominal pain and diarrhea. (Id.) During the period of

disability, Plaintiff was unable to perform past relevant work and was unable to performing work at

any exertional level on a regular and continuous basis. (TR at 24-25.) 

The ALJ determined, however, that as of September 15, 2005, Plaintiff’s medical condition

had undergone significant improvement relative to her ability to engage in gainful employment. (TR

at 26.) The ALJ cited several pieces of medical evidence in support of his conclusion, including a

report from Plaintiff’s treating gastroenterologist, examination notes from Plaintiff’s primary care

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physician, and the results of a consultative examination of a board-certified internist, as well as the

results of various diagnostic tests. (TR at 26-27.) As a result of Plaintiff’s purported improvement

as of September 15, 2005, the ALJ found that Plaintiff no longer needed to take breaks of two or

more hours during an eight-hour workday, and could resume gainful employment in her prior

relevant areas of experience. (TR at 27-30.) In making this determination, the ALJ gave the

greatest weight to the medical opinion evidence of Dr. Mahawar, the board-certified internist, and

Dr. Acenas, the examining psychiatrist, because those opinions were “mutually supporting and well

supported by the evidence in the case record as a whole as they apply to the period beginning

September 15, 2005.” (TR at 29.) At the same time, the ALJ discounted the contrary opinion of Dr.

Hutchinson, Plaintiff’s treating physician, on the grounds that Dr. Hutchinson’s opinion was

“inconsistent with his own treatment notes” and “less well supported by the evidence in the case

record.” (Id.) 

Presently before the Court are the parties’ Cross-Motions for Summary Judgment.

III. STANDARDS

To be eligible for benefits under Title XVI of the Social Security Act, the claimant must be

disabled. The claimant bears the burden of proving disability within the meaning of the Social

Security Act. Miller v. Heckler, 770 F.2d 845, 849 (9th Cir. 1985) (internal citations omitted); see

also 42 U.S.C. § 1382(c)(3). A claimant is “disabled” for purposes of receiving Social Security

benefits if she is unable to engage in any substantial gainful activity owing to a physical or mental

impairment that is expected to result in death or last for a continuous period of at least twelve

months. 42 U.S.C. § 423(d)(1)(A).

There is a five-step sequential evaluation process to determine disability. 20 C.F.R. §

416.920. If at any step, the Social Security Administration makes a determination of disability or

non-disability, the evaluation process terminates. 20 C.F.R. § 416.920(a)(4). First, the evaluator

considers the claimant’s current work activity and makes a determination of non-disability if she is

performing “substantial gainful activity.” Second, the evaluator determines whether the claimant

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2

 Between the third and fourth steps of the disability determination, the evaluator assesses

the claimant’s residual functional capacity (“RFC”). 20 C.F.R. § 416.920(a)(4). RFC is determined

based on medical and other evidence in the claimant’s record and is used during the final two steps

to determine whether the claimant is able to do her relevant previous work or other work. 20 C.F.R.

§ 416.920(e). 

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 Additionally, during the fifth step, the evaluator considers the “vocational factors” of age,

education, and past work experience to determine whether the claimant can transition to other work. 

20 C.F.R. § 416.920(f).

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has suffered from a severe, medically determinable impairment for at least twelve months and makes

a determination of non-disability if she has not. Third, the evaluator assesses whether the claimant’s

condition meets or equals any impairments on the Social Security Administration’s list of predefined

qualifying impairments, and makes a determination of disability if it does.2

 Fourth, the evaluator

determines whether the claimant can perform her past relevant work and makes a determination of

non-disability if she can. Fifth, the evaluator considers whether the claimant can move to alternative

work; the evaluator makes a determination of disability if she cannot, and a determination of nondisability if she can.3

 Id.; see also Barnhart v. Thomas, 540 U.S. 20 (2003).

A district court overturns an ALJ’s determination of non-disability only if it is unsupported

by substantial evidence or based on legal error. See Magallanes v. Bowen, 881 F.2d 747, 750 (9th

Cir. 1989). Substantial evidence “means more than a mere scintilla, but less than a preponderance;”

it is “such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.” 

Id. (internal citations and quotation marks omitted.) The reviewing court considers the record as a

whole, not merely the evidence lending support to the ALJ’s findings. See Reddick v. Chater, 157

F.3d 715, 720 (9th Cir. 1998). The court cannot substitute its own conclusion for the ALJ’s if there

is sufficient evidence to support the ALJ’s outcome. See Tackett v. Apfel, 180 F.3d 1094, 1098 (9th

Cir. 1999). Questions of credibility and resolution of conflicts in the testimony are solely

determinations to be made by the ALJ. Allen v. Heckler, 749 F.2d 577, 579 (9th Cir. 1984).

IV. DISCUSSION

Plaintiff moves for summary judgment or remand on the grounds that (1) the ALJ failed to

cite to any evidence of Plaintiff’s medical improvement after September 14, 2005, to justify a denial

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of benefits after that date; (2) the ALJ failed to adequately provide a basis for rejecting the opinions

of Plaintiff’s treating physician; and (3) the ALJ failed to consider Plaintiff’s reactive depression and

anxiety. (Motion at 8-13.) Defendant contends that all of the ALJ’s findings were appropriately

supported by substantial evidence and that the denial of benefits should be affirmed. (Cross-Motion

at 3-7.) The Court considers each of Plaintiff’s contentions in turn.

A. Evidence of Plaintiff’s Medical Improvement After September 14, 2005

Plaintiff contends that the ALJ’s determination of medical improvement after September 14,

2005 was not supported by substantial evidence. (Motion at 9.)

In evaluating a disabled claimant’s continued eligibility for benefits, the ALJ “must consider

whether ‘there has been any medical improvement in [the claimant’s] impairment(s) and, if so,

whether this medical improvement is related to [the claimant’s] ability to work.’” Johnson v. Apfel,

191 F.3d 770, 771 (7th Cir. 1999) (quoting 20 C.F.R. § 404.1594). The government must establish

“that [the claimant is] currently able to engage in substantial gainful activity before [the

government] can find that [the claimant is] no longer disabled.” 20 C.F.R. § 404.1594. 

Furthermore, “medical improvement” is defined as:

any decrease in the medical severity of [the claimant’s] impairment(s) which was

present at the time of the most recent favorable medical decision that [the

claimant was] disabled or continued to be disabled. . . . A determination that there

has been a decrease in medical severity must be based on changes (improvement)

in the symptoms, signs, or laboratory findings associated with [claimant’s]

impairment(s).

20 C.F.R. § 416.994a(c). “The key question” when determining whether a claimant has undergone

medical improvement “is not whether the claimant still suffered from the same medical problem he

had when benefits were awarded, but whether the severity of the problem had decreased sufficiently

to enable him to engage in gainful activity.” Warre v. Comm’r of the Soc. Sec. Admin., 439 F.3d

1001, 1006 (9th Cir. 2006). 

In this case, the ALJ stated that “the medical evidence indicates that [Plaintiff’s] condition

had improved significantly by September 15, 2005.” (TR at 26.) First, the ALJ cited an

examination conducted by Dr. Linda Nguyen on September 14, 2005. Following that examination,

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Dr. Nguyen reported that Plaintiff’s diarrhea was under control with medication. (TR at 228.) 

Second, the ALJ relied on a January 27, 2006 examination of Plaintiff’s treating physician, Dr.

James Hutchinson, after which Dr. Hutchinson noted that Plaintiff did not have abdominal

tenderness. (TR at 311.) Third, the ALJ referenced “diagnostic tests performed after September 15,

2005 [that] were repeatedly essentially normal or only minimally abnormal.” (TR at 230-46.) 

Finally, the ALJ included a discussion of Plaintiff’s examination by Dr. Suresh Mahawar on October

6, 2005, after which Dr. Mahawar indicated that Plaintiff had undergone a number of signs of

medical improvement. (TR at 296-304.) 

Upon review of the rationale given for the ALJ’s conclusion that Plaintiff was not disabled

after September 14, 2005, the Court finds that the ALJ inappropriately relied on or interpreted

several relevant pieces of evidence. First, the “normal or only minimally abnormal” test results cited

by the ALJ all occurred prior to September 15, 2005, during the period Plaintiff was deemed

disabled. The ALJ, however, stated that they took place after this date. (TR at 26 (citing Exhibit

7F).) Since this testing did not undermine a finding of disability before September 15, 2005, it is not

clear why it speaks to Plaintiff’s purported medical improvement after this time. 

Second, the ALJ relied on the examination of Dr. Mahawar, which the ALJ stated took place

on October 6, 2005, three weeks after the ALJ’s termination of Plaintiff’s disability status. This

exam, however, actually took place on October 6, 2006, more than a year after the ALJ found that

Plaintiff was no longer disabled. (See TR at 296-304.) At the very least, this raises questions about

Plaintiff’s disability status during the period from September 15, 2005 to October 6, 2006. 

Third, the ALJ cited treatment notes from Dr. Linda Nguyen, who stated that Plaintiff’s

diarrhea was under control with medication, as of September 14, 2005. At the same time, however,

Dr. Nguyen discussed various abnormal test results, and the physiological basis for those results. 

(See TR at 228.) Dr. Nguyen did not discuss, however, any of Plaintiff’s other symptoms, such as

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4

 Notably, after the ALJ issued his decision, Dr. Nguyen wrote a letter on behalf of Plaintiff,

in which Dr. Nguyen stated that her September 14, 2005 letter “in no way should be an indication

that [Plaintiff] would be able to return to full-time work on that date especially since on November

9, 2005 she was having ongoing symptoms.” (TR at 336.) Although Dr. Nguyen’s statement was

not before the ALJ at the time of his decision, the statement does suggest that the ALJ may have

overvalued the weight of once piece of symptom-related evidence in making his determination. 

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cramping and abdominal pain, which had contributed to her disability.4

 Taken together with several

misstatements in the record, and divorced from the complex nature of Plaintiff’s symptoms, it is not

clear why a reduction in the frequency of Plaintiff’s diarrhea indicated that Plaintiff had undergone

sufficient medical improvement so as to resume gainful employment. Although Defendant contends

that “[b]ecause Plaintiff’s diarrhea symptoms were controlled . . . and no longer impacted her

weight, the ALJ reasonably surmised that Plaintiff experienced medical improvement,” the Court is

not satisfied that this evidence leads to anything more than an inference of symptomatic

improvement. (Cross-Motion at 4.) That is, Plaintiff’s symptoms could have improved in some

respects without Plaintiff having concurrently undergone “medical improvement” within the

meaning of the Social Security regulations. The ALJ did not take the next step and connect the

improvement of Plaintiff’s diarrhea symptoms with a renewed ability to engage in gainful

employment activity. 

The Court next turns to whether the ALJ inappropriately discounted the opinion of Plaintiff’s

treating physician.

B. Plaintiff’s Treating Physician

Plaintiff contends that the ALJ erred in giving reduced weight to the opinion of Dr. James

Hutchinson, Plaintiff’s treating physician. (Motion at 10.) 

The opinion of a treating doctor is afforded more weight than the opinion of a doctor who

has not treated the claimant. Reddick v. Chater, 157 F.3d 715, 725 (9th Cir. 1998); 20 C.F.R. §

416.927(d)(2). Where the treating doctor’s opinion is uncontradicted, it may be rejected only for

“clear and convincing” reasons supported by substantial evidence in the record. Id. However,

where there is conflicting medical evidence, the ALJ must determine credibility and resolve the

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conflict. Matney v. Sullivan, 981 F.2d 1016, 1019 (9th Cir. 1992). Although the treating

physician’s opinion receives deference, the ALJ may reject the opinion of a treating physician in

favor of a conflicting opinion of an examining physician if the ALJ makes “findings setting forth

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

Thomas v. Barnhart, 278 F.3d 947, 956-57 (9th Cir. 2002). The ALJ must provide his own

interpretations and explain why he is crediting the examining physician’s opinions and discrediting

the treating physician’s opinions. Embrey v. Bowen, 849 F.2d 418, 421-22 (9th Cir. 1988).

In this case, the ALJ gave “little weight” to the opinion of Dr. Hutchinson, as it applied to the

period beginning September 15, 2005. (TR at 29.) As the basis for this conclusion, the ALJ stated

that Dr. Hutchinson’s treatment notes, which revealed improvement in Plaintiff’s abdominal

tenderness, were inconsistent with his opinion relating to the severity of Plaintiff’s condition, and

that Dr. Hutchinson’s opinion for the period beginning September 15, 2005 was based only on

Plaintiff’s “subjective complaints [which were] not entirely credible.” (Id.) The ALJ found that Dr.

Hutchinson’s opinion was less well supported by evidence than that of Dr. Mahawar, who had

“specialized expertise in evaluating the effect of medically determinable impairments on an

individual’s ability to perform and sustain work activity.” (Id.) 

The Court finds that the ALJ’s discussion of Dr. Hutchinson failed to cite to specific pieces

of evidence to discredit Dr. Hutchinson. Although the ALJ correctly observed that, following

January and April 2006 examinations of Plaintiff, Dr. Hutchinson noted that Plaintiff had “no

tenderness,” the ALJ did not give examples of why these two treatment note undermined Dr.

Hutchinson’s overall conclusions relating to Plaintiff’s complex medical condition. (See TR at 309-

11.) Instead, the ALJ generally explained that Dr. Hutchinson relied on Plaintiff’s non-credible

subjective complaints, and that Dr. Hutchinson possessed fewer relevant professional qualifications

than the examining physician, Dr. Mahawar. (TR at 29.) 

The record, however, is replete with Dr. Hutchinson’s treatment notes, which expressed

“doubt that [Plaintiff] will ever improve such as to engage in gainful employment.” (TR at 249.) 

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Indeed, Dr. Hutchinson made this particular statement on September 18, 2005, during the period

Plaintiff was no longer deemed disabled. The ALJ decision does not explain with specifics why this

opinion should be discounted as based on subjective evidence or why its import should be greatly

undermined by two cursory treatment notes made more than four months after the ALJ found that

Plaintiff was no longer disabled. Nor does the decision explain in any detail why, as a family

practitioner, Dr. Hutchinson’s opinion should be accorded less weight than that of a specialist. That

is, there is no discussion of Dr. Hutchinson’s relevant experience in dealing with the types of issues

associated with Plaintiff’s condition and no consideration given to the extensiveness of Dr.

Hutchinson’s history in providing treatment to Plaintiff. Although the ALJ does discuss the merits

of Dr. Mahawar’s relevant qualifications, he does not clearly articulate why Dr. Hutchinson was less

able to provide a reliable medical opinion with respect to Plaintiff’s particular condition.

Accordingly, the Court finds that the ALJ has not sufficiently set forth specific reasons for

discrediting Dr. Hutchinson based on substantial evidence in the record.

C. Reactive Depression and Anxiety

Plaintiff contends that the ALJ entirely failed to consider evidence of Plaintiff’s reactive

depression and anxiety. (Motion at 11.)

The ALJ “need not discuss all evidence presented” to him. Vincent v. Heckler, 739 F.2d

1393, 1394-95 (9th Cir. 1984). Instead, he “must explain why significant probative evidence has

been rejected.” Id. (quoting Cotter v. Harris, 642 F.2d 700, 706 (3d Cir. 1981)).

In this case, the ALJ did not discuss Plaintiff’s psychological condition, even though Plaintiff

had presented some evidence of depression and anxiety to the ALJ. (See, e.g., TR at 249A, 288.) It

is not clear, however, that this evidence was sufficiently probative to require express consideration

by the ALJ. The gravamen of Plaintiff’s disability, as presented to the ALJ, was the gastrointestinal

nerve damage and the severe symptomatic effects of that nerve damage. Although Plaintiff did

present evidence that her physical maladies had given rise to psychological impairments, the ALJ

was justified in focusing on Plaintiff’s gastrointestinal condition, because it was this condition that

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was at the heart of the disability inquiry. Since the ALJ was not presented with substantial evidence

that Plaintiff’s disability arose in any part out of the psychological ramifications of Plaintiff’s

physiological problems, the ALJ was not required to explain why he rejected the psychological

evidence presented. The ALJ appropriately limited his discussion to addressing the most significant

probative evidence relating to Plaintiff’s physical condition.

In sum, the Court concludes that the ALJ’s finding that Plaintiff’s disability ended on

September 14, 2005 was not based on substantial evidence. The primary reason for this conclusion

is that the ALJ did not adequately connect pieces of evidence in the record to that particular date. 

Rather, the ALJ discussed testing evidence from the period prior to September 14, 2005, when

Plaintiff was disabled, as well as evidence acquired well into 2006. Furthermore, the Court finds

that the ALJ’s discounting of Dr. Hutchinson’s opinion was overly cursory and not sufficiently

based on evidence in the record. Although a more detailed examination of the record may result in

the same outcome, the ALJ must, at the very least, articulate a more specific evidentiary basis for his

conclusion. To the extent the ALJ chooses a particular date for terminating Plaintiff’s disability

status, that date must be supported by substantial evidence.

Accordingly, the Court REMANDS this case to Defendant for further consideration of the

date on which Plaintiff’s disability terminated, if indeed a such a date can be found in the record. 

V. CONCLUSION

The Court GRANTS in part and DENIES in part Plaintiff’s Motion for Summary Judgment,

and REMANDS the case to the Commissioner for further consideration consistent with this Order. 

The Court DENIES Defendant’s Cross-Motion for Summary Judgment.

This remand is pursuant to sentence four of 42 U.S.C. § 405(g). See Shalala v. Schaefer, 509

U.S. 292, 302 (1993). Accordingly, judgment shall be entered in favor of Plaintiff and against

Defendant.

Dated: January 7, 2010 

JAMES WARE

United States District Judge

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THIS IS TO CERTIFY THAT COPIES OF THIS ORDER HAVE BEEN DELIVERED TO:

Shea Lita Bond shea.bond@ssa.gov

Terry LaPorte terry@terrylaporte.com

Dated: January 7, 2010 Richard W. Wieking, Clerk

By: /s/ JW Chambers 

Elizabeth Garcia

Courtroom Deputy

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