Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-2_10-cv-00710/USCOURTS-azd-2_10-cv-00710-0/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 (DIWC)

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Fibromyalgia is a rheumatic disease that causes inflammation of the fibrous

connective tissue components of muscles, tendons, ligaments and other tissue. Common

symptoms include chronic body pain, multiple tender points, fatigue, stiffness, and a pattern

of sleep disturbance that can exacerbate pain and fatigue. See Benecke v. Barnhart, 379 F.3d

587, 589 (9th Cir. 2004). Fibromyalgia is a “syndrome of chronic pain of musculoskeletal

origin but uncertain cure.” Stedman’s Medical Dictionary, at 671 (27th ed. 2000).

WO

IN THE UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF ARIZONA

Susan Kepling,

Plaintiff, 

vs.

Michael J. Astrue, Commissioner of Social

Security, 

Defendant. 

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No. CV 10-0710-PHX-EHC

ORDER

This is an action for judicial review of a denial of disability insurance benefits under

the Social Security Act, 42 U.S.C. § 405(g). The matter is fully briefed (Doc. 20, 21 & 25).

Plaintiff applied for disability benefits in January 2006 at approximately 45 years of

age (Administrative Record [Tr.] 76-84). Plaintiff alleged an onset of disability beginning

April 23, 2005 (Tr. 14, 81). Plaintiff is insured for benefits through March 31, 2010 (Tr. 14).

The Administrative Law Judge (“ALJ”) listed Plaintiff’s severe impairments as fibromyalgia1

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Irritable bowel syndrome is characterized by cramping, abdominal pain, bloating,

constipation and diarrhea. See, e.g., Caldwell v. Astrue, 2010 WL 5184247 *6 (S.D.W.Va.

2010). 

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and irritable bowel syndrome2

 (Tr. 15). Plaintiff’s past relevant work was listed as

employment at a dog track as clerk of scales, lead out starter, paddock judge, and waitress (Tr.

15). Plaintiff has a tenth grade education (Tr. 15, 100). Plaintiff’s application was denied

initially and upon reconsideration (Tr. 35-36, 38-39). After a hearing before an ALJ (Tr. 23-

34), Plaintiff’s application was denied (Tr. 11-20). The Social Security Appeals Council

denied Plaintiff’s request for review (Tr. 1-4), which was a final decision.

I.

Standard of Review

A person is “disabled” for purposes of receiving social security benefits if he or she

is unable to engage in any substantial gainful activity due to a 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 at least twelve months. Drouin v.

Sullivan, 966 F.2d 1255, 1257 (9th Cir. 1992). Social Security disability cases are evaluated

using a five-step sequential evaluation process to determine whether the claimant is disabled.

The claimant has the burden of demonstrating the first four steps. Tackett v. Apfel, 180 F.3d

1094, 1098 (9th Cir. 1999). 

In the first step, the ALJ must determine whether the claimant currently is engaged in

substantial gainful activity; if so, the claimant is not disabled and the claim is denied. The

second step requires the ALJ to determine whether the claimant has a “severe” impairment

or combination of impairments which significantly limits the claimant’s ability to do basic

work activities; if not, a finding of “not disabled” is made and the claim is denied. At the

third step, the ALJ determines whether the impairment or combination of impairments meets

or equals an impairment listed in the regulations; if so, disability is conclusively presumed and

benefits are awarded. If the impairment or impairments do not meet or equal a listed

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impairment, the ALJ will make a finding regarding the claimant’s “residual functional

capacity” based on all the relevant medical and other evidence in the record. A claimant’s

residual functional capacity (“RFC”) is what he or she can still do despite existing physical,

mental, nonexertional and other limitations. Cooper v. Sullivan, 880 F.2d 1152, 1155 n.5 (9th

Cir. 1989). At step four, the ALJ determines whether, despite the impairments, the claimant

can still perform “past relevant work”; if so, the claimant is not disabled and the claim is

denied. The Commissioner bears the burden as to the fifth and final step of establishing that

the claimant can perform other substantial gainful work. Tackett, 180 F.3d at 1099. 

The Court has the “power to enter, upon the pleadings and transcript of record, a

judgment affirming, modifying, or reversing the decision of the Commissioner of Social

Security, with or without remanding the cause for rehearing.” 42 U.S.C. § 405(g). The

decision to deny benefits should be upheld unless it is based on legal error or is not supported

by substantial evidence. Ryan v. Commissioner of Social Security, 528 F.3d 1194, 1198 (9th

Cir. 2008). Substantial evidence means “such relevant evidence as a reasonable mind might

accept as adequate to support a conclusion.” Richardson v. Perales, 402 U.S. 389, 401, 91

S.Ct. 1420, 1427 (1971). The Court must consider the record in its entirety and weigh both

the evidence that supports and the evidence that detracts from the Commissioner’s

conclusion. Jones v. Heckler, 760 F.2d 993, 995 (9th Cir.1985).

II.

Background Facts

In July 2004, Plaintiff was seen at Desert Grove Medical Center and reported a history

of fibromyalgia (Tr. 307). In October 2004, David Leff, D.O., diagnosed Plaintiff with

irritable bowel syndrome (IBS). Plaintiff also reported back and joint pain (Tr. 389-392). 

On January 20, 2005, Plaintiff was seen by Richard Dinsdale, M.D., Desert Grove

Medical, who noted Plaintiff’s diagnosis of fibromyalgia and depression (Tr. 315-316). In

February 2005, Plaintiff saw Dr. Leff for upper abdominal bloating and discomfort (Tr. 322).

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This report is contained in a letter that shows the signature of “Peter Trethewey, P.A.-

C”as dictated by Dr. Fairfax (Tr.279).

4

Snyder and McKee appeared to be working with Dr. Dinsdale (Tr. 344, 629).

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On April 6, 2005, Plaintiff was treated at Desert Grove Medical for possibly worsening

fibromyalgia, complaining of pain in her feet and ankles. Plaintiff was referred to a

rheumatologist (Tr. 326-327). In May 2005, Plaintiff told Dr. Leff she was “100% better” with

treatment for her IBS. Plaintiff said she had quit her job, her fibromyalgia was “acting up,”

and she was going to look for a desk job (Tr. 330-331, 375-376). 

In June 2005, Michael J. Fairfax, D.O., a rheumatologist, examined Plaintiff and noted

tenderness with light palpation over several major muscle, bursal, and tendon groups, and that

she exhibited 6 tender points. Dr. Fairfax assessed Plaintiff with possible chronic fatigue

syndrome or fibromyalgia and prescribed Neurontin (Tr. 274-275). On July 20, 2005, Dr.

Fairfax adjusted Plaintiff’s medication from Neurontin to Vicodin and noted suspected

fibromyalgia “although without convincing tender point examination.” Plaintiff reported

worsening IBS (Tr. 276). On August 24, 2005 Dr. Fairfax reported that Plaintiff had been

“firmly diagnosed with fibromyalgia,” noting she fit the American College of Rheumatology

criteria “quite nicely” (Tr. 279).3

 

Due to her insurance guidelines, from September 2005 into May 2006, Plaintiff was

seen on a monthly basis by providers at Desert Grove Medical, including nurses Paul Snyder

and Roger McKee,4

 regarding her fibromyalgia (Tr. 342-343, 353-360, 365, 367-372, 513-

518). During these consultations, Plaintiff reported chronic pain in her lower back, abdomen,

hands, feet, legs, head and neck, described as aching, shooting, stabbing, burning, etc., and

high blood pressure (Tr. 353-356, 367, 369, 371, 516-517, 513-514). A November 2005

physical exam indicated tenderness with range of motion of the wrist, hands, fingers, knees

and lower lumbar area (Tr. 353). March 2006 treatment notes showed back pain, joint pain

and stiffness, and neck stiffness (Tr. 371). On April 21, 2006, Plaintiff additionally

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complained of chronic fatigue (Tr. 516-517). At a May 2006 exam, tenderness was noted

throughout Plaintiff’s vertebral column (Tr. 513-514). At various times during this period,

Plaintiff’s prescribed medications included Lortab, Elavil, Ibuprofen 600 mg, Robaxin,

Quinine Sulfate, Elavil, Quinine, Prednisone, Vicodin, Lyrica and Morphine Sulfate (Tr. 354-

356, 516-517, 513-514). In February/March 2006, Plaintiff was referred to a pain management

specialist and to a cardiologist (Tr. 369-372). 

On May 23, 2006, Plaintiff presented to the Mesa Pain Management Center (Mesa

Center) where she was seen “in conjunction with Dr. Chirban” (Tr. 397). Plaintiff reported

overall constant pain and her medication (Neurontin, Flexeril and MS Contin) was adjusted.

Plaintiff was assessed with cervical pain, lumbar pain, and fibromyalgia (Tr. 396-397).

Plaintiff was treated at the Mesa Center once to twice monthly during 2006, complaining

mostly of constant back, hands and feet pain and occasionally of pain in her arms and neck

(Tr. 491-498, 600). Plaintiff’s prescribed medications included Neurontin, MS Contin,

Flexeril, Methadone, Soma and Celebrex (Tr. 495-498, 493). Plaintiff reported that her

quality of life had improved with treatment (Tr. 491-495). On September 6, 2006, x-rays of

Plaintiff’s right shoulder, elbow, forearm and wrist were unremarkable (Tr. 484). On

November 16, 2006, Plaintiff reported to her providers at Desert Grove who noted full range

of motion in Plaintiff’s extremities (Tr. 506). 

In January and February 2007, Plaintiff was seen at the Mesa Center for complaints

of constant all over body pain she described as stabbing, shooting and deep (Tr. 597-598).

In March 2007, Plaintiff reported to Angelo Chirban, M.D., Mesa Center, complaining of

whole body pain and her medication was adjusted. Dr. Chirban recommended a physical

exercise program such as aqua-therapy (Tr. 596). In April 2007, Plaintiff reported she had

started physical therapy without much relief but her medication was taking the “edge off” and

her functioning had improved (Tr. 595). In May 2007, Plaintiff was seen at the Mesa Center

complaining of constant all-over pain and difficulty sleeping due to back pain but said the

constant stabbing pain in the low back had improved with eipdural treatments (Tr. 682).

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Myofascial refers to the fascia (sheet of fibrous tissue) surrounding and separating

muscle tissue. Stedman’s Medical Dictionary at 647, 1173 (27th ed. 2000).

6

This medical report from the Mesa Center and subsequent such reports consist of an

assessment by a medical provider and a Pain Assessment Form completed by Plaintiff.

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On June 14, 2007, Plaintiff was seen at the Mesa Center and her diagnoses included

chronic cervical pain, fibromyalgia and IBS. Plaintiff reported that pain interfered with

sleeping, daily activities and thought processes. An examination indicated myofascial5

 trigger

points in Plaintiff’s cervical and lumbar areas and decreased range of motion in the upper

extremities. Plaintiff described the pain as stabbing, shooting, aching, sharp, throbbing and

penetrating, but was sometimes helped by pool therapy (Tr. 677-680).

 On July 12, 2007, Plaintiff was seen at the Mesa Center and her provider noted

Plaintiff’s reports of fair pain control and that she could perform all activities of daily living

and function independently (Tr. 672). A physical exam revealed myofascial trigger points and

muscle spasms in the lumbar spine and cervical spine (Tr. 671). Plaintiff’s assessments

included “mild” lumbar degenerative disc disease in addition to fibromyalgia, cervical pain,

IBS and carpal tunnel syndrome (Tr. 673). Plaintiff completed a Pain Assessment Form and

reported back, hand, arm and overall body pain described as shooting, aching, sharp,

throbbing, etc. She also reported difficulty thinking and memory loss (Tr. 674-675).6

 

Between August 2007 and November 2007, Plaintiff’s medical records from the Mesa

Center contain similar reports indicating myofascial trigger points in Plaintiff’s cervical,

lumbar and dorsal areas and occasionally in her chest area. Plaintiff’s providers noted her

reports of improved pain control, quality of life and functionality. Plaintiff continued to report

body pain that interfered with sleeping, daily living activities and thought processes in her

Pain Assessment Forms (Tr. 663-668, 657-661, 649-655, 643-647, 635-640). Plaintiff’s

November 2007 list of medications included Methadone, Carisoprodol, Hydrochlorothiazide,

Vytorin, Mag-G, Atenolol, Promethazine, Naproxen, and Activella (Tr. 648).

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On February 1, 2008, Plaintiff’s Mesa Center records noted her problems as

fibromyalgia, chronic cervical pain, mild lumbar degenerative disc disease and IBS (Tr. 751).

Plaintiff completed a Pain Assessment Form in which she reported back, legs, and stomach

pain described as stabbing, shooting, aching, etc., that interfered with her sleep and activities

of daily living (Tr. 752-753). She also reported chronic fatigue (Tr. 753). Plaintiff continued

to be seen at the Mesa Center for similar complaints in May, June and July 2008 (Tr. 746-749,

738-742, 730-735). 

On June 6, 2008, advance practice nurse Maureen Petrides of the Mesa Center opined

that Plaintiff could not consistently work 8 hours per day, 5 days per week; that Plaintiff could

lift less than 10 pounds; and, that Plaintiff could sit for less than 4 hours and stand or walk

less than one hour in an 8-hour day (Tr. 796-797).

Medical progress notes dated June 10, 2008 regarding Plaintiff’s treatment at Desert

Grove indicated that Plaintiff did not appear at the time to have any sort of rheumatoid

arthritis or rheumatologic disease (Tr. 709). On August 1, 2008, Plaintiff was seen at the

Mesa Center and her provider noted Plaintiff’s reports of adequate pain control and the ability

to function well and to perform all activities of daily living (Tr. 803-804). Plaintiff’s

complaint of lumbar pain was noted (Tr. 805).

State Agency Reviewing Report - 2006

On July 12, 2006, State Agency physician John Hayden, M.D., expressed the opinion

that Plaintiff’s functional abilities were consistent with the ability to perform light work (Tr.

434-441). Dr. Hayden noted that Plaintiff’s complaint of fibromyalgia had not been

established clinically (Tr. 435). 

Function Reports - 2006

In a Function Report dated November 6, 2006, Plaintiff said she watched television,

prepared at least simple (microwave) meals, did “a little bit” of laundry about once a week,

drove, shopped for groceries every two weeks, paid bills, used a checkbook, and counted

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change. Plaintiff said she could walk 8 to 10 steps before needing to stop and rest. Plaintiff

said she followed spoken and written instructions pretty well (Tr. 141-148). 

Plaintiff’s daughter, Nichole Schiller, completed a Third Party Function Report dated

November 6, 2006 and said that Plaintiff took a nap, watched television, prepared simple

meals, did a little bit of laundry, drove, and shopped for groceries. Ms. Schiller said Plaintiff

had difficulty concentrating, and that she could only walk 5 to 6 steps before she needed to

stop and rest (Tr. 149-156).

 III.

The Hearing Before the ALJ: October 6, 2008

Plaintiff, represented by counsel, and Vocational Expert (“VE”) Sandra Richter

testified at the hearing. Plaintiff said she is 4'11" tall and weighs 170 pounds (Tr. 30).

Plaintiff testified she has pain in her feet, legs and back, that her hands and feet swell

and she takes medication for the swelling (Tr. 26-27). Plaintiff said her migraine headaches

seemed to occur 3 to 4 times per month and last 5 to 6 hours on average (Tr. 28). When

Plaintiff has a migraine, she lies down in a dark place (Tr. 28). She has been prescribed

Ibuprofen, 800 mg, for the migraine headaches (Tr. 28-29). Plaintiff testified that her irritable

bowel condition is ongoing and includes constipation and bloated and upset stomach (Tr. 29).

Plaintiff has been diagnosed with fibromyalgia and is seeing a pain specialist on a

regular basis (Tr. 30). Plaintiff’s medication for fibromyalgia includes Methadone and Soma

(pain) and Naproxen (swelling, pain). Her other medications include Atenolol and Vytorin.

She reported no side effects (Tr. 30). Plaintiff’s water therapy provides relief in the moment

(Tr. 30-31). Plaintiff testified that she can stand for approximately 15 to 20 minutes, walk for

about 20 minutes, and sit for about 45 minutes (Tr. 31). She has difficulty sleeping at night,

stating that her problems are insomnia, pain and fatigue (Tr. 31). Plaintiff sleeps about 4 hours

at night and takes a nap during the day for about 2 and one-half hours (Tr. 31-32).

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Upon questioning by the ALJ, the VE testified that Plaintiff’s past work positions at

the dog track (clerk of scales, lead out starter, paddock judge and waitress) are all light,

semiskilled (Tr. 32-33). No skills were transferable to sedentary work (Tr. 33). 

When questioned by Plaintiff’s attorney, the VE said that assuming Plaintiff’s

testimony, she would not be able to perform her past work or any work (Tr. 33). The VE

testified that, assuming an individual who could sit up to 4 hours a day, could stand and walk

up to 2 hours a day, and could lift and carry less than 10 pounds, Plaintiff’s past work and all

work would be eliminated (Tr. 33). 

 IV.

The ALJ’s Findings

In a written decision dated October 27, 2008 (Tr. 14-20), the ALJ noted that Plaintiff

had alleged disability based on fibromyalgia, irritable bowel syndrome, headaches, back and

hand pain, swelling of the feet and hands, high blood pressure, and difficulty thinking clearly

(Tr. 15). The ALJ found that Plaintiff had fibromyalgia and irritable bowel syndrome which

are severe impairments but that Plaintiff did not have an impairment or combination of

impairments that met or equaled the listings in the regulations (Tr. 15). Plaintiff’s headaches,

mild degenerative disc disease, swelling/edema of the hands and feet, and hypertension were

determined to be non-severe impairments that would not prevent work activities (Tr. 17).

Plaintiff also had no severe cardiac impairment (Tr. 17). 

The ALJ found that the functional limitations from Plaintiff’s impairments are less

serious than she alleged, and that the objective evidence supported a finding that Plaintiff’s

impairments, while imposing some restrictions, do not prevent all work related activities (Tr.

16). The ALJ discussed medical records regarding Plaintiff’s treatment by Drs. Fairfax and

Dinsdale, and at the Mesa Center (Tr. 16-17). These records showed Plaintiff’s diagnosis of

fibromyalgia, irritable bowel syndrome and other conditions but that overall normal and

benign physical results were reported (Tr. 16-17). The ALJ did not give substantial weight

to the opinions of Nurse Petrides, finding they were not supported by the pain management

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records (Tr. 17). The ALJ found that no evidence supported Plaintiff’s allegations of

difficulty thinking clearly, noting that Plaintiff had not undergone any ongoing mental health

treatment and had not been prescribed psychotropic medications (Tr. 17-18). The ALJ found

that Plaintiff’s allegations were not wholly credible regarding the severity and extent of her

limitations upon consideration of the overall medical evidence and hearing testimony (Tr. 18).

The ALJ found that Plaintiff had the residual functional capacity to perform light work

and that Plaintiff could perform any of her past work at the dog track as well as other work

that exists in significant numbers in the national economy (Tr. 18). The ALJ found that

Plaintiff is not under a disability and that, regarding this finding, substantial weight was

afforded to the opinions of the State Agency reviewing consultants which were supported by

the overall evidence of record (Tr. 19). 

V.

Discussion

Plaintiff argues that the ALJ improperly discounted the effect of Plaintiff’s

fibromyalgia based on the lack of objective medical evidence; failed to properly weigh

Plaintiff’s subjective complaints; erred in weighing medical source opinion evidence; and

erred in not affording more weight to the third-party report of Plaintiff’s daughter. Plaintiff

seeks an award of benefits. Defendant has responded that substantial evidence supports the

ALJ’s finding that Plaintiff could perform a broad range of light work and determination that

Plaintiff is not disabled. Defendant argues that Plaintiff’s request for remand for an award of

benefits should be rejected but, in the alternative, if error is found, the case should be

remanded for further administrative proceedings. 

 In this case, the ALJ appears to have relied in part on the lack of objective medical

evidence in finding that Plaintiff’s impairments, which include fibromyalgia, do not preclude

all work (Tr. 16). The ALJ cited to Dr. Fairfax’s June 8, 2005 report that Plaintiff had no

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Synovitis refers to the inflammation of a synovial membrane, especially that of a

joint. Stedman’s Medical Dictionary, at 1773 (27th ed. 2000). 

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muscle weakness, no gross motor or sensory deficits, no active or chronic joint synovitis7

or

effusions, and had intact and symmetric deep tendon reflexes throughout, and only 6 tender

points (Tr. 16). The ALJ also referred to Dr. Dinsdale’s “few objective findings on

examination” (Tr. 16). The ALJ discussed that Plaintiff’s medical records from the Mesa

Center disclosed “positive findings of myofascial trigger points, somewhat decreased range

of motion in the lumbar spine” but otherwise showed “negative straight leg raise and normal

deep tendon reflexes, muscle strength, sensation, and joints” (Tr. 17). 

The Ninth Circuit has said that fibromyalgia is a disease that eludes objective evidence.

Benecke v. Barnhart, 379 F.3d 587, 590, 594 (9th Cir. 2004)(“[f]ibromyalgia’s cause is

unknown, there is no cure, and it is poorly-understood within much of the medical

community”). “The process of diagnosing fibromyalgia includes (1) the testing of a series of

focal points for tenderness and (2) the ruling out of other possible conditions through

objective medical and clinical trials.” Rogers v. Commissioner of Social Security, 486 F.3d

234, 244 (6th Cir. 2007). Fibromyalgia patients may “present no objectively alarming signs”

and may “manifest normal muscle strength and neurological reactions and have a full range

of motion.” Rogers, 486 F.3d at 243-244(noting that objective tests are of little relevance in

determining the existence or severity of fibromyalgia). In Benecke, the ALJ erred in requiring

objective evidence “for a disease that eludes such measurement.” Benecke, 379 F.3d at 590,

594 (fibromyalgia “is diagnosed entirely on the basis of patients’ reports of pain and other

symptoms”). 

The record shows that in August 2005, Dr. Fairfax, a rheumatologist, reported that

Plaintiff “fits the American College of Rheumatology criteria” for a fibromyalgia diagnosis

“quite nicely” (Tr. 279). The opinion of a rheumatologist is given greater weight than those

of other physicians because it is an opinion of a specialist about medical issues related to the

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doctor’s area of specialty. Benecke, 379 F.3d at 594 n. 4. Between November 2005 and May

2006, Plaintiff complained to medical providers of chronic pain in her head, back, hands, feet,

joints and neck; she sometimes complained of fatigue; she described the pain as aching,

shooting, stabbing and continuous; and she was treated at Desert Grove Medical for

fibromyalgia (Tr. 353, 367, 369, 371, 516-517, 513-514). During this period, Plaintiff’s

medication included Lortab, Elavil, Ibuprofen 600 mg, Robaxin, Vicodin, Lyrica and

Morphine Sulfate (Tr. 354, 355-356, 516-517, 513-514).

When Plaintiff began treatment at the Mesa Pain Management Center in May 2006,

Dr. Chirban assessed her conditions as including cervical pain, lumbar pain and fibromyalgia

(Tr. 396-397). Between May 2006 and July 2008, Plaintiff complained to providers at the

Mesa Center of pain in her back, legs, hands, feet, neck and shoulders, and of cervical pain

and overall body pain, which she described as stabbing, shooting, deep, aching, throbbing,

etc. (Tr. 396-397, 498, 497, 496, 495, 494, 493, 491, 492, 600, 599, 598, 596, 595, 682, 677-

680, 673-675, 667-668, 660-661, 653-654, 646-648, 639-640, 734-735, 741-742, 748-749,

752-753). Examination reports between June 14, 2007 and November 30, 2007 showed

myofascial trigger points in Plaintiff’s lumbar, cervical, dorsal and chest areas (Tr. 677-680,

671, 664, 657, 649-650, 636). Plaintiff at various times complained of fatigue (Tr. 668, 753,

749, 741-742) and reported that pain interfered with her sleep, daily activities and thought

processes (Tr. 677-680, 667-668, 660-661, 646-647, 639-640). Plaintiff’s prescribed

medication during this period included Neurontin, Flexeril, MS Contin, Soma, Methadone,

Celebrex, Carisoprodol, Promethazine and Naproxen (Tr. 396-397, 498, 495, 496, 493, 491,

648).

 With respect to Plaintiff’s symptom and pain evidence and the ALJ’s determination

discounting Plaintiff’s subjective complaints, unless there is affirmative evidence of

malingering, the ALJ’s reasons for rejecting the claimant’s testimony must be “clear and

convincing.” Reddick v. Chater, 157 F.3d 715, 722 (9th Cir. 1998). “[T]he ALJ must

identify what testimony is not credible and what evidence undermines the claimant’s

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complaints.” Reddick, 157 F.3d at 722. Once the claimant produces medical evidence of an

underlying impairment, the claimant’s testimony of symptom severity may not be discredited

solely because it is not supported by objective medical evidence. Bunnell v. Sullivan, 947

F.2d 341, 346-47 (9th Cir. 1991). 

Defendant argues that the ALJ reasonably discounted Plaintiff’s subjective complaints

based on inconsistencies between her reports to her treatment providers and her statements

during the administrative proceedings and based on Plaintiff’s reports that she was able to

perform her activities of daily living (Doc. 21 at 14 & n.5). The ALJ found that Plaintiff has

fibromyalgia which is a severe impairment (Tr. 15). The ALJ further found that Plaintiff’s

allegations were not wholly credible regarding the severity and extent of her limitations based

on review of the overall record (Tr. 18). Preceding this finding, the ALJ discussed the

objective medical evidence, noting the presence of only 6 tender points regarding Dr.

Fairfax’s June 2005 exam of Plaintiff, and other overall normal or benign physical findings

regarding exams in August 2005, September 2005, and January 2006 through June 2008 (Tr.

16). The ALJ discussed records from the Mesa Center noting Plaintiff’s reports that

medication had improved her quality of life and resulted in good pain control, and that she

could perform daily living activities (Tr. 17). The ALJ discussed the lack of medical evidence

to support Plaintiff’s allegations of difficulty thinking clearly (Tr. 17-18). The ALJ did not

cite to any evidence of malingering. 

In support of her argument that the ALJ improperly considered her pain and symptom

evidence, Plaintiff has cited to several medical reports that include Plaintiff’s complaints of

pain, fatigue and difficulty in thinking clearly as relevant to the limitations caused by her

fibromyalgia condition (Doc. 20 at 40-41). Certain of these medical reports have been

discussed above as relevant to Plaintiff’s fibromyalgia condition.

 Plaintiff’s reports to her providers at the Mesa Center between July 2007 and August

2008 of improved, adequate or good pain control, improved quality of life and improved

functional abilities regarding her daily living, were noted in “check-the-box”style statements

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(See, e.g., Tr. 637, 644, 651, 665, 672, 732, 739, 746, 804). The ALJ cited to these records

as part of the discussion relevant to not affording substantial weight to the opinions of Nurse

Petrides (Tr. 17). The record also shows that in October 2007 and July 2008, Plaintiff reported

that her IBS was “greatly improved” and was helped by medication (Tr. 652, 733). The Court

is mindful that impairments that can be controlled effectively with medication are not

disabling. Warre v. Comm’r of Soc. Sec. Admin., 439 F.3d 1001, 1006 (9th Cir. 2006).

However, such perfunctory or generic statements that a claimant is “doing better” do not

necessarily constitute evidence of an improvement in symptoms. Plaintiff’s medical records

show Plaintiff’s diagnosis of fibromyalgia, her attempts at treatment over a significant period

of time, and her repeated complaints of pain and other symptoms for which she was

prescribed a regimen of medication. “[O]ccasional symptom-free periods and even the

sporadic ability to work are not inconsistent with disability.” Reddick, 157 F.3d at 724. 

Plaintiff testified at the hearing that she has difficulty sleeping at night, her problems

are insomnia, pain and fatigue, and she has been diagnosed with fibromyalgia and is seeing

a pain specialist on a regular basis (Tr. 30-31). Dr. Fairfax’s diagnosis of fibromyalgia and

Plaintiff’s treatment by medical providers for the condition support Plaintiff’s credibility. 

Plaintiff reported that her daily activities include watching television, preparing simple

meals, doing a “little bit” of laundry once a week, driving, and grocery shopping every two

weeks. Plaintiff said she can walk 8 to 10 steps before needing to rest (Tr. 141-148). Plaintiff

testified she could walk about 20 minutes (Tr. 31). “[T]he mere fact that a plaintiff has

carried on certain daily activities such as grocery shopping, driving a car, or limited walking

for exercise, does not in any way detract from her credibility as to her overall disability. One

does not need to be ‘utterly incapacitated’ in order to be disabled.” Vertigan v. Halter, 260

F.3d 1044, 1050 (9th Cir. 2001)(quoting Fair v. Bowen, 885 F.2d 597, 603 (9th Cir. 1989)).

The RFC assessment provided by Dr. Hayden, a reviewing physician, indicating that

Plaintiff has the ability to perform light work was dated July 12, 2006 (Tr. 434-441; see Doc.

25 [Plaintiff’s Reply Brief] at 12) and did not take into account Plaintiff’s pain management

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treatment at the Mesa Center into 2008. Moreover, Dr. Hayden reported that Plaintiff’s

complaint of fibromyalgia had not been established clinically in contrast to the August 2005

opinion of Dr. Fairfax, a treating/examining physician and rheumatologist, that Plaintiff fit

the diagnosis for fibromyalgia. Generally, a treating physician’s opinion is afforded more

weight than the opinion of an examining physician, and an examining physician’s opinion is

afforded more weight than a non-examining reviewing or consulting physician’s opinion.

Holohan v. Massanari, 246 F.3d 1195, 1202 (9th Cir. 2001). 

The ALJ erred to the extent he relied on the lack of objective medical evidence in

assessing the limitations caused by Plaintiff’s fibromyalgia condition. The ALJ further erred

in discounting Plaintiff’s pain and symptom evidence and in affording substantial weight to

the opinion of a non-examining reviewing physician. 

Plaintiff contends that the ALJ erred in assessing Nurse Petrides’ opinion regarding

Plaintiff’s physical limitations. An ALJ may consider opinions from sources other than

“acceptable medical sources,” such as a nurse practitioner, to show the severity of the

claimant’s impairment(s) and how the impairment(s) affect the claimant’s ability to work. 20

C.F.R. § 416.913(d)(1). A non-acceptable medical source like a nurse cannot be considered

a “treating source,” and the opinion of a nurse is not entitled to “controlling weight.” See,

e.g., Kohler v. Astrue, 546 F.3d 260, 268 (2d Cir. 2008). The ALJ did not give substantial

weight to Nurse Petrides’ opinion finding it was not supported by the pain management

records (Tr. 17). While the ALJ was not required to give “controlling weight” to Nurse

Petrides’ opinion, it was error to not consider it as relevant to show the severity of Plaintiff’s

impairment and the effect on Plaintiff’s ability to work. 

Plaintiff contends that the ALJ disregarded the reports of Plaintiff’s daughter regarding

Plaintiff’s limitations. The ALJ must consider lay witness statements concerning a claimant’s

ability to do work. Stout v. Commissioner, 454 F.3d 1050, 1053 (9th Cir. 2006). The ALJ

must give specific, germane reasons for rejecting the opinion of the witness. Dodrill v.

Shalala, 12 F.3d 915, 919 (9th Cir. 1993). In this case, the ALJ read the report of Plaintiff’s

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daughter but found that the objective evidence established that Plaintiff’s impairments did not

preclude basic work functions (Tr. 18). This finding was error in light of Plaintiff’s medical

records.

The Commissioner’s ultimate decision to deny Plaintiff’s claim for benefits is based

on legal error and is not supported by substantial evidence.

The decision whether to remand for further proceedings or for immediate payment of

benefits is within the discretion of the court. Harman v. Apfel, 211 F.3d 1172, 1178 (9th Cir.

2000). Remand for an award of benefits is appropriate when 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. Varney v. Sec’y of HHS, 859 F.2d 1396, 1400 (9th Cir. 1988). The VE testified that

assuming Plaintiff’s testimony, Plaintiff would not be able to perform her past work or any

work (Tr. 33). After applying the credit-as-true rule, no outstanding issue remains to be

resolved before determining that Plaintiff is entitled to an award of benefits. 

 Accordingly, 

IT IS ORDERED that the decision of the Commissioner denying Plaintiff’s claim for

benefits is reversed.

IT IS FURTHER ORDERED that this case is remanded for an award of benefits to

Plaintiff. 

IT IS FURTHER ORDERED that the Clerk of Court shall enter Judgment

accordingly.

DATED this 10th day of August, 2011.

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